Publications by authors named "Michelle Smith"

275 Publications

Towards complete and error-free genome assemblies of all vertebrate species.

Nature 2021 Apr 28;592(7856):737-746. Epub 2021 Apr 28.

UQ Genomics, University of Queensland, Brisbane, Queensland, Australia.

High-quality and complete reference genome assemblies are fundamental for the application of genomics to biology, disease, and biodiversity conservation. However, such assemblies are available for only a few non-microbial species. To address this issue, the international Genome 10K (G10K) consortium has worked over a five-year period to evaluate and develop cost-effective methods for assembling highly accurate and nearly complete reference genomes. Here we present lessons learned from generating assemblies for 16 species that represent six major vertebrate lineages. We confirm that long-read sequencing technologies are essential for maximizing genome quality, and that unresolved complex repeats and haplotype heterozygosity are major sources of assembly error when not handled correctly. Our assemblies correct substantial errors, add missing sequence in some of the best historical reference genomes, and reveal biological discoveries. These include the identification of many false gene duplications, increases in gene sizes, chromosome rearrangements that are specific to lineages, a repeated independent chromosome breakpoint in bat genomes, and a canonical GC-rich pattern in protein-coding genes and their regulatory regions. Adopting these lessons, we have embarked on the Vertebrate Genomes Project (VGP), an international effort to generate high-quality, complete reference genomes for all of the roughly 70,000 extant vertebrate species and to help to enable a new era of discovery across the life sciences.
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http://dx.doi.org/10.1038/s41586-021-03451-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081667PMC
April 2021

Complete vertebrate mitogenomes reveal widespread repeats and gene duplications.

Genome Biol 2021 Apr 29;22(1):120. Epub 2021 Apr 29.

Oxford Nanopore Technologies Ltd, Oxford Science Park, Oxford, UK.

Background: Modern sequencing technologies should make the assembly of the relatively small mitochondrial genomes an easy undertaking. However, few tools exist that address mitochondrial assembly directly.

Results: As part of the Vertebrate Genomes Project (VGP) we develop mitoVGP, a fully automated pipeline for similarity-based identification of mitochondrial reads and de novo assembly of mitochondrial genomes that incorporates both long (> 10 kbp, PacBio or Nanopore) and short (100-300 bp, Illumina) reads. Our pipeline leads to successful complete mitogenome assemblies of 100 vertebrate species of the VGP. We observe that tissue type and library size selection have considerable impact on mitogenome sequencing and assembly. Comparing our assemblies to purportedly complete reference mitogenomes based on short-read sequencing, we identify errors, missing sequences, and incomplete genes in those references, particularly in repetitive regions. Our assemblies also identify novel gene region duplications. The presence of repeats and duplications in over half of the species herein assembled indicates that their occurrence is a principle of mitochondrial structure rather than an exception, shedding new light on mitochondrial genome evolution and organization.

Conclusions: Our results indicate that even in the "simple" case of vertebrate mitogenomes the completeness of many currently available reference sequences can be further improved, and caution should be exercised before claiming the complete assembly of a mitogenome, particularly from short reads alone.
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http://dx.doi.org/10.1186/s13059-021-02336-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082918PMC
April 2021

Implementing team-based learning in the life sciences: A case study in an online introductory level evolution and biodiversity course.

Ecol Evol 2021 Apr 17;11(8):3527-3536. Epub 2020 Dec 17.

Department of Ecology and Evolutionary Biology Cornell University Ithaca NY USA.

Team-Based Learning (TBL) is a pedagogical tool that has great potential to develop student engagement, accountability, and equity in the online classroom. TBL is rooted in evidence-based educational theories and practices that underlie many active learning approaches such as self-testing, team discussion, and application of knowledge. The use of these approaches is associated with better student performance, retention, and sense of belonging in the classroom, aspects that are often reported to be especially lacking in online courses. Here, we describe how we implemented TBL in a face-to-face and an online introductory level evolution and biodiversity course. We implemented TBL in the face-to-face course (~200 students) starting in 2018 and in the online course (~30 students) starting in the summer of 2019. We used several online applications to facilitate the transition to an online platform such as Simbio, Slack, VoiceThread, Articulate 360, and Teammates. Our experiences using TBL approaches in the online course have been rewarding, and students are engaged and accountable for their learning and performed well in the course. Our goal is to provide an example of how we designed a life science course using TBL approaches and transitioned the course to an online environment. With the current switch to remote instruction and online learning, we recommend the use of TBL as a course design approach that can improve the students' online learning experience.
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http://dx.doi.org/10.1002/ece3.6863DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057328PMC
April 2021

Serum Zonulin Measured by Commercial Kit Fails to Correlate With Physiologic Measures of Altered Gut Permeability in First Degree Relatives of Crohn's Disease Patients.

Front Physiol 2021 25;12:645303. Epub 2021 Mar 25.

Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada.

Intestinal epithelial cell tight junctions (TJs) contribute to the integrity of the intestinal barrier allowing for control of the physical barrier between external antigens or bacterial products and the internal environment. Zonula occludens-1 (ZO-1) is a protein that modulates intestinal TJs, and serum levels of ZO-1 has been suggested as a biomarker of disrupted barrier function in humans. Previous studies suggested that increased intestinal permeability was associated with evidence of TJ abnormalities. However, there is limited information on the serological measurement of ZO-1 and its relation to other tests of barrier function in healthy subjects. We investigated the correlation of serum ZO-1, with physiologic measures of intestinal permeability (as the ratio of the fractional excretion of lactulose-mannitol or LMR) in a cohort of 39 healthy FDRs of Crohn's disease (CD) patients. No significant correlation was found between LMR and ZO-1 levels (2 = 0.004, < 0.71), or intestinal fatty acid binding proteins (I-FABP) (2 = 0.004, < 0.71). In conclusion, our data show that ZO-1 and I-FABP are not a marker of gut permeability as defined by LMR.
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http://dx.doi.org/10.3389/fphys.2021.645303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8027468PMC
March 2021

Outbreak of COVID-19 and interventions in a large jail - Cook County, IL, United States, 2020.

Am J Infect Control 2021 Apr 2. Epub 2021 Apr 2.

Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA. Electronic address:

Background: Correctional and detention facilities are disproportionately affected by COVID-19 due to shared space, contact between staff and detained persons, and movement within facilities. On March 18, 2020, Cook County Jail, one of the United States' largest, identified its first suspected case of COVID-19 in a detained person.

Methods: This analysis includes SARS-CoV-2 cases confirmed by molecular detection among detained persons and Cook County Sheriff's Office staff. We examined occurrence of symptomatic cases in each building and proportions of asymptomatic detained persons testing positive, and timing of interventions including social distancing, mask use, and expanded testing and show outbreak trajectory in the jail compared to case counts in Chicago.

Results: During March 1-April 30, 907 symptomatic and asymptomatic cases of SARS-CoV-2 infection were detected among detained persons (n = 628) and staff (n = 279). Among asymptomatic detained persons in quarantine, 23.6% tested positive. Programmatic activity and visitation stopped March 9, cells were converted into single occupancy beginning March 26, and universal masking was implemented for staff (April 2) and detained persons (April 13). Cases at the jail declined while cases in Chicago increased.

Discussion/conclusions: Aggressive intervention strategies coupled with widespread diagnostic testing of detained and staff populations can limit introduction and mitigate transmission of SARS-CoV-2 infection in correctional and detention facilities.
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http://dx.doi.org/10.1016/j.ajic.2021.03.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016534PMC
April 2021

Clinical Tests of Tibialis Posterior Tendinopathy: Are They Reliable, and How Well Are They Reflected in Structural Changes on Imaging?

J Orthop Sports Phys Ther 2021 05 28;51(5):253-260. Epub 2021 Mar 28.

Objective: To determine the reliability of common clinical tests for tibialis posterior tendinopathy (TPT) and to investigate their relationship with grayscale ultrasound findings in individuals who have medial foot/ankle pain.

Design: Prospective cohort.

Methods: Fifty-two individuals reporting medial foot/ankle pain were clinically examined by 2 physical therapists using 4 clinical tests for TPT: pain on tendon palpation, swelling around the tendon, pain/weakness with tibialis posterior contraction, and pain during or inability to perform a single-leg heel raise (SLHR). Individuals also underwent an ultrasound examination by a sonographer. Physical therapists and the sonographer were blind to each other's findings. Positive ultrasound examination included at least 1 of the following grayscale changes: hypoechogenicity, fibrillar disruption, or thickening of the tendon. For reliability between the 2 physical therapists, we calculated kappa coefficients and 95% confidence intervals (CIs). To assess relationships between clinical and imaging findings, we calculated odds ratios and 95% CIs.

Results: The SLHR was the most reliable test, with substantial agreement between physical therapists ( = 0.74; 95% CI: 0.54, 0.93), while the other tests had moderate levels of reliability. Of all clinical tests, the SLHR was most related to grayscale findings on ultrasound (odds ratio = 5.8), but was imprecisely so, with a 95% CI of 1.7 to 20.4.

Conclusion: Of all tests, the SLHR was the most reliable between clinicians and best related to imaging findings in individuals presenting with TPT, aligning with contemporary thinking of tendinopathy as a load-related clinical presentation. There was a disconnect between clinical findings and ultrasound grayscale changes in the tibialis posterior tendon in individuals with TPT. .
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http://dx.doi.org/10.2519/jospt.2021.9707DOI Listing
May 2021

Parents' Perspectives on Using Artificial Intelligence to Reduce Technology Interference During Early Childhood: Cross-sectional Online Survey.

J Med Internet Res 2021 Mar 15;23(3):e19461. Epub 2021 Mar 15.

Division of General Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States.

Background: Parents' use of mobile technologies may interfere with important parent-child interactions that are critical to healthy child development. This phenomenon is known as technoference. However, little is known about the population-wide awareness of this problem and the acceptability of artificial intelligence (AI)-based tools that help with mitigating technoference.

Objective: This study aims to assess parents' awareness of technoference and its harms, the acceptability of AI tools for mitigating technoference, and how each of these constructs vary across sociodemographic factors.

Methods: We administered a web-based survey to a nationally representative sample of parents of children aged ≤5 years. Parents' perceptions that their own technology use had risen to potentially problematic levels in general, their perceptions of their own parenting technoference, and the degree to which they found AI tools for mitigating technoference acceptable were assessed by using adaptations of previously validated scales. Multiple regression and mediation analyses were used to assess the relationships between these scales and each of the 6 sociodemographic factors (parent age, sex, language, ethnicity, educational attainment, and family income).

Results: Of the 305 respondents, 280 provided data that met the established standards for analysis. Parents reported that a mean of 3.03 devices (SD 2.07) interfered daily in their interactions with their child. Almost two-thirds of the parents agreed with the statements "I am worried about the impact of my mobile electronic device use on my child" and "Using a computer-assisted coach while caring for my child would help me notice more quickly when my device use is interfering with my caregiving" (187/281, 66.5% and 184/282, 65.1%, respectively). Younger age, Hispanic ethnicity, and Spanish language spoken at home were associated with increased technoference awareness. Compared to parents' perceived technoference and sociodemographic factors, parents' perceptions of their own problematic technology use was the factor that was most associated with the acceptance of AI tools.

Conclusions: Parents reported high levels of mobile device use and technoference around their youngest children. Most parents across a wide sociodemographic spectrum, especially younger parents, found the use of AI tools to help mitigate technoference during parent-child daily interaction acceptable and useful.
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http://dx.doi.org/10.2196/19461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074848PMC
March 2021

Parents' Perspectives on Using Artificial Intelligence to Reduce Technology Interference During Early Childhood: Cross-sectional Online Survey.

J Med Internet Res 2021 Mar 15;23(3):e19461. Epub 2021 Mar 15.

Division of General Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States.

Background: Parents' use of mobile technologies may interfere with important parent-child interactions that are critical to healthy child development. This phenomenon is known as technoference. However, little is known about the population-wide awareness of this problem and the acceptability of artificial intelligence (AI)-based tools that help with mitigating technoference.

Objective: This study aims to assess parents' awareness of technoference and its harms, the acceptability of AI tools for mitigating technoference, and how each of these constructs vary across sociodemographic factors.

Methods: We administered a web-based survey to a nationally representative sample of parents of children aged ≤5 years. Parents' perceptions that their own technology use had risen to potentially problematic levels in general, their perceptions of their own parenting technoference, and the degree to which they found AI tools for mitigating technoference acceptable were assessed by using adaptations of previously validated scales. Multiple regression and mediation analyses were used to assess the relationships between these scales and each of the 6 sociodemographic factors (parent age, sex, language, ethnicity, educational attainment, and family income).

Results: Of the 305 respondents, 280 provided data that met the established standards for analysis. Parents reported that a mean of 3.03 devices (SD 2.07) interfered daily in their interactions with their child. Almost two-thirds of the parents agreed with the statements "I am worried about the impact of my mobile electronic device use on my child" and "Using a computer-assisted coach while caring for my child would help me notice more quickly when my device use is interfering with my caregiving" (187/281, 66.5% and 184/282, 65.1%, respectively). Younger age, Hispanic ethnicity, and Spanish language spoken at home were associated with increased technoference awareness. Compared to parents' perceived technoference and sociodemographic factors, parents' perceptions of their own problematic technology use was the factor that was most associated with the acceptance of AI tools.

Conclusions: Parents reported high levels of mobile device use and technoference around their youngest children. Most parents across a wide sociodemographic spectrum, especially younger parents, found the use of AI tools to help mitigate technoference during parent-child daily interaction acceptable and useful.
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http://dx.doi.org/10.2196/19461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074848PMC
March 2021

Health-Related Behaviours, HIV and Active Tuberculosis are Associated with Perioperative Adverse Events Following Emergency Laparotomy at a Tertiary Surgical Service in KwaZulu-Natal, South Africa.

World J Surg 2021 Jun 27;45(6):1672-1677. Epub 2021 Feb 27.

Department of General Surgery & Trauma, Greys Hospital, Pietermaritzburg, South Africa.

Introduction: This project aims to define the common comorbidities associated with patients undergoing emergency laparotomy in South Africa, to review the impact of these comorbidities on outcome and to attempt to model these various factors.

Method: A retrospective review of all patients undergoing emergency laparotomy for an emergency general surgical condition was performed from the prospectively entered Hybrid Electronic Medical Registry (HEMR). Univariate and multiple logistic regression analysis was performed to establish associations and independent risk factors for developing an adverse event.

Results: Over a six-year time period, a total of 1464 patients underwent emergency laparotomy. The median age was 34 years. Males constituted 58.8% (861) of the patients and 754 patients (51.5%) experienced at least one adverse event. The mortality rate was 12 percent. Comorbidities and social factors were documented in 912 patients (62.3%). The rate of adverse events among patients with comorbidities was 59% (538). Patients without comorbidities or significant social factors had an adverse event rate of 39.1% (216). This difference was statistically significant (p < 0.001). The most frequent comorbidity in our sample was HIV, followed by hypertension, underlying malignancy, diabetes mellitus, active TB and cardiovascular disease.

Conclusion: Emergency laparotomy in South Africa is associated with significant morbidity and mortality. The patients are younger than in high-income countries. Diabetes mellitus, hypertension, HIV and active TB are associated with the development of an AE.
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http://dx.doi.org/10.1007/s00268-021-05986-9DOI Listing
June 2021

Hip and knee muscle torque and its relationship with dynamic balance in chronic ankle instability, copers and controls.

J Sci Med Sport 2021 Feb 9. Epub 2021 Feb 9.

School of Health and Rehabilitation Sciences, The University of Queensland, Australia. Electronic address:

Objectives: We compared hip and knee isometric muscle torque between individuals with chronic ankle instability (CAI), those who have sustained one ankle sprain with no ongoing problems (copers) and healthy controls. Our secondary objective was to compare balance between groups and investigate the relationship between muscle torque and balance.

Design: Cross-sectional study.

Methods: 22 CAI, 20 copers and 22 uninjured participants were tested. Isometric torque (normalised to body mass (Nm/kg)) was measured using a rigidly-fixated hand-held dynamometer. Balance was assessed with the Y-balance test.

Results: Knee and hip flexor and extensor, and hip adductor and abductor muscle torque was less in individuals with CAI compared to controls (standardised mean difference (SMD) >1.2). Hip and knee flexor and extensor muscle torque was less in CAI participants than copers (SMD: 0.69-1.1). Hip external and internal rotator torque did not differ between groups. There was no difference in hip or knee muscle torque between controls and copers (SMD: 0.01-0. 54). Balance was impaired in CAI participants compared to copers and controls in all directions. There was a strong positive correlation between posterolateral Y-balance test performance and torque of the hip adductors (r=0.53), flexors (r=0.52) and extensors (r=0.50).

Conclusions: Individuals with CAI have weak knee and hip muscles compared to copers and controls. Hip strength was shown to be related to posterolateral balance performance. Future studies may investigate the effect of hip and knee strengthening exercise on ongoing ankle problems, such as episodic giving way in individuals with CAI.
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http://dx.doi.org/10.1016/j.jsams.2021.01.009DOI Listing
February 2021

Bow Hunter's Syndrome: A rare cause of vertebrobasilar insufficiency.

Radiol Case Rep 2021 Apr 30;16(4):867-870. Epub 2021 Jan 30.

Department of Radiology, Main Line Health, 130 S Bryn Mawr Ave, Bryn Mawr, PA 19010.

Bow Hunter's syndrome, also referred to as rotational occlusion of the vertebral artery, is caused by dynamic compression of a patient's dominant vertebral artery. We reported a case of successful clinical and imaging work up of Bow Hunter's Syndrome that occurred in a 79-year-old female patient. We discussed the clinical presentation, imaging findings, and subsequent management options of this rare syndrome. The gold standard for diagnosis is dynamic cerebral angiography, which allows the reproduction of symptoms with head turn greater than 30-45 degrees. Subsequent management is based on the underlying etiology causing rotational compression.
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http://dx.doi.org/10.1016/j.radcr.2021.01.041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850963PMC
April 2021

Spectrum and Outcome of Emergency General Surgery Laparotomies at a Tertiary Center in South Africa.

J Surg Res 2021 Jun 3;262:65-70. Epub 2021 Feb 3.

Department of Surgery, University of KwaZulu-Natal, South Africa.

Background: Nontraumatic surgical emergencies constitute a significant portion of total surgical workload and are associated with a significant mortality rate. The spectrum and outcome of surgical emergencies in a low-middle-income country may differ from that in high-income countries. This study aims to describe the spectrum and outcome of emergency laparotomy for nontrauma surgical emergencies at a single-tertiary center in South Africa.

Methods: A retrospective interrogation of a hybrid electronic record system of consecutive patients undergoing emergency laparotomy for nontraumatic surgical emergencies presenting to Greys Hospital from December 2012 to December 2018.

Results: One thousand four hundred sixty four patients were included with a median age of 34 y (IQR 23-52) and male predominance (861; 59%). The mortality rate was 12.5% (183). The most common comorbidity was human immunodeficiency virus (353; 24.1%) which did not influence mortality. At least one comorbidity increased the odds of mortality by 4 times (95% CI 2.7-6.2). Mortality was associated with longer waiting times to operation (12.8 versus 8.4 h; P < 0.001) and longer operating times (105 min versus 80 min respectively; P < 0.001). Temporary abdominal closure was used in 245 (16.7%) patients. Planned repeat laparotomy was performed in 193 (13.2%) patients. Acute appendicitis (594, 40.6%) was the most common pathology of which 61.4% had the American Association for the Surgery of Trauma grade of 4 or more (high grade). This was followed by perforated peptic ulcer disease (10.5%). The adverse event rate was 51.5% (754). Postoperative pulmonary complications and acute kidney injury were the most common. The strongest predictors of mortality were abdominal compartment syndrome (OR 26.5, 95% CI 9.36-94.13) and postoperative hemodynamic instability 17.43 (OR 17.4, 95% CI 11.80-25.98).

Conclusions: Our spectrum of disease differs to that found in high-income countries. The morbidity and mortality rates are significant, and attention must be focused on attempts to reduce this. Various comorbidities and adverse events are associated with increased mortality.
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http://dx.doi.org/10.1016/j.jss.2020.12.062DOI Listing
June 2021

Absence of CCR2 reduces spontaneous intestinal tumorigenesis in the Apc mouse model.

Int J Cancer 2021 Jan 26. Epub 2021 Jan 26.

Department of Microbiology and Immunology, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA.

The biological activities of chemokine (C-C motif) ligand 2 (CCL2) are mediated via C-C chemokine receptor-2 (CCR2). Increased CCL2 level is associated with metastasis of many cancers. In our study, we investigated the role of the CCL2/CCR2 axis in the development of spontaneous intestinal tumorigenesis using the Apc mouse model. Ablation of CCR2 in Apc mice significantly increased the overall survival and reduced intestinal tumor burden. Immune cell analysis showed that CCR2 Apc mice exhibited significant reduction in the myeloid cell population and increased interferon γ (IFN-γ) producing T cells both in spleen and mesenteric lymph nodes compared to Apc mice. The CCR2 Apc tumors showed significantly reduced levels of interleukin (IL)-17 and IL-23 and increased IFN-γ and Granzyme B compared to Apc tumors. Transfer of CCR2 Apc CD4 T cells into Rag2 mice led to development of colitis phenotype with increased CD4 T cells hyper proliferation and IL-17 production. In contrast, adoptive transfer of CCR2 Apc CD4 T cells into Rag2 mice failed to enhance colonic inflammation or IL-17 production. These results a suggest novel additional role for CCR2, where it regulates migration of IL-17 producing cells mediating tumor-promoting inflammation in addition to its role in migration of tumor associated macrophages.
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http://dx.doi.org/10.1002/ijc.33477DOI Listing
January 2021

Making a First Impression: Exploring What Instructors Do and Say on the First Day of Introductory STEM Courses.

CBE Life Sci Educ 2021 03;20(1):ar7

Department of Chemistry, University of Virginia, Charlottesville, VA 22904.

Student impressions formed during the first day of class can impact course satisfaction and performance. Despite its potential importance, little is known about how instructors format the first day of class. Here, we report on observations of the first day of class in 23 introductory science, technology, engineering, and math (STEM) courses. We first described how introductory STEM instructors structure their class time by characterizing topics covered on the first day through inductive coding of class videos. We found that all instructors discussed policies and basic information. However, a cluster analysis revealed two groups of instructors who differed primarily in their level of STEM content coverage. We then coded the videos with the noncontent Instructor Talk framework, which organizes the statements instructors make unrelated to disciplinary content into several categories and subcategories. Instructors generally focused on building the instructor-student relationship and establishing classroom culture. Qualitative analysis indicated that instructors varied in the specificity of their noncontent statements and may have sent mixed messages by making negatively phrased statements with seemingly positive intentions. These results uncovered variation in instructor actions on the first day of class and can help instructors more effectively plan this day by providing messages that set students up for success.
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http://dx.doi.org/10.1187/cbe.20-05-0098DOI Listing
March 2021

The Influence of Forced Social Isolation on the Auditory Ecology and Psychosocial Functions of Listeners With Cochlear Implants During COVID-19 Mitigation Efforts.

Ear Hear 2020 12 22;42(1):20-28. Epub 2020 Dec 22.

Department of Communication Sciences and Disorders, The University of Iowa, Iowa City, Iowa, USA.

Objectives: The impact of social distancing on communication and psychosocial variables among individuals with hearing impairment during COVID-19 pandemic. It was our concern that patients who already found themselves socially isolated (Wie et al. 2010) as a result of their hearing loss would be perhaps more susceptible to changes in their communication habits resulting in further social isolation, anxiety, and depression. We wanted to better understand how forced social isolation (as part of COVID-19 mitigation) effected a group of individuals with hearing impairment from an auditory ecology and psychosocial perspective. We hypothesized that the listening environments would be different as a result of social isolation when comparing subject's responses regarding activities and participation before COVID-19 and during the COVID-19 pandemic. This change would lead to an increase in experienced and perceived social isolation, anxiety, and depression.

Design: A total of 48 adults with at least 12 months of cochlear implant (CI) experience reported their listening contexts and experiences pre-COVID and during-COVID using Ecological Momentary Assessment (EMA; methodology collecting a respondent's self-reports in their natural environments) through a smartphone-based app, and six paper and pencil questionnaires. The Smartphone app and paper-pencil questionnaires address topics related to their listening environment, social isolation, depression, anxiety, lifestyle and demand, loneliness, and satisfaction with amplification. Data from these two-time points were compared to better understand the effects of social distancing on the CI recipients' communication abilities.

Results: EMA demonstrated that during-COVID CI recipients were more likely to stay home or be outdoors. CI recipients reported that they were less likely to stay indoors outside of their home relative to the pre-COVID condition. Social distancing also had a significant effect on the overall signal-to-noise ratio of the environments indicating that the listening environments had better signal-to-noise ratios. CI recipients also reported better speech understanding, less listening effort, less activity limitation due to hearing loss, less social isolation due to hearing loss, and less anxiety due to hearing loss. Retrospective questionnaires indicated that social distancing had a significant effect on the social network size, participant's personal image of themselves, and overall loneliness.

Conclusions: Overall, EMA provided us with a glimpse of the effect that forced social isolation has had on the listening environments and psychosocial perspectives of a select number of CI listeners. CI participants in this study reported that they were spending more time at home in a quieter environments during-COVID. Contrary to our hypothesis, CI recipients overall felt less socially isolated and reported less anxiety resulting from their hearing difficulties during-COVID in comparison to pre-COVID. This, perhaps, implies that having a more controlled environment with fewer speakers provided a more relaxing listening experience.
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http://dx.doi.org/10.1097/AUD.0000000000000991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773050PMC
December 2020

Novel Fecal Biomarkers That Precede Clinical Diagnosis of Ulcerative Colitis.

Gastroenterology 2021 Apr 10;160(5):1532-1545. Epub 2020 Dec 10.

Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada. Electronic address:

Background & Aims: Altered gut microbiota composition and function have been associated with inflammatory bowel diseases, including ulcerative colitis (UC), but the causality and mechanisms remain unknown.

Methods: We applied 16S ribosomal RNA gene sequencing, shotgun metagenomic sequencing, in vitro functional assays, and gnotobiotic colonizations to define the microbial composition and function in fecal samples obtained from a cohort of healthy individuals at risk for inflammatory bowel diseases (pre-UC) who later developed UC (post-UC) and matched healthy control individuals (HCs).

Results: Microbiota composition of post-UC samples was different from HC and pre-UC samples; however, functional analysis showed increased fecal proteolytic and elastase activity before UC onset. Metagenomics identified more than 22,000 gene families that were significantly different between HC, pre-UC, and post-UC samples. Of these, 237 related to proteases and peptidases, suggesting a bacterial component to the pre-UC proteolytic signature. Elastase activity inversely correlated with the relative abundance of Adlercreutzia and other potentially beneficial taxa and directly correlated with known proteolytic taxa, such as Bacteroides vulgatus. High elastase activity was confirmed in Bacteroides isolates from fecal samples. The bacterial contribution and functional significance of the proteolytic signature were investigated in germ-free adult mice and in dams colonized with HC, pre-UC, or post-UC microbiota. Mice colonized with or born from pre-UC-colonized dams developed higher fecal proteolytic activity and an inflammatory immune tone compared with HC-colonized mice.

Conclusions: We have identified increased fecal proteolytic activity that precedes the clinical diagnosis of UC and associates with gut microbiota changes. This proteolytic signature may constitute a noninvasive biomarker of inflammation to monitor at-risk populations that can be targeted therapeutically with antiproteases.
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http://dx.doi.org/10.1053/j.gastro.2020.12.004DOI Listing
April 2021

The Arkansas Minority Barber and Beauty Shop Health Initiative: Meeting People Where They Are.

Prev Chronic Dis 2020 12 3;17:E153. Epub 2020 Dec 3.

Arkansas Department of Health, Little Rock, Arkansas.

Introduction: The Office of Health Equity at the Arkansas Department of Health created the Arkansas Minority Barber & Beauty Shop Health Initiative (ARBBS) to address cardiovascular disease (CVD) among racial/ethnic minority populations. The objective of this study was to describe CVD-related screening results for ARBBS participants and their knowledge of CVD-related risk factors, signs, and symptoms before and immediately after participation in a screening event.

Methods: ARBBS screening events were held from February 2016 through June 2019 at barber and beauty shops in 14 counties in Arkansas. During each event, participants were screened for hypertension, high cholesterol, and diabetes; surveys on CVD-related knowledge were administered before (pretest) and after (posttest) screening. Onsite public health practitioners reviewed surveys and identified abnormal screening results. Participants with abnormal screening results were counseled and given a referral to follow up with a primary care physician, wellness center, or charitable clinic. The nurse coordinator followed up to confirm that a visit or appointment had been made and provide case-management services.

Results: During the study period, 1,833 people were screened. The nurse coordinator followed up with 320 (55.7%) of 574 unique referrals. Of the 574 referrals, 418 (72.8%) were for hypertension, 156 (27.2%) for high cholesterol, and 120 (20.9%) for diabetes. The overall knowledge of risk factors and symptoms of heart attack and stroke increased significantly by 15.4 percentage points from pretest to posttest (from 76.9% to 92.3%; P < .001). The follow-up approach provided anecdotal information indicating that several participants discovered they had underlying medical conditions and were given medical or surgical interventions.

Conclusion: Through referrals and follow-ups, ARBBS participants gained greater knowledge of chronic disease prevention and risk factors. Additionally, this program screened for and identified people at risk for CVD.
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http://dx.doi.org/10.5888/pcd17.200277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735488PMC
December 2020

Multidisciplinary Community-Based Investigation of a COVID-19 Outbreak Among Marshallese and Hispanic/Latino Communities - Benton and Washington Counties, Arkansas, March-June 2020.

MMWR Morb Mortal Wkly Rep 2020 Dec 4;69(48):1807-1811. Epub 2020 Dec 4.

By June 2020, Marshallese and Hispanic or Latino (Hispanic) persons in Benton and Washington counties of Arkansas had received a disproportionately high number of diagnoses of coronavirus disease 2019 (COVID-19). Despite representing approximately 19% of these counties' populations (1), Marshallese and Hispanic persons accounted for 64% of COVID-19 cases and 57% of COVID-19-associated deaths. Analyses of surveillance data, focus group discussions, and key-informant interviews were conducted to identify challenges and propose strategies for interrupting transmission of SARS-CoV-2, the virus that causes COVID-19. Challenges included limited native-language health messaging, high household occupancy, high employment rate in the poultry processing industry, mistrust of the medical system, and changing COVID-19 guidance. Reducing the COVID-19 incidence among communities that suffer disproportionately from COVID-19 requires strengthening the coordination of public health, health care, and community stakeholders to provide culturally and linguistically tailored public health education, community-based prevention activities, case management, care navigation, and service linkage.
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http://dx.doi.org/10.15585/mmwr.mm6948a2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714036PMC
December 2020

Frequent User System Engagement: A Quality Improvement Project to Examine Outcomes of a Partnership to Improve the Health of Emergency Department Frequent Users.

J Nurs Care Qual 2020 Nov 23. Epub 2020 Nov 23.

Department of Professional Practice, Bronson Methodist Hospital, Kalamazoo, Michigan.

Background: Patterns of frequent emergency department (ED) use correlate with a variety of care needs. Health care systems should address these needs in collaboration with community health partners.

Local Problem: Approximately 600 patients frequent a local ED for nonemergent needs. Approximately 15% of those patients are homeless.

Methods: A program consistent with the Corporation for Supportive Housing's Frequent User System Engagement (FUSE) model was developed and implemented in a community setting. Eleven participants were enrolled in this pilot program.

Interventions: Eligible candidates enrolled in the program received coordinated multidisciplinary care and stable housing.

Results: ED visits, primary care provider visits, and number of diagnostic tests and costs changed significantly over time.

Conclusion: The FUSE program is equipped to address the needs of the whole person, resulting in a meaningful impact on overall health while decreasing frequency of ED visits.
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http://dx.doi.org/10.1097/NCQ.0000000000000534DOI Listing
November 2020

Disability, Physical Impairments, and Poor Quality of Life, Rather Than Radiographic Changes, Are Related to Symptoms in Individuals With Ankle Osteoarthritis: A Cross-sectional Laboratory Study.

J Orthop Sports Phys Ther 2020 Dec;50(12):711-722

Objective: To compare physical and patient-reported outcomes between (1) individuals with symptomatic radiographic ankle osteoarthritis (OA) and asymptomatic individuals, and (2) asymptomatic individuals with and without radiographic ankle OA.

Design: Cross-sectional study.

Methods: Ninety-six volunteers (31 symptomatic individuals with radiographic ankle OA, 41 asymptomatic individuals with radiographic ankle OA, and 24 asymptomatic individuals without radiographic ankle OA) completed a survey on quality of life (QoL), function, pain, disability, kinesiophobia, ankle instability, and physical activity, and undertook physical assessments of ankle muscle strength, heel-raise endurance, dorsiflexion range of motion (ROM), and ambulatory function.

Results: Symptomatic individuals with radiographic ankle OA reported greater pain (standardized mean difference [SMD], 1.70; 95% confidence interval [CI]: 1.18, 2.23), disability (SMD, 1.44; 95% CI: 0.93, 1.95), and instability (SMD, -3.92; 95% CI: -4.68, -3.17), and lower patient-reported function (SMD, -2.10; 95% CI: -2.66, -1.54) and QoL (SMD, -0.98; 95% CI: -1.47, -0.50), than asymptomatic individuals. Muscle strength (all SMDs, -0.73 or greater), heel-raise endurance (SMD, -0.71; 95% CI: -1.16, -0.25), dorsiflexion ROM (SMD, -1.54; 95% CI: -2.02, -1.06), and ambulatory function (all SMDs, 0.57 or greater) were significantly impaired in symptomatic individuals with radiographic ankle OA compared to asymptomatic individuals. Most patient-reported and physical outcomes were similar between asymptomatic individuals with and without radiographic ankle OA.

Conclusion: Individuals with symptomatic radiographic ankle OA had poorer physical outcomes, function, and QoL compared to asymptomatic individuals with and without radiographic ankle OA. This suggests that disability in ankle OA is related to symptoms rather than to radiographic evidence of degeneration. .
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http://dx.doi.org/10.2519/jospt.2020.9376DOI Listing
December 2020

Small herbaria contribute unique biogeographic records to county, locality, and temporal scales.

Am J Bot 2020 11 20;107(11):1577-1587. Epub 2020 Nov 20.

Department of Biology, Central Michigan University, 2401 Biosciences, Mount Pleasant, MI, 48859, USA.

Premise: With digitization and data sharing initiatives underway over the last 15 years, an important need has been prioritizing specimens to digitize. Because duplicate specimens are shared among herbaria in exchange and gift programs, we investigated the extent to which unique biogeographic data are held in small herbaria vs. these data being redundant with those held by larger institutions. We evaluated the unique specimen contributions that small herbaria make to biogeographic understanding at county, locality, and temporal scales.

Methods: We sampled herbarium specimens of 40 plant taxa from each of eight states of the United States of America in four broad status categories: extremely rare, very rare, common native, and introduced. We gathered geographic information from specimens held by large (≥100,000 specimens) and small (<100,000 specimens) herbaria. We built generalized linear mixed models to assess which features of the collections may best predict unique contributions of herbaria and used an Akaike information criterion-based information-theoretic approach for our model selection to choose the best model for each scale.

Results: Small herbaria contributed unique specimens at all scales in proportion with their contribution of specimens to our data set. The best models for all scales were the full models that included the factors of species status and herbarium size when accounting for state as a random variable.

Conclusions: We demonstrated that small herbaria contribute unique information for research. It is clear that unique contributions cannot be predicted based on herbarium size alone. We must prioritize digitization and data sharing from herbaria of all sizes.
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http://dx.doi.org/10.1002/ajb2.1563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756855PMC
November 2020

The genome sequence of the eastern grey squirrel, Gmelin, 1788.

Wellcome Open Res 2020 13;5:27. Epub 2020 Feb 13.

Tree of Life, Wellcome Sanger Institute,Wellcome Genome Campus, Hinxton, CB10 1SA, UK.

We present a genome assembly from an individual male (the eastern grey squirrel; Vertebrata; Mammalia; Eutheria; Rodentia; Sciuridae). The genome sequence is 2.82 gigabases in span. The majority of the assembly (92.3%) is scaffolded into 21 chromosomal-level scaffolds, with both X and Y sex chromosomes assembled.
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http://dx.doi.org/10.12688/wellcomeopenres.15721.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7653645PMC
February 2020

The genome sequence of the channel bull blenny, (Günther, 1861).

Wellcome Open Res 2020 24;5:148. Epub 2020 Jun 24.

Wellcome Sanger Institute, Cambridge, CB10 1SA, UK.

We present a genome assembly for (channel bull blenny, (Günther, 1861)); Chordata; Actinopterygii (ray-finned fishes), a temperate water outgroup for Antarctic Notothenioids. The size of the genome assembly is 609 megabases, with the majority of the assembly scaffolded into 24 chromosomal pseudomolecules. Gene annotation on Ensembl of this assembly has identified 21,662 coding genes.
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http://dx.doi.org/10.12688/wellcomeopenres.16012.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649722PMC
June 2020

Network Characteristics and Visualization of COVID-19 Outbreak in a Large Detention Facility in the United States - Cook County, Illinois, 2020.

MMWR Morb Mortal Wkly Rep 2020 Nov 6;69(44):1625-1630. Epub 2020 Nov 6.

Correctional and detention facilities have been disproportionately affected by coronavirus disease 2019 (COVID-19) because of shared space and movement of staff members and detained persons within facilities (1,2). During March 1-April 30, 2020, at Cook County Jail in Chicago, Illinois, >900 COVID-19 cases were diagnosed across all 10 housing divisions, representing 13 unique buildings. Movement within the jail was examined through network analyses and visualization, a field that examines elements within a network and the connections between them. This methodology has been used to supplement contact tracing investigations for tuberculosis and to understand how social networks contribute to transmission of sexually transmitted infections (3-5). Movements and connections of 5,884 persons (3,843 [65%] detained persons and 2,041 [35%] staff members) at the jail during March 1-April 30 were analyzed. A total of 472 (12.3%) COVID-19 cases were identified among detained persons and 198 (9.7%) among staff members. Among 103,701 shared-shift connections among staff members, 1.4% occurred between persons with COVID-19, a percentage that is significantly higher than the expected 0.9% by random occurrence alone (p<0.001), suggesting that additional transmission occurred within this group. The observed connections among detained persons with COVID-19 were significantly lower than expected (1.0% versus 1.1%, p<0.001) when considering only the housing units in which initial transmission occurred, suggesting that the systematic isolation of persons with COVID-19 is effective at limiting transmission. A network-informed approach can identify likely points of high transmission, allowing for interventions to reduce transmission targeted at these groups or locations, such as by reducing convening of staff members, closing breakrooms, and cessation of contact sports.
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http://dx.doi.org/10.15585/mmwr.mm6944a3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643900PMC
November 2020

Response profile of fibular repositioning tape on ankle osteokinematics, arthrokinematics, perceived stability and confidence in chronic ankle instability.

Musculoskelet Sci Pract 2020 12 9;50:102272. Epub 2020 Oct 9.

School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, 4072, Australia.

Background: Preliminary evidence suggests that fibular repositioning tape reduces risk of recurrent ankle injuries, but the underlying mechanism has not been investigated.

Objective: To investigate the effects of fibular repositioning tape on ankle osteokinematics, arthrokinematics and perceived stability and confidence in individuals with chronic ankle instability immediately post-tape and following exercise.

Design: Cross-sectional repeated measures study.

Method: Passive ankle plantarflexion-inversion range of motion, weight-bearing dorsiflexion range of motion, anteroposterior translation, inversion-eversion tilt, and perceived ankle stability and confidence during hopping were assessed before and immediately after the application of fibular repositioning tape and after 15 min of exercise in 14 individuals with chronic ankle instability.

Results: Ankle plantarflexion-inversion range of motion, inversion-eversion tilt and anteroposterior translation were reduced immediately after the application of tape compared to pre-tape (p < 0.01). After exercise, total inversion-eversion tilt was significantly lower than pre-tape (p = 0.01), but there were no differences for any of the other mechanical outcomes. Dorsiflexion range of motion did not differ between conditions (p > 0.11). Perceived ankle stability, ankle and task confidence were greater immediately post-tape and post-exercise compared to pre-tape (p < 0.01).

Conclusions: Fibular repositioning tape was associated with a restriction of ankle total inversion-eversion tilt and improved perceived ankle stability and confidence both immediately after application of tape and after participating in exercise. This data provides grounds for exploring mechanical and psychological mechanisms underpinning any clinical efficacy of fibular repositioning tape.
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http://dx.doi.org/10.1016/j.msksp.2020.102272DOI Listing
December 2020

Management Strategies and Outcomes of Hemorrhagic Traumatic Brain Injury on Oral Anticoagulants.

Cureus 2020 Sep 17;12(9):e10508. Epub 2020 Sep 17.

Department of Trauma, OSF Healthcare, Bloomington, USA.

Introduction: Traumatic brain injury (TBI) is common, and the frequency of patients taking oral anticoagulants is increasing. However the optimal initial triage, management, and long term care plans of hemorrhagic TBI patients taking oral anticoagulants is not clear.

Objectives: To determine the usage pattern of reversal agents for hemorrhagic TBI patients taking oral anticoagulants, and examine their characteristics and outcomes as compared to hemorrhagic TBI patients not taking these medications.

Methods: This was a single-center, retrospective, observational study. Included were adults with trauma categorization and traumatic intracranial hemorrhage (ICH) between April 1, 2017 and December 31, 2019. Patient age, type of ICH, initial Glasgow Coma Scale (GCS) score, oral anticoagulant prescribed pre-injury, anticoagulation reversal agent given, and hospital discharge disposition were recorded.

Results: For the entire sample size (n=111), the mean age and GCS were 71.6 years old and 13.8, respectively. Compared to patients not taking oral anticoagulants, patients taking oral anticoagulants were older (76.7 years old versus 69.1; <0.01), had similar GCS scores (13.7 versus 13.9; =0.69), had fewer subarachnoid hemorrhages (18.9% versus 37.8%; =0.04), were less likely to discharge home (48.6% versus 73.0%; =0.01), and had similar incidence of mortality (13.5% versus 6.7%; =0.30). A total of 14/37 (37.8%) patients taking oral anticoagulants received reversal agents in the emergency department. Compared to patients taking oral anticoagulants and not given reversal agents, patients taking oral anticoagulants and given reversal agents had similar ages (78.8 years old versus 75.4; =0.41), had similar GCS scores (12.9 versus 14.1; =0.17), had similar ICH types (all =1.0), were less likely to discharge home (48.6% versus 73.0%; =0.01), and had higher incidence of mortality (28.6% versus 4.2%; =0.05).

Conclusions: This limited data set did not show improved outcomes by giving reversal agents to hemorrhagic TBI patients taking oral anticoagulants. However, until more robust data is available, judicious use of reversal agents in this high-risk patient population should remain common practice.
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http://dx.doi.org/10.7759/cureus.10508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571597PMC
September 2020

Associations of NOD2 polymorphisms with Erysipelotrichaceae in stool of in healthy first degree relatives of Crohn's disease subjects.

BMC Med Genet 2020 10 15;21(1):204. Epub 2020 Oct 15.

Department of Medicine, University of Toronto, Toronto, ON, Canada.

Background: Genetic analyses have identified many variants associated with the risk of inflammatory bowel disease (IBD) development. Among these variants, the ones located within the NOD2 gene have the highest odds ratio of all IBD genetic risk variants. Also, patients with Crohn's disease (CD) have been shown to have an altered gut microbiome, which might be a reflection of inflammation itself or an effect of other parameters that contribute to the risk of the disease. Since NOD2 is an intracellular pattern recognition receptor that senses bacterial peptidoglycan in the cytosol and stimulates the host immune response (Al Nabhani et al., PLoS Pathog 13:e1006177, 2017), it is hypothesized that NOD2 variants represent perfect candidates for influencing host-microbiome interactions. We hypothesized that NOD2 risk variants affect the microbiome composition of healthy first degree relative (FDR) of CD patients and thus potentially contribute to an altered microbiome state before disease onset.

Methods: Based on this, we studied a large cohort of 1546 healthy FDR of CD patients and performed a focused analysis of the association of three major CD SNPs in the coding region of the NOD2 gene, which are known to confer a 15-40-fold increased risk of developing CD in homozygous or compound heterozygous individuals.

Results: Our results show that carriers of the C allele at rs2066845 was significantly associated with an increase in relative abundance in the fecal bacterial family Erysipelotrichaceae.

Conclusions: This result suggests that NOD2 polymorphisms contribute to fecal microbiome composition in asymptomatic individuals. Whether this modulation of the microbiome influences the future development of CD remains to be assessed.
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http://dx.doi.org/10.1186/s12881-020-01115-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566148PMC
October 2020

Demystifying the Meaning of Active Learning in Postsecondary Biology Education.

CBE Life Sci Educ 2020 12;19(4):ar52

Department of Biological Sciences, Auburn University, Auburn, AL 36849.

Active learning is frequently used to describe teaching practices, but the term is not well-defined in the context of undergraduate biology education. To clarify this term, we explored how active learning is defined in the biology education literature ( = 148 articles) and community by surveying a national sample of biology education researchers and instructors ( = 105 individuals). Our objectives were to increase transparency and reproducibility of teaching practices and research findings in biology education. Findings showed the majority of the literature concerning active learning never defined the term, but the authors often provided examples of specific active-learning strategies. We categorized the available active-learning definitions and strategies obtained from the articles and survey responses to highlight central themes. Based on data from the BER literature and community, we provide a working definition of active learning and an Active-Learning Strategy Guide that defines 300+ active-learning strategies. These tools can help the community define, elaborate, and provide specificity when using the term active learning to characterize teaching practices.
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http://dx.doi.org/10.1187/cbe.20-04-0068DOI Listing
December 2020

What Psychosocial and Physical Characteristics Differentiate Office Workers Who Develop Standing-Induced Low Back Pain? A Cross-Sectional Study.

Int J Environ Res Public Health 2020 09 28;17(19). Epub 2020 Sep 28.

School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia.

This study examines demographic, physical and psychosocial factors associated with an increase in low back pain (LBP) during a one-hour standing task. A cross-sectional survey with 40 office workers was conducted. The primary outcome was pain severity during a one-hour standing task recorded every 15 min using a 100 mm Visual Analogue Scale (VAS). Participants were defined as pain developers (PD), if they reported a change in pain of ≥10 mm from baseline, or non-pain developers (NPD). Physical outcomes included participant-rated and examiner-rated trunk and hip motor control and endurance. Self-report history of LBP, physical activity, psychosocial job characteristics, general health and pain catastrophising were collected. Fourteen participants were PD. Hip abduction, abdominal and spinal muscle endurance was lower for PD ( ≤ 0.05). PD had greater self-reported difficulty performing active hip abduction and active straight leg raise tests ( ≤ 0.04). Those reporting a lifetime, 12 month or 7-day history of LBP ( < 0.05) and lower self-reported physical function ( = 0.01) were more likely to develop LBP during the standing task. In conclusion, a history of LBP, reduced trunk and hip muscle endurance and deficits in lumbopelvic/hip motor control may be important to consider in office workers experiencing standing-induced LBP.
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http://dx.doi.org/10.3390/ijerph17197104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579504PMC
September 2020

Do women runners report more pelvic floor symptoms than women in CrossFit®? A cross-sectional survey.

Int Urogynecol J 2021 Feb 21;32(2):295-302. Epub 2020 Sep 21.

School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Brisbane, Australia.

Introduction And Hypothesis: Women who perform high-impact activities might be at greater risk of pelvic floor dysfunction (PFD) than those participating in low-impact exercise; however, little is known about whether PFD is more common in one type of high-impact activity than another. The aim of this study was to compare the prevalence of PFD symptoms in women who engage in high-impact activity compared with CrossFit®-brand training (CF).

Methods: An online survey collected data from 1,379 women (521 runners, 858 CF) on exercise participation, parity, and PFD symptoms, via the Pelvic Floor Distress Inventory (PFDI-20). Specific questions from each PFDI-20 subscale further investigated symptoms of pelvic organ prolapse (POP), anal incontinence (AI), as well as stress (SUI) and urgency (UUI) urinary incontinence.

Results: Symptoms of POP and AI were significantly higher in runners (POP 12.7%, AI 34.0%) than in CF (POP 7.8%, p = 0.003; AI 27.7%, p = 0.014). There was no significant difference in SUI symptoms between groups (37.0% vs 41.0% respectively, p = 0.141). Vaginally parous runners reported significantly more symptoms of POP (19.0% vs 12.2%, p = 0.023), AI (39.3% vs 27.2%, p = 0.001), and UUI (36.3% vs 29.0%, p = 0.037) than CF.

Conclusion: Women, particularly parous women, who participate in running, have a higher prevalence of POP and AI symptoms than women who participate in CF. This suggests that CrossFit®-brand training might not be more detrimental to PFD symptoms than other high-impact activity, such as running. This study does not conclude a pelvic floor health benefit of one exercise over another, but highlights that exercise options can be provided to women.
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http://dx.doi.org/10.1007/s00192-020-04531-xDOI Listing
February 2021