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Nurse education in higher education: understanding cultural barriers to progress.

Nurse education is established in higher education but nurse academics remain concerned about nursing's lack of equal status within the academy. This paper reports findings of a small study of nurse lecturers' views which support other published studies. It argues that cultural factors which contribute to nursing's problems gaining equal status include anti-intellectualism within nursing and academic denigration of practice. These cultural factors are linked to the history of women in higher education, the separation between intellectual education and practical, skill-based training, the low status of caring courses and the resulting mutual denigration of culturally opposed groups. Anti-intellectualism in nursing can be seen as a defensive reaction against an academic culture that defines practical activity as inferior to abstract thinking skills. This can lead to limited educational opportunities to examine the structural and cultural context of nursing. In Freire's view, this is a necessary part of education for freedom. Current cultural change, in nursing and higher education, including an emphasis on learning outcomes and transferable skills, provides new opportunities for nursing to contribute to educational change. Removing cultural barriers to the educated nurse is a responsibility shared by universities and by the nursing profession.

Attitude of Health Personnel↗

Simple models for reading neuronal population codes.

In many neural systems, sensory information is distributed throughout a population of neurons. We study simple neural network models for extracting this information. The inputs to the networks are the stochastic responses of a population of sensory neurons tuned to directional stimuli. The performance of each network model in psychophysical tasks is compared with that of the optimal maximum likelihood procedure. As a model of direction estimation in two dimensions, we consider a linear network that computes a population vector. Its performance depends on the width of the population tuning curves and is maximal for width, which increases with the level of background activity. Although for narrowly tuned neurons the performance of the population vector is significantly inferior to that of maximum likelihood estimation, the difference between the two is small when the tuning is broad. For direction discrimination, we consider two models: a perceptron with fully adaptive weights and a network made by adding an adaptive second layer to the population vector network. We calculate the error rates of these networks after exhaustive training to a particular direction. By testing on the full range of possible directions, the extent of transfer of training to novel stimuli can be calculated. It is found that for threshold linear networks the transfer of perceptual learning is nonmonotonic. Although performance deteriorates away from the training stimulus, it peaks again at an intermediate angle. This nonmonotonicity provides an important psychophysical test of these models.

Animals↗

Summarizing lecture: factors influencing enzymatic H-transfers, analysis of nuclear tunnelling isotope effects and thermodynamic versus specific effects.

In the articles in this Discussion, a wide variety of topics are treated, including reorganization energy, initially introduced for electron transfers ('environmentally assisted tunnelling'), nuclear tunnelling, H/D and 12C/13C kinetic isotope effects (KIEs), the effect of changes of distal and nearby amino acid residues using site-directed mutagenesis, and dynamics versus statistical effects. A coordinate-free form of semi-classical theory is used to examine topics on data such as tunnelling versus 'over-the-barrier' paths and temperature and pressure effects on KIEs. The multidimensional semi-classical theory includes classically allowed and classically forbidden transitions. More generally, we address the question of relating kinetic to thermodynamic factors, as in the electron transfer field, so learning about specific versus thermodynamic effects in enzyme catalysis and KIEs.

Amino Acids↗

Epidural spinal-cord stimulation facilitates recovery of functional walking following incomplete spinal-cord injury.

We investigated a novel treatment paradigm for developing functional ambulation in wheelchair-dependent individuals with chronic, incomplete spinal-cord injury. By coordinating epidural stimulation of the dorsal structures of the spinal cord with partial weight bearing treadmill therapy, we observed improvement in treadmill and over-ground ambulation in an individual with chronic incomplete tetraplegia. The application of partial weight-bearing therapy alone was not sufficient to achieve functional ambulation over ground, though treadmill ambulation improved significantly. Combining epidural spinal-cord stimulation (ESCS, T10-T12 vertebral levels) with partial weight-bearing therapy resulted in further improvement during treadmill ambulation. Moreover, the combination of therapies facilitated the transfer of the learned gait into over ground ambulation. Performance improvements were elicited by applying continuous, charge-balanced, monophasic pulse trains at a frequency of 40-60 Hz, a pulse duration of 800 micros, and an amplitude determined by the midpoint (50%) between the sensory and motor threshold values. The participant initially reported a reduction in sense of effort for over ground walking from 8/10 to 3/10 (Borg scale), and was able to double his walking speed. After several weeks of over ground training, he reached maximum walking speeds of 0.35 m/s, and was able to ambulate over 325 m. We propose that ESCS facilitated locomotor recovery in this patient by augmenting the use-dependent plasticity created by partial weight bearing therapy. Confirmation of these promising results in a controlled study of groups of spinal-cord-injured subjects is warranted.

Adaptation, Physiological↗

Importance of corpus callosum for visual receptive fields of single neurons in cat superior colliculus.

1. Section of the posterior two-thirds of the corpus callosum eliminates almost completely the response of superior colliculus (SC) neurons to stimulation of the contralateral eye in split-chiasm cats. On the contrary, the responsiveness of SC neurons to stimulation of the contralateral eye is not abolished by a transection of the posterior and tectal commissures leaving the corpus callosum intact. The callosal section also reduces the number of SC receptive fields abutting the vertical meridian in the ipsilateral eye of split-chiasm cats. 2. In cats with intact optic pathways, a similar callosal section abolishes the SC representation of the ipsilateral visual field in the ipsilateral eye and also reduces the number of receptive fields adjoining the vertical meridian in the same eye. In the contralateral eye, the SC representation of the ipsilateral visual field is reduced in extension to about one-fifth of that seen in cats with intact commissures. 3. The results suggest that the corpus callosum is the main pathway for cross-midline communication of visual information at not only the cortical, but also the midbrain level. The corpus callosum may subserve this function because it contains uninterrupted crossed corticotectal projections or because it transmits visual information from one hemisphere to contralateral cortical areas projecting ipsilaterally to SC. The latter hypothesis is more likely but, in any case, the findings imply that the lack of interhemispheric transfer of visual learning in cats with a chiasmatic and callosal section may depend on a midline disconnection of both subcortical and cortical visual centers. 4. The corpus callosum is also responsible for the representation of the ipsilateral visual field of the ipsilateral eye in the cat SC. The SC representation of the ipsilateral visual field in the contralateral eye is due, in minimal part, to direct retinotectal connections from temporal retina and, for the largest part, to the corpus callosum. 5. Finally, the corpus callosum contributes to the representation of the contralateral visual field near the vertical meridian of the temporal retina in both split-chiasm and normal cats. This is probably due to the scarcity of direct retinotectal projections from this part of the retina and to their supplementation by corticotectal neurons influenced by the callosal afferents.

Animals↗

The effects of social skills instruction and parental involvement on the aggressive behaviors of African American males.

The purpose of this study was to investigate the effects of social skills instruction on identified acts of aggression. Five elementary-aged African American male students attending general education classes in an urban public school setting were taught social skills using modeling, role playing, corrective feedback, and differential reinforcement of alternative or incompatible behaviors. Parent training and parent notes were used for the maintenance and transfer of newly learned social skills. A multiple baseline design across students, combined with a withdrawal feature, was employed to assess the effectiveness of the social skills instruction. Data were collected in the classroom and cafeteria to assess generalization of the training to naturalistic settings. Results indicate the social skills instructional package to be functionally related to a decrease in aggressive behaviors with four of the five students and maintained by parental involvement.

Black or African American↗

Image transfer and computer-supported cooperative diagnosis.

The KAMEDIN system was designed as a low-cost communication tool as part of a computer-supported cooperative work project that included synchronized user interaction, telepointing and audioconferencing. During a five-month field trial, it was used for medical image transfer and cooperative diagnosis in 14 clinics and medical departments in Germany. During the field test, 297 teleconsultations were performed via ISDN and 875 MByte of data were transferred. An image compression ratio of 2-3 was obtained, so that the total quantity of data transferred corresponded to 14,000-21,000 magnetic resonance images or 3500-5250 computerized tomography images. Furthermore, 694 local sessions were conducted for the preparation of teleconsultations and the review of transferred images. Participants learned to handle the KAMEDIN system in a few hours. This was mainly owing to the design of the user-oriented graphical user interface and the restriction of the system to a set of essential image-processing functions.

Computers↗

Cognitive development, memory, trauma, treatment: An integration of psychoanalytic and behavioral concepts in light of current neuroscience research.

The goal of Freud's Project was to place all psychological functioning on a neurological foundation; however, the resources of his time were inadequate for the task. This article attempts to link basic psychoanalytic and behavioral constructs to current neuroscience, specifically the memory paradigm of multiple trace theory. We propose that Freud's theory of early cognitive development, in which primary process is succeeded by secondary process, corresponds to the progression from a noncontextual taxon-based memory system to a locale system (mediated by hippocampal and cortical structures) in which memories are formed within space/time contexts. The effects of trauma within these models is then examined by noting how Freud's views of repression and regression parallel neuropsychological hypotheses about the ways in which traumatic experience impacts specific brain areas. Finally, the treatment implications of this theoretical synthesis are explored. We posit that transference resembles the learning theory construct of generalization, and the non-contextualized coding of the taxon system. In conclusion, we suggest that orthodox psychoanalytic approaches may have overestimated the efficacy of words and intellectual vectors in effecting therapeutic change. Nonverbal strategies may be required to reach material that is stored in early developing brain areas that may be inaccessible to words.

Behavior Therapy↗

Simultaneous determination of aniline and cyclohexylamine by principal component artificial neural networks.

A specterophotometric method for simultaneous determination of aniline and cyclohexylamine using principal component artificial neural networks is proposed. This method is based on the reactions involving aniline and/or cyclohexylamine, with bis(acetylacetoneethylendiamine)tributylphosphine cobalt(III) perchlorate as a complexing reagent. A nonionic surfactant, Triton X-100, was used for dissolving the complexes and intensifying the signals. The absorption data were based on the spectra registered in the range of 350 - 550 nm. An artificial neural network consisting of three layers of nodes was trained by applying a back-propagation learning rule. Sigmoid transfer functions were used in the hidden and output layers to facilitate nonlinear calibration. The predictive ability of artificial neural networks was examined for the determination of aniline and cyclohexylamine in synthetic mixtures.

Journal Article↗

[Value of a good example: a search for role models in practical clinical teaching].

The importance of the role model function of the 'teacher' (m/f) was always realized to some extent in practical clinical teaching, but appears to be gaining renewed interest at present. There exists, however, a discrepancy between the importance attached by many experienced clinicians and their students to the role model on the one hand, and the amount of systematical study that has been dedicated to it on the other hand. The available date show an impressionistic image of the qualities these students and interns consider important in role models. However, the 'why' of the importance of role models is seldom considered. In an era in which it is considered important that 'learning targets', 'learning moments' and 'transfer mechanisms' are defined in detail, the function of role models in practical clinical teaching should also be given more attention. Insights from other fields of knowledge than the medical field might be of value in designing research leading to a clearer image of the function and the value of role models in practical clinical education.

Education, Medical↗

Are relaxation techniques effective in relief of chronic pain?

Alternative therapies are becoming more popular in the United States despite the lack of scientific evidence supporting that they are effective treatments. Some alternative therapies used in the relief of chronic pain are relaxation techniques, guided imagery, and biofeedback. Overall, the existing research suggests that relaxation techniques are effective in reducing pain [6,8,21]. Research concerning guided imagery has also suggested that it is helpful in reducing pain [19,22,23]. Finally, most of the research concerning biofeedback and the reduction of pain in people with chronic pain has been positive [7,10,14,20]. Despite these findings, one can not conclude that relaxation techniques, guided imagery, and biofeedback are effective in reducing pain in individuals with chronic pain. There were many problems with most of the studies, including small sample sizes and unstated reliability and validity of assessments. These limitations lower the significance of the studies, which makes it impossible to draw conclusions from the research as a whole. More research needs to be conducted to determine the effectiveness of relaxation techniques, guided imagery, and biofeedback concerning chronic pain. Information regarding the transference of these learned techniques to one's roles and daily activities should also be incorporated into the research by occupational therapists.

Journal Article↗

Addressing tobacco in managed care: results of the 2003 survey.

INTRODUCTION: Although tobacco control activity in the United States during the past several years has increased dramatically, tobacco use continues to have devastating consequences among all age cohorts. METHODS: In November 2003, a survey of tobacco control practices and policies in health insurance plans was conducted by America's Health Insurance Plans' national technical assistance office. The survey was the fourth and final survey conducted as part of the Addressing Tobacco in Managed Care program. Of the 215 plans in the sample, 160 (74%) completed the survey. Collectively, these plans represent more than 60 million members of health maintenance organizations. RESULTS: From 1997 to 2003, health insurance plans have demonstrated increasing use of evidence-based programs and clinical guidelines to address tobacco use. The number of plans providing full coverage for any type of pharmacotherapy for tobacco cessation has more than tripled since 1997. Plans have also shown substantial improvement in their ability to identify all or some of their members who smoke. Similarly, a greater percentage of plans are using strategies to address smoking cessation during treatment for other chronic diseases and after acute events such as a myocardial infarction. CONCLUSION: Despite improvements, important opportunities remain for health insurance plans and other stakeholders to expand their tobacco control activities and transfer the lessons learned to other health problems.

Data Collection↗

Guidelines for reporting innovations in computer-based information systems for nursing.

Inconsistent, incomplete reporting of computer applications in nursing is a barrier to building a knowledge base in the field. Progress in building this knowledge base might be accelerated if system developers could use the available literature to build upon work previously done and to profit from lessons already learned. This article presents guidelines for developing articles and reports on computer applications in nursing. Important topics include statement of the problem, proposed solution, description of the system, system impact, relationship to previous work, problems encountered, lessons learned, professional issues, transferability, and future plans. A checklist is provided. The authors welcome comments on these guidelines.

Communication↗

Acquiring and maintaining self-care skills after stroke. The predictive value of apraxia.

The degree of self-care in 120 patients who had suffered unilateral cerebrovascular accident (CVA) was assessed at different stages of recovery. The level of ADL (activities of daily living) function was determined on admission and discharge. Patients with right-sided hemiplegia (r. hem.) were given a set of apraxia tests on admission to the hospital. The results of ADL evaluation showed improved ADL function between admission and discharge, but a worsening after returning home. There were some significant relationships between ADL function in hospital and apraxia. All the apraxia variables are significant as predictors of subsequent dependency. The results show the seriousness of problems related to apraxia in rehabilitation of stroke patients with a lesion in the left hemisphere. One conclusion is that the treatment procedure ought to be directed to the various symptoms of apraxia. The effect of apraxia on ADL in the domestic situation has to be given more attention. More treatment should be given in the home, as patients seem to have difficulty in transferring the skills learned in hospital to the home situation and in maintaining them.

Activities of Daily Living↗

The distribution of the cells of origin of callosal projections in cat visual cortex.

The distribution of neurons projecting through the corpus callosum (callosal neurons) was examined in retinotopically defined areas of cat visual cortex. As many callosal neurons as possible were labeled in a single animal by surgically dividing the posterior two-thirds of the corpus callosum and exposing the cut ends of callosal axons to horseradish peroxidase. The distribution of callosal neurons within a visual field representation was related to standard electrophysiological maps as well as to recording sites marked by electrolytic lesions. Callosal neurons were found in every retinotopically defined cortical area. The portion of the visual field representation that contained callosal neurons increased progressively from the area 17/18 border to area 19, to areas 20 and 21, and to the lateral suprasylvian visual areas. In area 17, the portion of the visual field representation containing callosal neurons extended from the vertical meridian out to a maximum of 10 degrees azimuth. In the posteromedial lateral suprasylvian visual area, callosal neurons were present in a region extending from the vertical meridian representation out to a representation of 60 degrees azimuth. Most callosal neurons were medium to large pyramids at the border of layers III and IV. A few layer IV stellates were among the callosal neurons of areas 17 and 18. In area 19 and even more so in the lateral suprasylvian visual areas, callosal neurons included pyramidal and fusiform-shaped cells in layers V and VI. The laminar distributions of callosal neurons in areas 20 and 21 were similar to those of area 19 and the lateral suprasylvian visual areas. The widespread distribution of callosal neurons in areas 20 and 21 and in the lateral suprasylvian visual areas suggests that the regions of peripheral visual field representation in cat cortex, as well as the representations of the vertical meridian, have access to the opposite cerebral hemisphere. This finding is significant in light of demonstrations of the importance of some of these cortical areas in the interhemispheric transfer of visual learning.

Animals↗

Motor control.

The acquisition of motor skills involves learning, memory, and transfer as well as attention. The aspects of motor control most relevant for everyday practice are the conditions of practice, the knowledge of results, and the assessment of athletes to identify talented performers. The optimal conditions for practice and methods for developing a test battery for use in a sports tryout are discussed.

Attention↗