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This article details a 'puzzling' teaching and learning method to engage undergraduate nursing (BSN) and exercise sciences (BSES) students in physiology or medicine Nobel Prize-winning discoveries, while reviewing course material through the "Puzzling Physiology and Nobel Laureates" (PPNL) game. The qualitative evaluations of 117 undergraduate BSN and BSES students revealed that 95% and 96%, respectively, agreed the game provided an opportunity to utilize critical thinking and problem-solving skillsets. Moreover, 96% of the 117 anonymous student respondents voted on increasing the number of PPNL game sessions per semester, and 94% agreeing the gamified learning strategy should be offered in subsequent classes as well. Interestingly, nearly 90% agreed that the learning experience was 'fun', and that it increased awareness of physiology and/or medicine discoveries. The style of the "Puzzling Physiology and Nobel Laureates" game lends to its reproducibility in a wide array of physiology courses for both majors and nonmajors.

Student-generated videos (SGVs) are gaining popularity and have been increasingly incorporated into undergraduate curricula in many disciplines. Through the creation of their own educational digital videos, students learn course content and transferrable skills. However, the use of SGVs in anatomy and physiology (A&P) is virtually undocumented. In this mixed-methods study, students in online and face-to-face A&P courses independently created short videos about relevant physiological phenomena. The results indicate that perceived and actual learning, as well as enjoyment, were positively impacted by the creation of the SGVs. Though it was not required, students watched their peers' videos over 12,000 times in the online course and over 1,100 times in the face-to-face course. These findings demonstrate the value of SGVs in the A&P lecture classroom for the first time.

Human Anatomy and Physiology courses are "gateway" courses that students must pass with high grades in order to proceed through their program of study. However, student pass rates are often low, resulting in students attempting the course multiple times and delaying their graduation. Supplemental instruction performed by peer leaders is one mechanism that has been used to increase student success. The goal of this study was to evaluate the effectiveness of peer-led supplemental instruction by comparing predicted and actual course grades. We learned that students predicted to earn a C achieved higher grades when they utilized supplemental instruction. While those students performed better than predicted, supplemental instruction did not improve ABC rates for the class. We conclude that supplemental instruction can be of benefit for some students.

In the United States, there is a demand for registered nurses. To be admitted into the nursing program, students need to complete prerequisite courses such as human anatomy and physiology. Many students find human anatomy and physiology challenging due to the nature of the content. Poor performance in human anatomy and physiology can preclude a student from enrolling in the nursing program. Professors can support students in their learning activities with strategies that can have a positive impact on learning and improve learner outcomes. The objectives of this study are to use consistent formative assessments such as pre-course assessment, course syllabus quiz, reading assignments (pre-learning), in-class activities (during learning), and post-learning activities to engage students in a human anatomy and physiology course. It is important to share these strategies for engaging students with other educators of allied health students. Data were collected on students' performance on pre-course assessment, course syllabus quiz, pre-learning, during learning, and post-learning activities (n=9). Pre-course assessment, course syllabus quiz, and post-learning quizzes were completed on Moodle. Pre-learning reading assignments were completed using McGraw Hill Connect embedded within Moodle. During learning and post-learning activities were completed in the classroom. The mean data for different forms of formative assessment are pre-course assessment (67.8%), course syllabus quiz (84.4%), pre-learning reading assignments (99%), during learning activities (94.2%), and post-learning activities (78.8%). The data show that consistent formative assessments can be used to engage students in active learning, help them prepare for summative assessments, and impact knowledge with positive learner outcomes.

Electronic student worksheets (e-worksheet) are needed as alternative teaching materials in learning. This study aims to produce teaching materials in the form of e-worksheet based on Search Solve Create and Share (SSCS) Islamic context to improve science process skills on class XI excretory system material that is worthy of the results of validity, responses of students and biology teachers. This research was conducted at MAN 1 Bogor. The research model used is a 4D model (Define, Design, Develop, Disseminate), but in research only to the development stage (Develop). The e-worksheet teaching materials developed are tested for validity. The results of validity tests by design and media experts obtained 89% in the very decent category, material expert assessments obtained 84% in the very feasible categories, and expert assessments of Islamic religious education obtained 100% in the very feasible categories. The results of student responses obtained percentages of 89% in limited trials and 89.7% in expanded trials. Based on the findings of the research results, it can be concluded that E e-worksheet based on Search Solve, Create and Share (SSCS), an Islamic context to improve science process skills on the excretory system material developed, is very feasible to be used and applied to biology learning.

In this industrial revolution era, university-level education emphasises higher-order thinking skills. This research aims to analyse the effect of implementing the PjB-HOTS learning model on cognitive learning, creative thinking skills, analytical thinking skills, and metacognitive skills of the students studying osmoregulation concepts in Animal Physiology courses. The sample consisted of 61 fifth-semester students divided into two classes. An open-ended test was used to measure students' cognitive learning levels, creative thinking skills, analytical thinking skills, creative thinking skills, and metacognitive skills. The research data were analysed using the Analysis of Covariance (ANCOVA). The results of this research show that the learning model had a significant effect on the cognitive learning gains (0.000< [alpha]= 0.05), creative thinking skill (0.001< [alpha]= 0.05), analytical thinking skill (0.000< [alpha]= 0.05), and metacognitive skill (0.000< [alpha]= 0.05). These results indicate that the combined syntax of PjBL and HOTS can foster students' higher-order thinking skills and improve their cognitive learning gains. We recommend the PjB-HOTS learning model be used for other biological concepts at the university-level.

This paper presents a review of the literature pertaining to exam anxiety, highlighting findings from empirical studies, theoretical frameworks, and practical strategies. Exam anxiety is a pervasive issue affecting students worldwide, impacting academic performance and psychological well-being. This review explores the causes, manifestations, and consequences of exam anxiety, and evaluates existing interventions. By examining a diverse range of scholarly works, this paper seeks to contribute to a deeper understanding of exam anxiety and offers insights for educators as well as students. The paper also provides a brief list of alternative forms of summative assessment that have the potential to alleviate exam anxiety.

Although integrating the history of science (HOS) into teaching has long been recommended in science education research, studies have revealed conflicting results on its effectiveness. These are mainly due to the need for more studies in this context. Therefore, this research aimed to explore the impact of HOS teaching on science process skills, knowledge of science concepts, and attitudes toward science. In this research, a quasi-experimental research design was employed. The HOS was contextualized into the topic of the circulatory system. Two intact classes were chosen as the experimental group (EG) and the two others as the control group (CG). The EG students were involved in HOS activities during the treatment, while the CG students followed the curriculum-driven activities. The findings indicated that the impact of HOS education was evident, as students in the EG outperformed those in the CG in retaining knowledge of science concepts and demonstrating positive attitudes towards science. However, HOS education and curriculum-driven instruction have similarly impacted the development of science process skills. These results support the conceptual premise that HOS teaching is an alternative and a worthy way of supporting students' scientific literacy.

Are children from "Eastern" cultures less emotionally expressive and reactive than children from "Western" cultures? To answer this, we used a multi-level and multi-contextual approach to understand variations in emotion displays and cortisol reactivity among preschoolers living in China and the United States. One hundred two preschoolers from China (N = 58; 55% males) and the United States (N = 44, 48% males) completed three (i.e., control, interpersonal-related, and achievement-related) emotion-challenging paradigms over 3 days. Behavioral emotion expressions were coded, and salivary cortisol was sampled 30 minutes before and across 90 minutes post-task. Without considering context, Chinese preschoolers displayed fewer levels of positive and negative emotion expressions relative to their United States counterparts. However, Chinese preschoolers displayed similar levels of expressions as their United States counterparts during an achievement-related challenge that is more salient to their sociocultural emphases and showed higher negative emotion expressions in this challenge, relative to other contexts. Moreover, only the achievement-related challenge elicited increased cortisol levels among Chinese preschoolers, and this was correlated with higher levels of negative expressions. For US preschoolers, no cortisol increase was observed in any challenging paradigms, nor was cortisol associated with emotional expressions. Findings counter prior notions that East Asian children are generally less emotionally expressive. Instead, an achievement-related challenge elicited higher emotion expression and cortisol reactivity among Chinese preschoolers, suggesting that children's emotion expression and biological reactivity may be most responsive to contexts salient to their socio-cultural environments. We discuss the importance of considering cultural contexts when studying emotion regulation.

There is a high prevalence of adolescent girls with ovulatory menstrual (OM) dysfunction, which is associated with school absenteeism and mental health challenges. Low menstrual health literacy among this group has evoked calls to review OM health education. This qualitative study sought to explore gaps in current OM health education and to validate a holistic school-based OM health literacy program named "My Vital Cycles"®. Findings are based on 19 written reflections, six focus group discussions and three interviews conducted with 28 girls aged 14-18 years from 11 schools, and five mothers. Six themes compared current OM health education with "My Vital Cycles"®: understating health, comprehensiveness, resources, teaching, parents and cycle tracking. Future refinements to the program comprised: inclusion of the complete reproductive lifespan, use of visual media and developing a mobile application. These findings inform future research in a whole school approach, strengths-based teaching and changes in the health curriculum.

Background: People with intellectual disabilities are at much higher risk of preventable deaths compared to the general community. However, studies identifying the cause of death in people with intellectual disability are generally based on one primary cause which is frequently attributed to the person's disability. Therefore, the aim of this study was to identify the most common associated causes that may have contributed to the deaths of Australians with intellectual or learning disabilities, particularly those that may be avoidable. Methods: Linked data that had previously been used to identify underlying causes of deaths were re-analysed to determine other contributing causes of death in Australians with intellectual disabilities aged under 65 years who accessed disability services between July 2013 and June 2018. Findings: Two thousand three hundred and thirty-three deaths occurred among 180,790 people with intellectual disability. Contributing causes of death with the greatest disparities compared to the general community were lung diseases due to external agents (adjusted rate ratio (RR) 70.6 (95% confidence interval [95% CI] 63.7-78.2), influenza and pneumonia (RR 18.3; 95% CI 16.4-20.4), and coronary heart disease (RR 3.3; 95% CI 2.8--3.8). Conclusions: Analysing all contributing causes of death in people with intellectual disabilities can ensure that the higher rates of preventable deaths in people with intellectual disability are identified and addressed earlier in the disability and health sectors.

Background: Across the life course, women and girls with learning disabilities and their carers report difficulties in accessing information and support with menstruation, yet their experiences are often overlooked in initiatives to improve menstrual health and wellbeing. Our aim was to collaborate with women with learning disabilities to co-produce future research priorities in a UK context. Methods: We undertook a two-part scoping exercise to explore what is known about this topic from a life course perspective, beginning pre-menarche and extending to post-menopause support. This combined a rapid scoping review of the literature since 1980 with a stakeholder consultation where people with learning disabilities, family carers, advocacy groups and staff working across education, health and social care were invited to share their experiences of menstruation support. Findings: UK and international literature provided insight across five narrative themes. Seventy stakeholders took part in our consultation, enabling the identification of five key themes. Findings across both highlight examples of supportive practice and valued resources alongside enduring health inequalities and barriers to menstruation support faced by women and girls with learning disabilities across the life course. Conclusion: Our scoping exercise identified multiple gaps in research and practice, ongoing reproductive health inequalities and a need for improved access to peer support, resources and training that take a life course approach. The scoping exercise indicates the need for further empirical research on menstruation and learning disability, with a particular focus on collating people's lived experiences.

The complexity of modern societies necessitates that children learn highly abstract material, such as mathematics, which often conflicts with behavioral goals that are innately motivating. For instance, children's educational success is generally evaluated based on their individual achievements, while humans are motivated to learn by engaging in socially relevant behaviors. Additionally, science-related content typically requires higher-level abstract thinking to comprehend related concepts and perform the underlying cognitive processes, whereas humans evolved primarily to monitor and manipulate the physical environment by moving within it to execute foraging and hunting behaviors. Moreover, school systems inherently prescribe top-down strategies in which teachers transfer knowledge by providing instructions to guide students' knowledge acquisition. By contrast, humans evolved to learn through bottom-up processes motivated by the learner's internal drive to explore their physical and social environment. As a consequence, skeletal cognitive competencies that evolved throughout human history create a mismatch between why children are motivated to learn and how they are expected to learn. This review adopts an evolutionary perspective to examine how the interplay between students' internal physiological and psychological adaptations and external instructional methods of modern educational systems impacts motivation and learning. Ultimately, the review offers suggestions on how to motivate the learning process by integrating self-determination theory principles into a dynamical systems framework.

Purpose: This study aimed to investigate challenges in speech-in-noise (SiN) processing faced by school-age children with autism spectrum conditions (ASCs) and their impact on listening effort. Method: Participants, including 23 Mandarin-speaking children with ASCs and 19 age-matched neurotypical (NT) peers, underwent sentence recognition tests in both quiet and noisy conditions, with a speech-shaped steady-state noise masker presented at 0-dB signal-to-noise ratio in the noisy condition. Recognition accuracy rates and task-evoked pupil responses were compared to assess behavioral performance and listening effort during auditory tasks. Results: No main effect of group was found on accuracy rates. Instead, significant effects emerged for autistic trait scores, listening conditions, and their interaction, indicating that higher trait scores were associated with poorer performance in noise. Pupillometric data revealed significantly larger and earlier peak dilations, along with more varied pupillary dynamics in the ASC group relative to the NT group, especially under noisy conditions. Importantly, the ASC group's peak dilation in quiet mirrored that of the NT group in noise. However, the ASC group consistently exhibited reduced mean dilations than the NT group. Conclusions: Pupillary responses suggest a different resource allocation pattern in ASCs--An initial sharper and larger dilation may signal an intense, narrowed resource allocation, likely linked to heightened arousal, engagement, and cognitive load, whereas a subsequent faster tail-off may indicate a greater decrease in resource availability and engagement, or a quicker release of arousal and cognitive load. The presence of noise further accentuates this pattern. This highlights the unique SiN processing challenges children with ASCs may face, underscoring the importance of a nuanced, individual-centric approach for interventions and support.

The purpose of this study was to examine potential differences in social learning between individuals with fragile X syndrome (FXS), the leading known inherited cause of intellectual disability, and individuals with non-syndromic autism spectrum disorder (ASD). Thirty school-aged males with FXS and 26 age and symptom-matched males with non-syndromic ASD, were administered a behavioral treatment probe designed to improve levels of social gaze during interactions with others. The treatment probe was administered by a trained behavior therapist over two days in our laboratory and included reinforcement of social gaze in two alternating training conditions -- looking while listening and looking while speaking. Prior to each session, children in each group were taught progressive muscle relaxation and breathing techniques to counteract potential increased hyperarousal. Measures included the rate of learning in each group during treatment, in addition to levels of social gaze and heart rate obtained during administration of a standardized social conversation task administered prior to and following the treatment probe. Results showed that learning rates obtained during administration of the treatment probe were significantly less steep and less variable for males with FXS compared to males with non-syndromic ASD. Significant improvements in social gaze were also observed for males with FXS during the social conversation task. There was no effect of the treatment probe on heart rate in either group. These data reveal important differences in social learning between the two groups and have implications for early interventions in the two conditions.

Menstruation is a global public health issue with negative discourses of shame, embarrassment, and disgust. There is growing anecdotal evidence linking negative menstruation experiences at school to absenteeism. This systematic review and line-of-argument synthesis aims to develop a conceptual understanding of menstruation experiences in schools in high-income countries. MEDLINE (Ovid), PsycINFO (Ovid), EMBASE (Ovid), HMIC (Ovid), and ERIC databases were searched. NVivo was used for thematic synthesis and reciprocal translation to generate third-order constructs: overarching themes that interpretatively describe social processes around menstruation in schools. One thousand three hundred and thirty-three studies were screened, with 19 meeting inclusion criteria. Six third-order constructs were identified and integrated into a synthesized line-of-argument illustrating menstrual injustice at school. To ensure menstruating students do not face academic disadvantage because of schools' failure to accommodate menstrual needs, schools should challenge stigma, provide facilities to improve students' capability and confidence to manage menstruation, and provide academic support to menstruating students who miss classes. Future research should explore experiences of period poverty in HIC schools, examining the influence of gender identity, disability, race, and class on menstruation experiences.

Background: Endovascular clot retrieval (ECR) is known to reduce global disability at 3 months post stroke however limited research exists regarding the trajectory of specific clinical impairments including language, swallowing and cognitive deficits between onset and 3 months. Aims: To assess language, swallowing, and cognitive performance following ECR and explore whether impairment severity is correlated with modified Thrombolysis in Cerebral Infarction score (mTICI), stroke severity or quality of life (QoL). Methods: Assessment was completed within 7 days (T1), 1 month (T2) and 3 months (T3) post-stroke. Performance was measured with the Functional Oral Intake Scale (FOIS), Repeatable Battery for Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT A and B) and Brixton Spatial Awareness Test. The Western Aphasia Battery (WAB) was used for left hemisphere stroke. QoL was measured with the Stroke and Aphasia Quality of Life Scale. Results: Twenty-five participants (median 72 years; 64% male) were prospectively recruited following ECR. High reperfusion success (68% mTICI 3) and low stroke severity post ECR (median 24 h NIHSS = 3, IQR 7-18) were noted. At T1, 10 participants presented with aphasia, eight required a modified diet and 20 had impaired cognition. At T3 all had recovered to a normal oral diet, 39% had persistent cognitive impairment and 45% of patients with left hemisphere stroke remained aphasic. Performance on the WAB, FOIS, RBANS and TMT changed significantly over time (all p < 0.05). The severity score at T1 for all measures, excluding TMT B and Brixton, was significantly correlated with 24 h NIHSS. WAB scores at T3 were correlated with QoL (r = 0.618; p = 0.043). Conclusion: This exploratory study found the longitudinal performance of language, swallowing and cognition significantly improved over time and severity in the first-week post-ECR was correlated with 24 h NIHSS rather than the degree of reperfusion.

Sustained attention (SA) is an endogenous form of attention that emerges in infancy and reflects cognitive engagement and processing. SA is critical for learning and has been measured using different methods during screen-based and interactive contexts involving social and nonsocial stimuli. How SA differs by measurement method, context, and stimuli across development in infancy is not fully understood. This 2-year longitudinal study examines attention using one measure of overall looking behavior and three measures of SA--mean look duration, percent time in heart rate-defined SA, and heart rate change during SA--in N = 53 infants from 1 to 24 months across four unique task conditions: social videos, nonsocial videos, social interactions (face-to-face play), and nonsocial interactions (toy engagement). Results suggest that developmental changes in attention differ by measurement method, task context (screen or interaction), and task stimulus (social or nonsocial). During social interactions, overall looking and look durations declined after age 3-4 months, whereas heart rate-defined attention measures remained stable. All SA measures were greater for videos than for live interaction conditions throughout the first 6 months, but SA to social and nonsocial stimuli within each task context were equivalent. In the second year of life, SA measured with look durations was greater for social videos compared to other conditions, heart rate-defined SA was greater for social videos compared to nonsocial interactions, and heart rate change during SA was similar across conditions. Together, these results suggest that different measures of attention to social and nonsocial stimuli may reflect unique developmental processes and are important to compare and consider together, particularly when using infant attention as a marker of typical or atypical development.

Objective: This paper examines the ways in which young people in Eastern Canada learn about menstruation and construct personal period pedagogies through embodied experiences and encounters with digital and social media. Design: A qualitative exploratory approach was undertaken to elicit the stories and voices of young people who menstruate. Menstruation is conceptualised as a deeply bio-social phenomenon and knowledge was understood as created, contested and negotiated across settings and contexts. Methods: Semi-structured interviews were conducted with nine university students (ages 19-23 years) in Eastern Canada as part of a pilot project informing a broader study about menstruation education and menstrual experiences. To be eligible for inclusion, participants were required to have experienced one menstrual cycle in the past 6 months and engaged with social media at least once per week. Setting: This project was conducted in a small University town in Maritime Canada. Results: Young people interviewed learned about menstruation through knowledges assembled from conversations family members and peers, educational and medical settings and content encountered on social and digital media. Three themes were developed from the analysis. The first two capture how young people actively try to 'Fill in the Gaps' left by conventional menstrual education approaches and therefore turn to informal and narrative knowledges circulating on social media in efforts to answer the question 'Am I normal'. The third theme describes how participants actively 'Balance Authority and Intimacy' when seeking menstrual information that resonates with their embodied experiences. Conclusion: Substantial gaps exist in the menstrual knowledges available to young people, particularly in relation to the embodied and emotional dimensions of having and managing a period. Digital and social media have the capacity to contribute to personal period pedagogies by acknowledging and exploring aspects of menstruation not adequately addressed in other contexts.

In 1993, an increase was observed in the spatial IQ scores of the volunteers who listened to Mozart's sonata K448 for 10 min, and this phenomenon entered the literature as the "Mozart effect." Other studies have shown that this effect is particularly evident in spatial skill tests. A large body of research has provided evidence that spatial ability is associated with success in learning anatomy. In this study, Kastamonu University Faculty of Medicine students were divided into two groups during 16-h practical training spanning 30 days. While one of the groups listened to Mozart's K448 sonata as the background music in all lessons, the control group attended the lessons in their standard form. At the end of each lesson, all students solved a modified mental rotation test including questions involving anatomical structures. Before starting the study, after the first laboratory class, on the 15th and 30th day of the study, blood samples were taken from the participants, and plasma brain-derived neurotrophic factor (BDNF) levels were determined. The effect of time on mental rotation score and plasma BDNF level was significant (p < 0.001 for both). The effect of group was also significant (p < 0.001 for both). Pairwise comparisons showed significance in the fifth, sixth, seventh, and eighth mental rotation test (p < 0.001, p = 0.041, p < 0.001, p < 0.001, respectively) and in the third (Day 15) and fourth (Day 30) BDNF measurement (p < 0.001 for both). Our findings may indicate that specific background music may be useful for anatomy teaching.

Previous research indicates that menopause can be an extremely difficult transition for some autistic people. This study asks how autistic people experience menopause and how they can better access services, support and information; autistic Community Research Associates played an important role in each stage of the research. Online focus groups and interviews were conducted with 24 autistic participants who lived in Canada (n = 13) or the United Kingdom (n = 11) and had experience with the menopausal transition. Transcripts were coded and analysed by four team members using reflexive thematic analysis. Four themes and eight subthemes were identified: (1) Complexity, multiplicity and intensity of symptoms (0 subthemes); (2) Life experience and adversity converging at midlife (three subthemes); (3) The importance of knowledge and connection (two subthemes); and (4) Barriers to support and care (three subthemes). Limitations include a potential sample bias towards difficult experiences of menopause. The majority of our sample had a late diagnosis or discovery of autism, and their experiences might not generalize to wider autistic populations. This research may help autistic people prepare for menopause and recognize symptoms earlier. Hearing about the experiences of others may let autistic people who struggle with menopause know they are not alone.

Fixel-based analysis was used to probe age-related changes in white matter micro- and macrostructure of the corpus callosum between participants with (N = 54) and without (N = 50) autism spectrum disorder (ASD). Data were obtained from the Autism Brain Imaging Data Exchange-II (ABIDE-II). Compared to age-matched controls, young adolescents with ASD (11.19 ± 7.54 years) showed reduced macroscopic fiber cross-section (logFC) and combined fiber-density and cross-section (FDC). Reduced fiber-density (FD) and FDC was noted in a marginally older (13.87 ± 3.15 years) ASD cohort. Among the oldest ASD cohort (17.07 ± 3.56 years), a non-significant trend indicative of reduced FD was noted. White matter aberration appears greatest and most widespread among younger ASD cohorts. This supports the suggestion that some early neuropathophysiological indicators in ASD may dissipate with age.

As a result of the COVID-19 pandemic, anatomy education was forced to adopt online modes of delivery. Previous research on student views revealed areas of strong preference (asynchronous lectures) and strong dislike (virtual specimens) in online anatomy courses. The current study seeks to compare the views of a single cohort of students experiencing both online and in-person undergraduate introductory anatomy and physiology courses. This comparison can highlight what students consider beneficial to their education and can inform future hybrid course offerings. Q-methodology was used to assess the opinions of students. Students sorted 41 statements on anatomy education in a quasi-normally distributed grid based on their degree of agreement with the statements. The rankings underwent a by-person factor analysis which categorized students with shared perceptions into groups. Data were collected from 246 students in the primarily online fall semester and 191 students in the primarily in-person winter semester. Analysis revealed three distinct factors (groups) in the cohort. Factor one (n = 113 (fall), n = 93 (winter)), was satisfied overall with the course materials and delivery. Factor two (n = 52 (fall), n = 18 (winter)) had a deep dislike of online learning, and factor three (n = 37 (fall), n = 49 (winter)) had a strong preference for online learning. While many students were comfortable in both online and in-person learning environments, this was not the case for all learners. The strengths and weaknesses of each teaching modality suggest the opportunity to explore hybrid learning as an option for future course offerings and specifically highlight valuable aspects to incorporate from each environment.

Menarche can be a difficult transition for young people. With appropriate education, youth can feel more positively about the menstrual experience. Since many elementary teachers are not equipped with menstrual health knowledge, the education falls to the school nurse. However, it is unknown if school nurses feel comfortable communicating about menstruation with young people. The purpose of this study was to explore school nurses' perceptions regarding menstrual health education in elementary schools (grades K-5). An online mixed-methods survey was established using Qualtrics. Through snowball sampling, 30 elementary school nurses responded. Using the Integrated Behavioral Model (IBM) as a framework, a deductive semantic thematic analysis was used to identify themes for each question. Data suggested that elementary school nurses would participate in professional development regarding menstrual health and hygiene. School health nurses are receiving limited knowledge/skills surrounding pedagogy and are not familiar with cultural differences when it comes to menstrual health.

Extant literature has demonstrated that children's diurnal stress physiology often looks different on childcare versus home days. Specifically, children experience a rise in cortisol, rather than a decline, over the day while in full-time care. Additionally, temperamental fit within classroom environment may influence both child and teacher cortisol and outcomes. The current study investigated whether teachers' cortisol levels (n = 11) were associated with child cortisol levels (n = 71, mean age = 4.18 ± 0.81, 51% female) in the classroom while taking into account temperament, child sex assigned at birth, and classroom quality. Cortisol samples were collected on consecutive days at home and childcare for children, and at childcare for teachers. We hypothesized that (1) teacher cortisol will predict child afternoon cortisol, (2) that a portion of the variance in this relationship will be accounted for by classroom quality. Using a cross-sectional design, children in this sample had higher cortisol values in the afternoon while at childcare than at similar times of day at home. Teachers demonstrated a typical diurnal decline across the day but variation in total cortisol output at childcare. Two distinct predictors of afternoon cortisol levels were identified in children attending childcare: child age and mean teacher cortisol levels across the day, while negative affect and classroom quality were not significant. Younger children and children whose teachers had higher mean cortisol levels were more likely to have high afternoon cortisol at childcare. Higher diurnal cortisol values for teachers may indicate a higher stress environment for both teachers and children. These preliminary findings suggest that teacher stress may not only have implications for children in terms of teacher burnout, high staff turnover, and learning, but possibly also for children's health and well-being. Implications for research and policy, as well as limitations and strengths, are discussed.

Views of obesity as a consequence of "lack of willpower" or other behavioral choices, rather than a complex array of biological and other factors, are quite common among undergraduate students. Many undergraduates in prenursing or biology programs have little exposure to the physiology and pathophysiology of obesity, including learning about leptin and other hormones involved in appetite control. I developed materials for teaching about the pathophysiology of obesity in two different pathophysiology courses: one designed as a survey of pathophysiology topics for prenursing majors, and the other designed as an in-depth exploration of the molecular and cellular basis of selected diseases for upper-division biology majors. In the molecular basis of disease course, obesity is covered as part of a unit organized around metabolic syndrome. The discussion includes molecular and cellular mechanisms that link obesity to several other diseases, including type 2 diabetes and atherosclerosis. This article briefly describes the approaches I have taken for teaching obesity to two different undergraduate student populations and lists several resources that may be useful tools for teaching about obesity.

Here we demonstrate how data from the clinical pulmonary function lab can help students learn about the principle of airway-parenchymal interdependence. We examined the relationship between airway conductance (Gaw) and lung volume (thoracic gas volume, TGV) in 48 patients: 17 healthy; 20 with emphysema, expected to have reduced airway-parenchymal interdependence; and 11 with pulmonary fibrosis, expected to have increased airway-parenchymal interdependence. Our findings support these expectations, with the slope of Gaw vs. TGV being steeper among those with pulmonary fibrosis and flatter among those with emphysema, compared to the slope of the healthy group. This type of analytic approach, using real-world patient data readily available from any pulmonary function laboratory, can be used to explore other fundamental principles of respiratory physiology.

We offered an enrichment program for high school students with the theme, "The Environment, Health, and You" during the Summer of 2022 and the Spring of 2023. We developed several educational modules for high school students that provided them with an opportunity to learn and explore the foundations of physiological systems, nutrient needs to maintain health, and the impact that environmental factors can have on them. The modules included videos, discussion boards, games, readings, and labs. These modules were integrated into the first session: Your Body and Health. On "day 1," the first module explored the basic physiology and anatomy of the body with respect to the organization of cells into organ systems. Additionally, the educational content included information on macro- and micronutrients and their impact on body development, nutrition, and metabolism. The nutrition module explored nutrition concepts and various factors that can impact healthy eating patterns, such as food insecurity issues and the consumption of ultraprocessed foods. A lab activity on label reading was included to help empower students to make healthy choices. A total of 43 high school students participated in the program. Overall, the quality of the educational content in the modules was rated highly by the students, and they indicated that the educational experience inspired them to learn more about the physiology and nutrition concepts associated with human metabolism, and the importance of healthy food choices to maintain health.

In response to COVID-19, educators rapidly pivoted to new and innovative ways of delivering lecture material. The ability to host synchronous lectures on platforms like Zoom gave students continued access to classroom material in the face of an ongoing pandemic. The purpose of this study was to investigate the differences in exam scores between students attending a physiology class (PHSL3051) synchronously via Zoom or asynchronously by viewing recorded lectures posted after class. Students in PHSL3051 were evaluated with four unit exams and one cumulative final exam. Although pooled analysis of all students showed that synchronous lecture viewing positively predicted exam scores, this positive association was even larger when the data were analyzed by gender and ethnicity. For female-identified students and students of color (SOC), attending lectures synchronously was associated with average scores on every unit exam that were higher by 2.7-7.4 percentage points. Moreover, the greater a student's synchronous participation in the course throughout the semester, the better that student's performance on the cumulative final exam was likely to be. These data highlight the need to better understand how different groups of undergraduate students select and respond to different assessment methods used in the same course, which may have long-term effects on their overall performance at 4-year institutions.

The multidisciplinary nature of physiology requires students to acquire, retain, apply, and evaluate knowledge from different scientific disciplines. Optimal learning techniques, such as active learning, interleaving topics and conditions, and recall, can greatly enhance the speed and effectiveness with which students achieve this type of higher-order thinking. However, developing and implementing optimal learning techniques in the classroom can be both time-intensive and challenging for the instructor. In addition, students may be resistant or slow to accept novel learning processes. One way to potentially introduce these learning techniques in a fun and engaging way is through educational gaming, or using a game or game elements intentionally to support learning. In this article we present an easy-to-implement adaptation of the Codenames board game for the physiology classroom. The activity requires minimal preparation while addressing high-level learning outcomes. Postintervention surveys of students were collected in three different health-related academic programs, both graduate and undergraduate, at two different institutions. Results suggest that participating in the activity both actively engaged the students and pushed them toward high-level, integrative thinking regardless of class level.

This article introduces an innovative teaching and learning tool called "Edelman Gamblegrams" that aims to help medical learners better understand disorders related to water/plasma tonicity homeostasis, i.e., hyponatremia and hypernatremia. Gamblegrams, named after physician James L. Gamble, are bar diagrams displaying the relative abundance of extracellular anions and cations and are commonly used in the analysis of acid-base disorders. The Edelman equation represents the physiological variables that determine plasma sodium concentration, namely, total body sodium mass, total body potassium mass, and total body water volume. Edelman Gamblegrams inspired by traditional Gamblegrams but using the components of the Edelman equation, visually demonstrate how sodium, potassium, and water contribute to plasma sodium concentration under normal and pathological conditions. Scenarios that lead to hypotonic hyponatremia and hypernatremia in Edelman Gamblegrams are also discussed. Furthermore, examples of how these visual aids can enhance understanding of the pathogenesis of dysnatremias are also presented. Overall, the use of Edelman Gamblegrams has the potential to improve comprehension and retention of concepts related to water/plasma tonicity homeostasis.

The advent of artificial intelligence (AI)-powered language models presents new opportunities and challenges in education. By teaching students how to craft prompts that elicit insightful responses, faculty can scaffold activities where AI acts as a supplemental resource to amplify critical thinking and support student learning. Ongoing dialogue and iteration focused on ethical usage norms can achieve the right balance between emerging technology and foundational skills development. With care and intention, AI-assisted study tactics offer students personalized support while adhering to academic standards. While AI-powered tools provide many positive opportunities, students and faculty need to learn about and use them responsibly and ethically, not as replacements for required thinking and effort. Before implementing these AI tools for studying biology, there are several key things to discuss with students. This article outlines several ways that students can employ these tools to support better learning along with a set of guidelines for all to be wary of when implementing these in an academic setting.

Mnemonic devices are memory aids that make it easier to recall information and are widely used by students studying anatomy and physiology. Simple musical instruments and toys can serve as mnemonic devices for students learning the functional anatomy of the larynx: balloons can help learners understand and recall how sound is produced; tuning pegs can help learners understand how tension affects vocal pitch; fingers on a fretboard can help learners understand how pitch is further modulated; and a common coach's whistle can demonstrate how vocal volume is controlled. Using instruments and toys engages adult learners and helps them connect complex laryngeal anatomy with previous experiences.

The early years of physiology education in medical curricula provide unique challenges. As well as inculcating concepts that are seen as difficult, modern curricula require that students learn in context in case-based learning courses. Additionally, regulating bodies stress that the soft skills of compassion, communication, and empathy are embedded throughout curricula. This has driven work in our organization involving drama and final-year medicine students during which they collaborate in realistic simulations of doctor/patient interactions. We adapted this transdisciplinary approach to second-year physiology tutorials. This emphasized the holistic importance of physiology to patient care, while also embedding "human factors" skills from the very earliest stages of the curriculum. After preparing by attending acting classes based on aspects of Konstantin Stanislavski's "System," the authors supervised tutorials in which drama students participated in a "physiology of hypofertility" session for second-year medical students, playing a 34-year-old woman with premature menopause (or their partner). Opinion (from all students) was evaluated by Likert questionnaires (which included open questions). A focus group of drama students was also interviewed, and the conversation was recorded for thematic analysis. Positive Likert scores were recorded for the authenticity of the tutorials, skills development, fostering empathy, and motivating students to improve. All participants evaluated the tutorial as highly enjoyable. These scores are reflected in positive open commentary on the questionnaires and in the focus group interviews. The results suggest that even basic science tutorials give opportunities for interdisciplinary study and enhancement of behavioral skills while gaining enthusiastic student acceptance.

Diabetes mellitus and obesity are major public health issues that significantly impact the health care system. The next generation of health care providers will need a deep understanding of the pathophysiology of these diseases if we are to prevent, treat, and eventually cure these diseases and ease the burden on patients and the health care system. Physiology core concepts are a set of core principles, or "big ideas," identified by physiology educators that are thought to promote long-term retention, create a deeper understanding, and help with formation of critical thinking skills. Here we describe our scaffolded teaching approach in an upper year undergraduate pathophysiology course to educate students about these two diseases and discuss how learning about the basis of these highly integrative diseases from the biochemical to whole body level is a meaningful tool in the physiology educator toolbox to reinforce physiology core concepts. This teaching strategy is designed to engage students in the scientific process and hone their problem-solving skills such that they are hopefully equipped to treat and eventually cure these diseases as they move forward in their careers.

Medical students face challenging but important topics they must learn in short periods of time, such as autonomic pharmacology. Autonomic pharmacology is difficult in that it requires students to synthesize detailed anatomy, physiology, clinical reasoning, and pharmacology. The subject poses a challenge to learn as it is often introduced early in medical school curricula. To ease the difficulty of learning autonomic pharmacology, we created a free web application, PharmaMemory (www.pharmamemory.com), that interactively depicts the effects of high-yield autonomic drugs on the human body. PharmaMemory provides users with the opportunity to read and quiz themselves on the mechanisms, side effects, indications, and contraindications of these drugs while interacting with the application. We provided PharmaMemory to first-year medical students for three consecutive years of quality improvement and assessed the application's perceived effects on learning via user surveys. Survey feedback showed that users viewed PharmaMemory favorably and self-reported increased knowledge and confidence in the subject of autonomic pharmacology. Comments revealed that users liked the website's visuals, opportunity for challenged recall, and conciseness. PharmaMemory utilizes challenged recall, visual stimulation, and interactive learning to provide users with a multifaceted learning tool. Preliminary data suggest that students find this method of learning beneficial. Further studies are needed to assess PharmaMemory compared with more traditional learning methods such as PowerPoint or text-based learning. Additionally, further research is needed to quantitatively assess reduction in cognitive load.

Medical students must be adept at critical thinking to successfully meet the learning objectives of their preclinical coursework. To encourage student success on assessments, the course director of a first-year medical physiology course emphasized the use of learning objectives that were explicitly aligned with formative assessments in class. The course director introduced the physiology discipline, learning objectives, and evidence-based methods of studying to students on the first day of class. Thereafter, class sessions started with a review of the learning objectives for that session and included active learning opportunities such as retrieval practice. The instructor provided short answer formative assessments aligned with the learning objectives, intended to help the students apply and integrate the concepts. Midsemester, students received a link to an online survey with questions on studying habits, class attendance, and student engagement. After finals, students were invited to participate in focus groups about their class experience. A qualitative researcher moderated focus groups, recorded responses, and analyzed the narrative data. Of 175 students, 95 submitted anonymous online surveys. Student engagement was significantly correlated with in-person class attendance (r = 0.26, T = 2.5, P = 0.01) and the completion of open-ended formative assessments (r = 0.33, T = 3.3, P = 0.001). Focus groups were held via videoconference. From the class, 14 students participated in 4 focus groups; focus group participants were mostly women (11 of 14) and mostly in-class attendees (13 of 14). The students in this sample valued critical thinking but misunderstood expectations on exams and few students used learning objectives to study.

Endocrine physiology is a complex subject for students. Game-based learning (GBL) and case-based learning (CBL) are active methodologies that are widely used because of their potential for motivation and greater proximity to the reality of modern students. We evaluated the effectiveness of GBL and CBL among veterinary medicine students compared with a control group using peer tutoring. Students (n = 106) from two institutions volunteered to participate in this study. The participants were submitted to a pretest questionnaire and subsequently were divided into three paired groups by their performance on the pretest exam: (1) traditional class + peer tutoring, (2) traditional class + GBL, and (3) traditional class + CBL. After the students completed the activities, their performance was once again evaluated by applying a new test with the same initial 10 questions and another set of 10 different questions. The students' perceptions and satisfaction with the methodologies and learning strategies were assessed. Anxiety was assessed with the State-Trait Anxiety Inventory before and after the conventional class and after the active methodologies. The GBL group significantly improved their correct answers compared with the baseline (P < 0.05), with no significant difference from CBL and peer tutoring. Anxiety levels did not differ regardless of the time of evaluation or the teaching methodology applied. GBL promoted a greater perception of the stimulus for self-study and problem-solving ability and contributed to the development of group dynamics compared with the group who received CBL (P < 0.05). In conclusion, GBL showed better results than peer tutoring and CBL.

Emotional intelligence (EI) has a positive correlation with the academic performance of medical students. However, why there is a positive correlation needs further exploration. We hypothesized that the capability of answering higher-order knowledge questions (HOQs) is higher in students with higher EI. Hence, we assessed the correlation between EI and the capability of medical students to answer HOQs in physiology. First-year undergraduate medical students (n = 124) from an Indian medical college were recruited as a convenient sample. EI was assessed by the Schutte Self-Report Emotional Intelligence Test (SSEIT), a 33-item self-administered validated questionnaire. A specially designed objective examination with 15 lower-order and 15 higher-order multiple-choice questions was conducted. The correlation between the examination score and the EI score was tested by Pearson's correlation coefficient. Data from 92 students (33 females and 59 males) with a mean age of 20.14±1.87 yr were analyzed. Overall, students got a percentage of 53.37±14.07 in the examination, with 24.46±9.1 in HOQs and 28.91±6.58 in lower-order knowledge questions (LOQs). They had a mean score of 109.58±46.2 in SSEIT. The correlation coefficient of SSEIT score with total marks was r ¼ 0.29 (P ¼ 0.0037), with HOQs was r ¼ 0.41 (P < 0.0001), and with LOQs was r = 0.14 (P = 0.19). Hence, there is a positive correlation between EI and the capability of medical students to answer HOQs in physiology. This study may be the foundation for further exploration of the capability of answering HOQs in other subjects.

Resting-state alpha brain rhythms provide a foundation for basic as well as higher-order brain processes. Research suggests atypical maturation of the peak frequency of resting-state alpha activity (= PAF) in autism spectrum disorder (ASD). The present study examined resting-state alpha activity in young school-aged children, obtaining magnetoencephalographic (MEG) eyes-closed resting-state data from 47 typically developing (TD) males and 45 ASD males 6.0 to 9.3 years old. Results confirmed a higher PAF in ASD versus TD, and demonstrated that alpha power differences between groups were linked to the shift of PAF in ASD. Additionally, a higher PAF was associated with better cognitive performance in TD but not ASD. Finding thus suggested functional consequences of group differences in resting-state alpha activity.

Medical personnel often experience stress when responding to a medical emergency. A known stress-response is a measurable reduction in heart rate variability. It is currently unknown if crisis simulation can elicit the same stress response as real clinical emergencies. We aim to compare heart rate variability changes amongst medical trainees during simulated and real medical emergencies. We performed a single center prospective observational study, enrolling 19 resident physicians. Heart rate variability was measured in real time, using a 2-lead heart rate monitor (Bodyguard 2, Firstbeat Technologies Ltd) worn during 24 h critical care call shifts. Data was collected at baseline, during crisis simulation and when responding to medical emergencies. 57 observations were made to compare participant's heart rate variability. Each heart rate variability metric changed as expected in response to stress. Statistically significant differences were observed between baseline and simulated medical emergencies in Standard Deviation of the N-N interval (SDNN), Root mean square standard deviation of the N-N interval (RMSSD), Percentage of successive R-R intervals that differ by more than 50 ms (PNN50), Low Frequency (LF) and Low Frequency: High Frequency ratios (LF:HF). No statistically significant differences between simulated and real medical emergencies were identified in any heart rate variability metrics. We have shown using objective results, that simulation can elicit the same psychophysiological response as actual medical emergencies. Therefore, simulation may represent a reasonable way to practice not only essential skills in a safe environment but has the additional benefit of creating a realistic, physiological response in medical trainees.

Introduction: Speech Language Therapy First Point of Contact Clinic (SLT-FPOCC) models can assist assessment of low-risk patient populations referred to ear, nose and throat (ENT) services. To further improve ENT waitlist management and compliance with best-practice care, consideration of other low-risk populations that could be safely managed through this service model is needed. The aims of this paper are to evaluate the clinical and service outcomes of completing vocal cord check (VCC) assessments for patients' pre and post thyroid/parathyroid surgery within an SLT-FPOCC model and examine consumer perceptions. Methods & Procedures: The service followed existing SLT-FPOCC procedures, with ENT triaging referrals, then SLT completing pre- and postoperative VCC assessment (interview, perceptual assessment, flexible nasendoscopy), with assessment data later reviewed by ENT to diagnose laryngeal pathology. Clinical and service outcomes were collected prospectively. Patients completed an anonymous post-service satisfaction survey. Results: Of the first 100 patients referred for preoperative VCCs, SLT assessment identified 42 with dysphonia and 30 reporting dysphagia, while ENT confirmed 9 with significant preoperative anatomical findings. Eighty-three underwent surgery, with 63 (95 nerves at surgical risk) returning for a postoperative VCC. Postoperative VCC identified three temporary neuropraxias (3.2%) and three unilateral vocal fold paresis (3.2%). Patients were highly satisfied with the service. All 163 pre-/postoperative VCCs were completed with no adverse events. Conclusion & Implications: The current data support SLT-FPOCC service expansion to include pre and post thyroid/parathyroid surgery VCC checks, with positive consumer perception. The model supports delivery of best practice management (i.e., pre- and postoperative VCC) for patients receiving surgery for thyroid/parathyroid dysfunction, and associated efficiencies for ENT services.

This pilot study adds to the understanding of interventions to manage acculturative stress experienced during undergraduate study abroad programs. It was designed to evaluate the impact of cognitive behavioral strategy training combined with intentional practice during mixed reality (MR) simulations on acculturative stress. Participants included a convenience sample of undergraduate nursing students enrolled in a faculty-led study abroad course. Students participated in two MR simulations within a virtual environment over back-to-back days. Simulations were written by nursing faculty experts to reproduce realistic clinical situations students may encounter while studying in Peru. The Generalized Self-Efficacy Scale, State-Trait Anxiety Inventory, and Slater-Usoh-Steed questionnaire were administered. Quantitative biometric indices assessed during simulations included estimates of heart rate, blood pressure, respiratory rate, oxygen saturation and alterations in sweat gland activity reflective of changes in emotional state (galvanic skin response). There were changes in biometric indices within each simulation, but indices were not different between pre- and post- cognitive behavioral strategy training. Intentional reflective writing before, during, and after the study abroad program demonstrated an iterative cycle of reflection on action and mindfulness. These qualitative data suggest that pre-departure cognitive based behavior stress management strategies paired with simulated practice prior to departure may be one way to help nursing students deal with acculturative stress during study abroad experiences.

The beauty of the sound is not only due to advanced singing voice but also depends on breathing techniques. This paper aims to study knowledge about the physiology of breathing and singing, including the effectiveness of conscious control in vocal training and innovative technologies. The authors used observation methods to achieve this goal. They developed mechanisms to set breathing that promote singing using modern technology. As a result, the authors identified the following indicators: body coordination, diaphragmatic respiratory training, inhalation and exhalation training, mixed respiratory training, as well as coordination of the vocal apparatus. Videos, Sing Sharp, Prana Breath, Erol Singer's Studio, and SwiftScales served as tools to provide instruction. The results showed that body coordination and mixed respiratory training significantly influence the sound's naturalness. The singing purity results from body coordination and the vocal apparatus. The study involved two groups of students: Group 1 included vocalists who studied according to the proposed technique; Group 2 united amateur performers. A specific efficiency and quality of singing characterized the performance of the students from Group 1 when playing folk (83%) and popular compositions (77%). The results showed that the students of Group 2 generally received average scores for the performance of folk (54%) and popular (53%) compositions. The practical significance of the work lies in the possibility of developing a singing voice with the help of breathing and modern technology.

This study provides a comprehensive overview of methodological aspects when using heart rate variability (HRV) measures in educational research. Following PRISMA 2020 guidelines, we searched four databases for relevant studies published until March 5, 2024. From the 48 studies reviewed, we extracted data across three analytical categories: (1) area of study interest and participant populations, (2) data collection and analysis methodologies, and (3) the concurrent and predictive validity of HRV measurement for educational research. Study quality was evaluated using QualSyst assessment criteria. Most studies measured stress and enlisted undergraduate students as participants. Data were predominately collected using wearable devices, measuring HRV for durations of less than 30 min, and in varied contexts, including during exams, while learning, and in experiments. The parameters analyzed varied within both time and frequency domains. HRV data had a moderate level of concurrent validity as a measure of stress in an educational context. The concurrent validity of HRV data for measuring attention remains uncertain with insufficient evidence. Limited correlations appeared between stress and performance. The findings, potentials, and limitations of HRV measures are discussed, and synthesized recommendations for educational research using HRV data are provided.

Concept maps help detect misconceptions and provide revision exercises to assess comprehension once a topic has been introduced. A concept map is a schematic drawing used to show the connection among the concepts in propositional form. A concept map is a helpful tool for illustrating the relationships between main concepts and sub-concepts. The main objective of the study was to identify misconceptions about the human digestive system among higher secondary students using concept maps. The data was collected from higher secondary students XI class students) (N = 388) with the help of students' preliminary concept maps and researcher-made concept map tools. Findings of the study showed that secondary school students hold misconceptions related to the human digestive system, i.e. few (22.68%) students have misconceptions such as 'Human Digestive System is the process by which hard food is converted into simple diffusible assimilable nutrients', few (19.32%) students have misconceptions such as 'Alimentary Canal starts with the throat," etc. The present paper will help use concept maps for the identification and remediation of students' misconceptions.

The arrival of the metaverse, as a new generation of information technology, will bring great changes to people's production, life, and learning. The educational metaverse is regarded as a new form of educational development, which will bring a transformative impact on educational teaching activities. In this context, this study has developed a general architecture of educational metaverse system, which includes the physical layer, software layer, data layer, and application layer, based on the technical, theoretical, and architectural support and its digital ecology of educational metaverse system construction. The study has tried to construct a physiology virtual experimental teaching system and taken the rabbit's exercise of respiration regulation experiment as an example to start the research on the educational metaverse in physiology experimental teaching. Participants of the study were 120 students from the 2019 clinical medicine class at School A. By analyzing the learning outcome of students in the virtual experiment course of the educational metaverse, it is concluded that educational metaverse can promote both teaching and learning in the process of experimental teaching; this research has explored the path for the new form of Internet education, which is of great significance for promoting the efficient construction of new education infrastructure and the innovative development of education modernization.