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With the increasing evidence supporting exercise as an intervention for the prevention and treatment of multiple health conditions, it is important to consider how best to prepare students for their future careers where they will prescribe exercise. Case-Based Learning (CBL) and Problem-Based Learning (PBL) are two approaches that can introduce the complexities of the real-world into the classroom to reduce the gap between academic training and professional practice. The similarity in their aims and the flexibility available in structuring CBL and PBL, has made it difficult to distinguish between them, influencing both research and practice. In order to understand the literature, as well as to implement these approaches appropriately, it is important to understand the similarities and differences between CBL and PBL. The objective of this work was to distinguish between CBL and PBL. A state-of-the-art review is presented to provide a comprehensive overview and comparison of these learning approaches. The primary finding was that PBL is more complex and demanding than CBL because it requires students to create a solution without direct help from the instructor. Conversely, CBL provides an intermediary to develop required critical reasoning and problem solving skills, which may facilitate the transition from traditional lecture-based learning to PBL. However, success using each approach is very dependent on how it is implemented and hence must be adapted to suit the student, instructor and available resources.

AimWe assessed the utilization of the National Institutes of Health Quality of Life in Neurological Disorders (Neuro-QoL) in pediatric patients with Sturge-Weber syndrome, a rare neurovascular disorder which frequently results in seizures, brain atrophy, calcification, and a range of neurological impairments.MethodsSubjects were seen clinically and consented for research. All 22 patients filled out the Pediatric Neuro-QoL. The Neuro-QoL subscores were converted to T-scores to compare with the referenced control population. Twenty-one participants also filled out the Brain Vascular Malformation Consortium Database Questionnaire containing data pertaining to Sturge-Weber syndrome-related medical history, medications, comorbidities, and family history. All data were analyzed with a significance threshold of P

BackgroundSturge-Weber syndrome (SWS) is caused by a somatic mutation in GNAQ leading to capillary venous malformations in the brain presenting with various neurological, ophthalmic, and cognitive symptoms of variable severity. This clinical variability makes accurate prognosis difficult. We hypothesized that the greater extent of physical factors (extent of skin, eye, and brain involvement), presence of possible genetic factors (gender and family history), and age of seizure onset may be associated with greater symptom severity and need for surgery in patients with SWS.MethodsThe questionnaire was collected from 277 participants (age: two months to 66 years) with SWS brain involvement at seven US sites.ResultsBilateral brain involvement was associated with both learning disorder and intellectual disability, whereas port-wine birthmark extent was associated with epilepsy and an increased likelihood of glaucoma surgery. Subjects with family history of vascular birthmarks were also more likely to report symptomatic strokes, and family history of seizures was associated with earlier seizure onset. Learning disorder, intellectual disability, strokelike episodes, symptomatic stroke, hemiparesis, visual field deficit, and brain surgery were all significantly associated with earlier onset of seizures.ConclusionThe extent of brain and skin involvement in SWS, as well as the age of seizure onset, affect prognosis. Other genetic factors, particularly variants involved in vascular development and epilepsy, may also contribute to neurological prognosis, and further study is needed.

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Rheumatoid arthritis (RA) is characterized by deteriorated vascular health and increased cardiovascular risk. Physical activity (PA) is recommended for cardiovascular management in RA, but evidence on the associations between objectively measured PA and vascular health markers in RA is limited. In this cross-sectional study, 82 postmenopausal women with RA (62 ± 7 yr) undertook ultrasound assessments of vascular function and structure, including brachial and superficial femoral artery (BA and SFA) flow-mediated dilation; baseline and post-hyperemia peak diameters; and carotid intima-media thickness. Participants also performed a 7-day accelerometer-based assessment of PA and sedentary behavior (SB). Fitted regression models controlled for age, body mass index, and disease activity were conducted to examine associations between vascular and PA outcomes. Regression analyses revealed that prolonged SB (bouts >60 min) and total sedentary time were inversely associated with both baseline and peak BA diameters, with each additional hour of SB resulting in decreases of 0.08–0.1 mm in these diameters (P ≤ 0.01). Total sedentary time also showed similar negative associations with peak SFA diameters (β = −0.14 [−0.24 to −0.05], P < 0.01). Conversely, light-intensity PA and stepping time were positively associated with both baseline and peak BA diameters, with each additional hour increasing these diameters by 0.10–0.24 mm (P ≤ 0.02). Finally, standing time was positively associated with SFA peak diameter (β = 0.11 [0.01–0.20], P = 0.02). No associations were found between moderate-to-vigorous PA and vascular outcomes. In conclusion, in patients with RA, SB was negatively, whereas light PA was positively, associated with BA and SFA diameters. These findings suggest that reducing SB and increasing PA, even at light intensities, may improve vascular health in RA. NEW & NOTEWORTHY: This was the first study to investigate associations between objectively measured physical activity and markers of vascular health in rheumatoid arthritis (RA). The findings suggest that reducing sedentary behavior and increasing light or total physical activity are associated with improved vascular outcomes in RA. These results support further investigation into interventions aimed at reducing sedentary time and replacing with any type of physical activity as a potential strategy for improving cardiovascular outcomes in individuals with RA. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to establish the potential therapeutic profile of neutrophil‐derived extracellular vesicles (EVs) in experimental inflammatory arthritis and associate pharmacological activity with specific EV components, focusing on microRNAs. Methods: Neutrophil EVs were administered intra‐articularly through a prophylactic or therapeutic protocol to male C57BL/6 mice undergoing serum‐transfer–induced inflammatory arthritis. Transcriptomic analysis of knees was performed on joints following EV administration, naive and arthritic mice (untreated; n = 4/group) and EV‐treated diseased mice (intra‐articular administration) with contralateral (vehicle‐treated; n = 8/group). Comparison of healthy donor and patients with rheumatoid arthritis (RA) neutrophil EVs was performed. Results: EVs afforded cartilage protection with an increase in collagen‐II and reduced collagen‐X expression within the joint. To gain mechanistic insights, RNA sequencing of the arthritic joints was conducted. A total of 5,231 genes were differentially expressed (P < 0.05), with 257 unique to EV treatment. EVs affected key regenerative pathways involved in joint development, including Wnt and Notch signaling. This wealth of genomic alteration prompted to identify microRNAs in EVs, 10 of which are associated with RA. As a proof of concept, we focused on miR‐455‐3p, which was detected in both healthy donor and RA EVs. EV addition to chondrocyte cultures elevated miR‐455‐3p and exerted anticatabolic effects upon interleukin‐1β stimulation; these effects were blocked by actinomycin or miR‐455‐3p antagomir. Conclusion: Neutrophils from patients with RA yielded EVs with composition, efficacy, and miR‐455‐3p content similar to those of healthy volunteers, suggesting that neutrophil EVs could be developed as an autologous treatment to protect and repair joint tissue of patients affected by inflammatory arthritides. [ABSTRACT FROM AUTHOR]

Inconsistent filtering of force plate data persists in published studies. Previous evidence suggests that low pass filtering produces the largest error when calculating jump height, but used jump height from unfiltered force plate data as the criterion. This study investigated the effects of low pass filtering on jump height calculated from force plate data, using jump height recorded from optical motion capture as the criterion. Unfiltered as well as both single and dual pass filtered data, with cutoff frequencies of 100, 50 and 5 Hz, were used to calculate jump height using take-off velocity (TOV) and take-off velocity summed with displacement (TOV+s). The TOV+s method using the 5 Hz single pass filtered signal, best agreed with the criterion (p < 0.001). This was accomplished through changes in the force-time signal that decreased velocity and increased displacement at take-off (p < 0.001). This is contrary to previous recommendations and informs the development of standard procedures.

ObjectiveTo determine the clinical and biological characteristics of an exceptionally high functioning index person (IP) with schizophrenia in her mid-50s, which may represent compensatory mechanisms, and potentially, avoidance of the accelerated aging typically associated with schizophrenia.MethodIP, 11 other women with schizophrenia, and 11 non-psychiatric comparison (NC) women were assessed with standard ratings of psychopathology, neurocognitive function, decisional capacity, and functional brain imaging. IP was also compared to a sample of demographically similar NCs (N=45) and persons with schizophrenia (N=42) on a set of blood-based biomarkers of aging related to metabolic function, oxidative stress, and inflammation.ResultsIP's scores on working memory, and levels of brain activation during an affective face matching task in the left fusiform, right lingual, and left precentral gyri, exceeded NCs. IP was similar to NCs in severity of negative symptoms, most neurocognitive functions, decisional capacity, and brain activation in the left inferior occipital gyrus during a selective stopping task. IP's levels on 11 of 14 metabolic and inflammatory biomarkers of aging were better than NCs and the schizophrenia group.ConclusionAlthough speculative, results suggest a possible model in which superior working memory permits a person to be aware of the potentially psychotic nature of a thought or perception, and adjust response accordingly. Compensatory overactivity of brain regions during affective processing may also reflect heightened meta-awareness in emotional situations. Biomarker levels raise the possibility that IP partially avoided the accelerated biological aging associated with schizophrenia.

OBJECTIVES:Optimizing the research consent process simultaneously fosters respect for autonomy and protection of those with diminished capacity for autonomy. This study evaluated the effectiveness of an enhanced research consent procedure, employing multimedia disclosure and corrective feedback, in improving decisional capacity among 114 people with mild-to-moderate Alzheimer's disease (AD) and 134 non-psychiatric comparison (NC) subjects. METHODS:Participants were randomized to consent type (routine versus enhanced) and protocol type (lower versus higher risk). Outcomes included a 5-item questionnaire assessing immediate comprehension, MacArthur Competence Assessment Tool for Clinical Research assessing four components of decision-making capacity, and categorical decisional capacity (based on a cut-score established in reference to expert judgments for a subset of participants). RESULTS:There was no significant effect of the enhanced consent procedure, relative to routine consent, on immediate comprehension or decisional capacity. CONCLUSIONS:Multimedia tools do not appear to be the solution to better consent for AD research. CLINICAL IMPLICATIONS:Given the ethical primacy of informed consent and issues of justice for impaired populations who might be harmed by an absence of research-based treatment advances, continued search for ways to more meaningfully engage people with AD in the consent or assent process is warranted.