The Transfer of Problem-Based Learning Skills to Clinical Practice

The purpose of this article is to present and discuss the reported impact of a fully problem-based learning (PBL) master’s program on the way graduates worked with patients and colleagues in Ireland. These graduates had completed a sixteen-month fully PBL master’s in sonography while concurrently working in clinical practice. Semi-structured telephone interviews were used to collect qualitative data from graduates of the PBL program. PBL graduates reported four notable changes in their approach to clinical practice following the PBL MSc ultrasound program: (1) thinking more before, during, and after clinical practice; (2) more effective communication with patients; (3) improved communication with colleagues; and (4) an increase in proactivity in clinical practice. The transfer of skills developed during the PBL program, as reported by sonography graduates, led to the development of more patient-centered, evidence-based, proactive clinical practice

Aryl Phosphoramidates of 5-Phospho Erythronohydroxamic Acid, A New Class of Potent Trypanocidal Compounds

RNAi and enzymatic studies have shown the importance of 6-phosphogluconate dehydrogenase (6-PGDH) in Trypanosoma brucei for the parasite survival and make it an attractive drug target for the development of new treatments against human African trypanosomiasis. 2,3-O-Isopropylidene-4-erythrono hydroxamate is a potent inhibitor of parasite Trypanosoma brucei 6-phosphogluconate dehydrogenase (6-PGDH), the third enzyme of the pentose phosphate pathway. However, this compound does not have trypanocidal activity due to its poor membrane permeability. Consequently, we have previously reported a prodrug approach to improve the antiparasitic activity of this inhibitor by converting the phosphate group into a less charged phosphate prodrug. The activity of prodrugs appeared to be dependent on their stability in phosphate buffer. Here we have successfully further extended the development of the aryl phosphoramidate prodrugs of 2,3-O-isopropylidene-4-erythrono hydroxamate by synthesizing a small library of phosphoramidates and evaluating their biological activity and stability in a variety of assays. Some of the compounds showed high trypanocidal activity and good correlation of activity with their stability in fresh mouse blood

Predicting conversion to dementia in a memory clinic: A standard clinical approach compared with an empirically defined clustering method (latent profile analysis) for mild cognitive impairment subtyping

AbstractIntroductionMild cognitive impairment (MCI) has clinical value in its ability to predict later dementia. A better understanding of cognitive profiles can further help delineate who is most at risk of conversion to dementia. We aimed to (1) examine to what extent the usual MCI subtyping using core criteria corresponds to empirically defined clusters of patients (latent profile analysis [LPA] of continuous neuropsychological data) and (2) compare the two methods of subtyping memory clinic participants in their prediction of conversion to dementia.MethodsMemory clinic participants (MCI, n = 139) and age-matched controls (n = 98) were recruited. Participants had a full cognitive assessment, and results were grouped (1) according to traditional MCI subtypes and (2) using LPA. MCI participants were followed over approximately 2 years after their initial assessment to monitor for conversion to dementia.ResultsGroups were well matched for age and education. Controls performed significantly better than MCI participants on all cognitive measures. With the traditional analysis, most MCI participants were in the amnestic multidomain subgroup (46.8%) and this group was most at risk of conversion to dementia (63%). From the LPA, a three-profile solution fit the data best. Profile 3 was the largest group (40.3%), the most cognitively impaired, and most at risk of conversion to dementia (68% of the group).DiscussionLPA provides a useful adjunct in delineating MCI participants most at risk of conversion to dementia and adds confidence to standard categories of clinical inference

PREDICTING CONVERSION TO DEMENTIA IN A MEMORY CLINIC A STANDARD CLINICAL APPROACH COMPARED WITH AN EMPIRICALLY DEFINED CLUSTERING METHOD LATENT PROFILE ANALYSIS FOR MILD COGNITIVE IMPAIRMENT SUBTYPING

Introduction: Mild cognitive impairment (MCI) has clinical value in its ability to predict later dementia. A better understanding of cognitive profiles can further help delineate who is most at risk of conversion to dementia. We aimed to (1) examine to what extent the usual MCI subtyping using core criteria corresponds to empirically defined clusters of patients (latent profile analysis [LPA] of continuous neuropsychological data) and (2) compare the two methods of subtyping memory clinic participants in their prediction of conversion to dementia. Methods: Memory clinic participants (MCI, n = 139) and age-matched controls (n = 98) were recruited. Participants had a full cognitive assessment, and results were grouped (1) according to traditional MCI subtypes and (2) using LPA. MCI participants were followed over approximately 2 years after their initial assessment to monitor for conversion to dementia. Results: Groups were well matched for age and education. Controls performed significantly better than MCI participants on all cognitive measures. With the traditional analysis, most MCI participants were in the amnestic multidomain subgroup (46.8%) and this group was most at risk of conversion to dementia (63%). From the LPA, a three-profile solution fit the data best. Profile 3 was the largest group (40.3%), the most cognitively impaired, and most at risk of conversion to dementia (68% of the group). Discussion: LPA provides a useful adjunct in delineating MCI participants most at risk of conversion to dementia and adds confidence to standard categories of clinical inference

Veterans’ Experiences of Successfully Managing Post-Traumatic Stress Disorder

Purpose Prevalence of post-traumatic stress disorder (PTSD) amongst UK veterans is higher than in the general population. However, prevalence figures do not reflect the complexity of this phenomenon and ways in which it may be bound up with veterans’ experiences of adjusting to civilian life. The purpose of this study was to explore veterans’ experiences of successfully managing PTSD. Design/methodology/approach Semi-structured interviews were conducted with six veterans who had served in the UK armed forces, and analysed using interpretative phenomenological analysis. Findings Three themes were developed: (1) accepting the problem, taking responsibility and gaining control; (2) talking to the right people; and (3) strategies, antidotes and circling back around. Managing PTSD appeared to be bound up with veterans’ experience of renegotiating their identity, where positive aspects of identity lost on leaving the military were rebuilt, and problematic aspects were challenged. Participants sought to speak about their difficulties with others who understood the military context. They felt that their experiences made them a valuable resource to others, and they connected this with a positive sense of identity and value. Practical implications The findings suggest the importance of wider provision of peer support, and education for civilian health services on veterans’ needs. Originality/value This study adds to our understanding of what meaningful recovery from PTSD may involve for veterans, in particular its potential interconnectedness with the process of adjusting to civilian life

Professional Education to Reduce Provider Stigma Toward Harm Reduction and Pharmacotherapy

Aims: A novel professional training was developed to reduce stigma toward harm reduction and pharmacotherapy for substance use disorders. Methods: The training was delivered over three sessions to n = 147 health professionals in Utah between 2019 and 2020, including n = 40 substance use disorder treatment professionals. Pre and post-training survey measures provided evaluation information on knowledge, attitudes, and planned action regarding harm reduction and pharmacotherapy. Items were grouped into a stigma score, and multilevel modeling, regression analyses, and McNemar tests were used to quantify changes in overall stigma toward harm reduction interventions both before and after the training. Results: The training significantly decreased the total stigma score toward harm reduction (b = -0.09, p \u3c .001, β = -0.34). At the individual item level, 6 of the 22 items showed significant change in reduced stigma (all p \u3c .047), and all items moved in the direction of decreased stigma. These items include both attitudes and planned action aspects of the total stigma score. Conclusions: This study suggests that education targeting prejudice and discriminatory actions against harm reduction and pharmacotherapy interventions among healthcare professionals may contribute to stigma reduction. These results provide a basis for intervention effectiveness, addressing preconceived ideas, and show community need for such substance use interventions, as a component of future stigma reduction efforts

The utility of convection-permitting ensembles for the prediction of stationary convective bands

This study examines convection-permitting numerical simulations of four cases of terrain-locked quasi-stationary convective bands over the UK. For each case, a 2.2-km grid-length 12-member ensemble and 1.5-km grid-length deterministic forecast are analyzed, each with two different initialization times. Object-based verification is applied to determine whether the simulations capture the structure, location, timing, intensity and duration of the observed precipitation. These verification diagnostics reveal that the forecast skill varies greatly between the four cases. Although the deterministic and ensemble simulations captured some aspects of the precipitation correctly in each case, they never simultaneously captured all of them satisfactorily. In general, the models predicted banded precipitation accumulations at approximately the correct time and location, but the precipitating structures were more cellular and less persistent than the coherent quasi-stationary bands that were observed. Ensemble simulations from the two different initialization times were not significantly different, which suggests a potential benefit of time-lagging subsequent ensembles to increase ensemble size. The predictive skill of the upstream larger-scale flow conditions and the simulated precipitation on the convection-permitting grids were strongly correlated, which suggests that more accurate forecasts from the parent ensemble should improve the performance of the convection-permitting ensemble nested within it

Microstructural abnormalities in white and gray matter in obese adolescents with and without type 2 diabetes

Aims/hypotheses In adults, type 2 diabetes and obesity have been associated with structural brain changes, even in the absence of dementia. Some evidence suggested similar changes in adolescents with type 2 diabetes but comparisons with a non-obese control group have been lacking. The aim of the current study was to examine differences in microstructure of gray and white matter between adolescents with type 2 diabetes, obese adolescents and healthy weight adolescents. Methods Magnetic resonance imaging data were collected from 15 adolescents with type 2 diabetes, 21 obese adolescents and 22 healthy weight controls. Volumetric differences in the gray matter between the three groups were examined using voxel based morphology, while tract based spatial statistics was used to examine differences in the microstructure of the white matter. Results Adolescents with type 2 diabetes and obese adolescents had reduced gray matter volume in the right hippocampus, left putamen and caudate, bilateral amygdala and left thalamus compared to healthy weight controls. Type 2 diabetes was also associated with significant regional changes in fractional anisotropy within the corpus callosum, fornix, left inferior fronto-occipital fasciculus, left uncinate, left internal and external capsule. Fractional anisotropy reductions within these tracts were explained by increased radial diffusivity, which may suggest demyelination of white matter tracts. Mean diffusivity and axial diffusivity did not differ between the groups. Conclusion/interpretation Our data shows that adolescent obesity alone results in reduced gray matter volume and that adolescent type 2 diabetes is associated with both white and gray matter abnormalities

Vagal Blocking for Obesity Control : a Possible Mechanism-Of-Action

14 September 2016 Erratum to: Vagal Blocking for Obesity Control: a Possible Mechanism-Of-Action Helene Johannessen, David Revesz, Yosuke Kodama, Nikki Cassie, Karolina P Skibicka, Perry Barrett, Suzanne Dickson, Jens Holst, Jens Rehfeld, Geoffrey van der Plasse, Roger Adan, Bård Kulseng, Elinor Ben-Menachem, Chun-Mei Zhao, Duan Chen, 2016, 2016. Obesity surgery. In the original article on page 4 the figures are referred to as (Fig. 1b-d) and (Fig. 1e) in the text. The correct reference is (Fig. 1b-e) and (Fig. 1f), respectively. In the original article on page 5 the figures are referred to as (Fig. 3c) and (Fig. 3d) in the text. The correct reference is (Fig. 3c,d) and (Fig. 3e,f), respectively. Peer reviewedPostprin