Fitting the Means to the Ends: One School’s Experience with Quantitative and Qualitative Methods in Curriculum Evaluation During Curriculum Change

Curriculum evaluation plays an important role in substantive curriculum change. The experience of the University of Texas Medical Branch (UTMB) with evaluation processes developed for the new Integrated Medical Curriculum (IMC) illustrates how evaluation methods may be chosen to match the goals of the curriculum evaluation process. Quantitative data such as ratings of courses or scores on external exams are useful for comparing courses or assessing whether standards have been met. Qualitative data such as students’ comments about aspects of courses are useful for eliciting explanations of observed phenomena and describing relationships between curriculum features and outcomes. The curriculum evaluation process designed for the IMC used both types of evaluation methods in a complementary fashion. Quantitative and qualitative methods have been used for formative evaluation of the new IMC courses. They are now being incorporated into processes to judge the IMC against its goals and objectives

Integration of the Head and Forelimb in Bipedal Hominids

Integration, a fundamental property of organisms, occurs via multiple mechanisms and for diverse reasons. Although there has been substantial work on the genetic and epigenetic mechanisms by which developmental integration occurs, we have less of an understanding of the evolutionary relationships between functional and developmental integration. In this respect, human evolution provides an interesting test case. In quadrupedal mammals, there is considerable functional integration among and between the limbs, but little functional integration between the limbs and the skull. The evolution of bipedalism in hominids, however, provided new opportunities for novel forms of integration by emancipating the forelimbs from any major role in locomotion. Here we consider how the forelimb and head become increasingly integrated in the genus Homo because of the biomechanical challenges of running. While the arm and the head interact little during walking, we have found that, during running, the stance side arm acts as a counterbalance to the head, stabilizing it against impulsive pitching forces generated by the heel strike transient. Moreover, the functional properties of this linkage may have driven several developmental changes in the proportions of the arm and the anatomy of the shoulder girdle during human evolution. Thus, evolutionary changes in arm and head morphology during human evolution may be more integrated than previously considered.AnthropologyHuman Evolutionary Biolog

Testosterone Influence on Gene Expression in Lacrimal Glands of Mouse Models of Sjögren Syndrome

Purpose: Sjögren syndrome is an autoimmune disorder that occurs almost exclusively in women and is associated with extensive inflammation in lacrimal tissue, an immune-mediated destruction and/or dysfunction of glandular epithelial cells, and a significant decrease in aqueous tear secretion. We discovered that androgens suppress the inflammation in, and enhance the function of, lacrimal glands in female mouse models (e.g., MRL/MpJ-Tnfrsf6lpr [MRL/lpr]) of Sjögren syndrome. In contrast, others have reported that androgens induce an anomalous immunopathology in lacrimal glands of nonobese diabetic/LtJ (NOD) mice. We tested our hypothesis that these hormone actions reflect unique, strain- and tissue-specific effects, which involve significant changes in the expression of immune-related glandular genes. Methods: Lacrimal glands were obtained from age-matched, adult, female MRL/lpr and NOD mice after treatment with vehicle or testosterone for up to 3 weeks. Tissues were processed for analysis of differentially expressed mRNAs using CodeLink Bioarrays and Affymetrix GeneChips. Data were analyzed with bioinformatics and statistical software. Results: Testosterone significantly influenced the expression of numerous immune-related genes, ontologies, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways in lacrimal glands of MRL/lpr and NOD mice. The nature of this hormone-induced immune response was dependent upon the autoimmune strain, and was not duplicated within lacrimal tissues of nonautoimmune BALB/c mice. The majority of immune-response genes regulated by testosterone were of the inflammatory type. Conclusions: Our findings support our hypothesis and indicate a major role for the lacrimal gland microenvironment in mediating androgen effects on immune gene expression

The Evolution of Endurance Running and the Tyranny of Ethnography: A Reply to Pickering and Bunn (2007)

Endurance running (ER) poses a conundrum for paleoanthropologists. As summarized in Bramble and Lieberman (2004), human ER capabilities, which are unique among primates, either match or exceed those of mammals adapted for running (cursors), including dogs and equids. Because many of the biomechanical and physiological challenges of human ER are so different from those of walking, we can conclude that human ER capabilities did not arise merely as a by-product of selection for walking. Instead, the available evidence suggests that an array of features that improve ER performance were selected in the genus Homo, and they were probably present to some extent by the appearance of Homo erectus at approximately 1.9 Ma. Yet, ER is no longer necessary for human survival, even among extant foragers such as the Hadza or the Bushmen. Thus, a puzzle that paleoanthropologists must solve is identifying what past behaviors - behaviors no longer common among living foragers - favored the evolution of ER. Pickering and Bunn’s (2007) criticisms of the ER hypothesis center on two issues: first, that early Homo lacked the tracking abilities necessary for successful pursuit hunts, and second, that recent ethnographic evidence suggests that modern hunter-gatherers rarely use ER to either hunt or scavenge. These arguments are based on a presumptive link between modern human- like cognition and tracking abilities, as well as the notion that the modern ethnographic record provides an adequate reflection of past behaviors. Both of these assumptions are flawed. Although tracking is complex, there is little evidence to suggest that early hominids lacked the tracking abilities of much less encephalized carnivores. Additionally, as noted by Marlowe (2005), comparatively recent inventions, such as the bow and arrow, the spear thrower, nets, and even the spear point, fundamentally altered how humans hunt and scavenge. A strict reliance on the recent ethnographic record, what Wobst (1978) termed the ‘‘tyranny of ethnography,’’ is a fundamentally problematic way of testing hypotheses of past hunting behavior. Even so, a review of the ethnographic evidence reveals errors in Pickering and Bunn’s contentions.Anthropolog

Control and Function of Arm Swing in Human Walking and Running

We investigated the control and function of arm swing in human walking and running to test the hypothesis that the arms act as passive mass dampers powered by movement of the lower body, rather than being actively driven by the shoulder muscles. We measured locomotor cost, deltoid muscle activity and kinematics in 10 healthy adult subjects while walking and running on a treadmill in three experimental conditions: control; no arms (arms folded across the chest); and arm weights (weights worn at the elbow). Decreasing and increasing the moment of inertia of the upper body in no arms and arm weights conditions, respectively, had corresponding effects on head yaw and on the phase differences between shoulder and pelvis rotation, consistent with the view of arms as mass dampers. Angular acceleration of the shoulders and arm increased with torsion of the trunk and shoulder, respectively, but angular acceleration of the shoulders was not inversely related to angular acceleration of the pelvis or arm. Restricting arm swing in no arms trials had no effect on locomotor cost. Anterior and posterior portions of the deltoid contracted simultaneously rather than firing alternately to drive the arm. These results support a passive arm swing hypothesis for upper body movement during human walking and running, in which the trunk and shoulders act primarily as elastic linkages between the pelvis, shoulder girdle and arms, the arms act as passive mass dampers which reduce torso and head rotation, and upper body movement is primarily powered by lower body movement.AnthropologyHuman Evolutionary Biolog

The Human Gluteus Maximus and its Role in Running

The human gluteus maximus is a distinctive muscle in terms of size, anatomy and function compared to apes and other non-human primates. Here we employ electromyographic and kinematic analyses of human subjects to test the hypothesis that the human gluteus maximus plays a more important role in running than walking. The results indicate that the gluteus maximus is mostly quiescent with low levels of activity during level and uphill walking, but increases substantially in activity and alters its timing with respect to speed during running. The major functions of the gluteus maximus during running are to control flexion of the trunk on the stanceside and to decelerate the swing leg; contractions of the stance-side gluteus maximus may also help to control flexion of the hip and to extend the thigh. Evidence for when the gluteus maximus became enlarged in human evolution is equivocal, but the muscle’s minimal functional role during walking supports the hypothesis that enlargement of the gluteus maximus was likely important in the evolution of hominid running capabilities.Anthropolog

Is arm swing active or passive during human walking and running?

Humans habitually swing their arms in phase with the contralateral leg during walking and running. This arm motion is generally thought to counteract the torque about the body’s vertical axis (i.e. yaw moment) that is generated by the legs as they swing with each step. Thus it has been argued that the motion of the arms is a tuned, habitual, active response that is critical for maintaining stability during human locomotion, especially running. In this study, we investigated whether arm swing is in fact an active behavior, or is instead a passive response that follows solely as a consequence of our anatomical design. Human subjects walked and ran on a treadmill under different arm- and leg-weighting conditions, and without armswing, while kinematic and surface EMG data were recorded. A modeling study was also performed to determine the inherent effect of leg swing on arm movement in a human-like biped. Results of both studies suggest that arm swing is largely a passive response, and is not entirely an active, tuned behavior. Arm swing may therefore be an emergent property of human bipedalism, with the arms acting largely as passive damping mechanisms that decrease whole-body yawing.AnthropologyHuman Evolutionary Biolog

Application of a single-objective, hybrid genetic algorithm approach to pharmacokinetic model building.

A limitation in traditional stepwise population pharmacokinetic model building is the difficulty in handling interactions between model components. To address this issue, a method was previously introduced which couples NONMEM parameter estimation and model fitness evaluation to a single-objective, hybrid genetic algorithm for global optimization of the model structure. In this study, the generalizability of this approach for pharmacokinetic model building is evaluated by comparing (1) correct and spurious covariate relationships in a simulated dataset resulting from automated stepwise covariate modeling, Lasso methods, and single-objective hybrid genetic algorithm approaches to covariate identification and (2) information criteria values, model structures, convergence, and model parameter values resulting from manual stepwise versus single-objective, hybrid genetic algorithm approaches to model building for seven compounds. Both manual stepwise and single-objective, hybrid genetic algorithm approaches to model building were applied, blinded to the results of the other approach, for selection of the compartment structure as well as inclusion and model form of inter-individual and inter-occasion variability, residual error, and covariates from a common set of model options. For the simulated dataset, stepwise covariate modeling identified three of four true covariates and two spurious covariates; Lasso identified two of four true and 0 spurious covariates; and the single-objective, hybrid genetic algorithm identified three of four true covariates and one spurious covariate. For the clinical datasets, the Akaike information criterion was a median of 22.3 points lower (range of 470.5 point decrease to 0.1 point decrease) for the best single-objective hybrid genetic-algorithm candidate model versus the final manual stepwise model: the Akaike information criterion was lower by greater than 10 points for four compounds and differed by less than 10 points for three compounds. The root mean squared error and absolute mean prediction error of the best single-objective hybrid genetic algorithm candidates were a median of 0.2 points higher (range of 38.9 point decrease to 27.3 point increase) and 0.02 points lower (range of 0.98 point decrease to 0.74 point increase), respectively, than that of the final stepwise models. In addition, the best single-objective, hybrid genetic algorithm candidate models had successful convergence and covariance steps for each compound, used the same compartment structure as the manual stepwise approach for 6 of 7 (86 %) compounds, and identified 54 % (7 of 13) of covariates included by the manual stepwise approach and 16 covariate relationships not included by manual stepwise models. The model parameter values between the final manual stepwise and best single-objective, hybrid genetic algorithm models differed by a median of 26.7 % (q₁ = 4.9 % and q₃ = 57.1 %). Finally, the single-objective, hybrid genetic algorithm approach was able to identify models capable of estimating absorption rate parameters for four compounds that the manual stepwise approach did not identify. The single-objective, hybrid genetic algorithm represents a general pharmacokinetic model building methodology whose ability to rapidly search the feasible solution space leads to nearly equivalent or superior model fits to pharmacokinetic data

Determinants of polyp Size in patients undergoing screening colonoscopy

<p>Abstract</p> <p>Background</p> <p>Pre-existing polyps, especially large polyps, are known to be the major source for colorectal cancer, but there is limited available information about factors that are associated with polyp size and polyp growth. We aim to determine factors associated with polyp size in different age groups.</p> <p>Methods</p> <p>Colonoscopy data were prospectively collected from 67 adult gastrointestinal practice sites in the United States between 2002 and 2007 using a computer-generated endoscopic report form. Data were transmitted to and stored in a central data repository, where all asymptomatic white (n = 78352) and black (n = 4289) patients who had a polyp finding on screening colonoscopy were identified. Univariate and multivariate analysis of age, gender, performance site, race, polyp location, number of polyps, and family history as risk factors associated with the size of the largest polyp detected at colonoscopy.</p> <p>Results</p> <p>In both genders, size of the largest polyp increased progressively with age in all age groups (<it>P </it>< .0001). In subjects ≥ 80 years the relative risk was 1.55 (95% CI, 1.35-1.79) compared to subjects in the youngest age group. With the exception of family history, all study variables were significantly associated with polyp size (<it>P </it>< .0001), with multiple polyps (≥ 2 versus 1) having the strongest risk: 3.41 (95% CI, 3.29-3.54).</p> <p>Conclusions</p> <p>In both genders there is a significant increase in polyp size detected during screening colonoscopy with increasing age. Important additional risk factors associated with increasing polyp size are gender, race, polyp location, and number of polyps, with polyp multiplicity being the strongest risk factor. Previous family history of bowel cancer was not a risk factor.</p

A planar calculus for infinite index subfactors

We develop an analog of Jones' planar calculus for II_1-factor bimodules with arbitrary left and right von Neumann dimension. We generalize to bimodules Burns' results on rotations and extremality for infinite index subfactors. These results are obtained without Jones' basic construction and the resulting Jones projections.Comment: 56 pages, many figure