A comparison of physiotherapy students' perception about blended learning with online learning during COVID-19 pandemic: A mixed method of study.

BACKGROUND: The COVID-19 pandemic has affected face-to-face teaching across the globe. The sudden shift in learning methods has impacted learning experiences significantly. Students' perception about online compared to blended learning might affect learning. The objective of this study was to evaluate physiotherapy students' perception of blended compared to online learning. MATERIALS AND METHODS: This mixed-method study documents physiotherapy students' perception about the courses delivered through blended learning (BL) mode during the COVID-19 pandemic. Physiotherapy graduates and postgraduate students who completed their evidence-based physiotherapy practice courses at Sri Ramachandra Institute of Higher Education and Research, Chennai (N = 68) participated in this study. The participants' perceived experience about synchronous online mode and BL during the pandemic was assessed using a questionnaire and focus group discussion. RESULTS: All the participants felt that the course outcomes were met and that they gained knowledge and skills in evidence-based practice. Most of the students (93%) recommended a blended mode of learning compared to online learning alone. Thematic analysis of the focus group discussion (FGD) identified enhanced learning experience, collaborative learning as enablers to BL, and availability of gadgets and quality of online contents as barriers. CONCLUSION: Participants showed par preference for blended learning over online learning as it provided flexibility and facilitated active learning compared to online learning alone.

Immunogenicity, reactogenicity and safety of an inactivated quadrivalent influenza vaccine in children and adolescents 6 months through 17 years of age in India.

Efficacy and safety data on quadrivalent influenza vaccines (QIVs) for immunization of Indian children are scarce. This phase 3, registration study evaluated the immunogenicity, safety, and tolerability of a QIV in Indian children aged 6-35 months (Group 1) and 3-17 y (Group 2). Subjects received one or two doses (0.5 mL each) of the study vaccine based on their priming status. Immunogenicity (post-vaccination geometric mean fold increase in hemagglutination inhibition [HI] titers and proportion of patients with seroprotection and seroconversion against the four influenza strains), unsolicited adverse events (AEs), and tolerability were analyzed. Among 118 subjects enrolled in each group, the geometric mean(standard deviation) fold increase in HI titers against A(H3N2), A(H1N1), B(Victoria), and B(Yamagata) strains were 31.7(5.33), 10.5(6.06), 4.1(5.70), and 8.6(5.34) in Group 1 and 14.0(4.37), 9.2(4.26), 14.3(6.73), and 14.4(5.41) in Group 2, respectively. Seroprotection was achieved by 91.2%, 83.3%, 41.2%, and 68.4% subjects in Group 1 and 100%, 95.8%, 73.7%, and 89.8% subjects in Group 2, respectively. Seroconversion was achieved by 87.7%, 66.7%, 41.2%, and 64.9% subjects in Group 1 and 89.0%, 78.8%, 69.5%, and 75.4% subjects in Group 2, respectively. Vaccination site pain and fever were the most common local and systemic reactions, respectively. Systemic reactions were more frequent in Group 1 (16.9% vs 7.6%). Most subjects (>90%) did not experience inconvenience within 7 d of vaccination; <10% in both groups reported unsolicited AEs. Thus, the QIV had a positive benefit/risk profile in Indian children/adolescents aged 6 months to 17 y.CTRI Registry No: CTRI/2018/05/014191Registry Name: Clinical Trials Registry - IndiaDate of Trial Registration: May 29, 2018Study Dates: August 03, 2018 (first subject first visit) to January 31, 2019 (last subject last visit)Drugs Controller General of India [DCGI] permission letter number: CT-03/2018.

Indian Academy of Pediatrics Consensus Guidelines on Prevention and Management of Suicidal Behavior in Adolescents.

JUSTIFICATION: Suicide is an important cause of adolescent mortality and morbidity in India. As pediatricians are often the first point of contact for adolescents and their families in the healthcare system, they need guidelines to screen, assess, manage and prevent adolescent suicidal behavior to ensure survival, health and mental well-being of this vulnerable population. OBJECTIVES: To formulate guidelines to aid pediatricians for prevention and management of adolescent suicidal behavior. PROCESS: Indian Academy of Pediatrics, in association with Adolescent Health Academy, formed a multidisciplinary committee of subject experts in June, 2019 to formulate guidelines for adolescent suicide prevention and management. After a review of current scientific literature and preparation of draft guidelines, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by refining of draft guidelines, and discussions over e-mail where suggestions were incorporated and the final document was approved. GUIDELINES: Pediatricians should screen for mental distress, mental disorders and suicidal and para-suicidal (non-suicidal self-injury) behavior during adolescent health visits. Those with suicidal behavior should be referred to a psychiatrist after providing emergency healthcare, risk assessment, immediate counselling and formulation of a safety plan. Pediatricians should partner with the community and policymakers for primary and secondary prevention of adolescent suicide.

Food cue images and subjective appetitive responses in obese children.

BACKGROUND: Food decision-making is based on various intrinsic and extrinsic factors of an individual. Food preferences and food cue sensitivity influence energy intake, which in turn affects body weight. AIM: The present study assessed the subjective appetite of obese children in response to food cue images. METHODS: A total of 70 obese children (37 boys and 33 girls) of the age group 7-10 years were recruited for the study; 34 images of food items grouped under ten food blocks were used as cues to study the self-reported hunger, appetite and satiety sensations among the participants. A visual analogue scale (VAS) was used to measure participant responses for each food block. RESULTS: The mean (standard deviation (SD)) body mass index-for-age 'Z' scores (BAZ) of the participants was found to be 2.15 (0.36). The subjective appetitive responses assessed using VAS showed that the hunger ratings of participants were found to be higher in response to images of cereals and cereal products (92.86%), and sweets (97.14%); satiety ratings of the participants were observed to be higher for milk and milk products (87.14%); cereals and savoury foods (78.57%); and higher appetite ratings of participants were recorded for sweets (97.14%) and cereals (92.86%). CONCLUSION: Sophisticated neuroimaging techniques are well established in measuring appetite, but our study focused on the subjective analysis of appetite using cost-effective tools such as food cue images and visual analogue scales to further expand the research platform in appetite regulation and obesity.

Entry level nursing graduate students' perception and readiness toward online component of blended learning: A mixed method study.

BACKGROUND: Blended learning (BL), the integration of online with face to face teaching, is established as a teaching method in higher education. Understanding the learner's readiness toward online component of BL is important in designing and delivering BL. Nursing students require proficiency in interpersonal relationship and social interaction apart from knowledge and skills. BL may provide an opportunity to acquire the professional skills better than the traditional face to face sessions. The objectives of this study were to identify the nursing student's readiness toward BL and perceptions about the online learning component of BL. MATERIALS AND METHODS: First- and second-year entry level graduate nursing students of Sri Ramachandra Institute of Higher Education, Chennai, India, were the participants of the study. This study used a mixed method approach. An online questionnaire, developed based on the literature and expert consensus, was used in the first phase. A focus group discussion (FGD) with ten random participants of the survey was conducted to understand the perceptions and readiness to adopt the online component of BL. The present study was conducted from December 2019 to January 2020. Survey results were analyzed through descriptively. Content analysis was carried to summarize FGD results. RESULTS: A total 158 students of entry level nursing graduate programme participated in the survey. 53.8% of felt BL will have positive effect on their learning and 70% of the respondents were ready to adopt BL. The FGD identified two themes: (I) Readiness to adopt online learning as a component of BL and (II) perceived barriers and challenges in adopting online contents. CONCLUSION: Entry level nursing graduate students had a positive perception about the online components. Majority of them are confident in accessing the online contents. Willingness to learn through online, previous experience with online learning, and perceived advantages of online component might influence the learner's readiness. Availability of internet and absence of teachers were perceived as the barriers to online learning by the participants.

Evaluating the effectiveness of an online faculty development programme for nurse educators about remote teaching during COVID-19.

OBJECTIVE: Engaging learners during the COVID-19 pandemic is a significant challenge for educators. The pandemic has propelled the popularity of online learning, with Google Classroom being widely used by educational institutions as a remote learning platform. This study aimed to evaluate the impact of an online faculty development programme on nurse educators' perceived competency in creating and delivering e-content using Google Classroom and other freely available digital tools. METHODS: A pre-experimental design was adopted for the research. A six-module online faculty development course was conducted for 24 nurse educators of an affiliated nursing college, over a period of eight days. A debriefing session was held on ninth day after the completion of the course. A 10-item rating scale was used to assess the participants' perceptions of their competency in using Google Classroom and other digital tools for online teaching before and after the online faculty development course. RESULTS: Out of 24 trained participants, 18 completed the post-evaluation rating scale, giving a response rate of 75%. In the post-evaluation phase, a high level of competency was perceived by 83.3% of participants for using Google Classroom and 66.7% for creating video lectures and using an online grade book. A statistically significant difference (p < 0.001) between pre- and post-course evaluations was observed. CONCLUSION: This study shows that the online faculty development programme enhanced the perceived skills of faculty members in effectively delivering online teaching using various digital tools during the pandemic.

Development and validation of a structured feedback questionnaire from postgraduates on various elements of postgraduate medical curriculum.

BACKGROUND: Medical Council of India, introduced the Post Graduate (PG) curriculum as 'Competency Based Medical Education' (CBME). Feedback from the end users is a vital step in curriculum evaluation. Therefore, the primary objective of this study was to develop and validate a Structured Feedback Questionnaire (SFQ) for postgraduates, encompassing all the components of the PG-CBME curriculum. METHODS: SFQ was developed with 23 Likert based questions and four open ended questions. Content validation was done by Lawshe method. After getting institutional ethics clearance and informed consent, SFQ was administered to 121 final year PGs (response rate 100%). We performed Principal component analysis (PCA), Structural equation modeling (SEM), Chi squared test (χ2/df); goodness-of-fit index (GFI); adjusted GFI; comparative fit index (CFI) and root mean square error of approximation (RMSEA). Cronbach's alpha was done for estimating the internal consistency. RESULTS: The validation resulted in a three-factor model comprising of "curriculum" (42.1%), "assessment" (28%), and "support" (18.5%). Chi squared test (χ2/df ratio) < 2, CFI (0.78), GFI (0.72) and RMSEA (0.09) indicated superior goodness of fit for the three-factor model for the sample data. All the extracted factors had good internal consistency of ≥0.9. CONCLUSION: We believe that this 23 item SFQ is a valid and reliable tool which can be utilized for curriculum evaluation and thereby formulating recommendations to modify the existing curriculum wherever required, facilitating enriched program outcomes.

Blended learning and health professional education: Protocol for a mixed-method systematic review.

Blended learning (BL) refers to a systematic teaching method, which combines the aspects of face-to-face and online interactions using appropriate Information and Communication Technologies. This mixed-method systematic review (SR) protocol is developed with the objective to determine the effectiveness and appropriateness of BL in the health-care professional education. Mixed-method SR protocol: For the purpose of this SR, PICO is defined as P-entry level graduate students of health sciences program; I-BL; C-traditional face-to-face training; and O-achievement of learning outcomes, learner's and teacher's perception (primary). The search will be done through possible database using predetermined search strategy. Eligible studies will be appraised independently by authors. Joanna Briggs Institute's mixed-method protocol will be used to assess and synthesis the data. This protocol is registered with the International Register of Systematic Reviews (PROSPERO) with the registration number CRD42018082699.

Effect of stress on sleep hygiene among school going adolescents in Chennai.

BACKGROUND: Stress is a psychophysiological phenomenon. Due to recent lifestyle modifications prevalence of stress is increasing among adults and adolescents. Adolescence is a period of storm and stress and any excess stress would have negative impact on their sleep and would ultimately affect their academic performance and health. Hence the current study proposes to evaluate the effect of stress on sleep hygiene among school going adolescents in Chennai. MATERIALS AND METHODS: A cross-sectional study and participants were healthy male (84) and female (48) school going adolescents between the age group of 15-19 years (n = 132). Stress was assessed using Perceived Stress Scale (PSS) and sleep hygiene was assessed using Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD). RESULTS: In all, 84.8% of the adolescents reported that they are academically overloaded. Both the genders were found to be moderately stressed (Males: 63.6%; females: 66.7%). Prevalence of sleep disturbances was found to be 23.5% and increase in stress was found to be associated with decrease in sleep quality. DISCUSSION: The study shows that prevalence of stress is high among adolescents and it is negatively influencing their sleep hygiene. Hence, early identification and management of stress is required for school going late adolescents for better academic performance and wellbeing.

Clinical study of safety and immunogenicity of pentavalent DTP-HB-Hib vaccine administered by disposable-syringe jet injector in India.

INTRODUCTION: We conducted a randomized, observer-blind, non-inferiority, parallel-group clinical study of diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b conjugate (pentavalent) vaccination of infants in India. Goals were to determine whether the seropositivity rate after vaccination via disposable-syringe jet injector (DSJI) was non-inferior to that via needle and syringe (N-S), and to compare the safety of vaccination by the two methods. METHODS: Healthy children received a three-dose series of vaccine intramuscularly by DSJI or N-S beginning at 6-8 weeks of age. Immunoglobulin G antibody levels were measured by ELISA at 4-6 weeks after the third dose. The main secondary endpoint was safety, measured as injection site and systemic reactions. DISCUSSION: The study was stopped early out of caution beyond that specified in the protocol stopping criteria, after the Data Safety Committee noted a higher frequency of injection site reactions, especially moderate and severe, in the DSJI group. As a result, 128 subjects-DSJI group 61; N-S group 67-completed the study, rather than the 340 planned, and the study was not sufficiently powered to compare immunogenicity endpoints for the groups. Descriptive statistics indicate that seropositivity induced by vaccination with the DSJI was similar to that of N-S for all five antigens. Pentavalent vaccine includes whole-cell pertussis vaccine and an aluminum adjuvant, which may have contributed to the higher number of local reactions with the DSJI. The reactions caused no serious or long-term sequelae, and may be more acceptable in other populations or circumstances.US National Institutes of Health clinical trials identifier: NCT02409095.

Subtelomeric rearrangements in Indian children with idiopathic intellectual disability/developmental delay: Frequency estimation & clinical correlation using fluorescence in situ hybridization (FISH).

BACKGROUND & OBJECTIVES: Subtelomeres are prone to deleterious rearrangements owing to their proximity to unique sequences on the one end and telomeric repetitive sequences, which increase their tendency to recombine, on the other end. These subtelomeric rearrangements resulting in segmental aneusomy are reported to contribute to the aetiology of idiopathic intellectual disability/developmental delay (ID/DD). We undertook this study to estimate the frequency of subtelomeric rearrangements in children with ID/DD. METHODS: One hundred and twenty seven children with idiopathic ID/DD were tested for subtelomeric rearrangements using karyotyping and FISH. Blood samples were cultured, harvested, fixed and GTG-banded using the standard protocols. RESULTS: Rearrangements involving the subtelomeres were observed in 7.8 per cent of the tested samples. Detection of rearrangements visible at the resolution of the karyotype constituted 2.3 per cent, while those rearrangements detected only with FISH constituted 5.5 per cent. Five deletions and five unbalanced translocations were detected. Analysis of parental samples wherever possible was informative regarding the inheritance of the rearrangement. INTERPRETATION & CONCLUSIONS: The frequency of subtelomeric rearrangements observed in this study was within the reported range of 0-35 per cent. All abnormal genotypes were clinically correlated. Further analysis with array technologies presents a future prospect. Our results suggest the need to test individuals with ID/DD for subtelomeric rearrangements using sensitive methods such as FISH.

Assessment of safety and immunogenicity of two different lots of diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b vaccine manufactured using small and large scale manufacturing process.

BACKGROUND: Hib vaccine can be easily incorporated in EPI vaccination schedule as the immunization schedule of Hib is similar to that of DTP vaccine. To meet the global demand of Hib vaccine, SIIL scaled up the Hib conjugate manufacturing process. This study was conducted in Indian infants to assess and compare the immunogenicity and safety of DTwP-HB+Hib (Pentavac(®)) vaccine of SIIL manufactured at large scale with the 'same vaccine' manufactured at a smaller scale. METHODS: 720 infants aged 6-8 weeks were randomized (2:1 ratio) to receive 0.5 ml of Pentavac(®) vaccine from two different lots one produced at scaled up process and the other at a small scale process. Serum samples obtained before and at one month after the 3rd dose of vaccine from both the groups were tested for IgG antibody response by ELISA and compared to assess non-inferiority. RESULTS: Neither immunological interference nor increased reactogenicity was observed in either of the vaccine groups. All infants developed protective antibody titres to diphtheria, tetanus and Hib disease. For hepatitis B antigen, one child from each group remained sero-negative. The response to pertussis was 88% in large scale group vis-à-vis 87% in small scale group. Non-inferiority was concluded for all five components of the vaccine. No serious adverse event was reported in the study. CONCLUSIONS: The scale up vaccine achieved comparable response in terms of the safety and immunogenicity to small scale vaccine and therefore can be easily incorporated in the routine childhood vaccination programme.