GETTING BETTER: ALN AND STUDENT SUCCESS

This paper examines paradigms used in online learning, with a specific emphasis on how to effectively employ asynchronous learning networks (ALN) for the delivery of online courses. Recent progress in ALNs is presented, methodologies for getting started in creating an ALN course given and relationships between traditional teaching and learning methods and ALN-based courses discussed. To illustrate a specific ALN model, the paper presents a case study about the creation of an online course. The prospects for online education and the challenges that face the ALN field are considered.

While much research has shown that asynchronous learning networks (ALNs) can produce learning equivalent to face-to-face (FTF) classrooms, there has been little research that explicitly explores similarities and differences between the learning processes that occur in ALN and FTF activities. This study used a content analytic framework (derived primarily from previous work of Anderson, Archer, Garrison, and Rourke) to analyze transcripts from eight case study discussions, four FTF and four ALN. While previous authors developed a model that studies cognitive, social, and teaching processes in ALN discussions, the current scheme also considers characteristics of the discourse process. The findings provide evidence that ALNs generate high levels of cognitive activity, at least equal to, and in some cases superior to, the cognitive processes in the FTF classroom. The findings also suggest that students assume some aspects of the teacher's role in ALNs, and that student-to-student interactions contain a greater proportion of high-level cognitive indicators than do student-to-teacher interactions.

In the Fall 1997 semester, Northern Virginia Community College (NVCC), through its Extended Learning Institute (ELI), is offering what is to our knowledge the first Associate in Science (AS) engineering degree available via distance education to home-based learners in the US. Funded largely by grants from the Alfred P. Sloan Foundation during the past four years, NVCC/ELI has developed the engineering, mathematics, chemistry and physics courses required to offer a complete AS engineering degree program. This paper describes how NVCC/ELI has incorporated asynchronous learning networks (ALNs) into its math, science, and engineering courses and highlights some of the issues involved in developing ALNs for home-based community college students.

This paper presents a qualitative study of role changes that occur when faculty becomes virtual professors. In 20 semi-structured interviews of faculty, coded with pattern analysis software, the authors captured role changes enacted by instructors in asynchronous learning network (ALN) settings-cognitive roles, affective roles, and managerial roles. The cognitive role, which relates to mental processes of learning, learning, information storage, and thinking, shifts to one of deeper cognitive complexity. The affective role, which relates to influencing the relationships between students, the instructor, and the classroom atmosphere, required faculty to find new tools to express emotion, yet they found the relationship with students more intimate. The managerial role, which deals with class and course management, requires greater attention to detail, more structure, and additional student monitoring. Overall, facility reported a change in their teaching persona, towards more precision in their presentation of materials and instructions, combined with a shift to a more Socratic pedagogy, emphasizing multilogues with students.

To analyse data from a bedside ultrasound-assisted ascites procedure service in a National Health Service District General Hospital and compare them to results of studies in the medical literature. A retrospective review of audit data collected (January 2013 to December 2019) of the practice of paracentesis in a National Health Service District General hospital. All adult patients referred to the ascites assessment service were included. Bedside ultrasound detected location and volume of ascites, if present. Abdominal wall diameters were determined in order to select the appropriate needle length for procedures. Results and scan images were recorded on a pro-forma. Patients who underwent a procedure were followed up for 7 days, with complications documented. Seven hundred and two scans were performed on 282 patients - 127 (45%) male and 155 (55%) female. In 127 (18%) patients, an intervention was avoided. Five hundred forty-five (78%) patients underwent a procedure: 82 (15%) were diagnostic aspirations and 463 (85%) were therapeutic (large volume) paracentesis. Most scans were performed between 08:00-17:00. Average time from patient assessment to diagnostic aspiration was 4 hours 21 minutes. Complications included three failed procedures (0.6%) and one iatrogenic peritonitis (0.2%), but no bowel perforation, no major haemorrhage or death. It is possible to introduce a bedside ultrasound-assisted ascites procedure service to a National Health Service District General Hospital with a high success and low complication rate.

EDITOR: Dr Kotsev's comments seem to stem from an archaic attitude towards airway management and a failure to grasp the importance of bougie-guided insertion of the ProSeal laryngeal mask airway for airway rescue [1,2]. We will address each of his points in turn. First, this patient was reviewed both by a second anaesthetist and a clinical psychologist who found that he had a rational fear of awake intubation: his brother had undergone a rather gruesome awake intubation for an elective cholecystectomy (on the basis of having buck teeth and a beard) which left him with a vocal cord injury. Second, spontaneous breathing was not lost after induction. We took over the patient's ventilation to allow better gas exchange and to deepen anaesthesia. Having established successful ventilation, we felt it was safe to administer a muscle relaxant. It is debatable as to whether suxamethonium would have been a better choice than atracurium. Third, the principle that ‘the natural airway is better maintained when the patient remains breathing spontaneously’ makes little sense and is almost certainly wrong. The natural airway is usually lost once the patient is anaesthetised and gas exchange is usually worse with spontaneous rather than positive pressure ventilation. Other than providing information about depth of anaesthesia and perhaps reducing the frequency of gastric insufflation and barotrauma, spontaneous breathing under anaesthesia is neither natural nor beneficial. Fourth, the concept that inhalational anaesthesia is best if airway problems are anticipated is entrenched in anaesthesia teaching, yet few clinicians adhere to it and it remains (and probably always will be) unproven. The primary benefit of inhalational induction is that if problems arise they occur slowly and can easily be reversed – but is this true? More importantly, can these problems be reversed more rapidly than after an intravenous induction with modern short acting agents? There is no answer. Certainly, most of us have experienced horrendous gas inductions in adults. Fifth, it took less than 20 s to work through the section of the algorithm which relates to guided insertion techniques, and a further 10 s to remove the ProSeal laryngeal mask airway and railroad the tracheal tube into position. Thus we wasted no time in securing the patients airway. The minimal SPO2 was 94%. Our algorithm is not particularly complex: it certainly has fewer steps than the American Society of Anesthesiologists difficult airway algorithm. Sixth, we do not consider that there are compelling reasons to perform awake tracheal intubation in a patient with a history of difficult tracheal intubation if other forms of airway management have proved to be easy. In this case, face mask ventilation was known to be easy (admittedly it required a Guedel airway) and there were no signs that laryngeal mask airway insertion/function would be difficult. Certainly, if both face mask ventilation and laryngeal mask airway insertion are predicted to be easy, it is difficult to justify awake tracheal intubation, especially against a patient's wishes. Finally, all anaesthesiologists should familiarise themselves with the bougie-guided technique for insertion of the ProSeal laryngeal mask airway. It is a powerful yet simple new concept in airway management: using a tube that is easily accessible (the oesophagus) to secure access to a tube that is not easily accessible (the trachea). The combination of the best extraglottic device with this new technique for placement results in remarkably high insertion success rates. In our experience of over 15 000 uses, it has a failure rate of 0.5% falling to 0.1% after the application of the algorithm. We recently found that even personnel with no experience of airway management have exceptionally high success rates (100 out of 100 patients) following brief manikin-only training [3]. In our view, it is one of the most successful airway management techniques in anaesthesia practice today and our algorithm further increases its success.

The proliferation of distributed systems has enabled collaboration and cooperation among learners, and has enhanced cross-cultural interactions across educational boundaries. The issue of cross-cultural communication is fundamental in asynchronous learning research since the learners involved have communication norms that are significantly different across cultures. The influence wielded by the cultural values of individual learners in a heterogeneous group can impact upon the learning process and outcome of the entire group of learners. Concurrently, the degree of social presence supported by the media used in asynchronous learning networks can also affect learning. This paper discusses the relationship between cultural traits and media social presence with the focus on asynchronous learning networks. A set of propositions delineating cross- cultural and media impact on learning processes is highlighted with respect to the cultural dimension of individualism-collectivism. Preliminary findings of a pilot study are discussed.

BackgroundIn 2009, an outbreak of respiratory illness caused by influenza A H1N1 virus occurred worldwide. Some patients required Intensive Care Unit (ICU) admission. The use of non-invasive ventilation (NIV) in these patients is controversial, as the aerosol dispersion may contaminate the environment and health-care co-workers.MethodsDescribe the respiratory profile, the mortality rate, and the benefit of using NIV in patients with confirmed diagnosis of influenza AH1N1 who were admitted in the ICU during the year 2009.ResultsA total of 1, 401 cases of influenza A H1N1 were confirmed in our hospital by real-time RT-PCR in 2009, and 20 patients were admitted to the ICU. The patients' ages ranged from 18 to 74 years (median of 42). Acute Respiratory Failure (ARF) was present in 70% of patients. The median Acute Physiology and Chronic Health Evaluation II score was 7 (range 7 to 25). Of the 14 patients who developed ARF, 85.7% needed NIV and 14% needed invasive MV at admission. Our success rate (41.6%) with NIV was higher than that described by others. The hospital mortality rate was 2.1%. When influenza A H1N1 arrived in Brazil, the disease was already on endemic alert in other countries. The population was already aware of the symptoms and the health-care system of the treatment. This allowed patients to be properly and promptly treated for influenza A H1N1, while health-care workers took protective measures to avoid contamination.ConclusionIn our study we found a high success and low mortality rates with non-invasive ventilation in patients with influenza A H1N1.

Asynchronous Learning Networks ( ALNs) use computer-mediated communication to support online courses of study, in which anytime, anywhere access to interactions among the students and the teacher/facilitator is a key element. In addition to class discussions, other elements frequently incorporated are use of the World Wide Web and of web-based tutorials or simulations. A number of contingencies determine the extent to which ALN's are successful learning environments, including characteristics of the software used, whether the pedagogical techniques employed fit the medium, and characteristics of the individual learners.We have selected three papers which represent some of the basic objectives of research on Asynchronous Learning Networks. Our first paper by Catherine Middleton compares two asynchronous conferencing systems; the results are very interesting. The second paper by Urban Nulden discusses an educational philosophy for structuring asynchronous courses. The third paper, by Jane Leuthold discussed whether computer-based learning is right for everyone

In this study a change in teaching strategy to involve a greater emphasis on asynchronous learning networks (ALNs) was implemented and the views of students (n=51) to this change were evaluated through responses to an online questionnaire. In response to Likert-type questions the majority of students demonstrated a positive view of this new model. Sixty-one percent of students felt that other types of online material would benefit the learning process and 80 % would recommend this module to a friend. Students acknowledged that the use of ALN-supported learning made the material easierto understand (52%), the lecturer more accessible (66%) and enabled them to take a more active role in the learning process (55%). Though only 10% of students utilized the asynchronous newsgroup more than 5 times, 77% found reading the contributions of others useful. Contrary to this 76% preferred the more familiar lecturebased environment for subject delivery. In response to open-ended questions students’ views were more reserved and highlighted a range of problems such as inadequate infrastructure, unreliable computers, and poor access to the online material as well as resistance to a new teaching paradigm. Student performance was influenced by age and contribution to the newsgroup. Those who were younger had a lower grade (47.8 ? 15.8) than those who were older (52.0 ? 11.4). Students with higher grades (56.2 ? 10.3) contributed to the newsgroup while students with lower grades (45.7 ?12.5) did not. Based on these observations, it is apparent that students do appreciate the advantages of ALNsupported learning though for a shift toward this model to be effective problems of access and system failure must be resolved. Implications for future ALN-based modules are discussed.

As asynchronous learning becomes the norm throughout academia, changes are taking place in campus information systems. Academic libraries, as the entity responsible for serving the information needs of the university, have little choice but to change dramatically. In fact, academic libraries have a history of being aggressive in adapting state-of-the-art technologies. One can point to decades-long involvement with the development of online catalogs and the use of shared cataloging utilities. Libraries continue to serve academic teaching and learning by taking on new roles, revising traditional services, and time and space constraints.Libraries have, however, been slower to adjust organizational structures and processes to leverage the potential of technology. Replies to a recent survey of Association of Research Libraries (ARL) indicate that change in the responding libraries at this time is incremental rather than dramatic. Patterns are emerging, however, relative to resource reallocation and the formation of partnerships with other university units that reflect new priorities.This article describes two examples of innovative information delivery initiatives. VIVA, the Virtual Library of Virginia, was proposed by the state’s Library Advisory Council in 1993 to encourage collaboration among the Commonwealth’s institutions of higher education and to support the electronic dissemination of information. Academic libraries are also leading the way by providing new and unique sources of online information such as Electronic Theses and Dissertations (ETDs), by developing electronic submissions, online archiving, and Web access, as well as bringing to the forefront discussions about issues such as copyright and publishers’ control of academic publications. Network-based access to information resources such as these is changing higher education, and the opportunities offered by asynchronous learning networks are challenging libraries to adjust their policies, processes, and services.

Interactional coherence in asynchronous learning networks: A rhetorical approach

In 11 brief therapeutic treatments, affective facial behavior of therapists and patients as well as the latter's Core Conflictual Relationship Themes (CCRTs) were investigated and related to treatment outcome. It has been found that compensatory not reciprocal affective facial behavior of the therapeutic dyad in the first session is indicative of success. A scale describing reciprocity vs. compensation in facial behavior correlated significantly positively with self-reports of outcome and symptom change. Two psychoanalytic treatments, one with the highest reciprocity and least success rate and one with the highest success rate and high compensation, were analyzed in detail according to the temporal development of affect exchange and narration through the course of the complete treatment. In both therapies the frequency of narratives were negatively correlated with the frequency of facial affects of the patient, so that the hypothesis of a parallel processing of affective facial behavior and narration could be ruled out. In the successful treatment, the therapist showed those affects during the narration of the patient which could have been expected from the latter. A very distinct temporal organization within the successful treatment including an enactment period, a period of instability, and a period of consolidation, contrasted with a homogenous distribution of affect in the unsuccessful one. The relevance of these results for a theory of the therapeutic process is discussed.Im Rahmen von 11 Kurzzeitpsychotherapien wurden der emotionale Gesichtsausdruck der Therapeuten und Patienten sowie deren zentrale Beziehungskonfliktthemen untersucht und zum Behandlungserfolg in Beziehung gesetzt wird. Es zeigte sich, dass ein kompensatorischer, nicht ein reziproker Gesichtsausdruck in der therapeutischen Dyade der ersten Sitzung den Behandlungserfolg indiziert. Eine Skala, die die Reziprozität versus Kompensation im mimischen Verhalten beschreibt, korrelierte signifikant positiv mit Selbstbeschreibungen des Therapieergebnisses und symptomatischen Veränderungen. Zwei psychoanalytische Behandlungen, die eine mit der höchsten Reziprozität und dem geringsten Erfolg, die eine mit dem grössten Erfolg und einem hohen Mass an Kompensation, wurden detailliert analysiert im Hinblick auf die zeitliche Entwicklung des Affektaustausches und der Narration über den gesamten Therapieverlauf. In beiden Therapien war die Häufigkeit von Narrativen negative korreliert mit der Häufigkeit von Affekten in der Mimik des Patienten, so dass die Hypothese eines parallelen Verlaufes affektiven mimischen Verhaltens und der Narration verworfen werden konnte. In der erfolgreichen Behandlung zeigte der Therapeut während der Berichte des Patienten jene Affekte, die man eigentlich von letzterem hätte erwarten können. Eine sehr unterschiedliche zeitliche Organisation in der erfolgreichen Therapie, welche eine Phase der Festlegung, eine Phase der Instabilität und eine Phase der Konsolidierung umfasste, stand im Gegensatz zu einer relativ homogenen Verteilung des Affektes in der weniger erfolgreichen Behandlung. Die Relevanz der Befunde für eine Theorie des therapeutischen Prozesses wird diskutiert.Dans 11 thérapies brèves, l'expression mimique affective des thérapeutes et des patients, ainsi que les thèmes relationnels conflictuels centraux ont été explorés et mis en relation avec l'effet du traitement. Il a été démontré qu'une mimique affective compensatoire et non réciproque de la dyade thérapeutique lors du premier entretien indique le succès. Une échelle décrivant la réciprocité, respectivement la compensation de l'expression mimique établit une corrélation significativement positive avec les autodescriptions de l'effet et la modification des symptômes. Deux traitements psychanalytiques, l'un avec la plus grande réciprocité et le moins de succès, l'autre avec le plus grand succès et un haut niveau de compensation, ont été analysés dans les détails en fonction du développement temporel de l'échange affectif et de la narration tout au long du traitement. Dans les deux thérapies, la fréquence des narrations était corrélée négativement avec la fréquence des affects dans la mimique du patient, ainsi l'hypothèse d'un processus parallèle de l'expression mimique et de la narration a pu être rejetée. Lors du traitement à succès, le thérapeute a produit les affects qui auraient pu être attendus du côté du patient. Une organisation temporelle très distincte dans le traitement à succès, comptant une période de performance, une période d'instabilité et une période de consolidation, a contrasté avec une distribution homogène d'affects dans le traitement sans succès. L'importance de ces résultats pour une théorie des processus thérapeutiques est discutée.

Comparison of six different intubation aids for use while wearing CBRN-PPE: A manikin study

Next-Generation Sequencing-Based Assay Shows High Clonal Characterization Success Rate for Plasma Cell Neoplasms, and Concordance with Flow Cytometry in Minimal Residual Disease Detection