Use of Dramatization to Teach Cardiac Cycle Physiology to Medical Students

Part of the educator’s mission is to develop new methodologies that promote active learning. This study examines the use of dramatization of the cardiac cycle in medical school. Two groups (n=42, 21 each) of first-year medical students participated. Group A was initially taught through dramatization alone, while Group B was taught through lecture followed by dramatization. Students completed a 13-item assessment (pretest and posttest) designed to measure knowledge of the cardiac system immediately before and after participating in the dramatization activity. Six months later students completed a third posttest assessment (follow-up) to assess their retention of cardiac cycle content. Students also rated their prior knowledge of general physiology and their confidence level in learning the material presented. Students in groups A and B scored at the same approximate level on the initial pretest (57% and 61% respectively, p=0.53). Scores for both groups increased significantly on the immediate posttest compared to pretest (p<0.0001). Both groups scored equally well on the immediate posttest (88% and 89% respectively, p=0.48), even though Group A had been taught the content based on dramatization alone. Both groups subsequently scored equally well on the six-month follow-up assessment (p<0.0001). Levels of self-reported confidence in knowledge also increased in both groups (p<0.05). This interactive teaching method increases student confidence in their knowledge and promotes learning in the short term equally well when compared to more traditional teaching methods. Implications for further research on dramatization as a teaching method are explored

Preparation for Medical School via an Intensive Summer Program for Future Doctors: A Pilot Study of Student Confidence and Reasoning Skills

A medical school conducted a summer pre-matriculation program. The program provided basic sciences content comparable to first year medical student instruction along with clinical and other learning experiences. The study purpose was to examine self-confidence levels and reasoning skills of a single cohort of students. We examined the association between students’ confidence, reasoning skills and performance measures. We also examined performance differences based on student gender, ethnicity and socioeconomic backgrounds. 32 students were given two confidential surveys in a pre/post-test format. Student confidence was measured using a modified version of the Motivated Strategies for Learning Questionnaire (MSLQ). Student reasoning skills were measured using the Health Sciences Reasoning Test (HSRT). Student performance was measured via written exams. Survey item mean differences and inter-item correlations were examined using the T-test and Spearman procedures. Data were analyzed using SPSS software, with significance levels for all tests set at p=.05. Completed pre- and post-test surveys were returned from 29 students (91%) for the MSLQ and 18 students (56%) for the HSRT. A single item on the MMSLQ was significantly different on the post-test. Student race, gender and socioeconomic background were poor predictors of overall performance but were associated with selected measures of student confidence and reasoning skills. Students enrolled in medical school preparatory classes may be overly confident prior to experiencing medical school. Demographic variables deserve attention by medical school staff, particularly when the school’s mission focuses on successful performance by students from under-represented groups

Highly migratory shark fisheries research by the National Shark Research Consortium (NSRC), 2002-2007

The National Shark Research Consortium (NSRC) includes the Center for Shark Research at Mote Marine Laboratory, the Pacific Shark Research Center at Moss Landing Marine Laboratories, the Shark Research Program at the Virginia Institute of Marine Science, and the Florida Program for Shark Research at the University of Florida. The consortium objectives include shark-related research in the Gulf of Mexico and along the Atlantic and Pacific coasts of the U.S., education and scientific cooperation

A prospective ascertainment of cancer incidence in sub-Saharan Africa: The case of Kaposi sarcoma.

In resource-limited areas, such as sub-Saharan Africa, problems in accurate cancer case ascertainment and enumeration of the at-risk population make it difficult to estimate cancer incidence. We took advantage of a large well-enumerated healthcare system to estimate the incidence of Kaposi sarcoma (KS), a cancer which has become prominent in the HIV era and whose incidence may be changing with the rollout of antiretroviral therapy (ART). To achieve this, we evaluated HIV-infected adults receiving care between 2007 and 2012 at any of three medical centers in Kenya and Uganda that participate in the East Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA) Consortium. Through IeDEA, clinicians received training in KS recognition and biopsy equipment. We found that the overall prevalence of KS among 102,945 HIV-infected adults upon clinic enrollment was 1.4%; it declined over time at the largest site. Among 140,552 patients followed for 319,632 person-years, the age-standardized incidence rate was 334/100,000 person-years (95% CI: 314-354/100,000 person-years). Incidence decreased over time and was lower in women, persons on ART, and those with higher CD4 counts. The incidence rate among patients on ART with a CD4 count &gt;350&nbsp;cells/mm(3) was 32/100,000 person-years (95% CI: 14-70/100,000 person-years). Despite reductions over time coincident with the expansion of ART, KS incidence among HIV-infected adults in East Africa equals or exceeds the most common cancers in resource-replete settings. In resource-limited settings, strategic efforts to improve cancer diagnosis in combination with already well-enumerated at-risk denominators can make healthcare systems attractive platforms for estimating cancer incidence

Forgiveness and Health: Age Differences in a U.S. Probability Sample

Forgiveness is a variable closely related to religiousness and spirituality that has been hypothesized to be protective of mental and physical health. However, we do not clearly understand which aspects of forgiveness are most clearly associated with health outcomes, and the conditions under which these relationships occur. This study used national probability data to systematically examine age differences in the association between forgiveness, religiousness/ spirituality, and respondent reports of mental and physical health. Results showed age differences in the levels of forgiveness of others and feeling forgiven by God. In both cases, middle and old age adults showed higher levels of these forms of forgiveness than young adults. Furthermore, the relationship between forgiveness of others and respondent reports of mental and physical health varies by age. Forgiveness of others was more strongly related to self-reported mental and physical health for middle and old age adults than for young adults.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44638/1/10804_2004_Article_341950.pd

Critical assessment and ramifications of a purported marine trophic cascade

When identifying potential trophic cascades, it is important to clearly establish the trophic linkages between predators and prey with respect to temporal abundance, demographics, distribution, and diet. In the northwest Atlantic Ocean, the depletion of large coastal sharks was thought to trigger a trophic cascade whereby predation release resulted in increased cownose ray abundance, which then caused increased predation on and subsequent collapse of commercial bivalve stocks. These claims were used to justify the development of a predator-control fishery for cownose rays, the “Save the Bay, Eat a Ray” fishery, to reduce predation on commercial bivalves. A reexamination of data suggests declines in large coastal sharks did not coincide with purported rapid increases in cownose ray abundance. Likewise, the increase in cownose ray abundance did not coincide with declines in commercial bivalves. The lack of temporal correlations coupled with published diet data suggest the purported trophic cascade is lacking the empirical linkages required of a trophic cascade. Furthermore, the life history parameters of cownose rays suggest they have low reproductive potential and their populations are incapable of rapid increases. Hypothesized trophic cascades should be closely scrutinized as spurious conclusions may negatively influence conservation and management decision

A thoracic surgery clinic dedicated to indeterminate pulmonary nodules: Too many scans and too little pathology?

ObjectiveWidespread application of computed tomographic scans has increased detection of asymptomatic pulmonary nodules. A dedicated clinic was established to encourage referral and manage large numbers of patients with such nodules.MethodsPatients were evaluated periodically by a nurse practitioner with surgeon oversight, and follow-up imaging was centralized. Patients were rescanned at intervals on the basis of radiologist recommendation.ResultsA total of 414 patients, 189 male and 225 female with a median age of 60.2 years (20.7–84.1 years), were evaluated since April 2000. Median follow-up was 1.51 years (0–6.65 years). Thirty-seven percent (153/414) were older than 60 years with at least 10 pack-years of tobacco use, whereas 30% (123/414) had never smoked. A total of 286 patients completed at least 2 years of follow-up computed tomographic evaluation. After 2 years, 24.2% (69/286) were deemed in stable condition and were discharged from further follow-up, whereas 22.4% (64/286) of patients were followed up longer than 2 years owing to the development of new nodules. Forty-five percent (127/286) of patients did not complete their recommended follow-up at our clinic. Overall, 3% (13/414) of our patients have been shown to have a malignant tumor. Only 5 patients underwent curative resection of a primary lung cancer.ConclusionIn a population of patients with indeterminate nodules in routine clinical practice, few patients required intervention and few cancers were detected. Although the benefits of a “nodule” clinic may include patient reassurance and convenience to referring physicians, a significant number of patients did not complete their follow-up in our clinic

Trends in the clinical characteristics of HIV-infected patients initiating antiretroviral therapy in Kenya, Uganda and Tanzania between 2002 and 2009

East Africa has experienced a rapid expansion in access to antiretroviral therapy (ART) for HIV-infected patients. Regionally representative socio-demographic, laboratory and clinical characteristics of patients accessing ART over time and across sites have not been well described. We conducted a cross-sectional analysis of characteristics of HIV-infected adults initiating ART between 2002 and 2009 in Kenya, Uganda and Tanzania and in the International Epidemiologic Databases to Evaluate AIDS Consortium. Characteristics associated with advanced disease (defined as either a CD4 cell count level of less than 50 cells/mm3 or a WHO Stage 4 condition) at the time of ART initiation and use of stavudine (D4T) or nevirapine (NVP) were identified using a log-link Poisson model with robust standard errors. Among 48,658 patients (69% from Kenya, 22% from Uganda and 9% from Tanzania) accessing ART at 30 clinic sites, the median age at the time of ART initiation was 37 years (IQR: 31-43) and 65% were women. Pre-therapy CD4 counts rose from 87 cells/mm3 (IQR: 26-161) in 2002-03 to 154 cells/mm3 (IQR: 71-233) in 2008-09 (p<0.001). Accessing ART at advanced disease peaked at 35% in 2005-06 and fell to 27% in 2008-09. D4T use in the initial regimen fell from a peak of 88% in 2004-05 to 59% in 2008-09, and a greater extent of decline was observed in Uganda than in Kenya and Tanzania. Self-pay for ART peaked at 18% in 2003, but fell to less than 1% by 2005. In multivariable analyses, accessing ART at advanced immunosuppression was associated with male sex, women without a history of treatment for prevention of mother to child transmission (both as compared with women with such a history) and younger age after adjusting for year of ART initiation and country of residence. Receipt of D4T in the initial regimen was associated with female sex, earlier year of ART initiation, higher WHO stage, and lower CD4 levels at ART initiation and the absence of co-prevalent tuberculosis. Public health ART services in east Africa have improved over time, but the fraction of patients accessing ART with advanced immunosuppression is still high, men consistently access ART with more advanced disease, and D4T continues to be common in most settings. Strategies to facilitate access to ART, overcome barriers among men and reduce D4T use are needed

Extinction risk and conservation of the world\u27s sharks and rays

The rapid expansion of human activities threatens ocean-wide biodiversity. Numerous marine animal populations have declined, yet it remains unclear whether these trends are symptomatic of a chronic accumulation of global marine extinction risk. We present the first systematic analysis of threat for a globally distributed lineage of 1,041 chondrichthyan fishes&mdash;sharks, rays, and chimaeras. We estimate that one-quarter are threatened according to IUCN Red List criteria due to overfishing (targeted and incidental). Large-bodied, shallow-water species are at greatest risk and five out of the seven most threatened families are rays. Overall chondrichthyan extinction risk is substantially higher than for most other vertebrates, and only one-third of species are considered safe. Population depletion has occurred throughout the world&rsquo;s ice-free waters, but is particularly prevalent in the Indo-Pacific Biodiversity Triangle and Mediterranean Sea. Improved management of fisheries and trade is urgently needed to avoid extinctions and promote population recovery