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A Five-Year Review of Enhanced Learning through Integration: Anatomy and Clinical Practice  [PDF]
Melanie Hagen, Brian K. Cooke, Ashleigh Wright, Kyle E. Rarey
Creative Education (CE) , 2017, DOI: 10.4236/ce.2017.811121
Abstract: Many medical schools have undergone curricula revisions and attempted to integrate basic and clinical sciences. In 2012, our program at the University of Florida College of Medicine underwent significant curricular reform, transitioning from the standard medical curriculum to a systems-based approach. The teaching of anatomy, clinical skills, radiology, ethics, population health, human behavior, and evidence-based medicine was integrated into one class, “Introduction to Clinical Medicine”, which spans 68 weeks in the pre-clerk- ship curriculum. As a result, there was a reduction of anatomy teaching from 166 to 120 hours. Our curriculum integration demonstrates opportunities for enhanced teaching including increasing peer learning, incorporating multidisciplinary case presentations, and allowing for a deliberate overlap and layering of anatomy education across two years of medical school. This paper describes our reflection on the effect of the curriculum change on student learning. Five years after implementation of these changes shows that our efforts also illustrate the challenges inherent to curricular integration including scheduling constraints, unclear sources of financial support, apprehension about the effect on future National Board of Medical Examiners (NBME) scores, and difficulty assessing which areas a student needs to remediate within a failed integrated course. Overall, the integration of anatomy with other classes into a revised course at our College of Medicine has been well received and successful.
Birthing and Mining in John Donne’s “To His Mistress Going to Bed”  [PDF]
Ashleigh Frayne
Advances in Literary Study (ALS) , 2017, DOI: 10.4236/als.2017.54006
Abstract: This paper uncovers an aspect of “To His Mistress Going to Bed” that has largely been ignored by critics of the poem, namely, the poem’s interest in the interrelationship between power, geological exploration, and childbirth. Over the past twenty years, social historians and historians of medicine have explored early modern accounts of childbirth, making it possible for scholars to recover the historical context framing Donne’s depictions of childbirth. Placing “To His Mistress” within this historical context forces us to rethink a number of critical assumptions about the poem: in particular that the poem concerns sex but not procreation. In this paper, I explore the implications that medical beliefs about reproduction and the medical politics of childbirth had for Donne as he set about trying to dramatize male desire and uncover the hidden interior of the female body. My historical analysis reveals how the poem fits within the early modern conversation about women’s reproductive power and artificial birth. By illuminating interwoven references to childbirth with references to mining, I situate Donne’s poem within the larger early modern conversation about women’s reproductive power and artificial birth. This repositioning has important implications for Donne’s sexual politics and the medical context informing his work.
Controlled Roof Collapse during Secondary Mining in Coal Mines
Ashleigh Hutchinson
International Journal of Differential Equations , 2012, DOI: 10.1155/2012/806078
Abstract: The problem considered is an investigation of the possible collapse of the roof between the pillar next to be mined in secondary coal mining and the first line of pillar remnants called snooks. The roof rock between the pillar, which is the working face, and the snook is modelled as an Euler-Bernoulli beam acted on at each end by a horizontal force and by its weight per unit length. The beam is clamped at the pillar and simply supported (hinged) at the snook. The dimensionless differential equation for the beam and the boundary conditions depend on one dimensionless number . We consider the range of values of before the displacement and curvature first become singular at . The model predicts that for all practical purposes, the beam will break at the clamped end at the pillar. The failure of the beam for values of greater than is investigated computationally. 1. Introduction We consider the challenge posed by coal mine pillar extraction [1, 2]. Secondary mining involves revisiting a mine and extracting coal from the pillars. The mining of these pillars commences from the area furthest away from the point of entry of the mine. This exercise involves cutting the existing pillars into smaller pillars called snooks. As each section is mined, the roof must collapse in a controlled manner in order to pose no safety risk to those miners operating underground. We analyse the behaviour of the roof of the mine between the pillar next to be mined and the first line of snooks. This is the work area and must be safe for the miners. 2. Model In Figure 1, a mining panel in shown prior to pillar extraction. The tunnels are excavated in coal which are approximately 5?m to 7?m wide. They are excavated in a fixed pattern crossing at right angles creating a checker board layout. The coal between the tunnels forms the pillars which support the overburden rock. The width of the pillars is approximately 10?m to 20?m wide and is a function of the depth of the mine. The height of the tunnels ranges from 3?m to 4?m. Secondary mining is carried out in two stages. In the initial stage, approximately 5 to 10 pillars are removed and the roof is left to collapse. This stage is modelled in [2]. Following this, adjacent pillars are mined and smaller sections are left to collapse. The purpose of this paper is to model the second stage in the extraction process. Figure 2 shows the snooks after pillar extraction. The pillars are cut to leave four snooks, approximately 2?m, one at each corner. The snooks have to be small enough to fail when the miners are a safe distance (about the width
Adaptation of the Feedforward Postural Response to Repeated Continuous Postural Perturbations  [PDF]
Ashleigh Kennedy, Nicoleta Bugnariu, Arnaud Guevel, Heidi Sveistrup
Neuroscience & Medicine (NM) , 2013, DOI: 10.4236/nm.2013.41007

We examined the adaptation of the postural response to repeated predictable platform oscillations. Our main goals were to determine whether the short-term changes that occurred during a minute long continuous postural perturbation trial were maintained in subsequent trials and to determine how many trials were required before participants fully adapted to the postural task. Ten participants performed ten minute-long postural trials on a platform that oscillated at 0.25 Hz before increasing to 0.50 Hz half way through each trial. Postural muscle onset latencies, burst amplitudes, and anterior posterior displacements of the center of pressure (COP) and center of mass (COM) were calculated for the last five cycles performed in each trial at 0.50 Hz. The postural strategy evolved in two phases: 1) immediate decrease in COP displacement; 2) earlier activation of the postural muscles with smaller muscle burst amplitudes. After seven trials the postural response remained consistent.

Estimation of the Underlying Burden of Pertussis in Adolescents and Adults in Southern Ontario, Canada
Ashleigh A. McGirr, Ashleigh R. Tuite, David N. Fisman
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0083850
Abstract: Despite highly successful vaccination programs and high vaccine uptake, both endemic pertussis and periodic pertussis outbreaks continue to occur. The under-recognized role of adolescents and adults in disease transmission, due to waning immunity following natural infection and vaccination, and reduced likelihood of correct diagnosis, may contribute to pertussis persistence. We constructed a mathematical model to describe the transmission of pertussis in Southern Ontario in both pre-vaccine and vaccine eras, to estimate the underlying burden of pertussis in the population. The model was well calibrated using the best available data on pertussis in the pre-vaccination (1880–1929) and vaccination (1993–2004) eras in Ontario. Pertussis under-reporting by age group was estimated by comparing model-projected incidence to reported laboratory-confirmed cases for Greater Toronto. Best-fit model estimates gave a basic reproductive number of approximately 10.6, (seasonal range 9.9 to 11.5). Under-reporting increased with age, and approximately >95% of infections in children were caused by infections in persons with waning immunity to pertussis following prior infection or vaccination. A well-calibrated model suggests that under-recognized cases of pertussis in older individuals are likely to be an important driver of ongoing pertussis outbreaks in children. Model projections strongly support enhancement of booster vaccination efforts in adults.
Characteristics of the Early Immune Response Following Transplantation of Mouse ES Cell Derived Insulin-Producing Cell Clusters
Ashleigh S. Boyd,Kathryn J. Wood
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0010965
Abstract: The fully differentiated progeny of ES cells (ESC) may eventually be used for cell replacement therapy (CRT). However, elements of the innate immune system may contribute to damage or destruction of these tissues when transplanted.
Estimation of the Health Impact and Cost-Effectiveness of Influenza Vaccination with Enhanced Effectiveness in Canada
David N. Fisman, Ashleigh R. Tuite
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0027420
Abstract: Introduction The propensity for influenza viruses to mutate and recombine makes them both a familiar threat and a prototype emerging infectious disease. Emerging evidence suggests that the use of MF59-adjuvanted vaccines in older adults and young children enhances protection against influenza infection and reduces adverse influenza-attributable outcomes compared to unadjuvanted vaccines. The health and economic impact of such vaccines in the Canadian population are uncertain. Methods We constructed an age-structured compartmental model simulating the transmission of influenza in the Canadian population over a ten-year period. We compared projected health outcomes (quality-adjusted life years (QALY) lost), costs, and incremental cost-effectiveness ratios (ICERs) for three strategies: (i) current use of unadjuvanted trivalent influenza vaccine; (ii) use of MF59-adjuvanted influenza vaccine adults ≥65 in the Canadian population, and (iii) adjuvanted vaccine used in both older adults and children aged < 6. Results In the base case analysis, use of adjuvanted vaccine in older adults was highly cost-effective (ICER = $2111/QALY gained), but such a program was “dominated” by a program that extended the use of adjuvanted vaccine to include young children (ICER = $1612/QALY). Results were similar whether or not a universal influenza immunization program was used in other age groups; projections were robust in the face of wide-ranging sensitivity analyses. Interpretation Based on the best available data, it is projected that replacement of traditional trivalent influenza vaccines with MF59-adjuvanted vaccines would confer substantial benefits to vaccinated and unvaccinated individuals, and would be economically attractive relative to other widely-used preventive interventions.
Inguinal Neuritis in Open Recurrent Hernia Repair  [PDF]
Robert Charles Wright, Robert James Wright
International Journal of Clinical Medicine (IJCM) , 2014, DOI: 10.4236/ijcm.2014.513106

PURPOSE: To investigate the pattern of occurrence of inguinal neuritis in recurrent inguinal hernia. We hypothesize that neuritis will occur in more nerves with a wider distribution than in primary repair. METHODS: Retrospective chart review of thirty consecutive recurrent inguinal hernia repairs concentrating on the occurrence of inguinal neuritis. These are not chronic pain patients. Nerves suspected of containing inguinal neuritis were sent for histologic examination. Ilioinguinal nerves were routinely resected. Operative parameters and nerve pathology reports were reviewed. These data were compared with a recent series of one hundred consecutive primary inguinal hernia repairs with a 34% incidence of inguinal neuritis. An independent statistician from Whitman University reviewed the data. RESULTS: Twenty patients were found to have inguinal neuritis among thirty recurrent open inguinal hernia repairs (66%). This compares to 34% among primary repairs, but it is a similar rate (P > 0.42) assuming that the damaged nerve was left intact in 34% of these recurrences during the primary repair. In recurrent inguinal hernia 69% of neuritis occurred in the ilioinguinal nerve compared to 88% of damaged ilioinguinal nerves in the primary hernia. A test for the difference in proportions gives P > 0.10. The most common site of neuritis occurrence in recurrent hernias with nerve damage to the ilioinguinal nerve was at the external oblique neuroperforatum among 70% of patients compared to 83% in primary cases. A test for difference in proportions gives P > 0.36. Two separate nerves were found to exhibit neuritis in six patients (20%) significantly higher than 1% among primary hernias (P < 0.01). CONCLUSION: The overall incidence of inguinal neuritis was 66% in recurrent inguinal hernia repairs. The ilioinguinal nerve was most commonly affected in these recurrent hernias. Inguinal neuritis occurs more commonly in recurrent hernia compared with primary inguinal hernia; however, it has a similar distribution. Neuritis occurs in two nerves with 20% frequency (P < 0.01), so all nerves should be assessed during recurrent herniorrhaphy. The data support the hypothesis.

Socio-Cultural Identities, Perceptions of Sexuality/Sexual Behavior and Cultural Contexts as Determinants of HIV and AIDS Prevalence in Southern Africa  [PDF]
Chijioke Uwah, Susan Wright
World Journal of AIDS (WJA) , 2012, DOI: 10.4236/wja.2012.21003
Abstract: This paper attempts to examine the connection between one’s socio cultural setting and the prevalence of HIV/AIDS. Often, local communities form the contexts within which people negotiate their social and sexual lives and identities. These communities also play a key role in enabling or restraining people from taking control over their health. The paper will try to demonstrate through specific examples that in African societies, sexual behavior is a product of one’s socio-cultural environment and structural contexts and not the cognitive properties of the individual. The article draws from the qualitative study (Focus group sessions, individual interviews) conducted in three high schools in the Boland area of the Western Cape with about 18 learners, 3 Life skills teachers, 3 Performer-Educators on the efficacy of the HIV/AIDS intervention by The Centre for HIV/AIDS Management theatre group based at the University of Stellenbosch. The aim of the study was to ascertain the cultural content of their campaign model as well as their knowledge of the determinants of sex and sexuality of their target areas. Based on the findings of this study, I argue that theatre will achieve greater success in its campaign against HIV/AIDS in South Africa if the designers of the campaign models adopt a more participatory approach, make indigenous culture central to the design of their intervention model and pay closer attention to what Campbell refers to as “community level of analysis” which simply put implies a greater understanding of the target audiences local communities and its determinants of sex and sexuality.
What Is Narcissistic Personality Disorder? Lay Theories of Narcissism  [PDF]
Kirstie Wright, Adrian Furnham
Psychology (PSYCH) , 2014, DOI: 10.4236/psych.2014.59124

There are various studies on mental health literacy which examine lay people’s knowledge and understanding of various mental disorders. Many are interested in beliefs about cause, manifestation and cure as well as the relationship between those beliefs. This study examines lay beliefs regarding the manifestations, aetiology and treatment of Narcissistic Personality Disorder (NPD), and their determinants using a questionnaire divided into three parts. Participants (N = 201) answered 45 attitudinal statements designed for this study regarding NPD. They consisted of 18 manifestation items, 15 aetiology items and 12 treatment items referring to NPD. They also completed the Narcissistic Personality Inventory. Each section of the questionnaire was factor analysed to determine the structure of those beliefs. Factors derived from a principle component analysis of lay beliefs demonstrate poor knowledge of NPD. Factors derived from the manifestations, aetiology and treatment section were modestly and coherently correlated. No demographic factors correlated with all aspects of mental health literacy and lay theories. People are surprisingly misinformed about NPD. They believed that narcissists manifested superficiality and social problems, business abilities and fragility. No distinction was made between biological and psychological causes or genetics and early negative events. Inability to identify NPD may account for many reports of sub-clinical narcissism being associated with leadership derailment.

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