Learner-Adaptive Educational Technology for Simulation in Healthcare: Foundations and Opportunities.
Simul Healthc. 2018 Jan 17;:
Authors: Lineberry M, Dev P, Lane HC, Talbot TB
Despite evidence that learners vary greatly in their learning needs, practical constraints tend to favor "one-size-fits-all" educational approaches, in simulation-based education as elsewhere. Adaptive educational technologies - devices and/or software applications that capture and analyze relevant data about learners to select and present individually tailored learning stimuli - are a promising aid in learners' and educators' efforts to provide learning experiences that meet individual needs. In this article, we summarize and build upon the 2017 Society for Simulation in Healthcare Research Summit panel discussion on adaptive learning. First, we consider the role of adaptivity in learning broadly. We then outline the basic functions that adaptive learning technologies must implement and the unique affordances and challenges of technology-based approaches for those functions, sharing an illustrative example from healthcare simulation. Finally, we consider future directions for accelerating research, development, and deployment of effective adaptive educational technology and techniques in healthcare simulation.
PMID: 29346223 [PubMed - as supplied by publisher]
Habitable Worlds: Delivering on the Promises of Online Education.
Astrobiology. 2018 Jan;18(1):86-99
Authors: Horodyskyj LB, Mead C, Belinson Z, Buxner S, Semken S, Anbar AD
Critical thinking and scientific reasoning are central to higher education in the United States, but many courses (in-person and online) teach students information about science much more than they teach the actual process of science and its associated knowledge and skills. In the online arena specifically, the tools available for course construction exacerbate this problem by making it difficult to build the types of active learning activities that research shows to be the most effective. Here, we present a report on Habitable Worlds, offered by Arizona State University for 12 semesters over the past 6 years. This is a unique online course that uses an array of novel technologies to deliver an active, inquiry-driven learning experience. Learning outcomes and quantitative data from more than 3000 students demonstrate the success of our approach but also identify several remaining challenges. The design and development of this course offers valuable lessons for instructional designers and educators who are interested in fully capitalizing on the capabilities of 21st-century technology to achieve educational goals. Key Words: Online education-Active learning-SETI-Astrobiology-Teaching. Astrobiology 17, 86-99.
PMID: 29345987 [PubMed - in process]
The Impact of Quantitative Data Provided by a Multi-spectral Digital Skin Lesion Analysis Device on Dermatologists'Decisions to Biopsy Pigmented Lesions.
J Clin Aesthet Dermatol. 2017 Sep;10(9):24-26
Authors: Farberg AS, Winkelmann RR, Tucker N, White R, Rigel DS
BACKGROUND: Early diagnosis of melanoma is critical to survival. New technologies, such as a multi-spectral digital skin lesion analysis (MSDSLA) device [MelaFind, STRATA Skin Sciences, Horsham, Pennsylvania] may be useful to enhance clinician evaluation of concerning pigmented skin lesions. Previous studies evaluated the effect of only the binary output. OBJECTIVE: The objective of this study was to determine how decisions dermatologists make regarding pigmented lesion biopsies are impacted by providing both the underlying classifier score (CS) and associated probability risk provided by multi-spectral digital skin lesion analysis. This outcome was also compared against the improvement reported with the provision of only the binary output. METHODS: Dermatologists attending an educational conference evaluated 50 pigmented lesions (25 melanomas and 25 benign lesions). Participants were asked if they would biopsy the lesion based on clinical images, and were asked this question again after being shown multi-spectral digital skin lesion analysis data that included the probability graphs and classifier score. RESULTS: Data were analyzed from a total of 160 United States board-certified dermatologists. Biopsy sensitivity for melanoma improved from 76 percent following clinical evaluation to 92 percent after quantitative multi-spectral digital skin lesion analysis information was provided (p<0.0001). Specificity improved from 52 percent to 79 percent (p<0.0001). The positive predictive value increased from 61 percent to 81 percent (p<0.01) when the quantitative data were provided. Negative predictive value also increased (68% vs. 91%, p<0.01), and overall biopsy accuracy was greater with multi-spectral digital skin lesion analysis (64% vs. 86%, p<0.001). Interrater reliability improved (intraclass correlation 0.466 before, 0.559 after). CONCLUSION: Incorporating the classifier score and probability data into physician evaluation of pigmented lesions led to both increased sensitivity and specificity, thereby resulting in more accurate biopsy decisions.
PMID: 29344323 [PubMed]
Interstitial Glucose and Physical Exercise in Type 1 Diabetes: Integrative Physiology, Technology, and the Gap In-Between.
Nutrients. 2018 Jan 15;10(1):
Authors: Moser O, Yardley JE, Bracken RM
Continuous and flash glucose monitoring systems measure interstitial fluid glucose concentrations within a body compartment that is dramatically altered by posture and is responsive to the physiological and metabolic changes that enable exercise performance in individuals with type 1 diabetes. Body fluid redistribution within the interstitial compartment, alterations in interstitial fluid volume, changes in rate and direction of fluid flow between the vasculature, interstitium and lymphatics, as well as alterations in the rate of glucose production and uptake by exercising tissues, make for caution when interpreting device read-outs in a rapidly changing internal environment during acute exercise. We present an understanding of the physiological and metabolic changes taking place with acute exercise and detail the blood and interstitial glucose responses with different forms of exercise, namely sustained endurance, high-intensity, and strength exercises in individuals with type 1 diabetes. Further, we detail novel technical information on currently available patient devices. As more health services and insurance companies advocate their use, understanding continuous and flash glucose monitoring for its strengths and limitations may offer more confidence for patients aiming to manage glycemia around exercise.
PMID: 29342932 [PubMed - in process]
Understanding differences between summer vs. school obesogenic behaviors of children: the structured days hypothesis.
Int J Behav Nutr Phys Act. 2017 07 26;14(1):100
Authors: Brazendale K, Beets MW, Weaver RG, Pate RR, Turner-McGrievy GM, Kaczynski AT, Chandler JL, Bohnert A, von Hippel PT
BACKGROUND: Although the scientific community has acknowledged modest improvements can be made to weight status and obesogenic behaviors (i.e., physical activity, sedentary/screen time, diet, and sleep) during the school year, studies suggests improvements are erased as elementary-age children are released to summer vacation. Emerging evidence shows children return to school after summer vacation displaying accelerated weight gain compared to the weight gained occurring during the school year. Understanding how summer days differ from when children are in school is, therefore, essential.
DISCUSSION: There is limited evidence on the etiology of accelerated weight gain during summer, with few studies comparing obesogenic behaviors on the same children during school and summer. For many children, summer days may be analogous to weekend days throughout the school year. Weekend days are often limited in consistent and formal structure, and thus differ from school days where segmented, pre-planned, restrictive, and compulsory components exist that shape obesogenic behaviors. The authors hypothesize that obesogenic behaviors are beneficially regulated when children are exposed to a structured day (i.e., school weekday) compared to what commonly occurs during summer. This is referred to as the 'Structured Days Hypothesis' (SDH). To illustrate how the SDH operates, this study examines empirical data that compares weekend day (less-structured) versus weekday (structured) obesogenic behaviors in U.S. elementary school-aged children. From 190 studies, 155 (~80%) demonstrate elementary-aged children's obesogenic behaviors are more unfavorable during weekend days compared to weekdays.
CONCLUSION: In light of the SDH, consistent evidence demonstrates the structured environment of weekdays may help to protect children by regulating obesogenic behaviors, most likely through compulsory physical activity opportunities, restricting caloric intake, reducing screen time occasions, and regulating sleep schedules. Summer is emerging as the critical period where childhood obesity prevention efforts need to be focused. The SDH can help researchers understand the drivers of obesogenic behaviors during summer and lead to innovative intervention development.
PMID: 28747186 [PubMed - indexed for MEDLINE]
Should Degree Programs in Biomedical and Health Informatics be Dedicated or Integrated? : Reflections and Recommendations after more than 40 Years of Medical Informatics Education at TU Braunschweig, including 10 Years of B.Sc. and 15 Years of M.Sc. Integrated Degree Curricula.
J Med Syst. 2017 Jul;41(7):116
Authors: Haux R, Marschollek M, Wolf KH, Zeisberg U
Education in biomedical and health informatics (BMHI) has been established in many countries throughout the world. For degree programs in BMHI we can distinguish between those that are completely stand-alone or dedicated to the discipline vs. those that are integrated within another program. After running integrated degree medical informatics programs at TU Braunschweig for 10 years at the B.Sc. and for 15 years at the M.Sc level, we (1) report about this educational approach, (2) analyze recommendations on, implementations of, and experiences with degree educational programs in BMHI worldwide, (3) summarize our lessons learned with the integrated approach at TU Braunschweig, and (4) suggest an answer to the question, whether degree programs in biomedical and health informatics should be dedicated or integrated. According to our experience at TU Braunschweig and based on our analysis of publications, there is a clear dominance of dedicated degree programs in BMHI. The specialization in medical informatics within a computer science program, as offered at TU Braunschweig, may be a good way of implementing an integrated, informatics-based approach to medical informatics, in particular if a dual degree option can be chosen. The option of curricula leading to double degrees, i.e. in this case to two separate degrees in computer science and in medical informatics might, however, be a better solution.
PMID: 28647790 [PubMed - indexed for MEDLINE]
A research agenda for the European Association for Endoscopic Surgeons (EAES).
Surg Endosc. 2017 May;31(5):2042-2049
Authors: Francis N, Kazaryan AM, Pietrabissa A, Goitein D, Yiannakopoulou E, Agresta F, Khatkov I, Schulze S, Arulampalam T, Tomulescu V, Kim YW, Targarona EM, Zaninotto G
INTRODUCTION: The European Association of Endoscopic Surgeons (EAES) conducted this study aiming to identify the top research questions which are relevant to surgeons in Minimal Access Surgery (MAS). This is in order to promote and link research questions to the current clinical practice in MAS in Europe.
METHODS: Using a systematic methodology, (modified Delphi), the EAES members and leadership teams were surveyed to obtain consensus on the top research priorities in MAS. The responses were categorized and redistributed to the membership to rate the level of importance of each research question. The data were reported as the weighted average score with a scale from 1 (lowest agreement) to 5 (highest agreement).
RESULTS: In total, 324 of 2580 (12.5%) of the EAES members and the leaders responded to the survey and contributed to the final consensus. The ranked responses over the 80th percentile identified 39 research priorities with rating ranged from 4.22 to 3.67. The top five highest ranking research priorities in the EAES were centered on improving training in MAS, laparoscopic surgery for benign upper gastrointestinal conditions, integration of novel technology in OR, translational and basic science research in bariatric surgery and investigating the role of MAS in rectal cancer.
CONCLUSION: An EAES research agenda was developed using a systematic methodology and can be used to focus MAS research. This study was commissioned by the European Association for Endoscopic Surgery (EAES).
PMID: 28417229 [PubMed - indexed for MEDLINE]
New Generation of Three-Dimensional Tools to Learn Anatomy.
J Med Syst. 2017 May;41(5):88
Authors: Tabernero Rico RD, Juanes Méndez JA, Prats Galino A
We present a new generation tool based of interactive 3D models. This models are based on the radiological two-dimensional images by computed tomography imaging. Our article focuses on the anatomical region of the skull base. These new three-dimensional models offer a wide field of application in the learning, as they offer multiple visualization tools (rotation, scrolling, zoom…). In this way, understanding of the anatomical region is facilitated. A feature to be dismissed is that a professional workstation is not required to work with three-dimensional models, since a personal computer can be viewed and interacted with the models. Educational and clinical applications are also discussed.
PMID: 28405946 [PubMed - indexed for MEDLINE]
3D Digitization and Prototyping of the Skull for Practical Use in the Teaching of Human Anatomy.
J Med Syst. 2017 May;41(5):83
Authors: Lozano MTU, Haro FB, Diaz CM, Manzoor S, Ugidos GF, Mendez JAJ
The creation of new rapid prototyping techniques, low cost 3D printers as well as the creation of new software for these techniques have allowed the creation of 3D models of bones making their application possible in the field of teaching anatomy in the faculties of Health Sciences. The 3D model of cranium created in the present work, at full scale, present accurate reliefs and anatomical details that are easily identifiable by undergraduate students in their use for the study of human anatomy. In this article, the process of scanning the skull and the subsequent treatment of these images with specific software until the generation of 3D model using 3D printer has been reported.
PMID: 28386686 [PubMed - indexed for MEDLINE]
SAGE(S) advice: application of a standardized train the trainer model for faculty involved in a Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) hands-on course.
Surg Endosc. 2017 May;31(5):2017-2022
Authors: Wyles SM, Schwarz E, Dort J, Tariq N, Cecil T, Coleman MG, Paige J, Dunkin BJ
INTRODUCTION: Currently, no prerequisite teaching qualification is required to serve as faculty for SAGES hands-on courses (SAGES-HOC). The Lapco-Train-the-Trainers (Lapco-TT) is a course for surgical trainers, in which delegates learn a standardized teaching technique for skills acquisition. The aims of this study were to 1) determine if this curriculum could be delivered in a day course to SAGES-HOC faculty and 2) assess the impact of such training on learners' educational experience taught by this faculty at a subsequent SAGES-HOC.
METHODS AND PROCEDURES: Six experts attended a one-day Lapco-TT course. SAGES-HOC participants were split into two groups: Group A taught by Lapco-TT trained, and Group B by "untrained" course faculty. Opinion surveys were completed by both the SAGES-HOC learners and the Lapco-TT trained course faculty. Furthermore, the latter underwent self-, learner-, and observer-based evaluation using a previously validated teaching assessment tool (cSTTAR). Mean scores were reported and analyzed [Mann-Whitney U, t test (p < 0.05)].
RESULTS: All 6 Lapco-TT delegates found the course useful (5), and felt that it would influence the way they taught in the OR (4.83), that their course objectives were met (4.83), and that they would recommend the course to their colleagues (4.83). Of the SAGES-HOC participants, compared to Group B (n = 22), Group A learners(n = 10) better understood what they were supposed to learn (5 vs. 4.15 [p = 0.046]) and do (5 vs. 4 [p = 0.046]), felt that the session was well organized (5 vs. 4 [p = 0.046]), that time was used effectively (5 vs. 3.9 [p = 0.046]), and that performance feedback was sufficient (5 vs. 3.9 [p = 0.028]) and effective (5 vs. 3.95 [p = 0.028]). Group A faculty were rated significantly higher by their learners on the cSTTARs than Group B (p < 0.0005). Group A faculty rated themselves significantly lower than both expert observers (p < 0.0005) and compared to the Group B faculty's self-assessment (p < 0.002).
CONCLUSIONS: The Lapco-TT course can be delivered effectively over one day and impacts the educational experience of learners at a SAGES-HOC. This could help establish a standardized method of teaching at SAGES-HOCs and thereby increase their value for learners.
PMID: 28289974 [PubMed - indexed for MEDLINE]
Association Between Parent Television-Viewing Practices and Setting Rules to Limit the Television-Viewing Time of Their 8- to 12-Year-Old Children, Minnesota, 2011-2015.
Prev Chronic Dis. 2017 Jan 19;14:E06
Authors: Kubik MY, Gurvich OV, Fulkerson JA
INTRODUCTION: Television (TV) viewing is popular among adults and children, and child TV-viewing time is positively associated with parent TV-viewing time. Efforts to limit the TV-viewing time of children typically target parent rule-setting. However, little is known about the association between parent TV-viewing practices and rule-setting.
METHODS: We used baseline height and weight data and survey data collected from 2011 through 2015 on parents and their 8- to 12-year-old children (N = 212 parent/child dyads) who were participants in 2 community-based obesity prevention intervention trials conducted in metropolitan Minnesota. Multivariable binary logistic regression analysis was used to assess the association between parent TV-viewing time on weekdays or weekend days (dichotomized as ≤2 hrs/d vs ≥2.5 hrs/d) and parent rules limiting child TV-viewing time.
RESULTS: Child mean age was 10 (standard deviation [SD], 1.4) years, mean body mass index (BMI) percentile was 81 (SD, 16.7), approximately half of the sample were boys, and 42% of the sample was nonwhite. Parent mean age was 41 (SD, 7.5) years, and mean BMI was 29 (SD, 7.5); most of the sample was female, and 36% of the sample was nonwhite. Parents who limited their TV-viewing time on weekend days to 2 hours or fewer per day were almost 3 times more likely to report setting rules limiting child TV-viewing time than were parents who watched 2.5 hours or more per day (P = .01). A similar association was not seen for parent weekday TV-viewing time.
CONCLUSION: For most adults and children, a meaningful decrease in sedentariness will require reductions in TV-viewing time. Family-based interventions to reduce TV-viewing time that target the TV-viewing practices of both children and parents are needed.
PMID: 28103183 [PubMed - indexed for MEDLINE]
RE-DO STATIONS AFTER HIGH-FIDELITY SIMULATION DEBRIEF IN NURSING EDUCATION.
Aust Nurs Midwifery J. 2016 10;24(4):34
Authors: Sivertsen N, McNeill L
While use of simulation in nursing education is both complex and well established, learning by re-doing is a scaffolded learning strategy neglected in simulation and minimal research has been conducted with it.
PMID: 29249090 [PubMed - indexed for MEDLINE]
How obesity relates to socio-economic status: identification of eating behavior mediators.
Int J Obes (Lond). 2016 Nov;40(11):1794-1801
Authors: Pigeyre M, Rousseaux J, Trouiller P, Dumont J, Goumidi L, Bonte D, Dumont MP, Chmielewski A, Duhamel A, Amouyel P, Dallongeville J, Romon M, Meirhaeghe A
BACKGROUND: Socio-economic status (SES) is a strong determinant of eating behavior and the obesity risk.
OBJECTIVE: To determine which eating and lifestyle behaviors mediate the association between SES and obesity.
METHODS: We performed a case-control study of 318 obese people and 371 non-obese people in northern France. Ten eating behavior traits were assessed using the Three-Factor Eating Questionnaire Revised 21-Item and an eating attitude questionnaire (on plate size, the number of servings, reasons for stopping eating and the frequency of eating standing up, eating in front of the television set (TV) and eating at night). The SES score (in three categories) was based on occupation, education and income categories. Mediation analysis was performed using the test of joint significance and the difference of coefficients test.
RESULTS: The age- and gender-adjusted obesity risk was higher for individuals in the low-SES groups (odds ratio (OR) (95% confidence interval (CI)=1.82 (1.48-2.24), P<0.0001). Additional servings were associated with a higher obesity risk (OR=3.43, P<0.0001). Cognitive restraint (P<0.0001) and emotional eating (P<0.0001) scores were higher in obese participants than in non-obese participants but did not depend on SES. Of the 10 potential factors tested, eating off a large plate (P=0.01), eating at night (P=0.04) and uncontrolled eating (P=0.03) significantly mediated the relationship between SES and obesity.
CONCLUSION: Our results highlighted a number of obesogenic behaviors among socially disadvantaged participants: large plate size, uncontrolled eating and eating at night were significant mediators of the relationship between SES and the obesity risk.
PMID: 27377952 [PubMed - indexed for MEDLINE]
Sleep Duration and Media Time Have a Major Impact on Insulin Resistance and Metabolic Risk Factors in Obese Children and Adolescents.
Child Obes. 2016 Aug;12(4):272-8
Authors: Sayin FK, Buyukinan M
BACKGROUND: Lifestyle factors sleep duration and media time during childhood differ between countries. This study examined whether sleep duration and media time affect metabolic risk factors insulin resistance (IR), blood lipid profile, and liver enzymes, and whether there is a relationship between sleep time and media time in Turkish obese children and adolescents.
METHODS: Subjects included 108 obese children and adolescents (aged 10-15 years) whose lifestyle factors were assessed using a survey containing questions about sleep durations, television viewing, media use, and demographic factors. Metabolic risk factors were compared among groups categorized according to sleep and media duration.
RESULTS: Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and triglyceride (TG) levels and homeostasis model assessment of insulin resistance (HOMA-IR) values were higher in subjects who spent >5 hours/day on media. Children 10-13 years old who slept <9 hours/day were more likely to have higher insulin and HOMA-IR (p < 0.05) levels and lower high-density lipoprotein cholesterol (HDL-C) levels compared with subjects who slept 9-10 hours/day and >10 hours/day. Correlation analysis revealed a negative relationship between sleep time and media time (r = -0.471, p = 0.000).
CONCLUSIONS: Short sleep duration was associated with IR and an elevated plasma lipoprotein profile in children and adolescents. Our results suggest that insufficient sleep and excessive media exposure may contribute to metabolic risk in the context of obesity, and therefore, working to improve sleep duration and limit media time could help reduce metabolic risk in obese children and adolescents.
PMID: 26978730 [PubMed - indexed for MEDLINE]
Screen time exposure and reporting of headaches in young adults: A cross-sectional study.
Cephalalgia. 2016 Oct;36(11):1020-1027
Authors: Montagni I, Guichard E, Carpenet C, Tzourio C, Kurth T
Objective The objective of this article is to investigate whether excessive screen time exposure is associated with non-migraine headache and migraine in young adults. Background Increased levels of television time have been associated with increased risk of headache. However, time spent using newer electronic devices with a screen (smartphone, tablet) has not been examined yet. Methods We conducted a cross-sectional study among 4927 participants of the French i-Share cohort. Demographic characteristics, screen time exposure (computers, tablets, smartphones and television) as well as headache/migraine symptoms were recorded in a standardized questionnaire. Multinomial logistic regression models were used to evaluate the association between screen time exposure and headache status. Results Participants had a mean age of 20.8 years and 75.5% were female. The multivariable model showed that students in the highest screen time exposure quintile had an increased risk for migraine. The odds ratio (OR) (95% confidence interval (CI)) was 1.37 (1.14 to 1.66) for migraine when compared with students without headache and with low screen time exposure. This association was somewhat stronger for migraine without aura (OR = 1.50, 95% CI 1.19 to 1.89). We found no significant association between screen time exposure and non-migraine headache. Conclusion High levels of screen time exposure are associated with migraine in young adults. No significant association was found with non-migraine headache.
PMID: 26634831 [PubMed - indexed for MEDLINE]
Subgingival instrumentation to remove simulated plaque in vitro: influence of operators' experience and type of instrument.
Clin Oral Investig. 2015 Jun;19(5):987-95
Authors: Graetz C, Schwendicke F, Plaumann A, Rauschenbach S, Springer C, Kahl M, Sälzer S, Dörfer CE
BACKGROUND: There is uncertainty regarding the benefits and risks of hand versus powered root surface instrumentation. Moreover, the influence of operators' experience on treatment results is unclear. We compared newly developed sonic, ultrasonic and hand instruments, hypothesizing that powered devices allow to remove more simulated plaque in less time than hand instruments, with significant influence of operators' experience.
METHODS: Sonic scaler (AIR), ultrasonic scaler (TIG) device and double Gracey curettes (GRA) were utilized by seven experienced operators (EOs) and four less experienced operators (LOs) in periodontitis manikin heads. The time required for treatment, the proportion of residual-simulated plaque and the weight loss caused by scaling as a proxy for root surface destruction were measured.
RESULTS: Using different instruments led to significantly different proportions of removed simulated plaque regardless of operators' experience (AIR, 80.2 ± 21.3 %, TIG, 69.9 ± 22.5 %, GRA, 73.1 ± 20.0 %) (p < 0.001). Treatment times did not significantly differ between EO and LO (p > 0.05). Weight loss was increased when using hand instead of powered instruments (p < 0.001), with significantly higher weight loss induced by LO than EO (p = 0.004).
CONCLUSION: Within the present study, EO did not remove more simulated plaque in less time but induced less root surface destruction. Using a sonic device was most beneficial for plaque removal.
CLINICAL RELEVANCE: Successful root surface debridement requires both time and training regardless of the used instrument. Hand instruments might cause more damage to root surfaces, especially in the hands of less experienced operators.
PMID: 25231069 [PubMed - indexed for MEDLINE]