Developing tool and Measuring Integration Characteristics of Basic Science Curriculum to Improve Curriculum Integration

Background Integrated curriculum enhances students' learning and the retention of knowledge. At Patan Academy of Health Sciences, integrated organ system based curriculum is used with Problem Based Learning as the principle teaching learning method to foster students' learning. In addition, other approaches of integration were under taken such as integrated assessment; logical arrangement teaching learning methods (lectures and practicals); joint effort of faculty in curriculum planning and delivery; conducive environment to foster hidden curriculum. This study describes the perception of faculty and students on integration characteristics of Basic Science curriculum. Objective To measure the integration characteristics of Basic Science Curriculum. Method Tool was developed to measure integration characteristics of Basic Science Curriculum and ensure whether such planned integration has been achieved. Mixed method was used to measure the perception of the integration characteristics i) quantitatively by questionnaire survey to faculty and students ii) qualitatively by in-depth interview of students. Result Both faculty and students perceived that all the blocks in Basic Science was well integrated in the quantitative questionnaire survey. But, in the in-depth interview, students perceived integration of curriculum in organ system blocks were better integrated compared to Principle of Human Biology blocks where fundamentals of basic science disciplines were delivered. Students reflected that Problem Based Learning not only integrated Basic Science disciplines but also with clinical sciences and the social context. But, students perceived that Community Health Sciences curriculum was not so well integrated with Basic Science subjects. Conclusion Overall, this study showed that planned integration in Basic Science curriculum was successfully executed during curriculum implementation.

Blazar spectral variability as explained by a twisted inhomogeneous jet

Blazars are active galactic nuclei, which are powerful sources of radiation whose central engine is located in the core of the host galaxy. Blazar emission is dominated by non-thermal radiation from a jet that moves relativistically towards us, and therefore undergoes Doppler beaming. This beaming causes flux enhancement and contraction of the variability timescales, so that most blazars appear as luminous sources characterized by noticeable and fast changes in brightness at all frequencies. The mechanism that produces this unpredictable variability is under debate, but proposed mechanisms include injection, acceleration and cooling of particles, with possible intervention of shock waves or turbulence. Changes in the viewing angle of the observed emitting knots or jet regions have also been suggested as an explanation of flaring events and can also explain specific properties of blazar emission, such as intra-day variability, quasi-periodicity and the delay of radio flux variations relative to optical changes. Such a geometric interpretation, however, is not universally accepted because alternative explanations based on changes in physical conditions-such as the size and speed of the emitting zone, the magnetic field, the number of emitting particles and their energy distribution-can explain snapshots of the spectral behaviour of blazars in many cases. Here we report the results of optical-to-radio-wavelength monitoring of the blazar CTA 102 and show that the observed long-term trends of the flux and spectral variability are best explained by an inhomogeneous, curved jet that undergoes changes in orientation over time. We propose that magnetohydrodynamic instabilities or rotation of the twisted jet cause different jet regions to change their orientation and hence their relative Doppler factors. In particular, the extreme optical outburst of 2016-2017 (brightness increase of six magnitudes) occurred when the corresponding emitting region had a small viewing angle. The agreement between observations and theoretical predictions can be seen as further validation of the relativistic beaming theory.

Deposition and spatial variation of thoron decay products in a thoron experimental house using the Direct Thoron Progeny Sensors

Experiments have been carried out using the deposition-based Direct Thoron Progeny Sensors (DTPS) in a thoron experimental house. The objective was to study the thoron decay product characteristics such as the deposition velocities, spatial variability and dependence on aerosol particle concentrations. Since the deposition velocity is an important characteristic in the calibration of the DTPS, it is very important to study its dependence on aerosol concentration in a controlled environment. At low aerosol concentration (1500 particles/cm³) the mean effective deposition velocity was measured to be 0.159 ± 0.045 m h^-1; at high aerosol concentration (30 000 particles/cm³) it decreased to 0.079 ± 0.009 m h^-1. The deposition velocity for the attached fraction of the thoron decay products did not change with increasing aerosol concentration, showing measurement results of 0.048 ± 0.005 m h^-1 and 0.043 ± 0.014 m h^-1, respectively. At low particle concentration, the effective deposition velocity showed large scattering within the room at different distances from center. The attached fraction deposition velocity remained uniform at different distances from the wall. The measurements in the thoron experimental house can be used as a sensitivity test of the DTPS in an indoor environment with changing aerosol concentration. The uniform spatial distribution of thoron decay products was confirmed within the experimental house. This indicates that direct measurement of thoron decay product concentration should be carried out instead of inferring it from thoron gas concentration, which is very inhomogeneous within the experimental house.

Effectiveness of amitriptyline and lamotrigine in traumatic spinal cord injury-induced neuropathic pain: a randomized longitudinal comparative study

STUDY DESIGN

Randomized longitudinal comparative study.

OBJECTIVES

To compare the efficacy of lamotrigine and amitriptyline in the management of traumatic spinal cord injury (SCI)-induced neuropathic pain (NP).

SETTING

Sawai Man Singh Medical College and Hospital, Jaipur, India.

METHODS

A total of 147 individuals with NP were randomized for a 3-week trial of either amitriptyline or lamotrigine. Amitriptyline was administered orally at doses of 25, 50 and 100 mg once daily at night time, and lamotrigine was administered orally at doses of 25, 50 and 100 mg twice daily, both for 1 week by means of optional titration. Assessment of NP was done at baseline and thereafter at 1, 2 and 3 weeks using Short-form MC Gill Pain Questionnaire-2 (SFMPQ2) scores.

RESULTS

There was a significant difference between the mean values of the SFMPQ2 score at baseline and those at each follow-up for amitriptyline. Similar results were seen in the lamotrigine group. When the differences in mean SFMPQ2 scores at different time frames from baseline were compared with those of the other group, values were found to be nonsignificant as seen on the Mann-Whitney U-test.

CONCLUSIONS

These findings support the use of both amitriptyline and lamotrigine in the management of NP after traumatic SCI.

Effect of 220Rn gas concentration distribution on its transmission from a delay chamber: evolving a CFD-based uniformity index

(220)Rn mitigation can be achieved by delay chamber technique, which relies on the advantage of its short half-life. However, flow rate as well as inlet-outlet position for the delay chamber can have a significant impact on (220)Rn concentration distribution patterns and hence transmission factor. In the present study, computational fluid dynamics simulations to estimate the concentration distribution has been carried out in a chamber of 0.5 m(3) for the combination of six different inlet-outlet positions and five different flow rates. Subsequently, the transmission factor (TF) for the chamber was evaluated and found to be highly dependent on the flow rate and inlet-outlet positions. For ease of scale up, the dependency of TF on the flow rate and the inlet-outlet positions is best summarised by relative transmission factor (RTF), which is the ratio of the TFs for the case of inlet and outlet on different faces to that on the same face.

NMR-based metabonomics for understanding the influence of dormant female genital tuberculosis on metabolism of the human endometrium

STUDY QUESTION

Does investigation of metabolic perturbations in endometrial tissue of women with dormant genital tuberculosis (GTB) during the window of implantation (WOI) assist in improving the understanding of endometrial receptivity?

SUMMARY ANSWER

In dormant GTB cases significant alterations in endometrial tissue metabolites occur, largely related to energy metabolism and amino acid biosynthesis in dormant GTB cases.

WHAT IS KNOWN ALREADY

As an intracellular pathogen, Mycobacterium tuberculosis strongly influences the metabolism of host cells causing metabolic dysregulation. It is also accepted that dormant GTB impairs the receptive status of the endometrium. Global metabolic profiling is useful for an understanding of disease progression and distinguishing between diseased and non-diseased groups.

STUDY DESIGN, SIZE, DURATION

Endometrial tissue samples were collected from patients reporting at the tertiary infertility care center during the period September 2011-March 2013. Women having tested positive for GTB were considered as the study group (n = 24). Normal healthy women undergoing sterilization (n = 26) and unexplained infertile women with repeated IVF failure (n = 21) volunteered to participate as controls.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Endometrial tissue samples were collected 6-10 days after confirmation of ovulation. PCR and BACTEC-460 culture were used for diagnosing GTB. Proton nuclear magnetic resonance (1H NMR) spectra of tissue were recorded using a 700 MHz Bruker Avance AV III spectrometer. Following phase and baseline correction of all NMR spectra by Bruker Topspin 2.1 software, spectral peak alignment of the data was performed. Multivariate analysis was applied to all spectra and individual metabolites identified and multiple correlation analysis was performed.

MAIN RESULTS AND THE ROLE OF CHANCE

Leucine, isoleucine, acetate, lactate, glutamate, glutamine, methionine, lysine, creatine, glycogen, glycine, proline and choline were found to be significantly increased (P < 0.05) in endometrial tissue of women with dormant GTB compared with unexplained infertile women with repeated implantation failure. Valine, citrate, succinate and aspartate were also observed to be significantly up-regulated (P < 0.01). Furthermore, a significant decrease in glucose (P < 0.05), threonine (P < 0.05), tyrosine (P < 0.01) and phenylalanine (P < 0.0001) was observed in women with dormant GTB. Pearson's correlation analysis between the expression of various endometrial receptivity markers and metabolites showed a significant negative correlation (-0.236 to -0.545, P < 0.05). Also, the metabolites were positively correlated with endometrial receptivity markers (0.207 to 0.618, P < 0.05).

LIMITATIONS, REASONS FOR CAUTION

It is often difficult to diagnose dormant GTB because it tends to exist without any clinical signs or symptoms. In addition, the diagnosis of GTB by culture remains a challenge due to low detection rates and its paucibacillary nature. Testing for prostate-specific antigen or the Y chromosome in order to account for the possible influences of recent exposure to semen on endometrial metabolism would be important.

WIDER IMPLICATIONS OF THE FINDINGS

The metabolic changes associated with the dormant tubercle infection are of potential relevance to clinicians for the treatment of dormant GTB-related infertility.

STUDY FUNDING/COMPETING INTERESTS

Government of India, Indian Council of Medical Research. There are no conflicts of interest.

Dexamethasone may be the most efficacious corticosteroid for use as monotherapy in castration-resistant prostate cancer

Corticosteroids have been used in the therapy for castration-resistant prostate cancer (CRPC) for decades, both as monotherapy and in combination with additional agents. In this article the authors report the results of a phase II trial of dexamethasone versus prednisolone as monotherapy for CRPC. The study suggests improved PSA and radiographic response rates as well as improved time to PSA progression for dexamethasone over prednisolone therapy; however the differences only trend toward statistical significance. Nonetheless, in light of these data, when treating patients with corticosteroid monotherapy for CRPC it may be prudent to consider using daily dexamethasone over prednisone/prednisolone.

Evaluation of the immature platelet fraction as an indicator of platelet recovery in dengue patients

INTRODUCTION

Thrombocytopenia is a common complication in many disorders (such as aplastic anemia, ITP, dengue fever,), the etiology being multifactorial. Immature platelet fraction (IPF) is a new parameter which is a measure of reticulated platelets that reflects the rate of thrombopoiesis. We tried to evaluate IPF as an indicator to predict the recovery of platelets in patients with dengue.

METHODS

A total of 32 patients suffering from dengue fever (as confirmed by NS1 antigen or IgM antibody positivity for dengue) were taken for the study. The platelet count and IPF value of all these patients were evaluated on a daily basis.

RESULTS

It was found out that IPF has a strong correlation with the recovery of platelet counts in patients with dengue. 84.3% patients showed recovery within 24 h after attaining the peak IPF, 93.75% of the patients showed recovery within 24-48 h of the rise of the IPF compared with the previous day's value, and 100% patients showed a recovery within 24 h of the fall of the IPF compared with the previous days. It was also observed that 93.75% of the patients show platelet recovery within 24-48 h if the IPF was more than 10%.

CONCLUSION

Based on our study, we concluded that IPF can be used to evaluate the recovery of platelets in patients with dengue. It holds a great promise of becoming a reliable future guide for decisions concerning platelet transfusions.

Study of indoor radon distribution using measurements and CFD modeling

Measurement and/or prediction of indoor radon ((222)Rn) concentration are important due to the impact of radon on indoor air quality and consequent inhalation hazard. In recent times, computational fluid dynamics (CFD) based modeling has become the cost effective replacement of experimental methods for the prediction and visualization of indoor pollutant distribution. The aim of this study is to implement CFD based modeling for studying indoor radon gas distribution. This study focuses on comparison of experimentally measured and CFD modeling predicted spatial distribution of radon concentration for a model test room. The key inputs for simulation viz. radon exhalation rate and ventilation rate were measured as a part of this study. Validation experiments were performed by measuring radon concentration at different locations of test room using active (continuous radon monitor) and passive (pin-hole dosimeters) techniques. Modeling predictions have been found to be reasonably matching with the measurement results. The validated model can be used to understand and study factors affecting indoor radon distribution for more realistic indoor environment.

CFD based simulation of thoron ((220)Rn) concentration in a delay chamber for mitigation application

The release of (220)Rn gas (conventionally referred to as thoron) is an issue of concern from the radiological point of view for occupational environments pertaining to the thorium fuel cycle. Studies for understanding its release and developing systems to control it are crucial for exposure control research. A thorough study of the "Delay Volume Technique" for mitigation of (220)Rn has been carried out. Experiments have been carried out with (220)Rn source and associated measurement system in a cubical chamber (delay chamber) of 0.5 m(3) volume. For different flow conditions and inlet-outlet positions, (220)Rn transmission factor has been obtained. Computational Fluid Dynamics (CFD) technique has been employed for these experimental conditions and the simulated transmission factors have been compared. The results show that the flow and the position of the inlet and outlet play an imperative role in the transportation, mixing and subsequent mitigation of thoron inside the chamber. Predictive capability of CFD technique for such delay volume experiments has been validated in this work. A comparison has been made with uniform mixing model and it is found that the results of simulation differ appreciably from that of uniform mixing model at the tested flow regime.

OnabotulinumtoxinA 100U provides significant improvements in overactive bladder symptoms in patients with urinary incontinence regardless of the number of anticholinergic therapies used or reason for inadequate management of overactive bladder

INTRODUCTION

A prespecified pooled analysis of two placebo-controlled, phase 3 trials evaluated whether the number of prior anticholinergics used or reason for their discontinuation affected the treatment response to onabotulinumtoxinA 100U in overactive bladder (OAB) patients with urinary incontinence (UI).

METHODS

Patients with symptoms of OAB received intradetrusor injections of onabotulinumtoxinA 100U or placebo, sparing the trigone. Change from baseline at week 12 in UI episodes/day, proportion of patients reporting a positive response ('greatly improved' or 'improved') on the treatment benefit scale (TBS), micturition and urgency were evaluated by number of prior anticholinergics (1, 2 or ≥ 3) and reason for their discontinuation (insufficient efficacy or side effects). Adverse events (AE) were assessed.

RESULTS

Patients had taken an average of 2.4 anticholinergics before study enrolment. OnabotulinumtoxinA reduced UI episodes/day from baseline vs. placebo, regardless of the number of prior anticholinergics (-2.82 vs. -1.52 for one prior anticholinergic; -2.58 vs. -0.58 for two prior anticholinergics; and -2.92 vs. -0.73 for three or more prior anticholinergics; all p < 0.001). The proportion of TBS responders was higher with onabotulinumtoxinA vs. placebo (69.0% vs. 37.2% for one prior anticholinergic; 58.8% vs. 24.8% for two prior anticholinergics and 56.4% vs. 22.5% for three or more prior anticholinergics; all p < 0.001). Similar results were observed regardless of the reason for discontinuation. OnabotulinumtoxinA reduced the episodes of urgency and frequency of micturition vs. placebo in all groups. AEs were well tolerated, with a comparable incidence in all groups.

CONCLUSION

In patients with symptoms of OAB who were inadequately managed by one or more anticholinergics, onabotulinumtoxinA 100U provided significant and similar treatment benefit and safety profile regardless of the number of prior anticholinergics used or reason for inadequate management of OAB. ClinicalTrials.gov: NCT00910845, NCT00910520.

Educational barriers of nurses caring for sick and at-risk infants in India

AIM

To gain ideas and information from healthcare providers to optimize the education and clinical practices of nurses caring for sick or at-risk newborns in India.

BACKGROUND

Improving infant survival has been identified as a Millennium Development Goals; however, India still faces many challenges with 3.1 million neonatal deaths and 2.6 million stillbirths annually. Skilled nursing care has been associated with decreased morbidity and mortality in newborns. However, core competencies in newborn care education and training are lacking for nurses.

METHODS

Qualitative data were collected from 12 focus groups with 101 newborn care providers from three areas of India as well as from a 2-day stakeholders' meeting. Data analysis was undertaken using descriptive and thematic content analysis.

RESULTS

Perceived challenges included limited manpower and high nurse turnover, lack of access to evidence-based orientation to newborn care and problems with access to appropriate learner-based, neonatal training. Relevant, ongoing education opportunities, led by nursing leaders were identified to be important solutions.

CONCLUSION

Findings provide insight into the current healthcare system in India with specific reference to the nursing care of at-risk newborns. There is a lack of existing resources to provide standardized and specific orientation curricula for nurses.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Policy makers in health and education need to: support and enact learner-based orientation and continuing educational opportunities as well as ongoing competency-based education programmes; encourage nurse leader involvement and support; and provide sustainable system-related supports. Nurses and other health providers need to work together to influence government policy.