The Taxonomy of Opportunities to Learn (TxOTL): a tool for understanding the learning potential and substance of interactions in faculty (online) learning community meetings.

BACKGROUND: While many research-based instructional strategies in STEM have been developed, faculty need support in implementing and sustaining use of these strategies. A number of STEM faculty professional development programs aim to provide such pedagogical support, and it is necessary to understand the activity and learning process for faculty in these settings. In this paper, a taxonomy for describing the learning opportunities in faculty (online) learning community meetings is presented. Faculty learning communities, meeting either in-person or (increasingly) online, are a common form of professional development. They aim to develop the pedagogical and reflective skills of participants through regular meetings centered on conversations about teaching and learning. RESULTS: The tool presented in this paper, the Taxonomy of Opportunities to Learn (TxOTL), provides a structured approach to making sense of the dynamic interactions that occur during faculty learning community meetings. The origins and development of the TxOTL are described, followed by a detailed presentation of the constructs that make up the TxOTL: communicative approach used in a conversation, the concepts developed, and the meeting segment category. The TxOTL characterizes the learning opportunities presented by a faculty learning community conversation through describing the content of the conversation as well as how participants engage in the conversation. Examples of the tool in use are provided through an application to a faculty online learning community serving instructors of a physical science curriculum. A visual representation used to compactly display the results of applying the taxonomy to a meeting is detailed as well. These examples serve to illustrate the types of claims the TxOTL facilitates. CONCLUSIONS: The TxOTL allows one to examine learning opportunities available to a faculty learning community group, analyze concept development present in their conversations, track change over time in a given group, and identify patterns between meeting segment categories and communicative approaches. It is useful for researchers as well as facilitators of these STEM faculty professional development groups. The taxonomy is most applicable to faculty (online) learning communities, with limited use for workshops and K-12 professional development contexts. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at (10.1186/s40594-021-00301-3).

Analyzing a faculty online learning community as a mechanism for supporting faculty implementation of a guided-inquiry curriculum.

BACKGROUND: Adoption and use of effective, research-based instructional strategies (RBISs) for STEM education is less widespread than hoped. To promote further use of RBISs, the propagation paradigm suggests that developers work with potential adopters during the development process, and provide ongoing support after adoption. This article investigates the impact of a faculty online learning community (FOLC) as a professional development mechanism for supporting faculty adopting a research-based curriculum. A FOLC uses video conference technology and online platforms to connect geographically dispersed faculty with similar backgrounds (e.g., physics faculty) and supports their teaching development. In the context of a specific FOLC, this article seeks to determine the outcomes the FOLC achieves, and how. RESULTS: Analysis of a FOLC meeting identified opportunities for rich, complex social interaction centered on the research-based curriculum. By functioning as a sounding board for ideas, a space to share experiences, a source of affective support, and a venue for troubleshooting, the FOLC mediates the achievement of a range of outcomes related to implementation of the curriculum. Survey results indicate that members feel a sense of community in the FOLC and that it provides encouragement through teaching challenges. Further results indicate participants' increased confidence in using the curriculum; familiarity with the curriculum structure and content; increased knowledge of pedagogical techniques; reflection on teaching practices in the curriculum; and use of pedagogical techniques aligned with the curriculum's core principles. Emerging evidence supports more distal outcomes, including student learning, persistence in using the curriculum, reflection in teaching practice across courses taught, and use of research-based pedagogy in other courses. CONCLUSIONS: The propagation paradigm emphasizes the need for ongoing support for adopters of RBISs. The FOLC model provides participating faculty with ongoing support through participation in a community and is an effective support mechanism for adopters of a research-based curriculum. In this study, FOLC members are increasing their knowledge and use of pedagogical techniques in the curriculum-specific course and beyond. This is facilitated by the opportunities in the FOLC for troubleshooting, idea sharing, and receiving encouragement through challenges. This model has the potential to support adopters of additional educational innovations. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40594-020-00268-7.

Effects of an Innovative Psychotherapy Program for Surgical Patients: Bridging Intervention in Anesthesiology--A Randomized Controlled Trial.

BACKGROUND: The stepped care program Bridging Intervention in Anesthesiology (BRIA) aims at motivating and supporting surgical patients with comorbid mental disorders to engage in psychosocial mental healthcare options. This study examined the efficacy of BRIA. METHODS: This randomized, parallel-group, open-label, controlled trial was conducted in the preoperative anesthesiological assessment clinics and surgical wards of a large university hospital in Germany. A total of 220 surgical patients with comorbid mental disorders were randomized by using the computer-generated lists to one of two intervention groups: BRIA psychotherapy sessions up to 3 months postoperatively (BRIA) versus no psychotherapy/computerized brief written advice (BWA) only. Primary outcome was participation in psychosocial mental healthcare options at month 6. Secondary outcome was change of self-reported general psychological distress (Global Severity Index of the Brief Symptom Inventory) between baseline and month 6. RESULTS: At 6-month follow-up, the rate of patients who engaged in psychosocial mental healthcare options was 30% (33 of 110) in BRIA compared with 11.8% (13 of 110) in BWA (P = 0.001). Number needed to treat and relative risk reduction were 6 (95% CI, 4 to 13) and 0.21 (0.09 to 0.31), respectively. In BRIA, Global Severity Index decreased between baseline and month 6 (P < 0.001), whereas it did not change significantly in BWA (P = 0.197). CONCLUSIONS: Among surgical patients with comorbid mental disorders, BRIA results in an increased engagement in subsequent therapy options and a decrease of general psychological distress. These data suggest that it is reasonable to integrate innovative psychotherapy programs into the context of interdisciplinary surgical care.

In vitro microbial culture models and their application in drug development.

Drug development faces its nemesis in the form of drug resistance. The rate of bacterial resistance to antibiotics, or tumor resistance to chemotherapy decisively depends on the surrounding heterogeneous tissue. However, in vitro drug testing is almost exclusively done in well stirred, homogeneous environments. Recent advancements in microfluidics and microfabrication introduce opportunities to develop in vitro culture models that mimic the complex in vivo tissue environment. In this review, we will first discuss the design principles underlying such models. Then we will demonstrate two types of microfluidic devices that combine stressor gradients, cell motility, large population of competing/cooperative cells and time varying dosage of drugs. By incorporating ideas from how natural selection and evolution move drug resistance forward, we show that drug resistance can occur at much greater rates than in well-stirred environments. Finally, we will discuss the future direction of in vitro microbial culture models and how to extend the lessons learned from microbial systems to eukaryotic cells.

Persistence of psychological distress in surgical patients with interest in psychotherapy: results of a 6-month follow-up.

OBJECTIVES: This prospective observational study investigated whether self-reported psychological distress and alcohol use problems of surgical patients change between preoperative baseline assessment and postoperative 6-month follow-up examination. Patients with preoperative interest in psychotherapy were compared with patients without interest in psychotherapy. METHODS: A total of 1,157 consecutive patients from various surgical fields completed a set of psychiatric questionnaires preoperatively and at 6 months postoperatively, including Patient Health Questionnaire-4 (PHQ-4), Brief Symptom Inventory (BSI), Center for Epidemiologic Studies Depression Scale (CES-D), World Health Organization 5-item Well-Being Index (WHO-5), and Alcohol Use Disorder Identification Test (AUDIT). Additionally, patients were asked for their interest in psychotherapy. Repeated measure ANCOVA was used for primary data analysis. RESULTS: 16.7% of the patients were interested in psychotherapy. Compared to uninterested patients, they showed consistently higher distress at both baseline and month 6 regarding all of the assessed psychological measures (p's between <0.001 and 0.003). At 6-month follow-up, neither substantial changes over time nor large time x group interactions were found. Results of ANCOVA's controlling for demographic variables were confirmed by analyses of frequencies of clinically significant distress. CONCLUSION: In surgical patients with interest in psychotherapy, there is a remarkable persistence of elevated self-reported general psychological distress, depression, anxiety, and alcohol use disorder symptoms over 6 months. This suggests high and chronic psychiatric comorbidity and a clear need for psychotherapeutic and psychiatric treatment rather than transient worries posed by facing surgery.

[Web-based for preanesthesia evaluation record: a structured, evidence-based patient interview to assess the anesthesiological risk profile]. / Webbasierte Anästhesieanamnese - Patienteninterview zur Erfassung des anästhesiologischen Risikoprofils.

At present, providers at an Anesthesia Preoperative Evaluation Clinic (APEC) may have difficulties in gaining access to relevant clinical information, including external medical records, surgical dictations etc. This common occurence makes obtaining an informed consent by the patient after a complete pre-anesthetic assessment difficult. This form of patient information is subject to wide interindividual variations and, thus, represents a challenge for quality assurance. Insufficient or not completed pre-anesthetic assessments can lead to an untimely termination of an elective procedure.A web-based pre-anesthetic evaluation record moves the time point of the first contact to well before the day of admission. The current pre-anesthesia evaluation record is replaced by a structured interview in the form of a complex of questions in a specific hierarchy taking guidelines, standard operating procedures (SOP) and evidence-based medicine (EBM) into consideration. The answers to the complex of questions are then classified according to agreed criteria and possible scoring systems of relevant classifications. The endpoints result in procedural recommendations not only for the informing anesthesiologist but also for the patient. The standardized risk criteria can be used as core process indicators to check the process quality of the anesthesiological risk evaluation. Short-notice cancellations of elective operations due to incomplete premedication procedures will then be avoided with the help of such structured and evidence-based patient interviews with detailed assessment of the anesthesiological risk profile.The web-based anesthesia evaluation record (WAR) corresponds with the recommendations of the DGAI to carry out the staged information in analogy to the staged information of Weissauer. The basic practice is not changed by WACH. By means of WACH, the time point of the first contact with anesthesia is moved forward and occurs within a different framework. WACH has potential advantages for both patient and anesthesiologist, not least due to a higher patient safety.

Alcohol use disorder and perioperative immune dysfunction.

The anesthesiological sequelae of long-term alcohol abuse include a three to fivefold increased risk of postoperative infection, prolonged intensive care unit stays and longer hospital stays. The cause of the higher infection rates is an altered immune response in long-term alcoholic patients. Preoperatively, the T helper cells 1 to T helper cells 2 ratio is depressed in long-term alcoholic patients and remains suppressed after surgery. The lower preoperative T helper cells 1 to T helper cells 2 ratio is predictive of later onset of infections. Postoperatively, the cytotoxic lymphocyte (Tc1/Tc2) ratio is decreased in long-term alcoholic patients and remains depressed for 5 days. The interleukin (IL)-6/IL-10 ratio and the lipopolysaccharide-stimulated interferon gamma/IL-10 ratio in whole blood cells are decreased after surgery in long-term alcoholic patients. Depressed Tc1/Tc2, IL-6/IL-10 and lipopolysaccharide-stimulated interferon gamma/IL-10 ratios in the postoperative period are predictive of subsequent postoperative infections. Perioperative interventions should aim to minimize dysregulation of the immune system.

The effect of stress-reducing, low-dose ethanol infusion on frequency of bleeding complications in long-term alcoholic patients undergoing major surgery.

Perioperative low-dose ethanol infusion is a feasible option for stress reduction and prophylaxis of alcoholism-associated complications. Because alcohol has inhibitory effects on hemostasis, our study focused on the effect of perioperative low-dose ethanol infusion on bleeding complications, defined as transfused blood units and reoperations, in alcoholic patients undergoing major surgery. We included 44 long-term alcoholic patients scheduled for tumor resection of the aerodigestive and gastrointestinal tract. Patients were randomly assigned to the ethanol or control group. Ethanol infusion (0.5 g ethanol/kg body weight/24 hours) started before surgery and was continued until the postoperative Day 3. Regarding all patients, there was no statistically significant difference in the amount of transfused blood between the ethanol and control groups. However, the effect of ethanol infusion on bleeding complications depended on the site of surgery. Ethanol infusion resulted in an increased number of transfused blood units in gastrointestinal patients and a decreased number of transfused units in patients undergoing tumor resection of the aerodigestive tract. In conclusion, perioperative ethanol infusion in long-term alcoholic patients with tumor resections of the aerodigestive tract is an option for stress reduction without increased risk for blood transfusion. In contrast, ethanol infusion in patients with tumor resections in the gastrointestinal tract could increase the risk for bleeding complications.

Predictors of loss to follow-up in young patients with minor trauma after screening and written intervention for alcohol in an urban emergency department.

OBJECTIVE: In health promotion studies, young age, male gender, low education, and substance use have been found to be relevant predictors of loss to follow-up. The purpose of this study was to assess factors of loss to follow-up after screening and tailored brief advice for alcohol problems in an emergency department setting. METHOD: A randomized controlled intervention study was conducted and followed up at 12 months. At baseline (T0), 2,562 consecutive trauma patients (62.1% male) were screened for substance use (smoking, alcohol consumption, and illicit drug use) and for socioeconomic factors (income, relationship status, and education). Patients with five points or more in the Alcohol Use Disorders Identification Test randomly received tailored brief advice on alcohol and were followed up at 3 (T3), 6 (T6), 9 (T9), and 12 months (T12). RESULTS: At baseline, median age was 32 years (range: 18-89). There was a loss of 950 participants (37.1%) from T0 to T12. Loss to follow-up was strongly dependent on social factors. In participants with a high school diploma, only smoking was predictive of loss to follow-up (odds ratio [OR] = 1.81, 95% confidence interval [CI] = 1.43-2.29). In participants with no high school diploma, alcohol problems alone predicted loss to follow-up (medium level of alcohol problems, OR = 1.57, 95% CI = 1.09-2.27; high level of alcohol problems, OR = 1.62, 95% CI = 0.96-2.76; p = .017). Smoking (OR = 1.35, 95% CI = 0.97-1.89) and, for smokers, age 18-31 years (OR = 1.65, 95% CI = 0.98-2.78) showed a tendency toward an increased risk of loss to follow-up. CONCLUSIONS: After screening and a brief intervention in an emergency department, substance use and differences in education level predicted loss to follow-up. Patients with alcohol problems and no high school diploma are at increased risk of becoming lost to follow-up.

Intervention at the level of the neuroendocrine-immune axis and postoperative pneumonia rate in long-term alcoholics.

RATIONALE: Postoperative pneumonia is three to four times more frequent in patients with alcohol use disorders followed by prolonged intensive care unit (ICU) stay. Long-term alcohol use leads to an altered perioperative hypothalamus-pituitary-adrenal (HPA) axis and immunity. OBJECTIVES: The aim of this study was to evaluate HPA intervention with low-dose ethanol, morphine, or ketoconazole on the neuroendocrine-immune axis and development of postoperative pneumonia in long-term alcoholic patients. METHODS: In this randomized, double-blind controlled study, 122 consecutive patients undergoing elective surgery for aerodigestive tract cancer were included. Long-term alcohol use was defined as consuming at least 60 g of ethanol daily and fulfilling the Diagnostic and Statistical Manual of Mental Disorders IV criteria for either alcohol abuse or dependence. Nonalcoholic patients were included but only as a descriptive control. Perioperative intervention with low-dose ethanol (0.5 g/kg body weight per day), morphine (15 mug/kg body weight per hour), ketoconazole (200 mg four times daily), and placebo was started on the morning before surgery and continued for 3 d after surgery. Blood samples to analyze the neuroendocrine-immune axis were obtained on the morning before intervention and on Days 1, 3, and 7 after surgery. MEASUREMENTS AND MAIN RESULTS: In long-term alcoholic patients, all interventions decreased postoperative hypercortisolism and prevented impairment of the cytotoxic T-lymphocyte type 1:type 2 ratio. All interventions decreased the pneumonia rate from 39% to a median of 5.7% and shortened intensive care unit stay by 9 d (median) compared with the placebo-treated long-term alcoholic patients. CONCLUSIONS: Intervention at the level of the HPA axis altered the immune response to surgical stress. This resulted in decreased postoperative pneumonia rates and shortened intensive care unit stay in long-term alcoholic patients.

Hazardous alcohol consumption and sense of coherence in emergency department patients with minor trauma.

BACKGROUND: The concept of sense of coherence (SOC) measures the extent to which people are able to cope with stressful life events. Since excessive alcohol consumption may be, in part, the result of failed coping strategies, further investigations between hazardous alcohol consumption and SOC are necessary. METHODS: Survey in an Emergency Department in an inner city university hospital. Overall, 1,833 patients were screened for hazardous alcohol consumption, illicit drug use, smoking status, socioeconomic status and sense of coherence. RESULTS: Mean age of participants was 34+/-12 years and 62% were male. Overall, 23% of patients showed a pattern of hazardous alcohol consumption, 23% had abused illicit drugs and 46% were smokers. Mean SOC score was 48.9+/-8.6 points, with no difference between genders. Lower SOC-quartiles were associated with significantly higher prevalence of hazardous alcohol consumption as well as illicit drug abuse and smoking. Lower SOC-quartiles were associated with significantly lower values on socioeconomic variables (e.g. lower income, less education). The negative association between SOC and alcohol consumption was independent of age, gender, smoking, illicit drug use and all socioeconomic variables. CONCLUSION: SOC and hazardous alcohol consumption were significantly associated. Our data support Antonovsky's original concept of increased alcohol consumption as a result of failed coping strategies.