Suturing Workshop for Third-Year Medical Students: A Modern Educational Approach

Background: This study sought to determine if developing suturing workshops based on modern educational theory would lead to a significant increase in third-year medical students’ confidence and preparedness as compared to before the workshop. Methods: A group of pre-clinical, third-year medical students (n = 20) were voluntarily recruited. The workshop consisted of an interactive didactic session, a hands-on suturing session, and a question-answer session with surgeons. The nine-point Likert scale surveys were given pre-and post-workshop to 17 participants. Total scores of “confidence” and “preparedness” were analyzed using the Student t-test. Results of Q-Q plot and normality tests were used to validate the normality assumption. All analysis was conducted using SAS Software 9.4 (Cary, North Carolina). Results: A statistically significant increase in both confidence and preparedness was found between results of pre- and post-workshop surveys. Average total scores in confidence increased by 19.7 points, from 19.3 to 39 (95% CI: 15.0-24.4; P value \u3c 0.001). For scores in preparedness, the total score increased by an average of 18.4 points, from 22.8 to 41.2 (95% CI: 14.1-22.8; P value \u3c 0.001). Conclusions: These findings suggest that a structured course based on modern educational theory can increase both the confidence and preparedness of third-year medical students who are matriculating into their hospitalbased clerkships

Assessing the applicability of the Revised Universal Soil Loss Equation (RUSLE) to Irish Catchments

Elevated suspended sediment concentrations in fluvial environments have important implications for system ecology and even small concentrations may have serious consequences for sensitive ecosystems or organisms, such as freshwater pearl mussels (<i>Margaritifera margaritifera</i>). Informed decision making is therefore required for land managers to understand and control soil erosion and sediment delivery to the river network. However, given that monitoring of sediment fluxes requires financial and human resources which are often limited at a national scale, sediment mobilisation and delivery models are commonly used for sediment yield estimation and management. The Revised Universal Soil Loss Equation (RUSLE) is the most widely used model for overland flow erosion and can, when combined with a sediment delivery ratio (SDR), provide reasonable sediment load estimations for a catchment. This paper presents RUSLE factors established from extant GIS and rainfall datasets that are incorporated into a flexible catchment modelling approach. We believe that this is the first time that results from a RUSLE application at a national scale are tested against measured sediment yield values available from Ireland. An initial assessment of RUSLE applied to Irish conditions indicates an overestimation of modelled sediment yield values for most of the selected catchments. Improved methods for model and SDR factors estimation are needed to account for Irish conditions and catchment characteristics. Nonetheless, validation and testing of the model in this study using observed values is an important step towards more effective sediment yield modelling tools for nationwide applications

The food choice at work study: effectiveness of complex workplace dietary interventions on dietary behaviours and diet-related disease risk - study protocol for a clustered controlled trial

Background: Dietary behaviour interventions have the potential to reduce diet-related disease. Ample opportunity exists to implement these interventions in the workplace. The overall aim is to assess the effectiveness and cost-effectiveness of complex dietary interventions focused on environmental dietary modification alone or in combination with nutrition education in large manufacturing workplace settings. Methods/design: A clustered controlled trial involving four large multinational manufacturing workplaces in Cork will be conducted. The complex intervention design has been developed using the Medical Research Council's framework and the National Institute for Health and Clinical Excellence (NICE) guidelines and will be reported using the TREND statement for the transparent reporting of evaluations with non-randomized designs. It will draw on a soft paternalistic 'nudge' theoretical perspective. It will draw on a soft paternalistic "nudge" theoretical perspective. Nutrition education will include three elements: group presentations, individual nutrition consultations and detailed nutrition information. Environmental dietary modification will consist of five elements: (a) restriction of fat, saturated fat, sugar and salt, (b) increase in fibre, fruit and vegetables, (c) price discounts for whole fresh fruit, (d) strategic positioning of healthier alternatives and (e) portion size control. No intervention will be offered in workplace A (control). Workplace B will receive nutrition education. Workplace C will receive nutrition education and environmental dietary modification. Workplace D will receive environmental dietary modification alone. A total of 448 participants aged 18 to 64 years will be selected randomly. All permanent, full-time employees, purchasing at least one main meal in the workplace daily, will be eligible. Changes in dietary behaviours, nutrition knowledge, health status with measurements obtained at baseline and at intervals of 3 to 4 months, 7 to 9 months and 13 to 16 months will be recorded. A process evaluation and cost-effectiveness economic evaluation will be undertaken. Discussion: A 'Food Choice at Work' toolbox (concise teaching kit to replicate the intervention) will be developed to inform and guide future researchers, workplace stakeholders, policy makers and the food industry. Trial registration: Current Controlled Trials, ISRCTN35108237

A study of the norcaradiene-cycloheptatriene equilibrium in a series of azulenones by NMR spectroscopy; the impact of substitution on the position of equilibrium

A systematic investigation of the influence of substitution at positions C-2 and C-3 on the azulenone skeleton, based on NMR characterisation, is discussed with particular focus on the impact of the steric and electronic characteristics of substituents on the position of the norcaradiene-cycloheptatriene (NCD-CHT) equilibrium. Variable temperature (VT) NMR studies, undertaken to enable the resolution of signals for the equilibrating valence tautomers revealed, in addition, interesting shifts in the equilibrium

Reaching consensus on definitions for food and physical activity policies: experience from the Policy Evaluation Network

Background - An upsurge in policy evaluation research within public health sciences has led to multi-disciplinary research networks like the ‘Policy Evaluation Network’ (PEN). This multi-disciplinary collaboration highlighted the need for consensus on clear, common terminology and definitions to facilitate the multi-disciplinary research. This article outlines the development process of the PEN definitions glossary tool, with a focus on the key domains of policy design, implementation and outcomes as they apply to physical activity, sedentary behaviour and dietary behaviours. Methods - A project specific participatory process was undertaken, involving PEN researchers (n = 48) from seven European countries across various disciplinary backgrounds. All involved researchers were invited to identify and collate definitions that were commonly used in their research field. Terms and definitions were discussed and debated during three online workshops. Subsequently, the definitions were discussed and refined until consensus was reached. Results - Consensus definitions for 93 terms related to the evaluation of policy design, implementation and outcomes are provided. Consensus was reached on a range of terms where the terms were understood and used differently across represented disciplines (e.g. ‘Outcome’ and ‘Impact’). A conceptual ‘Inter-relations in policy-related concepts’ diagram was developed to enable navigation through an online database with key terms. Conclusions -The definitions resulting from this participatory process has supported PEN researchers and practitioners across disciplines to reach a shared understanding of different terms related to policy evaluation. Thus, providing a platform for avoiding conflicting use of the same terms in differing contexts over the course of the PEN work programme, facilitating clear and consistent communication, and allowing for clarity within collaborative multi-disciplinary projects and in public-facing messages

Selecting the touched vertebra as the lowest instrumented vertebra in patients with Lenke type-1 and 2 curves: Radiographic results after a minimum 5-year follow-up

BACKGROUND: The selection of the lowest instrumented vertebra (LIV) in patients with adolescent idiopathic scoliosis (AIS) is still controversial. Although multiple radiographic methods have been proposed, there is no universally accepted guideline for appropriate selection of the LIV. We developed a simple and reproducible method for selection of the LIV in patients with Lenke type-1 (main thoracic) and 2 (double thoracic) curves and investigated its effectiveness in producing optimal positioning of the LIV at 5 years of follow-up. METHODS: The radiographs for 299 patients with Lenke type-1 or 2 AIS curves that were included in a multicenter database were evaluated after a minimum duration of follow-up of 5 years. The touched vertebra (TV) was selected on preoperative radiographs by 2 independent examiners. The LIV on postoperative radiographs was compared with the preoperative TV. The final LIV position in relation to the center sacral vertical line (CSVL) was assessed. The CSVL-LIV distance and coronal balance in patients who had fusion to the TV were compared with those in patients who had fusion cephalad and caudad to the TV. The sagittal plane was also reviewed. RESULTS: In 86.6% of patients, the LIV was selected at or immediately adjacent to the TV. Among patients with an A lumbar modifier, those who had fusion cephalad to the TV had a significantly greater CSVL-LIV distance than those who had fusion to the TV (p = 0.006) or caudad to the TV (p = 0.002). In the groups with B (p = 0.424) and C (p = 0.326) lumbar modifiers, there were no differences among the TV groups. CONCLUSIONS: We recommend the TV rule as a third modifier in the Lenke AIS classification system. Selecting the TV as the LIV in patients with Lenke type-1 and 2 curves provides acceptable positioning of the LIV at long-term follow-up. The position of the LIV was not different when fusion was performed caudad to the TV but came at the expense of fewer motion segments. Patients with lumbar modifier A who had fusion cephalad to the TV had greater translation of the LIV, putting these patients at risk for poor long-term outcomes. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence

The effect of complex workplace dietary interventions on employees' dietary intakes, nutrition knowledge and health status: a cluster controlled trial

Background: Evidence on effective workplace dietary interventions is limited. The comparative effectiveness of a workplace environmental dietary modification and an educational intervention both alone and in combination was assessed versus a control workplace on employees' dietary intakes, nutrition knowledge and health status. Methods: In the Food Choice at Work cluster controlled trial, four large, purposively selected manufacturing workplaces in Ireland were allocated to control (N = 111), nutrition education (Education) (N = 226), environmental dietary modification (Environment) (N = 113) and nutrition education and environmental dietary modification (Combined) (N = 400) in 2013. Nutrition education included group presentations, individual consultations and detailed nutrition information. Environmental dietary modification included menu modification, fruit price discounts, strategic positioning of healthier alternatives and portion size control. Data on dietary intakes, nutrition knowledge and health status were obtained at baseline and follow-up at 7–9 months. Multivariate analysis of covariance compared changes across the four groups with adjustment for age, gender, educational status and other baseline characteristics. Results: Follow-up data at 7–9 months were obtained for 541 employees (64% of 850 recruited) aged 18–64 years: control: 70 (63%), Education: 113 (50%), Environment: 74 (65%) and Combined: 284 (71%). There were significant positive changes in intakes of saturated fat (p = 0.013), salt (p = 0.010) and nutrition knowledge (p = 0.034) between baseline and follow-up in the combined intervention versus the control. Small but significant changes in BMI (− 1.2 kg/m2 (95% CI − 2.385, − 0.018, p = 0.047) were observed in the combined intervention. Effects in the education and environment alone workplaces were smaller and generally non-significant. Conclusion: Combining nutrition education and environmental dietary modification may be an effective approach for promoting a healthy diet and weight loss at work

Plasmacytoid dendritic cells orchestrate innate and adaptive anti-tumor immunity induced by oncolytic coxsackievirus A21

Background: The oncolytic virus, coxsackievirus A21 (CVA21), has shown promise as a single agent in several clinical trials and is now being tested in combination with immune checkpoint blockade. Combination therapies offer the best chance of disease control; however, the design of successful combination strategies requires a deeper understanding of the mechanisms underpinning CVA21 efficacy, in particular, the role of CVA21 anti-tumor immunity. Therefore, this study aimed to examine the ability of CVA21 to induce human anti-tumor immunity, and identify the cellular mechanism responsible. Methods: This study utilized peripheral blood mononuclear cells from i) healthy donors, ii) Acute Myeloid Leukemia (AML) patients, and iii) patients taking part in the STORM clinical trial, who received intravenous CVA21; patients receiving intravenous CVA21 were consented separately in accordance with local institutional ethics review and approval. Collectively, these blood samples were used to characterize the development of innate and adaptive anti-tumor immune responses following CVA21 treatment. Results: An Initial characterization of peripheral blood mononuclear cells, collected from cancer patients following intravenous infusion of CVA21, confirmed that CVA21 activated immune effector cells in patients. Next, using hematological disease models which were sensitive (Multiple Myeloma; MM) or resistant (AML) to CVA21-direct oncolysis, we demonstrated that CVA21 stimulated potent anti-tumor immune responses, including: 1) cytokine-mediated bystander killing; 2) enhanced natural killer cell-mediated cellular cytotoxicity; and 3) priming of tumor-specific cytotoxic T lymphocytes, with specificity towards known tumor-associated antigens. Importantly, immune-mediated killing of both MM and AML, despite AML cells being resistant to CVA21-direct oncolysis, was observed. Upon further examination of the cellular mechanisms responsible for CVA21-induced anti-tumor immunity we have identified the importance of type I IFN for NK cell activation, and demonstrated that both ICAM-1 and plasmacytoid dendritic cells were key mediators of this response. Conclusion: This work supports the development of CVA21 as an immunotherapeutic agent for the treatment of both AML and MM. Additionally, the data presented provides an important insight into the mechanisms of CVA21-mediated immunotherapy to aid the development of clinical biomarkers to predict response and rationalize future drug combinations

The fitness of African malaria vectors in the presence and limitation of host behaviour

&lt;p&gt;Background Host responses are important sources of selection upon the host species range of ectoparasites and phytophagous insects. However little is known about the role of host responses in defining the host species range of malaria vectors. This study aimed to estimate the relative importance of host behaviour to the feeding success and fitness of African malaria vectors, and assess its ability to predict their known host species preferences in nature.&lt;/p&gt; &lt;p&gt;Methods Paired evaluations of the feeding success and fitness of African vectors Anopheles arabiensis and Anopheles gambiae s.s in the presence and limitation of host behaviour were conducted in a semi-field system (SFS) at Ifakara Health Institute, Tanzania. In one set of trials, mosquitoes were released within the SFS and allowed to forage overnight on a host that was free to exhibit natural behaviour in response to insect biting. In the other, mosquitoes were allowed to feed directly on from the skin surface of immobile hosts. The feeding success and subsequent fitness of vectors under these conditions were investigated on 6 host types (humans, calves, chickens, cows, dogs and goats) to assess whether physical movements of preferred host species (cattle for An. arabiensis, humans for An. gambiae s.s.) were less effective at preventing mosquito bites than those of common alternatives.&lt;/p&gt; &lt;p&gt;Results Anopheles arabiensis generally had greater feeding success when applied directly to host skin than when foraging on unrestricted hosts (in five of six host species). However, An. gambiae s.s obtained blood meals from free and restrained hosts with similar success from most host types (four out of six). Overall, the blood meal size, oviposition rate, fecundity and post-feeding survival of mosquito vectors were significantly higher after feeding on hosts free to exhibit behaviour, than those who were immobilized during feeding trials.&lt;/p&gt; &lt;p&gt;Conclusions Allowing hosts to move freely during exposure to mosquitoes was associated with moderate reductions in mosquito feeding success, but no detrimental impact to the subsequent fitness of mosquitoes that were able to feed upon them. This suggests that physical defensive behaviours exhibited by common host species including humans do not impose substantial fitness costs on African malaria vectors.&lt;/p&gt