Standardized Training Research Articles

The status quo of global geriatric radiation oncology education: A scoping review

PurposeTo identify potential gaps in geriatric radiation oncology (RO) education worldwide, as measured by geriatric oncology (GO) content within postgraduate RO training program (TP) curricula across 8 focus countries. Methods and materialsThe need for improved education around GO is internationally recognized and is a key strategic priority of the International Society of Geriatric Oncology (SIOG).Two reviewers undertook a systematic scoping review from March to September 2023. Focus countries were selected using predefined selection criteria based on national radiation therapy (RT) service provision, RT access and post-graduate specialty training standards. This review is in accordance with evidence-based curriculum design methodology and represents the initial phase i.e., problem identification and needs assessment. ResultsOverall RO TP and curriculum elements varied by jurisdiction. Common elements included length of training, summative assessments and prerequisite requirements. Considerable variability exists across TPs around identified learning outcomes, content, TP organization, training networks and accreditation.Across 6 TPs, only 2 had any documented GO curriculum content. Of these, only one contained geriatric RO content scoring moderate to high based on accepted quality benchmarks. Outside official RO TPs, there is considerable GO online education content, including face to face courses, peer-reviewed articles, learning materials and resources relevant to RO postgraduate training worldwide. However accessibility to these learning interventions may be region specific and content is not standardized. ConclusionsAs expected, this systematic scoping review has identified significant gaps in GO education within RO TPs worldwide. These findings represent an essential step in the development of evidence-based recommendations for updating standards for GO training within RO training programs and establishing a globally accepted, standardized benchmarks for minimal geriatric RO education. In turn, this will ensure future radiation oncologists are able to deliver a high standard of care to and improve outcomes for older people with cancer.

Adversarial Training With Anti-Adversaries.

Adversarial training is effective in improving the robustness of deep neural networks. However, existing studies still exhibit significant drawbacks in terms of the robustness, generalization, and fairness of models. In this study, we validate the importance of different perturbation directions (i.e., adversarial and anti-adversarial) and bounds from both theoretical and practical perspectives. The influence of adversarial training on deep learning models in terms of fairness, robustness, and generalization is theoretically investigated under a more general perturbation scope that different samples can have different perturbation directions and varied perturbation bounds. Our theoretical explorations suggest that combining adversaries and anti-adversaries with varied bounds in training can be more effective in achieving better fairness among classes and a better tradeoff among robustness, accuracy, and fairness in some typical learning scenarios compared with standard adversarial training. Inspired by our theoretical findings, a more general learning objective that combines adversaries and anti-adversaries with varied bounds on each training sample is presented. To solve this objective, two adversarial training frameworks based on meta-learning and reinforcement learning are proposed, in which the perturbation direction and bound for each sample are determined by its training characteristics. Furthermore, the role of the combination strategy with varied bounds is explained from a regularization perspective. Extensive experiments under different learning scenarios verify our theoretical findings and the effectiveness of the proposed methodology.

Repurposing of monocyclic β-lactams as anti-inflammatory agents – The case of new ferrocene-azetidin-2-one hybrids

There is growing interest in developing monotherapy drugs that treat inflammation caused by microbial infections, focusing on dual antimicrobial and anti-inflammatory agents with minimal side effects and high safety margins. This study synthesized and characterized a library of novel cis-4-ferrocenylazetidin-2-ones, evaluating their antimicrobial and anti-inflammatory activities. These organometallic monocyclic β-lactams showed moderate in vitro antimicrobial activity against various standard microbial strains, including yeasts and Gram-negative and Gram-positive bacteria. Some compounds overcame the resistance of clinical Staphylococcus aureus isolates. Traditionally, monocyclic β-lactams target Gram-negative bacilli, but adding a ferrocene moiety and substituting the COOH group near the N-1 position with a non-ionizable ester group (COOR) extended their activity spectrum. The anti-inflammatory properties were assessed in macrophage-based models, revealing non-cytotoxicity below 10 μM. Two compounds were shown to be strong and selective arginase inhibitors, while five others effectively suppressed excessive NO formation without affecting basal NO production. The presence of a phenoxy group at C-3 of the β-lactam ring appeared to be crucial for selective NO inhibition. These hybrids did not scavenge NO but inhibited NO synthesis by suppressing iNOS expression. Overall, two novel hybrids were identified as promising hit candidates for treating infection-induced inflammatory reactions.

Scenario-based simulation training, occupational burnout and psychological capital in hospital-based nursing instructors: A cross-sectional study

AimThis study aimed to scrutinize the extent of engagement in the implementation of scenario-based simulation training within hospital settings and the status of occupational burnout and psychological capital among nursing instructors. MethodsThis research spanned from August 2022 to June 2023. A total of 172 nursing instructors from 67 hospitals participated in an electronic survey, which included knowledge, attitudes, and practices questionnaires related to scenario-based simulation training, the Maslach burnout inventory-general survey for assessing occupational burnout, and the 24-item Psychological Capital Questionnaire. ResultsThe findings revealed that the average scores for knowledge and attitude in scenario-based simulation training among the 172 nursing instructors were (54.85 ± 13.26) and (76.55 ± 28.82), respectively. Out of these, 105 instructors (61.0%) have engaged in scenario-based simulation training, with an average practice score of (64.0 ± 25.4). Psychological capital emerged as a significant influencing factor on the attitudes and practices of nursing instructors in scenario-based simulation training (p = .046, p = .004, respectively). Positive correlations were observed between knowledge, attitude, and practice, while a positive association was noted between occupational burnout and psychological capital. ConclusionNursing instructors exhibited a relatively low proficiency in knowledge acquisition, positive attitudinal disposition, and inadequacy in engagement concerning scenario-based simulation training. The study advocated for the augmentation of standardized training programs tailored specifically for nursing instructors in scenario-based simulation training. Additionally, the study underscored the importance of prioritizing interventions that could enhance the psychological capital of nursing instructors as a pivotal strategy to ameliorate the overall quality of simulation training.

ЄВРОПЕЇЗАЦІЯ ПРОФЕСІЙНОЇ ПІДГОТОВКИ МАЙБУТНЬОГО ФАХІВЦЯ ГОТЕЛЬНО-РЕСТОРАННОЇ СПРАВИ: МОЖЛИВОСТІ ЗАСТОСУВАННЯ ШТУЧНОГО ІНТЕЛЕКТУ

The purpose of the study is possibilities and prospects of using artificial intelligence for Europeanization of professional training of future specialists in hotel and restaurant business. To achieve this goal, we set several tasks: to study European standards of professional training of specialists; to evaluate current trends in application of artificial intelligence in education; to identify opportunities and challenges of AI integration into educational process of professional training of future specialists in hotel and restaurant business. During the scientific search, a complex of methods was applied: bibliographic, analysis and synthesis for the study of psychological and pedagogical literature (theoretical). A monographic method was used for logical presentation of the results. Results. Europeanization of professional training of future specialists in hotel and restaurant business of Ukraine as an important stage of adaptation of national education system to international standards has been studied. Main standards are considered through partial characterization of a number of documents. Challenges of Europeanization are characterized, namely: standards and accreditation, updating of curricula and programs, human resources, financing. Possibilities of Europeanization of professional training of future specialists in hotel and restaurant business, including improving quality of education, possibility of international internships and exchanges, increasing prestige of the profession of future specialists in the field of hotel and restaurant business and likely attraction of investments, have been allocated. Role of artificial intelligence in professional education has been investigated. Importance of AI has been proved through the implementation of a number of innovative solutions that can significantly improve educational process, namely: adaptive learning systems, virtual simulators, learning management systems. Conclusions. Main results of the study show that use of artificial intelligence has great potential for Europeanization of professional training in the field of hotel and restaurant business. Prospects for further research may include studying the impact of AI on specific aspects of educational process, developing new technologies for educational purposes, and analyzing long-term effects of AI integration on the labor market. Key words: professional training, future specialists, hotel and restaurant business, higher education institution, artificial intelligence, Europeanization.

Insights on High-Value Procedures From the ISASS 4-Part Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery Based on Surgeon Experience.

The authors conducted a comprehensive review and integration of insights from 4 webinars hosted by the International Society for the Advancement of Spine Surgery (ISASS) to arrive at recommendations for best clinical practices for guideline development for endoscopic spine surgery. This perspective article discusses the limitations of traditional surgical trials and amalgamates surgeons' experience and research on various cutting-edge techniques. Data were extracted from surveys conducted during each webinar session involving 3639 surgeons globally. The polytomous Rasch model was employed to analyze responses, ensuring a robust statistical assessment of surgeon endorsements and educational impacts and focusing on operative nuances and experience-based outcomes. Bias detection was performed using the differential item functioning test. The ISASS webinars provided a dynamic platform for discussing advances in endoscopic spine surgery, identifying a range of high-value procedures from basic discectomies to complex lumbar interbody fusions. Each high-value endoscopic spine surgery was highlighted in separate peer-reviewed publications, which form the basis for this summary document that synthesizes key takeaways from these webinars. High-value clinical applications of endoscopic spine surgery, primarily defined as higher-intensity endorsement transformation from the pre- to postwebinar survey with a shift to higher mean logit locations of test items both with unbiased and orderly threshold progression, were: (a) Percutaneous interlaminar endoscopic decompression for lateral canal stenosis, (b) transforaminal debridement of low-grade degenerative spondylolisthesis, (c) transforaminal full-endoscopic interbody fusion for hard disc herniation, (d) endoscopic standalone lumbar interbody fusion, (e) endoscopic debridement of spondylolytic spondylolisthesis, and (f) posterior cervical foraminotomy for herniated disc and bony stenosis. The ISASS webinar series has significantly impacted surgeons' education and contributed to the identification of high-value endoscopic spine surgery practices that may serve as a cornerstone for surgeon training standards, policy, and guidelines development. Ongoing research on technological advancements and expansions of clinical indications combined with systematic review is expected to refine the recommendations on high-value endoscopic spinal surgeries recommended for enhanced reimbursement. Assessing surgeon confidence and acceptance of endoscopic spinal surgeries using polytomous Rasch analysis. Level 2 (inferential) and 3 (observational) evidence because Rasch analysis provides statistical validation of instruments rather than direct clinical outcomes.

Non-technical factors on ophthalmology education: a narrative review

Ophthalmology education is increasingly influenced by non-technical factors. This paper examines the multifaceted influences on ophthalmology education, focusing on direct and indirect factors that have shaped the training and wellbeing of ophthalmology students and residents. A systematic search of PubMed and Embase was carried out, searching date was from inception to 01/07/2024. A total of 8,232 articles were screened, of which 7,976 were excluded following abstract review. After reading the remaining 256 articles in full, a further 228 were excluded. A total of 28 original articles were included in this systematic review. The non-technical factors that influenced ophthalmology education included various crisis, inadequate curricular time, training resources, lack of training standardization and shortage of financial support and teaching resources. The review summarizes the influences on ophthalmology education of various non-technical factors, thereby helping educators improve the training methods.

Comparison of intra-assay and inter-assay reproducibility and positive detection times of two different (BacT/Alert 3D and Autobio BC) commercial blood culture systems.

In our study, we aimed to compare the performance of the BacT/Alert 3D (bioMerieux, France) system, which is currently used in our laboratory, and the Autobio BC (Autobio, China) system, which was newly introduced in our country, using standard and clinical isolates. Bacterial suspension was prepared by two technicians on the same day and three consecutive days from five different standard strains with 0.5 McFarland turbidity, then serial dilution to a final concentration was adjusted and was simultaneously inoculated in aerobic blood culture bottles. The bacterial concentration was measured by making a quantitative counting plate. The same procedure was also performed for 55 clinical isolates belonging to eleven species. After simulated bacteremia with standard and clinical isolates, the growth results were confirmed by inoculation from positive blood culture bottles onto solid medium and identification was made in the next day with MALDI-TOF MS (bioMérieux). In each study, sterile saline and blood was inoculated into the bottles as a negative control to check contamination. Intra-assay and inter-assay reproducibility of recovery rates and detection times of standard strains; recovery rates and detection times of clinical isolates were compared for both systems. Recovery rates were 100% in both systems, and when positive detection times were compared, it was found that there was no difference between the two devices in clinical isolates (p:0.262) but that Autobio BC gave significantly (p<0.001) earlier results in standard strains. In our simulated bloodstream infection study, Autobio BC was found to be comparable with BacT/Alert 3D, both recovery rates and growth detection time performance were found to be very good, and it can be used in routine microbiology laboratories.

Exploring the dynamics of ultrasound training in medical education: current trends, debates, and approaches to didactics and hands-on learning.

Medical education, especially in ultrasound training, is undergoing significant changes. This study examines practical issues in ultrasound medical education, emphasizing state-of-the-art teaching methods, their effectiveness, and implementation challenges. The study analyzed advancements in ultrasound education, including randomized controlled trials comparing peer-to-peer teaching with traditional faculty-led instruction. It evaluated the effectiveness of collaborative small-group training and group size impact in simulation-based training. The study also assessed practical training components outlined in the WFUMB Position Paper Part II. Findings indicate that peer-to-peer and collaborative small-group training are effective and cost-efficient. Group size did not significantly affect training outcomes. Key practical training elements, including early hands-on sessions and exposure to various equipment, substantially improved learning outcomes. Simulation tools like virtual reality (VR), augmented reality (AR), and phantoms were crucial for teaching standardized procedures and rare pathologies. Challenges identified include developing robust image acquisition skills, scarcity of qualified student tutors, and the need for reliable ultrasound skill assessment methods. Integrating peer-to-peer teaching and advanced simulation technologies significantly advances ultrasound medical education. These methods enhance cognitive and psychomotor skills but also present challenges such as ensuring quality education and developing effective assessment methods. Future research should compare different simulation tools and establish objective ultrasound proficiency assessment criteria. Continual method evaluation and improvement are essential for effective and standardized ultrasound training, ultimately enhancing patient care and clinical outcomes.

Structure-mutagenicity relationships on quinoline and indole analogues in the Ames test.

Although the in silico predictive ability of the Ames test results has recently made remarkable progress, there are still some chemical classes for which the predictive ability is not yet sufficient due to a lack of Ames test data. These classes include simple heterocyclic compounds. This study aimed to investigate the mutagenicity and structure-mutagenicity relationships for some heterocycles in the Ames test. In the present study, we selected 12 quinoline analogues containing one or two nitrogen atoms in the naphthalene ring and 12 indole analogues containing one to three nitrogen atoms in the indole ring, without any side moiety. The Ames test was performed with five standard bacterial strains (TA100, TA1535, TA98, TA1537, and WP2uvrA) using the pre-incubation method with and without rat liver S9. Five quinoline and two indole analogues were mutagenic. Among the five quinoline analogues, four were mutagenic in the presence of S9 mix with TA100, whereas cinnoline was mutagenic in the absence of S9 mix with TA1537. Among the two indole analogues, indazole was mutagenic in the presence and absence of S9 mix with WP2uvrA and 4-azaindole was mutagenic in the absence of S9 mix with TA1537. The mechanisms underlying the induction of mutagenesis appear to differ between quinoline and indole analogues. In addition, we performed in silico analysis of the mutagenicity of all these analogues using DEREK Nexus 6.1.1 (Lhasa Limited) and GT_EXPERT from CASE Ultra 1.8.0.5 (MultiCASE Inc.) as knowledge-based models and GT1_BMUT from CASE Ultra 1.8.0.5 (MultiCASE Inc.) as a statistical-based model. The knowledge-based model showed low sensitivity for both the quinoline and indole analogues (DEREK Nexus and GT_EXPERT: 20% for quinolines and 0% for indoles). Conversely, the statistical model showed high sensitivity (100% for both quinolines and indoles) and low specificity (43% for quinolines and 10% for indoles). Based on the Ames test results, we proposed structural alerts noting that quinoline analogues were mutagenic when they had nitrogens in any of the positions 2, 5, 7, or 8 in addition to 1, and indole analogues were mutagenic when they had nitrogens at positions 2 or 4 in addition to 1.

Antimicrobial Activity of Copolymer Structures from Bio-Based Monomers.

The urgent need for new antimicrobial compounds has led scientists to explore antimicrobial peptides (AMPs) and antimicrobial polymers as solutions for multidrug resistance. In this study, we synthesized copolymers with cationic and hydrophobic moieties by free-radical polymerization (FRP) using a chain transfer agent to control molecular weights. The potential of natural products as part of the hydrophobic moiety was evaluated, along with variations in their monomer content (13-25%) and the molecular weight (MW) of the copolymer (5000-20,000 g·mol-1). Hydrophobicity was evaluated using the theoretical Log Poct values and surface areas (SAs). Biological assays included antimicrobial activity against Escherichia coli and Staphylococcus aureus standard strains, hemolytic activity in red blood cells (RBC), and cytotoxicity tests against HEK293T cells. Keys findings indicate that copolymers with tropolone moieties, lower MWs, and an optimal balance between hydrophobic and cationic moieties show a promising basis for future generations of antimicrobials.

Application of clinical thinking training system based on entrustable professional activities in emergency teaching.

Standardized training for resident physicians (STRP) is essential for improving their clinical skills. The standardized training for resident physicians in emergency medicine differs from other disciplines, focusing more on knowledge related to medical emergencies and emergency care skills requiring urgency and real-time response. There are specific differences in knowledge content, teaching methods, curriculum design, and career development compared to other specialties. As a national-level teaching base for emergency medicine, our hospital continuously explores and innovates in teaching models, discovering a model more suitable for emergency medicine. This study summarizes practical experience in teaching and assessment integration (TAA), evaluates teaching training effectiveness with the Clinical Thinking Training System (CTTS), and examines integrating this system with innovative teaching and assessment models' impact on resident physicians' clinical abilities. In our study, we selected residents who rotated in our department from July-December 2023 and randomly divided them into a reform group (n = 106) and a control group (n = 104). The reform group received training using the Clinical Thinking Training System (CTTS) while the control group received standard training consistent with the existing STRP framework. We integrate innovative teaching and assessment (TAA) modelsand theEntrustable Professional Activities(EPAs) scale to assess students' abilities, stratifying by grade level, background, and major to evaluate students' departmental rotation examination (DRE) and EPAs scores. The DRE scores and Mini-CEX scores were significantly higher in the reformed group compared to the control group. The final assessments showed the reform group scored significantly higher in first-case documentation and overall clinical thinking decision-making. Specifically, the reform group had significantly higher scores in first-case documentation for second-year, third-year, undergraduate, and graduate students, and non-emergency specialty students. The clinical thinking decision-making scores of the reform group were significantly higher across different years, specialties, and educational backgrounds. All the EPAs results indicated the CTTS improved treatment decision-making abilities among students with different years of training, educational backgrounds, and specialties. Moreover, the ability for continuous patient management improved to some extent among students in different years and with different educational backgrounds. The integration of innovative teaching and assessment models with the CTTS is more conducive to improving the examination performance and confidence in professional behavior of resident physicians.

Problem-based learning on the WeChat public platform in radiation oncology residency training programs.

This study explored the effectiveness of a Problem-based Learning (PBL) teaching model on the WeChat public platform for radiation oncology residency training programs. The WeChat PBL program was initiated in 2019. The study recruited student participants, on a voluntary basis, who were in their first and second years of standardized training in radiation oncology. We selected classic and trending issues in radiation oncology as the two main teaching topics. Students in the PBL group searched for relevant literature, summarizing PowerPoint presentations or academic speeches on specific issues published on the professional WeChat public platform after an in-depth review by teachers. The final national standardized training examination scores for resident physicians were used to evaluate teaching effectiveness. The graduation scores of the PBL and non-PBL groups were compared, and a stratified analysis was conducted based on the year of participation to assess the teaching effectiveness of this model. Moreover, questionnaires were administered to evaluate students' experiences. Among the 36 students who joined the study in 2019, 16 (44.0%) voluntarily joined the PBL teaching group. Nine students started teaching PBL in their first year of residency, accounting for 47.4% of that year, and seven started in their second year, accounting for 41.2%. The average graduation scores of the PBL group were superior to those of the non-PBL-focused group for the same grade. The rate of high scores among students in the PBL group (56.3%) was higher than that of students in the non-PBL group (25%). Specifically, first-year residents who joined the PBL group had an average score of 92.3 ± 2.2, significantly higher than their non-PBL counterparts, who scored an average of 88.6 ± 4.6, showing a statistically significant advantage (p = 0.042). All students were satisfied with the PBL WeChat teaching and would recommend the PBL WeChat course to others. The PBL residency teaching model on the WeChat platform improved residency scores and garnered student satisfaction.

Phytochemical Characterization and Antibacterial Activity of Carthamus Caeruleus L. Aqueous Extracts: In Vitro and In Silico Molecular Docking Studies

In order to valorize natural resources and the traditional use of medicinal plants in Algeria, this study exploits the antibacterial effect of Carthamus caeruleus L. Since there are few studies on this plant despite its notable therapeutic potential, this work aims to characterize the chemical composition of Carthamus caeruleus L. leaf and root aqueous extracts and to evaluate their antibacterial activity through an in vitro and in silico studies. Spectrophotometric assays and HPLC results revealed 22 components in the roots and 16 in the leaves. Disc diffusion and microdilution methods were used to study the antibacterial properties against nine standard bacterial strains. The results showed that roots exhibited the best activity on most tested strains. Both extracts were also able to inhibit the growth of Staphylococcus aureus ATCC 25923 and Escherichia coli ATSC 25922. Furthermore, no nucleic acid leakage or membrane damage was detected. However, molecular docking of the molecules indicates that some constituents have significant affinity and stability for DNA gyrase. Gallic acid, luteolin, myricetin, and orientin were found to have the highest score. The molecular docking data suggest, for the first time, that the antibacterial activity may be caused by the inhibition of DNA gyrase.

Online public response to emergency department diagnostic error report: A qualitative study.

The 2022 study on diagnostic error in the emergency department (ED) published by the Agency for Healthcare Research and Quality (AHRQ) reported that one in every 18 ED patients is misdiagnosed. The report was methodologically critiqued by emergency physicians and researchers. However, little is known about public perception of error in the ED. We sought to characterize public response to AHRQ's publication. A search was conducted for online news articles published December 2022 reporting the AHRQ study and containing "public comment" sections. Verbatim comments and relevant characteristics were collected. Three coders completed content analysis and resolved any differences. Descriptive statistics and themes are reported. Fifteen online articles were reviewed; three had public comment sections (New York Times, DailyMail, and Boston Globe). There were 553 unique user comments; 293 were original comments (53%) and 260 were replies to comments (47%). The 260 replies were in response to 113 original comments, with the remaining original comments having 0 replies (n = 180). Of the 202 commenters who identified a personal role in a health care encounter, 70 (35%) identified as patients and 68 (34%) identified as physicians. Comments centered on seven major themes: (1) negative personal experiences, (2) reframing study conclusions, (3) sense of decline in training standards, (4) internal stressors impeding ED diagnostic accuracy, (5) external stressors impeding ED diagnostic accuracy, (6) suggested solutions, and (7) role of the ED in diagnosis. The news coverage of AHRQ's report provided individuals a platform to share their perspectives. Many comments reflected a nuanced understanding of the role of emergency care and the stressors of the ED environment. Despite questions about the report's accuracy, there were many individuals who shared personal negative experiences suggesting that the public may feel directly impacted by error in the ED.

Current status of ultrasound training in obstetrics and gynecology: a scoping literature review

IntroductionAs a widely accessible, cost-effective, and safe imaging tool, obstetric and gynecologic (OB/GYN) ultrasound (ULS) plays a vital role in diagnostics and patient care. With its growing relevance, the demand for comprehensive education in this field increases. The objective of this work was to outline the current state of OB/GYN ULS education.MethodsA scoping literature search was performed until May 2023 using the medical database PubMed according to PRISMA guidelines. Using specific keywords, relevant publications were filtered. Subsequently, abstracts were independently reviewed by two authors and the inclusion of each publication was assessed against pre-defined key search terms. Full-text versions of the included publications were scrutinized and pertinent information was extracted.ResultsIn this review, 126 articles from the literature search matched the inclusion criteria and were investigated. Our findings revealed a diverse range of course concepts and programs, a lot of them not meeting the expectations of trainees and international guidelines. OB/GYN ULS training primarily targets residents, yet opportunities for early exposure and continuing education are underexplored. International organizations, such as the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and the German Society for Ultrasound in Medicine (DEGUM) have proposed guidelines and curricula for standardized training. However, adoption remains varied. There is an emergent need to innovate teaching methods.ConclusionThere is consensus that standardizing OB/GYN ULS curricula could enhance training quality and streamline the creation of new programs, ultimately improving patient care. Further research is needed to define the most effective strategies for curriculum development and implementation.

Genotyping of human isolates from human toxoplasmosis outbreak: Restriction Fragment Length Polymorphism and Sanger Sequencing.

Toxoplasmosis is a parasitic disease caused by infection with Toxoplasma gondii, capable of infecting a wide range of hosts. The parasite exhibits a broad genetic diversity, necessitating genotypic characterization for genotype identification and associations with epidemiological information. Therefore, the Restriction Fragment Length Polymorphism (RFLP) technique is used for characterization. This study aimed to perform genotypic characterization of isolates from pregnant women infected during a human toxoplasmosis outbreak, comparing the RFLP and Sanger Sequencing methodologies. For this purpose, six human isolates were subjected to conventional PCR, Multiplex PCR, Nested PCR, Enzymatic Digestion, and Sanger Sequencing. Additionally, the standard strains GTI (Type I), PTG (Type II), and CTG (Type III) were also subjected to the same techniques described above. Subsequently, the amplified DNA products were compared with the standard strains. As a result, it was observed that Sanger Sequencing provides the same information as RFLP PCR, as well as the possibility of cost reduction for genotypic characterization, and providing greater agility in issuing results. Additionally, Sanger Sequencing of T. gondii isolates allows for detailed evaluation of nucleotide sequences, including the assessment of SNPs and enzymatic restriction sites, which the RFLP technique does not.

Energy‐Efficient Hardware Implementation of Spiking‐Restricted Boltzmann Machines Using Pseudo‐Synaptic Sampling

Stochastic sampling is performed to reduce hardware energy consumption and prevent overfitting by reducing parameters, because not all data are required for learning. In this study, a new approach, pseudo‐synaptic sampling (PS2) method, which approximates the conventional synaptic sampling machine (S2M) method through a hardware‐friendly implementation while demonstrating superior efficiency, is introduced. By sampling in front of neurons rather than at each synapse, the PS2 method improves hardware energy efficiency and ensures scalability. Furthermore, it improves energy and area efficiency by eliminating the additional circuit required by other techniques, such as the random walk (RW) method previously used which requires an additional circuit to frequently charge/discharge the membrane potential. Herein, the average firing rate equation for the S2M method is modified to suit the experimental conditions of this study. Through this numerical simulations, it is confirmed that the activation function of the PS2 method aligns with that of the S2M method and verified that the PS2 method can implement stochasticity for restricted Boltzmann machine (RBM) neurons. Experimental validation of the PS2 method, compared to the RW method, for Modified National Institute of Standards and Technology database (MNIST) training and inference on field‐programmable‐gate‐array‐implemented spiking RBM chips reveals promising results. In an MNIST 100‐handwritten digit experiment, the PS2 method exhibits on‐chip training accuracy (92%) comparable to that of the RW method (93%). Furthermore, in the energy consumption analysis, it is shown that the PS2 method reduces power consumption by 94.94% compared to the RW method, highlighting its enhanced power efficiency due to a reduced number of circuit elements. In the investigation into the impact of increasing the frequency at which random bits are generated, it is shown that the RW method experiences accuracy degradation even with slight increases, whereas the PS2 method maintains accuracy over significantly longer periods. This enables further power reduction by allowing for a longer period during random bit generation. In this study, a foundation is laid for maximizing the energy efficiency of spiking neural network processors by optimizing internal noise generation mechanisms.

H-NS is a Transcriptional Repressor of the CRISPR-Cas System in Acinetobacter baumannii ATCC 19606.

Acinetobacter baumannii is a multidrug-resistant opportunistic pathogen primarily associated with hospital-acquired infections. The bacterium can gain multidrug resistance through several mechanisms, including horizontal gene transfer. A CRISPR-Cas system including several Cas genes could restrict the horizontal gene transfer. However, the molecular mechanism of CRISPR- Cas transcriptional regulation remains unclear. We identified a type I-F CRISPR-Cas system in A. baumannii ATCC 19606T standard strain based on sequence analysis. We focused on the transcriptional regulation of Cas3, a key protein of the CRISPR-Cas system. We performed a DNA affinity chromatography-pulldown assay to identify transcriptional regulators of the Cas3 promoter. We identified several putative transcriptional factors, such as H-NS, integration host factor, and HU, that can bind to the promoter region of Cas3. We characterized AbH-NS using size exclusion chromatography and cross-linking experiments and demonstrated that the Cas3 promoter can be regulated by AbH-NS in a concentration-dependent manner via an in vitro transcription assay. CRISPR-Cas expression levels in wild-type and hns mutant strains in the early stationary phase were examined by qPCR and β-galactosidase assay. We found that H-NS can act as a repressor of Cas3. Our transformation efficiency results indicated that the hns mutation decreased the transformation efficiency, while the Cas3 mutation increased it. We report the existence and characterization of the CRISPR-Cas system in A. baumannii 19606T and demonstrate that AbH-NS is a transcriptional repressor of CRISPR-Cas-related genes in A. baumannii.

Hospitals’ readiness to attract health tourists: a comparative study in Iran

BackgroundUnderstanding the influential factors in attracting foreign patients is possible by evaluating and identifying hospitals’ capabilities, strengths, and weaknesses. This study assessed Ahvaz hospitals’ readiness to attract health tourists using International Joint Commission (IJC) standards.MethodsThis descriptive-analytical study examined 21 hospitals in Ahvaz using IJC standard questionnaires with 76 questions across six fields. Data were analyzed using descriptive statistics and the Mann–Whitney test in SPSS version 22.ResultsThe overall compliance rate with organization-oriented standards was 79.53%. Staff training and qualification standards scored highest at 81.79%, while information management standards scored lowest at 76.26%. Non-academic hospitals averaged higher scores than academic hospitals, though this difference was insignificant (p > 0.05). Bed occupancy rates ranged from 40.96% to 85.33%, with average lengths of stay between 1.33 and 64.31 days.ConclusionAhvaz hospitals demonstrated above-average readiness to attract medical tourists across most dimensions. To enhance their competitiveness, hospitals should prioritize improvements in information management systems, leverage strengths in staff training and qualifications, address disparities between academic and non-academic institutions, and invest in marketing their unique capabilities to potential health tourists.