Forming Student Online Teams For Maximum Performance

What is the best way to assign graduate business students to online team-based projects?  Team assignments are frequently made on the basis of alphabet, time zones or previous performance.  This study reviews personality as an indicator of student online team performance.  The personality assessment IDE (Insights Discovery Evaluator) was administered to 450 students in the first six-week course of a proprietary online university MBA program. The IDE was utilized for the study because the university had selected the IDE as a part of its business curriculum. In the second week, students were randomly placed on 138 virtual teams and quantitative data collected from an assignment where students self-reported their IDE type. A qualitative method was used to determine subject IDE type in those cases where subjects did not clearly identify their type. Performance was measured using three instructor- graded assignments completed during the course. Student virtual teams were categorized as random, variable and dominant, contingent upon the composition of team personality types. This study found no statistically significant relationship between IDE’s personality types or the cognitive trait variables of attitude (extroversion and introversion) or trait function (thinking and feeling) on team performance.  Personality trait did not appear to be a variable with the intentional formation of higher performing online student teams. All personality traits performed equally as well. Personality Bias (IDE type homogeneity) was the closest to being statistically significant as a factor in virtual team performance. A model is presented describing the relationship between personality and performance

Estimating the prevalence of renal insufficiency in seniors requiring long-term care

Estimating the prevalence of renal insufficiency in seniors requiring long-term care.BackgroundRenal function declines with age, but little is known about the extent of renal insufficiency among the institutionalized elderly. The objective of this study was to estimate the prevalence of low glomerular filtration rate (GFR) in a large sample of elderly adults living in long-term care facilities, and to compare two commonly used methods for estimating GFR.MethodsA total of 9931 residents aged 65years and older participated in a retrospective cross-sectional study of 87 long-term care facilities in Ontario. GFR was estimated by the Cockcroft-Gault and Modification of Diet in Renal Disease Study (MDRD) equations. The prevalence of low GFR, using the Cockcroft-Gault equation (<30mL/min), was compared with the MDRD equation (<30mL/min/1.73m2).ResultsA total of 17.0% (95% CI 15.6 to 18.5) of men and 14.4% (95% CI 13.6 to 15.3) of women had a serum creatinine concentration above the laboratory reported upper reference limit of normal. The prevalence of both elevated serum creatinine and low GFR were observed to increase with age (P < 0.0001). The Cockcroft-Gault equation produced a consistently lower estimate of GFR than did the MDRD equation, a discrepancy most pronounced in the oldest residents. Among all men, a low GFR was more prevalent using the Cockcroft-Gault (10.3%, 95% CI 9.2 to 11.5) than MDRD (3.5%, 95% CI 2.8 to 4.2) equation, with a similar difference also seen in women (23.3%, 95% CI 22.4 to 24.3 versus 4.0%, 95% CI 3.6 to 4.5, respectively). Of all residents whose Cockcroft-Gault estimated GFR was under 30mL/min, 14.7% (95% CI 13.2 to 16.3) were found to have GFR greater than 60mL/min/1.73m2 according to the MDRD equation.ConclusionAge-associated renal impairment is common among elderly long-term care residents, but there exists a clear discrepancy between the Cockcroft-Gault and MDRD equations in predicting GFR. Consideration should be given to medication dose adjustment, based on a practical estimate of GFR. However clarification is needed about which method, if either, is most valid among the frail elderly. Complex patient and societal issues surrounding advanced care directives, treatments associated with renal insufficiency, and, if and when to initiate dialysis, require further attention

Genetics University of Toronto Thrombophilia Study in Women (GUTTSI): genetic and other risk factors for venous thromboembolism in women

BACKGROUND: Women may be at increased risk for venous thromboembolism (VTE) as compared with men. We studied the effects of genetic and biochemical markers of thrombophilia in women, in conjunction with other established risk factors for VTE. METHOD: The present retrospective case-control study was conducted in a thrombosis treatment programme at a large Toronto hospital. The cases were 129 women aged 16-79 years with objectively confirmed VTE. Age-matched control individuals were women who were free of venous thrombosis. Neither cases nor control individuals had known cardiovascular disease. Participants were interviewed regarding personal risk factors for VTE, including smoking, history of malignancy, pregnancy, and oestrogen or oral contraceptive use. Blood specimens were analyzed for common single nucleotide polymorphisms of prothrombin, factor V and methylenetetrahydrofolate reductase (MTHFR; C677T, A1298C and T1317C), and the A66G polymorphism for methionine synthase reductase (MTRR).Fasting plasma homocysteine was also analyzed. RESULTS: Women with VTE were significantly more likely than female control individuals to carry the prothrombin polymorphism and the factor V polymorphism, or to have fasting hyperhomocysteinaemia. Homozygosity for the C677T MTHFR gene was not a significant risk factor for VTE, or were the A1298C or T1317C MTHFR homozygous variants. Also, the A66G MTRR homozygous state did not confer an increased risk for VTE. CONCLUSION: Prothrombin and factor V polymorphisms increased the risk for VTE in women, independent from other established risk factors. Although hyperhomocysteinaemia also heightens this risk, common polymorphisms in two genes that are responsible for homocysteine remethylation do not. These findings are consistent with previous studies that included both men and women

Tracheotomy care simulation training program for inpatient providers

Objectives: Tracheotomy complications can be life-threatening. Many of these complications may be avoided with proper education of health care providers. Unfortunately, access to high-quality tracheotomy care curricula is limited. We developed a program to address this gap in tracheotomy care education for inpatient providers. This study aimed to assess the efficacy of this training program in improving trainee knowledge and comfort with tracheotomy care. Methods: The curriculum includes asynchronous online modules coupled with a self-directed hands-on simulation activity using a low-cost tracheotomy care task trainer. The program was offered to inpatient providers including medical students, residents, medical assistants, nurses, and respiratory therapists. Efficacy of the training was assessed using pre-training and post-training surveys of learner comfort, knowledge, and qualitative feedback. Results: Data was collected on 41 participants. After completing the program, participants exhibited significantly improved comfort in performing tracheotomy care activities and 15% improvement in knowledge scores, with large effect sizes respectively and greater gains among those with little prior tracheotomy care experience. Conclusion: This study has demonstrated that completion of this integrated online and hands-on tracheotomy simulation curriculum training increases comfort and knowledge, especially for less-experienced learners. This training addresses an important gap in tracheotomy care education among health care professionals with low levels of tracheotomy care experience and ultimately aims to improve patient safety and quality of care. This curriculum is easily transferrable as it requires only access to the online modules and low-cost simulation materials and could be used in other hospitals, long-term care facilities, outpatient clinics, and home settings

Risk of Fetal Death Associated With Maternal Drug Dependence and Placental Abruption: A Population-Based Study

Abstract Objective: Substance use in pregnancy is associated with placental abruption, but the risk of fetal death independent of abruption remains undetermined. Our objective was to examine the effect of maternal drug dependence on placental abruption and on fetal death in association with abruption and independent of it. Methods: To examine placental abruption and fetal death, we performed a retrospective population-based study of 1 854 463 consecutive deliveries of liveborn and stillborn infants occurring between January 1, 1995 and March 31, 2001, using the Canadian Institute for Health Information Discharge Abstract Database. Results: Maternal drug dependence was associated with a tripling of the risk of placental abruption in singleton pregnancies (adjusted odds ratio [OR] 3.1; 95% confidence intervals [CI] 2.6-3.7), but not in multiple gestations (adjusted OR 0.88; 95% CI 0.12-6.4). Maternal drug dependence was associated with an increased risk of fetal death independent of abruption (adjusted OR 1.6: 95% CI 1.1-2.2) in singleton pregnancies, but not in multiples. Risk of fetal death was increased with placental abruption in both singleton and multiple gestations, even after controlling for drug dependence (adjusted OR 11.4 in singleton pregnancy; 95% CI 10.6-12.2, and 3.4 in multiple pregnancy; 95% CI 2.4-4.9). Conclusion: Maternal drug use is associated with an increased risk of intrauterine fetal death independent of placental abruption. In singleton pregnancies, maternal drug dependence is associated with an increased risk of placental abruption. Résumé Objectif : Bien que la consommation d&apos;alcool et de drogues au cours de la grossesse soit associée au décollement placentaire, le risque de mort foetale n&apos;étant pas associé à ce dernier demeure indéterminé. Notre objectif était d&apos;examiner l&apos;effet de la dépendance de la mère aux drogues sur le décollement placentaire, ainsi que sur la mort foetale attribuable à ce dernier et sur la mort foetale n&apos;y étant pas attribuable. Résultats : La dépendance de la mère aux drogues a été associée à un risque triplé de décollement placentaire dans le cas des grossesses monofoetales (rapport de cotes [RC] corrigé, 3,1; intervalle de confiance [IC] à 95 %, 2,6-3,7), mais non pas dans celui des grossesses multiples (RC corrigé, 0,88; IC à 95 %, 0,12-6,4). La dépendance de la mère aux drogues a été associée à une hausse du risque de mort foetale n&apos;étant pas attribuable au décollement (RC corrigé, 1,6; IC à 95 %, 1,1-2,2) dans le cas des grossesses monofoetales, mais non pas dans celui des grossesses multiples. Le risque de mort foetale connaissait une hausse en présence d&apos;un décollement placentaire, tant dans le cas des grossesses monofoetales que dans celui des grossesses multiples, et ce, même à la suite de la neutralisation de l&apos;effet de la dépendance aux drogues (dans le cas des grossesses monofoetales : RC corrigé, 11,4; IC à 95 %, 10,6-12,2; dans celui des grossesses multiples : RC corrigé, 3,4; IC à 95 %, 2,4-4,9). Méthodes Conclusion : La consommation de drogues par la mère est associée à une hausse du risque de mort foetale intra-utérine, peu importe la présence ou non d&apos;un décollement placentaire. Dans le cas des grossesses monofoetales, la dépendance de la mère aux drogues est associée à une hausse du risque de décollement placentaire

Risk of adverse outcomes among infants of immigrant women according to birth-weight curves tailored to maternal world region of origin

Background: Infants of immigrant women in Western nations generally have lower birth weights than infants of native-born women. Whether this difference is physiologic or pathological is unclear. We determined whether the use of birth-weight curves tailored to maternal world region of origin would discriminate adverse neonatal and obstetric outcomes more accurately than a single birth-weight curve based on infants of Canadian-born women. Methods: We performed a retrospective cohort study of in-hospital singleton live births (328 387 to immigrant women, 761 260 to nonimmigrant women) in Ontario between 2002 and 2012 using population health services data linked to the national immigration database. We classified infants as small for gestational age (\u3c 10th percentile) or large for gestational age (≥ 90th percentile) using both Canadian and world region-specific birthweight curves and compared associations with adverse neonatal and obstetric outcomes. Results: Compared with world region-specific birth-weight curves, the Canadian curve classified 20 431 (6.2%) additional newborns of immigrant women as small for gestational age, of whom 15 467 (75.7%) were of East or South Asian descent. The odds of neonatal death were lower among small-for-gestational-age infants of immigrant women than among those of nonimmigrant women based on the Canadian birth-weight curve (adjusted odds ratio [OR] 0.83, 95% confidence interval [CI] 0.72-0.95), but higher when small for gestational age was defined by the world region- specific curves (adjusted OR 1.24, 95% CI 1.08- 1.42). Conversely, the odds of some adverse outcomes were lower among large-forgestational- age infants of immigrant women than among those of nonimmigrant women based on world region-specific birth-weight curves, but were similar based on the Canadian curve. Interpretation: World region-specific birthweight curves seemed to be more appropriate than a single Canadian population-based curve for assessing the risk of adverse neonatal and obstetric outcomes among small- and large-for-gestational-age infants born to immigrant women, especially those from the East and South Asian regions