Twelve tips for optimising medical student retention of anatomy.

Concern that many graduate medical students do not know sufficient anatomy to safely and effectively assess and treat patients is a frequent complaint by clinicians. Although downgrading of anatomy relative to newer basic sciences is often blamed, there is evidence students rapidly forget anatomy. However, there are a number of ways instructors can foster long-term retention of anatomy, the most powerful involving intertwining clinical and anatomical information and assessing in-depth processing. Assisting this process is 'triaging' the curriculum so it contains only clinically engaged anatomy. Students are far more likely to remember information which they consider to be relevant to their future vocation. Therefore, teaching only anatomy which is likely to be useful in a clinical context tends to improve long-term retention of anatomy by medical students. Other helpful techniques include incorporating surface and radiological anatomy in a vertically integrated curriculum, reciprocal peer teaching and employing clinically qualified instructors.

Evaluation of DSM-5 and IWG-2 criteria for the diagnosis of Alzheimer's disease and dementia with Lewy bodies.

Despite differing target audiences and scope it is possible to compare the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington: American Psychiatric Association, 2013] and the Second International Working Group for New Research Criteria for the Diagnosis of Alzheimer's Disease (IWG-2) [Dubois B, Feldman HH, Jacova C, Hampel H, Molinuevo JL, Blennow K, et al. Advancing research diagnostic criteria for Alzheimer's disease: the IWG-2 criteria. Lancet Neurol 2014;13:614-29] diagnostic criteria for both Alzheimer's disease (AD) and dementia with Lewy bodies (DLB). With regard to the diagnosis of AD the principal difference is the inclusion of biomarkers in the IWG-2 diagnostic criteria for this condition. This creates a number of difficulties including a lack of regulatory approval, cultural and other objections to the collection of cerebrospinal fluid (CSF), and a lack of facilities for collection and analysis restricting analysis of CSF proteins to larger tertiary centres [Dubois B, Feldman HH, Jacova C, Hampel H, Molinuevo JL, Blennow K, et al. Advancing research diagnostic criteria for Alzheimer's disease: the IWG-2 criteria. Lancet Neurol 2014;13:614-29]. With regard to diagnostic criteria for DLB, IWG-2 research criteria designate the co-occurrence of AD and DLB as 'mixed AD'. However, Alzheimer's type pathology (ADTP) and Lewy body pathology frequently occur together rendering a separate 'mixed AD' category superfluous. The reality is that routine clinical diagnosis of AD and DLB will continue to be based on a thorough general and neurological examination indicating a preponderance of signs and symptoms for one or other of these conditions [Seeley WW, Miller BL. Alzheimer's disease and other dementias. In: Hauser SL, Josephson SA, editors. Harrison's neurology in clinical medicine, 3rd ed. New York: McGraw Hill, 2013]. Similarly, AD and DLB research will continue to primarily depend on clinically focussed DSM-5 criteria, making DSM-5 superior to IWG-2 in both clinical and research settings.

Dependence Independence Measure for Posterior and Anterior EMG Sensors Used in Simple and Complex Finger Flexion Movements: Evaluation Using SDICA.

Identification of simple and complex finger flexion movements using surface electromyography (sEMG) and a muscle activation strategy is necessary to control human-computer interfaces such as prosthesis and orthoses. In order to identify these movements, sEMG sensors are placed on both anterior and posterior muscle compartments of the forearm. In general, the accuracy of myoelectric classification depends on several factors, which include number of sensors, features extraction methods, and classification algorithms. Myoelectric classification using a minimum number of sensors and optimal electrode configuration is always a challenging task. Sometimes, using several sensors including high density electrodes will not guarantee high classification accuracy. In this research, we investigated the dependence and independence nature of anterior and posterior muscles during simple and complex finger flexion movements. The outcome of this research shows that posterior parts of the hand muscles are dependent and hence responsible for most of simple finger flexion. On the other hand, this study shows that anterior muscles are responsible for most complex finger flexion. This also indicates that simple finger flexion can be identified using sEMG sensors connected only on anterior muscles (making posterior placement either independent or redundant), and vice versa is true for complex actions which can be easily identified using sEMG sensors on posterior muscles. The result of this study is beneficial for optimal electrode configuration and design of prosthetics and other related devices using a minimum number of sensors.

Alteration of select gene expression patterns in individuals infected with HIV-1.

Multiple human proteins have been shown to both support and restrict viral replication, and confirmation of virus-associated changes in the expression of these genes is relevant for future therapeutic efforts. In this study a well-characterized panel of 49 individuals either infected with HIV-1 or uninfected was compiled and analyzed for the effect of HIV infection status, viral load, and antiretroviral treatment on specific gene expression. mRNA was extracted and reverse transcribed from purified CD4+ cells, and quantitative real-time PCR was utilized to scrutinize differences in the expression of four host genes that have been demonstrated to either stimulate (HSP90 and LEDGF/p75) or restrict (p21/WAF1 and APOBEC3G) proviral integration. HIV infection status was associated with slight to moderate alterations in the expression of all four genes. After adjusting for age, mRNA expression levels of HSP90, LEDGF/p75 and APOBEC3G were found to all be decreased in infected patients compared to healthy controls by 1.43-, 1.26-, and 4.71-fold, respectively, while p21/WAF1 expression was increased 2.35-fold. Furthermore, individuals receiving raltegravir exhibited a 1.28-fold reduction in LEDGF/p75 compared to those on non-raltegravir antiretroviral treatment. Identification of these and similar HIV-induced changes in gene expression may be valuable for delineating the extent of host cell molecular mechanisms stimulating viral replication.

Assessment of the upper limb in acute stroke: the validity of hierarchal scoring for the Motor Assessment Scale.

BACKGROUND/AIM: Stroke is the greatest contributor to disability in Australian adults and much of this disability results from a stroke-affected upper limb. This study aimed to determine the validity of hierarchal scoring for the upper limb subscale of the Motor Assessment Scale (UL-MAS) in acute stroke using Rasch analysis. METHOD: This study applied Rasch analysis to 40 UL-MAS assessment results across 25 subjects to determine the validity of the hierarchy of the three upper limb subsets: upper arm function (six), hand movements (seven) and advanced hand activities (eight). Rasch analysis examines the relationship between 'item difficulty' and 'person ability' and produces an output which represents the difficulty of each item in relation to each other. RESULTS: As hypothesised, the hierarchy was upheld within subset 6. In subset 7, the hierarchy was not upheld. Results indicated that item 3 was the least difficult, followed by items 1, 4, 2, 5 and 6 in order of increasing difficulty. In subset 8 the hierarchy was not upheld. Results indicated that item 1 was the least difficult, followed by item 6, then 2 and 5 of equal value and then 3 and 4 of equal value. CONCLUSIONS: The hierarchal scoring is not supported for subsets 7 and 8 and future research is required to explore the validity of alternate scoring methods. At present, the authors recommend that the UL-MAS should be scored non-hierarchally, meaning that every item within the subsets should be scored regardless of its place within the hierarchy (UL-MAS-NH).

Therapeutic use of arteriovenous fistula in children with haemophilia.

Haemophilia is an X-linked inherited bleeding disorder, which only affects males. Contemporary treatment of children with haemophilia requires adequate venous access for the administration of prophylactic therapy which commences as a relatively early age. In the majority of children this treatment is administered at home, usually by the parents and then, once competent, by the boys themselves. As venous access in young children is fraught with difficulty, central venous access devices have become the mainstay of haemophilia care. However, these devices come with their own difficulties, with infection and thrombosis causing significant side-effects in some children. Small but substantial cohorts of boys with haemophilia develop antibodies (or inhibitors) to coagulation factors, rendering them both more likely to experience bleeding and more complex to treat. These boys are, for reasons not yet fully understood, more likely to experience central line infections, which also affect overall treatment outcomes. Arteriovenous fistulae were used in four such boys in an attempt to eliminate central line infection and to enable continued treatment administration. The experience and outcomes of these four boys is discussed along with considerations and implications for nurses caring for them.

Red cell pyruvate kinase deficiency: 17 new mutations of the PK-LR gene.

The PK-LR gene was studied in 23 patients with congenital haemolytic anaemia associated with erythrocyte pyruvate kinase (PK) deficiency. Twenty-seven different mutations were detected among the 42 mutated alleles identified: 19 missense mutations, four splice site mutations and one nonsense, one single base deletion and two large deletions. Seventeen of them (107G, 278T, 403T, 409A, 661A, 859C, 958A, 1094T, 1190T, 1209A, 1232C, 1369G, 507A, IVS9 -1c, IVS9 +43c [corrected] del C224, del 5006bp IVS3--> nt 1431) were new. Although all the exons, the flanking regions and the promoter were sequenced in all cases, we failed to detect the second expected mutation in four subjects. To correlate genotype to phenotype, the molecular results were related to the biochemical properties of the mutant enzymes by an analysis of the three-dimensional structure of erythrocyte PK. The new mutant 409A, found in association with the large deletion of 5006 bp in a newborn baby who died soon after birth, was functionally characterized by mutagenesis and in vitro expression of the protein to investigate its contribution in the severity of the clinical pattern. However, the biochemical data obtained for the mutant enzyme cannot explain the severe anaemia found in the PK-deficient patient hemizygous for this mutation.

Toxic equivalency factors for PAH and their applicability in shellfish pollution monitoring studies.

Fish and shellfish are exposed to a wide range of polycyclic aromatic hydrocarbons (PAH) following oil spills at sea, and can become contaminated as a result. Finfish have a more effective mixed-function oxidase enzyme system than shellfish, and are therefore able to metabolise and excrete PAH more effectively than the invertebrates. Thus, contamination by high-molecular weight PAH, including those with carcinogenic potential and so of concern with regard to human consumers, is therefore usually observed in shellfish, and particularly in bivalve molluscs. Oil spills are not the sole source of PAH, however, as parent compounds are also generated by a wide range of combustion processes. In this paper, consideration is given to monitoring data gathered following recent oil spills (both of crude oil and diesel fuel), alongside data from other studies. These include studies conducted around a former gasworks site and downstream of an aluminium smelter in the UK, and from mussel monitoring studies undertaken in the UK and the USA (including the Exxon Valdez oil spill and the National Status and Trends programme), and in other countries in Europe. For comparative purposes the PAH concentrations are summed and also expressed as benzo[a]pyrene equivalents, their relative concentrations being weighted in relation to the carcinogenic potential of individual PAH compounds using toxic equivalency factors (TEF). Our aim was to assess the utility of this approach in fishery resource monitoring and control following oil spills. Certainly this approach seems useful from the data assessed in this study. and the relative ranking of the various studies seems to reflect the relative degree of concern for human consumers due to the differing contamination sources. As a simple tool for control purposes it is equally applicable to PAH derived from oil spills, and from industrial and combustion sources.