Medicine as a performing art: a worthy metaphor

 Despite numerous calls for reform over several decades, medical educators have been unable to address many significant challenges. Potentially, employing new metaphors and looking at the teaching and learning of medicine in a new way will facilitate the development of creative solutions. Main findings  In this paper we propose the metaphor of medicine as a performing art. Building on this metaphor, string music education is compared to medical education. Principal conclusions  Looking to string education as a model, suggestions for reorganisation of learning experiences, academic structure and assessment are discussed. Medical educators are encouraged to think about the challenges they face in creative ways. By looking outside traditional medical education, solutions may be found to new and old educational dilemmas.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73574/1/j.1365-2923.2003.01636.x.pd

Compensatory saccade in the vestibular impaired monkey

IntroductionLoss of the vestibulo-ocular reflex (VOR) affects visual acuity during head movements. Patients with unilateral and bilateral vestibular deficits often use saccadic eye movements to compensate for an inadequate VOR. Two types of compensatory saccades have been distinguished, covert saccades and overt saccades. Covert saccades occur during head rotation, whereas overt saccades occur after the head has stopped moving. The generation of covert saccades is part of a central vestibular compensation process that improves visual acuity and suppresses oscillopsia. Understanding the covert saccade mechanism may facilitate vestibular rehabilitation strategies that can improve the patient’s quality of life. To understand the brain mechanisms underlying covert saccades at the neural level, studies in an animal model are necessary. In this study, we employed non-human primates whose vestibular end organs are injured.MethodsWe examined eye movement during the head-impulse test, which is a clinical test to evaluate the vestibulo-ocular reflex. During this test, the monkeys are required to fixate on a target and the head is rapidly and unexpectedly rotated to stimulate the horizontal semi-circular canals.ResultsSimilar to human subjects, monkeys made compensatory saccades. We compared these saccades with catch-up saccades following a moving target that simulates the visual conditions during the head impulse test. The shortest latency of the catch-up saccades was 250 ms, which indicates that it requires at least 250 ms to induce saccades by a visual signal. The latency of some compensatory saccades is shorter than 250 ms during the head impulse test, suggesting that such short latency compensatory saccades were not induced visually. The peak velocity of the short latency saccades was significantly lower than that of longer latency saccades. The peak velocity of these longer latency saccades was closer to that of visually guided saccades induced by a stepping target.ConclusionThese results are consistent with studies in human patients. Thus, this study demonstrates, for the first time, compensatory covert saccades in vestibular impaired monkeys

Serologic and Hematologic Values of Bison in Colorado

Recent economic and aesthetic interest in North American bison (Bison bison) has lead to increased interstate transport of these animals. Serologic and hematologic standards for bison are needed to detect disease in transported animals as well as within herds. This paper describes variation in blood physiological parameters in bison caused by variations in diet and season. Blood was taken from six bison and analyzed for serologic and hematologic parameters. Significant variation was found in blood urea nitrogen, chloride, cholesterol, creatinine, eosinophil, glucose, hemoglobin, lactic dehydrogenase, leukocyte, packed cell volume, potassium, serum globulin, serum glutamic oxalacetic transaminase, SGPT, and sodium levels between animals receiving a high energy-high nitrogen diet and animals receiving a low energy-low nitrogen diet

Does the contribution of women to household expenditure explain contraceptive use? An assessment of the relevance of bargaining theory to Africa

This paper draws on the concept of bargaining theory to interpret contraceptive decision-making among women who express a desire to limit or space children. Bargaining theory assumes conflict in decision making within households and posits that such conflict is resolved through bargaining. Women’s bargaining power is said to increase with more control of resources. The underlying assumption is that household decisions are governed by economics. This paper acknowledges that economics may influence reproductive decisions, but posits that African social norms and institutions are more important in defining conjugal roles than spousal relative economic contribution to family expenditure. Findings from seven African countries show that women who contribute more income to household expenditure are no more likely to adopt family planning as predicted by bargaining theory. These results bring into question theoretical perspectives that are sometimes promoted as generic explanatory models without validation in specific cultural settings

Cost of implementing a community-based primary health care strengthening program: The case of the Ghana Essential Health Interventions Program in northern Ghana

Background The absence of implementation cost data constrains deliberations on consigning resources to community-based health programs. This paper analyses the cost of implementing strategies for accelerating the expansion of a community-based primary health care program in northern Ghana. Known as the Ghana Essential Health Intervention Program (GEHIP), the project was an embedded implementation science program implemented to provide practical guidance for accelerating the expansion of community-based primary health care and introducing improvements in the range of services community workers can provide. Methods Cost data were systematically collected from intervention and non-intervention districts throughout the implementation period (2012–2014) from a provider perspective. The step-down allocation approach to costing was used while WHO health system blocks were adopted as cost centers. We computed cost without annualizing capital cost to represent financial cost and cost with annualizing capital cost to represent economic cost. Results The per capita financial cost and economic cost of implementing GEHIP over a three-year period was $1.79, and$1.07 respectively. GEHIP comprised only 3.1% of total primary health care cost. Health service delivery comprised the largest component of cost (37.6%), human resources was 28.6%, medicines was 13.6%, leadership/governance was 12.8%, while health information comprised 7.5% of the economic cost of implementing GEHIP. Conclusion The per capita cost of implementing the GEHIP program was low. GEHIP project investments had a catalytic effect that improved community-based health planning and services (CHPS) coverage and enhanced the efficient use of routine health system resources rather than expanding overall primary health care costs

Compression garments reduce muscle movement and activation during submaximal running

Purpose The purpose of this study was to investigate the effectiveness of sports compression tights in reducing muscle movement and activation during running. Methods A total of 27 recreationally active males were recruited across two separate studies. For study 1, 13 participants (mean ± SD = 84.1 ± 9.4 kg, 22 ± 3 yr) completed two 4-min treadmill running bouts (2 min at 12 and 15 km·h-1) under two conditions: a no-compression control (CON1) and compression (COMP). For study 2, 14 participants (77.8 ± 8.4 kg, 27 ± 5 yr) completed four 9-min treadmill running bouts (3 min at 8, 10, and 12 km·h-1) under four conditions: a no-compression control (CON2) and three different commercially available compression tights (2XU, Nike, and Under Armor). Using Vicon 3D motion capture technology, lower limb muscle displacement was investigated in both study 1 (thigh and calf) and study 2 (vastus lateralis + medialis [VAS]; lateral + medial gastrocnemius [GAS]). In addition, study 2 investigated the effects of compression on soft tissue vibrations (root-mean-square of resultant acceleration, RMS Ar), muscle activation (iEMG), and running economy (oxygen consumption, VO2) during treadmill running. Results Wearing compression during treadmill running reduced thigh and calf muscle displacement as compared with no compression (both studies), which was evident across all running speeds. Compression also reduced RMS Ar and iEMG during treadmill running, but it had no effect on running economy (study 2). Conclusion Lower limb compression garments are effective in reducing muscle displacement, soft tissue vibrations, and muscle activation associated with the impact forces experienced during running

The child survival impact of the Ghana Essential Health Interventions Program: A health systems strengthening plausibility trial in Northern Ghana

Background: The Ghana Health Service in collaboration with partner institutions implemented a five-year primary health systems strengthening program known as the Ghana Essential Health Intervention Program (GEHIP). GEHIP was a plausibility trial implemented in an impoverished region of northern Ghana around the World Health Organizations (WHO) six pillars combined with community engagement, leadership development and grassroots political support, the program organized a program of training and action focused on strategies for saving newborn lives and community-engaged emergency referral services. This paper analyzes the effect of the GEHIP program on child survival. Methods: Birth history data assembled from baseline and endline surveys are used to assess the hazard of child mortality in GEHIP treatment and comparison areas prior to and after the start of treatment. Difference-in-differences (DiD) methods are used to compare mortality change over time among children exposed to GEHIP relative to children in the comparison area over the same time period. Models test the hypothesis that a package of systems strengthening activities improved childhood survival. Models adjusted for the potentially confounding effects of baseline differentials, secular mortality trends, household characteristics such as relative wealth and parental educational attainment, and geographic accessibility of clinical care. Results: The GEHIP combination of health systems strengthening activities reduced neonatal mortality by approximately one half (HR = 0.52, 95% CI = 0.28,0.98, p = 0.045). There was a null incremental effect of GEHIP on mortality of post-neonate infants (from 1 to 12 months old) (HR = 0.72; 95% CI = 0.30,1.79; p = 0.480) and post-infants (from 1 year to 5 years old) -(HR = 1.02; 95% CI = 0.55–1.90; p = 0.940). Age-specific analyses show that impact was concentrated among neonates. However, effect ratios for post-infancy were inefficiently assessed owing to extensive survival history censoring for the later months of childhood. Children were observed only rarely for periods over 40 months of age. Conclusion: GEHIP results show that a comprehensive approach to newborn care is feasible, if care is augmented by community-based nurses. It supports the assertion that if appropriate mechanisms are put in place to enable the various pillars of the health system as espoused by WHO in rural impoverished settings where childhood mortality is high, it could lead to accelerated reductions in mortality thereby increasing survival of children. Policy implications of the pronounced neonatal effect of GEHIP merit national review for possible scale-up