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.

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.

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.

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.

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.

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.

Implementation of a Longitudinal Mentorship Program for Quality of Life, Mental Health, and Motivation of Brazilian Medical Students.

OBJECTIVES: Mentoring has been used as a strategy for mental health prevention and the promotion of quality of life in medical students, with mixed results. The aim of this study was to compare the levels of mental health, quality of life, and academic motivation of medical students after implementation of a longitudinal curricular mentoring program relative to those students without mentoring in their curricula. METHOD: The results of the mentoring program were assessed by comparing two classes of 2nd-year students of a school of medicine (one that had received mentoring since admission and another which had no exposure to the method during the course). Self-report questionnaires were used to collect data on sociodemographics, quality of life (WHOQOL-BREF), mental health (DASS-21), and academic motivation (Academic Motivation Scale-AMS). RESULTS: A total of 95 medical students were included: 55 received the mentoring program and 40 did not receive the program. The Multivariate GLM regression model revealed no significant main effect of mentoring on domains of the WHOQOL-BREF (Wilks's Lambda = 0.938, F = 1.427, p < 0.232); the DASS-21 (Wilks's Lambda = 0.051, p < 0.985); or the AMS (Wilks's Lambda = 0.957, F = 0.628, p < 0.708). Likewise, the Univariate GLM regression showed no significant main effect of mentoring on medical students' perceived health (F = 0.585; d.f. = 1; p = 0.446). CONCLUSION: Mentoring promoted no significant changes in the students of this Brazilian institution. These results highlight the challenges faced in structuring, maintaining, and assessing an effective mentoring program for students on medicine courses.

ß-Fructofuranosidase and ß -D-Fructosyltransferase from New Aspergillus carbonarius PC-4 Strain Isolated from Canned Peach Syrup: Effect of Carbon and Nitrogen Sources on Enzyme Production.

ß-fructofuranosidase (invertase) and ß-D-fructosyltransferase (FTase) are enzymes used in industrial processes to hydrolyze sucrose aiming to produce inverted sugar syrup or fructooligosaccharides. In this work, a black Aspergillus sp. PC-4 was selected among six filamentous fungi isolated from canned peach syrup which were initially screened for invertase production. Cultivations with pure carbon sources showed that invertase and FTase were produced from glucose and sucrose, but high levels were also obtained from raffinose and inulin. Pineapple crown was the best complex carbon source for invertase (6.71 U/mL after 3 days of cultivation) and FTase production (14.60 U/mL after 5 days of cultivation). Yeast extract and ammonium chloride nitrogen sources provided higher production of invertase (6.80 U/mL and 6.30 U/mL, respectively), whereas ammonium nitrate and soybean protein were the best nitrogen sources for FTase production (24.00 U/mL and 24.90 U/mL, respectively). Fermentation parameters for invertase using yeast extract were Y P/S = 536.85 U/g and P P = 1.49 U/g/h. FTase production showed values of Y P/S = 2,627.93 U/g and P P = 4.4 U/h using soybean protein. The screening for best culture conditions showed an increase of invertase production values by 5.10-fold after 96 h cultivation compared to initial experiments (fungi bioprospection), while FTase production increased by 14.60-fold (44.40 U/mL) after 168 h cultivation. A. carbonarius PC-4 is a new promising strain for invertase and FTase production from low cost carbon sources, whose synthesized enzymes are suitable for the production of inverted sugar, fructose syrups, and fructooligosaccharides.

Medical students' critical thinking assessment with collaborative concept maps in a blended educational Strategy.

BACKGROUND: Concept maps (CMs) are tools used to represent how new knowledge is integrated into the cognitive structure. In this study, we investigated the role of collaborative CMs in improving medical students' critical thinking and knowledge acquisition. METHODS: A pre-post interventional study was conducted. In the 1st week of the clerkship rotation, a group of 10-14 students were asked by a faculty member to make a CM (CM1). After this first exposure (weeks 2/3), students learned the content through online forums. In the final week (week 4), students discussed what they had learned and made a final CM (CM2). RESULTS: A total of 104 students participated in the study, making twenty CM1 and twenty CM2. There was a statistically significant difference between CM1 and CM2 for overall scores, proposition units, and hierarchy units (P < 0.001). DISCUSSION: Collaborative CMs may be useful tools to help teachers better understand their students' critical thinking changes during a blended strategy.

The Use of Smartphones in Different Phases of Medical School and its Relationship to Internet Addiction and Learning Approaches.

The use of smartphones is revolutionizing the way information is acquired, leading to profound modifications in teaching medicine. Nevertheless, inadvertent use can negatively affect student learning. The present study aims to evaluate smartphone use in the educational context as well as Internet addiction and its repercussions on surface and deep learning and to compare them during the different phases of medical students' education. This is a cross-sectional study involving medical students in all phases of education. Sociodemographic data, type and frequency of smartphone use, degree of digital addiction (Internet Addiction Test - IAT), and surface and deep approaches to learning (Biggs) were analyzed. A total of 710 students were included. Almost all students had a smartphone and a total of 96.8% used it during lectures, classes, and meetings. Less than half of the students (47.3%) reported using a smartphone for more than 10 min for educational purposes, a usage that is higher among clerkship students. At least 95% reported using a smartphone in the classroom for activities not related to medicine (social media and searching for general information) and 68.2% were considered problematic Internet users according to the IAT. The most common reasons for noneducational use were that the class was uninteresting, students needed to receive or make an important call, and the educational strategy was not stimulating. The "frequency of smartphone use" and higher "internet addiction" were correlated to both higher levels of surface learning and lower levels of deep learning. Educators should advise and educate their students about conscientious use of this tool to avoid detrimental impact on the learning process.

Cross-cultural Differences in Mental Health, Quality of Life, Empathy, and Burnout between US and Brazilian Medical Students.

OBJECTIVE: This study aimed to compare mental health, quality of life, empathy, and burnout in medical students from a medical institution in the USA and another one in Brazil. METHODS: This cross-cultural study included students enrolled in the first and second years of their undergraduate medical training. We evaluated depression, anxiety, and stress (DASS 21), empathy, openness to spirituality, and wellness (ESWIM), burnout (Oldenburg), and quality of life (WHOQOL-Bref) and compared them between schools. RESULTS: A total of 138 Brazilian and 73 US medical students were included. The comparison between all US medical students and all Brazilian medical students revealed that Brazilians reported more depression and stress and US students reported greater wellness, less exhaustion, and greater environmental quality of life. In order to address a possible response bias favoring respondents with better mental health, we also compared all US medical students with the 50% of Brazilian medical students who reported better mental health. In this comparison, we found Brazilian medical students had higher physical quality of life and US students again reported greater environmental quality of life. Cultural, social, infrastructural, and curricular differences were compared between institutions. Some noted differences were that students at the US institution were older and were exposed to smaller class sizes, earlier patient encounters, problem-based learning, and psychological support. CONCLUSION: We found important differences between Brazilian and US medical students, particularly in mental health and wellness. These findings could be explained by a complex interaction between several factors, highlighting the importance of considering cultural and school-level influences on well-being.

Experiencing aging or demystifying myths? - impact of different "geriatrics and gerontology" teaching strategies in first year medical students.

BACKGROUND: With the aging of the population comes a greater need for geriatric and gerontology teaching. However, there is currently a dearth of investigations on the impact of different educational methodologies for teaching in this area early in medical courses. The present study aims to determine the impact of two educational strategies on the topic "Geriatrics and Gerontology" ("experiencing aging" and "myths of aging") as compared to a control group (no intervention) on the attitudes, empathy and knowledge of first year medical students. METHODS: An intervention-based study in education was conducted at the beginning of the first year of a medical course. Students submitted to educational strategies were compared against students with no intervention. The two strategies were: "Experiencing Aging" - also known as the "aging game" (simulation of the disabilities and physiological changes of aging), and "Myths of Aging" - a knowledge discussion based on a "quiz show", questioning common myths about aging. All students were assessed on their attitudes towards older persons (Maxwell-Sullivan, UCLA attitudes), empathy (Maxwell-Sullivan), knowledge on facts and positive view about aging (Palmore), and cognitive knowledge. Data were analysed using Student's t, Chi-squared or ANOVA tests. RESULTS: A total of 230 students were assessed. The "experiencing aging" intervention was associated with improvement in empathy but worsening of attitude. The "myths of aging" intervention was associated with an improved attitude overall and positive view about aging but with no change in empathy towards older persons. CONCLUSION: Educational strategies can influence the attitudes and empathy of students, leading to different outcomes. These data highlight the importance of assessing the outcomes of educational strategies in medical teaching to ascertain in what manner (how), situations (when) and settings (where) these activities should be introduced.

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.

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.

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.

Deciphering the magainin resistance process of Escherichia coli strains in light of the cytosolic proteome.

Antimicrobial peptides (AMPs) are effective antibiotic agents commonly found in plants, animals, and microorganisms, and they have been suggested as the future of antimicrobial chemotherapies. It is vital to understand the molecular details that define the mechanism of action of resistance to AMPs for a rational planning of the next antibiotic generation and also to shed some light on the complex AMP mechanism of action. Here, the antibiotic resistance of Escherichia coli ATCC 8739 to magainin I was evaluated in the cytosolic subproteome. Magainin-resistant strains were selected after 10 subsequent spreads at subinhibitory concentrations of magainin I (37.5 mg · liter⁻¹), and their cytosolic proteomes were further compared to those of magainin-susceptible strains through two-dimensional electrophoresis analysis. As a result, 41 differentially expressed proteins were detected by in silico analysis and further identified by tandem mass spectrometry de novo sequencing. Functional categorization indicated an intense metabolic response mainly in energy and nitrogen uptake, stress response, amino acid conversion, and cell wall thickness. Indeed, data reported here show that resistance to cationic antimicrobial peptides possesses a greater molecular complexity than previously supposed, resulting in cell commitment to several metabolic pathways.

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.

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.