Production of Extracellular Enzymes by Lentinula edodes Strains in Solid-State Fermentation on Lignocellulosic Biomass Sterilized by Physical and Chemical Methods.

Two methods of sterilization of lignocellulosic biomass were performed in this study. Eucalypt waste (EW) supplemented with rice bran (RB) was added in the proportions 80:20 and 90:10 in dry weight. The compositions were sterilized by physical method (autoclaving) and by chemical method (H2O2). The production of extracellular enzymes by Lentinula edodes strains was compared within the two methods. Inactivation of catalase present in RB was achieved with 250 mM H2O2. The use of H2O2, when compared by physical method, favored high production of hydrolytic enzymes such as endoglucanase (1,600 IU/kg), twofold higher, ß-glucosidase (1,000 IU/kg), fivefold higher, xylanase (55,000 IU/kg), threefold higher and ß-xylosidase (225 IU/kg), similar results. Oxidative enzymes, MnP and laccase, were produced within a different profile between strains, with shorter times for laccase (2,200 IU/kg) by SJC in 45 days and MnP (2,000 IU/kg) by CCB-514 in 30 days. High production of extracellular enzymes is achieved by the use of the chemical method of sterilization of lignocellulosic biomass; in addition to no energy consumption, this process is carried out in a shorter execution time when compared to the physical process. The use of H2O2 in sterilization does not produce toxic compounds from the degradation of hemicellulose and cellulose such as furfural and hydroxy-methyl-furfural that cause inhibition of microorganisms and enzymes.

A Challenge Called Ogilvie´s Syndrome.

Ogilvie´s syndrome is a colonic dilation without any existing mechanical obstruction. The risk factors that cause it are not completely understood, but if untreated, the distension can result in rupture or ischaemic bowel perforation. Additionally, the existing guidelines do not agree with each other about the next steps if conservative treatment fails. We report the case of a 71-year-old woman in whom Ogilvie´s syndrome was particularly difficult to manage, and with it, we try to add clinical data to a field with scarce evidence.

MEASURING HEALTH STUDENTS' ATTITUDES, PERCEPTIONS AND READINESS FOR INTERPROFESSIONAL LEARNING: RELIABILITY, VALIDITY AND PSYCHOMETRIC PROPERTIES OF THREE SCALES ADAPTED INTO PORTUGUESE.

Background and Purpose: To adapt, validate and assess the psychometric properties of the Readiness for Interprofessional Learning Scale (RIPLS-19 items), Interdisciplinary Education Perception Scale (IEPS-18 items) and Team Skills Scale (TSS-17 items) in 484 undergraduate students. Methods: Transcultural adaptation of the scales was performed. Internal consistency, test-retest reliability, factor analysis, and convergent and discriminant validity were determined. Results: The instruments showed good internal consistency and test-retest reliability for total score. However, factor analyses revealed differences in the subscales compared to the original validations. The RIPLS detected more differences, discriminating gender, race, course semester and course enrolled. The TSS and IEPS detected differences in age and course enrolled. Conclusions: These scales appear to have satisfactory psychometric properties and could be used in both research and education. The subscales, however, should be interpreted with caution.

The current status of "spirituality and health" teaching in Brazilian medical schools: a nationwide survey.

BACKGROUND: Recent data on the teaching of "spirituality and health" (S/H) in medical schools are needed. In this study, we aimed to investigate the current status of S/H teaching in Brazilian medical schools, the opinions of medical directors/deans on this topic and the factors associated with its incorporation into the curriculum. METHODS: A nationwide cross-sectional survey was carried out in 2021. Information concerning the S/H content in the curricula of medical schools was obtained through medical school representatives and other sources. Medical school representatives were asked about their opinions of and barriers to S/H teaching. Regression models were used to evaluate the factors associated with the incorporation of such content into the curriculum. RESULTS: Information on the incorporation of S/H content in medical curricula was retrieved from different sources for all 342 (100%) Brazilian medical schools. Among the representatives, 150 (43.9%) completed the online form. An increase in the S/H content in Brazilian medical schools was observed (from 40% to 2011 to 65.5% in 2021). Most medical school representatives agreed that this issue is important in medical training and that more space in the curriculum is needed. However, they also observed several barriers, such as a lack of knowledge of medical teachers/faculty, a lack of time, and the topic not being included in teaching plans. The most important factors that influenced the incorporation of S/H teaching in medical schools and representatives' opinions were a lack of time and knowledge, professor preparedness and standardized national competency requirements. CONCLUSION: These results could help medical educators rethink the incorporation of S/H content into their curricula.

Association of Smartphone Use and Digital Addiction with Mental Health, Quality of Life, Motivation and Learning of Medical Students: A Two-Year Follow-Up Study.

Background: Despite studies evaluating the insertion of technology and the use of smartphones in the mental health and learning of medical students, few have investigated these outcomes longitudinally. This study aims to investigate the association between smartphone use and digital addiction with mental health, quality of life, learning, and academic motivation of medical students. Methods: This is a longitudinal study conducted between 2016 and 2018. Socio-demographics, smartphone use, digital dependence (Internet Addiction Test), surface and deep learning approach (Biggs), motivation (Academic Motivation Scale), evaluation of symptoms of depression, anxiety, and stress (DASS- 21) and Quality of Life (WHOQOL-BREF) were assessed. Adjusted regression models were used for data analysis. Results: A total of 269 students were included(51.4% of the total). In the two-year follow-up, despite an increase in the frequency of smartphone use in general and also in the classroom for non-educational activities, no increase in digital dependence was found. In the adjusted models, the frequency of smartphone use and digital dependence were predictors of lower academic motivation and greater surface learning after two years of follow up. However, only digital dependence was a predictor of worse mental health (anxiety, depression, and stress) and worse quality of life. Conclusion: Greater use of smartphones and high addiction scores were associated with worse educational outcomes. Digital dependence was another marker of outcomes in mental health and quality of life. It is important that educators are aware of these negative effects and can guide students on the proper and safe use of these devices.

Developing current procedural terminology codes that describe the work performed by machines.

The "Taxonomy of Artificial Intelligence for Medical Services and Procedures" became part of the Current Procedural Terminology (CPT®) code set effective January 1, 2022. It provides a framework for discrete and differentiable CPT codes which; are consistent with the features of the devices' output, characterize interaction between the device and the physician or other qualified health care professional, and foster appropriate payment. Descriptors include "Assistive", "Augmentative", and "Autonomous". As software increasingly augments the provision of medical services the taxonomy will foster consistent language in coding enabling patient, provider, and payer access to the benefits of innovation.

Factors Associated with Motivation in Medical Students: A 30-Month Longitudinal Study.

This longitudinal study aimed to assess the factors associated with motivation in 303 Brazilian medical students after a 30-month follow-up. Their demographics, study habits, sleep quality, motivation (Brazilian version of the Academic Motivation Scale-BAMS), learning approaches (R-SPQ-2F scale), and stressors (MSSF-Medical Student Stress Factor scale) were examined. We found an increase in amotivation and extrinsic motivation through external regulation (e.g., "I come to school to earn a degree") and a decrease in intrinsic motivation and extrinsic motivation through integrated regulation (e.g., "because studying broadens our horizons") in medical students after the 30-month follow-up. Students in earlier stages of medical training showed greater increases in amotivation. Factors such as the learning approach, hours spent studying, sex, stressors, studying just before examinations, and sleep problems were predictors of the different dimensions of motivation. Medical students' motivation changed negatively as medical training progressed.

Comparison of the Role of Different Levels of Religiousness and Spirituality in Controversial Ethical Issues and Clinical Practice among Brazilian Resident Physicians: Results from the Multicenter SBRAMER Study.

This study compares clinical practice and objections to controversial ethical issues among 836 Brazilian resident physicians according to levels of religiousness/spirituality. Residents with low religiousness/spirituality (s/r) believed less in the influence of spirituality on clinical practice, were less comfortable addressing this issue, tended to listen less carefully and try to change the subject more than other groups. Residents with high spirituality and low religiousness (S/r) inquired more about religious/spiritual issues, while those with high religiousness/spirituality (S/R) were more supportive and reported fewer barriers to addressing these issues. Concerning ethical issues (e.g., physician-assisted suicide, withdrawal of life support, abortion), S/R had more objections than others.

Short and medium-term effects of different teaching strategies for interprofessional education in health professional students: A randomized controlled trial.

BACKGROUND: Interprofessional education (IPE) is recognized as important for teaching in healthcare. However, few studies comparing active versus traditional strategies for this teaching approach have been conducted. OBJECTIVES: This study aims to compare the use of different educational strategies (i.e. active learning versus formal lectures) for teaching interprofessional geriatric competencies in health professional students from different healthcare courses. DESIGN: Randomized controlled trial. SETTINGS: Public university. PARTICIPANTS: Health professional students (nursing, physiotherapy, medicine, nutrition and psychology courses). METHODS: Different theoretical educational strategies (active learning in intervention group versus formal lectures in control group) were associated with case-based group discussions. The RIPLS (Readiness for Interprofessional Learning Scale), IEPS (Interdisciplinary Education Perception Scale) and TSS (Team Skills Scale) instruments were applied at 3 timepoints: on first day of class, on last day of class and at 6 months post-intervention. RESULTS: Of 151 eligible students, 99 concluded all stages of the study and were subsequently included in the analysis. A significant increase in scores on the RIPLS, IEPS and TSS was measured on the last day of class and this performance gain persisted after 6 months for both strategies. However, no significant performance difference between the two strategies was found. Similarly, although student satisfaction was very good, no difference in ratings between the strategies was evident. CONCLUSIONS: The results of this project, besides developing and fostering important discussion on IPE, can add to the literature and aid researchers in IPE by furthering knowledge on how different teaching strategies can impact future health professionals.

Reproducibility of an endurance test for master swimmers

Abstract Aim: This study aimed to verify the reproducibility of an endurance test for master swimmers. Methods: Seventeen male swimmers, aged from 30 to 50 years (35.06 ± 5.36), weight (78.71 ± 13.06 kg), height (174.35 ± 0.07 cm), participated in this study. The participants underwent the Progressive Swim Test (PSwT), which corresponds to swimming progressively to exhaustion in a 25-meter pool, guided by the recording of sound signals indicating the swimming rhythm. We verified the following variables: heart rate before the test (BHR) and right after the end of the test (AHR), followed by the rate of perceived exertion (RPE) and a total of laps performed (SN - swimming number). For comparison between the three days of tests, the one-way repeated measures ANOVA with Tukey's Post-Hoc was performed. Relative reproducibility was performed by the r test and the intraclass correlation coefficient (ICC). Absolute reproducibility was determined using the coefficient of variation (CV) and the confidence interval (CI). Results: The results showed high reproducibility in (PSwT) in master swimmers in the analyzed variables of intergroup and intragroup with relative reproducibility of r > 0.60 and ICC > 0.70 and absolute reproducibility with CI 95% (lower −1.10 and upper 0.99) and CV < 10%. Most of the cases were within the limits of agreement of the Bland-Altman tests, all variables were considered a level of significance with (p <0.05). Conclusion: The Progressive Swim Test (PSwT) is a reproducible instrument in the assessment of endurance in master swimmers.

The Use of Feedback in Improving the Knowledge, Attitudes and Skills of Medical Students: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

This study aims to investigate the effectiveness of the use of different feedback modalities in improving the knowledge, attitudes, and skills of medical students compared to students receiving no feedback or unstructured feedback. A systematic review and meta-analysis of randomized controlled trials was conducted based on a search of the Cochrane, ERIC, PubMed, Scopus, and Web of Science databases. A total of 26 studies were included for the systematic review and 13 for the meta-analysis. The meta-analysis revealed that the use of feedback was associated with better results compared to control groups (SMD = 0.80 [0.56-1.04], p < 0.001), and also when only high-quality studies were included (SMD = 0.86 [0.56-1.16], p < 0.001). Our findings revealed high heterogeneity in the use of feedback in medical education. However, the results of most of the studies and of the meta-analysis were positive, showing that feedback had a positive influence on the education-learning process of the students. PROSPERO registration: CRD42018112688.

Religiosity/Spirituality and Mental Health and Quality of Life of Early Pregnant Women.

The present study aims to investigate how religious/spiritual (R/S) beliefs are associated with depressive, anxious and stress symptoms and quality of life (QOL) of 160 Brazilian women in early pregnancy. In this cross-sectional study, religiosity/spirituality (DUREL, Daily Spiritual Experiences, Brief-RCOPE), mental health (DASS-21) and quality of life (WHOQOL-Bref) were assessed. Negative R/S coping was associated with higher levels of depressive, anxious and stress symptoms and worse physical and psychological QOL. On the other hand, positive R/S coping, intrinsic religiosity, and spirituality were associated with better psychological QOL, while only spirituality was associated with better social QOL.

Religiosity and Spirituality of Resident Physicians and Implications for Clinical Practice-the SBRAMER Multicenter Study.

OBJECTIVES: To assess the attitudes, knowledge, and experiences of Brazilian resident physicians regarding religiosity/spirituality (R/S), factors associated with addressing this issue, and its influence on clinical practice. METHODS: We report results of the multicenter "Spirituality in Brazilian Medical Residents" (SBRAMER) study involving 7 Brazilian university centers. The Network for Research Spirituality and Health (NERSH) scale (collecting sociodemographic data, opinions about the R/S-health interface, and respondents' R/S characteristics) and the Duke Religion Index were self-administered. Logistic regression models were constructed to determine those factors associated with residents' opinions on spirituality in clinical practice. RESULTS: The sample comprised 879 resident physicians (53.5% of total) from all years of residency with 71.6% from clinical specialties. In general, the residents considered themselves spiritual and religious, despite not regularly attending religious services. Most participants believed R/S had an important influence on patient health (75.2%) and that it was appropriate to discuss these beliefs in clinical encounters with patients (77.1%), although this was not done in routine clinical practice (14.4%). The main barriers to discussing R/S were maintaining professional neutrality (31.4%), concern about offending patients (29.1%), and insufficient time (26.2%). Factors including female gender, clinical specialty (e.g., internal medicine, family medicine, psychiatry) as opposed to surgical specialty (e.g., surgery, obstetrics/gynecology, orthopedics), having had formal training on R/S, and higher levels of R/S were associated with greater discussion of and more positive opinions about R/S. CONCLUSION: Brazilian resident physicians held that religious and spiritual beliefs can influence health, and deemed it appropriate for physicians to discuss this issue. However, lack of training was one of the main obstacles to addressing R/S issues in clinical practice. Educators should draw on these data to conduct interventions and produce content on the subject in residency programs.

Initial Impact of COVID-19 on Radiology Practices: An ACR/RBMA Survey.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic affected radiology practices in many ways. The aim of this survey was to estimate declines in imaging volumes and financial impact across different practice settings during April 2020. METHODS: The survey, comprising 48 questions, was conducted among members of the ACR and the Radiology Business Management Association during May 2020. Survey questions focused on practice demographics, volumes, financials, personnel and staff adjustments, and anticipation of recovery. RESULTS: During April 2020, nearly all radiology practices reported substantial (56.4%-63.7%) declines in imaging volumes, with outpatient imaging volumes most severely affected. Mean gross charges declined by 50.1% to 54.8% and collections declined by 46.4% to 53.9%. Percentage reductions did not correlate with practice size. The majority of respondents believed that volumes would recover but not entirely (62%-88%) and anticipated a short-term recovery, with a surge likely in the short term due to postponement of elective imaging (52%-64%). About 16% of respondents reported that radiologists in their practices tested positive for COVID-19. More than half (52.3%) reported that availability of personal protective equipment had become an issue or was inadequate. A majority (62.3%) reported that their practices had existing remote reading or teleradiology capabilities in place before the pandemic, and 22.3% developed such capabilities in response to the pandemic. CONCLUSIONS: Radiology practices across different settings experienced substantial declines in imaging volumes and collections during the initial wave of the COVID-19 pandemic in April 2020. Most are actively engaged in both short- and long-term operational adjustments.

Use of feedback on medium-term blood pressure measurement skills in medical students: a randomized controlled trial.

BACKGROUND: The objective of this study was to assess the effect of feedback on medium-term blood pressure (BP) measurement skills in medical students versus a control group. METHODS: A randomized controlled trial in first-year medical students was conducted. After theoretical-practical training on measuring BP, the students were randomized into a control group or intervention group. The skill was assessed immediately after the training (T1) by evaluating students with a simulated standardized patient using a checklist. Students in the intervention group received feedback immediately after assessment, whereas the control group received no feedback. After 3 months (T2), each student was reassessed in the same way as for (T1). RESULTS: Ninety-two first-year medical students took part in the study (45 in control group and 47 in intervention group). At T1, there were no differences in the skill measured. At T2 (after three months), there was a significant difference in the intervention group (score = 23.97 ± 3.82) compared with the control group (score = 20.91 ± 4.87), P < 0.001, d = 0.69. In the intervention group, the scores were maintained at 3 months (T1 = 23.23 and T2 = 23.97, P = 0.335), whereas in the control group, scores declined significantly (T1 = 23.44 and T2 = 20.91; P = 0.002). CONCLUSION: Receiving feedback promotes retention of learning of BP measurement skills over the medium term. Further studies applying feedback to other skills should be conducted.

Radiology Practice Consolidation: Fewer but Bigger Groups Over Time.

PURPOSE: The aim of this study was to assess recent trends in US radiology practice consolidation. METHODS: Radiologist practice characteristics were obtained from the Medicare Physician Compare database for 2014 and 2018. Radiologists were classified on the basis of their largest identifiable practice affiliations. Single-specialty radiology practices were identified using practice names. Temporal trends in practice sizes were assessed. RESULTS: At the individual radiologist level from 2014 to 2018, the fraction of all radiologists in groups with 1 or 2 members declined from 3.2% to 2.1%, 3 to 9 members from 10.2% to 6.7%, 10 to 24 members from 18.2% to 14.1%, 25 to 49 members from 16.6% to 15.1%, and 50 to 99 members from 13.3% to 11.5%. In contrast, the fraction in groups with 100 to 499 members increased from 15.7% to 21.8% and with ≥500 members from 22.9% to 28.7%. At the practice level, the fraction of all radiologists' practices with 1 or 2 members decreased from 26.9% to 22.8%, whereas the fraction with 100 to 499 members increased from 7.6% to 10.2% and with ≥500 members from 2.5% to 4.1%. Similar shifts were present for single-specialty radiology practices and all geographic regions nationally. The 30,492 radiologists identified in 2014 were affiliated with 4,908 group practices, including 2,812 single-specialty practices. In comparison, the 32,096 radiologists identified in 2018 were affiliated with 4,193 group practices (a 14.6% decline), including 2,216 single-specialty practices (a 21.2% decline). CONCLUSIONS: In very recent years, the US radiologist workforce has consolidated, leading to increased practice sizes and a substantial decline in the number of distinct practices, disproportionately affecting single-specialty radiology practices. The impact of this consolidation on cost, quality, and patient access merits further attention.

Effects of a Required Large-Group Mindfulness Meditation Course on First-Year Medical Students' Mental Health and Quality of Life: a Randomized Controlled Trial.

BACKGROUND: Teaching mindfulness techniques has been used in the attempt to prevent mental health problems in medical students. Although it has already shown promising results when offered to volunteers, the use as a required strategy is still controversial. OBJECTIVES: To verify the efficacy of teaching mindfulness techniques to large groups when made part of a required discipline at the beginning of medical training. DESIGN: Randomized controlled trial PARTICIPANTS: First-year medical students at the Federal University of Juiz de Fora, Brazil METHOD: Students were randomized into two groups: an intervention group (receiving a 6-week mindfulness protocol) and a control group (given a 6-week course containing organizational aspects of the medical school). MAIN MEASURES: Intervention and control groups were compared on the levels of quality of life (WHOQOL-Bref), stress, anxiety and depression (DASS 21) and the facets of mindfulness (FFMQ) at baseline and at the end of the intervention. RESULTS: A total of 141 students were included in the study, 70 in the intervention group and 71 in the control group. No significant differences were found between the intervention and control groups in all mental health, quality of life, and FFMQ scores (Cohen's d = 0.01 to 0.14). Likewise, no significant gains in mental health measures, quality of life, and FFMQ were identified in the intervention group when compared with the control group (Cohen's d = 0.02 to 0.33). CONCLUSIONS: The incorporation of a required mindfulness course for large groups in the curriculum during the first semester of medical training was not associated with an improvement on medical students' mental health and quality of life. CLINICAL TRIALS REGISTRATION: NCT03132597.