Self-regulated learning of anatomy during the COVID-19 lockdown period in a low-income setting.

In March 2020, universities in Zimbabwe temporarily closed and switched to remote learning to contain the spread of SARS Cov2 infections. The sudden change to distance learning gave autonomy to students to direct their own learning. To understand how the students at the University of Zimbabwe and Midlands State University adapted to emergency remote learning, focus group discussions and a self-administered questionnaire survey based on the self-regulated learning inventory were conducted to capture cognitive, motivational, and emotional aspects of anatomy learning during the COVID-19 pandemic. Thematic analysis was used to identify patterns among these students' lived experiences. Two coders analyzed the data independently and discussed the codes to reach a consensus. The results showed that students at the two medical schools cognitively and meta-cognitively planned, executed and evaluated self-regulated strategies in different ways that suited their environments during the COVID-19 lockdown. Several factors, such as demographic location, home setting/situation, socioeconomic background and expertise in using online platforms, affected the students' self-directed learning. Students generally adapted well to the constraints brought about by the lockdown on their anatomy learning in order to learn effectively. This study was able to highlight important self-regulated learning strategies that were implemented during COVID-19 by anatomy learners, especially those in low-income settings, and these strategies equip teachers and learners alike in preparation for similar future situations that may result in forced remote learning of anatomy.

Anatomical variations of the brachial plexus in adult cadavers: A descriptive study and clinical significance.

BACKGROUND: Brachial plexus injury is recognized as one of the most severe clinical challenges due to the complex anatomical configuration of the brachial plexus and its propensity for variation, which complicates safe clinical interventions. This study aimed to ascertain the prevalence and characterize the types of brachial plexus variations, and to elucidate their clinical implications. MATERIALS AND METHODS: We conducted meticulous dissections of 60 formalin-fixed cadavers' upper arm, axilla and lower neck to reveal and assess the roots, trunks, divisions, cords, and branches of the brachial plexus. The pattern of branching was noted by groups of dissecting medical students and confirmed by the senior anatomists. The variations discovered were record and photographed using a digital camera for further analysis. RESULTS: Variations in the brachial plexus were identified in 40 of the 60 cadavers, yielding a prevalence rate of 66.7%. These variations were classified into root anomalies (2.1%), trunk anomalies (8.5%), division anomalies (2.1%), and cord anomalies (4.3%). Notably, anomalies in communicating branches were observed in 39 cadavers (83.0%): 14 with bilateral anomalies, 14 with anomalies on the left side, and 11 on the right side. These communicating branches formed connections between the roots and other segments, including trunks, cords, and terminal nerves, and involved the median, musculocutaneous, and ulnar nerves. CONCLUSION: The frequency and diversity of brachial plexus variations, particularly in communicating branches, are significant in cadavers. It is imperative that these variations are carefully considered during the diagnostic process, treatment planning, and prior to procedures such as supraclavicular brachial plexus blocks and nerve transfers, to mitigate the risk of iatrogenic complications.

Pre-Clinical Medical Students' Use of Motivational and Cognitive Study Strategies During Anatomy Learning: A Three-Year Cross-Sectional Survey.

Medical students' motivation and study strategies are crucial in determining academic performance. This study aimed to assess the motivation and learning strategies of medical students as well as their association with performance in anatomy examinations. The Motivated Strategies for Learning Questionnaire, two focus group discussions, and students' current anatomy cumulative grade point average (cGPA) were used. Generally, the medical students strongly felt that anatomy is fundamental to the practice of medicine and surgery. This result was consistent with high task value scores of 5.99 ± 1.25. They were also driven by extrinsic goal orientation (5.59 ± 1.42) and intrinsic goal orientation (5.08 ± 1.26). Most medical students typically relied on elaboration (5.35 ± 1.25) ahead of other cognitive strategies namely rehearsal (5.30 ± 1.11), organization (5.15 ± 1.34), and lowest-rated critical thinking (4.77 ± 1.19). The students also relied on resource management strategies, effort regulation (5.15 ± 1.20) and time and study environment regulation (5.03 ± 1.03) more than the moderately scored peer learning (4.95 ± 1.50) and help-seeking (4.95 ± 1.09). In the focus group discussions, students reported that they often narrate or explain to each other what they would have read and understood from anatomy lectures, tutorials, and textbooks. They also bemoaned the lack of institutional support for stress burdens. The motivation and learning strategies subscales were not correlated with anatomy cGPA. Males were driven by extrinsic goals and experienced significantly higher levels of test anxiety than females (P < 0.05). Knowing the motivation and learning strategies students employ early in the medical curriculum can be leveraged to promote self-directed learning and academic achievement.

Zimbabwean PreClinical Medical Students Use of Deep and Strategic Study Approaches to Learn Anatomy at Two New Medical Schools.

Anatomy is a challenging preclinical subject owing to the vast amount of information that students need to master. The adoption of relevant study approaches is key to the development of a long-lasting understanding of anatomical subject matter. Phenomenographic educational research describes the medical students as using a variable mix of deep, strategic, and surface approaches to study. Continually assessing students' learning preferences and approaches is crucial for achieving the desired learning outcomes. The approaches to studying anatomy in two groups of first-year Zimbabwean medical students from two newly established medical schools were collected using the Approaches and Study Skills Inventory for Students (ASSIST) instrument and than analyzed. At least 90% of the students believed that anatomy involved reproducing knowledge or personal understanding and development. Overall, the majority of the students adopted deep and strategic approaches, while a distant minority used the surface approach. There was no significant correlation between either the students' sex or age and their preference for a specific approach to studying. The mean anatomy grades for students using a strategic approach were significantly higher than those using deep or surface approaches. The number of strategic learners was double that of deep learners among the high achievers subgroup. The strategic approach positively correlated with performance in examinations. Generally, the students shared a common understanding of the concept of anatomy learning. Studies such as this can assist with the identification of students at risk of failure and empower lecturers to recommend the adoption of more beneficial strategic and deep learner traits.

MicroRNA-137-3p Protects PC12 Cells Against Oxidative Stress by Downregulation of Calpain-2 and nNOS.

The imbalance between excess reactive oxygen species (ROS) generation and insufficient antioxidant defenses contribute to a range of neurodegenerative diseases. High ROS levels damage cellular macromolecules such as DNA, proteins and lipids, leading to neuron vulnerability and eventual death. However, the underlying molecular mechanism of the ROS regulation is not fully elucidated. Recently, an increasing number of studies suggest that microRNAs (miRNAs) emerge as the targets in regulating oxidative stress. We recently reported the neuroprotective effect of miR-137-3p for brachial plexus avulsion-induced motoneuron death. The present study is sought to investigate whether miR-137-3p also could protect PC12 cells against hydrogen peroxide (H2O2) induced neurotoxicity. By using cell viability assay, ROS assay, gene and protein expression assay, we found that PC-12 cells exposed to H2O2 exhibited decreased cell viability, increased expression levels of calpain-2 and neuronal nitric oxide synthase (nNOS), whereas a decreased miR-137-3p expression. Importantly, restoring the miR-137-3p levels in H2O2 exposure robustly inhibited the elevated nNOS, calpain-2 and ROS expression levels, which subsequently improved the cell viability. Furthermore, the suppressive effect of miR-137-3p on the elevated ROS level under oxidative stress was considerably blunted when we mutated the binding site of calpain-2 targted by miR-137-3p, suggesting the critical role of calpain-2 involving the neuroprotective effect of miR-137-3p. Collectively, these findings highlight the neuroprotective role of miR-137-3p through down-regulating calpain and NOS activity, suggesting its potential role for combating oxidative stress insults in the neurodegenerative diseases.

Astrocytic endothelin-1 overexpression promotes neural progenitor cells proliferation and differentiation into astrocytes via the Jak2/Stat3 pathway after stroke.

BACKGROUND: Endothelin-1 (ET-1) is synthesized and upregulated in astrocytes under stroke. We previously demonstrated that transgenic mice over-expressing astrocytic ET-1 (GET-1) displayed more severe neurological deficits characterized by a larger infarct after transient middle cerebral artery occlusion (tMCAO). ET-1 is a known vasoconstrictor, mitogenic, and a survival factor. However, it is unclear whether the observed severe brain damage in GET-1 mice post stroke is due to ET-1 dysregulation of neurogenesis by altering the stem cell niche. METHODS: Non-transgenic (Ntg) and GET-1 mice were subjected to tMCAO with 1 h occlusion followed by long-term reperfusion (from day 1 to day 28). Neurological function was assessed using a four-point scale method. Infarct area and volume were determined by 2,3,5-triphenyltetra-zolium chloride staining. Neural stem cell (NSC) proliferation and migration in subventricular zone (SVZ) were evaluated by immunofluorescence double labeling of bromodeoxyuridine (BrdU), Ki67 and Sox2, Nestin, and Doublecortin (DCX). NSC differentiation in SVZ was evaluated using the following immunofluorescence double immunostaining: BrdU and neuron-specific nuclear protein (NeuN), BrdU and glial fibrillary acidic protein (GFAP). Phospho-Stat3 (p-Stat3) expression detected by Western-blot and immunofluorescence staining. RESULTS: GET-1 mice displayed a more severe neurological deficit and larger infarct area after tMCAO injury. There was a significant increase of BrdU-labeled progenitor cell proliferation, which co-expressed with GFAP, at SVZ in the ipsilateral side of the GET-1 brain at 28 days after tMCAO. p-Stat3 expression was increased in both Ntg and GET-1 mice in the ischemia brain at 7 days after tMCAO. p-Stat3 expression was significantly upregulated in the ipsilateral side in the GET-1 brain than that in the Ntg brain at 7 days after tMCAO. Furthermore, GET-1 mice treated with AG490 (a JAK2/Stat3 inhibitor) sh owed a significant reduction in neurological deficit along with reduced infarct area and dwarfed astrocytic differentiation in the ipsilateral brain after tMCAO. CONCLUSIONS: The data indicate that astrocytic endothelin-1 overexpression promotes progenitor stem cell proliferation and astr ocytic differentiation via the Jak2/Stat3 pathway.

The applied anatomy and clinical significance of the proximal, V1 segment of vertebral artery.

BACKGROUND: The aim of the study was to probe the morphological features of the proximal segment (V1) of vertebral artery (VA) in a sample of Chinese cadavers. MATERIALS AND METHODS: The origin, course and outer diameter at origin of the pre-vertebral part of the VAs were evaluated in 119 adult cadavers. RESULTS: It was found that 94.12% of the VAs originated from the subclavian arteries, bilaterally. The variant origins were present in 5.88% of the cadavers and all originated directly from the arch of the aorta. All the variations were observed on the left side of male cadavers. The average outer diameters at origin of the normal and variation groups were 4.35 ± 1.00 mm and 4.82 ± ± 1.42 mm, respectively, p = 0.035. In the normal group, but not in the variation group, the average diameter in the males was significantly larger than that in the females (4.50 ± 0.99 mm, 3.92 ± 0.92 mm, respectively, p = 0.000). In addition, only 5 cadavers in the normal group had hypoplastic VAs (4.20%, 4 males, 3 right-sided). Vertebral artery dominance (VAD) was present in 91 (69 males) out of 112 cadavers and more common on the left (n = 48). In addition, 3 cadavers satisfied conditions for coexistence of VAD and vertebral artery hypoplasia. All 7 cadavers in the variation group exhibited VAD, which was more common on the right side (n = 5). CONCLUSIONS: The morphologic variations and frequencies described above have implications for the early prevention, abnormal anatomy detection, accurate diagnosis, safe surgery and endovascular treatment of cardiovascular and neurological disease.

Anatomical variations of the aortic arch branches in a sample of Chinese cadavers: embryological basis and literature review.

OBJECTIVES: The aim of this study is to determine the incidence and explore the types of aortic arch branch variations found in our cadavers. METHODS: The types and incidence of aortic branch variations in 120 cadavers were analysed after careful dissection. RESULTS: One hundred and six of 120 cadavers had normal aortic arch branches and gave rise to usual branches, namely the brachiocephalic trunk, the left common carotid artery and the left subclavian artery. The remaining 14 cadavers had 2 basic types of branch variations, thus accounting for an incidence of 11.67%. A total of 9 aortic arches emitted 4 branches; the brachiocephalic trunk, the left common carotid artery, the left vertebral artery and the left subclavian artery (incidence 7.5%). The second subgroup of 5 cadavers also emitted 4 aortic branches: the right common carotid artery, the left common carotid artery, the left subclavian artery and the right subclavian artery (incidence 4.16%). In this group, the right subclavian artery sprung as a distal branch of the aortic arch (descending), thus making a vascular ring that takes a superoposterior course round the back of the trachea and the oesophagus to reach the right side. There was a single cadaver, different from the other 4 aortic branches of the second group which had a common origin for the common carotid arteries, while the left subclavian artery and distally placed right subclavian artery were present. We did not observe any Kommerell's aortic diverticula. CONCLUSIONS: The variations of aortic arch branching are complex and diverse due to varied possible alterations in the embryological processes. There is an imperative need for further research on these variations to elucidate the possible relationships with clinical diagnostic or surgical events.

Unraveling the evolutionary radiation of the families of the Zingiberales using morphological and molecular evidence.

The Zingiberales are a tropical group of monocotyledons that includes bananas, gingers, and their relatives. The phylogenetic relationships among the eight families currently recognized are investigated here by using parsimony and maximum likelihood analyses of four character sets: morphological features (1), and sequence data of the (2) chloroplast rbcL gene, (3) chloroplast atpB gene, and (4) nuclear 18S rDNA gene. Outgroups for the analyses include the closely related Commelinaceae + Philydraceae + Haemodoraceae + Pontederiaceae + Hanguanaceae as well as seven more distantly related monocots and paleoherbs. Only slightly different estimates of evolutionary relationships result from the analysis of each character set. The morphological data yield a single fully resolved most-parsimonious tree. None of the molecular datasets alone completely resolves interfamilial relationships. The analyses of the combined molecular dataset provide more resolution than do those of individual genes, and the addition of the morphological data provides a well-supported estimate of phylogenetic relationships: (Musaceae ((Strelitziaceae, Lowiaceae) (Heliconiaceae ((Zingiberaceae, Costaceae) (Cannaceae, Marantaceae))))). Evidence from branch lengths in the parsimony analyses and from the fossil record suggests that the Zingiberales originated in the Early Cretaceous and underwent a rapid radiation in the mid-Cretaceous, by which time most extant family lineages had diverged.

Phylogenetic relationships of Theaceae inferred from chloroplast DNA sequence data.

Tribal and generic relationships within Theaceae were investigated using cladistic analyses of chloroplast-encoded rbcL and matK + flanking intergenic spacer region data. Molecular data were employed because recent morphological and anatomical studies of tea (Camellia sinensis) and related plant species provide conflicting support for tribal and generic relationships within the family. Parsimony analyses of separate and combined data consistently identify three strongly supported lineages: Theeae, Stewartieae, and Gordonieae. These data support the broad generic circumscription of Camellia and Stewartia but do not support the recognition of Gordonia sensu lato. Gordonia lasianthus and Gordonia brandegeei are the basal clade in Gordonieae, a position far removed from all other representatives of Gordonia sensu lato (Polyspora and Laplacea) included in this study. This phylogeny most closely mirrors Airy-Shaw's tribe Camellieae [= Theeae] and his two subtribes Stewartiinae and Gordoniinae, first published in 1936. We recognize all three major lineages at the tribal level, although there is weak statistical support for a sister relationship between Gordonieae and Theeae. We also find statistical support for the recognition of the two former subfamilies Theoideae and Ternstroemioideae as two separate families, Theaceae and Ternstroemiaceae.

Relationship of physicians' nonverbal communication skill to patient satisfaction, appointment noncompliance, and physician workload.

A field study of 28 residents in family practice was conducted. Physicians' self-reports of empathy, self-monitoring ability, and affective communication skill as well as their objectively measured nonverbal communication skills were examined as predictors of patient satisfaction, appointment noncompliance, and physician workload (schedule density). Physicians completed the Hogan Empathy Scale, Snyder Self-Monitoring Scale, Affective Communication Test, short form of the Profile of Nonverbal Sensitivity, and a nonverbal encoding task. Patient satisfaction with communication, affective care, and technical care was assessed using a 25-item, visit-specific satisfaction scale. Appointment records were used to determine the number of patients seen by each physician and the compliance of patients with scheduled appointments. Results indicated that the three self-report measures were unrelated to the measures of patient noncompliance and patient satisfaction, but self-reported affective communication ability was significantly correlated with physician workload. Objectively measured physician sensitivity to audio communication predicted patient compliance: More sensitive physicians experienced fewer unrescheduled appointment cancellations. Nonverbal encoding skill was significantly related to patient satisfaction with affective care and to physician workload.

Predicting patient satisfaction from physicians' nonverbal communication skills.

The relationship between physicians' nonverbal communication skills (their ability to communicate and to understand facial expression, body movement and voice tone cues to emotion) and their patients' satisfaction with medical care was examined in 2 studies. The research involved 71 residents in internal medicine and 462 of their ambulatory and hospitalized patients. Standardized, reliable and valid measures of nonverbal communication skills were administered to the physicians. Their scores on these tests were correlated with ratings they received from a sample of their patients on measures of satisfaction with the technical aspects and the socioemotional aspects (or art) of the medical care they received. While the nonverbal communication skills of the physicians bore little relationship to patients' ratings of the technical quality of care, measures of these skills did predict patient satisfaction with the art of medical care received. Across both samples, physicians who were more sensitive to body movement and posture cues to emotion (the channel suggested by nonverbal researchers as the one in which true affect can be perceived) received higher ratings from their patients on the art of care than did less sensitive physicians. In addition, physicians who were successful at expressing emotion through their nonverbal communications tended to receive higher ratings from patients on the art of care than did physicians who were less effective communicators. The implications of successfully identifying characteristics of physicians with whom patients are satisfied are discussed.

PIP: The association between the nonverbal communication skills of physicians and patient satisfaction with medical care was assessed in 2 studies involving 71 residents in internal medicine and 462 patients. Scores on standardized, reliable, and valid measures of nonverbal skills such as the ability to communicate and to understand facial expressions, body movement, and voice tone cues to emotion were correlated with the ratings physicians received from patients regarding satisfaction with the technical and socioemotional aspects of the medical care received. Although physicians' nonverbal communication skills were little related to patients' ratings of the technical qualities of care received, measures of these skills did predict satisfaction with "art of care" aspects. Specifically, the art of care assessment was dependent on the physicians' skill at understanding bodily nonverbal communication, the physicians' capacity to express emotion through voice tone, and their ability to avoid communicating negative emotion when intending positive. These findings provide support to the centrality of interpersonal effectiveness to the physician-patient relationship, especially nonverbal sensitivity and expressiveness. Improvements in the level of physicians' nonverbal encoding and decoding skills through training and selection can be expected to improve the quality of medical care and perhaps even its cost-effectiveness.

Patients' percentions of physicians' behavior: determinants of patient commitment to the therapeutic relationship.

This study examines the hypothesis that patients decide to remain committed to their primary care physicians (or to leave them and "doctor shop") primarily on the basis of the "socioemotional" aspects of the physicians' behavior. It was hypothesized that physicians' demonstrations of caring for patients as people and their openness of communication would be predictive of patient commitment to the therapeutic relationship, and that the physicians' competence and role performance (including thoroughness of information gathering) as perceived by patients would be less important. Interviews were conducted with 342 inpatients and ambulatory patients in a large urban community teaching hospital after a visit with one of 38 house officers in internal medicine. Each patient was asked to (a) rate his or her physician on nine performance variables, (b) indicate his or her intention to return to that physician in the future or seek a different one, and (c) state his or her education, occupation, age, and present illness condition. The physicians' socioemotional behavior (caring and openness to communication), as well as their accessibility, tended to weight heavily in patients' decisions to continue the physician-patient relationship. In addition, the importance of some specific physician behaviors (for example, the physician's willingness to explain the medical condition) varied among subpopulations of patients.