Nursing students' experiences of flipped classroom teaching method in higher education: a systematic review.

BACKGROUND: During the COVID-19 pandemic face-to-face activities were suspended, boosting the delivery of online teaching. As students returned to campuses, the delivery of active learning teaching methods followed a blended learning style. The flipped classroom, which is a student-centred approach, appears to be an effective teaching method, generating improved learning outcomes. No systematic review has so far explored students' experiences of this teaching method - a knowledge gap that this review aims to address. METHODS: Studies published between 2012 and 2023 were identified from seven databases. The JBI critical appraisal tool was adopted to select high-quality studies and add credibility. Following extraction of qualitative data, meta-aggregation was used to identify synthesised findings. RESULTS: The findings were aggregated into seven categories. Based on meaning similarity, three synthesised findings were identified to answer the research question on how nursing students experience the flipped classroom method. CONCLUSION: Several factors affect the student experience. Although variables are interrelated and complex to analyse, this approach is a valuable teaching method, positively experienced by students with the potential to improve engagement and learning outcomes. The group activities used as a feature of the flipped classroom can be seen as an instrument to deliver a safer and high quality of care.

Cardiac amyloidosis at a glance.

Amyloidosis can affect any organ in the body by deposition of amyloid fibrils. When these aggregate in the heart, it leads to cardiac amyloidosis a life-threatening and progressive disease. Although considered a rare condition, advances in imaging techniques and raised awareness have shown that it might be more frequent than has been historically estimated. Cardiac amyloidosis can be hereditary or occur as a consequence of the ageing process but, regardless of type, patients experience a heavy symptomatic burden. This article provides an overview of its pathophysiology, signs and symptoms and how any nurse can look for the main red flags in clinical practice. Early referral for specialist care can have a significant impact on disease progression and patient quality of life.

Non-invasive and contemporaneous cardiac imaging in heart failure.

This article reviews the current non-invasive cardiac imaging modalities used in the diagnosis and management of heart failure patients. Heart failure is a complex syndrome secondary to functional and structural changes of the heart, with a wide range of possible causes for its onset. Different imaging investigations can inform diagnosis and guide care plans, so nurses across clinical practice will benefit from having knowledge on when these modalities are used. Echocardiography remains the most common investigation due to its low cost and reproducible nature when compared with other methods. It allows quantification of left ventricular function, which is an important prognostic marker in heart failure. Through cardiac magnetic resonance imaging, identification of potential reversible causes is possible, and further identification of underlying causes, when other modalities fail to do so. Finally, computed tomography coronary angiography is the currently recommended test in all patients presenting with typical or atypical anginal symptoms, diagnostically comparable to invasive coronary angiography.

The renal system and associated disorders.

Disorders of the renal system, including the kidneys and urinary tract, are increasingly recognised as a public health concern, accounting for 830 000 deaths worldwide. Patients often have comorbidities, with many presenting with other diseases. Health professionals require good knowledge of the renal system and associated disorders to create holistic care plans to meet individual patients' needs. This article covers the pathophysiology of some of the most common problems, patient assessment and investigations, and considerations in helping patients with self-management.

The challenges of formal volunteering in hospitals.

The role and tasks performed by hospital volunteers (HV), their relationship with other stakeholders and the management of volunteers, are controversial topics, not widely explored in literature. Through an exploratory study, which incorporated the collection and analysis of qualitative data, involving 46 interviews with volunteers, staff and hospital administration from three hospitals in Portugal, we analyze hospital volunteers, as well as the tasks they perform, how these tasks are assigned, and how they relate to other stakeholders. As a result, we conclude that the job definition of HV is generic, open to different interpretations and that the assigned functions of HV are not known from all stakeholders. This problem can have negative repercussions in the relationship between volunteers and health professionals, potentially fostering conflict. Nevertheless, most respondents are satisfied with the current format of volunteer management.

Assessing social structure: a data-driven approach to define associations between individuals.

Our interpretation of animal social structures is inherently dependent on our ability to define association criteria that are biologically meaningful. However, association thresholds are often based upon generalized preconceptions of a species' social behaviour, and the impact of using these arbitrary definitions has been largely overlooked. In this study we suggest a probability-based method for defining association thresholds using lagged identification rates on photographic records of identifiable individuals. This technique uses a simple model of emigration/immigration from photographable clusters to identify the time-dependent lag value between identifications of two individuals that corresponds to approximately 75% probability of being in close spatial proximity and likely associating. This lag value is then used as the threshold to define associations for social analyses. We applied the technique to a dataset of northern resident killer whales (Orcinus orca) in the Northeast Pacific and tested its performance against two arbitrary thresholds. The probabilistic association maximized the variation in association strengths at different levels of the social structure, in line with known social patterns in this population. Furthermore, variability in inferred social structure metrics generated by different association criteria highlighted the consequential effect of choosing arbitrary thresholds. Data-driven association thresholds are a promising approach to study populations without the need to subjectively define associations in the field, especially in societies with prominent fission-fusion dynamics. This method is applicable to any dataset of sequential identifications where it can be assumed that associated individuals will tend to be identified in close proximity. Supplementary Information: The online version contains supplementary material available at 10.1007/s42991-022-00231-9.

Runs of homozygosity in killer whale genomes provide a global record of demographic histories.

Runs of homozygosity (ROH) occur when offspring inherit haplotypes that are identical by descent from each parent. Length distributions of ROH are informative about population history; specifically, the probability of inbreeding mediated by mating system and/or population demography. Here, we investigated whether variation in killer whale (Orcinus orca) demographic history is reflected in genome-wide heterozygosity and ROH length distributions, using a global data set of 26 genomes representative of geographic and ecotypic variation in this species, and two F1 admixed individuals with Pacific-Atlantic parentage. We first reconstructed demographic history for each population as changes in effective population size through time using the pairwise sequential Markovian coalescent (PSMC) method. We found a subset of populations declined in effective population size during the Late Pleistocene, while others had more stable demography. Genomes inferred to have undergone ancestral declines in effective population size, were autozygous at hundreds of short ROH (<1 Mb), reflecting high background relatedness due to coalescence of haplotypes deep within the pedigree. In contrast, longer and therefore younger ROH (>1.5 Mb) were found in low latitude populations, and populations of known conservation concern. These include a Scottish killer whale, for which 37.8% of the autosomes were comprised of ROH >1.5 Mb in length. The fate of this population, in which only two adult males have been sighted in the past five years, and zero fecundity over the last two decades, may be inextricably linked to its demographic history and consequential inbreeding depression.

Hyperandrogenism, oligomenorrhea, and erythrocytosis caused by an ovarian Leydig cell tumor: A case report.

Leydig cell tumors are rare ovarian neoplasms. Affected individuals typically present with amenorrhea/oligomenorrhea and rapidly progressive features of virilization. Erythrocytosis can also occur as a result of high testosterone levels.

Systematic screening for SARS-CoV-2 in pregnant women admitted for delivery in a Portuguese maternity.

Objectives The burden of undocumented SARS-Cov-2 infections in Portuguese pregnant women is unknown. At our institution, routine COVID-19 testing was implemented from 19th of March on to all pregnant women who were admitted for delivery. The purpose of the study was to estimate the SARS-CoV-2 infection rate in our obstetric population admitted for delivery. Mathods Between 19th March and May 4th, 184 pregnant women were screened for SARS-CoV-2 infection upon admission. Results Eleven women were positive for SARS-CoV-2, corresponding to a global prevalence of 6.0%. Of these, only two reported symptoms at admission. The prevalence of asymptomatic infection was 4.9%. We report a lower rate of positive cass than other studies. Eighty-two percent of our cases had no symptoms at admission. Conclusions The proportion of asymptomatic infection highlights the importance of universal laboratory screening for all women admitted for delivery as opposed to symptom-based screening.

Apontamentos sobre a dimensão territorial da pandemia da Covid-19 e os fatores que contribuem para aumentar a vulnerabilidade socioespacial nas unidades de desenvolvimento humano de áreas metropolitanas brasileiras / Nota Técnica n. 15 (Dirur): Apontamentos sobre a dimensão territorial da pandemia da Covid-19 e os fatores que contribuem para aumentar a vulnerabilidade socioespacial nas unidades de desenvolvimento humano de áreas metropolitanas brasileira / Português

A nota explora a associação entre as características socioeconômicas, demográficas e as condições de infraestrutura urbana dos espaços urbanos e a vulnerabilidade à contaminação pela Covid-19, propondo a identificação e o mapeamento do grau de vulnerabilidade socioespacial à contaminação pela Covid-19.

Killer whale genomes reveal a complex history of recurrent admixture and vicariance.

Reconstruction of the demographic and evolutionary history of populations assuming a consensus tree-like relationship can mask more complex scenarios, which are prevalent in nature. An emerging genomic toolset, which has been most comprehensively harnessed in the reconstruction of human evolutionary history, enables molecular ecologists to elucidate complex population histories. Killer whales have limited extrinsic barriers to dispersal and have radiated globally, and are therefore a good candidate model for the application of such tools. Here, we analyse a global data set of killer whale genomes in a rare attempt to elucidate global population structure in a nonhuman species. We identify a pattern of genetic homogenisation at lower latitudes and the greatest differentiation at high latitudes, even between currently sympatric lineages. The processes underlying the major axis of structure include high drift at the edge of species' range, likely associated with founder effects and allelic surfing during postglacial range expansion. Divergence between Antarctic and non-Antarctic lineages is further driven by ancestry segments with up to four-fold older coalescence time than the genome-wide average; relicts of a previous vicariance during an earlier glacial cycle. Our study further underpins that episodic gene flow is ubiquitous in natural populations, and can occur across great distances and after substantial periods of isolation between populations. Thus, understanding the evolutionary history of a species requires comprehensive geographic sampling and genome-wide data to sample the variation in ancestry within individuals.

Choroid plexus is an additional source of melatonin in the brain.

The cerebrospinal fluid melatonin is released from the pineal gland, directly into the third ventricle, or produced de novo in the brain from extrapineal melatonin sources leading to a melatonin concentration gradient in the cerebrospinal fluid. Despite the interest on this topic, the brain areas capable of producing melatonin are not yet clear. Bearing this in mind, we hypothesized that the choroid plexus (CP) could be one of these melatonin sources. We analyzed and confirmed the presence of the four enzymes required for melatonin synthesis in rat CP and demonstrated that arylalkylamine N-acetyltransferase shows a circadian expression in female and male rat CP. Specifically, this enzyme colocalizes with mitochondria in rat CP epithelial cells, an organelle known to be involved in melatonin function and synthesis. Then, we demonstrated that melatonin is synthesized by porcine CP explants, although without a circadian pattern. In conclusion, our data show that the CP is a local source of melatonin to the central nervous system, probably contributing to its high levels in the cerebrospinal fluid. We believe that in the CP, melatonin might be regulated by its endogenous clock machinery and by the hormonal background.

Killer whales (Orcinus orca) in Iceland show weak genetic structure among diverse isotopic signatures and observed movement patterns.

Local adaption through ecological niche specialization can lead to genetic structure between and within populations. In the Northeast Pacific, killer whales (Orcinus orca) of the same population have uniform specialized diets that are non-overlapping with other sympatric, genetically divergent, and socially isolated killer whale ecotypes. However, killer whales in Iceland show intrapopulation variation of isotopic niches and observed movement patterns: some individuals appear to specialize on herring and follow it year-round while others feed upon herring only seasonally or opportunistically. We investigated genetic differentiation among Icelandic killer whales with different isotopic signatures and observed movement patterns. This information is key for management and conservation purposes but also for better understanding how niche specialization drives genetic differentiation. Photo-identified individuals (N = 61) were genotyped for 22 microsatellites and a 611 bp portion of the mitochondrial DNA (mtDNA) control region. Photo-identification of individuals allowed linkage of genetic data to existing data on individual isotopic niche, observed movement patterns, and social associations. Population subdivision into three genetic units was supported by a discriminant analysis of principal components (DAPC). Genetic clustering corresponded to the distribution of isotopic signatures, mtDNA haplotypes, and observed movement patterns, but genetic units were not socially segregated. Genetic differentiation was weak (F ST < 0.1), suggesting ongoing gene flow or recent separation of the genetic units. Our results show that killer whales in Iceland are not as genetically differentiated, ecologically discrete, or socially isolated as the Northeast Pacific prey-specialized killer whales. If any process of ecological divergence and niche specialization is taking place among killer whales in Iceland, it is likely at a very early stage and has not led to the patterns observed in the Northeast Pacific.

24/7 Presence of Medical Staff in the Labor Ward; No Day-Night Differences in Perinatal and Maternal Outcomes.

Objective The objective of this study was to assess possible day-night differences in perinatal and maternal labor outcomes in a hospital setting with no day-night differences in the presence of experienced medical staff. Design This was a retrospective study conducted over 5 years between 2008 and 2012. Setting This study was set at the obstetric delivery unit in a tertiary hospital. Population A total of 9,143 singleton deliveries were assessed after 34 weeks of gestation and after exclusion of major congenital malformations, inductions of labor, and elective cesarean sections. Materials and Methods Data were collected using the hospital electronic medical records. Time periods of 8 hours were defined (daytime between 8 am and 4 pm, evening time between 4 pm and 12 pm, and nighttime between 12 pm and 8 am). Differences between the three time periods were assessed using software R Core Team (2013). Main outcome measures were neonatal birth asphyxia, neonatal intensive care unit admission, and neonatal death. Results There were no differences in perinatal and maternal outcomes in the course of the day, apart from a higher incidence of third- and fourth-degree tears during the evening. Neonatal outcome after obstetric emergencies (uterine rupture, partial placental abruption, and cord prolapse) also showed no day-night differences. Conclusion Adverse nighttime-related outcomes may be avoided by the 24/7 presence of experienced medical staff.

Interobserver agreement in CTG interpretation using the 2015 FIGO guidelines for intrapartum fetal monitoring.

BACKGROUND: Visual analysis of cardiotocographic (CTG) tracings has been shown to be prone to poor intra- and interobserver agreement when several interpretation guidelines are used, and this may have an important impact on the technology's performance. OBJECTIVES: The aim of this study was to evaluate agreement in CTG interpretation using the new 2015 FIGO guidelines on intrapartum fetal monitoring. STUDY DESIGN: A pre-existing database of intrapartum CTG tracings was used to sequentially select 151 cases acquired with a fetal electrode, with duration exceeding 60minutes, and signal loss less than 15%. These tracings were presented to six clinicians, three with more than 5 years' experience in the labor ward, and three with 5 or less years' experience. Observers were asked to evaluate tracings independently, to assess basic CTG features: baseline, variability, accelerations, decelerations, sinusoidal pattern, tachysystole, and to classify each tracing as normal, suspicious or pathologic, according to the 2015 FIGO guidelines on intrapartum fetal monitoring. Agreement between observers was evaluated using the proportions of agreement (Pa), with 95% confidence intervals (95%CI). RESULTS: A good interobserver agreement was found in the evaluation of most CTG features, but not bradycardia, reduced variability, saltatory pattern, absence of accelerations and absence of decelerations. For baseline classification Pa was 0.85 [0.82-0.90], for variability 0.82 [0.78-0.85], for accelerations 0.72 [0.68-0.75], for tachysystole 0.77 [0.74-0.81], for decelerations 0.92 [0.90-0.95], for variable decelerations 0.62 [0.58-0.65], for late decelerations 0.63 [0.59-0.66], for repetitive decelerations 0.73 [0.69-0.78], and for prolonged decelerations 0.81 [0.77-0.85]. For overall CTG classification, Pa were 0.60 [0.56-0.64], for classification as normal 0.67 [0.61-0.72], for suspicious 0.54 [0.48-0.60] and for pathologic 0.59 [0.51-0.66]. No differences in agreement according to the level of expertise were observed, except in the identification of accelerations, where it was better in the more experienced group. CONCLUSIONS: A good interobserver agreement was found in evaluation of most CTG features and in overall tracing classification. Results were better than those reported in previous studies evaluating agreement in overall tracing classification. Observer experience did not appear to play a role in agreement.