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PubMed1980

The management of congestive heart failure.

The symptoms and physical findings of congestive heart failure are learned during the early stages of medical education. They are considered prominently in physical diagnosis courses even before a medical student's clinical clerkships begin. Yet, the diagnosis and proper management of congestive heart failure may still represent a challenge even for the most experienced clinician. Obviously, there is more to this syndrome than a collection of symptoms and signs. In fact, it is probably best to reject entirely the concept of congestive heart failure as a syndrome and consider it merely a descriptive term that requires an application of knowledge and skills learned in physiology, pharmacology and clinical medicine if the patient is to receive proper care. Many fine monographs and textbooks have been written about congestive heart failure, from the standpoint of myocardial mechanics, pathophysiology, cardiovascular pharmacology and biochemistry. It is our aim in this monograph to provide clinical insights into the management of congestive heart failure, including such factors as myocardial mechanics and cardiovascular pharmacology only when applicable in a clinical sense. Several cases recently encountered are included to underscore certain concepts.

Diet, Sodium-Restricted↗

PubMedDate not supplied

Acetyl-1-carnitine. 1: Effects on mortality, pathology and sensory-motor performance in aging rats.

Three different test sites assessed the effects of acetyl-1-carnitine (AC) on age-related changes in general health, sensory-motor skills, learning, and memory. Two groups of rats began the experiments at 16 months of age. One group (OLD-AC) was given AC, 75 mg/kg/day, beginning at 16 months. The other group (OLD-CON) was treated identically except it was not given the drug. Beginning at 22 months of age, these rats and a group of young (3-4 months old) rats (YG-CON) were given a series of sensory-motor tasks. AC decreased mortality, and had no reliable effect on body weight, fluid intake, or the general health of the rats. These data indicate that a chronic dose of AC does not interfere with food and water intake, and may increase longevity. An age-related decline of performance occurred in most of the sensory-motor tasks; locomotor activity was reduced in a novel environment and in a runwheel, and the ability to prevent falling was reduced in tests on a taut wire, rotorod, inclined screen, and several types of elevated bridges. An age-related decline of performance did not occur in grooming, or in the latency to initiate several different behaviors. AC had no effect on performance in any sensory-motor task. These data indicate that the improvements produced by AC in some tests of spatial memory may be due to the effects of AC on cognitive abilities rather than on sensory-motor skills.

Acetylcarnitine↗

PubMed1998

Comparison of Self- and Faculty-Directed Learning of Psychomotor Skills.

This randomized controlled trial compared the effectiveness of self-directed learning (SDL) and faculty directed, demonstration-return-demonstration learning (DRD) for psychomotor clinical nursing skills and level of knowledge of second year baccalaureate nursing students. The self-directed learning approach of a university was compared to a community college's approach of tutor demonstration-student return demonstration for students from the University. Data were collected using questionnaires measuring academic outcomes after the students were exposed to the different learning approaches. The data were compared for differences in grades in an objective structured clinical examination (OSCE). Findings indicated that students perceived there were differences in the learning process, however there were no differences of interest in most of the academic outcomes. While students did not differ on the total OSCE grade, students using the SDL method received higher grades in only one of the marker stations and students using the DRD method received higher grades in only one marker and one observer station. The group of students receiving the DRD method indicated that they were given enough help from faculty, were allowed sufficient practice time and expected that the SDL method would be more stressful. 30.8% of the students in the SDL group recommended their learning method to future second year students, while 100% of the DRD group recommended the DRD method. Although the outcome appeared not to differ, more students indicated satisfaction with the faculty-directed (DRD) approach.

Journal Article↗

PubMed2006

Behavioral alterations in mice lacking the translation repressor 4E-BP2.

The requirement for de novo protein synthesis during multiple forms of learning, memory and behavior is well-established; however, we are only beginning to uncover the regulatory mechanisms that govern this process. In order to determine how translation initiation is regulated during neuroplasticity we engineered mutant C57Bl/6J mice that lack the translation repressor eukaryotic initiation factor 4E-binding protein 2 (4E-BP2) and have previously demonstrated that 4E-BP2 plays a critical role in hippocampus-dependent synaptic plasticity and memory. Herein, we examined the 4E-BP2 knockout mice in a battery of paradigms to address motor activity and motor skill learning, anxiety and social dominance behaviors, working memory and conditioned taste aversion. We found that the 4E-BP2 knockout mice demonstrated altered activity in the rotating rod test, light/dark exploration test, spontaneous alternation T-maze and conditioned taste aversion test. The information gained from these studies builds a solid foundation for future studies on the specific role of 4E-BP2 in various types of behavior, and for a broader, more detailed examination of the mechanisms of translational control in the brain.

Animals↗

PubMed1980

Traumatic quadriplegia: follow-up study of self-care skills.

In this study to assess the extent of use of the self-care skills learned during rehabilitation and of the orthotic devices provided to support function once community living was resumed, 35 persons with traumatic cervical cord injury were tested in the home environment 1 to 4 years after discharge from the hospital. Of this group, 20 had a functional spinal cord level of C6 or C7 and 15 of C4 or C5. The results indicated that the level of self-care achieved during rehabilitation was maintained by the majority of persons at follow-up. The areas most sensitive to change were toileting and bathing, desk skills, grooming, transfers and upper and lower extremity dressing for those with C6 or C7 functional spinal cord levels, and grooming, written communication and desk skills for those with C4 or C5 levels. The majority continued to use at least some of the prescribed upper extremity orthotics and assistive devices. Neither hand surgery nor equipment use was clearly related to functional status. The ratchet hand splint was well accepted by the C4-5 group. Changes in performance are discussed in terms of a restructuring of personal priorities, the availability of interpersonal support, and architectural and attitudinal barriers within the community.

Activities of Daily Living↗

PubMed1992

Lead neurotoxicity and disorders of learning.

Preventable and treatable causes of disorders of learning caused by lead exposure can be recognized by heightened awareness of this potential hazard. The Centers for Disease Control using data from many studies of neurobehavioral effects of lead in children and animals, has redefined the lead exposure threshold for clinical and social intervention from 25 micrograms/dL to 10 micrograms/dL. This article reviews the pertinent studies that provide evidence of the effects of lead exposure on development of the nervous system, effects on neural structures involved in memory and learning, and the impact of early lead encephalopathy on adolescent and adult learning skills and cognitive performance. Physicians, teachers, and child care personnel are responsible for identifying children with behavioral signs of subclinical lead intoxication as early as possible. Screening programs and preventive strategies, such as the multitier Centers for Disease Control approach referred to in this article, are necessary. It is no longer reasonable to assume that lead-exposure children not demonstrating severe encephalopathy will recover completely, without residual brain damage after removal from exposure. Sufficient evidence now exists to clearly demonstrate measurable effects of low levels of lead body burden on behavioral and intellectual performance, resulting in learning disorders.

Child↗

PubMed2003

Outbreak of tuberculosis in a homeless men's shelter.

This case-tuberculosis in a homeless men's shelter-is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine. Tuberculosis presents a significant public health challenge. In this teaching case, medical students are given information about four cases of active tuberculosis that occurred over a short period of time in residents of a homeless men's shelter. The students then walk through the steps that a local health department takes to identify and screen those individuals at risk for transmission of tuberculosis during an outbreak. During this process, they learn skills in epidemiology (such as defining "epidemic" and distinguishing uses for incidence and prevalence) as well as in population-based prevention of tuberculosis. Finally students discuss health policy as it relates to the control and prevention of tuberculosis.

Curriculum↗

PubMed1993

Multiculturalism and pluralistic thought in nursing education: Native American world view and the nursing academic world view.

Nursing's capability to meet the health care needs of America's increasing racial diversity is dependent on its capacity to embrace multicultural groups entering the profession. Faculty should be aware of both the culture and world view of nursing's Euro-American (Anglo) culture-based curriculum. As an example of how world view and culture affect learning and performance, this article juxtaposes nursing's and the Native American's educational world view and culture. Each group's survival is dependent on the culturally determined and learned skills of its members. As faculty and students become culture brokers/interpreters between their world views, student success is enhanced. Acknowledgement of differing world views mandates that caution against generalizations, stereotyping, nefarious comparison, or the devaluing of persons be exercised. This knowledge, appropriately used, provides significant direction in guiding students and planning nursing educational approaches and programs.

Curriculum↗

PubMed1989

Prosopagnosia: a defect in visual configural processing.

A patient with severe, lasting prosopagnosia could not get an immediate overview of a face sufficiently specific for successful identification. He also failed completely in tasks of visual closure despite adequate performances on numerous other tests of visual perception and memory. We conclude that prosopagnosia represents a loss of visual "configural processing"--a learned skill enabling immediate identification of individual members of a class without conscious visuospatial analysis or remembering. Prosopagnosia and agnosic alexia represent two distinct defects of configural processing: Alexics cannot identify items with distinctive features that are themselves identifiable. Prosopagnosics cannot identify objects whose critical distinguishing features have no independent identities.

Adult↗

PubMed2001

Motor learning as a function of KR schedule and characteristics of task-intrinsic feedback.

Forty participants (age range = 18-35 years) practiced 1 of 2 versions of an aiming task (with or without spring resistance). Knowledge of results (KR) was provided to them either immediately or after a delay of 2 trials. Immediate KR led to significantly more accurate performance during the 80 trials in acquisition but significantly less accurate performance on a 40-trial retention test given 24 hr after practice. In addition, the spring version of the task was performed significantly less accurately than the no-spring version on the 24-hr retention test. Most important, a significant interaction on the 24-hr retention test revealed that performance of the no-spring version of the task, when KR had been given after a 2-trial delay, was significantly more accurate than performance of the other 3 combinations of task version and KR schedule. The results suggest that KR dependency in motor skill learning is related to familiarity with task-intrinsic feedback in addition to the schedule on which KR is presented.

Adolescent↗

PubMed2002

From primed to learn: the saturation of repetition priming and the induction of long-term memory.

Although practice can make perfect, it is not clear how much practice is needed to trigger long-lasting performance gains on a given task. Here, using a letter enumeration task, we show that the transition of experience dependent performance gains to a relatively stable form, as well as the triggering of delayed, long-lasting, between session gains (both effects are considered manifestations of consolidation processes) is amount-of-practice dependent. We then show (a) that consolidation processes, once triggered, can proceed without further practice as a function of time and (b) that the triggering of consolidation processes is related to repetition priming effects--performance gains in processing a previously experienced item. However, we show that repetition priming effects saturate after a limited number of consecutive repetitions and reflect an initial, but potentially reversible, response to the repeated experience. Moreover, we show that one critical parameter determining the occurrence of repetition priming (but not skill learning) is the presence of interference (by a somewhat different set of items) prior to the primer presentation. Thus, our results suggest that the saturation of repetition priming effects, rather than priming per se, may be critical to the induction of slow learning processes and consolidation.

Adult↗

PubMed2001

Breakfast and performance.

Evidence suggests that the effect of fasting on performance is not uniform, but it is dependent on the basal nutritional status of the subject. Breakfast consumption has a short-term effect in improving selected learning skills, especially work memory. School breakfast programmes have a positive effect on the nutritional status of children, on school attendance and probably on dropout rates. The effect of breakfast consumption on school performance depends on the interaction between the programme, student characteristics (malnutrition) and school organisation. Unless the school setting guarantees a minimum quality standard, the benefits of breakfast consumption will not be evident in performance in complex areas like language or maths.

Child↗

PubMed1997

Revising educational requirements: challenging four hours for both basic life support and automated external defibrillators.

The instruction of cardiopulmonary resuscitation (CPR) faces new challenges. With the current poor resuscitation outcomes of victims of sudden death syndrome, the impetus to include early defibrillation as a basic skill for laypersons imposes the need to simplify CPR instruction and reduce the time required to teach this technique. The exploration of an alternative paradigm has gained both public and academic interest. Some of the constraints have evolved around the urgent need to bring both CPR and automated external defibrillation instruction to a much larger population segment and at the same time reduce the time needed to accomplish this task. Additional debate exists with respect to maintaining the current traditional training methods or the use of new media such as video-based instruction, interactive computer-based software, and public service announcements. To answer any one of these questions we are tasked with having to objectively document not only retention and performance of learned skills, but the ultimate impact that any of these elements have on survival and outcome. This has to balance against the ongoing scourge of sudden cardiac death, which claims the lives of 350,000 Americans each year.

Age Factors↗

PubMed2005

Traditional Chinese herbs against hypertension enhance memory acquisition.

Recent findings of a link between high blood pressure (BP) and dementia have given new prospects. The aim of this study is to analyze a mixture of Chinese herbs, Tianma Gouteng Decoction (TGD), which was traditionally used to treat hypertension, and investigate its relation to ameliorating cognitive impairment. We discovered that TGD also had properties involving enhancement of memory acquisition (learning) skills in mice, but not memory consolidation. It was observed that TGD could prolong the step-through latency at doses of 1.0 and 2.5 g/kg on passive avoidance task in mice. TGD could be developed further to treat mice with amnesia, which was induced by scopolamine at the same dose under long-term (8 days) administration.

Amnesia↗

PubMed1995

Evaluation of a community-oriented primary care workshop for family practice residents in Jerusalem.

BACKGROUND: A workshop on community-oriented primary care (COPC) has been integrated into Hebrew University's family practice residency program for several years. The participants of the first three workshops did an evaluation to assess subsequent application of the COPC approach. METHODS: The main objectives of the 45-hour workshop are: a) to learn the principles and practice of COPC as illustrated by the Hadassah Community Health Center programs, and b) to learn skills required in the COPC programs' various stages of development. In the workshop, physicians are required to work in groups of 5-6 to carry out the planning of COPC programs, which will be implemented in their practices. A structured questionnaire was sent 2-4 years after workshop completion to each of the 45 physicians who participated in these workshops. RESULTS: Thirty-six of the 45 physicians responded to the questionnaire. Of the 36 respondents, 75% reported that the content of the workshop was relevant to their daily work. Eighty percent of the physicians who were involved in intervention programs reported that participation in the workshop improved their ability to plan community programs. Fifty-five percent of the respondents reported the application of elements learned in the workshop to their current work, mainly in the performance of three COPC functions: definition of the community, identification of health problems, and planning community health interventions. Few (28%) were involved in evaluation measurements. CONCLUSIONS: A COPC workshop characterized by work groups of family physicians, epidemiological analysis of their practices' data, and the planning of a community program in their communities was positively evaluated according to the reported application of COPC functions by family physicians and residents in their daily work.

Education, Medical, Continuing↗

PubMed2006

Hand motor recovery after stroke: tuning the orchestra to improve hand motor function.

The motor deficits after stroke are not only the manifestation of the injured brain region, but rather the expression of the ability of the rest of the brain to maintain function. After a lesion in the primary motor cortex, parallel motor circuits might be activated to generate some alternative input to the spinal motoneurons. These parallel circuits may originate from areas such as the contralateral, undamaged primary motor area, bilateral premotor areas, bilateral supplementary motor areas, bilateral somatosensory areas, cerebellum, and basal ganglia. Most importantly, the efferent, cortico-spinal output pathways must be preserved for a desired behavioral result. Most of the recovery of function after a stroke may represent actual relearning of the skills with the injured brain. The main neural mechanisms underlying this relearning process after stroke involve shifts of distributed contributions across a specific neural network (fundamentally the network engaged in skill learning in the healthy). If these notions are indeed correct, then neuromodulatory approaches, such as transcranial magnetic stimulation, targeting these parallel circuits might be useful to limit injury and promote recovery after a stroke. This paper reviews the stroke characteristics that can predict a good recovery and compensations across brain areas that can be implemented after a stroke to accelerate motor function recovery.

Brain Damage, Chronic↗

PubMed2005

Behavioral, cognitive and biochemical responses to different environmental conditions in male Ts65Dn mice, a model of Down syndrome.

Ts65Dn mouse is the most widely accepted model for Down syndrome. We previously showed that environmental enrichment improved spatial learning in female but deteriorated it in male Ts65Dn mice. This study analyzed the factors contributing to the disturbed cognition of male Ts65Dn mice after enriched housing, by allocating male control and Ts65Dn mice in four conditions after weaning: small (n = 2-3) and large group (n = 8-10) housing, and enriched housing in small (2-3) and large groups (8-10). Learning, aggressive behavior, anxiety-like behavior and biochemical correlates of stress were evaluated when Ts65Dn and control mice were 4-5 months old. Environmental enrichment in large mixed colonies of Ts65Dn and diploid littermates disturbed behavioral and learning skills of Ts65Dn mice in the Morris water maze. ACTH and testosterone levels were not modified in any group of mice. Ts65Dn and control mice subjected to enriched housing in large groups and Ts65Dn mice housed in large groups showed higher corticosterone levels. Aggressive behavior was evaluated by measuring the number of attacks performed in the presence of an intruder. Ts65Dn mice performed less attacks than controls in all conditions, especially after enriched housing, indicating subordination. In the plus maze, cognitive aspects (i.e. risk assessment) and motor components (open arm avoidance) of anxiety behavior were evaluated; no difference in any condition was found. It is suggested that an excess of social and/or physical stimulation in Ts65Dn mice may affect cognition by disturbing the emotional and behavioral components of the learning process.

Adrenocorticotropic Hormone↗

PubMed2001

Exercise and training to optimize functional motor performance in stroke: driving neural reorganization?

Neurorehabilitation is increasingly taking account of scientific findings. Research areas directing stroke rehabilitation are neurophysiology; adaptability to use and activity; biomechanics; skill learning; and exercise science (task, context specificity). Understanding impairments and adaptations enables a reappraisal of interventions-for example, changes in motor control resulting from impairments (decreased descending inputs, reduced motor unit synchronization), secondary soft tissue changes (muscle length and stiffness changes) are adaptations to lesion and disuse. Changes in interventions include increasing emphasis on active exercise and task-specific training, active and passive methods of preserving muscle extensibility. Training has the potential to drive brain reorganization and to optimize functional performance. Research drives the development of training programs, and therapists are relying less on one-to-one, hands-on service delivery, making use of circuit training and group exercise and of technological advances (interactive computerized systems, treadmills) which increase time spent in active practice. Emphasis is on skill training, stressing cognitive engagement and practice, aiming to increase strength, control, skill, endurance, fitness, and social readjustment. Rehabilitation services remain slow to make the changes necessary to upgrade environments, attitudes, and rehabilitation methodologies to those shown to be more scientifically rational and for which there is evidence of effectiveness.

Exercise Therapy↗