Pseudo-discordance mimicking low-flow low-gradient aortic stenosis in transcatheter aortic valve replacement patients with severe symptomatic aortic stenosis.

BACKGROUND: While the combination of a small aortic valve area (AVA) and low mean gradient is frequently labeled 'low-flow low-gradient aortic stenosis (AS)', there are two potential causes for this finding: underestimation of mean gradient and underestimation of AVA. METHODS: In order to investigate the prevalence and causes of discordant echocardiographic findings in symptomatic patients with AS and normal left ventricular (LV) function, we evaluated 72 symptomatic patients with AS and normal LV function by comparing Doppler, invasive, computed tomography (CT) LV outflow tract (LVOT) area, and calcium score (CaSc). RESULTS: Thirty-six patients had discordant echocardiographic findings (mean gradient < 40 mmHg, AVA ≤ 1 cm²). Of those, 19 had discordant invasive measurements (true discordant [TD]) and 17 concordant (false discordant [FD]): In 12 of the FD the mean gradient was > 30 mmHg; technical pitfalls were found in 10 patients (no reliable right parasternal Doppler in 6). LVOT area by echocardiography or CT could not differentiate between concordants and discordants nor between TD and FD (p = NS). CaSc was similar in concordants and FD (p = 0.3), and it was higher in true concordants than in TD (p = 0.005). CaSc positive predictive value for the correct diagnosis of severe AS was 95% for concordants and 93% for discordants. CONCLUSIONS: Discordant echocardiographic findings are commonly found in patients with symptomatic AS. Underestimation of the true mean gradient due to technical difficulties is an important cause of these discrepant findings. LVOT area by echocardiography or CT cannot differentiate between TD and FD. In the absence of a reliable and compete multi-window Doppler evaluation, patients should undergo CaSc assessment.

Contributions of Neuroscience Knowledge to Teachers and Their Practice.

While neuroscience has elucidated the mechanisms underpinning learning and memory, accurate dissemination of this knowledge to teachers and educators has been limited. This review focuses on teacher professional development in neuroscience that harnessed the power of active-learning strategies and best educational practices resulting in increased teacher and student understanding of cognition and brain function. For teachers, the experience of learning a novel subject in an active manner enabled them to subsequently teach using similar strategies. Most important, participants viewed neuroscience as a frame for understanding why active-learning pedagogies work to engage and motivate students. Teachers themselves made connections applying neuroscience concepts to understand why learner-centered pedagogies are effective in promoting higher order thinking and deep learning in their students. Teachers planned and embraced pedagogies involving modeling, experimentation, discussion, analysis, and synthesis, increasing classroom cognitive engagement. Comprehending that everyone is in charge of changing their own brains is a tremendously powerful idea that may motivate science and non-science teachers to provide students opportunities to actively engage with content. Neuroscience courses for preservice and in-service teachers, provided as collaborations between scientists and teacher educators, can result in improved science education, pedagogy, and understanding of neuroscience.

Learning Neuroscience with Technology: A Scaffolded, Active Learning Approach.

Mobile applications (apps) for learning technical scientific content are becoming increasingly popular in educational settings. Neuroscience is often considered complex and challenging for most students to understand conceptually. iNeuron is a recently developed iOS app that teaches basic neuroscience in the context of a series of scaffolded challenges to create neural circuits and increase understanding of nervous system structure and function. In this study, four different ways to implement the app within a classroom setting were explored. The goal of the study was to determine the app's effectiveness under conditions closely approximating real-world use, and to evaluate whether collaborative play and student-driven navigational features contributed to its effectiveness. Students used the app either individually or in small groups, and used a version with either a fixed or variable learning sequence. Student performance on a pre- and post- neuroscience content assessment was analyzed and compared between students who used the app and a control group receiving standard instruction, and logged app data were analyzed. Significantly greater learning gains were found for all students who used the app compared to control. All four implementation modes were effective in producing student learning gains relative to controls, but did not differ in their effectiveness to one another. In addition, students demonstrated transfer of information learned in one context to another within the app. These results suggest that teacher-led neuroscience instruction can be effectively supported by a scaffolded, technology-based curriculum which can be implemented in multiple ways to enhance student learning.

Neuroscientists' classroom visits positively impact student attitudes.

The primary recommendation of the 2010 President's Council of Advisors on Science and Technology report on K-12 education was to inspire more students so that they are motivated to study science. Scientists' visits to classrooms are intended to inspire learners and increase their interest in science, but verifications of this impact are largely qualitative. Our primary goal was to evaluate the impact of a longstanding Brain Awareness classroom visit program focused on increasing learners understanding of their own brains. Educational psychologists have established that neuroscience training sessions can improve academic performance and shift attitudes of students from a fixed mindset to a growth mindset. Our secondary goal was to determine whether short interactive Brain Awareness scientist-in-the-classroom sessions could similarly alter learners' perceptions of their own potential to learn. Teacher and student surveys were administered in 4(th)-6(th) grade classrooms throughout Minnesota either before or after one-hour Brain Awareness sessions that engaged students in activities related to brain function. Teachers rated the Brain Awareness program as very valuable and said that the visits stimulated students' interest in the brain and in science. Student surveys probed general attitudes towards science and their knowledge of neuroscience concepts (particularly the ability of the brain to change). Significant favorable improvements were found on 10 of 18 survey statements. Factor analyses of 4805 responses demonstrated that Brain Awareness presentations increased positive attitudes toward science and improved agreement with statements related to growth mindset. Overall effect sizes were small, consistent with the short length of the presentations. Thus, the impact of Brain Awareness presentations was positive and proportional to the efforts expended, demonstrating that short, scientist-in-the-classroom visits can make a positive contribution to primary school students' attitudes toward science and learning.

Neuroscience in middle schools: a professional development and resource program that models inquiry-based strategies and engages teachers in classroom implementation.

The Department of Neuroscience at the University of Minnesota and the Science Museum of Minnesota have developed and implemented a successful program for middle school (grades 5-8) science teachers and their students, called Brain Science on the Move. The overall goals have been to bring neuroscience education to underserved schools, excite students about science, improve their understanding of neuroscience, and foster partnerships between scientists and educators. The program includes BrainU, a teacher professional development institute; Explain Your Brain Assembly and Exhibit Stations, multimedia large-group presentation and hands-on activities designed to stimulate student thinking about the brain; Class Activities, in-depth inquiry-based investigations; and Brain Trunks, materials and resources related to class activities. Formal evaluation of the program indicated that teacher neuroscience knowledge, self-confidence, and use of inquiry-based strategies and neuroscience in their classrooms have increased. Participating teachers increased the time spent teaching neuroscience and devoted more time to "inquiry-based" teaching versus "lecture-based teaching." Teachers appreciated in-depth discussions of pedagogy and science and opportunities for collegial interactions with world-class researchers. Student interest in the brain and in science increased. Since attending BrainU, participating teachers have reported increased enthusiasm about teaching and have become local neuroscience experts within their school communities.