Physiological Concepts Research Articles

Designing and testing an Integrated Study Strategy: Core Concepts in physiology and Mind Maps

This abstract shows the result of an innovative approach for learning physiology by combining two widely recognized methods: Core Concepts in physiology and Mind Maps. The objective is demonstrating the graphic product that visualize conceptual relationships holistically (mind map) combined with core concepts in cardiovascular physiology generated by a group of students enrolled to the integrative physiology course (2nd-year medical students, medical bachelor's degree, Professional Studies Faculty, Autonomous University of San Luis Potosí, México) during the semester august to December 2023. Methods: the curriculum content of cardiovascular physiology includes excitation-contraction coupling of the heart, the heart cycle, determinants of arterial pressure and peripheric vascular characteristics, including special circulations. The development of the mind map was according to the academic content of the course (4 weeks). The group of students worked with a training physiology teacher (including core concept training) for one 2-hour session per week (total= 4 sessions). The result is a mind map that includes the aspects of cardiovascular physiology addressed by the core concepts tool. Conclusion: Contemporary education faces increasing challenges in information retention and comprehension., and in this context, the integration of these two strategies emerges as a promising solution. This combination of learning tool is applicable in environments of low socioeconomical status because not involve doesn´t involve any monetary investments. Curricular Commission and the Academy or Clinical and Basic Sciences belonging to the bachelor´s degree of the Professional Studies Faculty, Autonomous University of San Luis Potosí, México. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Use of Function Diagrams in Physiology Education: Nessie the Nephron and Navigating the Lochs

Function diagrams focus on physiological concepts rather than associated structures and can serve as elaboration tools and mnemonic aids. A function diagram prototype of the gastrointestinal system was recently described (Wilson & Barrett, Adv Physiol Educ, 45:264–268, 2021). Currently, a functional diagram of the glomerulus, nephron, urinary system, and bladder is proposed. Colloquially named “Nessie the Nephron” to loosely capture the looping structure and illusive understanding of renal blood flow, glomerular filtration, and epithelial transport for the student, not to mention the nearly mythical countercurrent multiplier. “Navigating the Lochs” references Nessie’s possible habitat and more importantly the movement and storage of the modified ultrafiltrate from the nephron. The primary analogies that form the structure of this function diagram are: Rain Barrel, Soaker Hose, & Hose Nozzle (afferent and efferent blood flow and filtration pressure); Water Purification System (glomerular filtration barrier forming multiple step filtration process involving the capillary, basement membrane, and podocytes); Mixed Recycling Machine (proximal tubule individual, co-, and bulk transport); Desiccator & Briner (thin descending limb removal of water and thin/thick ascending limb movement of salt); Conveyor Belt Picker (distal nephron selective ion transport); and Concentrator (collecting duct water and urea transport). The primary analogies that elaborate “Navigating the Lochs” are Aqueduct & Cistern System (fluid movement and collection); and Pressure Gauge, Syringe Bulb, and Two-valve Plumbing (bladder storage and micturition). Complimenting these analogies is the rich potential for inclusion of clinical and comparative applications and examples to link previous knowledge and strengthen memories for future retrieval. University of Kentucky College of Medicine. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Physiology Core Concepts Guide Successful Mechanistic Reasoning

Mechanistic reasoning is a powerful strategy used to organize one’s thinking by leveraging the properties and behaviors of underlying entities to explain how and why phenomena occur. Modell identified seven “general models” (i.e., principles) in physiology that could serve as a cognitive framework for students to use to reason mechanistically about a variety of seemingly-distinct processes. Many of these principles are also Physiological Core Concepts. Though there are frameworks to analyze students’ use of mechanistic reasoning, there is currently no framework to analyze how physiology students use principles or Core Concepts to support their use of mechanistic reasoning to solve complex problems. In this study we ask two research questions about students use of the principle of Flux (i.e., the Core Concept of Flow Down Gradients) 1) How do students use the Flux Relationship to guide their mechanistic reasoning? 2) Are students who use the Flux Relationship to guide their mechanistic reasoning more successful when solving complex organismal biological problems? We recorded and transcribed in-class discussions of 14 introductory biology students in 4 small groups as they worked across a term to solve complex problems related to the principle of Flux (rate of movement ∝ gradient/resistance). To address RQ1, we combined emergent codes with established frameworks for mechanistic reasoning and Flux reasoning. We iteratively applied our codes to a subset of transcripts, compared interpretations and coding, revised the framework and re-coded. In this way we developed a framework to characterize how students use the Flux Relationship to guide their mechanistic reasoning. To address RQ2, we scored each discussion for accuracy and whether or not the students used the Flux relationship to guide their mechanistic reasoning. We then used a chi-square test to determine if more students who used Flux to guide their reasoning were accurate. RQ1 results: Our principle-based mechanistic reasoning framework for Flux includes two established mechanistic reasoning categories: identification (introduction of components of a system) and chaining (using the relationships between components to reason mechanistically). The framework then identifies how students use flux, or don’t, while discussing a complex physiological problem. For example, students may 1) identify or chain without using Flux, 2) identify an aspect of the Flux Relationship without using it to chain, 3) use the Flux relationship to chain. RQ2 results: We found that students who used the Flux Relationship to chain were significantly more likely to be accurate in their discussion. Our study adds to the current literature by providing researchers and instructors with a more meaningful analysis of how students use physiological principles/Core Concepts when mechanistically reasoning to solve complex problems. Additionally, our results support the claim that supporting students' use of principles/Core concepts can lead to higher accuracy in their reasoning. Finally, our framework can be used to measure the impact of instructional interventions designed to increase the use of students' principle-based mechanistic reasoning. Work funded by NSF. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Technology-Mediated Learning in Higher Education Physiology Classes: The Use of MeGli App to Teach Glycemic Control

Glycemic control is a fundamental physiological concept in diabetes and obesity. Proper training of healthcare professionals in this content is essential for disease prevention and management. Active learning methods, including technology-mediated learning (TML), are important for effective education and student engagement. Given the complexity of physiology, educational technology can facilitate the visualization of its dynamic processes. Thus, we've developed the MeGli smartphone application as an educational tool to teach glycemic control and related conditions, aimed at undergraduate students in health and biological courses. Our hypothesis is that the use of MeGli in Physiology classes promotes student learning and satisfaction. MeGli ( https://t.ly/crEwT ) is a didactic simulator for glycemic metabolism, allowing users to observe postprandial and fasting events, interact with objects, and explore cellular processes. The aim of this study was to conduct and evaluate a TML class using the app and its impact on students' outcomes in Biological Sciences Physiology classes at University of Campinas (n = 23). We analyzed pretest-posttest knowledge questionnaires using the Wilcoxon matched-pairs signed rank test (p ≤ 0.05) due to non-normal data (Shapiro-Wilk normality test). Additionally, we applied a Likert scale opinion survey. Prior to the intervention, students provided informed consent, ensuring anonymous participation. The use of MeGli in a non-expository class, where students consulted the app in an active-learning process for answering and discussing questions, led to a significant improvement in their performance on the topic of glucose metabolism and diabetes (pretest mean 5,739± 0,3784 versus 8,652± 0,2142 on posttest; p < 0.0001). In terms of student feedback, opinion questionnaire results were overwhelmingly positive. All students agreed that the app was useful for learning and helped in their understanding of diabetes mechanisms. 87% understood the importance of healthy eating and physical exercise through the app. 91.3% reported a higher acquisition of knowledge due to the app's use and found the app-integrated class more stimulating and engaging. These findings strongly support the effectiveness of the MeGli application in facilitating physiology education, leading to a more motivating educational experience. Consequently, this study is significant in introducing an innovative tool that mediates active learning with technology, enhancing physiology teaching strategies and improving the education of future healthcare professionals. CNPq (441028/2020-9), FAPESP (2018/26080-4), CEPID (2013/07607-8). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Embedding undergraduate Research Experience in Human Physiology Labs at Salt Lake Community College

We completely overhauled the laboratory portion (BIOL 2425) of our Human Physiology course at Salt Lake Community College. Our objective was to create a laboratory component that allows students to explore Human Physiology more deeply through iterative and connected projects that scaffold into a group Course-based Undergraduate Research Experience (CURE). We report the results from seven semesters of weekly student assessments. Our findings suggest that implementing this CURE increases undergraduate involvement in research and helps students achieve a deeper understanding of Human Physiology concepts. The Allen Foundation SLCC School of Science, Math, and Engineering. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Enhancing Medical Education through the "Distribute, Discuss, and Develop" Method: A Comparative Study of Small-Group Discussions.

Background Small-group discussions (SGDs) are pivotal in medical education, facilitating the development of critical thinking, communication skills, and teamwork. However, traditional SGDs face challenges such as scalability and maintaining student engagement. This study aims to evaluate the "Distribute, Discuss, and Develop" (3D) method for enhancing learning outcomes in medical education. Methods A single-blinded interventional study was conducted with 125 first-year Bachelor of Medicine and Bachelor of Surgery students, who were divided into intervention and control groups through random assignment. The intervention group employed the 3D method across two thematic units: hematology and muscle nerve physiology. The study assessed learning outcomes using pre- and posttests, class-average normalized gain ("g"), and feedback questionnaires to capture student perceptions of interaction, communication enhancement, and session summarization. Results The intervention group showed significantly improved learning outcomes in both thematic units, with larger effect sizes (hematology: 1.55; muscle nerve physiology: 1.4) compared to the control group. The normalized gain "g" indicated a medium effectiveness level for the intervention group in both themes, suggesting enhanced learning. Feedback questionnaires revealed higher satisfaction levels within the intervention group regarding interaction, communication skills, and session summarization. Conclusions The 3D method addresses the challenges faced by traditional SGDs, providing a scalable and engaging approach to medical education. By fostering more effective student-centered learning, the method enhances the comprehension of complex physiological concepts and improves communication skills. The 3Dmethod significantly improves learning outcomes, interaction, and communication skills in medical education. This innovative approach to SGDs offers a promising strategy for enhancing the educational experience in medical schools, supporting the development of more articulate and professionally competent medical graduates.

Towards humanlike grasp in robotic hands: mechanical implementation of force synergies

In the field of robotic hands, finger force coordination is usually achieved by complex mechanical structures and control systems. This study presents the design of a novel transmission system inspired from the physiological concept of force synergies, aiming to simplify the control of multifingered robotic hands. To this end, we collected human finger force data during six isometric grasping tasks, and force synergies (i.e. the synergy weightings and the corresponding activation coefficients) were extracted from the concatenated force data to explore their potential for force modulation. We then implemented two force synergies with a cable-driven transmission mechanism consisting of two spring-loaded sliders and five V-shaped bars. Specifically, we used fixed synergy weightings to determine the stiffness of the compression springs, and the displacements of sliders were determined by time-varying activation coefficients. The derived transmission system was then used to drive a five-finger robotic hand named SYN hand. We also designed a motion encoder to selectively activate desired fingers, making it possible for two motors to empower a variety of hand postures. Experiments on the prototype demonstrate successful grasp of a wide range of objects in everyday life, and the finger force distribution of SYN hand can approximate that of human hand during six typical tasks. To our best knowledge, this study shows the first attempt to mechanically implement force synergies for finger force modulation in a robotic hand. In comparison to state-of-the-art robotic hands with similar functionality, the proposed hand can distribute humanlike force ratios on the fingers by simple position control, rather than resorting to additional force sensors or complex control strategies. The outcome of this study may provide alternatives for the design of novel anthropomorphic robotic hands, and thus show application prospects in the field of hand prostheses and exoskeletons.

The Reflex Republic: Physiologies of Art in the Early Soviet Union

Abstract In the immediate wake of the Russian Revolution, Pavlovian reflex conditioning was rapidly elevated to a universal materialist model for understanding and manipulating human behavior, including the production and reception of art. This article explores the little-known history of the “reflexology of art,” a movement that applied physiological concepts and techniques to drama, cinema, and literature with the aim of molding atomized individual subjectivities into a corporeal collective. This movement—which involved figures like Vsevolod Meyerhold, Sergei Eisenstein, and Sergei Tret'iakov—formed part of the highly politicized dialogue between science, politics and the arts in the 1920s. By reconstructing the critical discourse around the reflexology of art within the cultural production of the early Soviet state, the article sheds light on the contradictory impulses animating an avant-garde caught between deterministic visions of social engineering and the subversive passions of revolution.

Utilizing a medical school outreach program to help high school students explore the impact of food security and ultraprocessed foods on health risks.

We offered an enrichment program for high school students with the theme, "The Environment, Health, and You" during the Summer of 2022 and the Spring of 2023. We developed several educational modules for high school students that provided them with an opportunity to learn and explore the foundations of physiological systems, nutrient needs to maintain health, and the impact that environmental factors can have on them. The modules included videos, discussion boards, games, readings, and labs. These modules were integrated into the first session: Your Body and Health. On day 1, the first module explored the basic physiology and anatomy of the body with respect to the organization of cells into organ systems. Additionally, the educational content included information on macro- and micronutrients and their impact on body development, nutrition, and metabolism. The nutrition module explored nutrition concepts and various factors that can impact healthy eating patterns, such as food insecurity issues and the consumption of ultraprocessed foods. A lab activity on label reading was included to help empower students to make healthy choices. A total of 43 high school students participated in the program. Overall, the quality of the educational content in the modules was rated highly by the students, and they indicated that the educational experience inspired them to learn more about the physiology and nutrition concepts associated with human metabolism, and the importance of healthy food choices to maintain health.NEW & NOTEWORTHY We describe how we integrated guided learning teaching modules in an enrichment program for high school students with the aim of enhancing their knowledge and skills to empower them to take charge of their own health risks and well-being.

Sourcebook update: RBC hemolysis studies using a simple modified blood film technique.

Water movement across the cell membrane is crucial, with red blood cells (RBCs) experiencing the flow of water in both directions at a rate of approximately 100 times their volume per second. This process typically results in no net water flow due to an equal balance of water movement in opposite directions, a phenomenon known as osmosis, driven by water potential or impermeant solute concentration. Understanding osmosis is essential for both physiology and medical practice, yet its complexity may not be effectively conveyed to the students through traditional teaching methods. This study presents a novel approach to observing the osmotic effect on RBCs using a simple, modified blood film technique. Aimed at enhancing educational understanding of cellular behavior in different osmotic environments, this method provides a practical hands-on learning experience. By applying various osmotic solutions to prepared blood films and observing the resultant morphological changes in RBCs under a microscope, this technique allows for direct visualization of osmosis in action.NEW & NOTEWORTHY This study presents an innovative teaching approach for understanding osmosis and its effects on red blood cells. Using a simple, modified blood film technique, students can visually observe and engage with the dynamic process of osmosis. This hands-on method enhances learning, making complex physiological concepts accessible and practical. Ideal for resource-limited settings, it bridges theoretical knowledge and practical application, transforming physiology education.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Anemia tolerance mechanisms

Understanding the physiological concepts of oxygen delivery is essential to discern the mechanisms that influence its increase, reduction or maintenance in the body. This text explores the different mechanisms that help maintain oxygen delivery even in the face of reduced hemoglobin levels. Adequate oxygen delivery ensures tissue and metabolic balance, which is crucial to avoid harmful consequences such as metabolic acidosis and cellular dysoxia. The complex interaction between variables such as cardiac output, hemoglobin and heart rate (HR) plays a fundamental role in maintaining oxygen delivery, allowing the body to temporarily adjust to situations of anemia or high metabolic demand. It is important to emphasize that blood transfusions should not be based on fixed values, but rather on individual metabolic needs. Strategies to reduce myocardial consumption and monitor macro and micro hemodynamics help in making rational decisions. Individualizing treatment and considering factors such as blood viscosity in relation to the benefits of transfusion are increasingly relevant to optimize therapy and minimize risks, especially in complex clinical scenarios, such as neurocritical patients and trauma victims.

Drawing for Retention: Using Visual Arts to Teach Cardiovascular Pathophysiology in Athletic Training

Context Sudden cardiac arrest is the leading cause of sport-related deaths in young athletes. Athletic training students must understand cardiovascular anatomy and physiology in addition to pathophysiology to appropriately care for patients with cardiovascular conditions. Objective Describe a teaching technique to actively engage students in lecture about cardiovascular anatomy, physiology, pathophysiology, and electrocardiograms. Background Drawing for retention is an educational technique used in medical education to help students recognize patterns, reinforce knowledge, and retain information. Using drawing for abstract concepts that cannot always be visualized or applied enhances comprehension. Description An educational technique using drawing for retention to teach cardiovascular concepts, conditions, and basic electrocardiogram interpretation was implemented in an emergency care in athletic training course. The instructor drew and lectured on concepts of anatomy, physiology, pathophysiology, electrocardiograms, and interventions while the students drew and took notes on the concepts. Educational Advantage(s) Students describe this activity as a beneficial way to learn and apply cardiovascular anatomy and physiology to cardiovascular conditions and treatment. Conclusions Faculty may consider implementing drawing for retention as an active learning technique to engage students with complex or abstract topics.

Optimal bispectral index exists in healthy patients undergoing general anesthesia: A validation study.

Continuous cerebrovascular reactivity monitoring in both neurocritical and intra-operative care has gained extensive interest in recent years, as it has documented associations with long-term outcomes (in neurocritical care populations) and cognitive outcomes (in operative cohorts). This has sparked further interest into the exploration and evaluation of methods to achieve an optimal cerebrovascular reactivity measure, where the individual patient is exposed to the lowest insult burden of impaired cerebrovascular reactivity. Recent literature has documented, in neural injury populations, the presence of a potential optimal sedation level in neurocritical care, based on the relationship between cerebrovascular reactivity and quantitative depth of sedation (using bispectral index (BIS)) - termed BISopt. The presence of this measure outside of neural injury patients has yet to be proven. We explore the relationship between BIS and continuous cerebrovascular reactivity in two cohorts: (A) healthy population undergoing elective spinal surgery under general anesthesia, and (B) healthy volunteer cohort of awake controls. We demonstrate the presence of BISopt in the general anesthesia population (96% of patients), and its absence in awake controls, providing preliminary validation of its existence outside of neural injury populations. Furthermore, we found BIS to be sufficiently separate from overall systemic blood pressure, this indicates that they impact different pathophysiological phenomena to mediate cerebrovascular reactivity. Findings here carry implications for the adaptation of the individualized physiologic BISopt concept to non-neural injury populations, both within critical care and the operative theater. However, this work is currently exploratory, and future work is required.

Conceptual Approach to Body Fluids and Edema, EducationDetermines Clinical Outcomes in Heart Failure.

In this brief communication, we reemphasize the importance of critical thinking in clinical practice using the example of edema. The common practice of thinking and inquiry by practicing clinicians has beneficial implications for healthcare by improving outcomes and patient care while alleviating the burden of misconceptions in practice. We provide an in-depth and interactive investigation of physiological concepts as a foundation for understanding body fluid dynamics. Finally, we offer a new classification of symptoms of heart failure. DOI: 10.52547/ijkd.8171.

Conceptual Approach to Body Fluids and Edema, EducationDetermines Clinical Outcomes in Heart Failure.

In this brief communication, we reemphasize the importance of critical thinking in clinical practice using the example of edema. The common practice of thinking and inquiry by practicing clinicians has beneficial implications for healthcare by improving outcomes and patient care while alleviating the burden of misconceptions in practice. We provide an in-depth and interactive investigation of physiological concepts as a foundation for understanding body fluid dynamics. Finally, we offer a new classification of symptoms of heart failure. DOI: 10.52547/ijkd.8171.

The small molecule activator S3969 stimulates the epithelial sodium channel by interacting with a specific binding pocket in the channel's β-subunit

The epithelial sodium channel (ENaC) is essential for mediating sodium absorption in several epithelia. Its impaired function leads to severe disorders, including pseudohypoaldosteronism type 1 and respiratory distress. Therefore, pharmacological ENaC activators have potential therapeutic implications. Previously, a small molecule ENaC activator (S3969) was developed. So far, little is known about molecular mechanisms involved in S3969-mediated ENaC stimulation. Here, we identified an S3969 binding site in human ENaC by combining structure-based simulations with molecular biological methods and electrophysiological measurements of ENaC heterologously expressed in Xenopus laevis oocytes. We confirmed a previous observation that the extracellular loop of β-ENaC is essential for ENaC stimulation by S3969. Molecular dynamics (MD) simulations predicted critical residues in the thumb domain of β-ENaC (Arg388, Phe391, and Tyr406) that coordinate S3969 within a binding site localized at the β-γ-subunit interface. Importantly, mutating each of these residues reduced (R388H; R388A) or nearly abolished (F391G; Y406A) the S3969-mediated ENaC activation. MD simulations also suggested that S3969-mediated ENaC stimulation involved a movement of the α5 helix of the thumb domain of β-ENaC away from the palm domain of γ-ENaC. Consistent with this, the introduction of two cysteine residues (βR437C – γS298C) to form a disulfide bridge connecting these two domains prevented ENaC stimulation by S3969 unless the disulfide bond was reduced by DTT. Finally, we demonstrated that S3969 stimulated ENaC endogenously expressed in cultured human airway epithelial cells (H441). These new findings may lead to novel (patho-)physiological and therapeutic concepts for disorders associated with altered ENaC function.

Ovarian follicular waves in ovulation induction in assisted reproduction techniques

Background: A greater understanding of the menstrual cycle and multiple waves of antral ovarian follicular development has challenged traditional concepts of female reproductive physiology and the foundations of assisted reproductive technologies (ART). Approximately two-thirds of women develop two follicle waves throughout an interovulatory interval, and the remainder exhibit three waves of follicle development. Major and minor waves of follicle development have been observed. Major waves are those in which a dominant follicle develops; dominant follicles either regress or ovulate. In minor waves, the physiological selection of a dominant follicle is not manifested. Knowledge of the waves of antral follicular development has led to the global adoption of novel ovarian stimulation strategies in which stimulation can be initiated at various times throughout the cycle. Random-start and luteal-phase ovarian stimulation regimens have important clinical applications in women requiring urgent oocyte or embryo cryopreservation for fertility preservation before chemotherapy.
 Objective: To evaluate the role of multiple waves of the antral ovarian follicular in the menstrual cycle in ovulation induction in ART.
 Methods: A literature search using the keywords “multiple waves of antral ovarian follicular development, In Vitro Fertilization, Ovarian stimulation ” was performed in the PubMed database.
 Outcome: Random start and luteal phase of ovulation induction in ART offer the same results in fertilization and pregnancy rates as conventional early follicular phase start.
 Conclusion: The primary benefits of the random-start protocol include a patient-oriented approach to care, timely and efficient treatment, and a lower dropout rate. Women with poor ovarian reserve and those diagnosed with cancer will have a greater chance of successful assisted reproduction with the use of these strategies.

Speech Science as the Foundation for Voice and Motor Speech Disorders

Purpose: Physiological concepts can be effectively taught in speech science. These will serve as the foundation for understanding the physiological changes associated with neurogenic and voice disorders. In this tutorial, relevant concepts are highlighted across the respiratory, phonatory, velopharyngeal, and articulatory systems. Student activities and illustrative videos are presented. The culminating activity is based on a speech sample of an individual with moderate flaccid–spastic dysarthria. Students relate the physiological changes associated with dysarthria to the acoustic outcomes. Conclusions: Although traditionally speech science focuses on acoustics, this tutorial provides guidance on shaping the class to highlight the physiology underlying the acoustics. In this manner, students more easily see the clinical relevance.

Multi-focused laboratory experiments based on Quorum Sensing and Quorum Quenching for acquiring Microbial Physiology concepts.

After a time away from the classrooms and laboratories due to the global pandemic, the return to teaching activities during the semester represented a challenge to both teachers and students. Our particular situation in a Microbial Physiology course was the necessity of imparting in shorter time, laboratory practices that usually take longer. This article describes a 2-week-long laboratory exercise that covers several concepts in an interrelated way: conjugation as a gene transfer mechanism, regulation of microbial physiology, production of secondary metabolites, degradation of macromolecules, and biofilm formation. Utilizing a Quorum Quenching (QQ) strategy, the Quorum Sensing (QS) system of Pseudomonas aeruginosa is first attenuated. Then, phenotypes regulated by QS are evidenced. QS is a regulatory mechanism of microbial physiology that relies on signal molecules. QS is related in P. aeruginosa to several virulence factors, some of which are exploited in the laboratory practices presented in this work. QQ is a phenomenon by which QS is interrupted or attenuated. We utilized a QQ approach based on the enzymatic degradation of the P. aeruginosa QS signals to evidence QS-regulated traits that are relevant to our Microbial Physiology course. Results obtained with the same test performed by a random group of students before and after the activities show the positive effectiveness of the approach presented in this work.

Mechanical Ventilation, Past, Present, and Future.

Mechanical ventilation (MV) has played a crucial role in the medical field, particularly in anesthesia and in critical care medicine (CCM) settings. MV has evolved significantly since its inception over 70 years ago and the future promises even more advanced technology. In the past, ventilation was provided manually, intermittently, and it was primarily used for resuscitation or as a last resort for patients with severe respiratory or cardiovascular failure. The earliest MV machines for prolonged ventilatory support and oxygenation were large and cumbersome. They required a significant amount of skills and expertise to operate. These early devices had limited capabilities, battery, power, safety features, alarms, and therefore these often caused harm to patients. Moreover, the physiology of MV was modified when mechanical ventilators moved from negative pressure to positive pressure mechanisms. Monitoring systems were also very limited and therefore the risks related to MV support were difficult to quantify, predict and timely detect for individual patients who were necessarily young with few comorbidities. Technology and devices designed to use tracheostomies versus endotracheal intubation evolved in the last century too and these are currently much more reliable. In the present, positive pressure MV is more sophisticated and widely used for extensive period of time. Modern ventilators use mostly positive pressure systems and are much smaller, more portable than their predecessors, and they are much easier to operate. They can also be programmed to provide different levels of support based on evolving physiological concepts allowing lung-protective ventilation. Monitoring systems are more sophisticated and knowledge related to the physiology of MV is improved. Patients are also more complex and elderly compared to the past. MV experts are informed about risks related to prolonged or aggressive ventilation modalities and settings. One of the most significant advances in MV has been protective lung ventilation, diaphragm protective ventilation including noninvasive ventilation (NIV). Health care professionals are familiar with the use of MV and in many countries, respiratory therapists have been trained for the exclusive purpose of providing safe and professional respiratory support to critically ill patients. Analgo-sedation drugs and techniques are improved, and more sedative drugs are available and this has an impact on recovery, weaning, and overall patients' outcome. Looking toward the future, MV is likely to continue to evolve and improve alongside monitoring techniques and sedatives. There is increasing precision in monitoring global "patient-ventilator" interactions: structure and analysis (asynchrony, desynchrony, etc). One area of development is the use of artificial intelligence (AI) in ventilator technology. AI can be used to monitor patients in real-time, and it can predict when a patient is likely to experience respiratory distress. This allows medical professionals to intervene before a crisis occurs, improving patient outcomes and reducing the need for emergency intervention. This specific area of development is intended as "personalized ventilation." It involves tailoring the ventilator settings to the individual patient, based on their physiology and the specific condition they are being treated for. This approach has the potential to improve patient outcomes by optimizing ventilation and reducing the risk of harm. In conclusion, MV has come a long way since its inception, and it continues to play a critical role in anesthesia and in CCM settings. Advances in technology have made MV safer, more effective, affordable, and more widely available. As technology continues to improve, more advanced and personalized MV will become available, leading to better patients' outcomes and quality of life for those in need.