The use of reflective practice to promote pharmacy students’ metacognition in a foundation anatomy course

Students’ ability to characterise their learning approaches has the potential to enhance their overall educational experience and guide educators to tailor their pedagogical approaches. The aim here, through students’ reflective practice, is to promote their metacognition. Also, to gain insights to pharmacy students’ initial approaches to studying anatomy and their perceived value of anatomy as a subject. The study also aimed to contextually capture students’ perceptions on their transition from secondary to tertiary education. This cross-sectional study entailed the use of reflective practice to promote metacognition in first year pharmacy students (Bachelors of Pharmacy students (n = 67)), at the University of Namibia’s School of Pharmacy. Results of this study indicate the initial learning approaches of most students to be haphazard. Students used varied, non-departmental resources to guide their learning whilst a few followed structured learning approaches. Results further indicate that students’ gradual transition and evolving metacognition appear to start during the initial few months of tertiary education. This transition appears to include feelings of apprehension, uncertainty and distress. Reflective practice creates awareness amongst students of possible gaps in their learning approaches and promote the value of anatomy as an  undergraduate subject. Data suggests that the formal incorporation of reflective practice as a metacognitive learning activity promotes students’metacognition by elucidating possible gaps in their learning approaches.Keywords: Learning approaches, anatomy, pharmacy students, reflective practice, metacognitio

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Гриби роду Lycoperdon Pers. на території Лівобережної України. I. Видова різноманітність і морфологічні комплекси

Обсуждается история развития концепции рода Lycoperdon и его изучения в мире и в Украине. На основе анализа образцов, собранных автором, а также гербарных материалов и данных предыдущих исследователей составлен список видов рода Lycoperdon Левобережной Украины, насчитывающий 18 видов и 4 разновидности. L. lambinonii впервые приводится для Украины, а L. atropurpureum, L. ericaeum, L. mammiforme, L. nigrescens — для Левобережной Украины. Внесены изменения во внутриродовую систему рода Lycoperdon, построенную на морфологических признаках

Retracted: The use of reflective practice to promote pharmacy students’ metacognition in a foundation anatomy course

This article has been retracted.Students’ ability to characterise their learning approaches has the potential to enhance their overall educational experience and guides educators to tailor their pedagogical approaches. The aim here, through students’ reflective practice, is to promote their metacognition. Also, to gain insights to pharmacy students’ initial approaches to studying anatomy and their perceived value of anatomy as a subject. The study also aimed to contextually capture students’ perceptions on their transition from secondary to tertiary education. This cross-sectional study entailed the use of reflective practice to promote metacognition in first year pharmacy students (Bachelors of Pharmacy students (n = 67)), at the University of Namibia’s School of Pharmacy. Results of this study indicate the initial learning approaches of most students to be haphazard. Students used varied, non-departmental resources to guide their learning whilst a few followed structured learning approaches. Results further indicate that students’ gradual transition and evolving metacognition appear to start during the initial few months of tertiary education. This transition appears to include feelings of apprehension, uncertainty and distress. Reflective practice appears creates awareness amongst students of possible gaps in their learning approaches and promote the value of anatomy as an undergraduate subject. Data suggests that the formal incorporation of reflective practice as a metacognitive learning activity promotes students’ metacognition by elucidating possible gaps in their learning approaches.Keywords: Learning approaches, anatomy, pharmacy students, reflective practice, metacognitio

Cell-Free Circulating Mitochondrial DNA: A Potential Blood-Based Marker for Atrial Fibrillation

Atrial fibrillation (AF), the most common, progressive tachyarrhythmia is associated with serious complications, such as stroke and heart failure. Early recognition of AF, essential to prevent disease progression and therapy failure, is hampered by the lack of accurate diagnostic serum biomarkers to identify the AF stage. As we previously showed mitochondrial dysfunction to drive experimental and human AF, we evaluated whether cell-free circulating

Reducing postoperative fasting times by implementing a food service in the Post Anaesthesia Care Unit (PACU)

Background & aims: Early oral postoperative nutrition is a proven beneficial element of postoperative care, resulting in improvement in quality of life and a shorter hospital stay. Guidelines state that postoperative oral nutrition can safely be started within the first hours after surgery. However, oral nutrition is mainly investigated starting from postoperative day one (POD1). This pragmatic study assessed whether a food service in the Post Anaesthesia Care Unit (PACU) may reduce postoperative fasting times on postoperative day zero (POD0) early after surgery on this high care unit. The primary outcome was postoperative fasting time in the PACU. Secondary outcomes were postoperative patient experiences and nutritional tolerance. Methods: This pragmatic prospective before-after study, included adult patients with a planned overnight stay in the PACU, and without anticipated postoperative dietary restrictions. A food service was developed, allowing re-uptake of oral nutrition early after surgery, already at POD0. Postoperative fasting time in the PACU was defined as the duration of time between the moment of arrival at the PACU, until first postoperative intake or until 9 a.m. on POD1, when most patients were discharged to the surgical ward. Secondary outcomes such as postoperative patient experiences and nutritional tolerance were scored on POD0 at 8 p.m. and on POD1 at 8 a.m. Results: A total of 235 patients were included, 119 in the pre-implementation (control) and 116 in the post-implementation (intervention) group. Mean postoperative fasting time was reduced by a mean of 6.0 h (95% CI 4.8–7.4, p-value ≤ .001), from 17.5 h in controls to 11.5 h in the intervention group. In the intervention group, 45% of patients had nutritional intake on POD0 (8 p.m.), increasing to 80% of patients on POD1 (8 a.m.), compared to no intake at both time-points in the control group. In the intervention group, average patient satisfaction increased over time. Flatus frequency was higher in the intervention group on POD1 (45% vs. 22%, p-value ≤ .001), while postoperative nausea and/or vomiting, and usage of anti-emetic medication were not different between groups. Conclusions: In a heterogeneous group of adult post-surgical patients with a planned overnight stay in the PACU, implementation of a food service resulted in a significant and clinically relevant reduction of postoperative fasting time, and increased patient satisfaction without compromising nutritional tolerance. Registered at www.isrctn.org with study ID ISRCTN17976930

Basin-Scale Observations of Monoterpenes in the Arctic and Atlantic Oceans

We report novel in situ speciated observations of monoterpenes (α- and β-pinene, myrcene, δ3-carene, ocimene, limonene) in seawater and air during three cruises in the Arctic and Atlantic Oceans, in/over generally oligotrophic waters. Oceanic concentrations of the individual monoterpenes ranged from below the detection limit of <1 pmol L -1 to 5 pmol L -1, with average concentrations of between 0.5 and 2.9 pmol L -1. After careful filtering for contamination, atmospheric mixing ratios varied from below the detection limit (<1 pptv) to 5 pptv, with averages of 0.05-5 pptv; these levels are up to 2 orders of magnitude lower than those reported previously. This could be at least partly due to sampling over waters with much lower biological activity than in previous studies. Unlike in previous studies, no clear relationships of the monoterpenes with biological variables were found. Based on our measured seawater concentrations and a global model simulation, we estimate total global marine monoterpene emissions of 0.16 Tg C yr -1, similar to a previous bottom-up estimate based on laboratory monoculture studies but 2 orders of magnitude lower than a previous top-down estimate of 29.5 Tg C yr -1