Massive Open Online Courses (MOOCs) have been touted as a disruptive innovation with a low-cost and flexible option for opening up higher education. However, existing barriers of MOOCs such as a low retention rate and a low forum participation rate have limited their capacity of serving learners. To strengthen the potential of MOOCs, a compelling design that enables an effective learning experience is needed. This article is aimed to propose a series of design guidelines for MOOCs, namely the LITTLE, as a preliminary design framework for an effective MOOC. The LITTLE includes guidelines such as learner-centered, inquiry-based, technology-enriched, trophy-driven, literature-guided, and evidence-based strategies. Examples are provided in concert with theoretical justifications to illustrate the guidelines. © 2022 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.
Educational research has increasingly drawn attention to teachers’ professional digital competence. Various theoretical and methodological perspectives involving a plethora of terms are used to investigate teachers’ competences in relation to technology-based teaching. The concept of teachers’ professional digital competence still appears to be ambiguous and elusive. This literature overview aims to scrutinise if, and how the concepts addressing teachers’ professional digital competence are defined or conceptualised in research. In the publications retrieved from the search in educational databases, we found that the concept of teachers’ professional digital competence, or related concepts, was frequently mentioned in abstracts, keywords and full texts, but to a large extent, it was rarely described in detail. In our final corpus of 18 publications, we could distinguish seven recurring aspects of teachers’ professional digital competence; 1) technological competence, 2) content knowledge, 3) attitudes to technology use, 4) pedagogical competence, 5) cultural awareness, 6) critical approach and 7) professional engagement, with the technological and pedagogical competences as the most prominent.
Background Benefits from low back pain (LBP) treatments seem to be related to patients changing their pain cognitions and developing an increased sense of control. Still, little is known about how these changes occur. The objective of this study was to gain insights into possible shifts in the understanding of LBP and the sense of being able to manage pain among patients participating in a LBP self-management intervention. Methods Using a qualitative study and a content analytic framework, we investigated the experiences of patients with LBP who participated in ‘GLA:D ® Back’, a group-based structured patient education and exercise program. Data were generated through qualitative semi-structured interviews conducted between January 2019 and October 2019. Interviews focused on experiences with pain and were analysed using a thematic analytical approach. The Common Sense Model and self-efficacy theory formed the theoretical framework for the interpretations. Participants were sampled to represent people who were either dissatisfied or satisfied with their participation in GLA:D ® Back. Fifteen participants aged 26–62, eight women and seven men, were interviewed from February to April 2020. Results Four main themes, corresponding to the characterisation of four patient groups, were identified: ‘Feeling miscast, ‘Maintaining reservations', ‘Struggling with habits’ and ‘Handling it’. The participants within each group differed in how they understood, managed, and communicated about their LBP. Some retained the perception of LBP as a threatening disease, some expressed a changed understanding that did not translate into new behaviors, while others had changed their understanding of pain and their reaction to pain. Conclusions The same intervention was experienced very differently by different people dependent on how messages and communication resonated with the individual patient's experiences and prior understanding of LBP. Awareness of the ways that individuals’ understanding of LBP interact with behaviour and physical activities appear central for providing adaptive professional support and meeting the needs of individual patients.
Background International guidelines do not recommend routine imaging, including magnetic resonance imaging (MRI), and seek to guide clinicians only to refer for imaging based on specific indications. Despite this, several studies show an increase in the use of MRI among patients with low back pain (LBP) and an imbalance between appropriate versus inappropriate use of MRI for LBP. This study aimed to investigate to what extent referrals from general practice for lumbar MRI complied with clinical guideline recommendations in a Danish setting, contributing to the understanding and approaches to lumbar MRI for all clinicians managing LBP in the primary sector. Materials and methods From 2014 to 2018, all referrals for lumbar MRI were included from general practitioners in the Central Denmark Region for diagnostic imaging at a public regional hospital. A modified version of the American College of Radiology Imaging Appropriateness Criteria for LBP was used to classify referrals as appropriate or inappropriate, based on the unstructured text in the GPs’ referrals. Appropriate referrals included fractures, cancer, symptoms persisting for more than 6 weeks of non-surgical treatment, previous surgery, candidate for surgery or suspicion of cauda equina. Inappropriate referrals were sub-classified as lacking information about previous non-surgical treatment and duration. Results Of the 3772 retrieved referrals for MRI of the lumbar spine, 55% were selected and a total of 2051 referrals were categorised. Approximately one quarter (24.5%) were categorised as appropriate, and 75.5% were deemed inappropriate. 51% of the inappropriate referrals lacked information about previous non-surgical treatment, and 49% had no information about the duration of non-surgical treatment. Apart from minor yearly fluctuations, there was no change in the distribution of appropriate and inappropriate MRI referrals from 2014 to 2018. Conclusion The majority of lumbar MRI referrals (75.5%) from general practitioners for lumbar MRI did not fulfil the ACR Imaging Appropriateness Criteria for LBP based on the unstructured text of their referrals. There is a need for referrers to include all guideline-relevant information in referrals for imaging. More research is needed to determine whether this is due to patients not fulfilling guideline recommendations or simply the content of the referrals.
Background Denmark and Israel both have highly rated and well-performing healthcare systems with marked differences in funding and organization of primary healthcare. Although better population health outcomes are seen in Israel, Denmark has a substantially higher healthcare expenditure. This has caused Danish policy makers to take an interest in Israeli community care organization. Consequently, we aim to provide a more detailed insight into differences between the two countries’ healthcare organization and cost, as well as health outcomes. Methods A comparative analysis combining data from OECD, WHO, and official sources. World Health Organization (WHO) and the Organisation for Economic Co-operation and Development (OECD) statistics were used, and national official sources were procured from the two healthcare systems. Literature searches were performed in areas relevant to expenditure and outcome. Data were compared on health care expenditure and selected outcome measures. Expenditure was presented as purchasing power parity and as percentage of gross domestic product, both with and without adjustment for population age, and both including and excluding long-term care expenditure. Results Denmark’s healthcare expenditure is higher than Israel’s. However, corrected for age and long-term care the difference diminishes. Life expectancy is lower in Denmark than in Israel, and Israel has a significantly better outcome regarding cancer as well as a lower number of Years of Potential Life Lost. Israelis have a healthier lifestyle, in particular a much lower alcohol consumption. Conclusion Attempting to correct for what we deemed to be the most important influencing factors, age and different inclusions of long-term care costs, the Israeli healthcare system still seems to be 25% less expensive, compared to the Danish one, and with better health outcomes. This is not necessarily a function of the Israeli healthcare system but may to a great extent be explained by cultural factors, mainly a much lower Israeli alcohol consumption.
Background Vocational rehabilitation programs (VRP) developing and improving work ability are used in Denmark to assist long-term unemployed citizens with complex problems. The aims of this study were to (1) describe VRP-participants in relation to general health, well-being, work ability and self-efficacy at baseline and one-year follow-up, (2) obtain an understanding of VRP-participants’ personal development towards improving work ability, and (3) explore VRP-participants’ hopes and thoughts about their future. Methods In a mixed methods approach, data from a longitudinal survey and semi-structured interviews were collected. In the quantitative longitudinal survey, all participants completed paper questionnaires at baseline and one-year follow-up. For the qualitative semi-structured interviews, VRP participants were recruited with a maximum variation sampling strategy through VRP coordinators and personal contact. Data were analysed by descriptive statistics and systematic text condensation. Following analysis, data were merged and presented in combination according to identified themes. Results At baseline and one-year follow-up 146 (response rate 34%) and 74 participants (response rate 52%) respectively, responded to the questionnaire. Seven participants were interviewed. The analysis revealed four themes: 1) Individual explanations of life situation and health; 2) Finding the path; 3) Work as giving meaning to life; 4) Hope for the future. Despite self-reported scores indicating poor general health, lack of well-being, low work ability and low self-efficacy, VRP-activities seemed to have assisted participants in finding meaning in life. VRP-components that may be drivers of successful recovery processes were identified. Conclusions VRP-participants experienced life situations that include multifactorial burdens, and low levels of general health, well-being, work ability, and self-efficacy at baseline and 1 year later. From the outset, most did not have a clear goal of employment, but over time, new goals were set as realistic opportunities for re-developing their work ability were explored. Successful core components of VRP were individually tailored programs and support, development of new relationships, and accommodated flexible internships and jobs. Trial registration ClinicalTrials.gov Identifier: NCT02641704 , date of registration December 29, 2015.
Background In Denmark, chiropractors in primary care work as independent private contractors regulated by the Danish National Health Authorities. The regulation includes partial reimbursement intended for standardised care packages for lumbar and cervical radiculopathy and lumbar spinal stenosis. Random checks have shown lower use than expected. This study aimed to describe and explore the utilisation of standardised chiropractic care packages and identify barriers to uptake. Methods A convergent mixed-method design was conceptualised. The use of standardised care packages was collected by register data. Potential determinants of difference in utilisation were assessed using a modified version of the Determinants of Implementation Behaviour Questionnaire (DIBQ) divided into 13 domains and sent to chiropractors in private clinics in Denmark in 2019. An open-ended question was added to the questionnaire, and thematic content analysis was applied. Qualitative findings were used to expand on the DIBQ data providing further insight into the clinicians’ perspective on standardised care packages. Results Registry data of 244 included chiropractic clinics showed limited and inconsistent use of the standardised chiropractic care packages. A total of 269 chiropractors (44%) answered the DIBQ, and 45 provided data for the qualitative analyses. At least 60% of the clinicians answered ‘Strongly agree’ or ‘Agree’ in 10 out of 13 DIBQ domains suggesting a positive attitude towards using the standardised care packages. Three domains were identified as ‘problematic’ as more than 20% of clinicians disagreed or strongly disagreed: ‘Socio-political context’, ‘Goals’ and ‘Innovation’. Qualitative findings indicated that lack of usage of the standardised care packages was mainly related to the practical organization of standardised care, the chiropractor’s role when managing patients, and the patient population of interest to the clinic (e.g., children, athletes). Conclusion In general, Danish chiropractors displayed positive attitudes towards standardised packages of care. However, considerable variation in the use of the standardised care programs was observed. Low utilisation seemed mainly related to logistics, the chiropractor’s role, collaboration with GPs, and the patient population of interest to the clinic. These findings should be further explored in more extensive qualitative studies to inform implementation initiatives to increase and rectify utility.
Background It is unclear if the use of imaging for low back pain (LBP) is impacted by patient beliefs. This study aimed to: (1) describe beliefs about the importance of imaging and whether patients wanted imaging when presenting for chiropractic care for LBP; (2) describe associations between baseline patient characteristics and imaging beliefs and whether patients wanted imaging; and (3) determine whether patients who believed imaging to be important in the management of LBP, or who wanted to receive imaging, were more likely to receive an imaging referral. Methods Cross-sectional observational data was collected between November 2016 to December 2019 from 10 primary care chiropractic clinics in Denmark. Consecutive patients aged 18 or older and presenting with a new episode of LBP were included (N = 2818). Beliefs about the importance of imaging (two questions) and whether imaging was wanted (one question) were collected at the initial visit, together with baseline participant characteristics and whether an imaging referral was provided. Associations between imaging beliefs/desire to receive imaging and participant characteristics were explored using multivariable logistic regression analysis. The relationships between imaging beliefs and desire to receive imaging with subsequent imaging referral were assessed using multivariable logistic regression analysis adjusted for pre-selected confounder variables. Results Approximately one third of participants believed imaging to be important for the management of LBP (29.5% (95%CI 27.8, 31.3) or 41.5% (95%CI 39.6, 43.3) depending on the two imaging beliefs questions). Approximately one quarter (26.1%, 95%CI 24.5, 27.7) of participants wanted to receive an imaging referral. Participants were more likely to believe in the importance of imaging or want an imaging referral if they had a longer duration of LBP, history of previous imaging for LBP, or a lower completed education level. Participants who wanted imaging at the initial consult were more likely to receive an imaging referral (Odds ratio; 95%CI 1.6; 1.2, 2.1). Conclusions Approximately one third of patients presenting for chiropractic care in Denmark believed imaging to be important in the management of LBP. One quarter wanted imaging at the initial consult. Patients’ desire for imaging appeared to impact the use of diagnostic imaging.
Background Practice-based guidelines recommend patient education and exercise as first-line care for low back pain (LBP); however, these recommendations are not routinely delivered in practice. GLA:D® Back, developed in Denmark to assist clinicians to implement guideline recommendations, offers a structured education and supervised exercise program for people with LBP in addition to a clinical registry to evaluate patient outcomes. In this study we evaluated the feasibility of implementing the GLA:D® Back program in Australia. We considered clinician and patient recruitment and retention, program fidelity, exploring clinicians’ and patients’ experiences with the program, and participant outcome data collection. Methods Clinicians (chiropractors and physiotherapists) were recruited and participated in a 2-day GLA:D® Back training course. Patients were eligible to participate if they had persistent or recurrent LBP. Feasibility domains included the ability to: (1) recruit clinicians to undergo training; (2) recruit and retain patients in the program; (3) observe program fidelity; and (4) perceive barriers and facilitators for GLA:D® Back implementation. We also collected data related to: (5) clinician confidence, attitudes, and behaviour; and (6) patient self-reported outcomes related to pain, disability, and performance tests. Results Twenty clinicians (8 chiropractors, 12 physiotherapists) participated in the training, with 55% (11/20) offering GLA:D® Back to their patients. Fifty-seven patients were enrolled in the program, with 67% (38/57) attending the final follow-up assessment. Loss to follow up was mainly due to the effects of the COVID-19 pandemic. We observed program fidelity, with clinicians generally delivering the program as intended. Interviews revealed two clinician themes related to: (i) intervention acceptability; and (ii) barriers and facilitators to implementation. Patient interviews revealed themes related to: (i) intervention acceptability; and (ii) program efficacy. At 3 months follow-up, clinicians demonstrated high treatment confidence and biomedical orientation. Patient outcomes trended towards improvement. Conclusion GLA:D® Back implementation in Australia appears feasible based on clinician recruitment, program acceptability and potential benefits for patient outcomes from the small sample of participating clinicians and patients. However, COVID-19 impacted patient recruitment, retention, and data collection. To scale-up GLA:D® Back in private and public settings, further work is warranted to address associated barriers, and to leverage facilitators.
Background Simulation-based training used to train healthcare teams’ skills and improve clinical practice has evolved in recent decades. While it is evident that technical skills training is beneficial, the potential of human factor training has not been described to the same extent. Research on human factor training has been limited to marginal and acute care scenarios and often to validate instruments. This systematic review aimed to investigate the effectiveness of simulation-based training in improving in-hospital qualified healthcare teams’ human factor skills. Method A review protocol outlining the study was registered in PROSPERO. Using the PRISMA guidelines, the systematic search was conducted on September 28th, 2021, in eight major scientific databases. Three independent reviewers assessed title and abstract screening; full texts were evaluated by one reviewer. Content analysis was used to evaluate the evidence from the included studies. Results The search yielded 19,767 studies, of which 72 were included. The included studies were published between 2004 and 2021 and covered research from seven different in-hospital medical specialisms. Studies applied a wide range of assessment tools, which made it challenging to compare the effectiveness of human factor skills training across studies. The content analysis identified evidence for the effectiveness. Four recurring themes were identified: (1) Training human factor skills in qualified healthcare teams; (2) assessment of human factor skills; (3) combined teaching methods, and (4) retention and transfer of human factor skills. Unfortunately, the human factor skills assessments are variable in the literature, affecting the power of the result. Conclusion Simulation-based training is a successful learning tool to improve qualified healthcare teams’ human factor skills. Human factor skills are not innate and appear to be trainable similar to technical skills, based on the findings of this review. Moreover, research on retention and transfer is insufficient. Further, research on the retention and transfer of human factor skills from simulation-based training to clinical practice is essential to gain knowledge of the effect on patient safety.
Background Centenarians are used as a model of healthy ageing and longevity. Diet is a factor known to affect mortality in middle aged adults and elderly. However, it is unknown whether diet has an impact on survival to 100 + years. The aims of this systematic review were to summarize the evidence on (i) the association between dietary patterns in late adult life and survival to 100 + years and (ii) the common characteristics across dietary patterns that are shown to be positively associated with survival to 100 + years. Methods We performed a systematic literature search in MEDLINE and EMBASE, and a hand search at four longevity projects homepages up to 4 June 2021. We searched for cohort and case–control studies investigating the association between dietary patterns and all-cause mortality among individuals aged ≥ 65 years at enrolment regardless of their health status and residence. Studies were excluded if follow-up was performed too soon to allow the population or a subgroup of it to have become 100 + years of age. Results Of 3,685 identified records 108 reports were retrieved and full text screened. No studies met our inclusion criteria, thus the review process resulted in no eligible studies found. Hence, no risk of bias assessment and no synthesis of data was performed. Conclusions No studies have investigated dietary patterns in late adult life in relation to survival to 100 + years of age. We have observed that as of June 2021 published cohort studies exist investigating all-cause mortality risk from different dietary patterns among the oldest old, but follow-up has been performed before the cohort could have reached 100 years of age. However, cohorts do exist where data on dietary habits in adult life has been collected decades ago and where follow-up in 2022 will allow the participants to have become 100 + years old. Registration The review protocol is published at University of Southern Denmark’s Research Portal (Poulsen et al. Dietary Patterns and Survival to 100 + Years: Protocol for a Systematic Review of cohort and case–control studies University of Southern Denmark's Research Portal: University of Southern Denmark, 2021) available at https://portal.findresearcher.sdu.dk/en/publications/kostm%C3%B8nstre-og-overlevelse-til-100-%C3%A5r-protokol-for-en-systematisk . We have specified aim (i) of our research question in this report compared to the protocol, by adding “late” to “adult life”.
When compared with other disciplines, sport management educators are more likely to encounter student-athletes in their classrooms. While faculty mentoring is a key to student success for all, better understanding of this mentoring dynamic between sport management faculty and student-athletes is important to advancing pedagogical knowledge within the discipline. And perhaps, even more importantly, it can aid in creating a pathway for faculty advocacy and dispelling stigmas related to student-athletes. Consequently, the Mentor Role Instrument was used to determine if faculty mentorship of student-athletes differs by function type (RQ1) and if this was impacted by gender or faculty appointment (RQ2). An online survey of 88 sport management educators indicated that a significant difference was found, F (8, 783) = 44.16; p < .001, among mentoring function type. Friendship and Acceptance were the most prevalent mentoring functions, while Protection was the least frequent. Results did not indicate that gender or faculty appointment impacted faculty mentorship styles toward student-athletes.
Individuals infer men's formidability through various facial and bodily features. Such inferences covary with perceptions of men's personalities and motivational states, potentially informing subsequent affiliative decisions. Within these inferences could be an implicit understanding of men's preferred humor styles. Across four studies, this research considered perceptions of men's proclivity to employ four humor styles through different formidability cues: upper body strength (Study 1), muscularity (Study 2), facial width-to-height ratio (Study 3), and neck musculature (Study 4). A relatively consistent perception emerged of formidable men as more likely to use aggressive humor. Conversely, an absence of formidability cues elicited perceptions of increased likelihood to use self-defeating humor. We interpret results from an evolutionary perspective for how individuals can identify behavioral strategies through morphological features.
Deficits in metacognitive capacity (i.e., the ability to integrate knowledge of oneself and others into a cohesive whole) have been shown to lead to poor functional outcome in psychosis. However, there is a gap in the literature concerning the role of metacognition in typically developing populations, which makes it difficult to define what level of metacognition is normative and at what point deficits in metacognition suggest pathology. To explore this issue, we utilized cross-sectional design to assess metacognitive capacities among 69 neurotypical adults whose ages varied from 18 to 65 using the Metacognitive Assessment Scale – Abbreviated (MAS-A) and then compared those with MAS-A scores from a second previously gathered sample of 360 adults diagnosed with psychosis across four key developmental windows: emerging adulthood, early adulthood, middle adulthood, and late adulthood. Our findings suggest that in our overall sample, individuals with psychosis had significantly lower levels of metacognitive capacity across all domains assessed by the MAS-A in comparison to neurotypical individuals. Additionally, our data suggest a deleterious effect of psychosis such that individuals with psychosis showed significantly lower metacognition in each developmental stage. Additionally, these differences were largest in emerging and late adulthood and for both groups awareness of others stood out as the single metacognitive domain which was significantly less impaired among older groups. Our results suggest a developmental course for metacognitive capacity such that awareness of others is the sole domain that grows over the lifespan.
We study composition operators in variable exponent Hölder space of holomorphic functions in the unit disc. We provide sufficient and, in some cases, necessary conditions for boundedness and for compactness of composition operators acting in these spaces.
The “11 for Health in Denmark” in‐school educational football program has shown to have numerous positive physiological and psychological effects in 10–12‐year‐old schoolchildren. A key part of the successful application of the program, however, has not yet been examined, namely the motivational processes underlying participation and behavioral changes. This study examined such motivational processes (i.e., autonomous motivation, beliefs, and intentions) using the trans‐contextual model (TCM) and investigated if the 11 for Health in Denmark program increased intentions to participate in physical activity (PA) outside of school in 10‐12‐year‐old schoolchildren. Using a web‐based questionnaire, Danish speaking schoolchildren (N = 276 (boys, 50.4%); Mage = 10.44, SD = .35) from three schools and seven classes completed TCM‐based questionnaires at three time‐points (weeks 0, 1 and 5) while participating in the 11 for Health in Denmark program. Single‐indicator structural equation modelling was performed to examine goodness‐of‐fit and parameter estimates. A path analysis using maximum likelihood estimation was used to test the direct and indirect effects of the TCM model. The results partly supported a mediation sequence, as we found significant direct effects in 8 of 13 motivational variables (β = ‐.25‐.83, p < .05), indirect effects in 1 of 9 variables (β = .15, p <.01), but no effects with regard to PA behaviour. Findings provide evidence for a motivational link between Danish speaking schoolchildren’s autonomous and controlled motivation from in school to out of school, and may inform future interventions promoting motivation and participation in out of school PA.
The paper presents the study of the influence of ammophos, potassium magnesia and ammonium nitrate on the content of protein, gluten and grain unit of winter wheat using No-Till technology in the edaphoclimatic conditions of the southern zone of Rostov Region. It was shown that the application of mineral fertilizers to the surface soil layer during winter wheat cultivation using No-Till technology improves the grain quality. The highest grain quality parameters (protein content – 13.4% and gluten content – 25.3%, grain unit – 780.0 g/l) were obtained when ammophos and potassium magnesia were jointly added prior to sowing at a depth of 10 cm with double dressing of ammonium nitrate in the tillering and booting phases. High direct dependence of protein content in winter wheat grain on the accumulation of nitrate nitrogen in soil in the booting phase was revealed in all test layers: 0–10 (r = 0.85), 10–20 (r = 0.72), 0–30 cm (r = 0.76). The gluten content in the grain and its grain unit significantly depended on the mobility of phosphorus in the surface soil layer – 0–10 cm (r = 0.66 and 0.52, respectively). Along with the quality improvement of winter wheat grain, the rational use of mineral fertilizers in the No-Till system increases its yield. There is a direct positive relationship between grain protein content and winter wheat yield (r = 0.93).
Multinational corporations face a litany of challenges regarding ethical decision-making as they traverse new variables in each country they operate in. Presented here is a new approach to ethical decision-making research for multinational corporations with the inclusion of moral virtues, national culture, and a feedback mechanism. The new proposed model builds off of the existing work by Trevino’s Person-Situated Interactionist Model. Hofstede’s work on individual national culture characteristics is used to move the conversation forward by explaining the relationships between individual moderators in Trevino’s model and the effect of national culture on them. The new proposed model recommends the inclusion of moral virtues, with honesty and integrity as examples, as individual moderators in the decision-making process based on previous work. It contributes to the literature by introducing moral virtues into traditional ethical decision-making process models and introduces a new variable with a feedback mechanism for future learning. The paper concludes with recommendations for the future direction of research for ethical decision-making models for multinational organizations.
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