Students' experiences of blended learning across a range of postgraduate programmes

The article describes the students' experiences of taking a blended learning postgraduate programme in a school of nursing and midwifery. The indications to date are that blended learning as a pedagogical tool has the potential to contribute and improve nursing and midwifery practice and enhance student learning. Little is reported about the students' experiences to date. Focus groups were conducted with students in the first year of introducing blended learning. The two main themes that were identified from the data were (1) the benefits of blended learning and (2) the challenges to blended learning. The blended learning experience was received positively by the students. A significant finding that was not reported in previous research was that the online component meant little time away from study for the students suggesting that it was more invasive on their everyday life. It is envisaged that the outcomes of the study will assist educators who are considering delivering programmes through blended learning. It should provide guidance for further developments and improvements in using Virtual Learning Environment (VLE) and blended learning in nurse education.     

A cellular level approach to predicting resting energy expenditure: Evaluation of applicability in adolescents

We previously derived a cellular level approach for a whole‐body resting energy expenditure (REE) prediction model by using organ and tissue mass measured by magnetic resonance imaging (MRI) combined with their individual cellularity and assumed stable‐specific resting metabolic rates. Although this approach predicts REE well in both young and elderly adults, there were no studies in adolescents that specifically evaluated REE in relation to organ–tissue mass. It is unclear whether the approach can be applied to rapidly growing adolescents. The aim of the present study was to evaluate the applicability of the previous developed REE prediction model in adolescents, and to compare its applicability in young and elderly adults. Specifically, we tested the hypothesis that measured REE can be predicted from a combination of individual organ and tissue mass and their related cellularity. This was a 2‐year longitudinal investigation. Twenty healthy male subjects with a mean age of 14.7 years had REE, organ and tissue mass, body cell mass, and fat‐free mass (FFM) measured by indirect calorimetry, whole‐body MRI, whole‐body ⁴⁰K counting and dual‐energy X‐ray absorptiometry, respectively. The predicted REE (REEp; mean ± SD, 1,487 ± 238 kcal/day) was correlated with the measured REE (REEm, 1,606 ± 237 kcal/day, r = 0.76, P < 0.001). The mean difference (118 ± 165 kcal/day) between REEm and REEp was significant (P = 0.0047), accounting for 7.3% of REEm for the entire group. The present study, the first of its type in adolescents, does not support the applicability of the organ–tissue‐based REE prediction model during rapid adolescent growth. A modified general REE prediction model is thus suggested which may account for the higher REE/FFM ratio observed in adolescents. Am. J. Hum. Biol. 2010. © 2010 Wiley‐Liss, Inc.     

Functional involvement of PHOSPHO1 in matrix vesicle-mediated skeletal mineralization.

PHOSPHO1 is a phosphatase highly expressed in bone. We studied its functional involvement in mineralization through the use of novel small molecule inhibitors. PHOSPHO1 expression was present within matrix vesicles, and inhibition of enzyme action caused a decrease in the ability of matrix vesicles to calcify. INTRODUCTION: The novel phosphatase, PHOSPHO1, belongs to the haloacid dehalogenase superfamily of hydrolases and is capable of cleaving phosphoethanolamine (PEA) and phosphocholine to generate inorganic phosphate. Our aims in this study were to examine the expression of PHOSPHO1 in murine mineralizing cells and matrix vesicles (MV) and to screen a series of small-molecule PHOSPHO1-specific inhibitors for their ability to pharmacologically inhibit the first step of MV-mediated mineralization. MATERIALS AND METHODS: q-PCR and immunohistochemistry were used to study the expression and localization profiles of PHOSPHO1. Inhibitors of PHOSPHO1's PEA hydrolase activity were discovered using high-throughput screening of commercially available chemical libraries. To asses the efficacy of these inhibitors to inhibit MV mineralization, MVs were isolated from TNAP-deficient (Akp2(-/-)) osteoblasts and induced to calcify in their presence. RESULTS: q-PCR revealed a 120-fold higher level of PHOSPHO1 expression in bone compared with a range of soft tissues. The enzyme was immunolocalized to the early hypertrophic chondrocytes of the growth plate and to osteoblasts of trabecular surfaces and infilling primary osteons of cortical bone. Isolated MVs also contained PHOSPHO1. PEA hydrolase activity was observed in sonicated MVs from Akp2(-/-) osteoblasts but not intact MVs. Inhibitors to PHOSPHO1 were identified and characterized. Lansoprazole and SCH202676 inhibited the mineralization of MVs from Akp2(-/-) osteoblasts by 56.8% and 70.7%, respectively. CONCLUSIONS: The results show that PHOSPHO1 localization is restricted to mineralizing regions of bone and growth plate and that the enzyme present within MVs is in an active state, inhibition of which decreases the capacity of MVs to mineralize. These data further support our hypothesis that PHOSPHO1 plays a role in the initiation of matrix mineralization.     

Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly

OBJECTIVE: To determine the association of sarcopenic obesity with the onset of Instrumental Activities of Daily Living (IADL) disability in a cohort of 451 elderly men and women followed for up to 8 years. RESEARCH METHODS AND PROCEDURES: Sarcopenic obesity was defined at study baseline as appendicular skeletal muscle mass divided by stature squared <7.26 kg/m2 in men and 5.45 kg/m2 in women and percentage body fat greater than the 60th percentile of the study sample (28% body fat in men and 40% in women). Incident disability was defined as a loss of two or more points from baseline score on the IADL. Subjects with disability at baseline (scores < 8) were excluded. Cox proportional hazards analysis was used to determine the association of baseline sarcopenic obesity with onset of IADL disability, controlling for potential confounders. RESULTS: Subjects with sarcopenic obesity at baseline were two to three times more likely to report onset of IADL disability during follow-up than lean sarcopenic or nonsarcopenic obese subjects and those with normal body composition. The relative risk for incident disability in sarcopenic obese subjects was 2.63 (95% confidence interval, 1.19 to 5.85), adjusting for age, sex, physical activity level, length of follow-up, and prevalent morbidity. DISCUSSION: This is the first study, to our knowledge, to indicate that sarcopenic obesity is independently associated with and precedes the onset of IADL disability in the community-dwelling elderly. The etiology of sarcopenic obesity is unknown but may include a combination of decreases in anabolic signals and obesity-associated increases in catabolic signals in old age.     

Total-body skeletal muscle mass: estimation by dual-energy X-ray absorptiometry in children and adolescents

BACKGROUND: Skeletal muscle (SM) is an important compartment but is difficult to quantify in children and adolescents. OBJECTIVE: We investigated the potential of dual-energy X-ray absorptiometry (DXA) for measuring total-body SM in pediatric subjects. DESIGN: A previously published adult DXA SM prediction formula was evaluated in children and adolescents aged 5-17 y (n = 99) who varied in pubertal maturation stage. SM estimated by whole-body magnetic resonance imaging (MRI) was used as the reference. The adult SM model was not accurate for subjects below Tanner stage 5 (n = 65; aged 5-14 y). New pediatric SM prediction models were therefore developed and validated in a separate group (n = 18). RESULTS: The adult DXA SM prediction model was valid in subjects at Tanner stage 5 but significantly (P < 0.001) overestimated SM in subjects below Tanner stage 5. New SM prediction formulas were developed with appendicular lean soft tissue (ALST) estimates by DXA as the main predictor variable (eg, model 1, ALST alone: R(2) = 0.982, SEE = 0.565 kg, P < 0.001). The new models were validated by the leave-one-out method and were cross-validated in a separate validation group. CONCLUSIONS: A previously reported adult DXA SM prediction model is applicable in children and adolescents late in pubertal development (Tanner stage 5). A new DXA SM prediction model was developed for prepubertal and pubertal subjects (Tanner stage /=5 y. DXA thus provides an important opportunity for quantifying total-body SM mass across most of the human life span.     

Split liver transplantation in adults

Split liver transplantation (SLT), while widely accepted in pediatrics, remains underutilized in adults. Advancements in surgical techniques and donor-recipient matching, however, have allowed expansion of SLT from utilization of the right trisegment graft to now include use of the hemiliver graft as well. Despite less favorable outcomes in the early experience, better outcomes have been reported by experienced centers and have further validated the feasibility of SLT. Importantly, more than two decades of experience have identified key requirements for successful SLT in adults. When these requirements are met, SLT can achieve outcomes equivalent to those achieved with other types of liver transplantation for adults. However, substantial challenges, such as surgical techniques, logistics, and ethics, persist as ongoing barriers to further expansion of this highly complex procedure. This review outlines the current state of SLT in adults, focusing on donor and recipient selection based on physiology, surgical techniques, surgical outcomes, and ethical issues.