Unlocking Math Minds: Using Inquiry-based Instruction to Increase Student Engagement and Learning in a Third Grade Classroom

This paper and supporting website include research and strategies to answer the research question, How can the implementation of inquiry-based math instruction increase student engagement and learning success in a third grade classroom? Inquiry-based learning is a process where the students are involved in their learning. The classroom is student-centered, not teacher-centered. Using the student-centered or inquiry-based approach, students do not learn through transmission. Instead, they collect information and synthesize the information they find through critical thinking skills. The learning process is considered to be higher-order learning. The research presented in this paper focuses on guided inquiry within a mathematics classroom. Guided inquiry allows for students to take agency in their learning, while the educator guides students through their attainment of the mathematical concept. They are “doing” math instead of just “knowing” math. The website designed in support of the research provides strategies that can be utilized both in and beyond the math classroom. Many of the strategies are based on the research and practices of Jo Boaler, professor at the Stanford Graduate School for Education. Boaler provides multiple strategies to support students’ learning through exploration, questioning, and “doing”. Furthermore, she emphasizes the importance of building a math community and growth mindset. Building a community in the classroom is critical to the successful implementation of inquiry-based learning. This website will provide educators with strategies to incorporate inquiry-based instruction into their classroom

Prenatal Genetic Counselors\u27 Perceptions of Non-Invasive Prenatal Testing (NIPT): A Look at the Informed Consent Process and Common Patient Misconceptions

Our study investigated prenatal genetic counselors’ perspectives on and overall satisfaction with the current practice of informed consent for non-invasive prenatal testing (NIPT). With the routinization of NIPT, it is increasingly necessary for healthcare providers other than genetic counselors to facilitate pretest counseling. This in turn raises concerns that time constraints and non-genetics providers’ lack of knowledge about NIPT will leave patients unprepared to make an informed decision about prenatal testing. To explore the frequency of perceived patient misconceptions and their perceived sources and identify potential strategies to address current challenges in the informed consent process, we created an online survey targeting past or currently practicing prenatal genetic counselors consisting of multiple-choice, Likert-scale, and open-ended questions. The survey was distributed to genetic counselors through the National Society of Genetic Counselors listserv as well as directly through professional connections and LinkedIn. Responses were analyzed using descriptive statistics. For open-ended questions, common themes were extracted through inductive analysis. A total of 154 counselors responded and 109 met eligibility criteria. Results showed that OB/GYNs, midwives, and maternal-fetal medicine specialists were most commonly the healthcare providers facilitating informed consent for NIPT. The most frequently reported patient misconceptions were that NIPT screens for all genetic conditions and that NIPT is a diagnostic test, with 82% (n=88) and 78% (n=85) of respondents respectively stating that their patients “sometimes” or “often” hold these beliefs. A majority of respondents expressed feeling frequently dissatisfied with the pretest counseling that their patients had received from non-genetics providers, and they identified a lack of provider education, time constraints, low patient health literacy, and language barriers as potential sources of patient misconceptions. Our results suggest that genetic counselors believe the most common source of patient misunderstandings about NIPT is non-genetics providers’ lack of knowledge about the test. Our results imply that genetic counselors are not confident patients are making fully informed and autonomous decisions when consenting to NIPT. When asked how we might improve the informed consent process for NIPT, respondents were most likely to suggest efforts to standardize non-genetics provider education and to introduce accessible patient resources

A Case of Cervical Chordoma

A 48 year old male presented with neck pain and left arm pain that worsened with movement alongside left arm weakness, numbness, and tingling. The differential diagnosis for a patient with symptoms of a neck mass includes benign tumors like neurofibromas, malignant tumors like chordomas, and non-neoplastic conditions like cervical spondylitis. A magnetic resonance imaging (MRI) study of the cervical spine with and without contrast identified a T1 hypointense, T2 hyperintense, heterogeneously enhancing prevertebral mass with parapharyngeal extension. A direct laryngoscopy with biopsy was performed and revealed a paraspinal tumor. The patient’s diagnosis of cervical chordoma was confirmed upon detection of Brachyury, a gene that encodes a transcription factor which promotes epithelial mesenchymal transition (EMT) in chordoma pathogenesis. Chordomas are slow-growing tumors located within the body’s midline and they are associated with poorer outcomes because of neurovascular encasement at time of presentation. Chordomas are rare, with an incidence of 1 in 1,000,000. Approximately 6% of chordomas are located in the cervical spine. They are typically treated with surgery followed by radiation therapy. The patient underwent anterior resection for the prevertebral mass in the C2-C6 section of the cervical spinal cord. Surgery achieved subtotal resection and involved removal of the spinous processes of C3-C5 and reconstruction of the cervical spine with implants. The patient will be starting proton beam radiotherapy for his adjuvant treatment. Although rare, it is important to keep chordomas in the differential diagnosis when evaluating a patient with a neck mass

Virtual Surgical Planning in Subscapular System Free Flap Reconstruction of Midface Defects.

OBJECTIVES: Reconstruction of the midface has many inherent challenges, including orbital support, skull base reconstruction, optimizing midface projection, separation of the nasal cavity and dental rehabilitation. Subscapular system free flaps (SF) have sufficient bone stock to support complex reconstruction and the option of separate soft tissue components. This study analyzes the effect of virtual surgical planning (VSP) in SF for midface on subsite reconstruction, bone segment contact and anatomic position. MATERIALS AND METHODS: Retrospective cohort of patients with midface defects that underwent SF reconstruction at a single tertiary care institution. RESULTS: Nine cases with VSP were compared to fourteen cases without VSP. VSP was associated with a higher number of successfully reconstructed subunits (5.9 vs 4.2, 95% CI of mean difference 0.31-3.04, p = 0.018), a higher number of successful bony contact between segments (2.2 vs 1.4, 95% CI of mean difference 0.0-1.6, p = 0.050), and a higher percent of segments in anatomic position (100% vs 71%, 95% CI of mean difference 2-55%, p = 0.035). When postoperative bone position after VSP reconstruction was compared to preoperative scans, the difference in anteroposterior, vertical and lateral projection compared to the preoperative \u27ideal\u27 bone position was82% of measurements. There were no flap losses. CONCLUSION: VSP may augment SF reconstruction of the midface by allowing for improved subunit reconstruction, bony segment contact and anatomically correct bone segment positioning. VSP can be a useful adjunct for complex midface reconstruction and the benefits should be weighed against cost

Taking Free Flap Surgery Abroad: A Collaborative Approach to a Complex Surgical Problem.

Accessibility to health care, especially complex surgical care, represents one of the major health care disparities in developing countries. While surgical teams may be willing to travel to these areas to help address these needs, there are many logistical and ethical dilemmas inherent in this pursuit. We reviewed our approach to the establishment of the team-based surgical outreach program, wherein we perform head and neck free tissue transfer surgery in Haiti. We describe the challenges encountered in the delivery of surgical care as well as ethical dilemmas relevant to surgical outreach trips, highlighting an approach reliant on strong local cooperation. Despite the obstacles in place, our experience shows that free flap surgery can be successfully and ethically performed in these areas of great need

Prognostic Significance of Tumor-Associated Macrophage Content in Head and Neck Squamous Cell Carcinoma: A Meta-Analysis.

Background: Head and neck squamous cell carcinoma (HNSCC) exists within a microenvironment rich in immune cells. Macrophages are particularly abundant in and around tumor tissue, and have been implicated in the growth, malignancy, and persistence of HNSCC (1). However, current literature reports variable degrees of association between the density of tumor-associated macrophages (TAMs) and clinicopathologic markers of disease (2, 3). These inconsistent findings may be a result of differences in approach to TAM detection. Authors have measured total TAMs in tumor tissue, while others have stained tumor samples for individual subtypes of TAMs, which include pro-inflammatory (M1-like) and immunosuppressive (M2-like). Our aim is to more clearly define the prognostic significance of the phenotypes of tumor-associated macrophages in HNSCC. Methods: We conducted a meta-analysis of the existing publications investigating the relationship between TAMs (total and M2-like subtype) and T stage, nodal involvement, vascular invasion, lymphatic invasion, and tumor differentiation (Figure 1). A total of 12 studies were included. Forest plots and risk ratios were generated to report overall effect. Results: Higher density of both total and M2-like subtype of TAMs in the tumor microenvironment is associated with advanced T stage, increased rates of nodal positivity, presence of vascular invasion, and presence of lymphatic invasion (p \u3c 0.0001; Figures 2–9). There is no significant association between TAM density, either total or M2-like subtype, and tumor differentiation (Figures 10, 11). Conclusions: Increased density of TAMs, including those of the M2-like phenotype, correlate with poor clinicopathologic markers in HNSCC. Our findings warrant additional investigation into the subpopulations of TAMs, the mechanisms behind their recruitment and differentiation, and the associated influence of each phenotype on tumor growth and invasion. A greater understanding of TAM dynamics in HNSCC is critical for directing further research and employing TAM-targeted adjunct therapies

Reliability of Surgical Margin Labels Using 3D Radiographic Software

Introduction: Surgical resection is a primary treatment for head and neck cancers that improves prognosis and quality of life for patients. Margin assessment is a critical component in this process as positive margins are associated with poor clinical outcomes. However, there is a lack of consensus on how surgical margins should be labeled for accurate origin identification. The objective of this project is to determine the difference in interpretation of surgical margin labels between and within Thomas Jefferson otolaryngologists and pathologists. Methods: Adults with head and neck cancer who underwent surgical resection were identified. Pre-operative head and neck CT DICOM files were obtained, and a 3D segmentation of the tumor was generated and validated by radiology. For each surgical specimen, the pathology report designating the text-based label for each surgical margin was obtained. Study subjects include Thomas Jefferson otolaryngologists and pathologists. Each subject will identify and mark surgical margins on each segmented tumor based on the text-based label. The mean difference for each surgical margin coordinate dimension (x, y, z) will be calculated and compared between and within each group using a paired t-test. Results: Anticipated results include variation in surgical margin origin between and within Thomas Jefferson otolaryngologists and pathologists. Preliminary data indicates lack of significant inter-surgeon reliability in the x dimension (p \u3e 0.02). Discussion: This study demonstrates inconsistent surgical margin labeling interpretation, suggesting a need for optimization and standardization. An optimized protocol has the potential to improve clinical outcomes for patients with head and neck cancers

Avoidance of Maxillary Swing for Nasopharyngectomy via Combined Open Lateral and Endoscopic Approach

Objectives: Nasopharyngectomy performed via a solely endoscopic approach has limitations in access and feasibility, particularly regarding management of the carotid artery. To address these limitations, we report three cases with one cadaver dissection where nasopharyngectomy was performed via a combined open lateral an endoscopic approach. We highlight the benefits and technical considerations for this operative technique. Study Design: Case Series Methods: Patients diagnosed with recurrent nasopharyngeal carcinoma (NPC) that underwent combined open lateral and endoscopic nasopharyngectomy from 2016-2020 were analyzed. A cadaver dissection was also performed. Results: We present the details of the approach and follow-up in three patients with recurrent nasopharyngeal carcinoma. Briefly, a preauricular incision is extended down to the neck. The zygoma and mandibular ramus can be removed and replaced if required. V3, the pterygoid plates and the eustachian tube can be resected or mobilized. The carotid artery may be identified proximally in the neck and traced to the skull base, where the carotid canal may be drilled to the level of the foramen lacerum and protected with a pledget. Then, tumor mucosal cuts are made via an endoscopic endonasal approach and connected to the lateral exposure. No carotid artery injuries occurred. Conclusion: The combined open lateral approach and endoscopic nasopharyngectomy technique is a useful technique in salvage patients. It provides excellent control of major vessels, adequate access to the carotid canal, V3, and remainder of the skull base, and cervical protection.https://jdc.jefferson.edu/otoposters/1009/thumbnail.jp

Sarcosine oxidase activity of rat liver tissue: Effect of folic acid deficiency and induced hyperthyroidism

The sarcosine oxidase content of hepatic tissue from rats made deficient in folic acid was similar to that of normal rats. This is taken as evidence that sarcosine oxidase activity is not dependent upon the presence of folic acid vitamins.The liver sarcosine content of vitamin B12-deficient rats was decreased below normal values. Since B12 supplementation did not increase the enzyme activity, it could not be ascertained whether the loss in enzyme activity was primarily due to a B12 deficiency or whether it was the result of other conditions imposed by a hyperthyroid state.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32539/1/0000648.pd