ABSTRACT
The shift to distance learning in response to the COVID-19 pandemic has presented teachers and students with several challenges. Teachers have found themselves quickly creating distance learning materials to provide equal or greater educational opportunity and engagement as in-person instruction. This shift is met with parallel increased demand on students to independently manage their learning and coursework with the absence of in-person supervision, support, and peer interaction. In this work, we describe our approach and observations in transitioning Discovery, a secondary student science, technology, engineering, and mathematics (STEM) education program, to a virtual platform. Developed by graduate students in 2016, Discovery was designed to engage secondary students in semester-long inquiry-based projects within the context of biomedical engineering. Projects are designed to foster and reinforce critical thinking skills required for post-secondary study. Throughout the semester, students design and execute experiments within post-secondary laboratories with instructional support from both their teachers and graduate student volunteers. In response to university teaching space closures in early 2020, we developed and delivered a virtual offering of Discovery. In contrast to in-person delivery, this initial virtual offering placed greater emphasis upon quantitative analysis rather than experimental design and execution. Access to virtual laboratory simulations was provided as a substitute for in-laboratory skill development. While overall assessment of student (survey instrument) and teacher (interviews) experiences revealed a highly positive perception of the program experience, areas for improvement were also highlighted. Many students reported struggling with motivation to keep up with course materials and soft deadlines (60%) as well as the lack of guidance provided by in-person mentor and teacher interactions (50%). Teacher interviews echoed quantified student perceptions, but further identified lamentation at the loss of student-driven, open-ended, and iterative problem-solving opportunities typically afforded by Discovery. Consequently, we developed an adjusted virtual program for the Fall 2020 term. The redesigned program reintroduced the open-ended aspect of previous in-person projects, and rather than including access to commercially available virtual laboratory simulation, greater focus was placed on design of experimental procedures that were evaluated and simulated by graduate students. Additionally, greater care was taken to discretize project components and deliverable deadlines to provide enhanced structure and guidance for students. We observed this updated program structure to similar outcomes of in-person offerings. A slight majority (51.4%) of Fall 2020 students achieved higher grades for Discovery deliverables than other class assessments. In post-program surveys, ~49% of students indicated they are more likely to pursue STEM courses, ~89% would participate in the program again, and ~78% responded that the experience made them more comfortable with completing university or college level laboratory work. While these results were encouraging, comparisons to previous in-person outcomes and analysis of teacher experiences (interviews) highlighted persistent gaps in student experience while completing the program virtually. © American Society for Engineering Education, 2021
ABSTRACT
INTRODUCTION: Clinical phenotypes of acute hypoxic respiratory failure (AHRF) in COVID-19 have been proposed- Gattinoni type ?L? with less interstitial edema/ lung weight and greater compliance vs type ?H? with a more classic acute respiratory distress syndrome (ARDS) pattern of interstitial edema, higher lung weight and lower compliance. Lung ultrasound (LUS) is a sensitive tool for the detection of interstitial pulmonary edema. Our objective was to describe lung US profiles in COVID-19 induced AHRF, in association with markers of severity and outcomes. METHODS: Retrospective observational study. Consecutive critically-ill adult COVID-19 patients with AHRF and P/F ratio <300mmHg who underwent LUS performed by a single provider in March-April 2020 were included. Patients with an established alternate etiology of AHRF, or chronic lung parenchymal pathology, were excluded. LUS was performed in the anterior and lateral zones. LUS phenotypes were: A (<3 B-lines per intercostal space (ICS) permitted), B (at least 3 B-lines in any ICS) and C (consolidation >1cm thickness). B and C profiles could overlap. The A-profile was compared to all others in the analyses of statistical significance. Outcomes included the need for and duration of mechanical ventilation, need for tracheostomy and mortality. RESULTS: Ten patients met eligibility criteria. 3 demonstrated A-profile, 6 B-profile and 1 C-profile. Median days (interquartile range) from symptom onset to LUS was: A- 6 (6-14, p=0.20), B- 18 (8-30), C- 6. Median P/F ratio at the time of LUS was: A- 152 (103-269, p=0.31), B- 131 (112- 146), C-98. Median C-reactive protein (mg/dL): A- 8 (5-10, p=0.3), B- 18 (6-31), C- 12. Median Lactate Dehydrogenase (IU/L) was: A- 528 (287-594, p=0.36), B- 622 (528-787), C- 258. Median D-Dimer (mg/L FEU) was: A- 0.88 (0.64- 3.12, p=0.57), B- 2.50 (1.74-35.00), C- 0.35. Mechanical ventilation was required in: A- 1 (33%, p=0.067), 6 (100%), C- 1 (100%). Median days of mechanical ventilation was: A- 0 (0-20, p=0.03), B- 36 (32-52), C- 88. Median static compliance (mL/cmH2O) was: A- 18, B- 27 (25-28), C- 37. Tracheostomy was performed in: A- 0 (0%, p=0.008), B- 6 (100%), C- 1 (100%). Mortality was: A- 0, B- 1 (17%), C- 0. CONCLUSIONS: An A-profile on LUS appeared to be associated with less severe respiratory illness in COVID-19 AHRF with P/F< 300mmHg.