Student perceptions of a problem-based learning course

Within occupational therapy education, there has been increased attention to curricula and courses that emphasize problem solving, clinical reasoning, and synthesis of information across traditional discipline-specific boundaries. This article describes the development, implementation, and outcomes of a problem-based learning course entitled Selected Cases in Occupational Therapy. The course was designed to help students to integrate the various elements of a specific occupational therapy curriculum and to enhance their abilities to respond to an ever-changing health care environment. An evaluation of the course by the first 11 students who completed it revealed both strengths and weaknesses. Students responded that the course enhanced their professional behavior, including interpersonal communication skills, team work, and follow-through with professional responsibilities; helped them to integrate the various elements of the total occupational therapy academic program; enhanced their clinical reasoning skills by providing a structure for thinking through clinical issues; and provided personal gain or benefit (i.e., students perceived the course to be a valuable, realistic, and motivating experience). The students also identified several specific course elements that contributed to its integrating function, including content, class session format, and students' role. Identified course weaknesses included the methods of evaluating student performance and the format and content of specific cases.

An interdisciplinary problem-based learning project for assistive technology education

The purpose of this paper is to describe the development, implementation, and outcomes of an extended problem-based learning project imbedded in an interdisciplinary assistive technology course. Students representing four health care disciplines worked together in small groups to address the complex needs of clients with significant issues regarding assistive technology (seating and mobility, augmentative communication, and computer access) and adaptive function. Problem-based learning was seen as a way to enhance the students' clinical reasoning and problem-solving skills and provide a "real life" treatment in a team experience. Formal and informal course evaluation results yielded qualitative data that reflected highly favorable impressions of the problem-based learning project, as well as suggestions for the future.

[Detection of microbubbles formed in the blood/CO2 interphase during decompression in barometric conditions similar to laparoscopy]

HYPOTHESIS AND OBJECTIVES

Intraperitoneal insufflation (IPI) with CO2 during laparoscopic surgery establishes a pressure gradient that determines the passage of gas from the peritoneal cavity to the blood and surrounding tissues. The transport and clearance of CO2 are assured by proper sweeping when regional blood flow is adequate in volume and distribution. But if IPI hyperpressure surpasses regional venous capillary pressure (10 to 15 mmHg) and there is no cardio-circulatory adaptation to the phenomenon, CO2 clearance may be compromised. Under these conditions, the expected post-insufflation increase in PetCO2 will not take place. Bearing in mind the physical characteristics of CO2, retention of this gas in the intraperitoneal cavity produces blood and tissue saturation under a higher-than-atmospheric pressure, after a certain period of time in contact. Rapid intraperitoneal decompression after laparoscopic surgery carries with it the risk of microbubble formation due to release of CO2 that had been dissolved under hyperbaric conditions.

MATERIAL AND METHODS

To test this hypothesis, the barometric conditions of laparoscopy were reproduced inside an observation capsule containing blood and CO2.

RESULTS

Magnification revealed that after decompression bubbles formed in the blood/CO2 interphase. The images were recorded on magnetic videotape. Thirty minutes after decompression, the bubbles could still be seen, even after the interphase was swept with a current of air.

DISCUSSION

Rapid intraperitoneal decompression after laparoscopy can generate the formation of microbubbles which, if not eliminated, will give rise to local ischemic manifestations. This same decompression, correcting the local circulatory alterations and activating the CO2 transport that had been compromised, could introduce gas bubbles into the blood stream such as are responsible for delayed gaseous microembolism. The simultaneous observation of changes in PetCO2 (stability or post-insufflation decreases) and hemodynamic parameters during laparoscopy, would allow evolving anomalies to be detected early and therapeutic action to be taken to prevent the formation of microbubbles.

Comparative analysis of cell surface antigens expressed by cell lines derived from human germ cell tumours

The pattern of cell surface antigen expression of a set of cell lines derived from human germ cell tumours and corresponding to various cell phenotypes found within these tumours was studied using immunofluorescence. Twenty-two different antibodies were used. Many of these antibodies have been noted to recognise epitopes that are either preferentially expressed by embryonal carcinoma (EC) cells, or by more differentiated cell types. Using scatter plots and rank correlations, 6 groups of antibodies were distinguished with respect to their staining patterns on the cell lines tested. Several antibodies showed a specific staining pattern in relation to the differentiation state of the cells. Two groups of antibodies included those recognising high m.w. glycoproteins (antibodies TRA-1-60, TRA-1-81, GCTM2, 3-177, K4 and K21) and the ganglioseries glycolipid antigens SSEA-3 and -4 (antibodies MC631 and MC813-70). These antibodies mostly stained EC cells but not other cell types, confirming previously published data. However, one of these groups, comprising antibodies K4 and MC631, was more exclusively associated with the EC cell phenotype than was the other group. Antibodies recognising the liver isozyme of alkaline phosphatase (TRA-2-49 and TRA-2-54) also reacted strongly with most EC cell lines, although they reacted significantly with a number of other cell lines as well, whereas antibodies to the placental isozyme tended to react only weakly with EC cells. The antibodies recognising the ganglioseries glycolipids GD2 and GD3 (VIN2PB22 and VINIS56) preferentially stained cells with neuroectodermal characteristics. Other antibodies showed a heterogeneous staining pattern for the cell lines with different phenotypes. The data obtained from the cell lines were, in general, similar to data obtained from immunohistochemical studies on tissue sections of primary germ cell tumours of the adult testis, including carcinoma in situ.

Determination of NMDA NR1 subunit copy number in recombinant NMDA receptors

Co-expression of wild-type and mutated NMDA NR1 (N598R) subunits in Xenopus oocytes has been used to determine the stoichiometry of the NMDA receptor-channel. When expressed together, wild-type NR2A and mutant NR1 (N598R) subunits produced channels with a main conductance of 2.6 pS and a sublevel of 1.2 pS. These conductances were clearly different from those obtained from wild-type NR1 and wild-type NR2A channels which gave characteristic 50 pS events with a 40 pS sublevel. When wild-type and mutant NR1 subunits were co-expressed together with NR2A subunits a different channel type with a main conductance of 15.2 pS and a sublevel of 11.4 pS was obtained, as well as the 'all wild-type' and 'all mutant' channels described above. These results indicate that there are likely to be two copies of the NR1 subunit in each NMDA receptor complex.

A phase I trial of bryostatin 1 in patients with advanced malignancy using a 24 hour intravenous infusion

Bryostatin 1 is a macrocyclic lactone derived from the marine invertebrate Bugula neritina. In vitro, bryostatin 1 activates protein kinase C (PKC), induces the differentiation of a number of cancer cell lineages, exhibits anti-tumour activity and augments the response of haemopoietic cells to certain growth factors. In vivo, bryostatin 1 is also immunomodulatory, but the range of tumours which respond to bryostatin 1 in xenograft tumour models is mostly the same as the in vitro tumour types, suggesting a direct mode of action. Nineteen patients with advanced malignancy were entered into a phase I study in which bryostatin 1 was given as a 24 h intravenous infusion, weekly, for 8 weeks. Myalgia was the dose-limiting toxicity and the maximum tolerated dose was 25 micrograms m-2 per week. The myalgia was cumulative and dose related, and chiefly affected the thighs, calves and muscles of extraocular movement. The mechanism of the myalgia is unknown. CTC grade 1 phlebitis affected every patient for at least one cycle and was caused by the diluent, PET, which contains polyethylene glycol, ethanol and Tween 80. Most patients experienced a 1 g dl-1 decrease in haemoglobin within 1 h of commencing the infusion which was associated with a decrease in haematocrit. Radiolabelled red cell studies were performed in one patient to investigate the anaemia. The survival of radiolabelled red cells during the week following treatment was the same as that seen in the week before treatment. However, there was a temporary accumulation of radiolabelled red cells in the liver during the first hour of treatment, suggesting that pooling of erythrocytes in the liver might account for the decrease in haematocrit. Total or activated PKC concentrations were measured in the peripheral blood mononuclear cells (PBMCs) of three patients for the first 4 h of treatment and during the last hour of the infusion. This showed that PKC activity was significantly modulated during the infusion. Bryostatin 1 is immunomodulatory in vitro, and we have confirmed this activity in vivo. An investigation of the first three cycles of treatment in seven patients showed an increased IL-2-induced proliferative response in peripheral blood lymphocytes and enhanced lymphokine-activated killer (LAK) activity. A previously reported rise in serum levels of interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF 1) was not confirmed in our study; of nine patients in this study, including patients at all dose levels, none showed an increase in these cytokines.(ABSTRACT TRUNCATED AT 400 WORDS)

The expression of p53 tumor-suppressor protein during progression of gastric and colorectal carcinomas

The expression of p53 was immunohistochemically determined in sets of biopsies from primary and recurrent colorectal (12) and gastric (17) tumours that had progressed to more advanged stages in the following 6-54 months. At presentation 7 carcinomas overexpressed p53 protein in the cell nucleus and 22 tumours had normal, undetectable levels of p53. In most patients, the p53 phenotype was maintained during the process of tumour progression. In two gastric and two colorectal carcinomas p53 overexpression was subsequently detected in recurrent tumour growth at the primary site and was also associated with the development of metastases. These results suggests that in some cases p53 alterations may contribute to the conversion to malignancy and in others to tumour progression and metastatic capacity.

Single channel properties of cloned NMDA receptors in a human cell line: comparison with results from Xenopus oocytes

1. Human embryonic kidney (HEK) 293 cells were transiently transfected with cDNAs encoding the NR1a-NMDA epsilon 1[NR2A] subunit combination of the NMDA receptor. Single channel behaviour was recorded from outside-out membrane patches, with the aim of comparing the results with those, recorded under the same conditions, from Xenopus oocytes injected with messenger RNA coding for the NR1a-NR2A combination. 2. Single channels in HEK 293 cells showed a main conductance level of 51.4 +/- 2.4 pS, compared with 50.1 +/- 1.4 pS for channels in oocytes. A subconductance level of 38.1 +/- 2.1 pS was found in HEK 293 cells, compared with 38.3 +/- 1.3 pS in oocytes. The frequencies of transitions between the shut and the two conductance levels were also very similar. 3. Distributions of shut times could be fitted with five exponential components. In HEK 293 cells the first three of these components had time constants of 39 +/- 4 microseconds, 0.54 +/- 0.04 ms and 9.94 +/- 1.3 ms; in oocytes the values were 69 +/- 35 microseconds, 0.54 +/- 0.15 ms and 6.53 +/- 4.6 ms, respectively. The relative areas of the components were also similar in the two systems. 4. The distribution of all apparent open times for the sublevels was fitted with two exponential components giving time constants of 0.18 +/- 0.02 ms and 1.31 +/- 0.17 ms (for HEK cells) or of 0.31 +/- 0.36 ms and 1.31 +/- 1.1 ms (for oocytes).(ABSTRACT TRUNCATED AT 250 WORDS)

A phase I study of intravenous bryostatin 1 in patients with advanced cancer

Bryostatin 1 is a novel antitumour agent derived from Bugula neritina of the marine phylum Ectoprocta. Nineteen patients with advanced solid tumours were entered into a phase I study to evaluate the toxicity and biological effects of bryostatin 1. Bryostatin 1 was given as a one hour intravenous infusion at the beginning of each 2 week treatment cycle. A maximum of three treatment cycles were given. Doses were escalated in steps from 5 to 65 micrograms m-2 in successive patient groups. The maximum tolerated dose was 50 micrograms m-2. Myalgia was the dose limiting toxicity and was of WHO grade 3 in all three patients treated at 65 micrograms m-2. Flu-like symptoms were common but were of maximum WHO grade 2. Hypotension, of maximum WHO grade 1, occurred in six patients treated at doses up to and including 20 micrograms m-2 and may not have been attributable to treatment with bryostatin 1. Cellulitis and thrombophlebitis occurred at the bryostatin 1 infusion site of patients treated at all dose levels up to 50 micrograms m-2, attributable to the 60% ethanol diluent in the bryostatin 1 infusion. Subsequent patients treated at 50 and 65 micrograms m-2 received treatment with an intravenous normal saline flush and they did not develop these complications. Significant decreases of the platelet count and total leucocyte, neutrophil and lymphocyte counts were seen in the first 24 h after treatment at the dose of 65 micrograms m-2. Immediate decreases in haemoglobin of up to 1.9g dl-1 were also noted in patients treated with 65 micrograms m-2, in the absence of clinical evidence of bleeding or haemodynamic compromise. No effect was observed on the incidence of haemopoietic progenitor cells in the marrow. Some patients' neutrophils demonstrated enhanced superoxide radical formation in response to in vitro stimulation with opsonised zymosan (a bacterial polysaccharide) but in the absence of this additional stimulus, no bryostatin 1 effect was observed. Lymphocyte natural killing activity was decreased 2 h after treatment with bryostatin 1, but the effect was not consistently seen 24 h or 7 days later. With the dose schedule examined no antitumour effects were observed. We recommend that bryostatin 1 is used at a dose of 35 to 50 micrograms m-2 two weekly in phase II studies in patients with malignancies including lymphoma, leukaemia, melanoma or hypernephroma, for which pre-clinical investigations suggest antitumour activity.

Recombinant human interleukin-4 (rhu IL-4) administered by the intravenous and subcutaneous routes in patients with advanced cancer--a phase I toxicity study and pharmacokinetic analysis

19 patients with advanced cancer were entered into a phase I study of recombinant human interleukin-4 (rhu IL-4). The predominant clinical side-effects included flu-like symptoms, gastrointestinal upset, lethargy and transient hypotension. In addition, there were several cases of capillary leak syndrome. 2 cases of gastrointestinal haemorrhage occurred; this was life threatening in 1 patient. The maximum tolerated dose (MTD) was 400 micrograms/m2/day. Biochemical toxicity was limited to asymptomatic elevation of liver enzymes suggesting IL-4 induced liver damage. Pharmacokinetic analysis following the intravenous bolus injection has shown that IL-4 is rapidly cleared (mean T1/2 = 19 +/- 8.7 min) from a small compartment (mean Vd = 4.9 +/- 3.68 l) probably indicating that IL-4 is retained in the systemic circulation or at most the extracellular fluid volume. 2 patients with non-Hodgkin lymphomas (NHL) showed a transient response to IL-4 whilst a third patient with NHL showed transient disease progression.

Single-channel conductances of NMDA receptors expressed from cloned cDNAs: comparison with native receptors

To cast light on the subunit composition of native NMDA-type glutamate receptors, four cloned subunits of the NMDA receptor have been expressed, in pairs, in Xenopus oocytes, and their single-channel properties have been measured. The conductances of the channels, and their characteristic patterns of sublevel transitions, turn out to be useful diagnostic criteria for subunit composition. The NR1-NR2A and NR1-NR2B combinations (which have identical TM2 sequences) are very similar to each other. Both have 50 pS openings and brief 40 pS sublevels (in 1 mM external Ca2+), with similar mean lifetimes and frequencies. They also show close quantitative resemblance to the channels of hippocampal CA1 and dentate gyrus cells and of cerebellar granule cells, except that the NR1-NR2A combination has a lower glycine sensitivity than the native channels. In contrast, the NR1-NR2C combination produces a channel with 36 pS and 19 pS conductances of similar (brief) duration; these closely resemble the 38-18 pS channels that have previously been observed in large cerebellar neurons in culture (together with 50 pS channels).

Controlled localized heat therapy in cutaneous warts

BACKGROUND

Controlled localized heating as a method of superficial tissue destruction has been used in veterinary medicine for the treatment of benign and malignant tumors. The rationale for its use is that the diseased tissue being treated is more sensitive to the effects of heating than is normal tissue. This technology was applied to the treatment of common hand warts in a placebo-controlled study.

OBSERVATIONS

Twenty-nine warts were treated one to four times (median, two times) at 50 degrees C for 30 to 60 seconds. Twenty-five (86%) of 29 treated verrucae regressed completely while seven (41%) of 17 control warts resolved during the course of the study. No wart that regressed regrew during the follow-up period (mean, 15.6 weeks).

CONCLUSIONS

Controlled localized heating can cause the regression of hand warts. The 86% regression rate compares favorably with other wart treatment modalities. The mechanism of action and the effect of heat on these virally induced tumors is not known but may involve direct antiviral effects, physical destruction of the tumor, or the promotion of an inflammatory response that ultimately eradicates the lesion.

Recombinant human interleukin 4 (IL-4) given as daily subcutaneous injections--a phase I dose toxicity trial

Recombinant Interleukin 4 was administered by subcutaneous injection at daily doses of 0.5, 1.0 or 5.0 micrograms kg-1 to nine patients as part of a Phase I Dose Toxicity Study. Dose limiting toxicity was reached at 5 micrograms kg-1 day-1. Symptoms of toxicity included fatigue, 'flu like symptoms and elevated liver enzymes. Modest but significant elevations of neutrophil and platelet counts occurred. No clear evidence of antitumour effects emerged although pain in metastatic lymph nodes and a small fall in myeloma paraprotein levels during dosing were observed. In vitro and murine in vivo studies indicate that patients with lymphoproliferative disease should be selected for Phase II trials.

Fast and slow components of unitary EPSCs on stellate cells elicited by focal stimulation in slices of rat visual cortex

1. Voltage and current recordings were made from visually identified non-pyramidal neurones in slices of layer IV of rat primary visual cortex using the whole-cell configuration of the patch clamp technique. These neurones are characterized by a high input resistance (0.5-2 G omega) and a non-adaptive behaviour of action potential frequency following depolarizing current injection, which suggests that they are stellate cells. 2. Excitatory postsynaptic currents (EPSCs) were recorded from these neurones during focal stimulation of neighbouring cells by a second patch pipette, the tip of which was placed on the soma of the stimulated cell. The response amplitude as a function of stimulus strength showed a sharp increase at a critical stimulus strength suggesting that stimulus-evoked currents represent unitary EPSCs. 3. In most cases the latencies of stimulus-evoked EPSCs were unimodally distributed with means in the range of 2.1-3.6 ms. In some experiments two peaks were seen in the distribution of latencies. The EPSC rise times, measured as the time from 20 to 80% peak amplitude, fell into a distribution ranging from 0.1 to 0.8 ms with a peak at 0.2 ms. The EPSC decay time course at -70 mV membrane potential was fitted by a single exponential with a time constant of 2.39 +/- 0.99 ms (mean +/- S.D.). The rise and decay times were independent of EPSC peak amplitudes. 4. The peak amplitude of successive unitary EPSCs, elicited by a constant stimulus, fluctuated at random. At a holding potential of -70 mV the peak amplitudes varied between 5 and 90 pA. In two out of ten cells the histogram of peak amplitudes could be well fitted by the sum of several equidistant Gaussians with a peak distance of around 10 pA. This suggests that the quantal conductance change underlying the peak current fluctuations is of the order of 100 pS. 5. At membrane potentials more positive than -70 mV the decay of stimulus-evoked EPSCs showed two components with very different time courses. In standard extracellular solution the current-voltage (I-V) relation for the fast component was almost linear whereas the slow component showed a J-shaped I-V relation with a region of negative slope conductance between -30 and -70 mV.(ABSTRACT TRUNCATED AT 400 WORDS)

Complications associated with brachytherapy alone or with laser in lung cancer

Relatively little has been reported about destruction through brachytherapy of mucosa-perforating and extraluminary tumors with probable large vessel involvement causing major hemorrhagic or fistular complications. We report 12 patients subjected to laser and brachytherapy for centrally occluding lung cancer, whom we have periodically followed up from June 1986 until they died. Although all laser procedures were free from complications, necrotic cavitation in five cases, two of which were accompanied by large bronchoesophageal fistulas, and massive fatal hemoptysis occurred in six. Minor complications included radiation mucositis (two), noncritical mucosal scarring (two), and cough (four). Characteristics that will identify patients at risk of developing fatal hemoptysis and fistulas should be better defined by imaging and endoscopic techniques. In such cases, modifying the protocol or using alternative procedures should be considered. Minor complications, such as cough, can be avoided by using topical steroid therapy (eg, beclomethasone dipropionate).

Gay men's perceptions and responses to AIDS

Gay men continue to be the largest group in Canada developing AIDS. They have responded to this threat on a personal and community level. The purpose of this study was to explore the perceptions of gay men about AIDS, and how they responded to these perceptions. Data were gathered through unstructured interviews with 34 healthy gay men, from participant observations chosen from logs that described nursing interactions with gay men who had AIDS, and fieldnotes collected during AIDS education programmes with health care workers and gay men. Using constant comparative analysis, a substantive conceptual framework was developed. Trusting was identified as the basic social psychological process that determined how gay men responded to AIDS. AIDS was perceived by all gay men in this study to threaten their own health and their acceptance by society. Variables identified behaviour, ranging from denial of personal risk to taking leadership roles in organizations to fight AIDS related to the trusting theory. This theoretical explanation of gay men's responses provides direction for programmes to educate gay men about HIV-related diseases, as well as to support those who acquire the HIV.

Investigation of expression of 5T4 antigen in cervical cancer

A monoclonal antibody detecting amniotrophoblastic antigen 5T4 has shown reactivity against various neoplastic cell lines and tumour specimens but with a relatively restricted normal tissue expression. This antibody has been investigated as a potential indicator of premalignant changes identified as cervical intra-epithelial neoplasia and malignant cervical lesions using immunohistochemistry on frozen tissue biopsies. The basal cells of normal cervical stratified epithelium exhibited faint staining, but a general increase in intensity and extent of specific labeling of this tissue was seen from the first premalignant stage through to carcinoma. In most cases, this was in accordance with the distribution of dysplastic cells, and was accompanied by increased specific staining of the stromal tissue. All invasive squamous carcinomas of the cervix were 5T4 antigen positive. Common inflammatory non-malignant diseases did show a certain degree of epithelial and stromal reactivity. These results, showing 5T4 reactivity with neoplastic and pre-neoplastic lesions, may provide a quantitative basis for its potential use as a tumour marker in the immunochemical detection on immunoassay of cervical cancer.

Coaches' goals for young children in a recreational sports program

Almost all children participate in sports at some time, and programs are being established for even younger children. Adults who coach the children largely determine what the children's sports experience will be. Coaches' perceptions of what is important for the young children they instruct have not yet been carefully investigated. This study was designed, therefore, to determine coaches' goals for young children. Data were gathered by use of an attitude questionnaire administered to 29 coaches of a recreational basketball program of children ranging in age from 6 to 10 years old. Of the 12 goals, feeling part of a team, learning to do my best, and having fun and excitement were most highly rated as extremely important, while becoming popular was lowest rated as not important. Results revealed that coaches in general are able to clearly define their goals and priorities, and these goals seem developmentally appropriate for the children. However, coaches make little differentiation in goals based on age.