Learning performance with interactive simulations in medical education: Lessons learned from results of learning complex physiological models with the HAEMOdynamics SIMulator

Objective

Since simulations are often accepted uncritically, with excessive emphasis being placed on technological sophistication at the expense of underlying psychological and educational theories, we evaluated the learning performance of simulation software, in order to gain insight into the proper use of simulations for application in medical education.

Design

The authors designed and evaluated a software packet, following of user-centered development, which they call Haemodynamics Simulator (HAEMOSIM), for the simulation of complex physiological models, e.g., the modeling of arterial blood flow dependent on the pressure gradient, radius and bifurcations; shear–stress and blood flow profiles depending on viscosity and radius.

Measurements

In a quasi-experimental real-life setup, the authors compared the learning performance of 96 medical students for three conditions: (1) conventional text-based lesson; (2) HAEMOSIM alone and (3) HAEMOSIM with a combination of additional material and support, found necessary during user-centered development. The individual student’s learning time was unvarying in all three conditions.

Results

While the first two settings produced equivalent results, the combination of additional support and HAEMOSIM yielded a significantly higher learning performance. These results are discussed regarding Mayer’s multimedia learning theory, Sweller’s cognitive load theory, and claims of prior research on utilizing interactive simulations for learning.

Conclusion

The results showed that simulations can be beneficial for learning complex concepts, however, interacting with sophisticated simulations strain the limitation of cognitive processes; therefore successful application of simulations require careful additional guidance from medical professionals and a certain amount of previous knowledge on the part of the learners. The inclusion of pedagogical and psychological expertise into the design and development of educational software is essential.     

Evaluating college students’ evaluations of a professor’s teaching effectiveness across time and instruction mode (online vs. face-to-face) using a multilevel growth modeling approach

Aims

Do college students’ ratings of a professor’s teaching effectiveness suggest that a professor’s teaching improves with time? Does anything predict which instructors receive the highest ratings or improve the fastest? And, importantly, do the correlates of change differ across face-to-face and online courses?

Methods

I used data from 10,392 classes taught by 1120 instructors across three years and fit a taxonomy of multilevel growth models to examine whether students’ ratings of teaching effectiveness (SETEs) changed across time, whether differences in average SETEs correlated with growth, and whether online vs. face-to-face, tenure, discipline, course level, sex, or minority status affected these estimates.

Results

SETEs remained relatively stable across time and teachers, although analyses uncovered a statistically significant, negative correlation between initial status and growth. Instructors starting with lower SETEs improved the fastest. These findings held across online and face-to-face instruction modes. However, in face-to-face classes, minority instructors received significantly lower average SETEs. This difference did not occur in online classes. No other predictors showed statistically significant effects. Finally, considerable SETE variance remained unexplained even when including the full predictor set in the model.

Discussion

These findings reveal that professors’ SETEs can improve. Additionally, they indicate that patterns of change in teaching effectiveness do not differ generally across online and face-to-face instruction modes. However, the results showed that minority teachers in face-to-face but not online classes received lower evaluations than their majority counterparts. Additional research should seek to understand what leads to SETE differences across minority and majority groups in face-to-face classes but not online classes.     

A web-based learning tool improves student performance in statistics: A randomized masked trial

Background

e-status is a web-based tool able to generate different statistical exercises and to provide immediate feedback to students’ answers. Although the use of Information and Communication Technologies (ICTs) is becoming widespread in undergraduate education, there are few experimental studies evaluating its effects on learning.

Method

All of the students (121) from an introductory course for statistics in dentistry were randomly assigned to use the tool with one of two 6-problem sets, known as types A and B. The primary endpoint was the grade difference obtained in the final exam, composed of two blocks of questions related to types A and B. The exam evaluator was masked to the intervention group.

Results

We found that the effect of e-status on the student grade was an improvement of 0.48 points (95% CI: 0.10–0.86) on a ten-point scale. Among the 94 students who actually employed e-status, the effect size was 0.63 (95% CI: 0.17–1.10).

Conclusions

It is feasible to formally assess the learning effect of an innovative tool. Providing e-status exercises to students has a direct effect on learning numerical operations related to statistics. Further effects on higher cognitive levels still have to be explored.     

DELIVER! - An educational game for teaching Earned Value Management in computing courses

Context

To meet the growing need for education in Software Project Management, educational games have been introduced as a beneficial instructional strategy. However, there are no low-cost board games openly available to teach Earned Value Management (EVM) in computing programs.

Objective

This paper presents an educational board game to reinforce and teach the application of EVM concepts in the context of undergraduate computing programs complementing expository lessons on EVM basics.

Method

The game has been developed based on project management fundamentals and teaching experience in this area. So far, it has been applied in two project management courses in undergraduate computing programs at the Federal University of Santa Catarina. We evaluated motivation, user experience and the game’s contribution to learning through case studies on Kirkpatrick’s level one based on the perception of the students.

Results

First results of the evaluation of the game indicate a perceived potential of the game to contribute to the learning of EVM concepts and their application. The results also point out a very positive effect of the game on social interaction, engagement, immersion, attention and relevance to the course objectives.

Conclusion

We conclude that the game DELIVER! can contribute to the learning of the EVM on the cognitive levels of remembering, understanding and application. The illustration of the application of EVM through the game can motivate its usefulness. The game has proven to be an engaging instructional strategy, keeping students on the task and attentive. In this respect, the game offers a possibility to complement traditional instructional strategies for teaching EVM. In order to further generalize and to strengthen the validity of the results, it is important to obtain further evaluations.     

Development of online diary and self-management system on e-Healthcare for asthmatic children in Taiwan

Objective

Many regional programs of the countries educate asthmatic children and their families to manage healthcare data. This study aims to establish a Web-based self-management system, eAsthmaCare, to promote the electronic healthcare (e-Healthcare) services for the asthmatic children in Taiwan. The platform can perform real time online functionality based upon a five-tier infrastructure with mutually supportive components to acquire asthma diaries, quality of life assessments and health educations.

Methods

We have designed five multi-disciplinary portions on the interactive interface functioned with the analytical diagrams: (1) online asthma diary, (2) remote asthma assessment, (3) instantaneous asthma alert, (4) diagrammatical clinic support, and (5) asthma health education. The Internet-based asthma diary and assessment program was developed for patients to process self-management healthcare at home. In addition, the online analytical charts can help healthcare professionals to evaluate multi-domain health information of patients immediately.

Results

eAsthmaCare was developed by Java™ Servlet/JSP technology upon Apache Tomcat™ web server and Oracle™ database. Forty-one voluntary asthmatic children (and their parents) were intervened to examine the proposed system. Seven domains of satisfiability assessment by using the system were applied for approving the development. The average scores were scaled in the acceptable range for each domain to ensure feasibility of the proposed system.

Conclusion

The study revealed the details of system infrastructure and developed functions that can help asthmatic children in self-management for healthcare to enhance communications between patients and hospital professionals.     

The relationship between usage intention and adoption of electronic health records at primary care clinics

Objective

Despite of emerging evidence that electronic health records (EHRs) can improve the clinical quality, enhances patient safety and efficiency. Most physicians in primary health care clinics in the Taiwan do not currently adopt EHR at their clinic practices. We aim to measure the relationship between usage intention and adoption behavior.

Study design and methods

We used structured questionnaires distributed both EHRs adopter and non-adopter group to the primary health care physicians which participated in the DOH project to establish the information exchange environment across Taiwan. The response rate of adopter and non-adopter is 54.7% and 55.0% respectively.

Measurements

EHRs adoption behavior.

Results

The EHRs adopter group has higher intention than non-adopter (p = 0.003). From the result of logistic regression analyses, we found the key factors affecting physicians’ adoption pattern were intention to use (OR: 2.85; 95% CI: 2.30–3.54). In addition, higher perceived usefulness (OR: 1.29; 95% CI: 1.06–1.56) and perceived ease to use (OR: 1.48; 95% CI: 1.22–1.79) increase adoption of EHR found.

Conclusion

The intention to use EHR, perceived usefulness and ease to use of primary care physicians were found as key factors influencing EHRs adoption. Thus, we suggest that government should promote the potential benefits of EHR and enhance physicians’ willingness to adopt the EHRs at their clinic practices.     

Computer program in the treatment for major depression and cognitive impairment in university students

Introduction

A depressed patient presents cognitive impairment that remains in spite of depression’s remission. This study intends to evaluate the impact of cognitive training in the treatment of depression, and also of the impairment that depression causes.

Method

A program for cognitive training (Alcor) was designed for and applied to a group of patients (n = 10) with non-medicated MDD; a group (N = 10) with MDD that was treated with the program and with anti-depressants, and to another group (n = 11) that was given anti-depressors only. The impact of this intervention was assessed by applying the following instruments: Beck Depression Inventory, WAIS, Spielberger State-Trait Anxiety Inventory, Externalized Problems Assessment Scale for Adolescents and Young Adults, and Attention Problems Assessment Scale. The program was applied to University students with MDD twice a week, until they had reached adequate levels of execution.

Results

The patients of all three groups showed MDD event remission. Those who received cognitive training showed a substantial increase of intellectual performance. The cognitive treatment group increased IQ in 12.9 units and the combined group increase in 13.3 units. There was a slight decrease of 1.9 units within the anti-depressant treatment group. The changes in attention and in externalized problems showed the same trends.     

A field intervention examining the impact of an office ergonomics training and a highly adjustable chair on visual symptoms in a public sector organization

Objective

Examine the effect of a multi-component office ergonomics intervention on visual symptom reductions.

Methods

Office workers were assigned to either a group receiving a highly adjustable chair with office ergonomics training (CWT), a training-only group (TO) or a control group (C). A work environment and health questionnaire was administered 2 and 1 month(s) pre-intervention and 3, 6, and 12 months post-intervention. Multi-level statistical models tested hypotheses.

Results

The CWT intervention lowered daily visual symptoms (p < 0.01) post-intervention. The TO group did not significantly differ from the control group. The CWT group differed significantly from the TO group (p = 0.01) post-intervention.

Conclusion

Workers who received a highly adjustable chair and office ergonomics training had reduced visual symptoms and the effect was maintained through twelve months post-intervention. The lack of a training-only group effect supports implementing training in conjunction with the highly adjustable chair to reduce visual symptoms.     

How did national life expectation related to school years in developing countries—An approach using panel data mining

Background

The purpose of the study was to probe into the changes in life expectancy associated with schooling years found by the Organization for Economic Co-operation and Development (OECD).

Methods

The study was based on the OECD database from the period 2000 to 2006. The data of thirty countries were constructed to allow comparisons over time and across these countries. Panel data analysis was used to estimate the relationship of national education, as defined as school years, with life expectancy. The control factors considered were numbers of practicing physicians, practicing nurses, hospital beds, and GDP.

Results

We used fixed effects of both country and time through linear regression, the coefficient of school years in relation to life expectancy was statistically significant but negative. This finding is not in accord with the hypothesis that investing in human capital through education stimulates better health outcomes.

Conclusion

Within developing countries, educational attainment is no longer keeping the same pace with life expectancy as before. Therefore, we suggest that an effective education policy should cover diverse topics, for example, balancing economic growth and mental hygiene, to improve national life expectancy.     

Nomophobia: Dependency on virtual environments or social phobia?

Background

The increasing use of new technologies and virtual communication involving personal computers (PCs), tablets and mobile phones are causing changes in individuals’ daily habits and behavior. We report the case of an individual with social phobia who developed a dependency on communication through virtual environments (i.e., nomophobia), and used a PC as a form of relating to the outside world to reduce stress and to avoid direct social relations. Nomophobia refers to the discomfort or anxiety caused by the non-availability of a mobile phone, PC or any another virtual communication device. Social phobia is described as an anxiety disorder of chronic evolution.

Objective

To study nomophobia as a manifest behavior that might serve as an indication of a possible anxiety disorder.

Methodology

The treatment consisted of the use of medication, cognitive-behavioral therapy (CBT) and the application of evaluation tools (interviews, scales, inventories and questionnaires).

Results

The individual responded satisfactorily to medication and CBT treatment, which reduced his time using the PC and increased his exposure to real-life situations.

Conclusion

Nomophobic behavior produces changes in daily habits and can reveal other aspects to be investigated, such as the presence of comorbid mental disorders.     

Code smells as system-level indicators of maintainability: An empirical study

Context

Code smells are manifestations of design flaws that can degrade code maintainability. So far, no research has investigated if these indicators are useful for conducting system-level maintainability evaluations.

Aim

The research in this paper investigates the potential of code smells to reflect system-level indicators of maintainability.

Method

We evaluated four medium-sized Java systems using code smells and compared the results against previous evaluations on the same systems based on expert judgment and the Chidamber and Kemerer suite of metrics. The systems were maintained over a period of up to 4 weeks. During maintenance, effort (person-hours) and number of defects were measured to validate the different evaluation approaches.

Results

Most code smells are strongly influenced by size; consequently code smells are not good indicators for comparing the maintainability of systems differing greatly in size. Also, from the comparison of the different evaluation approaches, expert judgment was found as the most accurate and flexible since it considered effects due to the system's size and complexity and could adapt to different maintenance scenarios.

Conclusion

Code smell approaches show promise as indicators of the need for maintenance in a way that other purely metric-based approaches lack.     

Machine learning-based assessment tool for imbalance and vestibular dysfunction with virtual reality rehabilitation system

Background and objective

Dizziness is a major consequence of imbalance and vestibular dysfunction. Compared to surgery and drug treatments, balance training is non-invasive and more desired. However, training exercises are usually tedious and the assessment tool is insufficient to diagnose patient's severity rapidly.

Methods

An interactive virtual reality (VR) game-based rehabilitation program that adopted Cawthorne–Cooksey exercises, and a sensor-based measuring system were introduced. To verify the therapeutic effect, a clinical experiment with 48 patients and 36 normal subjects was conducted. Quantified balance indices were measured and analyzed by statistical tools and a Support Vector Machine (SVM) classifier.

Results

In terms of balance indices, patients who completed the training process are progressed and the difference between normal subjects and patients is obvious.

Conclusions

Further analysis by SVM classifier show that the accuracy of recognizing the differences between patients and normal subject is feasible, and these results can be used to evaluate patients’ severity and make rapid assessment.     

Who benefits from simulator training: Personality and heart rate variability in relation to situation awareness during navigation training

Objective

This study tested the relationship between individual differences and Situation Awareness (SA) during training in a navigation simulator.

Background

Simulators have become an important tool in the training and education of maritime personnel with a view to improving decisions and performance. There are a few, inconclusive empirical studies that have focused on mapping personality characteristics and their link to the ability to generate and maintain SA during simulator training.

Method

Thirty-six first-year students from the Royal Norwegian Navy Officer Candidate School participated in the study. SA was measured using both subjective and observer ratings.

Results

The results indicated that low scores on Neuroticism and high scores on Extraversion and Conscientiousness (resilient personality type) predicted both subjective and observer-rated SA. Furthermore, participants with high SA were able to modulate their Heart Rate Variability (HRV), with suppression of HRV during navigation training as well showing recovery of HRV.

Application

The potential applications of this research include the assessment of personality differences as a tool in selecting navigators, and the use of HRV as an objective index of adaptability to environmental demands.     

Prevalence of carpal tunnel syndrome among employees at a poultry processing plant

Objective

To determine prevalence of carpal tunnel syndrome (CTS) among poultry processing employees while taking into account non-occupational factors and assess any association between CTS prevalence and exposure groups.

Methods

Performed a cross-sectional survey to assess CTS (n = 318). A CTS case was defined as an employee with self-reported CTS symptoms, an abnormal hand symptom diagram, and an abnormal nerve conduction study (NCS). Log-binomial regression was used to estimate prevalence ratios.

Results

Three hundred and one participants had sufficient symptom information or NCS data to be classified. 126 (42%) of 301 participants had evidence of CTS. In the adjusted analysis, the highest exposure group had CTS prevalence that was significantly higher than that for the lower exposure group [PR: 1.61; 95% CI = (1.20, 2.17)].

Conclusions

Increasing levels of hand activity and force were associated with increased CTS prevalence among participants. Recommendations were provided to reduce exposure to these risk factors.     

A study of cyclic dependencies on defect profile of software components

Background

Empirical evidence shows that dependency cycles among software components are pervasive in real-life software systems, although such cycles are known to be detrimental to software quality attributes such as understandability, testability, reusability, build-ability and maintainability.

Research goals

Can the use of extended object-oriented metrics make us better understand the relationships among cyclic related components and their defect-proneness?

Approach

First, we extend such metrics to mine and classify software components into two groups – the cyclic and the non-cyclic ones. Next, we have performed an empirical study of six software applications. Using standard statistical tests on four different hypotheses, we have determined the significance of the defect profiles of both groups.

Results

Our results show that most defects and defective components are concentrated in cyclic-dependent components, either directly or indirectly.

Discussion and conclusion

These results have important implications for software maintenance and system testing. By identifying the most defect-prone set in a software system, it is possible to effectively allocate testing resources in a cost efficient manner. Based on these results, we demonstrate how additional structural properties could be collected to understand component's defect proneness and aid decision process in refactoring defect-prone cyclic related components.     

A replicated field intervention study evaluating the impact of a highly adjustable chair and office ergonomics training on visual symptoms

Objective

Examine the effects of two office ergonomics interventions in reducing visual symptoms at a private sector worksite.

Methods

A quasi-experimental study design evaluated the effects of a highly adjustable chair with office ergonomics training intervention (CWT group) and the training only (TO group) compared with no intervention (CO group). Data collection occurred 2 and 1 month(s) pre-intervention and 2, 6 and 12 months post-intervention. During each data collection period, a work environment and health questionnaire (covariates) and daily health diary (outcomes) were completed. Multilevel statistical models tested hypotheses.

Results

Both the training only intervention (p < 0.001) and the chair with training intervention (p = 0.01) reduced visual symptoms after 12 months.

Conclusion

The office ergonomics training alone and coupled with a highly adjustable chair reduced visual symptoms. In replicating results from a public sector worksite at a private sector worksite the external validity of the interventions is strengthened, thus broadening its generalizability.     

Influence of wearing an unstable shoe on thigh and leg muscle activity and venous response in upright standing

Purpose

To quantify the effect of unstable shoe wearing on muscle activity and haemodynamic response during standing.

Methods

Thirty volunteers were divided into 2 groups: the experimental group wore an unstable shoe for 8 weeks, while the control group used a conventional shoe for the same period. Muscle activity of the medial gastrocnemius, tibialis anterior, rectus femoris and biceps femoris and venous circulation were assessed in quiet standing with the unstable shoe and barefoot.

Results

In the first measurement there was an increase in medial gastrocnemius activity in all volunteers while wearing the unstable shoe. On the other hand, after wearing the unstable shoe for eight weeks these differences were not verified. Venous return increased in subjects wearing the unstable shoe before and after training.

Conclusions

The unstable shoe produced changes in electromyographic characteristics which were advantageous for venous circulation even after training accommodation by the neuromuscular system.     

Influence of automobile seat lumbar support prominence on spine and pelvic postures: a radiological investigation

Background

The use of lumbar supports has been associated with decreased reports of low back pain during driving exposures. However, there has been limited work investigating whether lumbar supports actually change spine and pelvic postures at the level of the vertebrae.

Purpose

To investigate the effectiveness of a lumbar support in changing radiological measures of lumbar spine and pelvic postures and to examine the impact of support excursion magnitudes on these postures.

Methods

Eight male subjects were recruited with no history of back injury, pathologies or low back pain within the past 6 months. Radiographs were taken in four postures: standing, and sitting with 0 cm, 2 cm and 4 cm lumbar support prominence (LSP).

Results

Lumbar lordosis angle increased from 20° with no support to 25° with 2 cm support and 30° with 4 cm support. Lumbar lordosis angles were significantly different between 0 cm support and 4 cm support (p < 0.0001) and between 2 cm support and 4 cm support (p = 0.0256). Increasing lumbar support reduced the flexion at intervertebral disc joints throughout the lumbar spine, however, these remained significantly different from upright standing (p > 0.001) with the exception of L1/L2 in 4 cm support (p = 0.1381) and L5/S1 for all seated postures (p = 0.0687). All measures of pelvic posture were significantly different in sitting compared to standing (p < 0.0001), however, the lumbar support had no significant impact on seated pelvic posture.

Conclusions

Lumbar supports were shown to impact the vertebral rotations of the lumbar spine yet had no effect on pelvis postures. Increasing support from the current maximum of 2 cm–4 cm resulted in increased lumbar lordosis. The changes were mostly imparted at the upper lumbar spine joints with the most marked change being exhibited at the approximate level of the lumbar support apex: in the L2/L3 joint.     

Validity and reliability of a novel device for bilateral upper extremity functional measurements

Background and objective

This study was designed to establish the validity and reliability of a new device that measures bilateral shoulder and elbow range of motion (ROM) and grip force performance in vivo. A further aim was to investigate the control of inter-limb grip force coordination during isometric force-maintenance tasks. Validity of the ROM and grip force measurements was examined using a validated clinical goniometer and standard weights.

Subjects

Twenty-one healthy adults (six female, 15 male; mean ± standard deviation age = 23.05 ± 3.51) were recruited for this study.

Design

All subjects were asked to perform tests to evaluate the validity and reliability of ROM, grip force maximum voluntary contraction (MVC) and coordination control measurements.

Results

The ROM and grip force measurements were linearly correlated with criterion standards. For reliability testing, all of the intraclass correlation coefficient values were >0.99. The inter-limb grip force coordination control task showed that the force modulation timing during dominant-to-non-dominant hand transition was longer than the non-dominant-to-dominant hand transition (p < 0.05).

Conclusions

These results demonstrate that this device is valid and reliable when used to measure shoulder and elbow ROM and grip force of both hands. Isometric force-maintenance tasks also indicated changes in inter-limb grip force control.