Preparing medical students as agentic learners through enhancing student engagement in clinical education.

Publisher version made available in accordance with Publisher's copyright policy.Preparing medical students to be agentic learners is held to be increasingly important. This is because beyond sequencing, enhancing and varying of experiences across university and health care settings, medical students require epistemological agency to optimize their learning. The positioning of students in these settings, and their engagement with these is central to effective medical education. Consequently, when considering both the processes and outcomes of individuals’ learning to become a doctor, it is helpful to account for the interrelated pedagogical factors of affordance, guidance, and engagement. This paper focuses on the last set of concerns - the student’s engagement - with particular consideration to how they shape the relations between what experiences are afforded through the medical program and how they elect to engage with them. Evidence from a qualitative study is used to present five salient factors that are central to assist medical students prepare as agentic learners

Functional and clinical studies reveal pathophysiological complexity of CLCN4-related neurodevelopmental condition

Missense and truncating variants in the X-chromosome-linked CLCN4 gene, resulting in reduced or complete loss-of-function (LOF) of the encoded chloride/proton exchanger ClC-4, were recently demonstrated to cause a neurocognitive phenotype in both males and females. Through international clinical matchmaking and interrogation of public variant databases we assembled a database of 90 rare CLCN4 missense variants in 90 families: 41 unique and 18 recurrent variants in 49 families. For 43 families, including 22 males and 33 females, we collated detailed clinical and segregation data. To confirm causality of variants and to obtain insight into disease mechanisms, we investigated the effect on electrophysiological properties of 59 of the variants in Xenopus oocytes using extended voltage and pH ranges. Detailed analyses revealed new pathophysiological mechanisms: 25% (15/59) of variants demonstrated LOF, characterized by a shift of the voltage-dependent activation to more positive voltages, and nine variants resulted in a toxic gain-of-function, associated with a disrupted gate allowing inward transport at negative voltages. Functional results were not always in line with in silico pathogenicity scores, highlighting the complexity of pathogenicity assessment for accurate genetic counselling. The complex neurocognitive and psychiatric manifestations of this condition, and hitherto under-recognized impacts on growth, gastrointestinal function, and motor control are discussed. Including published cases, we summarize features in 122 individuals from 67 families with CLCN4-related neurodevelopmental condition and suggest future research directions with the aim of improving the integrated care for individuals with this diagnosis

Diffusion MR microscopy of cortical development in the mouse embryo

Cortical development in the mouse embryo involves complex changes in the microstructure of the telencephalic wall, which are challenging to examine using three-dimensional (3D) imaging techniques. In this study, high-resolution 3D diffusion magnetic resonance (dMR) microscopy of the embryonic mouse cortex is presented. Using diffusion-weighted gradient- and spin-echo based acquisition, dMR microimaging data were acquired from fixed mouse embryos at 7 developmental stages from embryonic day (E)12.5 to E18.5. The dMR imaging (dMRI) contrasts revealed microscopic structural detail in the mouse telencephalic wall, allowing delineation of transient zones in the developing cortex based on their unique diffusion signatures. With the high-resolution 3D data of the mouse embryo, we were able to visualize the complex microstructure of embryonic cerebral tissue and to resolve its regional and temporal evolution during cortical formation. Furthermore, averaged dMRI contrasts generated via deformable registration revealed distinct spatial and temporal gradients of anisotropy variation across the developing embryonic cortical plate and the ventricular zone. The findings of this study demonstrate the potential of 3D dMRI to resolve the complex microstructure of the embryonic mouse cortex, and will be important for investigations of corticogenesis and its disruption in embryonic mouse models

Advocacy for active transport: advocate and city council perspectives

<p>Abstract</p> <p>Background</p> <p>Effective advocacy is an important part of efforts to increase population participation in physical activity. Research about effective health advocacy is scarce, however, the health sector can learn from the experiences and knowledge of community advocates and those who are on the receiving end of this advocacy. The aim of this study is to explore advocacy for active transport from the perspectives of community advocates and representatives from City councils.</p> <p>Methods</p> <p>Cycling and walking advocates were identified from the local contact list of Cycling Advocates Network and Living Streets Aotearoa. Semi-structured telephone interviews were conducted with cycle and walking advocates from throughout New Zealand. Advocates also nominated a suitable council officer at their local City council to be interviewed. Interviews were recorded and transcribed and categories of responses for each of the questions created.</p> <p>Results</p> <p>Several processes were used by advocates to engage with council staff, including formal council submissions, meetings, stakeholder forums and partnership in running community events promoting active transport. Several other agencies were identified as being influential for active transport, some as potential coalition partners and others as potential adversaries. Barriers to improving conditions for active transport included a lack of funding, a lack of will-power among either council staff or councillors, limited council staff capacity (time or training) and a culture of providing infrastructure for motor vehicles instead of people. Several suggestions were made about how the health sector could contribute to advocacy efforts, including encouraging political commitment, engaging the media, communicating the potential health benefits of active transport to the general public and being role models in terms of personal travel mode choice and having workplaces that support participation in active transport.</p> <p>Conclusions</p> <p>There is potential for the health sector to make an important contribution to advocacy for active transport in New Zealand. While there are many barriers to achieving supportive environments for cycling and walking, a range of advocacy strategies were identified which could help ensure that health perspectives are considered in decisions relevant to active transport.</p

Nuclear factor I genes regulate neuronal migration

Neuronal migration plays a central role in the formation of the brain, and deficits in this process can lead to aberrant brain function and subsequent disease. Neuronal migration is a complex process that involves the interaction of the neuron with the surrounding environmental milieu, and as such involves both cell-intrinsic and cell-extrinsic mechanisms. Studies performed in rodent models to investigate the formation of brain structures have provided key insights into how neuronal migration is coordinated during development. Within the cerebral cortex, glutamatergic neurons derived from the cortical ventricular zone migrate radially into the cortical plate, whereas interneurons derived within the ventrally located ganglionic eminences migrate tangentially into the cortex. Within the embryonic cerebellum, cerebellar granule neuron progenitors migrate from the rhombic lip over the surface of the cerebellar anlage, before differentiating and migrating radially into the internal granule layer of the cerebellum perinatally. In this review, we focus on one family of proteins, the nuclear factor I transcription factors, and review our understanding of how these molecules contribute to the formation of the hippocampus and the cerebellum via the regulation of neuronal migration

Political activity for physical activity: health advocacy for active transport

Effective health advocacy is a priority for efforts to increase population participation in physical activity. Local councils are an important audience for this advocacy. The aim of the current study was to describe features of advocacy for active transport via submissions to city council annual plans in New Zealand, and the impact of an information sheet to encourage the health sector to be involved in this process. Written submissions to city council's annual consultation process were requested for 16 city councils over the period of three years (2007/08, 2008/09, and 2009/10). Submissions were reviewed and categories of responses were created. An advocacy information sheet encouraging health sector participation and summarising some of the evidence-base related to physical activity, active transport and health was released just prior to the 2009/10 submission time. Over the period of the study, city councils received 47,392 submissions, 17% of which were related to active transport. Most submissions came from city residents, with a small proportion (2%) from the health sector. The largest category of submissions was in support of pedestrian and cycling infrastructure, design and maintenance of facilities and additional features to support use of these transport modes. Health arguments featured prominently in justifications for active transport initiatives, including concerns about injury risk, obesity, physical inactivity, personal safety and facilities for people with disabilities. There was evidence that the information sheet was utilised by some health sector submitters (12.5%), providing tentative support for initiatives of this nature. In conclusion, the study provides novel information about the current nature of health advocacy for active transport and informs future advocacy efforts about areas for emphasis, such as health benefits of active transport, and potential alliances with other sectors such as environmental sustainability, transport and urban planning and local communities

Rocks and reactors : an atomic interpretation of human rights, 1941-1979

The atomic age was enacted by many scientists as a way to realize health and human rights. Human rights were conceived in this context as rights to economic development, science education, and nuclear medicine. The United States Atomic Energy Commission (AEC) acted hand in hand with UN agencies and educators to spread nuclear knowledge and technology as a tool to advance health and human rights for peace and prosperity. UN agencies such as UNESCO, IAEA, and WHO standardized AEC interpretations of radiation exposure. Academics served as the glue to promote nuclear and health physics, research reactors and uranium prospecting. Technical experts traveled the globe to build nuclear infrastructure and institute ideas of radiation exposure that originated from the AEC. Trust in the ability of scientific experts to provide radiation health safety was central to the expansion and acceptance of nuclear technology worldwide. Willard E. Libby of the US Atomic Energy Agency, while admitting uncertainty, believed that under a certain threshold, radiation would not be dangerous. The international field of health physics, dominated by the AEC trained scientists, interpreted radiation danger with one particular and lasting trope: artificial radiation below natural background radiation levels was safe and acceptable. The construction of background radiation as "safe" by American and international agencies was a speculative and exclusive process. Radioactive accidents were interpreted by agencies and nuclear scientists as experiments to improve technology. The AEC created unethical human radiation experiments and disregarded democracy and individual human rights. The expansion of nuclear technology created impingements on human rights, health and peace of mind. This history calls for a meta-analysis based on both heath and human rights aims and impingements. Contaminated communities access radioactive contamination as a permanent and irrevocable bodily and intergenerational taint that violates human rights. Claims were made after the first use of nuclear weapons that pre-existing international law and rights to "life, liberty and the pursuit of happiness" should protect people worldwide from dangerous, intergenerational radiation exposure. This can be seen in the experiences of the Navajo Nation with uranium mining and in anguished letters sent to Noble Prize winning chemist Linus Pauling during the fallout controversy. This history when transposed with the utopian hopes of nuclear scientists, questions the relationship between rationality, human rights, scientific ideology, regulations, ethics, and knowledge production during the Cold War. The exclusion from nuclear regulatory regimes of those who live contaminated by the nuclear fuel chain and in fear of nuclear pollution and weapons is a result of the lack of recognition of the integrity and sovereignty of one's body as an inalienable human right

PAX6 does not regulate Nfia and Nfib expression during neocortical development

The Nuclear factor I (NFI) family of transcription factors regulates proliferation and differentiation throughout the developing central nervous system. In the developing telencephalon of humans and mice, reduced Nfi expression is associated with agenesis of the corpus callosum and other neurodevelopmental defects. Currently, little is known about how Nfi expression is regulated during early telencephalic development. PAX6, a transcription factor important for telencephalic development, has been proposed as an upstream regulator of Nfi expression in the neocortex. Here we demonstrate that, in the developing neocortex of mice, NFIA and NFIB are endogenously expressed in gradients with high caudo-medial to low rostro-lateral expression and are most highly expressed in the cortical plate. We found that this expression pattern deviates from that of PAX6, suggesting that PAX6 does not drive Nfi expression. This is supported by in vitro reporter assays showing that PAX6 overexpression does not regulate Nfi promoter activity. Similarly, we also found that in the Pax6 Small Eye mutant, no changes in Nfi mRNA or protein expression are observed in the neocortical ventricular zone where PAX6 and the NFIs are expressed. Together these data demonstrate that in mice, PAX6 is not a transcriptional activator of Nfi expression during neocortical development

Prevention of secondary stroke in VA: Role of occupational therapists and physical therapists

Occupational therapists (OTs) and physical therapists (PTs) have the opportunity and obligation to advocate secondary stroke prevention via health promotion (HP) behaviors. This prospective survey of Department of Veterans Affairs (VA) OTs and PTs determined whether they know about VA stroke rehabilitation guidelines and whether they integrate secondary stroke prevention into poststroke rehabilitation care. Questions revolved around knowledge of VA guidelines, inclusion of stroke risk-factor modification, and HP education to patients. Thirty-four surveys (45%) were returned from six facilities. Participants included 12 OTs and 22 PTs. Half (53%) of the therapists were aware of the VA guidelines and nearly half (48%) provided HP activities to patients; PTs were significantly more likely to do so than OTs (p = 0.02). Half of the queried therapists were unaware of the VA guidelines; increasing therapists’ education about the guidelines and the necessity of HP and secondary stroke prevention may reduce veterans’ risk of a second stroke. Because many stroke risk factors are modifiable and stroke survivors spend a great deal of time with the rehabilitation therapist, OTs and PTs can and should provide such education to reduce the risk of a second stroke