Effects of vitamin D supplementation on bone density in healthy children: systematic review and meta-analysis

Objective To determine the effectiveness of vitamin D supplementation for improving bone mineral density in children and adolescents and if effects vary with factors such as vitamin D dose and vitamin D status

Teaching Courses Online: A Review of the Research

This literature review summarizes research on online teaching and learning. It is organized into four topics: course environment, learners’ outcomes, learners’ characteristics, and institutional and administrative factors. The authors found little consistency of terminology, discovered some conclusive guidelines, and identified developing lines of inquiry. The conclusions overall suggest that most of the studies reviewed were descriptive and exploratory, that most online students are nontraditional and Anglo American, and that few universities have written policies, guidelines, or technical support for faculty members or students. Asynchronous communication seemed to facilitate in-depth communication (but not more than in traditional classes), students liked to move at their own pace, learning outcomes appeared to be the same as in traditional courses, and students with prior training in computers were more satisfied with online courses. Continued research is needed to inform learner outcomes, learner characteristics, course environment, and institutional factors related to delivery system variables in order to test learning theories and teaching models inherent in course design

Automated Large Vessel Occlusion Detection Software and Thrombectomy Treatment Times: a Cluster Randomized Clinical Trial

IMPORTANCE: The benefit of endovascular stroke therapy (EVT) in large vessel occlusion (LVO) ischemic stroke is highly time dependent. Process improvements to accelerate in-hospital workflows are critical. OBJECTIVE: to determine whether automated computed tomography (CT) angiogram interpretation coupled with secure group messaging can improve in-hospital EVT workflows. DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized stepped-wedge clinical trial took place from January 1, 2021, through February 27, 2022, at 4 comprehensive stroke centers (CSCs) in the greater Houston, Texas, area. All 443 participants with LVO stroke who presented through the emergency department were treated with EVT at the 4 CSCs. Exclusion criteria included patients presenting as transfers from an outside hospital (n = 158), in-hospital stroke (n = 39), and patients treated with EVT through randomization in a large core clinical trial (n = 3). INTERVENTION: Artificial intelligence (AI)-enabled automated LVO detection from CT angiogram coupled with secure messaging was activated at the 4 CSCs in a random-stepped fashion. Once activated, clinicians and radiologists received real-time alerts to their mobile phones notifying them of possible LVO within minutes of CT imaging completion. MAIN OUTCOMES AND MEASURES: Primary outcome was the effect of AI-enabled LVO detection on door-to-groin (DTG) time and was measured using a mixed-effects linear regression model, which included a random effect for cluster (CSC) and a fixed effect for exposure status (pre-AI vs post-AI). Secondary outcomes included time from hospital arrival to intravenous tissue plasminogen activator (IV tPA) bolus in eligible patients, time from initiation of CT scan to start of EVT, and hospital length of stay. In exploratory analysis, the study team evaluated the impact of AI implementation on 90-day modified Rankin Scale disability outcomes. RESULTS: Among 243 patients who met inclusion criteria, 140 were treated during the unexposed period and 103 during the exposed period. Median age for the complete cohort was 70 (IQR, 58-79) years and 122 were female (50%). Median National Institutes of Health Stroke Scale score at presentation was 17 (IQR, 11-22) and the median DTG preexposure was 100 (IQR, 81-116) minutes. In mixed-effects linear regression, implementation of the AI algorithm was associated with a reduction in DTG time by 11.2 minutes (95% CI, -18.22 to -4.2). Time from CT scan initiation to EVT start fell by 9.8 minutes (95% CI, -16.9 to -2.6). There were no differences in IV tPA treatment times nor hospital length of stay. In multivariable logistic regression adjusted for age, National Institutes of Health Stroke scale score, and the Alberta Stroke Program Early CT Score, there was no difference in likelihood of functional independence (modified Rankin Scale score, 0-2; odds ratio, 1.3; 95% CI, 0.42-4.0). CONCLUSIONS AND RELEVANCE: Automated LVO detection coupled with secure mobile phone application-based communication improved in-hospital acute ischemic stroke workflows. Software implementation was associated with clinically meaningful reductions in EVT treatment times. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05838456

Teaching Courses Online: A Review of the Research

This literature review summarizes research on online teaching and learning. It is organized into four topics: course environment, learners’ outcomes, learners’ characteristics, and institutional and administrative factors. The authors found little consistency of terminology, discovered some conclusive guidelines, and identified developing lines of inquiry. The conclusions overall suggest that most of the studies reviewed were descriptive and exploratory, that most online students are nontraditional and Anglo American, and that few universities have written policies, guidelines, or technical support for faculty members or students. Asynchronous communication seemed to facilitate in-depth communication (but not more than in traditional classes), students liked to move at their own pace, learning outcomes appeared to be the same as in traditional courses, and students with prior training in computers were more satisfied with online courses. Continued research is needed to inform learner outcomes, learner characteristics, course environment, and institutional factors related to delivery system variables in order to test learning theories and teaching models inherent in course design