IntroductionThe last decade has seen many changes in graduate medical education training in the USA, most notably the implementation of duty hour standards for residents by the Accreditation Council of Graduate Medical Education. As educators are left to balance more limited time available between patient care and resident education, new methods to augment traditional graduate medical education are needed.ObjectivesTo assess acceptance and use of a novel gamification-based medical knowledge software among internal medicine residents and to determine retention of information presented to participants by this medical knowledge software.MethodsWe designed and developed software using principles of gamification to deliver a web-based medical knowledge competition among internal medicine residents at the University of Alabama (UA) at Birmingham and UA at Huntsville in 2012–2013. Residents participated individually and in teams. Participants accessed daily questions and tracked their online leaderboard competition scores through any internet-enabled device. We completed focus groups to assess participant acceptance and analysed software use, retention of knowledge and factors associated with loss of participants (attrition).ResultsAcceptance: In focus groups, residents (n=17) reported leaderboards were the most important motivator of participation. Use: 16 427 questions were completed: 28.8% on Saturdays/Sundays, 53.1% between 17:00 and 08:00. Retention of knowledge: 1046 paired responses (for repeated questions) were collected. Correct responses increased by 11.9% (p<0.0001) on retest. Differences per time since question introduction, trainee level and style of play were observed. Attrition: In ordinal regression analyses, completing more questions (0.80 per 10% increase; 0.70 to 0.93) decreased, while postgraduate year 3 class (4.25; 1.44 to 12.55) and non-daily play (4.51; 1.50 to 13.58) increased odds of attrition.ConclusionsOur software-enabled, gamification-based educational intervention was well accepted among our millennial learners. Coupling software with gamification and analysis of trainee use and engagement data can be used to develop strategies to augment learning in time-constrained educational settings.
Fecal microbiota transplantation has been shown to be an effective treatment for patients with recurrent C. difficile colitis. Although fecal microbiota transplantation helps to re-establish a normal gut function in patients, the extent of the repopulation of the recipient microbial community varies. To further understand this variation, it is important to determine the fate of donor microbes in the patients following fecal microbiota transplantation. We have developed a new method that utilizes the unique single nucleotide variants of gut microbes to accurately identify microbes in paired fecal samples from the same individual taken at different times. Using this method, we identified transplant donor microbes in seven recipients 3–6 months after fecal microbiota transplantation; in two of these fecal microbiota transplantation, we were able to identify donor microbes that persist in recipients up to 2 years post-fecal microbiota transplantation. Our study provides new insights into the dynamics of the reconstitution of the gastrointestinal microbe community structure following fecal microbiota transplantation.
Botulinum toxin type A has a good safety profile during the first months of use. However the occurrence of adverse events is more frequent among children with cerebral palsy than individuals with other conditions. Severe adverse events are potentially related with the use of botulinum toxin type A, but data are sparse and additional study is required to clarify the causal relation.
Abstract. This study was carried out to determine morphometric and meristic characteristics of two populations (wild and cultured) of Cichlasoma festae and to establish whether populations could be discriminated based on morphometric variability. Twenty-two morphometric and four meristic characters were used to test the hypothesis differentiation. Univariate analysis of variance (ANOVA) from 100 adult specimens showed significant differences (p < 0.05) for 21 standardized morphometric measurements out of 26 characters among the means of the wild and cultured Cichlasoma festae populations tested. Cross correlation amongst certain morphometric variables (i.e. body weight, total length, standard length, pre-ventral length, AC1, LC1 and P1) were medium-strong (r ≥ 0.5), while the remaining were weakly correlated (r < 0.5). The length-weight relationship parameter b and condition factor (K) values were respectively 2.21 and 1.97 (indicating allometric growth) for cultured fish groups and 2.86 and 4.07 (p < 0.05) for wild fish groups. The condition factor values were significantly different from each other and showed that feeding of cultured fish should be improved. Both groups were accurately separated (> 80 % success rate) by linear discriminant functions that included only four morphometric measures.
We report the use of fecal microbiota transplantation in a single heart-kidney transplant recipient with recurrent Clostridium difficile, vancomycin-resistant Enterococcus (VRE) fecal dominance, and recurrent VRE infections. Fecal microbiota transplantation resulted in the reconstruction of a diverse microbiota with (1) reduced relative abundance of C difficile and VRE and (2) positive clinical outcome.
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