Assessment of blood pressure measurement skills in second-year medical students after ongoing simulation-based education and practice.

BACKGROUND: Simulation-Based Education (SBE) simulates specific physiological characteristics of a patient, allowing student practice in developing clinical skills and assessment of skill competency. Literature is limited regarding SBE's effectiveness in curriculum enrichment. This study investigated Blood Pressure (BP) measuring proficiency of second-year medical students with first-year SBE training and a second-year review, by comparing data from Simulation-Based assessments in 2017 and 2019. METHODS: Second-year medical students measured BP on three manikin arms, associated with distinct clinical contexts (healthy young male, young female experiencing hypotension, and older male suffering hypertension and diabetes). All manikins' BP settings were independent of clinical context. In January 2019, 108 second-year medical students who received traditional training, as well as SBE in 2017 and Simulation-Based practice in 2018, were divided into four groups (n = 32, 24, 24, and 28), with two groups each assessed on consecutive days. The proportions of correct BP values in each of three contexts were compared between experiments in 2017 and 2019. Additionally, systolic (SBP) and diastolic (DBP) blood pressure results were stratified into three groups: lower than setting value, correct, and higher than setting vgalue, with proportions for each group compared for the 2017 and 2019 studies using Fisher's Exact Tests. RESULTS: In Case Two and Three, the proportion of correct BP values significantly increased from 2017 (Case Two: 51%; Case Three: 55%) to 2019 (Case Two: 73%; Case Three: 75%). Additionally, proportions of students who reported lower SBP values than setting values were significantly decreased in Case One and Two, with five failing all contexts. CONCLUSIONS: Second-year student BP measurement skills were improved, not only due to repeated Simulation-Based practice but advancing basic science knowledge and mastery experience in ongoing curriculum. Simulation-Based assessment provided an effective tool for evaluating skill retention and proficiency in medical training.

Scenario-based simulation health care education for performance of hand hygiene.

BACKGROUND: Simulation health care education is widely used in medical education and has great potential. However, scenario-based simulation health care education for preventing health care-associated infections has not been described. METHODS: A single-center, prospective cohort study was conducted at Tokyo Medical University Hospital (1,015 beds), an acute care teaching hospital, from January 2011 to December 2014. Each training course was held every month and lasted 2 hours. Trainees put on and removed personal protective equipment under scenarios of standard precaution (2 scenarios) and contact precaution with methicillin-resistant Staphylococcus aureus (1 scenario), while considering the timing of hand hygiene. We determined the correlations between the participation rate in the simulation education and the use of alcohol-based hand disinfection and reduction of catheter-related bloodstream infection. RESULTS: There were 1,077 trainees. The total participation rate for hospital staff, which increased gradually during the study period, was 76% by the end of the study. The overall correlation between the use of alcohol-based hand disinfection in the hospital and the course participation rate was significant (correlation coefficient, 0.97). An inverse correlation (-0.94) was observed for the relation between the training course participation rate and the incidence of catheter-related bloodstream infection. CONCLUSIONS: Our training course had a positive effect on hand hygiene. This study is the first effective scenario-based simulation health care education on hand hygiene and control of health care-associated infection.

Relation of clinical context to accuracy of simulator-based blood pressure measurement by first-year medical students.

OBJECTIVES: To explore the association between clinical contexts and accuracy of manikin blood pressure readings by first-year medical students after first Simulation-Based-Education training. METHODS: This cross-sectional study, in controlled simulation settings, was comprised of 121 first-year medical student participants after their first Simulation-Based-Education training. Divided into three groups (n = 39, 42 and 40), participants measured blood pressure on three simulator arms assigned different clinical contexts: healthy young male, young female with hypotension, and elderly male with hypertension and diabetes. Each group performed the same protocol on three different days. A Chi-squared test was performed for between-day and between-case differences of correct answers, and one-way ANOVA with Bonferroni post-hoc comparisons was performed for manikin-settings deviation (reported Systolic Blood Pressure (SBP) - set SBP) among cases. RESULTS: The proportion of correct answers of on Day Two was significantly lower than on the other two days (χ2(2, N = 285) = 0.34, p = .84), but roughly comparable among cases (χ2(2, N = 285) = 24.07, p < .001). The mean of the differences of (SBPreported - SBPset) of Case Two (M = -6.68, SD = 8.91) was significantly lower than Case One (M = -3.07, SD = 9.11) and Three (M = -1.63, SD = 7.76) (F (2, 274) = 8.68, p < .001). CONCLUSIONS: Although no statistical associations were found between clinical contexts and student performance in blood pressure measurement, student familiarity with diseases may be associated with performance in taking blood pressure. Day Two performance underscores the need to promote student confidence in diagnostic skills.

Selective Crystallization of Phosphoester Coordination Polymer for the Separation of Neodymium and Dysprosium: A Thermodynamic Approach.

Thermodynamics of the formation of coordination polymers (CPs) or metal-organic frameworks (MOFs) has not been focused on, whereas many CPs or MOFs have been synthesized in a solution. With a view of separating Nd3+ and Dy3+ in an aqueous solution, we demonstrate that crystallization of the CPs of Nd3+ and Dy3+ based on dibutyl phosphoric acid (Hdbp) can be thermodynamically described; crystallization yields of [Ln(dbp)3] (Ln = Nd or Dy) complex are predicted well using a simple calculation, which takes the apparent solubility products (Kspa) for [Ln(dbp)3] and the acid dissociation constant of Hdbp into account. The Kspa values of [Nd(dbp)3] and [Dy(dbp)3] are experimentally determined to be (1.3 ± 0.1) × 10-14 and (2.9 ± 0.4) × 10-18 M4, respectively, at 20 °C. The ratio of these Kspa values, that is, ca. 4500, is significantly larger than the ratio of the solubility products for inorganic salts of Nd3+ and Dy3+. Therefore, Nd3+ and Dy3+ are selectively crystallized in an aqueous solution via the formation of CPs. Under optimized conditions, Dy3+ crystallization is preferable, whereas Nd3+ remains in the solution phase, where the ratio of the Dy molar content to the total metal content (i.e., Nd + Dy) in the crystal is higher than 0.9. The use of acids, such as HCl or HNO3, has no practical impact on the separation in an aqueous solution.

[Study on job support programs for drug addicts in japan: results of a nationwide survey on drug addiction rehabilitation centers (DARC)].

In Japan, many drug addiction rehabilitation centers (DARC) provide various types of recovery programs for drug addiction. The purpose of this study was to clarify the attitudes of DARC staff and users regarding job support programs. A nationwide questionnaire survey was conducted in 2009. The staff of 46 facilities and 606 users returned questionnaires. The results indicated that many (92.1%) users had work experience before entering the recovery programs provided by DARC and about half (49.3%) of the users reported being motivated to work. Although many DARC have established various job support programs, the users faced various levels of anxieties to get employed and 60.4% of the users expected to learn more detailed and concrete methods for finding a job. Through the DARC programs, the users gradually realize the significance of basic daily living skills such as maintaining their rhythm of life or neat and presentable appearance. And the more they get recovered the more they understand the significance of "self-care" and "interpersonal relationship skills". These findings indicate that job support programs for drug addicts should also focus on these recovery processes. More extensive job supports dealing with more practical issues and covering a wide variety of anxieties would be imperative.

Lanthanide ion exchange properties of a coordination polymer consisting of di(2-ethylhexyl) phosphoric acid and trivalent metal ions (Ce3+, Fe3+, or Al3+).

Three kinds of coordination polymers ([M(dehp)3], M = Ce, Fe, or Al) were prepared by mixing the sodium form (Na(dehp)) of di(2-ethylhexyl) phosphoric acid and MCl3 in an ethanol-water binary mixture. They have monoclinic crystalline structure with similar lattice parameters. The lanthanide ion (Ln(3+) = La(3+), Sm(3+), Dy(3+), or Yb(3+)) exchange properties were studied in a 20 : 80 vol% ethanol-water binary mixture containing 2 mM Ln(NO3)3 at room temperature. The rate of Ln(3+) adsorption is relatively slow; it requires over 3 weeks to reach equilibrium. [M(dehp)3] has different Ln(3+) affinities depending on the kind of central metal ions: the affinity order at 3 week adsorption is Yb(3+) < La(3+) < Dy(3+) < Sm(3+) for [Ce(dehp)3], La(3+) < Sm(3+) < Dy(3+) < Yb(3+) for [Fe(dehp)3], and La(3+) < Sm(3+), Dy(3+), Yb(3+) for [Al(dehp)3]. The difference in affinity order can be explained by two factors: the coordination preference and steric strain caused by the polymeric structure. The chemical and structural analyses suggested that the Ln(3+) adsorption progresses first by the central M(3+)/Ln(3+) exchange, followed by a morphological change to a rod-like or fibrous form by a solid phase reaction. In the case of [Fe(dehp)3], the eluted Fe(3+) may be hydrolyzed and precipitated as amorphous iron hydroxide.

Central metal ion exchange in a coordination polymer based on lanthanide ions and di(2-ethylhexyl)phosphoric acid: exchange rate and tunable affinity.

In this paper the exchange of lanthanide(III) ions (Ln(3+)) between a solution and a coordination polymer (CP) of di(2-ethylhexyl)phosphoric acid (Hdehp), [Ln(dehp)3], is studied. Kinetic and selectivity studies suggest that a polymeric network of [Ln(dehp)3] has different characteristics than the corresponding monomeric complex. The reaction rate is remarkably slow and requires over 600 h to reach in nearly equilibrium, and this can be explained by the polymeric crystalline structure and high valency of Ln(3+). The affinity of the exchange reaction reaches a maximum with the Ln(3+) possessing an ionic radius 7% smaller than that of the central Ln(3+), therefore, the affinity of the [Ln(dehp)3] is tunable based on the choice of the central metal ion. Such unique affinity, which differs from the monomeric complex, can be explained by two factors: the coordination preference and steric strain caused by the polymeric structure. The latter likely becomes predominant for Ln(3+) exchange when the ionic radius of the ion in solution is smaller than the original Ln(3+) by more than 7%. Structural studies suggest that the incoming Ln(3+) forms a new phase though an exchange reaction, and this could plausibly cause the structural strain.

Steric effect involved in Ln3+/Ce3+ exchange in a coordination polymer based on di(2-ethylhexyl)phosphoric acid.

Coordination polymers can be attractive ion exchange materials because of their crystallinity and semi-flexibility, which are rather opposing properties, and play integral and synergistic roles in introducing unique ion-exchange behavior. In this paper, Ln(3+)/Ce(3+) exchange (Ln(3+) = Nd(3+), Gd(3+), Dy(3+), or Lu(3+)) in a coordination polymer, [Ce(dehp)3], based on di(2-ethylhexyl)phosphoric acid (Hdehp) is studied by distribution coefficient measurements, ion-exchange isotherms, Kielland plot analysis, and morphology observation. The ion-exchange selectivity is in the order Nd(3+) < Gd(3+) < Dy(3+) < Lu(3+) when a small amount of Ln(3+) is loaded, but Lu(3+) ≈ Nd(3+) < Gd(3+) ≈ Dy(3+) for a high loading ratio. The Kielland plot suggests that a steric effect is involved in the reactions, which becomes stronger in the order of Nd(3+)/Ce(3+) < Gd(3+)/Ce(3+) < Dy(3+)/Ce(3+) < Lu(3+)/Ce(3+) for exchange systems. This trend is attributable to the differences in the ionic sizes between an incoming Ln(3+) and original Ce(3+). Scanning electron microscopy observations reveal the generation of a new phase via the Ln(3+)/Ce(3+) exchange. Such a phenomena results from solid-solid transformation, rather than dissolution-recrystallization. The small steric strain in the Nd(3+)/Ce(3+) system leads to the formation of a Nd(3+)-and-Ce(3+) solid-solution, whereas the morphological change is possibly restrained by the strong strain caused by loaded Ln(3+) with an ionic size significantly smaller than the original Ce(3+).

Repeated scenario simulation to improve competency in critical care: a new approach for nursing education.

BACKGROUND: In Japan, nursing education is being reformed to improve nurses' competency. Interest in use of simulation-based education to increase nurses' competency is increasing. OBJECTIVES: To examine the effectiveness of simulation-based education in improving competency of cardiovascular critical care nurses. METHODS: A training program that consisted of lectures, training in cardiovascular procedures, and scenario simulations was conducted with 24 Japanese nurses working at a university hospital. Participants were allocated to 4 groups, each of which visited 4 zones and underwent scenario simulations that included debriefings during and after the simulations. In each zone, the scenario simulation was repeated and participants assessed their own technical skills by scoring their performance on a rubric. Before and after the simulations, participants also completed a survey that used the Teamwork Activity Inventory in Nursing Scale (TAINS) to assess their nontechnical skills. RESULTS: All the groups showed increased rubric scores after the second simulation compared with the rubric scores obtained after the first simulation, despite differences in the order in which the scenarios were presented. Furthermore, the survey revealed significant increases in scores on the teamwork scale for the following subscale items: "Attitudes of the superior" (P < .001), "Job satisfaction" (P = .01), and "Confidence as a team member" (P = .004). CONCLUSIONS: Our new educational approach of using repeated scenario simulations and TAINS seemed not only to enhance individual nurses' technical skills in critical care nursing but also to improve their nontechnical skills somewhat.

[Study on risk factors of suicidal ideation in people with drug abuse].

In Japan, the target mental disorders of preventive strategies for suicide had been limited to be mood disorder, but recently drug abuse are known to be significant as a cause of suicide because some researches has found the association between substance use disorder and suicidal behavior in Japan. However, the preventive plans for suicide of drug abusers has not been developed yet. In this study we would like to examine the risk factors of suicide ideation in Japanese drug abusers. We analyzed the data of 445 drug addicts from the Nationwide Research of Drug Addiction Rehabilitation Centers by Tokyo DARC and compared many variables including demographic factors, drug use status, family history, psychopathologies, treatment and daily life satisfactions between people with suicide ideations and without ideations. It was found that 182 cases (43.8%) had suicide ideations in a recent month, and that addicts who had suicide ideations had significantly shorter abstinence time, higher prevalence of victimized experiences before 15 years age, and more mental symptoms such as insomnia, depression, and psychotic symptoms, and more tendencies to use prescribed psychotropic drug than those without suicide ideation. These results suggested that to prevent suicide of drug abusers, we should pay attention to family histories, insomnia and abstinence periods, and help them recovery from psychological damages caused by childhood trauma without inappropriate medications.

HPLC analysis of lipoproteins in culture medium of hepatoma cells: an in vitro system for screening antihyperlipidemic drugs.

We isolated a HepG2-derived sub-clone (HepG2-Lipo), which possessed an increased lipoprotein synthesizing ability. HepG2-Lipo cells could secrete triglycerides (TG) and cholesterol at rates 9.4- and 6-fold higher, respectively, when compared to HepG2 cells. Real-time RT-PCR analysis revealed that the expression levels of sterol regulatory element-binding protein-1c and -2 were 2.9- and 1.5-fold higher than in HepG2 cells. Furthermore, two apolipoprotein (apo) genes (apoA-1 and apoB-100) in HepG2-Lipo cells were expressed at 2.8- and 1.9-fold higher levels when compared to those in parental cells. We examined the effects of three antihyperlipidemic agents on the lipoprotein profiles of HepG2-Lipo cells. Simvastatin at 5 microM selectively suppressed cholesterol secretion from HepG2-Lipo cells, and 500 microM fenofibrate inhibited both TG and cholesterol secretion from the cells.

[Correlation between childhood traumatic stress and present drug abuse: results of a nationwide survey of drug addiction rehabilitation facilities in Japan].

Child abuse is known to correlate with drug abuse and interferes with recovery from substance-related disorders. To determine the prevalence and severity of child abuse among drug addicts, we conducted a nationwide cross-sectional survey of residents and outpatients at drug addiction rehabilitation centers (DARC) in Japan. A total of 445 participants gave informed consent and completed a self-reporting questionnaire. Sixty-eight percent of participants had experienced some kind of child abuse by the time they reached junior high school. The kinds of abuse experienced were physical (53.7%), psychological (60.4%), sexual (5.4%) abuse and neglect (24.5%). Comparison of female and male participants revealed that more female than male participants had experienced psychological (76.9% vs. 58.2%) and sexual (17.5% vs. 4.0%) abuse. Comparison of participants who had experienced some kind of child abuse ("Abused" group 68.3%) and those who had not experienced abuse ("Non-abused" group 24.3%) revealed that the "Abused" group was younger than the "Non-abused" group (35.7 SD9.0 vs. 39.7 SD10.8). Participants in the "Abused" group were found to have more severe psychological difficulties than those in the "Non-abused" group for the following: anxiety (73.0% vs. 61.1%), delusional atmosphere (48.0% vs. 28.7%), lack of energy (53.9% vs. 40.7%), ideas of persecution (48.7% vs. 29.6%), depression (62.2% vs. 43.5%) and suicidal ideation in the previous year (50.7% vs. 24.3%). The present results suggest that additional program that prepared to care the drug addicts who experienced child abuse and are experiencing suicidal ideation is needed. Furthermore, intervention for families with risk factors for child abuse should be developed in order to prevent the victim from suffering not only from post traumatic stress disorder but also from substance related disorders.

Functional coexpression of the mitochondrial alternative oxidase and uncoupling protein underlies thermoregulation in the thermogenic florets of skunk cabbage.

Two distinct mitochondrial energy dissipating systems, alternative oxidase (AOX) and uncoupling protein (UCP), have been implicated as crucial components of thermogenesis in plants and animals, respectively. To further clarify the physiological roles of AOX and UCP during homeothermic heat production in the thermogenic skunk cabbage (Symplocarpus renifolius), we identified the thermogenic cells and performed expression and functional analyses of these genes in this organism. Thermographic analysis combined with in situ hybridization revealed that the putative thermogenic cells surround the stamens in the florets of skunk cabbage and coexpress transcripts for SrAOX, encoding Symplocarpus AOX, and SrUCPb, encoding a novel UCP that lacks a fifth transmembrane segment. Mitochondria isolated from the thermogenic florets exhibited substantial linoleic acid (LA)-inducible uncoupling activities. Moreover, our results demonstrate that LA is capable of inhibiting the mitochondrial AOX pathway, whereas the proportion of pyruvate-stimulated AOX capacity was not significantly affected by LA. Intriguingly, the protein expression levels for SrAOX and SrUCPb were unaffected even when the ambient air temperatures increased from 10.3 degrees C to 23.1 degrees C or from 8.3 degrees C to 24.9 degrees C. Thus, our results suggest that functional coexpression of AOX and UCP underlies the molecular basis of heat production, and that posttranslational modifications of these proteins play a crucial role in regulating homeothermic heat production under conditions of natural ambient temperature fluctuations in skunk cabbage.

Pyruvate-sensitive AOX exists as a non-covalently associated dimer in the homeothermic spadix of the skunk cabbage, Symplocarpus renifolius.

The cyanide-resistant alternative oxidase (AOX) is a homodimeric protein whose activity can be regulated by the oxidation/reduction state and by alpha-keto acids. To further clarify the role of AOX in the skunk cabbage, Symplocarpus renifolius, we have performed expression and functional analyses of the encoding gene. Among the various tissues in the skunk cabbage, SrAOX transcripts were found to be specifically expressed in the thermogenic spadix. Moreover, our data demonstrate that the SrAOX protein exists as a non-covalently associated dimer in the thermogenic spadix, and is more sensitive to pyruvate than to other carboxylic acids. Our results suggest that the pyruvate-mediated modification of SrAOX activity plays a significant role in thermoregulation in the skunk cabbage.

The detection of bovine lactoferrin binding protein on Trypanosoma brucei.

Trypanosoma brucei, the causative agent of sleeping sickness in humans, requires transferrin (TF) for growth. Therefore, T. brucei has a TF receptor that allows it to obtain iron from TF. Lactoferrin (LF), a member of the TF family protein, is an iron-binding protein that is found in most biological fluids of mammals. LF has been shown to interact with some bacteria species by specific receptor-ligand binding. We examined the ability of T. brucei to bind bovine LF (bLF) by using a fluorescence test, streptavidin-biotin (SAB) microplate analysis, and far Western blotting using a biotin-streptavidin system. We found that bLF bound to components of T. brucei, and that bLF hydrolysate disrupted the sites responsible for binding to parasite proteins. Furthermore, bLF, human LF, bovine TF, and ovotransferrin bound same proteins of T. brucei, which exhibited molecular masses of 40 and 43 kDa. The N-terminal amino acid sequence of the 40 kDa bLF binding protein was identified as glyceraldehyde-3-phosphate dehydrogenase (GAPDH).

Ubiquitous expression of a gene encoding for uncoupling protein isolated from the thermogenic inflorescence of the dead horse arum Helicodiceros muscivorus.

Uncoupling proteins (UCPs) are a family of mitochondrial inner membrane proteins that have been implicated in heat production in mammalian cells. The inflorescences of several members of the arum lily family (Araceae) have also been shown to produce heat during flowering, but the involvement of UCP-mediated heat production in plants is not known. In this work a gene has been isolated termed HmUCPa that encodes for a putative uncoupling protein from Helicodiceros muscivorus, a highly thermogenic arum lily. RT-PCR analysis revealed that the expression of HmUCPa was ubiquitously found, both in thermogenic male florets and appendix, and the non-thermogenic female florets, spathe and club-shaped organs of the spadix. These results suggest that HmUCPa is not primarily involved in organ-specific heat production in H. muscivorus.

The detection of bovine lactoferrin binding protein on Toxoplasma gondii.

Lactoferrin (LF), a member of the transferrin (TF) protein family, is an iron-binding protein that is known to interact with bacteria through a specific receptor. We examined the binding of bovine LF (bLF), bovine TF (bTF), and ovotransferrin (OTF) by Toxoplasma gondii using a fluorescence test and the streptavidin-biotin (SAB) method using biotin-streptavidin, and found that bLF, bTF, and OTF bound to the protein components of T. gondii. Furthermore, we confirmed that bLF, bTF, and OTF bound a 42 kDa soluble protein of T. gondii by far Western blot method. These results demonstrated that bLF binding proteins are present on T. gondii.