Implementation of the online learning management system ‘Moodle’ as a blended approach to online teaching

Objectives: Web-based learning is becoming a newly accepted standard in education, more so with COVID-19 pandemic. To use technology to redesign learning experiences, a blend of synchronous and asynchronous approaches was used wherein the routine lectures through MS Teams (synchronous) were integrated with an online learning management system (LMS), ‘Moodle’ (modular object-oriented dynamic learning environment) based, four-quadrant approach (asynchronous). We aimed to determine the student’s engagement, performance and perception of the new online LMS. Materials and Methods: All 170 students of the 1st year MBBS of batch 2020 were enrolled in the course. A module was developed for teaching ‘Physiology of Vision’ with this blended approach. Along with routine online lectures through Microsoft Teams, supplementary materials in the form of multimedia presentations and additional links to useful websites were provided through online LMS. The online activity of students was recorded and assessments were done. A feedback form was filled out by students at the end of the course. Results: A significant positive correlation of examination scores with individual student’s activity logs and significantly better scores in top Moodle users along with significantly higher marks in Moodle-based modules than in other modules confirmed the value of Moodle in improving student performance. Overall feedback from students was clearly in favour of implementing Moodle as a complementary tool to traditional teaching. Conclusion: Moodle improved the quality of learning. It developed interest and motivation among students and has a positive impact on academic outcomes.

Functional Autapses Form in Striatal Parvalbumin Interneurons but not Medium Spiny Projection Neurons / 神经科学通报·英文版

Autapses selectively form in specific cell types in many brain regions. Previous studies have also found putative autapses in principal spiny projection neurons (SPNs) in the striatum. However, it remains unclear whether these neurons indeed form physiologically functional autapses. We applied whole-cell recording in striatal slices and identified autaptic cells by the occurrence of prolonged asynchronous release (AR) of neurotransmitters after bursts of high-frequency action potentials (APs). Surprisingly, we found no autaptic AR in SPNs, even in the presence of Sr2+. However, robust autaptic AR was recorded in parvalbumin (PV)-expressing neurons. The autaptic responses were mediated by GABAA receptors and their strength was dependent on AP frequency and number. Further computer simulations suggest that autapses regulate spiking activity in PV cells by providing self-inhibition and thus shape network oscillations. Together, our results indicate that PV neurons, but not SPNs, form functional autapses, which may play important roles in striatal functions.

Experience of a medical school in the Philippines on the sudden shift to online learning amidst COVID-19

Introduction@#The COVID-19 pandemic forced educational institutions to adapt to a full online learning environment. Medical schools in particular were disrupted by this shift since the majority of the learning objectives, skills, and necessary competencies are learned through classroom and hospital face-to-face activities. @*Objective@#The purpose of this paper is to describe the experiences of a medical school in the country as it navigated the sudden shift to full online learning vis-à-vis a framework on the barriers and solutions to online learning. @*Method@#This is a descriptive paper written from the perspective and observations of an administrator who participated in crafting the immediate response of the school to the sudden shift to online delivery and who worked with the stakeholders of the Ateneo School of Medicine and Public Health (ASMPH). @*Results@#To address concerns on time, skills and infrastructure, the school reprioritized its learning objectives for the remainder of the school year. It conducted in-service sessions for faculty while also immediately setting up a learning management system and a technical support team that was available on demand. Strategies employed included a deliberate switch to asynchronous learning, curation of content and creativity in delivery and assessment, and the reshaping of the management and public health activities into the online platform. To manage attitudes and provide institutional support, the school worked collaboratively with stakeholders and transformed its traditional support services of campus ministry, counselling, formation, and physical and mental health to be readily available online. @*Conclusion@#We described the experience of ASMPH when medical schools were forced to completely shift to online delivery of their programs because of the pandemic. We identified the barriers and solutions of online learning in medical education. The unique context of the ASMPH for having a dual degree in medicine and management; having an inter-disciplinal, non-departmentalized set-up at each year level; and, possessing the traditions of Jesuit education were instrumental in the school’s ability to navigate this sudden shift.

Exploration and practice of new online teaching model of clinical microbiology laboratory technology theory course / 中华医学教育探索杂志

We have adopted various smart tools and applied multiple teaching models to smoothly carry out our on-line teaching. Aiming at encouraging students' self-learning and independent thinking, the first task is to cultivate students' self-learning ability and independent thinking way of clinical microbiology. Our online teaching model is based on the asynchronous small private online course (SPOC) of the Chinese University MOOC, the core part of our teaching model, and supplemented by the Sojump questionnaire test and WeChat, the inter-action channels among teachers and students. All of these build up an integrated teaching system which fully embodies the "student-oriented" teaching concept and pushes forward the promotion and application of online teaching in college specialized courses.

Release from Restraint / 医学教育

The faculty development for clinical supervisor teaching residents (FD) was held for two nights on site in Japan. However, corona pandemic made it difficult to conduct the FD on site, thus we conducted it completely online. To avoid participants’ burden of long hours of synchronous online learning, we adopted a flipped classroom in which assignments in asynchronous online learning was used in discussion in synchronous learning. Assignments were issued sequentially five weeks prior to the synchronous session, and the synchronous session was held from 5:00 p.m. on Friday, November 13, 2020 to Saturday, November 14, 2020 for 45 participants. All participants completed the course by submitting all the assignments. The online flipped classroom utilizing assignments has a potential to significantly reduce the time constraints on busy clinicians.

Cytosolic delivery of the immunological adjuvant Poly I:C and cytotoxic drug crystals

Co-delivery of chemotherapeutics and immunostimulant or chemoimmunotherapy is an emerging strategy in cancer therapy. The precise control of the targeting and release of agents is critical in this methodology. This article proposes the asynchronous release of the chemotherapeutic agents and immunostimulants to realize the synergistic effect between chemotherapy and immunotherapy. To obtain a proof-of-concept, a co-delivery system was prepared

Parto diferido o asincrónico del segundo gemelo: un caso clínico con buen desenlace neonatal / Delayed interval delivery or asynchronous birth of the second twin: a case report with a good outcome neonatal

Resumen ANTECEDENTES: El parto diferido o asincrónico ocurre cuando los fetos de un embarazo múltiple nacen con una diferencia de días o semanas. La finalidad es incrementar la edad gestacional del segundo gemelo y aumentar la tasa de supervivencia. CASO CLÍNICO: Paciente primigesta de 39 años, con embarazo gemelar bicorial, biamniótico logrado mediante fertilización in vitro. En la semana 23 + 2 acudió a urgencias por sangrado vaginal y dolor abdominal. En la especuloscopia se observó líquido amniótico claro y dilatación cervical de 4-5 cm. El registro cardiotocográfico reportó dinámica uterina franca. En la ecografía se visualizaron dos fetos: el primero en presentación podálica sin latido cardiaco y el segundo en transversa con latido cardiaco. Después del nacimiento del primer gemelo se observó la retracción del cuello uterino y desaparición de la dinámica uterina. El estudio ecográfico mostró la bolsa amniótica íntegra, sin signos de desprendimiento placentario ni pérdida del bienestar fetal. Se propuso a la pareja la posibilidad de realizar un cerclaje cervical y diferir el parto del segundo gemelo, hecho que fue aceptado. Se consiguió prolongar la gestación del segundo gemelo 77 días, que nació mediante parto, sin morbilidad materna ni fetal. CONCLUSIONES: El parto diferido es una práctica adecuada para incrementar la tasa de supervivencia del feto o fetos retenidos. Los protocolos asociados con este tipo de partos son variados. Se requieren estudios adicionales para establecer los criterios de tratamiento de este tipo de partos.

Abstract BACKGROUND: Delayed Interval delivery or asynchronous birth is when a multiple pregnancy`s fetuses are not born simultaneously, and with several day´s difference between their births. This practice´s objective is to increase the second twin´s gestational age and, as such, improve its survival rate. CLINICAL CASE: A 39 years-old patient with bicorial biamniotic twin pregnancy achieved by in vitro fertilization. At 23 + 2 weeks of pregnancy assisted to Emergency service for vaginal bleeding and abdominal pain. In the speculoscopy a clear amniotic fluid and cervical dilation of 4-5 cm was observed. The cardiotocographic record reported frank uterine dynamics. In the ultrasound, two files are displayed: the first in the syntax presentation in the heartbeat and the second in the transversal with heartbeat. After the birth of the first twin, retraction of the cervix and the disappearance of uterine dynamics were observed. The ecological study showed the amniotic bag intact, without signs of placental detachment or loss of fetal well-being. It was proposed to the couple the possibility of performing the cervical fence and the other part of the second day, which was accepted. It was possible to prolong the gestation of the second year to 77 days, which was born through childbirth, without registering maternal or fetal morbidity. CONCLUSIONS: Delayed Interval delivery is a good practice to increase the survival rate of a retained fetus or retained fetuses. The protocols associated with this type of births are varied. Additional studies are required to establish treatment criteria for this type of births.

Cost-effectiveness of synchronous vs. asynchronous telepsychiatry in prison inmates with depression / Costo-efectividad de telepsiquiatría sincrónica frente a asincrónica para personas con depresión privadas de la libertad

Abstract Introduction: Telepsychiatry is defined as the use of information and communication technology (ICT) in providing remote psychiatric services. Telepsychiatry is applied using two types of communication: synchronous (real time) and asynchronous (store and forward). Objective: To determine the cost-effectiveness of a synchronous and an asynchronous telepsychiatric model in prison inmate patients with symptoms of depression. Methods: A cost-effectiveness study was performed on a population consisting of 157 patients from the Establecimiento Penitenciario y Carcelario de Mediana Seguridad de Manizales, Colombia. The sample was determined by applying Zung self-administered surveys for depression (1965) and the Hamilton Depression Rating Scale (HDRS), the latter being the tool used for the comparison. Results: Initial Hamilton score, arrival time, duration of system downtime, and clinical effectiveness variables had normal distributions (p >0.05). There were significant differences (p < 0.001) between care costs for the different models, showing that the mean cost of the asynchronous model is less than synchronous model, and making the asynchronous model more cost-effective. Conclusions: The asynchronous model is the most cost-effective model of telepsychiatry care for patients with depression admitted to a detention centre, according to the results of clinical effectiveness, cost measurement, and patient satisfaction.

Resumen Introducción: La telepsiquiatría se define como la utilización de las tecnologías de la información y la comunicación (TIC) en la prestación de servicios de psiquiatría a distancia. La aplicación de la telepsiquiatría está dada por dos tipos diferentes de comunicación: sincrónico (tiempo real) y asincrónico (tiempo diferido). Objetivo: Determinar la costo-efectividad de un modelo de telepsiquiatría sincrónico frente a otro asincrónico en pacientes con síntomas de depresión internados en un centro de privación de libertad. Métodos: Se realizó un estudio de costo-efectividad. Constituyeron la población 157 pacientes del Establecimiento Penitenciario y Carcelario de Mediana Seguridad de Manizales, Colombia. La muestra se determinó con la encuesta auto aplicable Zung para la depresión (1965) y la escala de valoración de Hamilton para la evaluación de la depresión (Hamilton depression rating scale [HDRS]), instrumento con que se realizó la comparación. Resultados: Las variables Hamilton inicial, tiempo de llegada, duración de caídas del sistema y efectividad clínica presentaron distribución normal con p > 0,05; entre los diferentes modelos hubo diferencias significativas (p < 0,001) en los costos de atención, y se evidenció que, en promedio, el costo del modelo asincrónico es menor que el del sincrónico; en promedio, la modalidad asincrónica es más costo-efectiva. Conclusiones: El modelo de atención más costo-efectivo en telepsiquiatría para pacientes con trastorno depresivo internados en un centro de privación de libertad es el asincrónico según los resultados de efectividad clínica, medición de costos y satisfacción del paciente.

Excitability of cortical neurons and their neural network / 中国药理学与毒理学杂志

The cerebral cortex contains a large variety of neuronal cells, which connect with each other via synapses to form different neural networks and fundamental elements for brain functions such as sense, movement, learning, language and decision making. Information processing in the cerebral cortex requires the activation of individual neurons and their recurrent networks,that is,the generation of action potential (AP) (excitability of single neurons) and network activity (excitability of neural networks).Initiation of AP occurs at the axon and is determined by axonal ion channels as well as intrinsic biophysical properties.The excitability of recurrent networks is not only determined by the excitability of different types of neurons, but also regulated by the unique properties of neurotransmitter release in distinct synapses including excitatory and inhibitory ones.Traditionally,it is believed that the all-or-none AP is the only mode of information transmission-digital mode.Recent studies have shown that the subthreshold membrane potential fluctuations regulate AP-induced the synaptic transmission-analog mode. At the network level, the network activity is relatively stable, resulting from a dynamic balance of excitation and inhibition. The microcircuits of recurrent inhibition mediated by distinct inhibitory interneuron types and the modes of synaptic transmission,such as the analog mode of signal communication and asyn-chronous neurotransmitter release,play critical roles in maintaining the excitation and inhibition balance. Together,we present here some new insights into the mechanisms underlying the excitability of distinct types of cortical neurons and their interconnected networks.

Oocyte development and fecundity type of the Brazilian Snapper Lutjanus alexandrei Moura & Lindeman, 2007 (Perciformes: Lutjanidae) / Desenvolvimento ovocitário e tipo de fecundidade da baúna de fogo Lutjanus alexandrei Moura & Lindeman, 2007 (Perciformes: Lutjanidae)

Abstract Lutjanid species exhibit multiple spawning behaviour during an extended spawning season in warm months, asynchronous oocyte development and indeterminate fecundity. Although early studies have contributed to knowledge of the reproductive cycle of many species within the group, they have not considered aspects about the number of cortical alveoli oocyte stage throughout maturity phases along spawning season. The latter aspect is also considered very important to confirm indeterminate fecundity hypothesis. In the present study, were analyzed 154 Brazilian snapper Lutjanus alexandrei female gonads obtained from artisanal fisheries in Pernambuco State (Brazil) between October 2010 and March 2011. Were measured oocyte size frequency distribution for maturity phases (developing, spawning capable and actively spawning), and oocyte development stage (unyolked oocytes, cortical alveoli, primary, secondary and tertiary vitellogenic oocytes and hydrated oocytes), and also the oocyte stage frequency during spawning season. The frequency of cortical alveoli oocyte stage was constantly found in the spawning period (>37%), showing slight variation throughout maturity phases. The absence of gap in the oocyte size frequency distribution between primary and secondary oocyte growth stages during spawning season is a strong indicator of continuous oocyte recruitment from reserve stocks. In addition, co-occurrence of tertiary vitellogenic oocytes, hydrated oocytes, post-ovulatory follicles and yellow-brown bodies in the histological sections of ovaries reinforce indeterminate fecundity hypothesis.

Resumo Os lutjanídeos apresentam um comportamento de desovas parceladas ao longo de uma extensa estação reprodutiva nos meses mais quentes do ano, desenvolvimento assincrônico dos ovócitos e padrão de regulação de fecundidade indeterminado. Embora muitos estudos anteriores tenham contribuído no conhecimento do ciclo reprodutivo das espécies do grupo, não foram considerados os aspectos relacionados ao percentual dos ovócitos em estágio de cortical alveoli entre as fases de maturidade sexual durante a estação reprodutiva. Este último aspecto, considerado importante para confirmação da hipótese de fecundidade do tipo indeterminada. Para isso, no presente trabalho foram analisadas 154 gônadas de fêmeas da baúna de fogo Lutjanus alexandrei obtidas da pesca artesanal em Pernambuco entre o período de outubro de 2010 a março de 2011. Foram mensurados os diâmetros dos ovócitos nas fases de maturidade sexual (desenvolvimento, capaz de desovar e ativamente desovando), e para todos os estágios ovocitários (ovócitos pre-vitelogênicos, cortical alveolar, vitelogênese primária, secundária, terciária e ovócitos hidratados), e avaliada a frequência de ocorrência ao longo do período de desova. O percentual de ovócitos em estágio cortical alveoli permaneceu constante durante o período de reprodutivo (> 37%), apresentando pouca variação entre as fases de maturidade sexual. A ausência de um intervalo na frequência de diâmetro dos ovócitos em crescimento primário e secundário entre todas as fases de maturidade sexual é um forte indicador de recrutamento contínuo de ovócitos do estoque de reserva. Além disso, a presença conjunta de ovócitos em vitelogênese terciária, ovócitos hidratados, folículos pós-ovulatórios e corpos amarelados nos cortes histológicos reforçam a hipótese de fecundidade do tipo indeterminada.

Temporal protein expression pattern in intracellular signalling cascade during T-cell activation: A computational study.

Various T-cell co-receptor molecules and calcium channel CRAC play a pivotal role in the maintenance of cell’s functional responses by regulating the production of effector molecules (mostly cytokines) that aids in immune clearance and also maintaining the cell in a functionally active state. Any defect in these co-receptor signalling pathways may lead to an altered expression pattern of the effector molecules. To study the propagation of such defects with time and their effect on the intracellular protein expression patterns, a comprehensive and largest pathway map of T-cell activation network is reconstructed manually. The entire pathway reactions are then translated using logical equations and simulated using the published time series microarray expression data as inputs. After validating the model, the effect of in silico knock down of co-receptor molecules on the expression patterns of their downstream proteins is studied and simultaneously the changes in the phenotypic behaviours of the T-cell population are predicted, which shows significant variations among the proteins expression and the signalling routes through which the response is propagated in the cytoplasm. This integrative computational approach serves as a valuable technique to study the changes in protein expression patterns and helps to predict variations in the cellular behaviour.

Induced reproduction in a migratory teleost species by water level drawdown

Captive reproduction is one of the problems faced in aquaculture requiring the manipulation of environmental factors and/or hormonal treatment. Thus, we seek to verify experimentally which gonadal changes were present in mature individuals of Astyanax altiparanae arising from decreased water level. Collections were made every four hours, initiated four hours before and finished 28 hours after stimulation, at the Fish Farming Station of Companhia Energética de São Paulo, São Paulo, Brazil. The gonads were analyzed by light microscopy. The females had ovaries in the spawning capable phase until 12h; in 16h, in a more advanced stage of spawning capable phase; and, from 20h, in the regressing phase. Males had testes in the spawning capable phase until 8h; in 12h, in a more advanced stage of spawning capable phase; and, from 16h, the return to the spawning capable phase. The morphological description was corroborated by the proportion of cell classes. Females presented variation on the gonadosomatic index, but it was not found an emptying of the gonad for neither sex. The process of inducing reproduction with water level drawdown was considered satisfactory, since both sexes presented a reduction in the number of mature gametes at the end of the sample period.

Reprodução em cativeiro é um dos problemas enfrentados na aquicultura exigindo a manipulação de fatores ambientais e/ou tratamento hormonal. Assim, verificou-se experimentalmente as alterações gonadais presentes em indivíduos adultos de Astyanax altiparanae decorrentes da diminuição do nível da água. As coletas foram realizadas a cada quatro horas, iniciadas quatro horas antes e encerradas 28 horas após a estimulação, na Estação de Piscicultura da Companhia Energética de São Paulo, São Paulo, Brasil. As gônadas foram analisadas por microscopia de luz. As fêmeas apresentaram ovários na fase de apto à reprodução até 12h; em 16h, um estágio mais avançado desta fase; e, a partir das 20h, na fase de regressão. Os machos tiveram os testículos em fase de apto à reprodução até 8h; em 12h, um estágio mais avançado desta fase; e, a partir das 16h, o retorno à fase de apto à reprodução. A descrição morfológica foi corroborada pela proporção das classes celulares. As fêmeas apresentaram variação no índice gonadossomático, mas não foi estabelecido o esvaziamento das gônadas para nenhum dos sexos. O processo utilizado para a indução à reprodução foi considerado satisfatório, uma vez que ambos os sexos apresentaram redução no número de gametas maduros no final do período de amostragem.

The therapeutic effect of stereotactic γ-ray body radiation therapy for patients with asynchronous bilateral renal cell carcinoma / 中华放射医学与防护杂志

Objective To preliminarily evaluate the feasibility,therapeutic effect and normal tissue complications of stereotactic γ-ray body radiation therapy for patients with asynchronous bilateral renal cell carcinoma.Methods Nine patients with inoperable asynchronous bilateral renal cell carcinoma with a median time from the resection of the primary focus and discovery of the contralateral focus underwent stereotactic γ-ray body radiotherapy with OUR-QGD stereotactic γ-ray whole body therapeutic planning system.50％ isodose line,as the prescription dose line,was to cover the planning target volume (PTV) and the 70％ isodose line was to cover the gross target volume (GTV).Radiotherapy was delivered,with a single dose of 3-5 Gy per fraction,one fraction per day,5 fractions per week,and totally 10-17 fractions.The PTV edge total dose was 36-51 Gy,and the GTV edge total dose was 60-85 Gy.The patients were followed up for a median time of 24 months to evaluate the local control rate and overall survival rate.Results Of the 9 patients,1 presented complete remission (11.1％) and 4 partial remission (44.5％),with a total effective rate of 55.6％.The 1-,3-,and 5-year local control rates were 64.8％,43.2％,and 43.2％ respectively.The 1-,3-,and 5-year overall survival rates were 66.7％,53.3％,and 35.6％ respectively.Four patients (44.4％) had acute radiation reaction:2 cases with grade l leukocytopenia and 2 cases with grade 1 gastrointestinal reactions.Two patients showed grade 2 late radiation-induced reaction in gastrointestinal system.The Karnofsky score was significantly increased and the renal function was normal after radiotherapy.Conclusions Stereotactic γ-ray body radiation therapy is safe and effective in the treatment of asynchronous bilateral renal cell carcinoma.

Diagnosis and treatment of bilateral primary breast cancer: a report of 16 cases / 中华内分泌外科杂志

Objective To summarize our experience on diagnosis and treatment of bilateral primary breast cancer (BPBC). Methods Clinicopathologic records, including clinical manifestations, diagnosis and immunohistochemical expressions of 16 patients with BPBC, treated from 2001 to 2009 in Jiangsu Provincial Cancer Hospital, were analyzed retrospectively. Results The 16 patients with BPBC accounted for 0.47% of all patients diagnosed as malignant tumors of breast during the same period in our hospital. All of the 16 patients were women, with the median age of 53 years (ranged 41-69 years). 7 patients were in bilateral synchronous breast cancer (BSBC), with the median age 47 years (ranged 41-54 years), among whom 5 patients got BSBC just before menopause. 9 patients were in bilateral asynchronous breast cancer (BABC), with the median age 58 years (ranged 43-69 years), among whom 1 patient got BABC before menopause. The median interval between the first and second breast carcinoma of BABC was 52 months (ranged 14-196 months). Conclusions Compared with BABC, the occurrence age of the patients with BSBC was smaller. BABC was more common in premenopausal women. The interval time of BABC was irregular. The active follow-up after the occurrence of contralateral breast cancer and endocrine therapy for estrogen receptor-positive patients were recommended.

Câncer de mama masculino bilateral e assíncrono / A synchonous bilateral male breast cancer

Câncer de mama masculino é patologia rara e ainda pouco estudada. O diagnóstico geralmente é tardio e com prognóstico comprometido em virtude da resistência dos homens em procurar auxílio médico. Entretanto, quando diagnosticado precocemente, tem maior probabilidade de cura. Os autores relatam um caso de câncer mamário masculino bilateral assíncrono e fazem uma revisão dos casos semelhantes já publicados.

Male breast cancer pathology is rare and poorly studied. The diagnosis is usually delayed and the prognosis is compromised because of resistance from men to seek medical help. However, when diagnosed early, has a higher probability of cure. The authors report a case of asynchronous bilateral male breast cancer and do a review of similar cases already published cases.