Management of Chronic Subdural Hematoma: A Systematic Review and Component Network Meta-analysis of 455 Studies With 103 645 Cases.

BACKGROUND: Chronic subdural hematoma (CSDH) is a common neurosurgical condition with a high risk of recurrence after treatment. OBJECTIVE: To assess and compare the risk of recurrence, morbidity, and mortality across various treatments for CSDH. METHODS: A systematic review and meta-analysis was performed. PubMed/MEDLINE, EMBASE, SCOPUS, and Web of Science were searched from January 01, 2000, to July 07, 2021. The primary outcome was recurrence, and secondary outcomes were morbidity and mortality. Component network meta-analyses (CNMAs) were performed for surgical and medical treatments, assessing recurrence and morbidity. Incremental risk ratios (iRRs) with 95% CIs were estimated for each component. RESULTS: In total, 12 526 citations were identified, and 455 studies with 103 645 cases were included. Recurrence occurred in 11 491/93 525 (10.8%, 95% CI 10.2-11.5, 418 studies) cases after surgery. The use of a postoperative drain (iRR 0.53, 95% CI 0.44-0.63) and middle meningeal artery embolization (iRR 0.19, 95% CI 0.05-0.83) reduced recurrence in the surgical CNMA. In the pharmacological CNMA, corticosteroids (iRR 0.47, 95% CI 0.36-0.61) and surgical intervention (iRR 0.11, 95% CI 0.07-0.15) were associated with lower risk. Corticosteroids were associated with increased morbidity (iRR 1.34, 95% CI 1.05-1.70). The risk of morbidity was equivalent across surgical treatments. CONCLUSION: Recurrence after evacuation occurs in approximately 10% of cSDHs, and the various surgical interventions are approximately equivalent. Corticosteroids are associated with reduced recurrence but also increased morbidity. Drains reduce the risk of recurrence, but the position of drain (subdural vs subgaleal) did not influence recurrence. Middle meningeal artery embolization is a promising treatment warranting further evaluation in randomized trials.

Investigating the Role of an Inquiry-Based Biology Lab Course on Student Attitudes and Views toward Science.

Students' academic experiences can influence their conceptualization of science. In contrast experts hold particular beliefs, perceptions, opinions, and attitudes about science that are often absent in first-year undergraduate students. Shifts toward more expert-like attitudes and views have been linked to improved student engagement, critical-thinking ability, conceptual understanding, and academic performance. In this study, we investigate shifts in attitudes and views toward science by students in four biology classes with differences in student enrollment, academic support, and instruction. We observe significant, positive effects of enrollment in a guided-inquiry lab course and academic performance on the percentage of expert-like student attitudes and views at the end of term. We also identify variation in two aspects of student attitudes and views: 1) confidence and interest and 2) understanding and acceptance. In particular, enrollment in the lab course boosts student confidence and interest in scientific inquiry in the short term, even for students with low academic performance or little English-language experience. Our results suggest that low-performing students in particular may require additional opportunities for experiential learning or greater academic support to develop expert-like perceptions of biology as a science.

Development of the Statistical Reasoning in Biology Concept Inventory (SRBCI).

We followed established best practices in concept inventory design and developed a 12-item inventory to assess student ability in statistical reasoning in biology (Statistical Reasoning in Biology Concept Inventory [SRBCI]). It is important to assess student thinking in this conceptual area, because it is a fundamental requirement of being statistically literate and associated skills are needed in almost all walks of life. Despite this, previous work shows that non-expert-like thinking in statistical reasoning is common, even after instruction. As science educators, our goal should be to move students along a novice-to-expert spectrum, which could be achieved with growing experience in statistical reasoning. We used item response theory analyses (the one-parameter Rasch model and associated analyses) to assess responses gathered from biology students in two populations at a large research university in Canada in order to test SRBCI's robustness and sensitivity in capturing useful data relating to the students' conceptual ability in statistical reasoning. Our analyses indicated that SRBCI is a unidimensional construct, with items that vary widely in difficulty and provide useful information about such student ability. SRBCI should be useful as a diagnostic tool in a variety of biology settings and as a means of measuring the success of teaching interventions designed to improve statistical reasoning skills.

Development of the Biological Experimental Design Concept Inventory (BEDCI).

Interest in student conception of experimentation inspired the development of a fully validated 14-question inventory on experimental design in biology (BEDCI) by following established best practices in concept inventory (CI) design. This CI can be used to diagnose specific examples of non-expert-like thinking in students and to evaluate the success of teaching strategies that target conceptual changes. We used BEDCI to diagnose non-expert-like student thinking in experimental design at the pre- and posttest stage in five courses (total n = 580 students) at a large research university in western Canada. Calculated difficulty and discrimination metrics indicated that BEDCI questions are able to effectively capture learning changes at the undergraduate level. A high correlation (r = 0.84) between responses by students in similar courses and at the same stage of their academic career, also suggests that the test is reliable. Students showed significant positive learning changes by the posttest stage, but some non-expert-like responses were widespread and persistent. BEDCI is a reliable and valid diagnostic tool that can be used in a variety of life sciences disciplines.