Spinal and sacroiliac assessment and treatment techniques used by osteopathic physicians in the United States

Background

Without systematic exposure to biomedical research concepts or applications, osteopathic medical students may be generally under-prepared to efficiently consume and effectively apply research and evidence-based medicine information in patient care. The academic literature suggests that although medical residents are increasingly expected to conduct research in their post graduate training specialties, they generally have limited understanding of research concepts. With grant support from the National Center for Complementary and Alternative Medicine, and a grant from the Osteopathic Heritage Foundation, the University of North Texas Health Science Center (UNTHSC) is incorporating research education in the osteopathic medical school curriculum. The first phase of this research education project involved a baseline assessment of students' understanding of targeted research concepts. This paper reports the results of that assessment and discusses implications for research education during medical school.

Methods

Using a novel set of research competencies supported by the literature as needed for understanding research information, we created a questionnaire to measure students' confidence and understanding of selected research concepts. Three matriculating medical school classes completed the on-line questionnaire. Data were analyzed for differences between groups using analysis of variance and t-tests. Correlation coefficients were computed for the confidence and applied understanding measures. We performed a principle component factor analysis of the confidence items, and used multiple regression analyses to explore how confidence might be related to the applied understanding.

Results

Of 496 total incoming, first, and second year medical students, 354 (71.4%) completed the questionnaire. Incoming students expressed significantly more confidence than first or second year students (F = 7.198, df = 2, 351, P = 0.001) in their ability to understand the research concepts. Factor analyses of the confidence items yielded conceptually coherent groupings. Regression analysis confirmed a relationship between confidence and applied understanding referred to as knowledge. Confidence scores were important in explaining variability in knowledge scores of the respondents.

Conclusion

Medical students with limited understanding of research concepts may struggle to understand the medical literature. Assessing medical students' confidence to understand and objectively measured ability to interpret basic research concepts can be used to incorporate competency based research material into the existing curriculum.     

Using truncated lectures, conceptual exercises, and manipulatives to improve learning in the neuroanatomy classroom

Functional Neuroanatomy is a course designed to help students learn the function and anatomy of the human nervous system. Historically, students have had difficulty with the spinal tract curricular unit and frequently resorted to memorization to "learn" the material. They performed poorly on exams and failed to demonstrate competence in the functional application of their knowledge. In an effort to improve learning and promote critical thinking in this course, the instructor revised the curriculum to include 1) shorter, less detailed lectures; 2) a set of practice problems that presented the spinal tracts in an applied context; and 3) a manipulative, which was composed of a magnetic bulletin board and a kit of magnets representing structures of the nervous system. Student learning, as assessed by summative exams, improved under the revised curriculum. Scores on knowledge, analytical, and synthesis questions were significantly higher than scores from previous classes using the traditional lecture curriculum (P < 0.05). This curricular protocol could potentially be applied to other topics where students resort to memorization and fail to comprehend concepts and processes.     

Indicators of Dematerialization and the Materials Intensity of Use

We review the major empirical analyses of the related concepts of dematerialization and intensity of use. Dematerialization refen to the absolute or relative reduction in the quantity of materials used and/or the quantity of waste generated in the production of a unit of economic output A common indicator is the intensity of material use, which is the quantity of material used per unit of economic output. Our discussion focuses on seven topics: the environmental Kuznets curve for materials, material use and long wave theory material decomposition analysis, statistical, inpuboutput and dynamic models of material use, and analyses of national material use. We examine the measurement of aggregate material use and waste emissions, hypothesis testing, the importance of imports, and forces that countervail dematerialization such as rising affluence and the "rebound effect." We conclude that: our knowledge of the extent of and mechanisms behind the patterns of material use are limited largely to individual materials or very specific industries, and most of those examples are metals; the economy is getting "lighter" but the aggregate economic significance of that trend, if any, is unknown; there is no compelling macroeconomic evidence that the US. economy is "decoupled" from material inputs; and we know even less about the net environmental effects of many changes in materials use. We caution against gross generalizations about material use, particularly the "gut" feeling that technical change, substitution, and a shift t o the "information age" inexorably lead to decreased materials intensity and reduced environmental impact. We end with some suggestions for research that may help answer these important questions.     

Unhealthy body perception among Turkish youths: socioeconomic status and social comparisons

The purpose of this study was to determine the effect of socioeconomic status (SES) and social comparisons on body perception, and to identify their relationship to unhealthy behaviours and changing body structures, by assessing body perception in youths. A questionnaire was administered to 640 university students. The topics covered included SES, body definitions, behaviours related to body weight (such as exercise, dieting, starving, using diet foods, drug use, and bingeing and purging) and a social comparison scale. The prevalence of heavy exercise (42.9%) among male students was significantly higher in the low-income group (p < 0.01), whereas it was significantly higher (61.7%) among female students in the high-income group (p < 0.001). Behaviours such as dieting and starving for more than 24 hours were more common among female students in the high-income group (p < 0.01). The average social comparison scores were significantly lower among students with a higher body mass index. The social attractiveness subscale scores were significantly lower (p < 0.05) among students with unhealthy body definitions. The components of attractivity showed a clear correlation among students with unhealthy body definitions. As well as the increasing prevalence of obesity in developing countries, unnecessary body-measurement controls and "ideal" body images are affecting the behaviour of youths. Gender is related to most of these behaviours. Understanding the relationship between social comparisons and body appearance in adolescent females and males can be facilitated by examining certain features of attractiveness.     

Pedometer and Human Energy Balance Applications for Science Instruction

Teachers can use pedometers to facilitate inquiry learning and show students the need for mathematics in scientific investigation. The authors conducted activities with secondary students that investigated intake and expenditure components of the energy balance algorithm, which led to inquiries about pedometers and related data. By investigating the accuracy of pedometers and variables that may impact reported step counts, students can better understand experimental design and statistical concepts. Students can also examine other data (distance walked, kilocalories expended) using multifunction pedometers and apply the concepts of correlation and regression. This topic fits well with thematic learning and responds to concerns about excess energy intake and insufficient physical activity in the U.S. population.     

What do Israeli high school students understand about biodiversity? An evaluation of the high school biology programme, ‘Nature in a World of Change’

One of the most serious problems facing our planet is the biodiversity crisis. As a solution to this problem, both scientists and educators have emphasised the need for educating people about how to conserve the Earth’s biodiversity. As a small contribution to this effort, we have designed a learning unit about biodiversity, Nature in a world of change, which has recently been implemented with 74 12th-grade Israeli high-school biology students. This unit consists of two components: an introductory module and a collection of three articles adapted from the primary scientific literature. This paper focuses on an in-depth examination with 25 students participating in the programme’s implementation. The evaluation process includes a self-assessment of prior basic ecological knowledge and a post-test focusing on concepts and issues central to the understanding of biodiversity, such as niche and Simpson’s Index. Analysis of perturbations in a food web (by an invasive species) was a special focus of the assessments, reflecting similar concerns prevalent among the scientific community. The results of this evaluation revealed that students with a solid ecological background could successfully deal with the newly acquired concepts presented in the module and the articles.     

Helping Students Distinguish between Mixtures and Chemical Compounds

For most middle school-level students, summarizing main ideas can prove to be difficult, especially for those with low vocabulary and language acquisition skills. Working specifically with students who are English Language Learners (ELLs) and in a special education program, we discovered that teaching summarization as a reading strategy increased students' abilities to (a) acquire and use information and (b) better comprehend science concepts. In combination with other vocabulary attainment activities, summary frames enhanced the students' ability to apply information to discussions, laboratory reports, and projects. In this article, we demonstrate how to use the summary frame strategy in the context of a lesson on cells. This lesson allows for (a) knowledge of terminology through vocabulary card activities, (b) comprehension of concepts presented through summary frame activities, and (c) application of concepts through cell models and organelle classroom responsibilities.     

Traditional diet and food preferences of Australian aboriginal hunter-gatherers.

Until European settlement of Australia 200 years ago, Aborigines lived as nomadic hunter-gatherers all over the continent under widely varying geographic and climatic conditions. Successful survival depended on a comprehensive knowledge of the flora and fauna of their territory. Available data suggest that they were physically fit and lean, and consumed a varied diet in which animal foods were a major component. Despite this, the diet was not high in fat, as wild animal carcasses have very low fat contents through most of the year, and the meat is extremely lean. Everything on an animal carcass was eaten, including the small fat depots and organ meats (which were highly prized), bone marrow, some stomach contents, peritoneal fluid and blood. A wide variety of uncultivated plant foods was eaten in the traditional diet: roots, starchy tubers, seeds, fruits and nuts. The plant foods were generally high in fibre and contained carbohydrates, which was slowly digested and absorbed. Traditional methods of food preparation (usually baked whole or eaten raw) ensured maximum retention of nutrients. In general, traditional foods had a low energy density but high density of some nutrients. The low energy density of the diet and the labour intensity of food procurement provided a natural constraint on energy intake.(ABSTRACT TRUNCATED AT 250 WORDS)     

Problem-based writing with peer review improves academic performance in physiology

The aim of this study was to determine whether problem-based writing with peer review (PW-PR) improves undergraduate student performance on physiology exams. Didactic lectures were replaced with assignments to give students practice explaining their reasoning while solving qualitative problems, thus transferring the responsibility for abstraction and generalization to the students. Performance on exam items about concepts taught using PW-PR was compared with performance on concepts taught using didactic lectures followed by group work. Calibrated Peer Review, a Web-delivered program, was used to collect student essays and to manage anonymous peer review after students "passed" three calibration peer reviews. Results show that the students had difficulty relating concepts. Relationship errors were categorized as (1) problems recognizing levels of organization, (2) problems with cause/effect, and (3) overgeneralizations. For example, some described cells as molecules; others thought that vesicles transport materials through the extracellular fluid. With PW-PR, class discussion was used to confront and resolve such difficulties. Both multiple-choice and essay exam results were better with PW-PR instead of lecture.     

Teenagers' Experience with Occupational Health and Safety Issues in West Virginia

Students in three high schools in West Virginia completed one of three questionnaires according to work status. A total of 1156, 14- to 17-year-old students completed the survey, 17% had ever (currently or previously) worked. These students reported employment mostly during June to August (36%), mainly in recreational facilities (15%). The main task performed was cleaning (44%). Forty-five percent experienced one or more on-the-job injuries with cuts being the most common. A large number of the teenagers (84%) reported receiving training in how to do their job and little training on safety and health. When the teenagers were queried on who is at fault when a teenager is injured, 46% indicated that accidents just happen and 38% blamed the teenager. The respondents indicated they had used scaffolding and ladders (32%), power tools (29%), and/or driven mo tor vehicle (15%), all tasks prohibited by child labor laws. The results indicate a deficiency in knowledge among this group of teenagers on topics related to occupational safety and health and child labor laws. A need exists for a concerted team approach to address these problems.     

Nutritional ecology and diachronic trends in Paleolithic diet and health

Modern nutritional studies have found that diverse diets are linked to lower infant mortality rates and longer life expectancies in humans. This is primarily because humans require more than fifty essential nutrients for growth and cell maintenance and repair; most of these essential nutrients must come from outside food sources rather than being manufactured by the body itself; and a diversity of food types is required to consume the full suite of essential nutrients necessary for optimal human health. These principles and their related affects on human adaptations and demography are the hallmarks of a theoretical paradigm defined as nutritional ecology. This essay applies concepts derived from nutritional ecology to the study of human evolution. Principles of nutritional ecology are applied to the study of the Middle‐to‐Upper Paleolithic transition in order to broadly illustrate the interpretive ramifications of this approach. At any stage in human evolution, those hominid populations that chose to diversify their subsistence base may have had a selective advantage over competitors who restricted their diet principally to one food type, such as terrestrial mammals.     

Higher Risk Perception of HIV than of Chlamydia and HPV among Secondary School Students in Two German Cities

Background

Chlamydia and genital human papillomavirus (HPV) are the two most common sexually transmitted infections (STIs) among teens and young adults in industrialised countries. The majority of adolescents, however, have limited or no knowledge of these infections. Within the context of a cross-sectional survey on awareness and knowledge of sexually transmitted infections, secondary school students attending the 8th grade and above in Bremen and Bremerhaven, two cities in northern Germany, were asked to rate the risk of peers to get infected with HIV, HPV or chlamydia.

Methods

Between October and December 2011, students aged 12–20 years completed an anonymous, self-administered questionnaire at their school. In addition to answering questions on awareness and knowledge of sexually transmitted infections, all students were also asked to rate the risk of peers to get infected with HIV, HPV or chlamydia. Furthermore, those reporting ever having sexual intercourse were asked to rate their own risk of getting infected with each of the three infections.

Results

1,148 students, 55% female, completed the questionnaire. 27% of the students reported having had sexual intercourse. 68% of all students rated the risk of same-aged students to get infected with HIV/AIDS as high/medium. The corresponding proportions for HPV and chlamydia were 19 and 25% respectively. Those reporting ever having sexual intercourse generally perceived their own risk of getting infected with HIV, chlamydia or HPV as lower than that of their peers.

Conclusion

Generally, the risk of getting infected with HIV was perceived as being higher than that of getting infected with HPV or chlamydia, most likely due to the fact that the students were more aware of HIV than of the other two infections. Efforts should be made to improve awareness and knowledge of HPV and chlamydia among school going adolescents, and to make them realize that these are common infections that are preventable.     

Museum behind the scenes–an inquiry-based learning unit with biological collections in the classroom

The aim of this study was to design and evaluate an inquiry- and activity-based learning unit for the classroom that uses biological collections to teach key evolutionary concepts and to support the understanding and appreciation of the work of a museum. The unit consisted of three parts that focused on the most important tasks of museums: collecting and conserving, researching and exhibiting. The students created their own collection, performed research surrounding it and then designed an exhibition. Seventy-six secondary sixth- and seventh-grade students participated in the testing of the prototype unit. For evaluation, we carried out a pre-/post-test design using a questionnaire that assessed content knowledge and learning enjoyment. The mean knowledge score of the post-test indicated significant learning gains compared to the pre-test results. The test on learning enjoyment showed best mean values for actions that included the collection, compared to results of the theoretical parts of the unit. This approach demonstrates that the learning unit offers the opportunity to experience the tasks of a museum at first hand and to acquire knowledge about evolutionary science and evolutionary principles.     

Athletes' use of exercise imagery during weight training

Imagery is a cognitive process during which people use their minds to create (or recreate) experiences that are similar to real-life situations. This study examined how college athletes used imagery during weight training. Subjects were 295 Division I (n = 163) and Division II (n = 132) college student athletes (men: n = 138, women: n = 157) who participated in a weight training program as a requirement of their sport. They completed a slightly modified version of the "Weight Lifting Imagery Questionnaire." Results showed that appearance imagery (i.e., images related to the attainment of a fit-looking body) was used and considered the most effective followed by technique imagery (i.e., images related to performing the skill and techniques correctly with good form) and energy imagery (i.e., images related to getting "psyched up" or feeling energized). Other variables that effected imagery use were gender, age, time of season, and levels of motivation. In addition, gender, previous imagery training, and level of motivation had an effect on the perceptions of imagery effectiveness. Confidence in the ability to image was associated with both imagery use and effectiveness, and imagery use and effectiveness were associated with confidence in the weight room. The findings support previous research in exercise imagery that appearance imagery is most used followed by technique and energy imagery and extend them in such a way that strength coaches have practical advice on how to use imagery in a positive way with their athletes. Suggestions about how strength coaches can use imagery with their clients are provided.     

The transport of nutrients and energy into the Australian Snowy Mountains by migrating bogong moths Agrotis infusa

Although energy flows are fundamental to our understanding of the functioning of ecosystems, the extent of transport of energy and nutrients by biological agents into mountains is poorly understood. Bogong moths constitute a keystone species in the ecology of the alpine zone of mainland Australia. Although known to transport nutrients and energy essential to the functioning of the alpine ecosystem, this has never been quantified. By allocating mortality between predation, and non‐predator‐related causes, a model was constructed to calculate mortality of moths in the Snowy Mountains region of the Australian Alps. Density of predators, their food requirements and the proportion of predator diet that was moth were estimated, and energy and nutrient content of moths were measured. This allowed a first order estimate of the total mortality of moths above 1500 m in the Snowy Mountains annually (1015 million) and the annual contributions of energy (4929 GJ) and nutrients (7.2 t of nitrogen and 0.97 t of phosphorus) by these moths to the system. The deleterious effects of transportation of exogenous chemicals to the mountains have been explored elsewhere but the fertilizing effect of this transport of nutrients still requires attention.     

Promoting life skills and preventing tobacco use among low-income Mumbai youth: effects of Salaam Bombay Foundation intervention

Background

In response to India''s growing tobacco epidemic, strategies are needed to decrease tobacco use among Indian youth, particularly among those who are economically disadvantaged. The objective of this study was to assess the effectiveness of a school-based life-skills tobacco control program for youth of low socio-economic status in Mumbai and the surrounding state of Maharashtra. We hypothesized that compared to youth in control schools, youth exposed to the program would have greater knowledge of effects of tobacco use; be more likely to take action to prevent others from using tobacco; demonstrate more positive life skills and attitudes; and be less likely to report tobacco use.

Methods/Findings

Using a quasi-experimental design, we assessed program effectiveness by comparing 8^th and 9^th grade students in intervention schools to 8^th grade students in comparable schools that did not receive the program. Across all schools, 1851 students completed a survey that assessed core program components in early 2010. The program consisted of activities focused on building awareness about the hazards of tobacco, developing life skills, and advocacy development. The primary outcome measure was self-reported tobacco use in the last 30 days.Findings indicate that 4.1% of 8^th grade intervention students (OR = 0.51) and 3.6% of 9^th grade intervention students (OR = 0.33) reported using tobacco at least once in the last 30 days, compared to 8.7% of students in the control schools. Intervention group students were also significantly more knowledgeable about tobacco and related legislation, reported more efforts to prevent tobacco use among others, and reported stronger life skills and self-efficacy than students in control schools. Limitations to the study include schools not being randomly assigned to condition and tobacco use being measured by self-report.

Conclusions

This program represents an effective model of school-based tobacco use prevention that low-income schools in India and other low- and middle-income countries can replicate.     

Contributions of animal nutrition research in rostock to energetic feed evaluation

The Rostock research in animal nutrition has underlain in continuation and progressive development of Kellner's starch value system, net energy fat as measuring unit for energetic feed evaluation. Net energy‐fat was used as an uniform unit of measure for all farm animals with different performances. The scientific basis for the net energy‐fat system was created by numerous studies on energy retention and utilisation efficiency of pure nutrients and nutrients of feedstuffs and rations. For the estimation the energy content of feedstuffs and rations, multiple regression equations were derived on the basis of experimental results of the energy research group. The regressions for the estimation of energy values are used directly and modified in feed evaluation systems for practical use. The Rostock research group in energy metabolism created also essential contributions to factorial derivations of energy requirement of farm animals. In the presented paper selected results on maintenance energy requirement in relation to partial energy requirement values and utilisation efficiencies in growing, pregnant and lactating animals, especially cattle and pigs, are comprised. The Rostock results are compared to those from literature.     

Diagnostic Criteria for Problematic Internet Use among U.S. University Students: A Mixed-Methods Evaluation

Empirical studies have identified increasing rates of problematic Internet use worldwide and a host of related negative consequences. However, researchers disagree as to whether problematic Internet use is a subtype of behavioral addiction. Thus, there are not yet widely accepted and validated diagnostic criteria for problematic Internet use. To address this gap, we used mixed-methods to examine the extent to which signs and symptoms of problematic Internet use mirror DSM-5 diagnostic criteria for substance use disorder, gambling disorder, and Internet gaming disorder. A total of 27 university students, who self-identified as intensive Internet users and who reported Internet-use-associated health and/or psychosocial problems were recruited. Students completed two measures that assess problematic Internet use (Young’s Diagnostic Questionnaire and the Compulsive Internet Use Scale) and participated in focus groups exploring their experiences with problematic Internet use. Results of standardized measures and focus group discussions indicated substantial overlap between students’ experiences of problematic Internet use and the signs and symptoms reflected in the DSM-5 criteria for substance use disorder, gambling disorder, and Internet gaming disorder. These signs and symptoms included: a) use Internet longer than intended, b) preoccupation with the Internet, c) withdrawal symptoms when unable to access the Internet, d) unsuccessful attempts to stop or reduce Internet use, e) craving, f) loss of interest in hobbies or activities other than the Internet, g) excessive Internet use despite the knowledge of related problems, g) use of the Internet to escape or relieve a negative mood, and h) lying about Internet use. Tolerance, withdrawal symptoms, and recurrent Internet use in hazardous situations were uniquely manifested in the context of problematic Internet use. Implications for research and practice are discussed.