Integrated problem-based learning in the neuroscience curriculum – the SUNY Downstate experience

BACKGROUND: This paper reports the author's initial experience as Block Director in converting a Conventional Curriculum into a problem-based learning model (PBL) for teaching Psychopathology. As part of a wide initiative in curriculum reform, Psychopathology, which was a six-week course in the second-year medical school curriculum, became integrated into a combined Neuroscience block. The study compares curriculum conversion at State University of New York (SUNY), Downstate, with the experiences at other medical centres that have instituted similar curricula reform. METHODS: Student satisfaction with the Conventional and PBL components of the Neuroscience curriculum was compared using questionnaires and formal discussions between faculty and a body of elected students. The PBL experience in Psychopathology was also compared with that of the rest of the Neuroscience Block, which used large student groups and expert facilitators, while the Psychopathology track was limited to small groups using mentors differing widely in levels of expertise. RESULTS: Students appeared to indicate a preference toward conventional lectures and large PBL groups using expert facilitators in contrast to small group mentors who were not experts. Small PBL groups with expert mentors in the Psychopathology track were also rated favorably. CONCLUSION: The study reviews the advantages and pitfalls of the PBL system when applied to a Neuroscience curriculum on early career development. At SUNY, conversion from a Conventional model to a PBL model diverged from that proposed by Howard S. Barrows where student groups define the learning objectives and problem-solving strategies. In our model, the learning objectives were faculty-driven. The critical issue for the students appeared to be the level of faculty expertise rather than group size. Expert mentors were rated more favorably by students in fulfilling the philosophical objectives of PBL. The author, by citing the experience at other major Medical Faculties, makes a cautious attempt to address the challenges involved in the conversion of a Psychopathology curriculum into a PBL dominated format

Investigating the impact of staff training in positive behavioural support on service user quality of life

This research aimed to discover whether staff training in PBS (Positive Behavioural Support) improves service user quality of life. The study used t-tests to compare service user quality of life, as measured by the World Health organisation's WHOQOL BREF, in supported living homes where staff had received PBS training versus supported living homes where staff had not received PBS training. Results show that, although quality of life was good across the board, environmental quality of life was significantly better in those supported living homes where staff had been trained in PBS. The conclusion reached is that PBS training positively influences environmental quality of life for service users, and that it should continue to be the focus of organisational investment

Investigating the impact of staff training in positive behavioural support on service user quality of life

This research aimed to discover whether staff training in PBS (Positive Behavioural Support) improves service user quality of life. The study used t-tests to compare service user quality of life, as measured by the World Health organisation's WHOQOL BREF, in supported living homes where staff had received PBS training versus supported living homes where staff had not received PBS training. Results show that, although quality of life was good across the board, environmental quality of life was significantly better in those supported living homes where staff had been trained in PBS. The conclusion reached is that PBS training positively influences environmental quality of life for service users, and that it should continue to be the focus of organisational investment

Relationship of cognitive function in patients with schizophrenia in remission to disability: a cross-sectional study in an Indian sample

Background: Cognitive deficits in various domains have been consistently replicated in patients with schizophrenia. Most studies looking at the relationship between cognitive dysfunction and functional disability are from developed countries. Studies from developing countries are few. The purpose of the present study was to compare the neurocognitive function in patients with schizophrenia who were in remission with that of normal controls and to determine if there is a relationship between measures of cognition and functional disability. <p/>Methods: This study was conducted in the Psychiatric Unit of a General Hospital in Mumbai, India. Cognitive function in 25 patients with schizophrenia in remission was compared to 25 normal controls. Remission was confirmed using the brief psychiatric rating scale (BPRS) and scale for the assessment of negative symptoms (SANS). Subjects were administered a battery of cognitive tests covering aspects of memory, executive function and attention. The results obtained were compared between the groups. Correlation analysis was used to look for relationship between illness factors, cognitive function and disability measured using the Indian disability evaluation and assessment scale. <p/>Results: Patients with schizophrenia showed significant deficits on tests of attention, concentration, verbal and visual memory and tests of frontal lobe/executive function. They fared worse on almost all the tests administered compared to normal controls. No relationship was found between age, duration of illness, number of years of education and cognitive function. In addition, we did not find a statistically significant relationship between cognitive function and scores on the disability scale. <p/>Conclusion: The data suggests that persistent cognitive deficits are seen in patients with schizophrenia under remission. The cognitive deficits were not associated with symptomatology and functional disability. It is possible that various factors such as employment and family support reduce disability due to schizophrenia in developing countries like India. Further studies from developing countries are required to explore the relationship between cognitive deficits, functional outcome and the role of socio-cultural variables as protective factors

Testing for hereditary thrombophilia: a retrospective analysis of testing referred to a national laboratory

<p>Abstract</p> <p>Background</p> <p>Predisposition to venous thrombosis may be assessed through testing for defects and/or deficiencies of a number of hereditary factors. There is potential for confusion about which of these tests are appropriate in which settings. At least one set of recommendations has been published to guide such testing, but it is unclear how widely these have been disseminated.</p> <p>Methods</p> <p>We performed a retrospective analysis of laboratory orders and results at a national referral laboratory to gain insight into physicians' ordering practices, specifically comparing them against the ordering practices recommended by a 2002 College of American Pathologists (CAP) consensus conference on thrombophilia testing. Measurements included absolute and relative ordering volumes and positivity rates from approximately 200,000 thrombophilia tests performed from September 2005 through August 2006 at a national reference laboratory. Quality control data were used to estimate the proportion of samples that may have been affected by anticoagulant therapy. A sample of ordering laboratories was surveyed in order to assess potential measurement bias.</p> <p>Results</p> <p>Total antigen assays for protein C, protein S and antithrombin were ordered almost as frequently as functional assays for these analytes. The DNA test for factor V Leiden was ordered much more often than the corresponding functional assay. In addition, relative positivity rates coupled with elevations in prothrombin time (PT) in many of these patients suggest that these tests are often ordered in the setting of oral anticoagulant therapy.</p> <p>Conclusion</p> <p>In this real-world setting, testing for inherited thrombophilia is frequently at odds with the recommendations of the CAP consensus conference. There is a need for wider dissemination of concise thrombophilia testing guidelines.</p

Comparative genomics of isolates of a pseudomonas aeruginosa epidemic strain associated with chronic lung infections of cystic fibrosis patients

Pseudomonas aeruginosa is the main cause of fatal chronic lung infections among individuals suffering from cystic fibrosis (CF). During the past 15 years, particularly aggressive strains transmitted among CF patients have been identified, initially in Europe and more recently in Canada. The aim of this study was to generate high-quality genome sequences for 7 isolates of the Liverpool epidemic strain (LES) from the United Kingdom and Canada representing different virulence characteristics in order to: (1) associate comparative genomics results with virulence factor variability and (2) identify genomic and/or phenotypic divergence between the two geographical locations. We performed phenotypic characterization of pyoverdine, pyocyanin, motility, biofilm formation, and proteolytic activity. We also assessed the degree of virulence using the Dictyostelium discoideum amoeba model. Comparative genomics analysis revealed at least one large deletion (40-50 kb) in 6 out of the 7 isolates compared to the reference genome of LESB58. These deletions correspond to prophages, which are known to increase the competitiveness of LESB58 in chronic lung infection. We also identified 308 non-synonymous polymorphisms, of which 28 were associated with virulence determinants and 52 with regulatory proteins. At the phenotypic level, isolates showed extensive variability in production of pyocyanin, pyoverdine, proteases and biofilm as well as in swimming motility, while being predominantly avirulent in the amoeba model. Isolates from the two continents were phylogenetically and phenotypically undistinguishable. Most regulatory mutations were isolate-specific and 29% of them were predicted to have high functional impact. Therefore, polymorphism in regulatory genes is likely to be an important basis for phenotypic diversity among LES isolates, which in turn might contribute to this strain's adaptability to varying conditions in the CF lung

Wolbachia and DNA barcoding insects: patterns, potential and problems

Wolbachia is a genus of bacterial endosymbionts that impacts the breeding systems of their hosts. Wolbachia can confuse the patterns of mitochondrial variation, including DNA barcodes, because it influences the pathways through which mitochondria are inherited. We examined the extent to which these endosymbionts are detected in routine DNA barcoding, assessed their impact upon the insect sequence divergence and identification accuracy, and considered the variation present in Wolbachia COI. Using both standard PCR assays (Wolbachia surface coding protein – wsp), and bacterial COI fragments we found evidence of Wolbachia in insect total genomic extracts created for DNA barcoding library construction. When >2 million insect COI trace files were examined on the Barcode of Life Datasystem (BOLD) Wolbachia COI was present in 0.16% of the cases. It is possible to generate Wolbachia COI using standard insect primers; however, that amplicon was never confused with the COI of the host. Wolbachia alleles recovered were predominantly Supergroup A and were broadly distributed geographically and phylogenetically. We conclude that the presence of the Wolbachia DNA in total genomic extracts made from insects is unlikely to compromise the accuracy of the DNA barcode library; in fact, the ability to query this DNA library (the database and the extracts) for endosymbionts is one of the ancillary benefits of such a large scale endeavor – for which we provide several examples. It is our conclusion that regular assays for Wolbachia presence and type can, and should, be adopted by large scale insect barcoding initiatives. While COI is one of the five multi-locus sequence typing (MLST) genes used for categorizing Wolbachia, there is limited overlap with the eukaryotic DNA barcode region