The efficacy of blended learning in a pediatric spinal deformity management program in Tanzania

Introduction: Blended learning, which combines in-person learning and e-learning, has grown rapidly in education. Advantages of this modality include control over content, learning sequence, and pace of learning, allowing participants to tailor their experiences to meet their personal learning objectives. Blended learning enables adaptive and collaborative learning and transforms the teacher's role from transmitting knowledge (instructing) to facilitating learning. Objectives: Our study aimed to assess the efficacy of blended learning in a pediatric scoliosis training program through the largest Surgical Training Institution in Sub-Saharan Africa, The College of Surgeons of East, Central and Southern Africa (COSECSA). Material and Methods: The course comprised of three parts;1-the online portion, which allowed participants to review lectures, papers, and audiovisual materials over a 3-week period;2-the in-person session, where participants spent a full day with an international expert, reviewing cases in a team-based approach and coming to a consensus on treatment strategy;and 3-a one week, in-person experience where participants were exposed to pre-surgical planning conferences, clinic, casting, and scrubbing into surgeries with international experts. All participants completed a Needs Assessment (NA) and quiz prior to the course. The NA contained 6 various topics, with 3 questions for each topic scored by a 10-point scale in pediatric spine deformity. The quiz included 15 surgical and clinical questions related to the pediatric spine deformity topics. The NA and quiz were taken before the course, after the online session, and after the in-person session. A final survey was conducted at the end of the in-person surgical week. Results: Thirty-six orthopedic surgeons and neurosurgeons enrolled in the course primarily from Tanzania, Kenya, and Malawi. The NA assessment scores improved significantly over the course of the three surveys from 67.3 prior to the course, to 90.9 mid-course, and 94.0 after the course (p = 0.0007). The clinical quiz scores improved over the 3 time points from 9.91 to 11.9, and 12.3, respectively. At the end of the in-person surgical week, 100% of respondents stated that they had improvement in knowledge and 92% considered the knowledge sufficient to change their clinical practice. In surveying the persistent obstacles to translating knowledge gained through blended learning to clinical practice, the top responses were constraints in personnel and cost of implants at their home institution. Conclusion: The blended learning approach in a pediatric spine deformity program is effective, feasible, and shows a statistically significant change in participants' confidence and knowledgebase in these complex pathologies. Our results are limited due to the small sample size. Future studies will evaluate larger number of participants in the post-COVID era and translation to other areas of spine surgery, such as minimally-invasive surgery.

Transcriptional regulation and small compound targeting of ACE2 in lung epithelial cells.

Angiotensin-converting enzyme 2 (ACE2) is the receptor of COVID-19 pathogen SARS-CoV-2, but the transcription factors (TFs) that regulate the expression of the gene encoding ACE2 (ACE2) have not been systematically dissected. In this study we evaluated TFs that control ACE2 expression, and screened for small molecule compounds that could modulate ACE2 expression to block SARS-CoV-2 from entry into lung epithelial cells. By searching the online datasets we found that 24 TFs might be ACE2 regulators with signal transducer and activator of transcription 3 (Stat3) as the most significant one. In human normal lung tissues, the expression of ACE2 was positively correlated with phosphorylated Stat3 (p-Stat3). We demonstrated that Stat3 bound ACE2 promoter, and controlled its expression in 16HBE cells stimulated with interleukin 6 (IL-6). To screen for medicinal compounds that could modulate ACE2 expression, we conducted luciferase assay using HLF cells transfected with ACE2 promoter-luciferase constructs. Among the 64 compounds tested, 6-O-angeloylplenolin (6-OAP), a sesquiterpene lactone in Chinese medicinal herb Centipeda minima (CM), represented the most potent ACE2 repressor. 6-OAP (2.5 µM) inhibited the interaction between Stat3 protein and ACE2 promoter, thus suppressed ACE2 transcription. 6-OAP (1.25-5 µM) and its parental medicinal herb CM (0.125%-0.5%) dose-dependently downregulated ACE2 in 16HBE and Beas-2B cells; similar results were observed in the lung tissues of mice following administration of 6-OAP or CM for one month. In addition, 6-OAP/CM dose-dependently reduced IL-6 production and downregulated chemokines including CXCL13 and CX3CL1 in 16HBE cells. Moreover, we found that 6-OAP/CM inhibited the entry of SARS-CoV-2 S protein pseudovirus into target cells. These results suggest that 6-OAP/CM are ACE2 inhibitors that may potentially protect lung epithelial cells from SARS-CoV-2 infection.

¿Es viable implementar la renta básica universal en Colombia?

Este artículo tiene como objetivo analizar el debate presentado en Colombia sobre la posible implementación de la renta básica universal, entendida esta como una medida que busca garantizar un ingreso mínimo para las personas que no pueden acceder al mercado laboral. Así las cosas, en primera medida se explicará el contexto en el que surgió la propuesta en Colombia (la pandemia de la covid-19), luego estudiaremos la experiencia de otros países y, por último, analizaremos si en el contexto económico, político y social actual del país hay cabida para la aplicación de esta medida.Alternate :This paper aims to analyze the debate presented in Colombia on the possible implementation of the universal basic income. It is understood as a measure that seeks to guarantee a minimum income for people who cannot access to the labor market. Thus, first we will explain the context in which the proposal arose in Colombia (The covid-19 pandemic), then we will study the experience of other countries and finally, we will analyze if in the current economic, political and social context of the country, it is possible to apply this policy.