Asynchronous lecture participation negatively predicts exam scores for females and students of color in an introductory physiology course during COVID-19.

In response to COVID-19, educators rapidly pivoted to new and innovative ways of delivering lecture material. The ability to host synchronous lectures on platforms like Zoom gave students continued access to classroom material in the face of an ongoing pandemic. The purpose of this study was to investigate the differences in exam scores between students attending a physiology class (PHSL3051) synchronously via Zoom or asynchronously by viewing recorded lectures posted after class. Students in PHSL3051 were evaluated with four unit exams and one cumulative final exam. Although pooled analysis of all students showed that synchronous lecture viewing positively predicted exam scores, this positive association was even larger when the data were analyzed by gender and ethnicity. For female-identified students and students of color (SOC), attending lectures synchronously was associated with average scores on every unit exam that were higher by 2.7-7.4 percentage points. Moreover, the greater a student's synchronous participation in the course throughout the semester, the better that student's performance on the cumulative final exam was likely to be. These data highlight the need to better understand how different groups of undergraduate students select and respond to different assessment methods used in the same course, which may have long-term effects on their overall performance at 4-year institutions.NEW & NOTEWORTHY This study examined the relationship between lecture attendance (synchronous or asynchronous) and exam scores throughout the semester. Although everyone in the course benefited from synchronous lecture attendance, our data indicated that students of color (SOC) and female-identified students benefited most. SOC and female-identified students who participated synchronously had even higher mean scores on all exams within the course compared with SOC and female-identified students who participated asynchronously by watching recordings of the same lectures.

Protocol for the Brain Health Support Program Study of the Canadian Therapeutic Platform Trial for Multidomain Interventions to Prevent Dementia (CAN-THUMBS UP): A Prospective 12-Month Intervention Study.

BACKGROUND/OBJECTIVES: CAN-THUMBS UP is designed as a comprehensive and innovative fully remote program to 1) develop an interactive and compelling online Brain Health Support Program intervention, with potential to positively influence dementia literacy, self-efficacy and lifestyle risk factors; 2) enroll and retain a community-dwelling Platform Trial Cohort of individuals at risk of dementia who will participate in the intervention; 3) support an open platform trial to test a variety of multidomain interventions that might further benefit individuals at risk of dementia. This manuscript presents the Brain Health Support Program Study protocol. DESIGN/SETTING: Twelve-month prospective multi-center longitudinal study to evaluate a fully remote web-based educational intervention. Participants will subsequently be part of a Platform Trial Cohort and may be eligible to participate in further dementia prevention clinical trials. PARTICIPANTS: Three hundred fifty older adults who are cognitively unimpaired or have mild cognitive impairment, with at least 1 well established dementia risk factor. INTERVENTION: Participants engage in the Brain Health Support Program intervention for 45-weeks and complete pre/post intervention measures. This intervention is designed to convey best available evidence for dementia prevention, consists of 181 chapters within 8 modules that are progressively delivered, and is available online in English and French. The program has been developed as a collaborative effort by investigators with recognized expertise in the program's content areas, along with input from older-adult citizen advisors. MEASUREMENTS: This study utilizes adapted remote assessments with accessible technologies (e.g. videoconferencing, cognitive testing via computer and mobile phone, wearable devices to track physical activity and sleep, self-administered saliva sample collection). The primary outcome is change in dementia literacy, as measured by the Alzheimer's Disease Knowledge Scale. Secondary outcomes include change in self-efficacy; engagement using the online program; user satisfaction ratings; and evaluation of usability and acceptance. Exploratory outcomes include changes in attitudes toward dementia, modifiable risk factors, performance on the Neuropsychological Test Battery, performance on self-administered online cognitive assessments, and levels of physical activity and sleep; success of the national recruitment plan; and the distribution of age adjusted polygenic hazard scores. CONCLUSIONS: This fully remote study provides an accessible approach to research with all study activities being completed in the participants' home environment. This approach may reduce barriers to participation, provide an easier and less demanding participant experience, and reach a broader geography with recruitment from all regions of Canada. CAN-THUMBS UP represents a Canadian contribution to the global World-Wide FINGERS program (alz.org/wwfingers).

Community trial evaluating the integration of Indigenous healing practices and a harm reduction approach with principles of seeking safety in an Indigenous residential treatment program in northern Ontario.

OBJECTIVE: Our primary objective was to evaluate how the Indigenous Healing and Seeking Safety (IHSS) model impacted residential addiction treatment program completion rates. Our secondary objective was to evaluate health service use 6 months before and 6 months after residential treatment for clients who attended the program before and after implementing IHSS. METHODS: We observed clients of the Benbowopka Residential Treatment before IHSS implementation (from April 2013 to March 31, 2016) and after IHSS implementation (from January 1, 2018 - March 31, 2020). The program data were linked to health administration data, including the Ontario Health Insurance Plan (OHIP) physician billing, the Registered Persons Database (RPDB), the National Ambulatory Care Reporting System (NACRS), and the Discharge Abstract Database (DAD). Chi-square tests were used to compare patient characteristics in the no-IHSS and IHSS groups. We used logistic regression to estimate the association between IHSS and treatment completion. We used generalized estimating equation (GEE) regression model to evaluate health service use (including primary care visits, ED visits overall and for substance use, hospitalizations and mental health visits), Results: There were 266 patients in the no-IHSS group and 136 in the IHSS group. After adjusting for individual characteristics, we observed that IHSS was associated with increased program completion rates (odds ratio = 1.95, 95% CI 1.02-3.70). There was no significant association between IHSS patients' health service use at time one or time two. Primary care visits time 1: aOR 0.55, 95%CI 0.72-1.13, time 2: aOR 1.13, 95%CI 0.79-1.23; ED visits overall time 1: aOR 0.91, 95%CI 0.67-1.23, time 2: aOR 1.06, 95%CI 0.75-1.50; ED visits for substance use time 1: aOR 0.81, 95%CI 0.47-1.39, time 2: aOR 0.79, 95%CI 0.37-1.54; Hospitalizations time 1: aOR 0.78, 95%CI 0.41-1.47, time 2: aOR 0.76, 95%CI 0.32-1.80; Mental health visits time 1: aOR 0.66, 95%CI 0.46-0.96, time 2: aOR 0.92 95%CI 0.7-1.40. CONCLUSIONS: Our results indicate that IHSS positively influenced program completion but had no significant effect on health service use. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov (identifier number NCT04604574). First registration 10/27/2020.

The Tyranny of Content: "Content Coverage" as a Barrier to Evidence-Based Teaching Approaches and Ways to Overcome It.

Instructors have inherited a model for conscientious instruction that suggests they must cover all the material outlined in their syllabus, and yet this model frequently diverts time away from allowing students to engage meaningfully with the content during class. We outline the historical forces that may have conditioned this teacher-centered model as well as the disciplinary pressures that inadvertently reward it. As a way to guide course revision and move to a learner-centered teaching approach, we propose three evidence-based strategies that instructors can adopt: 1) identify the core concepts and competencies for your course; 2) create an organizing framework for the core concepts and competencies; and 3) teach students how to learn in your discipline. We further outline examples of actions that instructors can incorporate to implement each of these strategies. We propose that moving from a content-coverage approach to these learner-centered strategies will help students better learn and retain information and apply it to new situations.

Design and Assessment of Online, Interactive Tutorials That Teach Science Process Skills.

Explicit emphasis on teaching science process skills leads to both gains in the skills themselves and, strikingly, deeper understanding of content. Here, we created and tested a series of online, interactive tutorials with the goal of helping undergraduate students develop science process skills. We designed the tutorials in accordance with evidence-based multimedia design principles and student feedback from usability testing. We then tested the efficacy of the tutorials in an introductory undergraduate biology class. On the basis of a multivariate ordinary least-squares regression model, students who received the tutorials are predicted to score 0.82 points higher on a 15-point science process skill assessment than their peers who received traditional textbook instruction on the same topic. This moderate but significant impact indicates that well-designed online tutorials can be more effective than traditional ways of teaching science process skills to undergraduate students. We also found trends that suggest the tutorials are especially effective for nonnative English-speaking students. However, due to a limited sample size, we were unable to confirm that these trends occurred due to more than just variation in the student group sampled.

Improving Critical Thinking Using a Web-Based Tutorial Environment.

With a broad range of subject matter, students often struggle recognizing relationships between content in different subject areas. A scenario-based learning environment (SaBLE) has been developed to enhancing clinical reasoning and critical thinking among undergraduate students in a medical laboratory science program and help them integrate their new knowledge. SaBLE incorporates aspects of both cognitive theory and instructional design, including reduction of extraneous cognitive load, goal-based learning, feedback timing, and game theory. SaBLE is a website application that runs in most browsers and devices, and is used to develop randomly selected scenarios that challenge user thinking in almost any scenario-based instruction. User progress is recorded to allow comprehensive data analysis of changes in user performance. Participation is incentivized using a point system and digital badges or awards. SaBLE was deployed in one course with a total exposure for the treatment group of approximately 9 weeks. When assessing performance of SaBLE participants, and controlling for grade point average as a possible confounding variable, there was a statistically significant correlation between the number of SaBLE levels completed and performance on selected critical-thinking exam questions addressing unrelated content.

The accuracy of timed maximum local anaesthetic dose calculations with an electronic calculator, nomogram, and pen and paper.

Forty anaesthetists calculated maximum permissible doses of eight local anaesthetic formulations for simulated patients three times with three methods: an electronic calculator; nomogram; and pen and paper. Correct dose calculations with the nomogram (85/120) were more frequent than with the calculator (71/120) or pen and paper (57/120), Bayes Factor 4 and 287, p = 0.01 and p = 0.0003, respectively. The rates of calculations at least 120% the recommended dose with each method were different, Bayes Factor 7.9, p = 0.0007: 14/120 with the calculator; 5/120 with the nomogram; 13/120 with pen and paper. The median (IQR [range]) speed of calculation with pen and paper, 38.0 (25.0-56.3 [5-142]) s, was slower than with the calculator, 24.5 (17.8-37.5 [6-204]) s, p = 0.0001, or nomogram, 23.0 (18.0-29.0 [4-100]) s, p = 1 × 10-7 . Local anaesthetic dose calculations with the nomogram were more accurate than with an electronic calculator or pen and paper and were faster than with pen and paper.

A nomogram to calculate the maximum dose of local anaesthetic in a paediatric dental setting.

While local anaesthetic agents are usually safe and are used ubiquitously, inadvertent overdoses may have potentially fatal consequences. Errors in the dosing of local anaesthetics frequently occur due to inherent difficulties in remembering the toxic dosage limits, difficulties in performing the appropriate calculations correctly, and errors in estimating patient weight. We have developed a simple graphical calculation aid (nomogram) to overcome these problems and facilitate rapid cross-checking of the maximum safe dose for a variety of local anaesthetic agents in common use. Standard mathematical techniques were used to draft the nomogram. A randomised blinded study using simulated patient data and Bland-Altman analysis was used to assess the accuracy and precision of the nomogram. The nomogram was found to have a bias of 0.0 ml, with limits of agreement -0.05-0.04 ml. It was found to be easy to use and suitably accurate for clinical use.

An aid to drug dosing safety in obese children: development of a new nomogram and comparison with existing methods for estimation of ideal body weight and lean body mass.

The risk of accidental over-dosing of obese children poses challenges to anaesthetists during dose calculations for drugs with serious side-effects, such as analgesics. For many drugs, dosing scalars such as ideal body weight and lean body mass are recommended instead of total body weight during weight-based dose calculations. However, the complex current methods of obtaining these dosing scalars are impractical in the peri-operative setting. Arbitrary dose adjustments and guesswork are, unfortunately, tempting solutions for the time-pressured anaesthetist. The study's aim was to develop and validate an accurate, convenient alternative. A nomogram was created and its performance compared with the standard calculation method by volunteers using measurements from 108 obese children. The nomogram was as accurate (bias 0.12 kg vs -0.41 kg, respectively, p = 0.4), faster (mean (SD) time taken 2.8 (1.0) min (vs 3.3 (0.9) min respectively, p = 0.003) and less likely to result in mistakes (significant errors 3% vs 19%, respectively, p = 0.001). We present a system that simplifies estimation of ideal body weight and lean body mass in obese children, providing foundations for safer drug dose calculation.

A nomogram for calculation of the Revised Baux Score.

Since its original publication, the revised Baux score for mortality prediction in burns patients has been widely adopted. It uses readily available measures, and it is based on regression analysis from actual data rather than a theoretical model. However, the necessary calculations are too complex to perform with anything other than a scientific calculator or dedicated software, which may create issues in a clinical setting where access to electronic devices may be limited. We designed a nomogram capable of performing the calculation to a high degree of accuracy, and evaluated its performance on a set of randomly generated patient data to ensure that the nomogram gives accurate and repeatable results. The nomogram has a bias of -0.003 percentage points, with limits of agreement -0.3619 to 0.3550 and a repeatability coefficient of 0.29 percentage points. We feel that the nomogram's accuracy, low cost, speed and ease of use would make it a very useful adjunct during the initial assessment of burns patients. It could also realistically be used to crosscheck calculations made by other methods.

A nomogram for calculating the maximum dose of local anaesthetic.

Toxic dose limits (mg.kg(-1)) for local anaesthetics based on body weight are well-established, but calculation of the maximum safe volume (ml) of a given agent and formulation is complex, and frequently results in errors. We therefore developed a nomogram to perform this calculation. We compared the performance of the nomogram with a spreadsheet and a general purpose calculator using simulated clinical data. Bland-Altman analysis showed close agreement between the nomogram and spreadsheet, with bias of -0.07 ml and limits of agreement of -0.38 to +0.24 ml (correlation coefficient r(2) = 0.9980; p < 0.001). The nomogram produced fewer and smaller errors compared with the calculator. Our nomogram calculates the maximum safe volume (ml) of local anaesthetic to a clinically acceptable degree of accuracy. It facilitates rapid cross-checking of dosage calculations performed by electronic or other means at negligible cost, and can potentially reduce the incidence of local anaesthetic toxicity.

A nomogram to calculate the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM).

BACKGROUND: The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) is a well validated model for the prediction of perioperative mortality and morbidity with application to surgery and intensive care medicine. The outcome measure calculations are time-consuming, complex and potentially error-prone. Nomograms are low-cost easy-to-use graphic devices that can be used to make repeated calculations to an acceptable level of accuracy for most clinical purposes. This paper describes a nomogram to aid calculation of POSSUM scores. METHODS: This graphic solution consists of two sections: a tally sheet to calculate physiological and operative severity scores (PS and OS), and a nomogram to calculate mortality and morbidity. The latter was designed using standard mathematical methods, and drafted with the aid of commercially available software. Accuracy was confirmed by using a spreadsheet to generate 120 random sets of simulated values for PS and OS, and corresponding calculated values for predicted mortality and morbidity. The outcome values in each case were derived using the nomogram and compared with the spreadsheet values using Bland-Altman analysis. RESULTS: Bland-Altman analysis showed close agreement between nomogram and spreadsheet. Bias of the nomogram was -0·1 percentage points for mortality and 0·1 percentage points for morbidity, with limits of agreement of -2·1 to +1·9 and -1·4 to +1·6 percentage points for mortality and morbidity respectively. Correlation coefficients were r > 0·999 and P < 0·001 for both mortality and morbidity. CONCLUSION: The nomogram provides a rapid, accurate, low-cost means of performing, visualizing and cross-checking POSSUM calculations.

A delicate balance: integrating active learning into a large lecture course.

A lecture section of introductory biology that historically enrolled more than 500 students was split into two smaller sections of approximately 250 students each. A traditional lecture format was followed in the "traditional" section; lecture time in the "active" section was drastically reduced in favor of a variety of in-class student-centered activities. Students in both sections took unannounced quizzes and multiple-choice exams. Evaluation consisted of comparisons of student survey responses, scores on standardized teaching evaluation forms, section averages and attendance, and open-ended student comments on end-of-term surveys. Results demonstrate that students perform as well, if not better, in an active versus traditional environment. However, student concerns about instructor expectations indicate that a judicious balance of student-centered activities and presentation-style instruction may be the best approach.

Genetic association analyses of non-synonymous single nucleotide polymorphisms in diabetic nephropathy.

AIMS/HYPOTHESIS: Diabetic nephropathy, characterised by persistent proteinuria, hypertension and progressive kidney failure, affects a subset of susceptible individuals with diabetes. It is also a leading cause of end-stage renal disease (ESRD). Non-synonymous (ns) single nucleotide polymorphisms (SNPs) have been reported to contribute to genetic susceptibility in both monogenic disorders and common complex diseases. The objective of this study was to investigate whether nsSNPs are involved in susceptibility to diabetic nephropathy using a case-control design. METHODS: White type 1 diabetic patients with (cases) and without (controls) nephropathy from eight centres in the UK and Ireland were genotyped for a selected subset of nsSNPs using Illumina's GoldenGate BeadArray assay. A chi (2) test for trend, stratified by centre, was used to assess differences in genotype distribution between cases and controls. Genomic control was used to adjust for possible inflation of test statistics, and the False Discovery Rate method was used to account for multiple testing. RESULTS: We assessed 1,111 nsSNPs for association with diabetic nephropathy in 1,711 individuals with type 1 diabetes (894 cases, 817 controls). A number of SNPs demonstrated a significant difference in genotype distribution between groups before but not after correction for multiple testing. Furthermore, neither subgroup analysis (diabetic nephropathy with ESRD or diabetic nephropathy without ESRD) nor stratification by duration of diabetes revealed any significant differences between groups. CONCLUSIONS/INTERPRETATION: The nsSNPs investigated in this study do not appear to contribute significantly to the development of diabetic nephropathy in patients with type 1 diabetes.