Fascial bundles of the infraspinatus fascia: anatomy, function, and clinical considerations.

The infraspinatus fascia is a tough sheet of connective tissue that covers the infraspinatus fossa of the scapula and the muscle within. Muscle fibers originate from the fossa and fascia and then travel laterally to insert on the greater tubercle of the humerus. Frequently the infraspinatus fascia is quickly removed to appreciate the underlying muscle, but the fascia is an interesting and complex structure in its own right. Despite having a characteristic set of fascial bundles, no contemporary anatomy texts or atlases describe the fascia in detail. The infraspinatus fascia was dissected in detail in 11 shoulders, to characterize the fascial bundles and connections that contribute to it. Thereafter, 70 shoulders were dissected to tabulate the variability of the fascial bundles and connections. Six characteristic features of the infraspinatus fascia were noted: a medial band, an inferior-lateral band, and superior-lateral band of fascia, insertion of the posterior deltoid into the infraspinatus fascia, a transverse connection from the posterior deltoid muscle to the infraspinatus fascia, and a retinacular sheet deep to the deltoid and superficial to the infraspinatus and teres minor muscles. Although other structures of the shoulder are more frequently injured, the infraspinatus fascia is involved in compartment syndromes and the fascial bundles of this structure are certain to impact the biomechanical function of the muscles of the posterior shoulder.

Prediction intervals: Placing real bounds on regression-based allometric estimates of biomass.

Biomass allometry studies routinely assume that regression models can be applied across species and sites, and that goodness of fit of a regression model to its derivation dataset indicates both the relevance of the model to a new dataset and the likely error. Assuming that a model is relevant for a new sample, a prediction interval is a useful error measure for stand mass. Prediction coverage tests whether the model and hence the interval are appropriate in the new sample. Data for three similar shrubby species from four similar sites were combined in various ways to test the impact of varying levels of biodiverse heterogeneity on the performance of the four models most commonly used in published biomass studies. No one model performed consistently well predicting new data, and validation checks were not good indicators of prediction coverage. The highly variable results suggest that the common models might contain insufficient variables. Euclidean distance was used to quantify the relative similarity of samples as a possible means of estimating prediction coverage; it proved unsuccessful with these data.

Connection between the spinal dura mater and suboccipital musculature: evidence for the myodural bridge and a route for its dissection--a review.

A connective tissue link between the spinal dura mater and the rectus capitis posterior minor muscle was first described in 1995 and has since been readily demonstrated via dissection, magnetic resonance imaging, and plastinated cross-sections of the upper cervical region (Hack et al. [1995] Spine 20:2484-2486). This structure, the so-called "myodural bridge," has yet to be included in any of the American anatomy textbooks or dissection guides commonly used in medical education. This direct anatomic link between the musculoskeletal system and the dura mater has important ramifications for the treatment of chronic cervicogenic headache. This article summarizes the anatomic and clinical research literature related to this structure and provides a simple approach to dissect the myodural bridge and its attachment to the posterior atlanto-occipital membrane/spinal dura mater complex and summarizes the case for its possible inclusion in medical anatomy curricula.

Influence of study approaches on academic outcomes during pre-clinical medical education.

BACKGROUND: Different approaches to study lead to differing academic outcomes. Deep and strategic approaches have been linked to academic success while surface approaches lead to poorer understandings. AIMS: This study sought to characterize how the approaches to study used by medical students impacted their academic success as measured by three outcomes: cumulative grades at the end of the first year, cumulative grades at the end of the second year, and performance on a medical licensing examination. METHODS: The approaches and study skills inventory for students was administered to medical students to determine their predominant study approach (deep, strategic, superficial) at the beginning of their first year, end of first year, and end of second year. Each group's mean performance on each outcome measure was compared by ANOVA to find significant differences. RESULTS: For all three outcome measures, strategic approaches to study were associated with high performance while surface approaches with a poor one. Deep approaches were most popular at all times and were largely associated with adequate performance. CONCLUSIONS: Deep approaches to study are sufficient for success in the current paradigm of medical education but strategic ones may offer a selective advantage to those who use them. Surface approaches to study must be discouraged by instructors through deliberate course design.

First year medical students' approaches to study and their outcomes in a gross anatomy course.

Three approaches to study have been described in phenomenographic educational research: deep, strategic, and surface. Deep approaches to learning have been correlated with meaningful learning and academic success, whereas surface approaches produce an externalization of learning and poor outcomes. Students adopting a strategic approach adopt either a deep or surface approach in response to perceived examination demands. Despite being well known in Europe and Australia, this research paradigm has been applied sporadically in the United States. In this study, the approaches to study of a group of first year American medical students were collected using the Approaches and Study Skills Inventory for Students instrument at the beginning and end of their first year to find how consistent these approaches remained over time. At both times, the majority of participants adopted deep approaches, followed by strategic and then surface approaches. The percentage of participants using a surface approach grew during the first year but never exceeded 10%. The mean anatomy grades of students adopting each approach were then compared to find how each approach correlated with success in the course. Mean grades of students using a strategic approach were significantly higher than average at both times. Students who maintained a strategic approach throughout the first year had significantly higher mean grades than average while students who changed to a surface approach had significantly worse mean anatomy grades. Problem-based students had significantly higher scores on several deep submeasures than lecture-based peers and female students demonstrated greater fear of failure than male peers at both times.

Positive youth development within a family leisure context: youth perspectives of family outcomes.

Although a variety of recreation programs provide valuable settings for youth development and should continue, the home should be considered the first and perhaps the most essential context for positive youth development. Family leisure experiences are purposively or intentionally planned by invested adults (parents) to create and maintain meaningful relationships and provide supportive opportunities for their children to learn skills and develop behaviors that will not only strengthen current family life but ultimately contribute to their overall positive development. The article presents family leisure research from a youth perspective and sets out the implications of the role of home-based core types of leisure that families engage in.

Investigating the Presence of the History of Medicine in North American Medical Education: Can One of the Medical Humanities Concisely Integrate with Biomedical and Clinical Content with Reference to Clinical Competencies?

INTRODUCTION: As a curricular topic, the history of medicine can reinforce medical knowledge while integrating the benefits associated with humanities education. This study examined the degree to which medical history was present in the curricula of North American Medical Schools, how those sessions (if any) were delivered, and who delivered them. We hypothesized that medical history would be present but that very few American Medical schools would have mandatory sessions, that the presentation of this content would be very diverse, and that sessions would be presented by a variety of professionals. METHODS: We compiled a contact list of deans and curricular administrators at each institution and recruited respondents from an online discussion board. Respondents completed a short survey regarding the curriculum at their home institution. RESULTS: We received responses from 96 of 209 institutions (46.0%). Of these, 29.2% of respondents indicated that their institution had mandatory sessions on medical history, 42.7% had non-mandatory curricular sessions, 49.0% had extracurricular sessions, and 21.4% had electives on the history of medicine. Lecture was the primary means of delivery in all modalities except for the electives, which primarily used small group discussion. Clinical faculty were the most common people overseeing these sessions, but a wide variety of others also contributed. DISCUSSION: While few North American medical schools had mandatory sessions on the history of medicine, the topic was present in very diverse ways. The lack of standardization in teaching the history of medicine may provide fertile ground for subsequent research in medical education.

Tissue Adhesives for Hernia Mesh Fixation: A Literature Review.

In an effort to optimize the results during inguinal hernia repair, surgeons need to consider the role of different mesh fixation techniques. The use of tissue adhesives is proposed for mesh fixation, which demonstrate similar or improved outcomes in the realm of postoperative pain, hernia recurrence, cost, and formation of a hematoma or seroma. In this review, mesh fixation using fibrin glue and cyanoacrylate glue is compared to standard suture or tack techniques. The results of this investigation warrant consideration by surgeons seeking to improve patient outcomes.

Posterolateral Corner Knee Injuries: Review of Anatomy and Clinical Evaluation.

The structures in the posterolateral corner of the knee, which stabilize the joint, are often involved in injuries to the posterior cruciate ligament. Familiar structures include the anterior cruciate ligament, posterior cruciate ligament, tibial collateral ligament, and menisci. Less familiar are the structures of the posterolateral corner, the most important of which are the fibular collateral ligament, popliteus tendon, and popliteofibular ligament, which resist varus angulation, external rotation, or posterior translation of the tibia. Injury to the posterolateral corner can be assessed with the posterolateral drawer, dial, reverse pivot shift, external rotation recurvatum, and varus stress tests. The purpose of this review is to highlight the posterolateral corner of the knee and injuries to its structures so that physicians can more accurately diagnose these injuries and provide appropriate treatment. Management focuses on restoring the fibular collateral ligament, popliteofibular ligament, and, in certain cases, the popliteus tendon.

The influence of study methods and knowledge processing on academic success and long-term recall of anatomy learning by first-year veterinary students.

The purpose of this investigation was to quantitatively and qualitatively identify the study methods and learning strategies that veterinary students used to study anatomy during their first year of professional school and to correlate these with their academic achievement and long-term recall of information. It was surmised that active study methods would be more beneficial than passive method, but this hypothesis was not supported. The activity or passivity of each study method was secondary to the way in which the students processed the learning. No single study method was associated with academic success or long-term recall; instead, successful students used a multitude of study methods while the struggling students relied on a single method alone, although these methods varied from student to student. Students and their study methods were profiled using the qualitative technique known as phenomenographic analysis to find those who studied in a deep or surface way. The deep-processing students, who commonly used multiple study methods, not only succeeded in the class but also had better recall. Students who relied on a memorization-heavy surface approach to learning had limited recall and tended to perform poorly in the class. These results strongly suggest that by encouraging students to integrate their studying by using multiple methods educators can improve both student grades and recall of complex topics.