Metacognitive Management of Attention in Online Learning.

Performance during training is a poor predictor of long-term retention. Worse yet, conditions of training that produce rapidly improving performance typically do not produce long-lasting, generalizable learning. As a result, learners and instructors alike can be misled into adopting training or educational experiences that are suboptimal for producing actual learning. Computer-based educational training platforms can counter this unfortunate tendency by providing only productive conditions of instruction-even if they are unintuitive (e.g., spacing instead of massing). The use of such platforms, however, introduces a different liability: being easy to interrupt. An assessment of this possible liability is needed given the enormous disruption to modern education brought about by COVID-19 and the subsequent widespread emergency adoption of computer-based remote instruction. The present study was therefore designed to (a) explore approaches for detecting interruptions that can be reasonably implemented by an instructor, (b) determine the frequency at which students are interrupted during a cognitive-science-based digital learning experience, and (c) establish the extent to which the pandemic and ensuing lockdowns affected students' metacognitive ability to maintain engagement with their digital learning experiences. Outliers in time data were analyzed with increasing complexity and decreasing subjectivity to identify when learners were interrupted. Results indicated that only between 1.565% and 3.206% of online interactions show evidence of learner interruption. And although classroom learning was inarguably disrupted by the pandemic, learning in the present, evidence-based platform appeared to be immune.

Serial Trauma Abdominal Ultrasound in Children (STAUNCH): A Pilot Study.

BACKGROUND: Ultrasound has established utility within pediatric emergency medicine and has an added benefit of avoiding excessive radiation exposure. The serial focused assessment with sonography in trauma (sFAST) examination is a potential alternative to improve pediatric trauma evaluation. We sought to evaluate the accuracy of sFAST in pediatric patients with blunt abdominal trauma. METHODS: We performed a multicenter, retrospective observational study of electronic medical records, trauma registry data, and image archiving records of previous sFAST examinations. Examinations from pediatric patients (18 years or younger) who presented to an emergency department with blunt abdominal trauma were eligible for inclusion as long as the period between the first and second FAST was at least 30 minutes but no more than 24 hours. Demographic data and patient and outcomes were collected. RESULTS: Data collected from 3 institutions found a total of 38 sFAST performed between July 2017 and September 2021 on eligible patients. Of these, there were 6 (15.4%) FAST examinations that were positive after an initial negative or indeterminate interpretation. The overall sensitivity and specificity of sFAST were 66.7% (95% confidence interval 22.3-95.7%) and 93.8% (79.2-99.3%), respectively. CONCLUSIONS: This pilot study found that sFAST can enhance blunt trauma evaluation and improve sensitivity and diagnostic accuracy. More data are needed to determine how sFAST can be utilized in pediatric patients with blunt abdominal trauma.

Increased cyanophage infection at the bottom of the euphotic zone, especially in the fall.

Picocyanobacteria contribute greatly to offshore primary production with cells extending through the deep euphotic zone. Literature indicates high viral infection of cyanobacteria in ocean transition zones. We postulate that the bottom of the euphotic zone is a transition zone, where communities transition from phototrophic to aphotic processes. We use single-copy core genes to examine cyanophage to cyanobacteria ratios in cellular metagenomes in the subtropical North Atlantic and Pacific. Cyanophage to cyanobacteria terL/rpoB ratios generally increase to >10 in the deep euphotic zone. As light levels decrease in the fall, Prochlorococcus in the deep euphotic zone experience reduced light levels. We find clear differences between spring (Geotraces GA02) and fall (GA03) in the North Atlantic, with terL/rpoB ratios increasing to >40 in the fall. When examining 23 months of the North Pacific Hawaii Ocean Timeseries, the depth of elevated cyanophage to cyanobacteria ratios in cellular metagenomes negatively correlated with surface photosynthetic radiation (PAR), particularly with the change in PAR, which reflected the season. In fall, all picocyanobacteria ecotypes were found at depths enriched with viruses, while in summer, only low light ecotypes were affected. Thus, we find high cyanophage infection both in the deep euphotic zone and during seasonal transitions.

Associations between picocyanobacterial ecotypes and cyanophage host genes across ocean basins and depth.

Background: Cyanophages, viruses that infect cyanobacteria, are globally abundant in the ocean's euphotic zone and are a potentially important cause of mortality for marine picocyanobacteria. Viral host genes are thought to increase viral fitness by either increasing numbers of genes for synthesizing nucleotides for virus replication, or by mitigating direct stresses imposed by the environment. The encoding of host genes in viral genomes through horizontal gene transfer is a form of evolution that links viruses, hosts, and the environment. We previously examined depth profiles of the proportion of cyanophage containing various host genes in the Eastern Tropical North Pacific Oxygen Deficient Zone (ODZ) and at the subtropical North Atlantic (BATS). However, cyanophage host genes have not been previously examined in environmental depth profiles across the oceans. Methodology: We examined geographical and depth distributions of picocyanobacterial ecotypes, cyanophage, and their viral-host genes across ocean basins including the North Atlantic, Mediterranean Sea, North Pacific, South Pacific, and Eastern Tropical North and South Pacific ODZs using phylogenetic metagenomic read placement. We determined the proportion of myo and podo-cyanophage containing a range of host genes by comparing to cyanophage single copy core gene terminase (terL). With this large dataset (22 stations), network analysis identified statistical links between 12 of the 14 cyanophage host genes examined here with their picocyanobacteria host ecotypes. Results: Picyanobacterial ecotypes, and the composition and proportion of cyanophage host genes, shifted dramatically and predictably with depth. For most of the cyanophage host genes examined here, we found that the composition of host ecotypes predicted the proportion of viral host genes harbored by the cyanophage community. Terminase is too conserved to illuminate the myo-cyanophage community structure. Cyanophage cobS was present in almost all myo-cyanophage and did not vary in proportion with depth. We used the composition of cobS phylotypes to track changes in myo-cyanophage composition. Conclusions: Picocyanobacteria ecotypes shift with changes in light, temperature, and oxygen and many common cyanophage host genes shift concomitantly. However, cyanophage phosphate transporter gene pstS appeared to instead vary with ocean basin and was most abundant in low phosphate regions. Abundances of cyanophage host genes related to nutrient acquisition may diverge from host ecotype constraints as the same host can live in varying nutrient concentrations. Myo-cyanophage community in the anoxic ODZ had reduced diversity. By comparison to the oxic ocean, we can see which cyanophage host genes are especially abundant (nirA, nirC, and purS) or not abundant (myo psbA) in ODZs, highlighting both the stability of conditions in the ODZ and the importance of nitrite as an N source to ODZ endemic LLV Prochlorococcus.

Increased Incidence of Methicillin-Resistant Staphylococcus aureus in Knee and Hip Prosthetic Joint Infection.

BACKGROUND: Periprosthetic joint infection (PJI) is a devastating complication of knee and hip arthroplasty. Past literature has shown that gram-positive bacteria are commonly responsible for these infections, although limited research exists studying the changes in the microbial profile of PJIs over time. This study sought to analyze the incidence and trends of pathogens responsible for PJI over three decades. METHODS: This is a multi-institutional retrospective review of patients who had a knee or hip PJI from 1990 to 2020. Patients with a known causative organism were included and those with insufficient culture sensitivity data were excluded. There were 731 eligible joint infections from 715 patients identified. Organisms were divided into multiple categories based on genus/species and 5-year increments were used to analyze the study period. The Cochran-Armitage trend tests were used to evaluate linear trends in microbial profile over time and a P-value <.05 was considered statistically significant. RESULTS: There was a statistically significant positive linear trend in the incidence of methicillin-resistant Staphylococcus aureus over time (P = .0088) as well as a statistically significant negative linear trend in the incidence of coagulase-negative staphylococci over time (P = .0018). There was no statistical significance between organism and affected joint (knee/hip). CONCLUSION: The incidence of methicillin-resistant Staphylococcus aureus PJI is increasing over time, whereas, coagulase-negative staphylococci PJI is decreasing, paralleling the global trend of antibiotic resistance. Identifying these trends may help with the prevention and treatment of PJI through methods such as remodeling perioperative protocols, modifying prophylactic/empiric antimicrobial approaches, or transitioning to alternative therapeutic strategies.

Reducing central line-associated bloodstream infection (CLABSI) rates with cognitive science-based training.

There have been many tactics throughout the years aimed at reducing central line-associated bloodstream infections (CLABSI) in the healthcare setting. To reduce CLABSI rates at this facility, we employed cognitive science-based online training directed at nursing departments. Following implementation, we found significant reductions in CLABSI rates that were sustained for a minimum of 9 months. These results demonstrate that this learning methodology can be used to help decrease CLABSI and potentially other health care-associated infections.

An analysis of protists in Pacific oxygen deficient zones: implications for Prochlorococcus and N2 -producing bacteria.

Ocean oxygen deficient zones (ODZs) host 30%-50% of marine N2 production. Cyanobacteria photosynthesizing in the ODZ create a secondary chlorophyll maximum and provide organic matter to N2 -producing bacteria. This chlorophyll maximum is thought to occur due to reduced grazing in anoxic waters. We first examine ODZ protists with long amplicon reads. We then use non-primer-based methods to examine the composition and relative abundance of protists in metagenomes from the Eastern Tropical North and South Pacific ODZs and compare these data to the oxic Hawaii Ocean Time-series (HOT) in the North Pacific. We identify and quantify protists in proportion to the total microbial community. From metagenomic data, we see a large drop in abundance of fungi and protists such as choanoflagellates, radiolarians, cercozoa and ciliates in the ODZs but not in the oxic mesopelagic at HOT. Diplonemid euglenozoa were the only protists that increased in the ODZ. Dinoflagellates and foraminifera reads were also present in the ODZ though less abundant compared to oxic waters. Denitrification has been found in foraminifera but not yet in dinoflagellates. DNA techniques cannot separate dinoflagellate cells and cysts. Metagenomic analysis found taxonomic groups missed by amplicon sequencing and identified trends in abundance.

Confidence-weighted Testing as an Impactful Education Intervention within a Pediatric Sepsis Quality Improvement Initiative.

INTRODUCTION: Confidence-weighted testing assesses learners' beliefs about their knowledge and skills. As part of a hospital-wide quality improvement initiative to enhance care for pediatric patients with suspected sepsis, we developed a novel intervention using confidence-weighted testing to identify institutional areas of misinformation and knowledge gaps while also providing real-time feedback to individual learners. METHODS: We developed pediatric sepsis eLearning modules incorporating confidence-weighted testing. We distributed them to nurses, advanced practitioners, and physicians in emergency departments and acute care/non-intensive care unit inpatient settings in our hospital system. We analyzed completion and response data over 2 years following module distribution. Our outcomes included completion, confidently held misinformation (CHM; when a learner answers a question confidently but incorrectly), struggle (when a learner repeatedly answers a question incorrectly or with low confidence), and mastery (when a learner initially answers a question correctly and confidently). RESULTS: Eighty-three percent of assigned learners completed the modules (1,463/1,754). Although nurses had significantly more misinformation and struggled more than physicians and advanced practitioners, learners of all roles achieved 100% mastery as part of module completion. The greatest CHM and struggle were found in serum lactate interpretation's nuances and the hemodynamic shock states commonly seen in sepsis. CONCLUSIONS: Our novel application of confidence-weighted testing enhanced learning by correcting learners' misinformation. It also identified systems issues and institutional knowledge gaps as targets for future improvement.

Cyanophage host-derived genes reflect contrasting selective pressures with depth in the oxic and anoxic water column of the Eastern Tropical North Pacific.

Cyanophages encode host-derived genes that may increase their fitness. We examined the relative abundance of 18 host-derived cyanophages genes in metagenomes and viromes along depth profiles from the Eastern Tropical North Pacific Oxygen Deficient Zone (ETNP ODZ) where Prochlorococcus dominates a secondary chlorophyll maximum within the ODZ. Cyanophages at the oxic primary chlorophyll maximum encoded genes related to light and phosphate stress (psbA, psbD and pstS in T4-like and psbA in T7-like), but the proportion of cyanophage with these genes decreased with depth. The proportion of cyanophage with purine biosynthesis genes increased with depth in T4-like, but not T7-like cyanophages. No additional host-derived genes were found in deep T7-like cyanophages, suggesting that T4-like and T7-like cyanophages have different host-derived gene acquisition strategies, possibly linked to their different genome packaging mechanisms. In contrast to the ETNP, in the oxic North Atlantic T4-like cyanophages encoded psbA and pstS throughout the euphotic zone. Differences in pstS between the ETNP and the North Atlantic stations were consistent with differences in phosphate concentrations in those regimes. We suggest that the low proportion of cyanophage with psbA within the ODZ reflects the stably stratified low-light conditions occupied by their hosts, a Prochlorococcus ecotype endemic to ODZs.

When and why a failed test potentiates the effectiveness of subsequent study.

Teachers and trainers often try to prevent learners from making errors, but recent findings (e.g., Kornell, Hays, & Bjork, 2009) have demonstrated that tests can potentiate subsequent learning even when the correct answer is difficult or impossible to generate (e.g., "What is Nate Kornell's middle name?"). In 3 experiments, we explored when and why a failed test enhances learning. We found that failed tests followed by immediate feedback produced greater retention than did a presentation-only condition. Failed tests followed by delayed feedback, by contrast, did not produce such a benefit-except when the direction of the final test was reversed (i.e., the participants were provided with the target and had to produce the original cue). Our findings suggest that generating an incorrect response to a cue both activates the semantic network associated with the cue and suppresses the correct response. These processes appear to have 2 consequences: If feedback is presented immediately, the semantic activation enhances the mapping of the cue to the correct response; if feedback is presented at a delay, the prior suppression boosts the learning of the suppressed response.

Benefits of Accumulating Versus Diminishing Cues in Recall.

Optimizing learning over multiple retrieval opportunities requires a joint consideration of both the probability and the mnemonic value of a successful retrieval. Previous research has addressed this trade-off by manipulating the schedule of practice trials, suggesting that a pattern of increasingly long lags-"expanding retrieval practice"-may keep retrievals successful while gradually increasing their mnemonic value (Landauer & Bjork, 1978). Here we explore the trade-off issue further using an analogous manipulation of cue informativeness. After being given an initial presentation of English-Iñupiaq word pairs, participants received practice trials across which letters of the target word were either accumulated (AC), diminished (DC), or always fully present. Diminishing cues yielded the highest performance on a final test of cued recall. Additional analyses suggest that AC practice promotes potent (effortful) retrieval at the cost of success, and DC practice promotes successful retrieval at the cost of potency. Experiment 2 revealed that the negative effects of AC practice can be partly ameliorated by providing feedback after each practice trial.

The costs and benefits of providing feedback during learning.

It seems uncontroversial that providing feedback after a test, in the form of the correct answer, enhances learning. In real-world educational situations, however, the time available for learning is often constrained-and feedback takes time. We report an experiment in which total time for learning was fixed, thereby creating a trade-off between spending time receiving feedback and spending time on other learning activities. Our results suggest that providing feedback is not universally beneficial. Indeed, under some circumstances, taking time to provide feedback can have a negative net effect on learning. We also found that learners appear to have some insight about the costs of feedback; when they were allowed to control feedback, they often skipped unnecessary feedback in favor of additional retrieval attempts, and they benefited from doing so. These results underscore the importance of considering the costs and benefits of interventions designed to enhance learning.

Unsuccessful retrieval attempts enhance subsequent learning.

Taking tests enhances learning. But what happens when one cannot answer a test question-does an unsuccessful retrieval attempt impede future learning or enhance it? The authors examined this question using materials that ensured that retrieval attempts would be unsuccessful. In Experiments 1 and 2, participants were asked fictional general-knowledge questions (e.g., "What peace treaty ended the Calumet War?"). In Experiments 3-6, participants were shown a cue word (e.g., whale) and were asked to guess a weak associate (e.g., mammal); the rare trials on which participants guessed the correct response were excluded from the analyses. In the test condition, participants attempted to answer the question before being shown the answer; in the read-only condition, the question and answer were presented together. Unsuccessful retrieval attempts enhanced learning with both types of materials. These results demonstrate that retrieval attempts enhance future learning; they also suggest that taking challenging tests-instead of avoiding errors-may be one key to effective learning.