Student Engagement in a Team-Based Capstone Course: A Comparison of What Students Do and What Instructors Value

Student engagement is an important consideration across all levels of education. The adoption of student-centered teaching methods is an effective way to increase student engagement. Student engagement is at risk when instructor expectations and student participation in purposeful engagement activities are not aligned. Traditionally, student engagement is measured at the institutional level, which proves less than useful to instructors who wish to gauge engagement in specific courses in higher education. In this study, we sought to determine classroom level engagement in a capstone farm management course recently converted to the team-based learning format by comparing student perceptions regarding participation in engagement-specific activities with the instructors’ perceived importance of those same activities. The Classroom-Level Survey of Student Engagement (CLASSE) was utilized to collect student participation and instructor importance data. Data were examined utilizing a 2x2 quadrant analysis. Congruence between student participation frequency and instructor importance was found between 73.7% of the educational activities, while discrepancies were found on 26.3% of educational activities. Overall, students who completed the team-based learning-structured farm management course were physically and psychologically engaged in the learning environment. It is recommended that team-based learning be implemented in other courses within agricultural education to examine its utility in other contexts

Prognosis of patients with hepatocellular carcinoma. Validation and ranking of established staging-systems in a large western HCC-cohort.

HCC is diagnosed in approximately half a million people per year, worldwide. Staging is a more complex issue than in most other cancer entities and, mainly due to unique geographic characteristics of the disease, no universally accepted staging system exists to date. Focusing on survival rates we analyzed demographic, etiological, clinical, laboratory and tumor characteristics of HCC-patients in our institution and applied the common staging systems. Furthermore we aimed at identifying the most suitable of the current staging systems for predicting survival. Overall, 405 patients with HCC were identified from an electronic medical record database. The following seven staging systems were applied and ranked according to their ability to predict survival by using the Akaike information criterion (AIC) and the concordance-index (c-index): BCLC, CLIP, GETCH, JIS, Okuda, TNM and Child-Pugh. Separately, every single variable of each staging system was tested for prognostic meaning in uni- and multivariate analysis. Alcoholic cirrhosis (44.4%) was the leading etiological factor followed by viral hepatitis C (18.8%). Median survival was 18.1 months (95%-CI: 15.2-22.2). Ascites, bilirubin, alkaline phosphatase, AFP, number of tumor nodes and the BCLC tumor extension remained independent prognostic factors in multivariate analysis. Overall, all of the tested staging systems showed a reasonable discriminatory ability. CLIP (closely followed by JIS) was the top-ranked score in terms of prognostic capability with the best values of the AIC and c-index (AIC 2286, c-index 0.71), surpassing other established staging systems like BCLC (AIC 2343, c-index 0.66). The unidimensional scores TNM (AIC 2342, c-index 0.64) and Child-Pugh (AIC 2369, c-index 0.63) performed in an inferior fashion. Compared with six other staging systems, the CLIP-score was identified as the most suitable staging system for predicting prognosis in a large German cohort of predominantly non-surgical HCC-patients

Why don't we inform patients about the risk of diagnostic errors?

The principles of autonomy and informed consent dictate that patients who undergo a radiological examination should actually be informed about the risk of diagnostic errors. Implementing such a policy could potentially increase the quality of care. However, due to the vast number of radiological examinations that are performed in each hospital each day, financial constraints, and the risk of losing trust, patients, and income if the requirement for informed consent is not imposed by law on a state or national level, it may be challenging to inform patients about the risk of diagnostic errors. Future research is necessary to determine if and how an informed consent procedure for diagnostic errors can be implemented in clinical practice.</p

Influence of Lipid Heterogeneity and Phase Behavior on Phospholipase A2 Action at the Single Molecule Level

We monitored the action of phospholipase A2 (PLA2) on L- and D-dipalmitoylphosphatidylcholine (DPPC) Langmuir monolayers by mounting a Langmuir-trough on a wide-field fluorescence microscope with single molecule sensitivity. This made it possible to directly visualize the activity and diffusion behavior of single PLA2 molecules in a heterogeneous lipid environment during active hydrolysis. The experiments showed that enzyme molecules adsorbed and interacted almost exclusively with the fluid region of the DPPC monolayers. Domains of gel state L-DPPC were degraded exclusively from the gel-fluid interface where the build-up of negatively charged hydrolysis products, fatty acid salts, led to changes in the mobility of PLA2. The mobility of individual enzymes on the monolayers was characterized by single particle tracking (SPT). Diffusion coefficients of enzymes adsorbed to the fluid interface were between 3 mu m^2/s on the L-DPPC and 4.6 mu m^/s on the D-DPPC monolayers. In regions enriched with hydrolysis products the diffusion dropped to approx. 0.2 mu m^2/s. In addition, slower normal and anomalous diffusion modes were seen at the L-DPPC gel domain boundaries where hydrolysis took place. The average residence times of the enzyme in the fluid regions of the monolayer and on the product domain were between approx. 30 and 220 ms. At the gel domains it was below the experimental time resolution, i.e. enzymes were simply reflected from the gel domains back into solution.Comment: 10 pages, 10 figure

A Direct Comparison of the Prevalence of Advanced Adenoma and Cancer between Surveillance and Screening Colonoscopies

Background/Aims: Surveillance colonoscopy is recommended afterpolypectomy of adenoma and surgery for colorectal cancer. The purpose ofthis study was to assess the frequency of advanced adenoma and cancer incolonoscopies performed for surveillance compared to screeningcolonoscopies. Methods: Analysis of relative frequencies of findings incolonoscopies performed for post-adenoma surveillance (post-ad),post-cancer surveillance (post-crc), screening, and follow-up of apositive fecal occult blood test (FOBT). Logistic regression was used toidentify the risk for advanced adenoma (adenoma mm, containinghigh-grade dysplasia, or villous histology) and cancer. Results: 324,912 colonoscopies were included in the analysis: 81,877 post-ad, 26,89 6post-crc, 178,305 screening, 37,834 positive FOBT. Advanced adenoma(cancer) was diagnosed in 8.0% (0.4%) of post-ad, 5.0% (1.0%) ofpost-crc, 7.4% (1.1%) of screening, and 11.7% (3.6%) of positiveFOBT colonoscopies. Compared to screening, the odds ratios for findingadvanced adenoma were 0.93 (95% CI 0.88-0.98) for post-ad, 0.96(0.86-1.08) for post-crc, and 1.18 (1.09-1.28) for positive FOBTcolonoscopies. The odds ratios for the diagnosis of cancer were 0.29(0.24-0.36) for post-ad, 0.81 (0.61-1.07) for post-crc, and 2.77(2.43-3.17) for positive FOBT. Conclusion: Colonoscopy for post-adsurveillance but not colonoscopy for post-crc surveillance is associatedwith a lower risk of diagnosis of advanced adenoma and cancer

The clinical and prognostic value of late Gadolinium enhancement imaging in heart failure with mid-range and preserved ejection fraction

Heart failure (HF) with mid-range or preserved ejection fraction (HFmrEF; HFpEF) is a heterogeneous disorder that could benefit from strategies to identify subpopulations at increased risk. We tested the hypothesis that HFmrEF and HFpEF patients with myocardial scars detected with late gadolinium enhancement (LGE) are at increased risk for all-cause mortality. Symptomatic HF patients with left ventricular ejection fraction (LVEF) > 40%, who underwent cardiac magnetic resonance (CMR) imaging were included. The presence of myocardial LGE lesions was visually assessed. T1 mapping was performed to calculate extracellular volume (ECV). Multivariable logistic regression analyses were used to determine associations between clinical characteristics and LGE. Cox regression analyses were used to assess the association between LGE and all-cause mortality. A total of 110 consecutive patients were included (mean age 71 +/- 10 years, 49% women, median N-terminal brain natriuretic peptide (NT-proBNP) 1259 pg/ml). LGE lesions were detected in 37 (34%) patients. Previous myocardial infarction and increased LV mass index were strong and independent predictors for the presence of LGE (odds ratio 6.32, 95% confidence interval (CI) 2.07-19.31, p = 0.001 and 1.68 (1.03-2.73), p = 0.04, respectively). ECV was increased in patients with LGE lesions compared to those without (28.6 vs. 26.6%, p = 0.04). The presence of LGE lesions was associated with a fivefold increase in the incidence of all-cause mortality (hazards ratio 5.3, CI 1.5-18.1, p = 0.009), independent of age, sex, New York Heart Association (NYHA) functional class, NT-proBNP, LGE mass and LVEF. Myocardial scarring on CMR is associated with increased mortality in HF patients with LVEF > 40% and may aid in selecting a subpopulation at increased risk