The introduction of a new assessment system in restorative dentistry: the undergraduate and patient experience

In 2000, the University of Bristol Dental School Division of Restorative Dentistry carried out a review of the assessment methods used within the undergraduate programme. Following this review, a number of key recommendations were made and the system of formative assessment within the division was changed. Audits were conducted immediately prior to the introduction of the new system and 2 years after it had been introduced, the results of these audits are presented. There was no change in the number of failed appointments between the initial audit and the second audit. There was a reduction in the number of patients treated by more than one student from 25% to 14% (approximating to 3% if student withdrawal from the course is taken into account). The length of time taken to complete treatment reduced between the two audits with more than half of all patients having their treatment completed within 3 months of their initial examination in the second audit. Ninety-five percent of treatment plans were completed in the second audit compared with only 62% in the first audit. In the second audit, the outstanding 5% of cases were signed off as incomplete for satisfactory reasons by the member of supervisory staff (e.g. patients who had moved away or were discharged due to poor attendance). Student comments were mostly positive, the small number of negative comments related to some students being confused by the paperwork in the new system. The overall process has been an extremely positive experience which has resulted in an assessment system with increased clarity which appears to have reduced the stress levels reported by the undergraduate students on the programme and improved the quality of patient care within restorative dentistry.     

Nurse Migration: A Canadian Case Study

Objective. To synthesize information about nurse migration in and out of Canada and analyze its role as a policy lever to address the Canadian nursing shortage.
Principal Findings. Canada is both a source and a destination country for international nurse migration with an estimated net loss of nurses. The United States is the major beneficiary of Canadian nurse emigration resulting from the reduction of full-time jobs for nurses in Canada due to health system reforms. Canada faces a significant projected shortage of nurses that is too large to be ameliorated by ethical international nurse recruitment and immigration.
Conclusions. The current and projected shortage of nurses in Canada is a product of health care cost containment policies that failed to take into account long-term consequences for nurse workforce adequacy. An aging nurse workforce, exacerbated by layoffs of younger nurses with less seniority, and increasing demand for nurses contribute to a projection of nurse shortage that is too great to be solved ethically through international nurse recruitment. National policies to increase domestic nurse production and retention are recommended in addition to international collaboration among developed countries to move toward greater national nurse workforce self sufficiency.     

Staphylococcal toxins: screening of burn wound isolates and evidence for alphahaemolysin production in the burn wound

Culture filtrates of Staphylococcus aureus strains isolated from burn patients were examined for cytotoxic activities. A large molecular weight cytotoxin (MW=253000 daltons) that exhibited cytotoxicity for human foreskin cells and haemolytic activity against human and rabbit erythrocytes was identified. The cytotoxic activity could be completely neutralized by antiserum formed against the cytotoxin. Further characterization of the molecule by isoelectric focusing revealed that the cytotoxin was composed of at least two toxic factors of smaller molecular weight. Both factors exhibited cytotoxicity to tissue-culture cells. however, one factor lysed rabbit but not human erythrocytes whereas the other factor had the opposite haemolytic pattern. The cytotoxicity of each factor was neutralized by the antiserum formed against the cytotoxin. A cytotoxic factor that exhibited haemolytic activity for rabbit erythrocytes, and that was neutralized by the cytotoxin antiserum, was identified in burn wound extracts of mice infected with Staph. aureus. On the basis of molecular weight and isoelectric focusing data, we conclude that the large molecular weight cytotoxin was composed of an aggregation of alpha-haemolysin and another presently unidentified toxic molecule, possibly delta-toxin. Alpha-haemolysin appears to be produced in vivo during experimental staphylococcal burn wound infection.     

Delineating the sites and progression of in vivo atrophy in multiple system atrophy using fluid-registered MRI.

We describe the pattern and progression of atrophy delineated using fluid registration of serial magnetic resonance imaging scans in a case of multiple system atrophy (MSA). The in vivo findings were consistent with those found at postmortem, including significant supratentorial atrophy concurrent with an unusual degree of cognitive impairment for MSA.     

Parental Perceptions, Early Maladaptive Schemas, and Depressive Symptoms in Young Adults

Cognitive models of depression propose that negative schemas contribute to depressive symptoms. Early experiences, particularly parenting, have been proposed to influence cognitive schemas and have also been shown to correlate with depression. This study explores the concurrent relationship between retrospective reports of parenting, Early Maladaptive Schemas (EMSs) described by J. E. Young (1994), and symptoms of depression in a sample of undergraduate students (N = 194). The EMSs of defectiveness/shame, insufficient self-control, vulnerability, and incompetence/inferiority were associated with perceptions of parenting and depressive symptomatology. There was evidence that these four EMSs partially mediate the relationship between parental perceptions and depressive symptomatology. Results are discussed in relation to previous findings, theory, and the measurement of EMSs.     

Multiplex PCR analysis of in vivo-arising deletion mutations in the hprt gene of human T-lymphocytes

A multiplex polymerase chain reaction (PCR) procedure was adapted for the rapid and efficient evaluation of deletions of the hypoxanthine guanine phosphoribosyltransferase (hprt) gene in human T-lymphocytes. The hprt clonal assay was used to isolate in vivo-arising hprt-deficient T-cells from six healthy males. Mutant frequencies ranged from 9-27 × 10^?6. Simple crude cellular extracts from 223 mutants were analyzed for hprt gene deletion. Sixteen (7.2%) were found to be due to total gene deletion and 22 (9.9%) were due to partial gene deletion. The relatively high frequency of total gene deletions was caused by replicate isolates of a single mutational event as shown by single-strand conformation polymorphism (SSCP) analysis of rearranged T-cell receptor (TCR)-γ genes. Eighteen of the 22 partial hprt gene deletion mutants were determined to be of independent origin based on a unique hprt mutation or SSCP-TCR-γ pattern. One-half (9/18) of the partial deletion mutants involved all or part of exon 4 alone, suggesting that this region of the hprt gene is prone to deletion. The small deletions effecting exon 1 (1 mutant), exon 2 (2 mutants), and exon 4 (6 mutants) would not have been detected by conventional Southern blot analysis and may represent a new, previously unrecognized class of mutations. The ready isolation of such intragenic deletions will allow the characterization of breakpoint junctions and may provide insights into the important processes of DNA breakage and rejoining. © 1994 Wiley-Liss, Inc.     

Challenging the Presumption of Diminished Capacity to Parent: Does Divorce Really Change Parenting Practices?*

Abstract: The purpose of this paper is to determine whether divorced parents exhibit a diminished capacity to parent in the period following divorce. Using 2 waves of data from a national survey of Canadian children, the current study prospectively follows 5,004 children living in 2–biological parent households at initial interview and compares changes in parenting practices between households that subsequently divorce and those that remain intact. Results show that divorce is unrelated to changes in parenting behavior, suggesting that there are more similarities than differences in parenting among recently divorced and continuously married parents.     

Angiostrongylus (Parastrongylus) eosinophilic meningitis

Angiostrongylus (Parastrongylus) cantonensis is the commonest cause of eosinophilic meningitis in the world. Infective third-stage larvae develop in slugs and snails. Humans are infected primarily in the central nervous system after ingesting an infected intermediate host. Damage by motile worms, inflammatory responses to foreign bodies, and possible toxicity of worm substances work in concert to produce the pathologic and clinical picture of neurologic angiostrongyliasis. This disease manifests itself by headache, paresthesias, generalized weakness, and occasionally visual disturbances and extraocular muscular paralysis. Eosinophilic pleocytosis is the major laboratory finding. Although the diagnosis of neurologic angiostrongyliasis is usually made clinically, serologic methods such as ELISA (enzyme-linked immunosorbent assay) can be helpful. Occasionally, living larvae can be identified histologically in the CSF, eye, or other tissue. There is no specific treatment for this disease. Corticosteroids may be useful to relieve increased intracranial pressure. The role of anthelmintic drugs, such as thiabendazole and ivermectin, is not yet known. The prognosis of neurologic angiostrongyliasis is usually good; however, fatal and chronic cases do occur. Appropriate preparation of food, control of mollusks and planarians, and elimination of rodents are important measures in limiting the further spread of eosinophilic meningitis caused by A. cantonensis.