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To prepare global surgeons, academic institutions have created training programs that provide opportunities to develop foundational clinical knowledge, pursue academic inquiry, build surgical infrastructure and capacity, and become advocates and collaborators in resource-limited settings. Academic institutions can create a short course in global surgery, global surgery rotation, global surgery fellowship, or integrated global surgery residency. Global surgery training programs must account for ethics of global surgery engagement, sources of funding, structures for professional advancement, and trainee-appropriate partnerships. Global surgery training must include the establishment of accreditation systems, development of integrated training programs, and institutional investment in global surgery education.

This assessment aims to identify the increasing number of morbidity of drug susceptible tuberculosis (TB) and its treatment outcomes, government cost of medicines as well as the economic impact on society. A retrospective observational study had been conducted in a government hospital using a patient’s record from 2013 to 2017, treated under the Direct Observed Therapy Short Course (DOTS) program in Karachi, Pakistan. Altogether, 3872 drug-susceptible TB patients were included in the study. All data had been analyzed using SPSS version 16 software. It had been found from the data that each year number of new smear-positive TB patients remained same, that is, 85% in 2013, 90% in 2014, 89.5% in 2015, 91% in 2016 and 92.3% in 2017 while slight decrease in relapse cases, that is, 15, 10, 10.4, 9 and 7.6% in 2013 to 2017, respectively. The single factor analysis of variance (ANOVA) shows that there is no significant difference between the gender of TB patient throughout the duration with the p-value=0.3769. During the years of study, cost of medicine increased due to rapid rise of inflation in the region which inturn caused the significant financial constraint on patients and their families. moral and financial support are important to render an individual productive again in the society. Key words: Drug-susceptible tuberculosis (DS-TB), anti-tubercular therapy, cost of medicine.

Purpose Vigabatrin has proven efficacy in the treatment of infantile spasms, but it carries the risk of irreversible visual field constriction. The incidence of vigabatrin-induced visual field constriction seems to depend on the extent of vigabatrin exposure. The aim of this study was to evaluate whether the therapeutic effect of vigabatrin is maintained in patients with infantile spasms receiving a short vigabatrin course followed by switching to another antiepileptic drug. Methods Patients with infantile spasms responsive to initial vigabatrin treatment were divided into a vigabatrin switch group (n=25) and a vigabatrin maintenance group (n=41). In the former group, vigabatrin was switched to other drugs within 6 months of spasm remission. The rate of seizure recurrence at 6 and 12 months from spasm remission was compared between the two groups. Results No statistically significant differences were found between the vigabatrin switch and maintenance groups in the age of onset, presence of concomitant seizures, time from spasm onset to vigabatrin treatment, time from vigabatrin treatment initiation to spasm remission, or vigabatrin dose at spasm remission. The number of patients with seizure recurrence at 12 months after spasm remission was 3 (3/25, 12%) in the vigabatrin switch group and 10 (10/41, 24.4%) in the vigabatrin maintenance group. The seizure recurrence rate at 12 months from spasm remission was not significantly different between groups. Conclusion A short course of vigabatrin could be considered in patients with infantile spasms who are responsive to initial vigabatrin treatment, since spasm remission was maintained after switching to other drugs.

Aplicativos móveis (apps) podem ser bons recursos didáticos, favorecendo ações pedagógicas diversas. No entanto, é importante que a seleção de um app para uso educacional seja criteriosa, avaliando aspectos que possam influenciar os propósitos pretendidos. Nesse contexto, este artigo tem por objetivo apresentar a análise da avaliação da qualidade de seis apps que têm potencial para apoiar os processos de alfabetização e letramento. A referida avaliação foi realizada por quatro professoras dos anos iniciais do Ensino Fundamental, durante um minicurso organizado para esse fim. A pesquisa teve caráter qualitativo, e os dados coletados por meio de ficha de avaliação e analisados com base no referencial teórico possibilitaram observar aspectos positivos e algumas limitações nos apps analisados.

A two-week summer camp for high school students focused on sustainable polymers was developed and implemented. Students took part in experiments and interactive lessons that demonstrate polymer che...

Background: Tuberculosis remains a major global health problem. It causes ill-health among millions of people each year and ranks alongside the human immunodeficiency virus (HIV) as a leading cause of death worldwide. The objective of the study was to evaluate the clinical and humanistic outcomes of tuberculosis treatment at the directly observed treatment short-course (DOTS) centre in Jos University Teaching Hospital. Methods: Data for clinical outcomes was collected retrospectively at the directly observed treatment shortcouse centre of Jos University Teaching Hospital from a cross-section of patients’ folders who had been treated for tuberculosis at the study site for at least 12months as at 1st April to 30th September 2018 while a validated questionnaire was administered prospectively to a census population of tuberculosis patients still undergoing treatment between 1st October 2018 and 31st March 2019 to determine the humanistic outcomes. A descriptive data analysis was done using SPSS version 23 and proportions were tested using chi squared statistics with significance level set at P

Introduction Nigeria ranked 7th among the high TB burden nations globally and second most endemic in Africa. There are several highly effective interventions available for tuberculosis control. Operational challenges have been reported to interfere with the success of these interventions. This review was conducted to ascertain the treatment outcome using the Directly Observed Short Course Strategy implemented in the hospital. Methods A retrospective review of the Tuberculosis treatment was conducted in former Ebonyi State Teaching Hospital and Federal Teaching Hospital from 2008 to 2014 as part of the departmental critique of patients’ clinical care and tuberculosis control activities. Using the facility’s TB treatment register, information on the patient’s demography, clinical characteristics and treatment outcome was extracted. The data were analyzed using Epi Info version 7.2. Frequencies and proportions were calculated. Results A total of 1070 cases were reviewed with majority 491 (45.9%) belonging to 25–44 years age group. There were 585 (54.7%) males and 68 (11.6%) paediatrics. Pulmonary tuberculosis (667, 62.3%) was the most common presentation. Among those that did sputum smear AFB, 53.2% were smear negative. In all, 91.2% of the cases were treatment naive, 59.1% were HIV negative at beginning of their treatment while 8% had unknown HIV status. Of the treatment outcome, 40.5% were classified as treatment completed, 16.0% cured, 17.4% of the cases defaulted while 14.1% of the cases died on treatment. These patients were often referred from primary and secondary level hospitals. Conclusions The cure rate was very poor and treatment default rate high. The high default rate could be due to the referral nature of the hospital. The treatment success rate of 56.5% is still far below the national target of 85% treatment success rate for effective tuberculosis control. An operational research is recommended to elicit the root causes of low treatment success rate and high patient default rate.

Background: There is a significant shortage of genomics training curricula targeting health education (HE) students. This study assessed the impact of an online theory-based genomics short course focusing on family health history (FHH) to undergraduate HE students. Materials & methods: Junior and senior HE students (n = 69) at a research-intensive university completed the course and took the pre- and post-course surveys. Results: Participants demonstrated positive improvements in their scores regarding FHH knowledge as well as attitudes, intention and confidence in adopting FHH-based genomics skills into future practice. They also showed satisfaction with the genomics course. Conclusion: Based on the initial success of the results, offering this genomics course to more HE students for further testing is recommended in the future.

Reduction of the inappropriate use of antibiotics in clinical practice is one of the main goals of the Societa Italiana di Medicina Interna (SIMI) choosing wisely campaign. We conducted a systematic review of secondary studies (systematic reviews and guidelines) to verify what evidence is available on the duration of antibiotic treatment in Pneumonia. A literature systematic search was performed to identify all systematic reviews and the three most cited and recent guidelines that address the duration of antibiotic therapy in pneumonia. Moreover, a meta-analysis of non-duplicate data from randomized controlled trials (RCTs) considered in the enrolled systematic reviews was performed together with a trial sequential analysis to identify the need for further studies. Two systematic reviews on antibiotic duration in community-acquired pneumonia (CAP) for a total of 17 RCTs (2764 patients) were enrolled in our study. Meta-analysis of non-duplicate RCTs show a non-significant difference in rate of treatment failure between short (≤ 7 days) and long (> 7 days) antibiotic treatment course: RR 1.05 (95% CI, 0.82–1.36). The trial sequential analysis suggests that further data would not affect current evidence or become clinically relevant. Selected guidelines suggest consideration of a short course, with a low grade of evidence and without citing the already published systematic reviews. Antibiotic treatment of CAP for ≤ 7 days is not associated with a higher rate of treatment failure than longer courses and should thus be taken in consideration. Guidelines should upgrade the evidence on this topic.

Background and objective Previous studies have suggested that early pulmonary rehabilitation (PR) programmes post-AECOPD are an effective and safe intervention for reducing hospital admissions and improving quality of life. This study assessed whether a short course of exercise training post-AECOPD with periodic reinforcement exercise training and phone call reminders reduces readmissions and increases physical activity in COPD patients. Methods Subjects were randomized into either the (i) intervention group (IG), consisting of 4-8 weeks of training supervised by a physiotherapist and phone contact every 2 weeks by a case manager providing support and reinforcement of continuous exercise at home or (ii) usual care group (UG), which had no input by a physiotherapist or case manager. Readmissions were assessed at 12 months. Activities of all patients were assessed by an activity monitor at baseline, 3 and 12 months. Results Altogether, 136 subjects were included and randomized (68 in IG and 68 in UG). The age, gender and FEV1 % predicted were 75.0 ± 6.7 years, 132 males and 47.0 ± 16.2%, respectively. The mean number of readmissions for AECOPD (1.06 vs 1.72 times, P = 0.014) was less and time to first readmission was increased (146.8 vs 122.4 days, P = 0.005) in the IG versus UG at 12 months. At 12 months, there was no change in activity measured by activity monitor between the two groups. Conclusion This programme decreased exacerbation frequency and increased the time of readmissions for AECOPD. It did not improve physical activities and exercise tolerance at 12 months.

Introduction: Simulation-based learning (SBL) has been shown to effectively improve medical knowledge, procedural proficiency, comfort with undertaking taught tasks, inter-professional communication, teamwork and teaching skills. This study aimed to evaluate Rwandan medical students' attitudes, satisfaction and confidence level with SBL. Methods: Fifth year medical students at the University of Rwanda were given a short course on paediatric acute care using simulation. The simulation sessions were locally developed cases based on the pRRAPID materials, developed at the University of Leeds (UK). Equipment included low fidelity infant mannequins, basic airway devices, IV access, and monitoring. A four-part, Likert-scale questionnaire was distributed to medical students before and after their four-week simulation program. Results: 57 pre-simulation and 49 post-simulation questionnaires were completed. Confidence in skills increased in all fifteen domains of the questionnaire with the total skill confidence score rising from 44.0 (±12.3) to 56.2 (±8.8) after the simulation-based intervention (p

The role and sequencing of short-course radiation therapy (SCRT) in the preoperative management of locally advanced rectal cancer is unclear. This study of 39 patients compares outcomes between those who had surgery within 14 days after finishing SCRT and those who were delayed. Our data show similar outcomes between these groups, suggesting SCRT is well-tolerated regardless of sequence. BACKGROUND: The role of neoadjuvant short-course radiation therapy (SCRT) in treating rectal adenocarcinoma is a topic of ongoing debate. Growing interest in total neoadjuvant therapy has spurred discussion on the optimal sequence of preoperative SCRT and chemotherapy. PATIENTS AND METHODS: All patients receiving SCRT (5 Gy × 5 fractions) were identified. Details about preoperative treatments, radiation toxicities, and postoperative complications were collected. Patients were divided into 2 groups: those who underwent surgery within 14 days of completing SCRT and those with a longer delay. Outcomes compared included extent of pathologic response, margin-negative resection rate, acute radiation toxicities, and postoperative complications. RESULTS: Fifty-seven patients with locally advanced or metastatic rectal cancer received SCRT between 2008 and 2018. Thirty-nine of 57 patients underwent definitive pelvic surgery with total mesorectal excision. There were no significant differences in tumor downstaging, radial margin status, or percent tumor viability between patients with immediate surgery versus delayed surgery. The delay group had higher rates of nodal downstaging (64.7% vs. 18.2%; P = .003). There were no differences in total or grade 3+ gastrointestinal radiation toxicity, postoperative complications, reoperation, readmission, and mortality between the 2 groups. CONCLUSIONS: Though not yet common in the United States, SCRT has compared favorably with long course chemoradiation in multiple trials. Moreover, it is associated with greater efficiency and less disruption to chemotherapy. Our data show similar response and toxicity outcomes between the immediate and delay groups, suggesting SCRT is well-tolerated regardless of treatment sequence. Recently completed prospective trials may reveal the optimal preoperative treatment sequence.

Climate change has led to the need for innovation in resilient infrastructure and the social policies which will support those. This requires greater interdisciplinary interactions and knowledge building among emerging professionals. This paper presents a case study of a pilot short course intended to immerse graduate students in the design of resilient infrastructure using place-based and interdisciplinary active team learning. This course helps graduate students bridge the gap between research and practice on the social science and engineering of resilient infrastructure for coastal adaptation. The intellectual framework for the course (the Adaptive Gradients Framework) provides a holistic evaluation of adaptation design proposals and was used to recognize the complexity of social, ecological and engineering aspects and varied social benefits. The course provides a model to move outside rigid boundaries of institutions and disciplines to begin to build, in both students and instructors, the ability to work more effectively on complex social-ecological-engineering problems. Finally, this paper presents a summary of lessons learned from this pilot short course.

Background: Tuberculosis is a public health problem. In the present scenario, the disease burden lies in the low-income countries where a majority of the total population of the world lives. However, the disease is also reported from the developed world. In the present paper, authors aimed at analyzing the Directly Observed Treatment Short-course (DOTS) strategy under the Revised National Tuberculosis Control Program at one of the largest district of the national capital Delhi, by determining the strengths, weakness, opportunities, and threats to the program. Also, the paper gives insights into the various issues associated with it and suggests probable solutions for these issues. Methodology: A qualitative analytical study using structured questionnaires designed specifically for service recipients and service providers was done at the Chest Clinic, Moti Nagar, New Delhi, and its DOT centers and DMC’s. The data collection involved one to one interviews of study subjects and analysis of quarterly reports available at the CCMN and on the internet. The study was conducted from 19th January 2016 to 1 April 2016. Results: A total of 65 subjects were randomly selected and interviewed. Service providers-35, service recipients- 30 (patients taking Category–I treatment under the DOTS of the RNTCP). Conclusions: The study highlights various issues at a large center related directly or indirectly into DOTS and suggest possible solutions for the same. The data could be used to study in detail various other districts of India and other high TB burden countries. Keywords: Analysis, DOTS, RNTCP, TB.

Despite the availability of effective intervention programs over the years, tuberculosis remains a major global health problem. It causes ill-health among millions of people each year and ranks alongside the Human immunodeficiency virus (HIV) as a leading cause of death worldwide. The aim of this study is to assess the outcome of tuberculosis treatment in a Rural Primary Health Care Centre, Benue State, North Central Nigeria. A three-year retrospective study was employed to review 150 tuberculosis cases treated from January 2014 - December 2016. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20 and presented as tables and charts. The relationship between independent and outcome variables were tested with Chi-square test and P-value was set at 0.05. Of the 150 Tuberculosis patients treated, 84(56.0%) were males while 66(44.0%) were females. More than two-thirds (77.3%) of the patients had pulmonary tuberculosis. The successful treatment rate was 60.0% (32.7% treatment completed and 27.3% cured). Over twelve percent defaulted, 10.7% were lost to follow up, 6.7% were transferred out and 0.7% died. In this study, the successful treatment outcome was lower than the National target .The relationship between the disease sites; HIV status, Cotrimoxazole prophylaxis and the treatment outcome were statistically significant. Directly Observed Treatment Short Course (DOTS) providers should address issue of hindrances to adherence to treatment in order to improve the treatment success rate.

Relapse after complicated intra-abdominal infection (cIAI) remains common after treatment. The optimal antibiotic treatment duration for cIAIs is uncertain, especially in cases where source control is not achieved. We hypothesised that in patients with cIAIs, regardless of source control intervention, there would be a lower relapse rate with long-course antibiotics (28 days) compared with short course (≤ 10 days). We piloted a trial comparing ≤ 10-day with 28-day antibiotic treatment for cIAI. A randomised controlled unblinded feasibility trial was conducted. Eligible participants were adult patients with a cIAI that were diagnosed ≤ 6 days prior to screening. Randomisation was to long-course (28 days) or short-course (≤10 days) antibiotic therapy. Choice of antibiotics was determined by the clinical team. Participants were followed up for 90 days. Primary outcomes were willingness of participants to be randomised and feasibility of trial procedures. In total, 172 patients were screened, 84/172 (48.8%) were eligible, and 31/84 (36.9%) were randomised. Patients were assigned to either the short-course arm (18/31, 58.0%) or the long-course arm (13/31, 41.9%). One patient in the short-course arm withdrew after randomisation. In the short-course arm, 4/17 (23.5%) were treated for a cIAI relapse vs 0/13 (0.0%) relapses in the long-course arm. Protocol violations included deviations from protocol-assigned antibiotic duration and interruptions to antibiotic therapy. This feasibility study identified opportunities to increase recruitment in a full trial. This study demonstrates completion of a randomised controlled trial to further evaluate if the optimum antibiotic duration for cIAIs is feasible. ClinicalTrials.gov Identifier: NCT03265834

More people are living for longer following a cancer diagnosis, however long-term survivors are more likely to experience chronic illnesses. Improving their diet and physical activity behaviours may increase survival and reduce the risk of cancer recurrence and other non-communicable diseases. The World Cancer Research Fund and American Institute for Cancer Research recommend that cancer survivors aim to be a healthy weight and physically active; eat a diet rich in wholegrains, vegetables, fruits and beans; limit consumption of ‘fast foods’, red and processed meat, sugar sweetened drinks and alcohol; and meet nutritional needs through diet alone rather than relying on supplements. Evidence suggests that cancer survivors are receptive to receiving advice and making dietary and physical activity changes, but barriers to improving the diet and being physically active need to be explored and addressed. We collaborated with CLAN Cancer Support (an independent charity) to assess the feasibility of a two-day course designed to improve diet and physical activity in cancer survivors in Scotland. Further, it explored the barriers and facilitators that cancer survivors identify in relation to eating a healthy diet and being physically active. The course included presentations, practical activities and group discussions. Initial analysis indicates that factors specific to this population need to be designed into the delivery of the course to enhance recruitment and promote behaviour change. Research then needs to be translated into sustainable support programmes accessible by all cancer survivors. This article describes the rationale behind the study, its design and expected outcomes.

Introduction This case series outlines the results of using prednisolone in patients with moderated respiratory failure secondary to Covid 19 pneumonitis to prevent the progression to invasive ventilation. There is no consensus on the use of prednisolone in Moderate Covid respiratory failure early in the pandemic this should be an additional option where Dexamethasone is not available. Consent was obtained by the patients for anonymous publication of their data.Clinical Findings The author provides evidence of four (4) Covid 19 positive cases admitted to the High dependency Unit with moderate respiratory failure, defined as needing supplementary oxygen therapy to maintain saturations above 90%, who when treated with prednisolone rapidly decreased their oxygen requirement and were successfully weaned to room air within 72 hours of initiation of steroids.Diagnosis Four (4) patients admitted to the High Dependency Unit diagnosed with moderate respiratory failure secondary to PCR positive Covid 19.Intervention Covid 19 positive patients requiring oxygen therapy to maintain saturations above 90% were given a trial of oral prednisolone between 15-30mg until they were weaned to room air maintaining saturations >95%.Outcome Rapid resolution of worsening respiratory function of Covid 19 positive patients within the High Dependency unit in a tertiary medical center. The signs and symptoms of respiratory failure resolved after 72 hours of prednisolone treatment and none of these patients were escalated to non-invasive or invasive respiratory support. The patients were kept for a further 48 hours after the steroids were discontinued to monitor for relapse of symptoms which none of them had.Conclusion Initiation of a prednisolone steroid trial must be considered in Covid 19 positive patients needing supplementary oxygen therapy or developing worsening shortness of breath. Early Covid respiratory failure responds to a low dose for a short duration and prevents escalation to non-invasive/invasive respiratory support.

A 49- year old immunocompetent male presented with a right flank abscess and was found to have disseminated cryptococcal disease. Treatment was initiated with a one-week intravenous regime of amphotericin B and flucytosine based on recent trial data that this is as effective, and less toxic, than the standard two weeks. After completion of intravenous treatment he was discharged with oral anti-fungals and is making a good recovery with ongoing follow up.

This study is intended to determine sex and age differences in young Canadian freestyle swimmers aged from ≤10 to 18, for all 6 distances from 50m to 1500m in both short and long course indoor pools. The data set used in the studies is publicly available and categorized into sex/age/course/distance groups during seasons from 2008 to 2019. The sex differences in swimming speed were determined using independent Z-tests (two-sided, unequal SD). The age differences in swimming speed over all ages were analysed using classic one-way ANOVA with subsequent pairwise Tukey-HSD post-hoc tests and Welch’s ANOVA followed by pairwise Games-Howell post-hoc tests. They were then determined using paired two-sample t-tests (two-sided). Young male swimmers outperformed young female swimmers in most groups. Groups with similar performances or no significant differences were in younger age groups (10-year and 11-year). Sex differences increased as age increased, ranging from −0.96% to 13.54%. Sex differences in shorter distances and short course were smaller than in longer distances and long course for ≤12 years and became greater than in longer distances at ≥13 years. Age speed differences decreased as age increased until 17–18-years old, ranging from 12.79% to −0.37%. The performance of female swimmers became stable earlier than that of male swimmers. The age-to-age speed differences of male swimmers were greater than those of female swimmers. These gaps increased from 10–11-year to 13–14-year groups and decreased after that. Age differences in shorter distances and short course were greater than in longer distances and long course. Further studies are required to confirm and extend this research to swimmers at other age groups, in other strokes, and from other countries.

Background Systemic pentavalent antimonials, mainly meglumine antimoniate, continue to be the first-choice drugs for treatment of cutaneous leishmaniasis (CL) despite their toxicity, difficulty of administration and high cost. In the search for therapeutic alternatives, combining two treatment interventions has emerged as a potential alternative to either reduce the use of antimonials with the associated toxicities, or to increase efficacy. Here, we report the results of a recently completed trial assessing the efficacy and safety of a combination of thermotherapy (TT) plus a short course of miltefosine (MLT) for the treatment of uncomplicated CL in Colombia and Peru. Methods A multicenter, randomized, evaluator-blinded, phase II, controled clinical trial was conducted. Adult volunteers with a parasitologically confirmed diagnosis of uncomplicated CL were randomly allocated to receive either a single session of TT or a combination of TT plus a short course of MLT (3 weeks). Therapeutic response outcomes and safety were assessed. Results 130 subjects were included in the study, of whom 64 were randomly assigned to the TT arm and 66 to the TT + MLT arm. Cure at 3 months’ follow-up was achieved in 57.8% (n = 37) and 80.3% (n = 53) in the TT and TT + MLT groups, respectively, in the intention to treat analysis. The TT + MLT regimen was better that TT alone (p = 0.0055). The presence of vesicles at the site of heat application was the most common adverse event reported associated with the use of TT; while vomiting (31.8%) and elevation of liver enzymes (28.8%) were the most frequent adverse events reported associated with the use of MLT. Conclusion The combination of TT plus a short course of MLT was shown to be significantly better than TT alone for the treatment of uncomplicated CL in the New World. Trial registration Registered in clinicaltrials.gov NCT02687971.

Researchers have quantified swimming races for several decades to provide objective information on race strategy and characteristics. The purpose of the present review was to summarize knowledge established in the literature and current issues in swimming race analysis. A systematic search of the literature for the current narrative review was conducted in September 2020 using Web of Science, SPORTDiscus (via EBSCO), and PubMed. After examining 321 studies, 22 articles were included in the current review. Most studies divided the race into the start, clean swimming, turn, and/or finish segments; however, the definition of each segment varied, especially for the turn. Ideal definitions for the start and turn-out seemed to differ depending on the stroke styles and swimmers’ level. Many studies have focused on either 100 m or 200 m events with the four strokes (butterfly, backstroke, breaststroke, and freestyle). Contrastingly, there were few or no studies for 50 m, long-distance, individual medley, and relay events. The number of studies examining races for short course, junior and Paralympic swimmers were also very limited. Future studies should focus on those with limited evidence as well as race analysis outside competitions in which detailed kinematic and physiological analyses are possible.

Objectives: The authors aim to evaluate the ‘‘point-of-care’’ transfontanellar ultrasound (TU) as an extension to pediatric physical examination and suggest a TU teaching protocol. Methods: The students were randomly divided into two groups, group A (12 participants) and group B (15 participants). The first group only received theoretical training, while the second group received theoretical and practical training. A third group, group C, included 15 pediatricians and interns who also received theoretical and practical training. All the participants underwent multiple-choice testing before and after a four-hour short course on TU. Six months later, another evaluation was performed to analyze the retained knowledge. Furthermore, a questionnaire based on the Likert scale was administered to evaluate satisfaction. Results: The cognitive evaluation (maximum score = 10 points) before and after training increased in group A from 4,0 ± 1,04 to 7,5 ± 1,2 (p < 0.001) and, 6 months later, to 6,5 ± 1,16 (p < 0.003); in group B from 3,8 ± 1,24 to 8,8 ± 1,01 (p < 0.001) and, 6 months later, to 8,46 ± 0,91 (p < 0.001); and in group C from 6,0 ± 0,75 to 9,0 ± 0,75 (p < 0.001) and, 6 months later, to 8,8 ± 0,77 (p < 0.001). The average satisfaction estimated by the Likert scale was over 80% for all questions. Conclusion: Cognitive assessment before and after classes and training reveals progress in learning, with knowledge retention in 6 months. Theoretical-practical courses are well accepted.

The 2016 International Guidelines for the Management of Sepsis and Septic Shock recommend antibiotic therapy for 7-10 days for most patients with sepsis. However, evidence on critically ill patients is limited. Thus, we conducted the first systematic review and meta-analysis comparing the effectiveness and adverse events of shorter- (≤1 week) with longer-course antibiotics in adults with critical infections including sepsis.We searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi databases for randomised controlled trials (RCTs) and observational studies (OSs) from inception to 31 March 2021.We included 6 of 3,766 identified articles, incorporating data from 4 RCTs and 2 OSs (1,721 patients) in meta-analyses. Three RCTs and one OS focussed on ventilator-associated pneumonia, and one RCT and one OS investigated intra-abdominal infections. The severity score levels were similar to that of sepsis, but no study comprehensively focussing on sepsis was found. There were no significant differences in mortality at a maximum follow-up of 30 days (RR 1.08, 95%CI 0.80-1.46); 28-day mortality, clinical cure, the occurrence of new events, and the emergence of resistant organisms between the groups in the RCTs. The OSs findings were consistent. The quality of evidence was assessed as very low to moderate using the GRADE approach, with no uniform description of severity scores, sepsis, or adverse events.Shorter, fixed-duration antibiotic therapy for clinically heterogeneous sepsis or severe infections was not associated with poorer outcomes, but the overall quality of evidence was poor.

In higher education institutions, there is a growing popularity of the use of flipped learning (FL) pedagogy to enhance the learning experience of students. At the undergraduate level, there is increasing evidence to demonstrate the potential benefits of this teaching and learning approach. However, at the level of the postgraduate education, evidence is limited on potential impact of FL on students’ learning experience. We conducted qualitative in-depth interviews and focus groups involving postgraduate students and tutors to explore their perspectives of FL. Campus-based students pursuing the masters of public health (MPH) course, and their tutors at the School of Health and Related Research (ScHARR), University of Sheffield, UK were sampled to participate in the study. Tutors generally demonstrated good knowledge and understanding of the concept of FL and its application, although different tutors use different terms to describe FL. Motivations for the use of FL among tutors were identified as: decision informed by available evidence; curriculum design suited for FL; knowledge/expertise acquired through participating in an online FL short course; advise from colleagues and perception of how higher education students should be learning. Students’ views about FL suitability for their courses were generally positive, with only a few students showing a dislike of this teaching and learning method. Our study results show that tutors and postgraduate students in public health higher education place high value on FL pedagogy, and reported positive experiences of their encounter with the FL pedagogy. The results are encouraging and suggest that higher education institutions running postgraduate masters’ degree courses, particularly public health, could consider adopting and using FL approach to enhance the learning experiences of their students.

Objective Healthcare-acquired infection (HCAIs), have become a significant cause of morbidity as well as mortality among the hospitalized patients and health care workers. The implementation of air-borne infection control measures play an important role in prevention of health care acquired infections (HCAIs). Hence, this study was planned to assess the implementation status of National Airborne Infection Control Guidelines in the health care settings of a North Indian State. Study design A mixed method study was planned in all the 13 health facilities of Himachal Pradesh having both the Anti-Retroviral Therapy (ART) Centre and Directly observed Treatment Short course (DOTS) for TB center in the same facility. Methods The implementation of airborne infection control measures was evaluated using a Standardized Health Care Facility Airborne Infection Risk Assessment Tool and an observational checklist. In-depth interviews are conducted with hospital staff. At all health facilities, risk assessment and implementation of airborne infection control was evaluated by using a pretested semi-structured questionnaire. The qualitative data was analyzed manually and transcripts prepared from hand written notes and audio tape records were analyzed thematically. Results Only 5 out of 13 health facilities were having specially designated airborne infection control committee. The incidence of tuberculosis among hospital staff was 2.32% at secondary level health care facilities and 0.35% at tertiary care level health facilities. Among the tuberculosis cases, maximum were nursing staff (59.5%) as compared to other categories of health care workers. Improper functioning of health care system and individual factors were main reasons for deficiencies in the implementation of air-borne infection control measures. Conclusion The health care facilities were not implementing the infection control measure to the fullest both at secondary and tertiary care health facilities. There is a need to set up the surveillance of airborne infections in the hospital and especially the passive surveillance of tuberculosis among health care workers.

IntroductionMyIBD Care is a mobile phone application delivering digital therapeutics and remote monitoring for patients with inflammatory bowel disease (IBD). The app provides a library of self-management content, direct messaging with clinical teams, and a range of clinically validated disease-measures.During the first wave of the COVID pandemic many IBD patients were forced to shield due active disease or medication. In response to this we developed situationally relevant behavioral science-based courses to alleviate the increased risk of patients developing anxiety or depression due to isolation. Our two courses focussed on maintaining healthy relationships and exercise. The courses were created using the same behavior-change framework as existing courses in the app.MethodsFifteen MyIBD users participated in a study designed to evaluate the effectiveness of the ‘Life in Lockdown’ courses. We assessed changes in mental health (GAD-7) and disease control (IBD-Control) using patient-reported outcome measures delivered through the app.ResultsPatients scored significantly higher on the IBD-control questionnaire following completion of either the 4 or 5-day courses, indicating that they feel more control over their disease following the intervention (median score 5 vs 8.5, p

Appropriate control of the source of infection is of utmost importance in the management of surgical infections. Intra-abdominal infections (IAIs) are the sites where source control is more feasible and more impactful. In these settings appropriate source control can improve patient outcome and reduce antibiotic pressure by allowing a short course of antibiotic therapy.

A study was conducted to assess the economic impact and knowledge retention of participants that attended the Northeast Georgia Beef Cattle Short course over an eight-year period. The course is an educational program hosted by the University of Georgia Extension Service that brings evidence-based science, technology, and economic and management strategies to Georgia beef cattle producers. The short course is taught annually, lasts a full day, and offers guest speakers and demonstrations from University of Georgia faculty and staff along with industry professionals. Non-formal feedback received from participants showcases its value and supports its continuation, but little is known about how the program impacts beef production in Georgia. The goal of the study was to quantify the long-term impact of the short course while developing an assessment tool that can be used to analyze and improve the course moving forward. Qualtrics was used to distribute a survey to 308 attendees of the short course to gather information on respondents’ role in the cattle industry, knowledge of the concepts taught, comfort level utilizing what was learned, and self-reported economic impact. The response rate was 22% for this study. 41% of respondents are retired individuals, 18% were involved in agricultural production and the remainder of participants represented outside professions. 14% of respondents reported that they believed the knowledge they gained during the short course allowed them to save or gain more than $20 per head. An additional 84% reported an economic impact up to $20/head. The most frequently reported source of cattle information was extension programs, at 17%. Based on these data, Extension has a significant impact on the Georgia cattle industry. In order to further develop the program, the recommendation is made that future courses can be developed to further build relationships with cattle producers and larger operations across the state.

Objective : An innovative funding scheme for health care librarians to attend an intensive short course in teaching evidence-based practice was established in the West of England in 2016. This evaluation aims to understand the value of the scheme and the impact of the training opportunity for the librarians, establish an evidence base for continuing with the funding scheme, and inform the development of plans to build additional capacity among health care librarians to provide critical appraisal training. Methods : Seven librarians working in health care system settings were funded by the scheme between 2016 and 2018. Post-course feedback forms gathered initial views on course content and delivery, which informed the development of questions for the qualitative phase of the evaluation. All seven librarians participated in group discussions and individual interviews. Results : The course boosted confidence, provided valuable new skills, and positively impacted careers of the librarians through access to new opportunities. It inspired the development of new approaches to critical appraisal training. An important need was identified among the librarians for more education in teaching. Librarians funded by the scheme have successfully cascaded the training to their colleagues. Conclusion : This evaluation supports the continuation of the funding scheme to further build capacity among health care librarians to teach evidence-based practice. It suggests additional investment in this type of specialist training, as well as in education in teaching skills, would be beneficial for health care librarians. Evidence from this evaluation is informing new plans to support these professionals with the vital service they provide, which contributes to the evidence-based culture of their organizations and to patient outcomes.

Background Tuberculosis (TB) and Coronavirus disease (COVID-19) co-infection can increase the severity among affected patients. This study was conducted to study the burden, risk factors and perceptions of COVID-19 among TB patients. Methods This was a cross-sectional study conducted among TB patients at one of the Directly Observed Treatment Short Course (DOTS) centre of Urban Primary Health Centre (UPHC) of Delhi, India. Information regarding socio–demographic profile, TB disease profile, history of COVID-19 and perceptions about TB and COVID-19 co-infection was collected. Descriptive analysis was performed. Results A total of 107 study participants were enrolled. Twenty-two TB patients (20.6%) never got tested for COVID-19. Two TB patients out of 107 study participants had COVID-19 in past. Both were males in age group of 30–44 years, had drug sensitive TB and were having pre-existing co-morbidities. Transmission routes of TB and COVID-19 were not known to about half of the study participants. Approximately 42.1% study participants perceived TB patients to be at higher risk of COVID-19 and majority study participants agreed that they should follow COVID-19 appropriate behaviour. However, helpline numbers for COVID-19 were not known to most of the study participants. Conclusion One-fifth of TB patients were never tested for COVID-19 inspite of the bi-directional screening guidelines for TB patients. Guidelines need to be practised stringently to find out true burden of co-infection. As the two TB patients who had COVID-19 in past already had other pre-existing co-morbidities as risk factors, whether TB enhances the risk for coronavirus infection independently needs further research.

Background & Aims Shortened duration therapy for acute and recent HCV infection has been shown to be highly effective in several small non-randomised studies with direct-acting antiviral regimens; however, large randomised studies are lacking. Methods REACT was an NIH-funded multicentre international, open-label, randomised, phase IV non-inferiority trial examining the efficacy of short course (6-week) vs. standard course (12-week) therapy with sofosbuvir-velpatasvir for recent HCV infection (estimated duration of infection ≤12 months). Randomisation occurred at week 6. The primary endpoint was sustained virological response 12 weeks after treatment end (SVR12) in the intention-to treat (ITT) population. A total of 250 participants were due to be enrolled, but on advice of the data safety and monitoring board the study was halted early. Results The primary analysis population consisted of 188 randomised participants at termination of study enrolment; short arm (n = 93), standard arm (n = 95). Ninety-seven percent were male and 69% HIV positive. ITT SVR12 was 76/93, 81.7% (95% CI 72.4–89.0) in the short arm and 86/95, 90.5% (95% CI 82.7–95.6) in the standard arm. The difference between the arms was -8.8 (95% CI -18.6 to 1.0). In modified ITT analysis, wherein non-virological reasons for failure were excluded (death, reinfection, loss to follow-up), SVR12 was 76/85, 89.4% (95% CI 80.8–95.0) in the short arm and 86/88, 97.7% in the standard arm (95% CI 92.0–99.7; difference -8.3%, p = 0.025). Conclusions In this randomised study in recent HCV infection, a 6-week course of sofosbuvir-velpatasvir did not meet the criteria for non-inferiority to standard 12-week therapy. Lay summary In this randomised trial, 188 people with recently acquired hepatitis C infection were randomly assigned to treatment using either a short 6-week course (93 people) or standard 12-week course (95 people) of the hepatitis C treatment sofosbuvir/velpatasvir. There were 9 cases of relapse after treatment with the short course and 2 following the standard course. A shortened course of 6-week therapy for hepatitis C infection appeared to be less effective than a standard 12-week course in people with recently acquired hepatitis C infection. ClinicalTrials.gov Identifier NCT02625909 .

As a PhD graduate of The Institute of Optics in 1968, Jim Wyant made important technical contributions to the field in academia and industry. His thesis on topics in holography would augur decades of work in interferometric techniques that have been essential in applications from astronomy to computer technology. His journey from a farm in Ohio, to Case Institute of Technology to the University of Rochester, to the Itek Corporation in Boston and of course to the University of Arizona spanned the country and left an indelible print on the history of optics and The Institute itself. Throughout many years, even as he committed time to the University of Arizona, the OSA and the companies he founded, he continued to support The Institute of Optics through our summer short course program, through advice, and through generous support of professorships and programs at the University of Rochester.

Purpose of Review With increased therapeutic options in rectal cancer, a central question has become how to tailor therapy to patient preferences to avoid both over and under treatment. Total Neoadjuvant Therapy (TNT), defined as delivering all planned chemotherapy and radiation therapy (RT) before surgery, was developed with the primary goal of improving overall survival through early elimination of micrometastatic disease. In this narrative review assessing patients with operable adenocarcinoma of the rectum, we sought to evaluate TNT versus alternative options with regard to both quality of life (QoL) and oncologic outcomes. Recent Findings Survey data of patient preferences reveal that an increased focus on QoL when discussing options is essential. While evidence favors TNT improving distant metastases-free survival, this has not yet translated to a clear OS benefit. The improved pathologic complete response rate with TNT compared to short course RT or chemoradiation alone suggests proceeding to surgery might result in overtreatment, lending support to a Watch-and-Wait (W&W) option for patients with a goal for non-operative management (NOM) if a clinical complete response (cCR) is achieved. Similarly, for select low-risk patients, surgery may be the only local therapy required allowing for safe omission of RT. Conclusions In the treatment of rectal cancer, the future appears to be moving towards one local therapy. As an alternative to TNT, there is growing support for the concept we define herein as total definitive therapy (TDT) instead: chemoradiation followed by consolidation chemotherapy, saving surgery only for incomplete responders rather than as part of the initial treatment plan. Also, selective use of RT should be considered for low-risk patients. By thoroughly assessing how these treatment de-escalation options compare to more traditional treatment algorithms, this narrative review provides guidance on how to honor patient preferences for QoL by avoiding treatments that might offer negligible benefits in oncologic outcomes.

Undergraduate geoscience students are rarely exposed to history and philosophy of science (HPS). I will describe the experiences with a short course unfavourably placed in the first year of a bachelor of earth science. Arguments how HPS could enrich their education in many ways are sketched. One useful didactic approach is to develop a broader interest by connecting HPS themes to practical cases throughout the curriculum, and develop learning activities that allow students to reflect on their skills, methods and their field in relation to other disciplines and interactions with society with abilities gained through exposure to HPS. Given support of the teaching staff, the tenets of philosophy of science in practice, of conceptual history of knowledge, and of ethics of science for society can fruitfully and directly be connected to the existing curriculum. This is ideally followed by a capstone HPS course late in the bachelor programme.

INTRODUCTION: Exposure to elevated ambient ozone levels has been associated with exacerbation of asthma, likely mediated by oxidative stress. We have shown that supplementation with the antioxidant vitamin E isoform, gamma tocopherol, mitigates the inflammatory effects of inhaled endotoxin exposure, a key component of ambient air particulate matter. OBJECTIVE: The objective of the current study was to assess the efficacy of gamma tocopherol for mitigating pulmonary effects of ozone, using an abbreviated dosing regimen that could be rapidly begun when high ozone days are anticipated. MATERIALS AND METHODS: We conducted a randomized, double blind, placebo-controlled crossover study of adults with mild asthma who were pre-treated with gamma tocopherol-enriched supplement and exposed to 0.25 ppm ozone for 3 hours. Induced sputum samples were obtained before and after ozone exposure to measure airway inflammation. Mucociliary clearance was estimated using gamma scintigraphy. RESULTS: With the short course of gamma tocopherol pre-treatment, we found no significant effect on ozone-induced airway inflammation. A transient slowing of clearance in the large airways was seen following ozone exposure in the placebo treatment period that was not present during gamma tocopherol treatment. DISCUSSION: Short course gamma tocopherol did not protect against ozone-induced airway inflammation. Future work will focus on the efficacy of longer courses of gamma tocopherol supplementation for mitigating pollutant-induced health effects. The early transient ozone effect on airway clearance as well as the impact of gamma tocopherol on this effect will be further explored in future studies.

Objectives Systems thinking aims to understand the overall behavior of a system by examining the interdependencies of parts of the system. The objective of this study is to increase awareness of systems thinking and systems modeling in public health research and practice. Study design A short course was offered to public health professionals using a combination of teaching modalities: didactic lectures, group discussions, hands-on programming, and experiential learning. Methods Course participants completed surveys and provided feedback on the effectiveness of the course. A description of participant backgrounds, survey responses, and feedback were summarized. Results Overall, participants offered quantitative and qualitative feedback suggesting that course content was useful and effective for incorporating systems thinking/modeling in their public health practice. Conclusions Systems thinking can be taught through formal modes of instruction to public health workers, but more research and case studies are needed to identify who should be taught and when and how such instruction should take place given competing priorities of public health workers.

Tuberculosis (TB) is a contagious infectious disease caused by the bacterium Mycobacterium tuberculosis, which can attack various organs, especially the lungs. TB treatment can be given in 2 stages, the intensive phase 2 months of treatment and the next stage 4-6 months later. Non-adherence of TB patients to treatment at a health care facility regularly becomes an obstacle in achieving recovery and may increase the risk of morbidity, mortality, and drug resistance in both TB patients and the wider community. WHO applies the Direct Observed Treatment Short Course (DOTS) strategy in the management of TB patients to ensure that patients swallow the drug under direct supervision by a Drug Supervisor (PMO). In this case the family can act as a PMO and provide support to TB patients so that it can be an important factor in tuberculosis treatment adherence. Several studies have found a relationship of family social support and medication adherence. The family needs to provide positive support to involve the family as a supporter of treatment so that there is cooperation in monitoring the treatment between the officers and family members who are sick.

Data science skills are rapidly becoming a necessity in modern science. In response to this need, institutions and organizations around the world are developing research data science curricula to teach the programming and computational skills that are needed to build and maintain data infrastructures and maximize the use of available data. To date, however, few of these courses have included an explicit ethics component, and developing such components can be challenging. This paper describes a novel approach to teaching data ethics on short courses developed for the CODATA-RDA Schools for Research Data Science. The ethics content of these schools is centred on the concept of open and responsible (data) science citizenship that draws on virtue ethics to promote ethics of practice. Despite having little formal teaching time, this concept of citizenship is made central to the course by distributing ethics content across technical modules. Ethics instruction consists of a wide range of techniques, including stand-alone lectures, group discussions and mini-exercises linked to technical modules. This multi-level approach enables students to develop an understanding both of “responsible and open (data) science citizenship”, and of how such responsibilities are implemented in daily research practices within their home environment. This approach successfully locates ethics within daily data science practice, and allows students to see how small actions build into larger ethical concerns. This emphasises that ethics are not something “removed from daily research” or the remit of data generators/end users, but rather are a vital concern for all data scientists.

Liberia has no rheumatology providers for the nation's 4.7 million people. We proposed a short course format rheumatology curriculum to educate Liberian providers as an initial step in providing graduate medical education in musculoskeletal health.A 1-week training curriculum in rheumatology encompassing introduction to musculoskeletal exam and approach to rheumatology diagnosis and management was designed. The curriculum used multiple education methods including interactive lectures, bedside training, and hands-on learning.A 1-week rheumatology training curriculum for 24 local physicians was feasible. The execution of the designed rheumatology curriculum in Liberia relied upon a mixed method format that was both didactic and case-based. A survey of the Liberian trainees revealed that the curriculum was salient to care of patients and barriers to optimal learning such as time and space limitations were identified.A 1-week rheumatology training education program is possible and relevant to local providers, but training length and setting may need to be optimized. Future training will aim to minimize barriers to education and expand the cohort of providers with rheumatologic knowledge in Liberia.Key Points• Liberia, like many nations in sub-Saharan Africa, has no trained rheumatologists to serve the nation's population.• Education and capacity building for rheumatologic care in short course format are relevant and feasible to local health-care providers.• Further efforts are needed to develop and evaluate continuing rheumatology education in Liberia.

Context: Directly observed treatment short course (DOTS) was adopted as the strategy for the provision of treatment to increase treatment completion. Poor adherence to medication has been noted and poses a big challenge even after achieving 70% case detection and 85% cure rate. The focus remains on dealing with important reasons of default and timely retrieval of patients who interrupt the treatment. Aims: The aim of the study was to measure the noncompliance of DOTS and to determine the reason for the same among patients in rural area of Pune. Materials and Methods: An observational cross-sectional study was conducted with a study population comprising the patients who were getting treatment in November 2016 and must have completed at least 1 month of treatment in Mulshi block. The study period was from November 2016 to January 2017. All the patients were interviewed using a pretested questionnaire for their compliance. Results: The total number of patients included in the study was 88. The age was 18–70 years in which 77.3% were male and 22.7% were female. We found 71.6% new cases, and 27.3% were the previously treated patients, whereas 1.1% were multidrug-resistant patients. Among these patients, 25% were tobacco chewers and 31.8% were smokers. We found that 61.4% were compliance patients and 38.6% were noncompliance patients. Reasons given by the patients were side effects, stigma of the society, migration from one place to another, and felt better from symptoms after taking medication. Conclusion: Noncompliance in our study is high. We should take steps regarding this so that people adhere to the medication.

The article is devoted to the problem of periodization of universal history in the work "A Short Course in Economic Science" written by Alexander Bogdanov. It analyzes the changes in the periodization of the historical process in various editions of the work, identifies the intellectual sources of those changes and establishes a connection between the evolution of Bogdanov’s historical concept and the development of historical science in the late 19th and early 20th centuries. The main direction in the evolution of Bogdanov’s historical views was the transition from a linear progressive scheme of world history to a description of history as a complex non-linear process in which periods of development are combined with periods of decline and stagnation. Abandoning the idea of steady linear progress, Bogdanov also abandoned the strict correspondence between a specific economic form and a certain historical era and concluded that various economic forms could coexist. The changes in Bogdanov’s approaches to the question of the role of economic forms in the periodization of world historical process testify to his search for special features specifying various eras in the history of mankind and reflect a general interest in the substantial characteristics of time characteristic of the European intellectual space of the first third of the 20th century. © 2020, Perm State University. All rights reserved.