ED Course Research Articles

Caregiver Experiences with Prescribed Antibiotic Access After a Pediatric Emergency Department Visit: A Qualitative Study.

Approximately one third of caregivers do not obtain a prescribed medication after their child's pediatric emergency department visit. We sought to explore the facilitators and barriers that caregivers experience in accessing prescribed antibiotics after their child's pediatric emergency department visit. We conducted semi-structured interviews with caregivers of children who presented to a quaternary academic pediatric emergency department and were discharged with prescribed antibiotics. An interview guide was developed by the study team based on literature review and expert opinion. Interviews were coded, and thematic analysis was performed. Descriptive statistical analysis was used for demographic characteristics and medication pick up rates. Twenty-two interviews were completed. Caregivers unanimously felt that antibiotics were important. Themes pertaining to medication access included (i) pharmacy location and convenience, (ii) pharmacy efficiency, responsiveness, and medication availability, (iii) impact of receiving first dose of antibiotics in the ED, and (iv) clear verbal and written communication by healthcare providers regarding diagnoses, medication indication and discharge instructions. Factors contributing to medication access have an underlying theme surrounding convenience and emphasis on the impact of first antibiotic dose administration during ED course. As such, consideration of systems changes that allows caregivers to leave the hospital with the entire course of antibiotics in hand may improve caregiver access to prescribed medications.

Fostering Student Engagement and Success in STEM Education: An AI-Driven Exploration of High Impact Practices from Cross-Disciplinary General Education Courses

Due to the increase in data and software tools, the need for programmers and data analysts has risen in the United States during the 21st century. As a result, more students are enrolling in Computer Science, Information Technology, and Data Science programs nationwide. However, switching to online and blended learning and using cyberlearning tools have presented new challenges for student learning, retention, and program success. One way to overcome these challenges and improve student achievement is to implement evidence-based pedagogical strategies and innovative technologies within clear theoretical frameworks. Recent studies have shown that various Learning Engagement Strategies (LESs) in STEM education, such as gamification, active learning, feedback and assessment, and interactive multimedia, significantly increase student engagement and course completion rates. High-Impact Practices (HIPs), identified as crucial by Kuh in 2008, have become powerful tools for enhancing student involvement, retention, and completion in higher education. This article explores practices that can enhance student learning and success that have many benefits, including more robust relationships between students and faculty, cooperative learning, quick feedback, inclusive environments, and conflict resolution. The study uses NLP-based text analytics to investigate the application and impact of these High-Impact Practices (HIPs) across different disciplines. Firstly, it identifies the most prevalent HIPs in various General Education (Gen Ed) disciplines that impact student success. Secondly, it formulates AIdriven recommendations for cultivating a student-centric learning environment through HIPs within STEM education. The results of empirical analyses using course materials, survey data, syllabi, and pre/post-workshop surveys sourced from around 65 Gen Ed course at a small public university provides valuable insights into successful HIPs for STEM courses that can help instructors improve their online and blended course designs. By implementing these practices, educators can increase student engagement, retention, and completion rates across diverse student populations in Gen Ed STEM courses. Keywords— High-Impact Practices; General Education, STEM education; Natural Language Processing.

Application of machine learning approach in emergency department to support clinical decision making for SARS-CoV-2 infected patients.

To support physicians in clinical decision process on patients affected by Coronavirus Disease 2019 (COVID-19) in areas with a low vaccination rate, we devised and evaluated the performances of several machine learning (ML) classifiers fed with readily available clinical and laboratory data. Our observational retrospective study collected data from a cohort of 779 COVID-19 patients presenting to three hospitals of the Lazio-Abruzzo area (Italy). Based on a different selection of clinical and respiratory (ROX index and PaO2/FiO2 ratio) variables, we devised an AI-driven tool to predict safe discharge from ED, disease severity and mortality during hospitalization. To predict safe discharge our best classifier is an RF integrated with ROX index that reached AUC of 0.96. To predict disease severity the best classifier was an RF integrated with ROX index that reached an AUC of 0.91. For mortality prediction the best classifier was an RF integrated with ROX index, that reached an AUC of 0.91. The results obtained thanks to our algorithms are consistent with the scientific literature an accomplish significant performances to forecast safe discharge from ED and severe clinical course of COVID-19.

Emergency Department Immersion: A Clinical Elective

Many scholars agree that clinical experiences are the best way to develop deep knowledge of nursing practice. Even though clinical hours are planned in the curriculum, students enjoy additional opportunities to prepare for graduation and career opportunities. This article explains how an elective ED course helped to enhance nursing students’ clinical judgment, interprofessional collaboration skills, and technical nursing skills during the COVID-19 pandemic.

The Use of Point-of-Care Ultrasound for Arthrocentesis Among Emergency Medicine Residents

IntroductionThe objective of this study is to determine if EM resident physicians are able to successfully utilize POCUS to perform an arthrocentesis in the ED. This is a retrospective review of ED patients who received an ultrasound-guided or ultrasound-assisted arthrocentesis performed in the ED over a 6-year period by an EM resident physician.MethodsThis was a retrospective review of ED patients who received an ultrasound-guided or ultrasound-assisted arthrocentesis performed in the ED over a 6-year period by an EM resident physician. An ED POCUS database was reviewed for POCUS examinations where an arthrocentesis was performed. Electronic medical records were then reviewed for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, and the impact of the POCUS study on patient care and disposition.ResultsA total of 101 POCUS examinations of patients were included in the final analysis. The POCUS examinations and procedures were performed by 59 different EM residents at various levels of training. Overall, 92.1% (93/101) of the procedures were successful. When assessing for image quality, 98/101 (97%) had recognizable structures at minimum. The majority of the patients (84/101, 83.2%) received additional imaging of the affected joint. In the minority of cases (23/101, 22.8%), the ultrasound-assisted approach was utilized, while 78/100 (77.2%) utilized the ultrasound-guided approach. For the studies that utilized the ultrasound-guided approach, the quality of needle visualization was determined to be “good” 40/78 (51.3%).ConclusionEM resident physicians are able to utilize POCUS to perform an arthrocentesis in the ED. Further research is encouraged to determine whether having residents utilize POCUS to perform an arthrocentesis has a significant impact on outcomes and patient care.

Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives.

Alcohol withdrawal syndrome (AWS) is a common, heterogenous, and life-threatening complication of alcohol use disorder (AUD). AUD is a leading cause of worldwide mortality, and many patients with AUD will develop AWS during their ED course. This review summarizes the epidemiology, pathology, and management of AWS and AUD in the emergency setting. The time course of AWS and its impact on ED treatment is emphasized. Once AWS is diagnosed, symptom-triggered benzodiazepine administration remains the most commonly provided treatment but may not be appropriate for patients with significant medical or psychiatric comorbidity or pending discharge. In these cases, ED clinicians may consider short courses of barbiturates or alternative regimens based on novel anticonvulsants. Specific treatment protocols are enumerated for clinical practice. Finally, emergency providers must not only manage acute patients’ AWS but also lay the foundation for successful treatment of AUD. An approach to the disposition of the patient with AUD is presented. The authors examine shortcomings in the extant literature and suggest opportunities for further study.

THE CRIPPLING EFFECT OF MOLLY: RAPIDLY PROGRESSIVE MULTIORGAN FAILURE

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Synthetic drugs has been an increasing concern across USA given these drugs are combined with other synthetic drugs not detectable by urine toxicology. Ecstasy is a well known popular drug with street names such as ‘Molly’ which is chemically made up of N-methyl-3,4-methylenedioxy-amphetamine (MDA) or 3,4-methylenedioxy-methamphetamine (MDMA). Here we present a case of Molly overdose resulting in rapid multiple system organ failure. CASE PRESENTATION: 24 year old male with past medical history of Crohn’s Disease on adalimumab presented to ED with altered mental status. He was reportedly to have taken a dose of ‘Molly’ and developed ‘seizure-like’ activities. Vitals showed temperature 106.1F, heart rate 180 beats/minute, respiratory rate 26 breaths/min, BP: 101/52 mmHg, oxygen saturation on room air 98%. Lungs were clear to auscultation except coarse breath sounds at bibasilar bases, tachycardic, diaphoretic, remainder of physical exam was unremarkable. During the ED course, patient became increasingly tachypneic and was intubated and admitted to the MICU for drug overdose. He received aggressive IV fluid hydration with cooling blankets. Within hours of arriving at MICU, patient started to have uncontrollable bleeding from nasal passage, oropharynx, peripheral and central IV access. Coagulation profile was unable to be performed due to extreme high values. Patient was treated for DIC with multiple platelets and FFP transfusions. Lactic acid trended up to 27.9mmol/L. Troponins trended up to 61.3ng/ml. WBC up to 30.6K/uL with AST/ALT increasing up to 1173/1197 U/L and creatinine kinase levels over 50,0000 U/L. Urine toxicology was positive for amphetamines. Poison control recommended to continue with supportive measures and N-Acetylcysteine. Patient was also given cyproheptadine for possible serotonin syndrome. Despite all aggressive measures, patients’ vitals and labs continued to deteriorate and subsequently went into cardiac arrest and expired less than twenty hours after admission. DISCUSSION: There has been increasing concern with recreational drugs being combined with other toxic agents not detected by most urine toxicology screens. Post mortem autopsy on our patient revealed the cause of death as cardiac arrest due to drug intoxication with MDA and MDMA. Some patients can have rapid reversal of multiple organ failure with supportive measures while others as seen with our case can succumb to death in less than twenty-four hours. CONCLUSIONS: This case illustrates the importance of recognizing the multiple organ effects ecstasy can have on an individual. Medical staff should be cognizant of synthetic drug intoxications and consider it as one of their differentials when an individual presents with multiple organ derangements. Protocols should also be implemented at hospitals to address drug overdose especially with the increasing amounts of deaths associated with drug overdose. Reference #1: Hall, A. "Acute toxic effects of ‘Ecstasy’ (MDMA) and related compounds: overview of pathophysiology and clinical management". British Journal of Anaesthesia, vol 96 , no. 6, pp.678 - 685 DISCLOSURES: No relevant relationships by Utpal Bhatt, source=Web Response No relevant relationships by Hung-I Liao, source=Web Response No relevant relationships by Shamanthy Ratnasingam, source=Web Response

Fostering Student–Faculty Partnerships for Continuous Curricular Improvement in Undergraduate Medical Education

A number of medical schools have used curricular reform as an opportunity to formalize student involvement in medical education, but there are few published assessments of these programs. Formal evaluation of a program's acceptability and use is essential for determining its potential for sustainability and generalizability. Harvard Medical School's Education Representatives (Ed Reps) program was created in 2015 to launch alongside a new curriculum. The program aimed to foster partnerships between faculty and students for continuous and real-time curricular improvement. Ed Reps, course directors, and core faculty met regularly to convey bidirectional feedback to optimize the learning environment in real time. A survey to assess the program's impact was sent to students and faculty. The majority of students (202/222; 91.0%) reported Ed Reps had a positive impact on the curriculum. Among faculty, 35/37 (94.6%) reported making changes to their courses as a result of Ed Reps feedback, and 34/37 (91.9%) agreed the program had a positive impact on the learning environment. Qualitative feedback from students and faculty demonstrated a change in school culture, reflecting the primary goals of partnership and continuous quality improvement (CQI). This student-faculty partnership demonstrated high rates of awareness, use, and satisfaction among faculty and students, suggesting its potential for local sustainability and implementation at other schools seeking to formalize student engagement in CQI. Next steps include ensuring the feedback provided is representative of the student body and identifying new areas for student CQI input as the curriculum becomes more established.

Frequency, Predictors, and Outcomes of Prehospital and Early Postarrival Neurological Deterioration in Acute Stroke

Studies of neurological deterioration in stroke have focused on the subacute period, but stroke treatment is increasingly migrating to the prehospital setting, where the neurological course has not been well delineated. To describe the frequency, predictors, and outcomes of neurological deterioration among patients in the ultra-early period following ischemic stroke or intracranial hemorrhage. Exploratory analysis of the prehospital, randomized Field Administration of Stroke Therapy-Magnesium (FAST-MAG) Trial conducted from 2005 to 2013 within 315 ambulances and 60 stroke patient receiving hospitals in Southern California. Participants were consecutively enrolled patients with suspected acute stroke who were transported by ambulance within 2 hours of stroke onset. The main outcome was neurological deterioration, defined as a worsening of 2 or more points on the Glasgow Coma Scale (GCS), a level of consciousness scale ranging from 3 to 15, with higher scores indicating more alertness. Imaging outcomes were ischemic or hemorrhagic injury extent identified during the first brain imaging scan. Outcomes at 3 months included global disability level (assessed using the modified Rankin Scale [mRS]; range, 0-6, with higher numbers indicating greater disability) and mortality. Among the 1690 patients (99.4%), the mean (SD) age was 69.4 (13.5) years, and 43% were female. Final diagnoses were acute cerebral ischemia in 1237 patients (73.2%), intracranial hemorrhage in 386 patients (22.8%), and neurovascular mimic in 67 patients (4.0%). The median (interquartile range [IQR]) minutes between the last well-known time and GCS assessments were 23 (14-42) minutes for prehospital, 58 (46-79) minutes for ED arrival, and 149 (120-180) minutes for early ED course assessments. From prehospital to early postarrival, ultra-early neurological deterioration (U-END) occurred in 200 of 1690 patients (11.8%), more often among patients with intracranial hemorrhage than among those with acute cerebral ischemia (119 of 386 [30.8%] vs 75 of 1237 [6.1%], P < .001). Patterns of U-END were prehospital U-END without early recovery in 30 of 965 patients (3.1%), stable prehospital course but early ED deterioration in 49 of 965 patients (5.1%), and continuous deterioration in both prehospital and early ED phases in 27 of 965 patients (2.8%). Ultra-early neurological deterioration was associated with worse 3-month outcomes, including increased global disability (mRS score, 4.6 vs 2.4; P < .001), reduced functional independence (mRS score 0-2, 32 of 200 [16.0%] vs 844 of 1490 [56.6%]; P < .001), and increased mortality (87 of 200 [43.5%] vs 176 of 1490 [11.8%]; P < .001). Ultra-early neurological deterioration occurs in 1 in 8 ambulance-transported patients with acute cerebrovascular disease, including 1 in 3 patients with intracranial hemorrhage and 1 in 16 patients with acute cerebral ischemia, and is associated with markedly reduced functional independence and increased mortality. Averting U-END may be a target for future prehospital therapeutics. ClinicalTrials.gov Identifier: NCT00059332.

Abstract WP228: Imaging Findings Associated With Ultra-Early Neurological Deterioration in EMS-Transported Intracerebral Hemorrhage Patients

Background: With the rise of prehospital intervention, intracerebral hemorrhage (ICH) management is increasingly migrating to the field setting. Ultra-early neurologic deterioration (U-END), during prehospital transport and the first minutes after ED arrival, is a novel target for therapy, imaging determinants could provide useful pathophysiologic insights for treatment. Methods: We analyzed all ICH patients enrolled in the NIH Phase 3 Field Administration of Stroke Therapy - Magnesium (FAST-MAG) prehospital trial who had both ED-arrival and 6-48h follow-up brain CT or GRE-MRI. Deterioration was defined as worsening by ≥2 on the Glasgow Coma Scale (GCS), performed serially by paramedics in the field, upon ED arrival, and early in the ED course. Results: Among 213 ICH patients, age was 65.4 (±13.4) and 33.3% were female. Timing from last know well (LKW) to early serial GCS assessments were: field GCS by paramedic, 23 mins (IQR 14-39); ED arrival GCS, 57 mins (IQR 45-75); and early ED course GCS, 89 mins (IQR 65-107). Initial brain imaging was performed 80 min (IQR 66-98) after LKW, using noncontrast CT in 96%. Overall, 38.5% of ICH patients experienced ultra-early neurological deterioration, including 12.7% in prehospital phase only, 12.2% in early ED course only, and 10.3% in both. Initial imaging findings associated with U-END were: larger hematoma volume 28.3 vs 17.6 cc, p&lt;0.001; larger edema volume 15.4 vs 9.8 cc, p=0.001; moderate-severe midline shift 45.5% vs 6.8%, p&lt;0.001; hematoma irregularity, 53.2% vs 33.0%, p=0.002; hematoma heterogeneity, 63.6% vs 40.8%, p=0.001; and basal ganglia location, 64.9% vs 46.3%, p=0.006. In multivariate analysis, U-END in the prehospital phase was associated with hematoma margin irregularity, OR 1.5 (95%CI 1.1-2.2); while U-END during the early ED course was associated with midline shift, OR 7.2 (95%CI 1.9-26.4) and hematoma margin irregularity, OR 2.3 (95%CI 1.1 - 5.1). Conclusions: ICH patients with ultra-early neurological deterioration have larger hematoma and edema volumes on initial brain imaging. Greater hematoma shape irregularity suggests ongoing, multiphasic and multifocal, bleeding is an important, and potentially avertable, contributor to prehospital and early ED course deterioration.

A new take on the assessment of first-year art projects

In a search for fresh forms of formative assessment that promotes student learning and encourage students to take responsibility for their own learning, a reflective study was conducted after two assessment instruments were applied in the evaluation of first-year B Ed students in Art Education. The first assessment was designed to assist students to overcome their apprehension about mark-making (drawing) and with the second, consideration was given to whether assessments prepared students for a lifetime of learning. Many first-year students entering their teacher training have not done any art since primary school. As part of the B Ed course they are required to produce a practical portfolio where they apply the art elements. For some students, this is a daunting task because they have very little confidence in their own creative ability. As a strategy to overcome their initial fear of drawing, a River of Life (Fisher & White 2014) exercise was introduced to set off their practical work. The theoretical component of the B Ed 1 course in Art Education comprises of a) the didactics of the subject and b) basic background knowledge of South African art and artists. A component of this work is assessed by means of a written test, but in the past the outcome was very poor. In an attempt to improve their lack of knowledge in this regard, instead of a written test, students were required to come to class with prepared notes and using that, had to design a flowchart as if in preparation for a slide show of a particular component of the work. Some examples of the end results of the River of Life drawings were analysed and will be discussed to establish whether it could be considered a reliable instrument to assess the ability of B Ed 1 students in the practical application of the elements of art. Results of the flowcharts as part of the theory assessment have been analysed to ascertain whether it has been a reliable assessment tool for this particular component of their course, enabling students to source and apply knowledge about art and artists of South Africa. Results of this research could suggest guidelines to forms of assessment other than the traditional, as reliable instruments in Art Education.

Abstract TP233: Patterns, Determinants and Outcomes of Ultra-Early Neurological Deterioration (U-END) in Acute Ischemic Stroke

Background: The patterns and outcomes of deterioration during prehospital transport and the first phase of ED care are important for planning for diversion of acute cerebral ischemia (ACI) patients to designated stroke centers and design of prehospital treatment trials. Methods: We analyzed patients enrolled in the NIH Phase 3 Field Administration of Stroke Therapy - Magnesium (FAST-MAG) trial within 2h of last known well (LKW). Deterioration was defined as worsening by ≥2 on the Glasgow Coma Scale (GCS), performed serially by paramedics in the field, upon ED arrival, and after the early ED course. Results: Among 713 acute cerebral ischemia patients, age was 65.4 (±13.4), 45% female. Times from LKW to GCS assessments were: paramedic, 25 mins (IQR 15-46); ED arrival, 60 mins (IQR 48-82); and after early ED course, 83 mins (IQR 60-106). Overall, 16.3% experienced neurological deterioration, including 9.0% in prehospital phase only, 7.3% in early ED phase only, and none in both phases. Granular patterns of deficit progression were: Prehospital Sustained - prehospital deterioration, then stable early ED phase, 2.2% (16); Dippers - prehospital deterioration, then early ED improvement, 6.7% (48); Delayed - stable prehospital, then ED deterioration, 3.0% (22); and Peakers - prehospital improvement, then early ED deterioration, 4.2% (30) (Figure). Ischemic stroke patients who experienced any U-END had higher age, 73.2 vs 69.8, p&lt;0.01; lower prehospital GCS scores, 14 (IQR 11-15) vs 15 (IQR 14-15), p&lt;0.001; and greater prehospital focal weakness, LAMS 4.2 vs 3.6, p&lt;0.001. U-END was associated with higher rates of disability or death (mRS 2-6) at 90 days, 77.8% vs 53.8%, p&lt;0.001. Conclusions: Ultra-early neurological deterioration occurs in one-sixth of EMS-transported acute cerebral ischemia patients, and is associated with less favorable outcome. Early identification and effective management strategies are needed to reduce its occurrence.

Abstract 149: Patterns, Determinants and Outcomes of Ultra-early Neurological Deterioration (U-END) in Intracranial Hemorrhage

Background: The patterns and outcomes of deterioration during prehospital transport and the first phase of ED care are important for planning for design of prehospital intracranial hemorrhage (ICH) treatment trials. Methods: Patients were enrolled in the NIH Phase 3 Field Administration of Stroke Therapy - Magnesium (FAST-MAG) prehospital trial within 2h of last known well (LKW). Deterioration was defined as worsening by ≥2 on the Glasgow Coma Scale (GCS), performed serially by paramedics in the field, upon ED arrival, and after the early ED course Results: Among 213 patients with ICH, age was 65.4 (±13.4), 33.3% female. Times from LKW to GCS assessments were: paramedic, 23 mins (IQR 14-39); ED arrival, 57 mins (IQR 45-75); and after early ED course, 89 mins (IQR 65-107). Overall, 38.5% experienced neurological deterioration, including 12.7% in prehospital phase only, 12.2% in early ED phase only, and 10.3% in both. Granular patterns of deficit progression were: Prehospital Sustained - prehospital deterioration, then stable early ED phase, 6.1% (13); Dippers - prehospital deterioration, then early ED improvement, 6.6% (14); Delayed - stable prehospital, then ED deterioration, 12.2% (26); and Continuous - prehospital deterioration, then further deterioration in ED, 10.3% (22) (Figure). ICH patients who experienced any U-END had lower prehospital GCS scores, 15 (IQR 12-15) vs 15 (IQR 15-15), p&lt;0.001, greater prehospital focal weakness, LAMS 4.4 vs 3.9, p&lt;0.001, history of hypertension, 87.4% vs 74.9%, p&lt;0.001, higher ED SBP, 186 vs 174, p&lt;0.001, and larger ICH volume, 45.8 vs 21.8 cm 3 , p&lt;0.001. U-END was associated with higher dependence or death (mRS 3-6) at 90d, 90.1% vs 61.6%, p&lt;0.001. Conclusions: Ultra-early neurological deterioration occurs in more than one-third of EMS-transported ICH patients, is associated with elevated BP, and leads to unfavorable outcome. Clinical trials testing prehospital initiation of BP-lowering therapy for ICH are desirable.

Prehospital ketamine use by paramedics in the Australian Capital Territory: A 12 month retrospective analysis.

The aim of this study was to describe prehospital use of ketamine by ACT Ambulance Service, and frequency of endotracheal intubation. This was a retrospective study of patients receiving prehospital ketamine between 1 January and 31 December 2013. Episodes were identified from the prehospital electronic patient care records, then linkage to ED records at two receiving hospitals. Demographics, dose, indication and occasions of intubation were analysed. A total of 163 episodes were identified; 10 of these were excluded because of lack of identifying data or missing records (age 1-97 years [mean: 43, standard deviation: 21.7], 56% men). Median total dose was 60 mg (interquartile range 70; 5-400 mg) in three doses (interquartile range 3; 1-14 mg). For patients with a weight recorded (63%), median dose was 0.73 mg/kg. Indications were analgesia 68%, agitation/combative 25%, rapid sequence intubation 5% and others 2%. A total of 26 patients were endotracheally intubated, 11 prehospital (seven as an intended rapid sequence intubation and four combative patients with return of spontaneous circulation) and 15 in the ED. Of ED intubations, 10 were trauma patients and five were drug ingestion related. Patients receiving ketamine for combativeness were more likely to be intubated than those receiving it for analgesia (25 vs 7.2%; odds ratio: 3.46; 95% confidence interval: 1.12, 10.71). In those with a weight recorded, the mg/kg dose was not associated with subsequent intubation. Median dose for analgesia was comparable with other studies; dose for sedation was less than reported elsewhere. Intubation rate for patients receiving prehospital ketamine was 17%. Further study is recommended to assess the ED course of the non-intubated group of patients, and consideration should be given to non-weight-based methods of dose selection.

Current Ethical Issues in Teacher Education: A Critical Analysis on Pre-Service and In-service Emerging Teachers

The paper intends to examine the current professional ethics, its problems and teacher taught relationship in the field of teacher education as well as how they described negotiated relationship boundaries. This study conducted in a B. Ed college under Indra Prasta University that Ram Chandra Institute of Education and Technology and in-service students of Indira Gandhi National Open University (IGNOU), and designed to document examples of ethical dilemmas faced by pre-service and practicing teachers. Also aim to explore pre-service teachers’ perceptions on ethical education and to examine the B. Ed course curriculum for ethics subjects across the one-year and two year degree course. Results highlight a need for teacher training courses to include ethical philosophy subject, at the same time a code of ethics for teaching profession. This re presents a sustainable way to support professional practice and enhance teacher quality, by preparing and equipping teachers with techniques to explore and teach complex ethical issues in the classroom and ultimately it will help the teacher to create a conducive environment within the institution which is needed for best learning.

Conversion of Introductory Plant Biology Course and Lab to Web-Based Distance Ed Course

Conversion of the introductory plant biology course for non-majors from a lecture/lab format to a web-based course was a collaborative project between the Department of Plant Biology and the Instructional Support group at ASU. This course provides an introduction to biology through the world of plants by including lectures and laboratory activities that examine plant systems. The project was undertaken to provide students with an asynchronous opportunity to participate in either the course, the lab, or both. There were three distinct phases of implementation of the multimedia website: Design, Development, and Delivery. The design phase was driven by the faculty, who, along with graduate assistants, developed the course outline and content. They gathered images, identified concepts to be animated, and created storyboards to layout the sequence in the animation. The development stage was driven by the Instructional Designers who selected the appropriate media for animations and worked with developers to create them. The delivery phase was again driven by the professors. They implemented the website as a teaching tool, gathered feedback from students and teaching assistants, and worked with instructional designers and multimedia developers to improve the site. A wide variety of on-line multimedia components were incorporated into the website, including illustrations, images, animations, interactive modules, video and text. Three separate media packages were used: MacroMedia Flash (Macromedia, 2000), Director Shockwave (Macromedia, 2000), and QuickTime (Apple, Inc. 2000). Findings from surveys of students, faculty, and staff identified positive regard for the site as a whole. Several technological and logistical challenges were encountered and addressed.

The effects of learn units on student performance in two college courses.

Abstract We report an experiment examining academic performance of undergraduate students in two special education college courses. experimenter/professor taught both courses in which he presented curriculum material via written (LUs) (Greer & Hogin, 1999) or in a lecture format across randomly selected weeks in a 12-week semester. There were a total of 20 students (11 in Emotional Disturbance course, 9 in ABA course) primarily juniors and seniors majoring in special education ranging in age from 20 to 48. independent variable consisted of a series of written LUs presented to students in form of guided notes that were scripted in logical sequence (based upon textbook material). LUs were defined as a series of meshed or interlocking 3-term contingencies 1 for student and at least 2 for professor arranged through scripted curricula. During LU condition, professor (1) read a phrase or question from guided notes (with blank lines) that were distributed to students, (2) discussed phrase or question, (3) exposed phrase/question and its corresponding answer on overhead, (4) provided an opportunity for all students to respond by writing/copying answer, and (5) then immediately consequated their answers by checking their accurate completion of blank line. During lecture condition, professor lectured (from material obtained from textbook chapter) without providing any written LUs. dependent variable was student grade achievement on weekly short answer essay exams. Interobserver agreement for independent scoring of dependent variable for ABA exams was 97%. Interobserver agreement for independent scoring of dependent variable for ED exams was 95%. mean percentage of procedural integrity for ABA course was 88% ranging from 83% to 100%. mean percentage of procedural integrity for ED course was 100%. In ABA course, mean percentage correct on exams was 83% during LU class sessions and 68% during lecture sessions. In ED course, mean percentage correct on exams was 84% during LU class sessions and 74% during lecture sessions. Social validity measures indicated high student satisfaction with unit instructional procedure. These results were discussed in terms of potential utility of unit as a microanalytic measure of both teaching and learning particularly for subject matter in higher education containing specificity in terminology (i.e., factual and scientific content). Key Words: Learn Units, Instructional time, active student responding, interobserver agreement ********** Effects of Learn Units on Student Performance in Two College Courses It is generally agreed that goals of science are to understand, predict, and control behavior (Berliner, 1990). Consequently, every respected scientific discipline has its corresponding basic unit of measurement which is ultimately responsible for profession's advancement and improvement (e.g., biology: cell, nutrition: vitamins and calories, chemistry: molecules, engineering: micron). Unfortunately, professions of education and school psychology have lacked an accurate and replicable basic unit of measurement which may well account for decades of student underachievement. Greer (1994) states that the identification and use of a primary measure of teaching is essential to maturation of a science of pedagogy (p. 161). refinement of instructional time concepts in relationship to educational outcomes has evolved over decades (Fisher & Berliner, 1985). Recently, learn units have been identified within field of education: The unit consists of interlocking operants of instruction that incorporate particular student and teacher interactions that predict whether student behavior will be controlled by particular stimuli and setting events (p. …

Diagnosis

Diagnosis

Determining the need for admission in patients with new-onset seizures

To determine which adult patients with new-onset seizures require admission and whether those who require admission can be identified in the emergency department. Retrospective chart review of patients seen during a 5-year period. Urban county teaching hospital in southern California. Three hundred thirty-three adult patients with new-onset seizures. Patients were excluded if they had acute head trauma, hypoglycemia from diabetic therapy, or alcohol- or recreational drug-related seizures. Standardized medical evaluation including physical examination, CBC, SMA-7 (electrolytes, blood urea nitrogen, creatinine, glucose), calcium, cranial computed tomography (CT), lumbar puncture if indicated, and admission to the hospital. Forty-six percent of patients (136 of 294) admitted to our hospital required admission as judged by a retrospective evaluation of the ED and hospital course. The numbers of patients who had a clinically significant result with each part of the evaluation were: physical examination, 75 of 333 (23%); CBC, 25 of 319 (8%); SMA-7, 21 of 329 (6%); calcium, 2 of 208 (1%); CT, 134 of 325 (41%); and lumbar puncture, 19 of 227 (8%). Ninety-five percent of patients requiring admission (129 of 136) were detected by the standardized medical evaluation. One half of patients with new-onset seizures require admission. Patients with new-onset seizures who require admission can usually be detected by a standardized medical evaluation in the ED.

Encouraging student teacher confidence in the use of information technology

Homerton College has taken action to improve the confidence of student teachers on a 4 year primary B Ed course, in the use of computers. Surveys taken over 3 years show that students entering the course describe themselves as having low information technology skills. A 2-h IT induction session, supported by self-study materials, was introduced to raise the level of student confidence. A second survey of first year students at the end of the Autumn 1992 term indicates a significant change in students' perceptions of their own skill levels. However, although a majority felt competent in their own use of IT, few felt sufficiently confident to teach others. In a second course, offered in year three, students engaged over a much longer period in preparation of multi-media classroom resources. This experience does seem to have a more positive effect on students' confidence in terms of personal and classroom use of computers. As a result of this course, the students have all shown themselves prepared and able to use IT based resources in the classroom.