A mixed method analysis of student satisfaction with active learning techniques in an online graduate anatomy course: Consideration of demographics and previous course enrollment

Online learning has become an essential part of mainstream higher education. With increasing enrollments in online anatomy courses, a better understanding of effective teaching techniques for the online learning environment is critical. Active learning has previously shown many benefits in face-to-face anatomy courses, including increases in student satisfaction. Currently, no research has measured student satisfaction with active learning techniques implemented in an online graduate anatomy course. This study compares student satisfaction across four different active learning techniques (jigsaw, team-learning module, concept mapping, and question constructing), with consideration of demographics and previous enrollment in anatomy and/or online courses. Survey questions consisted of Likert-style, multiple-choice, ranking, and open-ended questions that asked students to indicate their level of satisfaction with the active learning techniques. One hundred seventy Medical Science master's students completed the online anatomy course and all seven surveys. Results showed that students were significantly more satisfied with question constructing and jigsaw than with concept mapping and team-learning module. Additionally, historically excluded groups (underrepresented racial minorities) were generally more satisfied with active learning than non-minority groups. Age, gender, and previous experience with anatomy did not influence the level of satisfaction. However, students with a higher-grade point average (GPA), those with only a bachelor's degree, and those with no previous online course experience were more satisfied with active learning than students who had a lower GPA, those holding a graduate/professional degree, and those with previous online course experience. Cumulatively, these findings support the beneficial use of active learning in online anatomy courses.

Human maxillary sinus size, shape, and surface area: Implications for structural and functional hypotheses

OBJECTIVES

Although research into human maxillary sinus (MS) morphology has overwhelmingly focused on sinus volume, other aspects of morphology (e.g., overall shape, mucosal surface area) factor prominently in hypotheses regarding MS form and function. Here, we investigate MS volume in conjunction with measures of MS shape and surface area in a large, diverse sample of modern humans. We test whether variation in MS volume is associated with predictable changes in MS shape (i.e., allometry) and investigate the influence of MS size-shape scaling on mucosal surface area dynamics.

MATERIALS AND METHODS

Measures of MS volume and surface area were obtained from computed tomographic (CT) scans of 162 modern human crania from three ancestral backgrounds-Equatorial Africa, Europe, and East Asia. 3D coordinate landmarks and linear measurements were also collected. Multivariate analyses were employed to test for associations between MS volume and other morphological variables.

RESULTS

Significant associations between MS volume and 3D shape were identified both across and within the subsamples. Variation in MS volume was found to predominantly relate to differences in MS height and width dimensions relative to MS length. This pattern of allometric scaling was found to differentially influence total mucosal surface area and the SAV ratio.

CONCLUSION

This study suggests that variation in MS volume is disproportionately mediated by MS width and height dimensions. This finding has implications for hypotheses which structurally link MS morphology to craniofacial ontogeny and those which suggest that MS morphology may perform adaptive physiological functions.

Ontogenetic variation in human nasal morphology

Internal nasal cavity morphology has long been thought to reflect respiratory pressures related to heating and humidifying inspired air. Yet, despite the widely recognized importance of ontogeny in understanding climatic and thermoregulatory adaptations, most research on nasal variation in modern and fossil humans focuses on static adult morphology. This study utilizes cross-sectional CT data of three morphologically distinct samples (African, European, Arctic) spanning from infancy to adulthood (total n = 321). Eighteen landmarks capturing external and internal regions of the face and nose were subjected to generalized Procrustes and form-space principal component analyses (separately conducted on global and individual samples) to ascertain when adult-specific nasal morphology emerges during ontogeny. Across the global sample, PC1 (67.18% of the variation) tracks age-related size changes regardless of ancestry, while PC2 (6.86%) differentiates between the ancestral groups irrespective of age. Growth curves tracking morphological changes by age-in-years indicate comparable growth trajectories across all three samples, with the majority of nasal size and shape established early in ontogeny (<5 years of age). Sex-based trends are also evident, with females exhibiting a more truncated growth period than males, particularly for nasal height dimensions. Differences are also evident between the anterior and posterior nose, with the height and breadth dimensions of the anterior nasal aperture and nasal cavity showing differential ontogenetic patterns compared to the choanae. Cumulatively, these results suggest that multiple selective pressures influence human nasal morphology through ontogenetic processes, including metabolic demands for sufficient oxygen intake and climatic demands for adequate intranasal air conditioning.

Ancestry-based variation in maxillary sinus anatomy: Implications for health disparities in sinonasal disease

Paranasal sinus drainage is mediated by mucociliary transport and gravity. However, human orthograde posture, along with the superior positioning of the maxillary sinus (MS) ostium, increases reliance on the mucociliary system. Previous research has thus suggested that differences in MS size and shape may impede mucociliary clearance, potentially contributing to disparities in sinusitis susceptibility. To further investigate this hypothesis, this study collected 29 three-dimensional (3D) coordinate landmarks and seven linear measurements of MS morphology from 167 computed tomography (CT) scans of crania of European, East Asian, or Equatorial African ancestry. MANOVA results reveal the Asian-derived individuals are characterized by both a significantly taller MS (F = 14.15, p <  0.0001) and a significantly greater distance from the MS floor to the ostium (F = 17.22, p <  0.0001) compared to those of European and African ancestry. A canonical variate (CV) analysis conducted on 3D landmark data provides corroborative results, distinguishing Asian-derived individuals predominantly on the basis of a relatively lower MS floor. As a greater distance between the MS floor and ostium may impede mucociliary clearance, our results suggest MS anatomy may be a more prominent factor in chronic sinusitis among individuals of Asian ancestry compared to those of European and African ancestries. This provides tentative evidence of an anatomical etiology for chronic sinusitis even in the absence of anatomical variants/abnormalities (e.g., nasal polyps, concha bullosa, Haller's cells, and Agger nasi cells). Further research into the relationship between MS anatomy and sinusitis, in addition to socioeconomic inequalities of healthcare, is warranted to continue evaluating possible contributions to health disparities.

Climatic adaptation in human inferior nasal turbinate morphology: Evidence from Arctic and equatorial populations

OBJECTIVES

The nasal turbinates directly influence the overall size, shape, and surface area of the nasal passages, and thus contribute to intranasal heat and moisture exchange. However, unlike the encapsulating walls of the nasal cavity, ecogeographic variation in nasal turbinate morphology among humans has not yet been established. Here we investigate variation in inferior nasal turbinate morphology in two populations from climatically extreme environments.

MATERIALS AND METHODS

Twenty-three linear measurements of the inferior turbinate, nasal cavity walls, and airway passages were collected from CT scans of indigenous modern human crania from Equatorial Africa (n = 35) and the Arctic Circle (n = 35). MANOVA and ANCOVA were employed to test for predicted regional and sex differences in morphology between the samples.

RESULTS

Significant morphological differences were identified between the two regional samples, with no evidence of significant sexual dimorphism or region-sex interaction effect. Individuals from the Arctic Circle possessed superoinferiorly and mediolaterally larger inferior turbinates compared to Equatorial Africans. In conjunction with the surrounding nasal cavity walls, these differences in turbinate morphology produced airway dimensions that were both consistent with functional expectations and more regionally distinct than either skeletal component independently.

CONCLUSION

This study documents the existence of ecogeographic variation in human nasal turbinate morphology reflecting climate-mediated evolutionary demands on intranasal heat and moisture exchange. Humans adapted to cold-dry environments exhibit turbinate morphologies that enhance contact between respired air and nasal mucosa to facilitate respiratory air conditioning. Conversely, humans adapted to hot-humid environments exhibit turbinate morphologies that minimize air-to-mucosa contact, likely to minimize airflow resistance and/or facilitate expiratory heat-shedding.

Zygomaticomaxillary Morphology and Maxillary Sinus Form and Function: How Spatial Constraints Influence Pneumatization Patterns among Modern Humans

Previous research has suggested that the maxillary sinuses may act as "zones of accommodation" for the nasal region, minimizing the impact of climatic-related changes in nasal cavity breadth on surrounding skeletal structures. However, a recent study among modern human crania has identified that, in addition to nasal cavity breadth, sinus morphology also tracks lateral facial form, especially anterior-posterior positioning of the zygomatics. Here, we expand upon this previous study to further investigate these covariation patterns by employing three samples with distinct combinations of nasal and zygomatic morphologies: Northern Asians (n = 28); sub-Saharan Africans (n = 30); and Europeans (n = 29). For each cranium, 30 landmarks were digitized from CT-rendered models and subsequently assigned to either a midfacial or maxillary sinus "block." Two block partial least squares (2B-PLS) analyses indicate that sinus morphology primarily reflects superior-inferior dimensions of the midface, rather than either nasal cavity breadth or zygomatic position. Specifically, individuals with relatively tall midfacial skeletons exhibit more inferiorly and laterally expanded sinuses compared to those with shorter midfaces. Further, separate across-group and within-group 2B-PLS analyses indicate that regional differences between samples primarily build upon a common pattern of midfacial and sinus covariation already present within each regional group. Allometry, while present, only explains a small portion of the midface-sinus covariation pattern. We conclude that previous findings of larger maxillary sinuses among cold-adapted individuals are not predominantly due to possession of relatively narrow nasal cavities, but to greater maxillary and zygomatic heights. Implications for sinus function and midfacial ontogeny are discussed. Anat Rec, 300:209-225, 2017. © 2016 Wiley Periodicals, Inc.

Absolute humidity and the human nose: A reanalysis of climate zones and their influence on nasal form and function

OBJECTIVES

Investigations into the selective role of climate on human nasal variation commonly divide climates into four broad adaptive zones (hot-dry, hot-wet, cold-dry, and cold-wet) based on temperature and relative humidity. Yet, absolute humidity-not relative humidity-is physiologically more important during respiration. Here, we investigate the global distribution of absolute humidity to better clarify ecogeographic demands on nasal physiology.

METHODS

We use monthly observations from the Climatic Research Unit Timeseries 3 (CRU TS3) database to construct global maps of average annual temperature, relative humidity and absolute humidity. Further, using data collected by Thomson and Buxton (1923) for over 15,000 globally-distributed individuals, we calculate the actual amount of heat and water that must be transferred to inspired air in different climatic regimes to maintain homeostasis, and investigate the influence of these factors on the nasal index.

RESULTS

Our results show that absolute humidity, like temperature, generally decreases with latitude. Furthermore, our results demonstrate that environments typically characterized as "cold-wet" actually exhibit low absolute humidities, with values virtually identical to cold-dry environments and significantly lower than hot-wet and even hot-dry environments. Our results also indicate that strong associations between the nasal index and absolute humidity are, potentially erroneously, predicated on individuals from hot-dry environments possessing intermediate (mesorrhine) nasal indices.

DISCUSSION

We suggest that differentially allocating populations to cold-dry or cold-wet climates is unlikely to reflect different selective pressures on respiratory physiology and nasal morphology-it is cold-dry, and to a lesser degree hot-dry environments, that stress respiratory function. Our study also supports assertions that demands for inspiratory modification are reduced in hot-wet environments, and that expiratory heat elimination for thermoregulation is a greater selective pressure in such environments.

Morphological Covariation between the Maxillary Sinus and Midfacial Skeleton among Sub-Saharan and Circumpolar Modern Humans

OBJECTIVES

Maxillary sinus volume tracks ecogeographic differences in nasal form and may serve as a zone of accommodation for ontogenetic and evolutionary changes in nasal cavity breadth. However, little is known regarding how sinus volume is distributed within the midface. This study investigates morphological covariation between midfacial and sinus shape to better understand structural and functional relationships between the sinus, midface, and nasal cavity.

METHODS

Cranial and sinus models were rendered from CT scans of modern human samples from two disparate climates: sub-Saharan (South Africans [n = 15], West Africans [n = 17]), and circumpolar (Siberian Buriats [n = 18], Alaskan Inuit [n = 20]). Twenty-five 3D coordinate landmarks were placed on the models and subjected to generalized Procrustes analysis. Two-block partial least squares (2B-PLS) analysis was employed to identify patterns of covariation.

RESULTS

The 2B-PLS analysis indicates PLS1 (58.6% total covariation) relates to height and breadth relationships between the midface, nasal cavity, and maxillary sinus. Significant regional differences in PLS1 scores are evident: circumpolar samples possess taller/narrower noses with taller/wider sinuses compared to sub-Saharan samples. Importantly, PLS1 indicates that sinus breadth is not exclusively related to nasal cavity breadth; variation in lateral sinus expansion toward the zygoma represents an important contributing factor. PLS2 (16%) relates to supero-inferior positioning of the sinus within the midface. Allometric trends, while statistically significant, explain only a small portion of these covariation patterns.

CONCLUSIONS

These results suggest that the maxillary sinus serves as a zone of accommodation at the confluence of multiple facial components, potentially minimizing effects of morphological alterations to certain components on adjacent structures. Am J Phys Anthropol 160:483-497, 2016. © 2016 Wiley Periodicals, Inc.

Geographic Variation in Zygomaxillary Suture Morphology and its Use in Ancestry Estimation

Angled/curved zygomaxillary suture coding is widely employed in cranial assessments of ancestry. However, the efficacy of this method has not been extensively evaluated across diverse populations. In this study, zygomaxillary suture morphology was assessed on a total of 411 human crania from six populations (European, Native American, African, Asian, Arctic Circle, and Aboriginal Australian) using a novel 3D coordinate landmark method. Our results indicate a predominance of angled sutures among native peoples of the Arctic and North America (85-86%), a prevalence of curved sutures among Africans and Aboriginal Australians (77-81%), and essentially equal proportions of both configurations in Asians and Europeans (50-56%). Statistically, angled/curved coding generally discriminates poorly between groups, except when populations with antithetically high frequencies of the two configurations (e.g., African vs. Native American) are compared. Moreover, comparisons across previous studies reveal conflicting frequencies for many populations, further suggesting limited utility of this trait in ancestry estimation.

Sexual dimorphism in relative sacral breadth among catarrhine primates

As the sacrum contributes to the size and shape of the birth canal, the sexually dimorphic sacrum of humans is frequently interpreted within obstetric contexts. However, while the human sacrum has been extensively studied, comparatively little is known about sacral morphology in nonhuman primates. Thus, it remains unclear whether sacral sexual dimorphism exists in other primates, and whether potential dimorphism is primarily related to obstetrics or other factors such as body size dimorphism. In this study, sacra of Homo sapiens, Hylobates lar, Nasalis larvatus, Gorilla gorilla, Pongo pygmaeus, Pan troglodytes, and Pan paniscus were evaluated for sexual dimorphism in relative sacral breadth (i.e., the ratio of overall sacral breadth to first sacral vertebral body breadth). Homo sapiens, H. lar, N. larvatus, and G. gorilla exhibit dimorphism in this ratio. Of these, the first three species have large cephalopelvic proportions, whereas G. gorilla has small cephalopelvic proportions. P. pygmaeus, P. troglodytes, and P. paniscus, which all have small cephalopelvic proportions, were not dimorphic for relative sacral breadth. We argue that among species with large cephalopelvic proportions, wide sacral alae in females facilitate birth by increasing the pelvic inlet's transverse diameter. However, given the small cephalopelvic proportions among gorillas, an obstetric basis for dimorphism in relative sacral breadth appears unlikely. This raises the possibility that sacral dimorphism in gorillas is attributable to selection for relatively narrow sacra in males rather than relatively broad sacra in females. Accordingly, these results have implications for interpreting pelvic dimorphism among fossil primates, including hominins.

Sutural growth restriction and modern human facial evolution: an experimental study in a pig model

Facial size reduction and facial retraction are key features that distinguish modern humans from archaic Homo. In order to more fully understand the emergence of modern human craniofacial form, it is necessary to understand the underlying evolutionary basis for these defining characteristics. Although it is well established that the cranial base exerts considerable influence on the evolutionary and ontogenetic development of facial form, less emphasis has been placed on developmental factors intrinsic to the facial skeleton proper. The present analysis was designed to assess anteroposterior facial reduction in a pig model and to examine the potential role that this dynamic has played in the evolution of modern human facial form. Ten female sibship cohorts, each consisting of three individuals, were allocated to one of three groups. In the experimental group (n = 10), microplates were affixed bilaterally across the zygomaticomaxillary and frontonasomaxillary sutures at 2 months of age. The sham group (n = 10) received only screw implantation and the controls (n = 10) underwent no surgery. Following 4 months of post-surgical growth, we assessed variation in facial form using linear measurements and principal components analysis of Procrustes scaled landmarks. There were no differences between the control and sham groups; however, the experimental group exhibited a highly significant reduction in facial projection and overall size. These changes were associated with significant differences in the infraorbital region of the experimental group including the presence of an infraorbital depression and an inferiorly and coronally oriented infraorbital plane in contrast to a flat, superiorly and sagittally infraorbital plane in the control and sham groups. These altered configurations are markedly similar to important additional facial features that differentiate modern humans from archaic Homo, and suggest that facial length restriction via rigid plate fixation is a potentially useful model to assess the developmental factors that underlie changing patterns in craniofacial form associated with the emergence of modern humans.

Allometric scaling of infraorbital surface topography in Homo

Infraorbital morphology is often included in phylogenetic and functional analyses of Homo. The inclusion of distinct infraorbital configurations, such as the "canine fossa" in Homo sapiens or the "inflated" maxilla in Neandertals, is generally based on either descriptive or qualitative assessments of this morphology, or simple linear chord and subtense measurements. However, the complex curvilinear surface of the infraorbital region has proven difficult to quantify through these traditional methods. In this study, we assess infraorbital shape and its potential allometric scaling in fossil Homo (n=18) and recent humans (n=110) with a geometric morphometric method well-suited for quantifying complex surface topographies. Our results indicate that important aspects of infraorbital shape are correlated with overall infraorbital size across Homo. Specifically, individuals with larger infraorbital areas tend to exhibit relatively flatter infraorbital surface topographies, taller and narrower infraorbital areas, sloped inferior orbital rims, anteroinferiorly oriented maxillary body facies, posteroinferiorly oriented maxillary processes of the zygomatic, and non-everted lateral nasal margins. In contrast, individuals with smaller infraorbital regions generally exhibit relatively depressed surface topographies, shorter and wider infraorbital areas, projecting inferior orbital rims, posteroinferiorly oriented maxillary body facies, anteroinferiorly oriented maxillary processes, and everted lateral nasal margins. These contrasts form a continuum and only appear dichotomized at the ends of the infraorbital size spectrum. In light of these results, we question the utility of incorporating traditionally polarized infraorbital morphologies in phylogenetic and functional analyses without due consideration of continuous infraorbital and facial size variation in Homo. We conclude that the essentially flat infraorbital surface topography of Neandertals is not unique and can be explained, in part, as a function of possessing large infraorbital regions, the ancestral condition for Homo. Furthermore, it appears likely that the diminutive infraorbital region of anatomically modern Homo sapiens is a primary derived trait, with related features such as depressed infraorbital surface topography expressed as correlated secondary characters.