Number Of Courses Research Articles

Influence of sex on the requirement for and outcomes following late postnatal corticosteroid treatment

There remains a disparity between the outcomes of male and female prematurely born infants. Our aim was to assess the influence of sex on the requirement for late (> 7 days) postnatal corticosteroid (PNS) treatment and the outcomes following treatment. A retrospective whole population study of infants born at less than 28 weeks of gestation in all neonatal units in England between 2014 and 2018. The impact of exposure to at least five consecutive days of dexamethasone or hydrocortisone on bronchopulmonary dysplasia (BPD) at 36 weeks corrected gestation and survival to discharge from neonatal care was determined. Ten thousand, six hundred and fifty-five infants survived to seven days. Male sex was associated with an increased incidence of BPD (OR 1.41, 95%CI 1.287–1.552, p < 0.001) and death (OR 1.227, 95%CI 1.123–1.452, p < 0.001). Two thousand, three hundred and forty-four infants (22%) received at least one course of PNS at a median of 23 (IQR 15–40) days after birth. Males (23.6%) were more likely to receive PNS than females (20.1%), p < 0.001 and receive repeated courses (mean 1.67 compared to a mean of 1.59 in the females), p = 0.027. Multivariate regression analysis identified no significant differences in the incidence of BPD or death between male and females who received PNS. Conclusions: Males and females had similar outcomes after receiving PNS, but a significantly greater proportion of males met the clinical threshold to receive PNS and were more likely to receive repeated courses which may expose them to a greater risk of adverse long-term outcomes.What is Known:• There remains a difference in outcomes of male and female infants born prematurely.• Prematurely born male infants were more likely to receive postnatal corticosteroids and a greater number of courses but had similar outcomes compared to female infants.What is New:• Postnatal corticosteroids have long-term adverse effects. Such outcomes should be considered when weighing up the risk–benefit ratio of prescribing postnatal corticosteroids, particularly in very prematurely born male infants.

Study of the Association between Study Time and Final Grades

Currently, many schools use test scores as a major criterion for measuring students' learning outcomes, and many students recognize increasing their personal performance as the main objective of education. Therefore, statistical learning method is utilized in this essay to examine the link between academic achievement and other variables. Using the student marks dataset, the link between students' grades and study time was investigated. To study if there is a direct correlation between study time and grades. With multiple regression, a proportionate relationship between study time and grades was determined. As predicted, study time had a substantial role in achieving great final marks. Additional investigation revealed that the impact of study time is greater than that of course load. Apparently, there is no evident association between the number of courses and the amount of time spent studying when viewed as independent variables for visual drawing. In conclusion, this paper suggest that if a student wants to increase his or her marks, increasing his or her study time is a beneficial option.

Strukturne karakteristike, kompresiona i prekidna svojstva desno-levih kuliranih pletenina pre i posle pranja

The structural characteristics, compression, and strength properties of knitted fabrics, before and after washing, were investigated in this paper. The experimental material consisted of three plain weft-knitted fabrics produced of cotton, wool, and organic wool. The structural characteristics of the knitted fabrics were analyzed by measuring the number of courses and Wales per centimeter, stitch density, yarn loop length, weight, and thickness. The compression properties were determined by measuring compressibility, thickness loss, and compressive resilience. The strength properties were investigated by measuring the bursting strength and ball traverse elongation. The results showed that stitch density and raw material composition affect compression properties, raw material composition affects strength properties, and washing affects structural characteristics, compression, and strength properties of knitted fabrics. After washing, all knitted fabrics increased in the number of courses and Wales per centimeter, stitch density, weight, thick-ness, compressibility, thickness loss, and ball traverse elongation, and decreased in compressive resilience and bursting strength. Additionally, shrinkage of the knitted fabrics was observed after washing. Also, cotton and organic wool knit-ted fabrics decreased in yarn loop length, while wool knitted fabric increased in yarn loop length after washing.

DH Eh? A Survey of Digital Humanities Courses in Canadian LIS Education

Library and librarian involvement in digital humanities (DH) has grown over the past few years. However, it is unclear whether current library and information studies (LIS) programs are properly preparing students for this type of work. This study analyzed course offerings at Canadian ALA-accredited LIS programs. While Canadian ALA-accredited LIS programs offer DH-relevant courses, the number of courses offered and their range/scope vary greatly among institutions. Although many are teaching the technical skills required by the field of DH librarianship, collaboration and project management training remain elusive in most programs.

Choosing Relevant Internet-Assisted Approaches for Professional Development Courses

Online teaching and learning for the professional development of workers in service is ever pervasive and continually growing. Yet, studies of learning with technology are mostly conducted in K-12, pre-service, or higher education settings resulting in a lack of attention given to the professional development. In addition, most studies are investigating learners instead of instructors, even though the latter are reportedly struggling in conducting online teaching. One of the struggles instructor faces includes choosing effective technologically enhanced pedagogy that are in line with the learning contents and intents. This study aims to alleviate the issue by investigating online learning in a professional development context, particularly one in a government institution such as the Financial Education and Training Agency (FETA) under the Indonesian Ministry of Finance. By analyzing curriculum documents known as program syllabi of 148 online courses conducted by FETA, informed by a prevailing theory of adopting educational technology known as the Substitution, Augmentation, Modification, and Redefinition (SAMR) model, the study found the majority of courses were under Substitution category for uses of technology, followed by Modification and Augmentation categories. Redefinition category had the least number of courses. Characteristics of each use of technology are explained in the Findings and Discussion section. It is hoped that the uses of technology explicated in this study will be useful for guiding the practice of crafting a defensible curriculum for online learning in professional development contexts.

Дисфункція дрібних дихальних шляхів та можливості її корекції при астмі

Abstract. Background. Although randomized controlled trials have shown that asthma control is an achievable goal, real-life studies over the past 20 years have shown that asthma remains poorly controlled in a significant proportion of patients, even among those receiving treatment at asthma specialist, and in patients with mild asthma who regularly take inhaled corticosteroids. Even when asthma control is achieved, it is not optimal on all GINA steps. The small airways have been recognized as the primary site of airflow limitation in asthma. The aim of the work: to study, according to the literature, the peculiarities of the dysfunction of the small airways in asthma and to evaluate the possibilities of its treatment. Materials and methods. Scientific articles that covered the pathophysiology of small airways disorders, their impact on asthma control, diagnostic methods, and pharmacological treatment methods were analyzed. The results. Airways with an internal diameter &lt; 2 mm, which do not contain cartilage in their walls and extend from the 8th generation of the airways to the periphery of the lung, are collectively called “small airways”. They are called the QUIET ZONE because they are difficult to assess and treat in patients with asthma who are not optimally controlled but have relatively normal FEV1 and disproportionate small airways dysfunction (SAD). Predominant in patients at all stages of treatment, associated with poor disease control. The ATLANTIS study showed that up to 91 % of patients with asthma have. The small airways have a high density of corticosteroid and β2-adrenoceptors, which means that they can be influenced. The main task is that the drugs should reach these small airways. Conventional inhalers that generate particles larger than 2 μm do not address the problem of SAD in patients with asthma. Inhaler devices that produce ultrafine particles of inhaled corticosteroids alone or in combination with long-acting β-agonists with a diameter of less than 2 μm have the potential to improve long-term asthma control along with a corresponding improvement in small airway function. The fixed combination of beclomethasone dipropionate with formoterol has optimal deposition in the respiratory tract — central pulmonary deposition accounts for 66 %, and peripheral — 34 % of the dose, thus the drug is delivered to both the central and peripheral respiratory tracts and affects inflammation and bronchoconstriction throughout the lungs. This is facilitated by MODULITE technology. The effectiveness and safety of the use of the BDP/F combination (Foster) in MART regimen is confirmed by a significant evidence base, which guaranteed its place in the Track1 treatment of asthma. Conclusions: Patients with asthma have a serious inflammatory process in the peripheral airways, which makes them the main site of obstruction in asthma; SAD predominates in patients at all stages of asthma, is associated with poor disease control, is responsible for air trapping, correlates with poor asthma control1, and predicts an increased risk of exacerbations in patients. The fixed combination of beclamethasone/formoterol in one inhaler (Foster) is the only extrafinely dispersed fixed combination of ICS/LABA that reaches the small airways; the fixed combination of BDP/Formoterol in the MART regimen provides a significant reduction in the frequency of severe complications, hospitalizations, emergency calls, and reduces the number of courses of systemic corticosteroids.

Эффективность ритуксимаба в терапии системного ювенильного идиопатического артрита

Эффективность ритуксимаба в терапии системного ювенильного идиопатического артрита

Оценка качества жизни больных лимфомой Ходжкина в дебюте заболевания и после перенесенной химиолучевой терапии

Introduction. An advance in understanding the biology of Hodgkin’s lymphoma (HL) and improved approaches to anticancer therapy of HL allowed increasing the survival of patients at all stages of the disease. Thus, the 5-year overall survival is more than 85% even in HL patients with III–IV stages. However, early complications and long-term effects of combined chemoradiotherapy remain an urgent problem, reducing the quality of life of patients. Aim. To assess the quality of life of patients with HL in different periods of the disease: at the time of diagnosis of the tumor process and after multiagent chemotherapy programs. Materials and methods. The study included 46 patients with newly diagnosed HL, hospitalized in the Hematology Departments of the City Clinical Hospital No. 2 and the Novosibirsk Regional Clinical Hospital. The control group was represented by 46 apparently healthy people without a tumor process or exacerbation of chronic diseases. The SF-36 Health Survey was used as a tool for assessing the quality of life. Results. The quality of life of patients was significantly higher in patients at onset of the disease than after specific anticancer therapy. Compared with the control group, in patients with HL, both before the start of treatment and after chemoradiotherapy, a deterioration in the physical condition affecting daily activities was noted. Also, with an increase in the in the number of courses of anticancer therapy, the emotional and physical health of patients with HL worsened significantly, and the intensity of pain syndrome was higher in patients with advanced stages of the disease. Conclusion. Currently, the assessment of the quality of life in patients with hematologic malignancies at onset of the disease and after anticancer therapy can help achieve optimal therapy results while maintaining a high level of quality of life.

Status of Dance-related Curriculums for University Acting Courses and their Implications

This study analyzed the present status of dance-related curriculums for acting courses offered by Korean universities and colleges with intent to identify the characteristics of those curriculums and provide implications thereof. Specifically, focused on the dance-related curriculums for 108 courses provided by 92 universities and colleges listed in the ‘2023 Entry to Theatre and Film Studies Guide(Jong-Yeul Lee, 2022),’ this study analyzed the number of courses offered, the number of units offered, the semesters in which such units were offered, the titles of such units, and the credit points assigned to such units. Based on the analysis, first, 86 acting courses provided dance-related curriculums (79.6%), and a majority of such courses spanned 4 years. Second, mostly dance-related units were offered in 4 semesters, and all types of the educational institutions selected here offered dance-related units nearly every semester. In total, 4-year universities offered 120 units, while 2~3-year colleges offered 42 units. Third, mostly, the titles of dance-related units involved body, dance, choreography and movement. Body- and dance-related titles of units outnumbered other types of titles at 4-year universities and 2~3-year colleges, respectively. As for the credit points assigned to dance-related units, 2 credit points showed the highest distribution. In conclusion, dance-related units accounted for high percentages in the curriculums for tertiary acting courses and their titles varied across semesters. These findings indicate dance-related units are used as a way of helping acting majors understand the movement of human body, and imply that scholarly and practical efforts need to be made to facilitate the systematic development of dance-related curriculums for acting courses by exploring the concept of physical training for actors and delivering the educational value of dance.

PENERAPAN METODE GENETIK PADA SISTEM INFORMASI PENJADWALAN PERKULIAHAN STMIK JAKARTA STI&amp;K

Lecture activities from a university are increasingly complex along with the number of scientific fields in a study program. One of these complications is the scheduling of courses given to students and supporting lecturers. The number of courses and the large number of lecturers make the scheduling process require extra in managing it. STMIK Jakarta STI&amp;K is a college in the field of computers that has several study programs in the field of computers consisting of the Information Systems Study Program, Computer Systems and Information Management. At the beginning of each lecture, they often experience difficulties in scheduling the lectures. The need for a system that can process scheduling data is very important so that it can help maximize the process so that lecture activities are more organized. Answering the problem of the complicated process of scheduling lectures for students and lecturers, in this study a scheduling system was developed using the Genetic Method. The use of this genetic method can minimize scheduling conflicts between courses, between lecturers and between classes. The development of this scheduling system was developed using the PHP language and MySQL database so that it can be applied online so that the results can be directly informed to lecturers and students. Based on the application of the system developed, it helps the scheduling department of STMIK Jakarta STI&amp;K faster in making schedules because it minimizes schedule conflicts, informs schedules more quickly so that all lecturers and students are better prepared. The comparison of the average speed of making schedules manually and using genetic methods is between 69.67 and 69.72.

CONTINUITY OF VOCATIONAL EDUCATION AS AN INNOVATIVE CHALLENGE IN THE CONDITIONS OF EUROPEAN INTEGRATION AND DIGITALIZATION

The article is devoted to the issue of continuity of vocational education in the conditions of European integration and digitalization. The purpose of research is analysis of strategic documents and accumulated better practices of the EU countries for identifying the main directions of development of the continuous education in Ukraine in the conditions of European integration and digitalization. Based on the analysis of the strategic documents of the European Union, it has been found that high-quality educational content (in terms of content and form of execution) with the possibility of interactive participation and mentoring is in demand today. Distance education has significant advantages for the implementation of continuous education that is oriented to an unlimited number of students with the possibility of obtaining knowledge at a convenient time, the possibility of choosing a convenient (optimal) learning pace. That variant of obtaining education is available for people of different training levels, age, social position and health. It has been summed up that the distance format is largely consistent with the principles of the concept of continuous education, and meet the dynamically changing needs of a modern person in applied knowledge. The general specific of the examined formats is strengthening the components of the informal nature of education, individualization (customization) of educational practices and orientation to the subjective needs of the personality. It has been determined that the key direction of development of the educational environment in the conditions of European integration and digitalization are distance education; gamification of education and using cloud technologies; implementation of augmented reality solutions and visualization technologies; development of social networks in education; development of mass opened online courses. It has been generalized that the following measures will facilitate the continuity of vocational education in the conditions of European integration and digitalization: educational trips, exchange of delegations; education in the format of "summer" and "winter" schools with "deep immersion", organization and conduction of author’s master classes, use of project technologies and techniques of game technology; increasing the share of distance learning to 50% of the total number of courses, using interactive forms (webinars, quizzes, virtual traineeships, etc.) with the involvement of representatives of educational organizations of the European Union.

Speech-Language Pathology Graduate Students' Perception of Satisfaction, Confidence, and Interpersonal Skill Development During Simulated Experiences Amid COVID-19

Purpose: This quantitative survey correlational study aimed to examine the satisfaction, confidence, and interpersonal skills of speech-language pathology (SLP) graduate students after participating in simulated learning experiences (SLEs) during the COVID-19 pandemic. The research questions addressed (a) How do SLP graduate students perceive satisfaction, confidence, interpersonal skills, and strengths and challenges of this learning after participating in SLEs? and (b) How do SLP graduate students perceive satisfaction, confidence, and interpersonal skills across the number of hours of the SLE, the number of courses that utilize simulation, and the types of simulation experiences? Method: We invited a total of 72 Midwest clinic directors to distribute the survey to students in their respective programs. The final sample included 327 SLP students. Participants responded to questions on satisfaction, confidence, and interpersonal skills after participating in SLEs. Results: Key findings included a positive correlation among student perceptions, including satisfaction, confidence, and interpersonal skills, but no correlations between student perceptions and the number of courses that integrated SLEs and number of hours of simulation experience. Simulation types were analyzed and showed significant differences in interpersonal skill development such that virtual patient simulation is associated with more positive interpersonal skills among all types. A summary of strengths and challenges from the SLP graduate student perspective was also synthesized. Conclusions: Findings necessitate further exploration as they relate to the SLP graduate clinical experiences. This study revealed moderate to positive feedback on SLEs (instead of overall positive feedback) regarding satisfaction, confidence, and interpersonal skill development; however, previous studies noted positive outcomes. Further research should include comparing face-to-face experiences with SLEs and replicating this survey after the COVID-19 pandemic subsides and graduate programs can return to normal operations.

554. Discharge Antibiotic Prescribing at Children’s Hospitals with Established Antimicrobial Stewardship Programs

Abstract Background Antibiotic stewardship programs optimize antibiotic use in hospitalized children, but most do not routinely review antibiotic prescriptions at discharge. Up to 30% of discharged children receive additional days of antibiotics, and one single-center study found that 27% of discharge prescriptions were suboptimal. Methods We conducted a retrospective cohort study to evaluate duration of therapy (DOT) and antibiotic choice for children &amp;lt; 18 years admitted to 4 children’s hospitals from January 1, 2019 - December 31, 2019 and prescribed antibiotics at discharge for uncomplicated community-acquired pneumonia (CAP), skin and soft tissue infection (SSTI), or urinary tract infection (UTI). We excluded children with complex medical conditions, &amp;gt; 1 infection requiring antibiotics, &amp;gt; 7 day hospital stay, or intensive care unit stay. The primary outcomes were the percentage of subjects prescribed optimal (1) total (inpatient plus outpatient) DOT (4-6 days for CAP and SSTI, ≤8 days for UTI), and (2) antibiotic choice (CAP: amoxicillin; SSTI: clindamycin, amoxicillin-clavulanate, cephalexin, or trimethoprim-sulfamethoxazole (TMP/SMX); UTI: cephalexin, amoxicillin, amoxicillin-clavulanate, TMP/SMX, or nitrofurantoin) based on current national guidelines and available evidence. Results 2105 encounters were included: 783 CAP, 916 SSTI, and 406 UTI. Median age was 4 years and 49% were female. DOT for each condition are shown in Figure 1 and antibiotic choice in Figure 2. Antibiotic choice was optimal for 66% with CAP, 98% with SSTI, and 88% with UTI. DOT was optimal for 11% with CAP, 4% with SSTI, and 21% with UTI. Both DOT and choice were optimal for 2% with CAP, 4% with SSTI, and 19% with UTI. For all indications, antibiotic choice was optimal for 84% and DOT was optimal for 10%, while only 6% of antibiotic courses included both optimal DOT and antibiotic choice. Total duration of therapy for 2105 children discharged with antibiotics for community-acquired pneumonia, urinary tract infection, and skin and soft tissue infection. Figure 1.Median duration of antibiotic therapy prescribed for 783 children with community-acquired pneumonia, 406 with urinary tract infection, and 916 with skin and soft tissue infection. The box and whiskers within each plot depict the median (white dot), interquartile range (box) and 5th/95th percentiles (whiskers); the width of each plot represents the number of courses that received that value for overall antibiotic duration. Discharge antibiotic choices for 2105 children with community-acquired pneumonia, urinary tract infection, and skin and soft tissue infection. Figure 2.The most commonly prescribed antibiotics at discharge for 2105 children with community-acquired pneumonia, urinary tract infection, or skin and soft tissue infection. Percentages based on total number of antibiotic prescriptions. Other antibiotics include: Cefadroxil, Cefdinir, Cefixime, Doxycycline, Levofloxacin, Linezolid, Nitrofurantoin, trimethoprim-sulfamethoxazole. Conclusion At 4 children’s hospitals with established antimicrobial stewardship programs, 94% of discharge antibiotic courses for CAP, UTI, and SSTI were suboptimal either by choice of antibiotic or duration of therapy. Discharge antibiotic prescribing represents a significant opportunity to improve antibiotic use in children. Disclosures Jason Newland, MD, AHRQ: Grant/Research Support|Merck: Grant/Research Support|NIH: Grant/Research Support|PEW Charitable Trust: Grant/Research Support|Pfizer: Grant/Research Support.

Quality criteria in MOOC: Comparative and proposed indicators.

The MOOC (Massive Open Online Course) offer revolution requires processes that can define their quality, especially due to the number of courses offered, as well as the high number of students enrolled in them. The objective of this study is to identify the main requirements and indicators of the MOOC following the ENQA (The European Association for Quality Assurance in Higher Education) considerations. To establish this system, the study has been carried out through the Delphi method with successive rounds of application from the systematic use of expert judgment. This method has been applied to achieve consensus on a set of requirements and indicators of 20 experts from eight different institutions in the field of application and development of MOOCs that assessed the indicators according to the quality criteria according to three aspects: relevance, feasibility, and comparability. Therefore, the outcome of this study is a system as a mechanism for the university to approve or disapprove a MOOC (checklist) and assess its quality.

Surgical resection of pediatric PRETEXT III and IV hepatoblastoma: A retrospective study investigating the need for preoperative chemotherapy.

This study analyzed the feasibility of upfront surgical resection for pediatric PRETEXT III and IV hepatoblastoma (HB). Neoadjuvant chemotherapy is recommended for patients with PRETEXT III and IV HB to obtain a chance of curative surgery. However, chemotherapy can cause toxic side effects and adverse outcomes, and the PRETEXT staging system may overstage the patients. Therefore, whether preoperative chemotherapy is necessary for HB patients remains unclear. The clinical data of 37 children who underwent surgical resection for PRETEXT III and IV HB at our hospital were obtained retrospectively. Patients were divided into the neoadjuvant chemotherapy group (NCG; n = 19) and the routine surgery group (RSG; n = 18). Clinicopathologic characteristics, treatment regimens, and outcomes were compared between the groups. The RSG had a lower incidence of portal vein involvement than the NCG (p < 0.002). The estimated 3-year event-free survival rates were similar (RSG: 89 ± 0.7% and NCG: 79 ± 0.9%, p = 0.3923). The RSG underwent fewer courses of chemotherapy than the NCG (five vs. six; p < 0.001). Furthermore, the RSG had lower incidences of febrile neutropenia, myelosuppression, and gastrointestinal reactions (all p < 0.05). The severity of surgery-related complications did not differ significantly. Upfront surgical resection in children with PRETEXT III and IV HB is safe and feasible, and reduces the total number of courses and side effects of chemotherapy. The degree of vascular involvement is the most important consideration when evaluating resectability during diagnosis.

Clinical characteristics of second primary malignancies among first primary malignancy survivors: A single-center study, 2005-2020.

The cancer survivor population is growing due to advances in detection and treatment. For improved long-term patient management, it is critical to examine the clinical characteristics and outcomes of second primary malignancies (SPMs). An SPM is defined as a second distinct pathological diagnosis, with the same or different origin as the first primary malignancy (FPM). In the present retrospective study, categorical clinical variables were compared between subgroups and the impact on overall survival was evaluated. A total of 1,188 patients with an FPM were included, of which 102 experienced an SPM (8.59%). When compared with the patients who did not develop an SPM, patients with an SPM were significantly older at first diagnosis, had a higher pathological stage and higher rates of biliary tract disease and thyroid disease. In addition, patients with an SPM were more likely to have received postoperative chemotherapy (28.43 vs. 12.16%, P<0.0001) and to be long-term consumers of cigarettes and alcohol (25.00 vs. 8.95%, P<0.05). In addition, an increase in the number of regimens received but not in the number of courses of chemotherapy was associated with a reduction in the time interval to SPM development. Non-small cell lung cancer (NSCLC) was the most common type of FPM (18.27%). In patients with NSCLC the occurrence of SPMs was relatively low (5.07%) and the SPM-associated mortality rate was 2.30%. Breast cancer was the second common type of FPM (12.09%). Patients with breast cancer had a relatively high likelihood of developing an SPM (9.30%), for which family history of malignancy and postoperative chemotherapy were identified as potential risk factors. Patients with stomach cancer were the most vulnerable to SPM (17.95%) and patients with digestive tract cancer had the longest time interval between the FPM and SPM development. In addition, thyroid adenoma was identified as a potential risk factor for SCLC. The findings of the present study may provide valuable guidance for the short- and long-term monitoring of FPM survivors.

Landscape of e-Learning during Covid-19: Case Study of Economic Disciplines in Croatia

Abstract Background: The Covid-19 pandemic has changed the digitalisation level of education. Many institutions had some knowledge and practical background in delivering lectures online. Some countries apply a top-down digitalisation approach driven by policy or strategy and externally impacted by the government. Some other countries rather initiate digitalisation internally by teachers and universities. Objectives: The main goal is to investigate the digitalisation level of the higher education system in Croatia, exploring the digitalisation of economic disciplines compared to other scientific fields. Methods/Approach: We assess the digitalisation level of higher education based on the regulatory framework, applied approach of digitalisation, the agility of transition to online teaching and the existing number of courses and online study programs. Education digitalisation in different countries is compared with the Croatian experience. Results: Although the satisfactory level of higher education institutions’ agility to switch online exist, there hasn’t been a centralised project led by the government and supported by proper funds to increase digitalisation in Croatia. Even before the pandemic, many e-courses from economics and business had been offered to students, but online study programs were exceptions, covering mainly the economics and business field. Conclusions: The Covid-19 pandemic has improved the digitalisation process in the Croatian education system. A general framework for the digitalisation of education should be developed containing the detailed administrative processes and appropriate funds to be implemented.

Impact of Antibiotic Use for Febrile Neutropenia on Gut Microbiome Phyla in Children with Leukemia and Lymphoma

Introduction: Approximately 40% of children with leukemia/lymphoma experience one or more episodes of febrile neutropenia. These episodes are treated with empiric intravenous antibiotics that include broad spectrum β-lactams and vancomycin. Although studies suggest antibiotics change the gut microbiome, the effect is unclear. This study reports the impact of repeated courses and duration of antibiotic use on microbiome. Methods: We examined 39 pediatric patients diagnosed and treated at the IWK Health Centre, Nova Scotia Canada for acute lymphoblastic leukemia (28), acute myeloid leukemia (5), non-Hodgkin lymphoma (4) or Hodgkin lymphoma (2) after informed consent. DNA was extracted from 127 stool samples from timepoints before and during treatment were used for whole shotgun sequencing (Nextera XT). Sequences were cleaned of low quality, and human, and PhiX174 contaminate sequences (kneaddata pipeline). MetaPhlAn3 was used to profile the taxonomic composition of the microbial community. Samples were grouped by number of courses, none, 1-2, or ≥3, and by duration of courses, none, short (≤10 days), long/mixed (>10 days or mix of long and short) of β-lactams, vancomycin, or general antibiotic use. The abundance of phyla within these groups were compared using the Kruskal Wallis test (α<0.05) and post hoc Dunn test for pairwise comparison, corrected for multiple tests. This study was approved by the IWK ethics board. Results: The 39 patients include 22 males and 17 females, with 29 patients over the age of 3 and 10 patients under 3. Bacteroidetes phylum abundant in the gut were decreased when exposed to repeated courses of all antibiotic groups with none vs ≥3 courses (β-lactam p=0.0012; vancomycin p=0.0018; multiple antibiotic p=0.0021) and 1-2 courses vs ≥3 courses (β-lactam p=3.1E-6; vancomycin p=0.024; multiple antibiotic p=1.6E-8). We also noted an increase in Firmicutes in the children who received 1-2 courses vs ≥3 courses of β-lactam antibiotics (p=0.034). The phylum Proteobacteria was increased across those children who received 1-2 courses vs ≥3 courses (β-lactam p=8.1E-6; vancomycin p=0.0018; multiple antibiotic p=1.6E-5) and also increased in none vs ≥3 courses for vancomycin (p=3.8E-4). We noted differences in abundance based on duration of antibiotic treatment. For Bacteroidetes the abundance is higher in children who receive short course antibiotics vs those that receive longer course (>10 days) for β-lactam and multiple antibiotic (p=1.3E-6 and p=4.4E-7 respectively) and lower in children who receive short course vancomycin vs longer course (p=0.024). The Proteobacteria in the samples of children treated with β-lactam and multiple antibiotics showed higher abundance in those who received longer duration antibiotics (p=2.7E-5 and p=8.7E-6 respectively) whereas the children who received short courses of vancomycin showed higher counts (p=0.0018). No difference in Firmicute abundance was detected. Discussion: Concordant with the spectrum of β-lactam antibiotics, we saw a decrease in abundance of Bacteroidetes a predominately gram-negative gut bacterium. In contrast the Proteobacteria, a gram-negative phylum, was increased in children exposed to repeated courses of antibiotics. When we consider duration of antibiotic treatment, we see that the Bacteroidetes have higher prevalence in children who do not receive antibiotics or receive shorter course antibiotics indicating that this phylum is controlled by antibiotic treatment. In contrast, the Proteobacteria are more prevalent in children who receive longer duration of β-lactam. One limitation of this study was non-uniformity of stool sample collection due to logistical reasons in pediatric population. Conclusion: Repeated courses of antibiotics administered empirically to pediatric cancer patients with leukemia/lymphoma increases the relative abundance of certain gram-negative bacteria in the microbiome. Longer courses of the β-lactams and multi-antibiotic samples result in higher relative abundance of Proteobacteria potentially increasing infections in immunocompromised children. Further studies to determine optimum antibiotic duration and therapy are needed.

An evaluation based on relative treatment intensity in older patients treated with reduced-dose R-THP-COP therapy for diffuse large B-cell lymphoma: A multicenter retrospective cohort study

IntroductionThe number of older patients with diffuse large B-cell lymphoma (DLBCL) is increasing. Although the standard treatment for newly diagnosed younger patients with DLBCL has been established, no consensus has been reached regarding the optimal chemotherapy intensity and regimen for older patients with DLBCL. In addition, no method for evaluating treatment intensity in retrospective studies when different numbers of chemotherapy courses are administered has been elucidated. Materials and MethodsA multicenter retrospective analysis was conducted to evaluate the outcomes of a reduced-dose R-THP-COP regimen, which included 30 mg/m2 of pirarubicin, in 54 patients with DLBCL who were aged ≥75. To assess treatment intensity, we defined the relative treatment intensity (RTI) as the number of courses administered multiplied by the relative dose intensity (RDI). ResultsThe estimated four-year overall survival rates (OS) of the patients aged 75–80 and ≥ 80 were 55.1% and 60.6%, respectively. There was no significant difference in four-year OS between these age groups. In our cohort, there was no significant difference in the estimated four-year OS between the patients who received reduced-dose R-THP-COP at an RDI of ≥61% and those that received it at an RDI of <61% (P = 0.35). On the other hand, the patients who received reduced-dose R-THP-COP at an RTI of ≥2.7 exhibited a significantly higher estimated four-year OS than those treated at an RTI of <2.7 (68.5% vs. 28.7%; P < 0.001). Multivariate analysis revealed that the RTI was a significant independent predictor of OS. The cumulative incidence of treatment-related mortality (TRM) at one year was 4.2% and 3.4% in the 75–80 and ≥ 80 age groups, respectively. The cumulative incidence of TRM was significantly worse among the patients with Charlson Comorbidity Index (CCI) scores of ≥2 than among those with CCI scores of 0 or 1. DiscussionOur study suggests that the reduced-dose R-THP-COP regimen is a suitable treatment option for older patients with DLBCL, especially those with CCI scores of <2. Our study also showed that the RTI may be a valuable tool for assessing treatment intensity in retrospective studies involving older patients.

Dropped Courses and Persistence in Online Undergraduate Nursing Programs.

Recent studies have linked dropped courses with an increased likelihood of persistence in nursing education. This study examined the association of dropped courses, demographic characteristics, and persistence among online undergraduate nursing students. A retrospective cohort study was conducted with 29,926 former undergraduate nursing students enrolled from 2015 to 2019. The study sample included 2,073 students formerly enrolled in an online baccalaureate nursing (BSN) program and 27,853 students formerly enrolled in an online RN-to-BSN program. RN-to-BSN students were more than twice as likely to drop a course than BSN students. For students in both programs, higher numbers of courses that were dropped before the course start date were associated with an increased likelihood of graduation. Understanding the extent to which course drops occur and their link to persistence in undergraduate nursing programs can assist academic program leaders in developing strategies to help students be successful. [J Nurs Educ. 2022;61(11):609-615.].