Curriculum design and specific topic selection for on-site practical courses in clinical disciplines with limited teaching time is challenging. An electronic learning supported curriculum based on ...the flipped classroom principle has a high potential to effectively gain knowledge and education along with improving practical experience. Here, we demonstrate the introduction of a flipped classroom curriculum for practical courses in Otorhinolaryngology (ORL) in real world practice to improve the on-site time management and students' experience.
Educational aims of our practical curriculum were analysed and rearranged into a flipped classroom (FC) framework. Core knowledge was taught preliminary based on a moodle platform in predominantly interactive formats. Two quasi-randomized groups were formed with 212 participants either receiving or not receiving access to the e-learning program to reduce a potential allocation bias to the e-learning group. All students completed a questionnaire with learning related items. Focusing the study on the intervention group, we investigated if students using the flipped classroom more often felt better prepared for the practical course.
The online learning platform was highly accepted and frequently used by 66% of participating students in the e-learning group. Students with frequent use of our e-learning platform significantly felt better prepared for the practical course (p = 0.001). The far majority of all students supports the idea of further development of e-learning. More than 70% were generally interested in ORL. Handouts were the overall most important learning resource and more than 50% relied solely on them.
Flipped classroom curricula can save time and help improving the on-site experience in practical courses especially in smaller surgical disciplines. The acceptance of digital learning is high, and most students rely on handouts for learning ORL, emphasizing the need for guidance by the teacher e.g. through electronic learning. Our results underline the high potential of FC to address teaching challenges for smaller medical disciplines with limited teaching time like ORL.
Optogenetic stimulation of type I spiral ganglion neurons (SGNs) promises an alternative to the electrical stimulation by current cochlear implants (CIs) for improved hearing restoration by future ...optical CIs (oCIs). Most of the efforts in using optogenetic stimulation in the cochlea so far used early postnatal injection of viral vectors carrying blue-light activated channelrhodopsins (ChRs) into the cochlea of mice. However, preparing clinical translation of the oCI requires (
) reliable and safe transduction of mature SGNs of further species and (
) use of long-wavelength light to avoid phototoxicity. Here, we employed a fast variant of the red-light activated channelrhodopsin Chrimson (f-Chrimson) and different AAV variants to implement optogenetic SGN stimulation in Mongolian gerbils. We compared early postnatal (p8) and adult (>8 weeks) AAV administration, employing different protocols for injection of AAV-PHP.B and AAV2/6 into the adult cochlea. Success of the optogenetic manipulation was analyzed by optically evoked auditory brainstem response (oABR) and immunohistochemistry of mid-modiolar cryosections of the cochlea. In order to most efficiently evaluate the immunohistochemical results a semi-automatic procedure to identify transduced cells in confocal images was developed. Our results indicate that the rate of SGN transduction is significantly lower for AAV administration into the adult cochlea compared to early postnatal injection. SGN transduction upon AAV administration into the adult cochlea was largely independent of the chosen viral vector and injection approach. The higher the rate of SGN transduction, the lower were oABR thresholds and the larger were oABR amplitudes. Our results highlight the need to optimize viral vectors and virus administration for efficient optogenetic manipulation of SGNs in the adult cochlea for successful clinical translation of SGN-targeting gene therapy and of the oCI.
Abstract
Background
The availability and popularity of laptops, tablet PCs and smartphones in private and work environments offers considerable potential for reasonably integrating blended learning ...formats into structured medical learning environments. The promising educational principle of the flipped classroom (FC) provides the opportunity to effectively combine e-learning and face-to-face teaching within a single framework. However, similar to most blended learning formats, the FC requires a solid groundwork of structured digitized learning content. As rearranging a whole curriculum is intense and time consuming, physicians occupied simultaneously in clinical practice and teaching may be confronted with a lack of time during this process.
Methods
We developed two straightforward approaches to transforming a pre-existing, lecture-based otolaryngology curriculum into interactive videos within a Moodle learning management system. Special attention was given to reducing individual working time for medical professionals. Thus, while one approach was mainly guided by a medical professional to control the content-related quality of video processing, we investigated an alternative approach outsourcing work to a technician. Afterwards, the working time was analysed and compared. The resulting videos were revised with the H5P plugin for moodle to adjust the content where necessary.
Results
We identified a fast-track approach for creating structured e-learning content suitable for flipped-classroom-based lectures, other blended learning formats, or even providing a whole curriculum online. The alternative approach significantly reduced working time for medical professionals but did not impair the content-related quality significantly.
Conclusions
The use of H5P interactive tools via Moodle LMS provides a major procedural benefit by allowing the easy adjustment of pre-existing video material into suitable online content. Reasonably outsourcing work to technicians can significantly reduce the working time of medical professionals without decreasing the quality of learning content. The presented workflow can be used as a flexible approach for flipped classroom frameworks or other blended learning strategies where interactive videos are applicable.
Toward the Optical Cochlear Implant Dombrowski, Tobias; Rankovic, Vladan; Moser, Tobias
Cold Spring Harbor perspectives in medicine,
08/2019, Letnik:
9, Številka:
8
Journal Article
Recenzirano
Odprti dostop
When hearing fails, cochlear implants (CIs) provide open speech perception to most of the currently half a million CI users. CIs bypass the defective sensory organ and stimulate the auditory nerve ...electrically. The major bottleneck of current CIs is the poor coding of spectral information, which results from wide current spread from each electrode contact. As light can be more conveniently confined, optical stimulation of the auditory nerve presents a promising perspective for a fundamental advance of CIs. Moreover, given the improved frequency resolution of optical excitation and its versatility for arbitrary stimulation patterns the approach also bears potential for auditory research. Here, we review the current state of the art focusing on the emerging concept of optogenetic stimulation of the auditory pathway. Developing optogenetic stimulation for auditory research and future CIs requires efforts toward viral gene transfer to the neurons, design and characterization of appropriate optogenetic actuators, as well as engineering of multichannel optical implants.
The flipped classroom (FC) is nowadays a popular principle of blended student-centered learning. Students first prepare basic knowledge at home and subsequently meet for consolidation and a more ...in-depth look at a certain topic. During the COVID-19 pandemic, several groups developed approaches to also transform the characteristic FC second session into an online-only format.
Herein, we present a pilot study on establishing an online-only FC format with elements of collaborative learning and its evaluation by medical students.
The FC design related to diseases of the salivary glands was transformed into an online-only event. After studying the basic information online, supported by self-made interactive videos and/or lecture recordings, students met in a video conference enriched by breakout sessions, interactive demonstration of the related clinical examination including ultrasound, and a formative assessment. A questionnaire with 27 items was answered by participants to evaluate the concept and the event.
Use of common hard- and software systems led to a technically stable video conference. A total of 55 students completed the questionnaire and were included into data analysis. During the breakout sessions, lively interaction between participants was observed. The evaluation of both the event itself and the related learning progress showed good results despite the lack of preparation beforehand in 27% of participants.
Online-only FC designs can result in high satisfaction. High quality of online preparation, a solid technical platform, accurate time management, and a reasonable selection of topics are the main parameters contributing to successful course design. Nowadays, embedding medical imaging can be realized in appropriate quality for educational purposes. The implementation of breakout sessions and voting tools enables collaborative online learning with high levels of interaction and satisfaction for both teachers and students.
Zusammenfassung
Hintergrund
Der Flipped Classroom (FC) ist eine mittlerweile populäre Variante des Blended Learning mit einem auf den Lernenden zentrierten, didaktischen Ansatz. Hierbei werden vorab ...Grundlagen eines Themas selbst erarbeitet und in der Präsenzphase gemeinsam vertieft. Getriggert durch die COVID-19-Pandemie haben sich bei ausbleibender Präsenzmöglichkeit neue Ansätze ergeben, einen volldigitalen FC umzusetzen.
Ziel der Arbeit
In dieser Arbeit wurde als Pilotprojekt ein interaktiver, volldigitaler FC mit Elementen kollaborativen Lernens etabliert und die Umsetzung aufgearbeitet.
Material und Methoden
Die FC-Veranstaltung zum Thema „Speicheldrüsenerkrankungen“ wurde in ein volldigitales Konzept transformiert. Nach dem Selbststudium mit digitalen Lerneinheiten oder Vorlesungsaufzeichnungen wurde die Präsenzveranstaltung online abgehalten und mit Breakout-Sessions, interaktiver Demonstration der klinischen Untersuchung inklusive Sonographie und formativem Assessment angereichert. Mit einem Fragebogen mit 27 Items erfolgt die dezidierte Evaluation der Veranstaltung.
Ergebnisse
Durch die Verwendung gängiger Hard- und Software konnte die Veranstaltung auf eine stabile technische Basis gestellt werden. Insgesamt konnten die Antworten von 55 Studierenden in die Auswertung mit einbezogen werden. In den Breakout-Sessions zeigte sich eine hohe Interaktion zwischen den Teilnehmern. Die Bewertung der Veranstaltung und insbesondere des Lernfortschritts zeigten gute Ergebnisse trotz fehlender Vorbereitung der Grundlagen bei 27 % des Untersuchungskollektivs.
Schlussfolgerung
Auch ein volldigitaler FC kann zu hoher Zufriedenheit führen. Für das Gelingen der Veranstaltung ist neben qualitativ hochwertiger Vorbereitung eine stabile technische Basis, ein sorgfältiges Zeitmanagement und eine geeignete Themenwahl erforderlich. Das Einbinden medizinischen Bildmaterials ist dabei in didaktisch guter Qualität möglich. Die zusätzliche Implementation von Breakout-Sessions und Voting-Tools kann dann zu einem für Dozierende und Studierende befriedigenden Lern- und Lehrerfolg in einer volldigitalen Lehrveranstaltung führen.
Optogenetic tools, providing non‐invasive control over selected cells, have the potential to revolutionize sensory prostheses for humans. Optogenetic stimulation of spiral ganglion neurons (SGNs) in ...the ear provides a future alternative to electrical stimulation used in cochlear implants. However, most channelrhodopsins do not support the high temporal fidelity pertinent to auditory coding because they require milliseconds to close after light‐off. Here, we biophysically characterized the fast channelrhodopsin Chronos and revealed a deactivation time constant of less than a millisecond at body temperature. In order to enhance neural expression, we improved its trafficking to the plasma membrane (Chronos‐ES/TS). Following efficient transduction of SGNs using early postnatal injection of the adeno‐associated virus AAV‐PHP.B into the mouse cochlea, fiber‐based optical stimulation elicited optical auditory brainstem responses (oABR) with minimal latencies of 1 ms, thresholds of 5 μJ and 100 μs per pulse, and sizable amplitudes even at 1,000 Hz of stimulation. Recordings from single SGNs demonstrated good temporal precision of light‐evoked spiking. In conclusion, efficient virus‐mediated expression of targeting‐optimized Chronos‐ES/TS achieves ultrafast optogenetic control of neurons.
Synopsis
Here we biophysically characterized and molecularly improved the fast gating blue‐light activated channelrhodopsin Chronos. Employing the potent viral vector AAV‐PHP.B we postnatally expressed the improved Chronos in cochlear neurons and achieved ultrafast neural control.
Biophysical characterization of the fast channelrhodopsin Chronos revealed a deactivation time constant of less than a millisecond at body temperature.
Molecular engineering of Chronos via adding trafficking sequences enhanced plasma membrane abundance of the opsin and use of postnatal AAV‐PHP.B carrying Chronos into the mouse cochlea enabled efficient expression in spiral ganglion neurons.
Chronos enabled synchronized optically driven firing in spiral ganglion neurons for stimulation rates of up to hundreds of Hz as required for future optical cochlear implants.
Biophysical characterization and molecular engineering of the fast channelrhodopsin Chronos results in a new optogentics tool for controlling fast neural circuitries with high temporal fidelity.
Digitale Strategien in der Lehre Dombrowski, Tobias; Dazert, Stefan; Volkenstein, Stefan
Laryngo- rhino- otologie,
03/2019, Letnik:
98, Številka:
S 01
Journal Article
Recenzirano
Odprti dostop
Zusammenfassung
Die Entwicklung digitaler Strategien in der Lehre beruht auf den technologischen Fortschritten der letzten Jahrzehnte, aber auch auf der Motivation, ein didaktisches Konzept verstärkt ...auf den Lernenden zu zentrieren. Aus verfügbaren Daten der deutschen Hochschulmedizin ergibt sich das Bild, dass in der Medizin ganz allgemein und speziell in der HNO-Heilkunde digitale Lehrkonzepte aktuell noch eine untergeordnete Rolle spielen. Durch Erhebung eigener Daten konnten wir zeigen, dass die Studierenden in der HNO-Heilkunde in der Mehrheit auf durch den Dozenten ausgegebene Materialien als einzige Lernquelle zurückgreifen. Die Anwendung fundierter digitaler Lehrstrategien bietet daher, insbesondere fachbezogen für die HNO-Heilkunde, besondere Chancen, u. a. um dem Überangebot von Informationen aus teils unklaren Quellen im Internet entgegenzutreten.
Der mögliche Digitalisierungsgrad der Lehre reicht heute von digitalen Serviceangeboten über punktuelle Angebote klassischer Lehrkonzepte und
Blended Learning
bis hin zum volldigitalen Studium. Die Attraktivität der curricularen Integration digitaler Lehrstrategien beruht dabei weniger auf der Nutzung rein technischer Fortschritte, sondern vielmehr auf den Möglichkeiten der Anwendung innovativer Curricula und neuer didaktischer Konzepte. In Abhängigkeit vom beabsichtigten Lehrzweck werden insbesondere dem
Flipped Classroom
und der digitalisierten Realität großes Potenzial zugeschrieben, während mobiles Lernen sich in der Praxis bereits individuell etabliert hat. Die Erprobung und Evaluierung digitaler Lehrinnovationen für konkrete Szenarien gehört aktuell zu den wichtigen wissenschaftlichen Herausforderungen digitaler Lehrkonzepte.
Der flächendeckenden Etablierung digitaler Lehre stehen heute weniger technische Voraussetzungen, sondern vielmehr fehlende Finanzierungsmöglichkeiten im Wege, da Förderungen derzeit überwiegend projektgebunden stattfinden, bei dauerhafter Umsetzung jedoch regelmäßige Kosten vorhanden sind. Zur Unterstützung dieser vielversprechenden Lehrformen könnte die Förderung der Einrichtung von Abteilungen für digitale Lehre mit Bereitstellung von entsprechenden Hard- und Softwarelösungen an den Universitäten wesentlich beitragen. Durch die Bildung von Kooperationen zur Nutzung solcher digitalen Plattformen ergäbe sich eine hohe Effizienz in der Verbreitung unter gleichzeitiger Ausnutzung von Sparpotenzialen.
Dupilumab has been shown to be safe and effective in treating chronic rhinosinusitis with polyposis (CRSwNP). There is to this date no published data whether subgroups like patients with aspirin ...exacerbated respiratory disease (AERD), increased histologic eosinophilia or elevated blood eosinophil or IgE-levels benefit greater from dupilumab therapy. Moreover, there is no data comparing the efficacy of functional endoscopic sinus surgery (FESS) with dupilumab therapy. We conducted a retrospective chart review of all patients that were treated at a tertiary referral center for CRswNP with dupilumab. We also contacted the patients with a questionnaire to evaluate the efficacy of previous surgeries and dupilumab therapy by visual analogue scale (VAS) and the glasgow benefit inventory (GBI) as well as report on side effects. Overall, 75 patients were included in the study at hand that reported back 138 times. While dupilumab treatment was efficient, we found no systematic evidence of greater efficacy of dupilumab in patients with AERD, histologic eosinophilia or increased blood eosinophil or IgE-levels. All patients showed a considerable decrease in subjective burden of disease, objective smell tests and endoscopic findings. From the patients point of view, dupilumab therapy showed greater efficacy both in the VAS and the GBI overall and all subcategories but "social support." Dupilumab is efficient in treating CRSwNP; this effect is independent from disease characteristics like AERD, histologic eosinophilia, serum IgE-levels or eosinophil counts. There seems to be a group of patients that benefit greater from dupilumab therapy compared to FESS.
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