Primary Molecular Disorders and Secondary Biological Adaptations in Bartter Syndrome

Bartter syndrome is a hereditary disorder that has been characterized by the association of hypokalemia, alkalosis, and the hypertrophy of the juxtaglomerular complex with secondary hyperaldosteronism and normal blood pressure. By contrast, the genetic causes of Bartter syndrome primarily affect molecular structures directly involved in the sodium reabsorption at the level of the Henle loop. The ensuing urinary sodium wasting and chronic sodium depletion are responsible for the contraction of the extracellular volume, the activation of the renin-aldosterone axis, the secretion of prostaglandins, and the biological adaptations of downstream tubular segments, meaning the distal convoluted tubule and the collecting duct. These secondary biological adaptations lead to hypokalemia and alkalosis, illustrating a close integration of the solutes regulation in the tubular structures

Scoring methods in script concordance tests : an exploratory psychometric study

BACKGROUND:Despite the increasingly popular role of script concordance test (SCT) scoring methods in the evaluation of clinical reasoning, studies examining these methods in nursing are relatively scarce. This study explored the psychometric properties of five SCT scoring methods. METHOD:An SCT was administered to 12 experts and 43 learners. Scores were calculated using five methods and descriptive statistics. Differences in scores were assessed with the Mann-Whitney U test, and Spearman correlation coefficients were calculated for the different methods. RESULTS:The median scores of both experts and learners differed substantially according to the scoring method used. Learners' scores were statistically different from experts' scores (p < .01) for each method. Spearman coefficients (range, 0.44 to 0.95) were positive for the different methods. CONCLUSION:Further research is needed to refine the influence of SCT scoring methods for use in certifying assessment of clinical reasoning in nursing. [J Nurs Educ. 2023;62(10):549–555.

Inefficient jet-induced star formation in Centaurus A:High resolution ALMA observations of the northern filaments

NGC 5128 is one of the best targets to study AGN-feedback in the local Universe. At 13.5 kpc from the galaxy, optical filaments with recent star formation lie along the radio-jet direction. It is a testbed region for positive feedback (jet-induced star formation). APEX revealed strong CO emission in star-forming regions but also in regions with no detected tracers of star formation. When observed, star formation appears to be inefficient compared to the Kennicutt-Schmidt relation. We used ALMA to map the 12CO(1-0) emission all along the filaments at 1.3"~ 23.8 pc resolution. The CO emission is clumpy and distributed in two main structures: (i) the Horseshoe complex, outside the HI cloud, where gas is mostly excited by shocks and no star formation is observed; (ii) the Vertical filament, at the edge of the HI shell, which is a region of moderate star formation. We identified 140 molecular clouds. A statistical study reveals that they have very similar physical properties that in the inner Milky Way. However, the range of radius available with the present observations does not enable to investigate whether the clouds follow the Larson relation or not. The large virial parameter of the clouds suggests that gravity is not dominant. Finally, the total energy injection in the filaments is of the same order as in the inner part of the Milky Way. The strong CO emission detected in the filaments is an indication that the energy injected by the jet acts positively in the formation of dense molecular gas. The relatively high virial parameter of the molecular clouds suggests that the injected kinetic energy is too strong for star formation to be efficient. This is particularly the case in the Horseshoe complex where the virial parameter is the largest and where strong CO is detected with no associated star formation. This is the first evidence of inefficient AGN positive feedback

Auto-effi cacité émotionnelle et épuisement professionnel de directions d’établissement d’enseignement

Cette étude évalue le rôle de l’auto-effi cacité émotionnelle (AEÉ) sur les symptômes de l’épuisement professionnel (ÉP). Trois hypothèses sont vérifi ées en lien avec des études antérieures, soit que l’AEÉ est négativement liée à l’épuisement émotionnel, à la perte d’accomplissement personnel au travail et à la dépersonnalisation. Les 406 participants dirigent des établissements d’enseignement de la province de Québec au Canada. L’échelle d’AEÉ (α = ,92) de Deschênes, Dussault, &amp; Fernet (2011) et le MBI-GS de Schaufeli, Leiter, Maslach, &amp; Jackson (1996) (épuisement émotionnel : α = ,91, dépersonnalisation : α = ,78 et perte d’accomplissement personnel : α = ,87) ont été utilisés pour mesurer les construits à l’étude. Le modèle vérifi é comprend sept indicateurs pour le facteur de l’AEÉ et deux indicateurs pour chaque symptôme de l’épuisement professionnel. Il présente de bonnes statistiques d’ajustement du modèle aux données qui confi rment les hypothèses : χ2 = 113,61, p &lt; ,001, χ2/dl = 1,93, NNFI = ,97, CFI = ,98 et RMSEA = ,05

Effectiveness of adaptive e-Learning environments on knowledge, competence, and behavior in health professionals and students : protocol for a systematic review and meta-analysis

Background: Adaptive e-learning environments (AEEs) can provide tailored instruction by adapting content, navigation, presentation, multimedia, and tools to each user’s navigation behavior, individual objectives, knowledge, and preferences. AEEs can have various levels of complexity, ranging from systems using a simple adaptive functionality to systems using artificial intelligence. While AEEs are promising, their effectiveness for the education of health professionals and health professions students remains unclear. Objective: The purpose of this systematic review is to assess the effectiveness of AEEs in improving knowledge, competence, and behavior in health professionals and students. Methods: We will follow the Cochrane Collaboration and the Effective Practice and Organisation of Care (EPOC) Group guidelines on systematic review methodology. A systematic search of the literature will be conducted in 6 bibliographic databases (CINAHL, EMBASE, ERIC, PsycINFO, PubMed, and Web of Science) using the concepts “adaptive e-learning environments,” “health professionals/students,” and “effects on knowledge/skills/behavior.” We will include randomized and nonrandomized controlled trials, in addition to controlled before-after, interrupted time series, and repeated measures studies published between 2005 and 2017. The title and the abstract of each study followed by a full-text assessment of potentially eligible studies will be independently screened by 2 review authors. Using the EPOC extraction form, 1 review author will conduct data extraction and a second author will validate the data extraction. The methodological quality of included studies will be independently assessed by 2 review authors using the EPOC risk of bias criteria. Included studies will be synthesized by a descriptive analysis. Where appropriate, data will be pooled using meta-analysis by applying the RevMan software version 5.1, considering the heterogeneity of studies. Results: The review is in progress. We plan to submit the results in the beginning of 2018. Conclusions: Providing tailored instruction to health professionals and students is a priority in order to optimize learning and clinical outcomes. This systematic review will synthesize the best available evidence regarding the effectiveness of AEEs in improving knowledge, competence, and behavior in health professionals and students. It will provide guidance to policy makers, hospital managers, and researchers in terms of AEE development, implementation, and evaluation in health care

Involvement of end users in the development of serious games for health care professions education : systematic descriptive review

Background: On the basis of ethical and methodological arguments, numerous calls have been made to increase the involvement of end users in the development of serious games (SGs). Involving end users in the development process is considered a way to give them power and control over educational software that is designed for them. It can also help identify areas for improvement in the design of SGs and improve their efficacy in targeted learning outcomes. However, no recognized guidelines or frameworks exist to guide end users’ involvement in SG development. Objective: The aim of this study is to describe how end users are involved in the development of SGs for health care professions education. Methods: We examined the literature presenting the development of 45 SGs that had reached the stage of efficacy evaluation in randomized trials. One author performed data extraction using an ad hoc form based on a design and development framework for SGs. Data were then coded and synthesized on the basis of similarities. The coding scheme was refined iteratively with the involvement of a second author. Results are presented using frequencies and percentages. Results: End users’ involvement was mentioned in the development of 21 of 45 SGs. The number of end users involved ranged from 12 to 36. End users were often involved in answering specific concerns that arose during the SG design (n=6) or in testing a prototype (n=12). In many cases, researchers solicited input from end users regarding the goals to reach (n=10) or the functional esthetics of the SGs (n=7). Most researchers used self-reported questionnaires (n=7). Conclusions: Researchers mentioned end users’ involvement in the development of less than half of the identified SGs, and this involvement was also poorly described. These findings represent significant limitations to evaluating the impact of the involvement of end users on the efficacy of SGs and in making recommendations regarding their involvement

Differentiating the design principles of virtual simulations and serious games to enhance nurses’ clinical reasoning

Virtual simulations and serious games are e-learning interventions with the potential to enhance nurses' clinical reasoning. However, distinctions in the design principles of each intervention remain ambiguous. Clarifications are needed to distinguish both interventions and ease the articulation between their design principles and the development of clinical reasoning. In this study, we examine the overlapping and unique design principles of virtual simulations and serious games

Theoretical foundations of educational strategies used in e-learning environments for developing clinical reasoning in nursing students : a scoping review

E-learning environments expand opportunities for the use of educational strategies that may contribute to the development of clinical reasoning in nursing students. The purposes of this scoping review were the following: 1) to map the principles of cognitive companionship and the theoretical foundations underlying the design and implementation of educational strategies used in e-learning environments for developing clinical reasoning in nursing students; and 2) to identify the types of educational strategies used in e-learning environments for developing or assessing clinical reasoning in nursing students. A scoping review was conducted and was based on the Joanna Briggs Institute Framework. Bibliographical databases were searched for studies published between January 2010 to July 2017. Out of 1202 screened articles, 18 met eligibility criteria and were included in this review. Principles of cognitive companionship in e-learning environments provide key clues from a learning support perspective, such as integrated feedback, interactive group discussion, gaming, and questioning. However, theoretical foundations underlying educational strategies in e-learning environments are poorly documented and insufficiently associated with cognitive learning models. E-learning environments must have solid theoretical foundations to provide support for the development of CR in nursing students

Mapping a lower limit on the mass fraction of the cold neutral medium using Fourier transformed HI 21cm emission line spectra: Application to the DRAO Deep Field from DHIGLS and the HI4PI survey

We develop a new method for spatially mapping a lower limit on the mass fraction of the cold neutral medium by analyzing the amplitude structure of $\hat T_b(k_v)$, the Fourier transform of $T_b(v)$, the spectrum of the brightness temperature of HI 21cm line emission with respect to the radial velocity $v$. This advances a broader effort exploiting 21cm emission line data alone (without absorption line data, $\tau$) to extract integrated properties of the multiphase structure of the HI gas and to map each phase separately. Using toy models, we illustrate the origin of interference patterns seen in $\hat T_b(k_v)$. Building on this, a lower limit on the cold gas mass fraction is obtained from the amplitude of $\hat T_b$ at high $k_v$. Tested on a numerical simulation of thermally bi-stable turbulence, the lower limit from this method has a strong linear correlation with the "true" cold gas mass fraction from the simulation for relatively low cold gas mass fraction. At higher mass fraction, our lower limit is lower than the "true" value, because of a combination of interference and opacity effects. Comparison with absorption surveys shows a similar behavior, with a departure from linear correlation at $N_{\rm HI}\gtrsim 3-5\times10^{20}$ cm$^{-2}$. Application to the DRAO Deep Field (DF) from DHIGLS reveals a complex network of cold filaments in the Spider, an important structural property of the thermal condensation of the HI gas. Application to the HI4PI survey in the velocity range $-90 < v < 90$ km/s produces a full sky map of a lower limit on the mass fraction of the cold neutral medium at 16'.2 resolution. Our new method has the ability to extract a lower limit on the cold gas mass fraction for massive amounts of emission line data alone with low computing time and memory, pointing the way to new approaches suitable for the new generation of radio interferometers.Comment: 29 pages, 35 figures, Accepted for publication in Ap