Repair and regeneration of osteochondral defects in the articular joints

People suffering from pain due to osteoarthritic or rheumatoidal changes in the joints are still waiting for a better treatment. Although some studies have achieved success in repairing small cartilage defects, there is no widely accepted method for complete repair of osteochondral defects. Also joint replacements have not yet succeeded in replacing of natural cartilage without complications. Therefore, there is room for a new medical approach, which outperforms currently used methods. The aim of this study is to show potential of using a tissue engineering approach for regeneration of osteochondral defects. The critical review of currently used methods for treatment of osteochondral defects is also provided. In this study, two kinds of hybrid scaffolds developed in Hutmacher's group have been analysed. The first biphasic scaffold consists of fibrin and PCL. The fibrin serves as a cartilage phase while the porous PCL scaffold acts as the subchondral phase. The second system comprises of PCL and PCL-TCP. The scaffolds were fabricated via fused deposition modeling which is a rapid prototyping system. Bone marrow-derived mesenchymal cells were isolated from New Zealand White rabbits, cultured in vitro and seeded into the scaffolds. Bone regenerations of the subchondral phases were quantified via micro CT analysis and the results demonstrated the potential of the porous PCL and PCL-TCP scaffolds in promoting bone healing. Fibrin was found to be lacking in this aspect as it degrades rapidly. On the other hand, the porous PCL scaffold degrades slowly hence it provides an effective mechanical support. This study shows that in the field of cartilage repair or replacement, tissue engineering may have big impact in the future. In vivo bone and cartilage engineering via combining a novel composite, biphasic scaffold technology with a MSC has been shown a high potential in the knee defect regeneration in the animal models. However, the clinical application of tissue engineering requires the future research work due to several problems, such as scaffold design, cellular delivery and implantation strategies.

The primary school as a logic machine

This paper makes a case for thinking about the primary school as a logic machine (apparatus) as a way of thinking about processes of in-school stratification. Firstly we discuss related literature on in-school stratification in primary schools, particularly as it relates to literacy learning. Secondly we explain how school reform can be thought about in terms of the idea of the machine or apparatus. In which case the processes of in-school stratification can be mapped as more than simply concerns about school organisation (such as students grouping) but also involve a politics of truth, played out in each school, that constitutes school culture and what counts as ‘good’ pedagogy. Thirdly, the chapter will focus specifically on research conducted into primary schools in the Northern Suburbs of Adelaide, one of the most educationally disadvantaged regions in Australia, as a case study of the relationship between in-school stratification and the reproduction of inequality. We will draw from more than 20 years of ethnographic work in primary school in the northern suburbs of Adelaide and provide a snapshot of a recent attempt to improve literacy achievement in a few Northern Suburbs public primary schools (SILA project). The SILA project, through diagnostic reviews, has provided a significant analysis of the challenges facing policy and practice in such challenging school contexts that also maps onto existing (inter)national research. These diagnostic reviews said ‘hard things’ that required attention by SILA schools and these included: · an over reliance on whole class, low level, routine tasks and hence a lack of challenge and rigour in the learning tasks offered to students ; · a focus on the 'code breaking' function of language at the expense of richer conceptualisations of literacy that might guide teachers’ understanding of challenging pedagogies ; · the need for substantial shifts in the culture of schools, especially unsettling deficit views of students and their communities ; · a need to provide a more ‘consistent’ approach to teaching literacy across the school; · a need to focus School Improvement Plans in order to implement a clear focus on literacy learning; and, · a need to sustain professional learning to produce new knowledge and practice . The paper will conclude with suggestions for further research and possible reform projects into the primary school as a logic machine.

Assessing clinical reasoning: A method to monitor its development in a PBL curriculum

The aim of this study was to develop and trial a method to monitor the evolution of clinical reasoning in a PBL curriculum that is suitable for use in a large medical school. Termed Clinical Reasoning Problems (CRPs), it is based on the notion that clinical reasoning is dependent on the identification and correct interpretation of certain critical clinical features. Each problem consists of a clinical scenario comprising presentation, history and physical examination. Based on this information, subjects are asked to nominate the two most likely diagnoses and to list the clinical features that they considered in formulating their diagnoses, indicating whether these features supported or opposed the nominated diagnoses. Students at different levels of medical training completed a set of 10 CRPs as well as the Diagnostic Thinking Inventory, a self-reporting questionnaire designed to assess reasoning style. Responses were scored against those of a reference group of general practitioners. Results indicate that the CRPs are an easily administered, reliable and valid assessment of clinical reasoning, able to successfully monitor its development throughout medical training. Consequently, they can be employed to assess clinical reasoning skill in individual students and to evaluate the success of undergraduate medical schools in providing effective tuition in clinical reasoning.

Elämän tiede : Tutkimus lääketieteellisestä teknologiasta, vanhemmuudesta ja perimän hallinnasta

Doctoral dissertation work in sociology examines how human heredity became a scientific, political and a personal issue in the 20th century Finland. The study focuses on the institutionalisation of rationales and technologies concerning heredity, in the context of Finnish medicine and health care. The analysis concentrates specifically on the introduction and development of prenatal screening within maternity care. The data comprises of medical articles, policy documents and committee reports, as well as popular guidebooks and health magazines. The study commences with an analysis on the early 20th century discussions on racial hygiene. It ends with an analysis on the choices given to pregnant mothers and families at present. Freedom to choose, considered by geneticists and many others as a guarantee of the ethicality of medical applications, is presented in this study as a historically, politically and scientifically constructed issue. New medical testing methods have generated new possibilities of governing life itself. However, they have also created new ethical problems. Leaning on recent historical data, the study illustrates how medical risk rationales on heredity have been asserted by the medical profession into Finnish health care. It also depicts medical professions ambivalence between maintaining the patients autonomy and utilizing for example prenatal testing according to health policy interests. Personalized risk is discussed as a result of the empirical analysis. It is indicated that increasing risk awareness amongst the public, as well as offering choices, have had unintended consequences. According to doctors, present day parents often want to control risks more than what is considered justified or acceptable. People s hopes to anticipate the health and normality of their future children have exceeded the limits offered by medicine. Individualization of the government of heredity is closely linked to a process that is termed as depolitization. The concept refers to disembedding of medical genetics from its social contexts. Prenatal screening is regarded to be based on individual choice facilitated by neutral medical knowledge. However, prenatal screening within maternity care also has its basis in health policy aims and economical calculations. Methodological basis of the study lies in Michel Foucault s writings on the history of thought, as well as in science and technology studies.

Duzentos anos de ensino médico no Brasil

Esta tese analisa o ensino médico brasileiro, nos 200 anos de existência, identificando os marcos e o contexto político, econômico, social e mundial. A metodologia escolhida foi a grounded teory (teoria fundamentada). A análise dos dados foi feita sob a luz do referencial teórico. Do levantamento quantitativo e qualitativo das escolas médicas brasileiras destacam-se distintos momentos de expansão das escolas médicas no Brasil. Registram-se, também, a evolução da criação das escolas médicas, a distribuição regional e os processos de avaliação governamental (Provão/SINAES) e da sociedade (CINAEM). Discute o papel indutor dos mecanismos de incentivos conduzidos pelo Estado, na interface da saúde e da educação. Foi detalhada a distribuição atual das 167 escolas médicas, que ofertaram 16.228 vagas no processo vestibular de 2007.

Entre crânios analógicos e imagens digitais: alguns antecedentes históricos e culturais das tecnologias de neuro-imageamento

Nos últimos anos, temos nos deparado com a difusão maciça e a popularização crescente de descrições biológicas para aspectos outrora pensados como mentais, sociais, ou relacionais. Visível em diversas arenas leigas e científicas, esta tendência freqüentemente elege o cérebro como o órgão privilegiado da sua atenção. A cada semana é divulgada uma nova localização cerebral correlacionada os mais variados aspectos comportamentais e ou de personalidade. Acompanhando este movimento, é notável o esforço intelectual e financeiro despendido nos últimos anos no campo da saúde mental, no sentido de fazer avançar pesquisas cujo foco central é a descoberta das bases neurobiológicas dos transtornos mentais. Esta tendência apontaria na direção de uma fusão entre a psiquiatria e a neurologia em uma disciplina única, de teor fisicalista, chamada por alguns de cerebrologia. Dentre os acontecimentos que serviram de alicerce para a legitimação e a popularização desta tendência, o desenvolvimento nas últimas décadas de novas técnicas e tecnologias de visualização médica, como a tomografia por emissão de pósitrons (PET scan) e a ressonância magnética funcional (fMRI), foi fundamental. Elas permitiram a construção de imagens das mais diversas categorias nosográficas construídas no campo psiquiátrico, veiculando tacitamente uma série de pressupostos e promessas. Malgrado o imaginário cultural sustentado por estas tecnologias e todo o esforço despendido nas últimas décadas no sentido de se tentar localizar os marcadores biológicos dos transtornos psiquiátricos, não há, até o presente momento, nenhum resultado conclusivo que autorize o diagnóstico por imagem de nosografias como a esquizofrenia, a depressão, e muito menos o jogo patológico. Apesar de todo o alarde midiático e dos montantes milionários direcionados para pesquisas nesta área, os resultados concretos obtidos até agora não estão livres das mais ferozes controvérsias. Entretanto, ainda que estejamos muito longe da construção de mapas precisos para as perturbações mentais é espantoso o poder de convencimento que as neuro-imagens comportam na atualidade. Os scans são exibidos como verdades visuais, ou fatos acerca das pessoas e do mundo, numa proporção muito superior aos dados que apresentam. Alguns críticos chamam este aspecto de neurorealismo, ou de retórica da auto-evidência. A intenção deste trabalho é problematizar o poder persuasivo que as neuro-imagens detém na contemporaneidade, especialmente quando utilizadas com a finalidade diagnóstica no campo da saúde mental. Se estas imagens transmitem uma ideia de neutralidade, transparência imediata e auto-evidência, este trabalho almeja inseri-las num contexto sócio-histórico, a partir do qual puderam adquirir sentido, familiaridade e valor de verdade. O ponto de partida é o de que elas estão localizadas no cruzamento de dois movimentos históricos distintos: o das ilustrações médicas, em sua relação com a produção de conhecimento objetivo; e o das pesquisas acerca da localização no córtex cerebral de comportamentos complexos e traços de personalidade. Além de estabelecer algumas condições históricas de possibilidade para a emergência de um neo-localizacionismo cerebral, mediado pelas novas tecnologias de imageamento, pretende-se enfatizar algumas descontinuidades com projetos anteriores e marcar a influência do contexto cultural da atualidade para o sucesso e poder persuasivo deste tipo de tecnologia.

Educação Médica para controle do câncer: avaliação de egressos de um curso de Medicina e a contribuição das ligas acadêmicas como mais uma estratégia de ensino

O câncer ganha cada vez mais destaque como problema de saúde pública. Desta forma, diversas estratégias somam-se com objetivo de reduzir a morbi-mortalidade associada a este conjunto de doenças. Para o pleno sucesso das políticas de controle, o profissional de saúde, em especial o médico, assume papel fundamental. Contudo, depara-se com a deficiência encontrada nos currículos das escolas médicas (EM), principalmente no que tange ao ensino de ações desenvolvidas dentro da atenção primária em saúde. No Brasil, diversos projetos genericamente denominados de Ligas Acadêmicas (LA) têm ganhado destaque como propostas para ensino, enquanto atividades extracurriculares, através da iniciativa discente. Esta dissertação tem como objetivos: (1) avaliar a capacitação de alunos de Medicina quanto a conhecimentos e práticas para prevenção, rastreamento e diagnóstico precoce das neoplasias mais frequentes no Brasil e (2) avaliar a repercussão e as propostas das LA como complementação de ensino. Foi realizada a adaptação transcultural de um questionário autopreenchível utilizado em estudos norte-americanos como instrumento para coleta de dados. Os dados foram obtidos de alunos do último ano de uma universidade pública no Rio de Janeiro. Dos 78 alunos elegíveis, 74 participaram do estudo. Destes, 87% consideram que o estudo de câncer no currículo é insuficiente. Apenas 4% souberam informar corretamente as neoplasias com protocolo de rastreamento recomendados no Brasil. Os resultados mostram que o treinamento em habilidades para o controle do câncer é fraco: quanto ao aconselhamento de pacientes, 30% receberam treinamento para orientar a cessação do tabagismo e um percentual ainda menor (15%) chegam ao final do curso sem terem sido treinados para avaliar a história nutricional dos pacientes. Em relação ao exame físico, quase 60% nunca foram treinados a realizar o exame clínico da pele, 50% terminam a graduação sem terem executado um preventivo ginecológico e quase 20% sem realizar o exame clínico das mamas. Já em relação a autopercepção, os alunos sentem-se muito mais preparados a aconselhar pacientes quanto a hábitos para prevenção do câncer. Outras variáveis estudadas (gênero, sistema de ingresso no vestibular e familiares/pessoas próximas com câncer) não afetaram o desempenho dos alunos nas dimensões avaliadas (treinamento, prática e autopercepção). Para avaliar o efeito graduação, foi utilizado um grupo controle formado por alunos do primeiro ano (n=77). Houve ganho significativo nas dimensões treinamento e prática quando comparamos os dois grupos e, numa proporção bem menor, na dimensão autopercepção. Para avaliação das LA, foi realizado um levantamento de todas as EM no Brasil que iniciaram suas atividades antes do ano de 2010 e, após relação nominal, foram identificadas aquelas com LA e com LA relacionada ao estudo do câncer. Contudo, o verdadeiro impacto destes projetos só pode ser entendido com uma análise qualitativa dos mesmos. Observa-se que, nas LA, os alunos são estimulados a desenvolver habilidades pouco abordadas nos currículos tradicionais, fundamentais para a formação profissional, como gestão, liderança, empreendedorismo, inovação, extensão universitária e construção da cidadania.

Procurement of electronic content across the UK National Health Service and Higher Education sectors. Report to JISC executive and LKDN executive.

Spink, S., Urquhart, C., Cox, A. & Higher Education Academy - Information and Computer Sciences Subject Centre. (2007). Procurement of electronic content across the UK National Health Service and Higher Education sectors. Report to JISC executive and LKDN executive. Sponsorship: JISC/LKDN

Appraisal and consequences of cadaver dissection

Abstract: First exposure to human cadaver dissection has the potential to be an actual stressor which can cause psychological trauma. This study examines the relationship between anatomy students’ experience of this potential stressor and various psychological and personal factors. Questionnaires measuring emotional reactions to cadaver dissection, coping strategies, personality and attitudes to death were administered to anatomy students at two medical schools immediately after their first exposure to human cadaver dissection. Emotional reactions to recalling this experience were assessed 4 months later. Data on these variables were obtained from 141 students. Students found the experience mostly challenging and, on average, did not report serious emotional difficulties. However, a minority of students (10/141) experienced serious adverse consequences. It is possible that the typical student who undertakes an anatomy course is already psychologically prepared for such transactions. However, low cost desensitization programs could be made available for the minority of individuals who may experience adverse reactions in this situation.

Disabled Children Negotiating School Life: Agency, Difference and Teaching Practice

This paper explores the school experiences of seven 11–14 year old disabled children, and focuses on their agency as they negotiated a complex, changing, and often challenging social world at school where “difference” was experienced in negative ways. The paper draws on ethnographic data from a wider three-year study that explores the influence of school experiences on both disabled and non-disabled children’s identity as they make the transition from primary to secondary school in regular New Zealand schools (although the focus of the present paper is only on the experiences of disabled children). The wider study considers how Maori (indigenous people of Aotearoa/New Zealand) and Pakeha (New Zealanders of NZ European descent) disabled children and their non- disabled matched peers (matched for age, gender and classroom) understand their personal identity, and how factors relating to transition (from primary to secondary school); culture; impairment (in the case of disabled children); social relationships; and school experience impact on children’s identities. Data on Maori children’s school experiences is currently being collected, and is not yet available for inclusion in this paper. On the basis of our observations in schools we will illustrate how disabled children felt and were made to feel different through an array of structural barriers such as separate provision for disabled students, and peer and teacher attitudes to diversity. However, we agree with Davis, Watson, Shakespeare and Corker’s (2003) interpretation that disabled children’s rights and participation at school are also under attack from a “deeper cultural division” (p. 205) in schools based on discourses of difference and normality. While disabled students in our study were trying to actively construct and shape their social and educational worlds, our data also show that teachers and peers have the capacity to either support or supplant these attempts to be part of the group of “all children”. We suggest that finding solutions that support disabled children’s full inclusion and participation at school requires a multi-faceted and systemic approach focused on a pedagogy for diverse learners, and on a consistent and explicitly inclusive policy framework centred on children’s rights.

Computer simulating a trial of a load-bearing implant: example of an intramedullary prosthesis

Computational modelling is becoming ever more important for obtaining regulatory approval for new medical devices. An accepted approach is to infer performance in a population from an analysis conducted for an idealised or ‘average’ patient; we present here a method for predicting the performance of an orthopaedic implant when released into a population—effectively simulating a clinical trial. Specifically we hypothesise that an analysis based on a method for predicting the performance in a population will lead to different conclusions than an analysis based on an idealised or ‘average’ patient. To test this hypothesis we use a finite element model of an intramedullary implant in a bone whose size and remodelling activity is different for each individual in the population. We compare the performance of a low Young’s modulus implant (View the MathML source) to one with a higher Young’s modulus (200 GPa). Cyclic loading is applied and failure is assumed when the migration of the implant relative to the bone exceeds a threshold magnitude. The analysis for an idealised of ‘average’ patient predicts that the lower modulus device survives longer whereas the analysis simulating a clinical trial predicts no statistically-significant tendency (p=0.77) for the low modulus device to perform better. It is concluded that population-based simulations of implant performance–simulating a clinical trial–present a very valuable opportunity for more realistic computational pre-clinical testing of medical devices.

The shifting engines of medicalization

Social scientists and other analysts have written about medicalization since at least the 1970s. Most of these studies depict the medical profession, interprofessional or organizational contests, or social movements and interest groups as the prime movers toward medicalization. This article contends that changes in medicine in the past two decades are altering the medicalization process. Using several case examples, I argue that three major changes in medical knowledge and organization have engendered an important shift in the engines that drive medicalization: biotechnology (especially the pharmaceutical industry and genetics), consumers, and managed care. Doctors are still gatekeepers for medical treatment, but their role has become more subordinate in the expansion or contraction of medicalization. Medicalization is now more driven by commercial and market interests than by professional claims-makers. The definitional center of medicalization remains constant, but the availability of new pharmaceutical and potential genetic treatments are increasingly drivers for new medical categories. This requires a shift in the sociological focus examining medicalization for the twenty-first century.

Hierarchy as a barrier to advancement for women in academic medicine

Background: Research on barriers to professional advancement for women in academic medicine has not adequately considered the role of environmental factors and how the structure of organizations affects professional advancement and work experiences. This article examines the impact of the hierarchy, including both the organization's hierarchical structure and professionals' perceptions of this structure, in medical school organization on faculty members' experience and advancement in academic medicine. Methods: As part of an inductive qualitative study of faculty in five disparate U.S. medical schools, we interviewed 96 medical faculty at different career stages and in diverse specialties, using in-depth semistructured interviews, about their perceptions about and experiences in academic medicine. Data were coded and analysis was conducted in the grounded theory tradition. Results: Our respondents saw the hierarchy of chairs, based on the indeterminate tenure of department chairs, as a central characteristic of the structure of academic medicine. Many faculty saw this hierarchy as affecting inclusion, reducing transparency in decision making, and impeding advancement. Indeterminate chair terms lessen turnover and may create a bottleneck for advancement. Both men and women faculty perceived this hierarchy, but women saw it as more consequential. Conclusions: The hierarchical structure of academic medicine has a significant impact on faculty work experiences, including advancement, especially for women. We suggest that medical schools consider alternative models of leadership and managerial styles, including fixed terms for chairs with a greater emphasis on inclusion. This is a structural reform that could increase opportunities for advancement especially for women in academic medicine. © 2010 Copyright Mary Ann Liebert, Inc.

A study of the relational aspects of the culture of academic medicine

PURPOSE: The impact of medical school culture on medical students has been well studied, but little documentation exists regarding how medical faculty experience the culture in which they work. In an ongoing project, the National Initiative on Gender, Culture and Leadership in Medicine, the authors are investigating how the existing culture of academic medical institutions supports all faculty members' ability to function at their highest potential. METHOD: The authors conducted a qualitative study of faculty in five disparate U.S. medical schools. Faculty in different career stages and diverse specialties were interviewed regarding their perceptions and experiences in academic medicine. Analysis was inductive and data driven. RESULTS: Relational aspects of the culture emerged as a central theme for both genders across all career categories. Positive relationships were most evident with patients and learners. Negative relational attributes among faculty and leadership included disconnection, competitive individualism, undervaluing of humanistic qualities, deprecation, disrespect, and the erosion of trust. CONCLUSIONS: The data suggest that serious problems exist in the relational culture and that such problems may affect medical faculty vitality, professionalism, and general productivity and are linked to retention. Efforts to create and support trusting relationships in medical schools might enhance all faculty members' efforts to optimally contribute to the clinical, education, and research missions of academic medicine. Future work will document the outcomes of a five-school collaboration to facilitate change in the culture to support the productivity of all medical faculty. © 2009 Association of American Medical Colleges.

Collaboration in academic medicine:Reflections on gender and advancement

Purpose: Collaboration in academic medicine is encouraged, yet no one has studied the environment in which faculty collaborate. The authors investigated how faculty experienced collaboration and the institutional atmosphere for collaboration. Method: In 2007, as part of a qualitative study of faculty in five disparate U.S. medical schools, the authors interviewed 96 medical faculty at different career stages and in diverse specialties, with an oversampling of women, minorities, and generalists, regarding their perceptions and experiences of collaboration in academic medicine. Data analysis was inductive and driven by the grounded theory tradition. Results: Female faculty expressed enthusiasm about the potential and process of collaboration; male faculty were more likely to focus on outcomes. Senior faculty experienced a more collaborative environment than early career faculty, who faced numerous barriers to collaboration: the hierarchy of medical academe, advancement criteria, and the lack of infrastructure supportive of collaboration. Research faculty appreciated shared ideas, knowledge, resources, and the increased productivity that could result from collaboration, but they were acutely aware that advancement requires an independent body of work, which was a major deterrent to collaboration among early career faculty. Conclusions: Academic medicine faculty have differing views on the impact and benefits of collaboration. Early career faculty face concerning obstacles to collaboration. Female faculty seemed more appreciative of the process of collaboration, which may be of importance for transitioning to a more collaborative academic environment. A reevaluation of effective benchmarks for promotion of faculty is warranted to address the often exclusive reliance on individualistic achievement. © 2009 The Association of American Medical Colleges.