Dose-Response of Creatine Supplementation on Cognitive Function in Healthy Young Adults.

To determine if creatine (Cr) supplementation could influence cognitive performance and whether any changes were related to changes in prefrontal cortex (PFC) activation during such cognitive tasks, thirty (M = 11, F = 19) participants were evenly randomized to receive supplementation with Cr (CR10:10 g/day or CR20:20 g/day) or a placebo (PLA:10 g/day) for 6 weeks. Participants completed a cognitive test battery (processing speed, episodic memory, and attention) on two separate occasions prior to and following supplementation. Functional near-infrared spectroscopy (fNIRS) was used to measure PFC oxyhemoglobin (O2Hb) during the cognitive evaluation. A two-way repeated measures ANOVA was used to determine the differences between the groups and the timepoints for the cognitive performance scores and PFC O2Hb. In addition, a one-way ANOVA of % change was used to determine pre- and post-differences between the groups. Creatine (independent of dosage) had no significant effect on the measures of cognitive performance. There was a trend for decreased relative PFC O2Hb in the CR10 group versus the PLA group in the processing speed test (p = 0.06). Overall, six weeks of Cr supplementation at a moderate or high dose does not improve cognitive performance or change PFC activation in young adults.

Acute Aerobic Exercise-Induced Motor Priming Improves Piano Performance and Alters Motor Cortex Activation.

Acute aerobic exercise has been shown to improve fine motor skills and alter activation of the motor cortex (M1). The intensity of exercise may influence M1 activation, and further impact whole-body motor skill performance. The aims of the current study were to compare a whole-body motor skill via a piano task following moderate-intensity training (MIT) and high-intensity interval training (HIIT), and to determine if M1 activation is linked to any such changes in performance. Nine subjects (seven females and two males), aged 18 ± 1 years completed a control, MIT, and HIIT trial followed by administration of a piano performance task. M1 activation was evaluated by measuring oxyhemoglobin (O2Hb) and hemoglobin difference (Hbdiff) changes during post-exercise piano performance using functional near-infrared spectroscopy (fNIRS). The results indicate that piano performance scores were higher after the MIT trial, but not HIIT trial, compared to the control trial. A negative relationship was detected between heart rate during HIIT and post-HIIT piano scores. M1 activation (as measured by Hbdiff) was significantly increased after the HIIT trial. M1 activation was also positively associated with piano performance when exercise trials (HIIT + MIT) and all trials (HIIT + MIT + Control) were combined. We found that acute moderate-intensity exercise led to an improvement in complex motor skill performance while higher-intensity exercise increased M1 activation. These results demonstrate that moderate-intensity exercise can prime the nervous system for the acquisition of whole-body motor skills, suggesting that similar exercise protocols may be effective in improving the outcomes of other motor tasks performed during regular routines of daily life (e.g., sporting tasks, activities of daily living or rehabilitation). In addition, it appears that improvements in motor task performance may be driven by M1 activation. Our findings provide new mechanistic insight into the complex relationship between exercise intensity, M1 activation, and whole-body motor skill performance.

"They Will Come to Understand": Supervisor Reflections on International Medical Electives.

Phenomenon: Increasing numbers of medical students from high-income countries are undertaking international medical electives (IMEs) during their training. Much has been written about the benefits of these experiences for the student, and concerns have been raised regarding the burden of IMEs on host communities. The voices of physicians from low- and middle-income countries who supervise IMEs have not been explored in depth. The current study sought to investigate host-physician perspectives on IMEs. Approach: Host supervisors were recruited by convenience sampling through students travelling abroad for IMEs during the summer of 2012. From 2012 through 2014, 11 semistructured interviews were conducted by telephone with host supervisors from Nepal, Uganda, Ghana, Guyana, and Kenya. Participants were invited to describe their motivations for hosting IMEs and their experiences of the benefits and harms of IMEs. Interviews were transcribed verbatim and checked for accuracy. An initial coding framework was developed and underwent multiple revisions, after which analytic categories were derived using conventional qualitative content analysis. Findings: For host supervisors, visits from international medical students provided a window into the resource-rich medical practice of high-income countries, and supervisors positioned themselves, their education, and clinical expertise against perceived standards of the international students' context. Hosting IMEs also contributed to supervisors' identities as educators connected to a global community. Supervisors described the challenge of helping students navigate their distress when confronting global health inequity. Finally, the desire for increasingly reciprocal relationships was expressed as a hope for the future. Insights: IMEs can be formative for host supervisors' identities and are used to benchmark host institutions compared with international medical standards. Reciprocity was articulated as essential for IMEs moving forward.

Health Status of North Korean Refugees in Toronto: A Community Based Participatory Research Study.

Increasing numbers of North Koreans are fleeing their country due to economic insecurity and political persecution, with over 1000 North Koreans Refugee (NKR) claims in Canada in the past decade. There is little published on their health. Using a Community-Based Participatory Research (CBPR) methodology, we investigated NKR health status through a retrospective chart review of 1022 patients rostered at a Toronto refugee clinic between December 2011 and June 2014. The health status of 117 NKRs was compared to that of 905 other refugees seen during the same period. There were lower rates of chronic diseases, including obesity and elevated blood pressure, among NKRs. Conversely, some infectious diseases were more prevalent, including hepatitis B and chlamydia. Female NKRs had higher rates of abnormal cervical cytology. This study uniquely uses CBPR methodology to examine the health of NKRs, and can help guide targeted interventions in this population.

Toward reciprocity: host supervisor perspectives on international medical electives.

CONTEXT: An increasing number of medical students are engaging in international medical electives, the majority of which involve travel from northern, higher-income countries to southern, lower-income countries. Existing research has identified benefits to students participating in these experiences. However, reports on the impacts on host communities are largely absent from the literature. OBJECTIVES: The current study aims to identify host country perspectives on international medical electives. METHODS: Questionnaires were delivered to a convenience sample of supervisors hosting international elective students (n = 39) from a Canadian medical school. Responses represented 22 countries. Conventional content analysis of the qualitative data was used to identify themes in host supervisor perspectives on the impact of international medical electives. RESULTS: Host country supervisors identified that in addition to the benefits realised by the elective students, supervisors and their institutions also benefited from hosting Canadian students. Although some host supervisors denied the occurrence of any harm, others expressed concern that international elective students may negatively impact the local community in terms of resource use and patient care. Host country supervisors also identified potential harms to travelling students including health risks and emotional distress. Ideas for improving international electives were identified and were largely centred around increasing the bidirectional flow of students by establishing formal partnerships between institutions. CONCLUSIONS: This research provides important insights into the impacts of international medical student electives from the perspective of host country supervisors. This research may be a starting point for further research and the establishment of meaningful partnerships that incorporate the self-identified needs of receiving institutions, especially those in lower-income settings.

CtBP1 interacts with Ikaros and modulates pituitary tumor cell survival and response to hypoxia.

C-terminal binding protein (CtBP) is a transcriptional corepressor that plays an important role in mammalian development and tumorigenesis. We demonstrate that CtBP is expressed in adenohypophyseal cells and is expressed at high levels in human corticotroph, somatotroph, and lactotroph pituitary adenomas. CtBP interacts with Ikaros isoforms in GH4 and AtT20 pituitary tumor cells. Ikaros and CtBP1 expression is coordinately induced by hypoxia, and this response is abrogated by CtBP1 deficiency. Forced reduction of CtBP1 leads to reduced cell growth, up-regulation of Sprouty 2, and down-regulation of ectonucleotide pyrophosphatase phosphodiesterase 2 (Enpp2). Consistent with diminished Enpp2 activity, CtBP1-deficient pituitary cells are more susceptible to hypoxia-induced apoptosis, which is rescued by Enpp2-derived lysophosphatidic acid treatment. These results identify putative oncogenic properties of CtBP1 and provide new insights into the overlapping functions of two members of the chromatin remodeling network in the response to hypoxic pituitary tumor cell drive.

Addressing the severe shortage of health care providers in Ethiopia: bench model teaching of technical skills.

CONTEXT: There is a severe shortage of health care workers in Ethiopia. This situation must be addressed by the efficient training of mass cohorts of students. OBJECTIVES: This study aimed to demonstrate that bench model training is a feasible approach to teaching surgical skills in Ethiopia. METHODS: A pre-test, simulation-based training intervention and post-test design was used. Two objective structured assessments of technical skills (OSATS) and a bench-top simulation training session were administered at the Black Lion Hospital, Addis Ababa, Ethiopia. Participants included 19 surgical residents who volunteered as trainees. Five surgical faculty members and one senior resident from the Black Lion Hospital, as well as two faculty members from the University of Toronto, participated as trainers and evaluators. The intervention consisted of OSATS tests comprising four stations, covering knot tying, closure of skin laceration, elliptical excision and bowel anastomosis. Tests were separated by 2-hour practice sessions. Main outcome measures included previously validated instruments comprising global rating scales (GRS) and skill-specific checklists (SSC). RESULTS: The measures showed no improvement on knot tying (GRS: P = 0.14; SSC: P = 0.7), marginal improvement on closure of laceration (GRS: P = 0.48; SSC: P = 0.003), and improvements on excision (GRS: P = 0.012; SSC: P = 0.003) and bowel anastomosis (GRS: P < 0.001; SSC: P < 0.001). CONCLUSIONS: The bench models and scoring schemes developed in Toronto, Canada were directly applicable in Addis Ababa, Ethiopia. This approach may prove a feasible, safe and cost-effective method for training a multitude of health care professionals in technical skills and may help to address the human resources deficit in Africa.

Tensiometry as a measure of improvement in knot quality in undergraduate medical students.

INTRODUCTION: This study examined the validity of tensiometry as an objective method of assessing the improvements in the quality of knots and technical performance due to practice on suturing and knot-tying skills. METHODS: We evaluated the quality of 1,830 knots produced by undergraduate medical students before training (pre-test), after (post-test), and after a week retention (retention-test) using tensiometry. These results were compared to expert-based assessments of products and performance. RESULTS: Tensiometry, as well as expert-based assessments can detect changes in the quality of knots and technical performance from pre to post and retention-test ( p<0.05). However, these three methods may assess different dimensions of the same products and actions. CONCLUSIONS: The development of trainee evaluation criteria for the acquisition of surgical skills is a crucial element in surgical education. Based on our patterns of results it is hypothesized that tensiometry can serve as an economic first approximation of the quality of knots and suturing performance.