"Nursing students' experiences with concept cartoons as an active learning strategy for developing conceptual understanding in anatomy and physiology: A mixed-method study".

AIM: The aim of this study was to explore bachelor-level nursing students' experiences with concept cartoons as an active learning strategy and formative assessment to develop conceptual understanding in anatomy and physiology (A&P). BACKGROUND: Many first-year nursing students struggle to understand central concepts in A&P. Concept cartoons-cartoon characters proposing scientifically acceptable statements and misconceptions combined with an illustration-might facilitate active learning in lectures, overcome misconceptions and promote deep learning. Voting on the most precise statement using a student response system gives formative information about the students' conceptual understanding. DESIGN: Parallel mixed methods design with an emphasis on a qualitative approach. METHODS: Nine concept cartoons were developed based on former students' written answers to exam items and applied in lectures at three universities/university colleges. Qualitative data of students' experiences were collected in three focus group interviews during November 2019, one focus group at each of the three universities/university colleges (n = 5, 8 and 8). A short questionnaire was also applied (n = 343) to all students at the three universities/university colleges. Qualitative data were analysed using qualitative content analyses, whereas frequency analysis and Chi-square statistics were applied for the quantitative data. The study was approved by the Norwegian Centre for Research Data, ref. 779586. RESULTS: Qualitative data analysis indicated that the use of concept cartoons addresses different learning styles and could promote deep learning and enhance the environment for learning. The concept cartoons were also seen as valuable for examination preparation. Regarding potential improvements, more information about concept cartoons, how they were developed and how they were supposed to be used would be beneficial, and the cartoons could be used in a more time-efficient manner during lectures. Quantitative data indicated that most of the students thought that concept cartoons were useful and inspiring in learning A&P, and they would recommend further use to increase their understanding of central concepts. There were no significant differences across sex, age, or entrance qualifications when it comes to the benefits of using concept cartoons in learning A&P. Compared to students born in Scandinavia, a larger proportion of students born outside Scandinavia found the use of concept cartoons inspiring for their learning in A&P. CONCLUSIONS: The use of concept cartoons was appreciated by the students to develop a conceptual understanding in A&P. Most students recommended future use. REGISTRATION NUMBER: At point of submission put this on title page Tweetable abstract: Concept cartoons are appreciated as an active learning strategy and formative assessment in developing nursing students' conceptual understanding of anatomy and physiology.

Impact of Initial Emotional States and Self-Efficacy Changes on Nursing Students' Practical Skills Performance in Simulation-Based Education.

Training through simulation has shown to increase relevant and specific skills sets across a wide range of areas in nursing and related professions. Increasing skills has a reciprocal relation to the development of self-efficacy. A study was conducted to assess changes in the development of self-efficacy in simulation training for 2nd year nursing students. Initial emotional states, pre and post self-efficacy, and expert ratings of simulation performance were assessed. Results show that students who displayed an increase in self-efficacy as a result of simulation training were also judged to perform better by expert ratings. The effect of simulation on self-efficacy could be influenced by initial states of physiological activation and over control. Results also showed that initial emotional states did not moderate self-efficacy development on outcome measures. These findings improve our understanding on the relationship between students' self-efficacy and performance of practical skills and inform pedagogical designs and targeted interventions in relation to feedback and supervision in nursing education.

A blended learning teaching strategy strengthens the nursing students' performance and self-reported learning outcome achievement in an anatomy, physiology and biochemistry course - A quasi-experimental study.

In nursing, bioscience is regarded as one of the cornerstones of nursing practice. However, bioscience disciplines as anatomy, physiology and biochemistry are considered challenging for students and the failure rate is high. In this study we explore a blended learning teaching strategy in an anatomy, physiology and biochemistry course for first year Bachelor nursing students. In the blended learning teaching strategy, short narrated online digital resources of bioscientific terms and concepts were integrated into the teaching design along with digital metacognitive evaluations of learning outcomes. Results show that compared to students receiving traditional face-to-face teaching, the students with a blended learning approach performed better on their national exam with a small to medium effect size (Cohen's d=0.23). Student course evaluations supported the blended learning delivery with small to medium effect sizes. The students reported that the digital resources supported their learning outcome achievement, that they better understood the teacher's expectations and that they were more satisfied with their virtual learning environment. This study adds to the growing literature of blended learning effectiveness in higher education, and suggests the use of digital resources as an enrichment of teaching and enhancement of students' study experience.

Long extensions with varicosity-like structures in gonadotrope Lh cells facilitate clustering in medaka pituitary culture.

Accumulating evidence indicates that some pituitary cell types are organized in complex networks in both mammals and fish. In this study, we have further investigated the previously described cellular extensions formed by the medaka (Oryzias latipes) luteinizing hormone gonadotropes (Lh cells). Extensions, several cell diameters long, with varicosity-like swellings, were common both in vitro and in vivo. Some extensions approached other Lh cells, while others were in close contact with blood vessels in vivo. Gnrh further stimulated extension development in vitro. Two types of extensions with different characteristics could be distinguished, and were classified as major or minor according to size, origin and cytoskeleton protein dependance. The varicosity-like swellings appeared on the major extensions and were dependent on both microtubules and actin filaments. Immunofluorescence revealed that Lhß protein was mainly located in these swellings and at the extremity of the extensions. We then investigated whether these extensions contribute to network formation and clustering, by following their development in primary cultures. During the first two days in culture, the Lh cells grew long extensions that with time physically attached to other cells. Successively, tight cell clusters formed as cell somas that were connected via extensions migrated towards each other, while shortening their extensions. Laser photolysis of caged Ca2+ showed that Ca2+ signals originating in the soma propagated from the soma along the major extensions, being particularly visible in each swelling. Moreover, the Ca2+ signal could be transferred between densely clustered cells (sharing soma-soma border), but was not transferred via extensions to the connected cell. In summary, Lh gonadotropes in medaka display a complex cellular structure of hormone-containing extensions that are sensitive to Gnrh, and may be used for clustering and possibly hormone release, but do not seem to contribute to communication between cells themselves.

Cytokine and Gene Expression Profiling in Patients with HFE-Associated Hereditary Hemochromatosis according to Genetic Profile.

BACKGROUND: Hemochromatosis gene (HFE)-associated hereditary hemochromatosis (HH) is characterized by downregulation of hepcidin synthesis, leading to increased intestinal iron absorption. OBJECTIVES: The objectives were to characterize and elucidate a possible association between gene expression profile, hepcidin levels, disease severity, and markers of inflammation in HFE-associated HH patients. METHODS: Thirty-nine HFE-associated HH patients were recruited and assigned to 2 groups according to genetic profile: C282Y homozygotes in 1 group and patients with H63D, as homozygote or in combination with C282Y, in the other group. Eleven healthy first-time blood donors were recruited as controls. Gene expression was characterized from peripheral blood cells, and inflammatory cytokines and hepcidin-25 isoform were quantified in serum. Biochemical disease characteristics were recorded. RESULTS: Elevated levels of interleukin 8 were observed in a significant higher proportion of patients than controls. In addition, compared to controls, gene expression of ζ-globin was significantly increased among C282Y homozygote patients, while gene expression of matrix metalloproteinase 8, and other neutrophil-secreted proteins, was significantly upregulated in patients with H63D. CONCLUSION: Different disease signatures may characterize HH patients according to their HFE genetic profile. Studies on larger populations, including analyses at protein level, are necessary to confirm these findings.