Extensive Planning Research Articles

P.144 Awake craniotomy in pregnancy: a systematic review

Background: Awake Craniotomy during pregnancy is a rare but urgent procedure. Since pregnancy can both accelerate the progression of a tumor and mask other diagnoses, cases may lead to premature termination of pregnancy. From a neurosurgical, anesthetic, and obstetrical perspective, these operations may be challenging. Methods: In accordance with the PRISMA guidelines, MEDLINE, Scopus, and Web of Science databases were searched from inception to January 3rd, 2023. Studies were included if they included pregnant patients who underwent awake craniotomy. Results: Nine papers fit the criteria for the final analysis. All investigations were case studies. A total of nine patients were included. Mean age at surgery was 26.9 years, and mean gestational age at craniotomy was 20.9 weeks. Eight (88.9%) patients underwent craniotomy for tumor resection and the other had a pseudoaneurysm repair. Glioma was the most common tumor pathology (n=5), followed by meningioma (n=1), and glioblastoma (n=1). None of the patients experienced significant intraoperative or immediate postoperative complications. There were no obstetrical complications or significant changes in fetal status during or after surgery, and all reported deliveries were successful with healthy infants. Conclusions: Awake craniotomy during pregnancy can be a safe procedure with appropriate pre-operative patient selection and extensive multidisciplinary planning.

Strategies Steering Intensification Pathways of Farmers in Central Malawi

AbstractSmallholder farmers face many challenges to improve their livelihoods and food security. Intensification of agricultural production can help to achieve these goals. Yet farmers are highly heterogenous in their strategies towards intensification, potentially following unsustainable intensification pathways. Using Q Methodology, we ascertain different strategies regarding farm improvement and intensification of smallholder farmers in the Dedza and Ntcheu Extension Planning Areas in Central Malawi. These strategies were associated to coherent sequential choices as expressed in “managerial intensification pathways” (MIPs). Three main strategies emerged: Seed Saving Peasants, Aspirant Modern Farmers and Entrepreneurial Business(wo)men. These were subsequently linked to four MIPs. Seed Saving Peasants focus strongly on local seed systems and post-harvest protection of grains, but also allocate more labour to improving crop residue use and manure quality, thus pointing to a labour-oriented MIP. Aspirant Modern Farmers willingly adopt hybrid seeds and inorganic fertilizers but require more extension support; these farmers follow a technology-oriented MIP. Entrepreneurial Business(wo)men are early adopters of new technologies and benefit from improved access to market information and suppliers of new technologies and follow a sustainable technology-based or techno-ecological intensification pathway. This study shows that strongly contrasting perspectives on intensification exist among smallholders and it is expected that their preferred intensification choices will have diverging impacts on the sustainability of their farms. A diversity of extension, advice and incentive instruments will be needed to support farmer decision making towards sustainably intensified farms.

Experience with Advisory Committee Meeting Preparation and Execution

The FDA uses advisory committees and panels to obtain independent expert advice on scientific, technical, and policy matters. Advisory Committee Meetings (ACMs) may be convened if the agency has significant questions or concerns about clinical data submitted for review. Statisticians from both FDA and industry can play a key role in providing insight into the data under review in an ACM. This requires extensive preparation and planning which extends beyond the data provided in the submission package. In this article, we review the contributions of industry Statisticians in the planning, preparation and responses for ACMs.

Combined use of intraoperative MRI and awake tailored microsurgical resection to respect functional neural networks: preliminary experience.

The combined use of intraoperative MRI and awake surgery is a tailored microsurgical resection to respect functional neural networks (mainly the language and motor ones). Intraoperative MRI has been classically considered to increase the extent of resection for gliomas, thereby reducing neurological deficits. Herein, we evaluated the combined technique of awake microsurgical resection and intraoperative MRI for primary brain tumours (gliomas, metastasis) and epilepsy (cortical dysplasia, non-lesional, cavernomas). Eighteen patients were treated with the commonly used "asleep awake asleep" (AAA) approach at Lille University Hospital, France, from November 2016 until May 2020. The exact anatomical location was insular with various extensions, frontal, temporal or fronto-temporal in 8 (44.4%), parietal in 3 (16.7%), fronto-opercular in 4 (22.2%), Rolandic in two (11.1%), and the supplementary motor area (SMA) in one (5.6%). The patients had a mean age of 38.4 years (median 37.1, range 20.8-66.9). The mean surgical duration was 4.1 hours (median 4.2, range 2.6-6.4) with a mean duration of intraoperative MRI of 28.8 minutes (median 25, range 13-55). Overall, 61% (11/18) of patients underwent further resection, while 39% had no additional resection after intraoperative MRI. The mean preoperative and postoperative tumour volumes of the primary brain tumours were 34.7 cc (median 10.7, range 0.534-130.25) and 3.5 cc (median 0.5, range 0-17.4), respectively. Moreover, the proportion of the initially resected tumour volume at the time of intraoperative MRI (expressed as 100% from preoperative volume) and the final resected tumour volume were statistically significant (p= 0.01, Mann-Whitney test). The tumour remnants were commonly found posterior (5/9) or anterior (2/9) insular and in proximity with the motor strip (1/9) or language areas (e.g. Broca, 1/9). Further resection was not required in seven patients because there were no remnants (3/7), cortical stimulation approaching eloquent areas (3/7) and non-lesional epilepsy (1/7). The mean overall follow-up period was 15.8 months (median 12, range 3-36). The intraoperative MRI and awake microsurgical resection approach is feasible with extensive planning and multidisciplinary collaboration, as these methods are complementary and synergic rather than competitive to improve patient oncological outcomes and quality of life.

What Goes Up, Must Come Down: A State-of-the-Art Electronic Health Record Downtime and Uptime Procedure in a Metropolitan Health Setting.

Electronic health records (EHRs) are used at most hospitals around the world, and downtime events are inevitable and common. Downtime represents a risky time for patients because patient information and critical EHR functionality are unavailable. Many institutions have used EHRs for years, with health professionals less likely to be familiar or comfortable with paper-based processes, resulting in an increased risk of errors during downtimes. There is currently limited guidance available on how to develop and operationalize downtime procedure at a local level. In this paper, we fill this gap by describing our state-of-the-art downtime and uptime procedure and its evaluation. A district-wide downtime and uptime procedure was revised and standardized based on lessons learned from other health care organizations. The procedure outlines downtime and uptime preparations including downtime drills, downtime viewer auditing, and downtime education; downtime response including activating downtime and tracking patient changes; and uptime recovery including medication reconciliation and uptime documentation. We implemented our new procedure across the district during an 8-hour planned downtime. A district downtime planning committee was formed, and a virtual command center was established to coordinate the downtime and uptime events. During downtime and uptime, onsite support was provided by the district's health informatics teams and clinicians. Data recovery was completed safely and efficiently with the revised uptime process. Following the event, we gathered staff feedback and reflections on implementing the procedure which highlighted its success but also revealed some areas for further improvement. In this paper, we describe a state-of-the-art EHR downtime and uptime procedure and lessons learned from its implementation. The implementation was successful with staff well prepared and information reconciled efficiently ensuring safe continuity of care. It was only through extensive planning, significant commitment, and engagement of all stakeholders that this outcome was possible.

Incidence and Possible Predictive Factors of Facial Nerve Paralysis after Superficial Parotidectomy for Benign Tumours: Our Experience.

Salivary gland tumors represent 3-10% of all head and neck neoplasms. Most of the tumours are benign with parotid gland being most commonly affected. Surgical intervention in the form of parotidectomy forms the mainstay of treatment. Among the various postoperative complications that may occur after parotidectomy, facial nerve weakness is the most dreaded one for both the surgeon as well as the patient. In the literature, the incidence of transient facial weakness after parotid surgery ranges from 10 to 68%, and long-term dysfunction ranges from 0 to 19%. Apart from injury mechanisms such as nerve division, stretch, thermal injuries, ischemia, several other risk factors such as tumour size, disease duration etc. have also been identified for post parotidectomy facial nerve dysfunction which vary considerably from study to study. Thus, facial nerve injury despite being a common and dreaded complication is also a preventable one. We in our institute conducted a retrospective study from January 2018 to December 2021to evaluate the incidence of facial nerve weakness and possible predictive factors among 60 patients who underwent superficial parotidectomy for benign tumours and found that when it comes to benign tumours surgical technique rather than tumour factors are more important in preventing nerve injury. Undertaking this study was important in order to emphasize the importance of extensive preoperative planning and better surgical practices among budding head and neck surgeons in our country.

Restoring Asia’s roar: Opportunities for tiger recovery across the historic range

Wildlife conservation in the Anthropocene requires bold conservation solutions including restoration of ecosystems and species. The recovery of large carnivore populations is a conservation goal which can generate significant benefits in terms of ecosystem services, ecological functionality, and human well-being. Tigers Panthera tigris, Asia’s most iconic species, are currently restricted to less than 10% of their historic range with recent national extinctions from a number of countries in mainland Southeast Asia. Tiger recovery through range expansion requires suitable habitat, a robust prey base, and high levels of institutional support for conservation. We explored government support for conservation to produce a ranking of the political opportunities for tiger restoration across current and former tiger range countries. We used this analysis, in combination with globally remotely sensed data-sets on human impact, to show that there is potential for significant tiger range expansion. We identified large expanses of currently unoccupied, but potentially suitable, habitat in at least 14 countries including all extant tiger range countries and four countries with extirpated tiger populations – Cambodia, Lao PDR, Viet Nam, and Kazakhstan. Thirty-two percent of expansion areas were within 50-km, and 50% within 100-km, of current tiger populations highlighting that in many landscapes range expansion could be driven by the natural dispersal of tigers provided connectivity is maintained or enhanced. The proportion of potential range within existing protected areas varied between <5% in India, Indonesia, and China, to >60% in Thailand and Cambodia. As such socially appropriate conservation approaches, in collaboration with local communities, will be necessary to support tiger recovery in many areas. We recommend that some of the areas which we have identified should be highlighted as significant for future tiger conservation by tiger range country governments. Whilst the landscapes and sites which we identify will require detailed ground-truthing, and all tiger reintroductions need extensive planning and feasibility assessments, safeguarding these areas for human-carnivore coexistence could provide significant planetary benefits and support both tiger recovery and Global Sustainable Development Goals.

Catastrophic Failure of Shanghai Metro Line 4 in July 2003: Postaccident Rehabilitation

The destructive failure of Shanghai Metro line 4 across underneath the Huangpu River on July 1, 2003, led to massive ground subsidence and collapse of pre-existing structures in the proximity; additionally, the failure generated large amounts of human-made rigid obstructions in the strata, which made rehabilitation of the collapsed metro line be very technically challenging. By extensive comparisons in terms of technical difficulties, economic costs, and construction durations, a plan of reconstruction of the collapsed metro line at its original location rather than relocation was selected finally for the postfailure rehabilitation. The majority of the failed metro line was replaced by a 262-m-long×23.7-m-wide×38.5–41.2-m-deep cut-and-cover tunnel bottoming out in the confined aquifer, whose two ends were connected with the existing intact metro line via two 10-m-long tunnels mined within the aquifer by the ground-freezing method. Excavation of the cut-and-cover tunnel was retained by 1.2-m-thick and 65-m-high perimeter diaphragm wall panels braced by 9–10 levels of steel-reinforced concrete struts. To ensure the project safety and mitigate potential adverse influences of field works on the urban environments, extensive innovative construction plans, measures, and techniques were designed and then implemented into the reconstruction, e.g., a lightweight cofferdam and pile-supported steel platform for diaphragm walling through the existing metro line underneath the river; unique protective solutions and construction techniques for execution of vertical and horizontal ground-freezing programs for diaphragm walling and mining; special procedures of cleaning up the existing tunnels previously filled with water, sand, and cement; innovative joints and grouting measures adopted between the reconstructed tunnel and the pre-existing intact metro line, and so on. Furthermore, the initial designs were optimized and adjusted with the progress of field construction works. Lastly, the long-term field performance data demonstrated the success of this rehabilitation project, which affected the urban environments rarely. The construction plans, measures, and techniques outlined in this paper are practical, useful references for professionals worldwide to deal with similar underground projects in the future.

On the Design of Aqueous Emulsions of Colophony Resin.

Companies regularly face market pressure to develop products faster but they also need to simultaneously incorporate technological constraints, sustainability trends, and customer requirements into their designs, which requires the use of systematic procedures. Firms that exploit natural resources and convert them into high-value products are among them. However, the literature on the application of such systematic approaches to products of this type remains scarce, as they often requrire extensive experimental plans involving the testing and optimization of multiple formulations. Here, we propose a systematic approach to the design of pine-resin-in-water emulsions, which can be used to fabricate pressure-sensitive adhesives. The strategy is customer-centric in the sense that the customers' specifications are integrated into the decision-making tool used to assess the quality of the formulations obtained through experiments. This tool uses loss functions to assess satisfaction with individual quality characteristics and multi-attribute decision-making methods to integrate them into an overall quality metric. Our framework is aligned with industrial practices and consists of three sequential stages: (i) screening of primary factors; (ii) optimization of secondary factors; and (iii) assessment of the experimental repeatability of the formulations. In each of these stages, the decision-making tool is used to "drive" the process of finding the optimal formulation.

Сучасні аспекти стійкого розвитку Поліського економічного регіону

Abstract. Introduction. The strategy of sustainable development is an extremely complex and extensive plan for predicting, preventing and solving problems on which depends the future survival of all living beings. It is quite difficult to operate with global goals without sufficient awareness of what is happening at the regional and local levels. Thus, a problem arises in the study of aspects of sustainable development of a specific economic region of Ukraine with the aim of determining its main properties and ways for improving regional policy. Purpose. Research of the current state of economy, ecology and social trends, definition of the main aspects and development of proposals for ways to improve and accelerate the sustainable development of the Polissya economic district. Results. Polissya economic district is a region where every global goal of sustainable development must be implemented at the local level, because economic sphere, environment, and society need considerable changes. Social sphere is dominated by depressive processes, the environment is constantly polluted by harmful emissions from enterprises and radiation pollution. All this factors directly affect the economy, which has lost its former potential and has focused only on extracting raw materials. The war became a catalyst for large-scale negative tendencies. But despite the factors listed above, Polissya economic district has a great potential in agro-industrial complex, tourism sector, and available renewable energy sources. Conclusions. Sustainable development should be completely supported by local population and government. Also implementation of environmental management system will be strong impulse for responsible and enhanced restoration of the environment, which will directly affect the condition of health of the local population.

Lifting a 183 t concrete digester roof safely and cost-effectively with hydraulic bottle jacks

A 183 t conical concrete roof of a cylindrical anaerobic digester tank at a UK sewage treatment works had to be lifted 150 mm to repair the seal underneath it. Due to limited space for a crane, an incremental hydraulic jacking procedure was used, with 32 bottle jacks in pockets cored out from the top of the concrete tank wall. This paper describes the temporary works design methodology, the extensive planning for risk mitigation, the practical implementation strategy and the lessons learned from using this safe and cost-effective approach.

Fishermen's Satisfaction with Fisheries Extension Activities in Padang Pariaman Regency, West Sumatra Province

Fisheries counseling activities are an asset in realizing independent, competitive, and resilient fishermen in Padang Pariaman regency. Fishermen have hopes and goals to develop their businesses, so they participate in fisheries extension activities. This study examines fishermen's satisfaction with fisheries extension activities in Padang Pariaman Regency, West Sumatra. The research implementation starts from June to October 2022. The research uses a survey method with an explanatory research approach. Respondents were taken based on the accidental sampling technique using the Slovin Formula, so the number of respondents used was 68 fishermen. This study uses descriptive analysis data. Fishermen's satisfaction in fisheries counseling activities is still felt to have yet to satisfy fishermen. Fishermen's satisfaction in fisheries extension activities consists of three stages of activity, namely: 1) Fishermen feel dissatisfied at the extension planning stage; 2) the implementation of fisheries counseling activities are in the dissatisfied category; 3) the evaluation of fisheries extension activities is in the dissatisfied category

Navigating urban tourism planning in a late-pandemic world: The Copenhagen case

This work explores the ways in which COVID-19 has affected the discourse on public tourism planning in Copenhagen and how policies meet the challenges of the climate crisis. Inspired by the concept of ‘governmobility’, we explore changes in discourse on how urban tourism policies aim to ease and control access, mobility, and circulation. The implementation of the DMO Wonderful Copenhagen's ‘localhood’ strategy has tried to cope with issues of over-tourism by engaging locals who also have access to the attractions and experiences offered to tourists. Meanwhile, the planned growth in international tourism, despite the COVID-19 lockdowns, has not been dismantled but rather reaffirmed. This includes plans for major extensions of Copenhagen Airport. Development corporations in tourism and urban development thus try to reconcile sustainable development with economic growth, which is apparent in the 2022 ‘Comeback Copenhagen’ and ‘Planet Copenhagen’ strategies. Copenhagen aims to become the most sustainable tourist destination, without taking into consideration that the main greenhouse gas emissions come from the ways tourists travel to and from the destination.

Experiencing Land Loss: Land Dispossession in the Name of National Security in Sylhet District, Bangladesh

ABSTRACT This article focuses on the inhabitants of Ratargul living next to the Sylhet Cantonment of the Bangladesh Army. Since 1977, construction of the cantonment has gradually driven villagers from their land, with no significant opposition. This alienation will soon reach full completion through the new extension plans of the cantonment. Villagers anticipate this expansion with fear and express anger at the poverty caused by land appropriation. However, in their accounts, dukkho (grief) overshadows their fear and anger. What do they grieve for, exactly? The article suggests that dukkho is an expression of grief over material losses but also of pain over the disappearance of previous forms of life. Additionally, dukkho represents villager’s regret over missed opposition opportunities that did not materialize because they were misled; as low-caste Hindus they lack solidarity; and it is still unclear who is responsible for the land capture: the army or the government.

A determination of the smartness level of university campuses: the Smart Availability Scale (SAS)

Technological developments on university campuses are among the most recently investigated topics, but the whole notion of a smart campus has yet to be developed. A smart campus can only be comprehended as a whole, which is why it requires an extensive planning process. This article investigates the required smart campus services with a holistic approach. The smart campus concept has been defined by three major categories: smart building, the scope, and the technology, and then the aspects that affect these categories are defined. A fundamental calculation has been constructed based on the smart campus concept created with newly consolidated categories and a case study with post-occupancy evaluations. The Smart Availability Scale (SAS) calculation is based on superimposing two matrices: campus system output and weighted value matrix. For this calculation, the multi-criteria decision-making (MCDM) method was adopted using newly created index parameters and categories. The technologies selected for this research are based on the most recent developments. It extracted valuable conclusions and inferences from this smart campus conceptual framework, providing insights and directions toward the required calculation technique for the services offered by the smart campus. During the evaluation period of traditional to smart universities, this research draws an outline and guidance for the stakeholders of the affiliated campus.

The effect of different area uses and topography on surface temperature and climate parameters.

Global warming and the ecological burden it causes affect people and the environment negatively and make adaptation difficult. For people to adapt to the environment and vice versa, they need to do extensive research and planning. Planning, on the other hand, is taking an easy form with the technology that has recently developed. GIS infrastructures and supporting satellite images along with software help with provincial-scale planning. This study has been handled on a scale covering the provincial borders of Nevsehir. The thermal data of the 10-year-old Landsat 7 satellite was analyzed and mapped in the Arc-GIS 10.2 package program. In the same way, maps of wind, air temperature, topography, and land use were created and the relationship between them was revealed by "Spearman's correlation" method. According to the results obtained, the average surface temperature in the study area was determined as 34.4°C. When evaluated in terms of land use, natural grasslands have the highest surface temperature of 40.6°C, while city structures have the highest average surface temperature of 33.3°C. At the same time, the lowest surface temperature measured in the study area, 13.8°C, is also found in natural grassland areas. A significant positive correlation was measured between the wind speed and the land use pattern, while a significant negative correlation emerged between the wind speed and the air temperature. In addition, there is another significant negative correlation between height and land surface temperature (LST). Furthermore, a high degree of positive significance was determined between altitude and wind speed. Finally, between air temperature and LST, a positive significance was observed.

A Rare Case of a Lisfranc Ligament Transection.

Ligamentous Lisfranc injuries, which mimic a surgical transection are rare. Left untreated or missed, these injuries may result in severe complications including long-term disability. The present case describes a unique mechanism of injury via a sharp object puncture through the plantar surface of the midfoot. It highlights the utility of planning staged procedures to remove a large foreign body object, reports notable intraoperative techniques, and provides a decision management guide for treating this type of injury. Extensive surgical planning may be required when encountering similar cases and knowledge of this may be useful to providers.

Soil Erosion Type and Risk Identification from the Perspective of Directed Weighted Complex Network

Identifying the geographic distribution and erosion risks of various soil erosion regions are critical inputs to the implementation of extensive and effective land protection planning. To obtain more accurate and sufficient erosion information on a large scope, this paper introduced the complex network theory to quantitatively simulate the topographic spatial structure and topological relationship of the erosion area. The watershed was selected as the basic study unit and the directed weighted complex network (DWCN) of each watershed was constructed from DEM data. The directed weighted complex network factor (DWCNF) of each watershed was calculated by the DWCN. After combining DWCNFs with existing SEEF, the soil erosion types and risks of sample areas in the Chinese Loess Plateau were identified by the random forest model. The results show that in both typical and atypical sample areas, the identification performance of soil erosion by combining DWCNFs with existing SEEFs was performed better than that by employing only the DWCNFs or SEEFs dataset. It is suggested that the quantitative description of the spatial structure and topological relationship of the watershed from the perspective of a complex network contributes to obtaining more accurate soil erosion information. The DWCNF of structural entropy, betweenness centrality, and degree centrality were of high importance, which can reliably and effectively identify the types and risks of soil erosion, thus providing a broader factor reference for relevant research. The method proposed in this paper of vectoring terrain into complex network structures is also a novel sight for geological research under complex terrain conditions.

Surgical planning, histopathology findings and postoperative outcome in MR-negative extra-temporal epilepsy using intracranial EEG, functional imaging, magnetoencephalography, neuronavigation and intraoperative MRI

ObjectiveMRI-negative drug-resistant epilepsy presents a challenge when it comes to surgical planning, and surgical outcome is worse than in cases with an identified lesion. Although increasing implementation of more powerful MRI scanners and artificial intelligence has led to the detection of previously unrecognizable lesions, in some cases even postoperative pathological evaluation of electrographically epileptogenic zones shows no structural alterations. While in temporal lobe epilepsy a standardized resection approach can usually be performed, the surgical management of extra-temporal lesions is always individual. Here we present a strategy for treating patients with extra-temporal MRI-negative epilepsy focus and report our histological findings and patient outcome. MethodsPatients undergoing epilepsy surgery in the Department of Neurosurgery at the University Hospital Erlangen between 2012 and 2020 were included in the study. Inclusion criteria were: (1) failure to identify a structural lesion on preoperative high-resolution 3 Tesla MRI with a standardized epilepsy protocol and (2) preoperative intracranial EEG (iEEG) diagnostics. ResultsWe identified 8 patients corresponding to the inclusion criteria. Second look MRI analysis by an experienced neuroradiologist including the most recent analysis algorithm utilized in our clinic revealed a possible lesion in two patients. One of the patients with a clear focal cortical dysplasia (FCD) finding on a second look was excluded from further analysis. Of the other 7 patients, in one patient iEEG was performed with subdural electrodes, whereas the other 6 were evaluated with depth electrodes. MEG was performed preoperatively in all but one patient. An MEG focus was implemented in resection planning in 3 patients. FDG PET was performed in all, but only implemented in one patient. Histopathological evaluation revealed one non-lesional case, 4 cases of FCD and 2 cases with mild developmental malformation. All patients were free from permanent neurological deficits and presented with Engel 1A or 1B outcome on the last follow-up. ConclusionWe demonstrate that extra-temporal MRI-negative epilepsy can be treated successfully provided an extensive preoperative planning is performed. The most important diagnostic was stereo-EEG, whereas additional data from MEG was helpful and FDG PET was rarely useful in our cohort.

Flipped classroom – A student perspective of an innovative teaching method during the times of pandemic

BackgroundFlipped Classroom is a blended form of learning in which the traditional didactic lectures are replaced by active classroom learning experience. Flipping the lectures outside the classroom and using the classroom for active interaction and projects has been the need of the hour. It is an innovative way of learning anatomy. MethodsThe study was done at Department of Anatomy, ESIC Medical College, KK Nagar, Chennai. After obtaining ethical committee approval and Consent for participating in the study, Pre-test questionnaire was shared through Google forms. The lecture PowerPoint about anatomy of larynx was shared with the students. Next day, during the scheduled class, the students were asked to present anatomy of larynx using different types of models. Post-test questionnaires were also shared, and the students were asked to submit feedback forms at the end of the session. The students were assessed by a group of subject experts who assessed the student’s anatomical knowledge, innovation with which they prepared the model, presentation, correctness of presentation and clinical application. ResultsOut of the 126 first year MBBS undergraduates, 100 students actively participated in the study. 41% of students agreed and 47% of students strongly agreed that flipped classroom was an enjoyable way of learning. 51% of students strongly agreed that they were able to go through the lecture prior to the presentation. ConclusionsFlipped classroom enhanced student learning through knowledge applications. Flipped classroom helped teachers to review and understand how much their students have read, retained, and applied the knowledge which was catered to them. There was largely a positive response for flipped classroom though flipped classroom cannot replace a regular classroom. Flipped classroom can be cumbersome as it involves extensive planning and coordination. It can be used to promote interest in the subject. Flipped classroom enhanced peer assisted learning.