Students' interaction anxiety and social phobia in interprofessional education in Hong Kong: mapping a new research direction

BACKGROUND

Interprofessional education (IPE) has been promoted as a breakthrough in healthcare because of the impact when professionals work as a team. However, despite its inception dating back to the 1960s, its science has taken a long time to advance. There is a need to theorize IPE to cultivate creative insights for a nuanced understanding of IPE. This study aims to propose a research agenda on social interaction by understanding the measurement scales used and guiding researchers to contribute to the discussion of social processes in IPE.

METHOD

This quantitative research was undertaken in a cross-institutional IPE involving 925 healthcare students (Medicine, Nursing, Social Work, Chinese Medicine, Pharmacy, Speech Language Pathology, Clinical Psychology, Food and Nutritional Science and Physiotherapy) from two institutions in Hong Kong. Participants completed the Social Interaction Anxiety Scale (SIAS-6) and Social Phobia Scale (SPS-6). We applied a construct validation approach: within-network and between-network validation. We performed confirmatory factors analysis, t-test, analysis of variance and regression analysis.

RESULTS

CFA results indicated that current data fit the a priori model providing support to within-network validity [RMSEA=.08, NFI=.959, CFI=.965, IFI=.965, TLI=.955]. The criteria for acceptable fit were met. The scales were invariant between genders, across year levels and disciplines. Results indicated that social interaction anxiety and social phobia negatively predicted behavioural engagement (F = 25.093, p<.001, R²=.065) and positively predicted behavioural disaffection (F = 22.169, p<.001, R²=.057) to IPE, suggesting between-network validity.

CONCLUSIONS

Our data provided support for the validity of the scales when used among healthcare students in Hong Kong. SIAS-6 and SPS-6 have sound psychometric properties based on students' data in Hong Kong. We identified quantitative, qualitative and mixed methods research designs to guide researchers in getting involved in the discussion of students' social interactions in IPE.Key MessagesThe Social Anxiety Scale (SIAS-6) and Social Phobia Scale (SPS-6) scales have sound psychometric properties based on the large-scale healthcare students' data in IPE in Hong Kong.Social interaction anxiety and social phobia negatively predicted students' behavioural engagement with IPE and positively predicted behavioural disaffection. The scales are invariant in terms of gender, year level and discipline.Quantitative, qualitative and mixed methods studies are proposed to aid researchers to contribute in healthcare education literature using the SIAS-6 and SPS-6.

Research evaluating the effectiveness of dementia interventions in low- and middle-income countries: A systematic mapping of 340 randomised controlled trials

OBJECTIVES

More people with dementia live in low- and middle-income countries (LMICs) than in high-income countries, but best-practice care recommendations are often based on studies from high-income countries. We aimed to map the available evidence on dementia interventions in LMICs.

METHODS

We systematically mapped available evidence on interventions that aimed to improve the lives of people with dementia or mild cognitive impairment (MCI) and/or their carers in LMICs (registered on PROSPERO: CRD42018106206). We included randomised controlled trials (RCTs) published between 2008 and 2018. We searched 11 electronic academic and grey literature databases (MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Global Health, World Health Organization Global Index Medicus, Virtual Health Library, Cochrane CENTRAL, Social Care Online, BASE, MODEM Toolkit) and examined the number and characteristics of RCTs according to intervention type. We used the Cochrane risk of bias 2.0 tool to assess the risk of bias.

RESULTS

We included 340 RCTs with 29,882 (median, 68) participants, published 2008-2018. Over two-thirds of the studies were conducted in China (n = 237, 69.7%). Ten LMICs accounted for 95.9% of included RCTs. The largest category of interventions was Traditional Chinese Medicine (n = 149, 43.8%), followed by Western medicine pharmaceuticals (n = 109, 32.1%), supplements (n = 43, 12.6%), and structured therapeutic psychosocial interventions (n = 37, 10.9%). Overall risk of bias was judged to be high for 201 RCTs (59.1%), moderate for 136 (40.0%), and low for 3 (0.9%).

CONCLUSIONS

Evidence-generation on interventions for people with dementia or MCI and/or their carers in LMICs is concentrated in just a few countries, with no RCTs reported in the vast majority of LMICs. The body of evidence is skewed towards selected interventions and overall subject to high risk of bias. There is a need for a more coordinated approach to robust evidence-generation for LMICs.

Strain measurement for 2D echo with ultrasound enhancing agents can be performed with software available for non-enhanced recordings

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): ABACUS Cardiovascular Research Centre, Mazankowski Alberta Heart Institute

Background

Global longitudinal strain (GLS) measurement are less reliable when 2D image quality is reduced. While ultrasound enhancing agents (UEA; also known as "echo contrast") have been shown to enhance the reliability of EF measurements, there has been sparse evidence on performing GLS measurements after UEA injection. The aim of this study was to assess the feasibility of GLS analysis using the same software validated for non-enhanced 2D recordings.

Methods

GLS measurements were performed before and after injection of an approved UEA in 131 patients with acceptable image quality for GLS measurements. These patients were referred prior to chemotherapy initiation or were being monitored for potential cardiotoxic effects. As all these patients undergo echocardiography with UEA in order to achieve the best reproducibility of EF measurements, comparison of GLS measurements with and without UEA was possible. A commercially available ultrasound system was used and the same analysis software was applied. On end-diastolic and end-systolic frames, the inner border of the region of interest was manually adjusted to align with interface between the compact and trabeculated myocardium on non-enhanced images and the LV blood pool on the recordings with UEA.

Results

GLS measurements on recordings with UEA were performed in 131 patients. A strong positive correlation (r 0.67, p &lt; 0.001) was found between measurements on non-enhanced recordings with mean bias 0.58% (see figure). Mean GLS was 19.5 +/- 2.1% from non-enhanced recordings and 20.1 +/- 2.2% from UEA recordings. Differences in GLS &gt; 2% between methods were related to foreshortening or suboptimal delineation of segments on non-contrast recordings.

Conclusion

On a commercially available echocardiography scanner, software developed for GLS measurements on non-enhanced 2D recordings can be also applied to recordings that use UEA. Comparable results are obtained, provided the LV cavity is well delineated and not foreshortened. Abstract Figure 1

Comparison of two ultrasound contrast agents for left ventricular opacification

Funding Acknowledgements

Type of funding sources: None.

Background

Several ultrasound contrast agents have been approved and used for measurement of LV volumes and ejection fraction (EF). However, there has been no direct comparison between these agents.

Purpose

To compare different imaging parameters between two widely used ultrasound contrast agents for LV opacification when imaged with a low power contrast specific imaging modality

Methods

A retrospective study was performed using recordings of the local echocardiography registry for patients undergoing chemotherapy for cancer treatment.  Patients were included who underwent follow-up echocardiograms (3 months) with 2 different ultrasound contrast agents and had only minor changes in the LV ejection fraction (EF) between the studies (&lt;5%). Qualitative and quantitative analysis of the contrast effect was performed in apical four- and two chamber views (4CV,2CV). For quantitative analysis of the LV opacification square regions of interest (ROI) were placed in the apical and basal regions of the ventricle in each echocardiographic recording and the arithmetic mean and standard deviation of pixel intensity within each ROI was recorded throughout the entire loop. Qualitative visual assessment was performed using a three step visual score in order to assess the endocardial border delineation, basal attenuation and apical swirling. Wilcoxon signed-rank test was used to compare the measurements obtained with different contrast agents.

Results

41 patients fulfilled the inclusion criteria. In all patients suitable recordings for measurement of LV volumes and EF were obtained. The mean + standard deviation of the EF was 61 + 9%. Both contrast agents provided intensive LV opacification in the basal and apical cavities. The video intensities (mean + standard deviation) in the apical and basal cavities were comparable across both contrast agents in the 2CV apical ROI (219.96 + 21.42 vs 224.69 + 20.23, p = 0.32), the 2CV basal ROI (114.55, 42.02 vs 112.79, 42.57, p = 0.81), the 4CV apical ROI (228.02, 17.80 vs 225.51, 20.37, p = 0.30), and the 4CV basal ROI (100.05, 41.11 vs 92.84, 42.54, p = 0.37). Visual assessment of endocardial delineation on end-diastolic and end-systolic frames revealed no statistical difference between the contrast agents.

Conclusion

In patients with normal LV function no clinically relevant differences were found between the two contrast agents regarding LV opacification and endocardial border delineation.

The clinicopathologic significance of p53 and p21 expression in the surgical management of lingual squamous cell carcinoma

The aim of the present study was to evaluate the clinicopathologic significance of p53 and p21 expression in lingual squamous cell carcinomas. Immunohistochemical staining was performed with p53 and p21 monoclonal antibodies on surgical specimens from 87 patients who underwent primary surgical treatment for lingual carcinoma between 1976 and 1996. We found positive expression of p53 in 45 (52%) of 87 cases and of p21 in 49 (56%) of 87 cases. There was no correlation of p53 and p21 expression with cancer stage, T stage, nodal metastasis, and tumor grade. Univariate analysis revealed that p21 expression, tumor stage, T stage, and nodal stage were significant prognostic factors for survival. However, only p21 expression and tumor stage were significant independent prognostic factors for survival in a multivariate Cox regression analysis. Overexpression of p21 but not p53 has prognostic value for survival in the surgical treatment of lingual carcinomas. The combination of stage with p21 expression is recommended for evaluation of prognosis and for management planning.

Outreach strategies for Southeast Asian communities: experience, practice, and suggestions for approaching Southeast Asian immigrant and refugee communities to provide thalassemia education and trait testing

This article outlines general strategies for outreaching to Southeast Asian immigrant and refugee communities with thalassemia education. Because of positive net migration and increased birthrates during the last 15 years, Asian Pacific Islanders are among the fastest growing populations in California. Dr. Fred Lorey of California Newborn Screening shows that 1 of 12 Southeast Asians is a carrier of hemoglobin E, demonstrating a particular need to outreach to these communities. The challenge of educating Southeast Asian populations include language barriers, differences in cultural and/or religious beliefs, geographic location, and unfamiliarity with and/ or mistrust of Western health care systems. In addition, outreach workers must consider the great diversity of ethnicity, language, literacy, and education levels, and degree of acculturation to the US within the Asian/Southeast Asian groups. It is crucial before embarking on any outreach campaign to understand the history and make-up of the target audience, including ethnic minorities and dialects, to translate written materials into appropriate languages or audio formats, and to have a group of trained interpreters for events. Additionally, a continuing education model for the outreach/medical staff is important to maintain robust understanding of these diverse communities. Specific strategies include using visual aids, medical professionals as authority figures, and bicultural high school and college students during presentations. Finally, establishing trust and maintaining a continued presence in communities are the most important aspects of a successful outreach campaign.

An etoposide-induced block in vaccinia virus telomere resolution is dependent on the virus-encoded DNA ligase

Etoposide, an inhibitor of the breakage-reunion reaction associated with cellular type II DNA topoisomerases, was shown to inhibit plaque formation of vaccinia virus. This drug had a major effect on the segregation of newly replicated DNA concatemers. Gene expression and the initiation and elongation phases of viral DNA replication were essentially unaffected. Pulsed-field gel electrophoresis of viral DNA replicated in the presence of etoposide revealed two major classes of DNA: the mature monomeric linear genome and DNA that failed to enter the gel (the relative proportions depending on the concentrations of drug). Restriction enzyme analysis showed a severe defect in telomere resolution. In addition, slowly migrating restriction fragments were suggestive of a general recombination defect. We have isolated several etoposide-resistant mutants and used marker rescue and DNA sequencing to localize the resistance-causing mutation to the amino terminus of the viral DNA ligase gene. Inactivation of the DNA ligase also resulted in an etoposide-resistant phenotype, but to a lesser extent. The telomere resolution and segregation defects were corrected both in the drug-resistant mutants and in the DNA ligase knockout mutants. Reinsertion of wild-type or mutant DNA ligase in the viral thymidine kinase locus confirmed the role of the viral DNA ligase in conferring sensitivity not only to etoposide but also to another topoisomerase II inhibitor, 4'-(9-acridinylamino) methanesulphon-m-anisidide (mAMSA). The data suggest that the nonessential DNA ligase is involved in telomere resolution, possibly as part of a general recombinase.

[Pseudocyesis: clinical and hormonal evaluation]

Hormonal and clinical evaluation was performed in eleven females with diagnosis of pseudocyesis. Plasma levels of pituitary gonadotropins (FSH-LH), progesterone, estradiol and thyroid hormones (T3, T4, TSH) under basal conditions were measured through radioimmunoassay. Diagnosis of pseudocyesis was made according to the following criteria: a) secondary amenorrhea (greater than 12 weeks); b) two or more symptoms of gestation; c) conviction of being pregnant; d) negative HCG or pelvic ultrasound study. The circulation levels of gonadotropins were within normal limits. Progesterone exhibited a ovulatory pattern and thyroid hormones were normal for every instance. Once case had slight hyperprolactinemia (26.0 ng/ml) with impaired gonadotropin production and ovulatory progesterone. All patients had galactorrhea. The psychological study disclosed a tendency toward depression. Our findings partially confirmed previous observations, differing basically on that we observed normal hormonal trend.

Morphology and transcriptional activity of mouse oocyte chromosomes

Lampbrush chromosomes of growing amphibian oocytes carry thousands of lateral loops each of which consists of a chromatin fiber heavily encrusted with nascent ribonucleoprotein fibrils. These are believed to be responsible for the accumulation and maintenance of RNA transcripts found stored in the egg. In the case of mammalian oocytes, lampbrush chromosomes are most likely to occur during the major growth phase and also possibly during pachytene-early diplotene stages of meiosis. We have examined pachytene and early diplotene mouse oocyte chromosomes through the light microscope using sections of plastic-embedded material and air dried spreads stained with either silver nitrate or methyl green pyronin. Our results indicates that the projections radiating from the chromosomal axis are bundles of chromatin fibers rather than single fibers covered with an ribonucleoprotein matrix. These bundles may represent partially unfolded chromomeres. The axis itself could be partially dispersed revealing threads surrounding a fine linear element. -- Little is known about chromosome structure in growing mammalian oocytes, the stage when transcriptional activity is likely to be most rapid. In our preparations chromosomes at this stage appear as partially condensed fuzzy threads of relatively uniform width. In some cases, the fuzzy thread is seen to contain a dense linear core in the center. Thus, during the growth phase, the chromosomes retain a relatively condensed axis, a characteristic of meiotic chromosomes in general. RNA-containing material is found diffusely spread within the nucleus but not specifically associated with the chromosomes. Electron microscopic analysis of spread chromatin from growing oocytes demonstrates that most transcription units possess only one or two nascent ribonucleoprotein fibrils while a few have more. These and other published data indicate that mouse oocytes do not have true lampbrush chromosomes at any stage of their development.