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Objectives Improving efficiencies in the education sector via the sharing of resources is currently the source of much interest and investment within Australia and throughout the world. Despite the development of multiple educational resource repositories worldwide, educators seldom use repositories to share materials. Interprofessional sharing is similarly scarce. This research was designed to identify staff perceptions about inter-departmental sharing of teaching and learning resources within a university faculty. Methods Representatives were recruited over a 2-week period from four campuses of a university, spanning six departments. Participants took part in two focus groups and six semi-structured interviews. A thematic analysis was undertaken by two independent researchers. Results Five key themes emerged: the benefits of electronic resources for improving student education; perceptions of sharing; perceptions of ownership; the ethical use of resources and digital repositories; the requirements for adoption. Conclusions Our research confirms that educators believe interprofessional resource sharing to be beneficial and appropriate. However, concerns that resources are of insufficient quality or will be incorrectly attributed surfaced as barriers to sharing. Poor understanding and ambiguity surrounding intellectual property rights highlighted the need for repository communities to be sufficiently educated. Developing a commonly agreed metadata and labelling system, and linking with existing infrastructure, will enhance the impact of a learning object repository. Providing avenues for sharing, such as resource repositories, may assist in aligning education with the well-established process of peer review utilised by the research community, improving resource quality through exposure to others' perspectives and feedback. Furthermore, the increased accountability, restriction and familiarity of repositories may prove beneficial in encouraging sharing. [ABSTRACT FROM AUTHOR]

Emerging technologies and student information technology literacy are enabling new methods of teaching and learning for clinical skill performance. Facilitating experiential practice and reflection on performance through student self-video, and exposure to peer benchmarks, may promote greater levels of skill competency. This study examines the impact of student self-video on the attainment of clinical skills. A total of 60 Physiotherapy students (100%) consented to participate in the randomised controlled trial. One group (50%) was taught a complex clinical skill with regular practical tutoring, whilst the other group (50%) supplemented the tutoring with a self-video task aimed at promoting reflection on performance. Student skill performance was measured in an objective structured clinical examination (OSCE). Students also completed an anonymous questionnaire, which explored their perception of their learning experiences. Students received significantly higher scores in the OSCE when the examined clinical skill had been supplemented with a self-video of performance task ( P = 0.048). Descriptive analysis of the questionnaires relating to student perceptions on the teaching methods identified that the self-video of performance task utilised contributed to improvement in their clinical performance and their confidence for future clinical practice. Students identified a number of aspects of the submission process that contributed to this perception of educational value. The novel results of this study demonstrate that greater clinical skill competency is achieved when traditional tutoring methods are supplemented with student self-video of performance tasks. Additional benefits included the ability of staff and students to monitor longitudinal performance, and an increase in feedback opportunities. [ABSTRACT FROM AUTHOR]

Effective education of practical skills can alter clinician behaviour, positively influence patient outcomes, and reduce the risk of patient harm. This study compares the efficacy of two innovative practical skill teaching methods, against a traditional teaching method. Year three pre-clinical physiotherapy students consented to participate in a randomised controlled trial, with concealed allocation and blinded participants and outcome assessment. Each of the three randomly allocated groups were exposed to a different practical skills teaching method (traditional, pre-recorded video tutorial or student self-video) for two specific practical skills during the semester. Clinical performance was assessed using an objective structured clinical examination (OSCE). The students were also administered a questionnaire to gain the participants level of satisfaction with the teaching method, and their perceptions of the teaching methods educational value. There were no significant differences in clinical performance between the three practical skill teaching methods as measured in the OSCE, or for student ratings of satisfaction. A significant difference existed between the methods for the student ratings of perceived educational value, with the teaching approaches of pre-recorded video tutorial and student self-video being rated higher than 'traditional' live tutoring. Alternative teaching methods to traditional live tutoring can produce equivalent learning outcomes when applied to the practical skill development of undergraduate health professional students. The use of alternative practical skill teaching methods may allow for greater flexibility for both staff and infrastructure resource allocation. [ABSTRACT FROM AUTHOR]

The U.S. Army is seeking to produce safer, less sensitive munitions through the addition of two new energetics, 2,4-dinitroanisole (DNAN) and -methyl paranitro aniline (MNA), to the munitions' formula. Production of these munitions would add them to the waste stream. The use of an anaerobic fluidized-bed bioreactor (AFBB) was studied for treating these compounds in a simulated wastewater with ethanol as the electron donor. The reactor degraded both of the compounds to below detection limits over a wide range of ethanol concentrations. The degradation was found to be a transformation into secondary products for both energetics: diaminoanisole (for DNAN) and -methyl--phenylenediamine (for MNA). Both of these by-products reacted upon exposure to air, forming azobond dimers. Potassium perchlorate was added to the feed stream to test if additional energetics would disrupt the transformation. The AFBB continued transformation and was able to remove the perchlorate after a two week acclimation period. The AFBB was an effective treatment method for DNAN and MNA, but further study is required to investigate the transformation products more thoroughly. [ABSTRACT FROM AUTHOR]

Background. Physical therapists often prescribe exercises for fall prevention.Understanding the factors influencing the clinical decision-making processes used by expert physical therapists working in specialist fall and balance clinics may assist other therapists in prescribing exercises for fall prevention with greater efficacy. Objectives. The objective of this study was to describe the factors influencing the clinical decision-making processes used by expert physical therapists to prescribe exercises for fall prevention. Design. This investigation was a qualitative study from a phenomenological perspective. Methods. Semistructured telephone interviews were conducted with 24 expertphysical therapists recruited primarily from the Victorian Falls Clinic Coalition.Interviews focused on 3 exercise prescription contexts: face-to-face individual therapy, group exercise programs, and home exercise programs. Interviews elicited information about therapist practices and the therapist, patient, and environmental factors influencing the clinical decision-making processes for the selection of exercise setting, type, dosage (intensity, quantity, rest periods, duration, and frequency), and progression. Strategies for promoting adherence and safety were also discussed. Data were analyzed with a framework approach by 3 investigators. Results. Participants described highly individualized exercise prescription approaches tailored to address key findings from physical assessments. Dissonance between prescribing a program that was theoretically correct on the basis of physiological considerations and prescribing one that a client would adhere to was evident. Safety considerations also were highly influential on the exercise type and setting prescribed. Terminology for describing the intensity of balance exercises was vague relative to terminology for describing the intensity of strength exercises. Conclusions. Physical therapists with expertise in fall prevention adopted an individualized approach to exercise prescription that was based on physical assessment findings rather than "off-the-shelf" exercise programs commonly used in fall prevention research. Training programs for people who prescribe exercises for older adults at risk of falling should encompass these findings. [ABSTRACT FROM AUTHOR]

Conventional techniques for central venous recanalization are successful in crossing most lesions but still fail in many patients. We used a radiofrequency wire in these failed cases. We report three patients with complicated central venous occlusions in whom conventional catheter and guidewire techniques were not successful and who were successfully treated using the PowerWire Radiofrequency Guidewire (Baylis Medical Company Inc, Montreal, QC, Canada). Occlusions were traversed using the radiofrequency wire, followed by angioplasty and stenting. The average length recanalized was 8.2 ± 3.6 cm. One patient required repeat angioplasty at 4 months. All stents were patent at 12 to 15 months. The radiofrequency wire is valuable in the management of patients with refractory central venous occlusions. [ABSTRACT FROM AUTHOR]

Objective: Older patients are thought to tolerate acute ischemia more poorly than younger patients. Since aging may depress both angiogenesis and arteriogenesis, we determined the effects of age on both angiogenesis and arteriogenesis in a model of severe acute limb ischemia. Methods: Young adult (3-months-old) and aged (18-months-old) C57BL/6 mice underwent right common iliac artery and vein ligation and transection. Data were collected on days 0, 7, and 14. Perfusion was measured with a laser Doppler scan and compared to the contralateral limb. Functional deficits were evaluated with the Tarlov scale. Capillary density and endothelial progenitor cell (EPC) number were determined by direct counting lectin-positive/alpha-actin-negative cells and VEGFR2/CXCR4 dually-positive cells, respectively; angiography was performed to directly assess arteriogenesis. Results: Young adult and aged mice had a similar degree of decreased perfusion after iliac ligation (young, n = 15: 20.4 ± 1.9%, vs aged, n = 20: 19.6 ± 1.3%; P = .72, analysis of variance [ANOVA]); however, young mice recovered faster and to a greater degree than aged mice (day 7, 35 ± 6% vs 17 ± 4%, P = .046; day 14, 60 ± 5% vs 27 ± 7%, P = .0014). Aged mice had worse functional recovery by day 14 compared to young mice (2.3 ± 0.3 vs 4.3 ± 0.4; P = .0021). Aged mice had increased capillary density (day 7, 12.9 ± 4.4 vs 2.8 ± 0.3 capillaries/hpf; P = .02) and increased number of EPC incorporated into the ischemic muscle (day 7, 8.1 ± 0.9 vs 2.5 ± 1.9 cells; P = .007) compared to young mice, but diminished numbers of collateral vessels to the ischemic limb (1 vs 9; P = .01), as seen on angiography. Conclusion: After severe hind limb ischemia, aged animals become ischemic to a similar degree as young animals, but aged animals have significantly impaired arteriogenesis and functional recovery compared to younger animals. These results suggest that strategies to stimulate arteriogenesis may complement those that increase angiogenesis, and may result in improved relief of ischemia. [Copyright &y& Elsevier]

Staging laparoscopy for patients with radiographically resectable pancreatic adenocarcinoma has been reported to yield an 8–15% finding of unresectable disease. Factors associated with the likelihood of subradiographic unresectable disease have not been clearly defined. A prospectively maintained pancreatic database was reviewed and patients were identified who underwent staging laparoscopy for radiographically resectable pancreatic adenocarcinoma between January 2000 and December 2006. Preoperative carbohydrate antigen 19-9 (CA 19-9) values were assessed for their association with the presence of subradiographic unresectable disease. Four hundred ninety-one patients underwent staging laparoscopy. Resection was performed in 80% ( n = 395). Of the 96 patients with unresectable disease, 75 (78%) had metastases either in the liver ( n = 60) or peritoneum ( n = 15). Preoperative CA 19-9 values were available for 262 of the 491 patients. Fifty-one of these patients had unresectable disease, of which 78% were due to distant disease. The median preoperative CA 19-9 value for patients who underwent resection was 131 U/ml versus 379 U/ml for those patients with unresectable disease ( P = 0.003). A receiver operating characteristics (ROC) curve was developed for preoperative CA 19-9 value and tumor resectability. The statistically optimal cutoff value was determined to be 130 U/ml. Unresectable disease was identified in 38 of the 144 patients (26.4%) with a preoperative CA 19-9 ≥ 130 U/ml, and in 13 of the 118 patients (11%) with a CA 19-9 < 130 U/ml ( P = 0.003). CA 19-9 values greater than 130 U/ml remained a predictor of tumor unresectability on multivariate regression analysis [hazard ratio (HR) 2.70, 95% confidence interval (CI) 1.34–5.44; P = 0.005]. In this study, preoperative CA 19-9 values were strongly associated with the identification of subradiographic unresectable disease. Preoperative CA 19-9 values may allow surgeons to better select patients for staging laparoscopy. [ABSTRACT FROM AUTHOR]

Background/Aims: Age-associated changes in endothelial nitric oxide synthase (eNOS) expression have not been definitively linked to the pathophysiology of aortic aneurysms. We examined the role of eNOS in human patients and an age-appropriate mouse model. Methods: eNOS transcripts and immunodetectable protein were assessed by quantitative PCR and immunohistochemistry in human ascending thoracic aneurysms (n = 29) and referent aortae (n = 31). Carotid aneurysms were induced with CaCl2 in young adult (3 months) and aged (18 months) C57BL/6 and eNOS-knockout (eNOS-KO) mice. Results: eNOS transcripts and protein were reduced in human aneurysms compared with controls, although aortic eNOS expression also decreased with patient age. Aged wild-type mice had significantly larger aneurysm diameter than young adult mice. Aged wild-type mice had reduced eNOS transcripts and protein compared with young adult mice. Aged eNOS-KO mice had smaller aneurysms compared with aged wild-type mice but similar size aneurysms compared with young eNOS-KO and young wild-type mice. Conclusion: eNOS expression is reduced in both aged human and aged mouse endothelium and eNOS expression is linked to aneurysm expansion in aged but not young adult mice. These findings support the relevance of age-associated changes in eNOS expression in clinical aneurysmal disease. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Vascular smooth muscle cells exhibit varied responses after vessel injury and surgical interventions, including phenotypic switching, migration, proliferation, protein synthesis, and apoptosis. Although the source of the smooth muscle cells that accumulate in the vascular wall is controversial, possibly reflecting migration from the adventitia, from the circulating blood, or in situ differentiation, the intracellular signal transduction pathways that control these processes are being defined. Some of these pathways include the Ras-mitogen–activated protein kinase, phosphatidylinositol 3-kinase-Akt, Rho, death receptor-caspase, and nitric oxide pathways. Signal transduction pathways provide amplification, redundancy, and control points within the cell and culminate in biologic responses. We review some of the signaling pathways activated within smooth muscle cells that contribute to smooth muscle cell heterogeneity and development of pathology such as restenosis and neointimal hyperplasia. [Copyright &y& Elsevier]

Abstract: Both neointimal hyperplasia and inward remodeling contribute to restenosis and lumen loss. Nogo-B has been recently described as an inhibitor of vascular injury and neointimal hyperplasia. To determine whether Nogo-B expression may be a mediator of inward remodeling, we examine the localization of expression of Nogo-B in an in vivo model that examines both neointimal hyperplasia and inward remodeling. The rabbit carotid artery was subjected to balloon injury, outflow branch ligation to reduce flow, or both balloon injury and reduction in flow. In balloon injury-induced neointimal hyperplasia Nogo-B expression was reduced in the intima and media but stimulated in the adventitia. In low flow-induced inward remodeling medial Nogo-B expression was not reduced and adventitial Nogo-B expression was not stimulated. Low flow significantly augmented balloon injury-induced neointimal hyperplasia and was accompanied by reduced intimal and medial Nogo-B expression, and increased adventitial Nogo-B expression in both smooth muscle cells and macrophages. Low flow-induced inward remodeling is not associated with changes in medial Nogo-B expression and is distinct from injury-induced neointimal hyperplasia. Pharmacological strategies to inhibit neointimal hyperplasia and restenosis using normal flow models may only partially account for lumen loss and therefore may not accurately predict responses in patients with extensive outflow disease. [Copyright &y& Elsevier]