bluuebunny/crossref_metadata_2025 huggingface dataset:
Physician engagement in hospitals: a scoping review protocol
Authors: Perreira Tyrone , Perrier Laure , Prokopy Melissa , Jonker Anthony
Published: January 2018

Introduction

Literature on healthcare reforms highlights the importance of physician engagement, suggesting that it is a critical factor for lowering costs while improving efficiency, quality of care, patient safety, physician satisfaction and retention. As a result, many hospitals have adopted physician engagement as a top strategic priority, but little is known about the actual evidence, making it difficult for hospital leadership to identify relationships between true physician ‘work engagement’ and work outcomes. The aim of this scoping review is to identify factors associated with, and tools used to measure, physician engagement.

Methods and analysis

This scoping review will be conducted as per Arksey and O’Malley (2005). The electronic databases that will be searched from inception onwards include MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials. Grey literature will be searched via websites of relevant agencies such as Agency for Healthcare Research and Quality. Conferences and abstracts will be viewed and full paper requests made as required. Supplementary articles may be obtained by contacting field experts and searching references of relevant articles. All quantitative and qualitative study designs will be eligible that describe factors associated with, and tools used to measure, hospital physician engagement. After a small calibration exercise, screening and abstraction will be completed separately by two individuals, with discrepancies resolved by a third. Quantitative (frequencies) and qualitative analyses (generation of descriptives) will be conducted. Thematic analysis will be used to evaluate and categorise study findings.

Implications and dissemination

This project is part of the Ontario Hospital Association’s (OHA) initiative to improve its understanding of physician engagement. The review findings will be shared with all Ontario hospitals. Dissemination will occur through peer-reviewed publications and to the OHA membership through the OHA Learning and Engagement team.
Intrapartum and neonatal mortality among low-risk women in midwife-led versus obstetrician-led care in the Amsterdam region of the Netherlands: a propensity score matched study
Authors: Wiegerinck Melanie M J , van der Goes Birgit Y , Ravelli Anita C J , van der Post Joris A M , Buist Fayette C D , Tamminga Pieter , Mol Ben W
Published: January 2018

Objective

To compare intrapartum and neonatal mortality in low-risk term women starting labour in midwife-led versus obstetrician-led care.

Study design

We performed a propensity score matched study using data from our national perinatal register, completed with data from medical files. We studied women without major risk factors with singleton pregnancies who gave birth at term between 2005 and 2008 in the Amsterdam region of the Netherlands. Major risk factors comprised non-vertex position of the fetus, previous Caesarean birth, hypertension, (gestational) diabetes mellitus, post-term pregnancy (≥42 weeks), prolonged rupture of membranes (>24 hours), vaginal bleeding in the second half of pregnancy or induced labour. Groups were devided by midwife-led versus obstetrician-led care at the onset of labour. The primary outcome was intrapartum and neonatal (<28 days) mortality. Secondary outcomes included obstetric interventions, 5 min Apgar scores<7 and neonatal intensive care admittance for >24 hours.

Results

We studied 57 396 women. Perinatal mortality occurred in 30 of 46 764 (0.64‰) women in midwife-led care and in 2 of 10 632 (0.19‰) women in obstetrician-led care (OR 3.4, 95% CI 0.82 to 14.3). A propensity score matched analysis in a 1:1 ratio with 10 632 women per group revealed an OR for perinatal mortality of 4.0 (95% CI 0.85 to 18.9).

Conclusion

Among low-risk women, midwife-led care at the onset of labour was associated with a statistically non-significant higher mortality rate.
Nurse compliance with a protocol for safe injectable medication administration: comparison of two multicentre observational studies
Authors: Schutijser Bernadette , Klopotowska Joanna Ewa , Jongerden Irene , Spreeuwenberg Peter , Wagner Cordula , de Bruijne Martine
Published: January 2018

Objectives

Medication administration errors with injectable medication have a high risk of causing patient harm. To reduce this risk, all Dutch hospitals implemented a protocol for safe injectable medication administration. Nurse compliance with this protocol was evaluated as low as 19% in 2012. The aim of this second evaluation study was to determine whether nurse compliance had changed over a 4-year period, what factors were associated over time with protocol compliance and which strategies have been implemented by hospitals to increase protocol compliance.

Methods

In this prospective observational study, conducted between November 2015 and September 2016, nurses from 16 Dutch hospitals were directly observed during intravenous medication administration. Protocol compliance was complete if nine protocol proceedings were conducted correctly. Protocol compliance was compared with results from the first evaluation. Multilevel logistic regression analyses were used to assess the associations over time between explanatory variables and complete protocol compliance. Implemented strategies were classified according to the five components of the Systems Engineering Initiative for Patient Safety (SEIPS) model.

Results

A total of 372 intravenous medication administrations were observed. In comparison with 2012, more proceedings per administration were conducted (mean 7.6, 95% CI 7.5 to 7.7 vs mean 7.3, 95% CI 7.3 to 7.4). No significant change was seen in complete protocol compliance (22% in 2016); compliance with the proceedings ‘hand hygiene’ and ‘check by a second nurse’ remained low. In contrast to 2012, the majority of the variance was caused by differences between wards rather than between hospitals. Most implemented improvement strategies targeted the organisation component of the SEIPS model.

Conclusions

Compliance with ‘hand hygiene’ and ‘check by a second nurse’ needs to be further improved in order to increase complete protocol compliance. To do so, interventions focused on nurses and individually tailored to each ward are needed.
Implementation of diagnostic pauses in the ambulatory setting
Authors: Huang Grace C , Kriegel Gila , Wheaton Carolyn , Sternberg Scot , Sands Kenneth , Richards Jeremy , Johnston Katherine , Aronson Mark
Published: January 2018

Background

Diagnostic errors result in preventable morbidity and mortality. The outpatient setting may be at increased risk, where time constraints, the indolent nature of outpatient complaints and single decision-maker practice models predominate.

Methods

We developed a self-administered diagnostic pause to address diagnostic error. Clinicians (physicians and nurse practitioners) in an academic primary care setting received the tool if they were seeing urgent care patients who had previously been seen in the past two weeks in urgent care. We used pre–post-intervention surveys, focus groups and chart audits 6 months after the urgent care visit to assess the impact of the intervention on participant perceptions and actions.

Results

We piloted diagnostic pauses in two phases (3 months and 6 months, respectively); 9 physicians participated in the first phase, and 16 physicians and 2 nurse practitioners in the second phase. Subjects received 135 alerts for diagnostic pauses and responded to 82 (61% response). Thirteen per cent of alerts resulted in clinicians reporting new actions as a result of the diagnostic pauses. Thirteen per cent of cases at a 6-month chart audit resulted in diagnostic discrepancies, defined as differences in diagnosis from the initial working diagnosis. Focus groups reported that the diagnostic pauses were brief and fairly well integrated into the overall workflow for evaluation but would have benefited as a real-time application for patients at higher risk for diagnostic error.

Conclusion

This pilot represents the first known examination of diagnostic pauses in the outpatient setting, and this work potentially paves the way for more broad-based systems and/or electronic interventions to address diagnostic error.
Euthanasia and palliative sedation in Belgium
Authors: Cohen-Almagor Raphael , Ely E Wesley
Published: January 2018

The aim of this article is to use data from Belgium to analyse distinctions between palliative sedation and euthanasia. There is a need to reduce confusion and improve communication related to patient management at the end of life specifically regarding the rapidly expanding area of patient care that incorporates a spectrum of nuanced yet overlapping terms such as palliative care, sedation, palliative sedation, continued sedation, continued sedation until death, terminal sedation, voluntary euthanasia and involuntary euthanasia. Some physicians and nurses mistakenly think that relieving suffering at the end of life by heavily sedating patients is a form of euthanasia, when indeed it is merely responding to the ordinary and proportionate needs of the patient. Concerns are raised about abuse in the form of deliberate involuntary euthanasia, obfuscation and disregard for the processes sustaining the management of refractory suffering at the end of life. Some suggestions designed to improve patient management and prevent potential abuse are offered.
Gastritis staging in the endoscopic follow-up for the secondary prevention of gastric cancer: a 5-year prospective study of 1755 patients
Authors: Rugge Massimo , Meggio Alberto , Pravadelli Cecilia , Barbareschi Mattia , Fassan Matteo , Gentilini Maria , Zorzi Manuel , Pretis Giovanni De , Graham David Y , Genta Robert M
Published: January 2018

Objective

Operative link on gastritis assessment (OLGA) staging for gastritis ranks the risk for gastric cancer (GC) in progressive stages (0–IV). This prospective study aimed at quantifying the cancer risk associated with each gastritis stage.

Design

A cohort of 1755 consecutive patients with dyspepsia underwent initial (T-0) oesophagogastroduodenoscopy with mapped gastric biopsies, OLGA staging and assessment ofHelicobacter pyloriinfection. Patients were followed for 55 months (median); patients with stages II III and IV underwent a second endoscopy/restaging (T-1), and those with stages 0 and I were followed clinically and through in-depth clinical and record checking. Endpoints were OLGA stage at T-1 and development of gastric epithelial neoplasia.

Results

At T-0, 77.6% of patients had stage 0, 14.4% stage I, 5.1% stage II, 2.1% stage III and 0.85% stage IV.H. pyloriinfection was detected in 603 patients at T-0 and successfully eradicated in 602 of them; 220 had a documented history ofH. pylorieradication; and 932 wereH. pylorinaïve-negative. Incident neoplastic lesions (prevalence=0.4%; low-grade intraepithelial neoplasia (IEN)=4; high-grade IEN=1; GC=2) developed exclusively in patients with stages III–IV. The risk for epithelial neoplasia was null in patients at stages 0, I and II (95% CI 0 to 0.4), 36.5 per 1000 person-years in patients at stage III (95% CI 13.7 to 97.4) and 63.1 per 1000 person-years in patients at stage IV (95% CI 20.3 to 195.6).

Conclusions

This prospective study confirms that OLGA staging reliably predicts the risk for development of gastric epithelial neoplasia. Although no neoplastic lesions arose inH. pylori-naïve patients, theH. pylorieradication in subjects with advanced stages (III–IV) did not abolish the risk for neoplastic progression.
PHysical activity Implementation Study In Community-dwelling AduLts (PHISICAL): study protocol
Authors: Carpenter Hannah , Audsley Sarah , Coupland Carol , Gladman John , Kendrick Denise , Lafond Natasher , Logan Philippa , Skelton Dawn A , Timblin Clare , Timmons Stephen , Ward Derek , Orton Elizabeth
Published: January 2018

Background

Falls in older people are a leading causes of unintentional injury. Due to an ageing population, injuries are likely to increase unless more is done to reduce older people’s falls risk. In clinical trials, the Falls Management Exercise (FaME) programme has reduced the rate of falls and falls-related injuries in community-dwelling older adults. However, the commissioning of FaME is inconsistent across England, potentially due to a lack of evidence that FaME can be delivered effectively in a ‘real world’ setting. The PHysical activity Implementation Study In Community-dwelling AduLts (PHISICAL) study is designed to study the implementation of FaME in a range of different settings in England.

Methods

The PHISICAL study will use a mixed-methods, triangulation, multilevel design to explore the implementation of FaME. Framework analysis of semistructured interviews with up to 90 stakeholders (exercise programme users, service providers, referrers and commissioners) and observational data from locally led communities of practice will identify the factors that influence FaME’s implementation. Quantitative, anonymised, routine service data from up to 650 exercise programme users, including measures of falls and physical activity, will allow assessment of whether the benefits of FaME reported in clinical trials translate to the ‘real world’ setting.

Conclusion

The findings from this study will be used to develop a toolkit of resources and guidance to inform the commissioning and delivery of future FaME programmes. This study has the potential to inform public health prevention strategies, and in doing so may reduce the number of falls in the older population while delivering cost savings to health and social care services.
Blind alleys and dead ends: researching innovation in late 20th century surgery
Authors: Palfreyman Harriet , Kneebone Roger L
Published: January 2018

This article examines the fortunes of one particular surgical innovation in the treatment of gallstones in the late 20th century; the percutaneous cholecystolithotomy (PCCL). This was an experimental procedure which was trialled and developed in the early days of minimally invasive surgery and one which fairly rapidly fell out of favour. Using diverse research methods from textual analysis to oral history to re-enactment, the authors explore the rise and fall of the PCCL demonstrating that such apparent failures are as crucial a part of innovation histories as the triumphs and have much light to shed on the development of surgery more generally.
Before narrative: episodic reading and representations of chronic pain
Authors: Wasson Sara
Published: January 2018

This article suggests that some illness experience may require a reading practice less concerned with narrative coherence or self-authorship, and more interested in the value of textual fragments, episodes and moments considered outside a narrative framework. Chronic pain can pose multiple challenges to the narrative orientations celebrated in both ‘survivorship’ discourse and classic medical humanities scholarship. In its recalcitrance to cure, its often mysterious aetiology and its complex blend of somatic, interpersonal and affective elements, representations of chronic pain can require a richer vocabulary of temporality. I draw on contemporary affect theory to augment the available critical vocabulary for the textual representation of protagonists’ temporal orientation within illness experience, identifying a language for the emergent present that resists a narrative form. Beyond identifying narrative ‘incoherence’, affect discourse gives a way to recognise the strained, equivocallabourof incoherence, of inhabiting a cryptic present moment. Affect theory’s attention to the emergent present may give a way to read incoherent ‘chaos’ outside from a narrative framework, not only as a dark, formless stage in a personal story. To expand our vocabulary for this position, I offer a term for a particular affective experience of the present amid repeated marginalisation: the temporality of thwarted connection. I illustrate how these concepts can enable an alternative reading stance by offering a brief analysis of Lous Heshusius’s hybrid autobiography and academic study,Chronic Pain from the Inside Out.
Efficacy and safety of intravenous recombinant tissue plasminogen activator in mild ischaemic stroke: a meta-analysis
Authors: You Shoujiang , Saxena Anubhav , Wang Xia , Tan WeeYong , Han Qiao , Cao Yongjun , Liu Chun-Feng
Published: January 2018

The benefits and safety of intravenous recombinant tissue plasminogen activator (IV-tPA) for patients with mild ischaemic stroke (MIS) are still unclear. The objective of this meta-analysis was to evaluate the efficacy and safety of IV-tPA as treatment for patients with MIS. We performed a systematic literature search across MEDLINE, Embase, Central, Global Health and Cumulative Index to Nursing and Allied Health Literature (CINAHL) , from inception to 10 November 2016, to identify all related studies. Where possible, data were pooled for meta-analysis with odds ratio (OR) and corresponding 95% confidence interval (CI) using the fixed-effects model. MIS was defined as having National Institutes of Health Stroke Scale score of ≤6. We included seven studies with a total of 1591 patients based on the prespecified inclusion and exclusion criteria. The meta-analysis indicated a high odds of excellent functional outcome based on the modified Rankin Scale or Oxfordshire Handicap Score 0–1 (OR=1.43; 95% CI 1.14 to 1.79; P=0.002, I2=35%) in patients treated with IV-tPA compared with those not treated with IV-tPA (74.8% vs 67.6%). There was a high risk of symptomatic intracranial haemorrhage (sICH) with IV-tPA treatment (OR=10.13; 95% CI 1.93 to 53.02; P=0.006, I2=0%) (1.9% vs 0.0%) but not mortality (OR=0.78; 95% CI 0.43 to 1.43; P=0.43, I2=0%) (2.4% vs 2.9%). Treatment with IV-tPA was associated with better functional outcome but not mortality among patients with MIS, although there was an increased risk of sICH. Randomised trials are warranted to confirm these findings.
Leisure-time vigorous physical activity is associated with better lung function: the prospective ECRHS study
Authors: Fuertes Elaine , Carsin Anne-Elie , Antó Josep M , Bono Roberto , Corsico Angelo Guido , Demoly Pascal , Gislason Thorarinn , Gullón José-Antonio , Janson Christer , Jarvis Deborah , Heinrich Joachim , Holm Mathias , Leynaert Bénédicte , Marcon Alessandro , Martinez-Moratalla Jesús , Nowak Dennis , Pascual Erquicia Silvia , Probst-Hensch Nicole M , Raherison Chantal , Raza Wasif , Gómez Real Francisco , Russell Melissa , Sánchez-Ramos José Luis , Weyler Joost , Garcia Aymerich Judith
Published: January 2018

Objective

We assessed associations between physical activity and lung function, and its decline, in the prospective population-based European Community Respiratory Health Survey cohort.

Methods

FEV1 and FVC were measured in 3912 participants at 27–57 years and 39–67 years (mean time between examinations=11.1 years). Physical activity frequency and duration were assessed using questionnaires and used to identify active individuals (physical activity ≥2 times and ≥1 hour per week) at each examination. Adjusted mixed linear regression models assessed associations of regular physical activity with FEV1 and FVC.

Results

Physical activity frequency and duration increased over the study period. In adjusted models, active individuals at the first examination had higher FEV1 (43.6 mL (95% CI 12.0 to 75.1)) and FVC (53.9 mL (95% CI 17.8 to 89.9)) at both examinations than their non-active counterparts. These associations appeared restricted to current smokers. In the whole population, FEV1 and FVC were higher among those who changed from inactive to active during the follow-up (38.0 mL (95% CI 15.8 to 60.3) and 54.2 mL (95% CI 25.1 to 83.3), respectively) and who were consistently active, compared with those consistently non-active. No associations were found for lung function decline.

Conclusion

Leisure-time vigorous physical activity was associated with higher FEV1 and FVC over a 10-year period among current smokers, but not with FEV1 and FVC decline.
Encapsulating peritoneal sclerosis in a young cat
Authors: Sonck Laurien , Chiers Koen , Ducatelle Richard , Van Brantegem Leen
Published: January 2018

A 10‐month‐old female Maine Coon was presented with repeated vomiting, abdominal distension and lethargy. Clinical examination, ultrasound and radiography revealed a copious amount of serohemorrhagic ascites accompanied with dorsal displacement of clustered small intestinal loops and a liver with rounded edges. On exploratory coeliotomy, the abdominal organs were small and poorly discernible. They were covered by a severely thickened peritoneum which caused an abnormal organ shape due to a scar‐like contraction of the organ’s capsule. Given the severe clinical signs, the chronic and severe appearance on exploratory coeliotomy, as well as the inability to remove the layer, the animal was euthanased. Gross and histological examinations demonstrated a diffuse fibrotic serosa with involvement of all abdominal organs. The condition was diagnosed as encapsulating peritoneal sclerosis grade 3. This is a rare, chronic inflammatory disease transforming the peritoneum into a thick, sclerotic layer. The disease usually presents as a partial intestinal obstruction.
Omental torsion in a dog
Authors: Garcia‐Pertierra Sofia , Catala Puyol Carmen , Vizcaino Reves Nuria , Closa Josep M
Published: January 2018

A five‐year‐old female intact German shepherd presented with an acute onset of abdominal pain. Abdominal ultrasound revealed a 5‐cm encapsulated, heterogeneous structure with hypoechoic patches near the right pancreatic lobe. An exploratory laparotomy revealed a partially encapsulated necrotic mass located at the greater omentum. A partial omentectomy was performed. Histopathological findings were consistent with necrosis of the omentum secondary to omental torsion. Postoperative course was uneventful. Omental torsion is a rare cause of abdominal pain in human beings and animals. In veterinary medicine, it has only been reported four times, none of them in a dog. Omental torsion should be included as a differential diagnosis for dogs with acute abdominal pain and gastrointestinal signs. Imaging studies can aid in the diagnosis but exploratory laparotomy is probably the best diagnostic and therapeutic intervention in these cases. Prognosis after surgery appears to be good but an underlying aetiology should be searched thoroughly.
Construction productivity fuzzy knowledge base management system
Authors: Elwakil Emad , Zayed Tarek
Published: January 2018

Construction companies need a knowledge management system to collate, share and ultimately apply this knowledge in various projects. One of the most important elements that determine the time estimates of any construction project is productivity. Such projects have a predilection towards uncertainty and therefore require new generation of prediction models that utilizes available historical data. The research presented in this paper develops, using fuzzy approach, a knowledge base to analyze, extract and infer any underlying patterns of the data sets to predict the duration and productivity of a construction process. A six-step protocol has been followed to create this model: (i) determine which factors affect productivity; (ii) select those factors that are critical; (iii) build the fuzzy sets; (iv) generate the fuzzy rules and models; (v) develop the fuzzy knowledge base; and (vi) validate the efficacy and function of these models in predicting the productivity construction process. The fuzzy knowledge base was validated and verified using a case study and the results were satisfactory with 92.00% mean validity. In conclusion, the developed models and system demonstrated the ability of a knowledge base management to predict the patterns and productivity of different construction operations.
Short-term stress for long-lasting otolith morphology — brief embryological stress disturbance can reorient otolith ontogenetic trajectory
Authors: Vignon Matthias
Published: January 2018

Long-term plasticity of otolith shape has become a unifying principle to use morphological differences as indicator of environmental conditions. Contrary to the longstanding paradigmatic view that otolith shape can only reflect residency in particular environmental conditions over long time periods, data emphasize that otolith ontogenetic trajectory may be reoriented in case of short-term episodes of environmental disturbance during early lifetime. Using geometric morphometrics, discrimination was posible in absence of growth-related differences between control and brown trout (Salmo trutta Linnaeus, 1758) that have experienced brief thermal stress prior to their emergence but have grown in similar conditions (i.e., cohabiting within the same aquarium) during 6 months. Data emphasize that brief stress during key developmental periods can durably influence ontogenetic trajectories, subsequent otolith development, and can consequently change otolith morphology in juveniles. Therefore, differences in shape between groups of fish may not be exclusively indicative of long-time residency in contrasted and (or) separated habitats as it is generally assumed. Moving beyond long-term assumptions is fundamental if otolith shape is to be used as an effective tool for management of fisheries resources in the future.
Polychronakos statistics and α-deformed Bose condensation of α-bosons
Authors: Chung Won Sang , Hassanabadi Hassan
Published: January 2018

In this paper, we consider the Polychronakos statistics for [Formula: see text]. We use the Stirling formula for the [Formula: see text]-Gamma function to find the distribution function for the [Formula: see text]-bosons. As application, we discuss the [Formula: see text]-deformed Bose condensation for [Formula: see text]-boson gas.
Ultrasound-Magnetic Resonance Imaging Fusion Scheme Based on Non-Negative Matrix Factorization and Dual Modality Contrast Agent
Authors: Hou Mo , Yang Maoyun , Yang Ruibo , Ren Shijin , Wang Shumei , Wang Nana , Xu Bin , Yu Wenhua
Published: January 2018

In order to realize the image fusion and improve the quality of the integration, with the aid of dual modality contrast agent (DMCA), a novel fusion method between ultrasound imaging (US) and magnetic resonance imaging (MRI) was put forward in this paper. Due to US’s strong speckle noise, it was an enormous challenge to fuse US with any other modality images. Under the circumstances, DMCA was used in both US and MRI to strengthen the most important information region of interest. Then, because of Rayleigh distribution of US, a self-adaptive weighted non-negative matrix factorization (SWNMF) scheme is constructed to complete the fusion process. In view of the above-mentioned method, the multiple group comparison tests indicated that US-MRI fusion may be a remarkable method for gaining high-quality fusion image.
Optional anatomy and physiology e-learning resources: student access, learning approaches, and academic outcomes
Authors: Guy Richard , Byrne Bruce , Dobos Marian
Published: January 2018

Anatomy and physiology interactive video clips were introduced into a blended learning environment, as an optional resource, and were accessed by ~50% of the cohort. Student feedback indicated that clips were engaging, assisted understanding of course content, and provided lecture support. Students could also access two other optional online resources, lecture capture recordings and an interactive atlas of anatomy, and individuals were tracked with respect to their access behavior, learning approach, and subject score. Deep learning was highest among those accessing the clips or atlas or those accessing more online resources, and thus self-regulatory skill development might be a useful approach to increase student access to optional online resources. Those who accessed clips, lecture capture recordings, or atlas achieved a significantly higher subject score than those who did not. When combinations of resources used were considered, we found an approximately linear relationship between number of resources accessed and subject score, with a 16% difference in score between those who accessed none or all of the resources. However, the low resource access rate suggests that academic advantage may not be simply due to the learning support offered by the resources. As students accessing the optional resources tended to be more self-regulated, it may be that it was the extra effort made with respect to other subject resources, rather than just the access to the online resources, that contributed to higher subject score. Further studies are required to establish the relationships between academic performance, optional online resource access, and deep learning.
Modified directed self-learning sessions in physiology with prereading assignments and Pecha Kucha talks: perceptions of students
Authors: Abraham Reem Rachel , Torke Sharmila , Gonsalves James , Narayanan Sareesh Naduvil , Kamath M. Ganesh , Prakash Jay , Rai Kiranmai S.
Published: January 2018

The present study reports perceptions of first-year undergraduate medical students ( n = 120), regarding modified directed self-learning (DSL) sessions in physiology. Students were provided with prereading assignments (faculty developed PowerPoint slides containing diagrams with incomplete labeling/flowcharts with missing steps) pertaining to the DSL topic 1 wk before the scheduled small-group DSL presentations. During DSL presentation sessions, which were facilitated by teachers, a few students individually presented learning objectives in the specified topic. Apart from that, students discussed answers for the questions in the prereading assignment. Students were also given an opportunity to use technology to support DSL, by way of involving them in Pecha Kucha (PK) talks. The impact of the modified DSL method was determined by requesting students to respond to a validated questionnaire. Frequency analysis of the responses revealed that >60% of students were positive about the modified DSL sessions improving their DSL, presentation, collaborative learning, and information retrieving skills. Students agreed that PK talks helped them to learn how to organize content (65%), present concise information (65.8%), and apply creativity (72.5%). Even though small in number, there were comments that the prereading assignments were useful for learning. The present study revealed that, even though students actively participated in modified DSL sessions, their perceptions on satisfaction and usefulness of the same toward achievement of various skills were not encouraging. The study generated significant results, which implies that undergraduate medical students should be oriented on the relevance of active learning strategies in their future studies.
Regenerative medicine: a vehicle to infuse laboratory-bench modules into an exercise physiology curriculum
Authors: Brown Jason M. , Guy Breonte S. , Henderson Dawn X. , Ebert C. Edward , Harp Jill , Markert Chad D.
Published: January 2018

Regenerative medicine is a novel discipline that both excites undergraduates and may be used as a vehicle to expose students to scientific concepts and opportunities. The goal of this article is to describe the implementation of a National Science Foundation-funded Targeted Infusion Project in which underrepresented minority undergraduates are exposed to laboratory-bench skills and summer research opportunities that they may not have encountered otherwise. A 3-wk infusion of laboratory-bench and data presentation skills, in the context of a regenerative medicine/bioengineering project, aimed to engage students and expose them to opportunities as summer researchers and teaching assistants. The infusion aimed to assess the extent to which students improved 1) attitudes toward laboratory-bench-based techniques, using attitudes toward science as a proxy; 2) perceptions of scientific inquiry; 3) intentions to engage in undergraduate research; and 4) intentions to persist in science, technology, engineering, and mathematics (STEM)-related fields. Results indicate that the 3-wk infusion had no effect on science attitudes, but transcribed responses to structured interviews administered after the summer research experience indicated that students who completed summer research projects had positive experiences. Differences in intentions to engage in research were detected between groups of students in different STEM majors, in addition to differences in intentions to pursue a career in science. We describe the implementation of the infusion and briefly discuss quantitative outcomes. We conclude that infusion of laboratory-bench modules in the context of a regenerative medicine/bioengineering project may play a small but important role in increasing (minority) participation and persistence in the STEM pipeline.
Utilizing a rat delayed implantation model to teach integrative endocrinology and reproductive biology
Authors: Geisert Rodney D. , Smith Michael F. , Schmelzle Amanda L. , Green Jonathan A.
Published: January 2018

In this teaching laboratory, the students are directed in an exercise that involves designing and performing an experiment to determine estrogen’s role in regulating delayed implantation (diapause) in female rats. To encourage active participation by the students, a discussion question is provided before the laboratory exercise in which each student is asked to search the literature and provide written answers to questions and to formulate an experiment to test the role of ovarian estrogen in inducing implantation in female rats. One week before the laboratory exercise, students discuss their answers to the questions with the instructor to develop an experiment to test their hypothesis that estrogen is involved with inducing implantation in the rat. A rat delayed implantation model was established that utilizes an estrogen receptor antagonist (ICI 182,780), which inhibits the action of ovarian estrogens. Groups of mated females are treated with either carrier (control) or ICI 182,780 (ICI) every other day, starting on day 2 postcoitus (pc) until day 8 pc. One-half of the females receiving ICI are injected with estradiol-17β on day 8 pc to induce implantation 4 days after the controls. If the ICI-treated females are not administered estradiol, embryo implantation occurs spontaneously ~4 days after the last ICI injection on day 8. This is a very simple protocol that is very effective and provides an excellent experiment for student discussion on hormone action and the use of agonists and antagonists.
Development and validation of simulated virtual patients to impart early clinical exposure in endocrine physiology
Authors: Gupta Akriti , Singh Satendra , Khaliq Farah , Dhaliwal Upreet , Madhu S. V.
Published: January 2018

In the country presently, preclinical medical students are not routinely exposed to real patients. Thus, when they start clinical postings, they are found to have poor clinical reasoning skills. Simulated virtual patients (SVPs) can improve clinical skills without endangering real patients. This pilot study describes the development of two SVPs in endocrine physiology and their validation in terms of acquisition of clinical knowledge and student engagement. Two SVPs, Nandini Sharma (unintentional weight gain) and Sunil Yadav (polyuria), were created and published on the i-Human Patients platform through an iterative, interdisciplinary, and transdisciplinary collaborative process using the conceptual framework of Kim et al. (Kim S, Phillips WR, Pinsky L, Brock D, Phillips K, Keary J. Med Educ 40: 867–876, 2006). After internal and external peer validation, the SVPs were piloted on 40 students (20 students per virtual patient) over 2 wk. A cognitive pretest was conducted before exposure, and a posttest soon after. Faculty and student feedback were collected. Faculty found SVPs authentic, helpful as teaching-learning tools, and useful for giving feedback and for assessment. Students found SVPs more engaging than paper cases and helpful in developing clinical reasoning and in imparting clinical exposure. Pretest and posttest scores indicated knowledge gain ( P < 0.01). Although challenging to create, SVPs created on the i-Human Patients platform improved learning in endocrine physiology and were well accepted by students and faculty as a means to provide early clinical exposure. More SVPs can be developed through collaboration between stakeholder departments and integrated into the curriculum for greater benefit.
Beyond “formative”: assessments to enrich student learning
Authors: Kulasegaram Kulamakan , Rangachari Patangi K.
Published: January 2018

Formative assessments can enhance and enrich student learning. Typically, these have been used to provide feedback against end-of-course standards and prepare students for summative assessments of performance or measurement of competence. Here, we present the case for using assessments for learning to encompass a wider range of important outcomes. We discuss 1) the rationale for using assessment for learning; 2) guiding theories of expertise that inform assessment for learning; 3) theoretical and empirical evidence; 4) approaches to rigor and validation; and 5) approaches to implementation at multiple levels of the curriculum. The literature strongly supports the use of assessments as an opportunity to reinforce and enhance learning. Physiology teachers have a wide range of theories, models, and interventions from which to prepare students for retention, application, transfer, and future learning by using assessments.
Hypoxia selectively upregulates cation channels and increases cytosolic [Ca2+] in pulmonary, but not coronary, arterial smooth muscle cells
Authors: He Xi , Song Shanshan , Ayon Ramon J. , Balisterieri Angela , Black Stephen M. , Makino Ayako , Wier W. Gil , Zang Wei-Jin , Yuan Jason X.-J.
Published: January 2018

Ca2+ signaling, particularly the mechanism via store-operated Ca2+ entry (SOCE) and receptor-operated Ca2+ entry (ROCE), plays a critical role in the development of acute hypoxia-induced pulmonary vasoconstriction and chronic hypoxia-induced pulmonary hypertension. This study aimed to test the hypothesis that chronic hypoxia differentially regulates the expression of proteins that mediate SOCE and ROCE [stromal interacting molecule (STIM), Orai, and canonical transient receptor potential channel TRPC6] in pulmonary (PASMC) and coronary (CASMC) artery smooth muscle cells. The resting cytosolic [Ca2+] ([Ca2+]cyt) and the stored [Ca2+] in the sarcoplasmic reticulum were not different in CASMC and PASMC. Seahorse measurement showed a similar level of mitochondrial bioenergetics (basal respiration and ATP production) between CASMC and PASMC. Glycolysis was significantly higher in PASMC than in CASMC. The amplitudes of cyclopiazonic acid-induced SOCE and OAG-induced ROCE in CASMC are slightly, but significantly, greater than in PASMC. The frequency and the area under the curve of Ca2+ oscillations induced by ATP and histamine were also larger in CASMC than in PASMC. Na+/Ca2+ exchanger-mediated increases in [Ca2+]cyt did not differ significantly between CASMC and PASMC. The basal protein expression levels of STIM1/2, Orai1/2, and TRPC6 were higher in CASMC than in PASMC, but hypoxia (3% O2 for 72 h) significantly upregulated protein expression levels of STIM1/STIM2, Orai1/Orai2, and TRPC6 and increased the resting [Ca2+]cyt only in PASMC, but not in CASMC. The different response of essential components of store-operated and receptor-operated Ca2+ channels to hypoxia is a unique intrinsic property of PASMC, which is likely one of the important explanations why hypoxia causes pulmonary vasoconstriction and induces pulmonary vascular remodeling, but causes coronary vasodilation.
Insulin signaling displayed a differential tissue-specific response to low-dose dihydrotestosterone in female mice
Authors: Andrisse Stanley , Billings Katelyn , Xue Ping , Wu Sheng
Published: January 2018

Hyperandrogenemia and hyperinsulinemia are believed to play prominent roles in polycystic ovarian syndrome (PCOS). We explored the effects of low-dose dihydrotestosterone (DHT), a model of PCOS, on insulin signaling in metabolic and reproductive tissues in a female mouse model. Insulin resistance in the energy storage tissues is associated with type 2 diabetes. Insulin signaling in the ovaries and pituitary either directly or indirectly stimulates androgen production. Energy storage and reproductive tissues were isolated and molecular assays were performed. Livers and white adipose tissue (WAT) from DHT mice displayed lower mRNA and protein expression of insulin signaling intermediates. However, ovaries and pituitaries of DHT mice exhibited higher expression levels of insulin signaling genes/proteins. Insulin-stimulated p-AKT levels were blunted in the livers and WAT of the DHT mice but increased or remained the same in the ovaries and pituitaries compared with controls. Glucose uptake decreased in liver and WAT but was unchanged in pituitary and ovary of DHT mice. Plasma membrane GLUTs were decreased in liver and WAT but increased in ovary and pituitary of DHT mice. Skeletal muscle insulin-signaling genes were not lowered in DHT mice compared with control. DHT mice did not display skeletal muscle insulin resistance. Insulin-stimulated glucose transport increased in skeletal muscles of DHT mice compared with controls. DHT mice were hyperinsulinemic. However, the differential mRNA and protein expression pattern was independent of hyperinsulinemia in cultured hepatocytes and pituitary cells. These findings demonstrate a differential effect of DHT on the insulin-signaling pathway in energy storage vs. reproductive tissues independent of hyperinsulinemia.
Different physiological roles of insulin receptors in mediating nutrient metabolism in zebrafish
Authors: Yang Bin-Yuan , Zhai Gang , Gong Yu-Long , Su Jing-Zhi , Peng Xu-Yan , Shang Guo-Hui , Han Dong , Jin Jun-Yan , Liu Hao-Kun , Du Zhen-Yu , Yin Zhan , Xie Shou-Qi
Published: January 2018

Insulin, the most potent anabolic hormone, is critical for somatic growth and metabolism in vertebrates. Type 2 diabetes, which is the primary cause of hyperglycemia, results from an inability of insulin to signal glycolysis and gluconeogenesis. Our previous study showed that double knockout of insulin receptor a ( insra) and b ( insrb) caused β-cell hyperplasia and lethality from 5 to 16 days postfertilization (dpf) (Yang BY, Zhai G, Gong YL, Su JZ, Han D, Yin Z, Xie SQ. Sci Bull (Beijing) 62: 486–492, 2017). In this study, we characterized the physiological roles of Insra and Insrb, in somatic growth and fueling metabolism, respectively. A high-carbohydrate diet was provided for insulin receptor knockout zebrafish from 60 to 120 dpf to investigate phenotype inducement and amplification. We observed hyperglycemia in both insra−/− fish and insrb−/− fish. Impaired growth hormone signaling, increased visceral adiposity, and fatty liver were detected in insrb−/− fish, which are phenotypes similar to the lipodystrophy observed in mammals. More importantly, significantly diminished protein levels of P-PPARα, P-STAT5, and IGF-1 were also observed in insrb−/− fish. In insra−/− fish, we observed increased protein content and decreased lipid content of the whole body. Taken together, although Insra and Insrb show overlapping roles in mediating glucose metabolism through the insulin-signaling pathway, Insrb is more prone to promoting lipid catabolism and protein synthesis through activation of the growth hormone-signaling pathway, whereas Insra primarily acts to promote lipid synthesis via glucose utilization.
Detrimental effects of 2-arachidonoylglycerol on whole blood platelet aggregation and on cerebral blood flow after a focal ischemic insult in rats
Authors: Shearer Jennifer A. , Coker Susan J. , Carswell Hilary V. O.
Published: January 2018

2-Arachidonoylglycerol (2-AG) is a major modulator of blood flow and platelet aggregation and a potential neuroprotectant. The present study investigated, for the first time, the effects of 2-AG on cerebral blood flow (CBF) in the first critical hours during middle cerebral artery occlusion (MCAO) and on platelet aggregation in rats. Adult male Sprague-Dawley rats ( n = 30) underwent permanent MCAO under isoflurane anesthesia and were randomly assigned to receive either 2-AG (6 mg/kg iv), monoacylglycerol lipase inhibitor JZL-184 (10 mg/kg iv), or vehicle ( n = 6 rats/group) treatment. CBF and cardiovascular responses were measured, by a blinded investigator, for up to 4 h. In separate experiments, platelet aggregation by 2-AG (19–300 µM) was assessed by whole blood aggregometry ( n = 40). 2-AG and JZL-184 significantly increased the severity of the CBF deficit versus vehicle (20.2 ± 8.8% and 22.7 ± 6.4% vs. 56.4 ± 12.1% of pre-MCAO baseline, respectively, P < 0.05) but had no effect on blood pressure or heart rate. While JZL-184 significantly increased the number of thrombi after MCAO, this did not reach significance by 2-AG. 2-AG induced platelet aggregation in rat whole blood in a similar manner to arachidonic acid and was significantly reduced by the cyclooxygenase inhibitors indomethacin and flurbiprofen and the thromboxane receptor antagonist ICI 192,605 ( P < 0.05). This is the first study showing that 2-AG increases the severity of the CBF deficit during MCAO, and further interrogation confirmed 2-AG-induced platelet aggregation in rats. These findings are important because 2-AG had previously been shown to exert neuroprotective actions and therefore force us to reevaluate the circumstances under which 2-AG is beneficial.

NEW & NOTEWORTHY 2-Arachidonoylglycerol (2-AG) has neuroprotective properties; however, the present study revealed that 2-AG increases the severity of the cerebral blood flow deficit during middle cerebral artery occlusion in rats. Further interrogation showed that 2-AG induces platelet aggregation in rats. These findings force us to reevaluate the circumstances under which 2-AG is beneficial.