Learn!Bio - A time-limited cross-sectional study on biosciences students' pathway to resilience during and post the Covid-19 pandemic at an UK university from 2020-2023 and insights into future teaching approaches. (preprint)

Higher education in biosciences is significantly informed by hands-on field trips and practical laboratory skills-training. With the first Covid-19 national lock-down in England in March 2020, on-campus education at higher education institutions was swiftly moved to alternative provisions, including online only options, a mix of synchronous or asynchronous blended, or hybrid adaptions. Students enrolled on an undergraduate bioscience programme have been faced with unprecedented changes and interruptions to their education. This study aimed to evaluate bioscience students' ability to adjust to a fast-evolving learning environment and to capture students' journey building up resilience and graduate attributes. Bioscience undergraduate students in years 1-3 at the biology department at a Northwest English university participated in this anonymous, cross-sectional, mixed-method study with open and closed questions evaluating their perception and feedback to remote and blended learning provisions during the Covid-19 pandemic and post pandemic learning capturing academic years 2019/20 to 2022/23. The Covid-19 pandemic and the consequent restriction of personal social interaction resulted in an significant decrease in the mental wellbeing of undergraduate bioscience students in this study, cumulating in poor or very poor self-rating of wellbeing in spring 2021; while at the same time students showed evidence of advanced adaption to the new learning and social environment by acquisition of additional technical, social and professional graduate-level skills, indicative of an, albeit unconscious, transition to resilience. Post pandemic, bioscience students worry about the increased living costs and are strongly in favour of a mixture of face-to-face and blended learning approaches. Our results show that bioscience students can experience poor mental health while developing resilience, indicating tailored support can aid students' resilience performance. Students have adjusted with ease to digital teaching provisions and expect higher education institutions continue to offer both, face-to-face, and blended teaching, reducing the burden on students' significantly risen living costs.

Classroom Community amid Covid-19: A Mixed-Methods Study of Undergraduate Students in Introductory Mathematics and Statistics (preprint)

A strong sense of classroom community is associated with many positive learning outcomes and is a critical contributor to undergraduate students' persistence in STEM, particularly for women and students of color. This chapter describes a mixed-methods investigation into the relationship between classroom community and course attributes in introductory undergraduate mathematics and statistics courses, mediated by student demographics. The project was motivated by and conducted amid the Covid-19 pandemic: data were collected from online courses in the 2021-21 academic year and from hybrid and in-person courses in the 2021-22 academic year. Quantitative data was gathered from both students and instructors and analyzed using structural equation modeling. The primary instrument was the validated Classroom Community Scale - Short Form. These quantitative results are complemented and contextualized by thematic and textual analyses of focus group data, gathered using a newly developed protocol piloted during the 2021-22 academic year. All data comes from a highly selective private university in the United States. Preliminary practical implications of the study include the value of synchronous participation in fostering connectedness and the importance of attending to students' personal identities in understanding their experiences of belonging.

Telehealth palliative care interventions for patients with advanced cancer: a scoping review (preprint)

Purpose:Telehealth allows patients to maintain contact with healthcare providers without necessitating travel, and is becoming increasingly utilized. The purpose of this study is to describe the components of telehealth palliative care interventions for patients with advanced cancer before the COVID-19 pandemic; identify any intervention components associated with improvements in outcomes; and evaluate reporting of interventions. Methods: This scoping review was registered on the Open Science Framework. We searched 5 medical databases from inception to June 19, 2020. Inclusion criteria were: age ≥18, advanced cancer, asynchronous or synchronous telehealth intervention, and specialized palliative care interventions in any setting. We assessed the quality of intervention reporting using the Template for Intervention Description and Replication (TIDieR) checklist. Results: Twenty-three studies met the inclusion criteria: 15 (65%) quantitative (7 randomized controlled trials, 5 feasibility trials, 3 retrospective chart reviews); 4 (17%) mixed methods, and 4 (17%) qualitative. Most quantitative and mixed methods studies were conducted in North America (12/19, 63%), reported on hybrid (in-person and telehealth) interventions (9/19, 47%), and were delivered by nurses (12/19, 63%) in the home setting (14/19, 74%). In most studies that reported improvements in patient- or caregiver-reported outcomes, the content was psychoeducational and resulted in improvements for psychological symptoms. No study provided complete reporting on all 12 TIDieR checklist items. Conclusion: Telehealth studies are needed that reflect palliative care’s mission to provide multidisciplinary team-based care that improves quality of life in diverse settings, and that provide detailed reporting of interventions.

The impact of prior COVID-19 on vaccine response and the resultant hybrid immunity are age-dependent (preprint)

ABSTRACT Background More people with a history of prior infection are receiving SARS-CoV-2 vaccines. Understanding the magnitude of protectivity granted by hybrid immunity, the combined response of infection- and vaccine-induced immunity, may impact vaccination strategies. Methods A total of 36 synchronously infected (prior infection) and, 33 SARS-CoV-2 naive (naive) individuals participated. Participants provided sera six months after completing a round of BNT162b2 vaccination, to be processed for anti-spike antibody measurements and neutralization assays. The relationships between antibody titer, groups and age were explored. Results Anti-spike antibody titers at 6 months post-vaccination were significantly higher, reaching 13- to 17-fold, in the prior infection group. Linear regression models showed that the enhancement in antibody titer attributable to positive infection history increased from 8.9- to 9.4- fold at age 30 to 19- to 32-fold at age 60. Sera from the prior infection group showed higher neutralizing capacity against all six analyzed strains, including the Omicron variant. Conclusions Prior COVID-19 led to establishing enhanced humoral immunity at 6 months after vaccination. Antibody fold-difference attributed to positive COVID-19 history increased with age, possibly because older individuals are prone to symptomatic infection accompanied by potentiated immune responses. Durable protection of hybrid immunity deserves reflection in vaccination campaigns.

Adapting cleft care protocols in low- and middle-income countries during and after COVID-19: a process-driven review with recommendations (preprint)

Objective: A consortium of global cleft professionals, predominantly from low- and middle-income countries, identified adaptions to cleft care protocols during and after COVID as a priority learning area of need. Design: A multidisciplinary international working group met on a videoconferencing platform in a multi-staged process to make consensus recommendations for adaptions to cleft protocols within resource-constrained settings. Feedback was sought from a roundtable discussion forum and global organisations involved in comprehensive cleft care. Results: Foundational principles were agreed to enable recommendations to be globally relevant and two areas of focus within the specified topic were identified. First the safety aspects of cleft surgery protocols were scrutinised and COVID adaptions, specifically in the pre and peri-operative periods, were highlighted. Second, surgical operations and access to services were prioritized according to their relationship to functional outcomes and time-sensitivity. The operations assigned the highest priority were emergent interventions for breathing and nutritional requirements and primary palatoplasty. The cleft services assigned the highest priority were new-born assessments, paediatric support for children with syndromes, management of acute dental or auditory infections and speech pathology intervention. Conclusions: A collaborative, interdisciplinary and international working group delivered consensus recommendations to assist with the provision of cleft care in low- and middle-income countries. At a time of global cleft care delays due to COVID-19, a united approach amongst global cleft care providers will be advantageous to advocate for children born with cleft lip and palate in resource-constrained settings.

E-learning-based medical education during COVID19 pandemic From Medical students' View Points (preprint)

Background Most universities around the world have replaced e-learning with face-to-face methods after Covid-19 Pandemic. The present study evaluates the students' viewpoints about the dimensions of e-learning during the COVID-19 pandemic.Methods This is a survey study aimed at investigating e-learning experiences of 550 students of Shiraz University of Medical Sciences(SUMS) during the time Coronavirus pandemic. To data collection, a research-made questionnaire was employed, and the data were analyzed using one sample T-test, Independent T-test, ANOVA, and MANOVA.Results The results demonstrated that the students had satisfactory e-learning experiences and the average dimensions of e-learning were: Technological facilities(M = 4.29 ± 1.13),Technical support (M = 4.00 ± 1.08), e-Content quality(3.84 ± 1.05), Asynchronous education (M = 3.73 ± 1.20), Teacher-learner interaction(3.63 ± 1.32) and Synchronous education(M = 3.59 ± 1.31)Respectively. Most important factor was the interaction and feedback between teacher and students. Students' views on the components of e-learning were related to their age, access to electronic devices, and their computer skills significantly.Conclusion It seems that e-Learning can be a relatively good alternative to face-to-face training, but the teacher-student interaction is the main element in the greater effectiveness of this method.

COVID-19: making the best out of a forced transition to online medical teaching. A mixed methods study (preprint)

Introduction: the COVID-19 pandemic resulted in a decreed confinement in our country from March until the end of term in June 2020. This forced a transition exclusively to distance learning. The aim of this study was to broaden the understanding of fully online distance learning from the experiences of undergraduate medical students and faculty members during confinement, and identify its key elements. Methods: A convergent mixed methods study analyzing: (a) an online teaching follow-up program, (b) two focus groups and a nominal group with students and faculty, respectively, and (c) a survey with students from 1st to 5th year. Results: Thirteen strongly interconnected categories were identified. Four played an organizational role: course planning, coordination, communication and pedagogical coherence. The remaining nine categories were: learning outcomes, teaching methodology, online resources, evaluation, time management, workload, student motivation, participation, and teacher-student relationship. Among the key aspects of learning were those that promoted rapport between faculty and students, such as synchronous sessions, especially those based on clinical cases. Conclusion: the experiences from confinement allowed us to gain insight into some of the key aspects of online medical teaching. Promoting student motivation and participation at all levels was essential to distance learning in Medicine.

Difficulties in Treating a Patient with Multiple Cancers in the COVID-19 Pandemic.

In the actual pandemic context, cancer patients are at additional risk, and protocols are always changing. We present the case of a 62-year-old patient who develops three types of cancer over four years and who was admitted to the hospital in the Emergency Room for hematemesis, melena, and abdominal pain. We know from the pathological antecedents that he was operated in 2017 for a left scapular tumour (basal cell carcinoma). The current clinical examination reveals another right scapular tumour (malignant melanoma), and the hematemesis comes from a gastro-esophageal junction tumour (squamous cell carcinoma). SARS CoV2 infection changes the rules of treatment in such a case. Thus, the patient is operated for the right scapular tumour, the gastrectomy being delayed due to the lung lesions given by SARS CoV2. Finally, the patient undergoes surgery for the gastric tumour, the RT-PCR retest being negative.

The Effectiveness of Synchronous Online Flipped Learning in College EFL Reading Course During the COVID-19 Epidemic (preprint)

The purpose of this study was to examine the effectiveness of synchronous online flipped learning (SOFL) when no one can go to school and merely rely on online learning during the COVID-19 epidemic. According to community of inquiry (CoI), put forward by Garrison et al (2001), only when the three key elements of blended teaching, social presence, teaching presence and cognitive presence reach a high level, can effective learning occur, which were used as the framework of this study. Mixed methods were used to evaluate the effectiveness of SOFL teaching. A total of 60 undergraduates from pre-service English teacher training program participated in an online questionnaire survey and 25 of them voluntarily joined online in-depth interviews. Results showed that the learning effect was improved in SOFL context. Anonymity was found to improve learning in asynchronous online learning while distraction and lack of sustainable attention were found in synchronous online learning session. The findings suggest that instructors may need to have a careful design, strict organization and scientific implementation of synchronous online teaching and learning in order to achieve distinctive teaching effects, and that they may also consider the complex influence factors of synchronous and asynchronous online learning to arouse students’ interest and attention, and meet their learning needs (Wong 2020).