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Evaluation of youth preferences for rapid and innovative human immunodeficiency virus antibody tests.

OBJECTIVE: To determine youth preferences for Food and Drug Administration (FDA)-approved and investigational human immunodeficiency virus (HIV) antibody collection and testing methods before and after subjects learned of test result response times; to determine how influential test result response times are on participants' preferences. DESIGN: After health educators explained and demonstrated 6 different HIV antibody collection and testing strategies (3 saliva, 1 urine, and 2 fingerstick methods), participants completed a confidential survey about test method preference and tried the different testing methods. The participants had an opportunity to re-rank their test method preference after learning about each test's result response time. SETTING: Health education sessions in both clinical and community settings. PARTICIPANTS: Youths aged 12 to 24 years. RESULTS: An oral collection device with a rapid saliva test was the most highly preferred test method. The preference for this method and the rapid response test methods via fingerstick procedures improved significantly after subjects learned of the rapid result response time, while the other methods were given significantly lower preference rankings after subjects learned of the longer result response times. Shifts in preference rankings were not related to sex, age, ethnic group, experience with HIV testing, or practice of risk behaviors. CONCLUSIONS: Our research supports the use of noninvasive and rapid HIV testing methods with rapid response times for adolescents to assist in the early identification of HIV status, while offering HIV prevention opportunities and immediate linkage to care.

Adolescent↗

What medical schools and universities can learn from one another.

Colleges and universities devoted to undergraduate education and non-medical graduate education (hereafter called "universities") have much to teach medical schools and much to learn from them. Universities and medical schools differ significantly in their sources of revenue, cultures of promotion and tenure, academic values, and decision-making processes. Yet from the experience of universities, medical schools can learn innovative techniques of curriculum assessment and teaching, how to handle diversity issues, and ways to expand the definition of scholarship. In turn, medical schools can help teach universities the importance of fiscal and regulatory accountability, the benefits of interdisciplinary efforts, the practical benefits of problem-based learning, and techniques for adjusting to rapid change. The authors, all with medical school faculty backgrounds, developed the views reported in this article when they were Fellows in a leadership training program sponsored by the American Council on Education (ACE). They urge their colleagues to reach out beyond their specialties and departments and learn from higher education institutions that are grappling with problems analogous to those faced by medical schools.

Schools, Medical↗

Learning disabilities in Costa Rica: challenges for an "army of teachers".

Special education services in the country of Costa Rica have been affected by factors that most developing countries confront: shortages of trained personnel, geographic isolation of a large sector of the population, and severe economic limitations. Despite these challenges, services for students with learning disabilities in Costa Rica have rapidly expanded in the last 15 years through the development of resource rooms, recargo classrooms, and itinerant teacher delivery systems. The history and evolution of special education services in Costa Rica are described, along with critical issues that impede the expansion of educational services to students with learning disabilities, particularly in rural areas.

Adolescent↗

Disruption of the dopamine beta-hydroxylase gene in mice suggests roles for norepinephrine in motor function, learning, and memory.

Mice unable to synthesize norepinephrine (NE) were created by targeted disruption of the dopamine beta-hydroxylase (DBH) gene. DBH-deficient (DBH -/-) mice display normal home cage activity; however, they swim more slowly than their littermates, and some drown. The mutant mice also perform less well on a rapidly rotating rod, and approximately 20% do not learn to walk when the rod begins to turn. Restoration of NE with dihydroxyphenylserine eliminated these motor deficits. DBH -/- mice exhibit normal learning and retention of a passive avoidance paradigm; however, they do not master an active-avoidance paradigm as readily as controls and exhibit more rapid extinction of the active-avoidance task. DBH -/- mice learn to find the hidden platform in the Morris water maze in spite of their slower swim speed and show normal preference for the correct quadrant in the transfer test immediately after training. However, this preference declines relative to controls during the next 2 days.

Animals↗

Conditioned activation of fetal behavior.

Previous demonstrations of prenatal learning have relied upon experimental protocols involving training at one gestational age and testing at a later age, potentially confounding effects of experience and retention with developmental changes in the fetus's behavioral repertoire. In this study, a single-session paradigm, which involved the pairing of a neutral chemosensory stimulus (sucrose CS) with a second stimulus that activates behavior (lemon US), was used to assess the learning capacity of the rat fetus. Four CS-US pairings were effective in promoting behavioral activity in 20-day-old rat fetuses when they were reexposed to the sucrose CS alone. The functional expression of conditioned behavioral activation on day 20 of gestation occurs at a time when CNS structures, many of which are involved in sensory processing and learning in older animals, are still undergoing rapid differentiation in the rat fetus.

Animals↗

Associative retuning in the thalamic source of input to the amygdala and auditory cortex: receptive field plasticity in the medial division of the medial geniculate body.

The medial division of the medial geniculate body (MGm) projects to the lateral amygdala and the upper layer of auditory cortex and develops physiological plasticity rapidly during classical conditioning. The effects of learning on frequency receptive fields (RFs) in the MGm of the guinea pig have been determined. Classical conditioning (tone-footshock), as indexed by rapid development of conditioned bradycardia, produced conditioned stimulus (CS)-frequency specific RF plasticity: increased response at the CS frequency with decreased responses at other frequencies, both immediately and after a 1-hr retention period. Sensitization training produced only general changes in RFs. These findings are considered with reference to both the elicitation of amygdala-mediated, fear-conditioned responses and the mechanism of retrieval of information stored in the auditory cortex during acquisition.

Amygdala↗

Acute effects of corticosterone on LiCl-induced rapid gustatory conditioning in rats: a microstructural analysis of licking patterns.

Acute administration of corticosterone (Cort) has been shown to potentiate a variety of learning processes. Here, the effects of Cort on rapid gustatory conditioning were examined using a lick monitoring system. Over a 3-day period, animals were given intraperitoneal (ip) injections of either a low dose of lithium chloride (LiCl; 0.75 mEq, ip) toxin or saline control (NaCl; 0.9%, ip) and then received an injection of Cort (5 mg/kg, ip) or cyclodextrin vehicle. In order to investigate the effect of acute increases in systemic Cort on gustatory conditioning, patterns of licking behavior were recorded while animals were exposed to a novel sucrose (0.3 M) tastant. Increased post-injection serum Cort levels were verified by radioimmunoassay analysis of trunk blood samples. Analysis of the licking patterns revealed evidence of rapid gustatory conditioning. Significantly reduced sucrose intake volumes and fewer total licks during the test sessions on Conditioning days were found in all groups that had received LiCl injections. Evidence of a Cort-potentiated conditioning effect was also found. Animals that had received Cort in addition to LiCl exhibited significantly shorter meal durations than did animals that had been administered LiCl alone and Cort significantly influenced the effects of LiCl on cluster number. These findings indicate that Cort facilitates conditioning, possibly by modulation of LiCl-induced visceral afferent and/or central feedback mechanisms.

Animals↗

Learning alters local face space geometry.

The effects of learning on the geometry of face space were investigated by measuring thresholds for discrimination and recognition of synthetic faces. This was based on a novel experimental technique that permitted measurement of psychometric functions for face recognition. Two major results were obtained. First, thresholds for face recognition were significantly better than thresholds for discrimination among novel faces. Second, rapid discrimination in the neighborhood of learned faces was better than discrimination near novel faces. Control experiments showed that this discrimination improvement occurred only with learned faces, and it could not be explained by generalized discrimination learning. Thus, face learning selectively alters or distorts face space in the vicinity of learned faces. This alteration may be due to an improvement in the signal/noise ratio as a result of face learning.

Discrimination, Psychological↗

Implementation of new surgical technology: outcome measures for lymphatic mapping of breast carcinoma.

BACKGROUND: Recent advances in technology and the subsequent development of minimally invasive surgical techniques have heralded a new era in the surgical treatment of breast cancer. The dilemma of how to train surgeons in new technologies requires teaching, certification, and outcomes reporting in a non-threatening and non-economically damaging manner. This study examines 700 cases of lymphatic mapping and sentinel lymph node (SLN) biopsy for breast cancer and documents surgeon-specific and institution-specific learning curves. METHODS: Seven hundred cases of lymphatic mapping and SLN biopsy were examined. All procedures were performed using a combination of vital blue dye and radiolabeled sulfur colloid. Learning curves were generated for each surgeon as a plot of failure rate versus number of cases. RESULTS: Examination of the learning curves in this study demonstrates similar characteristics. Following a high initial failure rate, there is a rapid decrease after the first twenty cases. The learning curve, representing the mean of the five surgeons' experience, indicates that 23 cases and 53 cases are required to achieve success rates of 90% and 95%, respectively. CONCLUSIONS: The initial reports regarding lymphatic mapping combined with this experience of 700 cases confirm the presence of a significant learning curve. Although this procedure may have an inherent failure rate, it is important to identify those factors that are under the control of the surgeon and, therefore, subject to improvement. We believe that these data provide surgeons performing lymphatic mapping and SLN biopsy with a new paradigm for assessing their skill and adequacy of training.

Axilla↗

[The role of quinine chlorhydrate in the conditioned inhibition of the tarsal reflex in Drosophila melanogaster].

The proboscis extension reflex (PER) can be elicited by applying a sucrose stimulation to the tarsus of a walking fly. This reflex decreases in frequency with repetition, presumably habituation, a nonassociative learning. If each sucrose stimulation is followed by a bitter stimulation, quinine chloride, the PER declines more rapidly, probably the result of conditioning, an associative learning. The present work shows that quinine chloride does not always inhibit PER suppressions but depends on the moment of delivery, being most effective when presented immediately after a sucrose stimulation. A bitter stimulus presented before, or simultaneously with a sucrose stimulation is less effective than habituation to sucrose alone. This experiment provides evidence for an interpretation in terms of cognitive association. The model of learning is not a Pavlovian conditioning as advanced by Medioni and Vaysse (1975), but corresponds to the punishment paradigm of Dyal and Corning (1973).

Animals↗

The effects of scopolamine and clonidine upon the performance and learning of a motor skill.

Twenty-eight subjects practised a task involving procedural knowledge in which a moving target has to be followed for two 3-min sessions. They were then randomly allocated to receive an IV injection of 0.4 mg scopolamine, 0.15 mg clonidine or saline. General impairment due to both active treatments was seen 20 min later in significantly decreased tracking performance. Subjects then had to learn a mirror-reversed version of the tracking task. This involved acquiring novel procedural knowledge. Subjects who had either saline or clonidine treatment showed rapid temporary improvements and also considerable permanent learning. Subjects treated with scopolamine, however, showed only slow temporary improvement and little permanent improvement in their performance at this task. This result suggests that a normally functioning cholinergic system is necessary not only for an efficient working memory but also for the long term acquisition of some kinds of procedural knowledge.

Adolescent↗

Unsupervised statistical learning of higher-order spatial structures from visual scenes.

Three experiments investigated the ability of human observers to extract the joint and conditional probabilities of shape co-occurrences during passive viewing of complex visual scenes. Results indicated that statistical learning of shape conjunctions was both rapid and automatic, as subjects were not instructed to attend to any particularfeatures of the displays. Moreover, in addition to single-shape frequency, subjects acquired in parallel several different higher-order aspects of the statistical structure of the displays, including absolute shape-position relations in an array, shape-pair arrangements independent of position, and conditional probabilities of shape co-occurrences. Unsupervised learning of these higher-order statistics provides support for Barlow's theory of visual recognition, which posits that detecting "suspicious coincidences" of elements during recognition is a necessary prerequisite for efficient learning of new visual features.

Adult↗

The learning curve for laparoscopic cholecystectomy. The Southern Surgeons Club.

BACKGROUND: The use of laparoscopic surgical procedures without previous training has grown rapidly. At the same time, there have been allegations of increased complications among less experienced surgeons. METHODS: Using multivariate regression analyses, we evaluated the relationship between bile duct injury rate and experience with laparoscopic cholecystectomy for surgeons in the Southern Surgeons Club. RESULTS: Fifty-five surgeons performed 8,839 procedures. Fifteen bile duct injuries (by 13 surgeons) resulted with 90% of the injuries occurring within the first 30 cases performed by an individual surgeon. Multivariate analyses indicated that the only significant factor associated with an adverse outcome was the surgeon's experience with the procedure. A regression model predicted that a surgeon had a 1.7% chance of a bile duct injury occurring in the first case and a 0.17% chance of a bile duct injury at the 50th case. CONCLUSIONS: While surgeons appear to learn this procedure rapidly, institutions might consider requiring surgeons to move beyond the initial learning curve before awarding privileges.

Bile Ducts↗

A new vision for distance learning and continuing medical education.

Increasing demands on continuing medical education (CME) are taking place at a time of significant developments in educational thinking and new learning technologies. Such developments allow today's CME providers to better meet the CRISIS criteria for effective continuing education: convenience, relevance, individualization, self-assessment, independent learning, and a systematic approach. The International Virtual Medical School (IVIMEDS) provides a case study that illustrates how rapid growth of the Internet and e-learning can alter undergraduate education and has the potential to alter the nature of CME. Key components are a bank of reusable learning objects, a virtual practice with virtual patients, a learning-outcomes framework, and self-assessment instruments. Learning is facilitated by a curriculum map, guided-learning resources, "ask-the-expert" opportunities, and collaborative or peer-to-peer learning. The educational philosophy is "just-for-you" learning (learning customized to the content, educational strategy, and distribution needs of the individual physician) and "just-in-time" learning (learning resources available to physicians when they are required). Implications of the new learning technologies are profound. E-learning provides a bridge between the cutting edge of education and training and outdated procedures embedded in institutions and professional organizations. There are important implications, too, for globalization in medical education, for multiprofessional education, and for the continuum of education from undergraduate to postgraduate and continuing education.

Education, Distance↗

The electronic learning zone in health informatics.

This paper outlines developments in health informatics education arising from the rapid development of the Internet and the growing importance of lifelong learning. The drivers for change in educational delivery are examined and examples of related uses of the Internet are given. The development of the Electronic Learning Zone at the University of Surrey is described and the paper concludes with the probable future extensions to support lifelong learning.

Computer-Assisted Instruction↗

Requirement of new protein synthesis of a transcription factor for memory consolidation: paradoxical changes in mRNA and protein levels of C/EBP.

Some specific transcription factors are essential for memory consolidation across species. However, it is still unclear whether only the activation of constitutively expressed forms of these conserved transcription factors is involved in memory consolidation or their de novo synthesis also occurs after learning. This question has remained unanswered partly because of the lack of an efficient method for the determination of copy numbers of particular mRNAs in single neurons, which allows the detection of new transcription at the cellular level. Here we applied a newly developed protocol of single-cell quantitative real-time polymerase chain reaction (qRT-PCR) to single neurons playing an important role in associative learning. Specifically, we examined the changes in the mRNA and protein expression levels of a highly conserved transcription factor, CCAAT/enhancer binding protein (C/EBP), in the paired B2 motoneurons of the pond snail Lymnaea stagnalis. These buccal neurons are involved in the motor control of feeding behavior, with a potentially important role in conditioned taste aversion (CTA). Single-cell qRT-PCR revealed a significant decrease in LymC/EBP mRNA copy numbers in the B2 motoneurons during memory consolidation after CTA training. By contrast, isoelectric focusing and immunoblotting of extracts of the buccal ganglia showed that translation and phosphorylation levels of LymC/EBP significantly increased during memory consolidation. The C/EBP-like immunoreactivity in the B2 motoneurons, which are the major immunopositive component in the buccal ganglia, also significantly increased during memory consolidation, suggesting that the main source of increase in the level of protein in the buccal ganglia are the B2 motoneurons. Thus, early memory consolidation after CTA learning in L.stagnalis involves both the rapid synthesis and phosphorylation of LymC/EBP as well as the rapid breakdown of LymC/EBP mRNA in the neural network controlling feeding, suggesting that all of these processes play a role in the function of C/EBP in memory consolidation.

Amino Acid Sequence↗

[The study of tool use as the way for general estimation of cognitive abilities in animals].

Investigation of tool use is an effective way to determine cognitive abilities of animals. This approach raises hypotheses, which delineate limits of animal's competence in understanding of objects properties and interrelations and the influence of individual and social experience on their behaviour. On the basis of brief review of different models of manipulation with objects and tools manufacturing (detaching, subtracting and reshaping) by various animals (from elephants to ants) in natural conditions the experimental data concerning tool usage was considered. Tool behaviour of anumals could be observed rarely and its distribution among different taxons is rather odd. Recent studies have revealed that some species (for instance, bonobos and tamarins) which didn't manipulate tools in wild life appears to be an advanced tool users and even manufacturers in laboratory. Experimental studies of animals tool use include investigation of their ability to use objects physical properties, to categorize objects involved in tool activity by its functional properties, to take forces affecting objects into account, as well as their capacity of planning their actions. The crucial question is whether animals can abstract general principles of relations between objects regardless of the exact circumstances, or they develop specific associations between concerete things and situations. Effectiveness of laboratory methods is estimated in the review basing on comparative studies of tool behaviour, such as "support problem", "stick problem", "tube- and tube-trap problem", and "reserve tube problem". Levels of social learning, the role of imprinting, and species-specific predisposition to formation of specific domains are discussed. Experimental investigation of tool use allows estimation of the individuals' intelligence in populations. A hypothesis suggesting that strong predisposition to formation of specific associations can serve as a driving force and at the same time as obstacle to animals' activity is discussed. In several "technically gifted" species (such as woodpecker finches, New Caledonian crows, and chimpanzees) tool use seems to be guided by a rapid process of trial and error learning. Individuals that are predisposed to learn specific connections do this too quickly and thus become enslaved by stereotypic solutions of raising problems.

Adaptation, Psychological↗

Effects of two ACTH analogs on successive odor discrimination learning in rats.

Olfactory discrimination learning has been shown to provide a powerful tool to investigate the mechanisms involved in the formation, storage and retrieval of information in rodent CNS. In the present study we tested the effects of two ACTH analogs, which were previously reported to influence the processes of learning and memory, on various olfactory learning tasks. The ACTH(4-9) analog HOE 427 produced an apparent increase in storage of olfactory information as shown by the difficulty experienced by the animals to rapidly reverse their behavioral responses to previously learned odors. Similarly, the ACTH (4-9) analog ORG 2766 appears to enhance the storage of olfactory information when administered either before or after the learning trials. These data are consistent with the notion that ACTH and related analogs facilitate performance in a variety of learning tasks. In addition, our results suggest possible mechanisms by which some neuroactive peptides might modulate learning and memory processes in the CNS.

Adrenocorticotropic Hormone↗