Beyond homogenization discourse: Reconsidering the cultural consequences of globalized medical education.

INTRODUCTION: Global medical education standards, largely designed in the West, have been promoted across national boundaries with limited regard for cultural differences. This review aims to identify discourses on cultural globalization in medical education literature from non-Western countries. METHODS: To explore the diversity of discourses related to globalization and culture in the field of medical education, the authors conducted a critical review of medical education research from non-Western countries published in Academic Medicine, Medical Education and Medical Teacher from 2006 to 2014. Key discourses about globalization and culture emerged from a preliminary analysis of this body of literature. A secondary analysis identified inductive sub-themes. RESULTS: Homogenization, polarization and hybridization emerged as key themes in the literature. These findings demonstrate the existence of discourses beyond Western-led homogenization and the co-existence of globalization discourses ranging from homogenization to syncretism to resistance. CONCLUSIONS: This review calls attention to the existence of manifold discourses about globalization and culture in non-Western medical education contexts. In refocusing global medical education processes to avoid Western cultural imperialism, it will also be necessary to avoid the pitfalls of other globalization discourses. Moving beyond existing discourses, researchers and educators should work towards equitable, context-sensitive and locally-driven approaches to global medical education.

Modulation of behavioral networks by selective interneuronal inactivation.

Gamma-aminobutyric acid (GABA)-ergic disturbances are hallmark features of schizophrenia and other neuropsychiatric disorders and encompass multiple interneuronal cell types. Using bacterial artificial chromosome-driven, miRNA silencing technology we generated transgenic mouse lines that suppress glutamic acid decarboxylase 1 (GAD1) in either cholecystokinin (CCK)- or neuropeptide Y (NPY)-expressing interneurons. In situ lipidomic and proteomic analyses on brain tissue sections revealed distinct, brain region-specific profiles in each transgenic line. Behavioral analyses revealed that suppression of GAD1 in CCK+ interneurons resulted in locomotor and olfactory sensory changes, whereas suppression in NPY+ interneurons affected anxiety-related behaviors and social interaction. Both transgenic mouse lines had altered sensitivity to amphetamine albeit in opposite directions. Together, these data argue that reduced GAD1 expression leads to altered molecular and behavioral profiles in a cell type-dependent manner, and that these subpopulations of interneurons are strong and opposing modulators of dopamine system function. Furthermore, our findings also support the hypothesis that neuronal networks are differentially controlled by diverse inhibitory subnetworks.

Comparison of radionuclide and contrast ventriculography for detection and quantitation of regions of myocardial ischemia in dogs.

Radionuclide and contrast ventriculography were evaluated for their ability to estimate myocardial ischemia. In 14 closed-chest, sedated dogs, a small and larger region of ischemia were produced by inflating balloon occluders on the left anterior descending coronary artery. The systemic arterial pressure, atrial-paced heart rate, global ejection fraction by radionuclide and contrast ventriculography, regional wall-motion abnormalities (as the percentage of abnormally contracting segments), and regional myocardial blood flow (using the microsphere technique) were measured during an initial control period, two separate ischemic periods, and a final control period. The regional ischemic weights based on myocardial blood flow ranged from 0 to 38.5 g and were grouped as zero, small (range 0 to less than 10 g, mean 3.40 g), and large regions of ischemia (greater than 10 g, mean 24.8 g). Regional wall-motion abnormalities were sensitive qualitative indicators of ischemia. Receiver operating characteristic analysis showed that both ventriculographic methods were highly sensitive, specific, and accurate for detecting regional ischemia. Contrast ventriculography was slightly superior for detecting small regions less than 4 g, but the methods were equal for regions greater than 4 g. The arterial pressure and heart rate were unchanged during ischemia. For small regions of ischemia, the global ejection fraction did not fall using either the contrast or radionuclide technique, but it fell significantly when large regions were produced. There was a quantitative relationship between the percentage of abnormally contracting segments and the grams of myocardial ischemia (for radionuclide ventriculography, r = 0.65, P = 0.003, and for contrast ventriculography, r = 0.75, P less than 0.001), but for many small regions of ischemia, wall-motion changes were greater than anticipated, suggesting hypofunction of the continguous normal tissue. This study demonstrated that both radionuclide and contrast ventriculography were quite sensitive and specific for detecting measured amounts of regional ischemia. The functional changes resulting from ischemia are quantitatively related to the extent of regional ischemia, small areas resulting in regional wall motion abnormalities, and large areas producing both reduced global ejection fraction and wall motion changes.

An unusual case of congenital hypertrophy of the retinal pigment epithelium.

Photographic documentation of enlargement of congenital hypertrophy of the retinal pigment epithelium is shown in a 42-year-old white woman. No other reports of enlargement have been made and previous articles have stated that these lesions do not grow.

Autosomal dominant exudative vitreoretinopathy.

Eight family members had familial exudative vitreoretinopathy. They exhibited a variety of clinical stages of the disease process. Some clinical findings included retinal detachment, fibrovascular masses with dragged disc and macula, neovascular fronds and intraretinal deposits. The fundus and angiographic findings were found to be similar to those in cases reported previously. Electroretinograms were normal. Of particular interest in this pedigree was the sole clinical finding of isolated intraretinal deposits in four family members. This characteristic may represent a mild expression of the disease and warrant appropriate genetic counseling. Our study confirms the variable clinical expression of the disease.

A naturalistic study of the impact of acute physical activity on feeling states and affect in women.

This field study used experience sampling procedures to examine the relationship of feeling states and affect to acute bouts of physical activity in women. Participants (N = 86) completed brief affect and feeling state measures (a) in response to random stratified pager tones and (b) before and after acute bouts of vigorous physical activity for 6 weeks. Analysis of averaged difference scores revealed that acute vigorous physical activity was associated with significant improvements in affect and feeling states, particularly in feelings of revitalization. Moreover, within-subject analyses indicated that the effects were moderated by preactivity scores, with the greatest improvements seen when women felt worst before activity.

Effects of baseline responses, in-task feelings, and duration of activity on exercise-induced feeling states in women.

This study investigated the hypothesis that the effects of acute aerobic exercise on feeling states may be influenced by the objective dose of activity, subjective responses during exercise, and preexisting levels of feeling states. College-age women (N = 80) completed baseline measures and were then randomly assigned to 1 of 4 conditions: attention control for 10 min, or exercise for 10 min, 25 min, or 40 min. Levels of exertion and affect were assessed during exercise, and posttesting occurred 20 min following activity. Exercise enhanced revitalization in comparison with the control condition; however, this effect occurred only for participants scoring low to moderate on the pretest. In addition, in-task feeling states predicted postexercise revitalization even after we controlled for the treatment, the pretest, and the Pretest x Treatment interaction.

Endoscopic orbital surgery.

Orbital endoscopy is useful in managing various types of orbital problems. A hand-held endoscope can be used for simple procedures. Surgery and prolonged observation require a mounted endoscope. These two techniques provided good results in 15 patients. Endoscopy proved useful in finding and removing orbital foreign bodies. It is potentially useful in the management of orbital tumors, but experience in this area is still limited.

An endoscope for ophthalmology.

An endoscope with a 1.7-mm diameter shaft has unique properties of focus, magnification, and large field of view that make it useful for both orbital and intraocular surgery.

Intraocular endoscopic surgery.

We have successfully used a new small endoscope in posterior segment surgery in situations where the operating microscope or binocular indirect ophthalmoscope provided an inadequate view. In this series of 18 procedures, we preformed posterior vitrectomies, removed retained foreign bodies, and reattached persistent retinal detachments. The only major complication was a retinal detachment. Learning to use a monocular system requires practice and preparation with experimental animals.

The curse of inactivity: failure of acute exercise to enhance feeling States in a community sample of sedentary adults.

This laboratory experiment used random digit dialing procedures to recruit a community sample of physically inactive participants into a study that was designed to examine the impact of different intensities of acute aerobic exercise on feeling states. Sedentary men (n 5 36) and women (n 5 36) were randomly assigned to experience a single bout of aerobic exercise at one of three intensities (30%, 50%, 70% of HRR). Each participant attended two counterbalanced laboratory sessions, one involving an attention-control manipulation and the other involving aerobic exercise. Before and after each session, they completed a feeling state questionnaire. Data suggested that there were neither widespread mood-enhancing effects of acute exercise nor evidence for a strong dose-response relationship.

Metacarpal and metatarsal fractures in dogs.

Metacarpal fractures were more common than metatarsal fractures in this retrospective study of 37 dogs. Fractures of one metacarpal or metatarsal bone occurred in 24 per cent of the dogs, two metacarpal bones in 16 per cent, three metacarpal or metatarsal bones in 19 per cent, and four metacarpal or metatarsal bones in 41 per cent. Eighty-seven per cent of the dogs with fractures of four bones had fracture displacement or malalignment of at least one digit. Progressive fracture healing usually occurred irrespective of stabilisation method. For malaligned fractures, however, external coaptation did not consistently improve alignment. Fracture alignment was consistently improved by open reduction and internal fixation of acute fractures with bone plates. Fractures of four bones occurred most often in the distal metacarpus as opposed to the proximal metatarsus. Therefore, open reduction and internal fixation may be more commonly indicated for severe metacarpal fractures, because fracture displacement or axial malalignment was significantly associated with fractures of the mid or distal regions of the metacarpus or metatarsus (P = 0.052).

Fire safety in the operating room.

The operating room environment is considered a potentially significant fire hazard. The role of the anesthetist in preventing and handling fires is pivotal to patient survival. Means of preventing fires as well as extinguishing them are discussed.