Constructive alignment: Teaching introductory gross anatomy to sport science students

The purpose of this descriptive article was to illustrate the process of using constructive alignment in redesigning an introductory gross anatomy unit that is taught specifically to sports science and physical education students at Victoria University. The unit was redesigned as an intensive learning unit in 2017 as part of a broader university-wide process. The teaching team decided that the first stage of the constructive alignment process should be necessarily focused on an understanding of the career destinations of graduates from the courses. With this understanding, it became easier to work through the redesign of intended learning objectives, the shift from systemic to regional anatomy changes in content and learning support mechanisms, and alterations to assessment practices. A comparison of student pass rates for the unit from 2018 to 2023 with pass rates in the previous semester-long version of the unit, suggests optimism about the changes that were made through the constructive alignment process. However, there were a number of other factors that may have contributed to this result, and more research is needed on the specific effectiveness of the changes made during the constructive alignment process before a confident conclusion about the success of the process can be made.

Development of a Digital Health Intervention to Support Patients on a Waitlist for Orthopedic Specialist Care: Co-Design Study

BACKGROUND

The demand for orthopedic specialist consultations for patients with osteoarthritis in public hospitals is high and continues to grow. Lengthy waiting times are increasingly affecting patients from low socioeconomic and culturally and linguistically diverse backgrounds who are more likely to rely on public health care.

OBJECTIVE

This study aimed to co-design a digital health intervention for patients with OA who are waiting for an orthopedic specialist consultation at a public health service, which is located in local government areas (LGAs) of identified social and economic disadvantage.

METHODS

The stakeholders involved in the co-design process included the research team; end users (patients); clinicians; academic experts; senior hospital staff; and a research, design, and development agency. The iterative co-design process comprised several key phases, including the collation and refinement of evidence-based information by the research team, with assistance from academic experts. Structured interviews with 16 clinicians (female: n=10, 63%; male: n=6, 38%) and 11 end users (age: mean 64.3, SD 7.2 y; female: n=7, 64%; male: n=4, 36%) of 1-hour duration were completed to understand the requirements for the intervention. Weekly workshops were held with key stakeholders throughout development. A different cohort of 15 end users (age: mean 61.5, SD 9.7 y; female: n=12, 80%; male: n=3, 20%) examined the feasibility of the study during a 2-week testing period. The System Usability Scale was used as the primary measure of intervention feasibility.

RESULTS

Overall, 7 content modules were developed and refined over several iterations. Key themes highlighted in the clinician and end user interviews were the diverse characteristics of patients, the hierarchical structure with which patients view health practitioners, the importance of delivering information in multiple formats (written, audio, and visual), and access to patient-centered information as early as possible in the health care journey. All content was translated into Vietnamese, the most widely spoken language following English in the local government areas included in this study. Patients with hip and knee osteoarthritis from culturally and linguistically diverse backgrounds tested the feasibility of the intervention. A mean System Usability Scale score of 82.7 (SD 16) was recorded for the intervention, placing its usability in the excellent category.

CONCLUSIONS

Through the co-design process, we developed an evidence-based, holistic, and patient-centered digital health intervention. The intervention was specifically designed to be used by patients from diverse backgrounds, including those with low health, digital, and written literacy levels. The effectiveness of the intervention in improving the physical and mental health of patients will be determined by a high-quality randomized controlled trial.

Routine screening of brain-damaged patients: a comparison of the Rivermead Perceptual Assessment Battery and the Chessington Occupational Therapy Neurological Assessment Battery

Thirty-two brain damaged patients undergoing rehabilitation were assessed independently by the Rivermead Perceptual Assessment Battery (RPAB) and the Chessington Occupational Therapy Neurological Assessment Battery (COTNAB). The detection of perceptual deficits was similar with both batteries. The RPAB was quicker and slightly easier to use but the COTNAB was considered to give considerably more information. This led us to conclude that the COTNAB was the preferred battery for routine use in our clinical setting. Patients found both batteries acceptable with no particular preference for one over the other.

Biomechanical balance response during induced falls under dual task conditions in people with knee osteoarthritis

OBJECTIVE

People with knee osteoarthritis (OA) are at twice the risk of falling compared to older people without knee OA, however the mechanism for this is poorly understood. This study investigated the biomechanical response of the trunk and lower limb joints during a forward induced fall under different task conditions in people with and without knee OA.

METHOD

Twenty-four participants with OA (68.6±6.2 years) and 15 asymptomatic controls (72.4±4.8 years) participated in the study. Forward fall was induced by releasing participants from a static forward leaning position. Participants were required to recover balance during three conditions: normal, physical (obstacle clearance) and cognitive dual tasks (counting backwards). Spatiotemporal parameters, lower limb joint kinematics and kinetics of the recovery limb were compared between the two groups and across the three task conditions.

RESULTS

The OA group demonstrated slower spatio-temporal characteristics and reduced hip and knee flexion angles, joint moments/powers and reduced muscle negative work at the knee and ankle (p<0.05). Cognitive dual task resulted in reduced centre of mass velocity and step length (p=0.03) compared to the physical dual task condition. Reduced knee (p=0.02) and hip joint powers (p=0.03) were demonstrated in the OA group in the physical task condition.

CONCLUSION

When simulating a forward fall, participants with OA demonstrated difficulty in absorbing the impact and slowing down the forward momentum of the body during a recovery step. Moreover, poor dynamic postural control was demonstrated as task complexity increased.

Contribution of lower limb eccentric work and different step responses to balance recovery among older adults

Falls during walking reflect susceptibility to balance loss and the individual's capacity to recover stability. Balance can be recovered using either one step or multiple steps but both responses are impaired with ageing. To investigate older adults' (n=15, 72.5±4.8 yrs) recovery step control a tether-release procedure was devised to induce unanticipated forward balance loss. Three-dimensional position-time data combined with foot-ground reaction forces were used to measure balance recovery. Dependent variables were; margin of stability (MoS) and available response time (ART) for spatial and temporal balance measures in the transverse and sagittal planes; lower limb joint angles and joint negative/positive work; and spatio-temporal gait parameters. Relative to multi-step responses, single-step recovery was more effective in maintaining balance, indicated by greater MoS and longer ART. MoS in the sagittal plane measure and ART in the transverse plane distinguished single step responses from multiple steps. When MoS and ART were negative (<0), balance was not secured and additional steps would be required to establish the new base of support for balance recovery. Single-step responses demonstrated greater step length and velocity and when the recovery foot landed, greater centre of mass downward velocity. Single-step strategies also showed greater ankle dorsiflexion, increased knee maximum flexion and more negative work at the ankle and knee. Collectively these findings suggest that single-step responses are more effective in forward balance recovery by directing falling momentum downward to be absorbed as lower limb eccentric work.

Synthesis and structure of [K(+)-(2,2)diaza-[18]-crown-6][K3Ge9]-2ethylenediamine: stabilization of the two-dimensional layer (2)(infinity)[K3Ge9(1-)]

Large bright-red, transparent crystalline plates of [K-(2,2)diaza-[18]-crown-6]K3Ge9-2en are obtained, in high-yield, from a reaction of (2,2)diaza-[18]-crown-6 in toluene with a solution of K4Ge9/potassium metal (K) in ethylenediamine (en). The compound crystallizes in the monoclinic space group P2(1)/m (a = 10.740(1) A, b = 15.812(1) A, c = 12.326(1) A, beta = 114.74 degrees; Z = 2). The crystal structure of [K-(2,2)diaza-[18]-crown-6]K3Ge9-2en features two-dimensional [K3Ge9] layers formed by uncomplexed K(+) cations and Ge94(-) anions. The "not-so-bare" cluster compound features a unique Ge94(-) cluster that exhibits a slightly distorted C(2v) geometry that is closer to D(3h) than the expected C(4v). Use of noncryptand sequestering agents in the isolation of Ge cluster anions from en solutions opens new avenues in understanding important cation-anion interactions in the stability and reactivity of Zintl ions, as well as a viable route to isolating Zintl anions with higher charges per atom.

An Unprecedented (1infinity)

A chain of vertex-linked "bare" nido-Ge(9)(2-) clusters (shown in the picture) is featured by the novel polymeric Zintl anion formed from the binary alloy "KGe(4)", ethylenediamine, and [18]crown-6. The polymerization of nido-Ge(9)(4-) clusters is counterintuitive to known two-electron oxidation behavior of nido clusters and the existence of the isolated closo-Ge(9)(2-) ion. The novel semiconducting cluster "wire" establishes direct structural and mechanistic links between molecular Zintl cluster ions with the extended structures of Zintl phases and elemental nanophase materials.

Monitoring cytokine production in peripheral blood during acute graft-versus-host disease following allogeneic bone marrow transplantation

Plasma concentrations and peripheral blood cells containing cytoplasmic cytokines were monitored during the post-transplant period in 10 patients who had received allogeneic bone marrow transplants (BMT) for the correction of inherited genetic disorders. The presence of CD14-positive cells containing cytoplasmic interleukin-1 alpha and beta in the peripheral blood was indicative of acute graft-versus-host disease (GVHD). Plasma concentrations of IL-1 alpha, IL-1 beta and TNF-alpha were significantly raised in the GVHD group when compared with the uneventful days. There was, however, poor temporal correlation between the plasma concentrations and clinical manifestations of acute GVHD. Cells containing cytoplasmic IL-6 were present in the peripheral blood when patients had clinically suspected and/or microbiologically confirmed infection. The results from this study demonstrate that analysis of peripheral blood cells for cytoplasmic IL-1 alpha and IL-1 beta are better markers of acute GVHD than is monitoring plasma concentrations of these cytokines.

Monitoring of veno-occlusive disease after bone marrow transplantation by serum aminopropeptide of type III procollagen

Differential diagnosis of hepatic complications after bone marrow transplantation (BMT) is often difficult. To assess whether serum concentrations of the aminopropeptide of type III procollagen (PIIINP) could facilitate diagnosis, we measured serum PIIINP, corrected for age by conversion to standard deviation scores (SDS), serially after BMT in 27 children. A preliminary study of 11 patients showed that a PNIIINP-SDS cutoff of 8.0 was an optimum for diagnosis of veno-occlusive disease (VOD). PIIINP-SDS was increased above cut-off 1-25 days before the onset of clinical signs in the 12 patients (4 from the preliminary group, the others from a group of 16 studied prospectively) who developed VOD, with subsequent changes in PIIINP-SDS mirroring the course of VOD. By contrast, PIIINP-SDS remained below cut-off in all other patients, including 7 with liver graft-versus-host disease and 3 with drug hepatotoxicity. PIIINP-SDS values greater than 8.0 predict, diagnose, and monitor VOD after BMT.

Encephalitis in a 13-year-old boy following 17D yellow fever vaccine

We report a case of encephalitis following yellow fever vaccine in a healthy 13 year-old-boy. This is the first reported case in a child older than 3 years of age and the second over the age of 9 months, before which time the vaccine is contraindicated for routine immunisation.