Cognitive engagement in the problem-based learning classroom

The objective of the present study was to examine to what extent autonomy in problem-based learning (PBL) results in cognitive engagement with the topic at hand. To that end, a short self-report instrument was devised and validated. Moreover, it was examined how cognitive engagement develops as a function of the learning process and the extent to which cognitive engagement determines subsequent levels of cognitive engagement during a one-day PBL event. Data were analyzed by means of confirmatory factor analysis, repeated measures ANOVA, and path analysis. The results showed that the new measure of situational cognitive engagement is valid and reliable. Furthermore, the results revealed that students’ cognitive engagement significantly increased as a function of the learning event. Implications of these findings for PBL are discussed

The Achilles Heel of the Trojan Horse Model of HIV-1 trans-Infection

To ensure their survival, microbial pathogens have evolved diverse strategies to subvert host immune defenses. The human retrovirus HIV-1 has been proposed to hijack the natural endocytic function of dendritic cells (DCs) to infect interacting CD4 T cells in a process termed trans-infection. Although DCs can be directly infected by certain strains of HIV-1, productive infection of DCs is not required during trans-infection; instead, DCs capture and internalize infectious HIV-1 virions in vesicles for later transmission to CD4 T cells via vesicular exocytosis across the infectious synapse. This model of sequential endocytosis and exocytosis of intact HIV-1 virions has been dubbed the “Trojan horse” model of HIV-1 trans-infection. While this model gained rapid favor as a strong example of how a pathogen exploits the natural properties of its cellular host, our recent studies challenge this model by showing that the vast majority of virions transmitted in trans originate from the plasma membrane rather than from intracellular vesicles. This review traces the experimental lines of evidence that have contributed to what we view as the “rise and decline” of the Trojan horse model of HIV-1 trans-infection

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Media representation of vaccine side effects and its impact on utilization of vaccination services in Vietnam

Bach Xuan Tran,1–3 Victoria L Boggiano,4 Long Hoang Nguyen,5 Carl A Latkin,2 Huong Lan Thi Nguyen,6 Tung Thanh Tran,6 Huong Thi Le,1 Thuc Thi Minh Vu,7 Cyrus SH Ho,8 Roger CM Ho9 1Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; 2Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 3Vietnam Young Physicians Association, Hanoi, Vietnam; 4Berkeley School of Public Health, University of California, Berkeley, CA, USA; 5Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; 6Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam; 7Department of Immunology and Allergy, National Otolaryngology Hospital, Hanoi, Vietnam; 8Department of Psychological Medicine, National University Health System, Singapore; 9Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Background: Media representation of vaccine side effects impacts the success of immunization programs globally. Exposure to the media can cause individuals to feel hesitant toward, or even refuse, vaccines. This study aimed to explore the impact of the media on beliefs and behaviors regarding vaccines and vaccine side effects in an urban clinic in Vietnam.Methods: A cross-sectional study was conducted in an urban vaccination clinic in Hanoi, Vietnam from November 2015 to March 2016. The primary outcomes of this study were the decisions of Vietnamese subjects after hearing about adverse effects of immunizations (AEFIs) in the media. Socio-demographic characteristics as well as beliefs regarding vaccination were also investigated. Multivariate logistic regression was used to identify factors associated with subjects’ behaviors regarding vaccines.Results: Among 429 subjects, 68.2% of them said they would be hesitant about receiving vaccines after hearing about AEFIs, while 12.4% of subjects said they would refuse vaccines altogether after hearing about AEFIs. Wealthy individuals (OR=0.41; 95% CI=0.19–0.88), and those who displayed trust in government-distributed vaccines (OR=0.20; 95% CI=0.06–0.72) were less likely to display hesitancy regarding vaccination. Receiving information from community health workers (OR=0.44; 95% CI=0.20–0.99) and their relatives, colleagues, and friends (OR=0.47; 95% CI=0.25–0.88) was negatively associated with vaccine hesitancy, but facilitated vaccine refusal after reading about AEFIs in the media (OR=3.12; 95% CI=1.10–8.90 and OR=3.75; 95% CI=1.56–9.02, respectively).Conclusion: Our results reveal a significantly high rate of vaccine hesitancy and refusal among subjects living in an urban setting in Vietnam, after hearing about AEFIs in the media. Vietnam needs to develop accurate information systems in the media about immunizations, to foster increased trust between individuals, health care professionals, and the Vietnamese government. Keywords: vaccination, Vietnam, media, mass media, health literac

Which Foods May Be Addictive? The Roles of Processing, Fat Content, and Glycemic Load

http://deepblue.lib.umich.edu/bitstream/2027.42/109750/1/StudyOne_FoodListMeans.savhttp://deepblue.lib.umich.edu/bitstream/2027.42/109750/2/StudyOne_Demographics.savhttp://deepblue.lib.umich.edu/bitstream/2027.42/109750/3/StudyTwo_LevelOne.savhttp://deepblue.lib.umich.edu/bitstream/2027.42/109750/4/StudyTwo_LevelTwo.savDescription of StudyOne_FoodListMeans.sav : Dataset for calculating the food frequencies in Study One (Table 2)Description of StudyOne_Demographics.sav : Dataset for demographics in Study OneDescription of StudyTwo_LevelOne.sav : Dataset for HLM level one in Study TwoDescription of StudyTwo_LevelTwo.sav : Dataset for HLM level two in Study Tw