Bone Microarchitecture Phenotypes Identified in Older Adults Are Associated With Different Levels of Osteoporotic Fracture Risk

Prevalence of osteoporosis is more than 50% in older adults, yet current clinical methods for diagnosis that rely on areal bone mineral density (aBMD) fail to detect most individuals who have a fragility fracture. Bone fragility can manifest in different forms, and a “one-size-fits-all” approach to diagnosis and management of osteoporosis may not be suitable. High-resolution peripheral quantitative computed tomography (HR-pQCT) provides additive information by capturing information about volumetric density and microarchitecture, but interpretation is challenging because of the complex interactions between the numerous properties measured. In this study, we propose that there are common combinations of bone properties, referred to as phenotypes, that are predisposed to different levels of fracture risk. Using HR-pQCT data from a multinational cohort (n = 5873, 71% female) between 40 and 96 years of age, we employed fuzzy c-means clustering, an unsupervised machine-learning method, to identify phenotypes of bone microarchitecture. Three clusters were identified, and using partial correlation analysis of HR-pQCT parameters, we characterized the clusters as low density, low volume, and healthy bone phenotypes. Most males were associated with the healthy bone phenotype, whereas females were more often associated with the low volume or low density bone phenotypes. Each phenotype had a significantly different cumulative hazard of major osteoporotic fracture (MOF) and of any incident osteoporotic fracture (p < 0.05). After adjustment for covariates (cohort, sex, and age), the low density followed by the low volume phenotype had the highest association with MOF (hazard ratio = 2.96 and 2.35, respectively), and significant associations were maintained when additionally adjusted for femoral neck aBMD (hazard ratio = 1.69 and 1.90, respectively). Further, within each phenotype, different imaging biomarkers of fracture were identified. These findings suggest that osteoporotic fracture risk is associated with bone phenotypes that capture key features of bone deterioration that are not distinguishable by aBMD. © 2021 American Society for Bone and Mineral Research (ASBMR).     

On ‘The Hatred of Learning from Experience’: A Work Journal Revisited

In January 1999, I started a two-year course in psychodynamic counselling. One of the course requirements was to produce several work journals each term. They could be on any topic the student wished to think about or explore that pertained to the course, be it clinical or theoretical work, or professional/personal development. Three months later, I wrote one on Bion's (1962) concept of ‘the hatred of learning from experience’, after a seminar on his work. In Section 1, I present the work journal itself, in which I described my difficulties with anxiety about the course in relation to this concept: how I felt I needed to be a perfect student who ‘knew everything’; my intolerance of making mistakes; and my hatred of not knowing; in tandem with my envy of others' knowledge. In Section 2, I describe my current understanding of what I was rather desperately attempting to work out in the journal – taking into consideration both my emerging feelings, in light of my own history and state of mind, together with what I had come to understand – that the course was poorly structured and did not provide an adequately safe framework for clinical work and learning. This resulted in my decision to leave. In Section 3, I write about the arduous but ultimately rewarding process of returning to training, eventually culminating in my qualification as a psychodynamic psychotherapist. My final thoughts are presented in Section 4.     

Making the neurology clerkship more effective: can e-Textbook facilitate learning?

Abstract

Objective: In 1998, the 4-week neurology elective clerkship was converted into a 2-week required neurology rotation at the University of Illinois at Chicago. We hypothesized that the interactive e-Textbook, a computer-assisted learning tool, could successfully replace a paper-based syllabus and a traditional neurology textbook during a 2-week rotation, while incorporating department teaching conferences to replace the medical student lecture series.

Methods: We created an e-Textbook and made it available simultaneously in a CD-ROM format and on a password-protected website. The online quiz and course assessment were administered by the Blackboard Web Server.

Results: After implementation of the e-Textbook over 6 years, the feedback shows high student satisfaction, and student evaluations of the neurology clerkship have risen. Creation of an e-Textbook for the neurology clerkship made our faculty more productive while increasing student satisfaction and facilitating learning efficacy.

Discussion: The results show that the e-Textbook is an appropriate alternative to facilitate learning of basic and clinical neurology during a 2-week rotation. The students demonstrated successful learning in a computerized environment.     

西医高职院校中医护理教学改革的思考与探索

针对当前西医高职院校中医护理教学的现状及今后教学改革进行了思考与探索,指出西医高职院校中医护理教学存在内容实用性差、重理论轻实践、学生学习兴趣欠佳等问题。提出认同中医护理是教学改革的基础,并从有机整合中医理论内容、改革教学方法、加强中医护理技术实践操作、通过隐性课程建设提高学生学习兴趣等方面阐述了教学改革的建议和策略。     

Short-term effects of a peer group intervention for HIV prevention among trainee teachers in Malawi

This report describes the implementation and short-term results of a peer group intervention for HIV prevention on the HIV-related attitudes, knowledge and behaviours of primary school teachers in Malawi. The intervention, based on the social-cognitive learning model, took place in 2000 at two teacher training colleges with a distance-learning programme. Primary school teachers attending a final six-week training session before certification volunteered to participate. Group leaders were teachers selected by each group, and after training they facilitated the peer group intervention. The teachers completed a pre-test and post-test questionnaire. The 286 trainee teachers whose pre- and post-test samples could be matched, largely reported positive changes in their HIV-prevention-related knowledge, attitudes, self-efficacy, behaviour change and condom-use intentions. However, at post-test immediately after the intervention they did not show a higher level of perceived-risk, a greater hope that people could change their high-risk sexual behaviour, or greater agreement that persons infected with HIV should be allowed in public places. This research demonstrates the feasibility of an HIV-prevention intervention for primary school teachers during their training. The Malawi Ministry of Education has since made the programme available to over 90 per cent of all trainee teachers through an NGO.     

Psychosocial Factors and High-Risk Sexual Behavior: Race Differences Among Urban Adolescents

Adolescence is a period of sexual experimentation. We examined psychosocial predictors of high-risk sexual behavior and condom use. The sample included 824 ninth-graders, most of whom are African American. We conducted separate analyses for whites and African Americans. Predictors included alcohol and substance use, delinquency, prosocial behaviors, and family and peer influences. We found that problem behaviors predicted high-risk sexual behavior, but the effects were stronger for white youth. We also found that friends' behaviors were more predictive than family influences, except for family conflict. In general, the models explained more variance for white youths than for African-American youths. The results suggest that problem behavior theory and social interactions theory may be most relevant for white youth and that other models may be necessary to explain high-risk sexual behavior among African-American youths.     

Postnatal dietary supplementation with either gangliosides or choline: Effects on spatial short-term memory in artificially-reared rats

This study addressed the hypothesis that dietary supplementation with either gangliosides or choline during the brain growth spurt would enhance short-term spatial memory. Male Long-Evans rats were reared artificially from postnatal days (PD) 5–18 and were fed diets containing either (i) choline chloride 1250 mg/l (CHL), (ii) choline chloride 250 mg/l and GD3 24 mg/l (GNG) or (iii) choline chloride 250 mg/l (STD). A fourth group (SCK) was reared normally. Rats were weaned onto AIN 93G diet and on PD 35 were trained on a cued delayed- matching-to-place version of the Morris water maze. All groups learned to swim to the beacon that indicated the platform position on the first trial; similarly, on the second un-cued trial, the distance swam to reach the platform decreased to the same extent in all groups over the five days of training. The groups also responded in the same way to an increase in delay between the first and second trial from 1 min to 1 h, showing an increase in the distance swam, accompanied by a decrease in the number of direct swims to the platform. Thus, all rats were equally proficient at using spatial short-term memory, regardless of the choline or ganglioside content of the preweaning diet.     

‘Now the Letters are All Back to Front and Upside Down’: Teaching and Learning in the Context of Life-Threatening Illness

This paper considers education in the context of life-threatening illness from a psychoanalytic perspective and is an edited and shortened version of a dissertation written for a Master's Degree in Psychoanalytic Observational Studies. Informed by the Work Discussion module, this paper uses observational material of a single case study during the author's time working as a learning mentor in a hospital school. The case study, with its participant observation method, considers the complexity of engaging a 4-year-old girl in learning while she undergoes treatment for cancer. The defences this child used against anxiety, such as a muscular rigidity as a form of protection against the trauma she was experiencing, will be explored. The author also suggests that with the consistent daily presence and available mind of the observer/mentor, who was able to think about Poppy's experience, the child began to let go of her ‘second-skin’ defences and showed the beginnings of an interest in learning. The way in which the staff group struggle to manage the intense anxieties stirred up by their everyday work will also be discussed.     

脑力智宝对学习记忆障碍模型小鼠的保护作用

[目的]观察脑力智宝对学习记忆障碍模型小鼠的保护作用.[方法](1)选用NIH小鼠32只随机分成假手术组,模型组,脑力智宝低、高荆量组(剂量分别为4、8 g·kg-1·d-1);除假手术组外,其他各组小鼠均进行脑缺血再灌注损伤造模,中药组小鼠连续灌胃给药10d后,采用跳台法观察小鼠的学习记忆能力,检测脑组织中丙二醛(MDA)与一氧化氮(NO)的含量、超氧化物歧化酶(SOD)与谷胱甘肤过氧化物酶(GSH-Px)的活力,高效液相色谱法检测大脑皮质中游离氨基酸的含量.(2)9月龄NIH小鼠40只随机分成正常对照组,拟衰老模型组,脑力智宝低、高剂量组(剂量分别为4、8 g·kg-1·d-1);除正常对照组外,其他组均腹腔注射50 g/L D-半乳糖0.5 mL连续6周,复制拟衰老模型,同时灌胃给药连续6周后,采用跳台法测试小鼠的学习记忆功能,检测大脑皮质单胺类神经递质去甲肾上腺素(NE)、肾上腺素(E)及5-羟色胺(5-HT)的合成前体物质色氨酸(TP)的含量.[结果](1)脑力智宝能显著提高脑缺血再灌注损伤小鼠的记忆能力(P＜0.01),降低小鼠脑组织中MDA、NO、谷氨酸(Glu)的含量(P＜0.05),提高SOD及GSH-Px的活力(P＜0.05或P＜0.01).(2)脑力智宝能显著改善拟衰老模型小鼠的学习记忆能力(P＜0.05或P＜0.01),提高大脑皮质NE、E及TP的含量(P＜0.05或P＜0.01).[结论]脑力智宝可以通过提高机体抗氧化酶活性,清除自由基,抑制兴奋性氨基酸与NO的神经毒性作用,调节大脑皮质单胺类神经递质含量等多种途径改善学习记忆功能.