Polarity Based Model for Guiding Medical School Strategy During Crisis - A Cross Sectional Qualitative Study.

BACKGROUND: Crises in academia can best be dealt with as a polarity that needs to be leveraged rather than a problem that needs to be solved. This work aimed at utilizing the Polarity Approach for Continuity and Transformation (PACT)™ to establish a guide for medical schools during times of crisis to minimize the effect of crisis-driven decisions on strategic growth. SUBJECTS AND METHODS: A qualitative study following the 5-Steps of the PACT process was conducted. A virtual mapping session was held with 108 medical educators from 22 countries to determine the upsides and downsides of strategic orientation and crisis management subsequently. RESULTS: Four polarity maps were generated identifying four tension areas; University reputation, mission, teams, and individuals followed by a 72-item assessment and another mapping session to map the warning signs and action steps. A comparison between private school scores and the whole cohort of respondents showed that private schools had the least problems in team-oriented work. CONCLUSION: This study highlighted the importance of taking measures to communicate the mission and supporting team functions inside universities either by enhancing resources or utilizing time and effort-saving strategies.

Model for utilizing distance learning post COVID-19 using (PACT)™ a cross sectional qualitative study.

BACKGROUND: COVID - 19 pandemic pressured medical schools globally to shift to Distance learning (DL) as an alternative way to ensure that the content delivered is satisfactory for student progression. AIM OF THE WORK: This work aims at mapping priorities for post-COVID planning for better balance between distance learning and face to face learning. METHODS: This qualitative study aimed to develop a model for utilizing DL using The Polarity Approach for Continuity and Transformation (PACT)™. A virtual mapping session was held with 79 faculty from 19 countries. They worked in small groups to determine upsides and downsides of face-to-face and DL subsequently. An initial polarity map was generated identifying five tension areas; Faculty, Students, Curriculum, Social aspects and Logistics. A 63-item assessment tool was generated based on this map, piloted and then distributed as a self-administered assessment. The outcomes of this assessment were utilized for another mapping session to discuss warning signs and action steps to maintain upsides and avoid downsides of each pole. RESULTS: Participants agreed that face-to-face teaching allows them to inspire students and have meaningful connections with them. They also agreed that DL provides a good environment for most students. However, students with financial challenges and special needs may not have equal opportunities to access technology. As regards social issues, participants agreed that face-to-face learning provides a better chance for professionalism through enhanced team-work. Cognitive, communication and clinical skills are best achieved in face-to-face. Participants agreed that logistics for conducting DL are much more complicated when compared to face-to-face learning. Participants identified around 10 warning signs for each method that need to be continuously monitored in order to minimize the drawbacks of over focusing on one pole at the expense of the other. Action steps were determined to ensure optimized use of in either method. CONCLUSION: In order to plan for the future, we need to understand the dynamics of education within the context of polarities. Educators need to understand that the choice of DL, although was imposed as a no-alternative solution during the COVID era, yet it has always existed as a possible alternative and will continue to exist after this era. The value of polarity mapping and leveraging allows us to maximize the benefit of each method and guide educators' decisions to minimize the downsides for the good of the learning process.

Evaluation of the effect of alternative measurements of body weight gain and dry matter intake for the calculation of residual feed intake in growing purebred Charolais and Red Angus cattle.

The objective of this study was to determine the effects of alternative-measurements of body weight and DMI used to evaluate residual feed intake (RFI). Weaning weight (WW), ADG, and DMI were recorded on 970 growing purebred Charolais bulls (n = 519) and heifers (n = 451) and 153 Red Angus growing steers (n = 69) and heifers (n = 84) using a GrowSafe (GrowSafe, Airdrie, Alberta, Canada) system. Averages of individual DMI were calculated in 10-d increments and compared to the overall DMI to identify the magnitude of the errors associated with measuring DMI. These incremental measurements were also used in calculation of RFI, computed from the linear regression of DMI on ADG and midtest body weight0.75 (MMWT). RFI_Regress was calculated using ADG_Regress (ADG calculated as the response of BW gain and DOF) and MMWT_PWG (metabolic midweight calculated throughout the postweaning gain test), considered the control in Red Angus. A similar calculation served as control for Charolais; RFI was calculated using 2-d consecutive start and finish weights (RFI_Calc). The RFI weaning weight (RFI_WW) was calculated using ADG_WW (ADG from weaning till the final out weight of the postweaning gain test) and MMWT_WW, calculated similarly. Overall average estimated DMI was highly correlated to the measurements derived over shorter periods, with 10 d being the least correlated and 60 d being the most correlated. The ADG_Calc (calculated using 2-d consecutive start and finish weight/DOF) and ADG_WW were highly correlated in Charolais. The ADG_Regress and ADG_Calc were highly correlated, and ADG_Regress and ADG_WW were moderately correlated in Red Angus. The control measures of RFI were highly correlated with the RFI_WW in Charolais and Red Angus. The outcomes of including abbreviated period DMI in the model with the weaning weight gain measurements showed that the model using 10 d of intake (RFI WW_10) was the least correlated with the control measures. The model with 60 d of intake had the largest correlation with the control measures. The fewest measured intake days coupled with the weaning weight values providing acceptable predictive value was RFI_WW_40, being highly correlated with the control measures. As established in the literature, at least 70 d is required to accurately measure ADG. However, we conclude that a shorter period, possibly as few as 40 d is needed to accurately estimate DMI for a reliable calculation of RFI.

Relationship between feed intake, feeding behaviors, performance, and ultrasound carcass measurements in growing purebred Angus and Hereford bulls.

The objectives of this study were to examine the growth, DMI, and feeding behaviors of Angus and Hereford bulls; identify the relationships between feeding behaviors and variation in DMI and residual feed intake (RFI); and determine the value of feeding behaviors in predicting DMI. Individual DMI was measured in Angus bulls (n=189; initial BW=427±3.4 kg) and Hereford bulls (n=146; initial BW=411±4.1 kg) fed a grower ration for 71 d in 2009, 78 d in 2010, and 74 d in 2011 using a GrowSafe intake monitoring system. Feeding frequency (FF, meals/d), head down duration (HDD, s/d), head down duration per meal (HDDM, HDD/FF, s/meal), average meal size [AMS, kg/(meal·d)], and feeding rate (FR, g/s) were also measured or calculated using behavior data collected by the GrowSafe system. Ultrasound measures of 12th-rib fat thickness (UFT), longissimus muscle area (ULMA), and intramuscular fat (IMF) were determined during the midtest-weight event of every trial. The data from 3 yr were pooled to generate mean differences between the breeds. Residual feed intake was calculated using a linear regression of DMI on ADG and midtest BW0.75 (MMWT). Animals were classified into 3 RFI groups based on their RFI score as Low (>0.5 SD below the mean), Average (±0.5 SD from the mean), or High RFI (>0.5 SD above the mean). Angus bulls in the Low RFI group consumed 17% (P<0.0001) less DM than the bulls in the High RFI group, while in the Hereford bulls there was a 14% (P<0.0001) difference in DMI between Low and High RFI groups. Significant phenotypic correlations were observed between RFI and DMI (0.83, 0.77), G:F (-0.65, -0.51), HDD (0.41, 0.59), HDDM (0.40, 0.53), AMS (0.52, 0.36), and FR (-0.31, -0.51) in Angus and Hereford bulls, respectively. The HDD, HDDM, and FR were significantly correlated with DMI. The feeding behavior traits, HDD, HDDM, and FR when added to the RFI base model, explained 18, 17, and 13%, respectively, of the variation in DMI not explained by ADG and MMWT in Angus bulls. Similarly, in Hereford bulls, HDD, HDDM, and FR explained 35, 26, and 24%, respectively, of the variation in DMI not explained by ADG and MMWT. These data suggest that feeding behaviors are related to DMI of growing Angus and Hereford bulls.

On-farm production of AM fungus inoculum in mixtures of compost and vermiculite.

On-farm production of arbuscular mycorrhizal (AM) fungus inoculum can reduce the cost of the inoculum and increase utilization of this symbiosis in plant production. Bahiagrass (Paspalum notatum Flugge) seedlings, colonized by AM fungi, were transplanted into raised bed enclosures. Media within the enclosures was vermiculite mixed with either field soil or yard clippings compost in Experiment I and vermiculite mixed with yard clippings compost or dairy manure/leaf compost in Experiment II. Compost and vermiculite mixtures yielded more propagules of AM fungi than soil-based mixtures in Experiment I. Growth of plants in a 1:4 (v/v) mixture of yard clippings compost and vermiculite produced more inoculum (503 propagules cm(-3)) than growth in 1:9 and 1:99 (v/v) mixtures (240 and 42 propagules cm(-3), respectively). Water, inorganic nutrient solution minus P, and fish protein digest were added to inoculum production enclosures in Experiment II. Results indicated that supplemental nutrient addition was unnecessary. This method produces a concentrated inoculum of AM fungi in a form readily used as an amendment to horticultural potting media for the production of vegetable seedlings.

Multicentre randomized therapeutic trial for advanced centrocytic lymphoma: anthracycline does not improve the prognosis.

Within a multicentre observation study on non-Hodgkin lymphomas (NHL) diagnosed according to the Kiel classification advanced stages III and IV of centrocytic (CC) lymphoma exhibited the worst prognosis among lymphomas of low-grade malignancy with a 5-year survival probability of less than 10 per cent. Treatment had been solely expectative and palliative with treatment results showing a prognostic superiority of patients achieving partial and complete remissions over non-responders. Therefore, a randomized multicentre study was initiated to compare the remission-inducing potential of the COP regimen (Bagley et al., 1972) with that of the more intensive adriamycin-containing CHOP regimen (McKelvey et al., 1976). From 91 newly diagnosed CC lymphomas 63 fulfilled randomization criteria with 37 patients assigned to the COP regimen and 26 patients to the CHOP regimen. Between the COP- and CHOP-treated patients no significant differences could be demonstrated with respect to initial clinical parameters, rate of complete (41 per cent versus 58 per cent) or partial remissions (43 per cent versus 31 per cent), median overall survival probability (32 versus 37 months), relapse-free survival (10 versus 7 months) and rates of relapse (73 per cent versus 67 per cent) and death (57 per cent versus 50 per cent). It can be concluded that CC lymphoma is a typical lymphoma of low-grade malignancy with its inability to reach stable remissions while the demonstration of identical survival probabilities for patients with complete and partial remissions constitutes a unique feature of this lymphoma entity. These observations prove advanced CC lymphoma to represent an incurable neoplastic disease under conventional therapeutic approaches.

Application of a microseparation technique allowing for extensive marker studies on small bone marrow specimens.

The characterization of surface and intracellular markers of hematopoietic cells by immunocytochemical methods is widely used. While examination of cells of the peripheral blood can easily be performed, investigations of bone marrow cells can be hampered by technical difficulties in labeling routine marrow smears or by limited size of specimens required for cytocentrifugation. A simple and highly efficient method for isolation of bone marrow cells by a microseparation technique is described. Only two to three drops of a routine bone marrow aspirate are necessary for preparation of up to 100 cytocentrifuge slides thereby exceeding separation efficiency of conventional gradient centrifugation by three- to more than four-fold. The application of the method for marker studies on normal marrow and marrow from patients with hematologic malignancies is exemplified.

[Significance of progesterone production in regulating the menstrual cycle]. / Untersuchungen über die Bedeutung der Progesteronbildung für die Regulation des Zyklus.

Premature luteolysis, which can be brought about by injection of a crystalline suspension of estradiol into the ovary carrying the corpus luteum, is cancelled out by a concomitant injection of an appropriate dose of a crystalline progesterone suspension, together with a simultaneous increase in the plasma progesterone level. The authors discuss whether preovulatory production of progesterone has a similar protective influence on the growth and estrogen and androgen production of the vesicular ovarian follicles and the dominant follicle.

Danazol in acquired amegakaryocytic thrombocytopenic purpura: a case report.

Acquired amegakaryocytic thrombocytopenic purpura is a rare disease. Most reported patients did not respond to any therapeutical approach. Recently we observed a striking improvement of this disorder in a female patient shortly after therapy with danazol had been initiated. This observation and its possible implication for the treatment of amegakaryocytic thrombocytopenia are reported herein.

[Allogeneic bone marrow transplantation after fractionated whole body irradiation. Results at the Kiel transplantation center]. / Allogene Knochenmarktransplantation nach fraktionierter Ganzkörperbestrahlung. Ergebnisse des Transplantationszentrums Kiel.

Allogeneic bone marrow transplantations were carried out between March 1983 and July 1985 in 31 patients aged 7 to 45 years (median 18 years). Acute lymphoblastic leukaemia in 1st to 5th remission was present in 8 patients, acute myeloblastic leukaemia in 1st and 2nd remission in 4 patients, chronic myeloid leukaemia, with various remission status, in 6 patients, 3 patients had severe aplastic anaemia and there were single cases of myelodysplasia and immature cell megakaryocytic myelosis. Transplantation was carried out during relapse in 8 patients with either acute myeloid or lymphoblastic leukaemia. Phenotypic HLA-identical mothers (n = 2) as well as genotypic HLA-identical siblings (n = 27), and in two cases HLA-non-identical mothers, served as bone marrow donors. In leukaemia patients the conditioning treatment consisted of fractionated total body irradiation and high dose cyclophosphamide or etoposide. Patients with severe aplastic anaemia received cyclophosphamide (4 X 50 mg/kg) and fractionated total nodal irradiation (total dose 8 Gy). 19 patients (61%) survived 14 to 605 days after bone marrow transplantation. 15 patients (48%) continue to remain in complete remission with Karnofsky indices of greater than or equal to 90%. Causes for death were infection (n = 3), interstitial pneumonia (n = 3), relapse (n = 3) as well as single cases involving acute graft-versus-host-disease, non-engraftment of donor marrow and veno-occlusive disease of the liver.

[Analysis of prognostic factors in plasmacytoma]. / Analyse prognostischer Faktoren beim Plasmozytom.

For analysis of prognostic factors the clinical course of 109 patients with multiple myeloma was evaluated. Survival curves of immunoglobulin (Ig)G- and IgA-myelomas were identical (Fig. 1) with median survival times of 52 and 42 months, respectively, whereas patients with IgD- and Bence-Jones-myeloma had short survival times (median 3 months). Most important risk factors were anemia, renal insufficiency, and hypercalcemia (Figs. 7 and 8). Median survival time dropped from 52 months (Hb above 100 g/l) to 22 (Hb 85-100 g/l) and 1 month (Hb below 85 g/l). Patients with serum creatinine values below 2 mg/dl lived significantly longer than those with values above. Median survival times were 52 and 1 month, respectively. All seven hypercalcemic patients had a renal insufficiency and were in a very poor condition; their median survival time was 1 month. Analysis of the widely used staging system of Durie and Salmon gave disappointing results. Survival curves of the three A-stages ran close together with median survival times of 58, 51, and 36 months. Only the A-B classification according to renal function (A: creatinine under 2 mg/dl; B: creatinine above 2 mg/dl) proved prognostically relevant.

Deposition of the terminal C5b-9 complement complex on erythrocytes by human red cell autoantibodies.

A radioassay for the detection of complement activating autoantibodies (autohaemolysins) in patients with autoimmune haemolytic anaemia (AIHA) is described. The method is based on immunoradiometric quantitation of the cytolytic C5b-9 complement complex following its antibody-dependent deposition on red blood cells (RBC). The use of affinity-purified, radiolabelled antibodies directed against the neoantigens of the C5b-9 complex ensured specificity of the test which proved more sensitive than conventional haemolytic assays and was not subject to disturbances by haemolytic sera. The results obtained in 70 patients with various forms of AIHA (warm type N = 45); cold type (N = 22); Donath-Landsteiner type (N = 3] support the prevailing assumption that autohaemolysins can trigger the complement cascade to completion. Since intact RBC from patients with detectable autohaemolysins carried C3/C4 components but never C5b-9, it is inferred that regulatory mechanisms operate in vivo at the level of C4b/C3b inactivation to arrest the cascade and rescue the autologous cells.

Platelet-associated complement C3 in thrombocytopenic states.

Platelet-associated complement components C3, C3d and C4 (PAC3, PAC3d, PAC4) were quantitated by a modification of the platelet radioactive anti-IgG test using highly purified C3 antibodies in 74 patients with immune thrombocytopenia (ITP), 26 patients with presumed nonimmune thrombocytopenia (NTP), and 114 normal individuals. Elevated PAC3 levels were found in 26 out of 74 patients with ITP (35%) and in 10 out of 26 patients with NTP. Although the percentage of elevated PAC3 values was higher in thrombocytopenic patients than in nonthrombocytopenic patients, no statistically significant correlation existed between platelet counts and PAC3 levels, neither for ITP nor for NTP. However, such a relationship was demonstrable between PAC3 and platelet-associated IgG, both for ITP (P less than 0.05) as well as NTP patients (P less than 0.001). We conclude that elevated PAC3 values are not restricted to immune thrombocytopenias. Quantitative differences of PAC3 between ITP and NTP patients suggest that part of the PAC3 is immunologically mediated and has a role in the pathogenesis of autoimmune thrombocytopenias.