Virtual patient design : exploring what works and why : a grounded theory study

Objectives: Virtual patients (VPs) are online representations of clinical cases used in medical education. Widely adopted, they are well placed to teach clinical reasoning skills. International technology standards mean VPs can be created, shared and repurposed between institutions. A systematic review has highlighted the lack of evidence to support which of the numerous VP designs may be effective, and why. We set out to research the influence of VP design on medical undergraduates. Methods: This is a grounded theory study into the influence of VP design on undergraduate medical students. Following a review of the literature and publicly available VP cases, we identified important design properties. We integrated them into two substantial VPs produced for this research. Using purposeful iterative sampling, 46 medical undergraduates were recruited to participate in six focus groups. Participants completed both VPs, an evaluation and a 1-hour focus group discussion. These were digitally recorded, transcribed and analysed using grounded theory, supported by computer-assisted analysis. Following open, axial and selective coding, we produced a theoretical model describing how students learn from VPs. Results: We identified a central core phenomenon designated ‘learning from the VP’. This had four categories: VP Construction; External Preconditions; Student–VP Interaction, and Consequences. From these, we constructed a three-layer model describing the interactions of students with VPs. The inner layer consists of the student's cognitive and behavioural preconditions prior to sitting a case. The middle layer considers the VP as an ‘encoded object’, an e-learning artefact and as a ‘constructed activity’, with associated pedagogic and organisational elements. The outer layer describes cognitive and behavioural change. Conclusions: This is the first grounded theory study to explore VP design. This original research has produced a model which enhances understanding of how and why the delivery and design of VPs influence learning. The model may be of practical use to authors, institutions and researchers

Routine versus selective use of episiotomy in primigravida: a prospective non-randomized case-control study

Background: Episiotomy is a surgically planned incision on the perineum and the posterior vaginal wall during second stage of labour. It is an inflicted second-degree perineal tear. Objective of this study was to determine the possible benefits and risks of the use of selective episiotomy versus routine episiotomy during delivery in primigravida.Methods: This is a prospective non-randomized case-control study designed to analyze and compare the maternal outcomes following routine versus selective use of episiotomy in primigravida. In control group, 122 patients were recruited and mediolateral episiotomy was given in all patients; while in study group, 61 patients were recruited, in whom episiotomy was given selectively.Results: In study group 61 patients were recruited, out of which episiotomy can be avoided in 23 (37.7%) of cases. There was no 3rd or 4th degree perineal tear found in any group. Perineal pain score on 3rd day postpartum was less in study group, as compared to control group on bed rest, sitting, walking and defecation.Conclusions: Selective use of episiotomy can improve maternal outcome by reducing perineal lacerations and those having intact perineum can have the best outcome when episiotomy is given selectively

Uninvolved Maternal Feeding Style Moderates the Association of Emotional Overeating to Preschoolers’ Body Mass Index z-Scores

Objective: To examine the relation between preschoolers\u27 eating behaviors and body mass index (BMI) z-scores (BMIz) and the moderating role of permissive parent feeding styles in these associations. Design: Cross-sectional study involving mothers\u27 report of food-related parenting styles and child eating behaviors. Setting: Small city in southern Mississippi. Participants: Mother–preschooler dyads (n = 104). Main Outcome Measure: Child body BMIz. Analysis: Moderated multiple regression. Results: An uninvolved feeding style moderated the relationship between emotional eating and BMIz such that children with higher emotional overeating scores had higher a BMIz in the presence of an uninvolved feeding style (B = 2.16; P = .01). Conclusions and Implications: An uninvolved feeding style may be a risk factor for higher BMIz in preschoolers who tend to overeat to cope with negative emotions. For other children in this population, self-regulatory aspects of eating may be more important than mothers\u27 feeding style in the maintenance of healthy weight

Effect of practicing Yoga on Aerodynamic measures of Voice

Yoga is a Sanskrit word which interprets to the meaning “the unity of body and mind”. It is a blend of breathing drills, physical stances, and contemplation, and has been practiced in eastern conventional medicine for more than thousands of years [1]. A modest effort was taken in this study to examine the effect of Long term yoga training on Aerodynamic measures and also to compare and contrast these measures between individuals who practice yoga and who don’t. A total of 120 phonation samples were obtained from participants who practice yoga and who don’t between the age ranges of 20-40 years. Samples assessing respiratory capacities were also taken from the above subjects. Statistical analysis showed a significant difference [p<0.05] between control group and experimental group for all parameters. Significant difference was also seen between genders [p<0.05]. Significant difference was seen in gender within control group [p=0.02] and also within experimental group [p=0.00]. The prevailing study establishes a positive correlation between practicing yoga and betterment in aerodynamic capacities. The results declare that there was significant escalation in vital capacity, maximum phonation duration, phonation quotient and mean air flow rate for individuals who practice regular yoga when compared to people who don’t. The outcome of the present study is a preliminary step towards creating evidence base for the practice of yoga towards overall aerodynamic improvement in healthy adult

Somatic embryo mediated mass production of Catharanthus roseus in culture vessel (bioreactor) – A comparative study

AbstractThe purpose of this study was to evaluate and compare the use of liquid and solid Murashige and Skoog (MS) medium in different culture vessels for mass production of Catharanthus roseus, an important source of anticancerous compounds, vincristine and vinblastine. Three media conditions i.e. agar-solidified medium (S), liquid medium in agitated conical flask (L) and growtek bioreactor (B) were used. Rapid propagation was achieved through in vitro somatic embryogenesis pathway. The process of embryogenesis has been categorized into induction, proliferation, maturation and germination stages. All in vitro embryogenesis stages were conducted by withdrawing spent liquid medium and by adding fresh MS medium. In optimized 4.52μM 2,4-D added MS, the callus biomass growth was low in solid (1.65g) compared to liquid medium in agitated conical flask (1.95g) and in bioreactor (2.11g). The number of normal somatic embryos was more in solid medium (99.75/50mg of callus mass) compared to liquid medium used in conical flask (83.25/callus mass) and growtek bioreactor (84.88/callus mass). The in vitro raised embryos maturated in GA3 (2.60μM) added medium; and in bioreactor the embryo growth was high, a maximum length of 9.82mm was observed at the end of four weeks. These embryos germinated into seedlings in BAP (2.22μM) added medium and the embryo germination ability was more (59.41%) in bioreactor compared to liquid medium in conical flask (55.5%). Shoot length (11.25mm) was also high in bioreactor compared to agitated conical flask. The liquid medium used in agitated conical flask and bioreactor increased seedling production efficiency, at the same time it also reduced plant recovery time. The embryo generated plants grew normally in outdoor conditions. The exploitation of medium to large culture vessel or bioreactor may make the process more efficient in getting large number of Catharanthus plant as it is the only source of anti-cancerous alkaloids, vincristine and vinblastine

Effect of practicing Yoga on Aerodynamic measures of Voice

Yoga is a Sanskrit word which interprets to the meaning “the unity of body and mind”. It is a blend of breathing drills, physical stances, and contemplation, and has been practiced in eastern conventional medicine for more than thousands of years [1]. A modest effort was taken in this study to examine the effect of Long term yoga training on Aerodynamic measures and also to compare and contrast these measures between individuals who practice yoga and who don’t. A total of 120 phonation samples were obtained from participants who practice yoga and who don’t between the age ranges of 20-40 years. Samples assessing respiratory capacities were also taken from the above subjects. Statistical analysis showed a significant difference [p<0.05] between control group and experimental group for all parameters. Significant difference was also seen between genders [p<0.05]. Significant difference was seen in gender within control group [p=0.02] and also within experimental group [p=0.00]. The prevailing study establishes a positive correlation between practicing yoga and betterment in aerodynamic capacities. The results declare that there was significant escalation in vital capacity, maximum phonation duration, phonation quotient and mean air flow rate for individuals who practice regular yoga when compared to people who don’t. The outcome of the present study is a preliminary step towards creating evidence base for the practice of yoga towards overall aerodynamic improvement in healthy adult

Examining Foods and Beverages Served and Child Food Insecurity across Early Care and Education (ECE) Programs in Communities with High Rates of Obesity and Food Insecurity

The purpose of this study was to examine implementation of serving food and beverage evidence-based practices (nutrition EBPs) across CACFP participating licensed childcare centers (CCCs, n = 51) and family childcare homes (FCCHs, n = 49) in central California. Results indicated that FCCHs reported significantly higher (p \u3c .05) implementation of nutrition EBPs and barriers than CCCs. Both CCCs and FCCHs refer families to WIC/SNAP when they observe child food insecurity and control how much food is served to children. It is important to consider organizational structure (CCCs, FCCHs) and child food insecurity when developing policies/interventions for improving implementation of nutrition EBPs in ECEs

IL-12 and Related Cytokines: Function and Regulatory Implications in Candida albicans Infection

IL-12 is a cytokine with links to both innate and adaptive immunity systems. In mice, its deletion leads to acute susceptibility to oral infection with the yeast Candida albicans, whereas such mice are resistant to systemic disease. However, it is an essential component of the adaptive response that leads to the generation of Th1-type cytokine responses and protection against disseminated disease. This paper presents an overview of the role of IL-12 in models of systemic and mucosal infection and the possible relationships between them

Role of food preoccupation and current dieting in the associations of parental feeding practices to emotional eating in young adults: A moderated mediation study

Parental feeding practices reflecting coercive control are related to children’s later eating behaviors, but the mechanisms underlying these effects remain poorly understood. This study examined the relationships between recalled childhood experiences of parental pressure to eat and restriction and current food preoccupation, dieting, and emotional eating in a racially diverse sample of college students (N = 711). Results revealed that parental restriction, but not pressure to eat, was associated with more emotional eating (r = 0.18, p \u3c 0.0001). Food preoccupation mediated the association between restriction and emotional eating (95% CI [3.6495–7.2231]); however, a moderated mediation model revealed that the strength of the indirect effect of restrictive feeding on emotional eating through food preoccupation was significantly different for dieters and non-dieters (index of moderated mediation = 1.79, Boot SE = 0.79; 95% bias-corrected bootstrap CI [–3.5490 to –0.4515]). These findings provide unique insight into the mechanisms linking parental feeding practices with emotional eating in young adulthood. Future studies attempting to clarify the processes through which child feeding practices impact later eating behaviors should consider the role of current dieting