The Cadaveric Skin Biopsy Project: description and student evaluation of an innovative approach to dermatology instruction in the preclerkship medical school curriculum.

BACKGROUND: Dermatology can develop creative ways of participating in the preclerkship medical school curriculum. OBJECTIVE: We sought to describe and report student survey results of a novel collaborative learning activity for medical students, directed by dermatology, histology, and gross anatomy faculty, which used cadavers to replicate the process of skin lesion biopsy and provided a realistic setting in which to learn normal-appearing and abnormal skin histology. METHODS: First-year medical students were surveyed regarding the impact of this activity on their understanding of skin histology and their appreciation of dermatology and dermatologic procedures. RESULTS: Students were appreciative of the opportunity to perform biopsies and discover the link between the clinical presentation of a lesion and its underlying histopathology. They were less impressed with the ability of the activity to improve their understanding of the characteristics of benign versus malignant lesions. LIMITATIONS: This is an early feasibility trial at 1 institution. CONCLUSIONS: This project represents one approach to introducing students to dermatology and dermatologic procedures and achieves institutional, Liaison Committee on Medical Education, and Association of American Medical Colleges educational goals. Overall, students highly valued the opportunities to practice clinical procedures and found it aided their understanding and appreciation of dermatology.

The vertebral formula of the last common ancestor of African apes and humans.

The modal number of lumbar vertebrae in modern humans is five. It varies between three and four in extant African apes (mean=3.5). Because both chimpanzees (Pan troglodytes) and gorillas (Gorilla gorilla) possess the same distributions of thoracic, lumbar, and sacral vertebrae, it has been assumed from parsimony that the last common ancestor (LCA) of African apes and humans possessed a similarly short lower back. This "short-backed LCA" scenario has recently been viewed favorably in an analysis of the intra- and interspecific variation in axial formulas observed among African apes and humans (Pilbeam, 2004. J Exp Zool 302B:241-267). However, the number of bonobo (Pan paniscus) specimens in that study was small (N=17). Here we reconsider vertebral type and number in the LCA in light of an expanded P. paniscus sample as well as evidence provided by the human fossil record. The precaudal (pre-coccygeal) axial column of bonobos differs from those of chimpanzees and gorillas in displaying one additional vertebra as well as significantly different combinations of sacral, lumbar, and thoracic vertebrae. These findings, along with the six-segmented lumbar column of early Australopithecus and early Homo, suggest that the LCA possessed a long axial column and long lumbar spine and that reduction in the lumbar column occurred independently in humans and in each ape clade, and continued after separation of the two species of Pan as well. Such an explanation is strongly congruent with additional details of lumbar column reduction and lower back stabilization in African apes.

Using Instrument-Guided Team Reflection and Debriefing to Cultivate Teamwork Knowledge, Skills, and Attitudes in Pre-Clerkship Learning Teams.

Drawing on the science of teamwork and the science of learning, we designed an instrument-guided team reflection and debriefing activity to foster teamwork knowledge, skills, and attitudes (KSAs) in medical students. We then embedded this activity within and between a biweekly series of pre-clerkship Team-Based Learning sessions with the goal of encouraging medical students to cultivate a practical and metacognitive appreciation of eight foundational teamwork KSAs that are applicable to both healthcare teams and classroom learning teams. On evaluations, 144 learners from a class of 156 reported increased appreciation for and team improvement with these teamwork KSAs.

Patterns of correlation and covariation of anthropoid distal forelimb segments correspond to Hoxd expression territories.

Anthropoids in general and hominoids in particular exhibit differential adaptations in forearm and digital skeletal proportions to a diverse array of locomotor modes. Hox genes act as selector genes with spatially regulated expression patterns during development. Their expression in the forelimb appears to define modules that specify differential skeletal growth. Here we explore forelimb skeletal proportions in a large sample of anthropoids from a background provided by Hoxd expression patterns in late-stage murine embryonic forelimbs. Interspecific correlation and principal components analyses of primate forelimb data indicate that morphological variation in anthropoids reflects well-defined developmental modules downstream of Hoxd expression. The phalanges of digit one appear to represent a single growth module, whereas the metacarpals and manual phalanges of the posterior digits correspond to a second, independent, expression territory that extends proximally into the distal zeugopod. In particular, hominoids show very high correlations among the posterior digits and the independence of digit one. In addition, the distal radius is generally highly correlated with the posterior digits and not digit one. Relying on established functional differences among Hox paralogs, we present a model that parsimoniously explains hominoid forearm and digital proportions as a consequence of downstream effects of Hox. We, therefore, suggest that Hox-defined developmental modules have served as evolutionary modules during manual evolution in anthropoids.

Spinopelvic pathways to bipedality: why no hominids ever relied on a bent-hip-bent-knee gait.

Until recently, the last common ancestor of African apes and humans was presumed to resemble living chimpanzees and bonobos. This was frequently extended to their locomotor pattern leading to the presumption that knuckle-walking was a likely ancestral pattern, requiring bipedality to have emerged as a modification of their bent-hip-bent-knee gait used during erect walking. Research on the development and anatomy of the vertebral column, coupled with new revelations from the fossil record (in particular, Ardipithecus ramidus), now demonstrate that these presumptions have been in error. Reassessment of the potential pathway to early hominid bipedality now reveals an entirely novel sequence of likely morphological events leading to the emergence of upright walking.

An enlarged postcranial sample confirms Australopithecus afarensis dimorphism was similar to modern humans.

In a previous study, we introduced the template method as a means of enlarging the Australopithecus afarensis postcranial sample to more accurately estimate its skeletal dimorphism. Results indicated dimorphism to be largely comparable to that of Homo sapiens. Some have since argued that our results were biased by artificial homogeneity in our Au. afarensis sample. Here we report the results from inclusion of 12 additional, newly reported, specimens. The results are consistent with those of our original study and with the hypothesis that early hominid demographic success derived from a reproductive strategy involving male provisioning of pair-bonded females.

Nasomaxillary remodeling and facial form in robust Australopithecus: a reassessment.

In a previous study of the patterns of facial growth remodeling characteristic of early hominid taxa, Bromage (1989) demonstrated that the nasoalveolar clivus of A. robustus was resorptive throughout ontogeny. Based upon the remodeling information provided by small samples (n=6 each) of chimpanzees and modern humans, he concluded that the clival resorption pattern characteristic of robust Australopithecus differed significantly from that of chimpanzees and was instead somewhat convergent upon that of modern humans, in that it served to emphasize a downward facial growth vector. The present study used the SEM/replica technique to assess nasomaxillary remodeling in larger, more age-varied samples of chimpanzee (n=33) and modern human crania (n=22). Results indicate far more intraspecific variability in nasomaxillary remodeling than suggested by Bromage's earlier study. In particular, results from an expanded sample demonstrate that the nasoalveolar clivus of chimpanzees is frequently resorptive, especially at later stages of ontogeny. However, the pattern of clival remodeling observed in chimpanzees is unlike that typical of robust Australopithecus, in which clival resorption occurs throughout ontogeny and in expansive fields that cover the entire clival surface. Although Bromage (1989) considered the pattern of nasomaxillary remodeling observed in robust Australopithecus to have been a byproduct of an extreme maxillary growth rotation, the failure of A. africanus to display a similar pattern suggests that some other factor(s) may have been involved. Regardless, it is unlikely that clival resorption in robust Australopithecus would have significantly impacted the overall vector of facial growth. Instead, the primary morphogenetic effect of this pattern of clival resorption would have been one of local surface sculpting.

Rethinking incisor size and diet in anthropoids: diet, incisor wear and incisor breadth in the African apes.

In a seminal study Hylander (1975) concluded that the length of the incisor row in catarrhines considered frugivores is longer relative to body mass than in those classified as folivores. Assuming that large fruits require greater incisal processing than do leaves, stems, berries, and seeds, he argued that the larger incisors of frugivores increased their resistance to wear. The present analysis examines diet, incisor wear, and incisor crown breadth in cranial samples of western lowland gorillas and chimpanzees. Incisor wear rate was assessed on the basis of the extent of incisor crown reduction observed at sequential stages of first molar wear. Incisor metrics were obtained from the unworn teeth of juveniles. Results suggest that incisor wear is greater in the more folivorous western lowland gorillas than in more frugivorous chimpanzees. Moreover, incisor crown dimensions do not differ appreciably among African apes. These findings fail to support the hypothesis that slower wear rates are associated with broader incisor crowns, and raise new questions regarding the significance of incisor row length in anthropoids.

Variation in mammalian proximal femoral development: comparative analysis of two distinct ossification patterns.

The developmental anatomy of the proximal femur is complex. In some mammals, including humans, the femoral head and greater trochanter emerge as separate ossification centres within a common chondroepiphysis and remain separate throughout ontogeny. In other species, these secondary centres coalesce within the chondroepiphysis to form a single osseous epiphysis much like the proximal humerus. These differences in femoral ontogeny have not been previously addressed, yet are critical to an understanding of femoral mineralization and architecture across a wide range of mammals and may have key implications for understanding and treating hip abnormalities in humans. We evaluated femora from 70 mammalian species and categorized each according to the presence of a 'separate' or 'coalesced' proximal epiphysis based on visual assessment. We found that ossification type varies widely among mammals: taxa in the 'coalesced' group include marsupials, artiodactyls, perissodactyls, bats, carnivores and several primates, while the 'separate' group includes hominoids, many rodents, tree shrews and several marine species. There was no clear relationship to body size, phylogeny or locomotion, but qualitative and quantitative differences between the groups suggest that ossification type may be primarily an artefact of femoral shape and neck length. As some osseous abnormalities of the human hip appear to mimic the normal morphology of species with coalesced epiphyses, these results may provide insight into the aetiology and treatment of human hip disorders such as femoroacetabular impingement and early-onset osteoarthritis.

Sexual dimorphism in Australopithecus afarensis was similar to that of modern humans.

The substantial fossil record for Australopithecus afarensis includes both an adult partial skeleton [Afar Locality (A.L.) 288-1, "Lucy"] and a large simultaneous death assemblage (A.L. 333). Here we optimize data derived from both to more accurately estimate skeletal size dimorphism. Postcranial ratios derived from A.L. 288-1 enable a significant increase in sample size compared with previous studies. Extensive simulations using modern humans, chimpanzees, and gorillas confirm that this technique is accurate and that skeletal size dimorphism in A. afarensis was most similar to that of contemporary Homo sapiens. These data eliminate some apparent discrepancies between the canine and skeletal size dimorphism in hominoids, imply that the species was not characterized by substantial sexual bimaturation, and greatly increase the probability that the reproductive strategy of A. afarensis was principally monogamy.