Search

Isaac A Janson,1 Ellen M Bloom,1 Kisha C Hampton,1 Emily Riehm Meier,1 Angeli G Rampersad,1 William G Kronenberger2 1Indiana Hemophilia and Thrombosis Center, Indianapolis, IN, USA; 2Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USACorrespondence: Isaac A Janson, Indiana Hemophilia and Thrombosis Center, 8326 Naab Road, Indianapolis, IN, 46260, USA, Tel +1-317-871-0011, Fax +1-317-871-0010, Email ijanson@ihtc.orgIntroduction: Hydroxyurea reduces the incidence of vaso-occlusive episodes, stroke, and respiratory, cardiac, and renal damage in sickle cell disease by increasing fetal hemoglobin. However, because suboptimal adherence to hydroxyurea limits its effectiveness, understanding patient-specific barriers to hydroxyurea adherence could help improve adherence and health outcomes in patients with sickle cell disease. The aim of this single-site, prospective, IRB-approved study was to validate a 24-item patient- and caregiver-reported hydroxyurea treatment adherence questionnaire, the Hydroxyurea Evaluation of Adherence for Life (HEAL) scale.Methods: A sample of 24 adults with sickle cell disease and 16 caregivers of children with sickle cell disease completed the HEAL scale, and a subset of the original sample provided a second HEAL scale for test-retest reliability. HEAL scale results were validated against global adherence ratings from participants and health-care providers, records of access to pill bottles, and laboratory values for fetal hemoglobin and absolute neutrophil count.Results and Discussion: Results demonstrated excellent internal consistency for the HEAL Total score and eight (3-item) subscale scores (Dose, Remember, Plan, Cost, Understand, Effectiveness, Laboratory, and Pharmacy), as well as strong test-retest reliability for all HEAL scores except the Cost subscale. HEAL Total scores correlated significantly with validity measures, including global adherence ratings and lab values. The HEAL scale offers significant clinical potential for understanding adherence in individual sickle cell disease patients and significant research potential for characterizing adherence in persons with sickle cell disease who are treated with hydroxyurea.Keywords: sickle cell disease, treatment adherence, hydroxyurea, reliability, validity, scale development

Academic motivation enables students to face challenges in their studies and is important for student performance. Academic self-concept refers to students' perceptions of their competencies and ability to learn. The goal of the study was to evaluate academic motivation and self-concept of undergraduate optometry students. We used a mixed methods research design involving a self-administered questionnaire and follow-up semi-structured interviews. Saturated sampling was used to recruit participants. Data were analysed using descriptive and inferential statistics and thematic content analysis. The sample consisted of 166 participants aged between 18 and 24 years with more females (n = 121) and fourth year students (n = 64). The mean score for extrinsic motivation (4.91 ± 1.42) was larger than the mean scores for intrinsic motivation (4.24 ± 1.48) and amotivation (1.58 ± 1.02). There was no difference in the mean scores for motivation between the different levels of study (p = 0.122) or gender groups (p = 0.100). The mean scores for academic confidence and academic effort were 4.45 ± 0.38 and 4.51 ± 0.69, respectively. The main factors that influenced student motivation were online learning, prospect of graduation, financial independence and support systems. Optometry students have positive perceptions of their academic capabilities and competence, and are motivated to engage in their studies. Students' motivation was influenced by external factors such as higher salaries, prestigious jobs, affluent lifestyle and recognition. Optometry lecturers and curriculum developers should consider academic motivation and self-concept when interacting with students for optimal student well-being. Contribution: This article focusses on academic motivation and self-concept of undergraduate students that may be of interest because of the ongoing corona virus disease 2019 (COVID-19) pandemic and the changes students have experienced for teaching and learning activities. Students must remain motivated to achieve their academic goals. Thus, this study can assist students to better understand how motivation affects their learning and what factors affect their motivation. Information from the study can also inform parents, lecturers and administrators on how to optimally support student growth and development as well as create learning environments better suited to the needs of students.

Natalie A Duncan,1 William G Kronenberger,2 Kisha C Hampton,1 Ellen M Bloom,1 Angeli G Rampersad,1 Christopher P Roberson,1 Amy D Shapiro11Department of Hematology, Indiana Hemophilia and Thrombosis Center, 2Department of Psychiatry, Indiana University School of Medicine Riley and Child Adolescent Psychiatry Clinic, Indianapolis, IN, USABackground: Antibiotic prophylaxis is a mainstay in sickle cell disease management. However, adherence is estimated at only 66%. This study aimed to develop and validate a Sickle Cell Antibiotic Adherence Level Evaluation (SCAALE) to promote systematic and detailed adherence evaluation.Methods: A 28-item questionnaire was created, covering seven adherence areas. General Adherence Ratings from the parent and one health care provider and medication possession ratios were obtained as validation measures.Results: Internal consistency was very good to excellent for the total SCAALE (α=0.89) and four of the seven subscales. Correlations between SCAALE scores and validation measures were strong for the total SCAALE and five of the seven subscales.Conclusion: The SCAALE provides a detailed, quantitative, multidimensional, and global measurement of adherence and can promote clinical care and research. Keywords: penicillin prophylaxis, SCAALE, newborn screening program, Sickle SAFE Program, hemoglobinopathy, compliance

Background: The clinical characteristics and outcomes of patients who develop cardiogenic shock (CS) secondary to primary valvular dysfunction (valvular cardiogenic shock [VCS]) remain unclear. Objectives: The purpose of this study was to describe the cohort of patients with VCS and understand their outcomes compared to other forms of CS. Methods: All patients admitted to Cleveland Clinic cardiac intensive care unit between January 1, 2010, and December 31, 2021, with a diagnosis of CS were retrospectively identified. Characteristics and outcomes for shock patients with VCS were compared to those without VCS. Results: A total of 2,754 patients were admitted to our cardiac intensive care unit with CS, of which 442 (16%) had VCS. The median age of patients with VCS was higher than those with non-VCS (70 years vs 64 years, P

This paper considers the widening access and participation agenda, its implications for higher education institutions (HEIs) and contends that it must be underpinned by strategic measurement and monitoring. Access is viewed through the following lenses: (i) supporting participation, and (ii) facilitating equity. Using mixed methods, the paper draws on data from The University of the West Indies (UWI) and provides examples from key plans and initiatives over 20 years to showcase how the UWI has increased access. Concurrently, the need for more nuanced and complex datasets to assess the extent of equity is highlighted with metrics drawn from the "Times Higher Education University Impact Ranking." The authors argue that the strategic use and management of data can promote public accountability associated with access and boost institutional reputation. However, universities will have to be innovative and accelerate measures to survive/thrive in the post-pandemic environment by identifying their institutional scope and "system of interest" in widening access.

The importance of digitalisation in teaching and learning, which is addressed in Education 4.0 systems, is a relatively recent concept. Education 4.0 involves integrating advanced digital technologies, such as artificial intelligence, big data, the Internet of Things, and automation, into the teaching and learning process. The need to transform the perception of educational resources arose from the transformation of productive resources, which is exemplified by Industry 4.0. Digitalisation in education has been rapidly advancing in recent years, regardless of a country's level of development, and has transformed how education is accessed and delivered. The COVID-19 pandemic has had a significant impact on higher education institutions worldwide, accelerating the use of digital tools in education. The BRICS countries face the immense challenge of maintaining their growing influence in the global order renewal, which requires bridging the educational technological gap with best practices from developed countries in line with Society 4.0. This article highlights the undeniable need for Education 4.0 in BRICS countries and the importance of striking a delicate balance between embracing technological advancement and preserving national cultural identities to promote sustainable development.

Purpose of Review: Diabetes is the most common cause of kidney disease in individuals that receive a kidney transplant, and those without pre-existing diabetes are at greater risk of developing diabetes following kidney transplant. A class of diabetes treatment medications called glucagon-like peptide-1 receptor agonists (GLP-1RA) has seen recent widespread use for people with diabetes or obesity, with efficacy for improved glycemic control, weight loss, and reduced risk of cardiovascular events. Given these benefits, and indications for use that often co-occur in kidney transplant recipients, use of GLP-1RAs warrants consideration in this population. Therefore, we sought to review the current literature to better understand the mechanisms of action, clinical application, and person-centred considerations of GLP-1RAs in kidney transplant recipients. Sources of Information: Original articles were identified between December 2023 and July 2024 from electronic databases including the Ovid MEDLINE database, PubMed, and Google Scholar using terms “kidney transplant,” “GLP-1,” “glucagon-like peptide-1 receptor agonist,” and “diabetes.” Methods: A comprehensive review of the literature was conducted to explore the relationship between GLP-1RAs and kidney transplant recipients. We reviewed the current state of evidence across the research disciplines of basic or fundamental science, clinical and health services research, and person-centred equity science, and highlighted important knowledge gaps that offer opportunities for future research. Key Findings: Numerous clinical studies have demonstrated the benefit of GLP-1RAs in people with and without diabetic kidney disease, including decreased risk of cardiovascular events. However, there is a paucity of high-quality randomized controlled trials and observational studies analyzing use of GLP-1RAs in kidney transplant recipients. Evidence of benefit in this population is therefore limited to small studies or inferred from research conducted in nontransplant populations. Growing evidence from preclinical and clinical studies may elucidate renoprotective mechanisms of GLP-1RAs and remove barriers to application of these drugs in the transplant recipient population. Individuals who are female, non-white, have lower socioeconomic status, and live in rural communities are at greater risk of diabetes and have lower uptake of GLP-1RAs. There is a need for clinical trials across diverse kidney transplant populations to estimate the efficacy of GLP-1RAs on important health outcomes. Limitations: The search strategy for this narrative review may not have been sensitive to identify all relevant articles. Our search was limited to English language articles.

Background: Epidemiological data on the prevalence, causes and risk factors associated with vision impairment (VI) is necessary to evaluate the effectiveness of eye care services. Aim: To determine the prevalence, causes and factors associated with VI among patients presenting to public hospitals of Limpopo province, South Africa. Setting: This study was conducted in public hospitals. Methods: A retrospective chart review of patients seen from April 2019 to March 2022 in 29 public hospitals was conducted. The following information was extracted: demographic information, medical history, visual acuity (VA), refractive and ophthalmoscopy findings. Results: Of the 1140 participants, 56.1% were women. Participants’ ages ranged from 5 to 94 years. The prevalence of VI was 61.5%. Most had moderate-severe VI (57.3%), followed by blindness (22.7%) and mild VI (20.0%). The leading causes of VI were uncorrected refractive error (URE) (28.1%), cataract (26.0%) and glaucoma (25.0%). The main causes of blindness were glaucoma (42.8%) and cataract (32.1%); while URE (7.5%), retinal anomalies (7.5%) and corneal anomalies (6.9%) accounted for almost equal proportions of blindness. Participants aged 50–64 years (odds ratio [OR]: 1.7; 95% confidence interval [CI]: 1.2–2.6); 65 years and older (OR: 6.6; 95% CI: 4.3–10.2); and those diagnosed with systemic hypertension (OR: 2.5; 95% CI: 1.9–3.2) and diabetes mellitus (OR: 2.9; 95% CI: 1.9–4.4) had increased risk of VI. Conclusion: The prevalence of VI in this population is relatively high. The main causes of VI are correctable, suggesting the need for improved measures to prevent avoidable VI. Contribution: The study addresses the gap in the province’s current prevalence, causes and factors related to VI.

BackgroundTranscranial temporal interference stimulation (tTIS) is a new, emerging neurostimulation technology that utilizes two or more electric fields at specific frequencies to modulate the oscillations of neurons at a desired spatial location in the brain. The physics of tTIS offers the advantage of modulating deep brain structures in a non-invasive fashion and with minimal stimulation of the overlying cortex outside of a selected target. As such, tTIS can be effectively employed in the context of therapeutics for the psychiatric disease of disrupted brain connectivity, such as major depressive disorder (MDD). The subgenual anterior cingulate cortex (sgACC), a key brain center that regulates human emotions and influences negative emotional states, is a plausible target for tTIS in MDD based on reports of its successful neuromodulation with invasive deep brain stimulation.MethodsThis pilot, single-site, double-blind, randomized, sham-controlled interventional clinical trial will be conducted at St. Michael’s Hospital – Unity Health Toronto in Toronto, ON, Canada. The primary objective is to demonstrate target engagement of the sgACC with 130 Hz tTIS using resting-state magnetic resonance imaging (MRI) techniques. The secondary objective is to estimate the therapeutic potential of tTIS for MDD by evaluating the change in clinical characteristics of participants and electrophysiological outcomes and providing feasibility and tolerability estimates for a large-scale efficacy trial. Thirty participants (18–65 years) with unipolar, non-psychotic MDD will be recruited and randomized to receive 10 sessions of 130 Hz tTIS or sham stimulation (n = 15 per arm). The trial includes a pre- vs. post-treatment 3T MRI scan of the brain, clinical evaluation, and electroencephalography (EEG) acquisition at rest and during the auditory mismatch negativity (MMN) paradigm.DiscussionThis study is one of the first-ever clinical trials among patients with psychiatric disorders examining the therapeutic potential of repetitive tTIS and its neurobiological mechanisms. Data obtained from this trial will be used to optimize the tTIS approach and design a large-scale efficacy trial. Research in this area has the potential to provide a novel treatment option for individuals with MDD and circuitry-related disorders and may contribute to the process of obtaining regulatory approval for therapeutic applications of tTIS.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT05295888.

Virchow’s law of thrombosis states that thrombosis in a vessel occurs as a combination of the following: (i) injury to the vessel wall, (ii) stasis of blood flow, and (iii) blood hypercoagulability. Injury to the wall includes infection/inflammation and/or injury to the resident cells of the wall. We postulate that in COVID-19, the SARS-CoV-2 virus directly infects the alveolar type II cell or directly or indirectly infects/injures the pericyte, promoting inflammation and interaction with endothelial cells, thereby causing a cascade of events leading to our observation that thrombosis occurred within the walls of the pulmonary vessels and not in the lumen of the vascular circulation.

Cystic artery pseudoaneurysm (CAP) is a rare entity, with just a few cases reported in the literature. The most common presentation of CAP is described by Quincke's triad of upper gastrointestinal bleeding, jaundice and right upper quadrant abdominal pain. We report the case of an 83-year-old male who presented to the adult emergency with a history of an acute cholecystitis 5 weeks prior for which responded to conservative management. Despite this patient not presenting with Quincke's triad, early suspicion of CAP was considered in light of his history of acute cholecystitis and a computed tomographic CT abdomen ordered promptly which showed a 6 mm cystic artery pseudoaneurysm and a thick-walled gallbladder with surrounding inflammatory changes. Management with an endovascular approach followed by an elective cholecystectomy was done.

The vasa vasorum of the large pulmonary vessels is involved in the pathology of COVID-19. This specialized microvasculature plays a major role in the biology and pathology of the pulmonary vessel walls. We have evidence that thrombosis of the vasa vasorum of the large and medium-sized pulmonary vessels during severe COVID-19 causes ischemia and subsequent death of the pulmonary vasculature endothelium. Subsequent release of thrombi from the vasa interna into the pulmonary circulation and pulmonary embolism generated at the ischemic pulmonary vascular endothelium site, are the central pathophysiological mechanisms in COVID-19 responsible for pulmonary thromboembolism. The thrombosis of the vasa vasorum of the large and medium-sized pulmonary vessels is an internal event leading to pulmonary thromboembolism in COVID-19.

Here, we describe strategies for integrating transferrable professional development (PD) skills into research learning environments for marginalized undergraduate students. The undergraduate research experience evolved to include the competencies students need to be successful and to gain a sense of belonging in the chemistry community they are seeking. These asset-based transferrable PD skills are part of the "hidden curriculum" not taught in traditional classrooms and yet are an integral part of student learning and success. Furthermore, current practices, or lack thereof, tend to promote inequity and fail to amplify key asset-based skills for marginalized students to navigate academic, industrial, and professional settings effectively. Consequently, many students leave STEM communities. The following six PD skills are core competencies that have been implemented in a diverse undergraduate research environment to equip students with the skills needed to navigate various STEM environments. These include: (1) Effective Communication, (2) Negotiation, (3) Leadership, (4) Networking, (5) Interpersonal skills, and (6) Active Listening. Learning topics for each of the PD skills enable mentors to help preprofessional, marginalized students gain a sense of belonging, build a network, connect with mentors, develop self-advocacy, implement interpersonal skills, manage conflict, and navigate spaces that do not fully represent them. The inclusive integration of scientific and PD skills into research experiences serves as a template that can be extended to high school and graduate students. These integrated transferrable skills are one way to increase diversity in STEM professions and bridge the gap in leadership in academia and industry.

Nishanee Rampersad, Nonkululeko Gcabashe, Darshan Chetty, Fanelesibonge Sinamile Dubazane, Catherine Lafitte, Zothile Ndwandwe, Faatima Zahra Rauff, Phumzile Sibiya, Andile Tembe Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, Durban, South AfricaCorrespondence: Nishanee Rampersad, Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, South Africa, Tel +27 31 260 7562, Fax +27 31 260 7666, Email rampersadn@ukzn.ac.zaPurpose: Although research on teaching style preferences is available in the literature, there is limited information on the preferences of optometry teachers. The Coronavirus disease 2019 pandemic has impacted educational practices in all sectors. This study focuses on the teaching style preferences and online teaching practices of optometry teachers during the COVID-19 pandemic.Patients and Methods: The study used a case study research design and a self-administered online questionnaire and follow-up semi-structured interview for data collection. The Grasha-Riechmann teaching style inventory was used to explore the teaching style preferences (Expert, Formal Authority, Demonstrator, Facilitator and Delegator). Quantitative and qualitative data were analyzed using descriptive statistics and thematic content analysis respectively.Results: The optometry teachers were aged between 29 and 51 years (median = 45 years) and had between 3 and 25 years of teaching experience (median = 5 years). All teachers scored high in the Expert teaching style and most had scores categorized as high for the Delegator, Facilitator and Formal Authority teaching styles. The teachers reported that the initial adaptation to online teaching was difficult and challenging as they were not prepared for the rapid transition to online learning. They used various resources and materials but felt that student participation and engagement was lower in online teaching. Teachers noted that more time was needed to prepare materials for online teaching than for face-to-face teaching.Conclusion: Optometry teachers adopted a multidimensional approach preferring the different teaching styles to varying degrees. Teachers noted challenges with the initial transition and adaptation to online teaching and used a combination of resources to support student learning.Keywords: teaching style, online teaching practices, Grasha-Riechmann teaching style inventory, teaching and learning, optometry teachers

Transcranial magnetic stimulation (TMS) is often applied to the motor cortex to stimulate a collection of motor evoked potentials (MEPs) in groups of peripheral muscles. The causal interface between TMS and MEP is the selective activation of neurons in the motor cortex; moving around the TMS ‘spot’ over the motor cortex causes different MEP responses. A question of interest is whether a collection of MEP responses can be used to identify the stimulated locations on the cortex, which could potentially be used to then place the TMS coil to produce chosen sets of MEPs. In this work we leverage our previous report on a 3D convolutional neural network (CNN) architecture that predicted MEPs from the induced electric field, to tackle an inverse imaging task in which we start with the MEPs and estimate the stimulated regions on the motor cortex. We present and evaluate five different inverse imaging CNN architectures, both conventional and generative, in terms of several measures of reconstruction accuracy. We found that one architecture, which we propose as M2M-InvNet, consistently achieved the best performance.