Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Curriculum: A Proposed Definitional Framework

Despite being one of the most important artifacts produced by higher education institutions, the curriculum is one of the least studied. This work-in-progress paper presents a proposed definitional framework for curriculum which if viable, should facilitate a common understanding of the elements, or component parts, from which a curriculum is constructed, and provide heuristic support to faculty as they design, develop, implement and maintain quality curricula. Furthermore, it is likely that a commonly understood and accepted definitional framework for curriculum will lead to meaningful discussion of and wise decisions about curriculu

How learners learn: A new microanalytic assessment method to map decision-making

<p><b>Background:</b> Microanalytic techniques have shown considerable potential as avenues for understanding learning in a range of learning contexts. If a microanalytic approach is to be tested for utility, a suitable learning context is required. We chose problem-based learning (PBL) tutorials as our context.</p> <p><b>Aims:</b> We sought to determine if a new microanalytic approach is suitable for investigating the learning decisions made by students during PBL and what this form of microanalysis reveals.</p> <p><b>Methods:</b> Stimulated recall interviews were used to question 17 first year graduate-entry medical students regarding the conscious decisions behind their actions during one PBL case. Responses were categorized and used to construct process maps to illustrate the students’ decision-making. These maps and the decisions within them were analyzed focusing on how learners learn.</p> <p><b>Results:</b> Stimulated recall interviewing (SRI) was conducted, during which students could articulate the conscious decisions they made during PBL. The data collected were used to construct 191 process maps and 802 categorized decisions for analysis. Students’ decisions became increasingly self-centered as the case progressed while maintaining an awareness of group dynamics.</p> <p><b>Conclusions:</b> The microanalytic approach employed in this study is a suitable tool for understanding the nature of learning in this, and other environments.</p

Medical Students’ Participation in Social Studying and Learning during COVID-19

COVID-19 transformed the medical school learning environment. How social studying and learning (SSL) may have changed was considered worthy of exploration. This study describes the effect of the learning environment transformation on how SSL is conducted by medical students and the reasoning behind any changes. A post-positivist stance was adopted with a mixed method convergent-parallel approach. An online survey explored the participation rate and nature of SSL and how these related to literature-identified underpinning factors that influence participation in SSL. A follow-up interview explored the survey responses. A total of 87 survey responses were collected. Following exclusion of incomplete responses, 57 responses were analysed, and nine follow-up interviews were conducted. Cross-tabulation and logistic regression were conducted to analyse the quantitative data and thematic analysis was conducted to analyse the qualitative data. No significant difference was observed in SSL participation rate during COVID-19. Students transitioned from in-person to Zoom meetings for sensibility, ease and convenience. Students continued participating in SSL for motivation and began participating for accountability, focus and replacement of lost social interaction. The same content was studied using a wider range of activities. Significant decreases were observed in students’ perception of the effect of a range of factors. The observed changes to SSL during online learning suggest that SSL is integral for many medical students and will be adapted as required. Given that medical school will always involve some periods of online learning, understanding of the nature of and driving factors behind how medical students engage in SSL during online learning may enable medical educators to support all aspects of student learning

Variation in personality traits of medical students between schools of medicine

Introduction: While there have been studies exploring the impact of personality on medical student selection and performance there has not been an investigation of the personality of students at different schools. Method: Demographic data and responses to the NEO measure of personality traits were collected from medical students in the first two weeks of their enrolment (2011) in seven medical schools in Australia. Personality traits were analysed by school features, gender and age using logistic regression. Results: Differences were detected between schools in the personality traits of Agreeableness and Conscientiousness. Higher Agreeableness and Conscientiousness were associated with attending an Undergraduate school (OR = 1.07 and 1.03, respectively) and a rural or community focussed school (1.06 and 1.03). Students attending a school that used interviews for selection had higher levels of Agreeableness (1.04) and lower levels of Neuroticism (0.96). Discussion: This is the first study to demonstrate that personality traits differ between students entering different medical schools. While there seems to be logic behind some differences, others are perplexing. Further research should expand on these findings and the implications to schools in regards to attracting students through selection processes, mission statements and their broader social focus

Hydraulic Shuttle Irradiation System (HSIS) Recently Installed in the Advanced Test Reactor (ATR)

2010 International Congress on Advances in Nuclear Power Plants (ICAPP’10) ANS Annual Meeting Imbedded Topical San Diego, CA June 13 – 17, 2010 Hydraulic Shuttle Irradiation System (HSIS) Recently Installed in the Advanced Test Reactor (ATR) Author: A. Joseph Palmer, Mechanical Engineer, Irradiation Test Programs, 208-526-8700, [email protected] Affiliation: Idaho National Laboratory P.O. Box 1625, MS-3840 Idaho Falls, ID 83415 INL/CON-10-17680 ABSTRACT Most test reactors are equipped with shuttle facilities (sometimes called rabbit tubes) whereby small capsules can be inserted into the reactor and retrieved during power operations. With the installation of Hydraulic Shuttle Irradiation System (HSIS) this capability has been restored to the Advanced Test Reactor (ATR) at Idaho National Laboratory (INL). The general design and operating principles of this system were patterned after the hydraulic rabbit at Oak Ridge National Laboratory’s (ORNL) High Flux Isotope Reactor (HFIR), which has operated successfully for many years. Using primary coolant as the motive medium the HSIS system is designed to simultaneously transport fourteen shuttle capsules, each 16 mm OD x 57 mm long, to and from the B-7 position of the reactor. The B-7 position is one of the higher flux positions in the reactor with typical thermal and fast (>1 Mev) fluxes of 2.8E+14 n/cm2/sec and 1.9E+14 n/cm2/sec respectively. The available space inside each shuttle is approximately 14 mm diameter x 50 mm long. The shuttle containers are made from titanium which was selected for its low neutron activation properties and durability. Shuttles can be irradiated for time periods ranging from a few minutes to several months. The Send and Receive Station (SRS) for the HSIS is located 2.5 m deep in the ATR canal which allows irradiated shuttles to be easily moved from the SRS to a wet loaded cask, or transport pig. The HSIS system first irradiated (empty) shuttles in September 2009 and has since completed a Readiness Assessment in November 2009. The HSIS is a key component of the ATR National Scientific User Facility (NSUF) operated by Battelle Energy Alliance, LLC and is available to a wide variety of university researchers for nuclear fuels and materials experiments as well as medical isotope research and production

Walking, swimming or hitching a ride? Phylogenetics and biogeography of the walking shark genus Hemiscyllium

It can be challenging to identify the forces that drive speciation in marine environments for organisms that are capable of widespread dispersal because their contemporary distributions often belie the historical processes that were responsible for their initial diversification. In this contribution we explore the likely sequence of events responsible for the radiation of walking sharks in the genus Hemiscyllium using a dated molecular phylogeny. The nine currently recognised species in the genus consist of small, benthic sharks that are restricted to the Indo-Australian Archipelago and show limited dispersal at both juvenile and adult stages. We discuss how major tectonic changes, sea level fluctuations and the unique biology of the species may have influenced speciation in the group, as well as the current distribution of the genus and each of its constituent species. Phylogeographic analysis of the genus combined with biogeographic reconstruction of the region shows a recent radiation during the Miocene and Pliocene, and supports a combination of vicariance and founder modes of speciation mediated by major tectonic, geological and oceanographic historical processes