Les simulations préparatoires aux consultations prénatales

Background: Rehearsal simulations are patient-specific case-matched tasks performed immediately prior to the actual task, with the objective of improving performance. Objective: How does rehearsal simulation for antenatal consults impact how residents learn to engage in difficult conversations with families? Study Design: Residents in the NICU performed case-matched video recorded rehearsal simulations, followed by actual antenatal consults. The purpose of antenatal consults is to prepare parents expecting a complication with their baby before birth. Questionnaires assessed changes in resident confidence and self-assessment of communication skills. Residents were interviewed for qualitative data to explore the overall impact of rehearsal simulation on their learning and performance. Results: Thirteen residents participated. Rehearsal simulation improved confidence with a more organized approach of medical content and better communication techniques, allowing for a shift of focus from a checklist approach to building rapport and displaying empathy. Conclusions: While rehearsal simulation did not prepare residents for unexpected parent responses, trainees’ increased confidence with medical content organization and communication techniques created space for reflection-in-action and compassionate approaches.Contexte : Les simulations préparatoires correspondent à des cas spécifiques de patients et elles sont effectuées immédiatement avant l’intervention réelle, dans le but d’améliorer la performance. Objectif : Comment la simulation préparatoire pratiquée avant une consultation prénatale influence-t-elle la manière dont les résidents apprennent à engager une conversation difficile avec les familles? Méthodes : Les résidents de l’unité de soins intensifs néonatals ont effectué des simulations préparatoires adaptées à la situation clinique à venir, qui ont été filmées. Ils ont par la suite effectué les consultations prénatales réelles. L’objet des consultations prénatales est de préparer les parents lorsque des complications sont anticipées, et ce  avant la naissance de leur bébé. Nous avons évalué les changements au niveau de la confiance des résidents et l’autoévaluation par ces derniers de leurs compétences en communication par le biais de questionnaires. Les résidents ont participé à une entrevue, qui a fourni les données qualitatives afin d’explorer l’impact global de la simulation sur leur apprentissage et leur performance. Résultats : Treize résidents ont participé à l’étude. La simulation préparatoire a rehaussé leur confiance en eux, car elle les a aidés à adopter une approche plus organisée du contenu médical et de meilleures techniques de communication, permettant de passer d’une approche par  « cases à cocher » à une approche basée sur l’établissement d’un lien avec les parents et à la manifestation d’empathie. Conclusions : Bien que la simulation préparatoire n’ait pas préparé les résidents aux réactions inattendues des parents, la confiance accrue des stagiaires en leur capacité à organiser le contenu médical et en leurs techniques de communication a laissé place à la réflexion dans l’action et aux approches compatissantes

Human cortical perfusion and the arterial pulse: a near-infrared spectroscopy study

BACKGROUND: The pulsatile nature of the arterial pulse induces a pulsatile perfusion pattern which can be observed in human cerebral cortex with non-invasive near-infrared spectroscopy. The present study attempts to establish a quantitative relation between these two events, even in situations of very weak signal-to-noise ratio in the cortical perfusion signal. The arterial pulse pattern was extracted from the left middle finger by means of plethesmographic techniques. Changes in cortical perfusion were detected with a continuous-wave reflectance spectrophotometer on the scalp overlying the left prefrontal cortex. Cross-correlation analysis was performed to provide evidence for a causal relation between the arterial pulse and relative changes in cortical total hemoglobin. In addition, the determination of the statistical significance of this relation was established by the use of phase-randomized surrogates. RESULTS: The results showed statistically significant cross correlation between the arterial and perfusion signals. CONCLUSIONS: The approach designed in the present study can be utilized for a quantitative and continuous assessment of the perfusion states of the cerebral cortex in experimental and clinical settings even in situations of extremely low signal-to-noise ratio

Limiting the Persistence of a Chromosome Break Diminishes Its Mutagenic Potential

To characterize the repair pathways of chromosome double-strand breaks (DSBs), one approach involves monitoring the repair of site-specific DSBs generated by rare-cutting endonucleases, such as I-SceI. Using this method, we first describe the roles of Ercc1, Msh2, Nbs1, Xrcc4, and Brca1 in a set of distinct repair events. Subsequently, we considered that the outcome of such assays could be influenced by the persistent nature of I-SceI-induced DSBs, in that end-joining (EJ) products that restore the I-SceI site are prone to repeated cutting. To address this aspect of repair, we modified I-SceI-induced DSBs by co-expressing I-SceI with a non-processive 3′ exonuclease, Trex2, which we predicted would cause partial degradation of I-SceI 3′ overhangs. We find that Trex2 expression facilitates the formation of I-SceI-resistant EJ products, which reduces the potential for repeated cutting by I-SceI and, hence, limits the persistence of I-SceI-induced DSBs. Using this approach, we find that Trex2 expression causes a significant reduction in the frequency of repair pathways that result in substantial deletion mutations: EJ between distal ends of two tandem DSBs, single-strand annealing, and alternative-NHEJ. In contrast, Trex2 expression does not inhibit homology-directed repair. These results indicate that limiting the persistence of a DSB causes a reduction in the frequency of repair pathways that lead to significant genetic loss. Furthermore, we find that individual genetic factors play distinct roles during repair of non-cohesive DSB ends that are generated via co-expression of I-SceI with Trex2

Total quality index of commercial oyster mushroom Pleurotus sapidus in modified atmosphere packaging

Purpose The purpose of this paper is to identify the strain of oyster mushroom (OM) Pleurotus sapidus cultivated in a local (commercial) farm, and to generate a total quality index (TQI) on the strain using different modified atmosphere packaging (MAP) gas mixtures. Design/methodology/approach A phylogenetic tree was constructed using the MEGA software to identify the specific strain of P. sapidus grown in a local farm. The effects of MAP on fresh fruiting bodies of the identified strain were determined under three conditions: high carbon dioxide packaging (HCP: 20 per cent CO2, 15 per cent O-2), low carbon dioxide packaging (LCP: 2 per cent CO2, 30 per cent O-2) and high nitrogen packaging (HNP: 85 per cent N-2, 15 per cent O-2). All samples were stored at 4 C-o for up to ten days, and subjected to total phenolic content (TPC), colour retention (CR) and sensory analysis. Quality parameters such as chewiness and odour were used to obtain the TQI. Findings From the phylogenetic analysis, a new strain (P. sapidus strain QDR) with 99 per cent similarity to P. sapidus was identified. Among the three MAP treatments, HCP recorded the highest TPC (2.85 mg GAE/g) and CR (60.36) after ten days, although only its CR was significantly different (p lt 0.05) from the control. Feedback from 30 sensory panellists indicated that both HCP and LCP were generally more effective in retaining the colour-odour of OM. The optimum TQI for HCP was obtained based on the observed parameters, which is useful for the large-scale packaging of OM. Originality/value Scientific evidence has revealed that packaging trend for commercially grown OM affects consumer's acceptance

A New Model for Increasing Information Access and Literacy in the Global South

Rapid advances in technology infrastructure and increasing access to constant connectivity are paving the way for more innovative methods to support knowledge sharing in Global South countries. We present a model for knowledge sharing that is open, interactive, draws on diverse expertise and experience, and builds a searchable information repository that can be used by multiple communities and organizations. In addition, we envision that this model can be an effective and low-cost stepping stone to improved information literacy across the developing world.ye