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e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK [email protected]

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Page 1: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

e-learning, learning, and e

Dr. Stephen BostockAdvisor for Technology and Learning

Keele University, [email protected]

Page 2: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Summary

• E

• Learning

• Face to Face e-learning, an example

• Online e-learning

• Blended learning, an example

• Conclusion

Page 3: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

The e in e-learning

• Borrowed from e-commerce: electronic transactions between businesses and with customers

• E-learning: buying degrees online?

• Learning is far more complex than e-commerce – the wrong connotations (commercialization, commodification)

Page 4: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

The learning in e-learning

• eLearning is learning

• A cognitive-social-constructivist view

• Learning requires intellectual activity, engagement

• Students expect a personal transaction with a teacher

• Education is a personal service, not a commodity, not publishing

• “E-learning” – we’re stuck with it

Page 5: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Types of Teaching-Learning Activities and technology support

• Pedagogy should drive the choice and use of technology – what supports the chosen learning activities?

• There are many classifications of activities necessary for learning!

• E.g. Laurillard’s 10; Shuell’s 12; Salmon’s 32 e-tivities; Biggs 16; etc.

• Level of detail, fine-grained or coarse

• Five will do here; they map to the others

Page 6: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Student modes of engagement in TLAs

1. Information transmission/receptionteacher talk or writing about content, student listening, reading & note taking

2. Multimedia transmission/reception listening, watching content, realism

3. Individual activitydoing, practising

4. Interactivity in student groups discussing, proposing, defending, reflecting

5. Student – teacher interactivity individual feedback to and from a teacher

Page 7: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

The when and where

Page 8: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

TLA typemode of engagement

F2FTLA examples

Technologysupportexample

OnlineTLAexamples

Technologysupportexamples

1 transmission/reception

Didactic lecture

MicrophoneChalk?PowerPoint?

ShovelwareSet text

Resource files

2 multimedia transmission/reception

Images, video demonstration debate

+ projector and DVD, VCR, IAW

Images, video, audio

+ multimedia files, streaming

3 Individualactivity

Answer, question, read, reflect

handout, calculator, pen,

Answer, question, read, reflect

Web, Google, Word, simulation

4 Studentinteractivity

Discussion, PBL, collaboration

Groupware?IAW

Small group work

CMC: email, discussion board, chat

5 Student/teacherinteractivity

Tutorial, interactive lecture

Voting PRS Tutorial, Q&A + FAQs, tests, tutorial, voting

integrated intoComputer console, IAW

Virtual Learning Environment

Page 9: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Information Transmission

Page 10: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Enhanced presentation

Page 11: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Individual activity

Page 12: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Interactivity

Page 13: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Student-teacherinteractivity

Page 14: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

How many modes of engagement are there in student groups?

1 Vote A

2 Vote B

3 Vote C

4 Vote D

5 Vote E

6 Vote F

Page 15: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Cheap, simple alternatives to electronic voting

A show of hands Any questions? Volunteers Random selection of students Coloured cards CommuniCubes

Page 16: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

First year Psychology

Page 17: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Second year Law

Page 18: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

• Electronic voting handsets• anonymous but can opt out• automatic counting and

display• electronic: high risk for

teacher, training needed• expensive

CommuniCubes - partially anonymous - manual counting/ estimating - low tech, low risk, no training - cheap

Simila

r pedagogy

Response technologies

Page 19: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Types of questions with a Personal Response System

• “Concept check”: Multiple choice quiz on content just delivered

• Multiple choice quiz/problem solving at start to diagnose initial understanding

• Students self-report relevant experience

• Students self-report level of understanding

• Students opt for a revision topic

• Combine MCQ with activity, interactivity, and presentations.

Page 20: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

After several sessionsOn balance, what net (dis)advantage?

0

5

10

15

20

25

1 2 3 4 5 6 7 8 9advantage (1 = best, 5=neutral, 9 = worst)

3 = "a significant advantage"

fre

qu

en

cy

1st yr Psy

3rd yr Law

2nd yr Law

Page 21: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

VoteVote for:

1. Continue to the next topic

2. Say more about electronic Personal Response Systems

3. Say more about CommuniCubes

4. Say more about student evaluation of CommuniCubes

Page 22: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

TLA typemode of engagement

F2FTLA examples

Technologysupportexamples

OnlineTLAexamples

Technologysupportexamples

1 transmission/reception

Didactic lecture

MicrophoneChalk?PowerPoint?

ShovelwareSet text

Resource files

2 multimedia transmission/reception

Images, video demonstration debate

+ projector and DVD, VCR, IAW

Images, video, audio

+ multimedia files, streaming

3 Individualactivity

Answer, question, read, reflect

handout, calculator, pen,

Answer, question, read, reflect

Web, Google, Word, simulation

4 Studentinteractivity

Discussion, PBL, collaboration

Groupware?IAW

Small group work

CMC: email, discussion board, chat

5 Student/teacherinteractivity

Tutorial, interactive lecture

Voting PRS Tutorial, Q&A + FAQs, tests, tutorial, voting

integrated intoComputer console, IAW

Virtual Learning Environment

Page 23: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Online learningBasic functions

• Learning resourcesthe Web, subject gateways, course web site, e-library, e-journals e.g. Keele Learning Server (modes 1, 2)

• Tools e.g. Google, Scholar, Word (mode 3)• Discussion boards for asynchronous group

text e.g. BSCW (modes 4,5) • Computer Assisted Assessment

testing and quizzing e.g. QuestionMark (mode 5)

Page 24: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Additional functions inVirtual Learning Environments

• Easy organization of small groups within courses

• Student work submission, integration with plagiarism detection

• Activity tracking of cohorts and individuals

• Selective release of resources, tests, discussions etc. for individuals depending on activity

• Calendar, announcements, and other utilities

• Real-time chat: text, voting, shared whiteboard

Many teacher administrative tools: Virtual Teaching Environments

Page 25: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Blended learning

• Adopted by HEFCE after their e-learning strategy consultation: normal practice!

• Our daily lives are a blend of F2F and online (cyberspace) activity; so should education be, for similar reasons

• What is the optimum (effective and efficient) mix of TLAs, traditional and technology-based? F2F and online?

• An example: engagement mode 4, blending traditional with electronic, F2F with online

Page 26: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

TLA typemode of engagement

F2FTLA examples

Technologysupportexamples

OnlineTLAexamples

Technologysupportexamples

1 transmission/reception

Didactic lecture

MicrophoneChalk?PowerPoint?

ShovelwareSet text

Resource files

2 multimedia transmission/reception

Images, video demonstration debate

+ projector and DVD, VCR, IAW

Images, video, audio

+ multimedia files, streaming

3 Individualactivity

Answer, question, read, reflect

handout, calculator, pen,

Answer, question, read, reflect

Web, Google, Word, simulation

4 Studentinteractivity

Discussion, PBL, collaboration

Groupware?IAW

Small group work

CMC: email, discussion board, chat

5 Student/teacherinteractivity

Tutorial, interactive lecture

Voting PRS Tutorial, Q&A + FAQs, tests, tutorial, voting

integrated intoComputer console, IAW

Virtual Learning Environment

Page 27: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

A 2004-5 example PBL in UG medicine

• Groups of 8-12 students with a facilitator • A rotating Chair and Scribe• 3 one-hour meetings per case, per week• Process:

• Definitions: words they don’t know• Cues, of three types• Links between cues, and their explanations• Learning objectives: questions to answer

• All recorded on a whiteboard and then lost, unless on a flipchart

Page 28: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Traditional whiteboards from an example PBL case

Page 29: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 30: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 31: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 32: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 33: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 34: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 35: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 36: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Why introduce an “interactive whiteboard”?

• All the work could be saved electronically

• A shared record to be printed or distributed to all group members

• Added to in later sessions

Page 37: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

First semester plan

• Two year 1, two year 2 groups, four facilitators

• Student scribe to use “flipchart” software by handwriting or typing • Training sessions offered for hardware and

software

• Tutors to convert flipchart files to Word or PowerPoint files and distribute by email after each session

• Questionnaire at end of semester: features helpful and unhelpful to learning, and net worth to learning

Page 38: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 39: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 40: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

First semester results27% response

• Many groups preferred typing to hand writing “Nice, neat, readable notes.”

• Liked file distribution “Allowed everyone in the group to have a copy of the same notes.”

• and re-editing “Access to previous notes quickly and accurately”

Page 41: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

However,

• Many thought the software slow, it crashed too much, and handwriting was not readable

• Year 1 groups liked IAW at least as much as traditional technology, year 2 groups did not.

• On a scale of 0 (unhelpful) to 10 (helpful), net advantage:

Sem 1 yr2 IAW yr1 IAW yr1 tradit.medians 3 8 6

Page 42: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Second semester

• Watching the four PBL groups at work: what will save them time?

• PowerPoint 2003 instead of flipchart software• Allows annotation• No conversion to Office files needed• Case texts prepared on slides, for highlighting

and linking• Notes stored on the Web instead of emailing – web

spaces with passwords for each PBL group• Simpler process, fewer risks, less dependence on

tutor

Page 43: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

7 - MartaMarta (54) is a slim, well-dressed woman who is financially secure and has never needed to work. Her pride and joy are her three sons: the youngest has just graduated from university. Marta is a keen gardener. She and her husband have an active social life that includes ballroom dancing. Recently, she has found it difficult to keep up with him on the dance floor; she blames this on getting old. Suddenly, whilst digging the garden, Marta has an intense chest pain that quickly spreads to the left side of her jaw and her back. The pain goes away after she stops digging but it recurs the next month when she is again working in the garden and the weather is unusually cold. She goes to her GP who asks questions about chest pains during the previous year. All that Marta recalls is a few bouts of indigestion during the last 6 months. She admits to being a social smoker, but says she has decided to stop, insisting this will not be a problem because she has a lot of will power. Her father died from a heart attack in his 50s and her mother from a stroke in her 60s. Despite this family history, Marta is confident that her female hormones will protect her from heart disease. The GP measures her blood pressure and does a resting ECG (both are normal) and takes a venous blood sample for lipid analysis. He writes a prescription for glyceryl trinitrate (GTN) tablets (1 prn under the tongue), instructs Marta to start taking half an aspirin tablet a day and to return in 5 days. By then the hospital pathology service sends him the lipid data: serum cholesterol 6.8 mmol/L [desirable value <5.0]; low density lipoprotein (LDL) 5.2 mmol/L [desirable value <3.5]. On Marta’s next visit, she gets a prescription for simvastatin. For 2 years, until she is 56, Marta’s occasional chest pain is controlled by GTN. But, whilst clearing autumn leaves, she has a chest pain that is so bad and long lasting that her husband dials 999 for an ambulance. She arrives in A & E pale and clammy. Her pulse is a regular 60/min and her arterial pressures are 100/60 mmHg. The ECG has elevated ST segments and inverted T waves. A blood sample shows raised cardiac enzymes. Initial treatment includes oxygen by mask, and intravenous infusions of streptokinase, morphine sulphate and GTN. After 3 hours in A & E she is admitted to the coronary care unit (CCU). Her condition gives rise to concern because she is still complaining of chest pain. Emergency coronary angiography is undertaken and an immediate angioplasty is performed on her circumflex artery. The procedure is alarming and painful, but it stops the pain. She is sedated and closely monitored for several days – initially in coronary care and then on a medical ward. When she goes home on day 7, her drug treatment comprises atenolol, aspirin and simvastatin plus GTN when needed. Marta is invited to join the cardiac rehabilitation group at the hospital gym as the start of a comprehensive rehabilitation programme. Marta’s son shows her how to search the internet to find if such programmes work before she takes up the offer. But she turns it down saying “she had never been the sporty type” and “it would not suit her”. She is not keen to be “out of action” and intends to be back to normal soon.

Page 44: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

7 - MartaMarta (54) is a slim, well-dressed woman who is financially secure and has never needed to work. Her pride and joy are her three sons: the youngest has just graduated from university. Marta is a keen gardener. She and her husband have an active social life that includes ballroom dancing. Recently, she has found it difficult to keep up with him on the dance floor; she blames this on getting old. Suddenly, whilst digging the garden, Marta has an intense chest pain that quickly spreads to the left side of her jaw and her back. The pain goes away after she stops digging but it recurs the next month when she is again working in the garden and the weather is unusually cold. She goes to her GP who asks questions about chest pains during the previous year. All that Marta recalls is a few bouts of indigestion during the last 6 months. She admits to being a social smoker, but says she has decided to stop, insisting this will not be a problem because she has a lot of will power. Her father died from a heart attack in his 50s and her mother from a stroke in her 60s. Despite this family history, Marta is confident that her female hormones will protect her from heart disease. The GP measures her blood pressure and does a resting ECG (both are normal) and takes a venous blood sample for lipid analysis. He writes a prescription for glyceryl trinitrate (GTN) tablets (1 prn under the tongue), instructs Marta to start taking half an aspirin tablet a day and to return in 5 days. By then the hospital pathology service sends him the lipid data: serum cholesterol 6.8 mmol/L [desirable value <5.0]; low density lipoprotein (LDL) 5.2 mmol/L [desirable value <3.5]. On Marta’s next visit, she gets a prescription for simvastatin. For 2 years, until she is 56, Marta’s occasional chest pain is controlled by GTN. But, whilst clearing autumn leaves, she has a chest pain that is so bad and long lasting that her husband dials 999 for an ambulance. She arrives in A & E pale and clammy. Her pulse is a regular 60/min and her arterial pressures are 100/60 mmHg. The ECG has elevated ST segments and inverted T waves. A blood sample shows raised cardiac enzymes. Initial treatment includes oxygen by mask, and intravenous infusions of streptokinase, morphine sulphate and GTN. After 3 hours in A & E she is admitted to the coronary care unit (CCU). Her condition gives rise to concern because she is still complaining of chest pain. Emergency coronary angiography is undertaken and an immediate angioplasty is performed on her circumflex artery. The procedure is alarming and painful, but it stops the pain. She is sedated and closely monitored for several days – initially in coronary care and then on a medical ward. When she goes home on day 7, her drug treatment comprises atenolol, aspirin and simvastatin plus GTN when needed. Marta is invited to join the cardiac rehabilitation group at the hospital gym as the start of a comprehensive rehabilitation programme. Marta’s son shows her how to search the internet to find if such programmes work before she takes up the offer. But she turns it down saying “she had never been the sporty type” and “it would not suit her”. She is not keen to be “out of action” and intends to be back to normal soon.

Page 45: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

USEFUL CAL PACKAGES:• Coronary circulation• Cardiovascular tutorial• CVS histology• ECGsON THE MANCHESTER WEBSITE:• Drugs and the heart• Psychology of heart disease

Social and Behavioural Science Activities• Talk to some lay people about what they think causes coronary heart disease. Compare this with the published literature.• Investigate what cardiac rehabilitation programmes are available in Manchester and which kinds of health care professionals usually run them.• Identify the British Heart Foundation’s statement on evidence for efficacy of cardiac rehabilitation.

Prepared slide from case book

Page 46: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Definitions

Stroke – a sudden attack of weakness affecting one side of the bodyAka - apoplexyHeart attack – death of a segment of the heart muscle due to interruption of its blood SupplySimvastatin – drug used to lower abnormally high amount of blood cholesterol PRN – pro re nata: as requiredStreptokinase – enzyme produced by certain strains of streptococcus that can liquefy blood clots Angiography- radiographic technique where radio opaque contrasts material isinjected into the blood vesselAtenolol – oral beta blocker Angioplasty – method of treating a narrowing or blocake of blood vessel, inflating a balloon inside the vessel to open narrowing

Page 47: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Objectives

1) Coronary arteries, cardiac pacemakers and conducting system, autonomic innervation of the heart, hormonal affect on heart – anatomy and physiology

2) Atheroma

3) Angina

4) Ischemia, anoxia and infarction

5) Drugs – streptokinase, atenolol, simvastatin, GTN, Aspirin and effects of cardio tonic drugs

6) Angiography & angioplasty

7) Serum cholesterol & LDL

8) ECG and the changes with a myocardial infarction and ischemia

9) Cardiac rehabilitation

10) Personality type

11) Risk factors for cardiac disease (Framingham )

Page 48: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Objectives1) Coronary arteries • Left and right coronary arteries are first branches of the ascending aorta • Come off just after the aortic valve • Left coronary artery divides into circumflex artery and anterior

interventricular artery • Coronary veins – they drain into the coronary sinus (posterior side of the

heart) in between the ventricle and atria. • Coronary sinus drain into the right atrium next to vena cave

• Conducting system • Sino atrial node situated in the wall of the right atrium (group of pace

maker cells)• Wave of depolarization moves to the AV node located in the right atrium • The sa node is the group of cells that has the fastest rate of pace making

ability. There are other cells in the heart with this ability but their not as fast

• Hearts myogenic

Page 49: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

2) Atheroma

Atherosclerosis – thickening of arteries as well as a loss of elasticity mainly affecting medium and large size arteries.

Atheroma – describes plaque

Plaque – consists of fibrous scar tissue, cholesterol and cholesterol esters, fat and inflammatory cells.

LDL – taken up by macrophages and oxidised to form foam cells – may or may not lead to fibrosis plaque (appearance of fatty streaks) – accumulate under the endothelium – more lipid collects fibrous plaque consists of smooth muscle cells and elastic fibres forms. Complicated plaque – small deposits of fibrous material and then calcification.

Why plaque development in arteries compared to veins?

Incorrect repair process lead to the development of plaque

Pressure on the wall leads to collagen build up

Difference in diameter of vessel veins wider therefore less prone

Process of calcification? – objective

Page 50: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Atheroma cont…

75% occlusion leads to ischemia developing and possible MI

plaque – thrombus – embolus – distal arteries causing occlusion – ischemia

embolus may also form directly from the plaque

below 75% occlusion, vessels dilate to compensate for reduced blood flow

Angina

Definition: characterised by paroxysmal and usually recurrent attacks of sub-sternal chest discomfort caused by myocardial ischemia which does not cause necrosis

Systolic stretch In MI - necrosis – leads to ventricular walls become thin – compression causes the thin walls to bulge – thereby reducing contracting ability (enlarged Heart)

Types

Chronic stable angina/ exercised induced

Unstable angina/ crescendo angina (pain increases in frequency and duration)

Page 51: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Angina Cont…

Variant angina/prinzmetal

Pain starts from sub- sternal region – left pectorals muscle – shoulder

Afferent nerve fibre from heart and cutaneus cells join the spinal cord at the same segment – relaying message to the brain via a common pathway

MI

Affects two areas

Sub-endocardial - Which is limited to the inner third of ventricle wall or Transmural (whole of the ventricle wall) most affects left as this where the greatest oxygen demand is present

Risk factors

Hyper tension

Smoking

Page 52: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Drugs

Simvostatin – HMG CoA reductase inhibitor competitively inhibits the rate limiting step of cholesterol synthesis

Inhibits the conversion of HMG CoA – mevalonate

Result is Fall in cholesterol

Cells can regulate cholesterol synthesis, can increase enzyme production that results in reduced cholesterol and therefore increased LDL receptors because the cells cant compensate for drop in cholesterol level.

Atenelol

Comp antagonises beta 1 adreno-receptors on cardiac cells

Reducing heart rate , contraction blood pressure

Hydrophilic leass absorbed from the gut

Increased diastole period giving time for coronary arteries to fill up

Page 53: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

ECG

MI

•ST elevation

•Inverted T wave

•Abnormal Q waves

Lack O2 – cells die – therefore no conduction through these cells and thereby no contraction of these cells - MI

Monitor cardiac enzymes to determine death of cells

Rehabilitation

Just as effective as drugs

Improvement of lifestyle – exercise, risk factor modification – stop smoking, reduce salt intake, psychological

Personality type – A

Use family and existing social activities to educate about exercise

Page 54: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Links

Digging in garden - chest pain

increased O2 requirement because of exercise–increased cardiac output required to supply tissues– heart muscle workload increases - (Exercise induced angina)

Not a problem with lungs because Marta is not breathless

Cold weather – chest pain

Trying to maintain core temp – metabolic rate increased via symp system –vasodilatation of blood vessels – increased cardiac workload – chest pain

Chest pain – left side of jaw arm and back

Nerves share the common pathway from the spinal cord C4 –T4 and therefore the brain is unable to distinguish which area the pain is from

Female hormones – protection from cardiac disease

Oestrogen protects from cardiac disease but the number of females with cardiac disease increase after the age of menopause.

Page 55: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Genetic link

Familial raised cholesterol level – increased risk of cardiac disease

Normal resting ECG – = angina - rules out other cardiac disease

Elevated level of cholesterol and LDL – simvastatin given to prevent cholesterol synthesis

GTN –

Chest pain + normal ECG = possible blockage of blood vessels GTN vasodilator compensate for areas of blockage.

Pale and clammy

Chest pain -Stimulation of symp system – vasoconstriction (pale) – sweat glands increased production

Reduced pulse rate and BP

Due to reduced cardiac output – part of the cardiac muscle has necrosed

Raised cardiac enzymes – ischemia - (damage to cardiac cells)

Monitor over days as levels fluctuate

Page 56: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 57: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Case 2 - Mohammed and Nusrat want a BabyMohammed and Nusrat Ahmed have been unable to conceive and their GP referred them to St. Mary's Hospital. Mohammed is 36 years old and is an industrial safety officer. Nusrat is 26 years old and is a primary school teacher. They have been married for three years and trying to conceive for the last two. Nusrat had her first period at the age of 15. Her periods have always been very irregular, bleeding occurring for between 3 and 10 days every 5 to 8 weeks. At the age of 18 her GP prescribed the oral contraceptive pill in order to regulate her cycle. She had regular withdrawal bleeds and continued the pill until her final year at college when she stopped taking it because she read a magazine article reporting side effects with prolonged use. However, she did use oral contraception during the first year of her marriage. Nusrat has always been overweight and thinks she is currently 3 stones too heavy. She has also noticed an increasing, embarrassing growth of hair on her upper lip, chin and thighs. Her periods are very infrequent. There is no other relevant personal or family history.Mohammed is fit and healthy. He has never been in hospital and is not taking any drugs. His work does not expose him to any toxic chemicals.Mohammed and Nusrat both felt stressed by their infertility and this was causing strains in their married and sexual life. They found it difficult to discuss these issues with their GP; when they presented with the problem initially he dismissed their worries claiming they had not been trying for long enough and, later, he refused to refer them for in vitro fertilisation (IVF) because of its low success rate. They joined the local branch of “Issue”, where they were encouraged to insist on treatment for their infertility. However, they felt a little overwhelmed with the amount of information the organisation gave them. Subsequently, they were referred to the Department of Reproductive Medicine at St. Mary's Hospital.Result of Investigations at St. Mary’s HospitalNusratHeight 1.62m, weight 84kg, BMI 32, BP 120/70, pulse 72 regularIncreased hair on face, breasts, sternum, abdomen and thighs. Breasts normally developed. No masses. No secretion from nipples.Pelvis: external genitalia normal, no clitoromegaly. Vagina, uterus and cervix normal.Endocrine investigations (ELISA assays): luteinising hormone 28IU/l (normal range 2-14 IU/l), follicle stimulating hormone 5IU/l (normal range 2-15 IU/l) on day 3 of her cycle, prolactin 548mU/l (normal up to 425mU/l), testosterone 5.1 nmol/l (normal up to 3.2 nmol/l), androstenedione 14.4 nmol/l (normal range 2-12 nmol/l), sex hormone binding globulin 17 nmol/l (normal range 24-82 nmol/l), free androgen index 18.2 (normal up to 7.5).Pelvic ultrasound: bilateral enlarged ovaries with multiple small cysts. Normal uterine cavity with patent fallopian tubes Hysterosalpingogram: available in DR resource area normal uterine cavity with patent fallopian tube.MohammedMohammed's semen will be analysed in the physiological practical. The size of his testes was normal and serum testosterone was in the normal range.TreatmentNusrat's initial treatment, involving stimulation of her ovaries, was unsuccessful. Consequently the couple were finally accepted into an IVF programme. The IVF was carried out by standard procedures. Eighteen days after replacement of the embryos (at the 4-cell stage), Nusrat had not menstruated and a urine pregnancy test was positive.

Page 58: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

• contraceptive pill – 3 types•Over weight 84kg and BMI 32•Depression?•Irregular periods

•High Testosterone•Increased hair face chin breasts and sternum

• polycystic ovaries•Enlarged ovaries•Increased hormones •The pill •Irregular periods

•Embarrassed by her appearance so no sex• not able to conceive•Irregular periods

• over weight •No conception

•IVF •Stimulation of overies•Urine preg tests•Hormone tests?

• decrease in sbh•Increase free androgen•Increase in LH•Increase in androstenedione•Triggered by increase in insulin

Complex issue of weights relationship with fertility

?

Page 59: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

WebResources Polycystic Ovarian Syndrome Association Infertility Network UK

Page 60: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Learning objectives

1. Mechanisms of oral contraception and side effects2. Out line of female reproductive system and its development3. Causes of infertility (polycystic ovaries, delayed puberty, weight) male 4. What is IVF what do they do?5. What is prolactin and the other hormones mentioned and what do they do?6. What is an ultra sound?7. Procedures for infertile couples?8. Biology of conception both natural and ivf? Efficiency of conception

9. How does the pregnancy test work ?

Page 61: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 62: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 63: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 64: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Polycystic ovaries

Page 65: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 66: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 67: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 68: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

3 main oestrogens•Oestradiol•Oestone•Oestriole

Cholesterol Androstenedione

progesterone Testosterone

Oestradiol

OestroneAromatase

oestriole

Page 69: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 70: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 71: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Semester 2 evaluations

“A lot better now using Powerpoint. Easy to read and quick to use Interactive whiteboard“

They found helpful:

• Helps group process, saves time, notes are more readable

• Remote access to a permanent copy

• Ease of use

• Continuity between sessions

• Web access during session

Page 72: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

However, for some• Slows down the work, difficult to draw diagrams• System crashed (more training?)• One Year 2 group now also liked the IAW but

now one Year 1 group did not!

Big differences between groups or tutors

Sem 2IAW yr2

gp6IAW yr1

gp8IAW yr 1

gp1

Median 7.5 8 1

Page 73: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Next year …

• Initial student training in PowerPoint 2003 as part of IT skills, emphasizing Ink Annotations

• Put PowerPoint 2003 (with PCs, projectors) in all PBL rooms, for use with/without an IAW

• The PCs in all PBL rooms to load the web spaces without dependence on tutors

• Case texts ready in PowerPoint in web spaces

• Let PBL groups mix traditional whiteboards and flipcharts with PowerPoint-IAW-Web

Page 74: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Some conclusions from the PBL example

• Mixing traditional/technology + online/F2F group support in this way is not “out of the box”

• Not the intended use of any of the technology (Web, VLEs or IAWs) so unexpected problems (eg handwriting) and unexpected benefits (eg web access to images)

• Exploring the affordances of the technology blend• Success factors:

• Helping student productivity• Student view is different: creating a set of notes (product

not PBL process)• Minimum effort and risk

(familiar software, robust technology)• Informal plus formal evaluation• Experimentation, discussion, reflection

Page 75: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

The e in e-Learning

Exciting

Exhausting

Efficient

Effective

Enhancing

A

B

C

D

E

Page 76: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

The e in e-Learning

Experiment - Evaluate

Page 77: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 78: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Personal Response Systems PRS

• Infrared or radio handsets with unique codes in a set. Codes are detected and numbers fed to software to display/store results, maybe through PowerPoint.

• Can be anonymous or use non-anonymous class register

• Cost £60-150 per handset

• Staff training needed

• Risk of technical failure?

Page 79: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

CommuniCubes

• Coloured cards and triangles have been used for voting

• Cubes refine the idea and give 5 number choices

• Best in a raked lecture hall with benching or seminar with tables

• Pedagogic practice similar to PRS; participation is enforced; mix with other modes

• Anonymous to different degrees

• Different uses in seminars

• Intellectual Property Rights: Stephen Bostock

Page 80: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk
Page 81: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

CommuniCubes – an initial evaluation

• Foam and printed cubes made in Keele university

• First semester 2003-4 used in groups of 20-30 in Education, Computer Science and Law; and with 120 in a 2nd year Law lecture

• Second Semester 2003-4 used in • 250 1st year Psychology students (10 returns) • 31 students in 2nd and 3rd year in Law tutorials

(100% return)

• Two questionnaires: on first use and after several sessions

Page 82: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

1st year Psychology after several sessions: reasons cubes are helpful

Score: high= most important

12. Gave me feedback on my understanding

12. It was fun, made lecture interesting

8. Participation, made me think, contribute, be involved, express an opinion

6. (Mention of) “interactive”

Page 83: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

After several sessions : 1st year Psychology - reasons unhelpful

Score: high= most important

12: Get answer from seeing others’ votes

9: A distraction, irrelevant

7: Slowed things down, wastes time

Page 84: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

After several sessions : 3rd year Law - reasons helpful

Score: high= most important

39: Participation, made me think, contribute, be involved, express an opinion

5: Preparation for sessions improved

4: Gave me feedback on my learning

Page 85: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

After several sessions : 3rd year Law - reasons unhelpful

Score: high= most important

13: Can get the answer from seeing others’ vote

9: Wasted time

8: Had to make a decision too quickly or when undecided

Page 86: e-learning, learning, and e Dr. Stephen Bostock Advisor for Technology and Learning Keele University, UK s.j.bostock@keele.ac.uk

Evaluation conclusion

• Most students found them helpful to learning: modal value is “significant advantage”

• A few (able?) students may dislike them

• In first year lectures the main reasons were getting feedback on understanding and fun

• In second and third year seminars the reason was the enforced participation

• The learning gains will depend on appropriate use, of course