Is reflection like soap? a critical narrative umbrella review of approaches to reflection in medical education research

Reflection is a complex concept in medical education research. No consensus exists on what reflection exactly entails; thus far, cross-comparing empirical findings has not resulted in definite evidence on how to foster reflection. The concept is as slippery as soap. This leaves the research field with the question, ‘how can research approach the conceptual indeterminacy of reflection to produce knowledge?’. The authors conducted a critical narrative umbrella review of research on reflection in medical education. Forty-seven review studies on reflection research from 2000 onwards were reviewed. The authors used the foundational literature on reflection from Dewey and Schön as an analytical lens to identify and critically juxtapose common approaches in reflection research that tackle the conceptual complexity. Research on reflection must deal with the paradox that every conceptualization of reflection is either too sharp or too broad because it is entrenched in practice. The key to conceptualizing reflection lies in its use and purpose, which can be provided by in situ research of reflective practices.

Ticks, Human Babesiosis and Climate Change

The effects of current and future global warming on the distribution and activity of the primary ixodid vectors of human babesiosis (caused by Babesia divergens, B. venatorum and B. microti) are discussed. There is clear evidence that the distributions of both Ixodes ricinus, the vector in Europe, and I. scapularis in North America have been impacted by the changing climate, with increasing temperatures resulting in the northwards expansion of tick populations and the occurrence of I. ricinus at higher altitudes. Ixodes persulcatus, which replaces I. ricinus in Eurasia and temperate Asia, is presumed to be the babesiosis vector in China and Japan, but this tick species has not yet been confirmed as the vector of either human or animal babesiosis. There is no definite evidence, as yet, of global warming having an effect on the occurrence of human babesiosis, but models suggest that it is only a matter of time before cases occur further north than they do at present.

Role of the Combination of Cyclin-Dependent Kinase Inhibitors (CDKI) and Radiotherapy (RT) in the Treatment of Metastatic Breast Cancer (MBC): Advantages and Risks in Clinical Practice

Targeting cell cycle has become the gold standard for metastatic breast cancer (MBC), being cyclin-dependent kinase inhibitors (CDKIs) cornerstones of its treatment, alongside radiotherapy (RT). To date, no definite evidence regarding safety and efficacy of the combination of CDKIs plus radiotherapy (RT) is currently available. Purpose of this review is to collect data in favor or against the feasibility of the association of CDKIs + RT, describing its potential adverse events. Our review shows how CDKI + RT allows an overall satisfying disease control, proving to be effective and causing a grade of toxicity mainly influenced by the site of irradiation, leaning to favourable outcomes for sites as liver, spine or brain and to poorer outcomes for thoracic lesions or sites close to viscera; controversial evidence is instead for bone treatment. Toxicity also varies from patient to patient. To sum up, our contribution enriches and enlightens a still indefinite field regarding the feasibility of CDKIs + RT, giving cues for innovative clinical management of hormone-responsive MBC.

Wrapping It Up Like Paul

The peculiarity of 2 Corinthians 13:11–13 has been noticed by scholars since the eighteenth century, but suggestions about the passage have often briefly made without a thorough textual examination. Employing several types of evidence used for identifying interpolations, this article will demonstrate that the letter closing of 2 Corinthians (13:11–13) has three distinctive characteristics. Independently, these are not definite evidence, but their cumulative weight increases the possibility that this ending was created by a redactor.

Covid-19 pandemic and weather conditions: Can temperature curb the spread?

The coronavirus disease 2019 (Covid-19) pandemic began in December with the first case detected in Wuhan, China. As Covid-19 rapidly spread through human-to-human contact, it was declared a pandemic. How severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) acts in different weather conditions, whether it shows seasonal changes, and if these two factors affect the course of the pandemic are among the frequently asked questions. It is known that many virus pandemics are affected by seasonal conditions and often occur in winter when immunity is weakened. Studies reporting that the spread of Covid-19 will decelerate in summer are in the majority. The results of studies in which multiple countries have been evaluated, in particular, are that the increased temperature and humidity will reduce the spread of the virus. Studies have also claimed that Covid-19 is not affected by weather conditions. There is yet no definite evidence in how the seasonal change will be manifested in SARS-CoV-2. Measures for protection from the infection are essential to control the pandemic.International Journal of Human and Health Sciences Vol. 05 No. 02 April’21 Page: 264-266

Quantifying the information impact of future searches for exoplanetary biosignatures

One of the major goals for astronomy in the next decades is the remote search for biosignatures (i.e., the spectroscopic evidence of biological activity) in exoplanets. Here we adopt a Bayesian statistical framework to discuss the implications of such future searches, both in the case when life is detected and when no definite evidence is found. We show that even a single detection of biosignatures in the vicinity of our stellar system, in a survey of similar size to what will be obtainable in the next 2 decades, would affect significantly our prior belief on the frequency of life in the universe, even starting from a neutral or pessimistic stance. In particular, after such discovery, an initially agnostic observer would be led to conclude that there are more than105inhabited planets in the galaxy with a probability exceeding 95%. However, this conclusion would be somewhat weakened by the viability of transfer of biological material over interstellar distances, as in panspermia scenarios. Conversely, the lack of significant evidence of biosignatures would have little effect, leaving the assessment of the abundance of life in the galaxy still largely undetermined.

Ek […] wraitalaþo

Scholars have previously interpreted the sequence wraitalaþo on the Trollhättan II Bracteate as wrait alaþō ‘I wrote the magical formula’, wrait ā laþō ‘I wrote laþu in(to)’ or wraita laþō ‘I wrote as an invitation’. The first and second interpretations are improbable for semantic, morphological and syntactic reasons. The third interpretation does not consider the linguistic consequences of the strong preterite 1sg ending being retained as -a in Proto-Norse (PN). I will argue that final -a was preserved in early PN after a stressed syllable, but was lost after an unstressed one. I will reconsider the group of PN inscriptions that attest strong preterite verbs. Finally, I will conclude that all definite evidence of the loss of -a belongs to a later period. One exception, however, is the much-debated inscription on the Reistad Stone, which lacks the syncope and has an original word-final -a in unnam(ʀ̣) wraita.

Hepatic Sarcoidosis Complicated with Pancreatic Adenocarcinoma

Sarcoidosis is a systemic noncaseous granulomatous disease. The liver is a common location but usually asymptomatic. Current literature suggests an association between sarcoidosis and cancers. However, there is a lack of definite evidence. We present a case of a 59-year-old man with jaundice and acutely elevated alkaline phosphatase. The diagnosis was confirmed by obtaining a liver biopsy and was treated with 6 months of steroids. A year later, he had a recurrence of jaundice. MRCP showed biliary dilatation and a mass in the pancreatic head, confirmed by biopsy to be adenocarcinoma. This is the first case to be reported of hepatic sarcoidosis associated with pancreatic cancer.

IL-6 gene rs1800795 polymorphism and diabetes mellitus: a comprehensive analysis involving 39099 participants

Background Over the past two decades, many studies concentrated the association between a common polymorphism ( rs1800795 ) from interleukin-6 (IL-6) gene and Diabetes Mellitus (DM) risk have been published, however, the results remain ambiguous and indefinite.Methods In current, we performed a comprehensive analysis to explore above relationship. A search was conducted in the PubMed, Embase, Chinese (CNKI and Wanfang) databases, covering all papers published until Sep 20, 2019. Odds ratios (OR) with 95% confidence intervals (CI) was applied to evaluate the strength of this association. Publication bias was assessed with both Begg and Egger’s tests.Results Overall, 26 case-control studies with 5973 T2DM patients and 13968 controls, and 11 case-control studies (10193 T1DM patients and 8965 health controls) were included for analysis in our study. Finally, significant decreased association was observed between the rs1800795 polymorphism and T2DM risk in overall sample, Asians and hospital-based subgroup (for example: C-allele vs. G-allele: OR = 0.65, 95%CI = 0.53-0.81, P < 0.05), however, increased associations were found from Mixed population and hospital-based subgroup between rs1800795 polymorphism and T1DM susceptibility (for example: CC vs. GG: OR = 2.45, 95%CI = 1.18-5.07, P = 0.016 for Mixed individuals).Conclusions In summary, there had a definite evidence to confirm that IL-6 rs1800795 polymorphism was associated with susceptibility of decreased T2DM and increased T1DM.

Eli, “Enemy of a Temple”? A Study of מעון in 1 Samuel 2.29 and 2.32

The Septuagint’s reading of verses 29a and 32a in 1 Samuel 2 may appear to provide an explanation of the difficult readings of the Masoretic text, but in fact, the LXX complicates the matter. There is no definite evidence that the LXX is the original and MT its corrupt variant. I propose that MT מעון‎ “in a temple” in v. 29a and צר מעון‎ “enemy of a temple” in v. 32 not only make sense as they stand but also provide a hermeneutical key to understanding the story of the Elides’ degradation, which focuses on their negative role in the temple at Shiloh.