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The panel suggested several wording changes and provided two additional questions to add to the survey. All of the recommendations of the panel were addressed, and changes to the survey were made. Sixteen of 20 students in the fall cohort and 20 of 20 students in the spring cohort were surveyed using the revised instrument two thirds of the way through the semester in which they were assigned the tablet PCs.

Consent was obtained and the students were told that neither their participation in the study nor the evaluation of the survey would impact their course grade. There was no missing data, and 36 of 40 students in the two cohorts completed the survey. Simultaneously throughout the developmental research project, the researcher was designing materials and methods capitalizing on the use of the digital inking capabilities of tablet PCs. Nine different types of effective high-quality inking practices thought to improve instructor-learner dialogue were employed as follows:.

Controlling an active learning environment. The instructor, as moderator of the session, controlled the projecting rights of the view projector. Assessing for Instructional Decision-making. Concurrent and preformative assessments for instructional decision-making were employed using the inking features of the tablet. Various student responses to these items were projected on a whiteboard accompanied by discourse centered on verbalizing the knowledge the students brought to the learning opportunity. As the instructor viewed the work of several students, inconsistencies in the inked responses helped to identify their misunderstandings about necessary and sufficient conditions for geometric definitions.

Drawing attention for learners. Demonstrating solution strategies and thinking processes. Problems incorporated in the course required students to present and explain their solution strategies or explain their thinking processes by making them visible via digital ink. Some problems required a geometric approach, while others required some type of mathematical or physical representation to find a solution. These problems often required multiple steps to arrive at a solution. Some problems posed in the course required mathematical thinking that was not directly accessible to most students.

However, as students built upon the incomplete individual thinking processes demonstrated on the tablets, the group eventually arrived at better, more refined, thinking processes. Appendix C is an example in which the students were given a task to develop an algorithm for finding the area of any polygon on a geoboard.

To test the robust nature of their algorithm they were given nine different polygons with which their algorithm should be confirmed. The projection system supported sharing and discussing the various inked solution strategies, as well as the specific cases for which their algorithms were either successful or unsuccessful. Examples and counterexamples using the inking and projection system helped students to identify the flaws in their invented algorithms. The challenge problem required a test of the invented algorithms to find the area of a concave polygon like the one shown in Figure 1.

As students employed a chop-strategy algorithm the inkings helped them build a recursive outside-to-inside strategy, which served as a guide for students who were close to verbalizing the idea of recursion in the chop-strategy algorithm. As shown in Appendix C students were able to break the figure apart, put the relief polygons onto other geoboards and apply the chop-strategy. Concave polygon used as challenge problem in finding area algorithms. A class discussion would often start out having many branches and directions, but the process of selecting and weeding out other options and directions displayed on the digital tablets typically led to consensus as group members convinced one another to think in one way.

Capturing in-class spontaneous and dynamic expositions. Students and the instructor frequently created white space in documents to provide room for spontaneous on-task inking. Sometimes additional mathematics instruction was needed for students to arrive at a justified response or to further explore random examples until systematic examples were achieved enabling students to have a better feel for the problem. Creating collective lists of shared ideas.

Students were often given some time individually and in small groups to create a list collectively or respond to divergent high-level questions. They inked their ideas below the prompt on their tablet PCs. Items surfaced during the whole-group discussion were then added as new ideas in a different-colored ink than their original by students not previously listing these items. The potential for such a list goes beyond permitting a sense of ownership over the list, as an individual student can see his or her contributions added to those of others in the class and open for comparison.

The instructor is able to take the information gathered and determine next steps for further exploration. Marking-up and returning an electronic assignment. Students submitted drafts of lesson plans, journals, and homework assignments to instructors to obtain feedback by way of digital inking directly on the document. These inkings were saved on the document, and then the document was e-mailed back to the student.

The benefit of this type of mark-up was that the comments could not just be accepted as with the Track Changes tool option in Microsoft Word. Students had to go back to the original document, make decisions about which changes they were going to make, and then make the changes. The aforementioned environment and types of effective high-quality inking employed during the study were constantly entering cycles of revision. They were implemented, revised, and implemented again with the goal of improving the instructor-learner dialogue.

The participants in the study were surveyed about their perceptions of the use of digital ink technology for teaching and learning.

Tablet computer

Next, they responded to a 7-point Likert-type item rating the degree of their response see Figure 2 for an example question. Did you find the use of projected notes with student inking capabilities helpful? Example question from the Perceptions of Digital Ink Technology survey. A p -value of 0.

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A response above 4. All of the items were found to be significant at the 0. The effect size evaluates the degree that the mean scores on the test variable differ from the test value in standard deviation units. If the effect size equals 0, the mean of the scores is equal to the test value, but as the effect size becomes larger it is clear that the mean of the scores is different from the test value.

Traditionally, effect sizes of 0. In this study, all values for effect sizes exceeded 0. A Likert-type scale score of 7. The highest and lowest three items in ranking, by descending order of their means, were the following:. The results support the conclusions that preservice elementary teachers who are introduced to effective, high-quality use of digital ink technology for teaching and learning have positive perceptions with the following statements.

The statements are in descending order of their means. The most interesting finding was not necessarily associated with the survey item with the highest mean, but instead with the survey item for which all participants were in close agreement. The standard deviation shows agreement with an item.

Item 3 had the lowest standard deviation of all of the items, meaning that the participants held similar beliefs about the statement that the presentation was an integral part of the course. Further interpretation of these results may suggest that the participants recognized the benefits of learning with this technology and deemed it valuable. It is also valuable to make note of the survey items with lower means despite the significance and the effect size.

A classroom culture must be developed by the instructor to help students realize that incorrect answers or unproductive routes are acceptable, helpful, and often necessary in the learning process, especially in mathematics. Students failing to understand this point of conceptual pedagogy may still retain a lower appreciation of their comments being added to the display when they are incorrect.

Additional student comments might be helpful for making interpretations with regard to some of the lower frequencies recorded for the Likert-type item discussing the preference of availability of online inkable notes over printed notes see Item 5.

Statins: interactions, and updated advice for atorvastatin

Several students in the course found that they liked to print the prepared notes before class and interact with the notes in a paper-and-pencil fashion. In addition to creating a culture for accepting incorrect answers, an instructor must also help students develop dispositions of empathy and metacognitive thinking. Students might not practice empathy for the projected solutions of others or appreciate a solution strategy if the instructor does not spend time developing this disposition through investigative questions, comments, and challenges.

Students will also have difficulty recognizing the benefits of handwritten notes, or in this case, inked notes, on retention or recall of information if the instructor does not direct the students to think metacognitively about their own learning. The development of these two cultural norms in a classroom must be well thought out throughout the course if students are to grasp opportunities to learn these dispositions. The infrequent opportunities for awareness and development of these two dispositions may be the cause of the diminishment of the mean scores see Items 7 and 8.

Many of the benefits observed by the instructor were similar to the list of statements made earlier in the conclusions. Some additional benefits were noted by the instructors using the digital ink technology that were not measured by the survey instrument. Studying examples of effective instruction can help define instructional methods that may prove to be successful for other classroom teachers Schifter, Instructors and professors should learn to incorporate digital ink technology effectively.

Students feel engaged when the prepared notes encourage their direct involvement with the class discussion through inking. When instructors use the types of effective high-quality inking described in the methodology section of this paper, students feel like the inking is an integral part of the lesson rather than just a meaningless incorporation of technology in a course.

Instructors should encourage the use of inking as well as color coding and searching notes for items when studying for exams. Last, instructors should consider ways of sharing student solution strategies and creating a classroom culture that makes students more comfortable with learning from each other. Dispositions of empathy and self-knowledge must be taught as one would approach teaching content.

The next steps in this research project and opportunities for future research for other researchers, include examining the types of effective, high-quality inking; clarifying instructional methods for each type; and creating experimental design studies which test their effectiveness in the learning process. Principles and processes in the construction of meaning for geometric ideas. National Council of Teachers of Mathematics 69th yearbook pp.

National Council of Teacher of Mathematics. Learning and testing mathematics in context.

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Educational development and developmental research in mathematics education. Journal for Research in Mathematics Education, 25 5 , Using SPSS for windows: Analyzing and understanding data 2nd ed. Statins may affect coumarin anticoagulation and increase the risk of haemorrhagic events. Patients who are receiving warfarin should have INR monitoring before starting statins and regularly throughout treatment, especially with statin dose changes.

However, for pravastatin Lipostat , which is not metabolised by cytochrome P, warfarin interaction is less of a concern. The use of fibrates alone is occasionally associated with myopathy; use with statins may increase this risk.

Simvastatin and atorvastatin: interactions

Furthermore, gemfibrozil increases systemic exposure to simvastatin, atorvastatin, and rosuvastatin Crestor. Careful monitoring is therefore needed, and maximum daily dose of simvastatin is 10 mg daily when used with fibrates except fenofibrate. For rosuvastatin, start with 5 mg and do not exceed 20 mg during use with fibrates. Ezetimibe has no pharmacokinetic interaction with statins.

However, ezetimibe alone is associated with a risk of myopathy and an additive risk with statins cannot be ruled out. Caution is needed with ciclosporin, fluconazole, phenytoin, and glibenclamide—see product information for details. Rosuvastatin is not associated with cytochrome P interactions. Ciclosporin is contraindicated with rosuvastatin Crestor. HIV protease inhibitors strongly increase exposure to rosuvastatin through an unknown mechanism and are not recommended for combination use.

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Antacids reduce rosuvastatin plasma levels. Pravastatin is not associated with cytochrome P interactions. Caution is needed with ciclosporin, erythromycin, and clarithromycin.

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Cholestyramine and colestipol decrease plasma levels of pravastatin. Letter sent to healthcare professionals for atorvastatin in December Letter sent to healthcare professionals for atorvastatin in December Prescribing advice for fibrates: To help us improve GOV. It will take only 2 minutes to fill in. Skip to main content. Home Health and social care Medicines, medical devices and blood regulation and safety Vigilance, safety alerts and guidance Alerts and recalls.

Published 11 December Medicines and Healthcare products Regulatory Agency. Cardiovascular disease and lipidology. Contents Simvastatin and atorvastatin: January Statins are effective and widely used treatments for the prevention of cardiovascular events.

Starting dose If co-prescription with a drug that increases systemic exposure to statins is unavoidable, it is particularly important to start on the lowest statin dose. Maintenance doses The table below gives important dose restrictions for atorvastatin and simvastatin when used in combination with other drugs.