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Abstract Background Nonalcoholic steatohepatitis (NASH) is a severe form of nonalcoholic fatty liver disease (NAFLD) characterized by damage and inflammation of hepatocytes. Some medicinal plants have shown antioxidant and anti-inflammatory effects on liver cells. We aimed to investigate the hepatoprotective effect of Heptex® capsules containing 200 mg of Dukung Anak (a powdered extract from aerial parts of Phyllanthus niruri) and 100 mg of Milk Thistle (a powdered extract from fruits of Silybum marianum) in patients with an apparent risk factor for NASH. Methods This was a phase II, randomized, double-blind, placebo-controlled, three-arm, interventional clinical trial. Patients were randomized in a 1:1:1 ratio to receive placebo, low dose (one capsule) of Heptex®, or high dose (two capsules) of Heptex®. After 36 weeks, liver enzymes, Fib-4 score, lipid profile, CAP score, and kPa score were evaluated. Patients were monitored for safety throughout the treatment duration. Results A total of 146 patients were enrolled in the study. A significant decrease was observed in ALT levels in the low-dose group (57 IU/L to 40 IU/L, p = 0.026) and the high-dose group (61 IU/L to 47.5 IU/L, p

Purpose – This paper proposes a framework of instructional strategies that would facilitate active and reflective learning processes in the flipped classroom It is aimed at allowing one’s maximum potential to be reached regardless of any individual learning style. As tertiary classrooms increasingly needs to be as active and social as possible, the needs of the more introverted student could have been unintentionally overlooked. Therefore, the objective of this study was to produce an instructional design that could accommodate different learning styles and preferences in the flipped classroom. Method – A design-based research approach was employed in three phases (preliminary research, prototyping phase and assessment phase) in a flipped communication studies course of 24 students. The instructional design, based on a literature review on the flipped classroom and Felder and Silverman’s active-reflective learning style dimensions, was tested and refined over six iterative design cycles to produce a final design framework. Findings – Qualitative findings via observation showed that despite a learning curve, the finalized instructional design was able to facilitate different learning styles satisfactorily. Added benefits included learner empowerment, engagement, motivation and improved communication and thinking skills. Significance – As a design-based research, this study may be significant from the perspectives of both educational research and practice. Besides adding to the existent literature on different implementations of the flipped classroom, the proposed instructional design may serve as a practical guide for instructors who wish to flip their classrooms and spend face-to-face class time with their students on a more meaningful and personalized level.