Exploring digital teaching tools, including the use of social media, to support teaching; perspectives of M.Pharm. students

Background: The School of Pharmacy and Medical Sciences, University of Bradford, is keen to evaluate the potential benefits of digital tools to enhance the teaching and learning of all M.Pharm. students. Students are increasingly using digital technology for both educational and social purposes (Cheston et al., 2013). This project explored the views of pharmacy students about digital technology, including social media, for teaching in the M.Pharm. programme. Method: Convenience sampling was employed to recruit M.Pharm. students for focus groups. Each focus group, facilitated by student researchers with topic guide, was audio-recorded and analysed for themes. Ethics approval was obtained from the University. Results: Year 2 and 3 students from two focus groups (n1=8 (6 male), n2=10 (8 male)) identified three main digital teaching tools used in the current programme: Blackboard, response clickers, and iSTAN. Blackboard, a virtual learning environment, was seen as a hub for holding all required learning materials. However, its use depended on internet access and some felt they would benefit from offline use and improved compatibility with different devices. Audience response systems and a human patient stimulator were well received by students. However, participants strongly felt that they were underutilised. The main benefit of using social media for learning was instant feedback and the encouragement of informal discussions. Participants were not always comfortable posting within the current digital tools used in the programme (e.g. Blackboard) as they felt ‘monitored’. However, participants acknowledged that information obtained through social media might not be as reliable as information from digital tools moderated by academics. Interestingly, participants reported a lack of engagement with programme specific social media pages (e.g. Facebook page). They felt that the information provided was aimed at qualified pharmacists, rather than current students. Conclusion: Participants valued accessibility, flexibility and availability of instant feedback when using digital tools to support their learning. They felt positive about the digital tools used within the programme but emphasised the need of greater integration. References Cheston, C.C., Flickinger, T.E. & Chisom, M.S. (2013). Social media use in medical education: a systematic review. Academic Medicine, 88(6), 893-90

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Eco-friendly synthesis of anti-microbial and anti-fungal binary metal oxide decorated reduced graphene oxide nanocomposites with complimenting density functional studies

Recently, graphene-based nanocomposites are increasingly becoming popular for a variety of biological applications, due to their extraordinary physicochemical properties. Herein, we present an eco-friendly method for the preparation of a novel nanocomposite based on reduced graphene oxide (rGO) decorated with tin oxide (SnO2) and zinc oxide (ZnO) nanoparticles. The rGO and binary metal oxides-based nanocomposite (rGO/ZnO/SnO2) with enhanced biocompatibility was prepared by using Mentha longifolia extract as a non-hazardous reducing agent. The rich polyphenolic and flavonoids contents of Mentha longifolia have functioned as potential bio-reductants, which are not only suitable for the synthesis of rGO/ZnO/SnO2, but also effectively stabilized the resulting composite. Initially, to determine the reducing ability of Mentha longifolia, the redox potential and chemical composition of green extract was investigated by cyclic voltammetry (CV) and liquid chromatography-mass spectrometry (LC-MS), respectively. On the other hand, the structural composition and morphology of the resultant composite was confirmed by X-ray diffraction (XRD), Raman spectroscopy, Fourier transform infrared spectroscopy (FT-IR) and UV–visible spectroscopy (UV), scanning electron microscopy (SEM), transmission electron microscopy (TEM) and energy-dispersive X-ray spectroscopy (EDS). Furthermore, the biological potential of rGO/ZnO/SnO2 is determined by evaluating the antimicrobial and antifungal properties of the resulting composite against various pathogens such as, Staphylococcus aureus (SA), Candida albicans (CA) and Clostridium dificile (CD). Notably, the composite has demonstrated superior antibacterial and antifungal properties when compared to its individual counterparts including rGO, SnO2 and ZnO. Density functional calculations complement the experimental findings, as the periodic boundary conditions reveal high binding energy of −14.8 keV for the rGO/ZnO/SnO2 nanocomposite

Histomorphological studies of broiler chicken fed diets supplemented with either raw or enzyme treated dandelion leaves and fenugreek seeds

Aim: Herbal plants and their derived products are extensively used particularly in many Asian, African, and other countries of the world as they are considered as ideal feed additives because of their non-residual effect and ability to influence the ecosystem of gastrointestinal microbiota in a positive way. Further, the enzymatic treatment of these herbs helps in their efficient utilization by the host. Dandelion leaves and fenugreek seeds have been reported to have positive effect in terms of improving the performance of broiler chicken, but not much literature is available regarding their effect on gut histomorphology; therefore, the present study was conducted to explore the effect of these herbs either alone or in combination with or without enzyme treatment on histomorphology of liver and small intestine of broiler chicken. Materials and Methods: To achieve the envisaged objective, 273-day-old commercial broiler chicks were procured from a reputed source and reared together until 7 days of age. On the 7th day, the chicks were individually weighed, distributed randomly into 7 groups of 3 replicates with 13 chicks each. Birds in the control group were fed diets without additives (T1). The other six treatment groups were fed the basal diet supplemented with 0.5% dandelion leaves (T2), 1% fenugreek seeds (T3), combination of 0.5% dandelion leaves and 1% fenugreek seeds (T4), enzyme treated dandelion leaves 0.5% (T5), enzyme treated fenugreek seeds 1% (T6), and combination of enzyme treated dandelion leaves (0.5%) and (1%) fenugreek seeds (T7). The histomorphological study of liver and small intestines was conducted among different treatment groups. Results: The results revealed the hepato-protective nature of both dandelion leaves and fenugreek seeds either alone or in combination with or without enzyme treatment when compared with the control group. Moreover, the histomorphological findings of jejunum revealed the beneficial effect of dandelion leaves, fenugreek seeds and enzymes on the intestinal mucosa in terms of cellular infiltration, architecture of villi, villus height/crypt depth ratio, thereby improving the intestinal health. Conclusion: The dandelion leaves and fenugreek seeds have hepato-protective nature and beneficial effect on the intestinal morphology particularly when included along with enzymes in the diet of broiler chicken

Open-Circuit Fault Detection in a Multilevel Inverter Using Sub-Band Wavelet Energy

Recent research has focused on sustainable development and renewable energy resources, thus motivating nonconventional cutting-edge technology development. Multilevel inverters are cost-efficient devices with IGBT switches that can be used in ac power applications with reduced harmonics. They are widely used in the power electronics industry. However, under extreme stress, the IGBT switches can experience a fault, which can lead to undesirable operation. There is a need for a reliable system for detecting switch faults. This paper proposes a signal processing method to detect open-circuit problems in IGBT switches. Relative wavelet energy has been used as a feature for a machine learning algorithm to diagnose and classify the faulted switches. The switching sequence can be altered to restore a healthy output voltage. Inverter faults have been diagnosed by using support vector machine (SVM) and decision tree (DT), and an ensemble model based on decision tree (DT) and XG boost algorithm was developed, which yielded 92%, 88%, and 94.12% accuracy, respectively

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83-0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

BackgroundTranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding.MethodsWe did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.FindingsBetween July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98).InterpretationWe found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial.</div