Development, implementation, and perceptions of a 3D-printed human skull in a large dental gross anatomy course.

Skull anatomy is a difficult region for anatomy students to learn and understand but is necessary for a variety of health professional students. To improve learning, a 3D-printed human skull was developed, produced, and distributed to a course of 83 dental students for use as a take-home study tool over the 10-week anatomy course. The 70% scale human skull derived from CT data had a fully articulating mandible, simulated temporomandibular joint, and accurate cranial structures. At the course end, students completed a perception survey and responses were compared with those who made a grade of A, B, or C in the course. Students overall reported using the model less than 3 h per week, but those who scored an A in the course reported using the model more frequently than those who scored a B or C. Free responses revealed that students used the model in a variety of ways, but found that the model was quick and easily accessible to check understanding while studying at home in the absence of direct observation by faculty. Overall, this study provides evidence on the feasibility of large-scale 3D printing and the benefits of the use of a 3D-printed model as a take-home study aid.

Radiology for anatomy educators: Success of an online, 2-day course for radiology training.

Incorporation of radiology training into anatomy education from community college to health professional schools is becoming increasingly popular. However, anatomy educators generally lack training in common radiology modalities, including X-ray, CT, MRI, and ultrasound. Professional development or continuing education courses provide current and new educators the chance to gain new skills within a short timeframe. Here, a 2-day, online course for anatomy educators was created. The goals of which were for the participants: to gain basic knowledge of different radiology modalities, recognize normal radiographic images, and apply that information to common diseases or injuries in interactive case studies. Each day focused on different modalities, where Day 1 studied X-ray, CT, and MRI; and Day 2 studied Ultrasound. A 10-question pre- and post-test was taken by attendees for each day of instruction on a voluntary basis. Following the completion of the course, attendees were provided a survey to determine their perceptions on course content and knowledge acquired. Most attendees instructed undergraduates at 4-year universities, though several attendees came from community colleges and high schools. All attendees showed a significant improvement in knowledge from their pre- to post-test scores in X-ray, CT, MRI, and ultrasound following training. This was also reflected in their survey responses, where attendees felt the course was effective in increasing their knowledge and confidence in radiology. Overall, this study demonstrates the effectiveness of online continuing education courses and the need for more introductory radiology courses for anatomy educators.

What Does a Modern Anatomist Look like? Current Trends in the Training of Anatomy Educators.

Anatomical sciences are foundational to the health professions, yet little is known about the qualifications of anatomy educators at the graduate and professional level in the United States. Moreover, there is concern that the number of qualified anatomy educators being trained may be insufficient to meet the growing demand posed by new and expanded programs in medicine and allied health specialties. The authors surveyed anatomists from across the country to (i) characterize the educational credentials of current anatomy educators and (ii) assess the perceived need for education-focused postdoctoral positions or formal mentorships to prepare anatomists for teaching-intensive faculty positions. To probe the survey responses more deeply, one-on-one interviews were conducted with eight individuals selected to represent a diverse sample of respondents in terms of institution, gender, and academic rank. Results indicate that 30-40% of educators at the graduate level and approximately 60% of those at the undergraduate level lack graduate coursework in histology, embryology, and neuroanatomy. Forty-five percent of respondents had completed a postdoctoral fellowship. Eighty-six percent replied "yes/maybe" to the question of whether an anatomy education postdoctoral fellowship would benefit doctoral graduates. The top 3 reasons for this recommendation were to (i) establish independent educational research, (ii) improve a publication record, and (iii) gain additional teaching experience. Notable weaknesses of education-focused postdoctoral training were related to finances, fear of exploitation, and undervaluing of teaching. Moving forward, postdoctoral fellowships and other forms of postgraduate training may represent a key strategy for training anatomists in the current educational climate. Anat Sci Educ 00: 000-000. © 2018 American Association of Anatomists.

Is the supply of continuing education in the anatomical sciences keeping up with the demand? Results of a national survey.

Continuing education (CE) is an essential element in the life-long learning of health care providers and educators. Despite the importance of the anatomical sciences in the training and practice of clinicians, no studies have examined the need/state of anatomy-related CE nationally. This study assessed the current landscape of CE in the anatomical sciences to contextualize preferences for CE, identify factors that influence the perceived need for CE, and examine the association between supply and demand. Surveys were distributed to educators in the anatomical sciences, practicing physical therapists (PTs), and anatomy training programs across the United States. Twenty-five percent (9 of 36) of training programs surveyed offered CE, certificates, or summer series programs related to anatomy. The majority of PTs (92%) and anatomy educators (81%) felt they had a potential or actual need for anatomy related CE with the most popular formats being online videos/learning modules and intensive, hands-on workshops. The most commonly perceived barriers to participating in CE for both groups were program location, cost, and duration, while educators also perceived time of year as a significant factor. Logistic regression analyses revealed that no investigated factor influenced the need or desire for PTs to engage in anatomy related CE (P ≤ 0.124), while teaching experience and the highest level of learner taught significantly influenced the perceived need among anatomy educators (P < 0.001). Overall, quantitative and qualitative analyses revealed a robust need for CE that strategically integrates anatomy with areas of clinical practice and education. Anat Sci Educ 11: 225-235. © 2017 American Association of Anatomists.

Study skills in anatomy and physiology: Is there a difference?

Many factors influence the way individual students study, including but not limited to: previous coursework, attitudes toward the class (motivation, intimidation, risk, etc.), metacognition, and work schedules. However, little of this research has involved medical students. The present article asks the question, "Do individual medical students study differently for different classes?" Study skills surveys were given to United States medical students at an allopathic medical school and an osteopathic medical school. Students were surveyed near the end of their first year gross anatomy course and again near the end of their first year physiology course. Survey items included Likert scale and open-ended questions about study habits and basic demographic information. The survey responses were correlated with each student's final grade percentages in the courses. Analysis revealed that the four most common study habits were reviewing lecture notes, taking practice examinations, completing learning exercises, and making drawings and diagrams. The two surveys (anatomy and physiology) from each individual were also compared to see if students reported different study habits in anatomy versus physiology. A negative correlation was found between changing study habits between courses and final anatomy grade percentages. Additional analyses suggest that those students who do change their study habits between courses are increasing the number of study strategies that they attempt. This increase in the number of study strategies attempted may not allow the student to reach the same depth of understanding as their colleagues who utilize fewer strategies.

S6K1 determines the metabolic requirements for BCR-ABL survival.

In chronic myelogenous leukemia, the constitutive activation of the BCR-ABL kinase transforms cells to an addicted state that requires glucose metabolism for survival. We investigated S6K1, a protein kinase that drives glycolysis in leukemia cells, as a target for counteracting glucose-dependent survival induced by BCR-ABL. BCR-ABL potently activated S6K1-dependent signaling and glycolysis. Although S6K1 knockdown or rapamycin treatment suppressed glycolysis in BCR-ABL-transformed cells, these treatments did not induce cell death. Instead, loss of S6K1 triggered compensatory activation of fatty-acid oxidation, a metabolic program that can support glucose-independent cell survival. Fatty-acid oxidation in response to S6K1 inactivation required the expression of the fatty-acid transporter carnitine palmitoyl transferase 1c, which was recently linked to rapamycin resistance in cancer. Finally, addition of an inhibitor of fatty-acid oxidation significantly enhanced cytotoxicity in response to S6K1 inactivation. These data indicate that S6K1 dictates the metabolic requirements mediating BCR-ABL survival and provide a rationale for combining targeted inhibitors of signal transduction, with strategies to interrupt oncogene-induced metabolism.

Effects of organic and inorganic dietary selenium supplementation on gene expression profiles in oviduct tissue from broiler-breeder hens.

Selenium (Se) is an essential component of at least 25 selenoproteins involved in a multitude of physiological functions, including reproduction. However, relatively little is known about the mechanisms by which Se exerts its physiological effects in reproductive tissue. The objective of this study was to compare the effect of long-term inorganic Se (sodium selenite, SS) and organic yeast-derived Se (Sel-Plex(®), SP) supplementations on tissue Se content and gene expression patterns in the oviduct of broiler-breeder hens. Hens were randomly assigned at 6 weeks of age to one of the three treatments: basal semi-purified diet (control), basal diet+0.3 ppm Se as SP or basal diet+0.3 ppm Se as SS. At 49 weeks, oviduct tissue from hens randomly selected from each treatment (n=7) was analyzed for Se content and gene expression profiles using the Affymetrix Chicken genome array. Gene expression data were evaluated using GeneSpring GX 10.0 (Silicon Genetics, Redwood, CA) and Ingenuity Pathways Analysis software (Ingenuity Systems, Redwood City, CA). Oviduct Se concentration was greater with Se supplementation compared with the control (P≤0.05) but did not differ between SS- and SP-supplemented groups. Gene expression analysis revealed that the quantity of gene transcripts associated with energy production and protein translation were greater in the oviduct with SP but not SS supplementation. Targets up-regulated by SP, but not SS, included genes encoding several subunits of the mitochondrial respiratory complexes, ubiquinone production and ribosomal subunits. SS hens showed a decrease in transcripts of genes involved in respiratory complexes, ATP synthesis and protein translation and metabolism in oviduct relative to control hens. In this study, although tissue Se concentrations did not differ between hens fed SS- and SP-supplemented diets, expression patterns of genes involved in energy production and protein synthesis pathways differed between treatments. These variations may partially explain the differences in reproductive performance reported in hens fed different forms of Se.

Short-term consumption of a resveratrol-containing nutraceutical mixture mimics gene expression of long-term caloric restriction in mouse heart.

An active area of aging research is focused on identifying compounds having the ability to mimic the effects of caloric restriction (CR). From 2 to 5 months of age, we fed male B6C3F(1) mice either a 40% CR diet, a control diet supplemented with a commercially available nutraceutical mixture (NCM) containing resveratrol, quercetin and inositol hexaphosphate, or a diet supplemented with an equivalent dose of chemical-grade resveratrol (RES; 1.25 mg resveratrol kg(-1) day(-1)) from 2 to 5 months of age. Cardiac gene expression profiles were generated for the three groups of treated mice and compared to age-matched control (CO) mice. All three treatments were associated with changes in several cytoskeletal maintenance pathways, suggesting that RES and NCM are able to mimic short-term CR. CR uniquely affected several immune function pathways while RES uniquely affected multiple stress response pathways. Pathway analysis revealed that NCM (but not CR or RES) regulated multiple metabolic pathways that were also changed by long-term CR, including glucose and lipid metabolism, oxidative phosphorylation and chromatin assembly. Examination of key genes and pathways affected by NCM suggests that Foxo1 is a critical upstream mediator of its actions.

Putative contributors to the secular increase in obesity: exploring the roads less traveled.

OBJECTIVE: To investigate plausible contributors to the obesity epidemic beyond the two most commonly suggested factors, reduced physical activity and food marketing practices. DESIGN: A narrative review of data and published materials that provide evidence of the role of additional putative factors in contributing to the increasing prevalence of obesity. DATA: Information was drawn from ecological and epidemiological studies of humans, animal studies and studies addressing physiological mechanisms, when available. RESULTS: For at least 10 putative additional explanations for the increased prevalence of obesity over the recent decades, we found supportive (although not conclusive) evidence that in many cases is as compelling as the evidence for more commonly discussed putative explanations. CONCLUSION: Undue attention has been devoted to reduced physical activity and food marketing practices as postulated causes for increases in the prevalence of obesity, leading to neglect of other plausible mechanisms and well-intentioned, but potentially ill-founded proposals for reducing obesity rates.

Short-term outcome of seizure patients who refuse transport after out-of-hospital evaluation.

OBJECTIVE: To determine the short-term outcome of patients with a known seizure disorder who have a seizure, are evaluated by out-of-hospital care providers, and refuse transport. METHODS: This was a prospective study conducted over a 15-month period. Philadelphia Fire Department paramedics contacted a medical command physician whenever they encountered a patient with a known seizure disorder who had had another seizure and was refusing transport. After confirming that the patient had the mental capacity to refuse care and understood the associated risks, the physician recorded the patient's name, address, and telephone number. Beginning three days later, a registered nurse attempted to reach the patient by telephone and administer a brief questionnaire about his or her medical outcome. Patients not reached by telephone were sent a certified letter. The names of patients lost to follow-up were compared with medical examiner records to confirm that they had not died during the follow-up period. RESULTS: Of 63 patients enrolled in the study, 52 (82.5%) were reached in follow-up. Of these, three (5.8%) had another seizure within 72 hours and recontacted 911. One of these patients (1.9%) was hospitalized. Twenty (38.5%) patients contacted their primary care physicians. There were no deaths, including patients lost to follow-up. CONCLUSIONS: Most patients (94.2%) who were evaluated by out-of-hospital care providers for a seizure and refused transport had no further seizure activity in the subsequent 72 hours. However, because there is a risk of recurrence, out-of-hospital care providers and medical command physicians should ensure that patients understand the risks of refusal.

Impact of endotoxin on UCP homolog mRNA abundance, thermoregulation, and mitochondrial proton leak kinetics.

Linking tissue uncoupling protein (UCP) homolog abundance with functional metabolic outcomes and with expression of putative genetic regulators promises to better clarify UCP homolog physiological function. A murine endotoxemia model characterized by marked alterations in thermoregulation was employed to examine the association between heat production, UCP homolog expression, and mitochondrial proton leak ("uncoupling"). After intraperitoneal lipopolysaccharide (LPS, approximately 6 mg/kg) injection, colonic temperature (T(c)) in adult female C57BL6/J mice dropped to a nadir of approximately 30 degrees C by 8 h, preceded by a four- to fivefold drop in liver UCP2 and UCP5/brain mitochondrial carrier protein 1 mRNA levels, with no change in their hindlimb skeletal muscle (SKM) expression. SKM UCP3 mRNA rose fivefold during development of hypothermia and was correlated with an LPS-induced increase in plasma free fatty acid concentration. UCP2 and UCP5 transcripts recovered about three- to sixfold in both tissues starting at 6-8 h, preceding a recovery of T(c) between 16 and 24 h. SKM UCP3 followed an opposite pattern. Such results are not consistent with an important influence of UCP3 in driving heat production but do not preclude a role for UCP2 or UCP5 in this process. The transcription coactivator PGC-1 displayed a transient LPS-evoked rise (threefold) or drop (two- to fivefold) in SKM and liver expression, respectively. No differences between control and LPS-treated mouse liver or SKM in vitro mitochondrial proton leak were evident at time points corresponding to large differences in UCP homolog expression.

The short-term outcome of hypoglycemic diabetic patients who refuse ambulance transport after out-of-hospital therapy.

OBJECTIVE: To determine the short-term medical outcome of hypoglycemic insulin-dependent diabetic patients who refuse transport after out-of-hospital therapy and return to baseline mental status. METHODS: Prospective, descriptive, short-term medical outcome data for adult patients were collected between May 1996 and December 1996. Paramedics responding to the aid of hypoglycemic insulin-dependent diabetic patients who refused transport after administration of dextrose solution (D50W) contacted a medical command physician at the University of Pennsylvania. The patients' medical histories, names, addresses, and telephone numbers were recorded. Three days after their hypoglycemic episodes, these patients were contacted by telephone by a registered nurse to determine their medical conditions. RESULTS: Of 132 patients enrolled in the study, 103 (78%) could be contacted by telephone follow-up. Ninety-four (91%) of these patients had no recurrence of symptoms. Nine patients (9%) had recurrence of hypoglycemia and recontacted 911. Eight of these (8%) were transported to a hospital via ambulance and 3 (3%) were admitted, 1 (1%) for a cancer-related illness and 2 (2%) for hypoglycemia, 1 of whom died (1%). The remaining patient refused transport a second time after being treated, despite having the risks of refusal explained to him by a medical command physician. CONCLUSIONS: The practice of treating and releasing most hypoglycemic insulin-dependent diabetic patients who return to normal mental status after D50W administration appears in general to be safe. Patients should be advised of the risks of recurrent hypoglycemia.

Effect of oat bran consumption on total serum cholesterol levels in healthy adults.

The effect of oat bran on total nonfasting serum cholesterol levels in healthy adults was studied. Twenty volunteers whose cholesterol levels were greater than 200 mg/dl consumed 3 ounces of oat bran daily for 93 days in addition to their normal dietary intake. Rescreenings were conducted at days 31, 62, and 93. Repeated measures analysis of variance (ANOVA) revealed no significant difference in total serum cholesterol levels over the four consecutive screenings (a = 0.05, p = 0.054), although ANOVA for polynomial trends revealed a significant difference in total serum cholesterol levels across time (a = 0.05, p = 0.007) (quadratic effect). The interaction of gender with time revealed no significant difference. Thus, it is concluded from this study that daily addition of oat bran to the diet does not significantly lower total cholesterol levels for a sustained period of time.

Preparing for war: lessons learned from U.S. Army flight nurses of World War II.

The combat posture of today's military forces, and more specifically the emphasis on medical readiness for members of the health care professions, shows that the involvement of flight nurses in armed conflict cannot be ruled out. As part of a larger study of how military nurses cope with war, 25 former U.S. Army flight nurses of World War II were interviewed to learn how they coped with wartime situations they perceived as taxing or exceeding their resources. The purpose of this paper is to describe those aspects of wartime nursing that flight nurses interviewed would like to have been different and, subsequently, what advice they would offer today's flight nurses. The responses are examined within the theoretical framework of stress, appraisal, and coping developed by Lazarus and colleagues.

Coping behaviors of U.S. Army flight nurses in World War II: an oral history.

War is a universally stressful event that may tax or exceed one's ability to cope. This study addressed how flight nurses with the U.S. Army Air Forces in World War II coped with war; the purpose was to analyze data obtained from oral histories of 25 flight nurses who served in World War II. Content analysis of the data revealed two levels of coping; a taxonomy of coping efforts was developed for each level. The microscopic level consisted of specific external and internal demands occurring during the war that necessitated coping. The macroscopic level consisted of behavioral and cognitive efforts used to cope with the war in general. Findings suggest that the women perceived their wartime experience as a challenge rather than as a threat and were thus able to make the best of the stressful wartime situation.

Quality for Surgical Pathology 101.

The quality of surgical pathology cannot be evaluated like other work performed in the laboratory. Here is one quality improvement program that provides a beginning and is based on an analysis of the consultation process.

Strategic aeromedical evacuation: the inaugural flight.

Strategic aeromedical evacuation, a vital subsystem of the overall aeromedical airlift system, had its beginning in a confidential, poorly planned, poorly coordinated Air Transport Command flight from Karachi, Pakistan (then part of India) to Washington, DC, in January 1943. That the flight was successfully completed was due in large measure to the untiring efforts of the nurse, Second Lieutenant Elsie S. Ott, aboard the flight. Lessons learned in the form of recommendations made by Lt. Ott were implemented to improve succeeding strategic aeromedical evacuation missions. Largely through Lt. Ott's efforts, long range aeromedical evacuation was demonstrated to be a practicable method of transportation for seriously ill and wounded patients. A new dimension had been added to the overall aeromedical airlift mission.

Flight nurse firsts: the first flight nurse killed in action.

The first flight nurse killed in action was Second Lieutenant Ruth M. Gardiner. A graduate of the first organized course for flight nurses of the 349th Air Evacuation Group, Bowman Field, KY, Lieutenant Gardiner served in the Alaskan Theater of Operations with Flight A of the 805th Medical Air Evacuation Transport Squadron. Lieutenant Gardiner was killed in an aircraft accident on July 27, 1943, while enroute for the purpose of evacuating patients. Gardiner General Hospital in Chicago was named in her honor posthumously.