Thinking about teaching. More learning activities.
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Biomedical subjects
Publications and source records attributed to D Hall.
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In the fifth part of this series on teaching skills, Dai Hall suggests some ways of organising your material when imparting information or when organising a discussion.
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OBJECTIVE: To evaluate, in a pulsatile flow model simulating flow conditions in valvar stenoses, whether accurate determination of orifice area can be achieved by the continuity equation using automated determination of flow volumes based on spatiotemporal integration of digital colour Doppler flow velocities. METHODS: A method for automated determination of flow volumes which takes into account the velocity distribution across a region of interest was examined using flow through a tube and various restrictive outlet orifices with areas ranging between 0.2 and 3.1 cm2. The sampling rectangle of the Doppler method was positioned proximal to the obstructions within the flow convergence zone for evaluating prestenotic flow volume. Stenotic jet velocities were recorded by continuous wave Doppler to obtain the integral under the velocity curve. Prestenotic flow volume was then divided by the velocity integral to calculate functional orifice area according to the continuity equation. RESULTS: The presence of parabolically shaped velocity profiles across the prestenotic region was demonstrated by the Doppler method. Excellent agreement was found between prestenotic flow volumes measured by the Doppler technique and actual values (r = 0.99, SEE = 1.35 ml, y = 0.99x-0.24). Use of the continuity equation led to a close correlation, with a systematic underestimation of geometric orifice sizes. Correction of Doppler data for flow contraction yielded an excellent agreement with actual orifice areas. CONCLUSIONS: The study validated the accuracy of a Doppler method for automated determination of flow volumes for quantifying orifice area by the continuity equation. Prestenotic flow volume and functional orifice area could be evaluated reliably in the presence of non-flat velocity profiles. Thus the method contributes to the non-invasive assessment of valvar stenoses.
The influence of arachidonic acid (AA) on the feedback regulation of mesangial contraction by large Ca(2+)-activated K+ channels (BKCa) was determined through single-channel analysis using the patch clamp method. The mesangial BKCa is a low-gain negative feedback inhibitor of contraction that is activated in response to agonist-induced Ca2+ transients and membrane depolarization. AA activated BKCa in cell-attached patches in a dose-dependent manner with a maximal effect at 400 nM and a half-maximal response at 49 nM. In inside-out patches, AA directly activated BKCa with a maximal effect at 400 nM. BKCa was activated significantly in response to addition of 100 nM ANG II in the presence but not the absence of AA. Since it was shown previously that fatty acids stimulated both soluble and membrane-bound guanylyl cyclase, we determined whether AA activated BKCa by interfering with cGMP-mediated signal transduction pathways. It was previously shown that 10 microM cGMP, via cGMP-dependent protein kinase, activated BKCa in a biphasic manner with an early increase in probability of a channel existing in an open state (Po) and a subsequent inactivation mediated by protein phosphatase 2A (PP2A). We found that 10 microM dibutyryl-cGMP enhanced BKCa activity in an additive manner with saturating concentrations (400 nM) of AA. Moreover, the inactivation phase mediated by PP2A was not abolished. Thus AA does not affect the phosphorylation/dephosphorylation regulatory cycle for BKCa. It is concluded that AA potentiates the ANG II feedback response of BKCa by a mechanism that is independent of the phosphorylation cycle.
Head injury is a major cause of morbidity in Western society and sport related incidents account for approximately 11% of all head injured patients attending Accident and Emergency Departments. Golf was shown to be one of the sports most commonly associated with head injury requiring referral to a regional neurosurgical centre. Previous studies have demonstrated that it is predominantly children who sustain golf related head injuries which present either to an accident and emergency department or a regional neurosurgical centre. This study examines the number and pattern of golf related head injuries in children presenting to an accident and emergency department or requiring admission to the regional neurosurgical centre, over a three month period.
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Vasodilating agents induce relaxation of mesangial cells, in part through cGMP-mediated activation of large calcium-activated potassium channels (BKCa). Normally quiescent in cell-attached patches, the response of BKCa to nitric oxide, atrial natriuretic peptide, and dibutyryl cGMP (Bt2cGMP) is characterized by a biphasic increase and then decrease ("rundown") in open probability. Using the patch-clamp method in conjunction with phosphatase inhibitors, we investigated whether the run-down phase was the result of dephosphorylation by an endogenous protein phosphatase. In cell-attached patches, cantharidic acid (500 nM), okadaic acid (100 nM), and calyculin A (100 nM), nondiscriminant inhibitors of protein phosphatases 1 (PP1) and 2A (PP2A) at these concentrations, caused a significantly greater and sustained response of BKCa to Bt2cGMP. Within 2 min, the response of BKCa to the combination of cantharidic acid and Bt2cGMP was greater than the response to these agents added separately. Incubation of mesangial cells with okadaic acid for 20 min at a concentration (5 nM) specific for PP2A increased the basal open probability of BKCa and completely inhibited rundown after activation by Bt2cGMP. Incubation with calyculin A (10 nM), a more potent inhibitor of PP1, did not affect BKCa activity. In inside-out patches, Bt2cGMP plus MgATP caused a sustained activation of BKCa that was inhibited by exogenous PP2A but not PP1. It is concluded that either BKCa or a tightly associated regulator of BKCa is a common substrate for endogenous cGMP-activated protein kinase, which activates BKCa, and PP2A, which inactivates BKCa, in human mesangial cells.
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Child development teams (CDTs) have been in existence for a quarter of a century, yet little is known of how they function or what they do. This paper originated in a national seminar on how CDTs function and what they seek to achieve. It discusses the wide range of practice in CDTs across Britain and the apparent deficiencies in service provision for certain types of disability. Since each child has a unique set of needs, the composition of the team must be flexible and responsive to the changing circumstances of each child. The need for a philosophical shift to take account of changing parental expectations is stressed. There is a need for further research on a number of topics, including: the patterns of service provision and the differences between districts; the implementation of what is already known about standards of good practice; the possible role of a charter for disabled children and their families; the training needs of future CDT professionals.
The pace of medical change is in danger of paralysing the process of decision making, particularly in services where clinical improvements occur more slowly than the introduction of new interventions. Audit within an individual district enables staff to monitor progress towards desired goals and standards but rarely generates sufficient data to inform decision making about major policy changes. The paper describes how the findings from nine audits of a community paediatric audiology service over a 13-year period were combined with reviews of the literature, resulting in a series of changes to a children's audiological service. The interest and commitment of all the staff involved were maintained by involving them in the process and using them as a valuable source of qualitative data. Audit must be thorough and should be based on precise case definition and comprehensive casefinding if the results are to be meaningful. It is a more powerful means of achieving improvements in systems if it is combined with research evidence, and a readiness to change the system if the agreed goals are not being attained.