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Flipped learning has become a popular blended learning approach in higher education and is now being adopted in medical schools across Australia and internationally. There are a number of principal educational justifications for the introduction of this approach, primarily, that it fosters deeper student learning through active engagement in the classroom. As a pedagogical intervention however, what do the various stakeholders think about its introduction? This paper explores reactions to implementation of a flipped learning approach to pre-clinical medical education in a regional Victorian medical course, via a mixed method approach. A range of quantitative and qualitative data was collected concerning the implementation, including a student survey, student focus groups, a staff survey for both academic and professional staff members involved in the implementation of the approach, and an independent student-driven social media questionnaire conducted in the second year post implementation survey. These data provide critical feedback for refinement of the flipped learning approach, including more robust student and faculty development and support during implementation of this pedagogy. Taken together, our results provide a unique perspective of the introduction of the flipped approach through different stakeholder lenses, and over time.

Introduction: Differential attainment is a well‐known phenomenon in medical education. Despite a strong impetus for institutions and researchers to move away from a 'student deficit model' when exploring the attainment gap, little attention has been given to understanding the experiences of Black, Asian and Minority Ethnic (BAME) medical students. Informed by the social construction of learning theory, this is the first national study to explore how multiple dimensions of the medical school environment impact academic performance of BAME undergraduate medical students across the UK. Methods: Using a sequential explanatory mixed‐methods approach, the authors conducted a survey and facilitated three focus groups across medical schools in the UK between 2020–2021. Participants self‐identified as being from BAME backgrounds. Quantitative analyses included descriptive statistics and bivariate analyses. Qualitative data were analysed using thematic analysis, subsequently identifying inductive themes. Results: Three hundred sixty‐two respondents completed the Phase 1 survey, and 17 participants participated in the Phase 2 focus groups. Although both survey and focus group participants identified facilitators to learning such as supportive relationships, students reported facing numerous barriers that they felt impeded their learning and performance. These barriers included limited access to educational resources, and undiversified curricula and medical school populations. Students also described both experiencing and witnessing various forms of racism throughout their educational journeys. Discussion: Students encountered various difficulties throughout their medical training that they felt impacted their learning and performance. This study offers novel insights into the experiences of BAME students and builds upon previous research. It also reveals the pervasive nature of racism within medical schools, highlighting the urgent need for institutional changes. Educators and institutions must go beyond merely recognising these barriers and facilitators; they must proactively innovate and adapt. In doing so, they pave the way for inclusive learning environments that truly foster a sense of belonging for BAME students. In this mixed‐methods study, @DrNariell, Machado and Blackburn explore UK BAME medical students‐ perspectives on the barriers and facilitators they experience during their training. #MedEd #MedTwitter [ABSTRACT FROM AUTHOR]

The first harvest of Humulus lupulus (var. Cascade) in Brazil in 2016 originated as an aromatic hop that nowadays is gaining attention from the brewery industry. However, the chemical composition and the properties of this hop have not been well documented to date. In this study, the chemical profile of the phenolic compounds and essential oils of Cascade hops produced in Brazil (BH) and the USA (UH) was determined. The major phenolic compounds identified by LC-ESI-MS-MS in BH and UH were protocatechuic acid, isoquercitrin, and ferulic acid (4.18–11.39; 2.44–4.90; and 1.45–4.48 mg 100 g−1, respectively). The profile of essential oils was shown to differ between the two samples. The compounds trans-β-farnesene (20.60%), β-selinene (18.78%), myrcene (16.57%), and α-selinene (16.22%) were the main compounds in the BH essential oil, while the essential oil of UH showed a high content of α-humulene (35.35%), myrcene (22.35%), β-caryophyllene (12.81%), and trans-β-farnesene (10.59%). A higher antioxidant activity (by DPPH and ABTS) was observed for hop extracts when compared to the essential oils. The results indicated that the Brazilian hop sample analyzed had higher radical scavenging when compared to an American hop sample (associated with its bioactive compound composition). The Cascade hop from Brazil appears to be a high-quality raw material showing significant potential for future industrial applications. [ABSTRACT FROM AUTHOR]

Summary: Bioactive compounds from Brazilian hop (Humulus lupulus L.) cultivars were extracted by ultrasound and their phenolic profile compared with commercial hop from the USA. The most effective extraction conditions (solution of ethanol 49%, at 52 °C and a solid/liquid ratio of 1 g per 34 mL) for the total phenolic compounds (TPC) were determined using a Central Composite Rotatable Design. The Brazilian hop showed higher content of TPC (33.93 ± 0.67 mg GAE g−1), total flavonoids (54.47 ± 0.10 mg QE g−1) and higher antioxidant activity (ABTS: EC50 21.29 ± 1.36 μL mL−1; DPPH: EC50 3.91 ± 0.17 μL mL−1) when compared with the USA hop. The main phenolic compounds present in the extracts were the flavonoids isoquercitrin and quercetin. The antioxidant properties of the Brazilian hop extract had not been reported yet in the literature for this raw material, thus showing potential to be incorporated in polymeric films used as active packaging. [ABSTRACT FROM AUTHOR]

Objective: To assess the feasibility and safety of a physiotherapy protocol applied to pregnant women with preeclampsia.Methods: Randomized, controlled, single-blind feasibility study, with 24 hospitalized pregnant women with preeclampsia. The intervention group received one session of the physiotherapy. The control group remained under the routine care of the hospital. The primary outcomes were Doppler velocimetry, cardiotocography, and maternal-fetal hemodynamics. Secondary outcomes were pain and anxiety assessed before and after the interventions. A mixed effects linear regression model was used, and the data were compared with the level of significance at 5%.Results: The baseline characteristics of the participants were homogeneous between groups. Resistance index of the Middle Cerebral Artery (MAC) and Umbilical Artery (UA) and cardiotocography did not change significantly. The systolic blood pressure (SBP) increased 4.90 mmHg in the control group and 0.22 mmHg in the intervention group. The diastolic blood pressure (DBP) increased 1.34 mmHg in the control group and decreased 0.40 mmHg in the intervention group. The middle bood pressure (MBP) increased 4.66 mmHg in the control group while there was a decrease of 0.09 mmHg in the intervention group, without statistical difference. Heart rate (HR) decreased 0.94 bpm in the control group; whereas, in the intervention group, there was an increase of 6.30 bpm. The pain reduced clinically 2 points after the intervention. The anxiety reduced clinically in both the groups (-1.26 in the intervention group and -2.17 in the control group).Conclusion: The protocol applied in the intervention group is feasible and safe for both mother and fetus. Both groups showed clinical reduction in the levels of anxiety; whereas, pain was clinically reduced in the intervention group. [ABSTRACT FROM AUTHOR]

Objective:  To analyze the effect of the One-minute Preceptor model for preceptors who work at the emergency department of a maternity teaching hospital., Methods:   A quantitative intervention study conducted with Obstetrics and Gynecology residency preceptors at a maternity teaching hospital in northeastern Brazil. Three stages were performed: 1) a preintervention survey with the residents; 2) planning and execution of a pedagogical training course for the preceptors, which involved a lecture and a dramatization about the One-Minute Preceptor model; and 3) thirty days after the intervention, the residents answered another survey about the model and its repercussions and advantages., Results:  The preintervention assessment with the residents showed that 91.7% agreed that there were discrepancies regarding the teaching model among the preceptors. After the training, all preceptors agreed that the model engages the student in the decision-making process, and that they would apply it to their routine. The postintervention results showed that 95.8% agreed that the model is more inviting than traditional teaching approaches. There was a perception of improvement in learning among 70.9% of the residents. In addition, the present study found a significant change in feedback before and after implementing the model, from 20.8% to 66.7%., Conclusion:  The training course of preceptors in the One-Minute Preceptor model proved to be efficient in providing formative feedback to residents in the emergency department of a maternity school. Further studies are needed to assess the consolidation of the methodology in the long term., Competing Interests: The authors have no conflict of interests to declare., (Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Objective: To explore graduate-entry medical students experiences of undergraduate training in the context of academic underperformance of medical students from ethnic minority backgrounds., Design: Qualitative study using semi-structured focus groups., Setting: A West Midlands medical school., Participants: 24 graduate-entry MBChB students were recruited using volunteer and snowball sampling; all students self-identified as being from Black and Minority Ethnic (BME) backgrounds., Results: BME students reported facing a range of difficulties, throughout their undergraduate medical training, that they felt impeded their learning and performance. Their relationships with staff and clinicians, though also identified as facilitators to learning, were also perceived to have hindered progress, as many students felt that a lack of BME representation and lack of understanding of cultural differences among staff impacted their experience. Students also reported a lack of trust in the institution's ability to support BME students, with many not seeking support. Students' narratives indicated that they had to mask their identity to fit in among their peers and to avoid negative stereotyping. Although rare, students faced overt racism from their peers and from patients. Many students reported feelings of isolation, reduced self-confidence and low self-esteem., Conclusions: BME students in this study reported experiencing relationship issues with other students, academic and clinical staff, lack of trust in the institution and some racist events. Although it is not clear from this small study of one institution whether these findings would be replicated in other institutions, they nevertheless highlight important issues to be considered by the institution concerned and other institutions. These findings suggest that all stakeholders of graduate-entry undergraduate medical education should reflect on the current institutional practices intended to improve student-peer and student-staff relationships. Reviewing current proposals intended to diversify student and staff populations as well as evaluating guidance on tackling racism is likely to be beneficial., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Chemical investigations of the ethanolic extracts from the flowers and leaves of Hymenaea stigonocarpa Mart. ex Hayne afforded one new ent-halimane diterpenoid, 18-hydroxy-ent-halima-1(10),13-(E)-dien-15-oic acid (1), together with five known compounds (2-6). The structural elucidation was performed by means of NMR (COSY, HSQC, HMBC, and NOESY) and MS analyses. Complete (1)H and (13)C NMR data assignments are also reported for labd-13-en-8β-ol-15-oic (2) and labd-7,13-dien-15-oic (3) acids. The absolute configurations of 1 and 2 were established by comparison of experimental and calculated Raman optical activity spectra.

Objective: To determine the availability of noninvasive positive-pressure ventilation equipment, as well as the level of expertise and familiarity of physicians, nurses and physiotherapists with noninvasive positive-pressure ventilation in the intensive care units of public, private and teaching hospitals in the greater metropolitan area of São Paulo, Brazil., Methods: On-site administration of questionnaires., Results: Noninvasive positive-pressure ventilation equipment was widely available and was more commonly found in private hospitals than in teaching hospitals. Such equipment was least available in public hospitals, in which the predominant method was the use of mechanical ventilators designed for invasive ventilation and adapted to noninvasive positive-pressure ventilation. In private hospitals, continuous flow ventilators were more common, whereas, in teaching hospitals, ventilators specifically designed for noninvasive ventilation were typically employed. All physiotherapists felt themselves capable of initiating noninvasive positive pressure ventilation, compared with 72.6% of physicians and 33.3% of nurses. Physicians and physiotherapists presented high percentages of correct answers when asked about the indications and contraindications for the use of noninvasive positive-pressure ventilation. Over a one year period, more physiotherapists read articles about noninvasive positive-pressure ventilation and participated in related classes than did physicians, who in turn did so more than did nurses., Conclusion: Noninvasive positive-pressure ventilation equipment is widely available in the greater metropolitan area of São Paulo, although differences exist among public, private and teaching hospitals in terms of the type of equipment used. Physicians and physiotherapists exhibited considerable knowledge regarding the indications and contraindications for the use of noninvasive positive-pressure ventilation. More physiotherapists felt themselves able to initiate noninvasive positive-pressure ventilation, and their knowledge of the subject was more current than was that of physicians or nurses.