The impact of apparent temperature on the emergency visits for traumatic fractures in Hangzhou, China.

BACKGROUND: Traumatic fractures occur frequently worldwide. However, research remains limited on the association between short-term exposure to temperature and traumatic fractures. This study aims to explore the impact of apparent temperature (AT) on emergency visits (EVs) due to traumatic fractures. METHODS: Based on EVs data for traumatic fractures and the contemporary meteorological data, a generalized Poisson regression model along with a distributed lag nonlinear model (DLNM) were undertaken to determine the impact of AT on traumatic fracture EVs. Subgroup analysis by gender and age and sensitivity analysis were also performed. RESULTS: A total of 25,094 EVs for traumatic fractures were included in the study. We observed a wide "J"-shaped relationship between AT and risk of traumatic fractures, with AT above 9.5 °C positively associated with EVs due to traumatic fractures. The heat effects became significant at cumulative lag 0-11 days, and the relative risk (RR) for moderate heat (95th percentile, 35.7 °C) and extreme heat (99.5th percentile, 38.8 °C) effect was 1.311 (95% CI: 1.132-1.518) and 1.418 (95% CI: 1.191-1.688) at cumulative lag 0-14 days, respectively. The cold effects were consistently non-significant on single or cumulative lag days across 0-14 days. The heat effects were higher among male and those aged 18-65 years old. The sensitivity analysis results remained robust. CONCLUSION: Higher AT is associated with cumulative and delayed higher traumatic fracture EVs. The male and those aged 18-65 years are more susceptible to higher AT.

Digging and identification of novel microorganisms from the soil environments with high methanol-tolerant lipase production for biodiesel preparation.

Converting renewable biomass into carbon-neutral biofuels is one of the most effective strategies to achieve zero carbon emissions and contribute to environmental protection. Microorganisms from the soil were primarily screened on the rhodamine B-plate for highly-active lipase producing strains and re-screened on a tributyrin-methanol plate using crude lipases produced from the initially screened-out strains. The lipase-producing strains with higher methanol-tolerant lipase were identified based on morphological characteristics and 16S rDNA sequencing. The crude lipases with much higher methanol-tolerance from screened top-4 strains, Stenotrophomonas maltophilia D18, Lysinibacillus fusiformis B23, Acinetobacter junii C69, and A. pittii C95 showed temperature optima of 25 °C, 35 °C, 30 °C, and 30 °C at pH 7.0, respectively, while their pH optima were 8.0, 7.0, 7.5, and 7.5 at each optimum temperature, respectively. After 24-h incubation, they retained more than 85% of their original activities in 25%, 15%, 20%, and 20% of methanol, respectively. They catalyzed the conversion of soybean oil into biodiesel by yields of 63.1%, 35.4%, 74.6%, and 78.5% after 24-h reactions, respectively. In conclusion, the as-isolated microorganisms producing high methanol-tolerant lipase are considered promising to provide robust biocatalyst for efficient biodiesel preparation and other industrial applications.

Ghrelin attenuate cerebral microvascular leakage by regulating inflammation and apoptosis potentially via a p38 MAPK-JNK dependent pathway.

Ghrelin is a peptide hormone with strong anti-inflammatory properties. In fact, Ghrelin was reported to improve endothelial dysfunction caused by excessive fat. However, its role in preserving the integrity of brain microvascular, under conditions of lipid dysregulation and inflammation, is not known. The objective of this study is to characterize the role of Ghrelin in the protection of cerebral microvascular integrity, during atherosclerosis, and uncover its underlying molecular mechanism. Our results demonstrated that an atherosclerotic condition, brought on by a high fat diet (HFD), can produce massive increases in serum inflammatory factors, blood lipids, cerebral microvascular leakage, and activation of the p38 mitogen-activated protein kinase (MAPK) and c-Jun N-terminal kinase (JNK) (p38 MAPK-JNK) pathway. It also produced significantly damaged pericytes morphology, resulting in pericyte decrease. Ghrelin treatment, on the other hand, protected against cerebral microvascular leakage and pericytes damage. Ghrelin effectively downregulated the expression of pro-inflammatory cytokines, and it also suppressed the p38 MAPK-JNK signaling pathway. Additionally, in isolated mouse cerebral microvascular pericytes, ox-LDL lead to increased apoptosis and secretion of inflammatory factors, along with an elevation in phosphorylated p38 MAPK-JNK proteins. Alternately, Ghrelin administration markedly lowered expression of inflammatory factors, suppressed the p38 MAPK-JNK signaling path, and halted cell apoptosis. However, pretreatment of Hesperetin, a p38 MAPK-JNK agonist, abrogated the Ghrelin-mediated suppression of inflammation and apoptosis in pericytes. Taken together, these results suggest that Ghrelin restored cerebral microvascular integrity and reduced vascular leakage in atherosclerosis mice, in part, by its regulation of inflammatory and apoptotic signaling pathways in pericytes.

Gamma-Glutamyl Transpeptidase to Platelet Ratio: A New Inflammatory Marker Associated with Outcomes after Cardiac Arrest.

INTRODUCTION: In recent years, gamma-glutamyl transpeptidase to platelet ratio (GPR) has been proposed as a new inflammatory marker. We aimed to evaluate the association between GPR and outcomes after cardiac arrest (CA). METHODS: A total of 354 consecutive patients with CA were included in this retrospective study. Patients were divided into three groups according to tertiles of GPR (low, n = 119; middle, n = 117; and high, n = 118). To determine the relationship between GPR and prognosis, a logistic regression analysis was performed. The ability of GPR to predict the outcomes was evaluated by receiver operating characteristic (ROC) curve analysis. Two prediction models were established, and the likelihood ratio test (LRT) and the Akaike Information Criterion (AIC) were utilized for model comparison. RESULTS: Among the 354 patients (age 62 [52, 74], 254/354 male) who were finally included in the analysis, those in the high GPR group had poor outcomes. Multivariate logistic regression analysis revealed that GPR was independently associated with the three outcomes, for ICU mortality (odds ratios (OR) = 1.738, 95% confidence interval (CI): 1.221-2.474, P = 0.002), hospital mortality (OR = 1.676[1.164 - 2.413], P = 0.005), and unfavorable neurologic outcomes (OR = 1.623[1.121 - 2.351], P = 0.010). The area under the ROC curve was 0.611 (95% Cl: 0.558-0.662) for ICU mortality, 0.600 (95% CI: 0.547-0.651) for hospital mortality, and 0.602 (95% CI: 0.549-0.653) for unfavorable neurologic outcomes. Further, the LRT analysis showed that compared with the model without GPR, the GPR-combined model had a higher likelihood ratio χ 2 score and smaller AIC. CONCLUSION: GPR, as an inflammatory indicator, was independently associated with outcomes after CA. GPR is helpful in estimating the clinical outcomes of patients with CA.

Usefulness of fibrinogen-to-albumin ratio to predict no-reflow and short-term prognosis in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

No-reflow is one of the major complications of primary percutaneous coronary artery intervention (pPCI) in the treatment of acute ST-segment elevation myocardial infarction (STEMI). Fibrinogen-to-albumin ratio (FAR) has currently emerged as a novel inflammatory marker to predict inflammation in chronic diseases. This study aimed to investigate whether admission FAR values predicts angiographic no-reflow and short-term prognosis in all STEMI patients. A total of 510 consecutive STEMI patients who underwent successful pPCI between September 2016 and May 2018 were included in this study. Patients were divided into groups based on thrombolysis in myocardial infarction (TIMI) flow grades after pPCI. No-reflow was defined as a post-PCI TIMI flow grade of 0, 1, or 2. Angiographic success was defined as TIMI flow grade 3. Fibrinogen, hs-CRP, and admission FAR values were significantly higher among patients with no-reflow. On multivariate analysis, admission FAR was an independent predictor of angiographic no-reflow (p < 0.001). Receiver-operating characteristics analysis revealed the cut-off value of admission FAR was a predictor of no-reflow with a sensitivity of 79.59% and a specificity of 69.42%. In multivariable Cox regression models adjusted for potential confounders, admission FAR values, and LVEF, hs-CRP was independently and positively associated with the 30-day all-cause mortality. Admission FAR was associated independently and significantly with angiographic no-reflow and short-term mortality in patients with STEMI undergoing pPCI.

The quality of life of medical students studying in New Zealand: a comparison with nonmedical students and a general population reference group.

BACKGROUND: Quality of life is an essential component of learning and has strong links with the practice and study of medicine. There is burgeoning evidence in the research literature to suggest that medical students are experiencing health-related problems such as anxiety, depression, and burnout. PURPOSE: The aim of the study was to investigate medical students' perceptions concerning their quality of life. METHODS: Two hundred seventy-four medical students studying in their early clinical years (response rate = 80%) participated in the present study. Medical students were asked to fill in the abbreviated version of the World Health Organization Quality of Life questionnaire to elicit information about their quality of life perceptions in relation to their physical health, psychological health, social relationships, and environment. Subsequently, their responses were compared with two nonmedical students groups studying at a different university in the same city and an Australian general population norm. The findings were compared using independent group's t tests, confidence intervals, and Cohen's d. RESULTS: The main finding of the study indicated that medical students had similar quality of life perceptions to nonmedical students except in relation to the environment domain. Furthermore, the medical student group scored lower than the general population reference group on the physical health, psychological health, and environment quality of life domains. CONCLUSIONS: The results suggest that all university students are expressing concerns related to quality of life, and thus their health might be at risk. The findings in this study provided no evidence to support the notion that medical students experience lower levels of quality of life compared to other university students. When compared to the general population, all student groups examined in this study appeared to be experiencing lower levels of quality of life. This has implications for pastoral support, educationalists, student support personnel, and the university system.

D-dimer to Creatinine Ratio: A Novel Biomarker Associated with Gensini Score in ST-Segment Elevation Myocardial Infarction Patients.

OBJECTIVE: We propose for the first time that D-dimer to creatinine ratio (DCR) may serve as a new clinical biomarker and explore its association with ST-segment elevation myocardial infarction (STEMI). METHODS: 347 STEMI patients with complete D-dimer and creatinine were included in the analysis. According to the median of DCR value, patients were divided into the lower DCR group (DCR < 1.402, n = 173) and the higher DCR group (DCR ≥ 1.402, n = 174), and the differences between the two groups were compared. In addition, patients were divided into four groups according to the quartiles of Gensini score: Group 1(Gensini score ≤ 34, n = 88); Group 2(34 < Gensini score ≤ 65, n = 88); Group 3(65 < Gensini score ≤100, n = 87); Group 4(Gensini score ＞100, n = 84). Multivariate linear and multivariate logistic regression analyzes were performed to determine independent predictors of the Gensini score. RESULTS: High DCR group had higher Gensini score compared with the low DCR group (P < .05). DCR was positively correlated with Gensini score (r = 0.493, P < .001). Multiple linear regression analysis showed that Previous MI (r = 11.312, P = .035) and DCR (r = 5.129, P < .001) were independent risk factors associated with the Gensini score. Multivariate logistic regression analysis showed that, compared to Group 1, DCR was an independent risk factor in Group 2, Group 3, Group 4 (P < .001). CONCLUSIONS: As a new and useful clinical biomarker, DCR was positively correlated with coronary Gensini score in STEMI patients.

Appropriate level of cuproptosis may be involved in alleviating pulmonary fibrosis.

Objective: Cuproptosis is a newly discovered form of programmed cell death that has not been studied in pulmonary fibrosis. The purpose of the present study was to explore the relationship between cuproptosis and pulmonary fibrosis. Methods: Single-cell sequencing (scRNA-seq) data for human and mouse pulmonary fibrosis were obtained online from Gene Expression Omnibus (GEO) database. First, fibroblast lineage was identified and extracted using the Seurat toolkit. The pathway was then evaluated via Gene Set Enrichment Analyses (GSEA), while transcription factor activity was analyzed using DoRothEA. Next, fibroblast differentiation trajectory was inferred via Monocle software and changes in gene expression patterns during fibroblast activation were explored through gene dynamics analysis. The trajectory was then divided into three cell states in pseudotime order and the expression level of genes related to cuproptosis promotion in each cell state was evaluated, in addition to genes related to copper export and buffering and key genes in cellular metabolic pathways. Results: In the mouse model of pulmonary fibrosis induced by bleomycin, the genes related to cuproptosis promotion, such as Fdx1, Lias, Dld, Pdha1, Pdhb, Dlat, and Lipt1, were gradually down-regulated in the process of fibroblast differentiation from resting fibroblast to myofibroblast. Consistently, the same results were obtained via analysis of scRNA-seq data for human pulmonary fibrosis. In addition, genes related to copper ion export and buffering gradually increased with the activation of fibroblasts. Metabolism reprogramming was also observed, while fibroblast activation and tricarboxylic acid(TCA) cycle and lipid metabolism were gradually down-regulated and mitochondrial metabolism was gradually up-regulated. Conclusion: The present study is the first to reveal a negative correlation between cuproptosis and fibrosis, suggesting that an appropriate cuproptosis level may be involved in inhibiting fibroblast activation. This may provide a new method for the treatment of pulmonary fibrosis.

Blood urea nitrogen to serum albumin ratio as a new prognostic indicator in critical patients with chronic heart failure.

AIMS: Chronic heart failure (CHF) is often a common comorbidity in critically ill patients admitted to the intensive care unit (ICU) and carries an extremely poor prognosis. The study aimed to investigate the relationship between the blood urea nitrogen to serum albumin ratio (BAR) and the prognosis of patients with CHF admitted to the ICU. METHODS AND RESULTS: This retrospective cohort study included 1545 critically ill patients with CHF as a diagnosed comorbidity admitted to the ICU deposited in the MIMIC-III database, of whom 90 day all-cause mortality was 27.6% (n = 427) and in-hospital mortality was 17.3% (n = 267). The results of multiple logistic regression analysis indicated that BAR is an independent risk factor for in-hospital mortality in critically ill patients with CHF [compared with BAR ≤ 0.83; 0.83 < BAR ≤ 1.24: odds ratio (OR) 2.647, 95% confidence interval (CI) 1.797-3.900, P < 0.001; BAR ≥ 1.24: OR 3.628, 95% CI 2.604-5.057, P < 0.001]. Multiple COX regression analysis found a relationship between BAR and all-cause mortality at 90 day follow-up (0.83 < BAR ≤ 1.24: OR 1.948, 95% CI 1.259-3.014, P < 0.003; BAR ≥ 1.24: OR 1.807, 95% CI 1.154-2.830, P < 0.01; BAR ≤ 0.83 as a reference). Kaplan-Meier curves also showed similar results as well (P < 0.001). The areas under the receiver operating characteristic curves for predicting in-hospital mortality and 90 day all-cause mortality were 0.622 and 0.647, respectively. CONCLUSIONS: BAR is an independent risk factor for in-hospital mortality and 90 day mortality in critically ill patients with CHF admitted to the ICU.

Gpx3 and Egr1 Are Involved in Regulating the Differentiation Fate of Cardiac Fibroblasts under Pressure Overload.

Objectives: Although myocardial fibrosis is a common pathophysiological process associated with many heart diseases, the molecular mechanisms regulating the development of fibrosis have not been fully determined. Recently, single cell RNA sequencing (scRNA-seq) analysis has been used to examine cellular fate and function during cellular differentiation and has contributed to elucidating the mechanisms of various diseases. The main purpose of this study was to characterize the fate of cardiac fibroblasts (CFs) and the dynamic gene expression patterns in a model of cardiac pressure overload using scRNA-seq analysis. Methods: The public scRNA-seq dataset of the transverse aortic coarctation (TAC) model in mice was downloaded from the GEO database, GSE155882. First, we performed quality control, dimensionality reduction, clustering, and annotation of the data through the Seurat R package (v4.0.5). Then, we constructed the pseudotime trajectory of cell development and identified key regulatory genes using the Monocle R package (v2.22.0). Different cell fates and groups were fully characterized by Gene Set Enrichment Analysis (GSEA) analysis and Transcription factor (TF) activity analysis. Finally, we used Cytoscape (3.9.1) to extensively examine the gene regulatory network related to cell fate. Results: Pseudotime analysis showed that CFs differentiated into two distinct cell fates, one of which produced activated myofibroblasts, and the other which produced protective cells that were associated with reduced fibrosis levels, increased antioxidative stress responses, and the ability to promote angiogenesis. In the TAC model, activated CFs were significantly upregulated, while protective cells were downregulated. Treatment with the bromodomain inhibitor JQ1 reversed this change and improved fibrosis. Analysis of dynamic gene expression revealed that Gpx3 was significantly upregulated during cell differentiation into protective cells. Gpx3 expression was affected by JQ1 treatment. Furthermore, Gpx3 expression levels were negatively correlated with the different levels of fibrosis observed in the various treatment groups. Finally, we found that transcription factors Jun, Fos, Atf3, and Egr1 were upregulated in protective cells, especially Egr1 was predicted to be involved in the regulation of genes related to antioxidant stress and angiogenesis, suggesting a role in promoting differentiation into this cell phenotype. Conclusions: The scRNA-seq analysis was used to characterize the dynamic changes associated with fibroblast differentiation and identified Gpx3 as a factor that might be involved in the regulation of myocardial fibrosis under cardiac pressure overload. These findings will help to further understanding of the mechanism of fibrosis and provide potential intervention targets.

Effects of oral administration of ß-hydroxy ß-methylbutyrate on lean body mass in older adults: a systematic review and meta-analysis.

OBJECTIVE: Beta-hydroxy beta-methylbutyrate (HMB), a metabolite of leucine, is currently widely used in athletes to increase muscle mass and strength and has also been used as a nutritional supplement in recent years to maintain muscle mass in muscular atrophic diseases of older people. However, the effects of HMB supplementation on muscle mass, muscle strength, and physical function in older people remain controversial. The purpose of this review was to explore the effects of HMB on body composition in older adults. METHODS: The PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases were searched to obtain the randomized controlled trials needed as a basis for systematic review and meta-analysis. RESULT: A total of 9 studies (448 participants) were eventually found eligible. The pooled results showed that HMB supplementation significantly increased fat-free mass in older people compared with the control group (effect size: 0.37; 95% Cl 0.16, 0.58; Z value = 3.47, P = 0.001; Fixed-effect model). But it had no effect on fat mass (effect size: - 0.04 95% CI - 0.26, 0.18; Z value = 0.36, P = 0.716, fixed-effect model). Subgroup analysis of HMB supplementation alone showed a significant improvement in fat-free mass in older people (effect size: 0.59; 95% CI 0.32, 0.87; Z = 4.24, P < 0.001; fixed-effect model), whereas HMB supplementation combined with exercise intervention showed no additional fat-free mass change (effect size: 0.06; 95% CI - 0.26, 0.38; Z = 0.38, P = 0.705; Fixed-effect model). CONCLUSION: HMB supplementation is beneficial for improving body composition in older people. However, the effect of HMB supplementation combined with exercise therapy to improve muscle mass is not obvious. Exercise programs need to be designed according to the different physical health of older people.

Sitagliptin on carotid intima-media thickness in type 2 diabetes and hyperuricemia patients: a subgroup analysis of the PROLOGUE study.

BACKGROUND AND AIMS: Studies have shown that dipeptidyl peptidase-4 (DDP-4) inhibitors have anti-atherosclerotic effects. However, in the PROLOGUE study, sitagliptin failed to slow the progression of carotid intima-media thickness (CIMT) relative to conventional therapy. We conducted a post hoc analysis of the PROLOGUE study and compared the effects of sitagliptin and conventional therapy on changes in CIMT in subgroups with or without hyperuricemia. METHODS: The PROLOGUE study was a randomized controlled trial of 442 patients with type 2 diabetes mellitus (T2DM). Patients were randomized to receive sitagliptin added therapy or conventional therapy. Based on the serum uric acid levels of all study populations in the PROLOGUE study, we divided them into hyperuricemia subgroup (n = 104) and non-hyperuricemia subgroup (n = 331). The primary outcome was changed in carotid intima-media thickness (CIMT) parameters compared with baseline during the 24 months treatment period. RESULTS: In the hyperuricemia subgroup, compared with the conventional therapy group, the changes in the mean internal carotid artery (ICA)-IMT and max ICA-IMT at 24 months were significantly lower in the sitagliptin group [-0.233 mm, 95% confidence interval (CI) (-0.419 to 0.046), p = 0.015 and -0.325 mm, 95% CI (-0.583 to -0.068), p = 0.014], although there was no significant difference in the common carotid artery CIMT. CONCLUSION: The results of our analysis indicated that sitagliptin attenuated the progression of CIMT than conventional therapy in T2DM and hyperuricemia patients.

Association of fibrinogen/albumin ratio and coronary collateral circulation in stable coronary artery disease patients.

Aim: To investigate whether fibrinogen/albumin ratio (FAR) has an association with the coronary collateral circulation (CCC) in patients with stable coronary artery disease. Materials & methods: A total of 391 patients with stable coronary artery disease who underwent coronary angiography were included. The patients were divided into two groups according to the Rentrop score. Results: The poorly developed CCC group had a significantly higher FAR level compared with the well-developed CCC group (p < 0.001). In the multivariate analysis, the FAR (odds ratio: 1.700; 95% CI: 1.420-2.036; p < 0.001) was an independent predictor of poorly developed CCC. Conclusion: FAR can be used as one of the independent predictors of CCC formation.

[Relationship of atherogenesis and proteoglycans in wall of vein graft, an experimental study].

OBJECTIVE: To investigate the relationship between the concentrations of proteoglycans (PGs) and progress of atherogenesis in grafted vein. METHODS: A section of common carotid artery with a length of 0.5 cm was cut off and then a section of vein was implanted to the damage among 72 male New Zealand rabbits. Then the rabbits were randomly divided into two groups of 36 rabbits to be fed with high fat diet and ordinary diet respectively. Every six rabbits were killed one week, 2 weeks, 4 weeks, 8 weeks, 12 weeks, and 20 weeks after the operation. The implanted veins were taken to be observed by electron microscopy. The PGs in the implanted veins were extracted and divided into heparan sulfate proteoglycan (HSPG), chondroitin sulfate proteoglycan (CSPG), and dermatan sulfate proteoglycan (DSPG) by anion-exchange chromatography 8, 12, and 20 weeks postoperatively. The concentrations of PGs were measured. Blood was extracted from the heart to examine the level of LDL-cholesterol. The normal jugular veins on the opposite side were used as controls. RESULTS: The level of LDL-cholesterol in the high fat diet group was 26.5 +/- 7.49 mmol/L, significantly higher than that in the normal diet group (0.71 +/- 0.65 mmol/L, P < 0.05). In the normal diet group, the content of CSPG-DSPG was 1,077 +/- 116 micro g/g, significantly higher than that of the normal vein (809 +/- 75 micro g/g, P < 0.05), and not significantly different from that of the normal diet group (1,077 +/- 116 micro g/g) 8 weeks postoperatively, and became lower 12 and 20 weeks postoperatively (773 +/- 49 and 819 +/- 45 micro g/g respectively), both similar to that of normal vein (both P > 0.05). Foam cells were found 20 weeks postoperatively. In the high fat diet group, the content of CSPG-DSPG was 1,089 +/- 94 micro g/g 8 weeks postoperatively, significantly higher than that of normal vein (P < 0.05), and the high level lasted till the 20 th postoperative week (1,068 +/- 100 micro g/g, P < 0.05). Foam cells were detected as early since the 4 th postoperative week, unorganized areas were found 20 weeks after the operation. The HSPG content was not significantly different among the high fat diet group, normal diet group, and the normal vein (with a range of 213 +/- 34 - 278 +/- 33 micro g/g), The proportion of HSPG in total PGs 8, 12, and 20 weeks postoperatively in the high fat diet group were 19.6%, 18.6%, and 16.6% respectively, lower than those in the normal diet group (18.8%, 21.9%, 21.9%) and much lower than that in the normal vein (25.55%). CONCLUSION: CSPG-DSPG has auxo-action on atherogenesis in graft, but HSPG protects the graft against atherogenesis to an extent.

Rethinking the admission criteria to nursing school.

The main objective of this study was to identify the best predictors for student achievements (Undergraduate Grade Point Average (UGPA)) in their first year in an undergraduate nursing programme. Data were acquired from the Tracking Project database which is held by the Faculty of Medical and Health Sciences at the University of Auckland. The data (n=134) included information on student demographics, final year secondary school achievements (National Certificate of Educational Achievement Grade Point Average (NCEAGPA) & NCEA Credits), university admission ranking scores, and achievements in first year in the undergraduate nursing programme (UGPA). Linear regression models were used to identify the best predictors for first year students' UGPA in the nursing programme. The regression models suggest that the best predictor for the first year GPA is the NCEAGPA (beta=.488; R(2)(for the entire model)=.53), followed by the admission ranking scores (beta=.308; R(2)=.40). Based on these findings, it is suggested that a Dual Admission Model (DAM) be utilised whereby students could be admitted either by the current university admission criteria or by an alternative model, which is purely based on the predictability of achievement within the nursing programme. Application of the DAM to other institutions/countries was discussed.