Immersive learning: Enhancing student engagement using 360° photography and unity simulations in undergraduate medical science courses

Student engagement is a crucial factor that can influence both the student learning experience and student success. However, in response to the recent COVID-19 pandemic, learning for tertiary students had been affected as many universities introduced fully online learning. This shift to online learning has had an adverse effect on engagement for many students. Immersive online learning modules, including interactive simulations, have potential to enhance motivation and engagement. This study aimed to compare existing online standard module lessons (2D virtual laboratory spaces) with platforms and conditions that apply immersive virtual learning environments (360o photography and desktop Unity 3D immersive simulations) and evaluate the effects on the student learning experience and performance. Novel virtual learning environments were created to pilot within a third-year undergraduate pathology course, at the University of New South Wales. The study was conducted using a multimodal approach with two different pathology undergraduate cohorts from 2022 to 2023. Each cohort was randomly divided into two groups to trial a different learning environment. In 2022, we compared an existing online standard module (developed using a HTML platform, H5P) with a 360o laboratory space. In 2023, we compared the existing standard online module with an immersive 3D Unity laboratory simulation. Student engagement and performance was assessed across all learning environments using pre- and post-simulation knowledge/transfer tests, and Qualtrics feedback surveys. Qualitative and quantitative data obtained were used to compare factors such as student motivation, engagement, and confidence within the different learning environments. In feedback surveys, students reported being engaged and immersed in both the 360o environments and in the 3D Unity simulations. However, students also reported navigation issues within the virtual learning environments in addition to reporting cognitive overload. Quantitative data revealed an increase in performance on knowledge/transfer tests regardless of the learning environment type, but the level of improvement between each group was not significantly different. Further data revealed an overall improvement in understanding of content for all learning environments, but there was a greater increase with the standard module groups. This could be attributed to possible cognitive overload experienced within the new virtual learning environments. As reported in this study, despite the engaging/immersive properties of the 360o/Unity environments, newly developed learning simulations may overload or distract the learner. Therefore, further work is required on immersive learning environment factors that promote student engagement and motivation. These promoting factors could also be incorporated into face-to-face learning so that key elements for student engagement are aligned in all learning environments

Original Article The histone methyltransferase DOT1L: regulatory functions and a cancer therapy target

Abstract: DOT1L is a unique histone methyltransferase that targets the histone H3 lysine 79 (H3K79) residue for mono-, di-and tri-methylation. Histone H3K79 mono-and di-methylation results in active gene transcription, while H3K79 tri-methylation is associated with gene repression. DOT1L has a critical role in regulating gene transcription, development, cell cycle progression, somatic reprogramming and DNA damage repair. DOT1L interacts with Mixed Lineage Leukemia (MLL) fusion proteins, leading to enhanced H3K79 methylation, maintenance of open chromatin, overexpression of downstream oncogenes and leukemogenesis. Importantly, small molecule DOT1L inhibitors have been recently developed, and one of the DOT1L inhibitors is already under investigation in a Phase I clinical trial in patients with MLL fusion gene-driven leukemia

Disruption of MEF2C signaling and loss of sarcomeric and mitochondrial integrity in cancer-induced skeletal muscle wasting

Cancer cachexia is a highly debilitating paraneoplastic disease observed in more than 50% of patients with advanced cancers and directly contributes to 20% of cancer deaths. Loss of skeletal muscle is a defining characteristic of patients with cancer cachexia and is associated with poor survival. The present study reveals the involvement of a myogenic transcription factor Myocyte Enhancer Factor (MEF) 2C in cancer-induced skeletal muscle wasting. Increased skeletal muscle mRNA expression of Suppressor of Cytokine Signaling (Socs) 3 and the IL-6 receptor indicative of active IL-6 signaling was seen in skeletal muscle of mice bearing the Colon 26 (C26) carcinoma. Loss of skeletal muscle structural integrity and distorted mitochondria were also observed using electron microscopy. Gene and protein expression of MEF2C was significantly downregulated in skeletal muscle from C26-bearing mice. MEF2C gene targets myozenin and myoglobin as well as myokinase were also altered during cachexia, suggesting dysregulated oxygen transport capacity and ATP regeneration in addition to distorted structural integrity. In addition, reduced expression of calcineurin was observed which suggested a potential pathway of MEF2C dysregulation. Together, these effects may limit sarcomeric contractile ability and also predispose skeletal muscle to structural instability; associated with muscle wasting and fatigue in cachexia

Teaching and Learning Under COVID-19 Public Health Edicts: The Role of Household Lockdowns and Prior Technology Usage

Public health edicts necessitated by COVID-19 prompted a rapid pivot to remote online teaching and learning. Two major consequences followed: households became students\u27 main learning space, and technology became the sole medium of instructional delivery. We use the ideas of digital disconnect and digital divide to examine, for students and faculty, their prior experience with, and proficiency in using, learning technology. We also explore, for students, how household lockdowns and digital capacity impacted learning. Our findings are drawn from 3806 students and 283 faculty instructors from nine higher education institutions across Asia, Australia, Europe, and North America. For instructors, we find little evidence of a digital divide but some evidence of a digital disconnect. However, neither made a difference to self-reported success in transitioning courses. Faculty instructors were impacted in a myriad of diverse ways. For students, we show that closure and confinement measures which created difficult living situations were associated with lower levels of confidence in learning. The digital divide that did exist among students was less influential than were household lockdown measures in undermining student learning

Glutamine repeat variants in human RUNX2 associated with decreased femoral neck BMD, broadband ultrasound attenuation and target gene transactivation

RUNX2 is an essential transcription factor required for skeletal development and cartilage formation. Haploinsufficiency of RUNX2 leads to cleidocranial displaysia (CCD) a skeletal disorder characterised by gross dysgenesis of bones particularly those derived from intramembranous bone formation. A notable feature of the RUNX2 protein is the polyglutamine and polyalanine (23Q/17A) domain coded by a repeat sequence. Since none of the known mutations causing CCD characterised to date map in the glutamine repeat region, we hypothesised that Q-repeat mutations may be related to a more subtle bone phenotype. We screened subjects derived from four normal populations for Q-repeat variants. A total of 22 subjects were identified who were heterozygous for a wild type allele and a Q-repeat variant allele: (15Q, 16Q, 18Q and 30Q). Although not every subject had data for all measures, Q-repeat variants had a significant deficit in BMD with an average decrease of 0.7SD measured over 12 BMD-related parameters (p = 0.005). Femoral neck BMD was measured in all subjects (&minus;0.6SD, p = 0.0007). The transactivation function of RUNX2 was determined for 16Q and 30Q alleles using a reporter gene assay. 16Q and 30Q alleles displayed significantly lower transactivation function compared to wild type (23Q). Our analysis has identified novel Q-repeat mutations that occur at a collective frequency of about 0.4%. These mutations significantly alter BMD and display impaired transactivation function, introducing a new class of functionally relevant RUNX2 mutants.<br /

Endoplasmic reticulum stress, calcium dysregulation and altered protein translation : intersection of processes that contribute to cancer cachexia induced skeletal muscle wasting

Cancer cachexia is a debilitating paraneoplastic wasting syndrome characterized by skeletal muscle depletion and unintentional weight loss. It affects up to 50-80% of patients with cancer and directly accounts for one-quarter of cancer-related deaths due to cardio-respiratory failure. Muscle weakness, one of the hallmarks of this syndrome, has been postulated to be due to a combination of muscle breakdown, dysfunction and decrease in the ability to repair, with effective treatment strategies presently limite d.Excessive inflammatory cytokine levels due to the host-tumor interaction, such as Interleukin (IL)-6 and Tumor Necrosis Factor (TNF)-α, are hypothesised to drive this pathological process but the specific mechanisms by which these cytokines produce skeletal muscle dysfunction in cancer cachexia remain undefined. Endoplasmic Reticulum (ER) stress and the associated disruptions in calcium signaling have been implicated in cytokine-mediated disruptions in skeletal muscle and function. Disrupted ER stress-related processes such as the Unfolded Protein Response (UPR), calcium homeostasis and altered muscle protein synthesis have been reported in clinical and experimental cachexia and other inflammation-driven muscle diseases such as myositis, potentially suggesting a link between increased IL-6 and TNF-α and ER stress in skeletal muscle cells. As the concept of upregulated ER stress in skeletal muscle cells due to elevated cytokines is novel and potentially very relevant to our understanding of cancer cachexia, this review aims to examine the potential relationship between inflammatory cytokine mediated muscle breakdown and ER stress, in the context of cancer cachexia, and to discuss the molecular signaling pathways underpinning this pathology

Virtual patient consultations and the use of an ePortfolio assessment to support student learning of integrated professional skills

Introduction: Exercise physiology is a relatively new allied health profession and requires extensive knowledge and competency to assist patients with the management of chronic disease. Providing large numbers of students with meaningful training in competency development is important but challenging. The use of filmed or virtual patient consultations (vConsults) may support the student learning process and could be a valuable method of teaching effective teamwork skills, clinical reasoning and reflective thinking.\ud \ud Methods: Patient consultations were created using a virtual case study platform. The aims of the study were to determine whether virtual consultations (vConsults) can enhance the learning of professional skills and to assess their impact on student learning. Data were collected using a questionnaire and by qualitatively analysing student reflections within ePortfolios.\ud \ud Results: The vConsults significantly improved student confidence (p < 0.001) in conducting a cancer patient consultation, developing an exercise program to service the needs of a patient and talking with medical specialists about cancer diagnosis and treatment. All students agreed or strongly agreed that vConsults were interesting and engaging. They concurred that vConsults enabled self-paced learning, provided immediate feedback, supported their ability to work in groups and clarified and justified their thoughts with respect to patient management. Student also liked vConsults potential for future use in their practice. Most students (98%) found the structure of the model interactive and easy to follow, and all stated that the content helped them to understand clinically relevant concepts and that they would like to use more virtual consultations in their future learning.\ud \ud Conclusions: Pilot testing and ePortfolio assessment showed good acceptance by students, supporting their self-directed learning, reflective thinking, teamwork skills and clinical confidence