Academic Librarianship

Abstract

41P pendently during the perinatal period to define subsequent tissue and organ growth. The switch from proliferative (ie mitotic) to hypertrophic cel-lular growth occurs in the perinatal period as myocytes exit from the cell cycle, and beyond this period the myocardium is considered to be largely a terminally differentiated tissue. Thus, the myocyte population is essentially fixed at this time point, defining the non-replaceable pool of cells available to support ongoing maturational growth of the heart. As a highly metabolically active tissue, the heart is particularly vulnerable to substrate 'starvation' stress in the perinatal period, during transition from placental to lactational nutrition. To support energy homeostasis, autophagic activity is upregulated in mul-tiple tissues during the neonatal starvation period – and par-ticularly in the heart. A high level of autophagic activity can be lethal, and cell death by autophagy is recognized as a dis-tinctive, non-apoptotic type of programmed cell death. Thus, myocyte loss through autophagy during the perinatal period has the potential to significantly deplete the heart cell popu-lation. Recently, using novel experimental animal models, it has been possible to demonstrate a link between reduced cardiac myocyte population in the neonatal heart due to upregulated autophagy and abnormal cardiac enlargement in the adult. An interaction between angiotensin II/G-protein-coupled-receptor and IGF1/PI3Kinase-dependent signaling pathways is implicated in this neonatal growth suppression and autophagy induction. Furthermore there is emerging evidence that autophagy pre-disposition and the cross-talk between these signalling pathways is different in male and female hearts, and new findings that microRNA molecules (miR) are the key to sex-specific programming patterns of gene expression which have long-term tissue modeling influence on cardiac patho-physiology. Understanding the early epigenetics of disease predisposition has become an exciting and high priority research pursuit which will yeild important information about the mechanisms of sex difference in adult cardiac disease out-comes. Where applicable, the authors confirm that the experiments described here conform with The Physiological Society ethical requirements. Population theorists have described different generations according to their demographics and the key life events they grew up with. Accordingly, these collective life experiences result in particular attitudes and behaviors that may charac-terize a generation. The Millennial generation was born from 1981 to 1999. Key events in their formative years include 9-11 and a decade of international wars. Millennial students have been shaped by immersion in technology, and by the nurtur-ing of overprotective (" helicopter ") parents. This generation of students is said to be optimistic, generous, open-minded and team-oriented. They value association to others, have high expectations of technology and are accustomed to structured environments, and to receiving regular feedback. Their chal-lenges may include a lack of experience with unplanned envi-ronments and a tendency to worry (1,2). At the University of Central Florida we have built a new med-ical school that has graduated its first class and received full accreditation in 2013. This has been a rare opportunity to design a new curriculum and build new facilities. Our curricu-lum has three phases: 1) Foundations, 2) Systems-based study of disease, 3) Translation to practice. The first two phases are comprised of integrated instructional modules that precede clinical clerkships. Our pedagogic approach seeks to maximize opportunities for active and independent learning and to be congruent with the traits of the current generation of learn-ers. To support the required knowledge base, all our students receive an iPad that is loaded with interactive textbooks and have access to a fully electronic medical library. They are given training in the use of medical databases and reference organ-ization early in the curriculum. We make extensive use of online " self-learning modules " to prepare students for formal class-room activities. Our research on these online modules has iden-tified successful characteristics to include learner control, adherence to instructional design principles in the use of visu-als, and the inclusion of self-tests. When compared against segments of the curriculum without such online modules, stu-dent performance was shown to significantly increase (3). Our classroom instruction emphasizes co-operative learning to leverage the purported acumen of Millennial students in this kind of learning. The use of team-based learning, case-based learning, simulations and other approaches where group work occurs has the overall goal of using classroom time to engage higher order learning. We have developed software to deploy virtual laboratory classes and also use ADInstruments LabTutor software to author and present case-based learning materials. In both cases students work in groups to solve prob-lems and upload their collective solutions online, giving the opportunity for faculty feedback. Our qualitative research in this area suggests that students are highly accepting of the organizational structure and quality of content but also appre-ciate how the software supports group process, co-operative learning and that it allows self-monitoring (4). However, when comparing generic feedback to group-specific feedback we found a significant decline in student acceptance for this spe-cific component. Formative assessment provided during the learning process has long been considered an important component of curric-ula. The need for rich feedback is also a trait associated with Millennial students. We provide extensive formative assess-ment by giving not-for-credit online quizzes every week throughout the first two years in addition to self-testing embedded in online instructional materials and feedback about cases. Our research in this area shows that the degree of par-ticipation in voluntary quizzes is a good indicator of student success in summative assessment. Despite sharing this infor-mation with students during orientation, a significant fraction of students still opt not to take online quizzes in a timely man-ner. In an in-depth interview study we have discovered that fear of judgment, time management, quality of questions and quality of feedback are the major barriers to quiz use. Despite the availability of a lot of formative assessment we find that improving the quality of feedback remains a challenge to sat-isfy the present generation of students.