Integration of Ultrasound in Undergraduate Medical Education at the California Medical Schools

Since the first medical student ultrasound electives became available more than a decade ago, ultrasound in undergraduate medical education has gained increasing popularity. More than a dozen medical schools have fully integrated ultrasound education in their curricula, with several dozen more institutions planning to follow suit. Starting in June 2012, a working group of emergency ultrasound faculty at the California medical schools began to meet to discuss barriers as well as innovative approaches to implementing ultrasound education in undergraduate medical education. It became clear that an ongoing collaborative could be formed to discuss barriers, exchange ideas, and lend support for this initiative. The group, termed Ultrasound in Medical Education, California (UMeCali), was formed with 2 main goals: to exchange ideas and resources in facilitating ultrasound education and to develop a white paper to discuss our experiences. Five common themes integral to successful ultrasound education in undergraduate medical education are discussed in this article: (1) initiating an ultrasound education program; (2) the role of medical student involvement; (3) integration of ultrasound in the preclinical years; (4) developing longitudinal ultrasound education; and (5) addressing competency.     

Absence of oligodendroglial glucosylceramide synthesis does not result in CNS myelin abnormalities or alter the dysmyelinating phenotype of CGT‐deficient mice

To examine the function of glycosphingolipids (GSLs) in oligodendrocytes, the myelinating cells of the central nervous system (CNS), mice were generated that lack oligodendroglial expression of UDP‐glucose ceramide glucosyltransferase (encoded by Ugcg). These mice (Ugcg^flox/flox;Cnp/Cre) did not show any apparent clinical phenotype, their total brain and myelin extracts had normal GSL content, including ganglioside composition, and myelin abnormalities were not detected in their CNS. These data indicate that the elimination of gangliosides from oligodendrocytes is not detrimental to myelination. These mice were also used to asses the potential compensatory effect of hydroxyl fatty acid glucosylceramide (HFA‐GlcCer) accumulation in UDP‐galactose:ceramide galactosyltransferase (encoded by Cgt, also known as Ugt8a) deficient mice. At postnatal day 18, the phenotypic characteristics of the Ugcg^flox/flox;Cnp/Cre;Cgt^−/− mutants, including the degree of hypomyelination, were surprisingly similar to that of Cgt^−/− mice, suggesting that the accumulation of HFA‐GlcCer in Cgt^−/− mice does not modify their phenotype. These studies demonstrate that abundant, structurally intact myelin can form in the absence of glycolipids, which normally represent over 20% of the dry weight of myelin. © 2009 Wiley‐Liss, Inc.     

A comparative study of violence risk assessment tools: a systematic review and metaregression analysis of 68 studies involving 25,980 participants

There are a large number of structured instruments that assist in the assessment of antisocial, violent and sexual risk, and their use appears to be increasing in mental health and criminal justice settings. However, little is known about which commonly used instruments produce the highest rates of predictive validity, and whether overall rates of predictive validity differ by gender, ethnicity, outcome, and other study characteristics. We undertook a systematic review and meta-analysis of nine commonly used risk assessment instruments following PRISMA guidelines. We collected data from 68 studies based on 25,980 participants in 88 independent samples. For 54 of the samples, new tabular data was provided directly by authors. We used four outcome statistics to assess rates of predictive validity, and analyzed sources of heterogeneity using subgroup analysis and metaregression. A tool designed to detect violence risk in juveniles, the Structured Assessment of Violence Risk in Youth (SAVRY), produced the highest rates of predictive validity, while an instrument used to identify adults at risk for general offending, the Level of Service Inventory - Revised (LSI-R), and a personality scale commonly used for the purposes of risk assessment, the Psychopathy Checklist - Revised (PCL-R), produced the lowest. Instruments produced higher rates of predictive validity in older and in predominantly White samples. Risk assessment procedures and guidelines by mental health services and criminal justice systems may need review in light of these findings.     

Relevance of the anatomical location of the Adamkiewicz artery in spine surgery

Purpose  

The aim of this study was to describe the preoperative topography of the Adamkiewicz artery and the blood supply of the lumbosacral spinal cord in patients who underwent spinal surgery. The relevance for anterior approaches of the thoracolumbar spine was then analyzed.     

Mental health in three generations of Iranian medical students and doctors

Objective Despite research in Western countries finding high levels of psychological morbidity in medical students and doctors, little is known about difficulties faced by medical staff in the Middle East. The aim of the present study was to assess emotional disturbance and interpersonal attitudes in a representative sample of Iranian medical students and practitioners. Method A total of 82 medical students, 92 interns and 89 general practitioners (GPs) participated in the study. Participants rated the 28-item version of the General Health Questionnaire (GHQ-28) and a measure of interpersonal attitudes. Results A total of 44% of participants scored above the threshold of the GHQ-28, indicating probable psychiatric disorder. The GHQ-28 scores were higher in students than interns or GPs and in women compared with men. Medical students and doctors had high levels of indifference and cynicism. Conclusions This study suggests that psychological morbidity was common in Iranian medical students and practitioners, particularly women. Women were at particular risk. A high prevalence of emotional disturbance among health care practitioners is likely to compound existing problems of health care provision.     

NMDA receptor/nitrergic system blockage augments antidepressant-like effects of paroxetine in the mouse forced swimming test

Objective  

In this study, we evaluated the involvement of N-methyl-d-aspartate receptor (NMDAR)/nitric oxide (NO) system on the antidepressant-like effects of paroxetine in the mouse forced swimming test.     

Aortic valve-sparing operations for aortic root and ascending aortic aneurysms

PURPOSE OF REVIEW: Techniques of aortic root replacement have been developed that preserve the native aortic valve. These techniques avoid anticoagulation in patients who would otherwise receive a composite valve graft with a mechanical valve. RECENT FINDINGS: Longer-term data on the longevity of the main two techniques of aortic valve-sparing operations, the root remodeling and the valve reimplantation technique, are now becoming available. Root remodeling appears to have acceptable outcomes in patients without annuloaortic ectasia or Marfan syndrome. In such patients, the aortic valve reimplantation technique provides superior longevity because it provides external support for the aortic annulus and prevents ongoing dilatation. SUMMARY: Although aortic valve-sparing operations are being performed more frequently, particularly in younger patient populations, these procedures have not been adopted in the current guidelines. The excellent long-term outcomes of such procedures should facilitate their widespread adoption.     

Outcome measures used in forensic mental health research: a structured review

Background The evidence base for forensic mental health (FMH) services has been developing since the late 1990s. Are outcome measures sound enough for the evaluation tasks? Aims To identify, from published literature, outcome measures used in FMH research and, where feasible, assess their quality. Method A structured review was undertaken of trials and intervention studies published between 1990 and 2006. Details of outcome variables and measures were abstracted. Evidence regarding most frequently occurring outcome measures was assessed. Results Four hundred and fifty different instruments were used to assess outcomes, incorporating 1038 distinct variables. Very little evidence could be found to support the measurement properties of commonly used instruments. Conclusions and implications for practice There is little consistency in the use of outcome measure in FMH research. Effort is required to reach consensus on validated outcome measures in this field in order to better inform practice. Copyright © 2009 John Wiley & Sons, Ltd.     

The Structural and Functional Role of the B‐chain C‐terminal Arginine in the Relaxin‐3 Peptide Antagonist,R3(BΔ23‐27)R/I5

Relaxin‐3, a member of the insulin superfamily, is involved in regulating stress and feeding behavior. It is highly expressed in the brain and is the endogenous ligand for the receptor RXFP3. As relaxin‐3 also interacts with the relaxin receptor RXFP1, selective agonists and antagonists are crucial for studying the physiological function(s) of the relaxin‐3/RXFP3 pair. The analog R3(BΔ23‐27)R/I5, in which a C‐terminally truncated human relaxin‐3 (H3) B‐chain is combined with the INSL5 A‐chain, is a potent selective RXFP3 antagonist and has an Arg residue remaining on the B‐chain C‐terminus as a consequence of the recombinant protein production process. To investigate the role of this residue in the RXFP3 receptor binding and activation, the analogs R3(BΔ23‐27)R/I5 and R3(BΔ23‐27)R containing the B‐chain C‐terminal Arg as well as R3(BΔ23‐27)/I5 and R3(BΔ23‐27), both lacking the Arg, were chemically assembled and their secondary structure and receptor activity assessed. The peptides generally had a similar conformation but those with the extra Arg residue displayed a significantly increased affinity for the RXFP3. Interestingly, in contrast to R3(BΔ23‐27)R and R3(BΔ23‐27)R/I5, the peptide R3(BΔ23‐27) is a weak agonist. This suggests that the C‐terminal Arg, although increasing the affinity, alters the manner in which the peptide binds to the receptor and thereby prevents activation, giving R3(BΔ23‐27)R/I5 its potent antagonistic activity.