Video-assisted thoracoscopic surgery （VATS） for bilateral primary spontaneous pneumothorax

Objective:To review our experience of the treatment of bilateral primary spontaneous pneumothorax (PSP) by video-assisted thoracoscopic surgery (VATS). Materials and methods: Retrospective chart review was followed by an on-clinic or telephone interview. Patients were cared for by one thoracic surgeon in four medical centers or community hospitals in Northern and Central Taiwan. Thirteen patients with bilateral PSP underwent bilateral VATS simultaneously or sequentially from July 1994 to December 2005. Results: Twelve males and one female, with age ranging from 15 to 36 years (mean 23.1 years), were treated with VATS for bilateral PSP, under the indications of bilateral pneumothoracis simultaneously (n=4) or sequentially (n=9). The interval between the first and second contra-lateral VATS procedure for non-simultaneous PSP patients ranged from 7 d to 6 years. Eleven of 13 patients (84.6%) had prominent pulmonary bullae/blebs, and underwent bullae resection with mechanical or chemical pleurodesis. The mean operative time was (45.6±18.3) min (range 25-96 min) and (120.6±28.7) min (range 84-166 min) respectively for the non-simultaneous (second VATS for the recurrence of contralateral side after first VATS) and simultaneous (bilateral VATS in one operation) procedures. There was no postoperative mortality. However, prolonged air leakage (>7 d) occurred in one patient (7.7%) who recovered after conservative treatment. The mean duration of chest tube drainage was 3.1 d and the median follow up period was 3.4 years. Conclusions: VATS is a safe and effective procedure in the treatment of bilateral PSP. Bilateral VATS is only recommended for patients with simultaneously bilateral PSP, because the incidence of recurrence, even with visible bullae, was not so high in my group and in some previous literature. Bilateral VATS in a supine position should only be used in selective cases, because of possible pleural adhesion or hidden bullae on the posterior side.     

Determining the level of inquiry in teachers' questions

The purpose of this investigation was to determine if an instrument, originally designed to classify levels of teachers' questions on the basis of logical operations, could be utilized to measure the level of inquiry present in a classroom discussion and to determine if the inquiry questioning behavior of the teacher influenced student achievement. The results of the study show that the modified classification scheme could accurately and reliably measure the inquiry level of teachers' classroom questions. The data also indicated that teachers who ask a greater proportion of high inquiry questions cause a greater change in students as measured by an achievement examination.     

Child abuse: adolescent records vs. adult recall

In a follow-up study of incarcerated Connecticut youth, 69 subjects were interviewed during young adulthood. On follow-up, 26 gave histories of abuse discrepant with histories obtained from records and interviews conducted in adolescence. Eleven subjects agreed to an additional clarification interview, at which time they were apprised of the discrepancies. Of these, eight had adolescent records indicating that abuse had occurred but denied abuse during the adult follow-up interview. The remaining three had adolescent records indicating no abuse had ever occurred, but, on follow-up, reported having been abused. The additional clarification interviews revealed that all 11 subjects with discrepant histories had, in fact, been abused. Reasons for these discrepant data and strategies to enhance the investigator's ability to obtain accurate data regarding abuse are discussed.     

The easy-to-hard effect: Transfer along the dimension of orientation in the rat

Long-Evans rats were trained on an easy simultaneous discrimination problem and then transferred to a hard discrimination problem. The discriminanda were different orientations of stripes. In Experiment I, transfer was intradimensional with stimulus generalization controlled. The easy-to-hard effect was not found. In Experiment II transfer was intradimensional and either compatible (nonreversal) or incompatible (reversal). With compatible transfer, rats trained on a prior easy problem learned the hard problem faster than rats trained only on the hard problem. Persistent negative transfer was found with incompatible transfer. Attention was not supported as underlying the easy-to-hard effect. Explanations based on specific sources of intradimensional transfer, such as stimulus generalization or adaptation level, are suggested.     

On tonal pattern perception in monkeys (Cebus apella)

The monkey’s capacity to extract tonal pattern from a sequence of tones was assessed in four subjects that had the benefit of substantial past experience in discriminating, matching, and remembering acoustic stimuli. In Experiment 1, the monkeys failed to transfer their well-established matching behavior to the matching of two structured sequences of tones that differed primarily in tonal pattern, indicating that for them tonal pattern was not a salient feature of the acoustic stimuli. Experiment 2 was an attempt to encourage tonal pattern perception by employing, within a discrimination paradigm, very simple tonal patterns and multiple exemplars of the positive and negative patterns; the transfer design, borrowed from Hulse and Cynx (1985), was a powerful one for revealing tonal pattern perception. Verifying earlier results from our laboratory, there was little in the monkeys’ transfer performance to indicate that they had extracted tonal pattern from the acoustic stimuli. Major discriminative control seemed to be vested in the first tone of each exemplar. This apparent cognitive limitation may be rather general among animals, perhaps reflecting an intimate connection between the capacity for tonal pattern perception and that for acoustically based language.     

Career Counseling for Longevity: Self-Care and Burnout Prevention Strategies for Counselor Resilience

Balancing self-care and other-care is often a struggle for career counselors and others in the helping professions. The process of caring is made up of a constant series of empathic attachments, active involvements, and felt separations. The ability to continually engage in the caring cycle is important for success. However, the constant need to re-create the cycle of caring can lead to counselor depletion and burnout. This article provides a developmental framework for assisting career counselors to avoid depleted caring while prolonging their professional longevity. The model of self-care includes recognizing the hazards of high touch work, such as limited resources and constant one-way caring. Also addressed are specific means of professional and personal sustenance, such as maximizing experiences of professional success and balancing personal wellness throughout one's career.     

The effect of concept mapping on students' anxiety and achievement in biology

The results of recent studies into the use of the concept mapping heuristic seem to demonstrate that meaningful learning results through its use in science classrooms. While this underscores the need to use more effective instructional strategies in science teaching, the issue of the intervening variable of anxiety in learning and science achievement, and the possible use of a metacognitive strategy in anxiety reduction have not been addressed. This study, therefore, sought to find out if the metacognitive strategy of concept mapping reduces anxiety and thereby enhances achievement in biology. A total of 51 (30 boys, 21 girls) senior secondary one (grade 10) students participated in this experiment. Two instruments—the Zuckerman Affect Adjective Checklist and the Biology Achievement Test—were used in pre- and posttest administrations to measure the treatment effect on anxiety and achievement, respectively. Findings support the stand that concept mapping is significantly more effective than the traditional/expository teaching strategy in enhancing learning in biology. In addition, it apparently reduces students' anxiety towards the learning of biology. A significant reduction of anxiety was noticed for male subjects.     

Curriculum Design of a Flipped Classroom to Enhance Haematology Learning

A common trend in higher education is the “flipped” classroom, which facilitates active learning during class. The flipped approach to teaching was instituted in a haematology ‘major’ class and the students’ attitudes and preferences for the teaching materials were surveyed. The curriculum design was explicit and involved four major components (1) the preparation of the students; (2) the weekly pre-class work; (3) the in-class active learning strategies and (4) closing the learning loop using formative quizzes. Each of these components is discussed in detail and was informed by sound pedagogical strategies. Several different sources of information and several freely available software tools to engage the students are discussed. Two iterations are reported here, with improved pass rate for the final examination from 47 to 48 % in the traditional class to 56–65 % in the flipped classroom approach. The majority of students (93 and 89 %) came to the class prepared, after viewing the screencasts and engaged fully with the activities within the face-to-face time. The students perceived that solving case studies (93 %) was the most beneficial activity for their learning and this was closely followed by the production of essay plans (71 %). The majority of students recommended that this approach be repeated the following year (69 and 75 %).