Terry L. Schwinghammer, PharmD, FCCP, FASHP, FAPhA, BCPS
Arthur I. Jacknowitz Distinguished Chair in Clinical Pharmacy and Chair, Department of Clinical Pharmacy, West Virginia University School of Pharmacy, Morgantown, West Virginia
https://directory.hsc.wvu.edu/Profile/31766
However medications after stroke buy 1 mg requip amex, these superficial posterior neck nodes should not be surgically addressed medicine wheel images buy cheap requip 2mg online, except by someone very familiar with head and neck surgery medicine pictures discount requip 1mg otc. The spinal accessory nerve runs over the top of these nodes and can very easily be damaged if the physician is not experienced with this kind of surgery treatment lupus trusted requip 2 mg. This most often represents a parotid neoplasia, the most common of which is the benign mixed tumor (pleomorphic adenoma). A mass in this area, however, can be something as superficial as an epidermal inclusion cyst, or something more serious, such as lymphoma. The problem with this particular area is that it is quite difficult to distinguish between something that is merely subcutaneous and something that is in the parotid gland. The ascending ramus of the mandible is deep to the parotid gland; thus, a mass may be well within the substance of the gland and still feel very superficial, because there is a solid background immediately behind it. Well-intentioned surgeons, thinking this is a sebaceous cyst, have ventured into removing one of these lumps, and have found they unexpectedly need to go deep to the parotid fascia. If you ever find yourself in this position, you should recognize this situation for what it is, and appropriately cease further dissection. In situations such as this, it is better to refer the patient to an otolaryngologist. These carcinogenic agents act in a synergistic manner-that is, each promotes the occurrence of the cancer, but the combined effect is greater than the sum of the two. It follows that if a person gets one cancer, he or she may get another one in a different part of the upper aerodigestive tract (esophagus and lungs). Mucosal tumors of the upper aerodigestive tract are almost always squamous cell cancer, and occur as a result of exposure to tobacco and alcohol. The first is that it allows the physician to evaluate the size and extent of the primary tumor (the original mucosal tumor, the source of the metastases likely to be found in the neck). Many patients present with a mass in the neck, and you will need to use endoscopy to locate the primary tumor. About 10 percent of the time, the primary head and neck tumor cannot be found- this is called "carcinoma of unknown primary. The third reason to use endoscopy is to take a small piece of tissue with biopsy forceps and obtain a tissue diagnosis. Otolaryngologists use rigid endoscopes more than other specialists do, because they make it easier to get a good biopsy specimen. Rigid endoscopy is usually performed under general anesthesia for better patient relaxation and comfort. If the tumor is in the oral cavity, base of the tongue, or oral pharynx, it is palpated as well. The procedure usually takes less than an hour, and the patient may go home the same day. Overnight observation may be necessary if the patient has advanced cancer of the larynx, and there is a risk that the swelling caused by the procedure may obstruct the already compromised airway. One proviso: In the modern evaluation and treatment planning of head and neck cancers, diagnostic imaging. In many cases diagnostic imaging is conducted because it provides important information about the depth and extent of the tumor that cannot be appreciated otherwise. Mass occurring in mid-portion of right neck in a man with a past history of tobacco usage. This most likely represents metastatic squamous cell cancer from a primary site somewhere in the upper aerodigestive tract. Early detection and appropriate treatment provide the greatest opportunity for cure in these individuals. Remember that endoscopy is used to evaluate the size of the tumor, including estimation of the third dimension (depth). In general, T1 cancers measure less than two centimeters (cm), T2 cancers are two to four cm, T3 are larger than four cm, and T4 are large, invasive tumors involving vital structures with no clear Cancer of the larynx, particularly glottic cancer, is usually smaller at presentation because of the relatively quick onset of symptoms, and a different staging system is used. Small or early tumors without metastases do well, and large or metastatic tumors do poorly. In addition, chemotherapy potentiates the effects of irradiation, and has become an important adjunct in the treatment of head and neck cancer. When head and neck cancer patients receive radiation therapy as part of their treatment, it is usually given once a day for six weeks, although some physicians use twice-a-day protocols. It is generally felt that 5600 rads centigray (cGy) is a minimum dose for a neck with microscopic disease. Radioactive implants using a cesium source (brachytherapy) may be placed to deliver a very high, localized dose to a superficial tumor. Since teeth remineralize with the minerals in saliva, they are very prone to decay during and after this therapy. If a patient has teeth in very poor condition, all the teeth are extracted before the patient begins radiation therapy. If the tumor has metastasized to the lungs or liver, the role of surgery is limited to palliation. However, the lungs are infrequently involved with metastatic disease at the time of initial diagnosis. If the metastases are confined to the lymph nodes of the neck (the most common scenario), then a neck dissection-removing lymph nodes from the neck-is performed at the time of surgery. Selective neck dissection involves removing only nodes, fat, and fascia most likely involved by metastasis. The most common histopathologic diagnosis for cancer of the upper aerodigestive tract is. People who have one cancer of the upper aerodigestive tract may have another primary malignancy in the upper aerodigestive tract. This is called synchronous primary, which is one of the reasons why is performed. Taking a biopsy and evaluation of the actual size of a tumor are two other reasons why is performed before final treatment of a head and neck cancer. Small head and neck cancers can often be treated with either or. Large head and neck cancers are often treated with, and. Squamous cell carcinoma of the head and neck usually metastasizes to the lymph nodes in the before going to other sites. A mass in the neck may be a from a cancer somewhere in the upper aerodigestive tract. A patient who is hoarse for more than two weeks may have of the larynx. A patient with a lump below or in front of the ear may have a tumor of the gland and needs to see an otolaryngologist. When there is a normal ear exam, may be caused by a cancer in the pharynx. Persistent unilateral serous otitis media may be caused by a cancer in the nasopharynx obstructing the. Parotid masses feel superficial, because the parotid gland is immediately superficial to the of the mandible. Squamous cell carcinoma Synergistic Triple endoscopy Endoscopy Surgery, radiation therapy Surgery, radiation therapy, chemotherapy Neck Jugular vein Salivary 10.
Code laterality as "9 - Unknown treatment 4 pimples cheap 0.5mg requip amex," because there is no information concerning laterality in the implied diagnosis of lung cancer and the case is metastatic medications prescribed for adhd cheap requip 0.5 mg without prescription. The chart below lists sites for which laterality codes must be recorded: Laterality must be recorded for the following paired organs as 1-5 or 9 symptoms sinus infection discount 0.25 mg requip with visa. It is typically determined by matching an address to a reference file or by identifying the residence using satellite imagery symptoms 8 dpo requip 0.25mg cheap. If you do not know your Michigan Facility Number, contact your field representative or contact Amy Marquardt or Jetty Alverson. Do not use nicknames in this field; nicknames should be used in Alias Name field only. Examples: If the patient is multiracial Code all races using Race 1 through Race 5. If the person is multiracial and one of the races is Hawaiian Code Hawaiian as Race 1, followed by the other race(s). If unknown, and if follow-back has been conducted, record as such in this field so it is clear that follow-back has been attempted. If cancer abstraction software generates text automatically from codes, the text cannot be utilized to check coded values. Information documenting the disease process should be entered manually from the medical record and should not be generated electronically from coded values. When the supporting text information is printed for review, one should be able to re-abstract the case without obtaining additional medical records and have the same codes as the original abstract. This includes experimental treatments (when the mechanism of action for a drug is unknown), and blinded clinical trials. If the mechanism of action for the experimental drug is known, code to the appropriate treatment field. An abstract submitted with codes that lack supporting text data will be rejected in its entirety. If the patient quit smoking one year or less from the initial date of diagnosis, indicate "current use. Paper form submission: Paper Form Item 18: Mark appropriate value: current use, prior use, never used or unknown. This refers to size measured on the surgical resection specimen, when surgery is administered as the first definitive treatment, i. If neoadjuvant therapy is followed by surgery, do not record the size from the pathologic specimen. Code the largest size of tumor prior to neoadjuvant treatment; if unknown code size as 999. As is consistent with Administrative Rules; the cooperation of facility personnel in these four areas is essential. As cancer reports are received and processed, each will be reviewed for completeness, legibility and consistency. Contact with the reporting entity will occur to resolve identified problems in these areas as reports are initially processed and later as final processing occurs. Prompt attention to such issues by the personnel responsible for completing these reports is important for smooth processing. In assessing the quality of the cancer reports received from across the state, the office will contact hospitals, laboratories or registries for access to or copies of pertinent records. This is necessary in order to evaluate the quality and completeness of the information received from individual reporting entities. Problems that are identified during such reviews will be addressed as necessary to maintain or improve data quality and usefulness. When a research study is approved by the Director of the Michigan Department of Health and Human Services, study subjects will be drawn from the state registry. Hospitals, laboratories and registries will be contacted concerning each case reported by them to ascertain the physician treating the patient. Through this process, physicians can then be contacted and patient consent obtained. The Michigan Cancer Surveillance Program is required to conduct death clearance at least once a year. Through the death follow back study we add cases yearly which helps to create a more complete state cancer registry. If followback information is obtained, the case may be added as a missed incidence report. If an Unlinked Death Survey is forwarded to a facility, the cancer-related death information could not be obtained from follow-back with the certifying physician, which may include follow-back of a health care provider more closely connected with the diagnosis and /or treatment of the patient. If a cancer case report for the cancer case death cause was abstracted by the facility, attach a copy of the abstract to the Unlinked Death Survey and return in self-addressed envelope. Note: If the cancer-related death (cancer diagnosis) was identified as a missed report for the facility, in addition to completing the Unlinked Death Survey, please abstract the case and submit with next file submission. The administrative rules on cancer reporting provide the definition of a reportable cancer. The fifth digit, after the slash or solidus (/), is the behavior code and the sixth digit is the tumor grade. The first time a diagnosis of cancer is made with an "unknown primary" it should be reported as such. When reporting an unknown primary site, a behavior code "3 - malignant" must be used. For benign/borderline intracranial and central nervous system tumors, the terms "tumor" and "neoplasm" are considered clinically diagnostic for the purpose of case reporting, in addition to the terms generally applicable to malignant tumors. Histology for any of these cervical neoplasia conditions is coded as 8077 with or without the term "carcinoma in situ. Refer to the Multiple Primary & Histology Coding Rules Manual to determine single vs. If a patient has more than one lesion with these squamous histologies within a 12month period, only the lesion with earliest diagnosis date (or one lesion, if the lesions have the same diagnosis date) is eligible for inclusion. Histology codes 8140 (adenocarcinoma in situ) and 8560 (adenosquamous carcinoma) with behavior code 2 are considered to be the same for determining inclusion eligibility when reviewing multiple reports for the same patient. A subsequent lesion is eligible for inclusion only if its histology is different from the first eligible lesion. If a patient is diagnosed with another pre-invasive lesion with the same histology after the 12-month period following the first eligible lesion, the subsequent lesion is eligible for inclusion. If a patient has an invasive tumor diagnosed more than 60 days after the in situ tumor was diagnosed, then the invasive tumor is reported as a second primary tumor. If a patient is diagnosed with a pre-invasive (in situ) lesion within a 12-month period after having been diagnosed with an invasive lesion, the pre-invasive lesion is not considered to be eligible for inclusion. Below is a summary of the inclusion criteria for determination of an eligible case (also see Exhibit 1 & Exhibit 2). Record the histologically confirmed diagnosis in its entirety, exactly as it appears in the final diagnosis of the pathology report in the Path-Text Field. For any case that comes in with a histology code other than those listed, the pathology report should be carefully reviewed to make sure that it is not an invasive lesion (path report should specifically indicate "in situ" behavior) and that the histology has been coded accurately. Review the histologically confirmed diagnosis in its entirety to determine if any reportable conditions exist based on all reported terminology and staining results included in the pathology report. If necessary, check with lab to locate immunostaining information in patient record. Make sure the full diagnosis is reported, including all terminology and all staining information, type of test. Record the histologically confirmed diagnosis in its entirety, exactly as it appears in the final diagnosis of the pathology report. For these pre-invasive cervical cases, please enter all staining information in the Path Text Field rather than the Lab Field due to how these cases are reviewed and processed at the central registry. If a patient has more than one lesion with either of these histologies within a 12-month period, only the lesion with earliest diagnosis date (or one lesion, if the lesions have the same diagnosis date) is eligible for inclusion.
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This is an injury which treatment urinary tract infection generic 0.25mg requip free shipping, though reversible treatment 2 prostate cancer cheap requip 0.5mg amex, can be severe and can cause severe disruption of cell function medicine joint pain effective 2mg requip. Distinct non-staining vacuoles of fat lie in the cell cytoplasm medications used to treat anxiety 0.5 mg requip otc, displacing and compressing the nucleus. There are several mechanisms that can result in excess fat accumulation in a cell. These include: 1) dietary excesses of carbohydrates and/or triglycerides; 2) decreased oxidation of fatty acids leading to increased esterification of fatty acids to triglycerides; 3) decreased lipid acceptor protein (hypoxia, deficient dietary protein); 4) decreased transport from the cell; 5) dietary protein - fat imbalance. The fat content of the liver is quite variable in normal fish; diet and physiologic events have a bearing on this, as well as the species of the fish; some are always laden with fat (eg. With experience, you will develop an appreciation for the range of normal in various species. Hyaline change "Hyaline" is a commonly used adjective that does not imply any particular disease. It simply refers to a particular histologic appearance of cells or tissues when stained with H & E stain. It can be found under normal or pathologic conditions, and may or may not be reversible. It can represent an accumulation of material within the cell, or occur as a result of cell degeneration. Necrosis (Figures 13 through 20) Cell injury can progress to a point of no return, where the cell is unable to adapt and homeostasis is no longer possible. Major disruption of the cell membrane occurs during necrosis, accompanied by massive influx of calcium into the cell. The cytoplasmic features of necrosis include intense eosinophilia, loss of basophilia, and fragmentation or hyalinization of the cytoplasmic component. In addition to these cytological features, necrosis will induce localized inflammation (assuming death does not occur to quickly). Coagulative necrosis is characterized by retention of cellular/tissue architecture; cellular detail is retained in the face of cell necrosis. This is associated with diverse causes, including many infectious diseases, ischemia, burns, trauma, and toxic damage. Caseous necrosis is more easily recognized grossly; they have a dry, cheese-like consistency. Liquefactive necrosis features complete disintegration of the tissue into a liquid of varying consistencies. The liquefaction is caused by enzymes released from host cells, such as neutrophils or other inflammatory cells, or by toxins released from bacteria. Tissues with high fat content, such as the central nervous system, also may liquefy when necrotic. The tissue however may be able to regenerate and heal (see section on Healing and Repair). Programmed cell death and apoptosis Programmed cell death and apoptosis are similar processes, but have different triggers. It is a mechanism for elimination of selected cells during physiological processes of development and growth. The mechanism of cell death is complex, and results in cells with condensed chromatin and cytoplasm that fragment into membrane-bound particles, those fragments being engulfed by phagocytic cells. Apoptosis involves similar mechanisms and morphology, but its onset is triggered by injury, such as viral infection or exposure to a toxin; i. As cell fragments are bound by membranes, inflammation typically seen with necrosis is not present. Hyperemia is usually accompanied by evidence of inflammation, and is associated with vascular dilation due to localized release of inflammatory mediators. Passive congestion is associated with reduction in venous outflow due to non-inflammatory events such as cardiac failure, or constriction or obstruction of vascular outflow due to tissue torsions, tumors, or other compressive events. It is often difficult to distinguish hyperemia from congestion histologically; the distinction is usually more obvious at the gross level. Hemorrage (Figures 25 through 28) Hemorrhage is the escape of blood from the vascular system. It is caused by injury to vascular endothelium; this can be due to infection, inflammation, necrosis, neoplasia, or trauma. Thrombosis (Figure 29) Thrombosis is the result of activation of the coagulation cascade within the vasculature or heart of a living animal. Ischemia (deprivation of oxygenated blood), results in necrosis of the dependent tissue. These in turn can lodge in small vessels, obstruct blood flow, and cause ischemic necrosis. The affected area, or infarct, is usually well demarcated from adjacent viable tissue. Edema (Figure 30) the accumulation of excessive amounts of extracellular fluid in the interstitial spaces or body cavities is edema. Causes include changes in hydrostatic or osmotic pressure (cardiac failure, vascular obstructions, hypoproteinemia) and increases in vascular permeability that accompanies inflammation. The purpose of the inflammatory response is to dilute, isolate, and destroy the injurious agent, and to facilitate healing. The body only has a limited number of ways to respond to an injury, hence the pathogenesis of an inflammatory lesion and the histological appearance of that lesion can be similar whether the injury was caused by a bacterial cell, a foreign body, ionizing radiation, a toxin, or trauma. Inflammation can be divided into acute and chronic forms which differ histologically as well as in duration. Acute inflammatory episodes, characterized by vascular events and exudation, usually progress over a period of 3 to 10 days, then resolve as the injurious agent is eliminated. Chronic inflammation, characterized by cellular proliferation, can extend from weeks to months to the lifetime of the host, continuing as long as the injurious agent persists. Defects in the inflammatory response can lead to chronic illness as well as death. In addition to its protective function, inflammation also sets the stage for healing and repair. Acute inflammation (Figures 31 through 40) Acute inflammation is a complex interplay of a functioning vascular system, circulating and tissue-based inflammatory cells, and chemical mediators. It is characterized by exudation, the release of fluid and cells from the vasculature into the injured tissue. Following an injury, chemical signals from host cells result in rapid vasodilation and increased vascular permeability in capillaries and post-capillary venules. Immediately, protein rich fluid leaks from the vessels, bathing the site of injury in inflammatory. This fluid contains antibodies, complement, fibrin, and other host defense chemicals. The composition of this inflammatory edema fluid varies with the nature, severity, and duration of the injury, with some being simply watery with smaller proteins to others harboring larger proteins such as fibrin. If there is a fibrin component ("fibrinous exudates"), you will find web-like strands or sheets of polymerized fibrin adherent to the tissues. Histologcially, these exudates consist of eosinophilic staining in the intercellular space; fibrin will have the appearance of eosinophilic strands. More severe injuries, particularly bacterial infections, will elicit a cellular component to the exudate. As the vessels dilate and become leaky, neutrophils will move from the bloodstream, marginate to the vessel wall, stick to the endothelium, and migrate between endothelial cells into the extravascular space and proceed to undergo directed migration (chemotaxis) towards the site of injury. These inflammatory cells will then phagocytize and destroy injurious agents such as bacteria. Neutrophilic exudates are liquids of varying consistencies containing varying numbers of neutrophils, and tend to be yellow to tan; pus formation and the classic abscess are typical of a neutrophilic exudate. While most animals readily form neutrophilic (also know as suppurative or purulent) exudates or form abscesses in response to bacterial infections, fish are far less responsive; neutrophilic inflammation will be found, but true pus formation is not seen. Hint: look for hypercellularity in a low power field as a clue to the presence of inflammation. It is not unusual to find a few lymphocytes or macrophages in the area; these will increase in number if the injury is not resolved and the process moves toward chronic inflammation. As the acute inflammatory response resolves, the exudates and any necrotic tissue is removed by macrophages, and the stage is set for healing and repair.
Hypoesthesia covers the case of diminished sensitivity to stimulation that is normally painful medications prescribed for anxiety buy requip 0.25 mg on line. The implications of some of the above definitions may be summarized for convenience as follows: Allodynia: ` Hyperalgesia: Hyperpathia: Hypoalgesia: owered threshold: increased response: raised threshold: increased response: raised threshold: lowered response: stimulus and response mode differ stimulus and response mode are the same stimulus and response mode may be the same or different stimulus and response mode are the same the above essentials of the definitions do not have to be symmetrical and are not symmetrical at present 714x treatment for cancer generic requip 1mg visa. Also symptoms bipolar generic requip 1 mg on line, there is no category for lowered threshold and lowered response-if it ever occurs medications for bipolar generic requip 2 mg amex. Note: Common usage, especially in Europe, often implies a paroxysmal quality, but neuralgia should not be reserved for paroxysmal pains. Neurogenic Pain Neuropathic Pain Pain initiated or caused by a primary lesion, dysfunction, or transitory perturbation in the peripheral or central nervous system. Pain initiated or caused by a primary lesion or dysfunction in the nervous system. Peripheral neuropathic pain occurs when the lesion or dysfunction affects the peripheral nervous system. Central pain may be retained as the term when the lesion or dysfunction affects the central nervous system. Neuropathy A disturbance of function or pathological change in a nerve: in one nerve, mononeuropathy; in several nerves, mononeuropathy multiplex; if diffuse and bilateral, polyneuropathy. Neuropathy is not intended to cover cases like neurapraxia, neurotmesis, section of a nerve, or transitory impact like a blow, stretching, or an epileptic discharge. Nociceptor A receptor preferentially sensitive to a noxious stimulus or to a stimulus which would become noxious if prolonged. Note: Although the definition of a noxious stimulus has been retained, the term is not used in this list to define other terms. Note: Traditionally the threshold has often been defined, as we defined it formerly, as the least stimulus intensity at which a subject perceives pain. Properly defined, the threshold is really the experience of the patient, whereas the intensity measured is an external event. It has been common usage for most pain research workers to define the threshold in terms of the stimulus, and that should be avoided. In psychophysics, thresholds are defined as the level at which 50% of stimuli are recognized. In that case, the pain threshold would be the level at which 50% of stimuli would be recognized as painful. Pain tolerance level the greatest level of pain which a subject is prepared to tolerate. Note: As with pain threshold, the pain tolerance level is the subjective experience of the individual. The stimuli which are normally measured in relation to its production are the pain tolerance level stimuli and not the level itself. Thus, the same argument applies to pain tolerance level as to pain threshold, and it is not defined in terms of the external stimulation as such. After much discussion, it has been agreed to recommend that paresthesia be used to describe an abnormal sensation that is not unpleasant while dysesthesia be used preferentially for an abnormal sensation that is considered to be unpleasant. The use of one term (paresthesia) to indicate spontaneous sensations and the other to refer to evoked sensations is not favored. There is a sense in which, since paresthesia refers to abnormal sensations in general, it might include dysesthesia, but the reverse is not true. Dysesthesia does not include all abnormal sensations, but only those which are unpleasant. Peripheral neurogenic pain Peripheral neuropathic pain Pain initiated or caused by a primary lesion or dysfunction or transitory perturbation in the peripheral nervous system. Pain initiated or caused by a primary lesion or dysfunction in the peripheral nervous system. A quorum was present (see attached attendance sheet), along with other Academic Senate members and guests. Chair Constable welcomed everyone to the first Representative Assembly meeting of the 2020-2021 academic year. Chair Constable reviewed the Academic Senate Bylaws governing membership, privileges of the floor, and voting. Chair Constable explained that the Academic Senate is the primary vehicle through which faculty participate in shared governance. Chair Constable introduced Professor Tara Javidi as the San Diego Divisional Academic Senate Vice Chair. Chair Constable presented past Chair Corr with a plaque and thanked her for the skillful manner in which she performed her duties as Senate Chair during the 2019-2020 academic year. Professor Kuiyi Shen from the Department of Visual Arts and Professor Daniel Widener from the Department of History were nominated by the Committee on Committees. At the close of his announcements, Chair Constable invited Chancellor Pradeep Khosla to address the Assembly. The adaptive model includes risk mitigation, viral detection and 1 Representative Assembly Minutes October 13, 2020 intervention. The Chancellor emphasized that that face coverings and social distancing are mandatory. The Chancellor shared that the new test result dashboard went live on October 2, 2020. The Chancellor reported that test results are available approximately 15 hours after being tested. The Chancellor explained that there may be a need to expand housing availability for the Winter quarter as there are approximately 3,000 students on the wait list for housing. The campus can expand housing for up to 7,500 additional students and still maintain all single units. An expansion of housing for up to 9,500 additional students would allow the campus to offer both double and single units. A member asked whether or not the campus will increase access to daycare facilities on campus for faculty and staff. The Chancellor stated that it would be difficult to find space on campus to expand and operate more daycare facilities to the full extent necessary and remain in compliance with San Diego County health regulations. The Chancellor acknowledged having received a letter requesting such a meeting and thanked the member for submitting the request. The Chancellor reiterated his suggestion that the petitioners meet with first with administrative staff who have a greater expertise about decarbonization issues to discuss the matter, and then meet with the Chancellor subsequently, so that the Chancellor could make better informed decisions. Flammer shared that there have been many successes with respect to remote instruction since the spring. She explained that in some divisions, 50% of the faculty are new to the remote instruction modality and are still learning how to combine synchronous and asynchronous delivery, how to foster engagement, how to create equitable assessments and how to create a culture of academic integrity through the use of pedagogical technologies. Neiswender provided an overview of how to distribute content, assess learning and create community in the remote learning environment. She encouraged faculty to think of a remote class as a budget of time during which students acquire information, provide feedback to demonstrate what they learned and spend time connecting with others. Neiswender explained the difference between synchronous and asynchronous teaching and provided an overview of how to effectively utilize both modalities and how to combine both methods. Asynchronous teaching refers to when faculty and students occupy the same virtual space at different times. Synchronous teaching refers to when faculty and students occupy the same virtual space at the same time. One strategy for teaching in an asynchronous environment is to use short ten-minute focused videos where students respond to a quiz or answer questions based on the video. A strategy for synchronous instruction can involve the use of a tool or demonstration that allows students to accomplish a task. Neiswender explained that anything done in a synchronous environment can be retooled for an asynchronous learning experience. A combination of asynchronous and synchronous instruction gives students space to dig deep into course content and connect with their instructors. Neiswender explained that the assessment is a conversation between the instructor and the student wherein the instructor poses questions to the students and the students explain what they have learned. Neiswender shared ways to create community in a remote learning environment through multi-media and group projects. A member asked whether or not strategies can be recommended for teaching courses with several hundred students.
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