bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the effects of a drug with fiscalized substance dispensation, health education, and pharmacovigilance continuing education program in Colombia drugstores and drugstores/pharmacies: study protocol of a multicenter, cluster-randomized controlled trial
Authors: Ceballos Mauricio , Salazar-Ospina Andrea , Sabater-Hernández Daniel , Amariles Pedro
Published: June 2020

Background

Health disorders, due to the use of drugs with fiscalized substances, including controlled substances, have become a common problem in Colombia. Multiple reasons can help explain this problem, including self-medication, since access to these drugs may be easier. Also, there is a lack of knowledge that these drugs are safer than illicit drugs. The use of these drugs without a valid medical prescription and follow-up can have negative consequences such as drug abuse, addiction, and overdose, and eventually, have negative health consequences. Pharmacy staff is essential to both assure the correct drug use and minimize prescription errors to help outpatients have better management of their pharmacotherapy. For this reason, it is necessary to increase key competencies like knowledge, skills, and attitudes in the pharmacy staff of ambulatory (outpatients) pharmacies.

Methods

This study is a prospective, cluster-randomized, parallel-group, multicenter trial of drugstores and drugstores/pharmacies (ambulatory pharmacies). The study is designed to determine the effectiveness of a drug with fiscalized substance dispensation, health education, and pharmacovigilance continuing education program in drugstores and drugstores/pharmacies. Pharmacy staff will be randomly selected and assigned to one of the study groups (intervention or control). The intervention group will receive a continuing education program for over 12 months. The control group will receive only general information about the correct use of complex dosage forms. The primary objective is to evaluate the effectiveness of a continuing education program to improve pharmacy staff competencies (knowledge, skills, and attitudes) to improve the ambulatory (outpatient) pharmacy services: dispensation, health education, and pharmacovigilance of drugs with fiscalized substances. The secondary outcomes include (a) processes associated with the management of drugs with fiscalized substances in drugstores and drugstores/pharmacies, including regulation compliance; (b) degree of implementation of ambulatory (outpatient) pharmacy services targeting these drugs in drugstores and drugstores/pharmacies; (c) patient satisfaction with such services; and (d) pharmacy staff satisfaction with the continuing education program.

Discussion

This clinical trial will establish whether providing a continuing education program for the adequate utilization of drugs with fiscalized substances improves pharmacy staff competencies regarding these drugs.

Trial registration

ClinicalTrials.gov NCT03388567. Registered on 28 November 2017. First drugstore or drugstore/pharmacy randomized on December 1, 2018.

Protocol version

0017102017MC
Efficacy and safety of Dingkun pill for female infertility patients with low prognosis undergoing in vitro fertilization-embryo transfer: study protocol for a multicenter, double-blind, randomized, placebo-controlled trial
Authors: Song Jingyan , Ma Ting , Liang Yanlin , Cao Xianling , Sun Zhengao
Published: June 2020

Background

Approximately 15% of couples in the reproductive age are affected by infertility. Women with diminished ovarian reserves (DOR) or with a poor ovarian response (POR) are required to undergo in vitro fertilization and embryo transfer (IVF-ET) to achieve pregnancy. However, studies indicate that poor response to gonadotropin stimulation has been reported in women undergoing IVF-ET. Results from two recent clinical studies in China suggest that traditional Chinese medicine (TCM) formula Dingkun pill (DKP) showed a curative effect by improving the clinical pregnancy rate in women with DOR and POR. However, the heterogeneity of the studies does not allow one to draw a definitive conclusion on the therapeutic effect of DKP. Therefore, the purpose of this study was to investigate the effect of DKP on improving the clinical outcome of pregnancy of IVF-ET in women with low prognosis.

Methods

A multicenter, double-blinded, randomized placebo-controlled trial was conducted. A total of 460 infertile patients undergoing IVF or intracytoplasmic sperm injection (ICSI) were recruited from 12 public hospitals in China. Participants were randomly divided into the experimental group (DKP formula) or the placebo group (control) at a ratio of 1:1. All patients were treated with GnRH antagonist protocol and ovarian stimulation performed for 5 weeks (from the 5th day of the previous menstrual cycle to the day of oocyte retrieval). The patients were followed up for 6 months to record their conception outcome. The primary outcome is to compare the pregnancy outcome to those under placebo treatment. Secondary outcomes included the total count of the retrieved oocyte, embryo quality, endometrial thickness on ET day, implantation rate, and early miscarriage rate.

Discussion

Currently, no multicenter, double-blind, randomized, placebo-controlled trials have been performed on the use of the DKP formula to improve on the clinical outcome of the conception of IVF-ET in women with low prognosis. DKP might provide a good clinical solution for females with low prognosis and undergoing IVF. There is no contemporary Western medicine to improve on the clinical outcome of conception in IVF-ET in women with low prognosis. Therefore, it is important to undertake a well-designed randomized trial to determine the effect of DKP in improving the clinical outcome of the conception of IVF-ET in women with low prognosis.

Trial registration

Chinese Clinical Trial Registry (ChiCTR). Trial registration number: ChiCTR1900026614. Registered on 16 October 2019.
Transcriptional signatures of participant-derived neural progenitor cells and neurons implicate altered Wnt signaling in Phelan-McDermid syndrome and autism
Authors: Breen Michael S. , Browne Andrew , Hoffman Gabriel E. , Stathopoulos Sofia , Brennand Kristen , Buxbaum Joseph D. , Drapeau Elodie
Published: June 2020

Background

Phelan-McDermid syndrome (PMS) is a rare genetic disorder with high risk of autism spectrum disorder (ASD), intellectual disability, and language delay, and is caused by 22q13.3 deletions or mutations in the SHANK3 gene. To date, the molecular and pathway changes resulting from SHANK3 haploinsufficiency in PMS remain poorly understood. Uncovering these mechanisms is critical for understanding pathobiology of PMS and, ultimately, for the development of new therapeutic interventions.

Methods

We developed human-induced pluripotent stem cell (hiPSC)-based models of PMS by reprogramming peripheral blood samples from individuals with PMS (n = 7) and their unaffected siblings (n = 6). For each participant, up to three hiPSC clones were generated and differentiated into induced neural progenitor cells (hiPSC-NPCs; n = 39) and induced forebrain neurons (hiPSC-neurons; n = 41). Genome-wide RNA-sequencing was applied to explore transcriptional differences between PMS probands and unaffected siblings.

Results

Transcriptome analyses identified 391 differentially expressed genes (DEGs) in hiPSC-NPCs and 82 DEGs in hiPSC-neurons, when comparing cells from PMS probands and unaffected siblings (FDR < 5%). Genes under-expressed in PMS were implicated in Wnt signaling, embryonic development, and protein translation, while over-expressed genes were enriched for pre- and postsynaptic density genes, regulation of synaptic plasticity, and G-protein-gated potassium channel activity. Gene co-expression network analysis identified two modules in hiPSC-neurons that were over-expressed in PMS, implicating postsynaptic signaling and GDP binding, and both modules harbored a significant enrichment of genetic risk loci for developmental delay and intellectual disability. Finally, PMS-associated genes were integrated with other ASD hiPSC transcriptome findings and several points of convergence were identified, indicating altered Wnt signaling and extracellular matrix.

Limitations

Given the rarity of the condition, we could not carry out experimental validation in independent biological samples. In addition, functional and morphological phenotypes caused by loss of SHANK3 were not characterized here.

Conclusions

This is the largest human neural sample analyzed in PMS. Genome-wide RNA-sequencing in hiPSC-derived neural cells from individuals with PMS revealed both shared and distinct transcriptional signatures across hiPSC-NPCs and hiPSC-neurons, including many genes implicated in risk for ASD, as well as specific neurobiological pathways, including the Wnt pathway.
Genome engineering of induced pluripotent stem cells to manufacture natural killer cell therapies
Authors: Shankar Keerthana , Capitini Christian M. , Saha Krishanu
Published: June 2020

Natural killer (NK) cells play a crucial role in host immunity by detecting cells that downregulate MHC class I presentation and upregulate stress ligands, as commonly seen in cancers. Current NK therapies using primary NK cells are prone to manufacturing issues related to expansion and storage. Alternative cell sources utilizing immortalized NK cell lines require irradiation and are dependent on systemic IL-2 administration, which has been associated with adverse effects. In contrast, NK cells differentiated from induced pluripotent stem cells (iPSC-NK cells) offer an off-the-shelf alternative that may overcome these bottlenecks. The development of a serum-free and feeder-free differentiation protocol allows for the manufacturing of clinically adaptable iPSC-NK cells that are equally as effective as primary NK cells and the NK-92 cell line for many indications. Moreover, genetic modifications targeting NK-mediated antibody-dependent cellular cytotoxicity capabilities, cytotoxicity, and checkpoint inhibitors may increase the therapeutic potential of iPSC-NK products. This review will highlight the current sources for NK therapies and their respective constraints, discuss recent developments in the manufacturing and genetic engineering of iPSC-NK cells, and provide an overview of ongoing clinical trials using NK cells.
Solutions of two fractional q-integro-differential equations under sum and integral boundary value conditions on a time scale
Authors: Alzabut Jehad , Mohammadaliee Behnam , Samei Mohammad Esmael
Published: June 2020

In this manuscript, by using the Caputo and Riemann–Liouville type fractionalq-derivatives, we consider two fractionalq-integro-differential equations of the forms${}^{c}\mathcal{D}_{q}^{\alpha }[x](t) + w_{1} (t, x(t), \varphi (x(t)) )=0$Dqαc[x](t)+w1(t,x(t),φ(x(t)))=0and$$ {}^{c}\mathcal{D}_{q}^{\alpha }[x](t) = w_{2} \biggl( t, x(t), \int _{0}^{t} x(r) \,\mathrm{d}r, {}^{c} \mathcal{D}_{q}^{\alpha }[x](t) \biggr) $$Dqαc[x](t)=w2(t,x(t),∫0tx(r)dr,cDqα[x](t))for$t \in [0,l]$t∈[0,l]under sum and integral boundary value conditions on a time scale$\mathbb{T}_{t_{0}}= \{ t: t =t_{0}q^{n}\}\cup \{0\}$Tt0={t:t=t0qn}∪{0}for$n\in \mathbb{N}$n∈Nwhere$t_{0} \in \mathbb{R}$t0∈Randqin$(0,1)$(0,1). By employing the Banach contraction principle, sufficient conditions are established to ensure the existence of solutions for the addressed equations. Examples involving algorithms and illustrated graphs are presented to demonstrate the validity of our theoretical findings.
Acute myocardial infarction in patient without cardiac risk factors during emergence from general anesthesia: a case report
Authors: Dang Thu Nguyen , Hoai Nam Tran , Viet Son Nguyen , Le Huu Tri , Van Khuong Truong , Manh Cuong Nguyen , Dac Tiep Tran
Published: June 2020

Background

Perioperative myocardial infarction is a rare but highly fatal complication, which often occurs in patients with poor preoperative cardiac conditions undergoing high-risk surgery. We report a case of acute myocardial infarction in a patient without cardiac risk factors during emergence from general anesthesia for removal of spinal screws.

Case presentation

A 37-year-old, 60 kg, and 160 cm man, who had no history of cardiovascular diseases, underwent removal of loosen spinal plug screws at L4-L5. The preoperative investigations revealed no abnormality and the patient was ASA I. The surgery was uneventful. During aspiration of the endotracheal tube, the patient suddenly experienced paroxysmal atrial fibrillation and ST segment elevation in DII lead. He was treated with oxygenation, optimal hemodynamics, minimize cardiac work, antiarrhythmias, and anticoagulation. The clinical conditions improved. Sinus rhythm was regained after 24 h and discharged without complications.

Conclusions

Myocardial infarction can occur suddenly and unexpectedly in patients without risk factors after a low-risk surgery in any period of general anesthesia. Close monitoring and prompt treatment with this condition is important for improving outcomes.
Efficacy of the green lace wing, Chrysoperla zastrowi sillemi (Esben-Peterson) (Neuroptera: Chrysopidae), against sucking pests of tomato: an appraisal under protected conditions
Authors: Nair Indu J. , Sharma Sudhendu , Kaur Rabinder
Published: June 2020

Pest infestations in net-houses are not sometimes different from that under open-field conditions, necessitating usage of pesticides. To examine the hypothesis that bioagents may have more potential under restricted plant growing conditions, the predatory potential of green lace wing,Chrysoperla zastrowi sillemiEsben-Peterson (Neuroptera: Chrysopidae) was evaluated against the sucking pests of tomato under screen-house conditions. The rates of release were fixed as 4, 5, and 6 s instar grubs plant−1and a total of 3 releases were made at 7 days interval, with first release at appearance of the aphid,Myzus persicae(Sulzer) and whitefly,Bemisia tabaci(Gennadius). The pooled data for the years 2018 and 2019 revealed that, the release rates 4, 5, and 6 grubs plant−1were not statistically different in reducing the population of these pests. The factorial analysis based on the release rate and time of these releases suggested that single release ofC.zastrowi sillemiat 4 grubs plant−1was effective against sucking pests in tomato grown under screen-house conditions.
Hot stage microscopy and its applications in pharmaceutical characterization
Authors: Kumar Arun , Singh Pritam , Nanda Arun
Published: June 2020

Hot stage microscopy (HSM) is a thermal analysis technique that combines the best properties of thermal analysis and microscopy. HSM is rapidly gaining interest in pharmaceuticals as well as in other fields as a regular characterization technique. In pharmaceuticals HSM is used to support differential scanning calorimetry (DSC) and thermo-gravimetric analysis (TGA) observations and to detect small changes in the sample that may be missed by DSC and TGA during a thermal experiment. Study of various physical and chemical properties such sample morphology, crystalline nature, polymorphism, desolvation, miscibility, melting, solid state transitions and incompatibility between various pharmaceutical compounds can be carried out using HSM. HSM is also widely used to screen cocrystals, excipients and polymers for solid dispersions. With the advancements in research methodologies, it is now possible to use HSM in conjunction with other characterization techniques such as Fourier transform infrared spectroscopy (FTIR), DSC, Raman spectroscopy, scanning electron microscopy (SEM) which may have additional benefits over traditional characterization techniques for rapid and comprehensive solid state characterization.
Azimuthal P-P prestack amplitudes in the presence of oil-filled aligned porosity (fracture porosity)
Authors: Lynn Heloise Bloxsom , Goodway Bill
Published: June 2020

A 3D P-P high-fold full-azimuth full-offset reflection survey was acquired and processed to characterize a naturally fractured carbonate reservoir. The reservoir is a thick carbonate, which will flow commercial oil with a sufficient fracture network. Extensive calibration data include (1) a horizontal borehole’s resistivity image log, (2) the first 24 months cumulative oil produced, by stage, as known from chemical frac tracer data, (3) pre- and postfrac job instantaneous shut-in pressures, (4) microseismic, and (5) wireline log data. We used the cumulative oil production to document the spatially varying amount of aligned vertical porosity (aligned compliance or fracture porosity) connected to the stage borehole location. The stages of high oil production exhibited, for the fracture-perpendicular azimuth, the more positive amplitude variation with angle (AVA) gradients, and dimmer near-angle (6°–15° angles of incidence) amplitudes, compared to the fracture-parallel azimuth. The azimuthal variation of the AVA gradient fit the cos 2θ curve well, indicating the presence of one set of vertical aligned fractures dominating the azimuthal amplitude signature. In a similar fashion, the azimuthal variation of the mathematical intercept, physically the near-angle amplitudes, also fit the cos 2θ curve well. We have constructed crossplots of the azimuthal near-angle amplitude versus the AVA gradient on a bin-by-bin basis: we observed a straight line at bins with elevated oil production (elevated fracture density). A straight line crossplot of the (AVA gradient, mathematical intercept) is the signature of change of the (sensed) porosity, as long as the lithology and pore fluid are held constant. In accord with industry knowledge, we found that porosity affects the P impedance and thus the near-angle amplitudes: the aligned porosity yields azimuthal P impedance (measured at the 6°–15° angles of incidence). Legacy high-fold 3D P-P surveys rich in the 6°–20° angles of incidence should be considered for reprocessing and reinterpretation using these techniques.
Reduced lactate dehydrogenase activity in the heart and suppressed sex hormone levels are associated with female-biased mortality during thermal stress in Pacific salmon
Authors: Little A. G. , Hardison E. , Kraskura K. , Dressler T. , Prystay T. S. , Hendriks B. , Pruitt J. N. , Farrell A. P. , Cooke S. J. , Patterson D. A. , Hinch S. G. , Eliason E. J.
Published: June 2020

Female-biased mortality has been repeatedly reported in Pacific salmon during their upriver migration in both field studies and laboratory-holding experiments, especially in the presence of multiple environmental stressors, including thermal stress. Here we used coho salmon (Oncorhynchus kisutch) to test whether females exposed to elevated water temperatures (18°C) i) suppress circulating sex hormones (testosterone, 11-ketotestosterone, and estradiol), owing to elevated cortisol levels, ii) have higher activities of enzymes supporting anaerobic metabolism (e.g., lactate dehydrogenase), iii) lower activities of enzymes driving oxidative metabolism (e.g., citrate synthase; CS), in skeletal and cardiac muscle, and iv) have more oxidative stress damage and reduced capacity for antioxidant defense (lower catalase activity; CAT). We found no evidence that a higher susceptibility to oxidative stress contributes to female-biased mortality at warm temperatures. We did, however, find that females had significantly lower cardiac LDH and that 18°C significantly reduced plasma levels of testosterone and estradiol, especially in females. We also found that relative gonad size was significantly lower in the 18°C treatment regardless of sex, whereas relative liver size was significantly lower in females held at 18°C. Further, relative spleen size was significantly elevated in the 18°C treatments across both sexes, with larger warm-induced increases in females. Our results suggest that males may better tolerate bouts of cardiac hypoxia at high temperature, and that thermal stress may also disrupt testosterone- and estradiol-mediated protein catabolism, and the immune response (larger spleens) in migratory female salmon.
Greater agility increases probability of survival in the endangered northern quoll
Authors: Rew-Duffy Miranda , Cameron Skye F. , Freeman Natalie J. , Wheatley Rebecca , Latimer Jessica M. , Wilson Robbie S.
Published: June 2020

Introduced predators combined with habitat loss and modification are threatening biodiversity worldwide, particularly the ‘critical weight range’ (CWR) mammals of Australia. In order to mitigate the impacts of invasive predators on native species in different landscapes, we must understand how the prey's morphology and performance determine their survival. Here we evaluate how phenotypic traits related to escape performance predict the probability of survival for an endangered CWR mammal, the northern quoll (Dasyurus hallucatus). We measured mass, body size, body shape, body condition, and age, as well as maximum sprint speed, acceleration, and agility of female quolls over two consecutive years. Those with higher body condition and agility around a 135° corner were more likely to survive their first 21 months of life but were not more likely to survive after this period. No other morphological or performance traits affected survival. Heavier second-year individuals were more agile than first-years but second-years experienced higher mortality rates throughout the year. Females with higher body condition and agility around a 135° corner tended to have shorter limbs and feet but larger heads. Our findings suggest that higher body condition and agility are advantageous for survival in female northern quolls. These results can be used to develop predictive models of predator-prey interactions based on performance capacities and how performance is affected by habitat, aiding conservation efforts to predict and manage the impacts of introduced predators on native species.
Morphology, performance, and fluid dynamics of the crayfish escape response
Authors: Hunyadi Jocelyn , Currier Todd , Modarres-Sadeghi Yahya , Flammang Brooke E. , Clotfelter Ethan D.
Published: June 2020

Sexual selection can result in exaggerated morphology that constrains locomotor performance. We studied the relationship between morphology and the tail-flip escape response in male and female rusty crayfish (Faxonius rusticus), a species in which males have enlarged claws (chelae). We found that females had wider abdomens and longer uropods (terminal appendage of the tail fan) than males, while males possessed deeper abdomens and larger chelae, relative to total length. Chelae size was negatively associated with escape velocity, whereas longer abdomens and uropods were positively associated with escape velocity. We found no sex-specific differences in maximum force generated during the tail flip, but uropod length was strongly, positively correlated with tail-flip force in males. Particle image velocimetry (PIV) revealed that the formation of a vortex, rather than the expulsion of fluid between two closing body surfaces, generates propulsion in rusty crayfish. PIV also revealed that the pleopods (ventral abdominal appendages) contribute to the momentum generated by the tail. To our knowledge, this is the first confirmation of vortex formation in a decapod crustacean.
Wind and obstacle motion affect honeybee flight strategies in cluttered environments
Authors: Burnett Nicholas P. , Badger Marc A. , Combes Stacey A.
Published: June 2020

Bees often forage in habitats with cluttered vegetation and unpredictable winds. Navigating obstacles in wind presents a challenge that may be exacerbated by wind-induced motions of vegetation. Although wind-blown vegetation is common in natural habitats, we know little about how bees’ strategies for flying through clutter are affected by obstacle motion and wind. We filmed honeybees, Apis mellifera, flying through obstacles in a flight tunnel with still air, headwinds or tailwinds. We tested how their ground speeds and centering behavior (trajectory relative to the midline between obstacles) changed when obstacles were moving vs. stationary, and how bees’ approach strategies affected flight outcome (successful transit vs. collision). We found that obstacle motion affects ground speed: bees flew slower when approaching moving vs. stationary obstacles in still air but tended to fly faster when approaching moving obstacles in head- or tailwinds. Bees in still air reduced their chances of colliding with obstacles (whether moving or stationary) by reducing ground speed - whereas flight outcomes in wind were not associated with ground speed, but rather with improvement in centering behavior during the approach. We hypothesize that in challenging flight situations (e.g., navigating moving obstacles in wind), bees may speed up to reduce the number of wing collisions that occur if they pass too close to an obstacle. Our results show that wind and obstacle motion can interact to affect flight strategies in unexpected ways, suggesting that wind-blown vegetation may have important effects on foraging behaviors and flight performance of bees in natural habitats.
The effects of temperature on the defensive strikes of rattlesnakes
Authors: Whitford Malachi D. , Freymiller Grace A. , Higham Timothy E. , Clark Rulon W.
Published: June 2020

Movements of ectotherms are constrained by their body temperature due to the effects of temperature on muscle physiology. As physical performance often affects the outcome of predator-prey interactions, environmental temperature can influence the ability of ectotherms to capture prey and/or defend themselves against predators. However, previous research on the kinematics of ectotherms suggests that some species may use elastic storage mechanisms when attacking or defending, thereby mitigating the effects of sub-optimal temperature. Rattlesnakes (Crotalus) are a speciose group of ectothermic viperid snakes that rely on crypsis, rattling, and striking to deter predators. We examined the influence of body temperature on the behavior and kinematics of two rattlesnake species (C. oreganus helleri and C. scutulatus) when defensively striking towards a threatening stimulus. We recorded defensive strikes at body temperatures ranging from 15°C–35°C. We found that strike speed and speed of mouth gaping during the strike were positively correlated with temperature. We also found a marginal effect of temperature on the probability of striking, latency to strike, and strike outcome. Overall, warmer snakes are more likely to strike, strike faster, open their mouth faster, and reach maximum gape earlier than colder snakes. However, the effects of temperature were less than would be expected for purely muscle-driven movements. Our results suggest that, although rattlesnakes are at a greater risk of predation at colder body temperatures, their decrease in strike performance may be mitigated to some extent by employing mechanisms in addition to skeletal muscle contraction (e.g. elastic energy storage) to power strikes.
Multimodality imaging of adult rhabdomyosarcoma: the added value of hybrid imaging
Authors: Gennaro Nicolò , Marrari Andrea , Renne Salvatore Lorenzo , Cananzi Ferdinando Carlo Maria , Quagliuolo Vittorio Lorenzo , Di Brina Lucia , Scorsetti Marta , Pepe Giovanna , Chiti Arturo , Santoro Armando , Balzarini Luca , Politi Letterio Salvatore , Bertuzzi Alexia Francesca
Published: June 2020

Rhabdomyosarcoma (RMS) represents more than 50% of paediatric soft tissue tumours. Conversely, it is extremely rare among adults, where it shows peculiar biological and clinical features that are still poorly investigated. RMS patients should be referred to a Sarcoma Centre, where the contribution of experienced radiologists plays a relevant role in the diagnostic assessment of the disease, including precise localisation, staging, image-guided biopsy, response evaluation after treatment and follow-up. Besides CT and MRI, hybrid imaging including positron emission tomography (PET)/CT and PET/MRI are giving an increasing contribution to provide functional insights about tumour biology and to improve the diagnostic accuracy of the imaging work-up. This review paper provides a revision of the pathology, clinical and radiological features of adult RMS, with a particular focus on the growing role of hybrid PET-based imaging.
Comparison of performance of medical students between two teaching modalities “Flip the classroom” and traditional lectures: A single center educational interventional study
Authors: Taher Fadwa , Hafiz Bayan , Alnajjar Taghreed , Almehmadi Bayan , Besharah Bayan , Gari Abdulrahim , Katib Yasir
Published: June 2020

Objectives: This study aims to compare the students’ performance in Obstetrics and Gynecology by using two teaching modalities, i.e., Flip the classroom (FTC) compared to Traditional lectures (TL) among final year medical students and assessment of the students’ satisfaction towards FTC as learning modality.

Methods: An educational interventional study was conducted on 136 females final year medical students at Umm Al-Qura University, Makkah, Saudi Arabia from September to December; 2017. Out of 40 core topics of Obstetrics and Gynecology, eight were chosen for FTC and eight for TL. The performance in each teaching modality was assessed by comparing the score of the students in multiple choice question (MCQ) and objective structured clinical examination (OSCE) in the final examination. The final performance was compared between the FTC and TL selected topics. The data was analyzed by using SPSS version 16 (SPSS Inc., Chicago, IL, USA).

Results: MCQ and OSCE grades of students (n=136) were significantly higher in FTC versus TL topics, i.e., mean ± standard deviation (13.4 ± 2.7 vs. 12.3 ± 2.4; p < 0.001) and (33.9 ± 4.3 vs. 30.4 ± 4.7; p < 0.001), respectively. Almost 60% of the students expressed their satisfaction with FTC modality.

Conclusion: Scores were significantly high for Flip the classroom topics compared to Traditional lectures.

doi: https://doi.org/10.12669/pjms.36.5.2730

How to cite this:Tahir F, Hafiz B, Alnajjar T, Almehmadi B, Besharah B, Gari A, et al. Comparison of performance of medical students between two teaching modalities “Flip the classroom” and traditional lectures: A single center educational interventional study. Pak J Med Sci. 2020;36(5):958-964. doi: https://doi.org/10.12669/pjms.36.5.2730

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Recent advances in managing and understanding Stevens-Johnson syndrome and toxic epidermal necrolysis
Authors: Hasegawa Akito , Abe Riichiro
Published: June 2020

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening diseases characterized by detachment of the epidermis and mucous membrane. SJS/TEN are considered to be on the same spectrum of diseases with different severities. They are classified by the percentage of skin detachment area. SJS/TEN can also cause several complications in the liver, kidneys, and respiratory tract. The pathogenesis of SJS/TEN is still unclear. Although it is difficult to diagnose early stage SJS/TEN, biomarkers for diagnosis or severity prediction have not been well established. Furthermore, optimal therapeutic options for SJS/TEN are still controversial.

Several drugs, such as carbamazepine and allopurinol, are reported to have a strong relationship with a specific human leukocyte antigen (HLA) type. This relationship differs between different ethnicities. Recently, the usefulness of HLA screening before administering specific drugs to decrease the incidence of SJS/TEN has been investigated.

Skin detachment in SJS/TEN skin lesions is caused by extensive epidermal cell death, which has been considered to be apoptosis via the Fas-FasL pathway or perforin/granzyme pathway. We reported that necroptosis, i.e. programmed necrosis, also contributes to epidermal cell death. Annexin A1, released from monocytes, and its interaction with the formyl peptide receptor 1 induce necroptosis. Several diagnostic or prognostic biomarkers for SJS/TEN have been reported, such as CCL-27, IL-15, galectin-7, and RIP3.

Supportive care is recommended for the treatment of SJS/TEN. However, optimal therapeutic options such as systemic corticosteroids, intravenous immunoglobulin, cyclosporine, and TNF-α antagonists are still controversial. Recently, the beneficial effects of cyclosporine and TNF-α antagonists have been explored. In this review, we discuss recent advances in the pathophysiology and management of SJS/TEN.
Research protocol for a mixed-methods study to characterise and address the socioeconomic impact of accessing TB diagnosis and care in Nepal
Authors: Dixit Kritika , Rai Bhola , Prasad Aryal Tara , Mishra Gokul , Teixeira de Siqueira-Filha Noemia , Raj Paudel Puskar , Levy Jens W. , van Rest Job , Chandra Gurung Suman , Dhital Raghu , Biermann Olivia , Viney Kerri , Lonnroth Knut , Squire S Bertel , Caws Maxine , Wingfield Tom
Published: June 2020

Background: WHO’s 2015 End TB Strategy advocates social and economic (socioeconomic) support for TB-affected households to improve TB control. However, evidence concerning socioeconomic support for TB-affected households remains limited, especially in low-income countries.

Protocol: This mixed-methods study in Nepal will: evaluate the socioeconomic impact of accessing TB diagnosis and care (Project 1); and create a shortlist of feasible, locally-appropriate interventions to mitigate this impact (Project 2). The study will be conducted in the Chitwan, Mahottari, Makawanpur, and Dhanusha districts of Nepal, which have frequent TB and poverty.

The study population will include: approximately 200 people with TB (Cases) starting TB treatment with Nepal’s National TB Program and 100 randomly-selected people without TB (Controls) in the same sites (Project 1); and approximately 40 key in-country stakeholders from Nepal including people with TB, community leaders, and TB healthcare professionals (Project 2).

During Project 1, visits will be made to people with TB’s households during months 3 and 6 of TB treatment, and a single visit made to Control households. During visits, participants will be asked about: TB-related costs (if receiving treatment), food insecurity, stigma; TB-related knowledge; household poverty level; social capital; and quality of life.

During Project 2, stakeholders will be invited to participate in: a survey and focus group discussion (FGD) to characterise socioeconomic impact, barriers and facilitators to accessing and engaging with TB care in Nepal; and a one-day workshop to review FGD findings and suggest interventions to mitigate the barriers identified.

Ethics and dissemination: The study has received ethical approval. Results will be disseminated through scientific meetings, open access publications, and a national workshop in Nepal. 

Conclusions: This research will strengthen understanding of the socioeconomic impact of TB in Nepal and generate a shortlist of feasible and locally-appropriate socioeconomic interventions for TB-affected households for trial evaluation.
Consequences of untreated rheumatoid arthritis in an uncompliant patient.
Authors: Barieva B.
Published: June 2020

This article describes a clinical case of rheumatoid arthritis, actively "untreated" for several decades in an incompetent patient. The absence of basic therapy led to severe deformities of the limbs, movement restrictions, scleritis, and AA-amyloidosis.
Intellectual Capital in the Light of CREATIVITY and competitiveness: an Overview of Intangible Assets of Organizations on the Example of Ukraine
Authors: Myasoedov Aleksey
Published: June 2020

This article discusses several issues related to intellectual capital, including a historical review, interest in elusive and intangible assets, and the impact of recent technological progress related to the development of information technology. Ralph Styer, CEO of Johnsonville Foods Company, was the first to use the term “intellectual property” to refer to an organization’s intangible assets. This document also defines the concept of intellectual property, which is the totality of all the knowledge that organizations have that helps them achieve their goals. Intellectual property includes ideas, inventions, technologies, general knowledge, computer software products and programs, projects, data skills, processes, creativity and applications in all organizations. Intellectual capital is knowledge that can be converted into profit. The components of this concept were defined as follows: structural capital, human capital, social capital and psychological capital. The article also discusses various definitions presented by a number of scholars related to intellectual capital, including: Edvinsson & Malone, K.E. Svieby, Y. Malhorta, T. Stuart, Depres and Channel, as well as Mackenzie and Winkelen. The article concludes that specific issues regarding companies and the nature of the market do not allow for certain results that can be generalized by comparing modern administrative trends or attitudes that define intellectual capital as intangible assets.
Theoretical Approaches in the Study of the Non-Governmental, Non-Commercial Sector in Modern Russia
Authors: Jach Anna
Published: June 2020

As part of a political system constituted by individuals and social groups, due to its pro publico bono activities, the non-governmental, non-commercial sector (also known as institutions of civil society) is usually referred to by different terms, both in foreign (English) and Russian languages. Since the Russian nongovernmental, non-commercial sector (некоммерческая неправительственная организация) is not identical to its Western variants, it exhibits a number of differences, the sources of which are both exogenous and endogenous conditions. The issue of the specificities of the non-governmental, non-commercial sector can be researched through a system analysis. The theoretical context for this method creates a new institutionalism, also called neo-institutionalism. In turn, the institutional analysis refers to such theories as systemic change and neo-corporatism as well as the theory of participation or political participation. What turned out to be indispensable were the models defining the conceptual framework for such phenomena as group theory – interest/pressure, or metapolitics, but with regard to its civil forms of participation. The abovementioned methods and stances prove the complexity of the presented subject – the multifaceted nature of the problem, where the exploratory field requires referring to research techniques and tools from many related disciplines. The issue of the non-governmental, non-commercial sector in contemporary Russia should be perceived as a specific phenomenon, primarily because this sector is developing, no matter what transformations of an internal nature occur. Its exploration requires using such theoretical approaches that will allow its mechanisms to be defined. Such an approach must include the specifics of the society and the state within which the social sector develops. Therefore the presentation of theoretical premises applied in research on non-governmental, non-commercial sector in today’s Russia is the first step in diagnosing the phenomenon of the functioning of a non-governmental, non-commercial sector in the conditions of an authoritarian state.
Perspective Reformulations of Semicontinuous Quadratically Constrained Quadratic Programs
Authors: Zheng Xiaojin , Pan Yutong , Hu Zhaolin
Published: June 2020

We study perspective reformulations (PRs) of semicontinuous quadratically constrained quadratic programs (SQCQPs) in this paper. Based on perspective functions, we first propose a class of PRs for SQCQPs and discuss how to find the best PR in this class via strong duality and lifting techniques. We then study the properties of the PR class and relate them to alternative formulations that are used to derive lower bounds for SQCQPs. Finally, we embed the PR bounds in branch-and-bound algorithms and conduct computational experiments to illustrate the effectiveness of the proposed approach.
Invite Your Friend and You’ll Move Up in Line: Optimal Design of Referral Priority Programs
Authors: Yang Luyi
Published: June 2020

Problem definition : This paper studies the optimal design of referral priority programs, in which customers on a waiting list can jump the line by inviting their friends to also join the waiting list. Academic/practical relevance : Recent years have witnessed a growing presence of referral priority programs as a novel customer-acquisition strategy for firms that maintain a waiting list. Different variations of this scheme are seen in practice, raising the question of what should be the optimal referral priority mechanism. Methodology : I build an analytical model that integrates queuing theory into a mechanism design framework in which the objective of the firm is to maximize the system throughput, that is, accelerate customer acquisition as much as possible. Results : My analysis shows that the optimal mechanism has one of the following structures: full priority; partial priority; first in, first out (FIFO); and strategic delay. A full-priority (partial-priority) scheme enables referring customers to get ahead of all (only some) nonreferring ones. A FIFO scheme does not provide any priority-based referral incentive. A strategic-delay scheme grants full priority to referring customers but artificially inflates the delay of nonreferring ones. I show that FIFO is optimal if either the base-market size or the referral cost is large. Otherwise, partial priority is optimal if the base-market size is above a certain threshold; full priority is optimal at the threshold base-market size; strategic delay is optimal if the base-market size is below the threshold. I also find that referrals motivate the firm to maintain a larger capacity and therefore can surprisingly shorten the average delay, even though more customers sign up and strategic delay is sometimes inserted. Managerial implications : My paper provides prescriptive guidance for launching an optimal referral priority program and rationalizes common referral schemes seen in practice.
Learning in Combinatorial Optimization: What and How to Explore
Authors: Modaresi Sajad , Sauré Denis , Vielma Juan Pablo
Published: June 2020

When moving from the traditional to combinatorial multiarmed bandit setting, addressing the classical exploration versus exploitation trade-off is a challenging task. In “Learning in Combinatorial Optimization: What and How to Explore,” Modaresi, Sauré, and Vielma show that the combinatorial setting has salient features that distinguish it from the traditional bandit. In particular, combinatorial structure induces correlation between cost of different solutions, thus raising the questions of what parameters to estimate and how to collect and combine information. The authors answer such questions by developing a novel optimization problem called the lower-bound problem (LBP). They establish a fundamental limit on asymptotic performance of any admissible policy and propose near-optimal LBP-based policies. Because LBP is likely intractable in practice, they propose policies that instead solve a proxy for LBP, which they call the optimality cover problem (OCP). They provide strong evidence of practical tractability of OCP and illustrate the markedly superior performance of OCP-based policies numerically.
Technical Note—Time Inconsistency of Optimal Policies of Distributionally Robust Inventory Models
Authors: Shapiro Alexander , Xin Linwei
Published: June 2020

The authors extend previous studies of time inconsistency to risk averse (distributionally robust) inventory models and show that time inconsistency is not unique to robust multistage decision making, but may happen for a large class of risk averse/distributionally robust settings. In particular, they demonstrate that if the respective risk measures are not strictly monotone, then there may exist infinitely many optimal policies which are not base-stock and not time consistent. This is in a sharp contrast with the risk neutral formulation of the inventory model where all optimal policies are base-stock and time consistent.
SÍTIO VETOR DE FÉ E DE EXPANSÃO URBANA: A IGREJA DE NOSSA SENHORA DA SAÚDE
Authors: De Macedo Jackeline
Published: June 2020

A partir da abordagem da Arqueologia Histórica, pretendeu-se identificar os diversos atores (humanos e não-humanos) que se fizeram presentes na tessitura das redes estabelecidas na construção do sítio Igreja Nossa Senhora da Saúde, na cidade do Rio de Janeiro/RJ  bem como, destacar os processos que levaram ao rompimento dos limites do quadrilátero urbano da cidade colonial e a relevância do sítio da Saúde na constituição da paisagem urbana da região.
Research Roundup
Authors: Dening Karen Harrison
Published: June 2020

Karen Harrison Dening provides a synopsis and brief review of a selection of recently published research articles that are of interest to neuroscience nurses, highlighting key points to keep you up to date; a full reference is provided for those who wish to read the research in more detail
BANN explores changing professional roles during the pandemic
Authors: Spence Emily
Published: June 2020

In the face of the COVID-19 crisis, many health professionals found that their responsibilities changed drastically overnight. Redeployment and transfers to cope with patient intake has meant that many are revisiting old roles and skillsets, or quickly developing new ones. Emily Spence shares this issue's BANN pages with several neuroscience colleagues, telling their stories from the frontline of the pandemic
Real-time and high-throughput Raman signal extraction and processing in CARS hyperspectral imaging
Authors: Camp Jr. Charles H. , Bender John S. , Lee Young Jong
Published: June 2020

We present a new collection of processing techniques, collectively "factorized Kramers–Kronig and error correction" (fKK-EC), for (a) Raman signal extraction, (b) denoising, and (c) phase- and scale-error correction in coherent anti-Stokes Raman scattering (CARS) hyperspectral imaging and spectroscopy. These new methods are orders-of-magnitude faster than conventional methods and are capable of real-time performance, owing to the unique core concept: performing all processing on a small basis vector set and using matrix/vector multiplication afterwards for direct and fast transformation of the entire dataset. Experimentally, we demonstrate that a 703026 spectra image of chicken cartilage can be processed in 70 s (≈ 0.1 ms / spectrum), which is ≈ 70 times faster than with the conventional workflow (≈7.0 ms / spectrum). Additionally, we discuss how this method may be used for machine learning (ML) by re-using the transformed basis vector sets with new data. Using this ML paradigm, the same tissue image was processed (post-training) in ≈ 33 s, which is a speed-up of ≈ 150 times when compared with the conventional workflow.
Material decomposition from a single x-ray projection via single-grid phase contrast imaging
Authors: Groenendijk Celebrity F. , Schaff Florian , Croton Linda C. P. , Kitchen Marcus J. , Morgan Kaye S.
Published: June 2020

This study describes a new approach for material decomposition in x-ray imaging, utilizing phase contrast both to increase sensitivity to weakly attenuating samples and to act as a complementary measurement to attenuation, therefore allowing two overlaid materials to be separated. The measurements are captured using the single-exposure, single-grid x-ray phase contrast imaging technique, with a novel correction that aims to remove propagation-based phase effects seen at sharp edges in the attenuation image. The use of a single-exposure technique means that images can be collected in a high-speed sequence. Results are shown for both a known two-material sample and for a biological specimen.