Visualising the Dural Venous Sinuses Using Volume Tracing, a Novel Approach.

It is well established that the brain changes dramatically in appearance during gestation and even after birth. Due to the multi-channelled origins and the number of developmental options, the adult venous system is characterised by a higher incidence of anatomical variations than the arterial system. Limited information is available on imaging of the intracranial veins and sinuses. It is therefore important to understand the normal anatomy of the cerebral venous system and its variants in order to provide adequate and comprehensive training to medical students and researchers. We used a novel approach to trace the volumes of the dural venous sinuses. The approach included constructing three-dimensional (3D) models of the dural venous sinuses which could then be used for statistical and morphological analyses. This chapter will expand on current literature and visualisation techniques of the dural venous sinuses. The reader will be presented with a novel way of looking at the venous drainage of the brain and how to use this visualisation in understanding venous anatomy and its clinical implications.

Focused Multisensory Anatomy Observation and Drawing for Enhancing Social Learning and Three-Dimensional Spatial Understanding.

The concept that multisensory observation and drawing can be effective for enhancing anatomy learning is supported by pedagogic research and theory, and theories of drawing. A haptico-visual observation and drawing (HVOD) process has been previously introduced to support understanding of the three-dimensional (3D) spatial form of anatomical structures. The HVOD process involves exploration of 3D anatomy with the combined use of touch and sight, and the simultaneous act of making graphite marks on paper which correspond to the anatomy under observation. Findings from a previous study suggest that HVOD can increase perceptual understanding of anatomy through memorization and recall of the 3D form of observed structures. Here, additional pedagogic and cognitive underpinnings are presented to further demonstrate how and why HVOD can be effective for anatomy learning. Delivery of a HVOD workshop is described as a detailed guide for instructors, and themes arising from a phenomenological study of educator experiences of the HVOD process are presented. Findings indicate that HVOD can provide an engaging approach for the spatial exploration of anatomy within a supportive social learning environment, but also requires modification for effective curricular integration. Consequently, based on the most effective research-informed, theoretical, and logistical elements of art-based approaches in anatomy learning, including the framework provided by the observe-reflect-draw-edit-repeat (ORDER) method, an optimized "ORDER Touch" observation and drawing process has been developed. This is with the aim of providing a widely accessible resource for supporting social learning and 3D spatial understanding of anatomy, in addition to improving specific anatomical knowledge.

How Haptics and Drawing Enhance the Learning of Anatomy.

Students' engagement with two-dimensional (2D) representations as opposed to three-dimensional (3D) representations of anatomy such as in dissection, is significant in terms of the depth of their comprehension. This qualitative study aimed to understand how students learned anatomy using observational and drawing activities that included touch, called haptics. Five volunteer second year medical students at the University of Cape Town participated in a six-day educational intervention in which a novel "haptico-visual observation and drawing" (HVOD) method was employed. Data were collected through individual interviews as well as a focus group discussion. The HVOD method was successfully applied by all the participants, who reported an improvement of their cognitive understanding and memorization of the 3D form of the anatomical part. All the five participants described the development of a "mental picture" of the object as being central to "deep learning." The use of the haptic senses coupled with the simultaneous act of drawing enrolled sources of information that were reported by the participants to have enabled better memorization. We postulate that the more sources of information about an object, the greater degree of complexity could be appreciated, and therefore the more clearly it could be captured and memorized. The inclusion of haptics has implications for cadaveric dissection versus non-cadaveric forms of learning. This study was limited by its sample size as well as the bias and position of the researchers, but the sample of five produced a sufficient amount of data to generate a conceptual model and hypothesis.

An ultrasonographic analysis of the activation patterns of abdominal muscles in children with spastic type cerebral palsy and in typically developing individuals: a comparative study.

BACKGROUND: Abdominal muscles have stiffer appearance in individuals with spastic type cerebral palsy (STCP) than in their typically developing (TD) peers. This apparent stiffness has been implicated in pelvic instability, mal-rotation, poor gait and locomotion. This study was aimed at investigating whether abdominal muscles activation patterns from rest to activity differ in the two groups. METHOD: From ultrasound images, abdominal muscles thickness during the resting and active stages was measured in 63 STCP and 82 TD children. The thickness at each stage and the change in thickness from rest to activity were compared between the two groups. RESULTS: Rectus abdominis (RA) muscle was the thickest muscle at rest as well as in active stage in both groups. At rest, all muscles were significantly thicker in the STCP children (p <  0.001). From rest to active stages muscle thickness significantly increased (p <  0.001) in the TD group and significantly decreased (p <  0.001) in the STCP children, except for RA, which became thicker during activity in both groups. In active stages, no significant differences in the thickness in the four abdominal muscles were found between the STCP and the TD children. CONCLUSION: Apart from the RA muscle, the activation pattern of abdominal muscles in individuals with STCP differs from that of TD individuals. Further studies required for understanding the activation patterns of abdominal muscles prior to any physical fitness programmes aimed at improving the quality of life in individuals with STCP. TRIAL REGISTRATION: HREC REF: 490/2011. Human Research Ethics Committee, Faculty of Health Sciences, University of Cape Town, South Africa. November 17, 2011.

An electromyographic study of abdominal muscle activity in children with spastic cerebral palsy.

BACKGROUND: Inadequate knowledge in the recruitment patterns of abdominal muscles in individuals with spastic-type cerebral palsy (STCP). OBJECTIVES: To determine whether there is any difference between the neuromuscular activity (activation pattern) of the abdominal muscles in children with STCP and those of their typically developing (TD) peers. METHOD: The NORAXAN® electromyography (EMG) was used to monitor the neuromuscular activity in abdominal muscles of individuals with STCP (n = 63), and the results were compared with the findings from age-matched TD individuals (n = 82). RESULTS: EMG frequencies were recorded during rest and during active states and compared using repeated measures ANOVA. Spearman's rank order correlation was used to explore relationships between age, body mass index and abdominal muscle activity. With the exception of the rectus abdominis (RA) muscle, the pattern of neuromuscular activity in children with STCP differs significantly from that of their TD peers. Three of the muscles - external oblique abdominis (EO), internal oblique abdominis (IO) and RA - in both groups showed significant changes (p < 0.001) in the frequency of EMG activity between the resting and active states. An elevated EMG activity at rest in the EO and IO was recorded in the STCP group, whereas the RA during resting and active stages showed similar results to TD individuals. CONCLUSION: The findings from this study suggest that the RA could be targeted during rehabilitation regimens; however, the force generated by this muscle may not be sufficient for the maintenance of trunk stability without optimal support from the EO and IO muscles.

Embryological and molecular development of the adrenal glands.

In this mini review, the embryological and functional development of the adrenal glands is presented from a molecular perspective. While acknowledging that this is a highly complex series of events, the processes are described in simple and broad strokes in a single text for the reader who is interested in this field but is not an active researcher. The origin of the adrenal glands is in the mesodermal ridge as early as the fourth week of gestation. Between the eighth and ninth weeks of gestation, the adrenal glands are encapsulated and this results in the presence of a distinct organ. There have been great strides in deciphering the very complicated molecular aspects of adrenal gland development in which multiple transcription factors have been identified, directing the adrenogonadal primordium into the adrenal cortex, kidney, or bipotential gonad. Adrenocorticotrophic hormone is critical for early development of the hypothalamic-pituitary adrenal axis. Several mutations in transcription factors, responsible for normal adrenal gland development have been found to induce the familial syndrome of congenital adrenal hypoplasia or neoplasia.

Who donates their body to science? An international, multicenter, prospective study.

The altruistic act of body donation provides a precious resource for both teaching and researching human anatomy. However, relatively little is known about individuals who donate their bodies to science (donors), and in particular whether donors in different geographical locations share similar characteristics. A multicenter prospective survey of donors registering during 2010 in three different geographical locations, New Zealand, Ireland, and the Republic of South Africa, was conducted to identify donor characteristics. The 28-question survey included sections on body donation program awareness, reasons for donating, giving tendency, education, ethnicity, relationship status, occupation, religion, and political preference. Two hundred surveys (81%) were returned [New Zealand 123 (85% response rate), Republic of South Africa 41 (67%), and Ireland 36 (92%)]. Results indicate that donors share certain characteristics including reason for donating (80% cited a desire to aid medical science as the main reason for wishing to donate their body); family structure (most donors are or have been in long-term partnerships and ≥ 85% have siblings); and a higher proportion with no religious affiliation compared to their reference population. Some variations between locations were noted including donor age, the mode of program awareness, occupation, relationship status, political preference, organ donor status and with whom donors had discussed their decision to donate. This information could be important for assisting the identification of potential body donors in new and established bequest programs.

The reliance on unclaimed cadavers for anatomical teaching by medical schools in Africa.

The study of gross Anatomy through the use of cadaveric dissections in medical schools is an essential part of the comprehensive learning of human Anatomy, and unsurprisingly, 90% of the surveyed medical schools in Africa used cadaveric dissections. Donated cadavers now make up 80% of the total cadavers in North American medical schools and all the cadavers used for dissection in the United Kingdom are donated. Because the sources of cadavers used in Africa are not clearly known, a questionnaire to gather information on cadavers used at medical schools was designed from the relevant literature and was sent by electronic mail to 123 Anatomy lecturers in 23 African countries (48 medical schools). Fourteen lecturers from 14 medical schools in ten countries responded to the questionnaires. The results indicate that, in most countries, the cadavers are unclaimed bodies from the hospitals and prisons, and the bodies of dead bandits. In South Africa and Zimbabwe, the donations are mostly from the white community, and medical school in the Islamic country of Libya is importing cadavers from India. The lack of knowledge about body donation programes and firmly held cultural and religious burial traditions may explain the lack of bequests from black communities. The use of unclaimed bodies may disproportionally affect people who were homeless and poor, criminals, people with fewer social links, and social outcasts. The Anatomy lecturers felt that there should be broader national awareness programes for body donations, although the benefits of this could take decades to materialize.

The frequency of absence of palmaris longus in a South African population of mixed race.

The palmaris longus (PL) is a weak flexor of the wrist that may be harvested as a tendon graft and used in surgical procedures for reconstructive purposes. The PL is congenitally absent in 15% of the worldwide population. However, the frequency of absence varies considerably among different population groups, being as high as 63.9% in the Turkish population and as low as 3% in the black population in the Republic of Congo. In this study, South African persons of mixed race (n = 201) were assessed by two anatomists for the presence of the PL tendon using three clinical tests, namely the Traditional Test, Mishra's Test II, and the Gangata Test. The most reliable of the three tests used was determined using Kendall's coefficient of concordance. Of the total number of subjects used, 11.5% had absence (either bilaterally or unilaterally) of the PL tendon. There was a 5.5% bilateral absence of the PL. The study revealed that the PL tendon may present in six different patterns according to the clinical assessment tests applied, the presence or absence of the PL alongside the flexor capi radialis, and the degree of prominence of PL, if present. Using the Kendall's coefficient of concordance, the Mishra's Test II, and the Gangata Test, both involving abduction of the thumb, were found to be most effective in revealing the PL. The frequency of absence of the PL in South Africans of mixed race has been determined.

The contribution of the palmaris longus muscle to the strength of thumb abduction.

The palmaris longus muscle (PLM) is described as a weak flexor of the wrist and a tensor of the palmar aponeurosis, but not a thumb abductor. The PLM is believed to aid thumb abduction through its insertion onto the thenar eminence. Two groups, both right hand dominant, were selected from 1,200 sampled participants. The first group comprised of 38 subjects with unilateral presence of the PLM and was used to determine the strength of thumb abduction. The second group comprised of 30 subjects, with bilateral presence of the PLM, and it was used to calculate the effects of hand dominance. A significant number of subjects with bilateral absence of the PLM were observed and undocumented. Using a dynamometer in subjects with unilateral presence of the PLM, the force of thumb abduction was significantly greater on the hand with a PLM than the one without it (P = 0.014), irrespective of hand dominance. In the second sample with bilateral PLM, thumb abduction on the dominant hand was 10% stronger than on the nondominant hand and was similar to the universally accepted average of 10% increase in grip strength of the dominant hand. Thus, 10% was deducted from all the dominant hands, and the force of thumb abduction remained greater on the hand with PLM than the hand without it (P = 0.049). The results of this study demonstrated the PLM to be involved in thumb abduction, and the authors therefore recommend that this action of the muscle be universally accepted by anatomists and hand surgeons.

The place of anatomy in medical education: AMEE Guide no 41.

This Guide, a combined work by three authors from different countries, provides perspectives into the history of teaching gross anatomy, briefly, from the earliest of times, through to a detailed examination of curricula in both traditional didactic approaches and Problem-Based Learning (PBL) curricula. The delivery of a module within a curriculum in tertiary education is interplay between the content (knowledge and skills) of a subject, the teaching staff involved, the students and their approaches to learning, and the philosophy underpinning the delivery of the learning material. The work is divided into sections that deal with approaches to learning anatomy from the perspective of students, to delivery of the content of the curriculum by lecturers, including the assessment of knowledge, and itemises the topics that could be considered important for an appropriate anatomy module in an integrated course, delivered in a way that emphasises clinical application. The work concludes by looking to the future, and considering what measures may need to be addressed to ensure the continued development of anatomy as a clinically relevant subject in any medical curriculum.

What is medicine and what is a doctor? Medical students' perceptions and expectations of their academic and professional career.

BACKGROUND: Research was conducted at the University of Cape Town in South Africa where a new medical curriculum was introduced in 2002. This curriculum is largely problem-based and primary health care (PHC) driven. AIM: To qualitatively explore medical students' perceptions of medicine and doctors and their expectations of studying medicine and practising as a doctor. METHODS: A questionnaire was administered to all first-year students (n = 193) that assessed their perceptions of doctors, and their expectations of studying medicine and practising as a doctor. Interviews and focus groups were conducted with purposively selected first-, second-, third- and fourth-year students. RESULTS: Medical students at the University of Cape Town were found to have generally positive perceptions of medicine and doctors, and depicted the medical profession as one that is very significant because of its influence within society, to the point of being perceived as almost noble. Some of the more challenging and difficult aspects of a career in medicine were mentioned, but these seem to be minor compared to the positive aspects. Some students regarded the medical profession as having a biomedical and curative emphasis, although there seemed to be a strong move towards a more holistic view. However, students expected their degree to concentrate on the biomedical aspects of medicine, and therefore did not expect particular components of their degree, such as the psychosocial component. CONCLUSIONS: Unmet expectations regarding their curriculum seem to be a very significant issue for students. It is therefore important for educators who deliver the curriculum to be aware of and to understand medical students' perceptions and expectations of medicine and doctors, in order to detect and deal with conflict between these perceptions and expectations and what may be an educational institution's 'hidden curriculum'.

Height and weight differences among South African Urban schoolchildren born in various months of the year.

Among 1,165 subjects aged 6-18 years who were examined once cross-sectionally, a significant variation in body height and weight according to the month of birth of the subjects was found. All subjects belonged to the so-called Cape Coloured community, were born locally, and their parents belonged to the most affluent sector of the community. Individuals born in February to July were shorter and weighed less (by 13 to 17% of the standard deviation) than those born in August to January. These results are similar to those obtained for Canadian children, who were measured on their birthdays. Since our individuals were measured only once, at the same time of the year, observed differences cannot be ascribed to seasonal fluctuations of growth rates prior to measurement but must constitute a persistent effect of seasonal fluctuation in earlier growth. Immediate environmental conditions (food, temperature, rainfall, and insolation) in the Southern Hemisphere fluctuate seasonally 6 months out of phase from those in the Northern Hemisphere. Thus the similarity of our findings to those from the Northern Hemisphere suggests a factor common for the entire earth, possibly related to the ellipsoid shape of the orbit of the planet.