A&P workshop summary—Uniting Anatomy and Physiology through case studies

Introducing problem-solving based methods of pedagogy is one approach to engage students early in their careers with developing analytic and diagnostic skills. PBL approaches in anatomy and medical teaching are a logical extension of clinical case studies, wherein an example of a pathology or clinical procedure is provided, and students must ascertain the anatomical and/or physiological basis for it. Students report a deeper understanding of material presented in clinical case studies, as the ‘real world’ relevance and importance is immediately clear (Cliff and Wright, 1996)

Knowledge Hidden in Nuances: From Molecules to Society

The Goal: We have discussed the theme of reintegrating biology several times at the national level over several decades (ex. A New Biology for the 21st Century, National Academy of Sciences, 2009). While these discussions are fruitful and certainly the topic may require an adaptive framework, we suggest a fundamental change in how the scientific community approaches this topic. In particular, we propose that biology can only be integrated when the structural, societal and methodological barriers to participation in biology are alleviated. A focus on the average or most prevalent approach or system - whether it is the structure of a protein, a biological process or pathway, or the average scientist - they all end up excluding observations, people, and ideas. In contrast, we propose a focus on and inclusion of nuances will enable us to examine the boundaries and rarer instances whether of topic or of people, enable us to explore, and learn from diversity that is currently unnoticed and may provide new perspectives, insights about the range of possibilities, and solutions to current challenges. By extending this paradigm to our society, including diverse perspectives and experiences may shed light on how we can learn about new ideas, tools, and resources to enhance our collective toolkits and approach solutions for problems we are addressing. The paper will compare the benefits of applying a nuanced approach at a molecular, cellular, organismal, and population levels and then extend this thinking to science and society. We think that including individuals and perspectives that are beyond the current majority/mainstream will enhance our understanding and ability to approach/address problems. Adding nuance to our understanding of science can come from better inclusion and integration. The intended audience for our Vision paper includes the National Science Foundation (NSF), academic and research institutions, and society at large. We hope that NSF has the potential to create and support opportunities for multiscale scientific explorations at the edge of the boundary (outside the averages). Knowledge derived from these observations and analyses can inspire new perspectives and/or solutions that are universally usable. Additionally, other Vision groups in the Reintegrating Biology meetings include topics that could benefit from the vision presented here (space, time, resilience, modelling, communication/signalling, networks, animal learning, biocomplexity). Academic and research institutions may utilize the proposed framework to review their institutional policies that directly or indirectly (via access to resources, opportunities etc.,) restrict collaborations based on interests and expertise. Our hope for society at large is to consider including, sharing, and respecting diverse perspectives and experiences

Ontogenetic scaling of fore- and hind limb posture in wild chacma baboons (Papio hamadryas ursinus)

Sherpa Romeo green journal: open accessLarge-scale interspecific studies of mammals ranging between 0.04–280 kg have shown that larger animals walk with more extended limb joints. Within a taxon or clade, however, the relationship between body size and joint posture is less straightforward. Factors that may affect the lack of congruence between broad and narrow phylogenetic analyses of limb kinematics include limited sampling of (1) ranges of body size, and/or (2) numbers of individuals. Unfortunately, both issues are inherent in laboratory-based or zoo locomotion research. In this study, we examined the relationship between body mass and elbow and knee joint angles (our proxies of fore- and hind limb posture, respectively) in a cross-sectional ontogenetic sample of wild chacma baboons (Papio hamadryas ursinus) habituated in the De Hoop Nature Reserve, South Africa. Videos were obtained from 33 individuals of known age (12 to $108 months) and body mass (2–29.5 kg) during walking trials. Results show that older, heavier baboons walk with significantly more extended knee joints but not elbow joints. This pattern is consistent when examining only males, but not within the female sample. Heavier, older baboons also display significantly less variation in their hind limb posture compared to lighter, young animals. Thus, within this ontogenetic sample of a single primate species spanning an order of magnitude in body mass, hind limb posture exhibited a postural scaling phenomenon while the forelimbs did not. These findings may further help explain 1) why younger mammals (including baboons) tend to have relatively stronger bones than adults, and 2) why humeri appear relatively weaker than femora (in at least baboons). Finally, this study demonstrates how field-acquired kinematics can help answer fundamental biomechanical questions usually addressed only in animal gait laboratories.Ye

Mental, social, and physical well-being in New Hampshire, Oregon, and Washington, 2010 Behavioral Risk Factor Surveillance System: implications for public health research and practice related to Healthy People 2020 foundation health measures on well-being

BACKGROUND: Well-being is now accepted as one of four cross-cutting measures in gauging progress for Healthy People 2020. This shift to population indicators of well-being redresses notions of health that have focused on absence of illness (negative health) as a primary or sufficient indicator of positive functioning. The purpose of this study was to estimate mental, social, and physical well-being in three US states using new measures piloted on the 2010 Behavioral Risk Factor Surveillance Survey System (BRFSS). Baseline estimates were provided for states overall, and within states for demographic subgroups, those with chronic health conditions or disabilities, and those with behavioral risk factors. METHODS: Ten validated questions designed to assess mental (e.g., satisfaction with life, satisfaction with life domains, happiness), physical (e.g., satisfaction with energy level), and social dimensions (e.g., frequency of social support) of well-being were selected with state input for inclusion on BRFSS. 18,622 individuals responded to the BRFSS surveys administered by New Hampshire (N = 3,139), Oregon (N = 2,289), and Washington (N = 13,194). Multivariate adjusted proportions of positive responses to well-being items were examined. RESULTS: After adjustment for confounders, about 67% of adults in these states had high levels of well-being, including >80% reporting experiencing happiness. Most adults were satisfied with their work, neighborhood, and education, but significant differences were seen in subgroups. Well-being differed by demographic characteristics such as marital status, health behaviors, chronic conditions, and disability status, with those who reported a disability and smokers consistently experiencing the worst well-being. CONCLUSIONS: Well-being is accepted as one of four cross-cutting measures in gauging progress for Healthy People 2020. Well-being differs by important sociodemographic factors and health conditions (e.g., age, employment, smoking, disability status). These findings provide baseline estimates for the three states to use in gauging improvements in well-being and can serve as a model for other state-level or national surveillance systems. These findings also assist states in identifying vulnerable subgroups who may benefit from potential interventions such as those in the National Prevention Strategy that focus on enhancing well-being where such disparities exist

Renewable Energy Assessment Methodology for Japanese OCONUS Army Installations

Since 2005, Pacific Northwest National Laboratory (PNNL) has been asked by Installation Management Command (IMCOM) to conduct strategic assessments at selected US Army installations of the potential use of renewable energy resources, including solar, wind, geothermal, biomass, waste, and ground source heat pumps (GSHPs). IMCOM has the same economic, security, and legal drivers to develop alternative, renewable energy resources overseas as it has for installations located in the US. The approach for continental US (CONUS) studies has been to use known, US-based renewable resource characterizations and information sources coupled with local, site-specific sources and interviews. However, the extent to which this sort of data might be available for outside the continental US (OCONUS) sites was unknown. An assessment at Camp Zama, Japan was completed as a trial to test the applicability of the CONUS methodology at OCONUS installations. It was found that, with some help from Camp Zama personnel in translating and locating a few Japanese sources, there was relatively little difficulty in finding sources that should provide a solid basis for conducting an assessment of comparable depth to those conducted for US installations. Project implementation will likely be more of a challenge, but the feasibility analysis will be able to use the same basic steps, with some adjusted inputs, as PNNL’s established renewable resource assessment methodology

Prevalence of Coxiella burnetii in clinically healthy German sheep flocks

<p>Abstract</p> <p>Background</p> <p>Current epidemiological data on the situation of <it>Coxiella (C.) burnetii </it>infections in sheep are missing, making risk assessment and the implementation of counteractive measures difficult. Using the German state of Thuringia as a model example, the estimated sero-, and antigen prevalence of <it>C. burnetii </it>(10% and 25%, respectively) was assessed at flock level in 39/252 randomly selected clinically healthy sheep flocks with more than 100 ewes and unknown abortion rate.</p> <p>Results</p> <p>The CHECKIT™ Q-fever Test Kit identified 11 (28%) antibody positive herds, whereas real-time PCR revealed the presence of <it>C. burnetii </it>DNA in 2 (5%) of the flocks. Multiple-locus variable number of tandem repeats analysis of 9 isolates obtained from one flock revealed identical profiles. All isolates contained the plasmid QpH1.</p> <p>Conclusions</p> <p>The results demonstrate that <it>C. burnetii </it>is present in clinically inconspicuous sheep flocks and sporadic flare-ups do occur as the notifications to the German animal disease reporting system show. Although <it>C. burnetii </it>infections are not a primary veterinary concern due to the lack of significant clinical impact on animal health (with the exception of goats), the eminent zoonotic risk for humans should not be underestimated. Therefore, strategies combining the interests of public and veterinary public health should include monitoring of flocks, the identification and culling of shedders as well as the administration of protective vaccines.</p

Efficacy of an Educational Material on Second Primary Cancer Screening Practice for Cancer Survivors: A Randomized Controlled Trial

<div><h3>Background</h3><p>Cancer surivors have limited knowledge about second primary cancer (SPC) screening and suboptimal rates of completion of screening practices for SPC. Our objective was to test the efficacy of an educational material on the knowledge, attitudes, and screening practices for SPC among cancer survivors.</p> <h3>Methods</h3><p>Randomized, controlled trial among 326 cancer survivors from 6 oncology care outpatient clinics in Korea. Patients were randomized to an intervention or an attention control group. The intervention was a photo-novel, culturally tailored to increase knowledge about SPC screening. Knowledge and attitudes regarding SPC screening were assessed two weeks after the intervention, and screening practices were assessed after one year.</p> <h3>Results</h3><p>At two weeks post-intervention, the average knowledge score was significantly higher in the intervention compared to the control group (0.81 vs. 0.75, P<0.01), with no significant difference in their attitude scores (2.64 vs. 2.57, P = 0.18). After 1 year of follow-up, the completion rate of all appropriate cancer screening was 47.2% in both intervention and control groups.</p> <h3>Conclusion</h3><p>While the educatinal material was effective for increasing knowledge of SPC screening, it did not promote cancer screening practice among cancer survivors. More effective interventions are needed to increase SPC screening rates in this population.</p> <h3>Trial Registration</h3><p>ClinicalTrial.gov <a href="http://clinicaltrials.gov/ct2/show/NCT00948337">NCT00948337</a></p> </div

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden