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PubMed1989

Information technology in postgraduate medical education.

Information technology in postgraduate medical education has developed rapidly over the last 5 years. This report describes the experience of setting up a computer-based information system in postgraduate centres in the West of Scotland. It includes a viewdata service, library facilities, computer-assisted learning, word processing, and statistics. An electronic mail system provides rapid communication between users. The costing and some of the problems in setting up such systems are discussed.

Education, Medical, Graduate↗
PubMed1996

Spatial reversal learning in preclinical scrapie-inoculated mice.

Acquisition and reversal of a two-choice spatial discrimination were tested in scrapie-inoculated mice. Both acquisition and reversal were normal in mice tested 138 and 103 days prior to the onset of clinical symptoms. At 65 days before onset of clinical symptoms, scrapie-inoculated mice required more trails to criterion in reversal learning, but this effect was not significant in a second experiment (68 days preclinical) and was transient: no effect was seen 33 days before symptoms. However, the course of reversal learning was abnormal in all three late preclinical groups (68, 65 and 33 days before symptoms). Reversal learning in these three groups was characterized by a rapid extinction of the original discrimination, followed by a period, absent in controls, during which performance showed no further improvement. This effect corresponds in time of onset to the appearance of characteristic neuropathological features.

Animals↗
PubMedDate not supplied

Impaired conditioned taste aversion learning in spinophilin knockout mice.

Plasticity in dendritic spines may underlie learning and memory. Spinophilin, a protein enriched in dendritic spines, has the properties of a scaffolding protein and is believed to regulate actin cytoskeletal dynamics affecting dendritic spine morphology. It also binds protein phosphatase-1 (PP-1), an enzyme that regulates dendritic spine physiology. In this study, we tested the role of spinophilin in conditioned taste aversion learning (CTA) using transgenic spinophilin knockout mice. CTA is a form of associative learning in which an animal rejects a food that has been paired previously with a toxic effect (e.g., a sucrose solution paired with a malaise-inducing injection of lithium chloride). Acquisition and extinction of CTA was tested in spinophilin knockout and wild-type mice using taste solutions (sucrose or sodium chloride) or flavors (Kool-Aid) paired with moderate or high doses of LiCl (0.15 M, 20 or 40 mL/kg). When sucrose or NaCl solutions were paired with a moderate dose of LiCl, spinophilin knockout mice were unable to learn a CTA. At the higher dose, knockout mice acquired a CTA but extinguished more rapidly than wild-type mice. A more salient flavor stimulus (taste plus odor) revealed similar CTA learning at both doses of LiCl in both knockouts and wild types. Sensory processing in the knockouts appeared normal because knockout mice and wild-type mice expressed identical unconditioned taste preferences in two-bottle tests, and identical lying-on-belly responses to acute LiCl. We conclude that spinophilin is a candidate molecule required for normal CTA learning.

Animals↗
PubMed1987

Carbamazepine plasma concentration. Relationship to cognitive impairment.

Neuropsychological function was assessed before and after carbamazepine monotherapy in children with newly diagnosed complex partial epilepsy. Simultaneous video-electroencephalographic monitoring examined the influence of subclinical abnormal electrical discharges on performance. Total and unbound plasma carbamazepine concentrations were examined in relation to changes in performance at low (carbamazepine level, less than or equal to 32 mumol/L [less than or equal to 7.5 mg/L]) and moderate (carbamazepine level, greater than 34 mumol/L [greater than 8.0 mg/L]) drug levels. The data suggest a mild beneficial effect of carbamazepine on speeded eye-hand coordination and, at low drug levels, more rapid processing of items in memory. Efficiency of learning new information and memory-scanning rate displayed a concentration-dependent relationship with carbamazepine level, with poor performance significantly associated with higher carbamazepine plasma concentrations. Carbamazepine free levels were equivalent to total levels in predicting cognitive side effects.

Carbamazepine↗
PubMedDate not supplied

Measurements of volatile organic compounds in the earth's atmosphere using proton-transfer-reaction mass spectrometry.

Proton-transfer-reaction mass spectrometry (PTR-MS) allows real-time measurements of volatile organic compounds (VOCs) in air with a high sensitivity and a fast time response. The use of PTR-MS in atmospheric research has expanded rapidly in recent years, and much has been learned about the instrument response and specificity of the technique in the analysis of air from different regions of the atmosphere. This paper aims to review the progress that has been made. The theory of operation is described and allows the response of the instrument to be described for different operating conditions. More accurate determinations of the instrument response involve calibrations using standard mixtures, and some results are shown. Much has been learned about the specificity of PTR-MS from inter-comparison studies as well the coupling of PTR-MS with a gas chromatographic interface. The literature on this issue is reviewed and summarized for many VOCs of atmospheric interest. Some highlights of airborne measurements by PTR-MS are presented, including the results obtained in fresh and aged forest-fire and urban plumes. Finally, the recent work that is focused on improving the technique is discussed.

Journal Article↗
PubMed2007

Hepatitis C virus--biology, host evasion strategies, and promising new therapies on the horizon.

Hepatitis C reduces the quality of life for some 170 million people around the globe and is one of the most prevalent diseases on the planet. It is caused by the hepatitis C virus (HCV) that is replicated by an error-prone polymerase and therefore undergoes rapid evolution. To date, although much has been learned about the biology of HCV, only a partially effective combination therapy comprised of ribavirin and pegylated-interferon-alpha is available to hepatitis C sufferers. Given the prevalence of hepatitis C, together with the fact that almost half the chronically infected HCV patients are refractory to current therapy, there is an urgent need for an efficacious immunoprophylactic that protects individuals from HCV infection, as well as drugs that impede the viral life cycle effectively and eradicate infection. Herein, I provide an overview of the molecular biology of HCV, highlighting the functions of different virally encoded proteins in terms of how they alter signaling pathways of host cell to establish an infection and discuss whether a more promising therapy for treating hepatitis C is anywhere in sight.

Antiviral Agents↗
PubMed1994

A stimulus control technique for improving the efficacy of an established toilet training program.

Standard toilet training regimens used with children with developmental disabilities have demonstrated effectiveness at achieving bladder and bowel continence. However, in some clinical applications in everyday practice, success has not been achieved, necessitating research into possible modifications of the current approaches. A widely used toilet training program was modified to reduce toileting accidents of a referred child. The modification involved the assessment of the discriminative stimulus for eliminating, namely, his undergarments. By removing the undergarments when an elimination became imminent, an "errorless" learning paradigm was established that allowed for more rapid and enduring acquisition of toileting skills than seen in previous training attempts. The results indicate the present procedure could expedite training for individuals who are difficult to teach appropriate toileting skills through an analysis of the controlling antecedent stimulus for accidents and subsequent manipulation of such stimuli.

Autistic Disorder↗
PubMed1988

Rate of forgetting in mild Alzheimer's-type dementia.

Patients with mild dementia of the Alzheimer's type (DAT) and matched controls were examined for rate of forgetting line drawings of common objects. DAT patients demonstrated rapid forgetting in the first 10 min after learning to criterion. This finding is discussed with respect to memory consolidation and neuropathologic changes in dementia of the Alzheimer's type.

Aged↗
PubMed2005

Gaining hospital administrators' attention: ways to improve physician-hospital management dialogue.

BACKGROUND: Despite marked differences in training and professional interests, physicians and hospital managers face similar problems stemming from the unprecedented rate of change in the health care delivery system: failure of reimbursement to keep pace with rising costs, new therapeutic modalities, increasing government and managed care regulations, heightened consumerism, and an aging patient population. In the face of these mounting challenges, both physicians and hospital managers could benefit significantly from a climate of collaboration and interdependence. METHODS: This article presents a "case report" of a community teaching hospital in which practicing physicians and hospital administrators collaborated to develop an operating plan for the next 3 years to improve the practice environment. RESULTS: The physicians recommended new clinical priorities to enhance service to patients and families, to improve physician-physician communication, to develop clinical protocols, and to build coordinated diagnostic treatment centers, which the administration has implemented. SIGNIFICANCE: Physicians and hospital managers can no longer pass on cost increases at will to patients and third-party payers. Nor can physicians and managers ignore the heightened power of patients and third-party payers. Effective dialogue and collaboration are in all parties' interests to optimize patient care and to develop innovative services. Despite the tensions created by competition and rapid change, transformation from a blaming to a learning environment may be a key strategic advantage in today's health care marketplace.

Advisory Committees↗
PubMed1999

A survey on partial left ventriculectomy in the Asia-Pacific region.

BACKGROUND: There has been increasing interest in partial left ventriculectomy as a new therapy for end-stage heart failure. Because the most significant impact of this development is likely to be in regions where heart transplantation is largely unavailable, we conducted a survey among a group of cardiac surgeons based in the Asia-Pacific region to evaluate their overall views on partial left ventriculectomy procedures. METHODS: A questionnaire was sent to surgeons from 65 major institutions in 17 countries and regions in the Asia-Pacific. Questions examined current demographics and opinions regarding potential application and future prospects of this operation. RESULTS: Surveyed surgeons were based in equal proportions in academic, government, and private practice institutions. One third of respondents have already performed partial left ventriculectomy operations, largely in small numbers. In total, 86 procedures were performed with 75% hospital survival rate. Failures were thought to be caused by limited knowledge about patient selection criteria and lack of experience with operative technique and perioperative care. The majority of respondents believe that partial left ventriculectomy is potentially a valuable intervention and intend to perform more cases. Nevertheless, most surgeons identified the need to have larger clinical experience, to perform randomized trials against other therapeutic modalities, and to improve perioperative care. CONCLUSIONS: Although all surgeons recognize that more knowledge is needed before partial left ventriculectomy becomes a standard procedure, it is clear from this survey that the procedure has rapidly gained interest, with more surgeons seeking to learn it.

Cardiac Volume↗
PubMed2000

Effect of apomorphine on motor and cognitive function in melancholic patients: a preliminary report.

Given the many clinical parallels between melancholia and disorders associated with impaired dopaminergic function such as Parkinson's Disease (PD), it has been hypothesised that major depressive disorder, and in particular the psychomotor features of melancholic depression, may also be associated with a hypodopaminergic state. If this is the case, then the use of a dopamine agonist might lead to reversal of both the cognitive and motor impairments seen in these patients. A double-blind, placebo-controlled cross-over design was used to test the effect of apomorphine on motor and cognitive function in seven melancholic subjects (as defined by the CORE instrument) and five control subjects. The testing battery included the following items: finger tapping, rapid alternating movements, verbal fluency, Rey Auditory Verbal Learning Task, digit symbol substitution task and simple and complex reaction times. The independent t-test, after covarying for age, revealed significant impairment in melancholic subjects for the walking task and digit symbol substitution at baseline. Results of the ANCOVA revealed no impact of time or drug condition, either alone or in combination, upon task performance in either group whether assessed separately or jointly. Results of a MANCOVA revealed that apomorphine impaired performance on some cognitive tasks, and that this was seen to a lesser extent in melancholics than control subjects. There was no evidence that the dopamine agonist apomorphine improved cognitive or motor function in subjects with strictly defined melancholia, suggesting that psychomotor retardation is not associated with a hypodopaminergic state. Our conclusions, however, were limited by small sample size; minimal baseline task impairment in depressed compared to control subjects; mild sedation in many subjects during task performance; and lack of serum apomorphine levels.

Aged↗
PubMed2003

Hippocampal CA3 NMDA receptors are crucial for memory acquisition of one-time experience.

Lesion and pharmacological intervention studies have suggested that in both human patients and animals the hippocampus plays a crucial role in the rapid acquisition and storage of information from a novel one-time experience. However, how the hippocampus plays this role is poorly known. Here, we show that mice with NMDA receptor (NR) deletion restricted to CA3 pyramidal cells in adulthood are impaired in rapidly acquiring the memory of novel hidden platform locations in a delayed matching-to-place version of the Morris water maze task but are normal when tested with previously experienced platform locations. CA1 place cells in the mutant animals had place field sizes that were significantly larger in novel environments, but normal in familiar environments relative to those of control mice. These results suggest that CA3 NRs play a crucial role in rapid hippocampal encoding of novel information for fast learning of one-time experience.

Action Potentials↗
PubMed1994

The Learning Curve for Laparoscopically Assisted Vaginal Hysterectomy/Laparoscopic Hysterectomy

Appropriate training and experience necessary for a physician to safely perform laparoscopically assisted vaginal hysterectomy (LAVH) has been a subject of great concern. Reviewed is a 2-year experience of an accomplished endoscopist that includes 88 LAVHs. The learning curve was relatively short with the most rapid operating time and perhaps most difficult procedure encountered within the first 20 cases. After this initial experience, adaptations of basic techniques have been applicable to virtually all subsequent cases encountered. Complications were minor with a rate of 19.76%. One conversion to abdominal hysterectomy was necessary (1.15% conversion rate). The average operating time was 121 minutes with the uterine weight ranged from 60 to 740 g. Average hospital stay was 1.86 days with an average recovery time of 12.65 days. In establishing proficiency in performing LAVHs, it is the author's experience that 20 LAVH's are necessary to encounter a wide enough variation in pelvic pathology to mandate a modification of the basic surgical techniques. Thus, in establishing proficiency, it should be considered that the first 20 cases be performed under the supervision of an experienced endoscopic surgeon.

Journal Article↗
PubMed2003

A rapid-cycle collaborative model to promote guidelines for acute myocardial infarction.

BACKGROUND: This American College of Cardiology (ACC) Acute Myocardial Infarction (AMI) Guidelines Applied in Practice (GAP) collaborative in Michigan represented ACC's third initiative, in partnership with local health care coalitions and the Michigan Peer Review Organization. The GAP Pilot Project formed the basis for this project, which supported caregivers' efforts to improve their processes and consistently apply the evidence-based guidelines for AMI care. THE SOUTHEAST MICHIGAN EXPANSION PROJECT: The Institute for Healthcare Improvement (IHI) Breakthrough Series model of improvement was modified to merge the GAP Pilot Project's design with a rapid-cycle quality improvement model. The collaborative included learning sessions that focused on five phases--planning, tool implementation, monitoring tool use, remeasurement, and results--and on increasing tool use rates in each phase. CONCLUSIONS: Building on the work of two previous efforts, the ACC AMI GAP projects yielded substantial collective knowledge. Developing and fostering a collaborative culture allowed hospital teams to avoid barriers or overcome them successfully based on others' experiences and collectively solve problems, and it shortened the learning curve and accelerated QI.

Acute Disease↗
PubMed1990

Effects of brief monocular deprivation on binocular depth perception in the cat: a sensitive period for the loss of stereopsis.

The period of susceptibility for binocular depth vision was studied in kittens by subjecting them to periods of monocular deprivation beginning at different ages. In an initial study, we found that normally reared kittens can learn a depth-discrimination task much more rapidly when tested binocularly than monocularly, even when testing is begun as early at 30 d. In subsequent experiments, kittens were monocularly deprived by eyelid suture, following which their monocular and binocular depth thresholds were measured using the jumping-stand procedure. We obtained the following results: (1) When monocular deprivation is applied before the time of natural eye opening but is discontinued by no later than 30 d, there is very little effect on binocular depth thresholds. (2) When deprivation is begun at 90 d, binocular depth thresholds are unaffected. (3) When deprivation is begun between these two ages, the magnitude of the deficit varies with the period of deprivation and the age at which it begins. (4) By imposing brief (5 or 10 d) periods of deprivation, beginning at different ages, we were able to demonstrate that the peak of the sensitive period is between the ages of 35 and 45 d, with a fairly rapid decline in susceptibility outside those age limits. (5) Even with as little as 5 d of deprivation, substantial permanent deficits in binocular depth vision can be induced.

Animals↗
PubMedDate not supplied

Mutation and repair induced by the carcinogen 2-(hydroxyamino)-1-methyl-6-phenylimidazo[4,5-b]pyridine (N-OH-PhIP) in the dihydrofolate reductase gene of Chinese hamster ovary cells and conformational modeling of the dG-C8-PhIP adduct in DNA.

Three experiments using 20 microM 2-(hydroxyamino)-1-methyl-6-phenylimidazo[4,5-b]pyridine (N-OH-PhIP) were performed to induce mutations in the dihydrofolate reductase (DHFR) gene of a hemizygous Chinese hamster ovary (CHO) cell line (UA21). Metabolized forms of this chemical primarily bind at the C-8 position of guanine in DNA. In total, 21 independent induced mutants were isolated and 20 were characterized. DNA sequencing showed that the preferred mutation type found in 75% of the induced DHFR- clones was G.C-->T.A single and tandem double transversions. In addition to base substitutions, one mutant carried a-1 frameshift and another one had lost the entire locus by deletion. The induced changes affected purine targets on the nontranscribed strand of the gene in nearly all of the mutants sequenced (18/19). At the time that the first two experiments were performed, the initial adduct levels were quantitated in treated cells at the mutagenic dose by 32P-postlabeling. While the induced frequency of mutation was relatively low (approximately 5 x 10(-6), the adduct levels after a 1-h exposure of UA21 cells to 20 microM N-OH-PhIP were relatively high (13 adducts x 10(-6) nucleotides). This latter method was then employed to learn if the induced mutation frequency correlated with rapid overall genome repair of PhIP-DNA adducts. Total adduct levels, determined using DNA samples from treated cells collected after intervals of time, were reduced by about 50% after 6 h, and about 70% after 24 h. Since overall genome repair in CHO cells is relatively slow compared with preferential gene repair, the removal of dG-C8-PhIP adducts was apparently efficient. In order to better understand the mutational and repair results, we performed computational modeling to determine the lowest energy structure for the major dG-C8-PhIP adduct in a repetitively mutated duplex sequence opposite dA. Results of this analysis indicate that the PhIP-modified base resembles previous structural determinations of (deoxyguanosin-8-yl)-aminofluorene; the carcinogen is in the B-DNA minor groove and its adopts a syn conformation mispaired with an anti A. The implications of this conformational distortion in DNA structure for damage recognition by cellular repair enzymes are discussed.

Animals↗
PubMed2003

Can attentional theory explain the inverse base rate effect? Comment on Kruschke (2001).

In J. K. Kruschke's (2001; see record 2001-18940-005) study, it is argued that attentional theory is the sole satisfactory explanation of the inverse base rate effect and that eliminative inference (P. Juslin, P. Wennerholm, & A. Winman, 2001; see record 2001-07828-016) plays no role in the phenomenon. In this comment, the authors demonstrate that, in contrast to the central tenets of attentional theory, (a) rapid attention shifts as implemented in ADIT decelerate learning in the inverse base-rate task and (b) the claim that the inverse base-rate effect is directly caused by an attentional asymmetry is refuted by data. It is proposed that a complete account of the inverse base-rate effect needs to integrate attention effects with inference rules that are flexibly used for both induction and elimination.

Association Learning↗
PubMed2004

Failure to return for HIV test results among persons at high risk for HIV infection: results from a multistate interview project.

BACKGROUND: Voluntary counseling and testing is an important strategy for HIV prevention. For optimal impact, however, clients must return for HIV test results and counseling. The goal of this study was to document the frequency of self-reported failure to return for HIV test results (FTR) and associated reasons among persons at high risk for HIV infection. METHODS: Respondents were recruited at gay bars (men who have sex with men [MSM]), by street intercept (injection drug users [IDUs]), or at sexually transmitted disease clinics (high-risk heterosexuals [HRHs]) in 7 US states in 2000. Self-reported history of and reasons for FTR were evaluated. RESULTS: FTR was commonly reported among 2241 respondents: 10% of MSM, 20% of HRHs, and 27% of IDUs reported FTR at least once. FTR was significantly (P < 0.05) more common among those with higher perceived risk of HIV infection and significantly less common among HRHs who had completed more than high school (vs. high school or General Education Development certificate) or were employed part time (vs. unemployed). About one fourth of respondents cited fear of getting test results as an important reason for FTR. CONCLUSION: Self-reported occurrences of FTR in our venue-recruited sample were similar to proportions of FTR previously reported from publicly funded venues. Increased pretest counseling on fear of learning HIV status and on the availability of rapid testing may help to reduce FTR.

AIDS Serodiagnosis↗