Virtual patients in undergraduate psychiatry education: a systematic review and synthesis.

Virtual patients are increasingly used in undergraduate psychiatry education. This article reports on a systematic review aimed at providing an overview of different approaches in this context, describing their effectiveness, and thematically comparing learning outcomes across different undergraduate programs. The authors searched PubMed, PsycInfo, CINAHL, and Scopus databases for articles published between 2000 and January 2021. Quantitative and qualitative studies that reported on outcomes related to learners' knowledge, skills, and attitudes following an intervention with virtual patients in undergraduate psychiatry education were reviewed. Outcomes were thematically compared, and a narrative synthesis of the different outcomes and effectiveness was provided. Of 7856 records identified, 240 articles were retrieved for full-text review and 46 articles met all inclusion criteria. There were four broad types of virtual patient interventions: case-based presentation (n = 17), interactive virtual patient scenarios (n = 14), standardized virtual patients (n = 10), and virtual patient videogames (n = 5). The thematic analysis revealed that virtual patients in psychiatry education have been used for learners to construe knowledge about symptomatology and psychopathology, develop interpersonal and clinical communicative skills, and to increase self-efficacy and decrease stigmatizing attitudes towards psychiatric patients. In comparison with no intervention, traditional teaching, and text-based interventions, virtual patients were associated with higher learning outcomes. However, the results did not indicate any superiority of virtual patients over non-technological simulation. Virtual patients in psychiatry education offer opportunities for students from different health disciplines to build knowledge, practice skills, and improve their attitudes towards individuals with mental illness. The article discusses methodological shortcomings in the reviewed literature. Future interventions should consider the mediating effects of the quality of the learning environment, psychological safety, and level of authenticity of the simulation.

Formation of ß-Configured Thioglycosides of d-Glucosamine and d-Galactosamine and Synthesis of Protected Human Milk Oligosaccharides.

We report on the stereoselective multigram scale preparation of cyclohexyl- and phenyl thioglycosides of 2-azido-2-deoxy-ß-d-gluco- and galactopyranosides from d-N-acetylglucosamine using a catalytic and solvent-free method. Two of the prepared building blocks were used as key intermediates for the synthesis of human milk oligosaccharides LNT and LNnT in their protected form.

Consensus on communication curriculum content in Danish undergraduate medical education: A Delphi study.

BACKGROUND: The acquisition of skills in patient-centered communication is a critical aspect of medical education which demands both resource-intensive instruction and longitudinal opportunities for learning. Significant variation currently exists in the content and timing of communication education. The aim of this study was to establish consensus regarding communication curriculum content for undergraduate medical education (UME) within the country of Denmark. METHODS: This study employed a Delphi process which is a widely accepted method for establishing consensus among experts and can be utilized to guide planning and decision-making in education. For this study, consensus was based on greater than 60% agreement between participants. Diverse stakeholders, representing all four universities with medical schools in Denmark, participated in an iterative three-round Delphi process which involved: (1) identifying key curricular elements for medical student education, (2) rating the importance of each item, and (3) prioritizing items relative to one another and rating each item based on the level of mastery that was expected for each skill (i.e. knowledge, performance with supervision, or performance independently). RESULTS: A national sample of 149 stakeholders participated with a 70% response rate for round 1, 81% for round 2, and 86% for round 3. The completed Delphi process yielded 56 content items which were prioritized in rank order lists within five categories: (1) establishing rapport, engaging patient perspectives and responding to needs; (2) basic communication skills and techniques; (3) phases and structure of the encounter; (4) personal characteristics and skills of the student; (5) specific challenging patient groups and context-dependent situations. DISCUSSION: Using a Delphi process, it was possible to achieve consensus regarding communication curriculum content for UME. These findings provide an important foundation for ensuring greater uniformity in UME, as well as supporting the important longitudinal goals of communication skill development across medical training.

Students' Learning Experiences from Didactic Teaching Sessions Including Patient Case Examples as Either Text or Video: A Qualitative Study.

OBJECTIVES: The aim of this study was to explore medical students' learning experiences from the didactic teaching formats using either text-based patient cases or video-based patient cases with similar content. The authors explored how the two different patient case formats influenced students' perceptions of psychiatric patients and students' reflections on meeting and communicating with psychiatric patients. METHODS: The authors conducted group interviews with 30 medical students who volunteered to participate in interviews and applied inductive thematic content analysis to the transcribed interviews. RESULTS: Students taught with text-based patient cases emphasized excitement and drama towards the personal clinical narratives presented by the teachers during the course, but never referred to the patient cases. Authority and boundary setting were regarded as important in managing patients. Students taught with video-based patient cases, in contrast, often referred to the patient cases when highlighting new insights, including the importance of patient perspectives when communicating with patients. CONCLUSION: The format of patient cases included in teaching may have a substantial impact on students' patient-centeredness. Video-based patient cases are probably more effective than text-based patient cases in fostering patient-centered perspectives in medical students. Teachers sharing stories from their own clinical experiences stimulates both engagement and excitement, but may also provoke unintended stigma and influence an authoritative approach in medical students towards managing patients in clinical psychiatry.

Effect of red light on the development and quality of mammalian embryos.

PURPOSE: To assess irradiance and total energy dose from different microscopes during the in-vitro embryonic developmental cycle in mouse and pig and to evaluate its effect on embryonic development and quality in pig. METHOD: Spectral scalar irradiance (380-1050 nm) was measured by a fiber-optic microsensor in the focal plane of a dissection microscope, an inverted microscope and a time-lapse incubation system. Furthermore, the effect of three different red light levels was tested in the time-lapse system on mouse zygotes for 5 days, and on porcine zona-intact and zona-free parthenogenetically activated (PA) embryos for 6 days. RESULTS: The time-lapse system used red light centered at 625 nm and with a lower irradiance level as compared to the white light irradiance levels on the dissection and inverted microscopes, which included more energetic radiation <550 nm. Even after 1000 times higher total energy dose of red light exposure in the time-lapse system, no significant difference was found neither in blastocyst development of mouse zygotes nor in blastocyst rates and total cell number of blastocysts of porcine PA embryos. CONCLUSIONS: Our results indicate that red light (625 nm, 0.34 W/m(2)) used in the time-lapse incubation system does not decrease the development and quality of blastocysts in both mouse zygotes and porcine PA embryos (both zona-intact and zona-free).

Interscan reproducibility of computed tomography derived coronary plaque volume measurements.

BACKGROUND: Coronary computed tomography angiography (CCTA) enables detailed quantification and characterization of coronary atherosclerotic plaques, offering diagnostic and prognostic value. Interscan reproducibility studies on plaque volume measurements are limited. This study aims to assess the interscan reproducibility of coronary plaque quantification and the implications of clinical and technical characteristics on interscan reproducibility. METHODS: CCTA was performed twice in 101 patients with known coronary artery disease at a 1-h interval. The scans were conducted using identical CCTA acquisition protocols. Coronary plaque volumes were quantified using a semi-automated software and performed on a per-lesion, per-vessel, and per-patient level. RESULTS: Median plaque volumes were comparable between the first and second CCTA scan. Interscan correlation was high for total plaque (TP), non-calcified plaque (NCP), and calcified plaque (CP) across all analyses (Pearson's coefficient 0.93-0.99), but lower for low-density non-calcified plaque (LD-NCP) volume measurements (Pearson's coefficient 0.74-0.77). Bland-Altman analyses demonstrated higher interscan agreement on a per-patient level compared to on per-vessel and per-lesion level. Interscan reproducibility on CP volumes was affected by CT image quality with narrower LoA in scans with the highest image quality score (p â€‹= â€‹0.003), or lowest image reconstructive iteration level (p â€‹< â€‹0.001). Limits of agreement were significantly narrower for TP, NCP, and CP volumes in LAD-lesions and vessels compared to non-LAD lesions and vessels (p â€‹≤ â€‹0.001). CONCLUSION: Overall reproducibility of repeated CCTA derived plaque measurements by a semi-automated software was modest, and was influenced by image quality, image reconstruction settings, and lesion location.

Coronary CT angiography instead of invasive angiography before TAVI: Feasibility and outcomes.

AIMS: Concomitant coronary artery disease (CAD) is frequent in transcatheter aortic valve implantation (TAVI) candidates. Despite societal recommendations of performing invasive coronary angiography (ICA) for coronary assessment in the pre-TAVI diagnostic workup, the prognostic value of ICA and beneficial effect of revascularization in these patients remains unclear. We aimed to determine feasibility and outcomes following a strategy of cardiac CT + coronary CT angiography (cCTA) rather than cardiac CT + ICA before TAVI. METHODS AND RESULTS: We performed a single-center, observational cohort study including all patients, without previous coronary intervention, referred to TAVI between April 2020 and November 2021. CAD was assessed by cCTA, and only patients with proximal stenosis >70 %, or left main stenosis >50 %, or cCTA was non-evaluable regarding proximal segments were subsequently referred to ICA. 240 patients were included in the study. No adverse effects to pre-cCTA-scan nitroglycerin administration were observed. On cCTA, 92 % of the patients had atheroscerosis. 191 (80 %) patients had cCTA only performed, while 49 (20 %) patients underwent subsequent ICA. During a median (range) follow-up of 15 (Abdel-Wahab et al., 2012; Rapp et al., 2001; Sabbah et al., 2021; Gautier et al., 2011; Sankaramangalam et al., 2017; Otto et al., 2021; Tarantini et al., 2023; Vahanian et al., 2021; Faroux et al., 2019; Ferraro et al., 2020; Patterson et al., 2021; Blanke et al., 2019; Bleakley and Monaghan, 2018; Knuuti et al., 2020; Moss et al., 2017; van den Boogert et al., 2018; Collet et al., 2018; Linde et al., 2020; Schmidt et al., 2018; Hansson et al., 2013 [6-25]) months, no difference in procedural complication rates, mortality rates, or number of unplanned ICA was observed between patients evaluated with only cCTA vs cCTA+ICA. CONCLUSIONS: Upfront cCTA instead of ICA for assessment of obstructive CAD in the diagnostic workup of patients with severe aortic stenosis referred to TAVI is feasible, safe, and with similar procedural and clinical outcomes. Randomized studies are warranted to further validate the safety of using CTA rather than ICA for coronary assessment in TAVI candidates.

Dietary Long-Chain Fatty Acids Accelerate Metabolic Dysfunction in Guinea Pigs with Non-Alcoholic Steatohepatitis.

The composition of dietary fatty acids may be important for the development and progression of metabolic syndrome and non-alcoholic steatohepatitis (NASH). This study investigated the effect of two high-fat diets based on coconut oil, containing predominantly medium-chain fatty acids (MCFA), or cocoa butter, containing mainly long-chain fatty acids (LCFA), on glucose homeostasis and NASH in guinea pigs following 16 and 32 weeks of diet. At week 16, glucose intolerance was increased in the LCFA animals compared to the MCFA animals (p < 0.001), with both groups differing from the controls by week 32 (p < 0.0001), supported by increased hemoglobin A1c (p < 0.05). NASH was present in both high-fat groups from week 16, with advancing fibrosis appearing more progressive in the LCFA animals at week 16. In agreement, gene expression showed overall increased expression of NASH target genes in the LCFA animals compared to the MCFA animals at weeks 16 and 32 (p < 0.05 and p < 0.0001, respectively). The LCFA animals also displayed increased plasma uric acid at both time points (p < 0.05), a phenomenon linked to NASH in humans. In conclusion, this study reports that a diet high in LCFA promotes metabolic imbalance and may accelerate NASH-associated hepatic fibrosis. This highlights the importance of a critical evaluation of fatty acid composition when investigating NASH-associated endpoints.

A comparison of video-based and slide-based teaching before hands-on rubber dam application: A quantitative and qualitative study.

PURPOSE/OBJECTIVES: Instructional videos may demonstrate the execution of complex clinical procedures and the cooperation between members of the dental team better than traditional slide-based teaching materials. The aim of the present study was to compare the effect of a procedural video on student ratings to a traditional still-image-based presentation in a course on rubber dam application. METHODS: In a randomized, double-blind, parallel arm design, participants (46 dental students) completed a seven-item, five-step Likert-scale questionnaire at baseline (t1), after a video-based or slide-based demonstration of rubber dam application (t2) and after hands-on training (t3). The students' judgement on the benefits of rubber dam (items 1-3), their motivation to use rubber dam (item 4), their self-efficacy (items 5-6) and their expected use of the teaching material (item 7) were assessed. Changes in the students' individual answers were analyzed for each item and comparison between intervention groups made. Moreover, the impact of the teaching format on in-class discussions was analyzed qualitatively using a thematic approach RESULTS: Both interventions arose comparable significant improvement in the students' Likert-scale ratings from t1 to t2, and again from t2 to t3. No significant differences between intervention groups were found in the students' ratings or in the qualitative analysis. CONCLUSIONS: Procedural videos have proven to be a valuable learning aid in a variety of teaching formats, but in the context of a live lecture, they may not constitute an improvement over traditional text- and still-image-based presentations.

Comparison of the neuromuscular effects of two infusion rates of rocuronium in anesthetized pigs.

BACKGROUND: Neuromuscular blocking agents are frequently administered to pigs used for research. In humans, administration of the drugs is not without risk and may result in accidental awareness under general anaesthesia and postoperative residual neuromuscular blockade that can lead to serious respiratory complications. Despite the extensive administration, the pharmacodynamics of neuromuscular blocking agents are not thoroughly studied in pigs. Therefore, this study investigates the neuromuscular response of two infusion rates of rocuronium, a commonly used non-depolarizing neuromuscular blocking agent. A group of 14 female Danish Landrace-Yorkshire-Duroc pigs used for supervised surgical training, weighing 40.3 ± 2.1 kg (mean ± SD), were included in the study. They received a loading dose of 0.85 mg/kg rocuronium intravenously followed by infusion of either 2.5 mg/kg/hour (L, low dose) or 5 mg/kg/hour (H, high dose) rocuronium for 30 min. Neuromuscular monitoring was performed with acceleromyography using train-of-four (TOF) stimulation. Onset time, time to reappearance of T1, T4, TOF ratio 90% and 100% were recorded. RESULTS: All pigs in group H experienced loss of T1 throughout rocuronium infusion, whereas six out of seven pigs in group L had reappearance of T1 during rocuronium infusion, with additional reappearance of T4 in three of these pigs. The time to recovery of TOF ratio 90% was 14.0 ± 5.4 (L) and 21.7 ± 6.1 (H) minutes and recovery to TOF ratio 100% was 18.7 ± 6.5 (L) and 27.9 ± 9.2 min (H) (mean ± SD). Substantial inter-animal variation in neuromuscular recovery time was observed. CONCLUSION: The large inter-animal variation in pharmacodynamic profiles emphasizes that individual neuromuscular monitoring and titration to effect should be used routinely in research protocols that include rocuronium. In addition to other important measures, these actions are key in order to avoid overdosing and limit the risk of residual neuromuscular blockade.

Embryo quality, blastocyst and ongoing pregnancy rates in oocyte donation patients whose embryos were monitored by time-lapse imaging.

PURPOSE: In the current study, our aim was to demonstrate that EmbryoScope incubation conditions is comparable to standard laboratory incubation circumstances by comparing embryo quality, development and ongoing pregnancy rates between the EmbryoScope (ES) and a standard incubator (SI). We analyzed 478 embryos from 60 couples undergoing oocyte donation were included in the study. METHODS: All embryos retrieved from a patient were randomly distributed in the ES or SI. We calculated blastocyst development rate, blastocyst viability and ongoing pregnancy rate for embryo transfers from ES, SI and mixed (one embryo from the ES and one from the SI). Statistical analysis was conducted by Chi square tests, considering p < 0.05 significant. RESULTS: No significant differences were found between the ES and SI from all the parameters evaluated. CONCLUSIONS: Thus we concluded that time-lapse monitoring in the EmbryoScope does not impair embryo quality while allowing for morphological, spatial and temporal analysis of embryo development.

Hands-on live demonstration vs. video-supported demonstration of an aesthetic composite restoration in undergraduate dental teaching.

PURPOSE/OBJECTIVES: Live hands-on demonstration of dental procedures is a central format in undergraduate dental teaching. It captures the immediacy of the clinical situation and allows for direct communication between instructor and students, but it also requires an experienced instructor who is able to handle both the performed treatment and its visualization alongside the actual teaching. The aim of the present work is to compare the hands-on demonstration of a class IV composite restoration to a teaching format where the instructor guided the students through a prerecorded procedural video of the same treatment. METHODS: The effect of both interventions on the students' self-perceived learning outcomes was analyzed by questionnaires (response rate 100%) in a randomized controlled double-blind (participants, outcome assessor) parallel group design (September 10 to October 3, 2019). In-class discussions were explored qualitatively by thematic analysis. RESULTS: Both teaching formats increased the students' self-reported motivation, self-efficacy, and patient-centeredness in a similar way, with no significant differences between interventions. During in-class discussions, both the instructor and the students were more active in the video group. In contrast to the hands-on group, discussions in the video group also involved patient-related topics, such as aesthetics and general health. The video-supported teaching format considerably reduced the amount of time spent on optimizing the visualization of the performed treatment. CONCLUSION: Video-supported instructor-guided demonstrations may represent a promising teaching format as an alternative to live hands-on demonstrations of dental procedures in undergraduate dental education.

Video cases as tricksters, in medical students´ transition to psychiatric clerkship. A liminal perspective.

This article was migrated. The article was marked as recommended. OBJECTIVE: This study introduced a lens of liminal theory, drawn from anthropological classical ritual theory, to explore how a preparatory teaching format using video casesinfluenced medical students' patient approaches in their subsequent psychiatric clerkship. The video cases portrayed simulated patient-doctor encounters in diagnostic interview situations and were hypothesized to function as a liminal trickster. METHODS: The study applied a qualitative explorative design using individual rich picture interviews. We asked the students to draw their experiences, which we investigated using a semi-structured interview guide designed to capture and unfold the students' perspectives. We explored how students navigated insights from the preparatory teaching in their clerkship using liminal theory concepts in a mixed inductive and deductive thematic analysis. RESULTS: The results from 8 rich picture interviews demonstrated that students' ability to navigate insight gained from the video cases in their clerkship varied according to their roles in the clinical diagnostic interview situations. Students having active roles in the diagnostic interview situation adopted a patient-centred focus demonstrating empathic engagement and self-reflexivity related to their learning experiences with the video cases. Students with passive roles described a focus on how to adopt an appropriate appearance and copied the behaviour of the simulated doctors in the video cases. CONCLUSION: The liminal ritual theory perspective to explore the influence of preparatory teaching was useful for demonstrating how video cases could affect students' patient-centred learning. Without guidance and active roles in clerkship, medical students' learning experiences may lead to a prolonged liminal phase and may not capitalise on the potentially positive effects of the preparatory teaching. Liminal theory may further inform our understanding of students' learning considering patient cases in educational technology arrangements as tricksters.

Statistical and machine learning methods for analysis of multiplex protein data from a novel proximity extension assay in patients with ST-elevation myocardial infarction.

Using data from patients with ST-elevation myocardial infarction (STEMI), we explored how machine learning methods can be used for analysing multiplex protein data obtained from proximity extension assays. Blood samples were obtained from 48 STEMI-patients at admission and after three months. A subset of patients also had blood samples obtained at four and 12 h after admission. Multiplex protein data were obtained using a proximity extension assay. A random forest model was used to assess the predictive power and importance of biomarkers to distinguish between the acute and the stable phase. The similarity of response profiles was investigated using K-means clustering. Out of 92 proteins, 26 proteins were found to significantly distinguish the acute and the stable phase following STEMI. The five proteins tissue factor pathway inhibitor, azurocidin, spondin-1, myeloperoxidase and myoglobin were found to be highly important for differentiating between the acute and the stable phase. Four of these proteins shared response profiles over the four time-points. Machine learning methods can be used to identify and assess novel predictive biomarkers as showcased in the present study population of patients with STEMI.

Vitamin C Deficiency May Delay Diet-Induced NASH Regression in the Guinea Pig.

Oxidative stress is directly linked to non-alcoholic fatty liver disease (NAFLD) and the progression to steaotohepatitis (NASH). Thus, a beneficial role of antioxidants in delaying disease progression and/or accelerating recovery may be expected, as corroborated by recommendations of, e.g., vitamin E supplementation to patients. This study investigated the effect of vitamin C deficiency-often resulting from poor diets low in fruits and vegetables and high in fat-combined with/without a change to a low fat diet on NAFLD/NASH phenotype and hepatic transcriptome in the guinea pig NASH model. Vitamin C deficiency per se did not accelerate disease induction. However, the results showed an effect of the diet change on the resolution of hepatic histopathological hallmarks (steatosis, inflammation, and ballooning) (p < 0.05 or less) and indicated a positive effect of a high vitamin C intake when combined with a low fat diet. Our data show that a diet change is important in NASH regression and suggest that a poor vitamin C status delays the reversion towards a healthy hepatic transcriptome and phenotype. In conclusion, the findings support a beneficial role of adequate vitamin C intake in the regression of NASH and may indicate that vitamin C supplementation in addition to lifestyle modifications could accelerate recovery in NASH patients with poor vitamin C status.

Clinical outcomes following real-world computed tomography angiography-derived fractional flow reserve testing in chronic coronary syndrome patients with calcification.

AIMS: This study sought to investigate outcomes following a normal CT-derived fractional flow reserve (FFRCT) result in patients with moderate stenosis and coronary artery calcification, and to describe the relationship between the extent of calcification, stenosis, and FFRCT. METHODS AND RESULTS: Data from 975 consecutive patients suspected of chronic coronary syndrome with stenosis (30-70%) determined by computed CT angiography and FFRCT to guide downstream management decisions were reviewed. Median (range) follow-up time was 2.2 (0.5-4.2) years. Coronary artery calcium (CAC) scores were ≥400 in 25%, stenosis ≥50% in 83%, and FFRCT >0.80 in 51% of the patients. There was a lower incidence of the composite endpoint (death, myocardial infarction, hospitalization for unstable angina, and unplanned coronary revascularization) at 4.2 years in patients with any CAC and FFRCT > 0.80 vs. FFRCT ≤ 0.80 (3.9% and 8.7%, P = 0.04), however, in patients with CAC scores ≥400 the risk difference between groups did not reach statistical significance, 4.2% vs. 9.7% (P = 0.24). A negative relationship between CAC scores and FFRCT irrespective of stenosis severity was demonstrated. CONCLUSION: FFRCT shows promise in identifying patients with stenosis and calcification who can be managed without further downstream testing. Moreover, an inverse relationship between CAC levels and FFRCT was demonstrated. Studies are needed to further assess the clinical utility of FFRCT in patients with extensive coronary calcification.

Novel Blood-Derived Extracellular Vesicle-Based Biomarkers in Alzheimer's Disease Identified by Proximity Extension Assay.

Easily accessible biomarkers for Alzheimer's dementia (AD) are lacking and established clinical markers are limited in applicability. Blood is a common biofluid for biomarker discoveries, and extracellular vesicles (EVs) may provide a matrix for exploring AD related biomarkers. Thus, we investigated proteins related to neurological and inflammatory processes in plasma and EVs. By proximity extension assay (PEA), 182 proteins were measured in plasma and EVs from patients with AD (n = 10), Mild Cognitive Impairment (MCI, n = 10), and healthy controls (n = 10). Plasma-derived EVs were enriched by 20,000× g, 1 h, 4 °C, and confirmed using nanoparticle tracking analysis (NTA), western blotting, and transmission electron microscopy with immunolabelling (IEM). Presence of CD9+ EVs was confirmed by western blotting and IEM. No group differences in particle concentration or size were detected by NTA. However, significant protein profiles were observed among subjects, particularly for EVs. Several proteins and their ratios could distinguish cognitively affected from healthy individuals. For plasma TGF-α│CCL20 (AUC = 0.96, 95% CI = 0.88-1.00, p = 0.001) and EVs CLEC1B│CCL11 (AUC = 0.95, 95% CI = 0.86-1.00, p = 0.001) showed diagnostic capabilities. Using PEA, we identified protein profiles capable of distinguishing healthy controls from AD patients. EVs provided additional biological information related to AD not observed in plasma alone.

Metabolomic signatures of inbreeding at benign and stressful temperatures in Drosophila melanogaster.

While the population genetics of inbreeding is fairly well understood, the effects of inbreeding on the physiological and biochemical levels are not. Here we have investigated the effects of inbreeding on the Drosophila melanogaster metabolome. Metabolite fingerprints in males from five outbred and five inbred lines were studied by nuclear magnetic resonance spectroscopy after exposure to benign temperature, heat stress, or cold stress. In both the absence and the presence of temperature stress, metabolite levels were significantly different among inbred and outbred lines. The major effect of inbreeding was increased levels of maltose and decreased levels of 3-hydroxykynurenine and a galactoside [1-O-(4-O-(2-aminoethyl phosphate)-beta-d-galactopyranosyl)-x-glycerol] synthesized exclusively in the paragonial glands of Drosophila species, including D. melanogaster. The metabolomic effect of inbreeding at the benign temperature was related to gene expression data from the same inbred and outbred lines. Both gene expression and metabolite data indicate that fundamental metabolic processes are changed or modified by inbreeding. Apart from affecting mean metabolite levels, inbreeding led to an increased between-line variation in metabolite profiles compared to outbred lines. In contrast to previous observations revealing interactions between inbreeding and environmental stress on gene expression patterns and life-history traits, the effect of inbreeding on the metabolite profile was similar across the different temperature treatments.

Evaluating the effectiveness of video cases to improve patient-centeredness in psychiatry: a quasi-experimental study.

OBJECTIVES: To evaluate the effectiveness of including interactive video-based patient cases in preparatory lectures on medical students' patient-centredness and attitudes towards psychiatry. METHODS: This study was designed as a quasi-experimental intervention study. A preparatory lecture on diagnostic interviewing was given to 204 fourth-year medical students before a 4-week psychiatry clerkship. The students were divided into two groups. One group (n=102) received a preparatory lecture including an interactive video case portraying a doctor performing a diagnostic interview with a simulated patient (intervention group). The other group (n=102) received a conventional preparatory lecture using text-based instructional material (control group). We conducted a paired sample t-test to compare the students' confidence in exhibiting patient-centred communication and their attitudes towards psychiatry before receiving the preparatory lecture and after having completed a minimum of three weeks of clerkship training. RESULTS: A total of 102 students, 51 in each group, completed a questionnaire at both measurement points. In the intervention group, we found a statistically significantly difference for the students' patient-centredness before (M=69.4, SD=10.0) and after (M=73.8, SD=8.6) the intervention t(97)=2.38, p= 0.02, but no changes in attitudes t(98) =1.07, p=0.28. In the control group, we found no changes in patient-centredness or attitudes. CONCLUSIONS: Video cases in preparatory lectures appear to be better than text-based material at improving students' patient-centredness in psychiatry. However, neither video cases nor text-based material seem to influence the students' attitudes.

Extreme temperatures increase the deleterious consequences of inbreeding under laboratory and semi-natural conditions.

The majority of experimental studies of the effects of population bottlenecks on fitness are performed under laboratory conditions, which do not account for the environmental complexity that populations face in nature. In this study, we test inbreeding depression in multiple replicates of inbred when compared with non-inbred lines of Drosophila melanogaster under different temperature conditions. Egg-to-adult viability, developmental time and sex ratio of emerging adults are studied under low, intermediate and high temperatures under laboratory as well as semi-natural conditions. The results show inbreeding depression for egg-to-adult viability. The level of inbreeding depression is highly dependent on test temperature and is observed only at low and high temperatures. Inbreeding did not affect the developmental time or the sex ratio of emerging adults. However, temperature affected the sex ratio with more females relative to males emerging at low temperatures, suggesting that selection against males in pre-adult life stages is stronger at low temperatures. The coefficient of variation (CV) of egg-to-adult viability within and among lines is higher for inbred flies and generally increases at stressful temperatures. Our results contribute to knowledge on the environmental dependency of inbreeding under different environmental conditions and emphasize that climate change may impact negatively on fitness through synergistic interactions with the genotype.