3 Efficiency of Knowledge Transfer by Hearing a Conversation While Doing Something

One of the most common means of acquiring useful knowledge is reading suitable documents and websites. However, this is time-consuming and cannot be done in parallel with other tasks. Is there a way to acquire knowledge when we cannot read written texts, such as while driving a car, walking around or doing housework? It is not easy to remember the contents of a document simply by listening to its reading aloud from the top, even if we concentrate while listening. In contrast, it is sometimes easier to remember words heard on the radio or television even if we are not concentrating on them.

Introduction
One of the most common means of acquiring useful knowledge is reading suitable documents and websites. However, this is time-consuming and cannot be done in parallel with other tasks. Is there a way to acquire knowledge when we cannot read written texts, such as while driving a car, walking around or doing housework? It is not easy to remember the contents of a document simply by listening to its reading aloud from the top, even if we concentrate while listening. In contrast, it is sometimes easier to remember words heard on the radio or television even if we are not concentrating on them.
While we are doing something, listening to conversation is better than listening to a precise reading out of a draft or summary for memorizing the contents and turning them into knowledge. We are therefore trying to improve the efficiency of knowledge transfer 1 by "hearing a conversation while doing something." In order to support knowledge acquisition by humans, we aim to develop a system which provides people with useful knowledge while they are doing something or not concentrating on listening. We did not try to edit notes to be read out, or to summarize documents; rather, we aimed to develop a way of transferring knowledge. Specifically, in order to provide knowledge efficiently with computers, we consider how to turn the content into a dialogue that is easily remembered, and develop a system to produce dialogue by which one can easily acquire knowledge.
In the next section of this article, we explain our prototype system named "Sophisticated Eliza" (Isahara et al., 2005) Then, we discuss the idea of "Efficient knowledge transfer by hearing a conversation while doing something" (Yamamoto & Isahara, 2008).

Intelligent Systems 68
In section 4, we evaluate the effectiveness of knowledge transfer via listening to conversation, comparing it with listening to monologues. We firstly choose several topics and select suitable documents on the topic. Then we extract informative sentences from the document and form conversation by splitting a sentence into conversational fragments. In order to verify our hypothesis, we conduct evaluation on the usefulness of listening conversation formed by the fragments with human subjects. We will also get the suggestion from the experiments how to select suitable domain for our system.
In section 5, we introduce our prototype system and present some examples of the conversations extracted by the system. As for the information transfer system, although our final target is to handle topics which are practically useful such as knowledge from newspapers, encyclopedia and Wikipedia, as a first step we tried to compile rules for small procedural domains such as cooking recipes.

Sophisticated Eliza
Recently, thanks to the improvement of natural language processing (NLP) technology, development of high-performance computers and the availability of huge amounts of stored linguistic data, there are now useful NLP-based systems. There are also practical speech synthesis tools for reading out documents and tools for summarizing documents. These tools do not necessarily use state-of-the-art technologies to achieve deep and accurate language understanding, but are based on huge amounts of linguistic resources that used not to be available. Although current computer systems can collect huge amounts of knowledge from real examples, it is not obvious how to transfer knowledge more naturally between such powerful computer systems and humans. We need to develop a novel way to transfer knowledge from computers to humans.
We believe that, based on large amounts of text data, it is possible to devise a system which can generate dialogue by a simple mechanism to give people the impression that two intelligent persons are talking. We verified this approach by implementing a system named Sophisticated Eliza which can simulate conversation between two persons on a computer. Sophisticated Eliza is not a Human-Computer Interaction system; instead, it simulates conversation by two people and users acquire information by listening to the conversation generated by the system. Concretely, using an encyclopedia in Japanese (Kodansha International, 1998) as a knowledge base, we develop rules to extract information from the knowledge base and create fragments of conversation. We extract rules with syntactic patterns to make a conversation, for example, "What is A?" "It's B." from "A is B." The system extracts candidate fragments of conversation using these simple scripts and two voices then read the conversation aloud. This system cannot generate long conversations as humans do on one topic, but it can simulate short conversations from stored linguistic resources and continue conversations while changing topics. Figure 1 shows a screenshot of Sophisticated Eliza and Figure 2 shows its system flow. Figure 3 is examples of conversation generated by the system.
The encyclopedia utilized here contains all about Japan, e.g., history, culture, economy and politics. All sentences in the encyclopedia are analyzed syntactically using a Japanese parser www.intechopen.com and we use rules to extract the fragments of conversation using information in the encyclopedia. As for the manual compilation of rules, we carefully analyzed the output of the Japanese parser and found useful patterns to extract knowledge from the encyclopedia.
The terms extracted during the syntactic analysis are stored in the keyword table and are used for selection of topics and words during the conversation synthesis.

Fig. 3. Examples of Generated Conversation
Note that in our current system, we use Japanese documents as the input. Because we are using only syntactic information output by the Japanese parser, our mechanism is also applicable to other languages such as English. We use a rather simple mechanism to generate actual conversations in the system, which includes rules to select fragments containing similar words and rules to change topics. The contents in the encyclopedia are divided into seven categories, i.e. geography, history, politics, economy, society, culture and life. When the topic in a conversation moves from one topic to another, the system generates utterance showing such move. As for the speech synthesis part, we use the synthesizer "Polluxstar" developed by Oki Electric Industry Co. Ltd., Japan. The two authors of this paper, one male and one female, recorded 400 sentences each and the two characters in the system talk to each other by impersonating our voices. The images of the two characters are also based on the authors.
Because this system uses simple template-like knowledge, it cannot generate semantically deep conversation on a topic by considering context or by compiling highly precise rules to extract script-like information from text. Thus, the mechanism used in this system has room for improvement to create conversations for knowledge transfer.

Efficiency of hearing a conversation comparing with hearing a monologue
In the daily transfer of knowledge, such as in a cooking program on TV, there are not only the reading aloud of recipes by the presenter but also conversation between the cook and assistant. Through such conversations, information which viewers want to know and which they should memorize is transferred to them naturally.
To verify above mentioned fact, we conducted experiments with human subject.

Settings
We utilized the speech synthesizer "Polluxstar" by Oki Electric Co. Ltd., which enables speech synthesis with one's own voice. We input information of voice of authors of this paper (one male and one female).
We prepared three materials to be synthesized for the experiments. Two are about recipes and another is about sports news. For recipes, we chose them from one of recipes sites with movies in Japan (http://recipe.gnavi.co.jp/movie/sweetkitchen/). One is about cooking rice bowl with chicken and eggs, and the other is about cooking gratin. This site contains a short movie with chef and assistant, and contains written recipes for each dish. For dialogue example, we transcribed all conversation between chef and assistant and made speech synthesizer read it aloud. For monologue example, we simply made speech synthesizer read it aloud with one of two voices in the system. As for news article, we chose a news article about women's soccer games in the newspaper in Japan. For its monologue, we made speech synthesizer read it aloud with one of two voices in the system. For its dialogue, we added inquiries manually about some of the point of the news, and made speech synthesizer read it aloud.
We gathered participants of our experience among students of Toyohashi University of Technology, Japan. We had 33 participants and additional 4 male student participants. Because the main topic of the experience is recipe, we gathered mainly woman students. The participants were requested to listen to all six synthesized speeches, i.e. two dialogues for cooking, two monologues for cooking, one dialogue of news, and one monologue of news, and fill questionnaire when one finished each speech.
The items which are asked in the questionnaire are as follows;  (100) It seems that dialogue is slightly better than monologue. However, the experiment about gratin recipe shows different result, i.e., monologue is better than dialogue. We checked the result carefully and found the followings; A group which listened to Gratin dialogue listened to it at the beginning of the experiment. But another group which listened to Gratin monologue listened to Riceball speech before they listen to Gratin monologue. Therefore each participant who listened to Gratin monologue already knows what kind of inquiries they will be asked. They can concentrate to grasp such points. We did additional experiments with smaller participant where each participant listened to the Gratin dialogue after listening to the Riceball speech. Then, the results became closer to the Riceball case. Actually, Gratin dialogue can not be such worse than its monologue. In the free answer opinion in the questionnaire, more participants wrote that they prefer dialogue to monologue than the reverse.
This situation also occurred for Riceball case, i.e., Riceball monogolue was heard after Gratin speech. The difference between Dialogue and Monologue for riceball recipe can be bigger than the figures above.

News
We asked participant which you prefer between monologue and dialogue. Then more than two third of participants explicitly wrote that they prefer dialogue to monologue.

Discussion
As for recipe listening, dialogue seems slightly better than monologue. However, there are several factors in our experiment which affect the result in favor of monologue. We utilized written text on the web as a text for monologue. The important points of the recipe are listed at the end of the texts, therefore it will be memorable to listeners. If we make text for dialogue from written text, the result will be better than the one in our current settings.
As for news listening, the second speaker inserted only several inquiries about topics talked next. This is not a conversation but something like an interview. Some participants strongly prefer this situation. We should establish the way to generate dialogues properly from texts.
Our hypothesis is that dialogue is more useful to get information while doing something. However, in this experiment, participants were asked to listen to monologue and dialogue and answer questionnaire. This situation is different from our original settings. We should make more suitable way to verify our hypothesis.

Efficient knowledge transfer by hearing a conversation while doing something
We started to develop a mechanism to achieve natural knowledge acquisition for humans by turning information that is written in documents into conversational text. Efficient methods of acquiring knowledge include not only "reading documents" and "listening to passages read aloud," but also "hearing a conversation while doing something," provided that information is appropriately embedded into the conversation. We believe that we can verify that this "conversation hearing" can assist knowledge acquisition by developing a system for synthesizing conversations by collecting fragments of conversation and conducting experiments by using the system.
As a means to transfer information, contents conveyed by an interpretive reading with pronounced intonation are better retained in memory than if read monotonously from a document or summary. Furthermore, by turning contents into conversation style, even someone who is not concentrating on listening may become interested in the topic and acquire the contents naturally. This suggests that several factors in conversations, such as throwing in words of agreement, pauses and questions, which may appear to decrease the density of information, are actually effective means of transferring information matching humans' ability to acquire knowledge with limited concentration. Based on this idea, we propose a novel mechanism of an information transfer system by considering the way of transferring knowledge from computers to humans.
Various dialogue systems have already been developed as communication tools between humans and computers (Waizenbaum, 1966;Matsusaka et al., 1999). However, in our novel approach, the dialogue system regards the user as an outsider, presents conversation by two speakers in the computer which is of interest to the outside user, and thus provides the user with useful knowledge.
There are dialogue systems (Nadamoto & Tanaka, 2004; ALICE; UZURA) which can join in a conversation between a human and a computer, but they simply create fragments of conversation and so do not sound like an intelligent human speaker. One reason is that they do not aim to provide knowledge or transfer information to humans, and few theoretical evaluations have been done in this field. In this research, we consider a way to transfer knowledge and develop a conversation system which generates dialogue by which humans can acquire knowledge from dialogue conducted by two speakers in the computer. We analyze the way to transfer knowledge to humans with this system. This kind of research is beneficial not only from an engineering viewpoint but also cognitive science and cognitive linguistics. Furthermore, a speech synthesis system in which two participants conduct spoken conversation automatically is rare. In this research, we develop an original information-providing system by assigning conversation to two speakers in the computer in order to transfer knowledge to humans.

System implementation
The principle of Sophisticated Eliza is that because a large amount of text data is available, even if the recall of information extraction is low, we can obtain sufficient information to generate short conversations. However, the rules still need to be improved by careful analysis of input texts.
As for the information transfer system, although our final target is to handle topics which are practically useful such as knowledge from newspapers, encyclopedia and Wikipedia, as a first step we are trying to compile rules for small procedural domains such as cooking recipes. Concretely, we are developing the new system via the following five steps repeatedly.
1. Enlargement of conversational script and template in order to generate sentences in natural conversation We have already compiled simple templates for extracting fragments of conversation as a part of Sophisticated Eliza. We are now enlarging the set of templates to handle wider contexts, domain-specific knowledge and insertion of words. This enlargement is basically being done manually. Here, domain-specific knowledge includes domain documents in a specific format, such as recipes. Insertion of words includes words of agreement and encouragement for the other speaker, part of which is already introduced in Sophisticated Eliza. An example of synthesized conversation is shown in Figure 4. 2. Implementation of system in which two speakers (agents/characters) make conversation in a computer considering dialogue and document contexts Using the conversational templates extracted based on the contexts, the system continues conversation with two speakers. Fundamental functions of this kind have already been developed for Sophisticated Eliza.
Here, there are two types of "context." One is the context in the documents, i.e. knowledge-base. For the recipe example, cooking heavily depends on the order of each process and on the result of each process. The other type is the context in the conversation.

Fig. 4. Example conversation
If all subevents included in an event are explicitly uttered in conversation, it would be very dull and makes understanding obstruct. For example, "Make hot water in a pan. Peel potatoes and boil them" is enough and it is not necessary to say "boil peeled potatoes in the hot water in a pan." Appropriate use of ellipsis and anaphoric representation based on the context in the conversation are useful tools for easy understanding.
Though speech synthesis itself is out of the scope of our research, pauses in utterances are also important in natural communication. 3. Mechanism to extract (fragment of) knowledge from text Sophisticated Eliza outputs informative short conversations, but the content of the conversation is not consistent as a whole. In this research, we are developing a system to provide people with some useful knowledge. We have to recognize the useful part of the knowledge base and to place great importance on the extracted useful part of the text. We previously reported how to extract an informative set of words using a measure of inclusive relations (Yamamoto et al., 2005), and will apply a similar method to this conversation system. 4. Improvement of conversation script and template considering "fragment of knowledge" By considering the useful part of information written in the knowledge base, we modify the templates to extract conversational text. Contextual information such as ellipsis and anaphora is also treated in this part. As a first step, we will handle anaphora resolution in a specific domain, such as cooking, considering factors described at 2). We will use domain knowledge about cooking such as cookware, cookery and ingredient.

Evaluation
We will conduct tests with participants to evaluate our methodology and verify the effectiveness of our method for transferring knowledge. So far, we are reported by some small number of participants that it is rather easy to listen to the voice of the system, however, objective evaluation is still our future work.

Conclusion
We introduced an approach for developing an information-providing system in order to support knowledge acquisition. The system can transfer knowledge to humans even while the person is doing something or is not concentrating on listening to the voice. Our approach does not create a summary of the key points of what is being read out, but focuses on the knowledge transferring method. Specifically, to provide knowledge efficiently, we consider what kinds of conversation are naturally retained in the brain, as such conversations may enable people to obtain knowledge more easily. We aim to construct an intelligent system which can create such conversations by applying natural language processing techniques.


extfieldsofstudy: Mathematics Medicine

text:
Determining the Contribution of the Energy Systems During Exercise

One of the most important aspects of the metabolic demand is the relative contribution of the energy systems to the total energy required for a given physical activity. Although some sports are relatively easy to be reproduced in a laboratory (e.g., running and cycling), a number of sports are much more difficult to be reproduced and studied in controlled situations. This method presents how to assess the differential contribution of the energy systems in sports that are difficult to mimic in controlled laboratory conditions. The concepts shown here can be adapted to virtually any sport. The following physiologic variables will be needed: rest oxygen consumption, exercise oxygen consumption, post-exercise oxygen consumption, rest plasma lactate concentration and post-exercise plasma peak lactate. To calculate the contribution of the aerobic metabolism, you will need the oxygen consumption at rest and during the exercise. By using the trapezoidal method, calculate the area under the curve of oxygen consumption during exercise, subtracting the area corresponding to the rest oxygen consumption. To calculate the contribution of the alactic anaerobic metabolism, the post-exercise oxygen consumption curve has to be adjusted to a mono or a bi-exponential model (chosen by the one that best fits). Then, use the terms of the fitted equation to calculate anaerobic alactic metabolism, as follows: ATP-CP metabolism = A1 (mL . s-1) x t1 (s). Finally, to calculate the contribution of the lactic anaerobic system, multiply peak plasma lactate by 3 and by the athlete’s body mass (the result in mL is then converted to L and into kJ). The method can be used for both continuous and intermittent exercise. This is a very interesting approach as it can be adapted to exercises and sports that are difficult to be mimicked in controlled environments. Also, this is the only available method capable of distinguishing the contribution of three different energy systems. Thus, the method allows the study of sports with great similarity to real situations, providing desirable ecological validity to the study.

The following physiologic variables will be needed: rest oxygen consumption, exercise oxygen consumption, post-exercise oxygen consumption, rest plasma lactate concentration and post-exercise plasma peak lactate. To calculate the contribution of the aerobic metabolism, you will need the oxygen consumption at rest and during the exercise. By using the trapezoidal method, calculate the area under the curve of oxygen consumption during exercise, subtracting the area corresponding to the rest oxygen consumption. To calculate the contribution of the alactic anaerobic metabolism, the post-exercise oxygen consumption curve has to be adjusted to a mono or a bi-exponential model (chosen by the one that best fits). Then, use the terms of the fitted equation to calculate anaerobic alactic metabolism, as follows: ATP-CP metabolism = A 1 (mL . s -1 ) x t 1 (s). Finally, to calculate the contribution of the lactic anaerobic system, multiply peak plasma lactate by 3 and by the athlete's body mass (the result in mL is then converted to L and into kJ).
The method can be used for both continuous and intermittent exercise. This is a very interesting approach as it can be adapted to exercises and sports that are difficult to be mimicked in controlled environments. Also, this is the only available method capable of distinguishing the contribution of three different energy systems. Thus, the method allows the study of sports with great similarity to real situations, providing desirable ecological validity to the study.

Video Link
The video component of this article can be found at http://www.jove.com/video/3413/

Protocol Introduction
The energy necessary for sustaining a physical effort comes from two metabolic sources: aerobic and anaerobic metabolism. While the aerobic metabolism is more efficient than the anaerobic metabolism (i.e., it produces a higher amount of ATP per mol of substrate), producing energy through anaerobic metabolism can provide a high amount of energy in a very short time period. This may be decisive for any situation that requires extremely fast movements.
Each sport has specific characteristics in terms of motor skills that confer unique physiologic and metabolic demands for that particular sport. The most important aspect of the metabolic demand is the relative contribution of the energy systems to the total energy required for the activity.
To determine the specific demand of each sport is crucial for developing optimized training models, nutritional strategies and ergogenic aids that may maximize athletic performance.
Some sports are relatively easy to be reproduced in a laboratory setting, thus it is possible to create a controlled environment in which athletes can be evaluated. This is the case of running and cycling, for example. Predictable movements compose these sports and, therefore, they are easy to be studied. Using some simple equipment, it is possible to mimic quite exactly the same movements that athletes perform in real On the other hand, a number of sports are much more difficult to be reproduced in laboratory. These sports are unpredictable and dependent on the actions of the partner(s) and opponent(s). This leads to an inability to accurately reproduce the competitive conditions in the lab and an inability to assess these athletes in field during either training or competition. Maybe because of these problems, they have received much less attention from the scientists. This is the case of the majority of team sports and many individual sports 1 .
Considering these aspects, we aimed to describe how to assess the differential contribution of the energy systems in sports that are difficult to reproduce in controlled laboratory conditions. Because judo is a very complex and unpredictable sport, we will use judo as an example. However, the concepts shown here can be adapted to a number of different sports.

Physiological Measurements at Rest
1. Measure the athlete's body mass before he/she initiates exercising. 2. Before initiating the exercise, collect a small resting blood sample from earlobe or fingertip and keep it on ice until the whole experimental procedure is finished. 3. Following, place the calibrated portable gas analyser at the most convenient position, which depends on the movements that the athlete will perform, and record resting or baseline oxygen consumption for five minutes. During the baseline measurement, the athlete has to stay quiet standing on his/her feet (if the exercise will be performed in a standing position) or sat in the equipment that will be used (if the exercise will be performed in a cycloergometer or in any similar equipment).

Physiological Measurements during Exercise
1. After collecting resting blood sample and resting oxygen consumption, you may ask the athlete to start the specific exercise that you are studying. The portable gas analyser has to be placed in a position that will no interfere with exercise and that exercise will not damage the equipment. Continue measuring oxygen consumption throughout the exercise period.

Physiological Measurements after Exercise
1. After collecting exercise oxygen consumption data, keep recording oxygen consumption for ten minutes before shutting the equipment down.
Always recalibrate the gas analyser if more than one athlete is being evaluated in the same day. 2. In order to identify the peak plasma lactate after exercise, collect small blood samples immediately after exercise, three, five and seven minutes after exercise. Keep them on ice until analysis.

Blood Samples Processing and Peak Plasma Lactate Determination
1. All blood samples must be placed in microtubes containing a similar volume of a 2% NaF solution (i.e., if you are collecting 25 μL of blood, place it in 25 μL of 2% NaF). 2. When data collection is finished, separate plasma from erythrocytes by spinning the samples for 5 minutes at 2000 g at 4°C. 3. Plasma lactate can be determined through a variety of methods2,3. In our lab, we use the electrochemical method with the aid of an automatized lactate analyser (Yellow Springs 1500 Sport, Ohio).

Calculations
1. Calculate the net energy generated by the aerobic metabolism by subtracting rest oxygen consumption from exercise oxygen consumption. Oxygen consumption at rest is obtained by multiplying the average of the last 30 seconds of baseline oxygen consumption by the total exercise duration time. Then, calculate the area under the curve of exercise oxygen consumption by using the trapezoidal method. Finally, subtract the resting oxygen consumption from exercise oxygen consumption. 2. The contribution of the anaerobic alactic metabolism (i.e., the ATP-CP pathway) can be considered as the fast component of excess postexercise oxygen consumption [4][5][6] , as illustrated in Figure 1. Calculate the energy produced by the alactic system by fitting the kinetics of postexercise oxygen consumption to a bi-or a monoexponential curve. This can be done with the aid of mathematics' software (e.g. Microcal Origin version 7.0). Choose by the mono-or bi-exponential curve based on the model that best fits to your data set (i.e., the lowest residue). Then, use the terms provided by the fitted equation (Equation 1) to calculate alactic contribution according to Equation 2. where V O2(t) is oxygen uptake at time t, V O2baseline is oxygen uptake at baseline, A is the amplitude, δ is the time delay, τ is a time constant, and 1 and 2 denote the fast and slow components, respectively. 3. To calculate the contribution of the lactic anaerobic system, it is assumed that 1 mM of lactate above the resting values corresponds to 3 mL of oxygen consumed per kilogram of body mass7. Thus, calculate delta peak plasma lactate (i.e., peak plasma lactate minus resting plasma lactate) and multiply it by 3 and by the athlete's body mass. The obtained value of oxygen in mL is then converted to L and to energy (kJ), assuming that each 1 L of O 2 is equal to 20.92 kJ. 4. Finally, the result obtained by each energy system is summed so you have the total energy expenditure during the activity and the relative contribution of each of system can be calculated. Figure 2 depicts a representative curve of oxygen consumption at rest, during exercise and after exercise. In the example used here, athletes performed three different judo techniques (o-uchi-gari, harai-goshi and seoi-nage) for five minutes (one throw every 15 s) 8 . This is a typical response to intermittent exercise. After the calculations, we obtained the final results on the contribution of the energy systems during judo exercises ( Table 1).

Representative Results
Additional representative results are displayed in Table 2. In this example, indoor rock climbers of different competitive levels (i.e., recreational vs. elite) were assessed during a low-difficulty climb route. Individual results for one elite athlete and one recreational athlete are shown ( Table  2).

Discussion
The method we have shown hare can be used for both continuous and intermittent exercise. The great advantage of the method is that it can be adapted to exercises and sports that are difficult to be mimicked in controlled laboratory settings. Furthermore, this is the only available method capable of distinguishing the contribution of three different energy systems. Thus, the method allows the study of sports with great similarity to real situations, providing desirable ecological validity to the study 9 . For example, a recent study by Mello et al. 10 showed that the glycolytic contribution in a 2000 m on water rowing race is of only 7%, which means that rowing performance is mainly dependent on the aerobic metabolism. Similarly, a study by Beneke et al. 4 confirmed that the main source of energy during one of the most used anaerobic tests, the Wingate Anaerobic Test, is the anaerobic metabolism (20% aerobic; 30% alactic and 50% glycolytic). Recent studies by our group have also characterized the energy contributions of indoor climbing 6 and judo 8 , as reported in this example. Indeed, the knowledge on the energetic contribution is critical for the development of ergogenic strategies, training organization or even for validating a test. This method has some limitations. First, the cost of the equipment is somewhat high, and specialized trained personnel are required. Second, although most sports can be mimicked with this technique, it is not any type of exercise that can be studied using the portable gas analyzer. Finally, as plasma lactate does not exactly represent the total lactate produced by skeletal muscle during activity, the results obtained by this procedure can be considered as an estimative of the metabolic demand during exercise, rather than a precise quantification of the energetic contribution. Nonetheless, this is the only validated method available 11 capable of distinguishing the contribution of the three different energy systems.

Disclosures
The authors declare they have no conflict of interest regarding this study.


WC-BEM Implementation of outcome-based education incorporating technology innovation

This study investigated the impact of the implementation of outcome-based education (OBE) incorporating technology innovation in the teaching and learning of a higher education institution in Malaysia. In this study, OBE implementation was evaluated through report on average gap of entrance and exit survey, OBE-student centered learning average score, student online grading and analysis of examination score. This study investigated all OBE course codes offered in the campus under study. Data was collected for two semesters of year 2011, namely Semester April 2011 and Semester October 2011. The instruments of this study consisted of OBE report that contains information regarding average gap and OBE-student centered learning average score. Student online grading was generated from the computer system, as had been rated by the students. Report on OBE grade score, class size and semester of all OBE course codes offered was also analyzed. The data analysis revealed that there is no significant correlation between OBE grade score and average gap of entrance and exit survey. There is also no significant correlation between OBE grade score and OBE-student centered learning average score. No significant correlation is also reported between OBE grade score and student online grading. However, there is a significant negative correlation between OBE grade score and class size. This implied that the smaller the class size, the higher OBE grade score can be expected. Analysis of Variance revealed that there is a significant difference in OBE grade score among different parts of the students. Independent samples t-test revealed no significant difference in OBE grade score between Semester April 2011 and Semester October 2011 students. This study concluded with some recommendations for future study.

Introduction
In Malaysia, numerous issues in higher education are debated severely. Few of the issues include graduates are not capable of the needs of industry, high unemployed rate of graduates, unaccredited programmes, programmes accreditation for outcome-based education (OBE) in higher education institutions and so on. Among these, opinion concerning the implementation of OBE paradigm is recently seriously argued among the higher education institution. The controversy includes problematic or not to successfully implement OBE, its impact on students and lecturers, and also its effect on the whole education system. McDaniel, et al. (2000) commented that in many ways outcome-based education is radically different from the current credit-for-contact model of higher education; and its implementation requires significant adjustment to most institutional policies, procedures and structures. The benefits for student learning and the challenges and rewards of these new roles make re-thinking higher education structures and policies well worth the effort. Wang (2011) reported a clear message conveyed to higher education institutions in Hong Kong, that OBE should be implemented in a systematic manner in tertiary education programmes. The motivation is to improve education and to assess the quality of teaching and student learning in an effective way.
In view of the importance of properly implementing OBE, this study seeks to investigate the impact of the implementation of OBE incorporating technology innovation in the teaching and learning of a higher education institution in Malaysia. The following sections discuss the literature review of OBE and its implementation and impact on one public university in Malaysia.

OBE : Theory and Principles
William Spady, a leading developer of outcome-based education introduced the OBE paradigm into the U.S.A some 20 years ago. Spady (1994:1) defines OBE as a process of clearly focusing and organizing everything in an educational system around what is essential for all students to be able to do successfully at the end of their learning experiences. This means starting with a clear picture of what is important for students to be able to do, then organizing the curriculum, instruction and assessment to make sure this learning ultimately happens.
According to Harden et al. (1999:8), OBE is an approach to education in which decisions about the curriculum are driven by the outcomes the students should display by the end of the course.
-oriented that place the emphasis on the education process - Biggs and Tang (2009:7) reported that OBE educators strive for student achievement at a level appropriate for each individual, the outcomes are specifically to enhance teaching and assessment, always allowing for unintended but desirable outcomes.

Research Related to OBE
Researches related to the implementation of OBE encompass a variety of diverse opinions. Some parties advocate the implementation while the others do not advocate by stating there exists various disadvantages associated with OBE system. Many reviews reported the success stories with respect to the implementation of OBE. OBE is reported to be able to increase student self-esteem, improve attendance, result in high achievement of outcomes and result in better grades (Brown, 1988;Sambs, 1990).
Nevertheless, Towers (1994) reported that outcome-based teacher education makes job more difficult. Concern was raised on how the implementation of outcome-based teacher education affects education faculty members. However, according to Towers (1994) poorer class attendance was reported, for some students assumed the right answers on the evaluation instruments outweighed the importance of the education process and their participation. Many studies reported that it is proven problematic to successfully implement OBE, due to the unclear understanding of what to be implemented (Berlach & McNaught, 2007;Lee, 2003;Griffiths, et al., 2005;Vambe, 2005;de Jager & Nieuwenhuis, 2005;Vandeyar, 2005).

OBE Implementation: The Malaysian Experience
In Malaysia, OBE is the prime criteria for engineering accreditation, whereby Engineering Accreditation Council (EAC) require the implementation of OBE in engineering education sector. Starting from year 2004, all the engineering programmes in Malaysia have been instructed to adopt OBE by the EAC as a part of the requirement for Board of Engineers Malaysia (BEM) to be a full member of the Washington Accord. This act is to ensure that the engineering degree produced by the Malaysian universities would be recognized by the Washington Accord member, such as United States, United Kingdom, Australia, South Africa and other countries (Shahrir, et al., 2008).
Later, in year 2010, OBE was also introduced and piloted in disciplines of sciences and technology, social sciences and humanities in many universities in Malaysia as parallel with the Ministry of Higher Education reform policy and Malaysian Quality Assurance of higher education.
In MARA University of Technology (UiTM), Faculty of Electrical Engineering has introduced OBE knowledge amongst its staff since year 2005. Beginning 2007, all degree courses have OBE elements printed in each of its syllabus (Husna, et al., 2009). Components of outcome-based education (OBE) and student-centered learning (SCL) in UiTM comprise National Aspiration which is high income economy by year 2020, Malaysian Quality Assurance (MQA) and Ministry of Higher Education (MOHE) learning outcomes and soft skills tive, programme outcomes, course outcomes, students learning times, teaching delivery or student learning activities, student assessment and finally programme monitoring and evaluation (Academic Quality Assurance Unit UiTM, 2010).

Sample
All students in the campus under study participated in this study. The campus is a small branch campus with two hundred fifty capacities of students. All OBE course code offered for Semester April 2011 and Semester October 2011 were used for the analysis. However, religious codes and co-curriculum codes were excluded in the analysis as it might lead to bias result since students normally scored well in these codes.

Instruments
The instruments of this study consisted of OBE report that contains information regarding average gap and OBEstudent centered learning average score. Student online grading was generated from the computer system, as had been rated by the students. Report on OBE grade score, class size and semester of all OBE course codes offered was also analyzed. Report on OBE implementation was prepared by each lecturer for all OBE course codes at the end of every semester. The compilation of the report generated the overview of the outcome of implementing OBE system. All the instruments were standard as it was used throughout the whole system.

Data Collection Procedures
Early of each semester, normally before the lecture began, the lecturer of the respective course code distributed the entrance survey to be filled by the students. The entrance survey determined the level of knowledge students equipped before exposed to outcome-based education. Throughout the semester, the lecturers taught the students based on the OBE syllabus.
Students were taught with the assistance of technology innovation, for instance, being facilitated with internet access at computer lab while following a course code. More examples and contexts were illustrated through different computer programme. Students also assessed to a computer system named i-Learn whereby all sources of teaching material of a respective course code can be retrieved or downloaded.
Near the end of each semester, the students were asked to rate the OBE-student centered learning score through a given form which enable respective lecturer to evaluate the outcome of OBE implementation. The OBE-student centered learning average score was then calculated based on the rating of all the students for each course code, which lead to the identification of OBE-SCL Level. Exit survey for each course code was filled by the students at the end of the semester, more or less four to five being exposed to OBE system.

Data Analysis Procedures
Descriptive statistics, such as frequency, mean and standard deviation were performed to describe the data collected. Inferential statistics, such as Pearson Correlation Analysis, Analysis of Variance and Independent Samples t-test were performed to determine if there is any significant correlation or any significant difference among the variables under study.

Correlation between OBE grade score and other components
As illustrated in Table 1.1, there is no significant correlation between OBE grade score and average gap of entrance and exit survey (p>0.05). As shown in Table 1.2, there is also no significant correlation between OBE grade score and OBE-student centered learning average score. No significant correlation is also reported between OBE grade score and student online grading (refer Table 1.3). As revealed in Table 1.4, there is a significant negative correlation between OBE grade score and class size (p<0.05; r=-0.380). This implied that the smaller the class size, the higher OBE grade score can be expected.  -tailed) .010 N 45 45 *. Correlation is significant at the 0.05 level (2-tailed).

Analysis of Variance of OBE grade score among different parts of students
Analysis of Variance revealed that there is a significant difference in OBE grade score among different parts of the students (refer Table 1.5). As shown in Table 1.6 and Table 1.7, the mean OBE grade score of Part 3 students is the highest (3.1020), and is significantly higher than the mean OBE grade score of Part 1 students (2.4856). The mean OBE grade score of Part 1 students is the lowest among the three parts of students. Students spend one  19668 .321 -.1911 .7645 *. The mean difference is significant at the 0.05 level.
As illustrated in Table 1.8, Independent Samples t-test revealed no significant difference in OBE grade score between Semester April 2011 and Semester October 2011 students.

Conclusions and Discussions
As a conclusion, no significant correlation were reported between OBE grade score and average gap of entrance and exit survey, and OBE-student centered learning average score, and student online grading respectively. As illustrated from the finding of this study, it would seem that OBE grade score of the students was not related to -rating on the average gap score of entrance and exit knowledge. Neither does OBE grade score of the -students centered learning average score. This finding also suggested that OBE grade score of the students was not related to student online grading on their respective lecturer. the implementation of OBE. Nevertheless, a big drawback might due to smaller sample size of 45 course codes as compared to more amounts of course codes.
This finding revealed a significant negative correlation between OBE grade score and class size. This finding suggests that higher OBE grade score can be expected if the class size of the respective course code is small. This may due to the fact that when the class is small, the lecturers are more capable of monitoring the outcome of each of the students. Meaning that, the lecturers can easily monitor what the students learn and make sure they learn successfully at the end of the lecture when the class size is small. Future study can investigate on a larger sample size so that comparison or verification of results can be made. In addition to the replication of the study, the future study should focus on all higher education institutions in Malaysia to gather clearer and in-depth analysis of the implementation of OBE. The clarity of focus will help to better improve the quality of OBE implementation in Malaysia.


Time to Return to Play After High Ankle Sprains in Collegiate Football Players

Background: Determining the severity of high ankle sprains in athletes and predicting the time that an athlete can return to unrestricted sport activities following this injury remain significant challenges. Purpose: The objectives of this study were (1) to determine if objective measurements of injury severity after high ankle sprains could predict the time to return to play in Division I football players and (2) to determine whether physical examination or diagnostic musculoskeletal ultrasound was more predictive of return to play. The hypothesis was that objective measures of injury severity of a high ankle sprain can be predictive of time to return to athletic participation in collegiate football players. Study Design: Prospective case series. Methods: Twenty consecutive Division I collegiate football players with a diagnosis of a grade I high ankle sprain (syndesmosis sprain without diastasis) were studied. Two clinical measurements of injury severity were determined: the height of the zone of injury on physical examination and the height of the zone of injury as defined by diagnostic musculoskeletal ultrasound examination. All athletes followed a standardized treatment program and return-to-play criteria. A regression model and Cox proportional hazards model were developed to determine time to return to unrestricted play as a function of injury severity and player position. Results: Physical examination but not ultrasound was significantly correlated with time to return to play. Regression and Cox analyses revealed that injury severity on physical examination and player position were significant predictors of time to return to unrestricted play following high ankle sprain. Conclusions: Injury severity on physical examination and player position are associated with the time to return to unrestricted athletic activity after injury. A model based on the data can be applied to help predict the time to return to unrestricted play in Division I collegiate football players following high ankle sprain.

and the often-protracted time needed before return to athletic participation.
The objectives of this study were (1) to determine if objective measurements of injury severity after high ankle sprains could predict the time to return to play in Division I football players and (2) if return could be predicted, to determine whether physical examination or diagnostic musculoskeletal ultrasound was more predictive of return to play after this injury. Our hypothesis was that objective measures of injury severity at the time of diagnosis of a high ankle sprain can be predictive of time to return to athletic participation in collegiate football players.

Materials and Methods
This study was approved by our institutional review board, and all participants completed informed consent prior to enrollment.
Twenty consecutive Division I collegiate football players with a clinical diagnosis of a grade I high ankle sprain (syndesmosis sprain without diastasis) 5 were enrolled in this study over 3 years. Inclusion criteria included suspected injury to the ankle syndesmosis (anterior and posterior tibiofibular ligaments and interosseous ligament) after acute ankle injury in a game or training session based on physical examination and mechanism of injury. Athletes with prior syndesmosis injuries were excluded from the study. Patients with diastasis of the syndesmosis or associated fractures of the foot or ankle were excluded from the study, as described below.

Diagnosis and Inclusion
Athletes were suspected of having sustained a high ankle sprain if they presented with acute anterolateral ankle pain with weightbearing centered directly over the syndesmosis following a witnessed or reported injury involving external rotation and/or hyperdorsiflexion. Physical examination findings of tenderness over the syndesmosis, a positive "squeeze test," 9 and a positive external rotation test 1 confirmed the diagnosis. Patients underwent routine ankle radiographs or fluoroscopy to rule out fracture or diastasis of the syndesmosis joint. 8, 14 We do not routinely perform stress radiography as part of our standard evaluation of these injuries.

Injury Severity
After enrollment, 2 clinical measurements of injury severity were determined. The first was defined as the height of the zone of injury on physical examination. Specifically, this was defined as the distance in centimeters from the distal tip of the fibula to the highest point of tenderness along the interosseous membrane and anteromedial aspect of the fibula. This method has been described as a measure of injury severity in high ankle sprains. 13 This distance was measured by a single investigator for each of the 2 football teams under study, to minimize variability, and was recorded for subsequent analysis.
The second predictor of clinical severity was the height of the zone of injury, as defined by diagnostic musculoskeletal ultrasound examination. Within 72 hours of injury, both the injured and uninjured extremities were evaluated by musculoskeletal ultrasound examination. Ultrasound images were acquired using high-frequency linear transducers (10-17 MHz; Model iU22, Philips Medical Imaging, Bothell, Washington) by 1 of 2 musculoskeletal ultrasound technologists (9 and 11 years of experience) and were supervised by a single fellowship-trained musculoskeletal radiologist (18 years of experience). The static images and cine clips were then retrospectively reviewed on a digital workstation by the radiologist. The normal interosseous membrane was identified as a thin linear hyperechoic structure extending from the tibia to the fibula. The interosseous membrane was determined to be injured when the membrane was not visualized from abnormal hypoechogenicity. The distance in centimeters from the tibiotalar joint line to the highest point of injury, as visualized on ultrasound, was measured and recorded for subsequent analysis. The anterior tibiofibular ligament was also evaluated and assessed for complete tear. If the anterior tibiofibular ligament and interosseous membrane were not torn on ultrasound, then 0 cm was recorded. If the anterior tibiofibular ligament was completely torn and the interosseous membrane was normal at ultrasound, then 1 cm was recorded as the proximal extent of the injury. A ligament was noted to be normal if it was of uniform thickness and hyperechoic with a compact fibrillarechotexture. A ligament was noted to be completely torn if there was discontinuity and abnormal hypoechogenicity. The calcaneofibular ligament was also assessed by ultrasound, and the uninjured extremity was also scanned in all patients to serve as an internal control.
Participants and investigators were blinded to both injury severity measurements until after the patient had returned to full athletic participation to avoid treatment bias.
Patients underwent a standardized rehabilitation program (Table 1) and were permitted to progress to the next phase after successful completion of the preceding one. Athletes were allowed to return to unrestricted play after meeting standardized return-to-play criteria ( Table 2).

Data Analysis
Pearson correlation coefficients with 95% confidence intervals (CIs) were calculated to investigate the direction and magnitude of association between the 2 measures of injury severity and time to return to unrestricted play. A linear regression model (time to return to unrestricted play as a function of injury severity and player position) with 95% CIs was then developed. A Cox proportional hazards model with covariates of injury severity and player position was developed to investigate the effect of player position on return to play. Because of the sample size, player position was categorized either as lineman or other position.
Data analysis was performed on SAS 9.1.3.

Demographics
Twenty consecutive Division I collegiate football players from 2 teams were enrolled in the study between 2007 and 2010. All were men, with a mean age of 19.9 years (range, 19-23 years).
Ten of the 20 patients with a clinical diagnosis of high ankle sprain on physical examination had evidence of interosseous membrane tear on ultrasound, with a complete tear of the anterior tibiofibular ligament noted in all 10 ( Figure 1). The average superior extent of injury from the anterior tibiotalar joint in these 10 players with both interosseous membrane and anterior tibiofibular ligament tear was 7.4 cm (range, 4-20 cm). There were 6 with complete tears of the anterior tibiofibular ligament and a normal interosseous membrane, where the proximal extent of injury from the joint was recorded as 1 cm.
The remaining 4 had normal anterior tibiofibular ligament and interosseous membrane, where the proximal injury extent was therefore recorded as 0 cm. Four had concomitant injury to the calcaneofibular ligament, and 1 had injury to the deltoid ligament. No patients suspected of sustaining a high ankle sprain were excluded from the study with associated fractures or syndesmotic diastasis. No fractures of the fibular head were noted. Taping-circumferential strap to support anterior inferior tibiofibular ligament in addition to routine ankle taping; arch support to assist control of pronation Optional brace for return to practice

Correlation
There was a statistically significant positive correlation between the height of zone of injury on physical examination (tenderness) and time to return to unrestricted play (r = 0.68; 95% CI, 0.34, 0.86). The correlation between extent of interosseous membrane injury on ultrasound and return to play was weak and without statistical significance (r = .35; 95% CI, -0.11, 0.67). Furthermore, the correlation between injury severity on physical examination versus ultrasound was weak and without statistical significance (r = .31, 95% CI, -0.15, 0.66). When the ultrasound findings were compared with number of days to return to play, patients with an intact interosseous membrane had an average return to play of 12.6 days (range, 2-26 days), and those with an interosseous membrane tear had an average of 19.6 days (range, 8-30 days), which was not statistically significant (P = 0.19). However, patients with clinically suspected high ankle sprain and a normal anterior tibiofibular ligament on ultrasound had an average return to play of 3.3 days (range, 2-7 days), compared with those with a complete tibiofibular ligament tear, who averaged 19.2 days (range, 8-30 days), which was statistically significant (P < 0.01).

Regression and Cox Proportional Hazards Model
A linear regression analysis revealed that injury severity as measured on physical examination and player position were both significant predictors of time to return to unrestricted play following high ankle sprain. The model suggests that height of tenderness is a significant predictor of time to return to play while controlling for player position (P < 0.01), whereas player position is a significant predictor of time to return to play while controlling for injury severity (P = 0.04). A graph of the regression model illustrates that height of tenderness is a predictor of time to return to play (Figure 2). The full regression model, which includes the additional predictor variable of player position, is number of days to return to unrestricted play = -1.05 + (1.29 × height of zone of injury on physical examination in centimeters) + (6.25 × player position).
For the player position variable, lineman = 0 and all other positions = 1.
The Cox proportional hazard model investigating the effects of player position (linemen versus other) and injury severity (height of tenderness) on return to play, while controlling for injury severity on physical examination, suggests that linemen return to play sooner than other positions (hazard ratio = 0.24, P = 0.01). In addition, this model confirms that injury severity (height of tenderness) is associated with a delayed return to unrestricted football participation (hazard ratio = 0.87, P = 0.01).

discussion
There is a clear association between injury severity as measured by physical examination and the time to return to unrestricted play following high ankle sprains in Division I collegiate football players.
High ankle sprains remain a challenging injury in football players. Although injuries to the syndesmosis appear to be less common than isolated lateral ankle sprains, their clinical course is more protracted and appears to be more unpredictable. Numerous authors have reported that high ankle sprains in football players result in significantly greater time loss to play than lateral ankle sprains. 4,7,9,15 Professional football players with syndesmosis injuries lost significantly more time (2.5 vs 1.25 weeks), practices (11.7 vs 3.5 practice sessions), and games (1.4 vs 0.3 games) than those with simple lateral ankle sprains. 7 In addition, injuries to the syndesmosis have been associated with chronic symptoms and ankle dysfunction. 6,13,15 Nussbaum et al reported on collegiate athletes with syndesmotic sprains and also found an association between injury height on physical examination and time lost from athletic participation. 13 Although this study was not restricted to football players, without the effect of sex or sport in their results, a similar mean time lost from athletic participation as the present study was reported (13.4 vs 15.5 days). This study included only football players because different sports place different demands on the ankle. Focusing on a single sport strengthens the external validity of these findings when applied to football players. In addition, player position was included as a covariate in the analysis. Just as there are sportspecific demands on the ankle, position-specific demands exist, and the patients in this study were grouped accordingly. The analysis suggests that football linemen return to play sooner than other positions when controlling for injury severity. Because of the sample size, a further break down analysis by player position was not performed.
Little has been published regarding the rehabilitation of high ankle sprains, and the ideal treatment regimen remains undefined. The few studies that have presented rehabilitation protocols generally follow 3 phases: (1) an early phase of pain and inflammation control; (2) a middle phase focusing on mobility, function, and strengthening; and (3) a final phase of advanced training to prepare the athlete to return to competition. 6,13,16 This treatment protocol also follows the general strategy.
The value in establishing the association between injury severity and time to recovery is the application of these findings toward a prediction model. A mechanism for predicting time to return to play after injury is of value to athletes and caregivers alike. Athletes gain a sense of a reasonable timeline to recovery following high ankle sprain, while caregivers can more clearly define the window for return to play, facilitating communication with players and coaches. These findings allow for a reasonable prediction of such a "window" of return to play following injury. These findings might also be useful to identify injuries for more invasive measures to reduce the risk for further disability from syndesmotic injury.
The sample size of 20 represents a convenience sample that resulted from a planned data collection period over 3 consecutive college football seasons. Despite this relatively small sample size, the results mirror quite closely those reported by Nussbaum et al. 13 A larger sample size might alter the regression model but would certainly allow for a narrower prediction interval.
Historically, the physical examination has been the mainstay of diagnosis for suspected syndesmotic sprains. While there is a role for standard radiographs, the value of stress radiographs is unclear, and they are not part of the standard evaluation for these injuries. 2,3,16 Magnetic resonance imaging can also be used to diagnose injury to the syndesmosis, but its application in this setting has not been clearly defined. 12 Unique to the present study is the use of diagnostic musculoskeletal ultrasound to generate a prediction model. Dynamic musculoskeletal ultrasound provides accurate diagnosis of anterior inferior tibiofibular ligament ruptures in athletes. 10 For example, 4 athletes suspected of having sustained high ankle sprains in this study had no evidence of syndesmosis injury on ultrasound. These 4 athletes with "false positive" results on physical examination but with normal ligaments on ultrasound had a smaller zone of tenderness (3.8 vs 11.4 cm) and returned to unrestricted sports participation sooner (3.3 vs 19.2 days) than did those with syndesmosis injury on ultrasound. The data suggest that injury severity as measured by physical examination is more closely correlated with time to return to play than diagnostic ultrasound.
In conclusion, (1) injury severity on physical examination as defined by height of tenderness of the interosseous membrane and (2) player position are associated with the time needed to return to unrestricted athletic activity. A linear regression model based on these data may be applied to help predict the time to return to unrestricted play in Division I collegiate football players following high ankle sprain.