Crowdsourcing: A novel tool to elicit the student voice in the curriculum design process for an undergraduate diagnostic radiography degree programme.

INTRODUCTION: Stakeholder participation in healthcare curriculum design is an important aspect of higher education with stakeholders including students, staff members, clinical partners, healthcare organisations, patients and members of the public. Significantly, student co-creation, of the curriculum, has become increasingly important. Yet there is limited research which addresses how to engage this group in design processes. METHODS: This paper represents the first phase of a three stage action research spiral whereby the authors evaluated the use of a novel tool for curriculum design processes, anonymised crowdsourcing. This initial phase was open to all students enrolled on an undergraduate diagnostic radiography programme in the UK. To confirm the reliability of the crowdsource design an established eight point crowdsourcing verification tool was applied. RESULTS: Twenty-three unique ideas were generated by participants, 40 comments made and 173 votes cast. Inductive analysis of the comments generated five themes. These included: the role of technology enhanced learning; simulation activities; patient focused curriculum; mental wealth (resilience) authentic assessment approaches. An evaluation of those who had and had not engaged highlighted areas of improvement for the administration of the second and third iterations which will include a wider pool of participants. CONCLUSION: This study from a single programme offers lessons for others wishing to adopt and develop this approach elsewhere. IMPLICATIONS FOR PRACTICE: Several ideas elicited by the crowdsource have been considered by the curriculum design team and will be implemented in the 2020 curriculum thus demonstrating the impact on local education practice of this research approach.

Crowdsourcing in health professions education: What radiography educators can learn from other disciplines.

OBJECTIVES: Crowdsourcing works through an institution outsourcing a function normally performed by an employee or group of individuals. Within a crowdsource users, known as the crowd, form a community who voluntarily undertake a task which involves the pooling of knowledge resources. A literature review was undertaken to identify how the tool is being used in health professions education, and potential for use in radiography education. KEY FINDINGS: 17 papers were returned. Literature identified was assessed against an established crowdsourcing definition. Reviewing these yielded four themes for discussion: student selection procedures, lesson planning, teaching materials and assessment. CONCLUSION: Crowdsourcing is associated with innovative activities through collective solution seeking via a large network of users. It is increasingly being adopted in healthcare training and maybe transferable to educational activities within the field of radiography education.

Amygdala protein kinase C epsilon controls alcohol consumption.

Alcoholism is a progressive disorder that involves the amygdala. Mice lacking protein kinase C epsilon (PKCepsilon) show reduced ethanol consumption, sensitivity and reward. We therefore investigated whether PKCepsilon signaling in the amygdala is involved in ethanol consumption. Local knockdown of PKCepsilon in the amygdala reduced ethanol consumption and preference in a limited-access paradigm. Further, mice that are heterozygous for the PKCepsilon allele consume less ethanol compared with wild-type mice in this paradigm. These mice have a >50% reduction in the abundance of PKCepsilon in the amygdala compared with wild-type mice. We conclude that amygdala PKCepsilon is important for ethanol consumption in mice.

Increased sensitivity to the aversive effects of ethanol in PKCepsilon null mice revealed by place conditioning.

Determining the intracellular signaling pathways that mediate the rewarding effects of ethanol may help identify drug targets to curb excessive alcohol consumption. Mice lacking the epsilon isoform of protein kinase C (PKCepsilon) voluntarily consumed less ethanol than wild-type mice in two-bottle choice and operant self-administration assays. Decreased consumption may reflect either increased or decreased sensitivity to the rewarding effects of ethanol. Alternatively, decreased voluntary consumption may reflect a change in sensitivity to the aversive effects of ethanol. The authors used place conditioning to determine that PKCepsilon null mice have an increased sensitivity to the aversive effects of ethanol but a decreased sensitivity to the rewarding effects of ethanol. Together these data suggest that PKCepsilon null mice voluntarily consume less ethanol because they derive less reward and are more sensitive to the aversive effects of ethanol.

Increased response to morphine in mice lacking protein kinase C epsilon.

The protein kinase C (PKC) family of serine-threonine kinases has been implicated in behavioral responses to opiates, but little is known about the individual PKC isozymes involved. Here, we show that mice lacking PKCepsilon have increased sensitivity to the rewarding effects of morphine, revealed as the expression of place preference and intravenous self-administration at very low doses of morphine that do not evoke place preference or self-administration in wild-type mice. The PKCepsilon null mice also show prolonged maintenance of morphine place preference in response to repeated testing when compared with wild-type mice. The supraspinal analgesic effects of morphine are enhanced in PKCepsilon null mice, and the development of tolerance to the spinal analgesic effects of morphine is delayed. The density of mu-opioid receptors and their coupling to G-proteins are normal. These studies identify PKCepsilon as a key regulator of opiate sensitivity in mice.

Intracellular signaling pathways that regulate behavioral responses to ethanol.

Recent evidence indicates that ethanol modulates the function of specific intracellular signaling cascades, including those that contain cyclic adenosine 3', 5'-monophosphate (cAMP)-dependent protein kinase A (PKA), protein kinase C (PKC), the tyrosine kinase Fyn, and phospholipase D (PLD). In some cases, the specific components of these cascades appear to mediate the effects of ethanol, whereas other components indirectly modify responses to ethanol. Studies utilizing selective inhibitors and genetically modified mice have identified specific isoforms of proteins involved in responses to ethanol. The effects of ethanol on neuronal signaling appear restricted to certain brain regions, partly due to the restricted distribution of these proteins. This likely contributes specificity to ethanol's actions on behavior. This review summarizes recent work on ethanol and intracellular signal transduction, emphasizing studies that have identified specific molecular events that underlie behavioral responses to ethanol.

Macrophages restrain contraction of an in vitro wound healing model.

Significant numbers of macrophages are present during all stages of dermal wound repair, but the functional significance of these macrophages, especially during the later contraction and remodelling stages of repair, remains unclear. We investigated the effect of macrophages on wound contraction using a novel in vitro model based upon the contracting dermal equivalent (DE). Macrophages were found to reversibly restrain DE contraction, a rapid and sustained effect that was enhanced by lipolysaccharide (LPS) treatment of macrophages and partially inhibited by hydrocortisone. Prolonged inhibition of contraction was strongly correlated with an inhibition of fibroblast proliferation. The rapid contraction-inhibiting effect of the macrophages was mediated through activation of protein kinase C (PKC). These results suggest that inflammatory macrophages restrain the later stages of wound repair, namely matrix contraction and remodeling. The novel in vitro model established here provides a useful system for examining fibroblast-macrophage interactions in the healing wound.

Glenohumeral mechanics: a study of articular geometry, contact, and kinematics.

Stereophotogrammetry was used to investigate the functional relations between the articular surface geometry, contact patterns, and kinematics of the glenohumeral joint. Nine normal shoulder specimens were elevated in the scapular plane by using simulated muscle forces in neutral rotation (NR) and starting rotation (SR). Motion was quantified by analyzing the translations of the geometric centers of the humeral head cartilage and bone surfaces relative to the glenoid surface. In both NR and SR, the ranges of translations of the center of the humeral head cartilage surface were greatest in the inferior-superior direction (NR 2.0 +/- 0.7 mm, SR 2.9 +/- 1.2 mm). Results of this study also show that joints with less congruence of the articular surfaces exhibit larger translations, and elevation in SR yields greater translations than in NR. Kinematic analyses with the humeral head bone surface data yielded larger values of translation than analyses that used the cartilage surface data, suggesting that similar overestimations may occur in radiographic motion studies. Results of this study demonstrate that small translations of the humeral head center occurred in both SR and NR. The proximity of the origin of the helical axes to the geometric center of the humeral head articular surface confirmed that glenohumeral elevation is mainly rotation about this geometric center with small translations.

Rotator cuff tears and associated nerve injuries.

A series of 15 patients with concomitant rotator cuff tears and infraclavicular brachial plexus injuries treated between 1980 and 1989 were reviewed. There were 6 men and 9 women with a mean age of 65 years. Seventeen nerve injuries were identified, including 12 axillary nerves, 4 suprascapular nerves, and 1 musculocutaneous nerve. One patient had an injury to all three nerves. Thirteen patients underwent operative repair of the torn rotator cuff, and 2 patients who refused surgery were treated conservatively. The average time from injury to surgery was 7.7 months. Follow-up averaged 5.5 years (range: 2-10 years). Clinical results were graded according to pain, range of motion, and strength. Postoperatively, mean active forward elevation was 137 degrees and mean active external rotation was 40 degrees. Clinically, 8 patients achieved complete nerve recovery and 7 had an incomplete recovery. Satisfactory pain relief was achieved in 87% of patients with 60% having excellent or good function. Overall, the results of rotator cuff repair with concurrent nerve injury are less favorable than those of isolated cuff repairs. Careful preoperative assessment of concomitant nerve injury should be performed to better predict outcome.

The medial-lateral position of the patella on routine magnetic resonance imaging: when is normal not normal?

The purpose of this study was to determine the position of the normal patella during routine magnetice resonance imaging (MRI). The literature indicates that the normal patella is positioned laterally relative to the trochlea when the knee is fully extended. As such, a laterally positioned patella on MRI is often interpreted as normal. Yet, in our experience, patients with a normal extensor mechanism show a patella that is centered over the trochlea on MRI, and we set out to formally study this. The MRIs of 60 patients without knee extensor pathology were analyzed. In 59 patients, the patella was centered over the underlying femur. The discrepancy between these results and those in the literature can probably be accounted for by the following: (1) Knees in general are somewhat flexed during MRI, and (2) relative to patients in other studies, patients in this study were subject to stricter criteria of normality. The results of this study strongly suggest that the normal patella is centered over the underlying trochlea during routine MRI. A laterally positioned patella, although possibly common, should not be automatically dismissed as a (medically) normal finding.

Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder.

Twenty-five shoulders with recurrent instability and associated anterior glenoid rim lesions were reviewed to 1) develop a classification system of the lesions, 2) evaluate radiographic techniques in detecting the lesions, and 3) analyze the outcome of surgery. Lesions were classified into three types: Type I, a displaced avulsion fracture with attached capsule; Type II, a medially displaced fragment malunited to the glenoid rim; and Type III, erosion of the glenoid rim with less than 25% (Type IIIA) or greater than 25% (Type IIIB) deficiency. Lesions were detected by plain radiographs (19 shoulders) or supplemental CT-arthrograms (12 shoulders) or both. In 16 Type I fractures, both the bony fragment and capsule were reattached to the glenoid rim. In five Type II and three Type IIIA lesions, only the capsule was repaired to the remaining glenoid rim. In the one Type IIIB lesion, a coracoid transfer was performed. At an average followup of 30 months, 22 shoulders (88%) had satisfactory results without recurrent instability, whereas three shoulders (12%) had postoperative redislocations. The majority of recurrent anterior dislocations with associated glenoid rim lesions can be treated by suturing the fracture fragment or capsule or both to the glenoid rim and addressing associated capsular laxity.

Winner of the 1996 Cabaud Award. The effect of lifelong exercise on canine articular cartilage.

The effect of long-term exercise on canine knees was studied to determine whether an increased level of lifelong weightbearing exercise causes degeneration, or changes that may lead to degeneration, of articular cartilage. Eleven dogs were exercised on a treadmill at 3 km/hr for 75 minutes 5 days a week for 527 weeks while carrying jackets weighing 130% of their body weight. Ten control dogs were allowed unrestricted activity in cages for the 550 weeks. At the completion of the study all knee joints were inspected for evidence of joint injury and degeneration. Articular cartilage surfaces from the medial tibial plateau were examined by light microscopy, the cartilage thickness was measured, and the intrinsic material properties were determined by mechanical testing. No joints had ligament or meniscal injuries, cartilage erosions, or osteophytes. Light microscopy did not demonstrate cartilage fibrillation or differences in safranin O staining of the tibial articular cartilages between the two groups. Furthermore, the tibial articular cartilage thickness and mechanical properties did not differ between the two groups. These results show that a lifetime of regular weightbearing exercise in dogs with normal joints did not cause alterations in the structure and mechanical properties of articular cartilage that might lead to joint degeneration.

Trochanteric osteotomy and wire fixation: a comparison of 2 techniques.

Between 1986 and 1989, 190 patients (214 hips) with the diagnosis of osteoarthritis or posttraumatic arthritis underwent cemented Charnley total hip replacement surgeries via the biplane or single plane transtrochanteric approach. The technique of surgery was identical in every aspect except for the technique of the trochanteric osteotomy and reattachment. The results indicate that there was no significant difference in union rates between the 2 groups. Six (6.4%) patients in the biplane group and 7 (6.2%) patients in the single plane group had obvious evidence of nonunion at the 1-year evaluation. This study suggests no significant difference in union rate between a group of patients with biplane osteotomy and a closely paired group of patients with single plane osteotomy. Other equally important factors also may influence the rate of union of the trochanter in total hip arthroplasty.

Life structure revitalization: an adult developmental approach to psychodynamic psychotherapy.

In this paper we, first, briefly review existing efforts to integrate adult development theory into psychodynamic psychotherapy. Next, we examine the concept of life structure and discuss its evolution across the eras and periods of the adult years. We explore the added concepts of the core self, the vital life structure, and life structure management skills. In so doing, we provide a context for proposing a new definition of the primary task of treatment: to help patients develop life structures that ensure a good fit between internal aspects of the self and the roles, relationships, and activities that comprise their lives. The creation of a life structure that is as fully expressive of the core self as reality permits increases patients' sense of vitality and well-being.

A social system approach to the psychoanalytic treatment of personality disorders.

I present a social system conception of psychoanalytic psychotherapy and describe its uses in the treatment of individuals with personality disorders. By analyzing the divisions of labor and authority in treatment, I try to show that there exist fundamental role requirements upon the therapist to create and maintain structure, and upon the patient to respect it. I identify the treatment system's external and internal boundaries. Doing so makes it possible to distinguish two classes of resistance, system-threatening extramural resistance and intramural resistance. The first class of resistance is common in individuals with personality disorders, since they tend to act out against the structure of the treatment itself. In the matter of extramural resistance, the therapist needs not only to make interpretations, but also to manage the treatment enterprise effectively lest it be destroyed. A social system understanding of psychotherapy helps the clinician manage the boundaries without becoming authoritarian or parental.

Levinsonian studies of women's adult development.

We reviewed four unpublished dissertations that used Levinson's theory to study women's adult development. The 39 biographies presented in these studies suggested that the women progressed through the same developmental periods as had men in Levinson's study and at roughly the same ages. Although the timing of the periods and the nature of the developmental tasks appeared to be similar, the ways of working on these tasks as well as the outcomes achieved were different. These differences are understood in part as consequences of the greater complexity of women's dreams and the problems encountered in living them out.

Women in authority: a sociopsychological analysis.

The attempt to reduce discrimination against women in work settings has received new strength from the re-emergent feminist movement. Women are now more often being considered for positions of genuine organizational authority. We present and analyze a case example--a woman manager and her staff within a mental health center--that illustrates some basic problems arising from such social change. Our approach to the exercise of authority is sociopsychological: We seek to interrelate organizational structure, leadership style, and staff group dynamics.