探索学习对局灶性脑梗死大鼠学习记忆和新生血管的影响

目的:研究探索学习对局灶性脑梗死大鼠学习记忆及新生血管的影响。方法:采用开颅电凝法制作SD大鼠右侧大脑中动脉闭塞(MCAO)模型,术后24h随机分为标准环境(SE)组、探索学习环境(LE)组;另设假手术对照组(Sham)组,不电凝大脑中动脉,其余步骤与手术组相同。分别于术后第7天、28天进行Morris水迷宫测试大鼠学习记忆能力;以免疫组织化学法测定微血管密度。结果:在学习记忆能力上,LE组成绩明显优于SE组(P<0.01),与Sham组相比无显著差异(P>0.05);微血管密度显示LE组在术后第14天、28天新生血管明显多于SE组(P<0.05),与Sham组相比无显著差异(P>0.05)。结论:探索学习可促进局灶性脑梗死大鼠学习记忆能力的恢复与微血管新生,改善大鼠的预后。     

电针对脑缺血再灌注大鼠学习记忆能力及RhoA蛋白表达的影响

目的探讨电针神庭、百会穴对脑缺血再灌注模型大鼠学习记忆能力的影响及其可能机制。方法 45只雄性Sprague-Dawley大鼠随机分为假手术组(n=15)、模型组(n=15)和电针组(n=15)。模型组和电针组均采用左侧大脑中动脉缺血(MCAO)再灌注模型。电针组电针神庭、百会穴共7 d。采用Morris水迷宫测试观察大鼠学习记忆能力;尼氏染色观察大鼠海马神经元形态结构变化;Western blotting法检测大鼠左侧海马Rho A蛋白的表达。结果与模型组相比,电针组学习记忆能力改善(P0.05),海马神经元损伤减少(P0.05),海马组织中Rho A蛋白表达降低(P0.05)。结论电针能够改善脑缺血再灌注大鼠学习记忆能力,其机制可能与抑制Rho A蛋白表达有关。     

电针对脑梗死大鼠学习记忆能力和梗死侧海马CA3区突触结构的影响

目的研究电针对脑梗死大鼠学习记忆能力和梗死侧海马CA3区突触结构的影响。 方法48只Wistar雄性成年大鼠制成右侧大脑中动脉脑梗死模型后分为对照组和电针组,每组24只,2组又分别分为1,2,3周3个时段进行观察,每个时段8只。电针组于术后24 h开始进行电针治疗,对照组置于普通笼中正常喂养,不给予任何治疗。采用Morris水迷宫进行学习记忆能力评定,并观察梗死侧海马CA3区突触结构参数的变化。 结果电镜下观察到电针组各时段梗死侧海马CA3区突触后致密物厚度、活性区宽度及突触后膜曲率均较对照组明显增加,差异有统计学意义(P<0.05)。学习记忆能力测评：对照组大鼠表现明显的学习记忆障碍,电针组在Morris水迷宫定位航行试验中和空间探索试验中均明显优于对照组(P<0.05)。 结论电针可通过改变脑梗死大鼠梗死侧海马CA3区突触结构参数而改善脑梗死大鼠的学习记忆能力。     

电针百会、神庭穴对脑缺血再灌注大鼠学习记忆影响的小动物磁共振波谱研究

目的:观察脑缺血再灌注损伤大鼠海马区神经细胞代谢,探讨电针改善脑缺血再灌注损伤大鼠学习记忆能力的机制。方法:将SD大鼠按照随机数字表分为假手术组、模型组、电针组;利用Koizumi线栓法制备左侧大脑中动脉缺血再灌注大鼠模型,电针百会、神庭穴,每天1次,每次30 min,持续7 d;采用Morris水迷宫评估大鼠学习记忆能力,小动物核磁共振T2WI成像观察大鼠脑梗死,小动物磁共振波谱(MRS)观察大鼠海马区神经细胞代谢。结果:电针干预7 d后,大鼠在Morris水迷宫中穿越平台的次数显著增加(P0.01);大鼠脑梗死体积减少(P0.01),大鼠海马区N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)左侧/右侧含量的比值均升高(P0.05)。结论:电针刺激百会、神庭穴可改善脑缺血再灌注损伤大鼠海马区NAA和Cho的代谢,起到神经保护作用,从而改善学习记忆能力。     

电针百会和大椎穴两穴对脑缺血大鼠学习记忆能力和缺血侧海马CA3区脑源性神经营养因子的影响

目的研究电针刺激百会和大椎两穴对脑缺血大鼠学习记忆能力的影响,并通过对缺血侧海马CA3区脑源性神经营养因子（BDNF）的检测,进一步探讨其机制。 方法选取Wistar雄性成年大鼠48只,分为对照组（n＝24）和电针组（n＝24）,采用线拴法制成右侧大脑中动脉脑缺血模型,电针组于造模成功后第2天开始进行电针治疗,每日刺激1次,对照组造模成功后则采用常规饲养自由活动。2组大鼠均于电针组治疗1,2,3周后（造模成功后第8,15,22天后）每次取8只大鼠采用Morris水迷宫学习记忆行为测试评定2组大鼠的学习记忆能力,随后断头取脑,参照大鼠脑立体定位图定位取海马CA3区,并采用免疫组织化学法观察2组大鼠缺血侧海马CA3区BDNF的变化。 结果造模成功后第8,15,22天后,电针组大鼠在Morris水迷宫定位航行试验中和空间探索试验中的学习记忆能力均明显优于同时段仅采用常规饲养的对照组大鼠,差异有统计学意义(P<0.05)。在各个时间点,电针组缺血侧海马CA3区BDNF阳性细胞数均比对照组多,差异有统计学意义（P<0.05）。 结论电针刺激百会和大椎穴可改善脑缺血大鼠的学习记忆功能,其机制可能与脑缺血大鼠缺血侧海马CA3区BDNF的阳性表达增加有关。     

中枢白细胞介素-1β对大鼠全脑缺血后学习记忆的影响

目的：探讨白细胞介素-1β(IL-1β)对全脑缺血再灌注大鼠学习记忆的影响。方法：脑室注射(icv)IL-1β及抗体后，采用四动脉结扎法制备全脑缺血再灌大鼠模型。于全脑缺血10min后再灌注的6—9d，利用：Morris水迷宫，测试大鼠学习记忆功能，并对大鼠海马CAl区正常神经进行计数。结果：①给IL-1β预处理的缺血大鼠记忆功能明显下降，其在：Morris水迷宫内的逃逸潜伏期、游泳距离延长，但游泳速度却无改变；②各组比较，学习功能未发现显著性变化；③给IL-1β预处理的缺血大鼠，海马CAl区损伤神经百分数明显高于对照组。结论：IL-1β加重了脑缺血再灌注大鼠记忆障碍，其作用可能与海马CAl区神经元严重损伤有关。     

丰富环境对缺血缺氧脑损伤新生大鼠海马脑源性神经营养因子表达及细胞凋亡的影响

目的:探讨丰富环境对缺血缺氧脑损伤(HIBD)新生大鼠海马脑源性神经营养因子(BDNF)表达及细胞凋亡的影响。方法:采用随机数字表法将36只7日龄新生大鼠分为假手术组、模型组及丰富环境组,各组又分为术后7d、28d两个亚组(n=6)。采用Rice-Vannucci经典方法建立新生大鼠HIBD模型。模型组及假手术组不予任何干预,丰富环境组予以早期抚触及丰富环境刺激治疗。术后7d、28d采用水迷宫检测方法评估大鼠学习记忆能力,免疫组化法检测大鼠海马CA1区BDNF的表达,TUNEL法检测海马CA1区细胞凋亡。结果:术后7d、28d,与模型组比较,丰富环境组逃避潜伏期均缩短(P0.05),穿越平台次数增多(P0.05),BDNF表达升高(P0.05),TUNEL阳性细胞数降低(P0.05)。结论:丰富环境能改善HIBD新生大鼠学习记忆能力,其机制可能与上调海马区BDNF的表达及抑制细胞凋亡有关。     

探索学习对局灶性脑梗死大鼠梗死灶周围Flk-1、VEGF表达的影响

目的：研究探索学习对局灶性脑梗死大鼠梗死灶周围Flk-1、VEGF表达的影响。方法：采用开颅电凝法制作SD 大鼠右侧大脑中动脉缺血(MCAO) 模型,术后24h大鼠随机分为标准环境组(造模对照组,SE组) 、探索学习环境（LE）组,以免疫组织化学法检测血管内皮生长因子VEGF及血管内皮生长因子受体Flk-1的表达。结果：大鼠大脑中动脉栓塞后,梗死区神经元变性、坏死,VEGF和Flk-1在梗死周边区表达明显增加,经探索学习环境干预后,VEGF和Flk-1表达大量增加。 结论：LE可促使VEGF和Flk-1表达上调,进而促进微血管新生,利于脑损伤修复。     

电针百会、神庭穴对脑缺血再灌注大鼠学习记忆能力及海马5-羟色胺1A受体表达的影响

目的探讨电针百会、神庭穴对脑缺血再灌注(MCAO/R)大鼠学习记忆的影响及其可能的作用机制。方法将90只健康雄性Sprague-Dawley大鼠随机分为假手术组(n=18)和手术组(n=72)。手术组参照线栓法制备MCAO/R大鼠模型。将符合纳入标准的54只手术组大鼠随机分为模型组(n=18)、电针组(n=18)和非穴组(n=18)。电针组电针百会、神庭穴共14 d。小动物磁共振扫描检测脑梗死体积;Morris水迷宫测试检测学习记忆能力;免疫组化检测5-羟色胺1A(5-HT_(1A))受体的定位和表达。结果干预前各组大鼠脑梗死体积无显著性差异(F=1.678,P0.05)。干预后,与模型组和非穴组相比,电针组脑梗死体积显著减小(P0.001)。Morris水迷宫测试中,电针组较模型组和非穴组逃避潜伏期显著缩短(P0.001),穿越平台次数增加(P0.05)。5-HT_(1A)受体在缺血侧海马CA1、CA3和DG区均出现表达,电针组表达量较模型组和非穴组均降低(P0.05)。非穴组各项指标与模型组比较均无显著性差异(P0.05)。结论电针百会、神庭穴可有效改善MCAO/R大鼠的学习记忆能力,其机制可能与调节海马区5-HT_(1A)受体表达有关。     

电针对脑缺血再灌注大鼠学习记忆行为及海马区α7烟碱型乙酰胆碱受体的影响

目的:探讨电针对脑缺血再灌注大鼠学习记忆行为及海马区α7烟碱型乙酰胆碱受体(alpha7 nicotinic acetylcholine receptor,α7n ACh R)的影响。方法:将45只雄性SD大鼠按随机数字表法分为假手术组、模型组和电针组,每组均15只。模型组和电针组均参照Longa改良线栓法制备大鼠局灶性脑缺血再灌注模型。电针组电针神庭、百会穴,共7d,每次30min。采用Morris水迷宫实验观察大鼠的学习记忆功能;HE染色法观察大鼠海马神经元细胞结构变化;免疫组织化学染色法观测大鼠海马区α7n Ach R免疫阳性细胞的表达;Western blot法检测大鼠海马区α7n ACh R蛋白的表达。结果:各组大鼠游泳速度未见显著性差异(P0.05);模型组与假手术组相比大鼠逃避潜伏期明显延长(P0.01),跨越平台次数明显减少(P0.01);电针组与模型组相比大鼠逃避潜伏期明显缩短(P0.01),跨越平台次数明显增加(P0.01)。与假手术组相比,模型组海马区CA1区α7n ACh R免疫阳性细胞表达及整个海马区α7n ACh R蛋白的表达降低(P0.01),海马神经元细胞损伤加重;与模型组相比,电针上调海马区CA1区α7n ACh R免疫阳性细胞表达及整个海马区α7n ACh R蛋白的表达(P0.01),同时降低海马神经元细胞的损伤。结论:电针能改善脑缺血再灌注损伤大鼠的学习记忆能力,保护神经元细胞,其机制可能与上调海马区α7n ACh R表达有关。     

Introducing the Learning Practice--II. Becoming a Learning Practice

RATIONALE, AIMS AND OBJECTIVES: This paper is the second of three related papers exploring the ways in which the principles of Learning Organizations (LOs) could be applied in Primary Care settings at the point of service delivery. METHODS: Based on a theoretical and empirical review of available evidence, here we introduce the process by which a Practice can start to become a Learning Practice (LP). RESULTS AND CONCLUSIONS: Steps taken to enhance both individual and organizational learning begin the process of moving towards a learning culture. Attention is given to the routines that can be established within the practice to make learning systematically an integral part of what the practice does. This involves focusing on all three of single-, double- and triple-loop learning. Within the paper, a distinction is made between individual, collective and organizational learning. We argue that individual and collective learning may be easier to achieve than organizational learning as processes and systems already exist within the Health Service to facilitate personal learning and development with some opportunities for collective and integrated learning and working. However, although organizational learning needs to spread beyond the LP to the wider Health Service to inform future training courses, policy and decision-making, there currently seem to be few processes by which this might be achieved. This paper contributes to the wider quality improvement debate in three main ways. First, by reviewing existing theoretical and empirical material on LOs in health care settings it provides both an informed vision and a set of practical guidelines on the ways in which a Practice could start to effect its own regime of learning, innovation and change. Second, it highlights the paucity of opportunities individual general practitioner practices have to share their learning more widely. Thirdly, it adds to the evidence base on how to apply LO theory and activate learning cultures in health care settings.     

Speeding Up Learning: Accelerated Distance Learning in Rehabilitation Education

Distance learning in higher education involves a continuum of technologies ranging from teleconferencing to video streaming. The United States is approaching a crisis in personnel shortages in rehabilitation counseling and education. Because of these shortages, higher education is called upon to produce counselors in an abbreviated period of time. Thus, distance learning is recognized as an integral part of education, especially for adult learners. This article provides an overview and discussion of the relevance of distance and accelerated learning in rehabilitation and higher education.     

护理本科生学习倦怠和自主学习能力水平的相关性研究

目的调查护理本科生(简称护生)的自主学习能力和学习倦怠水平,了解两者之间的关系以及不同年级、专业方向护生学习倦怠水平的差异,以期为改进教学方法、提高护生的自主学习能力提供依据。方法采用一般资料问卷、护生自主学习能力问卷和学习倦怠情况问卷对南通大学护理学院四个年级的335名护生进行调查。结果 335名护生学习倦怠情况问卷中情绪低落得分最高;在自主学习能力问卷中,学习管理得分最高,资源利用得分最低;不同年级护生的成就感得分差异有统计学意义(P0.01);不同专业方向护生的情绪低落得分及学习倦怠总分的差异有统计学意义(P0.05或P0.01);自主学习能力和学习倦怠之间呈负相关(P0.05或P0.01)。结论护生的学习倦怠水平不容忽视,护理教育者应当采取恰当的教学方法促进护生自主学习能力的提高,同时重视培养护生的学习情感和资源利用能力。     

Introducing the Learning Practice--I. The characteristics of Learning Organizations in Primary Care

RATIONALE, AIMS AND OBJECTIVES: This paper is the first of three related papers exploring the ways in which the principles of Learning Organizations (LOs) could be applied in Primary Care settings at the point of service delivery. Here we introduce the notion of the Learning Practice (LP) and outline the characteristics and nature of an LP, exploring cultural and structural factors in detail. METHODS: Drawing upon both theoretical concepts and empirical research into LOs in health care settings, the format, focus and feasibility of an LP is explored. RESULTS AND CONCLUSIONS: Characteristics of LPs include flatter team-based structures that prioritize learning and empowered change, involve staff and are open to suggestions and innovation. Potential benefits include: timely changes in service provision that are realistic, acceptable, sustainable, and owned at practitioner level; smoother interprofessional working; and fast flowing informal communication backed up by records of key decisions to facilitate permanent learning. Critical comment on potential pitfalls and practical difficulties highlights features of the present system that hinder development: tightly defined roles; political behaviours and individual-oriented support systems; plus the ongoing difficulties involved in tolerating errors (whilst people learn). This paper contributes to the wider quality improvement debate in the area in three main ways. First, by locating Government's desires to create health systems capable of learning within the theoretical and empirical evidence on LOs. Second, it suggests what an LP could be like and how its culture and structures might benefit both staff and patients in addition to meeting externally driven reforms and health priorities. Third, it extends the application of LO concepts to the health care sector locating the principles in bottom-up change.     

手机移动学习在内科护理辅助学习中的效果研究

目的探讨手机移动学习在内科护理辅助学习中的效果。方法 2015年3-7月采用便利抽样法,选取护理系专科二年级2个班的学生为研究对象,按班级不同分为对照组和观察组,分别为47名及49名,两组学生采用相同的内科护理教学模式及常规复习及预习,观察组在对照组的基础上给予手机移动应用程序(application,APP)辅助学习,课程结束后对两组学生的内科护理成绩及自我导向学习能力进行评价。结果观察组内科护理理论成绩为(77.55±8.56)分,实践成绩为(82.35±6.32)分;对照组理论成绩为(73.78±7.22)分,实践成绩为(79.15±7.56)分,两组比较差异均有统计学意义(均P0.05);干预前自我导向学习能力得分对照组为(227.71±27.22)分,观察组为(229.09±29.45)分,两组比较差异无统计意义(P0.05);干预后自我导向学习能力得分对照组为(230.03±20.09)分,观察组为(240.96±30.95)分,两组比较差异有统计意义(P0.05)。结论基于手机的移动学习模式能够提升护生内科护理的学习效果,并能提升自我导向学习能力。     

合作学习法对成人大专护生自主学习能力的影响

目的探讨合作学习法对成人大专护生自主学习能力的影响。方法整群抽取2011级成人教育护理大专1个班38名护生为研究对象,在《护理学导论》理论与实践课教学中应用合作学习法。合作学习法干预前后,采用护理专业学生自主学习能力量表及自制问卷调查其实施效果。结果干预后护生的自主学习能力总分及各维度得分均高于干预前,差异均有统计学意义（P＜0.05或＜0.01）;课后教学效果反馈显示,护生反映其学习兴趣提高,学习目标更明确以及课外学习时间增加。结论合作学习法对于激发护生学习动机,提高自主学习能力有促进作用。     

High-Frequency Learning Goals: Using Self-Regulated Learning to Influence Day-to-Day Practice in Clinical Education

Problem: Although self-regulated learning (SRL) is considered a fundamental skill that must be developed in physician training, many programs of SRL utilize learning goals that are generated only at the beginning of learning experiences or are widely spaced apart in time. These goals are often not formally shared with those actually working with the learner in the clinical setting. Intervention: We developed a program of written, student-generated weekly learning goals in which students focused on processes of becoming better doctors for their patients. These goals were shared at the beginning of each week with students' clinical teams for feedback and incorporation into the work. Context: The weekly learning goals program was developed and implemented as part of a required 3rd-year neurology clerkship. At the end of each 4-week clerkship, students were asked to evaluate the program through an anonymous electronic survey utilizing quantitative and open-ended qualitative questions. Outcome: Seventy-six of 82 students completed the evaluation survey (93% response rate). Eighty-six percent reported that the weekly learning goals increased their awareness of their thoughts and actions. Seventy-eight percent reported that the learning goals helped to improve their clinical performance to some degree, and 57% reported that the learning goals increased their focus on patient care. Students described a greater sense of focus on self-assessment and accountability from their goals. Students often commented that engagement from attendings and residents regarding their goals was a key element for successful learning from their goals. Lessons Learned: Student-generated weekly learning goals on a neurology clerkship appear to be an effective method to operationalize SRL. For most students, the frequency of the goals allowed for close self-monitoring, and the act of sharing goals with the team opened a new avenue for dialogue between students and their supervisors.     

Click-level Learning Analytics in an Online Medical Education Learning Platform

Abstract

Theory

Learning in digital environments allows the collection of inexpensive, fine-grained process data across a large population of learners. Intentional design of the data collection can enable iterative testing of an instructional design. In this study, we propose that across a population of learners the information from multiple choice question responses can help to identify which design features are associated with positive learner engagement. Hypothesis: We hypothesized that, within an online module that presents serial knowledge content, measures of click-level behavior will show sufficient, but variable, association with a test-measure so as to potentially guide instructional design. Method: The Aquifer online learning platform employs interactive approaches to enable effective learning of health professions content. A multidisciplinary focus group of experts identified potential learning analytic measures within an Aquifer learning module, including: hyperlinks clicked (yes/no), magnify buttons clicked (yes/no), expert advice links clicked (yes/no), and time spent on each page (seconds). Learning analytics approaches revealed which click-level data was correlated with the subsequent relevant Case MCQ. We report regression coefficients where the dependent variable is student accuracy on the Case MCQ as a general indicator of successful engagement. Results: Clicking hyperlinks, magnifying images, clicking “expert” links, and spending >100?seconds on each page were learning analytic measures and were positively correlated with Case MCQ success; rushing through pages (<20?seconds) was inversely correlated with success. Conversely, for some measures, we failed to find expected associations. Conclusions: In online learning environments, the wealth of process data available offers insights for instructional designers to iteratively hone the effectiveness of learning. Learning analytic measures of engagement can provide feedback as to which interaction elements are effective.     

Exam Success at Undergraduate and Graduate-Entry Medical Schools: Is Learning Style or Learning Approach More Important? A Critical Review Exploring Links Between Academic Success,Learning Styles,and Learning Approaches Among School-Leaver Entry (“Traditional”) and Graduate-Entry (“Nontraditional”) Medical Students

Phenomenon: The literature on learning styles over many years has been replete with debate and disagreement. Researchers have yet to elucidate exactly which underlying constructs are measured by the many learning styles questionnaires available. Some academics question whether learning styles exist at all. When it comes to establishing the value of learning styles for medical students, a further issue emerges. The demographics of medical students in the United Kingdom have changed in recent years, so past studies may not be applicable to students today. We wanted to answer a very simple, practical question: what can the literature on learning styles tell us that we can use to help today's medical students succeed academically at medical school? Approach: We conducted a literature review to synthesise the available evidence on how two different aspects of learning—the way in which students like to receive information in a learning environment (termed learning “styles”) and the motivations that drive their learning (termed learning “approaches”)—can impact on medical students' academic achievement. Findings: Our review confirms that although learning “styles” do not correlate with exam performance, learning “approaches” do: those with “strategic” and “deep” approaches to learning (i.e., motivated to do well and motivated to learn deeply respectively) perform consistently better in medical school examinations. Changes in medical school entrant demographics in the past decade have not altered these correlations. Optimistically, our review reveals that students' learning approaches can change and more adaptive approaches may be learned. Insights: For educators wishing to help medical students succeed academically, current evidence demonstrates that helping students develop their own positive learning approach using “growth mind-set” is a more effective (and more feasible) than attempting to alter students' learning styles. This conclusion holds true for both “traditional” and graduate-entry medical students.