Developing an active-learning app to improve critical thinking: item selection and gamification effects.

Critical thinking (CT) is widely recognized as an important skill and attitude in this modern world, but few apps (web-based or installed on devices) have been developed to effectively train it. There is also little research on what kind of content to put into such apps and in what order, if the content is a series of reasoning questions that are intended as CT exercises. Therefore, this research project, consisting of two studies, tries to demonstrate how exercise questions can be presented to learners to sustain their motivation to work on multiple-choice CT questions. In Study 1, question banks were drawn from popular workbooks for CT and verbal reasoning. The questions were ranked in terms of difficulty based on the participation of university students (N = 73). In Study 2, the questions were loaded onto two types of web-based apps: (1) one that sequentially gives multiple-choice questions with immediate feedback and (2) one with minimum gamification of group/individual competition. The experiment to examine the effect of the gamification was conducted (N = 114). Both groups with and without gamification showed improvements in the scores of the pre-/post-tests using comparable questions, but there was no clear effect of gamification. These findings show that an effective CT app can be developed using existing question banks but that the effect of gamification needs further research.

Effect of multidisciplinary care of dialysis initiation for outpatients with chronic kidney disease.

BACKGROUND: The aim of comprehensive multidisciplinary care (MDC) by the chronic kidney disease (CKD) team is not only to prevent worsening renal function, but also provide education on the selection of renal replacement therapy (RRT) by shared decision making (SDM). The purpose of this study was to examine the effects of MDC for predialysis outpatients on dialysis therapy, especially with regard to peritoneal dialysis (PD). METHODS: This study evaluated 112 CKD patients who underwent dialysis at our hospital starting from 2012, with 53 outpatients receiving MDC from the CKD team and 59 outpatients not receiving MDC. Annual decreases in the estimated glomerular filtration rates (ΔeGFR), the duration from the time of intervention to dialysis initiation, the urgent dialysis rate using a temporary catheter, and the PD selection rate were compared and examined between the two groups. The ΔeGFR, the duration from intervention to PD initiation, and the PD retention rate were compared between 18 PD patients in the MDC group and 10 PD patients in the non-MDC group. RESULTS: The MDC group had a significantly lower ΔeGFR, significantly longer duration, and a significantly lower urgent dialysis initiation rate versus the non-MDC group. Moreover, there was a significantly higher PD selection rate, significantly prolonged duration, and significantly higher PD retention rate. CONCLUSIONS: Multidisciplinary CKD team care for outpatients is effective in delaying the progression of CKD and avoiding the initiation of urgent dialysis; contributing to improved PD selectivity and continuity by SDM.

Osteopenia and the physical function in Japanese patients with schizophrenia.

We evaluated the state of osteopenia and the physical function in 121 schizophrenic patients. These factors were worse in the inpatient group than in the outpatient group. The age, sex, body mass index (BMI), and physical function were correlated to the state of osteopenia. Physicians should consider the risk of osteopenia in elderly female psychiatric patients with low BMI. PURPOSE: Information about the actual state of osteopenia in patients with schizophrenia is limited. In the present study, we evaluated the factors related to osteopenia and patient's physical function and compared these factors between inpatients and outpatients. METHODS: A total of 121 schizophrenic patients were included in the present study. We divided the patients into two groups according to the therapeutic form. We collected data on their age, sex, body mass index (BMI), bone mineral density (BMD) in the lumbar spine and proximal femur, serum bone metabolic markers, risk of fracture, and physical function. RESULTS: The number of fractured vertebrae, risk of fracture, serum concentration of tartrate-resistant acid phosphatase 5b (TRACP-5b), and score of locomo25 were significantly higher and the BMI and BMD in the lumbar spine and proximal femur significantly lower in the inpatient group than in the outpatient group. A multiple regression analysis showed that the age, sex, BMI, the number of fractured vertebrae, and score of locomo 25 were correlated with the BMD in the lumbar spine and proximal femur. Neither the therapeutic form nor any bone metabolic markers were correlated with the BMD. The inpatient group had a lower average BMI, BMD, and physical function than the outpatient group. However, a multiple regression analysis showed that the therapeutic form was not correlated with the BMD. CONCLUSION: These findings suggest that physicians should consider elderly female schizophrenic patients with a low BMI to be at risk of developing osteopenia.

In situ harvesting of adhered target cells using thermoresponsive substrate under a microscope: principle and instrumentation.

A novel technique and instrumented device were developed to harvest target cells from multicellular mixture of different cell types under a microscope. The principle of the technique is that cells cultured on a thermoresponsive-substance-coated dish were detached by a region-specific cooling device and simultaneously harvested using a micropipette, both of which were assembled in an inverted microscope. Thermoresponsive coating consists of the mixture of poly(N-isopropylacrylamide) (PNIPAAm) and PNIPAAm-grafted gelatin. The former non-cell-adhesive polymer dissolves below at 32.1 degrees C in water and precipitates over that temperature (called lower critical solution temperature, LCST), and the latter cell-adhesive polymer has LCST of 34.1 degrees C. The appropriate mixing ratio of these thermoresponsive polymers exhibited high cell adhesion at physiological temperature and complete cell detachment at room temperature. A device developed as to cool at only a tiny area of the bottom of the dish, beneath which a cell that was targeted under a microscope, was assembled in a microscope. It was demonstrated that single cell or two cells that adhered to each other was detached from the surface and harvested by a micropipette within approximately 30s.

Effect of a modified S-form hip brace, WISH type, for patients with painful osteoarthritis of the hip: a role in daily walking as a hip muscle exercise.

A hip brace designated as WISH-type of S-form hip brace was applied for 14 patients with painful hip osteoarthritis (OA), who were required to walk as an exercise at least a half hour every day. Patients were independently evaluated and serially scored using the Harris and Japanese Orthopaedic Surgery (JOA) scores. Pain relief on gait was obtained immediately and dramatically in all patients, providing high compliance. Approximately three fourths of patients acquired independence from analgesics. Both Harris and JOA scoring systems indicated significant improvement of hip function. Only two cases showed poor responses, and common factors in these cases included bilateral involvement and unsuccessfulness of daily walking exercise. The present WISH-type hip brace may be one of the most valuable treatments in the management of the hip OA. Requirements of muscle exercise around the hip girdle involving daily walking should be emphasized for maintenance of the brace effects.