Promoting college students' systems thinking in asynchronous discussions: Encouraging students initiating questions.

Introduction: Systems thinking is one of the most important thinking skills for medical students. Most of the studies focused on designing technological-rich learning environments which usually take several weeks or months to implement. However, the occurring of COVID-19 health crisis does not allow extensive period of time to implement classroom interventions. How to support students' systems thinking in fully online environments remains an issue. This study examines if encouraging students initiating questions on asynchronous discussion forum supports their systems thinking development. Methods: Twenty-two junior students participated in this study. We compared if and how students developed systems thinking when they were encouraged asking questions in asynchronous discussion forums in one unit with another unit in which traditional method was used. Multiple analytical methods were applied in this study, including, social network analysis, epistemic network analysis, inferential statistical analysis and qualitative analysis. Results: Quantitative results showed that all students improved systems thinking compared with traditional teaching unit among which leader students improved most. Further analysis on students' discussion posts suggested leader students asked high systems thinking level questions and provided high level responses. Epistemic network analysis unpacked how leader, regular and peripheral students engaged in initiating questions and providing responses differently. Discussion: This study provides methodological and practical contributions. Methodologically, this study extends prior methods of applying network analysis beyond its original preservice teacher training contexts; practically, this study provides strategies to practitioners to support students' asynchronous forum discussions.

Diagnosis of fetal megacystis with chromosomal abnormality by 2D prenatal ultrasound: A case report.

RATIONALE: The pathogenesis of fetal megacystis is divided into obstructive and nonobstructive. Megacystis combined with chromosomal abnormalities is rare and most of the cases are nonobstructive. PATIENT CONCERNS: The fetus showed posterior urethral obstructive megacystis with features of bladder enlargement, "keyhole" feature, and thick bladder wall. DIAGNOSES: Here, we present a case of fetal megacystis diagnosed by ultrasound at pregnancy week 15+2 and with multisystem abnormalities. OUTCOMES: Moreover, the fetus showed edema, umbilical cord cyst, cardiac dysplasia, hook-shaped hand, and strephenopodia. These abnormalities strongly suggested chromosomal abnormalities. The fetus was diagnosed with trisomy 18 by amniocentesis. Posterior urethral obstructive megacystis was confirmed by pathology. LESSONS: In conclusion, this case suggests that in the presence of fetal megacystis and multisystem abnormalities, causes should be investigated and the possibility of chromosomal abnormalities should be considered in the presence of multisystem developmental abnormalities.

Physical activity level of urban pregnant women in Tianjin, China: a cross-sectional study.

OBJECTIVE: To determine the physical activity level and factors influencing physical activity among pregnant urban Chinese women. METHODS: This prospective cross-sectional study enrolled 1056 pregnant women (18-44 years of age) in Tianjin, China. Their socio-demographic characteristics were recorded, and the Pregnancy Physical Activity Questionnaire was used to assess their physical activity during pregnancy. The data were analyzed by multinomial logistic regression with adjustment for potential confounders. RESULTS: Median total energy expenditure of pregnant women in each of the three trimesters ranged from 18.50 to 21.90 metabolic equivalents of task (METs) h/day. They expended 1.76-1.85 MET h/day on moderate and vigorous activities and 0.11 MET h/day on exercise. Only 117 of the women (11.1%) met the international guideline for physical activity in pregnancy (≥150 min moderate intensity exercise per week). The most frequent reason given for not being more physically active was the fear of miscarriage. Higher education level (OR: 4.11, 95% CI: 1.59-10.62), habitual exercise before pregnancy (OR: 2.14, 95% CI: 1.39-3.28), and husbands who exercised regularly (OR: 2.21, 95% CI: 1.33-3.67) significantly increased the odds of meeting the guideline (p<0.001). A low pre gravid body mass index (OR: 0.42, 95% CI: 0.20-0.87) significantly decreased the odds (p<0.001). CONCLUSIONS: Few urban Chinese pregnant women met the recommended physical activity guideline. They also expended little energy exercising. Future interventions should be based on the clinic environment and targeting family members as well as the subjects. All pregnant women should be targeted, not just those in high-risk groups.