Authentic Cases Research Articles

Intraprofessional boundary crossing in acute paediatric care: A rich journey for general practice and paediatric residents.

Achieving optimal collaboration between general practitioners and hospital-based critical care doctors is vital yet challenging, necessitating targeted collaborative training during residency. Despite apparent benefits, implementing intraprofessional learning faces constraints. Understanding its occurrence is crucial for engaging and educating residents. Considering boundaries' learning potential, we developed and evaluated an educational programme for general practitioner (GP) and paediatric (P) residents in paediatric emergency care based on Akkerman's Boundary Crossing Theory. The study investigated how intraprofessional learning mechanisms occurred and what learning conditions facilitated or impeded learning of GP and P residents, aiming to optimise educational programme design for intraprofessional collaboration. We developed an educational programme with three activities: joint medical assessments of paediatric patients in each other's context, mutually mini-Clinical Evaluation Exercises (mini-CEXs) about intraprofessional collaboration skills and educational meetings about collaborative care. We performed a qualitative study with a constructivist approach to explore experiences of the programme. We conducted focus group interviews and analysed mini-CEXs, utilising Boundary Crossing theory for template analysis. Ten GP and eight P residents participated in our study. Learning mechanisms of identification and coordination dominated the joint medical assessments. Mini-CEXs stimulated reflection. Educational meetings with supervisors about intraprofessional barriers initiated transformation. Facilitated learning conditions were bidirectional crossing, enthusiastic supervisors, residents being familiar with each other, clear mini-CEX design and authentic paediatric cases. Unclear mutual expectations during joint medical assessments impeded learning of residents. Working in each other's context triggers learning mechanisms of identification, coordination and reflection, forming the basis for intraprofessional learning in paediatric emergency care for GP and P residents. For development of new collaboration practices, supervisors are necessary to translate reflection into transformation. Mutual responsibilities and expectations should be made more explicit to create a safer intraprofessional learning environment. Our findings extend to other medical training contexts, leveraging boundaries for learning.

Allograft Prosthetic Composite (APC) for Proximal Humeral Bone Deficiency in Revision Reverse Shoulder Arthroplasty: A Technical Note and Systematic Review.

Background: Proximal humeral bone deficiency in revision shoulder arthroplasty is an emerging and challenging problem as the use of reverse shoulder arthroplasty (RSA) increases. This paper presents a technical note discussing our detailed preoperative planning steps, surgical techniques, and their rationale in carrying out the use of an allograft prosthetic composite (APC) to address proximal humeral bone deficiency in revision RSA. The outcomes of this technique are also presented. This paper also presents a systematic review to further discuss the existing literature on RSA with APCs. Methods: The preoperative surgical planning and the surgical technique employed to execute proximal humeral reconstruction using APC during revision arthroplasty are discussed in the technical note. The preliminary clinical and radiological results of five patients who underwent revision shoulder arthroplasty with proximal humeral reconstruction using APCs are presented. The PRISMA guidelines were followed to perform the systematic review. A systematic search using PubMed, Embase, and Cochrane databases was conducted. All studies involving RSA and APCs were pooled, and the data were extracted and analyzed. Results: A total of 14 studies were eligible for inclusion in the systematic review, with a total of 255 patients and a mean follow-up of 57 months. All studies in the systematic review and the patients included in the author's case series showed improvements in the level of pain, range of motion, function, and satisfaction. Graft incorporation in the systematic review was 84%. Conclusions: Based on the available literature and the results of our case series, the use of an APC construct is a viable option for proximal humeral bone deficiency in revision shoulder arthroplasty.

Characterization of etomidate and emerging analogs in human hair using UHPLC-MS/MS and confirmation in real forensic cases

The regulation of etomidate, a widely used drug for anesthesia induction and short surgical procedures, has led to the emergence of etomidate analogs such as metomidate, propoxate, and isopropoxate. This study introduces and validates a simple, rapid, and cost-effective ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method for the determination and quantification of etomidate, etomidate acid, metomidate, propoxate, and isopropoxate in human hair. Using a five-minute gradient elution on a Phenomenex Kinetex Biphenyl column, the method achieves low limits of quantification (LOQs), ranging from 5 to 20 pg/mg. Method validation confirms robust linear calibration curves for the target substances in hair samples within the range of LOQs to 1000 pg/mg, with average correlation coefficients (r) all exceeding 0.999. The method also achieves acceptable intra-day and inter-day precision (<15 %) and trueness(bias, −10.9 % to 14.4 %). The matrix effect ranges from 46.9 % to 94.2 %, and the extraction recovery rate ranges from 84.5 % to 105 %. When applied to authentic cases, this method successfully identified 56 positive samples. The concentrations of etomidate, etomidate acid, metomidate, propoxate, and isopropoxate in positive samples ranged from 27 to 1.5 × 105 pg/mg, 21 to 1.5 × 103 pg/mg, 18 to 8.7 × 104 pg/mg, 25 to 1.6 × 104 pg/mg, and 22 to 5.0 × 105 pg/mg, respectively.

Detection of "smoke powder" etomidate and its metabolite etomidate acid in blood and urine by UHPLC-MS/MS: Application in authentic cases.

Recently, etomidate has been widely used as an alternative in illicit drug market. It is usually added to regular cigarette tobacco (commonly known as "cigarette powder") or mixed in e-cigarette oil sold through the Internet, retail stores, or entertainment outlets and other channels. An ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) method was developed to quantify etomidate and etomidate acid in human blood and urine. The limit of detection (LOD) of etomidate and etomidate acid in blood are 0.5 ng/mL and 2 ng/mL, respectively, and the lower limit of quantification (LLOQ) are 1 ng/mL and 5 ng/mL, respectively. The LOD of etomidate and etomidate acid in urine are1 ng/mL and 2 ng/mL, respectively, and the LLOQ are 2 ng/mL and 5 ng/mL, respectively. The precision, accuracy, recoveries and matrix effects of etomidate and etomidate acid determinations in blood and urine met the requirements for methodological validation. The method was successfully applied to the identification and quantification of etomidate and etomidate acid in blood and urine of 62 forensic cases. The concentration of etomidate ranged from 1.52 to 8.41 ng/mL (positive cases, n=5) and the concentration of etomidate acid ranged from 2.76 to 112 ng/mL (positive cases, n=5) in blood. The concentrations of etomidate and etomidate acid in urine samples were 2.64-79,300 ng/mL (positive cases, n=59) and 6.11-518,000 ng/mL (positive cases, n=60), respectively. Therefore, the concentration of etomidate in blood and urine is mostly higher than that of etomidate.

Librarian and Clinical Faculty Collaborative Use of Formative Assessment in a Longitudinal Evidence-Based Medicine Curriculum

Background The authors developed a longitudinal curriculum for teaching third- and fourth-year undergraduate medical students evidence-based medicine (EBM). This curriculum involved substantial librarian involvement, the use of formative assessment as a teaching method, and progressive repetition of skills. Methods Students in three clinical clerkships (Medicine, Pediatrics, OB/GYN) completed EBM assignments based on real-world scenarios in this quasi-experimental study. Each clerkship required students to submit an EBM plan, from which they received directed feedback from both the clerkship director and a librarian after submitting preliminary EBM plans. This study tracked student PICO and search submissions to determine if repeated exposure to EBM feedback resulted in improved summative assessments, both in isolation and longitudinally. Results Students’ PICO and searching performance improved between mid-clerkship formative feedback and end-clerkship summative assessment in all three clerkships using rubrics developed by the authors for each clerkship derived from existing literature. When examining student performance sequentially over three clerkships, there was significant improvement between the first and second clerkships, but this did not carry into the third clerkship. Discussion Our findings suggest that the significant inclusion of a librarian and feedback appears to have positive effects on student performance. While it may seem obvious that feedback results in improved outcomes, this method doesn’t appear widespread in medical education. Repetition, while not having a lasting increase in performance, may still be warranted to increase exposure to authentic cases and evidence types.

Postmortem distribution of ropivacaine and its metabolite in human body fluids and solid tissues by GC-MS/MS using standard addition method.

An analytical method was developed for determining ropivacaine and its main metabolite, 3-hydroxyropivacaine in biomedical samples using gas chromatography-tandem mass spectrometry (GC-MS/MS). Then, this established method was applied to investigate the distribution of ropivacaine and its metabolite in human fluids and solid tissues obtained from an authentic case ropivacaine involved. The fluid sample was added acetonitrile, and solid tissue was homogenized using a freezer mill and then added into acetonitrile. Then, an internal standard solution was added to the mixtures. The mixture was centrifuged at 12,000 × g for 5min, and the upper layer of acetonitrile was transferred to magnesium sulfate and octadecyl silica (C18) gel for cleaning up the sample. After centrifugation, the upper layer was then evaporated to dryness with nitrogen, and dissolved with methanol, then injected into the GC-MS/MS system. The coefficients of determination (r2) of constructed calibration curves were all greater than 0.999. The limits of detection for ropivacaine and 3-hydroxyropivacaine in target samples were 15ng/mL and 10ng/mL, respectively. The recovery rates of ropivacaine and 3-hydroxyropivacaine ranged from 97.6% to 103% and from 96.5% to 104%, respectively. The inter-day precision values of ropivacaine and 3-hydroxyropivacaine were not greater than 6.25% and 7.98%, respectively, and the inter-day trueness values were not greater than 6.90% and 8.33%, respectively; the intra-day precision and trueness values of ropivacaine and 3-hydroxyropivacaine were not greater than 3.20%, 6.78%, 7.84% and 8.99%, respectively. GC-MS/MS method for simultaneous detection and quantification of ropivacaine and 3-hydroxyropivacaine in biological samples was successfully developed. The method could also be applied to samples obtained from an authentic case; their distribution among tested fluids and solid tissues were also measured. This is the first report on the distribution of ropivacaine and its major metabolite 3-hydroxyropivacaine in a human case.

Multi-Class Analysis of 57 Drugs Quantitatively in Blood and Qualitatively in Urine by LC-MS/MS to Complement Comprehensive DFC, DUID and Postmortem Testing.

A streamlined LC-MS/MS method utilizing protein precipitation and filtration extraction was developed to consolidate analyses for drug-facilitated crime (DFC), postmortem investigations, and driving under the influence of drugs (DUID) testing. Fifty-seven target drug and metabolite analytes eluted in under 6-minutes and compromised of GHB precursors (1), hallucinogens (3), muscle relaxants (3), anticonvulsants (7), antidepressants (20), antihistamines (5), antipsychotics (11), antihypertensives and alpha-adrenergics (3), analgesics and anesthetics (3), and miscellaneous (1) in blood (quantitatively) and urine (qualitatively). Limits of detection were set to meet the more challenging sensitivity requirements for DFC, and are therefore also suitable for postmortem investigations, and other forensic casework, including DUID. Comprehensive ASB/ANSI validation was performed, and applicability studies examined 72 proficiency test blood and urine samples, along with 9,206 unique blood and urines samples from 5,192 authentic forensic cases that resulted in 11,961 positive analytes in samples. By expanding the analytical reach across multiple drug classes through a unified approach and screening a wider number of drugs, the technique can identify substances that might have previously evaded detection, thereby enhancing laboratory efficiency by minimizing the need for multiple tests. When combined with a recently developed in-house method, this integrated testing strategy meets the testing requirements outlined in ASB/ANSI standards and recommendations for DFC, postmortem, and Tier 1 DUID analyses.

Novel Technique for Simultaneous Ethylene Glycol and Its Metabolites Determination in Human Whole Blood and Urine Samples Using GC-QqQ-MS/MS.

Toxicological analyses often necessitate the identification of compounds belonging to diverse functional groups. For GC-MS analyses, derivatization of compounds belonging to different functional groups can pose a challenge and requires the development of comprehensive methods of analysis. One example could be ethylene glycol, whose widespread use is related to possible unintentional or suicidal intoxications. This fact clearly indicates the need to develop sensitive methods for the determination of ethylene glycol and its metabolites in biological material, as only such complex analysis allows for proper toxicological expertise. A simultaneous GC-QqQ-MS/MS method for the determination of ethylene glycol together with its metabolites, glyoxal and glycolic acid, as well as the detection of glyoxylic acid and oxalic acid, was developed and fully validated. A novel approach for simultaneous derivatization of substances from different groups (alcohols, aldehydes, and carboxylic acids) was established. Sample preparation included the addition of three internal standards (BHB-d4, ethylene glycol-d4 and methylglyoxal), precipitation with acetonitrile and subsequent derivatization with N-tert-butyldimethylsilyl-N-methyltrifluoroacetamide (MTBSTFA), as well as pentafluorophenylhydrazine (PFPH). Detection was carried out with the use of triple quadrupole mass spectrometer. The ionization method was electron impact, and quantitative analysis was carried out in multiple reaction monitoring mode. The lower limit of quantification was 1 μg/mL, 0.1 μg/mL, and 500 μg/mL for ethylene glycol, glyoxal, and glycolic acid, respectively. The presented method was applied in three authentic postmortem cases of ethylene glycol intoxication.

Feasibility and Educational Value of Clinical Cases Generated Using Large Language Models.

In medical education, case-based learning (CBL) is a fundamental method for training healthcare professionals across different levels of expertise. This approach hinges on using authentic or fabricated clinical cases to bridge the gap between theoretical knowledge and its practical application. It fosters active engagement and knowledge application among learners in healthcare domains. While creating effective cases demands substantial clinical understanding and time investment, the integration of Generative Artificial Intelligence (AI) presents a promising solution to this challenge. AI can efficiently analyze extensive medical data to generate diverse and realistic clinical scenarios, continuously updating case content based on emerging medical literature and guidelines. This study explores AI-generated cases' feasibility and educational value in continuing medical education, focusing on COVID-19 scenarios tailored for the MENA region. Results indicate the potential of AI-generated cases to foster engagement and critical thinking among learners, suggesting their suitability for different levels of education. This study highlights the advantages of integrating AI into CBL and emphasizes the need for future efforts to tackle obstacles and facilitate its successful adoption.

The Photovoice Project: Fostering Students' Autonomous, Collaborative, and Authentic Business/Engineering English Learning Experiences

This perspective article elaborates an instructional approach to business English learning utilizing a photovoice project as a strategy to promote a real-world learning encounter. In professional and vocational colleges, project-based learning (PBL) is an instructional strategy for promoting autonomous, collaborative, and authentic learning nuances. This article sheds light on how photovoice project fosters the students’ technical and business English learning experiences. The project empowers students to take charge of their learning, work collaboratively, and engage in real-world business context. This paper presents the concept of photovoice, learners’ autonomy and collaboration towards photovoice, authentic business English learning encounters, technology-integrated photovoice, project evaluation, and case studies on photovoice project. On top of that, language teachers can utilize project-based photovoice as a valuable tool for promoting innovative and engaging business English learning activities, thus providing students with contextual-based learning environment and preparing them for the real business world. It also brings several implications: 1) for vocational English teachers, implementing photovoice projects offers a powerful tool to create innovative and engaging learning activities, 2) for students, these projects provide a contextualized learning environment that prepares them for the real business world by developing practical language skills and industry-specific knowledge, and institutions will benefit by fostering an educational approach that bridges classroom learning with real-world applications, thereby enhancing the overall quality and relevance of their programs.

Virtual interprofessional education for the African continent: AFRI-VIPE

This article details how multiple universities came together in 2019 during the Africa Interprofessional Education Network (AfrIPEN) conference in Nairobi, Kenya, to create an interprofessional, multi-continent, multi-university opportunity to give their students an asynchronous and synchronous virtual interprofessional experience through a programme known as VIPE (virtual interprofessional education). The programme, which was created after the conference, was entitled AFRI-VIPE (Africa virtual interprofessional education). From that conference, four AFRI-VIPE events have been implemented to date. Asynchronous material was created, and synchronous sessions were held that utilised problem-based learning to reinforce the Interprofessional Education Collaborative (IPEC) core competencies. Students’ competency attainment was assessed using the Interprofessional Collaborative Competencies Attainment Survey (ICCAS), and analysis of those data showed significant improvements across all six interprofessional subscales for students at both North American- and African-based institutions, as well as across professional groups. All data were kept anonymous. Challenges experienced during AFRI-VIPE included the difference in time zones, student attrition, connectivity and survey response rates. Through their participation in the VIPE model, students and facilitators from a variety of countries and professions appreciated the opportunity to learn with, from and about other students through exposure to authentic case studies.

Discrepancies between the stated contents and analytical findings for electronic cigarette liquid products: Identification of the new cannabinoid, Δ9-tetrahydrocannabihexol acetate.

A number of synthetic cannabinoids have been appearing in the recreational drug market for more than a decade. Recent additions are so-called semi-synthetic cannabinoids, and they structurally closely resemble the main psychoactive component of cannabis, Δ9-tetrahydrocannabinol. Knowledge of new (semi-)synthetic cannabinoids is essential to help identify them in authentic forensic case samples. Therefore, the aim of the study was to examine two commercially available electronic cigarette liquid products claiming to contain cannabinoids and characterize the structures of the main compounds. The liquid products were analyzed by gas chromatography-mass spectrometry (GC-MS), GC-quadrupole time-of-flight mass spectrometry (GC-QTOF-MS), and liquid chromatography-high-resolution mass spectrometry (LC-HRMS). In product A, typical cannabinoids (cannabidiol, cannabigerol, and cannabinol) and terpenes (α-caryophyllene and β-caryophyllene) were identified by comparison with reference materials. An unknown peak was isolated by semi-preparative high-performance LC, analyzed by nuclear magnetic resonance (NMR) spectroscopy, and identified to be Δ9-tetrahydrocannabihexol acetate (Δ9-THCH-O). To the authors' knowledge, this is the first report of the identification of Δ9-THCH-O in commercially available products. Another compound estimated as cannabihexol acetate was also detected. In product B, cannabidiol, cannabinol, α-caryophyllene, and β-caryophyllene were identified, while two unknown peaks were estimated as tetrahydrocannabidiol isomers. Despite products A and B being labeled to contain "60% HHCPM" and "80% 10-OH-HHC," respectively, no such compounds were detected. The findings of this study could help detect Δ9-THCH-O in case samples and highlight the need to keep monitoring commercial products to identify new drugs, while warning that the package labels cannot be trusted.

AUTHENTICATION OF WIRELESS SYSTEMS BASED ON A DRONE SWARM AS A COMPONENT OF THE 5G RADIO ACCESS NETWORK ARCHITECTURE

Background. When establishing security measures for telecommunication networks involving unmanned aerial vehicles (UAVs), characteristics such as high scalability, device diversity, and high mobility should be considered. Authentication is a fundamental property that allows a UAV network to establish secure communication between its core components. Authentication also protects the UAV network from attackers impersonating legitimate UAVs. UAV authentication can further secure the communication channel by preventing impersonation and replay attacks. The design of UAV access control schemes, such as authorization and authentication mechanisms, remains a challenging research problem in UAV networks. The network becomes even more complicated when it interacts with a multitude of UAVs, called a swarm. A swarm by its very nature has a dynamic structure, and this raises the issue of unreliable constraints on UAVs in its composition. A standardized solution for the authentication of a single drone using the new 5G radio network (NR) is known, but for a swarm of drones, this is an open field of research. Per-UAV authentication key sharing as described in 5G NR does not scale across groups of UAVs. Objective. The purpose of this work is to conduct an analytical review and consider approaches to creating procedures for the authentication of a swarm of UAVs/drones with wireless equipment on board for the 5G NR network, taking into account the features of swarm formation and the very requirements for 5G authentication. Methods. Analysis of factors affecting the quality of provision of telecommunication services using UAVs in fifth generation networks. Analysis of well-known publications dedicated to the implementation of 5G networks and the use of drones in them. Comparing the implementation of UAV authentication procedures with on-board wireless equipment in the 5G network. Results. The widespread use of small UAVs, as well as the large expansion of wireless 5G networks, requires new security measures to prevent unauthorized access to sensitive data. Identification and Authentication for a mobile operator's network using drones allows for secure communication between its main components. This makes it possible to recognize the very drones that participate in the formation of such a network. Drone authentication often protects the communication channel by preventing replay attacks. The development of drone radio access control mechanisms, such as authorization and authentication mechanisms, remain relevant researches for the construction of promising radio access networks involving UAVs. It has been confirmed that the introduction of special group procedures for the authentication of a swarm of drones in the 5G network can significantly improve the quality of the provision of telecommunication services. Conclusions. When working with a swarm of drones, in addition to the usual problems with encryption and authentication (within the swarm and for communication between the swarm and the ground control station), there are additional problems related to the constant change in the composition of the swarm and its hovering position: drones can join or leave a swarm. Depending on the swarm management structure, a different method of authentication will be needed, which makes it difficult to unify such procedures for a swarm of drones. Authentication procedures for a swarm of drones in 5G can be implemented through the following approaches: individual authentication, when each drone as a member of the swarm undergoes authentication with one NR 5G ground station; you can consider such an approach as authentication of a group of IoT devices, if the traffic of the swarm is very limited; group authentication through a leader drone that communicates with swarm members and the 5G operator's network; group distributed authentication through edge drones. Group authentication via a drone leader is presented, where authentication is performed through a mechanism based on distributed delegation to reduce the service traffic directed to the 5G operator's core network. Here, legitimate drones are authorized as proxy delegated signers to perform authentication on behalf of the underlying network. Group distributed authentication through boundary drones is considered, which offers more solutions than the case of authentication through a leader drone. Here, a solution is possible for several cases at once, for example, authentication of new drones (entering the swarm or leaving the swarm) and merging two separate drone swarms.

Heart proteomic profiling discovers MYH6 and COX5B as biomarkers for sudden unexplained death

Sudden unexplained death (SUD) is not uncommon in forensic pathology. Yet, diagnosis of SUD remains challenging due to lack of specific biomarkers. This study aimed to screen differentially expressed proteins (DEPs) and validate their usefulness as diagnostic biomarkers for SUD cases. We designed a three-phase investigation, where in the discovery phase, formalin-fixed paraffin-embedded (FFPE) heart specimens were screened through label-free proteomic analysis of cases dying from SUD, mechanical injury and carbon monoxide (CO) intoxication. A total of 26 proteins were identified to be DEPs for the SUD cases after rigorous criterion. Bioinformatics and Adaboost-recursive feature elimination (RFE) analysis further revealed that three of the 26 proteins (MYH6, COX5B and TNNT2) were potential discriminative biomarkers. In the training phase, MYH6 and COX5B were verified to be true DEPs in cardiac tissues from 29 independent SUD cases as compared with a serial of control cases (n = 42). Receiver operating characteristic (ROC) analysis illustrated that combination of MYH6 and COX5B achieved optimal diagnostic sensitivity (89.7 %) and specificity (84.4 %), with area under the curve (AUC) being 0.91. A diagnostic software based on the logistic regression formula derived from the training phase was then constructed. In the validation phase, the diagnostic software was applied to eight authentic SUD cases, seven (87.5 %) of which were accurately recognized. Our study provides a valid strategy towards practical diagnosis of SUD by integrating cardiac MYH6 and COX5B as dual diagnostic biomarkers.

Facilitating interprofessional learning: experiences of using a digital activity for training handover of critically ill patients between a primary health care centre and ambulance services – a qualitative study

ObjectiveTo explore students’ and facilitators’ experiences of using a developed digital activity for interprofessional learning (IPL) focusing on critically ill patient handovers from a primary healthcare (PHC) centre to the...

Perception of enhanced learning in medicine through integrating of virtual patients: an exploratory study on knowledge acquisition and transfer

IntroductionVirtual Patients (VPs) have been shown to improve various aspects of medical learning, however, research has scarcely delved into the specific factors that facilitate the knowledge gain and transfer of knowledge from the classroom to real-world applications. This exploratory study aims to understand the impact of integrating VPs into classroom learning on students’ perceptions of knowledge acquisition and transfer.MethodsThe study was integrated into an elective course on “Personalized Medicine in Cancer Treatment and Care,” employing a qualitative and quantitative approach. Twenty-two second-year medical undergraduates engaged in a VP session, which included role modeling, practice with various authentic cases, group discussion on feedback, and a plenary session. Student perceptions of their learning were measured through surveys and focus group interviews and analyzed using descriptive statistics and thematic analysis.ResultsQuantitative data shows that students highly valued the role modeling introduction, scoring it 4.42 out of 5, and acknowledged the practice with VPs in enhancing their subject matter understanding, with an average score of 4.0 out of 5. However, students’ reflections on peer dialogue on feedback received mixed reviews, averaging a score of 3.24 out of 5. Qualitative analysis (of focus-group interviews) unearthed the following four themes: ‘Which steps to take in clinical reasoning’, ‘Challenging their reasoning to enhance deeper understanding’, ‘Transfer of knowledge ‘, and ' Enhance Reasoning through Reflections’. Quantitative and qualitative data are cohered.ConclusionThe study demonstrates evidence for the improvement of learning by incorporating VPs with learning activities. This integration enhances students’ perceptions of knowledge acquisition and transfer, thereby potentially elevating students’ preparedness for real-world clinical settings. Key facets like expert role modeling and various authentic case exposures were valued for fostering a deeper understanding and active engagement, though with some mixed responses towards peer feedback discussions. While the preliminary findings are encouraging, the necessity for further research to refine feedback mechanisms and explore a broader spectrum of medical disciplines with larger sample sizes is underscored. This exploration lays a groundwork for future endeavors aimed at optimizing VP-based learning experiences in medical education.

Kekuatan Hukum Atas Akta Pemberian Hak Tanggungan yang Tidak Mencantumkan Kuasa Pihak Perbankan

This study aims to analyze and criticize the position of APHT which does not include the power of of attorney for the banking party and PPAT's responsibility for its negligence in making APHT, which in the comparison of the deed does not include the power of the bank. This research is normative . The results of the study indicate that the making of a deed by PPAT is obliged to make APHT according to the guidelines for filling procedures based on Article 96 number (1) letter f as attached to VIb PERKABAN 8/2012, an error due to PPAT's negligence in making APHT in accordance with the author's case study caused The APHT made by PPAT XX Makassar City became null and void, because the APHT contained an inconsistency in the filling instructions which did not include a power of attorney from the bank, compared to APHT as the legal basis for acting on behalf of the directors of a banking company. The aggrieved party can also submit a complaint to the PPAT Regional Supervisory and Supervisory Council (MPPD), so that the PPAT concerned is given sanctions for negligence committed against the APHT he made.

Postmortem metabolomics: influence of time since death on the level of endogenous compounds in human femoral blood. Necessary to be considered in metabolome study planning?

IntroductionThe (un)targeted analysis of endogenous compounds has gained interest in the field of forensic postmortem investigations. The blood metabolome is influenced by many factors, and postmortem specimens are considered particularly challenging due to unpredictable decomposition processes.ObjectivesThis study aimed to systematically investigate the influence of the time since death on endogenous compounds and its relevance in designing postmortem metabolome studies.MethodsFemoral blood samples of 427 authentic postmortem cases, were collected at two time points after death (854 samples in total; t1: admission to the institute, 1.3–290 h; t2: autopsy, 11–478 h; median ∆t = 71 h). All samples were analyzed using an untargeted metabolome approach, and peak areas were determined for 38 compounds (acylcarnitines, amino acids, phospholipids, and others). Differences between t2 and t1 were assessed by Wilcoxon signed-ranked test (p < 0.05). Moreover, all samples (n = 854) were binned into time groups (6 h, 12 h, or 24 h intervals) and compared by Kruskal–Wallis/Dunn’s multiple comparison tests (p < 0.05 each) to investigate the effect of the estimated time since death.ResultsExcept for serine, threonine, and PC 34:1, all tested analytes revealed statistically significant changes between t1 and t2 (highest median increase 166%). Unpaired analysis of all 854 blood samples in-between groups indicated similar results. Significant differences were typically observed between blood samples collected within the first and later than 48 h after death, respectively.ConclusionsTo improve the consistency of comprehensive data evaluation in postmortem metabolome studies, it seems advisable to only include specimens collected within the first 2 days after death.

Complementary information concerning the suspected interindividual transmission of GW1516, a substance prohibited in sport, through intimate contact: a case report

PurposeInadvertent and/or unknowing exposure to drugs and drug residues has been frequently debated in situations of so-called adverse analytical finding (AAF) in the context of sports drug testing programs. Transfer of drug residues via unprotected intercourse is a conceivable scenario but scientific data and authentic case reports are scarce. Herein, investigations into two AAFs with the peroxisome proliferator-activated receptor delta (PPARδ) agonist GW1516 are reported and discussed.MethodsTo probe for a contamination scenario involving sexual intercourse, two assays were used to determine semenogelin in human urine, with one employing an immunochromatographic lateral flow approach and another based on liquid chromatography–tandem mass spectrometry. Further, drug-residue testing using patients’ ejaculate was conducted by utilizing liquid chromatography in conjunction with a triple quadrupole mass spectrometer, followed by re-analysis of suspect samples (i.e., samples indicating the presence of relevant compounds) using high resolution/high mass accuracy mass spectrometry.ResultsIn one case, but not the other, the possibility of intimate contact as the source of the AAF was confirmed after a thorough investigation of potential contamination scenarios. Subsequent research revealed analytical evidence for the presence of seminal fluid in one of the female athlete’s doping control urine samples, and the analysis of clinical ejaculate specimens provided first data on an authentic concentration level of GW1516 and its metabolites in human seminal fluid.ConclusionsThe combined facts substantiate the possibility of an AAF caused by unprotected sexual intercourse and the plausibility of the case-related arguments.

A Phenomenological Study of Intensive Experiential Learning for University Faculty Professional Development

Background: College students need the ability to generalize and apply solutions through reflective practice. University faculty need professional development to use authentic cases to prepare students for the future. Purpose: This study was to explore the experiences of faculty through a year-long professional development program that included a field experience contextually focused on natural disasters. Methodology: This phenomenological study used personal interviews with faculty about the essence of the shared experience. Data were analyzed through open coding, axial coding, and theoretical triangulation from Kolb’s experiential learning model. Findings/Conclusions: Participant interviews yielded 32 codes that were categorized into 12 themes and theoretically triangulated into the four components of Kolb’s experiential learning model: Experience, Reflection, Generalization, and Application. The concrete experience themes were connection to disasters, to other faculty, and new perspectives. Faculty reflected on their expertise, the importance of engaging experiences, and new realizations. Generalization broadened disciplinary perspectives and connections. Faculty gained teaching applications, including leadership concepts, and humanizing science. Implication: Professional development for faculty using experiential learning can improve teaching capacity for the next generation to solve complex problems of social, economic, and health concerns within communities.