Alteration of corticothalamic perfusion ratios during a PTSD flashback

We performed a single photon emission computed tomography (SPECT) study of patients with posttraumatic stress disorder (PTSD) by measuring changes in regional cerebral blood flow (rCBF) during provocation by combat stimuli. A single patient experienced an actual flashback following exposure to combat sounds, exhibiting tearfulness, diaphoresis, tachypnea, and severe agitation. Results from his SPECT study demonstrated a dramatically altered ratio of cortical to subcortical perfusion during the flashback but not during the control scan. This altered pattern, which showed a peak of activity in the thalamus, was not consistent with global rCBF changes induced by hyperventilation. The perfusion pattern during the patient's control scan was qualitatively indistinguishable from any of the SPECT scans obtained for the other patients. This single case suggests a possible role for corticothalamic dysfunction in flashbacks. Depression and Anxiety 4:146–150, 1996/1997. © 1997 Wiley-Liss, Inc.     

Guidelines for Best Practice in the Audiological Management of Adults with Severe and Profound Hearing Loss

Individuals with severe to profound hearing loss are likely to present with complex listening needs that require evidence-based solutions. This document is intended to inform the practice of hearing care professionals who are involved in the audiological management of adults with a severe to profound degree of hearing loss and will highlight the special considerations and practices required to optimize outcomes for these individuals.     

Availability of Healthy Food and Beverages in Hospital Outlets and Interventions in the UK and USA to Improve the Hospital Food Environment: A Systematic Narrative Literature Review

The aims of this systematic review are to determine the availability of healthy food and beverages in hospitals and identify interventions that positively influence the hospital food environment, thereby improving the dietary intake of employees and visitors. Embase, Medline, APA PsycInfo, Scopus, Google Scholar and Google were used to identify publications. Publications relating to the wider hospital food environment in the UK and USA were considered eligible, while those regarding food available to in-patients were excluded. Eligible publications (n = 40) were explored using a narrative synthesis. Risk of bias and research quality were assessed using the Quality Criteria Checklist for Primary Research. Although limited by the heterogeneity of study designs, this review concludes that the overall quality of hospital food environments varies. Educational, labelling, financial and choice architecture interventions were shown to improve the hospital food environment and/or dietary intake of consumers. Implementing pre-existing initiatives improved food environments, but multi-component interventions had some undesirable effects, such as reduced fruit and vegetable intake.     

Drugs used in the treatment of schizophrenia and bipolar disorder inhibit the replication of Toxoplasma gondii

The exact mechanisms of action of some antipsychotics and mood stabilizers have not been elucidated. Response to these medications can vary among individuals. Recent studies indicate that infection with the parasite Toxoplasma gondii may contribute to the symptoms of schizophrenia in some individuals. We investigated commonly used antipsychotic and mood stabilizing medications for their ability to inhibit the replication of this organism.We employed a system for testing compounds for in vitro activity against T. gondii. Human fibroblasts (HFF) were treated with test compounds and then exposed to Toxoplasma that has been genetically modified to express cytoplasmic beta-galactosidase. Inhibition by the drugs was determined by spectrophotometric analysis of colorimetric reactions.We tested 12 neuroleptic compounds and found that of these, the antipsychotic haloperidol and the mood stabilizer valproic acid most effectively inhibit Toxoplasma growth in vitro. Valproic acid inhibited the parasite at a concentration below that found in the cerebrospinal fluid and blood of individuals being treated with this medication and displayed synergistic activity with haloperidol and with trimethoprim, an antibiotic commonly used to treat Toxoplasma infections.Several medications used to treat schizophrenia and bipolar disorder have the ability to inhibit the in vitro replication of T. gondii.     

Neural stem cells spontaneously express dopaminergic traits after transplantation into the intact or 6-hydroxydopamine-lesioned rat

The ability to differentiate neural stem cells (NSCs) into dopamine neurons is fundamental to their role in cell replacement therapies for neurodegenerative disorders such as Parkinson's disease. We show here that when a clonal line (C17.2) of undifferentiated NSCs is transplanted into the intact or 6-hydroxydopamine-lesioned striatum, cells withdraw from the cell cycle (BrdU(-)), migrate extensively in the host striatum, and express markers associated with neuronal (beta-tubulin III(+), NSE(+), NeuN(+)) but not glial (GFAP(-), MBP(-), A2B5(-)) differentiation. Importantly, by 2-5 weeks postgrafting, in the majority of these transplants, nearly all engrafted cells express the dopamine-synthesizing enzymes tyrosine hydroxylase and aromatic L-amino decarboxylase, sometimes resulting in changes in motor behavior. In contrast, no NSCs stain for dopamine-beta-hydroxylase, choline acetyltransferase, glutamic acid decarboxylase, or serotonin. We conclude that, following transplantation into the intact or 6-hydroxydopamine-lesioned rat, the adult brain contains intrinsic cues sufficient to direct the specific expression of dopaminergic traits in immature multipotential neural stem cells.     

The use of an animal drawing test in the assessment and disposition of transsexualism

Reported results of a study that compared two projective techniques for a group of 19 transsexuals who were seeking sex reassignment surgery. The Draw-A-Person Test (DAP), widely used in clinical settings, was contrasted to the Animal and Opposite Drawing Technique (AODT), which is a relatively new and little-examined variation of the DAP. Discussion focuses on the use of both measures as predictors of those transsexuals to be recommended for surgery. Use of the AODT as an effective measure in the assessment of transsexualism is investigated.     

The hairless mouse as a model for evaluating promoters of hair growth

The hairless mouse may seem an unlikely model for assessing the influence of drugs on hair growth. Although the animal's first pelage is normal, a defect in the first catagen results in separation of the papilla from the shortening follicle.^1,2 These never reconnect, and the animal remains hairless thereafter. The scanty second pelage that occasionally occurs in some animals derives from a few surviving follicles. This research was undertaken to determine whether minoxidil might interfere with the follicular catastrophe at the end of the first pelage. The evidence of a second pelage would provide a quick and convenient end point. This article describes a preliminary study with minoxidil applied topically to Skh-hairless-1 neonate and weanling mice.     

Influence of route of administration on progesterone metabolism

While inducing similar progesterone levels, the ratio of 5α- and 5β-pregnanolone/progesterone plasma concentrations has been dramatically increased after oral as opposed to vaginal administration, in a cross-over study. The known psychotropic effects of 5α- and 5β-pregnanolone lead to different indications and precautions for oral and vaginal administration of progesterone.     

Sending messages: How faculty influence professionalism teaching and learning

Background: Ambiguity in understanding what “professionalism” means, and uncertainty in how best to teach it, remains. This study aimed to explore experiences of senior faculty in their endeavor to develop and include professionalism within a curriculum reform (CR), and illuminate challenges encountered.

Methods: Using a qualitative case study approach, data were collected from interviews with faculty who were involved in a major CR, plus archived document analysis to provide context, and aid triangulation. Data coding and analysis were inductive, using thematic analysis to generate initial coding scheme; exploring themes in the data.

Results: Seventeen interviews were undertaken and approximately 90 documents were reviewed. Analysis revealed: faculty may unintentionally influence, through mixed messages and hidden meanings, the content and processes of professionalism teaching and learning. We identified several intersecting tensions related to the nature of the existing curriculum, staff knowledge, resources, and lack of clear guidance about the “what and how” to teach professionalism.

Conclusion: This study illustrates, hidden messages and contextual factors can enable or inhibit the translation of professionalism into curricula. Those involved in implementing professionalism must be reflective, keep the “hidden curriculum” in the spotlight to consider how presuppositions and prejudices of their cultural milieu may shape curricular outcomes.     

Goal setting practice in chronic low back pain. What is current practice and is it affected by beliefs and attitudes?

Introduction: Goal setting, led by the patient, is promising as an effective treatment for the management of chronic low back pain (CLBP); however, little is known about current practice. The aims of the study were to explore (1) current goal setting practice in CLBP among physiotherapists; (2) perceived barriers to goal setting in CLBP; and (3) relationship between clinician’s attitudes and beliefs and goal setting practice. Method: A cross-sectional observational survey. Results: The majority of respondents used goal setting with the main aim of facilitating self-management. The greatest number of goals were set with 50% therapist/50% patient involvement. The most common perceived barriers to goal setting related to time constraints and lack of skill and confidence. A higher biomedical score for treatment orientation of the therapist was associated with a lower patient involvement score. Conclusion: Goal setting is common practice for CLBP and is perceived as a high priority. It is more often a collaboration between therapist and patient rather than patient-led with treatment orientation of the physiotherapist a predictor of patient involvement. Education of healthcare professionals needs to include better understanding of chronic pain to orient them away from a biomedical treatment approach, as well as to enhance skills in facilitating patient involvement in goal setting.