The Impact of COVID-19 in Reshaping Graduate Medical Education: Harnessing Hybrid Learning and Virtual Training.

Introduction  At the start of the COVID-19 pandemic, many graduate medical education (GME) programs switched from in-person to virtual training to ensure a safe learning environment. However, the preferences of US residents in the wake of the COVID-19 pandemic are largely unknown. Objective The authors surveyed PGY-2 psychiatry residents about their perception of the pandemic's impact on their clinical skills, didactics experience, training preferences, and future career perceptions. Methods The cross-sectional study was conducted from October 31, 2021, to December 31, 2021. The authors emailed a survey to directors of US general psychiatry residency programs to disseminate to PGY-2 residents. The survey had Likert-scale and open-ended questions about the pandemic's perceived impact on PGY-1 training and future training preferences. The authors used descriptive statistics for Likert-scale questions and reflexive thematic analysis for open-ended questions. Results Out of an estimated 1800 residents, only 116 (6.4%) participated; post-pandemic preferences emerged. A strong preference was expressed for hybrid didactics, combining in-person and virtual learning. Virtual patient evaluations, especially in emergency and inpatient settings, were highly valued. Conversely, entirely virtual didactics and clinical rounds were deemed least preferred, emphasizing the importance of interactive, hands-on learning experiences. Conclusions Respondents emphasized the significance of incorporating hybrid models for both in-patient care and didactic sessions in GME. These preferences signify the need for adaptable and flexible approaches to education in psychiatry residency programs as we emerge from the pandemic.

Assessing the health risks of heavy metals and seasonal minerals fluctuations in Camellia sinensis cultivars during their growth seasons.

The risk assessment of heavy metals in tea is extremely imperative for the health of tea consumers. However, the effects of varietal variations and seasonal fluctuations on heavy metals and minerals in tea plants remain unclear. Inductively coupled plasma optical emission spectrometry (ICP-OES) was used to evaluate the contents of aluminum (Al), manganese (Mn), magnesium (Mg), boron (B), calcium (Ca), copper (Cu), cobalt (Co), iron (Fe), sodium (Na), zinc (Zn), arsenic (As), cadmium (Cd), chromium (Cr), nickel (Ni), and antimony (Sb) in the two categories of young leaves (YL) and mature leaves (ML) of tea (Camellia sinensis) cultivars throughout the growing seasons. The results showed significant variations in the contents of the investigated nutrients both among the different cultivars and growing seasons as well. Furthermore, the average concentrations of Al, Mn, Mg, B, Ca, Cu, Co, Fe, Na, Zn, As, Cd, Cr, Ni, and Sb in YL ranged, from 671.58-2209.12, 1260.58-1902.21, 2290.56-2995.36, 91.18-164.68, 821.95-5708.20, 2.55-3.80, 3.96-25.22, 37.95-202.84, 81.79-205.05, 27.10-69.67, 0.028-0.053, 0.065-0.127, 2.40-3.73, 10.57-12.64, 0.11-0.14 mg kg-1, respectively. In ML, the concentrations were 2626.41-7834.60, 3980.82-6473.64, 3335.38-4537.48, 327.33-501.70, 9619.89-13153.68, 4.23-8.18, 17.23-34.20, 329.39-567.19, 145.36-248.69, 40.50-81.42, 0.089-0.169, 0.23-0.27, 5.24-7.89, 18.51-23.97, 0.15-0.19 mg kg-1, respectively. The contents of all analyzed nutrients were found to be higher in ML than in YL. Target hazard quotients (THQ) of As, Cd, Cr, Ni, and Sb, as well as the hazard index (HI), were all less than one, suggesting no risk to human health via tea consumption. This research might provide the groundwork for essential minerals recommendations, as well as a better understanding and management of heavy metal risks in tea.

In major dysmood disorder, physiosomatic, chronic fatigue and fibromyalgia symptoms are driven by immune activation and increased immune-associated neurotoxicity.

Major depressive disorder (MDD) is accompanied by activated neuro-immune pathways, increased physiosomatic and chronic fatigue-fibromyalgia (FF) symptoms. The most severe MDD phenotype, namely major dysmood disorder (MDMD), is associated with adverse childhood experiences (ACEs) and negative life events (NLEs) which induce cytokines/chemokines/growth factors. To delineate the impact of ACE + NLEs on physiosomatic and FF symptoms in first episode (FE)-MDMD, and examine whether these effects are mediated by immune profiles. ACEs, NLEs, physiosomatic and FF symptoms, and 48 cytokines/chemokines/growth factors were measured in 64 FE-MDMD patients and 32 normal controls. Physiosomatic, FF and gastro-intestinal symptoms belong to the same factor as depression, anxiety, melancholia, and insomnia. The first factor extracted from these seven domains is labeled the physio-affective phenome of depression. A part (59.0%) of the variance in physiosomatic symptoms is explained by the independent effects of interleukin (IL)-16 and IL-8 (positively), CCL3 and IL-1 receptor antagonist (inversely correlated). A part (46.5%) of the variance in physiosomatic (59.0%) symptoms is explained by the independent effects of interleukin (IL)-16, TNF-related apoptosis-inducing ligand (TRAIL) (positively) and combined activities of negative immunoregulatory cytokines (inversely associated). Partial least squares analysis shows that ACE + NLEs exert a substantial influence on the physio-affective phenome which are partly mediated by an immune network composed of interleukin-16, CCL27, TRAIL, macrophage-colony stimulating factor, and stem cell growth factor. The physiosomatic and FF symptoms of FE-MDMD are partly caused by immune-associated neurotoxicity due to T helper (Th)-1 polarization and M1 macrophage activation and relative lowered compensatory immunoregulatory protection.

Adverse childhood experiences and recent negative events are associated with activated immune and growth factor pathways, the phenome of first episode major depression and suicidal behaviors.

This research assessed the effects of adverse childhood experiences (ACEs) and negative life events (NLEs) on forty-eight cytokines/chemokines/growth factors, in 71 FE-MDMD patients and forty heathy controls. ACEs are highly significantly associated with the classical M1 macrophage, T helper (Th)-1, Th-1 polarization, IRS, and neurotoxicity immune profiles, and not with the alternative M2, and Th-2 immune profiles. There are highly significant correlations between ACEs and NLEs and different cytokines/chemokines/growth factors, especially with interleukin (IL)-16, CCL27, stem cell growth factor, and platelet-derived growth factor. Partial Least Squares analysis showed that 62.3 % of the variance in the depression phenome (based on severity of depression, anxiety and suicidal behaviors) was explained by the regression on IL-4 (p = 0.001, inversely), the sum of ACEs + NLEs (p < 0.0001), and a vector extracted from 10 cytokines/chemokines/growth factors (p < 0.0001; both positively associated). The latter partially mediated (p < 0.0001) the effects of ACE + NLEs on the depression phenome. In conclusion, part of the effects of ACEs and NLEs on the depression phenome is mediated via activation of immune and growth factor networks. These pathways have a stronger impact in subjects with lowered activities of the compensatory immune-regulatory system.

Molecular and haematological investigations on Anaplasma ovis infection in goats in Ahvaz, Iran: Insights into infection rate, haemolytic effect and breed influences.

BACKGROUND: Anaplasma ovis (A. ovis) is the predominant causative agent of anaplasmosis in goats and sheep in most tropical and subtropical regions of the world. However, there is considerable variation in reported infection rates, breed susceptibility, and controversial findings regarding the haemolytic effects of A. ovis infection in goats. OBJECTIVES: Thus, we investigated the molecular and haematological aspects of A. ovis infection in goats from Ahvaz city. METHODS: One hundred and fifty apparently healthy goats (74 blacks and 76 Najdi goats) were randomly sampled from six flocks in the Ahvaz suburb during ticks' activity season. Haematological evaluation, smear microscopic (SM) examination and PCR assay were performed to assess A. ovis infection. Additionally, the percentage of parasitemia was determined from blood smears. RESULTS: SM examination revealed that 25.7% of the goats displayed erythrocyte Anaplasma-like inclusion bodies. PCR analysis indicated that 54% of the goats were positive for A. ovis infection (44.6% of blacks and 63.2% of Najdi goats). No significant difference in haematological values was observed between healthy and infected goats based on PCR testing. However, a significant difference in haematological indices was observed between the group with parasitemia level of 0.01-0.02% (SM and PCR positive) compared to the healthy goats (SM and PCR negative), particularly concerning Hb, PCV and RBC count (p < 0.01). CONCLUSIONS: When the parasitemia exceeds 0.01%, A. ovis infection may disrupt haematological parameters in infected goats. The high prevalence of A. ovis infection (54%) among the studied goats underscores the importance of giving special attention to implementing necessary measures for disease control in the Ahvaz suburb.

Magnetically Selective Versatile Transport of Microrobotic Carriers.

Field-driven transport systems offer great promise for use as biofunctionalized carriers in microrobotics, biomedicine, and cell delivery applications. Despite the construction of artificial microtubules using several micromagnets, which provide a promising transport pathway for the synchronous delivery of microrobotic carriers to the targeted location inside microvascular networks, the selective transport of different microrobotic carriers remains an unexplored challenge. This study demonstrated the selective manipulation and transport of microrobotics along a patterned micromagnet using applied magnetic fields. Owing to varied field strengths, the magnetic beads used as the microrobotic carriers with different sizes revealed varied locomotion, including all of them moving along the same direction, selective rotation, bidirectional locomotion, and all of them moving in a reversed direction. Furthermore, cells immobilized with magnetic beads and nanoparticles also revealed varied locomotion. It is expected that such steering strategies of microrobotic carriers can be used in microvascular channels for the targeted delivery of drugs or cells in an organized manner.

Students' intrinsic motivation in EFL academic writing: Topic-based interest in focus.

Writing as a productive skill is extremely challenging for EFL students. To promote their writing effectiveness, students' intrinsic motivation must be enhanced by allowing them to self-assign writing topics or write about topics of interest. Therefore, this study describes how EFL students become motivated by self-assigning their writing topics and identifies students' attitudes and writing skills in topic-based interest in the EFL writing context. A descriptive-diagnostic method was applied to achieve the study objectives. A sample of 200 EFL students responded to a closed-item questionnaire on intrinsic motivation based on topic-based interest in writing. In addition, 20 students participated in semi-structured interviews on their attitudes toward topic-based interest. The study sample showed a high level of intrinsic motivation based on their self-assignment of writing topics. Furthermore, female students showed higher intrinsic motivation if they could self-assign their writing topics than male students. In addition, students with higher GPAs exhibited higher intrinsic motivation. Moreover, the interviews revealed that intrinsically motivated students most enhanced their writing skills in ideas, vocabulary, and choice of words. The researchers suggest that students' self-assignment of writing topics be considered in teaching writing as it contributes to improving intrinsic motivation.

Magnetic Lateral Ladder for Unidirectional Transport of Microrobots: Design Principles and Potential Applications of Cells-on-Chip.

Functionalized microrobots, which are directionally manipulated in a controlled and precise manner for specific tasks, face challenges. However, magnetic field-based controls constrain all microrobots to move in a coordinated manner, limiting their functions and independent behaviors. This article presents a design principle for achieving unidirectional microrobot transport using an asymmetric magnetic texture in the shape of a lateral ladder, which the authors call the "railway track." An asymmetric magnetic energy distribution along the axis allows for the continuous movement of microrobots in a fixed direction regardless of the direction of the magnetic field rotation. The authors demonstrated precise control and simple utilization of this method. Specifically, by placing magnetic textures with different directionalities, an integrated cell/particle collector can collect microrobots distributed in a large area and move them along a complex trajectory to a predetermined location.  The authors can leverage the versatile capabilities offered by this texture concept, including hierarchical isolation, switchable collection, programmable pairing, selective drug-response test, and local fluid mixing for target objects. The results demonstrate the importance of microrobot directionality in achieving complex individual control. This novel concept represents significant advancement over conventional magnetic field-based control technology and paves the way for further research in biofunctionalized microrobotics.

Neuropsychiatric lupus in late- and early-onset systemic lupus erythematosus patients: a systematic review and meta-analysis.

OBJECTIVES: Late-onset SLE is usually milder and associated with lower frequency of LN and neuropsychiatric manifestations. The diagnosis of NPSLE is especially challenging in older patients because of increased incidence of neurological comorbidities. We performed a systematic review and meta-analysis to evaluate the differences in NPSLE manifestations in early-onset (<50-year-old) vs late-onset (≥50-year-old) SLE patients. METHODS: A literature search was performed using the PubMed, Web of Science and Cochrane Library databases. Studies available in English (1959-2022) including a late-onset SLE comparison group and evaluating the frequency of NPSLE were eligible. A forest plot was used to compare odds ratios (95% CI) of incidence and manifestations of NPSLE by age groups. Study heterogeneity was assessed using I2 statistics. RESULTS: A total of 44 studies, including 17 865 early-onset and 2970 late-onset SLE patients, fulfilled our eligibility criteria. CNS involvement was reported in 3326 patients. Cumulative NPSLE frequency was higher in the early-onset group than in the late-onset group (OR: 1.41, 95% CI: 1.24, 1.59, P < 0.0001). In early-onset SLE patients, seizures (OR: 1.68, 95% CI: 1.27, 2.22) and psychosis (OR: 1.72, 95% CI: 1.23, 2.41) were more common than in late-onset SLE patients (P values, 0.0003 and 0.0014, respectively). Peripheral neuropathy was more commonly reported in the late-onset SLE group than in the early-onset SLE group (OR: 0.64, 95% CI: 0.47, 0.86, P = 0.004). CONCLUSION: Our meta-analysis revealed that the frequencies of overall NPSLE, seizures, and psychosis were less common in late-onset SLE patients than in early-onset SLE patients. In contrast, peripheral neuropathy was more common in the late-onset SLE group.

Curcuma longa essential oils: toxicity and repellency against imported fire ants (Formicidae: Hymenoptera).

Curcuma longa L. (Zingiberales: Zingiberaceae) leaf and rhizome essential oils were evaluated for their toxicity and repellency against invasive fire ants: red imported fire ants (RIFA), Solenopsis invicta Buren, black imported fire ants (BIFA), Solenopsis richteri Forel, and a reproductively functional hybrid (HIFA). Ar-turmerone was the major constituent of leaf (42.4%) and rhizome (40.4%) essential oils. A range of concentrations starting from 156 µg/g until the failure of treatment were used. Removal of treated sand in digging bioassay was used as a criterion for repellency. Leaf essential oil showed significantly higher repellency at concentrations of 19.5, 9.8, and 4.9 µg/g against RIFA, BIFA, and HIFA workers, respectively, as compared with control whereas rhizome essential oil was active at 39, 19.5, and 4.9 µg/g against BIFA, RIFA, and HIFA, respectively. Ar-turmerone exhibited repellency at 19.5 µg/g against HIFA workers whereas DEET (N,N-diethyl-meta-toluamide) failed at 39 µg/g. Leaf essential oil showed LC50 values of 85.8, 97.7, and 182.7µg/g against RIFA, BIFA and HIFA workers, whereas the rhizome essential oil had LC50 values of 127, 109.9, and 151.2 µg/g against these species, respectively. Ar-turmerone, tested only against HIFA, with LC50 value of 57.2 was the most active compound. Bifenthrin, a commonly used pyrethroid, with LC50 of 0.03, 0.32, and 0.018 µg/g was toxic against RIFA, BIFA, and HIFA workers, respectively. Both the essential oils and ar-turmerone showed toxicity and repellency against imported fire ants. Different formulations of these natural products will be tested to explore the use potential of these natural products under field conditions.

Epigenetic alterations fuel brain metastasis via regulating inflammatory cascade.

Brain metastasis (BrM) is a major threat to the survival of melanoma, breast, and lung cancer patients. Circulating tumor cells (CTCs) cross the blood-brain barrier (BBB) and sustain in the brain microenvironment. Genetic mutations and epigenetic modifications have been found to be critical in controlling key aspects of cancer metastasis. Metastasizing cells confront inflammation and gradually adapt in the unique brain microenvironment. Currently, it is one of the major areas that has gained momentum. Researchers are interested in the factors that modulate neuroinflammation during BrM. We review here various epigenetic factors and mechanisms modulating neuroinflammation and how this helps CTCs to adapt and survive in the brain microenvironment. Since epigenetic changes could be modulated by targeting enzymes such as histone/DNA methyltransferase, deacetylases, acetyltransferases, and demethylases, we also summarize our current understanding of potential drugs targeting various aspects of epigenetic regulation in BrM.

Mapping the Heartbeat of America with ChatGPT-4: Unpacking the Interplay of Social Vulnerability, Digital Literacy, and Cardiovascular Mortality in County Residency Choices.

Cardiovascular disease remains a leading cause of morbidity and mortality in the United States (US). Although high-quality data are accessible in the US for cardiovascular research, digital literacy (DL) has not been explored as a potential factor influencing cardiovascular mortality, although the Social Vulnerability Index (SVI) has been used previously as a variable in predictive modeling. Utilizing a large language model, ChatGPT4, we investigated the variability in CVD-specific mortality that could be explained by DL and SVI using regression modeling. We fitted two models to calculate the crude and adjusted CVD mortality rates. Mortality data using ICD-10 codes were retrieved from CDC WONDER, and the geographic level data was retrieved from the US Department of Agriculture. Both datasets were merged using the Federal Information Processing Standards code. The initial exploration involved data from 1999 through 2020 (n = 65,791; 99.98% complete for all US Counties) for crude cardiovascular mortality (CCM). Age-adjusted cardiovascular mortality (ACM) had data for 2020 (n = 3118 rows; 99% complete for all US Counties), with the inclusion of SVI and DL in the model (a composite of literacy and internet access). By leveraging on the advanced capabilities of ChatGPT4 and linear regression, we successfully highlighted the importance of incorporating the SVI and DL in predicting adjusted cardiovascular mortality. Our findings imply that just incorporating internet availability in the regression model may not be sufficient without incorporating significant variables, such as DL and SVI, to predict ACM. Further, our approach could enable future researchers to consider DL and SVI as key variables to study other health outcomes of public-health importance, which could inform future clinical practices and policies.

A Case of Angiotensin-Converting Enzyme (ACE) Inhibitor-Induced Small Bowel Angioedema.

Angioedema is a rare but known side effect of angiotensin-converting enzyme (ACE) inhibitor therapy. The most common presentations of ACE inhibitor-induced angioedema describe swellings in the oropharyngeal and periorbital regions. We describe a rare case of a 58-year-old female with a history of type 2 diabetes and hypertension taking lisinopril for the past three years and presented with recurrent episodes of abdominal pain, nausea, and vomiting around the same time she started taking the drug. Multiple computed tomography (CT) scans were performed, which showed findings consistent with edema in the proximal small bowel. Due to the recurrent nature of these episodes over the last three years, along with consistent findings of small bowel edema on imaging, lisinopril-induced angioedema was suspected. As a result, the patient was switched from lisinopril to amlodipine. During our follow-up with the patient, she reported that her symptoms had resolved following the withdrawal of lisinopril.

Reductive coupling of nitro compounds with boronic acid derivatives: an overview.

The purpose of this review is to summarize the current literature on reductive C-N coupling of nitro compounds and boronic acids, with special emphasis on the mechanistic features of the reactions. The metal-catalyzed reactions are discussed first. This is followed by electro-synthesis and organophosphorus-catalyzed reactions. Finally, the available examples of catalyst-free reactions will be covered at the end of this review.

Facilitating In-House Mobile App Development Within Psychiatric Outpatient Services for Patients Diagnosed With Borderline Personality Disorder: Rapid Application Development Approach.

BACKGROUND: Mobile app development within mental health is often time- and resource-consuming, challenging the development of mobile apps for psychiatry. There is a continuum of software development methods ranging from linear (waterfall model) to continuous adaption (Scrum). Rapid application development (RAD) is a model that so far has not been applied to psychiatric settings and may have some advantages over other models. OBJECTIVE: This study aims to explore the utility of the RAD model in developing a mobile app for patients with borderline personality disorder (BPD) in a psychiatric outpatient setting. METHODS: The 4 phases of the RAD model: (1) requirements planning, (2) user design, (3) construction, and (4) cutover, were applied to develop a mobile app within psychiatric outpatient services for patients diagnosed with BPD. RESULTS: For the requirements planning phase, a short time frame was selected to minimize the time between product conceptualization and access within a clinical setting. Evidenced-based interactive content already developed was provided by current staff to enhance usability and trustworthiness. For the user design phase, activity with video themes and a discrete number of functions were used to improve the app functionality and graphical user interface. For the construction phase, close collaboration between clinicians, researchers, and software developers yielded a fully functional, in-house-developed app ready to be tested in clinical practice. For the cutover phase, the mobile app was tested successfully with a small number (n=5) of patients with a BPD. CONCLUSIONS: The RAD model could be meaningfully applied in a psychiatric setting to develop an app for BPD within a relatively short time period from conceptualization to implementation in the clinic. Short time frames and identifying a limited number of stakeholders with relevant skills in-house facilitated the use of this model. Despite some limitations, RAD could be a useful model in the development of apps for clinical populations to enable development and access to evidence-based technology.

Baccharis Species Essential Oils: Repellency and Toxicity against Yellow Fever Mosquitoes and Imported Fire Ants.

Essential oils from five Baccharis species were screened for their toxicity and biting deterrence/repellency against yellow fever mosquito, Aedes aegypti (L.), and imported fire ants, including Solenopsis invicta Buren (RIFA), Solenopsis richteri Forel (BIFA) and their hybrids (HIFA). Baccharis microdonta DC. and B. punctulata DC. at 10 µg/cm2 showed biting deterrence similar to DEET, N, N-diethyl-meta-toluamide at 25 nmol/cm2, whereas the repellency of B. pauciflosculosa DC., B. sphenophylla Dusén ex Malme and B. reticularioides Deble & A.S. Oliveira essential oils was significantly lower than DEET against mosquitoes. Two major compounds from the active essential oils, kongol and spathulenol, also exhibited biting deterrence similar to DEET against mosquitoes. The highest toxicity exhibited against mosquitoes was by Baccharis punctulata essential oil (LC50 = 20.4 ppm), followed by B. pauciflosculosa (LC50 = 31.9 ppm), B. sphenophylla (LC50 = 30.8 ppm), B. microdonta (LC50 = 28.6 ppm), kongol (LC50 = 32.3 ppm), spathulenol (LC50 = 48.7 ppm) and B. reticularioides essential oil (LC50 = 84.4 ppm). Baccharis microdonta essential oil showed repellency against RIFA, BIFA and HIFA at 4.9, 4.9 and 39 µg/g, respectively. Baccharis microdonta essential oil also showed toxicity with LC50 of 78.9, 97.5 and 136.5 µg/g against RIFA, BIFA and HIFA, respectively, at 24 h post treatment.

Enhancing EFL students' critical thinking skills using a technology-mediated self-study approach: EFL graduates and labor market in perspective.

This research project bridges the gap between Saudi Vision 2030 and labor market needs by strengthening English as a Foreign Language (EFL) students' critical thinking skills. The increasing unemployment rates may not be due to insufficient vacancies in the labor market, but graduates' lack of the general abilities deemed vital to meet the labor market needs. With employability in mind, this study reiterates that graduates should ideally be advanced specialists, critical researchers, creative initiators, and active communicators to be more competitive and contribute to the prosperity of their nation. Therefore, this research employs a quasi-experimental design (time series design) to investigate how effectively students' critical thinking skills are enriched using a video-mediated self-study program through Telegram. Studies in this respect, regarding the Saudi EFL context, are limited. Therefore, this research employed a video-mediated self-study program through Telegram on learning critical thinking skills for EFL students majoring in English or Translation. The data collection included a pre-and post-test on critical thinking skills and a semi-structured interview. The findings showed that students improved their critical thinking skills due to the training program compared to their performance before the treatment at a low level. Besides, the participants evaluated learning critical thinking skills from thinking ways, feelings, benefits, motivation, challenges and problems, and suggestions. In light of the findings, recommendations were presented.