SIM Group Research Articles

Efficiency of the modified Sims maternal position in the rotation of persistent occiput posterior position during labor: A randomized clinical trial.

Fetal occiput posterior position in labor is associated with more painful and prolonged labor, and an increase in both maternal and fetal morbidity. The aim of this study is to assess whether the modified Sims position on the side of the fetal spine increases the rotation to occiput anterior position in women with epidural analgesia and a fetus in persistent occiput posterior (POP) position. This is an open, randomized controlled, clinical trial. One hundred and twenty women in labor with fetuses in POP position were included. The diagnosis was performed through digital vaginal examination and confirmed with an ultrasound scan. Women were randomized into the free position group or the modified Sims on the side of the fetal spine. The primary outcome was rotation to occiput anterior, and secondary outcomes were type of delivery, postpartum perineal condition, perinatal results, and maternal satisfaction. In pregnant women undergoing labor in the Sims position, fetuses in POP rotated to occiput anterior in 50.8% of cases, whilst in the free position group, the rotation occurred in 21.7% (P=.001). The rate of vaginal deliveries was higher in the Sims group compared with the free position group (84.7% vs 68.3%, P=.035). The modified Sims position is a maternal posture intervention efficient in POP rotation, which decreases cesarean delivery rate. It is a simple and noninvasive intervention, reproducible, and well tolerated by pregnant women.

Simultaneous Aerobic Exercise and Memory Training Program in Older Adults with Subjective Memory Impairments.

Background:Several modifiable lifestyle factors have been shown to have potential beneficial effects in slowing cognitive decline. Two such factors that may affect cognitive performance and slow the progression of memory loss into dementia in older adults are cognitive training and physical activity. There are currently no effective treatments for dementia; therefore, preventative strategies to delay or prevent the onset of dementia are of critical importance.Objective:The aim of this study was to determine the relative effectiveness of simultaneous performance of memory training and aerobic exercise to a sequential performance intervention on memory functioning in older adults.Methods:55 older adults (aged 60– 75) with subjective memory impairments (non-demented and non-MCI) completed the intervention that consisted of 90-minute small group classes held twice weekly. Participants were randomized to either 4-weeks of supervised strategy-based memory training done simultaneously while stationary cycling (SIM) or sequentially after the stationary cycling (SEQ). Standardized neurocognitive measures of memory, executive functioning, speed of processing, attention, and cognitive flexibility were assessed at baseline and post-intervention.Results:The SIM group, but not the SEQ group, had a significant improvement on composite memory following the intervention (t(51) = 2.7, p = 0.01, effect size (ES) = 0.42) and transfer to non-trained reasoning abilities (t(51) = 6.0, ES = 0.49) and complex attention (t(51) = 3.1, p = 0.003, ES = 0.70). Conversely, the SEQ group, but not the SIM, showed significant improvement in executive functioning (t(51) = 5.0, p = 0.0001, ES = 0.96).Conclusion:These findings indicate that a 4-week simultaneous memory training and aerobic exercise program is sufficient to improve memory, attention, and reasoning abilities in older adults.

Can simulator-based teaching improve medical students’ knowledge and competences? Results of a randomized trial using a coronary angiography simulator to learn coronary anatomy

Simulator-based teaching for coronary angiography (CA) is a seductive tool for medical students to improve knowledge and skills. Its pedagogical impact has not been fully evaluated yet. The aim of this study was to compare traditional face-to-face teaching with a simulator-based teaching. Hundred and eighteen students were prospectively randomized in two groups: a control teaching group ( n = 59, CONT group) and a simulator (Mentice AB, Sweden) group ( n = 59, SIM group). CONT group received a PowerPoint-based course (30 min), consisting of 15 slides encompassing predefined learning objectives (coronary anatomy, different projections, film interpretation). SIM group received a simulator-based course including exactly the same information in an interactive, real 3D environment. After the course, students were evaluated by 40 multiple-choice questions (maximum of 100 points (pts)), including questions on coronary anatomy (part 1:50 pts), on angiographic projections (part 2:10 pts), and real case interpretations (part 3:40 pts). Student characteristics were identical in both groups: 52.5% were female; age was 22.6 ± 1.4 years. 35.6% were in their 4th year of medical school, 35.6% in 5th year and 28.8% in 6th year. SIM students scored higher than CONT students irrespective of age and year of medical school (59.5 ± 10.8 pts vs. 43.7 ± 11.3 pts, P < 0.00001) for all parts of the evaluation (part 1: 36.9 ± 6.6 pts vs. 29.6 ± 6.9 pts, P < 0.00001; part 2: 5.9 ± 3.0 pts vs. 3.1 ± 2.8 pts, P < 0.00001; and part 3:16.8 ± 6.9 pts vs. 10.9 ± 6.5 pts, P < 0.00001). Student satisfaction was also higher in SIM group than in CONT group (98% vs. 75%, P < 0.0001) ( Fig. 1 ). This prospective, randomized trial suggests that simulator-based teaching in CA significantly improves students’ knowledge in coronary anatomy, angiography projections, but also clinical competence and decision making process. These results should encourage further evaluation of simulator-based teaching in other branches of medicine.

From Information to Simulation: Improving Competency in ECT Training Using High-Fidelity Simulation.

This study was intended to develop a new educational model that supplements ECT didactics with simulation-based procedural training and to evaluate the learning gains conferred by such a curriculum. Two types of curricula were evaluated for educational efficacy in this prospective randomized controlled trial. Psychiatry residents (n = 35) completed surveys to ascertain their baseline experience, knowledge, and proficiency with the ECT procedure. They were then block-randomized to receive either a didactic ECT curriculum (non-SIM) or one augmented by simulation training (SIM). Three months post-completion of the two types of instruction, all residents were re-administered the surveys and a procedural post-assessment. The median number of ECTs performed prior to the study was similar between the two groups (SIM group = 3, non-SIM group = 4.) The SIM group showed significant improvement on pre- and post- survey theoretical knowledge scores: 51% (95% CI = 41 to 61%) and 69% (95% CI = 64 to 74%), respectively, p = .02; this difference was not significant in the non-SIM group, p = .2. Improvement between pre- and post- proficiency scores were seen in the SIM group: 22% (95% CI = 13 to 32%) and 51% (95% CI = 53 to 59%), p < .001 while the effect was less pronounced in the non-SIM group. Inter-rater agreement for the proficiency assessment was excellent: k, = .9. Residents showed significant improvement in knowledge, comfort, and skills following ECT simulation training. With the proposed curriculum, residents would receive comprehensive education not only in the theory behind ECT but also in procedural skills. This curriculum can be modeled in other programs that do not have extensive ECT facilities.

Outcomes of open staged corrective surgery in the setting of adult spinal deformity

Background ContextAdult spinal deformity (ASD) represents a constellation of complex malalignments affecting the spinal column. Corrective surgical procedures aimed at improving ASD can be equally challenging, and commonly require multiple index procedures and potential revisions before definitive management. There is a paucity of data comparing the outcomes of same-day(simultaneous [SIM]) and 2-day (staged [STA]) procedures for long spinal fusions for ASD. Using a large patient cohort with surgeon- and patient-reported outcomes will be particularly useful in determining the utility and effect of staging long spinal fusions for ASD. PurposeThis study aimed to compare intraoperative, perioperative, and 2-year outcomes of STA and SIM procedures correcting ASD. Study DesignThis is a retrospective analysis of a prospective multicenter database. Patient SampleA total of 142 patients (71 STA, 71 SIM) were included. Outcome MeasuresPrimary outcome measures were intra- and perioperative (6 weeks) complication rates. Secondary outcome measures were 2-year thoracolumbar and spinopelvic radiographic parameters, 2-year health-related quality of life (HRQoL) changes (Oswestry Disability Index [ODI] and Short Form-36 [SF-36]), and 2-year complication rates. MethodsInclusion criteria included patients with ASD ≥18 years with 6-week and 2-year follow-up. Propensity score matching identified similar patients undergoing STA or SIM long spinal fusions based on surgical invasiveness, pelvic tilt, and sagittal vertical axis (SVA). Complications, HRQoL scores (Scoliosis Research Society-22 Patient Questionnaire [SRS-22r], SF-36, ODI), and patient characteristics were compared across and within treatment groups at follow-up with analysis of variance (ANOVA) and paired t tests at three surgical stages: intraoperatively, perioperatively (6 weeks), and postoperatively (>6 weeks). ResultsA total of 142 patients were included (71 STA, 71 SIM). Matching STA and SIM groups based on degree of deformity and surgical invasiveness created two groups similar in overall correction of the surgery. Patients undergoing STA underwent more anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) procedures, whereas patients undergoing SIM had longer fusions. Charlson comorbidity index and revision status were similar between groups (p>.05). Staging procedures had significantly more complications causing reoperation (STA: 47% vs. SIM: 8%, p=.021), and had a greater number of perioperative complications requiring a return to the operating room (OR) (STA: 9.9% vs. SIM: 1.4%, p=.029). There was no difference in intraoperative complications, mortality, or perioperative infection or wound complications (p>.05) between the two procedures. At 2-year follow-up, incidence of revision surgery was higher in STA (STA: 21.1% vs. SIM: 8.5%, p=.033). ConclusionStaged spinal fusions, which add ALIFs and LLIFs to the procedure, compared with similar-correction SIM procedures, result in similar intraoperative complication incidence, but significantly higher rates of peri- and postoperative complications leading to revision. Functional outcomes, radiographic parameters, and mortality were similar. This will aid surgeons in their determination of the optimal treatment for such complex procedures.

Orally administered simvastatin partially preserves lumbar vertebral bone mass but not integrity of intervertebral discs in ovariectomized rats.

The present study aimed to investigate the effect of orally administered simvastatin on lumbar vertebral bone mass and intervertebral disc (IVD) degeneration in ovariectomized (OVX) rats. A total of 30 female Sprague-Dawley (SD) rats were subjected to either bilateral ovariectomy (n=20) or sham surgery (n=10). After 12 weeks, the OVX rats were orally administered either saline vehicle (OVX + V group; n=10), or 5 mg/kg/day simvastatin (OVX + SIM group; n=10). Following 12 weeks of treatment, necropsy was conducted and bone mineral density (BMD) was determined in the L5-6 vertebrae. Furthermore, the microstructure and biomechanical properties of the L3 vertebrae were detected by micro-computed tomography and compression testing, respectively. The L5-6 vertebrae were analyzed by measurement of IVD height, observation of histological changes by van Gieson staining, and evaluation of collagen-II (col-II), aggrecan (AGG) and collagen I (col-I) expression by immunohistochemical analysis. Rats in the OVX+V group had lower BMD, bone volume/trabecular volume ratio, maximum load and elastic modulus than the sham group. Rats in the OVX + SIM group had higher BMD and biomechanical strength values than the rats in the OVX+V group. Histological analysis showed that the OVX + V and OVX + SIM groups exhibited significantly higher disc degeneration scores and significantly lower IVD height than the sham group. Immunohistochemical analysis revealed lower expression levels of col-II and AGG, but higher levels of col-I in the annulus fibrosis and endplate in OVX+V rats compared with the sham group. The OVX + SIM group exhibited levels of col-II, AGG and col-I expression comparable with those of OVX+V rats, with the exception of an upregulation of col-II expression in the annulus fibrosis. These data demonstrate that simvastatin treatment partially prevented bone loss and the deterioration of biomechanical properties of lumbar vertebrae, but not the progression of IVD degeneration in OVX rats.

REGUL ATORY EFFECT OF SIMVASTATIN ON MIDDLE/L ATE STAGES OSTEOGENIC DIFFERENTIATION OF BONE MARROW MESENCHYMAL STEM CELLS VIA p38MAPK PATHWAY

To investigate the regulatory effect of simvastatin on osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) at middle/late stages by p38MAPK pathway under condition of osteoinductive environment. The bone marrow of bilateral femur and tibia were harvested from 20 4-week-old female Sprague Dawley rats. BMSCs were isolated and cultured with whole bone marrow culture method; the second generation of cells were randomly divided into 5 groups: control group (complete medium, CM), simvastatin group (simvastatin medium, SIM), osteogenic induction group (osteogenic induction medium, OM), simvastatin and osteogenic induction group (simvastatin+osteogenic induction medium, OM+SIM), and blocker group (SB203580+simvastatin+osteogenic induction medium, OM+SIM+SB). MTT assay was used to detect the cell activity in CM group and SIM group at 2, 3, 4, 5, and 6 days, ELISA method to measure the content of alkaline phosphatase (ALP) in OM group and OM+SIM group at 7 and 14 days. The mRNA and protein expressions of osteocalcin (OCN) were detected by real-time quatitative PCR and Western blot after 1, 12, and 24 hours of osteogenic induction at 21 and 28 days. The protein expressions of phospho-p38 (p-p38) and p38 in OM group, OM+SIM group, and OM+SIM+SB group were detected by Western blot at the best induction time of simvastatin. MTT assay showed that no significant difference was found in absorbance (A) value between CM group and SIM group at each time point (P>0.05), indicating no effect of 1×10-7 mol/L simvastatin on cell viability. ELISA results showed that ALP content significantly increased in OM+SIM group when compared with OM group at 7 and 14 days; the ALP content was significantly higher at 7 days than 14 days in OM group and OM+SIM group (P<0.05). OCN mRNA and protein expressions at 12 hours were significantly higher than those at other time points in each group (P<0.05), and the expressions of OM+SIM group was significantly higher than those of OM group (P<0.05). The best induction time of simvastatin was 12 hours. At 12 hours after blocking intervention, the p-p38/p38 in OM+SIM+SB group was significantly lower than that in OM group and OM+SIM group (P<0.05), and the p-p38/p38 in OM+SIM group was significantly higher than that in OM group (P<0.05). Simvastatin can increase the mRNA and protein expression levels of OCN and the protein of p-p38 in osteogenic differentiation of BMSCs at middle/ late stages, and its best induction time is 12 hours.

Ciné-Forum: Screens Stop Here! Tax Credit Thinking and the Contemporary Meaning of “Local” Filmmaking

I live in Halifax, Nova Scotia, a place, like others, that cultural policy has built and reimagined many times over. Consider Halifax's central landmark, a harbour fortress called the Citadel. Initially conceived as an eighteenthcentury British colonial strategy to ward off French, and later American, intruders, its present day iteration is as a Canadian national historic site and tourist attraction. Now owned by Parks Canada, the site attempts to entice the same visitors that it once repelled. After paying an entrance fee, each visitor to the site receives a narrative that strategically situates colonial militarism in the nations historic past, and that can be delivered in one of Canada's two official languages. Conceptualized as a living artefact of policy, the Citadel is not simply a historic site. Arguably, it remains an active fortress that strategically defends the nation-state's quasi-official discourse about Canada's prehistory. Each day, the explosive sound of the Citadel's noon gun resonates throughout the city and the surrounding municipality. In doing so, the site's policy reverberations continue to assert themselves, literally and figuratively marking the present time in place.1Often, however, policy reverberations produce inadvertent effects. In what follows, I explore the idea that provincial credit policies, which have incentivized the development of regional film industries, have also altered the landscape and discourse of regional filmmaking to such an extent that these policies are becoming difficult to defend. I offer this theory as a way of interpreting last year's abrupt and emotionally charged changes to Nova Scotia's film incentive programme as well as the dominant rhetorical position that industry advocates used to protest the changes. Both sides of the debate have employed a discourse to defend their positions that I am calling tax credit thinking. This is to say that both sides have overwhelmingly aligned the purpose of regional filmmaking with industrial-economic over culturalartistic goals. With mounting reports from across North America arguing that provincial, state and municipal credit programmes do not recuperate their investments, that they create volatile industries and tenuous employment conditions dependent on the continuation and competitiveness of their subsidies, tax credit thinking is becoming an increasingly risky line of defense for industry advocates and film workers. It might be the case, in fact, that this line of defense is putting regional film industries in jeopardy. Ironically, one of the most significant effects of regional film incentive policies might turn out to be that they have created the very conditions, discourses and measures of success that are beginning to dismantle them.NOVA SCOTIA, FOR EXAMPLE2015 may well be remembered as the year that the screen industries went dormant in Nova Scotia. While some policy decisions have gradual effects, the provincial Liberal government s 9 April announcement that it would be eliminating the Nova Scotia Film Tax Credit (NS FTC) on 1 July had immediate and seismic effects. Right away, the loss of the 20 year-old incentive programme that, at its height, subsidized up to 65% of a film's qualifying labour costs through a refundable credit, was held responsible for film projects pulling out of the province.2 In August, citing a sharp decline in production, two of the three major equipment providers announced that they would be closing their Nova Scotia offices. John DeBoer, COO of SIM Group, justified the decision to Playback saying, [tjhere hasn't been a slowdown of work... there is absolutely no work in the film industry... and we see very little coming down the pipeline.3 In September, a Halifax editorial coinciding with the 40th Atlantic Film Festival argued that the impact of the cancelled programme fundamentally disrupted a production ecosystem that evolved over decades, a delicate and interrelated tripartite of production incentives, infrastructure, and skilled workers. …

Gestation and breastfeeding in schistosomotic mothers differently modulate the immune response of adult offspring to postnatal Schistosoma mansoni infection.

Schistosoma mansoni antigens in the early life alter homologous and heterologous immunity during postnatal infections. We evaluate the immunity to parasite antigens and ovalbumin (OA) in adult mice born/suckled by schistosomotic mothers. Newborns were divided into: born (BIM), suckled (SIM) or born/suckled (BSIM) in schistosomotic mothers, and animals from noninfected mothers (control). When adults, the mice were infected and compared the hepatic granuloma size and cellularity. Some animals were OA + adjuvant immunised. We evaluated hypersensitivity reactions (HR), antibodies levels (IgG1/IgG2a) anti-soluble egg antigen and anti-soluble worm antigen preparation, and anti-OA, cytokine production, and CD4+FoxP3+T-cells by splenocytes. Compared to control group, BIM mice showed a greater quantity of granulomas and collagen deposition, whereas SIM and BSIM presented smaller granulomas. BSIM group exhibited the lowest levels of anti-parasite antibodies. For anti-OA immunity, immediate HR was suppressed in all groups, with greater intensity in SIM mice accompanied of the remarkable level of basal CD4+FoxP3+T-cells. BIM and SIM groups produced less interleukin (IL)-4 and interferon (IFN)-g. In BSIM, there was higher production of IL-10 and IFN-g, but lower levels of IL-4 and CD4+FoxP3+T-cells. Thus, pregnancy in schistosomotic mothers intensified hepatic fibrosis, whereas breastfeeding diminished granulomas in descendants. Separately, pregnancy and breastfeeding could suppress heterologous immunity; however, when combined, the responses could be partially restored in infected descendants.

Effect of long-term use of simvastatin on AQP5 expression in a rat model of ventilator-induced lung injury

Objective To evaluate the effect of long-term use of simvastatin on aquaporin 5 (AQP5) expression in a rat model of ventilator-induced lung injury. Methods Thirty-two adult male Sprague-Dawley rats, weighing 250–280 g, were randomly divided into 4 groups (n= 8 each) using a random number table: control group (group C), simvastatin group (group Sim), mechanical ventilation group (group MV) and simvastatin + mechanical ventilation group (group SMV). In C and Sim groups, normal saline 1 ml/d and simvastatin 10 mg·kg–1·d–1 were injected, respectively, through a gastric tube into stomach for 4 weeks, and then the rats were tracheostomized, and mechanically ventilated, and the animals kept spontaneous breathing for 4 h. In MV and SMV groups, normal saline 1 ml/d and simvastatin 10 mg·kg–1·d–1were injected, respectively, through a gastric tube into stomach for 4 weeks, and then the rats were tracheostomized, and mechanically ventilated (tidal volume 50 ml/kg) for 4 h. The rats were then sacrificed, and lungs were removed for determination of wet to dry lung weight ratio (W/D ratio), activities of myeloperoxidase (MPO) and superoxide dismutase (SOD), malondialdehyde (MDA) content, and expression of AQP5 protein and mRNA in lung tissues, and for microscopic examination of pathological changes. Results Compared with group C, the W/D ratio, MPO activity, and MDA content were significantly increased, the SOD activity was decreased, and the expression of AQP5 protein and mRNA was down-regulated in group MV (P<0.01). Compared with group MV, the W/D ratio, MPO activity, and MDA content were significantly decreased, the SOD activity was increased, and the expression of AQP5 protein and mRNA was up-regulated in group SMV (P<0.01). The pathological changes of lungs were significantly mitigated in group SMV as compared with group MV. Conclusion Long-term use of simvastatin alleviates ventilator-induced lung injury, and the mechanism is related to down-regulated expression of AQP5 in rats. Key words: Simvastatin; Respiration, artificial; Respiratory distress syndrome, adult; Aquaporin 5

Clinical Placement Before or After Simulated Learning Environments?: A Naturalistic Study of Clinical Skills Acquisition Among Early-Stage Paramedicine Students.

There is conflicting evidence surrounding the merit of clinical placements (CPs) for early-stage health-profession students. Some contend that early-stage CPs facilitate contextualization of a subsequently learned theory. Others argue that training in simulated-learning experiences (SLEs) should occur before CP to ensure that students possess at least basic competency. We sought to investigate both claims. First-year paramedicine students (n = 85) undertook 3 days of CP and SLEs as part of course requirements. Students undertook CP either before or after participation in SLEs creating 2 groups (Clin → Sim/Sim → Clin). Clinical skills acquisition was measured via direct scenario-based clinical assessments with expert observers conducted at 4 intervals during the semester. Perceptions of difficulty of CP and SLE were measured via the National Aeronautics and Space Administration Task Load Index. Students' clinical assessment scores in both groups improved significantly from beginning to end of semester (P < 0.001). However, at semester's end, clinical assessment scores for the Sim → Clin group were statistically significantly greater than those of the Clin → Sim group (P = 0.021). Both groups found SLEs more demanding than CP (P < 0.001). However, compared with the Sim → Clin group, the Clin → Sim group rated SLE as substantially more time-demanding than CP (P = 0.003). Differences in temporal demand suggest that the Clin → Sim students had fewer opportunities to practice clinical skills during CP than the Sim → Clin students due to a more limited scope of practice. The Sim → Clin students contextualized SLE within subsequent CP resulting in greater improvement in clinical competency by semester's end in comparison with the Clin → Sim students who were forced to contextualize skills retrospectively.

Long-term knowledge retention following simulation-based training for electrosurgical safety: 1-year follow-up of a randomized controlled trial.

Despite the value of simulation for surgical training, it is unclear whether acquired competencies persist long term. A prior randomized trial showed that structured simulation improves knowledge of the safe use of electrosurgery (ES) amongst trainees up to 3 months after the curriculum (Madani et al. in Surg Endosc 28(10):2772-2782, 2014). We now analyse long-term knowledge retention. This study estimates the effects of a structured simulation-based curriculum to teach the safe use of ES on knowledge after 1 year. Trainees previously participated in a 1-h didactic ES course, followed by randomization into one of two groups: an unstructured hands-on session where trainees used ES devices (control group) or a goal-directed hands-on training session (Sim group). Knowledge of pre- and post-curriculum (immediate, 3 months and 1 year) and knowledge of ES safety were assessed using different multiple-choice examinations. Data are expressed as median (interquartile range), *p < 0.05. Fifty-nine trainees participated (30 control group; 29 Sim group). Despite equal baseline examination scores, Sim group demonstrated higher scores compared to control immediately (89% [83; 94] vs. 83% [71; 86]*), 3 months (77% [69; 90] vs. 60% [51; 80]*) and 1 year after curriculum (70% [61; 74] vs. 60% [31; 71]*). One-year score remained significantly greater compared to baseline in the Sim group (70% [61; 74] vs. 49% [43; 57]*), but was similar to baseline in the control group (60% [31; 71] vs. 45% [34; 52]). After ES simulation training, retention of competencies persists longer when the hands-on component is designed to reinforce specific learning objectives in a structured curriculum. Despite routine clinical use of ES devices, knowledge degrades overtime, suggesting the need for ongoing formal educational activities to reinforce curricular objectives.

Structured simulation improves learning of the Fundamental Use of Surgical Energy™ curriculum: a multicenter randomized controlled trial.

Energy devices can result in devastating complications to patients. Yet, they remain poorly understood by trainees and surgeons. A single-institution pilot study suggested that structured simulation improves knowledge of the safe use of electrosurgery (ES) among trainees (Madani et al. in Surg Endosc 28(10):2772-2782, 2014). The purpose of this study was to estimate the extent to which the addition of this structured bench-top simulation improves ES knowledge across multiple surgical training programs. Trainees from 11 residency programs in Canada, the USA and UK participated in a 1-h didactic ES course, based on SAGES' Fundamental Use of Surgical Energy™ (FUSE) curriculum. They were then randomized to one of two groups: an unstructured hands-on session where trainees used ES devices (control group) or a goal-directed hands-on training session (Sim group). Pre- and post-curriculum (immediately and 3 months after) knowledge of the safe use of ES was assessed using separate examinations. Data are expressed as mean (SD) and N (%), *p < 0.05. A total of 289 (145 control; 144 Sim) trainees participated, with 186 (96 control; 90 Sim) completing the 3-month assessment. Baseline characteristics were similar between the two groups. Total score on the examination improved from 46% (10) to 84% (10)* for the entire cohort, with higher post-curriculum scores in the Sim group compared with controls [86% (9) vs. 83% (10)*]. All scores declined after 3 months, but remained higher in the Sim group [72% (18) vs. 64% (15)*]. Independent predictors of 3-month score included pre-curriculum score and participation in a goal-directed simulation. This multi-institutional study confirms that a 2-h curriculum based on the FUSE program improves surgical trainees' knowledge in the safe use of ES devices across training programs with various geographic locations and resident volumes. The addition of a structured interactive bench-top simulation component further improved learning.

Postconditioning with simvastatin decreases myocardial injury in rats following acute myocardial ischemia.

The aim of the present study was to investigate whether postconditioning with simvastatin attenuated myocardial ischemia reperfusion injury by inhibiting the expression of high mobility group box 1 (HMGB1) in rat myocardium following acute myocardial ischemia. In total, 30 male Sprague-Dawley rats were divided into sham operation (sham; n=10), acute myocardial infarction (AMI; n=10) and simvastatin (sim; n=10) groups. The AMI and sim groups were subjected to ischemia for 30 min, followed by reperfusion for 180 min. The rats in the sim group were administered 20 mg/kg simvastatin intravenously 5 min prior to reperfusion. Subsequently, the infarct size, serum cardiac troponin (c-TnI), tumor necrosis factor (TNF)-α and myocardial malondialdehyde (MDA) levels and superoxide dismutase (SOD) activity were measured. Western blot analysis was used to detect the protein expression of HMGB1. Postconditioning with simvastatin was shown to decrease the infarct size and HMGB1 expression levels in the myocardium following AMI (P<0.05). In addition, postconditioning with simvastatin not only decreased the serum levels of c-TnI and TNF-α (P<0.05), but also inhibited the increase in MDA levels and the reduction in SOD activity (P<0.05). Therefore, postconditioning with simvastatin was shown to attenuate myocardial injury. The underlying mechanism may be associated with the downregulation of HMGB1 expression in the ischemic myocardium.

The Effects of Aromatic Water of Salix aegyptiaca L. and its Major Component, 1,4-Dimethoxybenzene, on Lipid and Lipoprotein Profiles and Ethology of Normolipidemic Rabbits.

We earlier reported that 1,4-dimethoxybenzene (DMB) was major component of aromatic water (AW) of Salix aegyptiaca L, Salicaceae, (SA). Here, Forty-eight male albino rabbits were divided into six equal groups: negative control (NC) group was gavaged with distilled water; positive control (PC) group was gavaged with simvastatin (0.6 mg/kg);SA1X and SA3X groups were gavaged with AW contains 1 mg/dl and 3 mg/dl essential oil, respectively and DMB1X and DMB3X were gavaged with 0.6 mg/dl and 1.8 mg/dl DMB, respectively. Serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) concentrations increased after 28 days in DMB-treated groups compared with NC group. The AW decreased TC level similar to the simvastatin-treated groups. DMB and SA intake did not positively modify highdensity lipoprotein cholesterol (HDL-C) and triacylglycerides (TGs) levels compared to NC group and similar levels of very low-density lipoprotein cholesterol (VLDL-C), HDL-C and LDL-C in SA-treated groups compared to NC showed that SA could not positively modify lipoprotein profile in normolipidemic rabbits. The atherogenic index level was higher in DMB3X group compared to NC and SIM groups. Stereotypies like body whirling, biting, escaping attempt and head shaking behaviors have been observed in DMB-treated groups.

Antioxidant activity stimulated by ultraviolet radiation in the nervous system of a crustacean

Ultraviolet (UV) radiation can produce biological damage, principally oxidative stress, by increasing the production of reactive oxygen species (ROS). This study evaluated biochemical impairments related to the oxidative stress induced by UVA, UVB and UVA+UVB (solar simulator-SIM) in environmental doses, during five consecutive days of exposure, in the brain and eyestalk of the crab Ucides cordatus. We evaluated these regions by sampling on the 1st, 3rd and 5th days of UV exposure for lipid peroxidation (LPO), antioxidant capacity against the peroxyl radical (ACAP), and the activities of catalase (CAT), glutathione peroxidase (GPX) and glutathione-S-transferase (GST). Immunohistochemical and immunoblotting assays were performed for anti-activated-caspase 3 in the brains. After the first day of exposure, LPO increased in the eyestalks and brains of the UV-exposed animals; ACAP, and CAT, GPX and GST activities also increased in the brains. On the third day, the LPO values in the eyestalk remained high in the UV-exposed groups, while ACAP decreased in the brain and eyestalk and CAT activity remained high in all irradiated groups in both regions. On the fifth day, LPO decreased in the eyestalk and brain of the UV-exposed groups. These results may have been a consequence of the antioxidant defense system (ADS) activity, since CAT activity was high in both regions, ACAP was high in the eyestalks of the SIM group, and GPX activity remained high in the eyestalks of the UVA and UVB groups. Immunohistochemical assays and immunoblotting showed that there was apoptosis in the brains of the UV-exposed crabs. In conclusion, environmental doses of UV can cause oxidative damage to the CNS cells, including apoptosis.

Impact of a hands-on component on learning in the Fundamental Use of Surgical Energy™ (FUSE) curriculum: a randomized-controlled trial in surgical trainees.

While energy devices are ubiquitous in the operating room, they remain poorly understood and can result in significant complications. The purpose of this study was to estimate the extent to which adding a novel bench-top component improves learning of SAGES' Fundamental Use of Surgical Energy™ (FUSE) electrosurgery curriculum among surgical trainees. Surgical residents participated in a 1-h didactic electrosurgery (ES) course, based on the FUSE curriculum. They were then randomized to one of two groups: an unstructured hands-on session where trainees used ES devices (control group) or a goal-directed hands-on training session (Sim group). Pre- and post-curriculum (immediate and at 3 months) assessments included knowledge of ES (multiple-choice examination), self-perceived competence for each of the 35 course objectives (questionnaire), and self-perceived comfort with performance of seven tasks related to safe use of ES. Data expressed as median[interquartile range], *p < 0.05. 56 (29 control; 27 Sim) surgical trainees completed the curriculum and assessments. Baseline characteristics, including pre-curriculum exam and questionnaire scores, were similar. Total score on the exam improved from 46%[40;54] to 84%[77;91]* for the entire cohort, with higher immediate post-curriculum scores in the Sim group compared to controls (89%[83;94] vs. 83%[71;86]*). At 3 months, performance on the exam declined in both groups, but remained higher in the Sim group (77%[69;90] vs 60%[51;80]*). Participants in both groups reported feeling greater comfort and competence post-curriculum (immediate and at 3 months) compared to baseline. This improvement was greater in the Sim group with a higher proportion feeling "Very Comfortable" or "Fully Competent" (Sim: 3/7 tasks and 28/35 objectives; control: 0/7 tasks and 10/35 objectives). A FUSE-based curriculum improved surgical trainees' knowledge and comfort in the safe use of electrosurgical devices. The addition of a structured interactive bench-top simulation component further improved learning and retention at 3 months.

Real Experiments versus Phet Simulations for Better High-School Students’ Understanding of Electrostatic Charging

This research investigates the influence of computer simulations (virtual experiments) on one hand and real experiments on the other hand on the conceptual understanding of electrical charging. The investigated sample consists of students in the second year (10 th grade) of three gymnasiums in Macedonia. There were two experimental groups and one control group. In one of the experimental groups, called Sim group, the instruction was realized by means of computer simulations. In the other experimental group, called Real group, the instruction was realized by means of real experiments. The difference between pre-test results and post-test results revel that the approaches used in experimental groups give more quality knowledge and skills than the one in the control group. The results in the Real group and Sim group are very similar. There are slight differences caused by the different features of the two approaches. Some differences occur based on the feature difference between real experiments and computer simulations.

Effectiveness of SIM Versus PIM on Neonatal Developmental Supportive Care in Terms of Knowledge among Nursing Students

Developmental care is a broad category of Interventions designed to minimize the stress of the newborns. Current study aimed to assess and compare the knowledge of nursing students regarding Neonatal Developmental Supportive Care before and after the administration of SIM and PIM and to determine the acceptability of SIM and PIM on Neonatal Developmental Supportive Care among nursing students. An experimental approach was used with pretest-posttest comparison group design on a sample of 60 B.Sc. Nursing IVth Year students i.e. 30 in SIM group and 30 in PIM group from M.M. College of Nursing, Mullana, Ambala, selected by Simple Random and Total Enumeration sampling technique respectively. The data was collected using Structured Knowledge Questionnaire and Structured Opinionnaire. In SIM group, the mean post-test knowledge score (36 ± 3.39) were significantly higher than the mean pre-test knowledge score (18.67 ± 3.81). In PIM group, the mean post-test knowledge score (43.63 ± 2.79) was higher than the mean pre-test knowledge score (19.27 ± 3.89). The mean post-test knowledge score (43.63 ± 2.79) and the mean acceptability score (27.07±2.08) of PIM group was higher than the mean post-test knowledge score (36 ± 3.39) and the mean acceptability score (24.87±1.66) of SIM group. Therefore both, SIM & PIM were effective methods for enhancing the knowledge of nursing students regarding Neonatal Developmental Supportive Care & PIM was more effective and highly acceptable method in terms of its approval and usefulness than SIM.

Effectiveness Of Structured Teaching Programme Vs. Self Instructional Module Regarding Prevention Of Acute Respiratory Infections In Children Among Mothers

Acute respiratory infections are a major cause of mortality and morbidity in young children worldwide .ARIs are heterogeneous group of diseases with different causative factors and it affects different parts of respiratory tract. In this study two teaching strategies used to improve the knowledge of mothers regarding acute respiratory infections in under-five children. The aim of the study was to determine the effectiveness of STP and SIM on knowledge regarding prevention of ARI among the two groups; and compare the effectiveness of STP and SIM on knowledge regarding prevention of ARI among the two groups. The quasi experimental two group pretest post test design was adopted .Simple random technique was adopted to select 60 mothers .The data were generated structured interview schedule .STP &SIM developed on ARI .Content validity of self constructed knowledge questionnaire, STP and SIM were obtained from experts of related departments. Mother's knowledge regarding ARI was assessed by using structured interview schedule method. On the first day of data collection (pre test) for STP & SIM groups .STP was administered on the same day. On seventh day, again the same mother's knowledge was assessed (post-test) using the same tool. The reliability of tool was determined by using Spearman's Brown Prophecy formula. The reliability of the structured questionnaire was found to be 0.94 and validity of the tool found to be 0.973.The pilot was conducted on 10 mothers with constructed tool which it was found to be reliable. The mean post test knowledge score 22.33 and t-value (t (29)=16.018,P<0.01)of STP was apparently higher than SIM the mean post test knowledge score 19.77 and t-value (t (29)=9.424,P<0.01) respectively. Hence STP is more effective than SIM. The developed tool can be used for different categories of population to evaluate the effectiveness of teaching strategies. Implication of various aspects of nursing are addressed and recommendations for future research are discussed.