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PubMed1990

Extended dissociative training of sudomotor response patterns.

Subjects viewed two feedback displays, one depicting skin conductance and the other either respiratory behavior (respiration group) or subtle body movements (movement group). The subject's task was to increase skin conductance and the concomitant activity on integration trials, and to increase conductance while holding the concomitant behavior constant on dissociation trials. All subjects succeeded at integration over 15 sessions of training. In addition, 4 of 5 subjects in the respiration group successfully increased skin conductance on dissociation trials without altering the pre-trial pattern of breathing. However, volar activities (e.g., finger-to-finger contact, finger flexion) were observed on these trials. Volar activities were also adopted on dissociation trials by subjects trained in the movement group. Successful subjects in this group identified volar manipulations that did not affect a sensitive movement transducer. Attempts by subjects to compensate for habituation of conductance responses to deep breaths and finger flexion reduced or reversed within-subject correlations involving these concomitants, on integration and dissociation trials. The results do not support the view that visceral-somatic linkages can be uncoupled through instrumental learning.

Adult↗
PubMed2005

Encouraging results with endoscopic vein harvest for infrainguinal bypass.

BACKGROUND: Wound complications after infrainguinal vein bypass remain a significant source of morbidity. Endoscopic saphenous vein harvest has emerged as a viable alternative to minimize vein harvest incisions. METHODS: Infrainguinal bypass using endoscopic vein harvest was performed in 214 limbs in 197 consecutive patients between May 1998 and July 2004. The indication for bypass was limb salvage in 88.3%, claudication in 9.3%, and other in 2.4%. Atherosclerotic risk factors were prevalent, with diabetes mellitus in 68% and dialysis-dependent renal failure in 11.7%. RESULTS: The procedure was successful in all but one patient. This patient was early in the series and had a friable varicose vein. Ipsilateral greater saphenous vein was used in 89.7%, contralateral greater saphenous vein in 8.4%, and lesser saphenous vein in 1.9%. Two injuries to the main trunk of the vein occurred early in the series. Assisted primary patency at a mean follow-up of 18 months (range, 1 to 48 months) is 77.2% by life-table analysis. For patients with claudication, rest pain, or minimal gangrene, the average length of stay was 3.15 days (range, 1 to 6 days). Wound complications occurred in 16 patients (7.5%), 10 of these required only local care (class I and II), and 6 had deep wounds threatening the leg or graft (class III). Only 5 patients, all with class III wounds, required readmission to the hospital for graft-related problems. There is no increase in operating room time once the learning curve is overcome. Patient satisfaction is very high. CONCLUSION: Endoscopic saphenous vein harvest is a useful adjunct to infrainguinal vein bypass, with short length-of-hospital stay, few wound complications, and low hospital readmission rates. Endoscopic vein harvest is recommended as the procedure of choice for vein procurement for infrainguinal bypass procedures.

Adult↗
PubMed1999

Reflective education for professional practice: discovering knowledge from experience.

To continually develop as a discipline, a profession needs to generate a knowledge base that can evolve from education and practice. Midwifery reflective practitioners have the potential to develop clinical expertise directed towards achieving desirable, safe and effective practice. Midwives are 'with woman', providing the family with supportive and helpful relationships as they share the deep and profound experiences of childbirth. To become skilled helpers students need to develop reflective skills and valid midwifery knowledge grounded in their personal experiences and practice. Midwife educators and practitioners can assist students and enhance their learning by expanding the scope of practice, encouraging self-assessment and the development of reflective and professional skills. This paper explores journal writing as a learning strategy for the development of reflective skills within midwifery and explores its value for midwifery education. It also examines, through the use of critical social theory and adult learning principles, how midwives can assist and thus enhance students learning through the development of professional and reflective skills for midwifery practice.

Adult↗
PubMed1996

Dental and life science students: a comparison of approaches to study and course perceptions.

Approaches to study and course perceptions were investigated and compared in both junior and senior students on a vocational course (dentistry) and on a non-vocational course (life sciences) using standard questionnaires. Junior dental students reported significantly greater tendencies towards both Deep and Surface Approaches than junior life science students. They also had significantly higher scores for Achieving Approach, but in senior students this trend was reversed. Final year dental students experienced greater workloads and less freedom in learning than life science students and they also reported less organized study methods. These course perceptions demonstrate similar trends to those reported by Ramsden (1991). The implications for the courses concerned and for curriculum development are considered.

Attitude↗
PubMed2002

Mindfulness meditation in the control of severe headache.

In the West, the use of the methods of alternative medicine, including meditation, has been on the rise. In the US, Kabat-Zinn and associates have pioneered the extensive use of mindfulness meditation (MM) for the treatment of people facing pain and illness. Among the essentials of MM is the observation of bodily sensations, including pain. In Taiwan, despite the deep cultural roots of meditation, its therapeutic use has received little attention from institutionalized medicine. We report on the case of a man who was prone to developing severe headaches due to activities requiring extreme concentration. He learned to control his pain and discomfort through mindfulness meditation, although this practice in fact induced headaches initially. It is suggested that training in MM may be a medically superior and cost-effective alternative to pain medication for the control of headaches with no underlying organic causes in highly motivated patients.

Adult↗
PubMed1982

On the underlying causes of semantic paralexias in a patient with deep dyslexia.

The nature of the underlying causes of paralexias produced by a patient exhibiting the syndrome of deep dyslexia was explored by pairing an oral reading task with a picture matching task using the same words. The results suggested two causes of semantic paralexias: word retrieval difficulties and impaired concept arousal. Parallel deficits in language tasks not involving written words were found. It is suggested that the major component of the deep dyslexia syndrome may reflect a deficit which is not specific to the written modality.

Anomia↗
PubMedDate not supplied

Neglect after section of a left telencephalotectal tract in pigeons.

The effects of unilateral and bilateral lesions of the telencephalotectal fibres of the tractus occipitomesencephalicus (OM) were studied in pigeons in a successive visual pattern discrimination. On alternate sessions the animals performed the task with both eyes open or sight restricted to one or the other eye. Unilateral lesions of the left OM led to severe deficits in the total number of pecking responses emitted under both monocular and binocular conditions. Pigeons with lesions of the right OM showed no deficits and the animals with bilateral lesions had an impaired performance only in the binocular condition. The percent correct discrimination performance of all experimental pigeons were at the same level as that of the control group. The results are discussed in the context of visual lateralization in birds. It is suggested that the deficits reflect a sensory neglect through deactivation of neurons in the deep tectal laminae which are known to have projections to reticular nuclei of the brainstem.

Animals↗
PubMed2004

Learning nonadjacent dependencies: no need for algebraic-like computations.

Is it possible to learn the relation between 2 nonadjacent events? M. Pena, L. L. Bonatti, M. Nespor, and J. Mehler (2002) claimed this to be possible, but only in conditions suggesting the involvement of algebraic-like computations. The present article reports simulation studies and experimental data showing that the observations on which Pena et al. grounded their reasoning were flawed by deep methodological inadequacies. When the invalid data are set aside, the available evidence fits exactly with the predictions of a theory relying on ubiquitous associative mechanisms. Because nonadjacent dependencies are frequent in natural language, this reappraisal has far-reaching implications for the current debate on the need for rule-based computations in human adaptation to complex structures.

Association↗
PubMed2005

Purkinje cell activity in the cerebellar anterior lobe after rabbit eyeblink conditioning.

The cerebellar anterior lobe may play a critical role in the execution and proper timing of learned responses. The current study was designed to monitor Purkinje cell activity in the rabbit cerebellar anterior lobe after eyeblink conditioning, and to assess whether Purkinje cells in recording locations may project to the interpositus nucleus. Rabbits were trained in an interstimulus interval discrimination procedure in which one tone signaled a 250-msec conditioned stimulus-unconditioned stimulus (CS-US) interval and a second tone signaled a 750-msec CS-US interval. All rabbits showed conditioned responses to each CS with mean onset and peak latencies that coincided with the CS-US interval. Many anterior lobe Purkinje cells showed significant learning-related activity after eyeblink conditioning to one or both of the CSs. More Purkinje cells responded with inhibition than with excitation to CS presentation. In addition, when the firing patterns of all conditioning-related Purkinje cells were pooled, it appeared that the population showed a pattern of excitation followed by inhibition during the CS-US interval. Using cholera toxin-conjugated horseradish peroxidase, Purkinje cells in recording areas were found to project to the interpositus nucleus. These data support previous studies that have suggested a role for the anterior cerebellar cortex in eyeblink conditioning as well as models of cerebellar-mediated CR timing that postulate that Purkinje cell activity inhibits conditioned response (CR) generation during the early portion of a trial by inhibiting the deep cerebellar nuclei and permits CR generation during the later portion of a trial through disinhibition of the cerebellar nuclei.

Animals↗
PubMed1999

[Perforating veins and venous insufficiency].

As communicating link between the deep and the superficial venous system the perforating veins are of special importance. With the introduction of the subfascial videoendoscopic dissection of the perforating veins the interest in anatomic and topographic aspects of the surgical treatment of insufficient perforators has increased. Different pathophysiological conditions can cause insufficient perforating veins. We can distinguish between a primary form and a secondary form caused by an advanced varicosis of the main superficial veins. A third entity consists in an insufficiency created by a postthrombotic alterations of the deep venous system. Primary insufficient perforators should be treated surgically. In the case of a secondary insufficiency the indication is dependent on the extent of the pathological findings. If there is an obstruction of the deep venous system which causes the insufficiency of a perforator the vein should not be divided. The videoendoscopic subfascial dissection of the insufficient perforating veins has several advantages compared with direct percutaneous exposure. The technique is easy to learn, however it requires profound knowledge about the compartmental spaces and the topographic anatomy of the perforating veins in the lower leg.

Endoscopes↗
PubMed1996

Differential expression of NADPH diaphorase in functionally distinct prefrontal cortices in the rhesus monkey.

The prefrontal cortex of primates is an integrative centre for sensory, cognitive, mnemonic and emotional processes. The cellular features which contribute to the functional specialization of its subsectors are poorly understood. In this study we determined the distribution of nicotinamide adenine dinucleotide phosphate-diaphorase-positive neurons in structurally and functionally distinct prefrontal cortices in the rhesus monkey. This class of neurons express nitric oxide synthase which is necessary for the production of nitric oxide, a novel neural messenger implicated in learning and memory. The density of diaphorase-positive neurons was approximately four times higher in olfactory areas than in eulaminate areas (areas 9, 10, 12, 46, and 8), and two- to three-times higher in the agranular limbic area PAll than in eulaminate areas. Positive neurons were concentrated in a deep band (layers V and VI), a superficial band (layers II and upper III), and were sparsely distributed in the central, thalamic recipient zone (deep layer III, layer IV and upper V). The highest densities of positive neurons were observed in the white matter where their prevalence followed the opposite trend than in the corresponding overlying cortices. The distribution of diaphorase-positive neurons was correlated with the regional anatomic and functional specialization of prefrontal cortices. Thus, diaphorase-positive neurons were most densely distributed in orbital and then medial prefrontal limbic cortices which have a low cell density and widespread connections. In contrast, positive neurons were comparatively sparse in eulaminate cortices, which have a high cell density and more restricted connections. These findings indicated that the distribution of diaphorase-positive neurons in prefrontal cortices is not random, but is associated with the structural architecture and functional attributes of these cortices. The preponderance of diaphorase-positive neurons in limbic cortices, which have been implicated in learning and memory, is consistent with the idea that nitric oxide may have a role in synaptic plasticity.

Animals↗
PubMedDate not supplied

Computerised biofeedback games: a new method for teaching stress management and its use in irritable bowel syndrome.

OBJECTIVES: To develop and test a computer biofeedback game designed to teach deep relaxation to patients with a stress related disorder and to assess whether relaxation can improve symptomatic episodes. STUDY DESIGN AND SETTING: An open, prospective, single centre study. Department of Gastroenterology, Royal Free Hospital, London. SUBJECTS: Forty patients with irritable bowel syndrome refractory to conventional medical treatment. MAIN OUTCOME MEASURES: Development of a computer aided biofeedback apparatus directed at the gut for teaching relaxation to patients with irritable bowel syndrome. The patients' ability to complete a computer game involving biofeedback modulated by a physiological loop that related changes in stress (monitored by electrodermal activity) to animated computer graphics. The degree to which deep relaxation was achieved was measured numerically by a progressive reduction in the sensitivity level of the biofeedback loop. The success of relaxation in ameliorating physical symptoms of irritable bowel syndrome was assessed by daily diaries in which global and weighted bowel symptom scores were entered. RESULTS: A computer biofeedback game based on animated gut imagery was successfully developed. Most patients learned to achieve progressively deeper levels of relaxation after four 30 minute biofeedback sessions (mean difference in sensitivity level 2.0 (95% confidence interval 0.96 to 2.93), p < 0.001). Use of 'dosed' relaxation when bowel symptoms were troublesome was helpful in 50% of patients. It reduced the global symptom score (mean difference 0.5 (0.02 to 0.32), p < 0.04) and the bowel symptom score (mean difference 0.8 (0.04 to 1.58), p < 0.04). At long term follow up, 64% of patients who had been helped by dosed relaxation continued to use the technique, although they had had no further contact with the hospital. CONCLUSIONS: This computer biofeedback game taught deep relaxation rapidly and effectively. Half the patients with refractory irritable bowel syndrome found the technique helpful on most occasions on which it was used. Computer biofeedback games may offer a simple, inexpensive strategy for managing other stress related medical disorders.

Adult↗
PubMed2026

Automated CEAP Classification of Venous Duplex Reports Using Multimodal Artificial Intelligence.

OBJECTIVE: To develop and internally validate a prototype multimodal artificial intelligence system for automated CEAP (Clinical, Etiological, Anatomical and Pathophysiological) classification of venous duplex ultrasound (VDUS) reports, integrating natural language processing of free-text components with computer vision analysis of hand-drawn anatomical diagrams. METHODS: Single centre retrospective observational study using routinely collected clinical data. One thousand consecutive venous duplex ultrasound reports from Cambridge University Hospitals NHS Foundation Trust, UK (July 2024 - May 2025) were labelled according to the CEAP classification, excluding the Etiological component, which could not be reliably determined from duplex reports alone. Transfer learning was applied using ClinicalBERT for text and MobileNetV3 for diagrammatic data. Clinical classes were predicted from request line text. Text- and image-based pathophysiological models were developed for four anatomical territories (Great Saphenous Vein, Small Saphenous Vein, Deep system, Perforators), combined using late fusion with probability averaging. RESULTS: The clinical CEAP model achieved accuracy of 0.91, macro-F1 of 0.82, and macro-AUC of 0.98. Pathophysiological prediction varied, with text models broadly outperforming image models. Fusion yielded heterogeneous benefits, improving SSV performance but reducing Deep system accuracy. The performance of the final pathophysiological CEAP fusion models varied across anatomical territories: accuracy ranged from 0.70-0.92 and macro-AUC from 0.80-0.92. CONCLUSION: This study demonstrates the feasibility of automated CEAP classification from VDUS reports. Despite class imbalance affecting minority class predictions, the strong discriminatory performance validates this multimodal ML model for extracting clinically meaningful information from real-world data. This approach offers potential, pending external validation, to streamline vascular services through automated triage and guideline-compliant decision making.

Artificial intelligence↗
PubMed2007

Effective heart disease prevention: lessons from a qualitative study of user perspectives in Bangladeshi, Indian and Pakistani communities.

OBJECTIVES: Coronary heart disease (CHD) has a high mortality, incidence and prevalence among Indian, Pakistani and Bangladeshi communities in the UK, indicating the need for effective heart disease prevention initiatives for these communities. This paper considers how service user perspectives can be used to develop effective, culturally focused CHD prevention interventions for these target groups by addressing identified barriers, including deeply held cultural beliefs. STUDY DESIGN: A qualitative research study, using a longitudinal action research approach. METHODS: This was a community-based study in Edinburgh. Six focus group discussions--two for each community--were organized with participants from these communities at the beginning of the project. A further six focus group discussions for the same communities were organized six months later. RESULTS: Over the period examined, participants reported varying changes in levels of knowledge relating to the nature, causes and symptoms of CHD. Some participants reported taking slight to significant steps to reduce or prevent heart disease, while others did not. The project was viewed as helpful in increasing knowledge about CHD and preventive measures and encouraging healthier lifestyles. However, persistent barriers to change were also identified, requiring changes to the project that involved not only matching intervention materials and messages to observable, superficial characteristics of the target population, but more fundamental changes that address the cultural, social, historical, environmental and psychological forces that influence health behaviour. CONCLUSION: CHD prevention initiatives need to identify and respond to deep-rooted influences on health-behaviour in 'at-risk' groups, in addition to superficial characteristics of the target populations. It is important for specific prevention initiatives to be linked into wider CHD frameworks to ensure transferability of learning and integration within wider service provision.

Asia, Western↗
PubMed2006

Being a young and inexperienced trainee anesthetist: a phenomenological study on tough working conditions.

BACKGROUND: Physicians at the beginning of their specialist education have been reported to be especially exposed to stress and difficult working conditions. Considerable worry has also been caused by reports about anaesthetists dying at a younger age than other specialists as well as by reports about higher than average suicide rates among anaesthetists. Maybe as a consequence, many young doctors are reluctant to choose anaesthesiology as their future specialty. The aim of this study was to investigate what difficulties trainee anaesthetists experience at work. METHODS: Nineteen trainee anaesthetists in six Swedish hospitals were interviewed. Phenomenological analysis of the interview text was performed. RESULTS: All trainees had experienced considerable, sometimes extreme demands at work. Most of them often felt insufficient and inadequate and had problems with the professional role. Support from consultants was sometimes lacking. Some trainees expressed deep feelings of loneliness and helplessness in difficult clinical situations. CONCLUSIONS: This study shows that trainee anaesthetists have to live up to high work demands, often with very little support. Because too much stress is an obstacle to professional learning, such working conditions are a hindrance to good specialist education. The first measure to be taken should be to ensure that all trainee anaesthetists always have easy access to senior cover.

Anesthesiology↗
PubMed1982

Children under fire: the role of the schools.

Responses of teachers and children in Northern Ireland and observations in other areas of the world beset by the daily threat of violence and death are reported. Respondents showed a deep concern about the role of schools in relation to children who have grown up with warfare in the streets. The concept of school-as-sanctuary is discussed in light of its effects on the processes of teaching, learning, and the emotional development of students.

Acting Out↗
PubMed1995

Early-age mortality, socio-economic development and the health system in Mongolia.

Since the 1920s Mongolia has developed an extensive and well-staffed health care system that has made modern health technologies accessible to most of its population. In addition, the country experienced rapid economic and social development whose benefits were equitably distributed among the population. In spite of this progress, infant and child mortality levels are high by contemporary standards and during the past 20 years these rates have remained virtually constant. The modern health care delivery system, externally imposed, failed to take into account the specific characteristics of the Mongolian culture; this fact is identified as one of the major determinants of the unexpected levels of early-age mortality. The excessive orientation toward curative medicine, the lack of health prevention and promotion activities and the lack of community participation have resulted in the people continuing to believe in traditional therapeutic patterns and self-care. They perceive the modern system exclusively in curative terms and not with regard to health preservation and disease prevention. Most Mongolians do not fully understand the health care system, and use its services mainly because they have no alternative, or because of coercion rather than conviction based on the learning and internalization of its basic principles. In practices and ideas of child care, preservation of health and disease prevention, people seem to identify more with the traditional health care system. Like other former socialist countries, Mongolia is experiencing deep economic and social transformations, whose implications for the health care system are discussed. An economic crisis whose end is nowhere in sight, emergent social inequalities, a vague health insurance model with unclear financing sources, and lack of concern by most policy-makers in strengthening the preventive component of the health system, are not positive factors for substantial infant and child mortality decline in the near future. A clear advantage is, however, the fact that there is a wide space for major improvements with existing internal and external resources.

Child, Preschool↗