Dreyfus scale-based feedback increased medical students’ satisfaction with the complex cluster part of a interviewing and physical examination course and improved skills readiness in Taiwan

Purpose In contrast to the core part of the clinical interviewing and physical examination (PE) skills course, corresponding to the basic, head-to-toe, and thoracic systems, learners need structured feedback in the cluster part of the course, which includes the gastrointestinal, neuromuscular, and musculoskeletal systems. This study evaluated the effects of using Dreyfus scale-based feedback, which has elements of continuous professional development, instead of Likert scale-based feedback in the cluster part of training in Taiwan. Methods Instructors and final-year medical students in the 2015–2016 classes of National Yang-Ming University, Taiwan comprised the regular cohort, whereas those in the 2017–2018 classes formed the intervention cohort. In the intervention cohort, Dreyfus scale-based feedback, rather than Likert scale-based feedback, was used in the cluster part of the course. Results In the cluster part of the course in the regular cohort, pre-trained standardized patients rated the class climate as poor, and students expressed low satisfaction with the instructors and course and low self-assessed readiness. In comparison with the regular cohort, improved end-of-course group objective structured clinical examination scores after the cluster part were noted in the intervention cohort. In other words, the implementation of Dreyfus scale-based feedback in the intervention cohort for the cluster part improved the deficit in this section of the course. Conclusion The implementation of Dreyfus scale-based feedback helped instructors to create a good class climate in the cluster part of the clinical interviewing and PE skills course. Simultaneously, this new intervention achieved the goal of promoting medical students’ readiness for interviewing, PE, and self-directed learning

Study of Chlorophyll-related Compounds from Dietary Spinach in Human Blood

Human bioavailability data on chlorophyll (Chl) is very limited. The distribution of Chl-related compounds (CRCs) derived from dietary spinach was investigated in human blood. Eight healthy adults, aged from 21 to 61 year-old, consumed 1.2 kg of just-boiled fresh spinach after an 8-h overnight fast. Before and then 3 h after consuming the spinach, blood samples were taken from each participant. Freeze-dried blood samples were prepared, and 80% acetone was added for grinding. Eight peaks were found in the blood using high-performance liquid chromatography (HPLC), and the main CRCs in the samples were pheophytin (Phe) and pheophorbide (Pho) derivates. Compared to a fasted state, markedly higher levels of blood CRCs were detected in all subjects, except that Pho metabolites were not found in two subjects. No significant differences were seen in most of the peaks between males and females; however, relatively higher CRCs levels were observed in females, particular of Pho derivates. In addition, the blood contained significantly higher levels of Phe in the 36~61-year-old group than in the 21~35-year-old group. These results suggest that the conversion of Chls to CRCs is a rapid process, and Chls obtained by ingestion can be absorbed by the human body

Effects of virtual reality training on decreasing the rates of needlestick or sharp injury in new-coming medical and nursing interns in Taiwan

Purpose Senior nursing and medical interns’ lack of familiarity and confidence with respect to practicing universal precaution for the prevention of occupational needlestick or sharp injuries may harm themselves. Trainees’ self-reported needlestick or sharp injury rate was known to be especially high during the first 2 months of internship in Taiwan. This prospective cohort study aimed to assess the effect of newly developed virtual reality (VR) game, which uses Gagne’s learning model to improve universal precaution for needlestick or sharp injury prevention and decrease the rates of needle stick or sharp injuries in new-coming medical and nursing interns in Taiwan. Methods From 2017 to 2019, the VR system was developed and applied in training of 59 new-coming nursing and 50 medical interns. Occupational needlestick or sharp injury prevention was sought to be achieved through a game of right and wrong choices for safe or unsafe universal precaution behaviors. Results In comparison with medical interns, a higher proportion of nursing interns had past experiences of deep occupational needlestick or sharp injury. Before VR training, the familiarity and confidence for needlestick or sharp injury prevention were higher among nursing interns than medical interns. Trainees with past experiences of deep needlestick or sharp injury exhibited better performance on the accuracy rate and time needed to complete 20 decisions than those without past experiences in VR practice. All trainees showed an improved performance after VR training. A high proportion of trainees reported that the VR-based training significantly decreased their anxiety about needlestick or sharp injury prevention. Conclusion This self-developed VR game system using Gagne’s flow improved universal precaution for needlestick or sharp injury prevention and reduced the needlestick or sharp injury rates in the first 2 months of nursing and medical internship

Assimilation of GPS Refractivity from FORMOSAT-3/COSMIC Using a Nonlocal Operator with WRF 3DVAR and Its Impact on the Prediction of a Typhoon Event

A nonlocal observation operator has been developed to assimilate GPS radio occultation (RO) refractivity with WRF 3DVAR. For simplicity, in the past GPS RO refractivity was often assimilated using a local observation operator with the assumption that the GPS RO observation was representative of amodel local point. Such an operator did not take into account the effects of horizontal inhomogeneity on the derived GPS RO refractivity. In order to more accurately model the observables, Sokolovskiy et al. (2005a) developed a nonlocal observation operator, which would take into account the effects of horizontal inhomogeneity on GPS RO measurements. This nonlocal observation operator calculates the integrated amount of the model refractivity along the ray paths centered at the perigee points. For comparative purposes, the nonlocal observation operator can be simplified by limiting the length of integration near the RO point. This is called the "local operator variant", which is equivalent to the original local operator except that the original one is performed with fixed tangent points at observation levels. For computational efficiency, assimilation using both the nonlocal operator and local operator variant now is performed with smear tangent points at the mean height of each model vertical level. In this study, the statistics of observation errors using both local and nonlocal operators were estimated based on WRF simulations. The observation errors produced by the nonlocal operator are about two times smaller than those generated by the local operator and in agreement with Sokolovskiy et al. (2005b)

Negative effects on medical students’ scores for clinical performance during the COVID-19 pandemic in Taiwan: a comparative study

Purpose Coronavirus disease 2019 (COVID-19) has heavily impacted medical clinical education in Taiwan. Medical curricula have been altered to minimize exposure and limit transmission. This study investigated the effect of COVID-19 on Taiwanese medical students’ clinical performance using online standardized evaluation systems and explored the factors influencing medical education during the pandemic. Methods Medical students were scored from 0 to 100 based on their clinical performance from 1/1/2018 to 6/31/2021. The students were placed into pre-COVID-19 (before 2/1/2020) and midst-COVID-19 (on and after 2/1/2020) groups. Each group was further categorized into COVID-19-affected specialties (pulmonary, infectious, and emergency medicine) and other specialties. Generalized estimating equations (GEEs) were used to compare and examine the effects of relevant variables on student performance. Results In total, 16,944 clinical scores were obtained for COVID-19-affected specialties and other specialties. For the COVID-19-affected specialties, the midst-COVID-19 score (88.51–3.52) was significantly lower than the pre-COVID-19 score (90.14–3.55) (P<0.0001). For the other specialties, the midst-COVID-19 score (88.32–3.68) was also significantly lower than the pre-COVID-19 score (90.06–3.58) (P<0.0001). There were 1,322 students (837 males and 485 females). Male students had significantly lower scores than female students (89.33–3.68 vs. 89.99–3.66, P=0.0017). GEE analysis revealed that the COVID-19 pandemic (unstandardized beta coefficient=-1.99, standard error [SE]=0.13, P<0.0001), COVID-19-affected specialties (B=0.26, SE=0.11, P=0.0184), female students (B=1.10, SE=0.20, P<0.0001), and female attending physicians (B=-0.19, SE=0.08, P=0.0145) were independently associated with students’ scores. Conclusion COVID-19 negatively impacted medical students' clinical performance, regardless of their specialty. Female students outperformed male students, irrespective of the pandemic

Down-regulation of PKCζ in renal cell carcinoma and its clinicopathological implications

<p>Abstract</p> <p>Background</p> <p>Metastatic renal cell carcinoma (RCC) is highly resistant to systemic chemotherapy. Unfortunately, nearly all patients die of the metastatic and chemoresistant RCC. Recent studies have shown the atypical PKCζ is an important regulator of tumorigenesis. However, the correlation between PKC<b>ζ </b>expression and the clinical outcome in RCC patients is unclear. We examined the level of PKCζ expression in human RCC.</p> <p>Methods</p> <p>PKCζ mRNA and protein expressions were examined by real-time polymerase chain reaction (PCR) and immunohistochemistry (IHC) respectively in RCC tissues of 144 patients. Cellular cytotoxicity and proliferation were assessed by MTT.</p> <p>Results</p> <p>PKCζ expression was significantly higher in normal than in cancerous tissues (<it>P </it>< 0.0001) by real-time PCR and IHC. Similarly, PKCζ expression was down-regulated in four renal cancer cell lines compared to immortalized benign renal tubular cells. Interestingly, an increase of PKCζ expression was associated with the elevated tumor grade (<it>P </it>= 0.04), but no such association was found in TNM stage (<it>P </it>= 0.13). Tumors with higher PKCζ expression were associated with tumor size (<it>P </it>= 0.048). Expression of higher PKCζ found a poor survival in patients with high tumor grade. Down-regulation of PKCζ showed the significant chemoresistance in RCC cell lines. Inactivation of PKCζ expression enhanced cellular resistance to cisplatin and paclitaxel, and proliferation in HK-2 cells by specific PKC<b>ζ </b>siRNA and inhibitor.</p> <p>Conclusions</p> <p>PKCζ expression was associated with tumorigenesis and chemoresistance in RCC.</p

The first discovery of amber resin in Lichi Mélange, Eastern Taiwan

Amber is fossilized tree resin produced by the metabolism of vascular plants that has experienced various geological processes, including burial, compression, and heating. Therefore, most of the previously reported amber pieces were unearthed from sedimentary rocks. The record of amber in tectonic active regions, e.g., Taiwan, is extremely poor and has not been scientifically certified, leading to a poor understanding of the history of prehistoric flora in this region. This study reports a 1-cm yellow-brown amorphous resin interspersed in sandstone blocks in the Lichi Mélange at the southernmost tip of the Coastal Range in eastern Taiwan, representing the first official record of amber from the mélange unit and as well as in Taiwan. The results, in addition to the affirmation of the amber, show that the amber is composed of sesquiterpenes and triterpenoids, indicating a possible origin of dipterocarp trees that are absent in the paleobotanic record and modern flora in Taiwan. Furthermore, infrared spectra analysis shows its compositional similarity to the amber from Sumatra, Indonesia, which boasts modern dipterocarp forests. Petrographic analysis of the surrounding sandstone suggests that the amber was deposited into the continental margin and allocated to Taiwan through the arc-continental collision in ∼6–7 Ma. In summary, this study represents the first report of amber unearthed in the mélange unit and Taiwan. It shows that amber is a durable and reliable information carrier in accordance with biogeographic and tectonic evidence

Meta-Analysis of TNF 308 G/A Polymorphism and Type 2 Diabetes Mellitus

BACKGROUND AND OBJECTIVES: Many investigations have focused the association between TNF 308 G/A polymorphism and risk for type 2 diabetes mellitus (T2DM). However, the sample sizes of most of the studies were small. The aim of this study is to evaluate the precise association between this variant and risk for T2DM in a large-scale meta-analysis. METHODS: All publications were searched on the association between TNF 308 G/A polymorphism and T2DM. The key words were as follows: diabetes, tumor necrosis factor and polymorphism/variant/genotype. This meta-analysis was assessed by Review manager 5.0. RESULTS: There were 18 studies identified. The odds ratios (ORs) and 95% confidence intervals (CI) for GA+AA versus GG genotype of TNF 308 G/A polymorphism were 1.03 (0.95-1.12), 1.03 (0.94-1.13) and 1.03 (0.78-1.36) in overall, Caucasian and Asian populations, respectively. The sensitivity analysis further strengthened the validity of this association. No publication bias or heterogeneity was observed in this study. CONCLUSION: In summary, there was no significant association detected between the TNF 308 G/A polymorphism and risk for T2DM

Dreyfus scale-based feedback increased medical students’ satisfaction with the complex cluster part of a interviewing and physical examination course and improved skills readiness in Taiwan

This study evaluated the effects of using Dreyfus scale-based feedback, which has elements of continuous professional development, instead of Likert scale-based feedback in the cluster part of training in Taiwan. Instructors and final-year medical students in the 2015–2016 classes of National Yang-Ming University, Taiwan comprised the regular cohort, whereas those in the 2017–2018 classes formed the intervention cohort. In the intervention cohort, Dreyfus scale-based feedback, rather than Likert scale-based feedback, was used in the cluster part of the course