6-week Course Research Articles

Transcranial Direct Current Stimulation Combined With Repetitive Transcranial Magnetic Stimulation for Depression

ImportanceRepetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are both recognized as effective treatments for depression when applied individually. However, it is unknown whether rTMS combined with tDCS has better efficacy in the treatment of major depressive disorder (MDD).ObjectiveTo investigate the clinical effectiveness and safety of rTMS, tDCS, tDCS + rTMS, and sham tDCS + sham rTMS after 2 weeks of treatment in patients with MDD.Design, Setting, and ParticipantsThis double-blind, sham-controlled randomized clinical trial was conducted from November 2021 to April 2023 at 3 hospitals in China (Kangning Hospital affiliated with Ningbo University, Lishui Second People’s Hospital, and Taizhou Second People’s Hospital). Adult patients (aged 18-65 years) who were diagnosed with major depressive disorder were recruited. Participants were randomly assigned to 1 of 4 interventions: active tDCS + active rTMS, sham tDCS + active rTMS, active tDCS + sham rTMS, and sham tDCS + sham rTMS. Data analysis followed an intention-to-treat approach.InterventionPatients received a 2-week course of treatment. The tDCS was administered using a 2-mA direct current stimulator with electrodes placed on the left and right dorsolateral prefrontal cortex (DLPFC). Each tDCS session lasted 20 minutes and was conducted 30 to 60 minutes prior to the rTMS session for a total of 10 sessions. The rTMS was delivered at a frequency of 10 Hz using a figure-8 coil placed on the left DLPFC, with each session consisting of 1600 pulses. Treatments were administered 5 times per week for 2 weeks. Sham treatments were performed with a pseudostimulation coil and emitted only sound.Main Outcomes and MeasuresThe primary outcome was the change in total score from baseline to week 2 on the 24-item Hamilton Depression Rating Scale (HDRS-24; score range: 0-52, with the highest score indicating more severe symptoms).ResultsA total of 240 participants (139 females [57.9%]; mean [SD] age, 32.50 [15.18] years) were included. As a primary outcome, patients who received active tDCS + active rTMS showed a significantly greater reduction in mean (SD) HDRS-24 total scores compared with patients in the other 3 groups (active tDCS + active rTMS: 18.33 [5.39], sham tDCS + active rTMS: 14.86 [5.59], active tDCS + sham rTMS: 9.21 [4.61], and sham tDCS + sham rTMS: 10.77 [5.67]; F3,236 = 35.79; η2 = 0.31 [95% CI, 0.21-0.39]; P < .001).Conclusions and RelevanceThis trial found that tDCS + rTMS was a more effective and safe treatment option than either the tDCS or rTMS intervention alone for patients with MDD.Trial RegistrationChina Clinical Trial Registry Identifier ChiCTR2100052122.

The effect of sevelamer on serum calcification propensity in patients with chronic kidney disease: the results of a multicentre, double-blind, placebo-controlled, randomized clinical trial

Abstract Background The serum calcification propensity test (or T50 test) might become a standard tool for the assessment of vascular calcification risk, and T50 might be a valuable biomarker in clinical trials of treatments intended to slow the progression of vascular calcification. Literature data suggest that non-calcium-containing phosphate binders can influence T50 in chronic dialyzed patients. However, it is not clear whether similar interventions are effective in patients at earlier stages of chronic kidney disease (CKD). Methods The “FGF23 Reduction efficacy of a new Phosphate Binder in CKD” (FRENCH) trial was a multi-centre, double-blind, placebo-controlled, randomized trial of sevelamer carbonate in participants with stage 3b/4 CKD. In this subanalysis of the FRENCH data, T50 and other laboratory variables (including fetuin A, and ionized and total magnesium) were measured centrally at baseline and after 12 weeks of treatment. Results A total of 96 patients were screened; 78 (55 men and 23 women) met the inclusion criteria and were randomized to receive placebo (n=39) or sevelamer carbonate (n=39). The median [interquartile range] patient age was 66 [56-72], the median eGFR was 25 [21-30] mL/min/1.73m², and the mean T50 was 335 (82) minutes. In a linear regression model, T50 was independently associated with serum ionized magnesium, fetuin-A and bicarbonate levels; and inversely associated with phosphate concentration. The within-group changes in the mean [95% confidence interval] T50 between week 0 and week 12 were not significant in the sevelamer group or the placebo group (4.6 [-13.6; 22.8] minutes (p=0.61) and 7.8 [-16.4; 32.1] minutes (p=0.51), respectively). Furthermore, we did not observe significant changes in fetuin-A and magnesium levels. Conclusion A 12-week course of the non-calcium-containing phosphate binder sevelamer carbonate was not associated with a significant change in T50 in patients with stage 3b/4 CKD. Phosphate binders might not be an effective strategy for modifying serum calcification propensity in non-dialysis-dependent patients with CKD.

Abstract 4119116: Percutaneous Aspiration of Mitral Valve Endocarditis using the AngioVac Device

Case Description: A 68-year-old man with end-stage renal disease on dialysis, peripheral vascular disease with metatarsal amputations, atrial fibrillation and type 1 diabetes was admitted for foot osteomyelitis secondary to MSSA bacteremia. Transesophageal echocardiogram revealed mobile mitral valve vegetations up to 1.8cm on the atrial aspect of the posterior mitral valve leaflet which prolapsed through the mitral valve during diastole. Ejection fraction was 60% and there was trivial-mild mitral regurgitation without valvular destruction or peri-annular extension into the mitral annulus. MRI brain showed bilateral cerebral and cerebellar hemispheric infarcts, consistent with acute embolic stroke. He was at high risk for both recurrent embolism and operative mortality (STS risk score 51%) due to his comorbidities and risk of hemorrhagic conversion of stroke. After shared decision making, percutaneous aspiration of the mitral vegetation was performed with AngioVac (Fig). Cerebral embolism protection devices were deployed prior to AngioVac evacuation of the mass. There was no residual mitral regurgitation and only a small vegetation strand remained (Fig). Surgical pathology confirmed MSSA endocarditis. Blood cultures remained negative, and the patient did not suffer from recurrent embolic events. The patient underwent revision metatarsal amputation and was discharged with a 6-week course of IV cefazolin. Discussion: Infective endocarditis with high embolic risk is life-threatening and challenging to treat in patients with high surgical risk. We illustrate a case of percutaneous vegetation aspiration using the AngioVac device in our patient who suffered from embolic strokes due to MSSA mitral valve endocarditis. Meta-analyses have shown clinically successful debulking in 90% of cases, with 82% of patients able to clear bacteremia with AngioVac. Although most commonly used in right-sided lesions, percutaneous debulking of left-sided endocarditis with AngioVac and cerebral protection can be considered as a treatment strategy in select patients with prohibitive surgical risk.

Narratives of Mental Illness and Well-being: A 6-Week Course Aiming to Improve Medical Student Empathy and Resilience Through the Creative Arts

Narratives of Mental Illness and Well-being: A 6-Week Course Aiming to Improve Medical Student Empathy and Resilience Through the Creative Arts

Semaglutide Ameliorates Diabetic Neuropathic Pain by Inhibiting Neuroinflammation in the Spinal Cord

Glucagon-like peptide 1 (GLP-1) receptor agonists are frequently used to treat type 2 diabetes and obesity. Despite the development of several drugs for neuropathic pain management, their poor efficacy, tolerance, addiction potential, and side effects limit their usage. Teneligliptin, a DPP-4 inhibitor, has been shown to reduce spinal astrocyte activation and neuropathic pain caused by partial sciatic nerve transection. Additionally, we showed its capacity to improve the analgesic effects of morphine and reduce analgesic tolerance. Recent studies indicate that GLP-1 synthesized in the brain activates GLP-1 receptor signaling pathways, essential for neuroprotection and anti-inflammatory effects. Multiple in vitro and in vivo studies using preclinical models of neurodegenerative disorders have shown the anti-inflammatory properties associated with glucagon-like peptide-1 receptor (GLP-1R) activation. This study aimed to investigate the mechanism of antinociception and the effects of the GLP-1 agonist semaglutide (SEMA) on diabetic neuropathic pain in diabetic rats. Methods: Male Wistar rats, each weighing between 300 and 350 g, were categorized into four groups: one non-diabetic sham group and three diabetic groups. The diabetic group received a single intraperitoneal injection of streptozotocin (STZ) at a dosage of 60 mg/kg to induce diabetic neuropathy. After 4 weeks of STZ injection, one diabetic group was given saline (vehicle), and the other two were treated with either 1× SEMA (1.44 mg/kg, orally) or 2× SEMA (2.88 mg/kg, orally). Following a 4-week course of oral drug treatment, behavioral, biochemical, and immunohistochemical analyses were carried out. The mechanical allodynia, thermal hyperalgesia, blood glucose, advanced glycation end products (AGEs), plasma HbA1C, and spinal inflammatory markers were evaluated. Results: SEMA treatment significantly reduced both allodynia and hyperalgesia in the diabetic group. SEMA therapy had a limited impact on body weight restoration and blood glucose reduction. In diabetic rats, SEMA lowered the amounts of pro-inflammatory cytokines in the spinal cord and dorsal horn. It also lowered the activation of microglia and astrocytes in the dorsal horn. SEMA significantly reduced HbA1c and AGE levels in diabetic rats compared to the sham control group. Conclusions: These results indicate SEMA’s neuroprotective benefits against diabetic neuropathic pain, most likely by reducing inflammation and oxidative stress by inhibiting astrocyte and microglial activity. Our findings suggest that we can repurpose GLP-1 agonists as potent anti-hyperalgesic and anti-inflammatory drugs to treat neuropathic pain without serious side effects.

Efficacy of 8-week daclatasvir-sofosbuvir regimen in chronic hepatitis C: a systematic review and meta-analysis

BackgroundThe high rates of the sustained virologic response 12 weeks after treatment (SVR12) in real world settings provoked the adoption of shortened courses of the costly direct-acting antivirals (DAAs) regimens. This study provides, to our knowledge, the first systematic review and meta-analysis for the efficacy of the shortened 8-week course of sofosbuvir (SOF) plus daclatasvir (DCV), the most accessible DAAs in the low-middle income countries (LMICs).MethodsWe performed a proportion meta-analysis to determine a reliable rate of SVR12 by pooling all studies that evaluated the results of the 8-week regimen of DCV + SOF. In addition, we applied sensitivity analyses using two imputation paradigms: a conservative approach, and a pragmatic approach to avoid overestimating the efficacy of the 8-week regimen in studies that followed a response-guided treatment (RGT) approach.ResultsSix studies with a total of 159 patients were included. The pooled SVR12 rate ranged from 91 to 97% in the included scenarios. The pragmatic scenario showed that the pooled SVR12 was 97% (95% confidence interval (CI) 91%; 100%) with lower variability as assessed by the prediction interval. The conservative approach revealed an SVR12 of 93% (95% CI 84%; 95%).ConclusionThe 8-week course of 60 mg DCV with SOF provided a comparable SVR12 to the standard 12-week regimen in treatment-naïve, non-HIV co-infected patients with a minimum estimated efficacy of 90%.

Fundamentals of leadership development: a randomized pilot study to evaluate implementation of a leadership curriculum for diversity, equity, and inclusion.

The Fundamentals of Leadership Development (FLD) Curriculum was created to increase integration of diversity, equity, and inclusion (DEI) in leadership skills. The pilot FLD course was utilized 1) evaluate short-term impact of the curriculum, and 2) evaluate optimal delivery methods of curricular interventions on diversity in a leadership context in a randomized fashion. After IRB approval, the pilot FLD course was opened to all SAGES Committee members for enrollment. All participants had access to the same online modules and discussion forum, but were randomized either to a 4-week longitudinal or 2-day intensive didactic session. Participants were asked to assess the curricular content after each online module and provide overall course feedback on all sessions. This data was collected along with leadership experience, course participation, and course completion data. A total of 79 participants registered for the FLD course, with 55 (69.7%) of participants completing the course. Of those that registered, 46 (58.2%) self-identified as underrepresented in medicine, 32 (40.5%) self-identified with she/her/hers pronouns, and 45 (57.0%) held an institutional leadership position. Fifty-nine (74.6%) participants were willing to be randomized. Course engagement was higher in the intensive course with 64.1% and 48.7% participation over days 1 and 2, respectively. In the longitudinal course, participation dropped off every week from 70%, 47.5%, 35%, and 27.5%, throughout the 4-week course. Participants who accessed the online modules spent a median time of 3h and 34min.User confidence after completion of each individual module were "somewhat confident" and "completely confident" for almost all survey respondents on a 5-tier Likert scale. The pilot FLD course appealed to SAGES members in leadership roles and who identified as. URiM. Course engagement was higher in the intensive course. Long-term behavior changes after course completion will need to be assessed with additional qualitative interviews. (300/300 words).

P32 A case of disseminated pneumococcal infection with musculoskeletal manifestations

Abstract Introduction Septic arthritis should be the first consideration in any patient presenting with a hot, swollen joint. Infection may affect one or more joints, and bacteria typically enter the joint through direct inoculation, haematogenous seeding, or spread from adjacent soft tissue or bone infection. Staphylococcus aureus is the most common causative organism. Streptococcus pneumoniae is an uncommon cause of septic arthritis, accounting for approximately 5% of cases. We present the case of a 78-year-old male with no significant medical history who presented with a polyarticular pattern of joint inflammation related to disseminated pneumococcal infection. Case description The patient presented with a one week history of gradual onset pain and swelling in the right knee and right wrist. He was previously well and remained physically active. He was a non-smoker, drank moderate alcohol and had no history of intravenous drug use. He had no current or preceding infective symptoms, including respiratory tract symptoms, nor history of trauma or recent foreign travel. Examination revealed a warm right knee effusion with restricted range of movement. There was swelling of both wrists (right more than left), both second metacarpophalangeal joints and the left ankle. There were no heart murmurs or peripheral stigmata of endocarditis. He was afebrile and haemodynamically stable. Admission blood tests showed WBC 21 x109/L, neutrophils 18 x109/L, CRP 369 mg/L, urate 452 µmol/L and procalcitonin 3.84 µg/L. Rheumatoid factor was 25.3 IU/mL with negative anti-CCP. Knee X-ray showed significant medial compartment osteoarthritis. Hand and wrist X-rays were unremarkable. Synovial fluid aspirate from the right knee grew Streptococcus pneumoniae and calcium pyrophosphate crystals were also seen on polarised light microscopy. Blood cultures were positive for the same organism. The patient underwent arthroscopic washout of the knee and was treated with colchicine and intravenous amoxicillin. He was taken to theatre for a right wrist washout, however the wrist was found to be clean and dry intraoperatively. He had two further washouts of the right knee and repeat intraoperative samples and blood cultures were negative. Additional screening for HIV, syphilis and myeloma was negative. Transthoracic echocardiogram showed no vegetations. CT chest showed basal atelectasis but no focal consolidation. Left hand and wrist MRI showed extensor compartment tenosynovitis and second metacarpophalangeal joint synovitis. His antibiotics were switched to intravenous ceftriaxone and oral doxycycline. He clinically improved and was discharged with a plan to complete a 6-week course with outpatient review. Discussion Streptococcus pneumoniae is an uncommon cause of septic arthritis, responsible for approximately 5% of all cases, but more often causes polyarticular infection than other organisms. This may be related to higher rates of bacteraemia in patients with pneumococcal septic arthritis. In one review of 190 cases of pneumococcal septic arthritis, polyarticular infection was present in 36% of patients and 72% had concomitant bacteraemia (compared with rates of approximately 20% polyarticular infection and 30-50% bacteraemia for septic arthritis overall). The joints most commonly affected are the knee, followed by the hip, shoulder, ankle and elbow. The original focus of infection is most commonly pneumonia or meningitis, but up to 50% of patients have no identifiable extra-articular source of infection. Pneumococcal septic arthritis more commonly affects patients with predisposing risk factors, such as rheumatoid arthritis, osteoarthritis, joint prosthesis, alcoholism, myeloma and other malignancies, diabetes and immunosuppression. Our patient had no specific predisposing medical conditions other than knee osteoarthritis, and his age was likely to be his main risk factor. It is also important to note that septic arthritis in the elderly can present atypically, with insidious onset and absence of fever or other signs of systemic infection. This was the case in our patient, who despite bacteraemia and markedly elevated inflammatory markers, did not otherwise appear floridly septic or unwell. Our patient presented with a polyarticular pattern of joint inflammation, although joint infection was only ultimately confirmed in the right knee. Also notable was the presence of calcium pyrophosphate crystals in the aspirate. One might theorise whether the infection might have triggered a reactive polyarthropathy or concurrent crystal arthritis. It is well recognised that septic arthritis and crystal arthritis can coexist in the same patient. The case also highlights the value in sampling multiple joints and taking blood cultures in such patients. Key learning points • Polyarthritis does not exclude the possibility of septic arthritis • Joint aspiration should be performed in all patients presenting with a hot, swollen joint • In cases of polyarthritis, consideration should be given to aspiration of all affected joints and taking blood cultures, particularly in the elderly and patients with predisposing risk factors for septic arthritis • Septic arthritis can present atypically in the elderly, with the absence of fever and other typical signs of systemic infection

Effects of MOOC and video conferencing deliveries on vocabulary usage and learning strategies

While vocabulary learning strategies (VLSs) have primarily been taught in physical classroom settings, the potential for applying strategy training in an online environment remains under-explored. With the rising acceptance of remote education, there is a need to investigate the impacts of applying strategy training in online contexts. Hence, this study explores the effects of online deliveries on VLSs and vocabulary usage in writing among adult English as second language (ESL) learners via massive open online course (MOOC) and video conferencing platforms. A total of 50 pre-intermediate ESL learners completed a 5-week VLSs course on a MOOC while 44 students learnt from the instructor synchronously using Microsoft Teams. The data comprised questionnaires and learners’ compositions, which were collected before and after treatment. The data analysis procedures involved Lextutor’s version of lexical frequency profiling (LFP), descriptive and inferential statistics. The results revealed that there was a significant increase of usage in all categories of the VLSs after the course for both groups. Additionally, the effects of VLSs instruction on vocabulary usage could be reflected in both groups’ writing though the choice of words might have been task-influenced. The findings from this study could yield useful insights on online vocabulary learning for ESL instructors and learners.

Police Leadership Education: Digital Didactics, Perceived Learning and Perceived Increased Competence as Police Leaders

Police leadership is an essential part of policing, as is the education of police leaders. Our study responds to the call for research on how to transform police leadership education into practice. In this longitudinal mixed-methods single case study we investigate two research questions: 1) How do the digital didactics of the digital police leadership course contribute to students’ perceived learning? 2) How are the knowledge and skills acquired in the digital police leadership course perceived to be applied 1.5 years after course completion? We collected data from students enrolled in a 12-week course. This course offered 24 students a two-day on-site course introduction, while the rest of the course was taught online. Data was collected through five surveys and follow-up interviews with six participants. The results show that police leaders perceived increased competence in being a police leader, report enhanced ability to bridge theory and practice, and improved their digital skills. They also reported increased confidence in the leadership role and increased sharing of competence after study completion. The findings suggest that digital didactics may achieve embedded police education as it can provide an interplay of individual and organizational factors.

A socially interactive communication skills training for competent health educators

Abstract Background Every contact with expectant and new parents can be a “teachable moment” for promoting the health of mother-baby-family; yet, healthcare providers may not effectively perform their educational role. Previous studies have described various setting-specific challenges. Procedural knowledge, resulting in lack of confidence and avoidance, is a universal theme, challenging current communications skills training. Given the evolving role of midwives under the new Cyprus National Healthcare System, there is need for innovative practices. Objectives “Baby Buddy Communicators” designed, implemented and piloted tested a socially interactive digital environment on the Edubreak platform, where practicing (N = 8) and in-training (N = 7) Midwives completed an 8-week iterative hybrid communication skills course along with service-users. Results Four situational-based scenarios were co-created with ‘holders of the experience’ tapping on key priorities (elective caesarean, breastfeeding challenges, baby in NICU, postnatal depression). Participants produced video artefacts of role-play consultations and engaged in peer-to-peer and service-user feedback via the in-built video annotations and blog writing tools. Deductive content analysis of the rich material using the 18-item Health Professionals Communications Skills (HPCS) scale identified recurrent patterns tapping on both informational aspects (e.g. incomplete information gathering, overload without assessing comprehension) as well as social skills (e.g. agenda setting, early reassurance, assertiveness). Conclusions This cross-sectoral transfer of social video from sports training to healthcare is a “proof of concept”. Inverted (i.e. making current practices visible) and experiential learning (e.g. feedforward) with cross-sectoral (service-user involvement) and cross-module dimensions (i.e. communication skills and evidence-based practice) provided the basis for evaluation and a source of shared learning and reflection. Key messages • Several areas of improvement in communication skills of maternal healthcare providers were identified while peer-to-peer and service-user feedback was a source of reflection. • The use of digital technology and social video allowed immersive role-playing, observation and constructive feedback loops providing a new paradigm in health communication skills training.

Hand Osteomyelitis: A Systematic Review of the Literature and Recommendations for Diagnosis and Management.

Hand osteomyelitis is a complex condition to diagnose and treat, with an opportunity to improve care through organization of existing evidence. The literature was systematically searched for series of hand osteomyelitis between 1990 and 2022 for evidence regarding diagnosis and treatment, to formulate recommendations. Twenty-one series reported at least 5 cases of hand osteomyelitis in adults, with a total of 666 cases. Surgical debridement is central to treatment and oral antibiotics are sufficient for individuals without diabetes, renal or vascular disease, after debridement and resolution of associated sepsis. A 4- to 6-week duration of antibiotic therapy according to organism sensitivities is recommended, or a 2-week course after amputation. Delayed presentation is common and if over 6 months is associated with high amputation rates. Hand osteomyelitis with renal failure is associated with systemic complications. Reconstruction options include antibiotic-eluting spacers, osteosynthesis or arthrodesis, vascularized bone or adipose, regional soft tissue coverage and silicone implant arthroplasty.Level of Evidence: IV.

Neuroborreliosis Presenting as Urinary Retention: Case Report.

Lyme disease is a tick-borne infectious disease caused by the spirochete Borrelia burgdorferi. Voiding dysfunction is a rare manifestation of neuroborreliosis with only a few cases reported. Here we describe a case of a 6-year-old male child with an acute urinary retention, paraparesis, and voiding difficulty in whom neuroborreliosis was diagnosed through serologic tests for antibodies, Western blot testing confirmation and intrathecal antibody synthesis. Magnetic resonance imaging (MRI) of the spine led to the diagnosis of acute transverse myelitis and a urodynamic study demonstrated detrusor areflexia. He received a 4-week course of intravenous ceftriaxone (2 g/d). The patient has recovered from the paraparesis but still suffers from a neurogenic bladder.

Can "LITE" Procedure Combined With a Short Course Antibiotic Treatment Be Effective in Treating the Chronic PJI?-A Prospective Randomized Controlled Trial.

The prevailing treatment for chronic periprosthetic joint infection (PJI) is a two-stage exchange, yet the optimal duration of antibiotic therapy following this procedure remains a topic of debate. This study aimed to determine whether a short course of postoperative antibiotic therapy can maintain infection control rates following a long interval two-stage exchange (LITE) for PJI. We conducted a prospective study enrolling patients with chronic PJI who underwent the LITE procedure at our institution from April 2018 to November 2021. Patients were randomly assigned to receive either a long course (12 weeks) or short course (2 weeks) of postoperative antibiotics. The pathogens, antibiotics, inflammatory markers, antibiotic-related complications, cases of reinfection, or re-operation were recorded. Continuous variables were analyzed using the two-sample t-test or Mann-Whitney U test, and categorical variables were analyzed using Fisher's exact tests. Kaplan-Meier survival analysis was used to compare infection control rates. A total of 60 patients with chronic PJI who completed the LITE procedure were included in the study (30 patients per group). All patients were followed for a minimum of 24 months (mean 39.2 ± 13.0 months). We observed that the infection control rate in the short-course group was not inferior to that in the long-course group (96.7% vs. 96.7%, p = 1.000). For patients with chronic PJI undergoing the LITE procedure, a 2-week course of postoperative antibiotics suffices to maintain infection control rates. Chinese Clinical Trial Registry: ChiCTR1900027089.

The effects of university badminton class on health and well-being in untrained college students

This study investigated the effects of a 6-week activity course on health and well-being in untrained college students. Twenty-two participants (ages 18–23) engaged in either badminton or soccer twice a week. Using Badminton World Federation (BWF) Shuttle Time Lesson Plans, both groups showed significant improvements in the quadrant jump and standing long jump tests, with badminton participants demonstrating greater gains in the quadrant jump. In addition, Resilience levels increased in both groups and exercise self-efficacy saw a larger rise in the soccer class. The data suggested that badminton might improve agility more due to the need for rapid direction changes in a smaller court. Further, university activity classes could enhance both physical and mental well-being, though prior soccer experience and limited badminton court access may boost self-efficacy more in soccer participants. Lastly, BWF Shuttle Time Lesson Plans proved effective for introducing badminton to beginners.

Enhancing Taxonomic Skills in West Africa and Supporting the Growth of GC Herbarium (Ghana)

Training the next generation of environmental scientists is critical to the future of life on Earth as acknowledged in 2021 by the Royal Botanic Gardens, Kew (RBG, Kew) in Our Manifesto for Change. RBG, Kew is also committed to strengthening capacity in the most biodiverse tropical countries by sharing expertise and collections, to enhance the global conservation effort. Developing training programmes to enhance taxonomic capacity in Africa and meeting the demand for early career in-country taxonomists was identified as the first step to accelerate the documentation and conservation of African plant diversity. Two years ago, RBG, Kew, in collaboration with the University of Ghana and the Ghana Herbarium (GC) and with support from the Schroder Charity Trust and Mallinckrodt Foundation, developed a tailored “Plant Taxonomy Skills for Ecology and Conservation” training course. This was planned to run in Africa, South America and Asia, alternating each year. The pilot was organised in Ghana, Africa in 2022. Participants for this 5-week course were selected from over 260 applicants. Delivered in a hybrid format, the course started with 3 weeks of online lectures, pre-recorded by 15 plant scientists and curators at RBG, Kew, as well as online interactive sessions. This was then followed by 2 weeks of in-person training in Ghana, including a 1-day field trip for practical collecting tips. The training covered herbarium curation techniques as well as concepts and skills needed for taxonomic revisions such as nomenclature, taxonomy, analysis of herbarium specimens, databasing, geo-referencing, preparation of morphological descriptions, diagnosis and identification keys as well as building distribution maps and red listing. The in-country teaching team included a curator-botanist, a plant taxonomist, a science education coordinator from RBG, Kew and two professors from University of Ghana. The course ended with a written assignment in the form of a taxonomic revision. A short survey was sent out to all course participants two years after the course to gather impacts of the training on their careers and uncover the most positive and negative aspects of the course. The course provided many positive outcomes: 15 plant taxonomists from eight African countries were trained, and jointly produced a taxonomic revision of 28 species of Ipomoea L. (Convolvulaceae) from Ghana (Williams et al. 2024). Additionally, The African Taxonomists Network was initiated by the course participants with a mission of ‘Fostering the next generation of taxonomists to bridge the generational gap and revitalize the relevance of taxonomy in Africa for the future.’ This network now has over 60 members, meets regularly online, and has a large presence on social media. Furthermore, the course also resulted in the awarding of the International Association for Plant Taxonomy (IAPT) Biodiversity Challenge grant to the GC Herbarium in 2022. This grant enabled acquiring essential plant collecting equipment and herbarium materials, either by sourcing them in Ghana or from abroad. The GC herbarium, founded in 1952, contains ~85,000 collections of plant and algae specimens from Ghana and across West Africa with high historical, teaching and research value. This collection is vital to enhancing in-country taxonomic capacity. Therefore, the improvement and upgrade supported by the grant, as well as its recognition, are essential. Another rewarding impact of the course is strengthening of links between RBG, Kew and African institutions of higher education. These links have quickly developed into a larger partnership and were the first step towards a long-term collaboration. The ultimate objective of this collaboration has been to create the necessary conditions, both in infrastructure and human capacity to deliver the Flora of Ghana. This will be achieved by implementing a project to support the maintenance and growth of the GC herbarium in addition to taxonomic capacity building and teaching. The participants benefited from the course by engaging with mentors, networking and exchanging ideas, forming links with individuals with similar research interests and obtaining additional training and career progression opportunities. In the feedback survey, all participants reported that this course made them consider a career or future studies in plant taxonomy and 80% of the participants reported securing a new job or a student position in plant taxonomy two years after the course. In addition, all participants listed several positive impacts of the course on their career such as confidence in producing a taxonomic revision, gaining herbarium management skills and opportunities for new collaborations. This course has been subsequently successfully run in South America (Bolivia) and Asia (Indonesia), with expectations of similarly positive outcomes, and is already planned to return to Africa (Kenya) in 2025.

The CERIC method plus social collaborative annotation improves critical reading of the primary literature in an interdisciplinary graduate course

BackgroundInnovative approaches to graduate education that foster interdisciplinary learning are necessary, given the expansion of interdisciplinary research (IDR) and its ability to explore intricate issues and cutting-edge technology.PurposeThis study examines an intervention to develop critical reading skills of the primary literature (CRPL), which are often assumed and unaided by formal instruction in graduate education (GE) yet are crucial for academic success and adapting to new research fields.MethodsThis study applied mixed methods and a pre-post design to assess the effectiveness of a CRPL intervention among 24 doctoral students from diverse fields engaging in the interdisciplinary field of science policy research. The intervention was a 4-week online course with explicit instruction in a categorical reading approach, the CERIC method (claim, evidence, reasoning, implications, and context), combined with social collaborative annotation (SCA) to facilitate low-stakes, peer-based discourse practice. It examined how participation changed participants’ CRPL skills and self-perceptions.ResultsThe intervention significantly improved CRPL, t(23) = 13.6, p < 0.0001; research self-efficacy, t(23) = 4.9, p < 0.0001; and reading apprehension, t(23) = 4.3, p < 0.0001. Qualitative findings corroborated these findings and highlighted the importance of explicit CRPL instruction and the value of reading methods applicable to IDR. These results aligned with sociocultural and social cognitive theories and underscored the role of discourse and social engagement in learning critical reading, which is traditionally viewed as a solitary activity.ConclusionThe findings present a valid and innovative model for developing CRPL skills in interdisciplinary GE. This approach provides a model for scaffolding CRPL that can be adapted to IDR contexts more broadly.ImplicationsThe study findings call for revising graduate curricula to incorporate explicit CRPL instruction with peer-based discourse, emphasizing integrations in higher education anywhere students encounter primary literature. The findings advocate for formal and informal adoption of the reviewed methods, offering a significant contribution to interdisciplinary GE pedagogy.

The effectiveness of 3d printing technology course on attitudes of occupational therapy students-a controlled study

There is interest in three-dimensional (3D) printing technology, but views on the integration of these technologies into business and education vary. It is crucial to determine how the introduction of new technologies will impact the attitudes of occupational therapy undergraduate students. Hence, the purpose of this study is to examine the effect of using this technology in the assistive technology (AT) lesson on the attitudes and acceptance of technology among students. This study was designed as a non-randomized controlled pretest and posttest control group study. The intervention group consisted of second-year undergraduate students (n = 50) enrolled in a compulsory “AT course,” while the control group consisted of third-year undergraduate students (n = 41) who had completed the AT course in the previous academic year. The intervention involved participants attending a 3D printing course in combination with an 8-week AT course. A Modified Technology Acceptance Model (M-TAM) questionnaire was used to assess students’ acceptance of 3D printing technology. The related study observed that experiencing and practicing new technologies, such as 3D printing and modeling course in the intervention group AT lesson effectively increased the acceptability of these new technologies that students encountered. The pre-post test analysis of the intervention group was statistically significant in all categories of the M-TAM questionnaire (p < 0.05). Compared to the control group, the effect size was small and moderate in all categories (p < 0.05). This course has increased student acceptance of this technology. Future studies should examine the long-term effects of such courses on student attitudes.

Improving learning experience through implementing standardized team-based learning process in undergraduate medical education

IntroductionTeam-Based Learning (TBL) is a highly structured active learning methodology shown to have positive learning outcomes in undergraduate medical education (UME). While many medical schools have increasingly adopted TBL, there is considerable variation reported in the literature in the implementation of the standard sequence and key components of TBL. The extent to which this variation affects the benefits of TBL is not well understood. This study aims to assess the impact of implementing the standardized framework of the TBL process on student perception of the benefits of TBL.MethodsFaculty at our institute were surveyed to determine the frequency of implementation of TBL standards, as described in the literature. Second-year osteopathic medical students (OMS II) were surveyed for their perception of the experience of TBL at the beginning of the academic year. Curricular interventions targeting the enforcement of the standard steps and key components of TBL were implemented in a particular 6-week system course. The students were re-surveyed at the end of the course. Descriptive and thematic analyses were performed on quantitative and qualitative data.ResultsTwenty four of 31 (77.4%) faculty participated in the faculty survey, 53 of 105 OMS II students (50.4%) participated in the pre-intervention survey, and 72 of 104 OMS II students (69.2%) participated in the post-intervention survey. Faculty survey results indicated inconsistent implementation of key steps and components of the TBL process. Comparisons of student pre- and post-survey means of the perceived value of various aspects of TBL showed significant improvement in multiple aspects of the TBL process, including readiness assurance tests, immediate feedback, and application activities. Both before and after the intervention, students highly rated the value of teamwork and opportunities for practical application of concepts within TBL.ConclusionWhile medical students value teamwork in UME and professional development, their perception of TBL can be less than positive if not conducted deliberatively. Assessment of the implementation of the standard TBL steps and components and development of corresponding targeted interventions may improve the TBL experience of medical students. Our process could be generalized to help educators interested in improving TBL in their home institutes.

Efficacy and uterine bleeding patterns in initiating goserelin therapy during different menstrual phases in patients with adenomyosis: a prospective cohortstudy.

We carried out this study to explore the possibility of initiating goserelin therapy during the non-menstrual period in patients diagnosed with adenomyosis. 115 premenopausal adenomyosis patients were enrolled and divided into three groups based on their menstrual cycle phase during the initial outpatient visit: menstrual, follicular, and luteal. Each received a 3.6 mg subcutaneous dose of goserelin monthly for three months. The endpoints encompassed alterations in uterine volume, dysmenorrhea Numerical Rating Scale (NRS) score, CA125 level, hemoglobin (HGB) after a 12-week treatment course, and the occurrence and duration of uterine hemorrhage during the first treatment cycle. Analysis revealed that the timing of goserelin therapy initiation in the menstrual cycle did not significantly impact its effectiveness in reducing uterine size, alleviating pain, lowering CA125 levels, or improving hemoglobin concentrations. However, patients starting treatment during the luteal phase experienced increased uterine bleeding (reference: menstrual period, OR = 4.33, 95% CI 1.23-15.25, p = .023). The results suggested non-inferiority of goserelin therapy initiated during the non-menstrual period, but the uterine bleeding rate was higher in the luteal phase group. Therefore, goserelin treatment for outpatient adenomyosis patients should not be limited to starting during the menstrual period; it can also be initiated outside the menstrual period, providing more convenience for patients as most consultations occur outside the menstrual period. However, the use of goserelin during the luteal phase should be avoided to reduce the risk of exacerbated bleeding, especially in anemic patients with heavy menstrual bleeding. This study highlights the importance of individualizing treatment initiation based on the patient's health profile to optimize therapeutic outcomes and minimize adverse effects. ChiCTR2200059548.