Integrated lymphoedema and tissue viability service: improving patient and wound outcomes.

This article will focus on the integration of tissue viability and lymphoedema services to improve outcomes for patients with leg ulceration. It will highlight why there is a need for lymphoedema specialist knowledge within the care of patients with leg ulceration and how the services are closely aligned. Lymphoedema can adversely affect wound healing and the article will provide case studies that highlight how developing a hybrid tissue viability and lymphoedema clinician or integration of the specialists can provide effective patient-centred care at reduced cost. The article offers potential strategies and suggestions on how to address inequalities in care and how to improve service provision.

Metacognition and Self-Efficacy in Action: How First-Year Students Monitor and Use Self-Coaching to Move Past Metacognitive Discomfort During Problem Solving.

Stronger metacognitive regulation skills and higher self-efficacy are linked to increased academic achievement. Metacognition and self-efficacy have primarily been studied using retrospective methods, but these methods limit access to students' in-the-moment metacognition and self-efficacy. We investigated first-year life science students' metacognition and self-efficacy while they solved challenging problems, and asked: 1) What metacognitive regulation skills are evident when first-year life science students solve problems on their own? and 2) What aspects of learning self-efficacy do first-year life science students reveal when they solve problems on their own? Think-aloud interviews were conducted with 52 first-year life science students across three institutions and analyzed using content analysis. Our results reveal that while first-year life science students plan, monitor, and evaluate when solving challenging problems, they monitor in a myriad of ways. One aspect of self-efficacy, which we call self-coaching, helped students move past the discomfort of monitoring a lack of understanding so they could take action. These verbalizations suggest ways we can encourage students to couple their metacognitive skills and self-efficacy to persist when faced with challenging problems. Based on our findings, we offer recommendations for helping first-year life science students develop and strengthen their metacognition to achieve improved problem-solving performance.

Venous and lymphovenous lower limb wound outcomes in specialist UK wound and lymphoedema clinics.

This article explores the impact of combining tissue viability and lymphoedema techniques on optimising time to healing. AIM: To investigate the healing rates observed in patients who presented to wound and lymphoedema specialist clinics, located in the south eastern region of England, with venous/lymphovenous ulceration of the lower limb during the COVID-19 pandemic in 2020-2022 (30 months in all). METHODOLOGY: A retrospective analysis of patient outcomes. RESULTS: 1041 patients were referred to the service, with a healing rate of 88.5% over 78 days. DISCUSSION: When comparing 2013-2019 healing rates/time to healing vs 2020-2022 there was a decrease of 1.5% in the rate of healing and a mean reduction in time to healing of 40 days. CONCLUSION: Despite the pandemic the service was able to maintain previous levels of outcomes and observed a decrease in the mean time to healing.

Implementing a new regimen to manage a difficult-to-heal lymphovenous leg ulcer.

The case study described in this article shows the use of different approaches and techniques that need to be utilised when treating patients presenting with a combination of venous and lymphatic disease (lymphovenous) in order to improve complex wound outcomes. The author highlights how lymphoedema can affect the wound healing process by increasing the risk of recurrent infection and a hardening of the tissues (fibrosis), reducing oxygenation and lymphatic flow to the wound, leading to chronic complex wounds.

What I Wish My Instructor Knew: How Active Learning Influences the Classroom Experiences and Self-Advocacy of STEM Majors with ADHD and Specific Learning Disabilities.

Our understanding of how active learning affects different groups of students is still developing. One group often overlooked in higher education research is students with disabilities. Two of the most commonly occurring disabilities on college campuses are attention-deficit/hyperactivity disorder (ADHD) and specific learning disorders (SLD). We investigated how the incorporation of active-learning practices influences the learning and self-advocacy experiences of students with ADHD and/or SLD (ADHD/SLD) in undergraduate science, technology, engineering, and mathematics (STEM) courses. Semistructured interviews were conducted with 25 STEM majors with ADHD/SLD registered with a campus disability resource center at a single university, and data were analyzed using qualitative methods. Participants described how they perceived active learning in their STEM courses to support or hinder their learning and how active learning affected their self-advocacy. Many of the active-learning barriers could be attributed to issues related to fidelity of implementation of a particular active-learning strategy and limited awareness of universal design for learning. Active learning was also reported to influence self-advocacy for some participants, and examples of self-advocacy in active-learning STEM courses were identified. Defining the supports and barriers perceived by students with ADHD/SLD is a crucial first step in developing more-inclusive active-learning STEM courses. Suggestions for research and teaching are provided.

"Oh, that makes sense": Social Metacognition in Small-Group Problem Solving.

Stronger metacognition, or awareness and regulation of thinking, is related to higher academic achievement. Most metacognition research has focused at the level of the individual learner. However, a few studies have shown that students working in small groups can stimulate metacognition in one another, leading to improved learning. Given the increased adoption of interactive group work in life science classrooms, there is a need to study the role of social metacognition, or the awareness and regulation of the thinking of others, in this context. Guided by the frameworks of social metacognition and evidence-based reasoning, we asked: 1) What metacognitive utterances (words, phrases, statements, or questions) do students use during small-group problem solving in an upper-division biology course? 2) Which metacognitive utterances are associated with small groups sharing higher-quality reasoning in an upper-division biology classroom? We used discourse analysis to examine transcripts from two groups of three students during breakout sessions. By coding for metacognition, we identified seven types of metacognitive utterances. By coding for reasoning, we uncovered four categories of metacognitive utterances associated with higher-quality reasoning. We offer suggestions for life science educators interested in promoting social metacognition during small-group problem solving.

Drawing on Internal Strengths and Creating Spaces for Growth: How Black Science Majors Navigate the Racial Climate at a Predominantly White Institution to Succeed.

To support Black students in earning undergraduate science degrees, faculty need to understand the mechanisms that Black students use to succeed. Following an anti-deficit achievement approach, we used the community cultural wealth framework to investigate the strengths that Black undergraduates bring to their science majors. Community cultural wealth consists of capital or "knowledge, skills, abilities, and contacts" that students of color can use in their education. Through participatory action research, we studied academically successful Black science majors in the final year of their undergraduate degrees at a research-intensive predominantly white institution (PWI; n = 34). We collected data using a demographic survey and two semistructured interviews. Three themes emerged from content and thematic analysis. First, Black science majors use their capital to navigate the racial climate at a PWI. Second, Black students use internal strengths as capital to succeed in their science majors at a PWI. Third, Black science majors create virtual and physical spaces where they can share their capital and thrive at a PWI. We use our results to offer suggestions for researchers and instructors who want to take action to support the success of Black science majors.

Fostering Metacognition to Support Student Learning and Performance.

Metacognition is awareness and control of thinking for learning. Strong metacognitive skills have the power to impact student learning and performance. While metacognition can develop over time with practice, many students struggle to meaningfully engage in metacognitive processes. In an evidence-based teaching guide associated with this paper (https://lse.ascb.org/evidence-based-teaching-guides/student-metacognition), we outline the reasons metacognition is critical for learning and summarize relevant research on this topic. We focus on three main areas in which faculty can foster students' metacognition: supporting student learning strategies (i.e., study skills), encouraging monitoring and control of learning, and promoting social metacognition during group work. We distill insights from key papers into general recommendations for instruction, as well as a special list of four recommendations that instructors can implement in any course. We encourage both instructors and researchers to target metacognition to help students improve their learning and performance.

Inside and Out: Factors That Support and Hinder the Self-Advocacy of Undergraduates with ADHD and/or Specific Learning Disabilities in STEM.

Self-advocacy is linked to the success and retention of students with disabilities in college. Self-advocacy is defined as communicating individual wants, needs, and rights to determine and pursue required accommodations. While self-advocacy is linked to academic success, little is known about how students with disabilities in science, technology, engineering, and mathematics (STEM) practice self-advocacy. We previously developed a model of self-advocacy for STEM students with attention-deficit/hyperactivity disorder (ADHD) and/or specific learning disabilities (SLD). Here, we use this model to examine what factors support or hinder self-advocacy in undergraduate STEM courses. We conducted semistructured interviews with 25 STEM majors with ADHD and/or SLD and used qualitative approaches to analyze our data. We found internal factors, or factors within a participant, and external factors, the situations and people, described by our participants, that influenced self-advocacy. These factors often interacted and functioned as a support or barrier, depending on the individuals and their unique experiences. We developed a model to understand how factors supported or hindered self-advocacy in STEM. Supporting factors contributed to a sense of comfort and security for our participants and informed their perceptions that accommodation use was accepted in a STEM course. We share implications for research and teaching based on our results.

Knowledge of Learning Makes a Difference: A Comparison of Metacognition in Introductory and Senior-Level Biology Students.

Metacognitive regulation occurs when learners regulate their thinking in order to learn. We asked how introductory and senior-level biology students compare in their use of the metacognitive regulation skill of evaluation, which is the ability to appraise the effectiveness of an individual learning strategy or an overall study plan. We coded student answers to an exam self-evaluation assignment for evidence of evaluating (n = 315). We found that introductory and senior students demonstrated similar ability to evaluate their individual strategies, but senior students were better at evaluating their overall plans. We examined students' reasoning and found that senior students use knowledge of how people learn to evaluate effective strategies, whereas introductory students consider how well a strategy aligns with the exam to determine its effectiveness. Senior students consider modifying their use of a strategy to improve its effectiveness, whereas introductory students abandon strategies they evaluate as ineffective. Both groups use performance to evaluate their plans, and some students use their feelings as a proxy for metacognition. These data reveal differences between introductory and senior students, which suggest ways metacognition might develop over time. We contextualize these results using research from cognitive science, and we consider how learning contexts can affect students' metacognition.

How Undergraduate Science Students Use Learning Objectives to Study.

Learning objectives communicate the knowledge and skills that instructors intend for students to acquire in a course. Student performance can be enhanced when learning objectives align with instruction and assessment. We understand how instructors should use learning objectives, but we know less about how students should use them. We investigated students' use and perceptions of learning objectives in an undergraduate science course at a public research university. In this exploratory study, students (n = 185) completed two open-ended assignments regarding learning objectives and we analyzed the content of their answers. We found that students used learning objectives in ways that reflected the recommendations of past and present instructors, suggesting that students are receptive to instruction on how to use learning objectives. Students generally found learning objectives to be useful because the objectives helped them to narrow their focus and organize their studying, suggesting that students may need additional help from instructors in order to self-direct their learning. Students who chose not to use learning objectives often found other resources, such as case studies covered in class, to be more helpful for their learning. Some of these students recognized that the concepts included in case studies and learning objectives overlapped, pointing to a benefit of alignment between instructional activities and learning objectives. These qualitative results provide the data necessary for designing a quantitative instrument to test the extent to which students' use of learning objectives affects their performance.

Characterization of aminoaciduria and hypoaminoacidemia in dogs with hepatocutaneous syndrome.

OBJECTIVE To characterize aminoaciduria and plasma amino acid concentrations in dogs with hepatocutaneous syndrome (HCS). ANIMALS 20 client-owned dogs of various breeds and ages. PROCEDURES HCS was definitively diagnosed on the basis of liver biopsy specimens (n = 12), gross and histologic appearance of skin lesions (4), and examination of skin and liver biopsy specimens (2) and presumptively diagnosed on the basis of cutaneous lesions with compatible clinicopathologic and hepatic ultrasonographic (honeycomb or Swiss cheese pattern) findings (2). Amino acid concentrations in heparinized plasma and urine (samples obtained within 8 hours of each other) were measured by use of ion exchange chromatography. Urine creatinine concentration was used to normalize urine amino acid concentrations. Plasma amino acid values were compared relative to mean reference values; urine-corrected amino acid values were compared relative to maximal reference values. RESULTS All dogs had generalized hypoaminoacidemia, with numerous amino acid concentrations < 50% of mean reference values. The most consistent and severe abnormalities involved glutamine, proline, cysteine, and hydroxyproline, and all dogs had marked lysinuria. Urine amino acids exceeding maximum reference values (value > 1.0) included lysine, 1-methylhistidine, and proline. CONCLUSIONS AND CLINICAL RELEVANCE Hypoaminoacidemia in dogs with HCS prominently involved amino acids associated with the urea cycle and synthesis of glutathione and collagen. Marked lysinuria and prolinuria implicated dysfunction of specific amino acid transporters and wasting of amino acids essential for collagen synthesis. These findings may provide a means for tailoring nutritional support and for facilitating HCS diagnosis.

Metacognition in Upper-Division Biology Students: Awareness Does Not Always Lead to Control.

Students with awareness and control of their own thinking can learn more and perform better than students who are not metacognitive. Metacognitive regulation is how you control your thinking in order to learn. It includes the skill of evaluation, which is the ability to appraise your approaches to learning and then modify future plans based on those appraisals. We asked when, why, and how upper-division biology students evaluated their approaches to learning. We used self-evaluation assignments to identify students with potentially high metacognition and conducted semistructured interviews to collect rich qualitative data from them. Through content analysis, we found that students evaluated their approaches to learning when their courses presented novel challenges. Most students evaluated in response to an unsatisfactory grade. While evaluating study strategies, many students considered performance and learning simultaneously. We gained insights on the barriers students face when they try to change their approaches to learning based on their evaluations. A few students continued to use ineffective study strategies even though they were aware of the ineffectiveness of those strategies. A desire to avoid feeling uncomfortable was the primary reason they avoided strategies that they knew were more effective. We examined the behavioral change literature to help interpret these findings.

Differences in metacognitive regulation in introductory biology students: when prompts are not enough.

Strong metacognition skills are associated with learning outcomes and student performance. Metacognition includes metacognitive knowledge-our awareness of our thinking-and metacognitive regulation-how we control our thinking to facilitate learning. In this study, we targeted metacognitive regulation by guiding students through self-evaluation assignments following the first and second exams in a large introductory biology course (n = 245). We coded these assignments for evidence of three key metacognitive-regulation skills: monitoring, evaluating, and planning. We found that nearly all students were willing to take a different approach to studying but showed varying abilities to monitor, evaluate, and plan their learning strategies. Although many students were able to outline a study plan for the second exam that could effectively address issues they identified in preparing for the first exam, only half reported that they followed their plans. Our data suggest that prompting students to use metacognitive-regulation skills is effective for some students, but others need help with metacognitive knowledge to execute the learning strategies they select. Using these results, we propose a continuum of metacognitive regulation in introductory biology students. By refining this model through further study, we aim to more effectively target metacognitive development in undergraduate biology students.

GnRH regulation of Jun and Atf3 requires calcium, calcineurin, and NFAT.

GnRH binds to its receptor on gonadotropes and activates multiple members of the MAPK signaling family that in turn regulates the expression of several immediate early genes (IEGs) including Jun, Fos, Atf3, and Egr1. These IEGs confer hormonal responsiveness to gonadotrope-specific genes including Gnrhr, Cga, Fshb, and Lhb. In this study we tested the hypothesis that GnRH specifically regulates the accumulation of Jun and Atf3 mRNA through a pathway that includes intracellular Ca²âº, calcineurin, and nuclear factor of activated T cells (NFAT). Our results indicate that pretreatment of murine LßT2 cells with 1, 2-bis-(o-aminophenoxy)-ethane-N,N,N',N'-tetraacetic acid tetra(acetoxymethyl)-ester, a Ca²âº chelator, reduced the expression of all the IEGs to varying degrees, whereas treatment with thapsigargin, an intracellular Ca²âº protein pump inhibitor, increased the expression of the IEG. Furthermore, cyclosporin A, a calcineurin-specific inhibitor, reduced the ability of GnRH to regulate accumulation of Jun and Atf3 mRNA and to a lesser extent Fos. In contrast, Egr1 mRNA was unaffected. NFATs are transcription factors regulated by calcineurin and were detected in LßT2 cells. GnRH increased luciferase activity of an NFAT-dependent promoter reporter that was dependent on intracellular Ca²âº and calcineurin activity. Additionally, although small interfering RNA specific for Nfat4 only marginally reduced GnRH regulation of Jun, Fos, and Atf3 mRNA accumulation, activity of an activator protein-1-responsive reporter construct was reduced by 48%. Together these data suggest that calcineurin and NFAT are new members of the gonadotrope transcriptional network that confer hormonal responsiveness to several key genes required for gonadotropin synthesis and secretion.

Simultaneous mutation of methylated lysine residues in histone H3 causes enhanced gene silencing, cell cycle defects, and cell lethality in Saccharomyces cerevisiae.

The methylation of specific lysine residues in histone H3 is integral to transcription regulation; however, little is known about how combinations of methylated lysine residues act in concert to regulate genome-wide transcription. We have systematically mutated methylated histone lysine residues in yeast and found that the triple mutation of H3K4, H3K36, and H3K79 to arginine (H3 K4,36,79R) is lethal. The histone H3 K4,36,79R mutant causes a mitotic cell cycle delay and a progressive transcription defect that initiates in telomere regions and then spreads into the chromosome. This effect is mediated by the silent information regulator (SIR) silencing complex, as we observe increased binding of the SIR complex to genomic regions adjacent to yeast telomeres in the H3 K4,36,79R mutant and deletion of SIR2, SIR3, or SIR4 rescues the lethal phenotype. Curiously, a yeast strain in which the histone methyltransferase genes are simultaneously deleted is viable. Indeed, deletion of the histone methyltransferase genes can suppress the H3 K4,36,79R lethal phenotype. These and other data suggest that the cause of lethality may in part be due to the association of histone methyltransferase enzymes with a histone substrate that cannot be methylated.

Ctk complex-mediated regulation of histone methylation by COMPASS.

A comparative global proteomic screen identified factors required for COMPASS (complex of proteins associated with Set1)-mediated mono-, di-, and trimethylation of the fourth lysine of histone H3 (H3K4), which included components of a cyclin-dependent protein kinase (Ctk complex) that phosphorylates the C-terminal domain of the largest subunit of RNA polymerase II (Pol II). Our results indicate that histone H3K4 methylation levels are regulated by the Ctk1, Ctk2, and Ctk3 components of the Ctk complex. We show that loss of Ctk1 kinase activity results in reduced histone H3K4 monomethylation levels, followed by a global increase in histone H3K4 trimethylation levels on chromatin. Ctk1 loss does not appear to have a substantial effect on histone H2B monoubiquitination levels or COMPASS and Paf1 complex phosphorylation. Our chromatin immunoprecipitation studies demonstrate that histone H3 eviction during active transcription is decelerated in a CTK1 deletion strain in response to reduced levels of Pol II recruitment. Our in vitro studies show that the onset of monomethylation on an unmethylated histone H3 by COMPASS is virtually immediate, while the onset of trimethylation occurs upon extended time of association between the histone tail and COMPASS. Our study suggests a role for the Ctk complex in the regulation of the pattern of H3K4 mono-, di-, and trimethylation via COMPASS.