Motivations for Entrustable Professional Activity Assessment: Gaps Between Curriculum Theory and Resident Reality.

Background Previous research demonstrates mixed reactions from residents toward competency-based medical education (CBME), and entrustable professional activities (EPAs) specifically. However, understanding what motivates residents to obtain EPAs may be vital to the longevity of CBME, given the emphasis on assessment for learning under this paradigm. Objective This study explored resident perspectives across 3 domains: motivation for obtaining EPAs, perceived importance of EPAs, and overall thoughts on CBME curriculum. Methods This was a sequential exploratory mixed-methods study involving 2 phases of data collection. Phase 1 was semi-structured interviews with residents enrolled in CBME at one Canadian institution from November 2019 to July 2020. Analyses included thematic and manifest content analysis. Phase 2 was an electronic close-ended survey to capture residents' primary motivation for requesting EPAs and importance of EPAs for learning. Survey data were analyzed descriptively. Results Of 120 eligible residents, 25 (21%) and 107 (89%) participated in the interview and survey, respectively. Program requirement was the dominant motivation for obtaining EPAs. There was variability in perceived importance of EPAs on learning. Increased resident workload, gaming the system to maximize EPA scores, and lack of shared ownership from preceptors were cited as critiques of the curriculum. Survey responses corroborated interview findings. Conclusions Although many residents recognize the value of EPAs, the majority are not intrinsically motivated to seek out assessment under the current CBME framework.

Synthesized novel chromogenic reagent and sensor: Detection and identification of dichlorvos.

We developed a novel chromogenic reagent and sensor by selective approach, for the detection and identification of dichlorvos, which we tested with the thin layer chromatography method. For the first time, we reported in situ-generated glyoxal as a hydrolysis product, which then interacts with isoniazid to produce a yellow-colored cyclic compound. We used well-known spectroscopic techniques to confirm the chemical identity of the final product. We initially investigated the reaction using a variety of approaches, followed by attempts to establish the reaction mechanism using Density Functional Theory by Gaussian software.

A rare case of type II tri-allelic inheritance at vWA, SE33, D8S1179, and D13S317 loci demonstrated by STR analysis in paternity testing.

Short tandem repeat (STR) typing has been regularly used in paternity disputes and forensic human identification linked caseworks. Occasionally, forensic scientists come across aberrant allele patterns during STR typing because of mutations, genetic variations, and other abnormalities. The tri-allelic pattern of STR is rare, particularly, the case where this pattern exists at 4 loci. Here, we report the type II tri-allelic patterns observed at vWA, SE33, D8S1179, and D13S317 loci in the product of conception (POC) sample during the course of our regular paternity case investigation. The DNA extracted from the blood samples and tissue of POC were subjected to STR typing for autosomal and sex STR loci using the commercial QIAGEN's Investigator® IDplex Plus Kit and QIAGEN's Investigator® 24plex QS Kit. Capillary electrophoresis was carried out in 3500 and 3500xL Genetic Analyzer Applied Biosystems and genotyped using GeneMapper ID-X Software v1.5 and v1.6. In this case of paternity inclusion, the POC sample displayed type II tri-allelic patterns at vWA (16, 19, 20), SE33 (19, 28.2, 29.2), D13S317 (16, 19, 20), and D8S1179 (10, 13, 17) loci. In addition, the POC displayed an abnormal genotype with a heterozygous peak imbalance (type II-B) of (1:2) pattern at D3S1358, D21S11, and D16S539 loci, of (2:1) pattern at D1S1656, D12S391, D10S1248, D2S1338, D2S441, D18S317, FGA, CSF1PO, and D5S818 loci, and type II-C allelic pattern (one single peak with triplicate height) at D19S433 and DS7820 loci. Understanding of such anomalous genotypes improves the knowledge about tri-allelic pattern of CODIS loci and helps in the appropriate interpretation of the results in STR typing.

Implicit versus explicit first impressions in performance-based assessment: will raters overcome their first impressions when learner performance changes?

First impressions can influence rater-based judgments but their contribution to rater bias is unclear. Research suggests raters can overcome first impressions in experimental exam contexts with explicit first impressions, but these findings may not generalize to a workplace context with implicit first impressions. The study had two aims. First, to assess if first impressions affect raters' judgments when workplace performance changes. Second, whether explicitly stating these impressions affects subsequent ratings compared to implicitly-formed first impressions. Physician raters viewed six videos where learner performance either changed (Strong to Weak or Weak to Strong) or remained consistent. Raters were assigned two groups. Group one (n = 23, Explicit) made a first impression global rating (FIGR), then scored learners using the Mini-CEX. Group two (n = 22, Implicit) scored learners at the end of the video solely with the Mini-CEX. For the Explicit group, in the Strong to Weak condition, the FIGR (M = 5.94) was higher than the Mini-CEX Global rating (GR) (M = 3.02, p < .001). In the Weak to Strong condition, the FIGR (M = 2.44) was lower than the Mini-CEX GR (M = 3.96 p < .001). There was no difference between the FIGR and the Mini-CEX GR in the consistent condition (M = 6.61, M = 6.65 respectively, p = .84). There were no statistically significant differences in any of the conditions when comparing both groups' Mini-CEX GR. Therefore, raters adjusted their judgments based on the learners' performances. Furthermore, raters who made their first impressions explicit showed similar rater bias to raters who followed a more naturalistic process.

Identification of a convergent spinal neuron population that encodes itch.

Itch is a protective sensation that drives scratching. Although specific cell types have been proposed to underlie itch, the neural circuit basis for itch remains unclear. Here, we used two-photon Ca2+ imaging of the dorsal horn to visualize the neuronal populations that are activated by itch-inducing agents. We identify a convergent population of spinal neurons that is defined by the expression of GRPR. Moreover, we discover that itch is conveyed to the brain via GRPR-expressing spinal output neurons that target the lateral parabrachial nucleus. Further, we show that nalfurafine, a clinically effective kappa opioid receptor agonist, relieves itch by inhibiting GRPR spinoparabrachial neurons. Finally, we demonstrate that a subset of GRPR spinal neurons show persistent, cell-intrinsic Ca2+ oscillations. These experiments provide the first population-level view of the spinal neurons that respond to pruritic stimuli, pinpoint the output neurons that convey itch to the brain, and identify the cellular target of kappa opioid receptor agonists for the inhibition of itch.

Extraction-free clinical detection of SARS-CoV-2 virus from saline gargle samples using Hamilton STARlet liquid handler.

As part of the COVID-19 pandemic, clinical laboratories have been faced with massive increases in testing, resulting in sample collection systems, reagent, and staff shortages. We utilized self-collected saline gargle samples to optimize high throughput SARS-CoV-2 multiplex polymerase chain reaction (PCR) testing in order to minimize cost and technologist time. This was achieved through elimination of nucleic acid extraction and automation of sample handling on a widely available robotic liquid handler, Hamilton STARlet. A customized barcode scanning script for reading the sample ID by the Hamilton STARlet's software system was developed to allow primary tube sampling. Use of pre-frozen SARS-CoV-2 assay reaction mixtures reduced assay setup time. In both validation and live testing, the assay produced no false positive or false negative results. Of the 1060 samples tested during validation, 3.6% (39/1060) of samples required retesting as they were either single gene positive, had internal control failure or liquid aspiration error. Although the overall turnaround time was only slightly faster in the automated workflow (185 min vs 200 min), there was a 76% reduction in hands-on time, potentially reducing staff fatigue and burnout. This described process from sample self-collection to automated direct PCR testing significantly reduces the total burden on healthcare systems in terms of human resources and reagent requirements.

"Building Your Neurology Acumen": A Flipped Classroom Approach for Internal Medicine Residents.

Globally, internal medicine (IM) residents often feel they lack the knowledge and skills to approach patients presenting with neurologic issues. We conducted a multiple method needs assessment to determine the feasibility of a novel neurology flipped classroom (FC) curriculum for internal medicine residents. Our primary findings include participants: (1) finding neurology a useful rotation; (2) feeling uncomfortable with the neurological examination; and (3) endorsing flipped classroom as a potential alternative but with significant barriers. Our findings elucidate upon the various extrinsic/intrinsic motivators for resident education and illustrate the need to re-examine the way in which neurology is being taught to off-service residents.

Paternal pregnancy-related anxiety: Systematic review of men's concerns and experiences during their partners' pregnancies.

BACKGROUND: Up to 25 % of expectant parents experience anxiety symptoms. Pregnancy-related anxiety is characterised by concerns and worries specific to pregnancy, childbirth, and the transition to parenthood. While pregnancy-related anxiety is well-researched in women, the exact nature of this construct in men is unclear. The purpose of the current review was to examine men's concerns, worries, and fears during pregnancy and gain an understanding of their experiences during pregnancy. METHODS: An integrative review design was adopted, using thematic content analysis to synthesise findings from quantitative and qualitative studies. Quality appraisal of the quantitative studies used the AXIS appraisal tool. The Critical Appraisal Skills Program (CASP) checklist was used for the qualitative studies. RESULTS: A comprehensive search of nine databases led to inclusion of 14 quantitative and 41 qualitative studies. Ten dimensions of paternal pregnancy-related anxiety were identified: childbirth concerns, attitudes towards childbirth, baby concerns, acceptance of pregnancy, partner concerns, relationship concerns, worry about self, transition to parenthood, attitudes towards health care professionals, and practical and financial concerns. The pregnancy transition was characterised by mixed emotions and conflicted experiences for fathers. LIMITATIONS: Generalizability of review findings was limited by poor reporting of demographic information by many included studies, exclusion of studies not published in English, and focus on heterosexual relationships. CONCLUSIONS: Expectant fathers may experience anxiety symptoms characterised by excessive worry across multiple domains of pregnancy-related concerns. Clinicians play an important role in identifying and supporting fathers with pregnancy-related anxiety and addressing the sense of exclusion often experienced by them.

Synthesis, Characterization, 'ADMET-SAR' Prediction, DPPH Assay, and Anti-Mycobacterium Study of 4-[(substituted benzyl) amino]benzo hydrazides and its Hydrazones as the Acyl-CoA Carboxylase, AccD5 Inhibitors.

BACKGROUND: Hydrazide-hydrazone derivatives have shown diverse biological activities, such as antitubercular (anti-TB), antibacterial, antifungal, anticancer, anti-inflammatory, antiviral, and antiprotozoal actions. OBJECTIVES: Hydrazide-hydrazones contain azomethine (-NH-N=CH-) group connected with carbonyl group and are believed to be responsible for various pharmaceutical applications. They aid in the synthesis of different five-membered heterocyclic systems, such as oxadiazole, triazoles, etc. Methods: In the present study, various hydrazines/hydrazones were synthesized starting from 4- amino benzoic acid derivatives. Structures of all 9 newly synthesized compounds (6a-6d and 8a- 8e) were further characterized by using various spectroscopic methods, such as 1H-NMR (Nuclear Magnetic Resonance), FT-IR (Fourier-transform infrared spectroscopy), Gas chromatographymass spectrometry (GC-MS), etc. Furthermore, molecular docking analysis against the acyl-CoA carboxylase, AccD5 (PDB ID: 2A7S), was also carried out using the Glide module, which depicted good binding scores than standard drugs. The anti-tuberculosis activity of all the hydrazides and hydrazones (6a-6d and 8a-8e) were evaluated against the Mycobacterium tuberculosis H37 RV strain using the Alamar-Blue susceptibility (MABA) test. The activity was expressed as the minimum inhibitory concentration (MIC) in µg/mL values. The antioxidant activity was also carried out using a DPPH assay. RESULTS: Our findings demonstrated highly encouraging in-vitro results (MABA assay, MIC: 1.2 µg/mL) of hydrazones as depicted by good antimycobacterial activity. The antioxidant results showed a moderate to a good percentage of DPPH inhibition. Our in-silico ADMET analysis further suggested good pharmacokinetic and toxicity-free profiles of synthesized analogues (6a-6d and 8a-8e). CONCLUSION: Our results signify hydrazones/hydrazines as potential hit candidates against the future developments of potent and safer anti-TB agents.

Metallic and metal oxide-derived nanohybrid as a tool for biomedical applications.

Nanotechnology covers a variety of scientific areas including chemistry, material science, physics, biomedicine, biology, and engineering. Metal nanohybrid with extraordinary properties is highly researched in comparison to bulky individual nanoparticles. Especially, metal and metal oxide nanoparticles are a new class of functional nanohybrids having broad, intriguing physio-chemical properties showing applications in nanoscience and biomedical research. Engineered inorganic nanoparticles have paved an essential component in the advancement of nanotechnologies. Synthesis is done through various physical, chemical, and biological methods with their special features and manipulation at the nano level in their physiochemical properties, controlling their shape, size, and surface functionality. Application of metal and metal oxide nanohybrid are discussed, including, gene delivery, theranostics, and catalysis. Due to the versatile application of nanohybrids, it can be used in the detection of tumors, cell tracking, and visualizing the specific region of disease. Development of accurate, multifunctional imaging and ambient data are indispensable for futuristic applications. Nanohybrids (NHs) can load therapeutic drugs in their sector of core and shell and have the ability to release them in a controlled and sequential manner of a delivery system. Novel nanohybrid with their multidimensional, integrated mechanistic property has also shown a great effect on environmental pollution control also. A proteomics and transcriptomics approach for the nanohybrid action of mechanism has been discussed and also includes limitations of MNHs and MONHs. The current manuscript critically reviewed several available recent kinds of literature and has the potential to offer a better understanding of metallic and metallic oxide nanohybrids having a multifunctional role in various biomedical applications.

Clinical Presentation and Platelet Profile of Dengue Fever: A Retrospective Study.

BACKGROUND: Dengue fever (DF) is a mosquito-borne viral illness carried worldwide by Aedes aegypti and Aedes albopictus mosquitoes. The aim of the present study was to observe the different clinical presentations of dengue fever and the platelet profile analysis in DF patients. METHODS: This retrospective study was performed on 130 diagnosed patients with dengue fever, aged over 14 years. Data collection included patient age, gender, clinical manifestations, hematocrit, platelet count, and evidence of plasma leakage. RESULTS: Most of the patients belong to the 21-30 year age group, with a greater number of males compared to females. The common presentation of dengue fever was fever and myalgia, observed in 100% and 95.3% of the patients, respectively. A platelet count of less than 1,00,000 was observed in 77% of patients, whereas decreased total leukocyte count (TLC) and hematocrit were observed in 52.3% and 40% of patients, respectively. About 46.15% of patients had bradycardia on examination. Pleural effusion and ascites were found in 20.7% and 15.3% of patients, respectively. CONCLUSION: Patients presenting with fever, hemorrhagic symptoms, or signs of plasma leakage should be promptly suspected, timely diagnosed and managed on the grounds of dengue fever.

Prevalence of Ascaris lumbricoides infections among elementary school children and associated risk factors from Southern Ethiopia.

Intestinal parasitic infections are distributed virtually throughout the world, with high prevalence rates in tropical and sub-tropical parts of the world as well as in Ethiopia. Children between age groups of 5-10 years are at the highest risk of infection. The intestinal nematode Ascaris lumbricoides infects approximately 25% of the world's population annually. Hence, this study was the first attempt to assess the prevalence and associated factors of A. lumbricoides infection among the school children from Offa district, Ethiopia. A cross-sectional study was conducted from January to April, 2020 in three selected elementary school. Data were collected through questionnaires and stool samples examination. The overall prevalence of A. lumbricoides was noted as 41.4% and was the leading cause of intestinal parasitoids followed by Schistosoma mansoni (27.6%), Trichuris trichiura (18.1%) and Strongyloides stercoralis (4.1%). Children age group between 5 and 10 years found more susceptible to the infection. Eating habits like unwashed raw vegetables (P = 0.035), absence of toilets (P = 0.000), children who defecate in open field (P = 0.041), drinking unprotected water (P = 0.034), toilet without cover (P = 0.027), lack of hand washing before meal and after defecation (P = 0.000), (P = 0.048) were the key factors significantly associated with A. lumbricoides infection. The present study showed that A. lumbricoides was a major health problem among school children and requires annual de-worming to control morbidity associated with intestinal parasites.

Exploration of Novel Lichen Compounds as Inhibitors of SARS-CoV-2 Mpro: Ligand-Based Design, Molecular Dynamics, and ADMET Analyses.

In the year 2019-2020, the whole world witnessed the spread of a disease called COVID-19 caused by SARS-CoV-2. A number of effective drugs and vaccine has been formulated to combat this outbreak. For the development of anti-COVID-19 drugs, the main protease (Mpro) is considered a key target as it has rare mutations and plays a crucial role in the replication of the SARS CoV-2. In this study, a library of selected lichen compounds was prepared and used for virtual screening against SARS-CoV-2 Mpro using molecular docking, and several hits as potential inhibitors were identified. Remdesivir was used as a standard inhibitor of Mpro for its comparison with the identified hits. Twenty-six compounds were identified as potential hits against Mpro, and these were subjected to in silico ADMET property prediction, and the compounds having favorable properties were selected for further analysis. After manual inspection of their interaction with the binding pocket of Mpro and binding affinity score, four compounds, namely, variolaric acid, cryptostictinolide, gyrophoric acid, and usnic acid, were selected for molecular dynamics study to evaluate the stability of complex. The molecular dynamics results indicated that except cryptostictinolide, all the three compounds made a stable complex with Mpro throughout a 100-ns simulation time period. Among all, usnic acid seems to be more stable and effective against SARS-CoV-2 Mpro. In summary, our findings suggest that usnic acid, variolaric acid, and gyrophoric acid have potential to inhibit SARS-Cov-2 Mpro and act as a lead compounds for the development of antiviral drug candidates against SARS-CoV-2.

Knowledge, Attitude, and Practice of Community towards an Onchocerciasis Elimination Program from South West Ethiopia.

Onchocerciasis is a neglected tropical disease that is prevalent throughout Africa, including developing countries such as Ethiopia. It affects around 37 million people, the majority of whom are from Africa. As a result, the study was designed to look into the community's knowledge, attitude, and practice about the onchocerciasis elimination campaign. Four communities from Gesha town, Southwest Ethiopia, were chosen. The population was selected using a basic random selection procedure, and 312 people were identified for the study based on the eligibility requirements, with 302 (96.79%) of them responding correctly. The data were analyzed using the descriptive method with the SPSS program version 20. It was discovered that the majority of communities (89.4%) are aware of onchocerciasis. They also have a good awareness of the severity, preventability, therapy, and mode of transmission, yet they have certain misunderstandings. The communities attitude towards community directed therapy (CDT) using Ivermectin is positive (68.5%). According to 56% of the community, offering incentives for community drug distributors (CDD) has the potential to make the elimination campaign more successful. Different measures, such as avoiding any activities near the river, are important in the process of eradicating this disease at the community level. As a result, the respondent demonstrates that covering the lower body part lessens the black fly's vulnerability because they may attack below the knee. In general, community awareness and attitude are required to eradicate this disease from the district. In addition, increased stakeholder participation and offering motivating rewards for CDT are required to make the elimination program a success.

Cross-Sectional Study on Assessment of Frequency of Intestinal Helminth Infections and Its Related Risk Factors among School Children from Adola Town, Ethiopia.

The three main intestinal helminth infections (IHIs), ascariasis, trichuriasis, and hookworm, are common clinical disorders worldwide. These IHIs are more prevalent in tropics and subtropical countries especially in developing countries like sub-Saharan Africa responsible for morbidity, mortality, and physical as well as intellectual growth retardation in children. In Ethiopia, the burden of IHIs appears in all ages mainly due to factors like lack of education, low socio-economic status, and inadequate supply of drugs and proper awareness. The present study was carried out to access the prevalence of intestinal helminth infections and associated risk factors among school children in Adola town from Guji Zone, Oromia, Ethiopia, from August 2019 to December 2019. 404 stool samples were collected in a clean, dry, screw-capped, and wide-mouthed plastic container, fixed with 10% formal-saline solution, and transported to the Adola Hospital laboratory for further microscopic analysis by wet mount following formal ether concentration technique. Data were analyzed using SPSS version 20 by binary logistic regression model using odd ratio with 95% CI. The overall prevalence of IHIs among school children was found to be 33.91% (137/404). Rate of double infection was noted to be 2.72% (11/404). Most dominant species was Ascaris lumbricoides (8.9%) followed by Hymenolepis nana (7.7%), Taenia saginata (5.4%), hookworm (4.7%), Trichuris trichiura (2.5%), Schistosoma mansoni (2.2%), Enterobius vermicularis (1.7%), and Strongyloides stercoralis (0.7%), respectively. Highest prevalence was observed in male students (39.6%) compared to female students (28.8%) (P < 0.05). The prevalence of IHIs among school children in the age group of 6-10, 11-15, 16-20, and above 20 was 49.6%, 35.8%, 10.9%, and 3.6%, respectively (P < 0.05). IHI was significantly associated with some of the risk factors such as gender, educational level of students', toilet usage habit, habit of hand washing, hand washing habit before feeding and after defecation, purpose of hand washing, and awareness to intestinal helminths (P < 0.05). In the study area, the prevalence of IHIs is moderately high and represents a public health problem in the school children. Therefore, all stakeholders should pay attention to raise awareness about health education programs such as proper personal hygiene, environmental sanitation, improving the quality of drinking water, and treatment to reduce the consequences of intestinal helminths.

Evaluation of observed and unobserved self-collection of saline gargle samples for the detection of SARS-CoV-2 in outpatients.

The diagnostic sensitivity of observed and unobserved self-collected saline gargle samples for the molecular detection of SARS-CoV-2 in adults and school-aged children was evaluated against a reference standard of health care worker collected nasopharyngeal flocked swab. A total of 46 participants had a positive nasopharyngeal swab sample; of these, 10 were in the observed phase and 36 were in the unobserved phase. Only one matching saline gargle sample tested negative and this was in the unobserved phase, giving an overall sensitivity of 98%. Average viral target Ct values were higher in the saline gargle samples. RNaseP Ct values were lower in unobserved collected samples compared to observed collected samples. Unobserved self-collection of saline gargle samples is a promising outpatient testing method for COVID-19 diagnosis. The self-collection method has potential to simplify the diagnostic cycle and facilitate implementation of COVID-19 testing, particularly in settings with limited access to health care workers.

Variability in Acetabular Component Position in Patients Undergoing Direct Anterior Approach Total Hip Arthroplasty Who Have Concomitant Spine Pathology.

BACKGROUND: Hip instability following total hip arthroplasty (THA) can be a major cause of revision surgery. Physiological patient position impacts acetabular anteversion and abduction, and influences the functional component positioning. Osteoarthritis of the spine leads to abnormal spinopelvic biomechanics and motion, but there is no consensus on the degree of component variability for THAs performed by anterior approach. Therefore, we sought to present guidelines for changes in acetabular component positioning between supine and standing positions for patients undergoing primary THA by a uniform anterior approach. METHODS: Perioperative patient radiographs of the pelvis and lumbar spine were collected. Images were used to determine acetabular component positioning and degree of coexisting spinal pathology, categorized as a Lane Grade (LG). Final analysis of variance was performed on a sample size of 643 anterior primary THAs. RESULTS: From supine to standing position, as the severity of lumbar pathology increased the change in anteversion also increased (LG:0 = -0.11° ± 4.65°, LG:1 = 2.02° ± 4.09°, LG:2-3 = 5.78° ± 5.72°, P < .001). The mean supine anteversion in patients with absent lumbar pathology was 19.72° ± 5.05° and was lower in patients with worsening lumbar pathology (LG:1 = 18.25° ± 4.81°, LG:2-3 = 16.73° ± 5.28°, P < .001). CONCLUSION: Patients undergoing primary THA by anterior approach with worsening spinal pathology have larger increases in component anteversion when transitioning from supine to standing positions. Consideration should be given to this expected variability when placing the patient's acetabular component.

Critical care ultrasound training: a survey exploring the "education gap" between potential and reality in Canada.

BACKGROUND: Critical care ultrasound (CCUS) is now a core competency for Canadian critical care medicine (CCM) physicians, but little is known about what education is delivered, how competence is assessed, and what challenges exist. We evaluated the Canadian CCUS education landscape and compared it against published recommendations. METHODS: A 23-item survey was developed and incorporated a literature review, national recommendations, and expert input. It was sent in the spring of 2019 to all 13 Canadian Adult CCM training programs via their respective program directors. Three months were allowed for data collection and descriptive statistics were compiled. RESULTS: Eleven of 13 (85%) programs responded, of which only 7/11 (64%) followed national recommendations. Curricula differed, as did how education was delivered: 8/11 (72%) used hands-on training; 7/11 (64%) used educational rounds; 5/11 (45%) used image interpretation sessions, and 5/11 (45%) used scan-based feedback. All 11 employed academic half-days, but only 7/11 (64%) used experience gained during clinical service. Only 2/11 (18%) delivered multiday courses, and 2/11 (18%) had mandatory ultrasound rotations. Most programs had only 1 or 2 local CCUS expert-champions, and only 4/11 (36%) assessed learner competency. Common barriers included educators receiving insufficient time and/or support. CONCLUSIONS: Our national survey is the first in Canada to explore CCUS education in critical care. It suggests that while CCUS education is rapidly developing, gaps persist. These include variation in curriculum and delivery, insufficient access to experts, and support for educators.

Learner Phenotypes in Competency-Based Medical Education.

With the launch of competency-based medical education internationally, the practical realities of implementation have failed to live up to many of the proposed theoretical benefits. Specifically, as educators we have observed a number of assessment challenges that seem directly related to identified learner phenotypes. This commentary seeks to describe these specific learner phenotypes, along with actionable recommendations for programs and their competence committees in order to overcome the associated obstacles in assessment. We describe strategies related to both the individual and program level, which can be utilized for both short-term adjustments and long-term programmatic transformation.

Investigating the Antioxidant and Cytocompatibility of Mimusops elengi Linn Extract over Human Gingival Fibroblast Cells.

Background-chlorhexidine (CHX) is most commonly used as a chemical plaque control agent. Nevertheless, its adverse effects, including teeth discoloration, taste alteration and calculus build-up, limit its use and divert us to medicinal herbs. The purpose of the study was to evaluate the phytochemical composition, antioxidant potential, and cytotoxic effects of Mimusops elengi Linn extract (ME) over normal human cultured adult gingival fibroblasts (HGFs). Methods-in vitro phytochemical screening, total flavonoid content, antioxidant potential by DPPH and Nitric Oxide (NO) radical scavenging activity, and cytotoxic effects of ME extracts over HGF were explored. The viability of HGF cells was determined using 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide (MTT), neutral red uptake, and trypan blue assay after treatment with different concentrations of CHX and ME (0.3125 to 10 µg/mL). Results-ME showed some alkaloids, glycosides, saponins and flavonoids exhibited relatively moderate-to-good antioxidant potential. Increasing the concentration of CHX and ME from 0.3125 to 10 µg/mL reduced cell viability from 29.71% to 1.07% and 96.12% to 56.02%, respectively. At higher concentrations, CHX reduced the viability of cells by 52.36-fold compared to ME, revealed by MTT assay. At 10 µg/mL concentration, the mean cell viability of CHX and ME-treated cells was 2.24% and 57.45%, respectively, revealed by a neutral red assay. The viability of CHX- and ME-treated HGF cells estimated at higher concentrations (10 µg/mL) using trypan blue assay was found to be 2.18% and 47.36%, respectively. A paired t-test showed significance (p < 0.05), and one-way ANOVA difference between the mean cell viability of CHX- and ME-treated cells at different concentrations. One-way ANOVA confirmed the significant difference between the viability of CHX- and ME-treated cells. Conclusions-The cytoprotective and antioxidant effects of ME emphasize its potential benefits. Therefore, it could emerge as a herbal alternative and adjunct to conventional oral hygiene methods, that can diminish periodontal tissue destruction.