Generative learning activities for online multimedia learning: when summarizing is effective but drawing is not.

Introduction: The goal of this study is to determine whether two commonly used generative learning activities for text-based lessons-writing a summary or creating a drawing-help students learn from a multimedia lesson involving animations with short text captions without prior training in the generative activities. Methods: Students viewed a series of four annotated animations on greenhouse gases. During pauses between the animations, students were asked to generate a written summary, to create a drawing, or to do both, whereas a control group viewed the lesson without any generative learning activities. Students were tested immediately (Experiment 1) or after a one-week delay (Experiment 2). Results: In both experiments, students who produced written summaries scored significantly higher on the posttest than those who engaged in no generative learning activities (d = 0.48 in Experiment 1, d = 0.54 in Experiment 2), but there was no significant difference on the posttest for students who generated drawings compared to those who engaged in no generative learning activities. In addition, those who engaged in drawing and summarizing did not have significantly different posttest performance than those engaged in summarizing alone. Discussion: We conclude that writing summaries during a highly visual animated lesson is effective for learning, possibly because it encourages students to engage in generative processing during learning more than drawing and we discuss potential reasons for this in the discussion. This work helps extend generative learning theory by pinpointing potential boundary conditions for learning by drawing and learning by summarizing.

Increasing the realism of on-screen embodied instructors creates more looking but less learning.

BACKGROUND: Although adding embodied instructors on the screen is considered an effective way to improve online multimedia learning, its effectiveness is still controversial. The level of realism of embodied on-screen instructors may be an influencing factor, but it is unclear how it affects multimedia learning. AIMS: We explored whether and how embodied on-screen instructors rendered with different levels of realism in multimedia lessons affect learning process and learning outcomes. SAMPLES: We recruited 125 college students as participants. METHODS: Students learned about neural transmission in an online multimedia lesson that included a real human, cartoon human, cartoon animal or no instructor. RESULTS: Students learning with cartoon human or cartoon animal instructors tended to fixate more on the relevant portions of the screen and performed better on retention and transfer tests than no instructor group. The real human group fixated more on the instructor, fixated less on the relevant portion of the screen and performed worse on a retention test in comparison to the cartoon human group. Fixation time on the instructor fully mediated the relationship between instructor realism and retention score. CONCLUSIONS: The addition of embodied on-screen instructors can promote multimedia learning, but the promotion effect would be better if the embodied instructor was a cartoon animal or cartoon human rather than a real human. This suggests an important boundary condition in which less realism of on-screen embodied instructors produces better learning processes and outcomes.

Onscreen presence of instructors in video lectures affects learners' neural synchrony and visual attention during multimedia learning.

COVID-19 forced students to rely on online learning using multimedia tools, and multimedia learning continues to impact education beyond the pandemic. In this study, we combined behavioral, eye-tracking, and neuroimaging paradigms to identify multimedia learning processes and outcomes. College students viewed four video lectures including slides with either an onscreen human instructor, an animated instructor, or no onscreen instructor. Brain activity was recorded via fMRI, visual attention was recorded via eye-tracking, and learning outcome was assessed via post-tests. Onscreen presence of instructor, compared with no instructor presence, resulted in superior post-test performance, less visual attention on the slide, more synchronized eye movements during learning, and higher neural synchronization in cortical networks associated with socio-emotional processing and working memory. Individual variation in cognitive and socio-emotional abilities and intersubject neural synchronization revealed different levels of cognitive and socio-emotional processing in different learning conditions. The instructor-present condition evoked increased synchronization, likely reflecting extra processing demands in attentional control, working memory engagement, and socio-emotional processing. Although human instructors and animated instructors led to comparable learning outcomes, the effects were due to the dynamic interplay of information processing vs. attentional distraction. These findings reflect a benefit-cost trade-off where multimedia learning outcome is enhanced only when the cognitive benefits motivated by the social presence of onscreen instructor outweigh the cognitive costs brought about by concurrent attentional distraction unrelated to learning.

Benefits of Taking a Virtual Field Trip in Immersive Virtual Reality: Evidence for the Immersion Principle in Multimedia Learning.

This study describes and investigates the immersion principle in multimedia learning. A sample of 102 middle school students took a virtual field trip to Greenland via a head mounted display (HMD) or a 2D video as an introductory lesson within a 6-lesson inquiry-based climate change intervention. The HMD group scored significantly higher than the video group on presence (d = 1.43), enjoyment (d = 1.10), interest (d = .57), and retention in an immediate (d = .61) and delayed posttest (d = .70). A structural equation model indicated that enjoyment mediated the pathway from instructional media to immediate posttest, and interest mediated the pathway from instructional media to delayed posttest score, indicating that these factors may play different roles in the learning process with immersive media. This work contributes to the cognitive affective model of immersive learning, and suggests that immersive lessons can have positive longitudinal effects for learning.

The positivity principle: do positive instructors improve learning from video lectures?

The positivity principle states that people learn better from instructors who display positive emotions rather than negative emotions. In two experiments, students viewed a short video lecture on a statistics topic in which an instructor stood next to a series of slides as she lectured and then they took either an immediate test (Experiment 1) or a delayed test (Experiment 2). In a between-subjects design, students saw an instructor who used her voice, body movement, gesture, facial expression, and eye gaze to display one of four emotions while lecturing: happy (positive/active), content (positive/passive), frustrated (negative/active), or bored (negative/passive). First, learners were able to recognize the emotional tone of the instructor in an instructional video lecture, particularly by more strongly rating a positive instructor as displaying positive emotions and a negative instructor as displaying negative emotions (in Experiments 1 and 2). Second, concerning building a social connection during learning, learners rated a positive instructor as more likely to facilitate learning, more credible, and more engaging than a negative instructor (in Experiments 1 and 2). Third, concerning cognitive engagement during learning, learners reported paying more attention during learning for a positive instructor than a negative instructor (in Experiments 1 and 2). Finally, concerning learning outcome, learners who had a positive instructor scored higher than learners who had a negative instructor on a delayed posttest (Experiment 2) but not an immediate posttest (Experiment 1). Overall, there is evidence for the positivity principle and the cognitive-affective model of e-learning from which it is derived.

Busting myths in online education: Faculty examples from the field.

The shift in learning environments due to the COVID-19 pandemic necessitates a closer look at course design, faculty approaches to teaching, and student interaction, all of which may predict learner achievement and satisfaction. Transitioning to an online environment requires the reinvention, reimagining, and applying of "e-flavors" of general learning theory. With this shift to online learning comes the opportunity for misunderstandings and "myths" to occur, which may stand in the way of faculty embracing online learning and fully realizing its potential. This article seeks to address several myths and misconceptions that have arisen in higher education during the rapid shift to online teaching and learning. While not comprehensive, these myths represent a snapshot of common challenges. These are we can transfer our in-person course design to online; adult learners do not need an empathetic approach; and online teaching and learning is socially isolating. Through an appreciative inquiry framework, we present each myth in the context of relevant literature and invite faculty with varied online teaching experience to share their own case studies that illustrate how they have "busted" these myths with the goal to identify existing examples of locally effective practices for the express purpose of replication that leads to positive change.

Benefits of Writing an Explanation During Pauses in Multimedia Lessons.

Generative learning theory posits that learners engage more deeply and produce better learning outcomes when they engage in selecting, organizing, and integrating processes during learning. The present experiments examine whether the generative learning activity of generating explanations can be extended to online multimedia lessons and whether prompts to engage in this generative learning activity work better than more passive instruction. Across three experiments, college students learned about greenhouse gasses from a 4-part online lesson involving captioned animations and subsequently took a posttest. After each part, learners were asked to generate an explanation (write-an-explanation), write an explanation using provided terms (write-a-focused-explanation), rewrite a provided explanation (rewrite-an-explanation), read a provided explanation (read-an-explanation), or simply move on to the next part (no-activity). Overall, students in the write-an-explanation group (Experiments 2 and 3), write-a-focused-explanation group (Experiment 2), and rewrite-an-explanation group (Experiment 3) performed significantly better on a delayed posttest than the no-activity group, but the groups did not differ significantly on an immediate posttest (Experiment 1). These results are consistent with generative learning theory and help identify generative learning strategies that improve online multimedia learning, thereby priming active learning with passive media.

Retrospective evaluation of attempted vaginal deliveries in dichorionic twin pregnancies.

PURPOSE: Numbers of planned cesarean deliveries are increasing in twin pregnancies, despite the lack of evidence for this approach, and the second twin is thought to be at risk for a poorer outcome. The aim of this study was to examine whether twins have a poorer outcome if an attempted vaginal delivery is changed to a cesarean section or combined delivery. METHODS: This retrospective data analysis included all women with dichorionic twin pregnancies attempting vaginal delivery over a 10-year period. Outcome parameters for the first and second twins relative to their mode of birth were compared. A correlation model between the interdelivery time interval and Apgar scores was calculated. Subgroup analyses assessing the birth mode of the first and second twins were conducted. RESULTS: A total of 248 women were enrolled in the study. The second twins had significantly lower values for outcome parameters, such as umbilical artery cord pH and Apgar scores in comparison with the first twins (P < 0.01). The subgroup analysis of birth modes in first and second twins showed a significantly poorer outcome in the cesarean section and combined delivery group (P < 0.05). The interdelivery time interval was significantly longer in the second twin cesarean section group (P < 0.01). There was no significant correlation between the interdelivery time intervals and Apgar scores (P > 0.05). CONCLUSION: Although outcome parameters were significantly lower in second twins and twins born via secondary cesarean section, the clinical relevance of this appears to be negligible.

Better together: Effects of four self-efficacy-building strategies on online statistical learning.

The goal of this study is to test the individual and combined effects of supplementing an online statistics lesson with four motivational strategies corresponding to Bandura's (1997) four sources of self-efficacy (anxiety coping, modeling, mental practice, and effort feedback) on cognitive, motivational, and affective outcomes. Internet participants (N = 279) completed an online statistics module in one of six conditions with one or all four self-efficacy-building strategies (5 treatment conditions) or none of these strategies (control condition). The results indicated that the four strategies worked effectively in combination, significantly improving transfer test scores (d = 0.608), increasing self-efficacy ratings (d = 0.696), and reducing task anxiety ratings (d = -0.534), as compared with the control condition. By contrast, no motivational strategy alone was effective. The results suggest the importance of taking advantage of the power of all four sources of self-efficacy information in combination when designing motivational interventions for online mathematical lessons.

Retrospective evaluation of established cut-off values for the sFlt-1/PlGF ratio for predicting imminent delivery in preeclampsia patients.

OBJECTIVE: The outcome of preeclampsia is difficult to predict. Laboratory markers such as soluble fms-like tyrosine kinase (sFlt-1) and placental growth factor (PlGF) are thought to be predictive factors. A 2012 study by Verlohren et al. evaluated cut-off values for assessing time to delivery in patients with elevated sFlt-1/PlGF ratios. The present study aimed to evaluate findings in patients with elevated sFlt-1/PlGF ratios who gave birth at Kepler University Hospital in Linz, Austria. The hypothesis was tested, that our patients show longer pregnancy duration despite elevated sFlt-1/PlGF ratios. STUDY DESIGN: This retrospective data analysis included all patients with sFlt-1/PlGF ratios above the established cut-off values between January 2014 and October 2017. Two groups were analyzed relative to gestational age and were matched with healthy controls: 24 + 0 to 33 + 6 gestational weeks, sFlt-1/PlGF ratio >655.2; and 34 + 0 to 36 + 6 gestational weeks, sFlt-1/PlGF ratio >201. MAIN OUTCOME MEASURES: sFlt-1/PlGF ratio and time to delivery correlation. RESULTS: In the <34-week group, 43.2% of the patients delivered beyond 48 h, with a mean sFlt-1/PlGF ratio of 885.06, showing a significantly lower sFlt-1/PlGF ratio than patients who delivered within 2 days (P = 0.04). In the >34-week group, 66.7% were still pregnant after 48 h, with a mean sFlt-1/PlGF ratio of 273.7. CONCLUSION: The sFlt-1/PlGF ratio appears to be a powerful tool for diagnosing and predicting preeclampsia. However, the data do not confirm the cut-off values described earlier, with longer pregnancy durations in this group of patients.

Time-lapse imaging of cytoplasmic strings at the blastocyst stage suggests their association with spontaneous blastocoel collapse.

RESEARCH QUESTION: To study the origin and temporal behaviour of cytoplasmic strings spanning the blastocoel (main objective) and their influence on treatment outcome (secondary objective). DESIGN: This retrospective analysis of prospectively collected data was set up in a university medical centre. Patients who either underwent fresh (n = 95) or vitrified-warmed (n = 55) single blastocyst transfer were included. Time-lapse sequences of in-vitro developed blastocysts were screened for the presence of cytoplasmic strings. Pregnancies in string-positive and string-negative transfers were followed up to live birth. RESULTS: A total of 387 blastocysts were obtained in the fresh cycles of 100 patients, corresponding to a blastocyst formation rate of 62.4%. Cytoplasmic strings were first detected around full stage (108.5 ± 6.4 h) in 170 blastocysts (43.9%). The number of strings varied (range: 1-7) and the duration of visibility was 5.2 ± 3.5 h. The occurrence of cytoplasmic strings was significantly associated with the presence of blastocoelic collapses (P < 0.001) but not with any of the annotated morphokinetic parameters. Live birth and neonatal outcome were the same for both string-positive and string-negative pregnancies. Moreover, collapses did not affect treatment outcome. CONCLUSION: Time-lapse analysis of cytoplasmic strings at the blastocyst stage revealed that this morphological feature was not a negative predictor as previously reported. Although physiologically normal, at least some of the cytoplasmic strings are an artefact, possibly associated with blastocoelic collapses.

Does the Porter formula hold its promise? A weight estimation formula for macrosomic fetuses put to the test.

PURPOSE: Estimating fetal weight using ultrasound measurements is an essential task in obstetrics departments. Most of the commonly used weight estimation formulas underestimate fetal weight when the actual birthweight exceeds 4000 g. Porter et al. published a specially designed formula in an attempt to improve detection rates for such macrosomic infants. In this study, we question the usefulness of the Porter formula in clinical practice and draw attention to some critical issues concerning the derivation of specialized formulas of this type. METHODS: A retrospective cohort study was carried out, including 4654 singleton pregnancies with a birthweight ≥ 3500 g, with ultrasound examinations performed within 14 days before delivery. Fetal weight estimations derived using the Porter and Hadlock formulas were compared. RESULTS: Of the macrosomic infants, 27.08% were identified by the Hadlock formula, with a false-positive rate of 4.60%. All macrosomic fetuses were detected using the Porter formula, with a false-positive rate of 100%; 99.96% of all weight estimations using the Porter formula fell within a range of 4300 g ± 10%. The Porter formula only provides macrosomic estimates. CONCLUSIONS: The Porter formula does not succeed in distinguishing macrosomic from normal-weight fetuses. High-risk fetuses with a birthweight ≥ 4500 g in particular are not detected more precisely than with the Hadlock formula. For these reasons, we believe that the Porter formula should not be used in clinical practice. Newly derived weight estimation formulas for macrosomic fetuses must not be based solely on a macrosomic data set.

Designing multimedia instruction in anatomy: An evidence-based approach.

This paper summarizes 10 research-based principles for how to design effective multimedia instruction in medical education involving anatomy. Clin. Anat. 32:2-11, 2019. © 2018 Wiley Periodicals, Inc.

Postpartum Galactostasis of the Vulva in a Case of Bilateral Lactating Ectopic Breast Tissue.

BACKGROUND: In the general population, the incidence of accessory breast tissue, a congenital malformation, is 1-5%. The most common site is the lower axilla. Detecting such tissue may be problematic, and accessory breasts below the umbilicus are extremely rare. CASE: This report describes the case of a 5-day postpartum 29-year-old woman, G2P2, with painful vulvar swelling 6 cm in diameter. The patient was diagnosed with polymastia in the vulva, without polythelia, with galactostasis due to suturing of a birth laceration covering an excretory duct. The sutures were removed, and the pain decreased. Breastfeeding was continued. CONCLUSION: Ectopic breast tissue is rare but should be taken into consideration in the differential diagnosis of a vulvar mass, especially postpartum in lactating women.

Equivalence of using a desktop virtual reality science simulation at home and in class.

The use of virtual laboratories is growing as companies and educational institutions try to expand their reach, cut costs, increase student understanding, and provide more accessible hands on training for future scientists. Many new higher education initiatives outsource lab activities so students now perform them online in a virtual environment rather than in a classroom setting, thereby saving time and money while increasing accessibility. In this paper we explored whether the learning and motivational outcomes of interacting with a desktop virtual reality (VR) science lab simulation on the internet at home are equivalent to interacting with the same simulation in class with teacher supervision. A sample of 112 (76 female) university biology students participated in a between-subjects experimental design, in which participants learned at home or in class from the same virtual laboratory simulation on the topic of microbiology. The home and classroom groups did not differ significantly on post-test learning outcome scores, or on self-report measures of intrinsic motivation or self-efficacy. Furthermore, these conclusions remained after accounting for prior knowledge or goal orientation. In conclusion, the results indicate that virtual simulations are learning activities that students can engage in just as effectively outside of the classroom environment.

The participation rate of migrant women in gestational diabetes screening in Austria: a retrospective analysis of 3293 births.

PURPOSE: This study evaluated the extent to which migrant women participate in the mandatory oral glucose tolerance test (OGTT) for gestational diabetes mellitus (GDM) screening in Austria. METHODS: A retrospective data analysis was carried out of births at an obstetrics unit in a university hospital between January 2013 and December 2015. The inclusion criteria were singleton pregnancies, live births, birth weight ≥ 3500, and no preexisting diabetes mellitus. The patient's extramurally obtained OGTT values and history of GDM were checked. If the mother's country of birth was not Austria, the woman was classified as a migrant. Three groups were defined: group 1-women with normal OGTT; group 2-women with pathological OGTT; and group 3-women without OGTT or with an incomplete OGTT. MAIN OUTCOME MEASURES: Numbers of complete and incomplete OGTTs and rate of women with pathological OGTTs not treated in accordance with the guidelines among mothers born in Austria or migrants. The groups were compared using the t-test, chi-squared test, or Fisher's exact test. RESULTS: A total of 3293 births met the inclusion criteria, and 43.52% of all mothers were migrants; 16.8% of all women had pathological OGTT findings. Only 60.1% of the latter received treatment in accordance with the guidelines. The proportion of mothers born in Austria who did not have OGTTs, or only incomplete ones, was 5.4%. In the group of migrant women, the corresponding figure was 10.5% (P < 0.01). CONCLUSIONS: Migrant women have significantly lower rates of participation in GDM screening.

The Role of Endometrial Volume and Endometrial and Subendometrial Vascularization Parameters in a Frozen Embryo Transfer Cycle.

The role of three-dimensional power Doppler ultrasonography of the endometrium in assisted reproduction is still far from clear. In this retrospective cohort study, transvaginal three-dimensional power Doppler examinations were performed 30 min before frozen-thawed embryo transfer. After pregnancy tests, two cohorts were established: P (pregnant, n = 31) and NP (nonpregnant, n = 31). The study only included nullipara with no uterine abnormalities who were undergoing infertility treatment at the Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Linz, Austria. The main outcome measures were the vascularization flow index (VFI), flow index (FI), and vascularization index (VI) in the endometrium/subendometrium, assessed using Virtual Organ Computer-aided AnaLysis (VOCAL™), and the endometrial volume. A total of 62 patients were enrolled in the study, forming two cohorts (pregnant, P; nonpregnant, NP). There were no significant differences between the two cohorts with regard to demographic data, numbers of embryos transferred, or embryo grading, but there was a significant difference in endometrial volume (cohort P, 3.17 ± 0.84 mL; cohort NP, 2.36 ± 0.9 mL; P = 0.001) and the pregnancy rate rises with larger volume. No differences were observed in the vascularization parameters FI, VFI, and VI in the endometrium and subendometrium. In the cohort of pregnant patients, there were 26 (41.9%) live births, with 21 term deliveries (80.8%). The endometrial volume was larger in the cohort of pregnant patients. Measurements were performed 30 min before embryo transfer, and no differences were observed in vascularization parameters in the subendometrium and endometrium.

Computer Games in Education.

Visionaries offer strong claims for the educational benefits of computer games, but there is a need to test those claims with rigorous scientific research and ground them in evidence-based theories of how people learn. Three genres of game research are ( a) value-added research, which compares the learning outcomes of groups that learn academic material from playing a base version of a game to the outcomes of those playing the same game with one feature added; ( b) cognitive consequences research, which compares improvements in cognitive skills of groups that play an off-the-shelf game to the skill improvements of those who engage in a control activity; and ( c) media comparison research, which compares the learning outcomes of groups that learn academic material in a game to the outcomes of those who learn with conventional media. Value-added research suggests five promising features to include in educational computer games: modality, personalization, pretraining, coaching, and self-explanation. Cognitive consequences research suggests two promising approaches to cognitive training with computer games: using first-person shooter games to train perceptual attention skills and using spatial puzzle games to train two-dimensional mental rotation skills. Media comparison research suggests three promising areas where games may be more effective than conventional media: science, mathematics, and second-language learning. Future research is needed to pinpoint the cognitive, motivational, affective, and social processes that underlie learning with educational computer games.

Disadvantages of a weight estimation formula for macrosomic fetuses: the Hart formula from a clinical perspective.

PURPOSE: Sonographic fetal weight (FW) estimation to detect macrosomic fetuses is an essential part of everyday routine work in obstetrics departments. Most of the commonly used weight estimation formulas underestimate FW when the actual birth weight (BW) exceeds 4000 g. One of the best-established weight estimation formulas is the Hadlock formula. In an effort to improve the detection rates of macrosomic infants, Hart et al. published a specially designed formula including maternal weight at booking. The usefulness of the Hart formula was tested. METHODS: Retrospective study of 3304 singleton pregnancies, birth weight ≥ 3500 g. The accuracy of the Hadlock and Hart formula were tested. A subgroup analysis examined the influence of the maternal weight. The Chi-squared test and one-way analysis of variation were carried out. For all analyses, p < 0.05 was considered statistically significant. RESULTS: The overall percentages of births falling within ± 5% and ± 10% of the BW using the Hadlock formula were 27% and 53%, respectively. Using the Hart formula, 24% and 54% were identified within these levels. With the Hart formula, 94% of all weight estimations fall within 4200 g ± 5% and nearly 100% fall within 4200 g ± 10%. CONCLUSIONS: Applying the Hart formula results in an overestimation of fetal weight in neonates with a birth weight < 4000 g and fails to identify high-risk fetuses. We, therefore, do not consider Hart's formula to be of clinical relevance.

Good-quality blastocysts derived from vacuolized morulas show reduced viability.

OBJECTIVE: To study whether late spontaneous vacuolization on day 4 is an artefact or an alternate means of blastocele formation and to analyze its impact on pregnancy outcome and live birth. DESIGN: Prospective observational study. SETTING: University teaching hospital. PATIENT(S): A total of 424 patients who fulfilled inclusion criteria were subgrouped according to the spontaneous vacuolization on day 4: Group 1 had all morulas affected, group 2 showed no signs of vacuoles, and group 3 was mixed (some day 4 embryos had vacuoles and others did not). INTERVENTION(S): Screening for the presence of vacuoles on day 4 and fresh single-blastocyst transfer. MAIN OUTCOME MEASURE(S): Morula and blastocyst scoring, utilization rate, pregnancy and live birth rates. RESULT(S): Patients of group 1 had a reduced blastocyst formation rate on day 5 (P<.01) and significantly fewer good-quality blastocysts for usage (P<.05). In addition, pregnancy (P<.001) and live birth (P<.01) rate were significantly worse in group 1 compared with groups 2 and 3. CONCLUSION(S): Late onset of vacuolization around compaction stage is a negative predictor of blastocyst formation and outcome.