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Articles 1141 - 1170 of 1237
Full-Text Articles in Medical Education
Flipping The Flipped: The Co-Creational Classroom, Vuk Uskoković
Flipping The Flipped: The Co-Creational Classroom, Vuk Uskoković
Pharmacy Faculty Articles and Research
The flip teaching model is being increasingly adopted by higher education institutions as an active learning alternative to traditional lecturing. However, the flip model shares a number of critical premises with the classical didactics. The further flips of the flip are thus advocated and the fear of returning the method to its initial state, prior to the flip, via such flips of the flipped dispelled. Proposed here is a seminal variation to the flip model based on the active involvement of students in searching, finding, selecting, and assembling knowledge from various literature sources into the learning material for the entire …
Three Professions Come Together For An Interdisciplinary Approach To 3d Printing: Occupational Therapy, Biomedical Engineering, And Medical Librarianship, Joan Wagner, Laurel Scheinfeld, Blanche Leeman, Keith Pardini, Jamie Saragossi, Katie Flood
Three Professions Come Together For An Interdisciplinary Approach To 3d Printing: Occupational Therapy, Biomedical Engineering, And Medical Librarianship, Joan Wagner, Laurel Scheinfeld, Blanche Leeman, Keith Pardini, Jamie Saragossi, Katie Flood
Library Faculty Publications
Background: Although many libraries have offered 3D printing as a service or available technology, there is a lack of information on course-integrated programs for 3D printing in which the library played a primary role. Therefore, librarians at the Touro College School of Health Sciences began exploring 3D printing for inclusion in the occupational and physical therapy curriculum. Case Presentation: The goal of this project was to educate occupational and physical therapy students and faculty about the potential applications of 3D printing in health care and provide hands-on experience, while increasing collaboration between librarians and faculty. Students’ tasks included designing and …
Success Rates Of Second Semester Anatomy Students In Online And On-Ground Classes At A Community College In East Tennessee, William Sproat
Success Rates Of Second Semester Anatomy Students In Online And On-Ground Classes At A Community College In East Tennessee, William Sproat
Electronic Theses and Dissertations
Educators expect the number of institutions offering online courses and the number of students enrolling in these courses to increase as many students, particularly nontraditional students, discover the advantages of online content delivery. Online courses require new methods of communication between students and faculty as well as discovering new ways to build relationships, earn student trust, conduct appropriate assessment, and deliver useful course content. Many institutions—public, private, and for-profit—offer a wide variety of online coursework but faculty, employers, and the public have expressed concerns about the quality of online course content. In particular, online delivery of coursework in the natural …
The Predictors Of Juvenile Recidivism: Testimonies Of Adult Students 18 Years And Older Exiting From Alternative Education, La Toshia Palmer
The Predictors Of Juvenile Recidivism: Testimonies Of Adult Students 18 Years And Older Exiting From Alternative Education, La Toshia Palmer
Dissertations
Purpose: The purpose of this descriptive, qualitative study was to identify and describe the importance of the predictors of juvenile recidivism and the effectiveness of efforts to prevent/avoid juvenile recidivism as perceived by previously detained, arrested, convicted, and/or incarcerated adult students 18 years of age and older exiting from alternative education in Northern California. A second purpose was to explore the types of support provided by alternative schools and the perceived importance of the support to avoid recidivism according to adult students 18 years of age and older exiting from alternative education.
Methodology: This qualitative, descriptive research design identified …
Athletic Training Students Demonstrate Supplemental Oxygen Administration Skill Decay, But Retain Knowledge Over Six Months, David C. Berry, Jennifer K. Popp
Athletic Training Students Demonstrate Supplemental Oxygen Administration Skill Decay, But Retain Knowledge Over Six Months, David C. Berry, Jennifer K. Popp
Internet Journal of Allied Health Sciences and Practice
Purpose: Research suggests skill decay occurs with emergency skills, such as supplemental oxygen administration (OA), since the frequency of medical emergencies in clinical settings is low. Identifying the presence and timeline for skill decay allows educators to employ strategies to prevent this occurrence. Therefore, this study evaluated retention of knowledge and clinical skills associated with supplemental oxygen administration, specifically nasal cannula (NC) and non-rebreather mask (NrM) usage in professional athletic training students.
Methods: Cross-sectional study. Twenty-nine athletic training students (males=11, females=18; age=21.03+1.38) enrolled in a Commission on Accreditation of Athletic Training Education (CAATE)-accredited professional athletic training programs. Participants’ …
Student And Faculty Perceptions Of Live Synchronous Distance Education For Allied Health Students Following Program Expansion To A Rural Campus, Betsy J. Becker, Kelsey Rutt, Allyson Huntley, Harlan Sayles, Kim Michael
Student And Faculty Perceptions Of Live Synchronous Distance Education For Allied Health Students Following Program Expansion To A Rural Campus, Betsy J. Becker, Kelsey Rutt, Allyson Huntley, Harlan Sayles, Kim Michael
Internet Journal of Allied Health Sciences and Practice
Background & Purpose: Distance education (DE) is a means to meet allied health workforce needs in rural locations where healthcare worker shortages are apparent. Five allied health programs were expanded to a rural campus teaching synchronously using distance education technology. The purpose of this convergent parallel mixed methods study was to explore perceptions of allied health students and faculty at two campus locations.
Methods: Quantitative and qualitative information were collected through a survey of students and faculty (physical therapy, physician assistant, and medical imaging [diagnostic medical sonography, radiography, magnetic resonance imaging] programs). Both campuses served as live and distance sites …
Introducing Trainees To Academic Medicine Career Roles And Responsibilities, Cristina Fernandez, Raymond Lucas, Maria Soto-Greene, John Sanchez
Introducing Trainees To Academic Medicine Career Roles And Responsibilities, Cristina Fernandez, Raymond Lucas, Maria Soto-Greene, John Sanchez
E-Learning Modules
Reproduced with permission of the American Association of Medical Colleges. Link to original publication
Development Of Physics Curriculum For Pre-Health Students, Elliot Eckman Mylott
Development Of Physics Curriculum For Pre-Health Students, Elliot Eckman Mylott
Dissertations and Theses
Many pre-health students are required to take introductory physics as undergraduates, though they often struggle to see the relationship between medicine and what they learn in these courses. In order to help students make that connection, reformed curriculum was adopted that teaches physics through the context of biomedicine. This dissertation will discuss the development, implementation, and assessment of the reformed curriculum for the introductory and intermediate level physics courses that targets the needs of pre-health students.
The curriculum created during this project include laboratory activities, multimedia content, and other instructional materials all of which present physics in biomedical contexts. The …
Newborn Care Curriculum: Newborn Medications, Lauren Rechtman, Rebekah Conroy
Newborn Care Curriculum: Newborn Medications, Lauren Rechtman, Rebekah Conroy
E-Learning Modules
Introduction: Based on a 2014 newborn education needs assessment, 39.6% of surveyed pediatric hospitalists expressed interest in receiving more education on newborn medications, and 94% were interested in computer-based learning modules as the method of learning. Thus, this module was designed to serve as a self-study tool or as a tool for small-group teaching.
Methods: Initially designed for pediatric hospitalists, the module can be used for any learner interested in newborn care as it is meant to provide practical applications to the bedside clinician. This module was first implemented as part of the multimodule Newborn Care Curriculum within the pediatric …
A Joint Quality Improvement And High-Value Care Curriculum In A Limited-Resource Setting, Anne Cioletti, Suzanne Sweidan
A Joint Quality Improvement And High-Value Care Curriculum In A Limited-Resource Setting, Anne Cioletti, Suzanne Sweidan
E-Learning Modules
Introduction: Since the release of the Institute of Medicine’s To Err Is Human, there has been an increased focus on quality improvement (QI). QI training is now a requirement monitored via ACGME’s clinical learning environment review committees. Given the significant cost of health care waste, teaching physicians to incorporate costs and value into medical decision making is crucial. Increasing information is available on methods to teach high-value care (HVC), but there is little information on combining HVC with QI. As these topics are intimately linked in efforts to provide effective, efficient care, a joint curriculum is a feasible solution.
Methods: …
The Use Of Hands-On Educational Pedagogy In A Standardized Science Curriculum, Sarah Alam
The Use Of Hands-On Educational Pedagogy In A Standardized Science Curriculum, Sarah Alam
Honors Undergraduate Theses
Introduction
The purpose of this project is to implement an innovative, and engaging knowledge transfer pedagogy for 5th grade science students. This project utilized Stealth Learning, a learning pedagogy developed by Dr. James Rosser.99,100,109,110 The program featured applied learning to develop skill sets in general and drone aviation, as well as minimally invasive surgery techniques. This was facilitated through the use of computers, table simulators, and drones.
Methodology
This project took standardized subject matter from the Florida Comprehensive Assessment Test (FCAT) and converted it into content featuring the Stealth approach. The section that was converted was the "Practice of …
International Education For Medical Students: An International Program Design In Publich Health, Elizabeth Anne Tyrie
International Education For Medical Students: An International Program Design In Publich Health, Elizabeth Anne Tyrie
Capstone Collection
Cultural Perspectives in Public Health: An International Education Program for Medical Students proposes a six-week international mobility course for medical students at Università Cattolica del Sacro Cuore. The course design was inspired by a request from the UCSC medical student cohort to expand credit-bearing international program opportunities. The program will introduce participants to Kolb’s (1984) experiential learning cycle in an effort to provide students with a framework to use when evaluating common practices in the medical field. The course aims to increase academic collaboration between Università Cattolica del Sacro Cuore, an Italian based Higher Education Institution, and the Higher Education …
Reframing Health Professions Leadership Education, Courtney E. Vannah
Reframing Health Professions Leadership Education, Courtney E. Vannah
CETL Mini-Grant Research Papers
As leadership training becomes more common in allied health professions curricula, efforts must be made to tailor training to student need. As such, understanding the frames through which health professions students view leadership is essential. According to Bolman and Deal, there are four leadership frames (human resource, structural, symbolic and political) and although most people access most readily one frame or another, the most effective leaders are able to access all four frames. This study describes what leadership frame(s) preference exists among an allied health professions student population in order to alert educators that frame preferences do exist so as …
Exploring Job Satisfaction And Preceptorship Capacity Among Applied Epidemiologists, Jessica C. Arrazola
Exploring Job Satisfaction And Preceptorship Capacity Among Applied Epidemiologists, Jessica C. Arrazola
College of Graduate Studies: Theses & Dissertations
Job satisfaction is important to consider when developing strategies for recruitment and retention. The Public Health Workforce Interests and Needs Survey (PH WINS) conducted in 2014 was the first nationally representative assessment of the state public health workforce. Prior to this assessment, the job satisfaction of state agency public health workers and preceptor capacity had not been measured. This study fills the current research gaps by studying the job satisfaction among the applied epidemiology workforce, identifying factors influencing job satisfaction, and the describing the preceptorship capacity among epidemiologists. This research is based on the 2014 PH WINS data. The analysis …
Healthy Homes, Healthy Futures: A Home Visitation Curriculum For Pediatric Residents, Kofi D. Essel, Sirisha Yalamanchi, Cara Lichtenstein, Erin Hysom
Healthy Homes, Healthy Futures: A Home Visitation Curriculum For Pediatric Residents, Kofi D. Essel, Sirisha Yalamanchi, Cara Lichtenstein, Erin Hysom
E-Learning Modules
A working knowledge of the home and neighborhood environment is critical to understanding the barriers that families face when struggling with obesity. Most doctors are only given the opportunity to address individuals with obesity in the office setting and usually describe their counseling abilities as ineffective. This focused home visitation curriculum offers a unique tool to improve residents’ understanding of the social determinants of health, how these determinants relate to obesity, and critical obesity-management skills. The curriculum requires residents to review three PowerPoint modules and an article on motivational interviewing. Residents then implement what they have learned by doing two …
Emerging Roles For Librarians In The Medical School Curriculum And The Impact On Professional Identity, Anne Linton
Emerging Roles For Librarians In The Medical School Curriculum And The Impact On Professional Identity, Anne Linton
Himmelfarb Library Faculty Publications
This article discusses the impact on professional identity for health sciences librarians participating in the curriculum revision and development process. A qualitative survey, designed to examine the current roles, values, and self-identification of health sciences librarians involved in curricular revision, was conducted. The respondents discussed how they had participated in the planning, implementation, and rollout phases of revised curricula. They identified skills and values essential to successful participation and described the impact of expanded professional relationships on new identities as educators, change agents, and problem solvers. The study may add to the knowledge base of skills and attitudes needed for …
Principles And Practices Fostering Inclusive Excellence: Lessons From The Howard Hughes Medical Institute’S Capstone Institutions, Patricia Marten Dibartolo, Leslie Gregg-Jolly, Deborah Gross, Cathryn A. Manduca, Ellen Iverson, David B. Cooke Iii, Gregory K. Davis, Cameron Davidson, Paul E. Hertz, Lisa Hibbard, Shubha K. Ireland, Catherine Mader, Aditi Pai, Shirley Raps, Kathleen Siwicki, Jim E. Swartz
Principles And Practices Fostering Inclusive Excellence: Lessons From The Howard Hughes Medical Institute’S Capstone Institutions, Patricia Marten Dibartolo, Leslie Gregg-Jolly, Deborah Gross, Cathryn A. Manduca, Ellen Iverson, David B. Cooke Iii, Gregory K. Davis, Cameron Davidson, Paul E. Hertz, Lisa Hibbard, Shubha K. Ireland, Catherine Mader, Aditi Pai, Shirley Raps, Kathleen Siwicki, Jim E. Swartz
Publications and Research
Best-practices pedagogy in science, technology, engineering, and mathematics (STEM) aims for inclusive excellence that fosters student persistence. This paper describes principles of inclusivity across 11 primarily undergraduate institutions designated as Capstone Awardees in Howard Hughes Medical Institute’s (HHMI) 2012 competition. The Capstones represent a range of institutional missions, student profiles, and geographical locations. Each successfully directed activities toward persistence of STEM students, especially those from traditionally underrepresented groups, through a set of common elements: mentoring programs to build community; research experiences to strengthen scientific skill/ identity; attention to quantitative skills; and outreach/bridge programs to broaden the student pool. This paper …
Written And Online Residency Guidebook To Improve Resident Efficiency And Knowledge Of Best Patient Care Practices, Michael Ortiz, Mary C. Ottolini, Dewesh Agrawal
Written And Online Residency Guidebook To Improve Resident Efficiency And Knowledge Of Best Patient Care Practices, Michael Ortiz, Mary C. Ottolini, Dewesh Agrawal
E-Learning Modules
**Contains time-sensitive information that will likely be inaccurate, obsolete, or irrelevant by December 01, 2018**
Residents at most institutions change rotations every 2 to 4 weeks. It often takes significant time for residents to become acclimated to the different protocols, expectations, and environments of each unique rotation. As a result, residents often spend time searching for answers, time that could be spent in outside learning and direct patient care. The goal of this resource is to provide a novel guidebook that improves residents’ efficiency and knowledge of best patient care practices. The guidebook begins with an introductory chapter with …
2016-2017 Lsu Health Sciences Center In New Orleans Catalog/Bulletin, Office Of The Registrar
2016-2017 Lsu Health Sciences Center In New Orleans Catalog/Bulletin, Office Of The Registrar
Catalogs and Bulletins
No abstract provided.
Reflect, React, Exchange: A Cultural Competency Co-Curriculum, Derrick Lewis
Reflect, React, Exchange: A Cultural Competency Co-Curriculum, Derrick Lewis
Capstone Collection
Cultural competency serves as key component to medical training and education and increasing interest in international health experiences denotes a recent need to respond to globalized health and populations. Reflect, React, Exchange (RRE) is a co-curriculum aims to provide a revised and integrated framework and foster awareness via experience, exchange, reflection, and dialogue at the Clinica de Familia La Romana in La Romana, Dominican Republic. RRE utilizes theories which are appropriate to the transformative learning aims and integral curricular activities of the CFLR Global Health Experience, an 8-week, global health internship experience for health science. It provides students with the …
Development Of A Course-Based Undergraduate Research Experience To Introduce Drug-Receptor Concepts, Hollie I. Swanson, Ok-Kyong Park-Sarge, Thushani Rodrigo-Peiris, Lin Xiang, Vincent M. Cassone
Development Of A Course-Based Undergraduate Research Experience To Introduce Drug-Receptor Concepts, Hollie I. Swanson, Ok-Kyong Park-Sarge, Thushani Rodrigo-Peiris, Lin Xiang, Vincent M. Cassone
Pharmacology and Nutritional Sciences Faculty Publications
Course-based research experiences (CUREs) are currently of high interest due to their potential for engaging undergraduate students in authentic research and maintaining their interest in science, technology, engineering, and mathematics (STEM) majors. As part of a campuswide initiative called STEMCats, which is a living learning program offered to freshman STEM majors at the University of Kentucky funded by a grant from Howard Hughes Medical Institute, we have developed a CURE for freshmen interested in pursuing health care careers. Our course, entitled “Drug–Drug Interactions in Breast Cancer,” utilized a semester-long, in-class authentic research project and instructor-led discussions to engage students in …
Fosces: Adding Another Library Tile To The Medical School Mosaic, Alexandra Gomes, Thomas Harrod
Fosces: Adding Another Library Tile To The Medical School Mosaic, Alexandra Gomes, Thomas Harrod
Himmelfarb Library Faculty Posters and Presentations
The 2014 launch of the revised medical school curriculum provided new opportunities for librarians to collaborate with faculty. Due to past informatics instruction in the first year curriculum, we were invited to expand this content as part of a new formative Objective Structured Clinical Examination (FOSCE) initiative. This poster will describe the development and implementation of the FOSCE informatics curriculum.
In FOSCEs, small groups of students rotated through simulated patient encounters in order to demonstrate their clinical knowledge and skills. Due to simulation center logistics, students alternated between skills demonstration and informatics activities. The informatics component consisted of fifty minute …
Relationship-Centred Care In Health: A 20-Year Scoping Review, Sophie Soklaridis Phd, Paula Ravitz Md Frcpc, Gili Adler Nevo Md Frcpc, Susan Lieff Md Prcpc
Relationship-Centred Care In Health: A 20-Year Scoping Review, Sophie Soklaridis Phd, Paula Ravitz Md Frcpc, Gili Adler Nevo Md Frcpc, Susan Lieff Md Prcpc
Patient Experience Journal
Relationship-centred care (RCC) is a framework for conceptualizing health care which recognizes that the nature and quality of relationships in health care influence the process and outcomes of health care. Our goal was to undertake a scoping review of the peer-reviewed and grey literature on RCC in health. Using Arksey and O’Malley’s scoping review methodology we identified literature about RCC in teaching, learning and clinical practice. Electronic databases were searched, and targeted searches were also conducted for grey literature to capture unpublished material. Subsequently, data abstraction tools were used with eligible studies for analysis. Sixty-nine publications originated mainly from the …
Sex And Sexual Education In China: Traditional Values And Social Implications, Isabella Steinhauer
Sex And Sexual Education In China: Traditional Values And Social Implications, Isabella Steinhauer
Independent Study Project (ISP) Collection
In China, the differing views of sex between younger and older generations is the clearest indicator ofthe division of modern and traditional thought in societyand their resulting repercussions. The paper examineswhat specific traditional Chinese norms and values spark many social issues in China, how those traditional values are reflected in the lack of sexual education, and then analyzes how the lack of sexual education impacts those social issues.Formal interviews were conducted in Kunming with seven college students (aged 18-23) from Yunnan Finance and Economics University and other universities, while more casual conversations were held with people of other ages in …
Resident Training Curriculum In Adolescent Depression And Suicide Screening, Angela Stanley, Gayathri Chelvakumar, Paula Cody, Mandakini Sadhir, Melodee Nugent, Raymond Hoffmann, Pippa Simpson
Resident Training Curriculum In Adolescent Depression And Suicide Screening, Angela Stanley, Gayathri Chelvakumar, Paula Cody, Mandakini Sadhir, Melodee Nugent, Raymond Hoffmann, Pippa Simpson
Pediatrics Faculty Publications
Introduction: Routine screening of adolescents for depression and suicide risk is now considered best clinical practice. However, due to a lack of training, many physicians do not engage in screening. The goal of this curriculum is to improve learner knowledge of and comfort in adolescent depression and suicide risk assessment and management. Methods: The didactic session typically takes 60-90 minutes to complete. In addition to a teaching PowerPoint that provides instruction in both the assessment and management of adolescent depression and suicide risk, the curriculum also includes a suicide assessment and management protocol. This protocol outlines an algorithm that assists …
Clinical Public Health Integration In Medical School Curriculum: Transitioning Medical Student Training From Medical Problems To Health Solutions, Ashtin Jeney, Bridget C. Huysman, Jamie Majdi, Kent Aje, Madeline Taskier, David K. Popiel, Lawrence R. Deyton, Karla Bartholomew
Clinical Public Health Integration In Medical School Curriculum: Transitioning Medical Student Training From Medical Problems To Health Solutions, Ashtin Jeney, Bridget C. Huysman, Jamie Majdi, Kent Aje, Madeline Taskier, David K. Popiel, Lawrence R. Deyton, Karla Bartholomew
GW Research Days 2016 - 2020
The current chronic disease burden, growing health disparities, and evolution of our healthcare system require that medical students be equipped with basic public health education to effectively manage patients, navigate the healthcare system, and advocate for health(1,2,3,4,5,6). The Institute of Medicine and the AAMC emphasize the need for physicians to be trained in public health(1,8). The inaugural year of the revised curriculum at The George Washington University School of Medicine and Health Sciences (GW SMHS) represented a first step at the institution to integrate clinical public health into medical education. As part of this process, the Clinical Public Health (CLiPH) …
Otolaryngology For Internal Medicine: Increasing Exposure To Otolaryngology Using Computer Assisted Instruction, Arielle Thal, Philip Zapanta
Otolaryngology For Internal Medicine: Increasing Exposure To Otolaryngology Using Computer Assisted Instruction, Arielle Thal, Philip Zapanta
GW Research Days 2016 - 2020
It has been well identified in previous literature that there is a lack of otolaryngology teaching for general practitioners. There is not currently a standardized curriculum for otolaryngology in undergraduate medical education or during residency for those pursuing a general field such as Emergency Medicine, Internal Medicine, Pediatrics or Family Medicine. While the need for more exposure to otolaryngology within these fields has been well documented, as 25% of primary care complaints are otolaryngology related, little has been done to identify the best method for educational intervention. Important topics for inclusion in such a curriculum have been identified and methods …
Medical Student Competency In Wound Care Guidelines, Sophia Akhiyat, Sean Mcnish, Kara S. Couch, Victoria K. Shanmugam
Medical Student Competency In Wound Care Guidelines, Sophia Akhiyat, Sean Mcnish, Kara S. Couch, Victoria K. Shanmugam
GW Research Days 2016 - 2020
Chronic wounds that have failed to heal after 3 months of appropriate wound care affect approximately 6.5 million people in the US with a prevalence of 1% and costs estimated at $25 billion per year. Medical students currently receive limited wound care training, yet to effectively manage chronic wounds, providers must both understand the biology of healing, and also remain up-to-date with wound care guidelines published by the Agency for Healthcare Research and Quality (AHRQ). The purpose of this student-led project was to investigate medical students' knowledge and comfort with wound care guidelines.
Effect Of Two Semesters Of Small Group Problem-Based Learning (Pbl) On Expectations Of Physician Assistant Students Regarding Self, Others, And Facilitator Using The Pbl Readiness Questionnaire, Susan Hawkins, Mark Hertweck, Anthony Goreczny, John Laird
Effect Of Two Semesters Of Small Group Problem-Based Learning (Pbl) On Expectations Of Physician Assistant Students Regarding Self, Others, And Facilitator Using The Pbl Readiness Questionnaire, Susan Hawkins, Mark Hertweck, Anthony Goreczny, John Laird
Internet Journal of Allied Health Sciences and Practice
Purpose: The purpose of this study was to assess changes in expectations and perceptions among physician assistant (PA) program matriculants regarding small group problem-based learning (PBL) from the beginning to the end of the first didactic year. Some of the stress experienced by students entering health science professional programs using PBL may be due to lack of awareness of the goals and norms of PBL which differ from those of traditional lecture-based curricula. A change in student expectations as a result of participation in PBL would indicate that these goals and norms can be learned through participation. Methods: The authors …
A Debriefing Technique In High-Fidelity Patient Simulation And Competent Decision-Making Abilities Among Nursing Students, Trena Seago
Theses and Dissertations--Curriculum and Instruction
Nursing faculty are utilizing high-fidelity patient simulation (HPS) with debriefing to help engage nursing students in making competent clinical decisions. This quasi-experimental study examined the use of HPS with debriefing and students’ ability to make nursing care decisions using standardized exams. The experimental group received debriefing after HPS and the control group did not receive debriefing after HPS. The pre- and post-test assessed participants’ ability to make clinical care decisions. The analysis of the pre-test and post-test HESI scores showed that there was no significant difference between the two groups.