Hyperchloremia, not Concomitant Hypernatremia, Independently Predicts Early Mortality in Critically Ill Moderate-Severe Traumatic Brain Injury Patients.

BACKGROUND: Hypernatremia has been associated with mortality in neurocritically ill patients, with and without traumatic brain injury (TBI). These studies, however, lack concomitant adjustment for hyperchloremia as a physiologically co-occurring finding despite the associations with hyperchloremia and worse outcomes after trauma, sepsis, and intracerebral hemorrhage. The objective of our study was to examine the association of concomitant hypernatremia and hyperchloremia with in-hospital mortality in moderate-severe TBI (msTBI) patients. METHODS: We retrospectively analyzed prospectively collected data from the OPTIMISM-study and included all msTBI patients consecutively enrolled between 11/2009 and 1/2017. Time-weighted average (TWA) sodium and chloride values were calculated for all patients to examine the unadjusted mortality rates associated with the burden of hypernatremia and hyperchloremia over the entire duration of the intensive care unit stay. Multivariable logistic regression modeling predicting in-hospital mortality adjusted for validated confounders of msTBI mortality was applied to evaluate the concomitant effects of hypernatremia and hyperchloremia. Internal bootstrap validation was performed. RESULTS: Of the 458 patients included for analysis, 202 (44%) died during the index hospitalization. Fifty-five patients (12%) were excluded due to missing data. Unadjusted mortality rates were nearly linearly increasing for both TWA sodium and TWA chloride, and were highest for patients with a TWA sodium > 160 mmol/L (100% mortality) and TWA chloride > 125 mmol/L (94% mortality). When evaluated separately in the multivariable analysis, TWA sodium (per 10 mmol/L change: adjusted OR 4.0 [95% CI 2.1-7.5]) and TWA chloride (per 10 mmol/L change: adjusted OR 3.9 [95% CI 2.2-7.1]) independently predicted in-hospital mortality. When evaluated in combination, TWA chloride remained independently associated with in-hospital mortality (per 10 mmol/L change: adjusted OR 2.9 [95% CI 1.1-7.8]), while this association was no longer observed with TWA sodium values (per 10 mmol/L change: adjusted OR 1.5 [95% CI 0.51-4.4]). CONCLUSIONS: When concomitantly adjusting for the burden of hyperchloremia and hypernatremia, only hyperchloremia was independently associated with in-hospital mortality in our msTBI cohort. Pending validation, our findings may provide the rationale for future studies with targeted interventions to reduce hyperchloremia and improve outcomes in msTBI patients.

Medical Students at Risk: Practical Lessons after 10 years of a Premedical Enrichment Program.

This article was migrated. The article was marked as recommended. Introduction: At the impending conclusion of a ten-year post baccalaureate program, the authors evaluated our Premedical Enrichment Program (PrEP) for effectiveness and component transferability to the medical curriculum. The study focused on two research questions: 1) was the PrEP successful in matriculating well prepared educationally disadvantaged students to medical school, and, 2) What did PrEP students value most about the program? Methods: We matched 61 PrEP participants to a nonparticipating student of the same cohort, age, ethnic status, gender, economic disadvantage, MCAT score, and undergraduate GPA. We compared Step 1 performance and academic performance. An online survey tool collected student views on PrEP program effectiveness and retrospective pre-post questions regarding academic preparedness. Results: PrEP student academic outcomes were equal to those of the matched comparison group despite higher MCAT scores and GPAs for the latter. Students valued the strong program relationships they built, ensuring study partners and emotional support during medical school. Students reported that the PrEP increased biochemistry knowledge, improved study skills, familiarized them with medical school processes, and introduced them to an active learning pedagogy. They expressed gratitude for having the opportunity to study medicine. They felt the program built their confidence, encouraged professional identity exploration, and that their diverse experiences and challenges were valued. Discussion/Conclusion: Results reiterate the importance of the social learning environment, the potential to strengthen academic performance by building genuine and long lasting relationships, and the subsequent potential for growth in confidence for medical school. Interconnected course content reinforces new learning and student confidence with learning strategies. Important goals for educationally disadvantaged student success include building these trust relationships with significant faculty and student colleagues. Confidence and trust have the opportunity to grow with authentic performance successes, witnessed, shared, and confirmed by sympathetic peers and faculty.

Undergraduate Performance in Solving Ill-Defined Biochemistry Problems.

With growing interest in promoting skills related to the scientific process, we studied performance in solving ill-defined problems demonstrated by graduating biochemistry majors at a public, minority-serving university. As adoption of techniques for facilitating the attainment of higher-order learning objectives broadens, so too does the need to appropriately measure and understand student performance. We extended previous validation of the Individual Problem Solving Assessment (IPSA) and administered multiple versions of the IPSA across two semesters of biochemistry courses. A final version was taken by majors just before program exit, and student responses on that version were analyzed both quantitatively and qualitatively. This mixed-methods study quantifies student performance in scientific problem solving, while probing the qualitative nature of unsatisfactory solutions. Of the five domains measured by the IPSA, we found that average graduates were only successful in two areas: evaluating given experimental data to state results and reflecting on performance after the solution to the problem was provided. The primary difficulties in each domain were quite different. The most widespread challenge for students was to design an investigation that rationally aligned with a given hypothesis. We also extend the findings into pedagogical recommendations.

The PULSE Vision & Change Rubrics, Version 1.0: A Valid and Equitable Tool to Measure Transformation of Life Sciences Departments at All Institution Types.

The PULSE Vision & Change Rubrics, version 1.0, assess life sciences departments' progress toward implementation of the principles of the Vision and Change report. This paper reports on the development of the rubrics, their validation, and their reliability in measuring departmental change aligned with the Vision and Change recommendations. The rubrics assess 66 different criteria across five areas: Curriculum Alignment, Assessment, Faculty Practice/Faculty Support, Infrastructure, and Climate for Change. The results from this work demonstrate the rubrics can be used to evaluate departmental transformation equitably across institution types and represent baseline data about the adoption of the Vision and Change recommendations by life sciences programs across the United States. While all institution types have made progress, liberal arts institutions are farther along in implementing these recommendations. Generally, institutions earned the highest scores on the Curriculum Alignment rubric and the lowest scores on the Assessment rubric. The results of this study clearly indicate that the Vision & Change Rubrics, version 1.0, are valid and equitable and can track long-term progress of the transformation of life sciences departments. In addition, four of the five rubrics have broad applicability and can be used to evaluate departmental transformation by other science, technology, engineering, and mathematics disciplines.

Commentary: PhDs in biochemistry education-5 years later.

In this commentary, the discussion of PhDs in biochemistry education research is expanded to explore a number of diverse pathways leading to a competitive research program in biochemistry education research.

A research-based laboratory course designed to strengthen the research-teaching nexus.

We describe a 10-week laboratory course of guided research experiments thematically linked by topic, which had an ultimate goal of strengthening the undergraduate research-teaching nexus. This undergraduate laboratory course is a direct extension of faculty research interests. From DNA isolation, characterization, and mutagenesis, to protein expression and structural analysis, the research protocols were adapted to suit the weekly 3-hour biochemistry course. The experiments described are flexible and hypothesis driven, allowing original research to be conducted. Students gain practice in some of the most common techniques used in biochemistry and molecular biology, including minipreps and DNA spectrophometric analysis, DNA restriction digestion and agarose gel electrophoresis, PCR mutagenesis, DNA sequencing analyses, E. coli transformations, whole cell protein extractions, SDS-PAGE, immunoblots, molecular modeling, and bioinformatics. The studies that begun in the classroom were continued in the research laboratory by undergraduate students, and eventually, the results were published in peer reviewed research articles. This research-educational program effectively integrated basic research endeavors into the undergraduate curriculum. It proved to be synergistic by nature: research stimulated teaching and teaching supported research. In our experience, this is an effective mechanism to conduct productive research while satisfying teaching duties in undergraduate institutions, where scholarly research is expected but teaching is the primary mission.

Gauging the gaps in student problem-solving skills: assessment of individual and group use of problem-solving strategies using online discussions.

For the past 3 yr, faculty at the University of New Mexico, Department of Biochemistry and Molecular Biology have been using interactive online Problem-Based Learning (PBL) case discussions in our large-enrollment classes. We have developed an illustrative tracking method to monitor student use of problem-solving strategies to provide targeted help to groups and to individual students. This method of assessing performance has a high interrater reliability, and senior students, with training, can serve as reliable graders. We have been able to measure improvements in many students' problem-solving strategies, but, not unexpectedly, there is a population of students who consistently apply the same failing strategy when there is no faculty intervention. This new methodology provides an effective tool to direct faculty to constructively intercede in this area of student development.

Lessons learned from a study-group pilot program for medical students perceived to be 'at risk'.

BACKGROUND: At the University of New Mexico School of Medicine (UNM-SOM) we have noticed that some first year medical students have difficulty accurately assessing their academic skills and are often afraid to seek help. This leads to marginal performance and sometimes even failure. Therefore, we developed a preemptive intervention using peer-led study groups based on the personalized System of Instruction (PSI). AIM: The goal of this pilot study was to evaluate this approach for assisting students, interms of student success, and cast benefit. METHODS: Thirteen first-year medical students considered to be 'at risk' of academic difficulty took part in a six-month pilot intervention. They participated in structured study groups that were facilitated by upper-level medical students. The groups met twice weekly for up to two hours each time. The at-risk students took short multiple-choice quizzes and discussed major concepts. If students did not achieve 80% or better on the quizzes, they were required to take a second quiz to demonstrate mastery. Summative exam scores from four groups of students were compared: those with Medical College Admission Test (MCAT) scores <25, who received the study group intervention; their classmates with MCAT scores >25 who did not receive the intervention; and two matched groups from the previous year, none of whom had access to the structured study groups. RESULTS: No significant differences in exam scores were seen between the group who received the intervention and the matched group who did not. CONCLUSIONS: Despite this result, we learned several useful lessons about study groups and interactions between first-year and upper-level medical students: (1) Students perceived participation in the study groups as a good learning strategy, but preferred participation not be mandated. It may be preferable to train and encourage students to run their own study groups. (2) Both students and proctors acknowledged interpersonal benefits from the program but, as these benefits can be achieved by other means, an expensive proctor-based program is not, we believe, the best use of academic support resources. (3) Focus in the study groups was on content for the quizzes, but more attention to how-to-learn strategies may have had greater impact.

Comparison of student performance in cooperative learning and traditional lecture-based biochemistry classes.

Student performance in two different introductory biochemistry curricula are compared based on standardized testing of student content knowledge, problem-solving skills, and student opinions about the courses. One curriculum was used in four traditional, lecture-based classes (n = 381 students), whereas the second curriculum was used in two cooperative learning classes (n = 39 students). Students in the cooperative learning classes not only performed at a level above their peers in standardized testing of content knowledge and in critical thinking and problem-solving tasks (p < 0.05), but they also were more positive about their learning experience. The testing data are in contrast to much of the medical school literature on the performance of students in problem-based learning (PBL) curricula, which shows little effect of the curricular format on student exam scores. The reason for the improvement is undoubtedly multifactorial. We argue that the enhancement of student performance in this study is related to: 1) the use of peer educational assistants, 2) an authentic PBL format, and 3) the application of a multicontextual learning environment in the curricular design. Though educationally successful, the cooperative learning classes as described in this study were too resource intensive to continue; however, we are exploring incorporation of some of the "high context" aspects of the small-group interactions into our current lecture-based course with the addition of on-line PBL cases.

Teachers as learners in a cooperative learning biochemistry class.

Upper level college students majoring in biochemistry at the University of New Mexico have the opportunity to participate in an advanced biochemistry course entitled "Biochemistry Education." This course introduces theories of teaching and learning, provides opportunities for participation in course organization, design, and assessment strategies, and requires practice in lecturing, exam writing, and grading. One component of this course required the biochemistry majors to act as educational assistants, leading problem-based learning sessions in a cooperative learning introductory survey biochemistry course for nonmajors. Problem-based learning scenarios used in this course were based on real-life biochemistry problems. As a result of their participation, the educational assistants increased their understanding of the biochemistry principles, gained an appreciation for the difficulty of the job of a "good teacher," developed new approaches to their own learning, and became more confident speakers. The participating biochemistry faculty were also positively affected by the collaborative approach they were attempting to model for the two sets of students and realized the benefits of truly cooperative team teaching.

Assessment of student skills for critiquing published primary scientific literature using a primary trait analysis scale.

Instructor evaluation of progressive student skills in the analysis of primary literature is critical for the development of these skills in young scientists. Students in a senior or graduate-level one-semester course in Immunology at a Masters-level comprehensive university were assessed for abilities (primary traits) to recognize and evaluate the following elements of a scientific paper: Hypothesis and Rationale, Significance, Methods, Results, Critical Thinking and Analysis, and Conclusions. We tested the hypotheses that average recognition scores vary among elements and that scores change with time differently by trait. Recognition scores (scaled 1 to 5), and differences in scores were analyzed using analysis of variance (ANOVA), regression, and analysis of covariance (ANCOVA) (n = 10 papers over 103 days). By multiple comparisons testing, we found that recognition scores statistically fell into two groups: high scores (for Hypothesis and Rationale, Significance, Methods, and Conclusions) and low scores (for Results and Critical Thinking and Analysis). Recognition scores only significantly changed with time (increased) for Hypothesis and Rationale and Results. ANCOVA showed that changes in recognition scores for these elements were not significantly different in slope (F1,16 = 0.254, P = 0.621) but the Results trait was significantly lower in elevation (F1,17 = 12.456, P = 0.003). Thus, students improved with similar trajectories, but starting and ending with lower Results scores. We conclude that students have greatest difficulty evaluating Results and critically evaluating scientific validity. Our findings show extant student skills, and the significant increase in some traits shows learning. This study demonstrates that students start with variable recognition skills and that student skills may be learned at differential rates. Faculty can use these findings or the primary trait analysis scoring scale to focus on specific paper elements for which they desire to improve recognition.