bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of Early Warning Score and Rapid Response Systems on nurses’ competence: An integrative literature review and synthesis
Authors: Jensen Jørghild Karlotte , Skår Randi , Tveit Bodil
Published: December 2017

Aims and objectives

To describe, interpret and synthesise the current research findings on the impact of the Early Warning Score and Rapid Response Systems on nurses’ competence in identifying and managing deteriorating patients in general hospital wards.

Background

As patient safety initiatives designed to ensure the early identification and management of deteriorating patients, the Early Warning Score and Rapid Response Systems have broad appeal. However, it is still unclear how these systems impact nurses’ competence when these systems are used in general hospital wards.

Methods

CINAHL, PubMed, Cochrane,EMBASEand OvidMEDLINEdatabases were systematically searched for relevant articles. Articles were appraised, a thematic analysis was conducted, and similar and divergent perspectives on emergent themes and subthemes were extracted by a team of researchers.

Results

Thirty‐six studies met the inclusion criteria. The analysis of findings showed how the Early Warning Score and Rapid Response Systems impacted three competence areas: (i) Nurses’ competence in assessing and caring for patients related to the subthemes: (a) sensing clinical deterioration and (b) the development of skills and knowledge. (ii). Nurses’ competence in referring patients, related to the subthemes: (a) deciding whether to summon help and (b) the language and communication lines in the referral process. (ii) Nurses’ coping and mastery experiences.

Conclusion

The impact of the Early Warning Score and Rapid Response Systems on nurses’ competence in identifying and managing deteriorating patients is beneficial but also somewhat contradictory.

Relevance to clinical practice

A greater understanding of nurses’ development of competence when using the Early Warning Score and Rapid Response Systems will facilitate the design of implementation strategies and the use of these systems to improve practice.
Is aspirin necessary in the acute phase of Kawasaki disease?
Authors: Huang Xijing , Huang Ping , Zhang Li , Xie Xiaofei , Xia Shuliang , Gong Fang , Yuan Jia , Jin Liling
Published: December 2017

Aim

To explore whether aspirin is necessary for treatment in the acute phase of Kawasaki disease (KD).

Methods

Nine hundred ten patients who fulfilled the criteria of KD and maintained follow‐up for 2 years were included in this retrospective study. All patients initially received a single dose of intravenous immunoglobulin (IVIG, 2 g/kg) in the acute phase. Patients were classified into three groups according to the doses of aspirin. Group 1 included 152 cases treated with IVIG only in the acute phase. Group 2 included 672 cases treated with IVIG plus 3–5 mg/kg/day aspirin as the low‐dose group, and group 3 included 86 cases treated with IVIG plus 30–50 mg/kg/day aspirin as the moderate‐dose group. Changes in inflammatory indices and platelet count after treatment were compared by one‐way analysis of variance or analysis of covariance to analyse the clinical effect of aspirin in acute KD. The relationship between aspirin use and coronary artery lesion complications was analysed by logistic regression.

Results

There was no significant difference among the three groups in terms of the anti‐inflammation effect revealed by C‐reactive protein level, white blood cell count, percentage of neutrophils in white blood cells, decreasing platelet count or prevention of the formation of coronary artery lesion.

Conclusions

The role of aspirin in the treatment of the acute phase of KD should be questioned as a definite benefit has not been shown in our study. Further prospective studies incorporating large multicentre samples of patients are needed to confirm this finding.
Prophylactic supplement with melatonin successfully suppresses the pathogenesis of periodontitis through normalizing RANKL/OPG ratio and depressing the TLR4/MyD88 signaling pathway
Authors: Renn Ting‐Yi , Huang Yung‐Kai , Feng Sheng‐Wei , Wang Hsiao‐Wei , Lee Wei‐Fang , Lin Che‐Tong , Burnouf Thierry , Chen Li‐You , Kao Pan‐Fu , Chang Hung‐Ming
Published: December 2017

Periodontitis (PD) is an inflammatory disease characterized by gingival inflammation and resorption of alveolar bone. Impaired receptor activator of nuclear factor‐kappa B ligand/osteoprotegerin (RANKL/OPG) signaling caused by enhanced production of pro‐inflammatory cytokines plays an essential role in the pathogenesis of PD. Considering melatonin possesses significant anti‐inflammatory property, this study aimed to determine whether prophylactic treatment with melatonin would effectively normalize RANKL/OPG signaling, depress toll‐like receptor 4/myeloid differentiation factor 88 (TLR4/MyD88)‐mediated pro‐inflammatory cytokine activation, and successfully suppress the pathogenesis of PD. PD was induced in adult rats by placing the ligature at molar subgingival regions. Fourteen days before PD induction, 10, 50, or 100 mg/kg of melatonin was intraperitoneally injected for consecutive 28 days. Biochemical and enzyme‐linked immunosorbent assay were used to detect TLR4/MyD88 activity, RANKL, OPG, interleukin 1β, interleukin 6, and tumor necrosis factor‐α levels, respectively. The extent of bone loss, bone mineral intensity, and calcium intensity was further evaluated by scanning electron microscopy, micro‐computed tomography, and energy‐dispersive X‐ray spectroscopy. Results indicated that high RANKL/OPG ratio, TLR4/MyD88 activity, and pro‐inflammatory cytokine levels were detected following PD. Impaired biochemical findings paralleled well with severe bone loss and reduced calcium intensity. However, in rats pretreated with melatonin, all above parameters were successfully returned to nearly normal levels with maximal change observed in rats receiving 100 mg/kg. As prophylactic treatment with melatonin effectively normalizes RANKL/OPG signaling by depressing TLR4/MyD88‐mediated pro‐inflammatory cytokine production, dietary supplement with melatonin may serve as an advanced strategy to strengthen oral health to counteract PD‐induced destructive damage.
Population genomic analysis suggests strong influence of river network on spatial distribution of genetic variation in invasive saltcedar across the southwestern United States
Authors: Lee Soo‐Rang , Jo Yeong‐Seok , Park Chan‐Ho , Friedman Jonathan M. , Olson Matthew S.
Published: December 2017

Understanding the complex influences of landscape and anthropogenic elements that shape the population genetic structure of invasive species provides insight into patterns of colonization and spread. The application of landscape genomics techniques to these questions may offer detailed, previously undocumented insights into factors influencing species invasions. We investigated the spatial pattern of genetic variation and the influences of landscape factors on population similarity in an invasive riparian shrub, saltcedar (Tamarix L.) by analysing 1,997 genomewide SNP markers for 259 individuals from 25 populations collected throughout the southwestern United States. Our results revealed a broad‐scale spatial genetic differentiation of saltcedar populations between the Colorado and Rio Grande river basins and identified potential barriers to population similarity along both river systems. River pathways most strongly contributed to population similarity. In contrast, low temperature and dams likely served as barriers to population similarity. We hypothesize that large‐scale geographic patterns in genetic diversity resulted from a combination of early introductions from distinct populations, the subsequent influence of natural selection, dispersal barriers and founder effects during range expansion.
Candida glabrata prosthetic joint infection, successfully treated with anidulafungin: A case report and review of the literature
Authors: Koutserimpas Christos , Samonis George , Velivassakis Emmanouil , Iliopoulou‐Kosmadaki Stylliani , Kontakis Georgios , Kofteridis Diamantis P.
Published: December 2017

Non‐albicans Candida prosthetic joint infection (PJI) is extremely rare. A case of a Candida glabrata knee PJI is a 68‐year‐old splenectomised female smoker, suffering from chronic obstructive pulmonary disease (COPD) and alcoholism is reported. The patient presented with a peri‐prosthetic fracture, 15 years after total knee replacement surgery. Cultures of the intraoperative peri‐prosthetic tissue and materials yielded C. glabrata, as well as a methicillin‐resistant S. epidermitis. The patient was treated with anidulafungin and vancomycin. The knee prosthetic joint was removed and cement‐spacer with vancomycin and gentamycin was placed. Additionally, an external fixation was performed. A second stage revision surgery was planned, after completion of the antimicrobial and antifungal treatment. The patient is followed up for 4 months without signs, symptoms or findings of infection. PJI Candida infections require a high clinical suspicion index. It is of utmost importance to report these cases, since there is no consensus yet of the proper antifungal treatment. Furthermore, a literature review regarding treatment of those cases is provided. First‐line treatment with an echinocandin seems most proper, due to their fungicidal properties, their effectiveness against biofilm, as well as their minimal toxicity, making them ideal for long‐term use. Further experience is needed, for better understanding the disease's pathogenesis and optimal treatment.
Interactions between Candida albicans and Candida glabrata in biofilms: Influence of the strain type, culture medium and glucose supplementation
Authors: Hosida Thayse Yumi , Cavazana Thamires Priscila , Henriques Mariana , Pessan Juliano Pelim , Delbem Alberto Carlos Botazzo , Monteiro Douglas Roberto
Published: December 2017

The relationship among Candida species may be influenced by several factors. Thus, this study evaluated the interactions between Candida albicans and Candida glabrata in biofilms, varying the strain type, culture medium and glucose supplementation. Biofilms were formed for 48 hours in Sabouraud dextrose broth (SDB) or RPMI 1640, supplemented with 0%, 1% or 5% glucose. Each strain of C. albicans was combined with two strains of C. glabrata, generating four biofilm associations, which were quantified by colony‐forming units (CFUs), total biomass and metabolic activity. Data were analysed by ANOVA and Tukey's HSD test (α = 0.05). For CFUs, all associations were classified as indifferent for biofilms formed in RPMI 1640, while for SDB the interactions were antagonistic for C. albicans and indifferent for C. glabrata. The association of reference strains resulted in a dual‐species biofilm with biomass significantly higher than that observed for each single biofilm developed in SDB. The metabolic activity of dual‐species biofilms did not significantly differ from that found for single ones, except for co‐culture of the reference strains. Glucose supplementation and culture media had a significant influence on all parameters. In conclusion, the strain type, culture medium and glucose supplementation influenced the interactions between C. albicans and C. glabrata.
Biological processes dominate seasonality of remotely sensed canopy greenness in an Amazon evergreen forest
Authors: Wu Jin , Kobayashi Hideki , Stark Scott C. , Meng Ran , Guan Kaiyu , Tran Ngoc Nguyen , Gao Sicong , Yang Wei , Restrepo‐Coupe Natalia , Miura Tomoaki , Oliviera Raimundo Cosme , Rogers Alistair , Dye Dennis G. , Nelson Bruce W. , Serbin Shawn P. , Huete Alfredo R. , Saleska Scott R.
Published: December 2017

Satellite observations of Amazon forests show seasonal and interannual variations, but the underlying biological processes remain debated.

Here we combined radiative transfer models (RTMs) with field observations of Amazon forest leaf and canopy characteristics to test three hypotheses for satellite‐observed canopy reflectance seasonality: seasonal changes in leaf area index, in canopy‐surface leafless crown fraction and/or in leaf demography.

Canopy RTMs (PROSAIL and FLiES), driven by these three factors combined, simulated satellite‐observed seasonal patterns well, explaining c. 70% of the variability in a key reflectance‐based vegetation index (MAIAC EVI, which removes artifacts that would otherwise arise from clouds/aerosols and sun–sensor geometry). Leaf area index, leafless crown fraction and leaf demography independently accounted for 1, 33 and 66% of FLiES‐simulated EVI seasonality, respectively. These factors also strongly influenced modeled near‐infrared (NIR) reflectance, explaining why both modeled and observed EVI, which is especially sensitive to NIR, captures canopy seasonal dynamics well.

Our improved analysis of canopy‐scale biophysics rules out satellite artifacts as significant causes of satellite‐observed seasonal patterns at this site, implying that aggregated phenology explains the larger scale remotely observed patterns. This work significantly reconciles current controversies about satellite‐detected Amazon phenology, and improves our use of satellite observations to study climate–phenology relationships in the tropics.
Ivan Illich’sMedical Nemesisand the ‘age of the show’: On the Expropriation of Death
Authors: Babich Babette
Published: December 2017

What Ivan Illich regarded in hisMedical Nemesisas the ‘expropriation of health’ takes place on the surfaces and in the spaces of the screens all around us, including our cell phones but also the patient monitors and (increasingly) the iPads that intervene between nurse and patient. To explore what Illich called the ‘age of the show’, this essay uses film examples, likeCreedand the controversial documentaryVaxxed, and the television seriesNurse Jackie. Rocky’s cancer in his last film (submitting to chemo to ‘fight’ cancer) highlights what Illich along with Petr Skrabanek called the ‘expropriation of death’. In contrast to what Illich denotes as‘Umsonstigkeit’– grace or gift, given undeservedly, i.e., gratuitously – medical science tends to be tempted by what Illich terms scientistic ‘black magic’, taking over (expropriating) the life and the death of the patient in increasingly technological ways, a point underscored in the concluding section on the commercial prospects of xenotransplants using factory farm or mass‐produced human‐pig mosaics or chimeras.
Improved Photophysical and Photochemical Properties of Thiopheneethoxy Substituted Metallophthalocyanines on Immobilization onto Gold‐speckled Silica Nanoparticles
Authors: Dube Edith , Oluwole David O. , Nyokong Tebello
Published: December 2017

This work reports on the synthesis of tetrakis‐[(thiophineethoxy) phthalocyaninato] indium(II) chloride (3). The photophysical behavior of complex 3 was compared to that of the Zn derivative (tetrakis‐[(thiophineethoxy) phthalocyaninato] zinc(II) (complex 2)). The compounds were interacted with gold‐speckled silica (GSS) nanoparticles via Au–S self assembly to afford the conjugates (2–GSS and 3–GSS). The photophysicochemical behavior of the compounds and their conjugates were assessed. The conjugates afforded a decrease in fluorescence quantum yields and lifetimes with improved triplet and singlet oxygen quantum yields in comparison with complexes 2 and 3 alone. The complexes and their conjugates could serve as good candidates for photodynamic therapy.
Dihydrotestosterone enhances growth and infectivity of Leishmania Mexicana
Authors: Sánchez‐García L. , Wilkins‐Rodriguez A. , Salaiza‐Suazo N. , Morales‐Montor J. , Becker I.
Published: December 2017

A strong sex‐associated susceptibility towards Leishmania has been reported in males, yet little is known on the effect of hormones in Leishmania physiopathogenicity. Due to the enhanced susceptibility of males to Leishmania mexicana infections, we were interested in analysing the effect exerted by the main androgen produced in males (DHT) on L. mexicana promastigotes. Thus, the aim of this study was to assess the regulation exerted by dihydrotestosterone (DHT) on L. mexicana replication, infectivity, survival and development of tissue lesions. Experiments included growth curves of L. mexicana promastigotes incubated with different doses of DHT, their infection rate, intracellular survival and lesion development in BALB/c mice. Our data show that DHT significantly enhances parasite replication, infection rate and survival in bone marrow‐derived macrophages (BMMФ). Promastigotes in the presence of DHT produced significantly larger lesions in BALB/c earlobes. These results suggest that DHT probably plays a critical role during L. mexicana infections, and the higher susceptibility of males possibly relates to benefits gained by the parasite from host‐derived hormones. Our data shed new light on the physiopathology of Leishmania infections and are the first attempt to understand the direct interaction between Leishmania and androgens, particularly DHT. Understanding this trans‐regulation process employed by parasites to exploit host molecules sheds new light on L. mexicana physiopathogenesis and opens a possible field for studies on drug development.
The metabolic (under)groundwork of the lily bulb toward sprouting
Authors: Lazare Silit , Burgos Asdrubal , Brotman Yariv , Zaccai Michele
Published: December 2017

Large bulbs of Lilium longiflorum have an obligatory cold requirement to flower. Bulb cooling is widely used to induce and accelerate flowering. However, in‐depth investigations of the effect of bulb cooling on major landmarks of plant development are lacking. It has been demonstrated that low temperature induces carbohydrate degradation, yet integrative studies on metabolic changes occurring in the bulb are not available. We detected that cold exposure mainly hastened bulb sprouting, rather than floral transition or blooming. Metabolite profiling of cooled and non‐cooled bulbs was carried out, revealing cold‐induced accumulation of soluble sugars, lipids and specific amino acids, and a significant reduction in tricarboxylic acid (TCA)‐cycle elements. We observed that metabolic pathways located in the cytosol – including glycolysis, lipid synthesis and part of the gamma‐Aminobutyric acid (GABA) shunt – were enhanced by cold exposure, while mitochondrial metabolism – namely the TCA cycle – was reduced by cold. We suggest a physiological model accounting for this metabolic discrepancy.
Impact of missed treatment opportunities on outcomes in hospitalised patients with heart failure
Authors: Walker Simon , Spackman Eldon , Conrad Nathalie , Emdin Connor A , Griffin Ed , Rahimi Kazem , Sculpher Mark
Published: December 2017

Objective

Many patients with heart failure (HF) do not receive recommended treatments, resulting in suboptimal outcomes. We aimed to investigate the impact of implementing recommended HF therapies on health outcomes, and the costs and effectiveness of interventions for improving adherence.

Methods

The health benefits of ACE inhibitor (ACEi), beta blockers and optimal therapy (ACEi and beta blockers if not contraindicated) following hospitalisation for HF were combined with evidence on uptake. The aim was to examine how much health was lost as a result of failure to follow guidelines, and how much could be gained using strategies to promote uptake.

The net health benefits of different treatments (measured in quality-adjusted life-years (QALY)) were estimated using a decision-analytic model and treatment effectiveness from the literature. Data on the number of patients who would have benefitted from the additional treatments were estimated from 2010 to 2013 using the National Heart Failure Audit.

Results

Each recommended treatment was associated with positive net health benefit. In 2010, up to 4019 (38.3%) patients would have benefitted from additional treatments rising to 4886 patients in 2013 (although falling to 25.2% of patients). Failure to follow guidelines resulted in large health losses. In 2010, if all patients had received optimal therapy, 1569 QALYs would have been gained, implying a maximum justifiable investment in interventions to promote uptake of £31.4 million.

Conclusion

Current gaps in translation of evidence to practise in hospitals are associated with significant health losses. Strategies to encourage uptake of guidelines could be effective and cost-effective.
Science education: too much of too little.
Authors: Malvin R L
Published: December 2017

By all measures attempted, scientific literacy of the American public is sadly wanting. The vast majority of our secondary school children and adults have no knowledge of most of the basic terms or concepts of science. The reasons for this shortcoming are many but prominent among them are sadly deficient texts, teachers untrained in the subject matter they teach, and college and university scientists who divorce themselves from the problem, although probably deploring it. Our institutions are no aid. They reward scientific productivity (read: number of papers published per year and research dollars), not teaching. Some suggested cures are production of better texts, training of science teachers in the field in which they teach, and, most importantly, involvement of scientists in the process. We must be willing to spend some of our time with secondary school pupils and their teachers. All will gain from the experience.
Laboratory experience for understanding the physiological basis of diuretic therapy.
Authors: Schwab T R , Knox F G
Published: December 2017

A combined lecture and laboratory experience was designed to enhance medical school students' understanding of the physiological basis of diuretic therapy. Studies are performed by students in anesthetized dogs to determine the effects of four clinically useful diuretics on renal function. The objective of the experience is to 1) learn the mechanisms of action, clinical indications, and adverse effects of diuretics; 2) review the renal physiology of glomerular filtration and sodium metabolism; and 3) complete analysis and interpretation of experimental data. These sessions provide an effective practical educational experience in applying the scientific method to begin to understand the physiology and pharmacology of diuretics.
Demonstration of temperature dependence of Na(+)-K+ pump activity of human blood cells.
Authors: Honig A , Oppermann H , Budweg C , Goldbecher H , Freyse E J
Published: December 2017

In our physiology laboratory course we introduced several simple but instructive experiments in which medical students make observations on their own blood cells. In this experiment, students measured and discussed the effect of different temperatures on Na+ and K+ distribution between blood cells and plasma. In venous blood of 35 female and 64 male students, plasma (extracellular) [Na+] and [K+] were measured with ion-selective electrodes immediately after blood sampling and successively four times in intervals of 1 h in three samples stored at 1, 20, and 37 degrees C. At 1 degree C, plasma [K+] increased significantly and nearly linearly with cooling time of the blood, whereas plasma [Na+] decreased. In contrast, at 37 degrees C plasma K+ levels significantly decreased in the first 2 h and then stabilized at new levels clearly below baselines. At 1 degree C blood cells had a greater K+ loss in women than in men, whereas at 37 degrees C the K+ loss was significantly less pronounced in women. Plasma Na+ did not significantly change at 37 degrees C. This remarkably reproducible experiment demonstrates the existence of active Na(+)-K+ transport in human blood cells by showing medical students, with their own blood, that the basal chemical processes of such pumps are inhibited at a temperature of 1 degree C and stimulated when blood temperature is slightly higher than the usual body temperature.
Cardiovascular physiology teaching: computer simulations vs. animal demonstrations.
Authors: Samsel R W , Schmidt G A , Hall J B , Wood L D , Shroff S G , Schumacker P T
Published: December 2017

The roots of physiology lie in laboratory observation, and physiology courses continue to rely on laboratory observation to provide students with practical information to correlate with their developing base of conceptual knowledge. To this end, animal laboratories provide a functioning example of interactions among organ systems and a source of data for student analysis. However, there are continuing objections to using animals for teaching, and animal labs are costly in time and effort. As an alternative laboratory tool, computer software can simulate the operation of multiple organ systems: responses to interventions illustrate intrinsic organ behavior and integrated systems physiology. Advantages of software over animal studies include alteration of variables that are not easily changed in vivo, repeated interventions, and cost-effective hands-on student access. Nevertheless, simulations miss intangible aspects of experimental physiology, and results depend critically on the assumptions of the model. We used both computer and animal demonstrations in teaching cardiovascular physiology to first-year medical students. The students rated both highly, but the computer-based session received a higher rating. We believe that both forms of teaching have educational merit. At the introductory level, the computer appears to provide an effective alternative.
First principles: physical science concepts as a foundation for advanced studies in physiology.
Authors: Bullock J O
Published: December 2017

The importance of mathematics and physical science to physiology is amply evident in both the classic and current literature of this field. Students who have completed typical medical school preparatory programs, however, have been poorly equipped to embark on serious graduate study in physiology. Because undergraduate education in the sciences is typically structured as narrowly defined, disjointed degree programs in separate disciplines, students of biology have had only limited access to the resources of physical science departments. Attempts by physiology faculty to remedy specific deficiencies on a piecemeal basis have been found to be both time consuming and ineffective. We describe an intensive one-semester course as an alternative. Maintaining high levels of generality and concentrating on the development of physical insight were possible only when the mathematical foundation attained by the students was adequate. Although physiological applications were stressed throughout, extended examination of complex problems was limited to a few examples of particular interest. Emphasis was placed on rigor and sophistication rather than proficiency and detail.
Attendance and grades in a human physiology course.
Authors: Hammen C S , Kelland J L
Published: December 2017

Teaching a lecture course in introductory human physiology with 40-183 students provided an opportunity to test the hypothesis that regular attendance is correlated with higher examination scores. Data on 556 students were recorded during five semesters, each consisting of three classes per week for 14 weeks. The students were in the second year of pharmacy, nursing, physical education, and dental hygiene programs. Attendance was recorded in each class. Regular attendance was encouraged but was not used to influence scores. The maximum possible score was 400 points, based on two 1-h examinations and a 2-h final examination. Examinations consisted of multiple-choice questions derived from reading assignments in a required textbook. Linear regression analysis indicated a small negative relation between total point scores and absences, amounting to an average decrease of 2 points for each absence, or a decrease of 0.5% per absence. Correlation coefficients averaged -0.33. The results suggest that regular attendance was helpful in a statistical sense but was not a decisive factor in learning human physiology as presented in current textbooks.
Resting membrane potentials: a student test of alternate hypotheses.
Authors: Thurman C L
Published: December 2017

The frog sartorius muscle is a model tissue for demonstrating to physiology students the principles underlying both membrane phenomena and hypothesis testing. Myocytes can be impaled with conventional glass microelectrodes to measure membrane voltage (Vm). Further, Vm is observed as extracellular K+ is altered and a K+ channel blocker is added. After the experiment, students examine the underlying assumptions of the Nernst equilibrium and the Goldman-Hodgkin-Katz equation. They ultimately determine which of the two algorithms best predicts the measured Vm. In addition, students learn micromanipulation and impalement techniques. This experiment facilitates the student's understanding of membrane permeability, ionic gradients, and membrane voltage.
An educational tool for understanding the cardiovascular changes associated with diabetes.
Authors: Collins H L , DiCarlo S E
Published: December 2017

Diabetes, a syndrome characterized by high plasma glucose and low plasma insulin concentrations, is associated with somatic and autonomic neuropadiabetes as well as cardiac and vascular disorders. These consequences of diabetes significantly affect the organism's ability to maintain homeostasis. To understand the changes associated with diabetes, we developed a laboratory exercise that compares and contrasts the cardiovascular responses to exercise in an individual with diabetes and in an individual without diabetes. This exercise provides a unique opportunity to analyze, integrate, and interpret the changes associated with diabetes, since more is learned about how a system operated when the system is forced to perform than when it is idle. In this laboratory, anatomical and physiological data concerning diabetes are provided. Subsequently, a figure that illustrates the response of a specific cardiovascular variable during exercise (e.g., heart rate, cardiac output, blood pressure) is presented. Students are challenged to analyze and assimilate information from figures, answer questions, make calculations, fill in tables, and plot graphs. The laboratory does not require equipment or software, only rulers and pencils. The answers to the questions and tables are provided in the APPENDIX. Students obtain experience in evaluating and understanding diabetes as well as applying basic cardiovascular concepts. The emphasis is on the application of basic cardiovascular principles, interpretation of pictorial or tabular material, and problem-solving skills.
Model demonstrating respiratory mechanics for high school students.
Authors: Chan V , Pisegna J , Rosian R , DiCarlo S E
Published: December 2017

We wanted to develop educational materials appropriate for the high school student which would present physiological concepts in an innovative way. The impetus was in response to the lack of physiology educational materials appropriate for the high school level. To this end, we developed an exercise that presents the physiological basis for respiratory mechanics. The materials were designed to engage students in interactive learning and to stimulate interest for future science study. The emphasis of the exercise was the construction of a model that could be built by high school students to demonstrate respiratory mechanics. The use of models to present complex materials has been shown to be an effective medium for science learning. Our exercise contains directions for an inexpensive, easy-to-build model, as well as many supplemental teaching tools. Questions are interspersed throughout the text and at the end of the laboratory experience to facilitate the learning process. Answers are provided to the questions. Students and teachers alike are challenged to build, manipulate, and discuss their experience during the investigation of respiratory mechanics.
Graphic analysis for the study of metabolic states.
Authors: Summers R L , Woodward L H , Sanders D Y , Hall J E
Published: December 2017

Graphic analyses have been used in the study of physiology as a means to better understand dynamic processes and to visualize the mechanisms of their interactions. A graphic analysis of glucose homeostasis was constructed by considering the main factors that influence glucose dynamics. The analysis is achieved by equating curves representing both the inflow and outflow of glucose from the circulation as dependent upon the serum insulin concentration. The point where these two curves intersect is the steady-state balance for blood glucose exchange and is termed the equilibrium point. With the use of this graphic depiction of glucose homeostasis, it is now possible to study the influence of multiple factors on glucose dynamics. A variety of metabolic states can also be analyzed by reconstructing the effects of the pathophysiology on the form and shape of the curves. Some of the metabolic states that have been analyzed by this technique include starvation, exercise, obesity, type I and type II diabetes mellitus, stress, hypopituitarism, hyperpituitarism, and hyperthyroidism. Although the analyses do not reflect all of the controversial nuances of the field, they do provide a means for a general approach to the study of glucose homeostasis and serve as a methodology that can be extrapolated to many areas of physiological study.
Introduction to medical physiology: cellular membranes and transmembrane transport of solutes and water.
Authors: Benos D J
Published: December 2017

This article summarizes the comments made in the introductory session of the Medical Physiology course taught at the University of Alabama School of Medicine. The main thesis is that learning physiology is easier when fundamental principles are first delineated. Four general principles of physiology (mass balance, force-flow, capacitance, and equilibrium) are discussed. Clinical medicine becomes more comprehensible when these basic principles are understood. Cellular Physiology is taught first because it forms the conceptual basis for what follows in the course. The idea that the root of clinical medicine lies in the basic sciences is emphasized.
How many pounds of oxygen do we "eat" each day?
Authors: Engelberg J
Published: December 2017

As teachers we feel the need to do more than merely teach basic facts and concepts. We want to make the subject matter more relevant; we would like to help integrate the various threads of the students' education and life experiences; and, finally, we wish to increase the students' interest and involvement in the learning process. There is the temptation, however, when thinking along these lines, to consider the use of time-consuming, complex methods of approach. These might involve slide presentations, videos, special lectures, special assignments, student, reports, etc: The very complexity of these approaches often reduces their effectiveness. Moreover, the time and effort required often keeps us from attempting them more than once or twice. Are simpler and more effective approaches to enrichment possible? Reflecting on our own education, many of us may recall the disproportionate impact of some revealing aside thrown by a teacher unexpectedly into an otherwise mundane lecture or discussion: perhaps a short, penetrating observation providing an unexpected perspective on what was being discussed, a bolt of lightening that briefly illuminated the dim landscape of the classroom. This we may remember when much from the course has been totally forgotten. These jewels of thought--epiphanies--can be shared by teachers to enrich, enlighten, and refresh their students and each other. The jewels we speak of need not be precious or rare. Indeed, the metaphors "a bolt of lightening" and "jewels" may mislead by their intensity and drama. Is it not in the often unexamined, simple, and humble all around us that wisdom can be found? The following is an example.
How to help students understand physiology? Emphasize general models.
Authors: Modell H I
Published: December 2017

Students generally approach topics in physiology as a series of unrelated phenomena that share few underlying principles. In many students' view, the Fick equation for cardiac output is fundamentally different from a renal clearance equation. If, however, students recognize that these apparently different situations can be viewed as examples of the same general conceptual model (e.g., conservation of mass), they may gain a more unified understanding of physiological systems. An understanding of as few as seven general models can provide students with an initial conceptual framework for analyzing most physiological systems. The general models deal with control systems, conservation of mass, mass and heat flow, elastic properties of tissues, transport across membranes, cell-to-cell communication, and molecular interaction.
Effects of an applied supplemental course on student performance in elementary physiology.
Authors: Richardson D , Birge B
Published: December 2017

The objective of this study was to determine whether students within a large (100-160 students) didactic lecture-based course, "Elementary Physiology" (EP), who were given an active-learning opportunity would perform better on objective examinations over EP material compared with their classroom peers who did not have the same active-learning experience. This was achieved by offering the EP students the option of taking a supplemental one credit hour discussion-based course, "Case Studies in Physiology" (CSP). Approximately 14% of the EP students opted for the CSP course. The format of CSP consisted of a one-hour-per-week discussion of applied problems based on the factual information presented in EP. On a subjective scale of 1 to 4, the CSP students felt that the course helped them to understand the EP material (3.5). This was reflected in the EP examination results for which the CSP students scored significantly higher compared with their non-CSP peers (81.1% vs. 75.7%; P < 0.05). These results indicate that when active-learning methods, such as discussion of applied problems, are used as a supplement to didactic lectures in physiology, performance on objective examinations of lecture material is improved.
BASIC PRINCIPLES OF SYNAPTIC PHYSIOLOGY ILLUSTRATED BY A COMPUTER MODEL
Authors: Davis Michael J.
Published: December 2017

A computer model is described that simulates many basic aspects of chemical synapse physiology. The model consists of two displays, the first being a pictorial diagram of the anatomical connections between two presynaptic neurons and one postsynaptic neuron. Either or both of the presynaptic cells can be stimulated from a control panel with variable control of the number of pulses and firing rate; the resulting presynaptic action potentials are animated. The second display plots the membrane potential of the postsynaptic cell versus time following presynaptic stimulation. The model accurately simulates temporal and spatial summation when the presynaptic cells are arranged and stimulated in parallel and simulates presynaptic inhibition when they are arranged and stimulated in series. Excitatory and inhibitory postsynaptic potentials can be demonstrated by altering the nature of the ionic conductance change occurring on the postsynaptic cell. The effects on summation of changing length constant or time constant of the postsynaptic cell can also be illustrated. The model is useful for teaching these concepts to medical, graduate, or undergraduate students and can also be used as a self-directed computer laboratory exercise. It is available for free download from the internet.
LINKING CARDIOVASCULAR THEORY TO PRACTICE IN AN UNDERGRADUATE MEDICAL CURRICULUM
Authors: Hudson J. N. , Buckley P. , McMillen I. C.
Published: December 2017

Case-based teaching (CBT) tutorials were introduced by the Physiology Department at Adelaide University to bridge the gap between theory and practice in the early years of undergraduate medical education. With the use of a clinical case-based environment, CBT aimed to achieve integration of structure-function relationships and an increase in students’ capacity to apply a physiological understanding to clinical observations/symptoms and data. With peer-peer interactions in small groups, students could trial history taking and examination skills, interpret common investigations, and relate their findings to an understanding of structure and function. Here, the cardiovascular tutorials highlight the centrality of an understanding of structure and function in the evaluation of a case of syncope. An independent evaluation of the students’ learning experience demonstrated that CBT tutorials were successful in their aims. The “hands-on” experience was highly rated, with students reporting that the CBT approach gave relevance to structure and function. Whatever the curriculum learning style, underpinning practice with an understanding of theory remains a desirable feature of medical education.
PROBLEM-BASED LEARNING WITHIN ENDOCRINE PHYSIOLOGY LECTURES
Authors: Walters Marian R.
Published: December 2017

Methods were needed to improve the interest of medical students in the 10-lecture Endocrine Physiology block at the end of the second semester of study. Other incentives for improvement included the possibility of attracting students into endocrine research electives and the pressure to improve teaching approaches that results from the high tuition they pay. The principal approach adopted was that of whole class problem-based learning sessions (PBLS) in which the lecture period begins with a brief overview of one to three simplified cases, followed by the usual didactic lecture. At the end of the lecture, each PBL case is read in detail, with several questions posed to the students. Their answers are then used to reinforce concepts from the lecture material. This method can also provide some continuity between lectures, either by using a case in several lectures to illustrate different points, or by posing a question at the beginning of class that illustrates a point from the prior lecture. The outcome of this approach has been very successful: student evaluations of the lecture block and their attendance have significantly improved.
INTEGRATION OF NEUROSCIENCE AND ENDOCRINOLOGY IN HYBRID PBL CURRICULUM
Authors: Cunningham J. Thomas , Freeman Ronald H. , Hosokawa Michael C.
Published: December 2017

At the University of Missouri-Columbia, the medical school employs a problem-based learning curriculum that began in 1993. Since the curriculum was changed, student performance on step 1 of the United States Medical Licensing Examination has significantly increased from slightly below the national average to almost one-half a standard deviation above the national mean. In the first and second years, classes for students are organized in classes or blocks that are 8 wk long, followed by 1 wk for evaluation. Initially, basic science endocrinology was taught in the fourth block of the first year with immunology and molecular biology. Student and faculty evaluations of the curriculum indicated that endocrinology did not integrate well with the rest of the material taught in that block. To address these issues, basic science endocrinology was moved into another block with neurosciences. We integrate endocrinology with neurosciences by using the hypothalamus and its role in neuroendocrinology as a springboard for endocrinology. This is accomplished by using clinical cases with clear neuroscience and endocrinology aspects such as Cushing’s disease and multiple endocrine neoplastic syndrome type 1.
Control of intracellular Ca2+ activity in rat myometrium
Authors: Janis R. A. , Crankshaw D. J. , Daniel E. E.
Published: December 2017

Four fractions enriched, respectively, in plasma membrane (PM), smooth endoplasmic reticulum (SER), rough endoplasmic reticulum (RER), and mitochondria were isolated from estrogen-dominated rat myometrium. Ca2+ uptake by these fractions was studied in order to estimate the relative potential of the corresponding organelles for controlling intracellular Ca2+ activity. Ca2+ uptake properties of the PM, SER, and RER fractions were similar except that potentiation by oxalate was in the order RER greater than or equal SER greater than PM. However, studies with the ionophores X-537A and A23187 suggested that Ca2+ was transported into the lumen of membrane vesicles of all these fractions. Unlike that of skeletal muscle sarcoplasmic reticulum, Ca2+ uptake by the myometrial fractions was not supported by high-energy compounds other than ATP. Mitochondria took up much less Ca2+ at low, and much more Ca2+ at high, free Ca2+ concentrations than did the other fractions. The amount of Ca2+ taken up in 30 s from a 1 muM free Ca2+ solution in the presence of ATP was similar for all fractions. These results suggested that mitochondria may act as an important Ca2+ control system in rat myometrium when the intracellular Ca2+ concentration is near 1 muM or higher, whereas the PM, SER, and RER may be of major importance at Ca2+ levels of 0.3 muM or lower.
Afferent discharges from venous pressoreceptors in liver
Authors: Nijima A.
Published: December 2017

Afterent discharges were observed in dissected filaments or single nerve fibers of hepatic nerve in the guinea pig and the rabbit. Increasing the perfusion pressure of the portal vein in isolated liver preparation in the guinea pig caused an increase in afferent discharge rate. Discharge patterns were compatible with those of the slowly adapting type. Increasing the portal venous pressure by means of intravenous injection of Locke's solution into the left jugular vein in the rabbit in vivo caused an increase in afferent discharge rate. Increasing the hepatic arterial pressure was without effect. It is suggested that pressoreceptors are present in or near the venous wall of the portal venous system and that they send information about blood pressure in the portal vein to the central nervous system.
Characteristics of response of isolated smooth muscle cells to cholinergic drugs
Authors: Fay F. S. , Singer J. J.
Published: December 2017

The contractile responses of suspensions of isolated smooth muscle cells from the stomach muscularis of Bufo marinus were assessed with a Coulter counter. Contractile responses of strips from the same tissue were recorded isotonically. Suspensions of isolated smooth muscle cells exhibit a dose-dependent graded response to cholinergic agonists. The intact tissue has a lower sensitivity than the isolated cells to acetycholine but a higher sensitivity to carbachol. The higher sensitivity of isolated cells to acetycholine probably reflected decreased efficiency of cholinesterases upon removal of diffusion barriers. Because the isolated smooth muscle cells have affinity constants for atropine (K1 equals 0.07 +/- 0.02NM) and carbachol (9.5 +/- 3.7 muM) similar to that in this and other intact tissues, the affinity of the cholinergic receptor appears unaffected by cell isolation. The rate constant for dissociation (k2) of atropine was estimated from the slowing of response to carbachol by atropine; k2 in the isolated cells is 100 times larger than seen in intact tissues. Further insight into the interaction of cholinergic substances with their smooth muscle receptors might by obtained using this system. The isolated cells contain intact receptors, and diffusion limitations inherent to intact tissue have been removed.
Converting enzyme activity in endothelial cells isolated from pig pulmonary artery and aorta
Authors: Ody C. , Junod A. F.
Published: December 2017

Converting enzyme activity was studied in endothelial cells, isolated from pig pulmonary arteries and aorta by exposure to collagenase. The measure was based on the release of His-Leu from Z-Phe-His-Leu was related to the DNA content of the cellular suspension. The same activity was found in the two types of endothelium: 1 nmol His-Leu/mug DNA per 30 min. Subendothelial cells showed a very low activity, amounting to 10% of the value found for the endothelium. The enzyme activity was 2inhibited by the nonapeptide SQ 20881, EDTA, and the lack of Cl- in the same fashion for the two types of endothelium. The presence of another enzyme hydrolyzing His-Leu was detected in both endothelial populations. Isolated fragments of plasma membrane, however, exhibited only converting enzyme activity. It can be concluded that endothelial cells isolated from large vessels of the pulmonary and the systemic circulations have similar properties when dipeptidyl carboxypeptidase activity is measured.