Does learning to code influence cognitive skills of elementary school children? Findings from a randomized experiment.

BACKGROUND: Coding has been added to school curricula in several countries, being one of the necessary competencies of the 21st century. Although it has also been suggested to foster the development of several cognitive skills such as computational thinking and problem-solving, studies on the effects of coding are very limited, provide mixed results, and lack causal evidence. AIM: This study aims to evaluate the impact of a learn-to-code programme on three cognitive skills in children: computational thinking, fluid intelligence, and spatial orientation, using a randomized trial. SAMPLE: One hundred seventy-four (n = 81 girls) 4th-grade children participated in the study. METHODS: Children were randomly assigned to one of the three 10-week learning programmes: learn-to-code (treatment of interest), mathematics (another STEM-related comparison treatment), and reading (control). Children responded to paper-pencil computational thinking, and spatial orientation measurements, and face-to-face matrix reasoning task at pre- and post-tests. RESULTS: Results showed that children's computational thinking scores increased significantly only in the learn-to-code condition. Fluid intelligence significantly increased in all conditions, possibly due to a practice effect. The spatial orientation did not improve in any of the conditions. CONCLUSION: These findings suggested that learning to code can be selectively beneficial for the development of computational thinking skills while not effective for spatial reasoning and fluid intelligence.

Causal Mediation Analysis in the Presence of Post-treatment Confounding Variables: A Monte Carlo Simulation Study.

In many disciplines, mediating processes are usually investigated with randomized experiments and linear regression to determine if the treatment affects the outcome through a mediator. However, randomizing the treatment will not yield accurate causal direct and indirect estimates unless certain assumptions are satisfied since the mediator status is not randomized. This study describes methods to estimate causal direct and indirect effects and reports the results of a large Monte Carlo simulation study on the performance of the ordinary regression and modern causal mediation analysis methods, including a previously untested doubly robust sequential g-estimation method, when there are confounders of the mediator-to-outcome relation. Results show that failing to measure and incorporate potential post-treatment confounders in a mediation model leads to biased estimates, regardless of the analysis method used. Results emphasize the importance of measuring potential confounding variables and conducting sensitivity analysis.

Comparison of alternative ßhCG follow-up protocols after single-dose methotrexate therapy for tubal ectopic pregnancy.

PURPOSE: To evaluate the performances of five different ßhCG follow-up protocols after single-dose methotrexate therapy for tubal ectopic pregnancy (EP). METHODS: Data of patients who received single-dose methotrexate therapy for tubal EP at a university hospital between January 2011 and July 2016 were reviewed. A 'successful methotrexate treatment' was defined if the EP treated with no need for surgery. The performances of different protocols were tested by comparing with the currently used '15% ßhCG decrease between days 4 and 7' protocol. The tested follow-up protocols were '20, 25%, and any ßhCG decrease between days 0/1 and 7' and '20% and any ßhCG decrease between days 0/1 and 4'. RESULTS: Among the 96 patients evaluated, 12 (12.5%) required second dose. Totally, 91 (94.8%) patients treated successfully with no need for surgery. Four patients were operated within 4 days following the second dose. One patient who did not need second dose according to the standard follow-up protocol was operated on the 10th day due to rupture (specificity = 80%). Two protocols, namely '20% ßhCG decrease between days 0/1 and 7' and 'any ßhCG decrease between days 0/1 and 7' did not show statistically significant differences from the index protocol regarding the number of patients who should be assigned to 2nd dose. CONCLUSIONS: 'Any ßhCG decrease between days 0/1 and 7' protocol may substitute the currently used one to decide second dose methotrexate in tubal EP management. Omitting 4th day measurement seems to be more convenient and cost effective.

Effects of umbilical cord milking on the need for packed red blood cell transfusions and early neonatal hemodynamic adaptation in preterm infants born ≤1500 g: a prospective, randomized, controlled trial.

OBJECTIVE: The aim of this study was to evaluate the effects of umbilical cord milking (UCM) on the need for packed red blood cell (PRBC) transfusion and hematologic and hemodynamic parameters in very-low-birth-weight infants. METHODS: The infants were randomized into 2 groups: group 1 (UCM) and group 2 (control). The primary outcome was the number of PRBC transfusions during the first 35 days of life. The secondary outcome measures were the hemodynamic variables during the first 24 hours of life. RESULTS: A total of 44 infants were included with 22 infants in each group. Two of 21 infants in group 1 and 4 of 21 infants in group 2 received transfusion in the first 3 days of life (P=0.384). The number and volume of PRBC transfusions were similar in both groups. However, the levels of hemoglobin (Hb) at the first and 24th hour of life were significantly higher in group 1. Phlebotomy volume was found as a statistically significant risk factor for the need for PRBC transfusion (P=0.005). CONCLUSIONS: UCM in delivery room results in a higher Hb level in the first day of life. In these groups of infants, phlebotomy losses may impact the transfusion need.

The value of the progesterone-to-estradiol ratio on the day of hCG administration in predicting ongoing pregnancy and live birth rates in normoresponders undergoing GnRH antagonist cycles.

OBJECTIVE: To investigate the relationship of the progesterone-to-estradiol (P/E2) ratio on the day of hCG administration with ongoing pregnancy rates in patients with normal ovarian reserve undergoing GnRH antagonist cycles. STUDY DESIGN: Observational cohort study including 129 women with normal ovarian reserve undergoing the GnRH antagonist protocol at the IVF unit of Ankara University School of Medicine. Receiver operating characteristics (ROC) analysis was performed to determine cut-off values for the P/E2 ratio detrimental to IVF/ICSI-ET outcomes. The ongoing pregnancy rate was the primary outcome measure. Groups were compared using the independent-samples Student's t-test, Mann Whitney and Chi-Square tests. Multivariate logistic regression analysis was used to study the association between the variables and the P/E2 ratio. RESULTS: The optimal cut-off value for P/E2 ratio in GnRH antagonist cycles was 0.48; ongoing pregnancy rates and live birth rates were found to be significantly higher in patients with P/E2 ratios≤0.48 than those with>0.48 (50% vs 22.4%, p=0.001 and 38.5% vs 19.7%, p=0.02, respectively). In logistic regression analysis, the P/E2 ratio was found to be an independent predictor for pregnancy, but the sensitivity (69%), specificity (61%) and overall accuracy (67%) were low as a predictor test for cycle outcome. CONCLUSION: Although a P/E2 ratio≤0.48 on the day of hCG administration was associated with significantly higher ongoing pregnancy and live birth rates, it has poor predictive value for cycle outcome in patients with normal ovarian reserve undergoing GnRH antagonist cycles.

Ectopic ovary autotransplanted over rectosigmoid colon: a case report.

OBJECTIVE: To report a case of an alive ectopic ovary over rectosigmoid colon serosa that was removed by laparoscopy. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology. PATIENT(S): A 30-year-old nulliparous woman. INTERVENTION(S): Ultrasonography, laparoscopy, and pathologic assessment. MAIN OUTCOME MEASURE(S): Alive and functional ectopic ovarian tissue in the cul-de-sac over rectosigmoid colon serosa. RESULT(S): At pathologic assessment, an alive ectopic ovary with focal infarct areas was determined. CONCLUSION(S): The treatment should be excision of the mass. However, in asymptomatic and nulliparous women who have future fertility desire, protecting the ectopic ovary to not decrease the ovarian reserve might be a beneficial option.

Microdose gonadotropin-releasing hormone agonist flare-up protocol versus multiple dose gonadotropin-releasing hormone antagonist protocol in poor responders undergoing intracytoplasmic sperm injection-embryo transfer cycle.

OBJECTIVE: To compare the efficacy of microdose GnRH agonist (GnRH-a) flare-up and multiple dose GnRH antagonist protocols in patients who have a poor response to a long luteal GnRH-a protocol. DESIGN: Prospective, randomized, clinical study. SETTING: University hospital. PATIENT(S): Forty-two poor responder patients undergoing intracytoplasmic sperm injection (ICSI)-embryo transfer cycle. INTERVENTION(S): Twenty-one patients received microdose leuprolide acetate (LA) (50 microg twice daily) starting on the second day of withdrawal bleeding. The other 21 patients received 0.25 mg of cetrorelix daily when the leading follicle reached 14 mm in diameter. MAIN OUTCOME MEASURE(S): Serum E(2) levels, number of growing follicles and mature oocytes, embryo quality, dose of gonadotropin used, cancellation, fertilization, implantation rate and pregnancy rate (PR). RESULT(S): The mean serum E(2) concentration on the day of hCG administration was significantly higher in the microdose GnRH-a group than in the GnRH antagonist group (1,904 vs. 1,362 pg/mL). The clinical PRs per started cycle of microdose GnRH-a and GnRH antagonist groups were 14.2% and 9.5%, respectively. There were no statistically significant differences in the other ovulation induction characteristics, fertilization and implantation rates. CONCLUSION(S): Microdose GnRH-a flare-up protocol and multiple dose GnRH antagonist protocol seem to have similar efficacy in improving treatment outcomes of poor responder patients.

Uterocutaneous fistula after surgical treatment of an incomplete abortion: methylene blue test to verify the diagnosis.

INTRODUCTION: Uterocutaneous fistula is an extremely rare clinical condition that can be seen after pelvic or uterine surgery. It can also complicate some obstetric procedures. CASE: We report of an unusual case of an uterocutaneous fistula that developed in a multiparous woman after surgical evacuation of an incomplete first trimester septic abortion. The fistula tract was depicted on computed tomography, and to verify the diagnosis methylene blue was given through a transcervically introduced uterine catheter, and blue dye flow out through the external opening of fistula was observed. At laparatomy fistula tract was completely excised along with the enclosing omentum. Postoperative recovery and follow-up were uneventful. DISCUSSION: Possible mechanisms of development of such a rare condition, and diagnostic and treatment options are discussed.

Cerebral infarctions manifesting as neonatal seizure.

Cerebral infarction is a common cause of seizures in neonates with a prevalence of I in 4000 live births. We report two neonates with different presentations due to cerebral infarction and discuss their etiological and neuroradiological findings in this case report. The initial signs were cyanosis and convulsion. In case 1, tonic convulsion, eye deviation, while case 2 had additionally poor sucking and dehydration as a risk factor. Their evaluation for hereditary causes of thrombosis was unremarkable. With these 2 cases, it is emphasized that neonatal cerebal infarction may be a cause of neonatal convulsion. Hence, neonates with cerebral infarction should be evaluated for hereditary conditions like protein C and S deficiency, anti-thrombin III deficiency, Factor V leiden mutation, prothrombin gene mutation and homocystinuria.

Effect of hormone replacement therapy on serum levels of tumor markers in healthy postmenopausal women.

OBJECTIVE: The effect of hormone replacement therapy (HRT) on serum levels of tumor markers is barely defined. The aim of this study was to evaluate the effect of HRT on levels of tumor markers CA 125, CA 15-3, CA 19-9, CEA and alpha-FP. METHODS: Retrospective analysis of prospectively collected data in healthy postmenopausal women under oral estrogen replacement therapy (ERT, conjugated equine estrogen (CEE) 0.625 mg (n = 21) or estradiol 2 mg (n = 31)), and continuous combined estrogen and progesterone regimen (HRT, CEE 0.625 mg plus medroxyprogesterone acetate 2.5 mg (n = 34) or estradiol 2 mg plus norethisterone acetate 1 mg (n = 37)). One hundred and twenty-three healthy women among a sampled population of 654 postmenopausal patients with complete records, initial normal tumor marker levels, and at least 1 year of follow-up were included into the study. Tumor markers were measured with 1-year interval. RESULTS: Fifty-two (41.5%) patients were under ERT and 71 (58.5%) were under combined HRT. The number of months since menopause, age and age at menopause did not influence tumor marker levels at first admission. All of the tumor marker levels were in normal range after 1 year. Pretreatment CA 125 II, CA 15-3 and CEA levels were significantly low (median and range) 5.0 (1.0-11.8) versus 7.45 (1.0-18.1) U/ml for CA 125, 27.05 (7.3-37.5) versus 32.6 (12.5-37.9) U/ml for CA 15-3, 0.88 (0.58-2.8) versus 1.34 (0.53-2.41) ng/ml for CEA in women with hysterectomy when compared to women without hysterectomy. There was no effect of ERT on CA 125 II, CA 19-9, CEA and alpha-FP levels. E2 led to a significant decrease in post-treatment CA 15-3 levels [32.9 (8.1-34.9) vs. 18.1 (6.7-31.4); P < 0.001]. CA 125 levels were only significantly reduced in hysterectomised women using continuously combined HRT [7.9 (2.6-17.7) vs. 5.6 (1.3-19.2) for CEE+MPA, and 7 (1-18.1) vs. 5.8 (1.8-17.4) for E2 + NETA; P < 0.05]. There was a small, but not significant, increase in CA 125 levels in women under ERT. CONCLUSION: Although there was a statistically significant decrease in CA 15-3 levels in current E2 and E2 + NETA users, and a decrease in CA 125 levels in combined regimens, this change is clinically not relevant in healthy postmenopausal women. This data will be useful for the caregivers in the management and follow-up of cancer survivors who preferred replacement therapy as the only treatment of their postmenopausal symptoms.