Developing a facilitated reflection tool using video technology, during a laparoscopic simulation activity, for doctors in postgraduate obstetrics & gynaecology training

The evidence for laparoscopic simulation as an effective educational intervention is well established with benefits such as shortening the learning curve, increased learner self-efficacy and developing surgical skills without compromising patient safety. What has not been explored widely in the literature is what are the educational mechanisms that facilitate this effective learning in laparoscopic simulation. Lack of curriculum, limited simulation design or insufficient understanding of learner’s needs may not achieve cost effective educational outcomes or lead to a principle goal of laparoscopic simulation - translation of learning into the operating theatre. Reflection has been postulated in the literature to be the most important educational mechanism that enhances effective learning in simulation. Thematic analysis from the literature review, exploring reflection in surgical simulation, uncovered four important phenomena. Firstly reflection in surgical simulation can be enhanced through facilitated reflection with a teacher, secondly the use of video technology synergistically amplifies this process, thirdly the centrality of emotion to the simulation learning environment and finally integrating learning frameworks can theoretically structure facilitated reflection in surgical simulation. Through the theoretical research conducted in this thesis, a facilitated reflection educational tool has been constructed, using video technology, that can be applied in a laparoscopic simulation context. The design of the facilitated reflection tool has been theoretically scaffolded from Mezirow’s works on critical reflection and transformative learning and is discussed in this thesis along with the justification for selecting this theoretical orientation. An instructional programme for the integration of the facilitated reflection tool using video technology is developed in this thesis, along with elaboration of the technical and theoretical steps to pragmatically implement the tool during a laparoscopic simulation activity. It is believed that this facilitated reflection tool, in conjunction with video technology, will lead to an improvement in laparoscopic procedural skill performance through the development and enhancement of learner reflection. A paradigm shift resulting in the development of learning interventions based on educational theory is much needed in the Obstetrics & Gynaecology training armamentarium and the facilitated reflection tool is one step towards that direction

Timing feedback-inhibition of the male reproductive hormone axis

Hormonal methods of male contraception have addressed feedback-inhbition of the cascade of hormones that has evolved to regulate sperm production but high concentrations of testosterone (T) in the blood have not worked satisfactorily. We hypothesized that an episodic event, such as degranulation of gonadotropin-releasing hormone (GnRH) neurons in the hypothalamus, could be as well inhibited by episodic interference as by continuously-applied suppression. We used a computational model of hypothalamus-pituitary-gonad axis described by Veldhuis et al. to test the hypothesis that episodic administration of T would inhibit GnRH and/or luteinizing hormone (LH) secretion. A set of stochastic differential equations model feedback as well as feed-forward actions of GnRH, LH and T. The model predicted feedback-inhibition of GnRH pulses in a dose and frequency dependent manner when transdermal patches or injections delivering pulsatile T were applied. Since the published model did not address the effect of chronic GnRH deprivation on the viability of pituitary gonadotrophes, we introduced a function to address this issue. Incorporation of this function in the model allowed the prediction of a “holiday period” in the contraceptive regimen, during which exogenous T would not be needed to protect from conception. Pulsatile T delivered by real-life transdermal delivery system applied as per a parsimonious regimen reduced secretion of LH and T and fertility. The vitality function, proposed to account for survival and proliferation of pituitary gonadotrophes correlated with in vivo observations as extensive apoptosis in the anterior pituitary was observed after application of transdermal T

Characterization of an olfactory receptor mediating aversive behaviour to a death-associated odour

Olfaction or the sense of smell is a strong driver of behavior in many animals and is important for their survival. Odors are perceived through a complex molecular recognition process which involves detection of odorants by odorant receptors in olfactory sensory neurons located in the nasal olfactory epithelium. The odorant receptors belong to the G protein–coupled receptors (GPCRs) class of proteins, which includes the trace amine–associated receptors (TAARs), a class of GPCRs associated with the detection of social cues. The present study focused on molecular characterization of a TAAR receptor, TAAR13c, in zebrafish. Cadaverine, a diamine produced by bacterial decarboxylation of lysine, and thus associated with odor emanating from decaying flesh was reported to be the primary ligand for TAAR13c. Aversion to cadaverine was observed in adult Zebrafish by behavior experiments. Here, the cell type expressing TAAR13c receptors was identified as ciliated OSNs. Double-labeling of TAAR13c-expressing neurons with cFos as neuronal activity marker after stimulation with cadaverine showed widespread expression of cFos in many cells, a few of which were also TAAR13c-positive. Another activity marker tested, Egr1, was also found to be nonselective. However, pERK, an activity marker, which does not rely on gene expression, but on phosphorylation and is therefore much faster, showed sparse cells activated after stimulation with cadaverine and a series of other diamines with different chain length. Double-labeling with pERK antibody and TAAR13c antibody showed cellular co-localization of pERK and TAAR13c signals upon cadaverine stimulus. Ontogenetic onset of avoidance behavior was studied using a two channel choice apparatus in Zebrafish larvae. A trend towards avoidance of cadaverine was observed from the larval behavior experiments. 6 Knockout of TAAR13c was attempted using TALEN and Crispr-Cas9 mediated mutagenesis. Unfortunately it was not possible to design completely specific screening strategies due to high sequence identity within the five members of the TAAR13 subfamily and the AT-rich coding region of TAAR13c. Two putative knockout mutations were obtained with optimized screening methods. Finally, the design of new constructs for a TAAR13 subfamily knockout may provide a useful tool in the future for creating a functional Taar13 knockout in zebrafish

Sleep duration in school-age children with epilepsy: A cross-sectional study

Background: Normal sleep is required for the optimal growth and development of the children. Ineffective or inadequate sleep is common in children with epilepsy. Objectives: The objectives of this study were to study the sleep duration and describe the factors affecting it in school-aged children with epilepsy attending the seizure clinic of a pediatric tertiary care hospital. Materials and Methods: 6–12-year-old children with epilepsy, attending the seizure clinic formed the study subjects. They were assessed for inclusion in the study using INCLEN diagnostic tool for epilepsy (INDT-Epi) to achieve a sample size of 139. Informed written consent was obtained from parents. Background sociodemographic information, seizure type and treatment details, and duration of sleep of the child were collected from the parents. The proportion of children with epilepsy who had sleep problems were expressed as percentage. Results: The mean age of study population was 9.07±2.09 years. The average sleep duration of the study population was 9.41±1.41 h. The mean nap time of the study population was 68.51±33.88 min. No significant association was seen among the factors that determine sleep duration. Conclusion: Children with epilepsy tend to sleep for lesser hours when compared to historic controls of normal school-age children reported in literature

Curriculum based dropout discriminator for domain adaptation

Domain adaptation is essential to enable wide usage of deep learning based networks trained using large labeled datasets. Adversarial learning based techniques have shown their utility towards solving this problem using a discriminator that ensures source and target distributions are close. However, here we suggest that rather than using a point estimate, it would be useful if a distribution based discriminator could be used to bridge this gap. This could be achieved using multiple classifiers or using traditional ensemble methods. In contrast, we suggest that a Monte Carlo dropout based ensemble discriminator could suffice to obtain the distribution based discriminator. Specifically, we propose a curriculum based dropout discriminator that gradually increases the variance of the sample based distribution and the corresponding reverse gradients are used to align the source and target feature representations. The detailed results and thorough ablation analysis show that our model outperforms state-of-the-art results.Comment: BMVC 2019 Accepted, Project Page: https://delta-lab-iitk.github.io/CD3A

An Introduction to Survival Analytics, Types, and Its Applications

In today’s world, data analytics has become the integral part of every domain such as IOT, security, healthcare, parallel systems, and so on. The importance of data analytics lies at the neck of what type of analytics to be applied for which integral part of the data. Depending upon the nature and type of data, the utilization of the analytical types may also vary. The most important type of analytics which has been predominantly used up in health-care sector is survival analytics. The term survival analytics has originated from a medical domain of context which in turn determines and estimates the survival rate of patients. Among all the types of data analytics, survival analytics is the one which entirely depends upon the time and occurrence of the event. This chapter deals with the need for survival data analytics with an explanatory part concerning the tools and techniques that focus toward survival analytics. Also the impact of survival analytics with the real world problem has been depicted as a case study

Ralstonia mannitolilytica bacteremia in a maintenance hemodialysis patient

Ralstonia mannitolilytica is a nonfermentative, Gram-negative bacterium isolated infrequently from clinical samples. It is widelydistributed in nature, being a frequent contaminant in water supplies. It is increasingly identified as an opportunistic pathogen innosocomial infections, especially among immunosuppressed patients. It has also been implicated in common source nosocomialinfection outbreaks due to the addition of contaminated water to parenteral fluids and to medical equipment presumed to besterile. True bacteremia with the organism, however, cannot be ruled out, especially if it is isolated repeatedly from the samepatient within 3 successive days from blood cultures. A 22-year-old Ethiopian male presented to us in December 2015 with feverwith chills and rigor, vomiting, and headache. He was a known end-stage renal disease patient on thrice per week hemodialysisthrough a tunneled hemodialysis catheter for the past 1 year. He had an episode of catheter-related blood stream infection inOctober-November 2015 and was treated at a multispeciality hospital with parenteral antibiotics (piperacillin-tazobactam) for2 weeks (for growth of Pseudomonas aeruginosa in blood cultures) during the same admission phase. The tunneled catheter wasnot removed then and lock therapy was used and the patient improved gradually with antibiotics. During the current admission,three blood culture sets (aerobic and anaerobic), one set from the dialysis line and two from the peripheral lines were submittedto microbiology laboratory. Blood cultures (one bottle from each of the three sets) flagged positive. The blood culture sentfrom the hemodialysis line was the first to flag positive 12 h after it was loaded onto the BACTEC 9050 system. This wasfollowed by the aerobic and anaerobic bottles from the peripheral lines. The preliminary Gram-stain showed Gram-negativebacilli and the cultures grew Gram-negative organisms. The organism was identified as R. mannitolilytica by the Vitek 2C.Disc diffusion (CLSI, 2015) was done for the various antibiotics, and there was a 6 mm resistant zone for the following paneltested: Gentamicin, cotrimoxazole, aztreonam, amikacin, ceftriaxone, cefotaxime, cefepime, ceftazidime, and carbapenems; theorganism was intermediate to piperacillin-tazobactam (17 mm) and was sensitive to and cefoperazone-sulbactum (23 mm). In ourset up, this was the first case of R. mannitolilytica isolated as a significant pathogen in a case of true bacteremia. R. mannitolilyticacan thus cause true bacteremia as well in addition to just being an environmental contaminant. Early recognition of the infectionhelps in instituting appropriate antibiotic with complete resolution of the infection. In our case report, the prompt report ofmicrobiology department enabled us to treat the patient on time with appropriate antibiotic and also prevented the prematureremoval of the tunneled catheter. The problems caused by this bacterium occur rapidly and disease progression is fast; therefore,R. mannitolilytica infections should draw sufficient attention from clinical physicians and bacteriology workers to respond to theresulting severe consequences