Students' Engagement in and Perceptions of Blended Learning in a Clinical Module in a Veterinary Degree Program.

Blended learning has received much interest in higher education as a way to increase learning efficiency and effectiveness. By combining face-to-face teaching with technology-enhanced learning through online resources, students can manage their own learning. Blended methods are of particular interest in professional degree programs such as veterinary medicine in which students need the flexibility to undertake intra- and extramural activities to develop the range of competencies required to achieve professional qualification. Yet how veterinary students engage with blended learning activities and whether they perceive the approach as beneficial is unclear. We evaluated blended learning through review of student feedback on a 4-week clinical module in a veterinary degree program. The module combined face-to-face sessions with online resources. Feedback was collected by means of a structured online questionnaire at the end of the module and log data collected as part of a routine teaching audit. The features of blended learning that support and detract from students' learning experience were explored using quantitative and qualitative methods. Students perceived a benefit from aspects of face-to-face teaching and technology-enhanced learning resources. Face-to-face teaching was appreciated for practical activities, whereas online resources were considered effective for facilitating module organization and allowing flexible access to learning materials. The blended approach was particularly appreciated for clinical skills in which students valued a combination of visual resources and practical activities. Although we identified several limitations with online resources that need to be addressed when constructing blended courses, blended learning shows potential to enhance student-led learning in clinical courses.

Microbial sequencing analyses suggest the presence of a fecal veneer on indoor climbing wall holds.

Artificial climbing walls represent a unique indoor environment in which humans interact closely with a variety of surface types. Climbing wall holds may mediate transmission of organisms between individuals, and yet there are no studies that identify microorganisms present on these surfaces. In the current study, the microorganisms found on climbing wall holds were characterized by analysis of amplified SSU rRNA gene sequences. In contrast to many other studies of built environments, the majority of microorganisms on holds were most closely related to microbes annotated as being recovered from environmental sources, such as soil, with human skin also representing an important source. Regional patterns were evident as rRNA gene sequences from the marine cyanobacterium Prochlorococcus were abundant in gyms found within 16 km of the ocean. Enterobacteriaceae were present on 100 % of holds surveyed, and the members detected are commonly associated with fecal matter.

Negative interaction between indomethacin and exercise in mice.

We examined the possible negative interaction of the combined use of the NSAID indomethacin (IND) and exercise in mice. Mice were assigned to one of 4 groups: Exercise 2.5 mg/kg IND (Ex-2.5), Sedentary 2.5 mg/kg IND (Sed-2.5), Exercise 5.0 mg/kg IND (Ex-5.0) and Sedentary 5.0 mg/kg IND (Sed-5.0). Mice were given IND (gavage) 1 h prior to exercise (treadmill run at 30 m/min, 8% grade for 90 min) or rest for 14 consecutive days. Run times, body weight and mortality were recorded daily. Sed-5.0 was highly toxic and caused 70% mortality compared to Sed-2.5, which was well tolerated (0% mortality) (P<0.05). While the addition of exercise had no greater effect on mortality in Ex-5.0, it increased it in the 2.5 group (52% vs. 0%; P<0.05). Run time was reduced from baseline beginning on day 2 (Ex-5.0), or day 3 (Ex-2.5) (P<0.05). Body weight (recorded in the 2.5 mg/kg groups only) was decreased from baseline in Ex-2.5 and Sed-2.5 (P<0.05), but this effect occurred earlier and was of greater magnitude in Ex-2.5. Exercise combined with IND use can lead to serious side effects in mice. Future research is needed to test the hypothesis that this effect is due to increased GI permeability and whether humans are also at risk.

Benefits of exercise training on breast cancer progression and inflammation in C3(1)SV40Tag mice.

Many observational epidemiologic studies suggest an association between exercise and breast cancer risk. However, the lack of controlled experimental studies that examine this relationship and the mechanisms involved weaken the basis for inferring a causal relationship. Inflammation plays a role in breast cancer progression and exercise has been reported to reduce inflammation; however, the anti-inflammatory effects of exercise in breast cancer have yet to be established. We examined the relationship between exercise training and systemic inflammation in relation to breast cancer progression in C3(1)SV40Tag mice. Female C3(1)SV40Tag mice were assigned to either exercise (Ex) or sedentary (Sed) treatment (n=12-14/group). Beginning at 4 wks of age mice (Ex) were run on a treadmill for 60 min/d (20 m/min and 5% grade), 6 d/wk for a period of 20 wks. Mice were examined weekly for palpable tumors, and tumor number and volume were recorded. At 24 wks of age mice were sacrificed and a more direct measure of tumor number and volume, and spleen weight was recorded. Plasma was analyzed for MCP-1 and IL-6 concentration using ELISA. Ex reduced palpable tumor number at sacrifice (24 wks) by approximately 70% (P<0.05). Tumor volume was also reduced in Ex at 21-23 wks (P<0.05). This reduction in tumor progression by Ex was associated with a reduction in plasma concentration of MCP-1 and IL-6, and spleen weight (P<0.05). These data provide strong support for a beneficial effect of exercise training on tumor progression in the C3(1)SV40Tag mouse model of breast cancer that may be partly mediated by its anti-inflammatory potential.

Exercise stress increases susceptibility to influenza infection.

Exercise stress is associated with an increased risk for upper respiratory tract infection (URTI) while moderate exercise has been associated with a decreased risk. We have shown that exercise stress can increase susceptibility (morbidity, symptom severity and mortality) to HSV-1 respiratory infection, but there is little evidence on the effects of stressful exercise on susceptibility to the principal etiological agents of human respiratory infections, including influenza viruses. This study examined the effects of stressful exercise on susceptibility to influenza virus (A/Puerto Rico/8/34 (H1N1)). Mice were assigned to one of two groups: exercise (Ex) or control (Con). Exercise consisted of a treadmill run to volitional fatigue ( approximately 120 min) performed on three consecutive days. Fifteen minutes after the last bout of exercise or rest, mice (n=20-21/group) were intranasally inoculated with a standardized dose of influenza virus (0.25 HAU). Mice were monitored daily for morbidity (time to sickness), symptom severity and mortality (time to death) for 21 days. Exercise stress was associated with an increase in susceptibility to infection (morbidity, mortality and symptom severity on days 6 and 7; P<0.05). These data from a controlled influenza virus challenge model add significantly to the growing body of evidence that severe exercise can increase susceptibility to URTI.

Monitoring circulating tumor cells in cancer vaccine trials.

The presence of circulating tumor cells (CTC) from various cancers has provided a wealth of information and possibilities. As the role of CTC detection in the treatment assessment of metastatic breast cancer becomes standard, there is interest in applying this tool in cancer vaccine development and clinical trial monitoring. Since we lack a proven immunologic assay that correlates with clinical response, CTC detection, quantification and phenotypic characterization may be a useful surrogate for clinical outcome. The Cancer Vaccine Development Program is involved in the development of HER2/neu peptide based vaccine development for the prevention of recurrence in HER2/neu expressing cancers like breast cancer. The CellSearch System (Veridex, LLC Warren, NJ) has been used by our lab in conjunction with in vivo and/or in vitro immunologic measurements to define a monitoring tool that could predict clinical response. Once validated, this assay could significantly shorten clinical trials and lead to more efficient assessment of potentially promising cancer vaccines.

Susceptibility to HSV-1 infection and exercise stress in female mice: role of estrogen.

Exhaustive exercise has been associated with an increased risk for upper respiratory tract infections in mice and humans. We have previously shown (Brown AS, Davis JM, Murphy AE, Carmichael MD, Ghaffer A, Mayer EP. Med Sci Sports Exerc 36: 1290-1295, 2004) that female mice are better protected from the lethal effects of herpes simplex virus type 1 (HSV-1) infection, both at rest and following exercise stress, but little is known about possible mechanisms. This study tested the effects of estrogen on HSV-1 infection and macrophage antiviral resistance following repeated exhaustive exercise. Female mice were assigned to either exercise (Ex) or control (C): intact female (I-C or I-Ex), ovariectomized female (O-C or O-Ex), or ovariectomized estrogen-supplemented female (E-C or E-Ex). Exercise consisted of treadmill running to volitional fatigue ( approximately 125 min) for 3 consecutive days. Intact female mice had a later time to death than O and E (P < 0.05) and fewer deaths than both O and E (P < 0.05). Exercise stress was associated with increased time to sickness (P < 0.05) and symptom severity at days 6 and 12-21 postinfection (P < 0.05) and decreased macrophage antiviral resistance (P < 0.001) in all groups. E had increased symptom severity at days 6 and 13-21 postinfection (P < 0.05). Results indicate that intact female mice are better protected from the lethal effects of HSV-1 infection and that exercise stress had a similar negative impact in all groups. This protective effect was lost in ovariectomized mice, but it was not reinstated by 17beta-estradiol replacement. This indicates that other ovarian factors, alone or in combination with estrogen, are responsible for the protective effects in females.

Nuclear matrix protein patterns in human benign prostatic hyperplasia and prostate cancer.

The nuclear matrix represents the structural component of the nucleus that determines nuclear shape and higher order DNA organization. We have previously shown tissue specificity in nuclear matrix proteins (NMP), in rat sex accessory tissues, and in a rat model of prostate cancer. This study compares NMP patterns for fresh human normal prostate, benign prostatic hyperplasia (BPH), and prostate cancer for 21 men undergoing surgery for clinically localized prostate cancer or BPH. NMP patterns were compared using high resolution two-dimensional polyacrylamide gel electrophoresis. We identified by molecular weight and isoelectric point 14 different proteins that were consistently present or absent among the various tissues. One protein (PC-1), a M(r) 56,000 protein with an isoelectric point of 6.58, appeared in 14 of 14 different nuclear matrix preparations from prostate cancer and was not detected in normal prostate (0 of 13) or BPH (0 of 14). The NMP patterns are consistent with a model of disease progression in which BPH shares many of the nuclear matrix changes observed in prostate cancer.

Feedback and clinical practice improvement: A tool to assist workplace supervisors and students.

In work integrated learning, students may report difficulties applying theory learned at university to clinical practice. One contributing factor may be students' inability to engage in meaningful reflection and self-correcting behaviours. This paper reports the evaluation of a tool, process and resources developed to assist students to reflect on feedback and engage in self-assessment. Students were assisted to develop self-assessment skills by reflecting on, and engaging with feedback from previous workplace experiences to develop goals, learning outcomes and strategies to improve performance with mostly positive results. A secondary aim was to identify common learning strategies or barriers that impacted on student outcomes. Four themes emerged from the qualitative data: 1) preparing for clinical learning, 2) relationships and engagement levels, 3) shared awareness and, 4) developing clinical practice. Overall students felt the tool assisted them to narrow their attention on what needed to be improved. While supervisors believed the tool helped them to focus on specific needs of each student. Common barriers to clinical practice improvement related to a lack of opportunity in some settings, and lack of staff willingness to support students to achieve identified goals. Students and supervisors found the use of the tools beneficial and assisted students to demonstrate a greater understanding of how to apply feedback received to support their learning in the clinical environment.

Circannual rhythms of ground squirrels: a test of the frequency demultiplication hypothesis.

The frequency demultiplication hypothesis (FDH) posits that circannual rhythms are generated from circadian cycles by frequency transformation to the lower-frequency rhythm. To test the FDH, we determined the periods of the circannual body mass and estrous cycles of golden-mantled ground squirrels with circadian locomotor activity rhythms entrained to 23-, 24-, or 25-hr days (T-cycles). Circannual period length did not differ among squirrels entrained to the different T-cycles; intergroup ranges were 298-314 days and 303-312 days, respectively, for body mass and estrus. These results are not consistent with the FDH and suggest instead that separate mechanisms generate circadian and circannual rhythms. In ground squirrels the circannual system influences circadian organization, but a reciprocal influence of circadian on circannual rhythms has yet to be demonstrated.

Plasma oxytocin increases in the human sexual response.

The purpose of this study was to determine whether plasma oxytocin (OT) levels change during human sexual responses and, if so, to demonstrate the temporal pattern of change. Plasma OT levels were measured by RIA before, during, and after private self-stimulation to orgasm in normal men (n = 9) and women (n = 13). Blood samples were collected continuously through indwelling venous catheters. The subjects pressed a signal to indicate the start and finish of orgasm/ejaculation. Objective assessment of sexual arousal and orgasm was obtained by measuring blood-pulse amplitude and electromyographic activity, recorded continuously throughout testing from an anal device containing a photoplethysmograph and electromyograph electrodes connected to a polygraph located in an adjacent room. These measures allowed collection of data from men and women of changes in blood flow and muscle activity in the lower pelvic/pubic area. Plasma OT levels increased during sexual arousal in both women and men and were significantly higher during orgasm/ejaculation than during prior baseline testing. We suggest that the temporal pattern of secretion could be related to smooth muscle contractions of the reproductive system during orgasm.

Effects of estrogen, androgen, and progestin on sexual psychophysiology and behavior in postmenopausal women.

To assess the contribution of gonadal steroids to sexual behavior in aging women, we conducted a 10-week, double-blind, hormone replacement study of 40 naturally menopausal women (mean age, 58.3 yr). Prospective measurements of basal and stimulated vaginal vasocongestion and daily self-reports of mood, physical symptoms, sexual behavior, and perceived sexual pleasure were collected. Daily treatments were either conjugated equine estrogen, i.e. Premarin (P; 0.625 mg), Premarin and medroxyprogesterone acetate, i.e. Provera (PP; 0.625 and 5 mg, respectively), Premarin and methyltestosterone (PT; 0.625 and 5 mg, respectively), or placebo (PL). Compared to placebo, hormone treatment had significantly reduced hot flashes in the P and PP groups by week 4 and in the PT group by week 5. Headaches were reduced in the P vs. PL group, only. Hormone treatment did not significantly alter mood ratings, sexual behaviors, or psychophysiologically measured sexual arousal. PT treatment significantly increased reports of pleasure from masturbation compared to the other three groups, underscoring the apparent contribution of androgens to self-stimulatory behavior. However, the data suggest that in these physically and sexually healthy women, gonadal steroids do not influence major components of sexual functioning, including arousal and a wide variety of sexual activity and experience.

Molecular biology of vasopressin receptors.

Despite the numerous studies that have been spawned by the cloning of more than 240 G-protein-coupled receptors, the molecular basis for receptor discrimination of receptor-ligand interactions remains a central issue in membrane receptor biology. The receptor's criteria for agonists and antagonists allow these types of ligands to compete for the same binding site on the receptor, but only agonists are able to stimulate intracellular signaling. Various vasopressin agonists and antagonists, which are known to have different binding affinities for the V1a and V2 vasopressin receptors, can be exploited in the search for the conformational changes that precede and accompany receptor activation. Because the V1a and V2 vasopressin receptors are coupled to different intracellular signaling systems, it should be possible to assay the functional components of binding and G-protein coupling in a series of chimeric receptors. With the ever-increasing database on the structural determinants of G-protein-coupled receptor function, at least some of the underlying mechanisms of transmembrane signal transduction should be better understood in the next few years.

Cardiac operation for congenital heart disease in children of Jehovah's Witnesses.

We reviewed the perioperative courses of 110 children of members of the Jehovah's Witness faith who underwent 112 operations for complete repair of congenital heart disease with cardiopulmonary bypass. Operations were performed over a 20 year period, ending June, 1983. The children ranged in age from 6 months to 12 years and weighed 5.2 to 42.3 kg. Thirty-nine (34.8%) of the patients weighed less than 15 kg, 36 (32.1%) were polycythemic preoperatively, and 26 (23%) had previous thoracic operations. All operations were performed during normothermic cardiopulmonary bypass with a glucose crystalloid prime. No patient received any blood or blood products during hospitalization. Perioperative mortality was 5.4%. Only one of the deaths could be attributed to blood loss. Complications occurred in 10 patients, and none of these could be attributed to failure to transfuse. The results demonstrate that cardiac operations can be safely performed in children denied transfusion and suggest that hemodilution techniques might be used more extensively in children undergoing cardiac operations.

Effects of moderate exercise and oat beta-glucan on lung tumor metastases and macrophage antitumor cytotoxicity.

Both moderate exercise and the soluble fiber beta-glucan can have beneficial effects on the initiation and growth of tumors, but the data are limited, and there is no information on their combined effects. This study tested the independent and combined effects of short-term moderate-exercise training and the soluble oat fiber beta-glucan (ObetaG) on the metatastic spread of injected tumor cells and macrophage antitumor cytotoxicity. Male C57BL/6 mice were assigned to one of four groups: exercise (Ex)-H2O, Ex-ObetaG, control (Con)-H2O, or Con-ObetaG. ObetaG was fed in the drinking water for 10 days before tumor administration and death. Exercise consisted of treadmill running (1 h/day) for 6 days. After rest or exercise on the last day of training, syngeneic B16 melanoma cells (2 x 10(5)) were administered via intravenous injection (n = 8-11 per group). Lungs were removed 14 days later, and tumor foci were counted. Additional mice (n = 8 per group) were killed, and peritoneal macrophages were assayed for cytotoxicity against the same mouse tumor cell line at various effector-to-target ratios. Both moderate exercise and ObetaG decreased lung tumor foci and increased macrophage cytotoxicity. However, there were no differences in lung tumor foci and macrophage cytotoxicity between Ex-ObetaG and either Ex-H2O or Con-ObetaG. These data suggest that, although not additive in their effects, both short-term moderate-exercise training and consumption of the soluble ObetaG can decrease the metatastic spread of injected B16 melanoma cells, and these effects may be mediated in part by an increase in macrophage cytotoxicity to B16 melanoma.

Unusual sequelae of colon interposition for esophageal reconstruction: late obstruction requiring reoperation.

Colon interposition has become a favored technique for esophageal reconstruction. Late morbidity is generally related either to technical problems associated with the procedure or to the development of new disorders in the transposed segment. Two patients are discussed who were seen with obstruction of colon interposition grafts ten and five years after esophageal reconstruction. In the first patient, a volvulus of the interposed colon associated with a chronically narrowed area distal to the looped segment resulted in obstruction. In the second patient, the redundant intrathoracic segment of the colon interposition became kinked at the diaphragmatic hiatus leading to dilatation and incomplete emptying. Both patients underwent successful reoperations and are doing well 10 and 12 months later. The causes and possible prevention of these and other late complications of colon interposition are discussed.

Preoperative evaluation of the thoracic aorta using MRI and angiography.

The ability of ECG-gated magnetic resonance imaging (MRI) to evaluate disease of the thoracic aorta compared with angiography was prospectively assessed in 28 patients. MRI identified abnormalities in all patients, with confirmation at operation in 22 (79%) and by angiography alone in all 28. In 20 of the patients, MRI correctly diagnosed 20 of 21 aneurysms of the thoracic aorta (6 dissecting, 4 saccular, 10 fusiform), but 1 surgically proven fusiform aneurysm was categorized as an enlarged aortic dissection based on both MRI and angiographic findings. One dissection and 1 fusiform aneurysm were shown by MRI only. Coarctation of the aorta was identified in 4 patients. Ascending aortic enlargement and left ventricular hypertrophy were identified by MRI in 4 patients with aortic stenosis. In 7 patients (25%), MRI provided additional important information not shown by angiography and in 1 patient, the MRI findings resulted in a change in the surgical approach. In 14 of 28 patients (50%), angiography was necessary for definitive preoperative evaluation of the aortic valve, the coronary arteries, or the brachiocephalic vessels. MRI was a useful noninvasive supplement to angiography for the preoperative assessment of thoracic aortic disease.

OA-519 (fatty acid synthase) as an independent predictor of pathologic state in adenocarcinoma of the prostate.

OBJECTIVES: To improve the prediction of pathologic stage beyond that provided by Gleason score. METHODS: We investigated the tissue expression in prostate cancer of a relatively new marker, oncoantigen 519 (OA-519). Because Gleason score is one of the most powerful predictors in prostate cancer, we restricted our evaluation to 66 radical prostatectomy specimens of varying pathologic stages which were either Gleason score 6 or 7. Immunohistochemical staining of OA-519 was assessed with a combined staining score from 0 to 8, taking into account both the intensity and percentage of tissue staining. In addition, an intensity score was derived based on whether any intense staining was present in case. RESULTS: OA-519 staining of the primary prostate cancer was highly predictive in separating cases with organ-confined disease or capsular penetration versus cases with seminal vesicle invasion or lymph node metastases; Gleason score 6 or 7 was also predictive. In a logistic multivariate regression analysis, both OA-519 and Gleason score were strong independent predictors of pathologic stage (P = 0.0004). CONCLUSIONS: OA-519 predicted pathologic stage well when analyzing primary prostate cancer in radical prostatectomy specimens and is presently being investigated on preoperative biopsy material to assess its ultimate clinical applicability. OA-519 has significant promise as a prognostic marker for prostate cancer and is one of the few markers that provides additional predictive information beyond that of the Gleason score.

Comparison of body protein metabolism during total parenteral nutrition using glucose or glucose and fat as the energy source.

Direct measurement of body protein metabolism using L-(1-14C) leucine during total parenteral nutrition following cholecystectomy demonstrated no significant difference between isocaloric isonitrogenous regimens containing glucose alone (n = 5) or with a fat emulsion (n = 5) as the energy substrates. It would appear that providing the obligatory requirement for glucose is met (about 150g d(-1)), fat and carbohydrate calories are inter-changeable with regards to fueling protein metabolism in the early period following moderately severe trauma.

Effect of abdominal surgery on intestinal myoelectric activity in the dog.

The effect of cholecystectomy and small bowel transection on the myoelectric activity of the small intestine was determined in conscious dogs. Three animals were implanted with electrodes spaced approximately 25 cm apart along the serosal surface of the small intestine. Recordings were made with dogs in the unanesthetized fasted state. After completion of control recordings, the gallbladder was removed from each animal. Recordings were made each day after surgery for a period of one week and then periodically during the next two weeks. At the end of three weeks, transection and end-to-end anastomosis of the mid-ileum was done. Once again recordings were obtained each day for one week and periodically for two subsequent weeks to insure return to normal fasted patterns. Neither cholecystectomy nor transection and anastomosis had an inhibitory effects of the myoelectric activity of the small intestine.