Student Engagement in an Online Engineering Afterschool Program During the COVID-19 Pandemic

The COVID-19 pandemic forced much of schooling online and limited students’ access to informal learning opportunities such as afterschool programs. The purpose of this study was to investigate how fourth- and fifth-grade students engaged in an online engineering program and what factors influenced their engagement. We drew on a four-dimensional model of student engagement to describe how students engaged in the afterschool engineering program and to identify the factors that enhanced or inhibited engagement. Using a case study design, we drew on interviews with six program mentors and ten students and observation data from weekly Zoom sessions throughout the 2020–2021 school year. We found examples of all four dimensions of engagement, but also of disengagement. The program influenced student engagement in multiple ways, including through the program mentors’ social, pedagogical, and managerial roles, students’ interest in and enjoyment of engineering, the drawbacks and benefits of the online learning environment and Zoom’s affordances, and the nature of the program’s activities. We connect these factors to the different dimensions of engagement. We conclude with a discussion of how our findings add to research on engineering education in informal online settings and offer implications for practitioners

Novel pharmacological therapy in type 2 diabetes mellitus with established cardiovascular disease: Current evidence

Cardiovascular diseases (CVDs) remain the leading cause of death in the world and in most developed countries. Patients with type 2 diabetes mellitus (T2DM) suffer from both microvascular and macrovascular diseases and therefore have higher rates of morbidity and mortality compared to those without T2DM. If current trends continue, the Center for Disease Control and Prevention estimates that 1 in 3 Americans will have T2DM by year 2050. As a consequence of the controversy surrounding rosiglitazone and the increasing prevalence of diabetes and CVDs, in 2008 the Food and Drug Administration (FDA) established new expectations for the evaluation of new antidiabetic agents, advising for pre and, in some cases, post-marketing data on major cardiovascular events. As a direct consequence, there has been a paradigm shift in new antidiabetic agents that has given birth to the recently published American Diabetes Association/European Association for the Study of Diabetes consensus statement recommending sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon like peptide-1 receptor agonists (GLP-1RA) in patients with T2DM and established CVD. As a result of over a decade of randomized placebo controlled cardiovascular outcome trials, the aforementioned drugs have received FDA approval for risk reduction of cardiovascular (CV) events in patients with T2DM and established CV disease. SGLT2i have been shown to have a stronger benefit in patients with congestive heart failure and diabetic kidney disease when compared to their GLP-1RA counterparts. These benefits are not withstanding additional considerations such as cost and the multiple FDA Black Box warnings. This topic is currently an emerging research area and this mini-review paper examines the role of these two novel classes of drugs in patients with T2DM with both confirmed, and at risk for, CVD. Core tip: Cardiovascular diseases are of significant concern in patients with type 2 diabetes mellitus. Novel therapies offer a new opportunity for cardiovascular risk reduction and add complexity in terms of selecting antihyperglycemic treatment. These pharmacological therapies, however, also have additional considerations

Current Management of Acute Pulmonary Embolism

Purpose: Acute pulmonary embolism (PE) remains a significant cause of morbidity and requires prompt diagnosis and management. While non-surgical approaches have supplanted surgery as primary treatment, surgical pulmonary embolectomy (SPE) remains a vital option for select patients. We review the current management of acute PE, with a focus on surgical therapy. Methods: A PubMed search was performed to identify literature regarding PE and treatment. Results were filtered to include the most comprehensive publications over the past decade. Results: PE is stratified based on presenting hemodynamic status or degree of mechanical pulmonary arterial occlusion. Although systemic or catheter-guided fibrinolysis is the preferred first-line treatment for the majority of cases, patients who are not candidates should be considered for SPE. Studies demonstrate no mortality benefit of thrombolysis over surgery. Systemic anticoagulation is a mainstay of treatment regardless of intervention approach. Following surgical embolectomy, direct oral anticoagulants (DOACs) have been shown to reduce recurrence of thromboembolism. Conclusions: Acute PE presents with varying degrees of clinical stability. Patients should be evaluated in the context of various available treatment options including medical, catheter-based, and surgical interventions. SPE is a safe and appropriate treatment option for appropriate patients

No Influence of Ovarian Hormones on Cerebrovascular Responses to the Valsalva Maneuver

Cerebral blood flow is modulated in part by arterial perfusion pressure and autonomic neural activity. Valsalva straining drives increases in cerebral perfusion pressure that may challenge cerebrovascular regulatory mechanisms. These challenges may be even greater during the normal menstrual cycle due to vasoactive influences of ovarian hormones. PURPOSE: To test the hypothesis that cerebral vascular responses to Valsalva straining are enhanced with increased plasma concentrations of estrogen and progesterone. METHODS: Twelve healthy eumenorrheic females (mean age 25 ± 1 yr; height 165 ± 3 cm; weight 66 ± 2 kg; mean ± SE) were studied during the early and late follicular (EF and LF) and early and late luteal (EL and LL) phases of the menstrual cycle. We recorded the ECG, beat-by-beat arterial pressure (Finometer), end-tidal CO2, and cerebral blood velocity (CBV) from the middle cerebral artery (transcranial Doppler ultrasound). Plasma ovarian hormone concentrations were assessed with high performance liquid chromatography. Supine subjects strained to an expiratory pressure of 40 mmHg for 15 seconds, and we recorded magnitudes of changes in arterial pressure and CBV. RESULTS: Compared with EF, estrogen was significantly higher during LF (111 ± 20 pg/ml) and EL (113 ± 27 pg/ml) (both P\u3c0.05). During EL (12 ± 6 pg/ml) and LL (7 ± 2 pg/ml), progesterone was significantly higher when compared with EF(1 ± .3 pg/ml) and LF(1 ± .2 pg/ml) (both P\u3c0.05). The magnitude of arterial pressure overshoot at the release of strain (an indirect indicator of peripheral sympathetic neural activation during straining) was significantly higher during LF (54 ± 9 mmHg) compared to EL and EF (both phases = 35 ± 4 mmHg; P=0.003). Changes in CBV during Valsalva straining and during release from strain were statistically identical across menstrual phases (P\u3e0.05). CONCLUSIONS: Despite indirect evidence that sympathetic neural activity during the Valsalva maneuver is increased when plasma estrogen concentrations are high, responses of the cerebral vasculature to Valsalva straining are unaffected by cycling ovarian hormones

Thermographic Imaging to Detect Reductions of Central Volume Induced by Simulated Hemorrhage

Hemorrhage is the leading cause of death on the battlefield, but the magnitude of blood loss can be difficult to determine. Therefore, medics would benefit from advanced tools to detect blood loss. As skin temperature likely decreases with peripheral vasoconstriction, a portable thermographic imaging (TI) device capable of measuring skin temperature may assist in the detection hemorrhage. PURPOSE: To determine whether skin temperature measured with TI track stroke volume reductions during simulated hemorrhage. METHODS: We studied fifteen healthy volunteers (7 female and 8 male; 24±1 yrs; 171±3 cm; 69±3 kg). ECG, beat-by-beat finger arterial pressure (Finometer), respiratory rate (pneumobelt and TI at the nose), stroke volume (inert rebreathing) and continuous TI skin temperatures were measured during progressive lower body negative pressure (LBNP; -3mmHg/min) to -60 mmHg. Changes of stroke volume, respiratory rate, and skin temperature were determined with repeated measures ANOVA and linear regression. RESULTS: Respiratory rates were consistent during LBNP, and were not significantly different between the pneumobelt (13.5 ± .2) and TI (14.3 ± .3). Stroke volumes decreased directly with negative pressure applied at a rate of -1.3 ml/mmHg (R2=0.96) from a baseline value of 123 ± 8 ml to 41 ± 3 ml at -60 mmHg (P\u3c0.001). Skin temperature (assessed from the ear) did not change with LBNP (P=.17). Skin temperature was 97.06 Fo at baseline, 97.14 Fo at – 60 mmHg, and did not correlate with stroke volume (R2=0.13). CONCLUSIONS: Changes in temperature measured at the nose with TI are sensitive enough to detect inspiration and expiration, and therefore such measures have utility as a method to detect respiratory rate. Progressive LBNP of a magnitude sufficient to decrease stroke volume by 66% does not change skin temperature at the ear, and therefore TI imaging may not be a good candidate technology to pursue for hemorrhage detection

A critical analysis of the pneumatology of Thomas Erskine of Linlathen

In performing an analysis of the pneumatology of Thomas Erskine it is first necessary to look for the presence of a traditional Trinitarian Pneumatology which is based on the historical findings of the church and which deals with the subject of hypostasis and the relationships between the Persons within the Godhead. This kind of pneumatology is found to be lacking in Erskine’s writings. The next step is to proceed to look for anything that could replace it. Erskine’s concept of the “first bond” of the flesh, the role of the human conscience, and the place of the living Word are three things that partially take the place of a formal pneumatology in Erskine’s thinking. Erskine was very interested in the West Country revival which began in Scotland in 1829. He visited the area and wrote about his observations and experiences there. This increased his interest in the actions of the Holy Spirit both in experience and the scriptures. Even though he later recanted his endorsement of these manifestations in his own day, he held to his belief that such phenomena should appear in a healthy church which follows a New Testament pattern. In this thesis Erskine’s writings are analyzed by scanning all of them into a computer database and searching for references to the actions of the Holy Spirit. From this a dynamic pneumatology emerges. A dynamic pneumatology is not concerned with historic creeds or the relationships within the Godhead, John McIntyre defines a dynamic pneumatology as one that speaks of what the Holy Spirit does. McIntyre’s taxonomy sets forth eleven patterns of dynamic pneumatology with many sub-patterns. This examination of the writings of Erskine reveals a strong dynamic pneumatology which is both relational and ecclesial

Profiling of Myositis Specific Antibodies and Composite Scores as an Aid in the Differential Diagnosis of Autoimmune Myopathies

Autoantibodies; Dermatomyositis; DiagnosisAutoanticuerpos; Dermatomiositis; DiagnósticoAutoanticossos; Dermatomiositis; Diagnòstic(1) Background: Myositis specific antibodies (MSA) represent important diagnostic and stratification tools in idiopathic inflammatory myositis (IIM) patients. Here we aimed to evaluate the clinical performance of MSA profiled by a novel particle based multi-analyte technology (PMAT) in IIM and subsets thereof. (2) Methods: 264 IIM patients and 200 controls were tested for MSA using PMAT (Inova Diagnostics, research use only). Diagnostic performance was analyzed and composite scores were generated. (3) Results: The sensitivity/specificity of the individual MSA were: 19.7%/100% (Jo-1), 7.2%/100.0% (Mi-2), 3.0%/99.0% (NXP2), 3.8%/100.0% (SAE), 2.7%/100.0% (PL-7), 1.9%/99.5 (PL-12), 1.1%/100.0% (EJ), 15.5%/99.5% (TIF1γ), 8.3%/98.5% (MDA5), 6.1%/99.0% (HMGCR) and 1.9%/98.5% (SRP). Of all IIM patients, 180/264 tested positive for at least one of the MSAs. In the individual control group, 12/200 (6.0%) tested positive for at least one MSA, most of which had levels close to the cut-off (except one SRP and one PL-12). Only 6/264 (2.3%) IIM patients were positive for more than one antibody (MDA5/HMGCR, EJ/PL-7, 2 x MDA5/TIF1γ, EJ/SAE, SAE/TIF1γ). The overall sensitivity was 68.2% paired with a specificity of 94.0%, leading to an odds ratio of 33.8. The composite scores showed good discrimination between subgroups (e.g., anti-synthetase syndrome). (4) Conclusion: MSA, especially when combined in composite scores (here measured by PMAT), provide value in stratification of patients with IIM

Concert recording 2014-04-06

[Track 01]. Rigaudon de Dardanus / Jean-Philippe Rameau ; arranged by Corroyez -- [Track 02]. What shall we do with a drunken sailor? / Sea Chantey ; arranged by Worley -- [Track 03]. Quartette / Caryl Florio -- [Track 04]. Diversions in denim. Excursion ; [Track 05]. Idlewood ; [Track 06]. Gallumphery ; [Track 07]. Lornsome ; [Track 08]. Shindig / Carl Anton Wirth -- [Track 09]. Finale from Brandenburg concerto no. 3 / J.S. Bach ; arranged by Laycock -- [Track 10]. Portals / Carl Anton Wirth -- [Track 11]. Moderato ; [Track 12]. Allegro / Erland von Koch