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Background: Collaborative learning is a group learning approach in which positive social interdependence within a group is key to better learning performance and future attitudes toward team practice. Recent attempts to replace a face-to-face environment with an online one have been developed using information communication technology. However, this raises the concern that online collaborative learning (OCL) may reduce positive social interdependence. Therefore, this study aimed to compare the degree of social interdependence in OCL with face-to-face environments and clarify aspects that affect social interdependence in OCL., Methods: We conducted a crossover study comparing online and face-to-face collaborative learning environments in a clinical reasoning class using team-based learning for medical students (n = 124) in 2021. The participants were randomly assigned to two cohorts: Cohort A began in an online environment, while Cohort B began in a face-to-face environment. At the study's midpoint, the two cohorts exchanged the environments as a washout. The participants completed surveys using the social interdependence in collaborative learning scale (SOCS) to measure their perceived positive social interdependence before and after the class. Changes in the mean SOCS scores were compared using paired t-tests. Qualitative data related to the characteristics of the online environment were obtained from the focus groups and coded using thematic analysis., Results: The matched-pair tests of SOCS showed significant progression between pre- and post-program scores in the online and face-to-face groups. There were no significant differences in overall SOCS scores between the two groups. Sub-analysis by subcategory showed significant improvement in boundary (discontinuities among individuals) and means interdependence (resources, roles, and tasks) in both groups, but outcome interdependence (goals and rewards) improved significantly only in the online group. Qualitative analysis revealed four major themes affecting social interdependence in OCL: communication, task-sharing process, perception of other groups, and working facilities., Conclusions: There is a difference in the communication styles of students in face-to-face and online environments, and these various influences equalize the social interdependence in a face-to-face and online environment., (© 2022. The Author(s).)

Research on online collaborative learning has explored various methods of collaborative improvement. Recently, learning analytics have been increasingly adopted for ascertaining learners' states and promoting collaborative performance. However, little effort has been made to investigate the transformation of collaborative states or to consider cognitive load as an essential factor for collaborative intervention. By bridging collaborative cognitive load theory and system dynamics modeling methods, this paper revealed the transformation of online learners' collaborative states through data analysis, and then proposed an optimized mechanism to ameliorate online collaboration. A quasi-experiment was conducted with 91 college students to examine the potential of the optimized mechanism in collaborative state transformation, awareness of collaboration, learning achievement, and cognitive load. The promising results demonstrated that students learning with the optimized mechanism performed significantly differently in collaboration and knowledge acquisition, and no additional burden in cognitive load was noted.

Investigation of consciousness (experience, mind, awareness, subjectivity) has become an accepted endeavor in contemporary neuroscience. However, current work is largely limited to study of neural correlates of consciousness. While this is interesting and important, it may not be sufficient to carry us to a place of truly new insight regarding consciousness. I argue that one element of expanding a science of consciousness is appreciation of the interdependent co-creation or enfolding of mind and world. Addressing this interdependence is an aspect of the collaborative engagement of the traditions of Buddhism and science-a project that is exploring how complementary worldviews and analytic procedures might further the development of an expanded science of mind. In this essay, written for a collection honoring the life and work of Jack Pettigrew, I describe his connection to this project., (© 2020 Wiley Periodicals, Inc.)

Objectives: This pilot study aimed to determine the effect of nurse/physician interdisciplinary team training on patient falls. Specifically, we evaluated team training in a simulation center as a method for targeting and minimizing breakdowns in perceptions of respect, collaboration, communication, and role misunderstanding behaviors between care disciplines., Methods: Registered nurses (RNs) were randomly assigned to participate. Residents were divided into groups and assigned based on their availability and clinical responsibility. All participants completed a demographic form, the Professional Practice Environment Assessment Scale (PPEAS), and the Mayo High Performance Teamwork Scale (MHPTS) after consenting and before participation in simulation training. The PPEAS and the MHPTS were readministered at 2 and 6 months after the simulation experience. Differences in MHPTS and PPEAS scores between the baseline and 2- and 6-month assessments were analyzed; fall rates over time were evaluated using Cochran-Armitage trend tests., Results: After the team training exercises, teamwork as measured by the MHPTS improved significantly at both 2 and 6 months (P = 0.01; P < 0.001) compared with baseline measurement. Practice environment subscores, with the exception of positive organizational characteristics, also increased when measured 6 months after training. The primary outcome, reduction in anticipated patient falls, improved significantly (P = 0.02) over the course of the study., Conclusions: Results of this pilot study show that team training exercises result in improvement in both patient safety (anticipated patient falls) and team member perception of their work environment. If validated by other studies, improvement in this patient safety metric would represent an important benefit of simulation and team training.

Health care team training and simulation-based education are important for preparing obstetrical services to meet the challenges of the COVID-19 pandemic. Priorities for training are identified in two key areas. First, the impact of infection prevention and control protocols on processes of care (e.g., appropriate and correct use of personal protective equipment, patient transport, preparation for emergency cesarean delivery with the potential for emergency intubation, management of simultaneous obstetric emergencies, delivery in alternate locations in the hospital, potential for increased decision-to-delivery intervals, and communication with patients). And second, the effects of COVID-19 pathophysiology on obstetrical patients (e.g., testing and diagnosis, best use of modified obstetric early warning systems, approach to maternal respiratory compromise, collaboration with critical care teams, and potential need for cardiopulmonary resuscitation). However, such training is more challenging during the COVID-19 pandemic because of the requirements for social distancing. This article outlines strategies (spatial, temporal, video-recording, video-conferencing, and virtual) to effectively engage in health care team training and simulation-based education while maintaining social distancing during the COVID-19 pandemic., (Copyright © 2020 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

Purpose: To explore team learning processes among interdisciplinary teacher teams in the development of integrated health professions education and to investigate students' perspectives on the quality of the educational courses., Method: Using an exploratory, sequential mixed-methods design, the first author conducted 17 vignette-guided, semistructured interviews with teachers originating from diverse disciplines. These teachers worked in different courses of integrated, undergraduate health professions programs at the Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands. The interview guide and vignettes were based on team learning research. The interviews sought to establish how interdisciplinary teacher team members work together on integrated curricula. The vignettes reflected constructs of team learning processes: sharing, co-construction, and constructive conflict. Data were collected between November 2017 and March 2018 and analyzed using template analysis. Sequentially, course evaluation data were used to provide a descriptive analysis of students' perspectives on educational quality (course organization, structure, learning effect, and alignment)., Results: Three team approaches were identified. In fragmented teams or "hangouts," teachers individually worked on tasks that they were interested in, leaving their disciplinary mark. Framework-guided teams or "distribution centers" aimed to work within the given frameworks and organizational expectations, striving for disciplinary balance. Integrated teacher teams or "melting pots" used an interdisciplinary approach on all topics and put students at the center. Integrated teams reflected high-level team learning processes and were most satisfied with their (team)work. In contrast, fragmented and framework-guided teams mainly reflected low-level team learning processes. Students evaluated courses of integrated teacher teams highest on all investigated quality items (course organization, structure, learning effect, and alignment)., Conclusions: Successful interdisciplinary teacher teams are represented by an integrated approach with high-level team learning behavior and the best course evaluations. Therefore, health professions education management should actively encourage and facilitate integrated teacher teamwork.

Practising team-based primary care allows Federally Qualified Health Centers (FQHC) in the USA to be accredited as patient-centred medical homes, positioning them for value-based models of shared savings in healthcare costs. Team-based care (TBC) involves redesign of staff roles and care delivery processes to improve efficiency and effectiveness, which requires a systematic and supportive approach to practice change over time. Thirteen FQHC primary care teams participated in an 8-month learning collaborative with a goal of providing teams with the knowledge, skills and coaching support needed to advance TBC in their organisations. The primary aim was to evaluate self-reported changes in FQHC teams' assessment of their practice relative to key concepts of TBC. The secondary aim was to evaluate how teams used the collaborative to develop new skills to advance TBC, and the implementation, service and patient outcomes they achieved. Site visits were conducted with three teams 6 months postcollaborative. Results: Two teams withdrew. The remaining teams embarked on 15 TBC improvement initiatives. Nine teams submitted a total of 11 playbooks to guide other staff in changes to their practice. Three teams reported improved efficiencies at the service level (screening and scheduling), and one improved outcomes in patients with diabetes. The nine teams that completed precollaborative and postcollaborative self-assessments reported improvements in their practice and in coach and team skills. Site visits revealed that actionable data were a barrier to improvement, coaching support from the collaborative was highly valued and FQHC leadership support was critical to improvement. Leadership investment in developing their primary care teams' quality improvement, coaching and data analytical skills can advance TBC in their organisations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: An estimated of 500,000 women and girls in the European Union (EU) have undergone female genital mutilation (FGM), with a further 180,000 at risk every year. Meeting the needs of these women and girls demands multidisciplinary action. This paper presents the United to End Female Genital Mutilation (UEFGM) knowledge platform, which is part of an EU-funded project. The platform is designed as a practice tool to improve the knowledge and skills of professionals who are likely to come into contact with women and girls affected by FGM. Method: Literature review was applied in regard to FGM along with expert validation process for the development of the modules particularly the e-learning section, expert and stakeholders' meetings for the other pillars of the Platform. Results: Three pillars were developed in the Platform: a) e-learning, b) country specific focus and c) live-knowledge discussion forum. The Platform explores related knowledge, skills, good practices, shared knowledge among professionals. UEFGM serves professionals and public as well in EU and worldwide. Conclusion: UEFGM comprises e-learning with a country-specific focus and a live discussion forum in which knowledge is shared between professionals worldwide. UEFGM discusses FGM and all related matters in a culturally- and gender-sensitive manner. It is a unique multidisciplinary and multilingual educational resource that has been found useful in everyday practice.

Introduction: Blended-learning methods could be a response to student nonattendance. Non-compulsory teaching combining e-learning/interactive face-to-face sessions has been implemented at Paris-Diderot Medical School for the teaching of intensive care and emergency medicine during the 2018/2019 university period. The aim of the study was to assess this newly-implemented blended teaching., Methods: Questionnaire submitted to the 388 DFASM3 medical students present at the faculty exam of intensive care/emergency medicine. Attendance at a teaching modality was defined by the follow-up of more than half of this teaching modality. Correlations between attendance at e-learning and/or interactive face-to-face sessions, and grade were performed., Results: A total of 358/388 (92%) students participated in this survey. A quarter of the students (88/321 - 25%) reported they usually attended at traditional lectures. Regarding blended-learning, 210/317 (67%) students reported having attended at e-learning courses and 84/321 (27%) attended at interactive face-to-face sessions. The distribution of students according to their attendance at e-learning and/or interactive face-to-face sessions was significantly different (P<0.01). There was a significant correlation (P<0.001) between attendance at e-learning and grade obtained at the faculty exam. Nevertheless, this correlation was also found for these students in another course taught traditionally. Overall, 309/315 (98%) students were satisfied with the blended teaching, 297/318 (93%) wanted its extent to the whole medical school's curriculum., Conclusion: The use of combined learning methods reached more students than traditional teachings and allowed the University to focus on its role of knowledge transfer., (Copyright © 2020 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Background and Purpose: To describe the implementation of blended learning in teaching motivational interviewing (MI) to third-year pharmacy students and evaluate changes in MI knowledge by assessing students' abilities to recognize and formulate responses using MI skills after the training and, for a subset of students, one year later., Educational Activity and Setting: The comMIt e-learning program was integrated into a third-year pharmacy communication course. Skills learned in the program were applied and assessed using e-learning quizzes, three in-class practice sessions and a 5-minute final assessment video. In addition, students completed a 22-item pre- and post-survey addressing their abilities to recognize and formulate statements using MI skills. This survey was voluntarily completed again one year later., Findings: Sixty students completed the training and showed a statistically significant improvement between the pre- and post-surveys. Twenty-seven students voluntarily responded to the survey one year later. While overall performance dropped between the post-survey and the one-year follow-up, students sustained their ability to formulate appropriate MI responses to the open-response questions., Summary: This study demonstrates that students can successfully learn and retain MI skills using blended learning via the comMIt e-learning program and in-class practice activities., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Deep neural networks (DNNs) have been very successful for supervised learning. However, their high generalization performance often comes with the high cost of annotating data manually. Collecting low-quality labeled dataset is relatively cheap, e.g., using web search engines, while DNNs tend to overfit to corrupted labels easily. In this paper, we propose a collaborative learning (co-learning) approach to improve the robustness and generalization performance of DNNs on datasets with corrupted labels. This is achieved by designing a deep network with two separate branches, coupled with a relabeling mechanism. Co-learning could safely recover the true labels of most mislabeled samples, not only preventing the model from overfitting the noise, but also exploiting useful information from all the samples. Although being very simple, the proposed algorithm is able to achieve high generalization performance even a large portion of the labels are corrupted. Experiments show that co-learning consistently outperforms existing state-of-the-art methods on three widely used benchmark datasets., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The opioid crisis has impacted vulnerable populations, specifically pregnant and postpartum women, and infants prenatally exposed to substances, including infants with Neonatal Abstinence Syndrome. Lack of access to clinical and social services; potential stigma or discrimination; and lack of resources for provision of services, including screening and treatment, have impacted the health of these populations. In 2018, using a systems change approach, the Association of State and Territorial Health Officials (ASTHO) and the Centers for Disease Control and Prevention (CDC) convened an Opioid use disorder, Maternal outcomes, Neonatal abstinence syndrome Initiative Learning Community (OMNI LC) that included other federal agencies, national clinical and nonclinical organizations, and 12 state leadership groups. The purpose of the OMNI LC was to determine areas of focus and identify strategies and best practices for implementing systems change to improve maternal and infant outcomes associated with opioid use disorder (OUD) during the perinatal period. Activities included in-person convenings with policy goal action plan development, virtual learning sessions, intensive technical assistance (TA), and temporary field placements. The OMNI LC partnering agencies and state teams met bimonthly for the first year of the initiative. At the in-person convening, state teams identified barriers to developing and implementing systems change in activity-specific action plans within five areas of focus: financing and coverage; access to and coordination of quality services; provider training and awareness; ethical, legal, and social considerations; and data, monitoring, and evaluation. State teams also identified stakeholder partnerships as a necessary component of strategy development in all areas of focus. Four virtual learning sessions were conducted on the areas of focus identified by state teams, and ASTHO conducted three intensive TA opportunities, and five states were identified for temporary field placement. To successfully address the impact of the opioid crisis on pregnant and postpartum women and infants, states developed innovative strategies focused on increasing support, services, and resources. Moving forward, state teams will participate in two additional in-person meetings, continue to identify barriers to the work, refine and customize action plans, and set new goals, to effect broad-ranging systems change for these vulnerable populations.

Interactive displays are becoming increasingly popular in informal learning environments as an educational technology for improving students' learning and enhancing their engagement. Interactive displays have the potential to reinforce and maintain collaboration and rich-interaction with the content in a natural and engaging manner. Despite the increased prevalence of interactive displays for learning, there is limited knowledge about how students collaborate in informal settings and how their collaboration around the interactive surfaces influences their learning and engagement. We present a dual eye-tracking study, involving 36 participants, a two-staged within-group experiment was conducted following single-group time series design, involving repeated measurement of participants' gaze, voice, game-logs and learning gain tests. Various correlation, regression and covariance analyses employed to investigate students' collaboration, engagement and learning gains during the activity. The results show that collaboratively, pairs who have high gaze similarity have high learning outcomes. Individually, participants spending high proportions of time in acquiring the complementary information from images and textual parts of the learning material attain high learning outcomes. Moreover, the results show that the speech could be an interesting covariate while analyzing the relation between the gaze variables and the learning gains (and task-based performance). We also show that the gaze is an effective proxy to cognitive mechanisms underlying collaboration not only in formal settings but also in informal learning scenarios.

Collaborative innovation is widely recognized as an instrument to promote technological convergence. However, its effects on technological convergence remain debatable. Using firm-level panel data of patenting in the Korean ICT industry from 1980 to 2015, I examine the effects of four collaborative innovation types (i.e., Inter-firm, Inter-ICT firm, Firm-University, and Firm-Government Research Institution (GRI) on ICT-based technological convergence. The results reveal the magnitude of Inter-ICT firm collaborative innovation was found to be significant and largest. The effects of the remaining three collaborative innovation types were significant but inconsiderable. Governments may consider the differential effects of collaboration types when designing incentive systems to promote technological convergence., Competing Interests: The author has declared that no competing interests exist.

Teaching and learning practices often fail to incorporate new concepts in the ever-evolving field of medical education. Although medical education research provides new insights into curricular development, learners' engagement, assessment methods, professional development, interprofessional education, and so forth, faculty members often struggle to modernize their teaching practices. Communities of practice (CoP) for faculty development offer an effective and sustainable approach for knowledge management and implementation of best practices. A successful CoP creates and shares knowledge in the context of a specific practice toward the development of expertise. CoPs' collaborative nature, based on the co-creation of practical solutions to daily problems, aligns well with the goals of applying best practices in health professions education and training new faculty members. In our article, we share 12 tips for implementing a community of practice for faculty development. The tips were based on a comprehensive literature review and the authors' experiences.

Background: There are challenges in creating positive clinical learning environments. A new model of practice learning for pre-registration nurse education was pilot-tested in the East of England. The Collaborative Learning in Practice model (CLIP) was developed from a similar model of practice learning used in the Netherlands., Objectives: We undertook an evaluation of a new approach to clinical learning. The aims of the project were to consider the challenges of implementation; consider the perception of gains and losses of students and stakeholders experiencing the new model of practice learning; and consider the sustainability of the new model in the context of service delivery., Methods: Mixed methods were used. Data were collected in three forms: (1) a survey of students undertaking the CLIP model and those learning within the existing mentorship model to assess the supervisory relationships and pedagogical atmosphere experienced; (2) student focus groups; and (3) qualitative one-to-one interviews with key stakeholders in the provision of practice learning environments., Results: A total of 607 questionnaires were returned out of the 738 distributed, five focus groups of a total of 30 students were undertaken, and 13 stakeholders were interviewed. Students who had experienced CLIP reported lower supervisory relationship scores compared with those without experience (mean difference = -0.24 points, 95% CI -0.21 to -0.094, p = 0.001). There was no difference in pedagogical atmosphere scores (mean difference -0.085 points, 95% CI -0.21 to 0.040, p = 0.19). Analysis of qualitative data produced two themes: 'Adapting the environment' illustrated the importance of learning context and 'learning to fly' highlighted the process of students gaining greater autonomy., Conclusion: Our findings suggest that collaborative learning in practice offers many benefits as an approach to clinical learning but with important caveats. Attention needs to be paid to particular aspects of the model such as sufficient numbers of students, and an acknowledgement of perceived losses as well as gains., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Teaching is a highly complex activity that draws on many kinds of knowledge. In this paper, we present our findings on the impact of implementing collaborative, active learning using peer instructions in pharmacology lectures. The hypothesis "implementation of collaborative, active learning increases students' understanding of pharmacological concepts, and thereby exam performance" was proven. Active learning was implemented in lectures on pharmacodynamics (10% of total lectures) in three different pharmacology courses. Teaching methods in the remaining lectures in the courses were unchanged. Prior to each lecture on pharmacodynamics, students were instructed to prepare using questions addressing key concepts in the curriculum that would be covered by the following lecture. In the lectures, students' understanding of these concepts was assessed using anonymous, online polls (ConcepTests). Collaborative learning was supported using peer instructions. Using the anonymous results of 15 written exams with 1097 submissions we show that the percentage of students achieving 50% or more of maximum points per exam question is significantly increased in questions relating to peer instructions lectures (P = 0.029, Odds Ratio (IQR) 1.83 (1.07, 3.15)). The observation is not explained by a general improvement of student performance (P = 0.289, Odds Ratio 1.15 (0.89, 1.51)). Both students' and the teacher have a positive perception of the active learning strategy and the possibility to give and receive instant feedback on students' learning progress. We conclude that implementation of collaborative, active learning using peer instructions, significantly improves students' learning in pharmacology., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Despite research support, evidence-based practices (EBPs) are inconsistently implemented throughout the United States. Facilitation is one implementation strategy to speed adoption in clinical settings. Facilitation has not been previously described in the literature as an implementation strategy within neonatal care., Purpose: The purpose of this study was to categorize and describe essential features of facilitation in the context of implementing an EBP using perspectives elicited from neonatal clinicians and external facilitators (EFs)., Methods: In this qualitative descriptive study, semistructured interviews were conducted with a purposive sample of neonatal clinicians and EFs. Participants shared their experiences related to the strategy of facilitation while implementing an EBP during the California Perinatal Quality Care Antibiotic Stewardship Collaborative. Interviews were transcribed, coded, and analyzed using directed content analysis., Results: Five categories emerged to address facilitation as an implementation strategy: (a) facilitated change management, (b) unit and organization receptivity, (c) evaluation strategies, (d) supportive culture, and (e) facilitator stewardship., Linking Evidence to Action: Implementing EBP is complex and multifactorial. Results from this study provide insights into influencing barriers and drivers as experienced by internal and external facilitators, and context factors that impacted the success of implementation., (© 2019 Sigma Theta Tau International.)

Purpose of Review: This review describes the global development of a model of technology-enabled collaborative learning for healthcare professionals called Project ECHO (Extension for Community Healthcare Outcomes) and its applications for the management of patients with skeletal diseases., Recent Findings: The prototype Bone Health TeleECHO was established in 2015, with others now operational in the USA and other countries, and more expected to follow soon. Each teleECHO program, in the right language and convenient time zone, provides a virtual community of practice for healthcare professionals to benefit from real-time interactive case-based learning and brief didactic presentations on topics of interest. Bone Health TeleECHO elevates the level of knowledge of participants and improves self-confidence in managing patients with skeletal diseases. The development of many teleECHO programs worldwide serves as a force multiplier, with the potential to narrow the osteoporosis treatment gap and enhance the effectiveness of fracture liaison services.

Objective. To describe students' experiences and perceptions of non-traditional student-preceptor learning models and evaluate the effectiveness of these models on students' learning experience. Methods. Pharmacy students who had completed at least one experiential rotation with a non-traditional learning model participated in semi-structured interviews. Models included peer-assisted learning (PAL; two or more students of same educational level), near-peer teaching (NPT; one or more junior students with one or more senior students), and co-preceptorship (CoP; two or more preceptors). Interviews were transcribed, coded, and analyzed for themes. Themes were mapped according to the Kirkpatrick model for evaluating educational training. Results. Twenty semi-structured interviews were conducted. Forty-three experiences (19 CoP, 14 PAL, 10 NPT) from 14 institutions were described. Many themes overlapped between the three models. In CoP, learners described increased preceptor availability and exposure to different patient care approaches. Challenges arose when preceptors had different expectations. Students overwhelmingly endorsed a multi-learner environment. Both PAL and NPT learners felt supported as collaboration with other learners was readily fostered. Potential challenges in PAL and NPT were difficulties when personalities conflicted and when there was a significant knowledge gap between the learners. All three models allowed for the development of skills, including communication and collaboration. Learners reported an enhanced approach to patient care and professional practice, including approaches to teaching as new preceptors. Conclusion. Pharmacy students and graduates valued their experiences in non-traditional student-preceptor models. Institutions may find support for using these precepting models to increase placement capacity., (© 2019 American Association of Colleges of Pharmacy.)

Introduction: Team-based learning (TBL) is an active learning strategy used at the University of Arkansas for Medical Sciences in both the preclinical and clinical years of medical school. The Department of Obstetrics and Gynecology (OB/GYN) uses TBLs during a 6-week clinical clerkship. This TBL is the first in a series of six and was designed to teach the topic of normal obstetrics to third-year medical students., Methods: Prior to the TBL, students were provided with learning objectives and a list of advance preparation resources. These resources included a reading assignment from the student textbook, as well as optional online videos and optional online interactive quizzes. The students then came to class and completed an individual readiness assurance test (iRAT) and a group readiness assurance test (gRAT). The majority of in-class time was spent working through complex application exercises in the form of case vignettes. The TBLs were facilitated by a faculty member in the OB/GYN department., Results: Since its initiation in June 2018, 93 students have participated in this TBL activity. The mean score on the iRAT was 88.9%, and the mean score on the gRAT was 98.8%. Ninety-eight percent of students reported that they were satisfied with this learning activity., Discussion: This TBL was well received by students and unique in that it utilized a variety of types of advance preparation resources. With few other published OB/GYN TBLs available, we believe that this module could be a valuable resource for OB/GYN clerkships., Competing Interests: None to report., (Copyright © 2019 Sward and Tariq.)

Introduction: Incorporating social writing habits into your practice has many benefits, including new ideas, growth and development, accountability, networking opportunities, better-focused writing, and even increased productivity. In this commentary, we discuss the social habits of writing as described by Dr. Helen Sword in her book Air & Light & Time & Space and provide suggestions for how to incorporate these habits in order to elevate your academic writing., Commentary: Social habits of writing include writing for others, writing with others, and writing among others. Writing for others highlights the important relationship between author and reader. As writers consider their audience, the goal is to share the efforts of their research or other learning, which includes lessons learned along the way. Serving as a peer reviewer can be beneficial to a writer's development and significantly contributes to the scientific community. Writing with others, or collaborating on a writing project, provides accountability, efficiency, and diversity of skills and viewpoints. When working with others, especially trainees, it is important to set clear expectations of roles, responsibilities, and timelines up front. Finally, writing among others, or working in concert with others but on different projects, can occur in person or virtually with the aid of technology. Writing among others can provide development, accountability, networking, and aid creativity., Implications: We can all work to elevate our writing through attention to the social habits of writing. Developing and using these techniques may take time to implement. Practically, making small changes may be the most successful., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The automated tape placement and the automated fiber placement (AFP) machines provide a safer working environment and reduce the labor intensity of workers than the traditional manual fiber placement does. Thus, the production accuracy, repeatability and efficiency of composite manufacturing are significantly improved. However, the current AFP systems can only produce the composite components with large open surface or simple revolution parts, which cannot meet the growing interest in small complex or closed structures from industry. In this research, by employing a 1-degree of freedom (DoF) rotational stage, a 6-RSS parallel robot, and a 6-DoF serial robot, the dexterity of the AFP system can be significantly improved for manufacturing complex composite parts. The rotational stage mounted on the parallel robot is utilized to hold the mandrel and the serial robot carries the placement head to mimic two human hands that have enough dexterity to lay the fiber to the mandrel with complex contour. Although the CCM system increases the flexibility of composite manufacturing, it is quite time-consuming or even impossible to generate the feasible off-line path, which ensures uniform lay-up of subsequent fibers considering the constraints like singularities, collisions between the fiber placement head and mandrel, smooth fiber direction change and keeping the fiber placement head along the norm of the part's surface, etc. Moreover, due to the existing positioning error of the robots, the on-line path correction is needed. Therefore, the on-line pose correction algorithm is proposed to correct the paths of both parallel and serial robots, and to keep the relative path between the two robots unchanged through the visual feedback when the constraint or singularity problems in the off-line path planning occur. The experimental results demonstrate the designed CCM system can fulfill the movement needed for manufacturing a composite structure with Y-shape.

Importance: Dermatofibrosarcoma protuberans (DFSP) may have a deceptively benign clinical appearance, including a nonprotuberant presentation. Patients with DFSP often perceive misdiagnoses and delays in receiving a diagnosis. Use of existing, patient-designed Facebook patient support groups (FBSGs) to recruit large numbers of patients with rare diseases may be an effective novel research method., Objectives: To collaborate with patients with rare disease through social media and answer questions important to both patients and the medical field, including sources of diagnostic delay, risk of recurrence, and flat presentation of DFSP., Design, Setting, and Participants: A multiple-choice survey created by a team of medical practitioners and patients with DFSP was administered to 214 patients with DFSP or family members from international DFSP FBSGs and a nonprofit foundation patient database via Lime Survey from October 30 to November 20, 2015. The survey asked questions designed to determine risk of recurrence and metastasis, surgical outcomes, sources of diagnostic delay, symptoms of recurrence, number of recurrences, scar size, and number of clinicians seen before biopsy. Statistical analysis was performed from January 1, 2016, to April 1, 2019., Main Outcomes and Measures: The study goal was to collect at least 200 survey responses., Results: Of 214 survey respondents (169 females and 45 males; mean [SD] age, 40.7 [12.1] years; range, <1 to 72 years), 199 were patients with DFSP and 15 were family members. Delays occurred between the patient noticing the DFSP lesion and receiving a diagnosis of DFSP (median, 4 years; range, <1 to 42 years). Most patients (112 [52.3%]) believed that they received a misdiagnosis at some point: by dermatologists (35 of 107 [32.7%]), primary care clinicians (80 of 107 [74.8%]), or another type of physician (27 of 107 [25.2%]). The most frequent prebiopsy clinical suspicion included cyst (101 [47.2%]), lipoma (30 [14.0%]), and scar (17 [7.9%]). Many patients first noticed their DFSP as a flat plaque (87 of 194 [44.8%]). Of these lesions, 73.6% (64 of 87) became protuberant eventually. Surgical treatments included Mohs micrographic surgery (56 of 194 [28.9%]), wide local excision (122 of 194 [62.9%]), and conservative excision (16 of 194 [8.2%]). The reported rate of recurrence was 5.4% (3 of 56) for Mohs micrographic surgery, 7.4% (9 of 122) for wide local excision, and 37.5% (6 of 16) for conservative excision. The higher rate of recurrence for conservative excision was significant (P = .001); there was no significant difference in the rate of recurrence between Mohs micrographic surgery and wide local excision (P = .76)., Conclusions and Relevance: This study reports what appears to be disease-relevant statistics from the largest survey of patients with DFSP to date. Because of the dissonance between the name of the neoplasm and its clinical presentation, the alternative term dermatofibrosarcoma, often protuberant is proposed. This study suggests that FBSGs are useful tools in medical research, providing rapid access to large numbers of patients with rare diseases and enabling synergistic collaborations between patients and medical researchers.

Purpose This study aimed to find out more about the effect of the use of the 1-3-6 early hearing detection and intervention (EHDI) timeline and interprofessional simulation training on audiology and speech-language pathology graduate students' confidence level of knowledge and skills. Method A 1-group pretest-posttest quasi-experimental study design was used to assess self-ratings of confidence in knowledge and skills. The mean age for 50 graduate students participating in this study was 25.32 years ( SD = ±3.77, range: 22-37 years). Participants completed a pre- and postevent questionnaire in which they rated their level of confidence for specific knowledge and skills. Three case scenarios represented by standardized parents were developed, and 8 students volunteered to participate in implementing the 1-3-6 EHDI timeline, whereas others participated as observers. All participants participated in the briefing and debriefing sessions immediately before and after each scenario. Participants were asked to rate their readiness for interprofessional education/practice and their satisfaction of the educational experience after the last case scenario. Results Overall, the pre- and postsimulation event questionnaire revealed a significant improvement in the participants' self-rated confidence levels in knowledge and skills. The mean difference between pre- and postevent scores was 0.78 ( p < .01). The mean interprofessional learning was 2.13 (range: 1.16-2.57, SD = ±0.24) based on a Likert scale, where 1 = strongly agree and 5 = strongly disagree. The mean satisfaction level was 4.37 (range: 3.94-4.72, SD = ±0.24) based on a Likert scale, where 1 = not satisfied and 5 = very satisfied. Conclusions The results demonstrated the value of using interprofessional simulation training among audiology and speech-language pathology students to improve their confidence in knowledge and skills. The curriculum developed in this study for the 1-3-6 EHDI timeline provides resources for educators in both professions and other related professions.

To better prepare physiology students for 21st century careers, we incorporated classroom-based undergraduate research experiences and service learning/community-engaged learning (SLCE) into a college-level physiology laboratory course. The interventions were incorporated over 4 yr and assessed using validated surveys of student-reported learning gains related to attitudes toward science, the scientific process, and career paths. Students reported the greatest learning gains in those years when students did novel research oriented around a common theme of water quality. The gains were greater than those of a matched cohort that participated in an apprentice-style summer undergraduate research experience. With respect to the SLCE related to youth science literacy, students provided evidence of learning related to academics, personal growth, and civic mindedness. For example, many expressed discomfort about being in a new situation, often describing the differences between themselves and the youth with whom they interacted. However, students also grew in confidence about collaborating with people who were different from them and in their role as the "scientist." Limitations of the study include the quasi-experimental design and the incorporation of multiple interventions at the same time. Future studies should examine improvement in content acquisition and competency-based learning skills. Nonetheless, these results suggest that both novel research and SLCE increase student learning in the context of an undergraduate physiology laboratory course. Many of the learning gains observed with the SLCE are particularly important for physiology students, many of whom aspire to careers in health sciences, where they will be regularly working with nonscientists.

Medical educators have not reached widespread agreement on core content for a U.S. medical school curriculum. As a first step toward addressing this, five U.S. medical schools formed the Robert Wood Johnson Foundation Reimagining Medical Education collaborative to define, create, implement, and freely share core content for a foundational medical school course on microbiology and immunology. This proof-of-concept project involved delivery of core content to preclinical medical students through online videos and class-time interactions between students and facilitators. A flexible, modular design allowed four of the medical schools to successfully implement the content modules in diverse curricular settings. Compared with the prior year, student satisfaction ratings after implementation were comparable or showed a statistically significant improvement. Students who took this course at a time point in their training similar to when the USMLE Step 1 reference group took Step 1 earned equivalent scores on National Board of Medical Examiners-Customized Assessment Services microbiology exam items. Exam scores for three schools ranged from 0.82 to 0.84, compared with 0.81 for the national reference group; exam scores were 0.70 at the fourth school, where students took the exam in their first quarter, two years earlier than the reference group. This project demonstrates that core content for a foundational medical school course can be defined, created, and used by multiple medical schools without compromising student satisfaction or knowledge. This project offers one approach to collaboratively defining core content and designing curricular resources for preclinical medical school education that can be shared.

Objectives: To determine the impact of authentic clinical tasks on student confidence in interprofessional communication and assess the perceptions of pharmacists and pharmacy undergraduate students on how their degree prepares them to communicate and integrate with other healthcare professionals., Methods: Pharmacists completed a questionnaire regarding how their degree prepared them to communicate with other healthcare professionals. Third- and fourth-year pharmacy undergraduate students completed a modified questionnaire with questions relating to interprofessional learning and their experiences of reflective interprofessional communication tasks whilst on hospital placement. The questionnaires produced a combination of qualitative and quantitative data., Key Findings: Pharmacists (n = 36) and pharmacy students (n = 186) were in agreement that interprofessional training is important for undergraduate pharmacy students. Over 80% of student respondents viewed the interprofessional communication skills task as a useful method to develop communication skills with an increase in confidence following completion of the task. A variety of methods ranging from classroom- to practical-based sessions may be used to develop communication skills and professional socialism., Conclusions: Interprofessional learning has an important role for all working within the multidisciplinary healthcare team and contributes to the development of collaborative working relationships. It should be introduced and reinforced throughout undergraduate studies and continued in the workplace., (© 2018 Royal Pharmaceutical Society.)

Objective: Increased demands from healthcare services have led to new roles for healthcare professionals (HCPs). Simulation based learning (SBL) can offer multidisciplinary HCPs and students a format to train for such emerging roles. The aim of this work was to adapt existing nursing SBL to involve pharmacy students and evaluate perceptions and effectiveness of SBL when used for interprofessional education (IPE)., Methods: Settings were a simulated hospital ward and a general practitioner (GP) practice. Participants were pharmacy and nursing students. Evaluation was by questionnaires and interviews. Ethical approval was obtained from the University Ethics Committee., Key Findings: A total of 440 students participated. The majority of respondents (317/330;96%) found the sessions useful. All elements were highly rated: briefing (315/340;93%), setting (301/321;94%), scenario (325/338;96%), feedback (303/327;93%), interaction with the "patient" (328/338;97%), interactions with other HCP trainee (293/329;89%). The majority (304/327;93%) agreed that they felt the sessions had enhanced their skills. Significant (p ≤ 0.05) enhancement in communication confidence was perceived by the students. Students gained understanding of each other's roles, and appreciated practicing communication and teamwork., Conclusions: Students recognised the importance, usefulness and need for IPE. SBL has the potential to support a variety of HCPs to facilitate uptake of new roles and working in multidisciplinary teams., (© 2019 Royal Pharmaceutical Society.)

Case: We report on a patient with heterozygous prothrombin G20210A mutation (PTM) and a history of venous thromboembolism (VTE) after knee arthroscopy, who was undergoing hip arthroscopy. This common mutation has an overall prevalence of 2.0% and results in a 280% to 420% likelihood of thrombosis compared to patients without the mutation., Conclusions: Hip arthroscopy is associated with a low risk of VTE with currently no guidelines for thromboprophylaxis. Patients should be managed in relation to their risk factors utilizing a collaborative, individualized approach. Treatment with short-term low-molecular-weight heparin resulted in no thromboembolism at 18-month follow-up for this patient with PTM.

Although cardiovascular disease is a major health burden for patients with chronic kidney disease, most cardiovascular outcome trials have excluded patients with advanced chronic kidney disease. Moreover, the major cardiovascular outcome trials that have been conducted in patients with end-stage renal disease have not demonstrated a treatment benefit. Thus, clinicians have limited evidence to guide the management of cardiovascular disease in patients with chronic kidney disease, particularly those on dialysis. Several factors contribute to both the paucity of trials and the apparent lack of observed treatment effect in completed studies. Challenges associated with conducting trials in this population include patient heterogeneity, complexity of renal pathophysiology and its interaction with cardiovascular disease, and competing risks for death. The Investigator Network Initiative Cardiovascular and Renal Clinical Trialists (INI-CRCT), an international organization of academic cardiovascular and renal clinical trialists, held a meeting of regulators and experts in nephrology, cardiology, and clinical trial methodology. The group identified several research priorities, summarized in this paper, that should be pursued to advance the field towards achieving improved cardiovascular outcomes for these patients. Cardiovascular and renal clinical trialists must partner to address the uncertainties in the field through collaborative research and design clinical trials that reflect the specific needs of the chronic and end-stage kidney disease populations, with the shared goal of generating robust evidence to guide the management of cardiovascular disease in patients with kidney disease., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.)

In 29 U.S. academic institutions, dental and dental hygiene students are educated on the same campus. The aims of this study were to explore the perceptions of dental and dental hygiene students on the same campus concerning the status quo of shared educational experiences, the benefits of shared education, and their curricular suggestions for shared education. Additionally, the study investigated whether the number of shared courses was correlated with the perceived benefits of shared learning. A survey was sent in 2016 to a chief administrator at all 29 dental school and dental hygiene programs that were on the same campus, with a request that the administrators forward the invitation email to all their students. A total of 375 dental and 117 dental hygiene students at 12 universities responded. The students reported that three of the nine dental hygiene programs and two of the six dental programs had no shared courses. The majority of dental/dental hygiene students agreed or agreed strongly that having joint classes would allow them to develop better relationships between dental and dental hygiene students (57%/57%) and gain a better understanding of each other's roles (50%/63%) and of what the other discipline "is all about" (54%/46%). Compared to dental hygiene students, dental students were less supportive of suggestions for curricular interventions such as partnering up in lab (on a five-point scale with 5=most positive: 3.99 vs. 3.56; p<0.001), using in-class time for shared group projects (3.83 vs. 3.27; p<0.001), and shadowing in clinics (4.26 vs. 3.16; p<0.001). The more courses dental and dental hygiene students jointly attended, the higher their percentage of clinic time spent on collaborative care (r=0.19; p<0.001). Having dental and dental hygiene programs on the same campus offers opportunities for shared learning, and this study's results suggest those opportunities may translate into increased shared learning.

Background: The inverted classroom approach is characterized by a primary self-study phase for students followed by an on-site, face-to-face teaching phase that is used to deepen the prior acquired knowledge. Obviously, this teaching approach relies on the students preparing before the on-site phase, which in turn requires optimized preparatory material as well as defined working instructions. The major aim of this study, therefore, was to investigate the effect of different preparatory materials and working instructions for the self-study phase of an e-learning-based inverted classroom on the knowledge gained by medical students in biochemistry. Furthermore, we analyzed whether collaborative dyadic learning during the self-study phase is more effective than individual learning with respect to knowledge gain., Methods: The study was performed in a biochemistry seminar for second semester medical students at Ulm University in Germany. This seminar was held using an e-learning-based inverted classroom. A total of 196 students were divided into three homogeneous study groups that differed in terms of the working material and instructions provided for the self-study phase. Knowledge gain was measured by formative tests at the beginning of the on-site phases. Questionnaires were also handed out asking about motivation, interest and learning time in the self-study phases., Results: Students who were told to prepare in collaborating dyads during the self-study phase performed better in formative tests taken at the beginning of on-site phases than learners who were told to prepare individually. The study material that was provided was of minor importance for the differences in formative testing since almost all students prepared for the on-site phases. With the dyadic learning approach, both students benefited from this collaboration, characterized by a higher motivation and interest in the topic, as well as a longer time spent on task., Conclusion: Our study provides strong evidence that the study material, but more importantly the instructions provided for the self-study phase, affect students` knowledge gain in an e-learning-based inverted classroom. The instructed collaboratively working group was the most successful.

Background: Contemporary teaching and learning pedagogy commands interprofessional collaboration among allied professions such as nursing and social work, two professions that have a natural inclination to partner in the workforce., Method: Nursing and social work students participated in a structured simulated learning experience where they demonstrated their respective professional practice skills in a supported learning environment while working collaboratively to assess one of two patient types: high-fidelity or simulated., Results: Both groups expressed initial worry during prebriefing but articulated their appreciation for and usefulness of working with the other profession. Future collaboration includes learning about respective professional roles, more direction regarding the professional handoff, and prior exposure to the appearance and functionality of high-fidelity patient types in an effort to establish best strategies for partnership., Conclusion: Interprofessional collaboration diverges from the silo effect, leading to collegiality among affiliated professionals, as well as increased patient safety and improved patient outcomes. [J Nurs Educ. 2019;58(2):110-113.]., (Copyright 2019, SLACK Incorporated.)

Purpose: The purpose of the study was to describe the development and implementation of a Team-based Learning (TBL) educational model in a predoctoral education course to assess its effectiveness in promoting student learning as measured by knowledge acquisition and student satisfaction., Methods: An interprofessional education course used the TBL structure for the second-year dental students, in which students had an opportunity to first work on the questions individually and then in groups. Each instruction session began with a readiness assurance test (RAT), which students were asked to complete in two formats: each student answered on their own, then each team worked on the same questions to arrive at a consensus decision followed by a team-based application exercise., Results: A significant difference existed in which team scores were higher than individual scores and on average, the teams scored higher than when students worked alone. Student feedback showed a strong preference of TBL over the traditional lecture format. Students found that the sessions helped them to understand the clinical cases from the perspective of other health care fields in this pedagogical approach., Conclusion: The TBL methods facilitated an interactive learning environment to promote student-centred learning in a predoctoral education course and the teams performed better in correct evaluation compared with the individual students., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The use of collaboration while in dental school can help prepare dental students for the team-oriented nature of the workforce. One way to do this is via collaborative group testing (CGT), a method of assessment allowing students to learn from one another. The aim of this study was to examine the CGT method in a predoctoral dental education setting to determine if student examination performance improved with the addition of collaboration and if collaborative testing was beneficial to students' learning process. In 2016, all first-year dental students (n=76) at one U.S. dental school were assessed in an introductory comprehensive care course using a two-stage CGT in which students were assessed individually, prior to taking the same test in collaboration with an assigned partner. Three quizzes and a final examination were given in which student participants served as both control (individual assessments) and treatment (collaborative assessment). At the conclusion of the course, a questionnaire was administered to ascertain student perspectives. All assessments yielded favorable results with an overall score improvement from a mean of 81.1% on individual assessments to 91% on collaborative assessments (p=0.001), indicating that collaboration improved assessment outcomes. Additionally, retention of material was suggested with individual scores on the cumulative final surpassing average individual scores of the preceding quizzes (p<0.001). Students' responses on the questionnaire indicated that they perceived implementation of CGT was beneficial to their learning process. With these results, this testing methodology shows promise to enhance dental student learning, material retention, and teamwork.

Background: Antimicrobial therapy for intra-abdominal infections is often inappropriately prolonged. An intervention addressing factors influencing the duration of intravenous antibiotic use was undertaken. This study reports the antibiotic prescribing patterns before and after the intervention and a qualitative analysis of the experience of the intervention., Methods: Quantitative: A retrospective audit of patients with complicated intra-abdominal infection before and after a multifaceted persuasive intervention was performed. Qualitative: Semi-structured interviews were performed to evaluate which elements of the intervention were perceived to be effective., Results: An intervention including collaborative inter-specialty and inter-professional educational meetings, and education of all professional streams was undertaken. Quantitative: Twenty-three patients before and 22 patients after the intervention were included. The total duration of antibiotics decreased significantly following the intervention (9.2 versus 6.6 days P = 0.02). The duration of intravenous antibiotics did not change significantly (5.4 versus 4.5 days, P = 0.06). Qualitative: Eighteen health-care professionals participated. Thematic analysis indicated that a collaborative approach between senior surgical and infectious disease specialists in the pre-intervention stage led to perceived ownership and leadership of the intervention by the surgical team, which was thought critical to the success of the intervention. Conversely, the ability of nurses and pharmacists to influence antibiotic practice was considered limited and a poster promoting the intervention was perceived as ineffective., Conclusion: Consultant leadership and specialty ownership of the process were perceived to be critical in the success of the intervention. Antibiotic stewardship programs which address social factors may have greater efficacy to optimize antimicrobial prescribing., (© 2018 Royal Australasian College of Surgeons.)

Research in the health sciences devotes much attention to overweight and obesity and, consequently, to body composition. In recent years, traditional body measures have been questioned as efficient variables in health sciences due to the fact that they cannot give information about body fat mass. Our aim is to teach how to analyze body composition through anthropometry and bioelectrical impedance analysis to our "Physiology of Vegetative and Reproductive Functions" students, who are studying for their degree in Biology. We proposed project-oriented-learning to promote collaborative interactions among students. Fifty-two students voluntarily formed five groups; they worked with the concepts of basal metabolic rate and body composition from a theoretical point of view and later transformed these concepts into a practical perspective by preparing a manuscript in groups with objectives proposed by our teaching team. In this research, we show a collaborative educational scenario for university students in which students are tutored from a constructivist perspective to promote social interactions, resulting in new knowledge acquisition.

Most often, members of the dental team are educated in separate programs. These professionals then come together in practice to work as a team, often with limited knowledge about each other's roles. The aim of this study was to assess the perspectives of dental and dental hygiene students regarding collaborative learning after taking two courses together. Five years (2010-14) of survey data were collected from a convenience sample of dental and dental hygiene students. The dental hygiene students were in their first and second years (DH1 and DH2) at Eastern Washington University (EWU). The dental students were in the University of Washington (UW) Regional Initiative in Dental Education (RIDE) program, taking their first year of courses in Eastern Washington with EWU's dental hygiene and UW's medical students. Eight first-year dental (D1) students participate in the RIDE program each year, totaling 40 across the five years. Because the same D1 students take both courses, this target population was 80. The number of DH1 and DH2 students in these courses ranges from 32-36 each year, for a target population of 323 across the five years. A total of 193 survey responses were collected, for an overall response rate of 48%; the D1 response rate was 72%, and the DH response rate was 42%. In the results, students perceived that learning collaboratively helped them think positively about other dental professionals, benefitted their problem-solving skills, increased their understanding of clinical problems, helped them become better team members, improved trust and respect, and improved their understanding of course content. These results suggest that collaborative learning had a positive impact on both groups. In comments, students suggested they would benefit from more shared learning experiences in the clinic and agreed that collaborative learning would help them create a more cohesive team.

Background: To date, studies evaluating outcome improvements associated with participation in physician-led collaboratives have been limited by the absence of a contemporaneous control group. We examined post cardiac surgery pneumonia rates associated with participation in a statewide, quality improvement collaborative relative to a national physician reporting program., Methods and Results: We evaluated 911 754 coronary artery bypass operations (July 1, 2011, to June 30, 2017) performed across 1198 hospitals participating in a voluntary national physician reporting program (Society of Thoracic Surgeons [STS]), including 33 that participated in a Michigan-based collaborative (MI-Collaborative). Unlike STS hospitals not participating in the MI-Collaborative (i.e., STSnonMI) that solely received blinded reports, MI-Collaborative hospitals received a multi-faceted intervention starting November 2012 (quarterly in-person meetings showcasing unblinded data, webinars, site visits). Eighteen of the MI-Collaborative hospitals received additional support to implement recommended pneumonia prevention practices ("MI-CollaborativePlus"), whereas 15 did not ("MI-CollaborativeOnly"). We evaluated rates of postoperative pneumonia, adjusting for patient mix and hospital effects. Baseline patient characteristics were qualitatively similar between groups and time. During the preintervention period (Q3/2011 through Q3/2012), there was no statistically significant difference in the adjusted odds of pneumonia for STS hospitals participating in the MI-Collaborative compared to the STS non-MI hospitals. However, during the intervention period (Q4/2012 through Q2/2017), there was a significant 2% reduction per quarter in the adjusted odds of pneumonia for MI-Collaborative hospitals (n=33) relative to the STS-nonMI hospitals. There was a significant 3% per quarter reduction in the adjusted odds of pneumonia for the MI-CollaborativeOnly (n=15) hospitals relative to the STS-nonMI hospitals. Over the course of the overall study period, the STS-nonMI hospitals had a 1.96% reduction in risk-adjusted pneumonia (pre- vs. intervention periods), which was less than the MI-Collaborative (3.23%, P=0.011). Over the same time period, the MI-CollaborativePlus (n=18) reduced adjusted pneumonia rates by 10.29%, P=0.001., Conclusions: Participation in a physician-led collaborative was associated with significant reductions in pneumonia relative to a national quality reporting program. Interventions including collaborative learning may yield superior outcomes relative to solely using physician feedback reporting., Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02068716.

The era of human brain science research is dawning. Researchers utilize the various multi-disciplinary knowledge to explore the human brain,such as physiology and bioinformatics. The emerging disease association prediction technology can speed up the study of diseases, so as to better understanding the structure and function of human body. There are increasing evidences that miRNA plays a significant role in nervous system development, adult function, plasticity, and vulnerability to neurological disease states. In this paper ,we proposed the novel improved collaborative filtering-based miRNA-disease association prediction (ICFMDA) approach. Known miRNA-disease associations can be viewed as a bipartite network between diseases and miRNAs. ICFMDA defined significance SIG between pairs of diseases or miRNAs to model the preference on the choices of other entities. The collaborative filtering algorithm is further improved by incorporating similarity matrices to enable the prediction for new miRNA or disease without known associations. Potential miRNA-disease associations are scored with the addition of bidirectional recommendation results with low computational cost. ICFMDA achieved a 0.9076 AUC of ROC curve in global leave-one-out cross validation, which outperformed the state-of-the-art models. ICFMDA is a compact and accurate tool for potential miRNA-disease association prediction. We hope that ICFMDA would be useful in future miRNA and brain researches,and achieve better understanding of the nervous system in molecular level, cellular level, cell change process, and thus can support the research of human brain.

Medical education, including education intended to prepare future physicians to care to older individuals, should include development and implementation of competencies relating to a physician's ability to understand and interact with the legal environment and legal actors who will affect the practice of medicine. The wisdom of integrating legal knowledge into the medical curriculum has been documented, and literature discusses the content and methods of teaching medical students and residents about law and the legal system. This article describes one unique but replicable, pedagogical approach to preparing future physicians to thrive in their inevitably interprofessional careers as they fulfill the fiduciary responsibilities that lie at the heart of their therapeutic and advocacy relationships with older patients.

Background: Collaborative learning has been used in nursing education for more than two decades. However, little is known about its relationship to quality of nursing education, its implementation process as well as what factors likely influence the effectiveness of the teaching approach., Methods: Previous relevant literature had been searched and located from three electronic databases including CINAIL, PubMed, and Google Scholar., Results: Collaborative learning had been employed in classroom teaching, clinical education and online course teaching. The strategy of instruction was found useful for improving nursing knowledge and skill performance, improving student clinical competency, as well as promote student group skills and learning behavior (e.g., Class engagement, motivation for learning, self-confidence)., Conclusions: It was recommended to integrate collaborative learning into nursing education due to positive influences on student learning., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Virtual patients (VPs) have been recently integrated within different learning activities., Aim: To compare between the effect of using VPs in a collaborative learning activity and using VPs in an independent learning activity on students' knowledge acquisition, retention and transfer., Methods: For two different topics, respectively 82 and 76 dental students participated in teaching, learning and assessment sessions with VPs. Students from a female campus and from a male campus have been randomly assigned to condition (collaborative and independent), yielding four experimental groups. Each group received a lecture followed by a learning session using two VPs per topic. Students were administrated immediate and delayed written tests as well as transfer tests using two VPs to assess their knowledge in diagnosis and treatment., Results: For the treatment items of the immediate and delayed written tests, females outperformed males in the collaborative VP group but not in the independent VP group., Conclusion: On the female campus, the use of VPs in a collaborative learning activity is more effective than its use as an independent learning activity in enhancing students' knowledge acquisition and retention. However, the collaborative use of VPs by itself is not enough to produce consistent results across different groups of students and attention should be given to all the factors that would affect students' interaction.