Shared learning in practice placements for health and social work students in East London: a feasibility study

A voluntary organisation providing family support and mental health services carried out an enquiry into the feasibility of setting up placements in primary care for students from professional qualifying courses in community nursing, social work and occupational therapy to experience shared practice learning in their placement. Consultation with a range of courses from two universities in London and with GP practices and other primary care agencies in East London established that there was wide support for the idea from practitioners, managers and academic teachers. It was recommended that a small number of pilot placements be set up. It was acknowledged that the diversity of placement requirements across the spectrum of professional education is a limiting factor in bringing students together for practice learning. The authors suggest that in the longer term, the development of an interprofessional approach to practice learning will require structural changes to professional courses so as to bring their placement requirements more into line with each other.     

Design principles for the use of simulation as an aid in interventional cardiology training

Learning complex skills through simulation is a goal for training physicians in specialties such as interventional cardiology, where traditional training puts patients at risk. Intuitively, interactive simulation of anatomy, pathology and therapeutic actions should lead to shortening of the learning curve for novice or inexperienced physicians. An accurate recreation of the interactions among anatomy, pathology and therapeutic actions is a necessary, but not sufficient, condition for the development of a simulation-based training system. In addition to real-time graphic interactivity coupled with haptic response, a successful training tool will require features of a 'learning system' such as: an embedded curriculum, functionality that allows rehearsal and practice, hypertext links to educational information, personal archiving, and instructor review and testing capabilities. We describe how such a system might look for the field of interventional cardiology, and suggest that designing a simulation with both technical and pedagogical fidelity is essential in developing simulation-based training systems in any field of medicine.     

Disease susceptibility genes for autism

Autism is a complex neurodevelopmental disorder characterized by impairment in social interaction accompanied by a delay or lack of language, restricted interests, stereotyped behavior, and repetitive movement. Genetic predisposition to autism is evident from family and twin studies, and heritability in idiopathic autism is estimated at over 90%. Frequency of the disorder is approximately 1:2000 with a male to female ratio of 4:1. Affected individuals look normal at birth, and the symptoms manifest at the first 2-3 years of life. The spectrum of clinical symptoms and the severity of the disorder are variable even among siblings. Family studies and several genome-wide linkage analyses support the hypothesis of complex inheritance with involvement of as many as 10-100 genes of moderate effect. Identification of genes responsible for the phenotype would help to understand the molecular mechanisms of the disorder. Several genes have been proposed to play a role in susceptibility to autism, and this paper will overview those genes and their potential role in the disorder.     

Qualities of a French version of the Wolf Motor Function Test: A multicenter study

IntroductionThere are currently a small number of standardized tools in French that measure and compare the effect of constraint-induced movement therapy, or other recent therapies promoting motor recoveryObjectiveTo create a French version of the Wolf Motor Function Test (WMFT) and assess its reliability, minimal detectable change, and criterion validity.MethodProspective multicenter repeated-measure design with 44 patients with post stroke hemiparesis. A French Version of the WMFT was created; it was then assessed against the Fugl Meyer Assessment-Upper Extremity (French version) to establish its reliability, the minimal detectable change and its validity.ResultsInter-rater reliability was very good. Reproducibility of the scores was good. Cronbach α coefficients showed adequate internal consistency. The minimal detectable change (MDC_95%) for functional ability scores was below 10% of the highest possible score; the MDC_95% for performance time was very high at more than 90 seconds. Criterion validity was good.ConclusionThe French version of the WMFT is reliable and valid. The test shows promise for use as an objective outcome measure for people post stroke in French speaking countries.     

微量元素锌对汞暴露大鼠学习记忆的影响

 目的探讨微量元素锌对汞暴露大鼠神经系统高级功能的影响.方法应用Y形迷宫试验作为学习记忆的监测标准,比较汞暴露大鼠、兼汞及锌暴露大鼠和对照组的学习记忆能力的差别.结果汞暴露大鼠学习记忆能力与对照组比较明显降低(P＜0.05),而同时暴露汞和锌两种元素的大鼠学习记忆能力较单独汞暴露大鼠有所提高,且较高剂量锌暴露组效果更加明显(P＜0.05).结论给与动物一定剂量的锌元素可以拮抗汞对神经系统高级功能的损害,为锌对中枢神经的保护性作用提供了依据.     

大学生色觉辨别能力与深度知觉的相关性分析

目的：评价色觉正常大学生的色觉辨别能力与深度知觉的关系。方法：选取巴什肯特大学医学专业学生52例,其中男性33例（63．46％）,女性19例（36．54％）,平均年龄21．18±2．52岁。参与学生视力正常（20／20）,且经Ishihara假同色测试法显示无先天性色觉缺陷。运用Gundogan方法确定主视眼（ DE ）。通过法－孟二氏100色度试验（FM100HT）检验色觉辨别能力,包括左右眼及双眼（TE）的总误差分（ TES ）、部分误差分（ LES ）。误差分分为三组：双眼、DE及非主视眼（ NDE ）。应用TNO检查双眼视觉与立体感,并根据480－15 arc／s范围的立体感水平分为四组。结果：FM100HT的误差分显示无性别差异的TES,蓝黄LES和红绿 LES 分别为61．22±30．32（58．50）[ mean ± SD],35．80±19.32（36．50）和25．42±14．65（24．00）。男性受试者（n＝31）分别为67．45±29．95（61．00）,40．25±18．83（39．00）和27．19±14．30（24．00）。女性受试者（n＝19）分别为51.05±28．84（47．00）,25．52±18．32（28．00）和22．52±31.13（23．00）。根据FM100 HT的误差分,得出女性颜色视觉辨别能力高于男性。通过FM100 HT将色觉辨别能力分为较高（6％,TES＝0～20）,中等（86％,TES＝20～100）和较低（8％, TES＞100）,中等水平最为常见（ P＜0.05）。 DE和NDE的红绿LES 分别为24．12±14．70和32．20±14．21, DE 和 NDE 的蓝黄 LES 分别为34．68±18.95和36．24±17．56。女性（ n＝19） DE和NDE的红绿色LES分别为21．89±15．06和31．00±22．42;男性（ n＝31）则为25．48±14．55和32．93±17．31。女性（ n＝19） DE和NDE 蓝黄色 LES 分别为29．63±18．62和33．42±17.38,男性（ n＝31）则为37．77±18．78和37．96±17．73。所有学生的TE,DE及NDE的TES和立体视觉水平均进行比较,差异均无统计学意义（P＝1）。研究表明色觉辨别能力和双眼深度知觉无关。结论：FM100 HT的TES显示：正常人不同个体立体视觉水平无差异,基于色觉分离的TNO检测的深度直觉与色觉辨别能力不相关。在之前的研究中, DE色觉辨别能力优于NDE。但目前研究表明在深度知觉方面DE并非优于NDE。     

Effect of the renin-angiotensin system on limb circulation and metabolism during exercise in patients with heart failure

The maximal aerobic exercise capacity of patients with chronic heart failure is frequently decreased because of inadequate blood flow to working skeletal muscle. To investigate whether this reduced flow is in part due to interference by angiotensin II with arteriolar dilation in working muscle, the effect of the angiotensin-converting enzyme inhibitor captopril on leg blood flow, leg vascular resistance, leg oxygen consumption (VO2) and leg lactate release during maximal upright bicycle exercise was examined in 12 patients with heart failure (maximal VO2 10.7 +/- 3.1 ml/min per kg). Captopril decreased leg resistance at rest (258 +/- 115 to 173 +/- 67 U, p less than 0.01) and maximal exercise (68 +/- 69 to 45 +/- 29 U, p less than 0.01) associated with proportionately similar decreases in systemic vascular resistance. However, maximal exercise duration and maximal VO2 were unchanged and, at identical peak exercise work times, there was no improvement in leg blood flow (2.0 +/- 0.9 to 2.0 +/- 1.1 liters/min, p = NS), leg VO2 (261 +/- 104 to 281 +/- 157 ml/min, p = NS) or leg lactate release (269 +/- 149 to 227 +/- 151 mg/min, p = NS). These data suggest that, during exercise in patients with heart failure, angiotensin II does not interfere with blood flow to working skeletal muscle.     

Importance of the pacing mode in the initiation of ventricular tachyarrhythmia in a canine model of chronic myocardial infarction

The use of unipolar anodal or bipolar pacing, as compared with unipolar cathodal pacing, purportedly increases the likelihood of inducing inadvertent ventricular fibrillation in susceptible patients. In this study, the ability to initiate sustained ventricular tachycardia or fibrillation with unipolar cathodal, unipolar anodal and bipolar pacing modes was compared using programmed ventricular stimulation at 82 subendocardial periinfarction sites in 11 dogs with chronic myocardial infarction. The late diastolic excitability threshold was significantly higher and the ventricular refractory period was significantly shorter (p less than 0.001) with anodal pacing (mean 0.62 mA, 156 ms, respectively) than with pacing in either the cathodal (0.12 mA, 174 ms) or the bipolar (0.13 mA, 173 ms) mode. At a current intensity twice that of the excitability threshold, the introduction of one or two extrastimuli induced ventricular tachycardia and ventricular fibrillation comparably among the three pacing modes. However, when three extrastimuli were used, ventricular fibrillation was induced with anodal pacing twice as frequently (50 [61%] of 82 sites) as with either of the other two pacing modes (each 23 [28%] of 82 sites, p less than 0.001), whereas the induction of ventricular tachycardia remained comparable with anodal pacing (15 [18%] of 82 sites) and cathodal and bipolar pacing (each 14 [17%] of 82 sites). Furthermore, a similarly high incidence of inducibility of ventricular fibrillation was observed with both cathodal pacing (56 [68%] of 82 sites) and bipolar pacing (40 [49%] of 82 sites) when an increased current equal to twice the anodal excitability threshold (1.23 mA) was used.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of movement imitation training in Parkinson's disease: A virtual reality pilot study

BackgroundHypometria is a clinical motor sign in Parkinson's disease. Its origin likely emerges from basal ganglia dysfunction, leading to an impaired control of inhibitory intracortical motor circuits. Some neurorehabilitation approaches include movement imitation training; besides the effects of motor practice, there might be a benefit due to observation and imitation of un-altered movement patterns. In this sense, virtual reality facilitates the process by customizing motor-patterns to be observed and imitated.ObjectiveTo evaluate the effect of a motor-imitation therapy focused on hypometria in Parkinson's disease using virtual reality.MethodsWe carried out a randomized controlled pilot-study. Sixteen patients were randomly assigned in experimental and control groups. Groups underwent 4-weeks of training based on finger-tapping with the dominant hand, in which imitation was the differential factor (only the experimental group imitated). We evaluated self-paced movement features and cortico-spinal excitability (recruitment curves and silent periods in both hemispheres) before, immediately after, and two weeks after the training period.ResultsMovement amplitude increased significantly after the therapy in the experimental group for the trained and un-trained hands. Motor thresholds and silent periods evaluated with transcranial magnetic stimulation were differently modified by training in the two groups; although the changes in the input–output recruitment were similar.ConclusionsThis pilot study suggests that movement imitation therapy enhances the effect of motor practice in patients with Parkinson's disease; imitation-training might be helpful for reducing hypometria in these patients. These results must be clarified in future larger trials.     

微波辐射对小鼠联合型学习记忆功能及海马组织结构的影响

目的 探讨微波辐射对联合型学习记忆功能及海马组织结构的影响。方法 将小鼠按随机数表法分为假辐射组和微波辐射组,各27只。采用2.856 GHz、8 mW/cm²微波辐射C57BL/6N小鼠15 min,建立微波辐射动物模型。采用Morris水迷宫和穿梭箱行为学实验,研究微波辐射对小鼠空间学习记忆和联合型学习记忆功能的影响。观察海马组织病理学变化,研究微波辐射后海马组织超微结构改变。结果 Morris水迷宫结果表明,微波辐射后小鼠反向空间探索实验跨越平台次数减少,由(3.60±0.79)次降至(2.55±0.47)次(t = 2.21,P= 0.046);穿梭箱实验结果表明,辐射后小鼠平均主动逃避率显著下降(t = 2.70,P<0.05),平均主动潜伏期和总电击时间显著延长(t = -3.09、-3.02,P < 0.05)。辐射后8 d,海马CA3和DG区部分神经元核固缩,海马CA3区神经元凋亡、突触间隙模糊、胶质细胞肿胀、血管周隙增宽。结论 微波辐射可引起小鼠空间参考记忆能力及联合型学习记忆能力下降,海马组织形态学病理改变是其功能障碍的结构基础。