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PubMed2026

Fantastic microbes and where to find them: evaluating learning-by-doing outcomes in a crowdfunded metagenomics workshop.

Metagenomics offers a powerful framework for authentic, interdisciplinary learning, yet it remains underrepresented in undergraduate education due to technical and infrastructural barriers. We hypothesized that a research-based, learning-by-doing metagenomics workshop supported by accessible bioinformatics tools could enhance students' perceived skills, self-efficacy, and conceptual understanding of metagenomic analysis. To test this hypothesis, we designed and evaluated a hybrid hands-on workshop in which undergraduate and postgraduate students analyzed real environmental shotgun metagenomic datasets generated from soil samples collected during a citizen science initiative. Using the graphical workflow platform KBase, participants completed an end-to-end metagenomic analysis, from quality control and assembly to genome reconstruction, taxonomic classification, functional annotation, and scientific presentation of results. Educational outcomes were assessed through validated retrospective pre-post questionnaires, self-efficacy scales, and an open-ended conceptual understanding task. Participants showed significant increases in perceived metagenomic skills and confidence in performing metagenomic analyses, while gains in perceived learning showed a positive trend. Conceptual understanding improved across educational levels, particularly among participants with limited prior experience. Together, these findings demonstrate that authentic, data-driven metagenomics activities can effectively lower barriers to computational biology and foster meaningful learning through hands-on research experiences.

Metagenomics↗
PubMed2000

A role of her own: female cowbirds, Molothrus ater, influence the development and outcome of song learning.

Previous work has shown that captive female cowbirds, Molothrus ater, can influence the outcome of male song development by affecting retention or deletion of song elements and by stimulating improvization. Here we looked for evidence of female influence during the process of learning, as males progress from subsong to plastic song to stereotyped song. In a longitudinal study, we measured the rate and timing of vocal development in captive, juvenile male brown-headed cowbirds, M. a. artemisiae. Half the young males were housed with female cowbirds from their own population (South Dakota: SD) and half with female cowbirds from a M. a. ater population (Indiana: IN). Both populations of females prefer local songs and differ in the time of breeding, with SD females breeding 2 weeks later than IN females. The results showed significant effects of female presence on the age at which males advanced through stages of vocal development: the SD males with SD females, as opposed to SD males with IN females, developed stereotyped song earlier, reduced motor practise earlier, and produced more effective playback songs. Longitudinal observations of social interactions showed that the two groups of females reliably differed in social responses to males. Degree of social proximity of females to males in the winter predicted song maturity, rate of rehearsal and song potency. Thus, females can stimulate the progression of song learning, as well as prune song content. Copyright 2000 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed2005

Behavioral and associative effects of differential outcomes in discrimination learning.

The role of the reinforcer in instrumental discriminations has often been viewed as that of facilitating associative learning between a reinforced response and the discriminative stimulus that occasions it. The differential-outcome paradigm introduced by Trapold (1970), however, has provided compelling evidence that reinforcers are also part of what is learned in discrimination tasks. Specifically, when the availability of different reinforcing outcomes is signaled by different discriminative stimuli, the conditioned anticipation of those outcomes can provide another source of stimulus control over responding. This article reviews how such control develops and how it can be revealed, its impact on behavior, and different possible mechanisms that could mediate the behavioral effects. The main conclusion is that differential-outcome effects are almost entirely explicable in terms of the cue properties of outcome expectancies-namely, that conditioned expectancies acquire discriminative control just like any other discriminative or conditional stimulus in instrumental learning.

Animals↗
PubMed1986

Computer learning strategies and outcomes: a field test in health services administration.

Decisions in the changing, competitive and highly complex health care market must be arrived at faster. The argument for the extensive use of computers by modern health care executives and the inclusion of computer training in the health administration curriculum rests on the fact that the survival and growth of health care institutions is vitally tied to the capacity of their managers to absorb increasingly complex data and turn it rapidly into usable information. Although educators cannot solve all health care industry implementation problems either as consultants or as analysis in implementation studies, they must provide clear direction in the analytical training of future managers concerning computer utilization and management information systems generally. Without the basic foundation in knowledge, attitude, and behavior reinforcement, the risk of improper and insufficient computer utilization in the industry is large. This article examines the curricular structure, learning theory, and preliminary student learning and behavior outcomes of a course developed in 1985 for health administration students at Sangamon State University.

Computer User Training↗
PubMed1999

Treating previable twin-twin transfusion syndrome with fetoscopic laser surgery: outcomes following the learning curve.

AIMS: We have performed fetoscopic laser occlusion of chorioangiopagous vessels (FLOC) in previable pregnancies affected by twin-twin transfusion syndrome (TTTS) since 1988. Treatment outcomes obtained after the procedure's learning curve are presented and compared to those from other centers performing FLOC or other treatment methods. METHODS: A total of 100 cases of FLOC have been performed at our centers. The later 67 TTTS patients had a mean gestational age of 21.1 +/- 1.7 weeks (range 18-24.5) with a mean fundal height of 33.1 +/- 4.9 cm (range 27-44) when treated. Eighteen (27%) had failed another treatment method before FLOC. RESULTS: All 67 cases have delivered with 82% (55/67) having at least one surviving twin and 93/134 (69%) of the twins surviving overall. Thirty-eight have surviving twins, 17 have one survivor (5 neonatal and 12 fetal deaths), and 12 have none. The mean duration of pregnancy following FLOC was 9.9 +/- 5.5 weeks (range 1.0-19). Only 4 of 93 (4.3%) survivors have significant handicaps at a mean follow-up of 14.3 +/- 10.1 months (range 1.0-34). CONCLUSION: Fetoscopic laser occlusion of chorioangiopagous vessels within the vascular equator limits the duration of fetal pathophysiology in TTTS and results in neonatal outcomes superior to the modified procedure and other treatment methods.

Diseases in Twins↗
PubMed2006

Outcome expectations drive learned behaviour in larval Drosophila.

Why does Pavlov's dog salivate? In response to the tone, or in expectation of food? While in vertebrates behaviour can be driven by expected outcomes, it is unknown whether this is true for non-vertebrates as well. We find that, in the Drosophila larva, odour memories are expressed behaviourally only if animals can expect a positive outcome from doing so. The expected outcome of tracking down an odour is determined by comparing the value of the current situation with the value of the memory for that odour. Memory is expressed behaviourally only if the expected outcome is positive. This uncovers a hitherto unrecognized evaluative processing step between an activated memory trace and behaviour control, and argues that learned behaviour reflects the pursuit of its expected outcome. Shown in a system with a simple brain, an apparently cognitive process like representing the expected outcome of behaviour seems to be a basic feature of behaviour control.

Animals↗
PubMed2005

Rehabilitation education program for stroke (REPS): learning and practice outcomes.

INTRODUCTION: New research knowledge acquired from Web-based sources may have a better chance of being translated into practice when accompanied by additional educational strategies. This study was undertaken to investigate that hypothesis. METHODS: The Rehabilitation Education Program for Stroke (REPS) combines a self-directed online learning module with support from peer mentors, technical skills workshops, and organizational supports. Participants completed learning tests and practice surveys before and after the program and at a 6-month follow-up. RESULTS: Learning and self-reported practice outcomes improved in the areas of assessment, client-centered practice, support for family and caregivers, and detecting depression. Participants also identified and reported specific strategies for individual and programmatic practice change. DISCUSSION: A multifaceted, interdisciplinary online education intervention can positively influence stroke rehabilitation practices.

Education, Medical, Continuing↗
PubMed2005

Exploring the learning curve, pathological outcomes and perioperative morbidity of laparoscopic partial nephrectomy performed for renal mass.

PURPOSE: We investigated the learning curve, pathological results and perioperative morbidity of laparoscopic partial nephrectomy (LPN). MATERIALS AND METHODS: The records of all LPN cases at our institution between January 1999 and March 2004 were reviewed. Of 223 cases 217 (97.3%) were performed for an enhancing renal mass. RESULTS: Mean tumor size was 2.6 cm (range 1 to 10) and 95.4% of patients had a normal contralateral kidney. Transient vascular control was performed in 75.1% of cases. Mean operative time (186 minutes) decreased with surgeon experience (p = 0.003) but was independent of tumor size (p = 0.964). Mean warm ischemia time (27.6 minutes) depended on tumor size (p = 0.005) but not on experience (0.964). Mean blood loss was 385 cc and the perioperative transfusion rate was 6.9%. Postoperative complications occurred in 23 cases (10.6%) with the most common being ileus (1.8%), bleeding (1.8%) and urinary leakage (1.4%). Although the mean serum creatinine change after LPN was a function of tumor size (p <0.001), it was clinically insignificant (0.13 mg/dl). No significant relationship was observed between warm ischemia time and creatinine change (p = 0.262). The final pathological evaluation revealed renal cell carcinoma in 144 patients (66.4%) and the overall positive margin rate was 3.5%. Only 2 renal cell carcinoma recurrences in the operated kidney (1.4%) were identified (mean followup +/- SD 24 +/- 12 months). CONCLUSIONS: LPN is an effective approach for treating small renal masses with low perioperative morbidity. Contrary to previous reports, more than 30% of the enhancing renal lesions excised in this series were found to be benign on final pathological evaluation.

Adult↗
PubMed2003

The interaction between discriminative stimuli and outcomes during instrumental learning.

Rats were trained on a biconditional discrimination in which the delivery of a food pellet stimulus signalled that pressing on one of two levers would be reinforced, whereas the delivery of a sucrose solution stimulus signalled that the reward was contingent on pressing the other lever. The outcome was the same food type as the discriminative stimulus in the congruent group but the other food type in the incongruent group. Both responses were rewarded with the same outcome in the same group. All the three groups learned the discrimination at statistically indistinguishable rates. Prefeeding one of the outcomes selectively reduced the associated response thereby demonstrating that responding was mediated by a representation of the outcome. Moreover, the outcome of one trial controlled responding on the next trial in accord with the stimulus function of the food type. These results are discussed in relation to the associative structures mediating the discriminative control of instrumental performance.

Animals↗
PubMed2004

Personal experience with the Whipple operation: outcomes and lessons learned.

Pancreaticoduodenectomy (PD) has evolved into a safe procedure in major high-volume medical centers. This retrospective outcome review is from a database of 134 consecutive PDs from 1985 through 2002; all of whom underwent resection in a community hospital with a general surgery residency. All resections were performed by senior residents under the supervision of the same attending surgeon (V.L.H.). Follow-up was 100 per cent. There were 117 (88%) pyloric-sparing pancreaticoduodenectomies (PSPD) and 17 (12%) standard Whipple (SW) operations. Mean age for patients was 60 years with a range 29 to 84 years. There were 62 female and 72 male patients. Resections performed were periampullary malignancies, 83.6 per cent; benign neoplasm, 3.7 per cent; and non-neoplastic disease, 12.7 per cent. For the pancreatic anastomoses, 84 (63%) were pancreaticogastrostomies (PGs) and 50 (37%) were pancreaticojejunostomies (PJs). Mortality was 3.7 per cent, and 60 major complications occurred in 38 patients (28%) which included pancreatic fistula, 5.2 per cent; bile leak, 0.7 per cent; other anastomotic leaks, 1.5 per cent; intra-abdominal abscesses, 8.2 per cent; intra-abdominal bleeding, 3.0 per cent; upper gastrointestinal bleeding, 3.7 per cent; bowel ischemia, 1.5 per cent; and delayed gastric emptying (DGE), 17.9 per cent. Reoperation was required in only five patients (3.7%). There were no complications in 96 patients (72%) with an average hospital stay of 9.0 days. Long-term complications were peptic ulcer disease, liver abscess, hepatic stones, pancreatic insufficiency, and radiation jejunal strictures. Long-term survival was achieved in periampullary malignancies including pancreatic with excellent functional status.

Adenocarcinoma↗
PubMed2003

Implementation of an institutional program to improve clinical and financial outcomes of mechanically ventilated patients: one-year outcomes and lessons learned.

OBJECTIVE: To determine the effect of an institutional approach to the care of patients requiring mechanical ventilation for longer than three consecutive days in five adult intensive care units (ICU) on clinical and financial outcomes. DESIGN: A multidisciplinary team was selected from five adult ICUs to design the approach. Planning occurred from August 1999 to September 2000. The process was called outcomes management (OM) and included an evidence-based clinical pathway, protocols for weaning and sedation use, and the selection of four advanced practice nurses (called outcomes managers) to manage and monitor the program. SETTING: The project was completed in a 550-bed mid-Atlantic academic medical center. The ICUs included the following: coronary care, medical ICU, neuroscience ICU, surgical trauma ICU, and thoracic cardiovascular ICU. PATIENTS: The sample included 595 pre-OM patients and 510 post-OM patients mechanically ventilated for greater than three consecutive days. INTERVENTIONS: Full implementation of the OM approach occurred in March 2001. Retrospective baseline (18 months pre-OM) and prospective (12 months OM) clinical and financial data were compared. MEASUREMENTS AND MAIN RESULTS: Statistically significant differences in clinical outcomes were demonstrated in the managed patients compared with those managed before the institutional approach. Outcomes include ventilator duration (median days declined from ten to nine; p =.0001), ICU length of stay (median days declined from 15 to 12; p =.0008), hospital length of stay (median days declined from 22 to 20; p =.0001), and mortality rate (declined from 38% to 31%, p =.02). More than 3,000,000 US dollars cost savings were realized in the OM group. CONCLUSIONS: This institutional approach to the care of patients ventilated >3 days improved all clinical and financial outcomes of interest. To date, few similar initiatives have demonstrated similar results. The approach and lessons learned in this process improvement project may be helpful to other institutions attempting to improve outcomes in this vulnerable population.

Academic Medical Centers↗
PubMed1997

Food- and nonfood-related differential outcomes in equivalence learning by adults with Prader-Willi syndrome.

Adults with Prader-Willi syndrome learned the conditional relations necessary for the formation of two equivalence classes under four conditions: (a) nondifferential, nonedible outcomes; (b) nondifferential, edible outcomes; (c) differential, nonedible outcomes; and (d) differential, edible outcomes. Tests for transitive relations revealed superior performance when the two differential outcomes procedures, in which a distinct reinforcer was associated with each stimulus set, were used during teaching. Performance on test trials following nondifferential outcomes training was better when edible outcomes were used during teaching for 4 of the 5 participants. An enhancement of performance on the derived relations separated by two or three nodal stimuli was seen when a differential outcomes procedure was used to teach the baseline conditional relations.

Adult↗
PubMed2006

Robotic assistance provides excellent outcomes during the learning curve for laparoscopic Roux-en-Y gastric bypass: results from 100 robotic-assisted gastric bypasses.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has a reported learning curve of 100 cases. Robotic-assisted surgery decreases the learning curve in complex laparoscopic surgeries. We hypothesize that robotic-assisted, hand-sewn gastrojejunostomy during a LRYGB will improve results during the initial 100 cases when compared with the literature. METHODS: Our first 100 robotic-assisted gastrojejunostomies performed during LRYGB were reviewed from a prospective database. Patient demographics, operative times, length of stay, reoperations, anastomotic leak, pulmonary embolus, and death were all evaluated. RESULTS: The mean age and body mass index were 42 and 50, respectively. Operative times ranged from 148 minutes to 437 minutes (mean = 254). There were no leaks or deaths. Four patients had complications, including reoperation (1), incisional hernia (1), pulmonary embolus (1), and recurrent umbilical hernia (1). CONCLUSIONS: Robotic-assisted LRYGB is feasible and safe, as evidenced by the excellent outcomes from this series during the initial learning curve for LRYGB.

Adult↗
PubMed2002

Using "concept sorting" to study learning processes and outcomes.

PURPOSE: First, to evaluate "concept sorting" as a tool for assessing knowledge organization in the memories of first-year medical students, and second, to study the relationship between knowledge organization and examination performance. METHOD: During 2001, first-year medical students taking the Renal Course at the University of Calgary Faculty of Medicine were given a questionnaire on scheme use and were given a concept-sorting task in the domain of metabolic alkalosis. The sophistication of their concept sorting was graded using the number of physiology-based groups they formed. Review of the course's examination scores allowed correlation with concept-sorting scores. Statistical analyses used Fisher's exact test and the two-sample t-test. Pearson's correlation coefficient and the kappa statistic were used for correlation between raters. RESULTS: A total of 81 of 99 students completed the study. The concept-sorting score (mean +/- SEM) for students who used the scheme was higher than was the score for students who did not (2.5 +/- 0.14 versus 1.91 +/- 0.12, p =.016). Students who scored higher in the concept-sorting task, referred to as "deep learners," scored higher than did "surface learners" on exam questions on metabolic alkalosis (2.81 versus 2.29, p =.02). There was no difference in the overall examination performances between the two groups. CONCLUSIONS: Concept sorting may be a useful tool for studying the learning process. Scheme use by students produces a positive outcome on examination performance.

Education, Medical, Undergraduate↗
PubMedDate not supplied

The differential outcomes procedure can interfere or enhance operant rule learning.

The differential outcomes effect--the enhancement of learning and memory performance by correlating distinct reinforcers with to-be-remembered events (sample stimuli)--has been stated to be one of the most robust phenomena in learning psychology. However, in this paper we demonstrate that the correlation between unique samples and unique reinforcers can either interfere with or enhance learning a spatial matching-rule, dependent on whether these two processes are trained concurrently or sequentially. If the Pavlovian conditioning (unique sample-reward pairings) occurs before the matching rule is learned (sequentially), the conditioned expectations of unique rewards will enhance the acquisition of the spatial matching-rule in rats (the differential outcomes effect will be observed). However, if rats are required to learn the Pavlovian associations and the matching-rule concurrently, they are impaired in acquiring the spatial matching-rule. Thus, employing the differential outcomes procedure can either enhance or detract from learning and remembering the task rule-dependent on the nature of the task and order of training. These data suggest that under some circumstances learning Pavlovian associations can compete with the formation of instrumental behavior.

Animals↗
PubMedDate not supplied

NSAIDs and COX-2 inhibitors: what can we learn from large outcomes trials? The gastroenterologist's perspective.

Many studies have shown that a variety of strategies, including the use of cyclooxygenase-2 (COX-2) inhibitors, or co-prescription of misoprostol or proton pump inhibitors, result in reduced endoscopic damage and ulceration compared with non-selective nonsteroidal anti-inflammatory drugs (NSAIDs) alone. Questions have been raised as to whether this would translate into improved clinical outcomes. Consequently, several studies have investigated whether use of COX-2 inhibitors (Vioxx Gastrointestinal Outcomes Research [VIGOR] and the Celecoxib Long-Term Arthritis Safety Assessment Study [CLASS] studies) or co-prescription with misoprostol (MUCOSA) would reduce the event rate of clinically significant ulcers. These studies have shown an approximate halving of such events. They have raised the possibility that use of low dose aspirin may compromise these benefits and appear to have shown differences between (at least some) COX-2 inhibitors and (at least some) NSAIDs with regard to myocardial infarction. Among the lessons learned from this experience are the need to define closely the outcomes of interest and possibly to concentrate on ulcer complications, the need for adequately powered studies, and the fact that endoscopic studies broadly predict outcomes. However, there are differences in the estimated rates of reduction. It is not self evident whether outcomes studies or endoscopic studies give a truer estimate of risk. A helpful development would be more standardized gastrointestinal assessment at the time of ulcer complications and this could be achieved if studies were done in countries with well-developed primary care systems.

Animals↗