Effects of using superheroes in an undergraduate human anatomy curriculum

Students often find human anatomy courses to be difficult due to the large amount of content covered at a fast pace, which can result in students failing to retain pertinent information. Superheroes are at the forefront of today's popular culture, with many students identifying with specific characters. Utilizing aspects of students' lives, or their agency, that they can resonate with in the classroom, such as their interests in superheroes or personal connections to fictional characters, may help drive students' motivation to learn course content. This study investigated if the use of superheroes in an anatomy curriculum helped undergraduate students learn, apply, and improve their anatomical knowledge. Two courses at The Ohio State University-Columbus Campus, one with a superhero-based curriculum and one with a traditional anatomy curriculum were compared over three semesters using quizzes and survey data. Results from this project found that the use of superheroes/pop culture in anatomy education is an effective way to teach content. The study also showed that most students found the use of superheroes increased their motivation to learn, helped them gain a deeper understanding of the material, and helped them find the content more approachable and enjoyable. In summary, anatomy curricula can still be taught and explained through these creative and "marvel"-ous examples as it can help students connect the material to their own agency and drive motivation to learn.

Essential anatomy for core clerkships: A clinical perspective

Clerkships are defining experiences for medical students in which students integrate basic science knowledge with clinical information as they gain experience in diagnosing and treating patients in a variety of clinical settings. Among the basic sciences, there is broad agreement that anatomy is foundational for medical practice. Unfortunately, there are longstanding concerns that student knowledge of anatomy is below the expectations of clerkship directors and clinical faculty. Most allopathic medical schools require eight "core" clerkships: internal medicine (IM), pediatrics (PD), general surgery (GS), obstetrics and gynecology (OB), psychiatry (PS), family medicine (FM), neurology (NU), and emergency medicine (EM). A targeted needs assessment was conducted to determine the anatomy considered important for each core clerkship based on the perspective of clinicians teaching in those clerkships. A total of 525 clinical faculty were surveyed at 24 United States allopathic medical schools. Participants rated 97 anatomical structure groups across all body regions on a 1-4 Likert-type scale (1 = not important, 4 = essential). Non-parametric ANOVAs determined if differences existed between clerkships. Combining all responses, 91% of anatomical structure groups were classified as essential or more important. Clinicians in FM, EM, and GS rated anatomical structures in most body regions significantly higher than at least one other clerkship (p = 0.006). This study provides an evidence-base of anatomy content that should be considered important for each core clerkship and may assist in the development and/or revision of preclinical curricula to support the clinical training of medical students.

Adaptation of an anatomy graduate course in ultrasound imaging from in-person to live, remote instruction during the Covid-19 pandemic

Health concerns during the Covid-19 pandemic required the adaptation of a lecture-laboratory course in ultrasound imaging for graduate students from an in-person to a live, remote learning format. The adaptation of in-person lectures to live, remote delivery was achieved by using videoconferencing. The adaptation of in-person laboratory sessions to live, remote instruction was achieved in the first half of the course by providing a hand-held ultrasound instrument to each student who performed self-scanning at their remote locations, while the instructor provided live instruction using videoconferencing. In the second half of the course, the students transitioned to using cart-based, hospital-type instruments and self-scanning in the ultrasound laboratory on campus. The aim of this study was to measure the success of this adaptation to the course by comparing assessment scores of students in the live, remote course with assessment scores of students in the in-person course offered in the previous year. There were no statistically significant differences in the assessment scores of students in the two courses. The adaptation of a course in ultrasound imaging from an in-person to a live, remote learning format during the Covid-19 pandemic described here suggests that contrary to the prevailing view, ultrasound imaging can be taught to students without in-person instruction. The adapted course can serve as a model for teaching ultrasound where instructors and learners are physically separated by constraints other than health concerns during a pandemic.

Anatomists Assemble! Integrating superheroes into the anatomy and physiology classroom

Anatomy and physiology courses are sometimes seen as difficult, which can lead to a lack of motivation in students to learn and engage in the course material. Students may also see the material as "dry," have issues forming personal connections, or struggle to connect the content to the real world. These issues may lead to students not performing well in the course or feeling that the health field is not ideal for them. Popular culture, especially mainstream superheroes, can serve as an option for mending these gaps by being a gateway to connecting to many students' lives. Superheroes can be integrated into the classroom through relevant, creative, and unique examples that include clinical correlates, modern scientific innovations, and some real-life "supers" living among us. Real anatomy and physiology can still be taught and explained through discussing these "incredible" examples and also present an opportunity for students to be creative in generating their own anatomical and physiological explanations for various superpowers. Superheroes also help open the classroom up to being a place of acceptance, primarily through their secret identities, which cover a broad range of idols that students can look up to, whether it is their career or based on a character's race or sexual orientation. Professors can become the superhero in their classroom and help students become more engaged and interested in the material.

A Novel Approach to Gross Dissection of the Human Pelvis and Perineum

Progressive curricular changes in medical education over the past two decades have resulted in the diaspora of gross anatomy content into integrated curricula while significantly reducing total contact hours. Despite the development of a wide range of alternative teaching modalities, gross dissection remains a critical component of medical education. The challenge posed to modern anatomists is how to maximize and integrate the time spent dissecting under the current curricular changes. In this study, an alternative approach to the dissection of the pelvis and perineum is presented in an effort to improve content delivery and student satisfaction. The approach involves removal of the perineum en bloc from the cadaver followed by excision of the pubic symphysis, removal and examination of the bladder and associated structures, examination and bisection of the midline pelvic organs in situ, and midsagittal hemisection of the pelvis for identification of the neurovasculature. Results indicate that this novel dissecting approach increases the number of structures identified by 46% ± 14% over current dissecting methods. Survey results indicate that students were better able to integrate lecture and laboratory concepts, understand the concepts, and successfully identify more structures using the new approach (P < 0.05). The concept of anatomic efficiency is introduced and proposed as a standard quantitative measure of gross dissection proficiency across programs and institutions. These findings provide evidence that innovative solutions to anatomy education can be found that help to maintain critical content and student satisfaction in a modern medical curriculum.

What type of learner are your students? Preferred learning styles of undergraduate gross anatomy students according to the index of learning styles questionnaire

Students learn and process information in many different ways. Learning styles are useful as they allow instructors to learn more about students, as well as aid in the development and application of useful teaching approaches and techniques. At the undergraduate level there is a noticeable lack of research on learning style preferences of students enrolled in gross anatomy courses. The Index of Learning Styles (ILS) questionnaire was administered to students enrolled in a large enrollment undergraduate gross anatomy course with laboratory to determine their preferred learning styles. The predominant preferred learning styles of the students (n = 505) enrolled in the gross anatomy course were active (54.9%), sensing (85.1%), visual (81.2%), and sequential (74.4%). Preferred learning styles profiles of particular majors enrolled in the course were also constructed; analyses showed minor variation in the active/reflective dimension. An understanding of students' preferred learning styles can guide course design but it should not be implemented in isolation. It can be strengthened (or weakened) by concurrent use of other tools (e.g., flipped classroom course design). Based on the preferred learning styles of the majority of undergraduate students in this particular gross anatomy course, course activities can be hands on (i.e., active), grounded in concrete information (i.e., sensing), utilize visual representation such as images, figures, models, etc. (i.e., visual), and move in small incremental steps that build on each topic (i.e., sequential). Anat Sci Educ 11: 358-365. © 2017 American Association of Anatomists.

Determinants of dynamic hyperinflation during metronome-paced tachypnea in COPD and normal subjects

In COPD, dynamic hyperinflation (DH) occurs during exercise and during metronome-paced tachypnea (MPT). We investigated the relationship of DH with breathing pattern and ventilation (V˙E) in COPD and normal subjects (NS). In 35 subjects with moderate COPD and 17 younger healthy volunteers we measured inspiratory capacity (IC), breathing frequency (fR), expiratory time (TE), ventilation (V˙E) and end-tidal carbon dioxide tension (PETCO2) at baseline and after 30s of MPT at 40breaths/min with metronome-defined I:E ratios of 1:1 and 1:2. A reduction in IC (ΔIC) was taken to indicate DH. In COPD subjects, DH correlated with TE but not with V˙E or PETCO2, and was best predicted by total lung capacity. NS also showed DH (although less than in COPD), which correlated with PETCO2 but not with fR, TE or V˙E. We conclude that MPT evokes DH in both NS and patients with COPD. TE is the most important determinant of DH during MPT in patients with COPD.

A case control study of lung cancer and exposure to chrysotile and amphibole at a slovenian asbestos-cement plant

A lung cancer case-control study was conducted in a Slovenian asbestos-cement factory for which unusually good records of asbestos exposures were available. The cohort consisted of all 6714 workers employed at the Salonit Anhovo factory after 31 December 1946 who worked there for at least one day between 1964 and 1994. Fifty-eight histologically confirmed cases of primary lung cancer and 290 controls were selected from the cohort. Working life exposure histories to amphibole and chrysotile forms of asbestos were estimated separately. Airborne asbestos concentrations were low. For example, the arithmetic mean exposure to all forms of asbestos in the highest exposure period (1947-1971) was 1.2 f/cm(3). Chrysotile asbestos made up about 90% of this exposure (mean 1.1 f/cm(3)), whereas amphibole accounted for 10% (0.1 f/cm(3)). Comparing those above and below the 90 percentile of cumulative exposure, the odds ratios for all asbestos, chrysotile and amphibole were 1.5, 1.6 and 2.0, respectively, but confidence intervals were wide. There are only a few asbestos-lung cancer studies with high-quality exposure data and exposures in this low range. Though imprecise, the findings are important to the ongoing debate about asbestos risks.

Historical cohort study of US man-made vitreous fiber production workers: VII. Overview of the exposure assessment

Data and procedures used to reconstruct the history of exposures at each of the 15 plants (19 distinct sites) are presented. The assessment consisted of five steps: (1) develop a Technical History of operations, stable periods, and time points of changes relevant for exposures, and identify the presence of potentially confounding co-exposures; (2) develop a set of unique department-job names with descriptions and a Job Dictionary for all verbatim names in work histories; (3) collect all company and other exposure data (> 1600 observed), and develop quantitative fiber, formaldehyde, and silica exposure estimates; (4) integrate estimates with the Technical History to make Exposure Extrapolation Tables; and (5) use the the Tables with job data to develop an Exposure Matrix for each plant. Nineteen Exposure Matrices were made, with 82 to 621 lines, covering up to 54 years of operations.

Historical cohort study of US man-made vitreous fiber production workers: I. 1992 fiberglass cohort follow-up: initial findings

This 1986 to 1992 update and expansion of an earlier historical cohort study examined the 1946 to 1992 mortality experience of 32,110 workers employed for 1 year or more during 1945 to 1978 at any of 10 US fiberglass (FG) manufacturing plants. Included are (1) a new historical exposure reconstruction for respirable glass fibers and several co-exposures (arsenic, asbestos, asphalt, epoxy, formaldehyde, polycyclic aromatic hydrocarbons, phenolics, silica, styrene, and urea); and (2) a nested, matched case-control study of 631 respiratory system cancer (RSC) deaths in male workers during 1970 to 1992 with interview data on tobacco smoking history. Our findings to date from external comparisons based on standardized mortality ratios (SMRs) in the cohort study provide no evidence of excess mortality risk from all causes combined, all cancers combined, and non-malignant respiratory disease. Also, excluding RSC, we observed no evidence of excess mortality risk from any of the other cause-of-death categories considered. For RSC among the total cohort, we observed a 6% excess (P = 0.05) based on 874 deaths. Among long-term workers (5 or more years of employment) we observed a not statistically significant 3% excess based on 496 deaths. Among the total cohort, we observed increases in RSC SMRs with calendar time and time since first employment, but these were less pronounced among long-term workers. RSC SMRs were not related to duration of employment among the total cohort or long-term workers. In an externally controlled analysis of male workers at risk between 1970 and 1992, we observed no association between RSC SMRs and increasing exposure to respirable FG. Our findings to date from internal comparisons based on rate ratios in the case-control study of RSC were limited to analyses of categorized study variables with and without adjustment for smoking. On the basis of these analyses, the duration of exposure and cumulative exposure to respirable FG at the levels encountered at the study plants did not appear to be associated with an increased risk of RSC. RSC risk also did not seem to increase with time since first employment. There is some evidence of elevated RSC risk associated with non-baseline levels of average intensity of exposure to respirable glass, but when adjusted for smoking this was not statistically significant, and there was no apparent trend with increasing exposure. This same pattern of findings was observed for duration of exposure, cumulative exposure, and average intensity of exposure to formaldehyde. None of the other individual co-exposures encountered in the study plants appeared to be associated with an increased risk of RSC. The primary focus of ongoing analyses is to determine the extent to which our present findings are robust to alternative characterizations of exposure.

Historical cohort study of US man-made vitreous fiber production workers: VIII. Exposure-specific job analysis

All jobs held by a cohort of US man-made vitreous fiber production workers were analyzed for airborne fiber exposure. This exposure-specific job analysis was part of an exposure assessment for an epidemiologic study of mortality patterns, with particular focus on respiratory cancer, among 35,145 workers employed in 10 fiberglass and five rock or slag wool plants. The exposure assessment was conducted from the start-up date of each plant (1917 to 1946) to 1990. For the job analysis, 15,465 crude department names and 47,693 crude job titles were grouped into 1668 unique department and job pairs (UDJobs), which represented a job title linked to a specific department within each plant. Every UDJob was evaluated according to a set of job elements related to airborne fiber exposure. The distribution of the cohort person-years by UDJob and the job-exposure elements was then evaluated. The results show the main departments and jobs that employed the workers for each plant. The distribution of person-years varies across the job-exposure elements. The same job title was used in different departments within and across plants. When job titles not linked to departments were evaluated, the values of the job-exposure elements varied considerably across all plants and within plant.

IN CONCLUSION

(1) exposure misclassification could occur if job title alone were used for the exposure assessment; (2) the job-exposure elements analysis provides an efficient way to identify major job determinants of exposure without relying on the more detailed, resource-intensive task-based approach; and (3) the evaluation of the cohort person-years by UDJobs and job-exposure elements is an effective way to identify which plants, departments, and jobs have sufficient information for making precise risk estimates in the broader epidemiologic study.

Implications of different fiber measures for epidemiologic studies of man-made vitreous fibers

BACKGROUND

Several researchers have proposed fiber size ranges representing hypotheses about the biological activity of fibers. Each of these indices has a biologically plausible rationale, yet they propose different fiber dimensions.

METHODS

Four biologically based and one standard fiber analytic method index, the NIOSH 7400 method with B rules, were evaluated in air monitoring data collected in a variety of fiber glass (FG) manufacturing settings to determine their impact on an assessment of fiber exposure for an epidemiologic study of the risk of respiratory cancer among FG production workers.

RESULTS

All indices varied considerably within and among the range of fiber size distributions sampled in the FG factories.

CONCLUSIONS

The asymptotic relative efficiencies (R(2)) calculated among the five indices indicate a potentially important loss of power from the use of the standard method index, if one of the biologically based indices is more closely related to the disease outcome in an epidemiologic study.

Sustainable production: a proposed strategy for the work environment

BACKGROUND

In the future, competitive industries will need to design for environment, health and safety as well as for productivity. Although the new areas of pollution prevention and clean production have evolved to address the design of production processes with concerns for the ambient environment, current pollution prevention models do not include explicit concerns for health, safety, and the work environment. The field of occupational health and safety has much to contribute to improve current pollution prevention approaches and solutions.

METHODS

The application of work environment disciplines will need to be expanded from the conventional focus on "end-of-pipe" assessment and solutions, which take the production processes and resulting hazards as a given, to include a new focus on materials selection and process redesign. To make this shift, a new framework called "sustainable production" is proposed. The basic unit of sustainable production is the production process. The framework integrates a focus on the ambient and work environment along with a focus on productivity and the economic viability of the business enterprise in setting production process design parameters.

RESULTS

By shifting the focus of occupational and environmental health and safety from exposure control to process design, sustainable production reduces the likelihood that concerns for health, safety, and the environment will be seen as antagonistic to productivity and economic development. To move a firm toward sustainable production, occupational health and safety professionals will need to participate in interdisciplinary workplace teams that design and build new production processes and that continuously evaluate and redesign existing processes.

CONCLUSIONS

This new strategy requires an expansion of the role of the occupational health and safety professional to include evaluation and redesign of processes that produce goods and services as well as the conventional evaluation of chemical, physical, and biological agents, work practices, and ergonomics. This expansion of occupational and environmental health and safety requires new research to develop the scientific and public policy basis of sustainable production.

Is your healthcare information system physician friendly?

An organization's healthcare information system (HIS) can be used as a tool to improve relationships with its physicians by facilitating physician work processes and research. An effective HIS should provide census reports tailored to individual physician needs, allow physicians access to information via dedicated personal computers (PCs) or terminals, and should have features, such as screen design and graphical interfaces that are easy to understand and use. In addition, the HIS should provide comprehensive reports, have online ordering capability, and respond quickly to the needs of busy physicians. A good HIS also supports physician-related activities occurring outside the hospital. For example, physician office managers should be able to access billing information, such as patient demographics and procedure codes, contained in the HIS. And, physicians should be able to retrieve archived information from their offices or homes. Critical to physicians' successful use of an organization's HIS is administration's attitude and support. An organization that places a priority on physician issues and needs can make even a basic HIS an effective tool for its physicians, while a sophisticated HIS that does not address physician needs will not maximize return on the investment.

Statistical power to detect occupationally related respiratory cancer risk in a cohort of female employees in the US man-made vitreous fiber industry

The current update of the US man-made vitreous fiber production worker cohort includes women for the first time. Preliminary comparisons of 3,820 female and 27,767 male workers from 11 participating fibrous glass plants show different hiring patterns during World War II. The gender-specific person-year distributions are similar with respect to duration of employment and time since first employment. The current follow-up of 118,559 person-years for women provides an estimated 80% power to detect a threefold relative risk of respiratory cancer for women who worked more than 14 years in these plants, based on a Poisson regression analysis of the cohort rates. When women comprise a small fraction of the cohort, the statistical power may be inadequate to detect risks of the magnitude typically of interest in studies of men.

Uterotropic action in rats of amsonic acid and three of its synthetic precursors

Prompted by reports of sexual impotence among chemical factory workers exposed to amsonic acid (4,4'-diaminostilbene-2,2'-disulfonic acid; CAS 81-11-8) and its synthetic precursors 4,4'-dinitrostilbene-2,2'-disulfonic acid (DNSDSA; CAS 128-42-7), 2-methyl-5-nitrobenzenesulfonic acid (MNBSA; CAS 121-03-09), and 4-nitrotoluene (CAS 99-99-0), the uterine-weight-increasing actions of single intraperitoneal doses of these chemicals were determined at 24 h after treatment in weanling female rats and compared to the results of similar experiments with diethylstilbestrol (DES; CAS 56-53-01), a synthetic estrogen chemically related to amsonic acid and DNSDSA. Doses of 100 mg/kg or less of amsonic acid were either without effects or produced equivocal effects, while uterine weights were increased after doses of 300 and 1000 mg/kg; doses of 3000 mg/kg were clearly toxic. Neither DNSDSA nor MNBSA increased uterine weight after doses that were not overtly toxic. Doses of 10 mg/kg or less of 4-nitrotoluene were without effect, but doses of 30 and 100 mg/kg increased uterine weights without producing overt toxicity; doses of 1000 mg/kg were clearly toxic. While both amsonic acid and 4-nitrotoluene exhibited uterotropic effects, they were both much weaker than DES in this respect. Other experiments indicated that the time course of the effects of approximately equiactive doses of amsonic acid and DES were very similar, and that the responses to oral doses of amsonic acid were not appreciably different from the responses to the same doses given intraperitoneally. Finally, a sample of amsonic acid taken from the workplace of the complaining workers was also found to have uterotropic activity. These experiments suggest that amsonic acid and 4-nitrotoluene have estrogenic activity, and thus provide a possible mechanistic explanation for the complaints of impotency in factory workers exposed to these substances.

Investigation of reports of sexual dysfunction among male chemical workers manufacturing stilbene derivatives

A Health Hazard Evaluation was conducted by the National Institute for Occupational Safety and Health in an area of a large chemical plant that manufactured the stilbene derivative 4,4'-diaminostilbene-2,2'-disulfonic acid, an intermediate used for the production of optical brightening agents. Men employed in the area reported problems with impotence. The study population consisted of 44 men aged 20-57 years (mean age 37) employed in the area at the time of the evaluation. An industrial hygiene investigation, health and work history questionnaire survey, physical examinations, and blood chemistry and serum hormone evaluation were conducted. Fourteen percent of the men reported symptoms of impotence over the preceding 6 or more months, 7% had potency problems of shorter duration, and 7% were not currently impotent but had experienced impotence for 6 or more months in the past; 36% experienced decreased libido, all since beginning work in the production area. Low levels of serum testosterone (less than 350 ng/dl) were observed in 37% of the men. The low serum testosterone concentrations were not accounted for fully by diurnal variation or an effect of rotating shift work. It is suggested that exposures to chemicals possessing estrogenic activity may be related to the observed health effects in these workers.

Modernization and trends in occupational health and safety in the People's Republic of China 1981-1986

Exchanges between U.S. and Chinese professionals have provided opportunities for observation of recent developments in occupational health in China. For the past decade, China has been committed to an unprecedented drive for economic modernization, including new policies on ownership, business management, employment, health care, and disability as well as increased activity in heavy, light, and service industries. Chinese occupational health professionals and labor organizations have set a goal of modernizing worker health along with the rest of society. Examples of advances in occupational health occurring since 1981 are the coordination of industrial hygiene and health research and services, an emphasis on epidemiology, interdisciplinary approaches to problem-solving, the pretesting of toxic substances, regulation and standard setting, and on-site workplace hazard prevention.

An asbestos hazard in the reprocessed textile industry

Epidemiologic studies have identified an excess risk of lung cancer and mesothelioma among workers in the reprocessed textile industry in Prato, Italy. These studies suggested that there may have been asbestos hazard in this industry although exposure was not known to exist. An industrial hygiene investigation was conducted to determine whether there was previous or current asbestos exposure in the industry. Walk-through surveys, environmental sampling, process documentation, and management and worker interviews were conducted in 13 textile reprocessing establishments. Polypropylene bags that once contained asbestos were found in 2 of the 13. Asbestos bags were cut open and used to cover bales of rags which were then distributed throughout the world. Workers were exposed to asbestos while handling the bags which were contaminated with chrysotile, amosite, and crocidolite. Additional sources of asbestos exposure that may have existed in the past in the industry are also discussed.