A review of online platforms in training and surgical education

Introduction: The use of technology in surgical education has rapidly evolved. Blended learning refers to provision of online instruction platforms by international technology companies, prompting a combination of face-to-face teaching with computer-mediated tuition. This nonsystematic literature review focuses on online teaching platforms with applications for potential use in future surgical education.Methods: A literature search was performed using PubMed, Embase, OVID, and Google Scholar. To identify studies on online platforms in surgical education, the following search terms were used: “online platform,” “online learning,” “surgical education and online learning,” and “surgical education and blended learning.” The search was limited to citations in English from 1998 to 2018. The first author performed the detailed literature search. The final list of the articles was included by consensus between authors. Search items were studied from the nature of the articles, country of origin, date of publication, and aims and findings in relation to use of online platforms surgical education.Results: Altogether 279 relevant citations were reviewed, of which 22 articles met the inclusion criteria: 19 papers (ten original research, two review items, seven Internet articles) and three books were found to be relevant for this study. Their analysis comprised models of platforms along with their applications in surgical education. Data on the advantages and disadvantages of online platforms as well as authors’ personal experience of this instruction manner in surgical education were extracted. Problems with determining, analyzing, and integrating reading matters in a nonsystematic literature review comprising different teaching methods combined with the use of online platforms in surgical education were discussed and resolved.Conclusion: Online platforms were introduced by international technology companies to encourage paperless blended learning in schools. We envisaged the use of online classrooms in surgical education because of its simple format, easy access, low costs, and interaction-inspiring nature between teachers and students in professional surgical education.</p

Local actors in global politics

Globalization and the new information and communication technologies(ICTs) have enabled a variety of local political actors to enter inter-national arenas once exclusive to national states. Multiple types of claim-making and oppositional politics articulate these developments. Going global has been partly facilitated and conditioned by the infrastructure of the global economy, even as the latter is often the object of those oppositional politics. Further, and in my analysis, very importantly, the possibility of global imag-inaries has enabled even those who are geographically immobile to become part of global politics. NGOs and indigenous peoples, immigrants and refugees who become subjects of adjudication in human rights decisions, human rights and environmental activists, and many others are increasingly becoming actors in global politics. That is to say, non-state actors can enter and gain visibility in inter-national fora or global politics as individuals and as collectivities, emerging from the invisibility of aggregate membership in a nation-state exclusively represented by the sovereign. One way of interpreting this is in terms of a

Fluctuation of Anti–Domain 1 and Anti–β2-Glycoprotein I Antibody Titers Over Time in Patients With Persistently Positive Antiphospholipid Antibodies

Objective: The present study was undertaken to longitudinally evaluate titers of antibodies against β2-glycoprotein I (anti-β2GPI) and domain 1 (anti-D1), to identify predictors of variations in anti-β2GPI and anti-D1 titers, and to clarify whether antibody titer fluctuations predict thrombosis in a large international cohort of patients who were persistently positive for antiphospholipid antibodies (aPL) in the APS ACTION Registry. Methods: Patients with available blood samples from at least 4 time points (at baseline [year 1] and at years 2–4 of follow-up) were included. Detection of anti-β2GPI and anti-D1 IgG antibodies was performed using chemiluminescence (BIO-FLASH; INOVA Diagnostics). Results: Among 230 patients in the study cohort, anti-D1 and anti-β2GPI titers decreased significantly over time (P &amp;lt; 0.0001 and P = 0.010, respectively). After adjustment for age, sex, and number of positive aPL tests, we found that the fluctuations in anti-D1 and anti-β2GPI titer levels were associated with treatment with hydroxychloroquine (HCQ) at each time point. Treatment with HCQ, but not immunosuppressive agents, was associated with 1.3-fold and 1.4-fold decreases in anti-D1 and anti-β2GPI titers, respectively. Incident vascular events were associated with 1.9-fold and 2.1-fold increases in anti-D1 and anti-β2GPI titers, respectively. Anti-D1 and anti-β2GPI titers at the time of thrombosis were lower compared to titers at other time points. A 1.6-fold decrease in anti-D1 titers and a 2-fold decrease in anti-β2GPI titers conferred odds ratios for incident thrombosis of 6.0 (95% confidence interval [95% CI] 0.62–59.3) and 9.4 (95% CI 1.1–80.2), respectively. Conclusion: Treatment with HCQ and incident vascular events in aPL-positive patients predicted significant anti-D1 and anti-β2GPI titer fluctuations over time. Both anti-D1 and anti-β2GPI titers decreased around the time of thrombosis, with potential clinical relevance. © 2023 The Authors. Arthritis &amp; Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology

Anti–Neutrophil Extracellular Trap Antibodies in Antiphospholipid Antibody–Positive Patients: Results From the Antiphospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking Clinical Database and Repository

Objective: This study aimed to elucidate the presence, antigen specificities, and potential clinical associations of anti–neutrophil extracellular trap (anti-NET) antibodies in a multinational cohort of antiphospholipid (aPL) antibody–positive patients who did not have lupus. Methods: Anti-NET IgG/IgM levels were measured in serum samples from 389 aPL-positive patients; 308 patients met the classification criteria for antiphospholipid syndrome. Multivariate logistic regression with best variable model selection was used to determine clinical associations. For a subset of the patients (n = 214), we profiled autoantibodies using an autoantigen microarray platform. Results: We found elevated levels of anti-NET IgG and/or IgM in 45% of the aPL-positive patients. High anti-NET antibody levels are associated with more circulating myeloperoxidase (MPO)–DNA complexes, which are a biomarker of NETs. When considering clinical manifestations, positive anti-NET IgG was associated with lesions affecting the white matter of the brain, even after adjusting for demographic variables and aPL profiles. Anti-NET IgM tracked with complement consumption after controlling for aPL profiles; furthermore, patient serum samples containing high levels of anti-NET IgM efficiently deposited complement C3d on NETs. As determined by autoantigen microarray, positive testing for anti-NET IgG was significantly associated with several autoantibodies, including those recognizing citrullinated histones, heparan sulfate proteoglycan, laminin, MPO–DNA complexes, and nucleosomes. Anti-NET IgM positivity was associated with autoantibodies targeting single-stranded DNA, double-stranded DNA, and proliferating cell nuclear antigen. Conclusion: These data reveal high levels of anti-NET antibodies in 45% of aPL-positive patients, where they potentially activate the complement cascade. While anti-NET IgM may especially recognize DNA in NETs, anti-NET IgG species appear to be more likely to target NET-associated protein antigens. © 2023 The Authors. Arthritis &amp; Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology