Essential Readings in Problem-Based Learning: Exploring and Extending the Legacy of Howard S. Barrows

Essential Readings in Problem-Based Learning represents an ambitious goal to include influential articles and chapters regarding the theories and research central to ill-structured problem solving. The book is unique because it goes beyond being a traditional handbook of research by also including previously written articles germane to foundations of problem- based learning (PBL). In doing so, the chapters provide an overview of the current debates in light of established writings. Collectively, the book serves as a great resource by synthesizing various articles relevant to learning theories, practical instructional strategies, and research

Using Analytics to Transform a Problem-Based Case Library: An Educational Design Research Approach

This article describes the iterative design, development, and evaluation of a case-based learning environment focusing on an ill-structured sales management problem. We discuss our processes and situate them within the broader framework of educational design research. The learning environment evolved over the course of three design phases. A semisummative evaluation of student concept maps after the third phase revealed unsatisfactory learning outcomes. This paper focuses on how we investigated design flaws that contributed to poor learning performance. A specific focus of our investigation was the use of Google Analytics data, which uncovered weaknesses in our design. Based on our findings, we used a rapid prototyping process to redesign the learning environment, emphasizing interactive and multimedia-rich elements. Processes and methods are reported along with discussion of implications for case-based reasoning, including relevant design principles. This article will provide insights into resolving design tensions for researchers and practitioners seeking to advance theory and practice in similar domains

Systematizing Scaffolding for Problem-Based Learning: A View from Case-Based Reasoning

Current theories and models of education often argue that instruction is best administered when knowledge is situated within a context. Problem-based learning (PBL) provides an approach to education that has particularly powerful affordances for learning disciplinary content and practices by solving authentic problems within a discipline. However, not all implementations of PBL have been equally successful at fostering such learning, and some argue that this form of instruction is beyond the capabilities of novices. We revisit the theoretical foundations of PBL and call on the theoretical foundations of case-based reasoning (CBR) to help us identify the reasons many PBL implementations do not succeed as well as expected. Based on that analysis, we suggest priorities for facilitator scaffolding during PBL, ways well-curated case libraries can expose novices to new experiences and help them direct attention to important variables that require additional investigation, and ways case-authoring tools can help foster the kinds of reflection needed for learning from problem-solving experiences. Finally, we discuss challenges that, if addressed, will support even more effective PBL implementations

The role of surface roughness, albedo, and Bowen ratio on ecosystem energy balance in the Eastern United States

Land cover and land use influence surface climate through differences in biophysical surface properties, including partitioning of sensible and latent heat (e.g., Bowen ratio), surface roughness, and albedo. Clusters of closely spaced eddy covariance towers (e.g., \u3c10 \u3ekm) over a variety of land cover and land use types provide a unique opportunity to study the local effects of land cover and land use on surface temperature. We assess contributions albedo, energy redistribution due to differences in surface roughness and energy redistribution due to differences in the Bowen ratio using two eddy covariance tower clusters and the coupled (land-atmosphere) Variable-Resolution Community Earth System Model. Results suggest that surface roughness is the dominant biophysical factor contributing to differences in surface temperature between forested and deforested lands. Surface temperature of open land is cooler (−4.8 °C to −0.05 °C) than forest at night and warmer (+0.16 °C to +8.2 °C) during the day at northern and southern tower clusters throughout the year, consistent with modeled calculations. At annual timescales, the biophysical contributions of albedo and Bowen ratio have a negligible impact on surface temperature, however the higher albedo of snow-covered open land compared to forest leads to cooler winter surface temperatures over open lands (−0.4 °C to −0.8 °C). In both the models and observation, the difference in mid-day surface temperature calculated from the sum of the individual biophysical factors is greater than the difference in surface temperature calculated from radiative temperature and potential temperature. Differences in measured and modeled air temperature at the blending height, assumptions about independence of biophysical factors, and model biases in surface energy fluxes may contribute to daytime biases

The Role of Using Formative Assessments in Problem-based Learning: A Health Sciences Education Perspective

Practitioners in the field of pharmacy are often confronted with ill-structured problems. Specifically, pharmacists are tasked with making patient-specific recommendations that are both safe and effective, which requires combining knowledge from the biomedical, behavioral, and pharmaceutical sciences. Given the dynamic nature of pharmacy as a profession, the field has begun to explore learning strategies that go beyond mere content coverage to strategies that better support higher-order learning outcomes. One of these approaches is problem-based learning (PBL). While studies have focused on how to support PBL to improve learning outcomes, the role of assessment is often overlooked. Further exploration is thus needed since assessment plays a pivotal role in teaching and learning. This Voices paper will explore this idea within a larger context; we will also share the experience of how a subject matter expert (SME) worked with a team of instructional designers (IDs) to revise an existing course to more explicitly employ PBL and thus adopt an inquiry-based mindset needed for complex clinical decision making. Given the inherent challenges of assessment in PBL, further discussion will be focused on how to (a) design ill-structured problems, (b) align assessments to the PBL curriculum, and (c) how to hold students accountable in cases where a traditional grade is not attached

Why Do We Fall? Using Experiences of Failure to Design Case Libraries

Instructional designers can support ill-structured problem solving through case libraries that detail domain-specific principles. In this design project, case libraries were employed in an undergraduate sales management course to contextualize knowledge and describe the ill-structured nature of how solutions are derived to solve authentic problems. Whereas many learning environments employ examples of model behavior (Jonassen, 2011), this instructional design was innovative in that the case libraries consisted of sales management failure experiences as the means to facilitate learning. The failure cases embedded within the learning environment engendered design tensions on multiple levels throughout the instructional design. Specifically, this article discusses the issues of engaging the subject matter expert (SME) to talk about failure cases and subsequent challenges to translate the experiences into meaningful learning resources for ill-structured problem solving. Other challenges included how to strategically design the learning environment so that the case library was available at the optimal time for the learners. The design case concludes with a reflection upon the process

Voluntary Medical Male Circumcision: Strategies for Meeting the Human Resource Needs of Scale-Up in Southern and Eastern Africa

Kelly Curran and colleagues conducted a program review to identify human resource approaches that are being used to improve voluntary medical male circumcision volume and efficiency, identifying several innovative responses to human resource challenges

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Expression profiling of in vivo ductal carcinoma in situ progression models identified B cell lymphoma-9 as a molecular driver of breast cancer invasion

Abstract Introduction There are an estimated 60,000 new cases of ductal carcinoma in situ (DCIS) each year. A lack of understanding in DCIS pathobiology has led to overtreatment of more than half of patients. We profiled the temporal molecular changes during DCIS transition to invasive ductal carcinoma (IDC) using in vivo DCIS progression models. These studies identified B cell lymphoma-9 (BCL9) as a potential molecular driver of early invasion. BCL9 is a newly found co-activator of Wnt-stimulated β-catenin-mediated transcription. BCL9 has been shown to promote progression of multiple myeloma and colon carcinoma. However BCL9 role in breast cancer had not been previously recognized. Methods Microarray and RNA sequencing were utilized to characterize the sequential changes in mRNA expression during DCIS invasive transition. BCL9-shRNA knockdown was performed to assess the role of BCL9 in in vivo invasion, epithelial-mesenchymal transition (EMT) and canonical Wnt-signaling. Immunofluorescence of 28 patient samples was used to assess a correlation between the expression of BCL9 and biomarkers of high risk DCIS. The cancer genome atlas data were analyzed to assess the status of BCL9 gene alterations in breast cancers. Results Analysis of BCL9, by RNA and protein showed BCL9 up-regulation to be associated with DCIS transition to IDC. Analysis of patient DCIS revealed a significant correlation between high nuclear BCL9 and pathologic characteristics associated with DCIS recurrence: Estrogen receptor (ER) and progesterone receptor (PR) negative, high nuclear grade, and high human epidermal growth factor receptor2 (HER2). In vivo silencing of BCL9 resulted in the inhibition of DCIS invasion and reversal of EMT. Analysis of the TCGA data showed BCL9 to be altered in 26 % of breast cancers. This is a significant alteration when compared to HER2 (ERBB2) gene (19 %) and estrogen receptor (ESR1) gene (8 %). A significantly higher proportion of basal like invasive breast cancers compared to luminal breast cancers showed BCL9 amplification. Conclusion BCL9 is a molecular driver of DCIS invasive progression and may predispose to the development of basal like invasive breast cancers. As such, BCL9 has the potential to serve as a biomarker of high risk DCIS and as a therapeutic target for prevention of IDC

Global, regional, and national burden of Alzheimer's disease and other dementias, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

BACKGROUND: The number of individuals living with dementia is increasing, negatively affecting families, communities, and health-care systems around the world. A successful response to these challenges requires an accurate understanding of the dementia disease burden. We aimed to present the first detailed analysis of the global prevalence, mortality, and overall burden of dementia as captured by the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, and highlight the most important messages for clinicians and neurologists. METHODS: GBD 2016 obtained data on dementia from vital registration systems, published scientific literature and surveys, and data from health-service encounters on deaths, excess mortality, prevalence, and incidence from 195 countries and territories from 1990 to 2016, through systematic review and additional data-seeking efforts. To correct for differences in cause of death coding across time and locations, we modelled mortality due to dementia using prevalence data and estimates of excess mortality derived from countries that were most likely to code deaths to dementia relative to prevalence. Data were analysed by standardised methods to estimate deaths, prevalence, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs; computed as the sum of YLLs and YLDs), and the fractions of these metrics that were attributable to four risk factors that met GBD criteria for assessment (high body-mass index [BMI], high fasting plasma glucose, smoking, and a diet high in sugar-sweetened beverages). FINDINGS: In 2016, the global number of individuals who lived with dementia was 43·8 million (95% uncertainty interval [UI] 37·8-51·0), increased from 20.2 million (17·4-23·5) in 1990. This increase of 117% (95% UI 114-121) contrasted with a minor increase in age-standardised prevalence of 1·7% (1·0-2·4), from 701 cases (95% UI 602-815) per 100 000 population in 1990 to 712 cases (614-828) per 100 000 population in 2016. More women than men had dementia in 2016 (27·0 million, 95% UI 23·3-31·4, vs 16.8 million, 14.4-19.6), and dementia was the fifth leading cause of death globally, accounting for 2·4 million (95% UI 2·1-2·8) deaths. Overall, 28·8 million (95% UI 24·5-34·0) DALYs were attributed to dementia; 6·4 million (95% UI 3·4-10·5) of these could be attributed to the modifiable GBD risk factors of high BMI, high fasting plasma glucose, smoking, and a high intake of sugar-sweetened beverages. INTERPRETATION: The global number of people living with dementia more than doubled from 1990 to 2016, mainly due to increases in population ageing and growth. Although differences in coding for causes of death and the heterogeneity in case-ascertainment methods constitute major challenges to the estimation of the burden of dementia, future analyses should improve on the methods for the correction of these biases. Until breakthroughs are made in prevention or curative treatment, dementia will constitute an increasing challenge to health-care systems worldwide