Norman geschwind lecture: Geschwind’s lesson

Norman Geschwind had a profound effect on behavioral neurology, not only on the basis of his research and theories expressed during his lifetime, but also through the impact that he had on colleagues privileged to train under him or have their work personally influenced by him. My work falls into the latter category. Novel associations between brain function/structure and behavior characterized his professional contributions, and offer a model for those who follow in his footsteps. He correctly predicted that like aphasic disorders, developmental dyslexia might be associated with deficits in color naming expressed currently as deficits in Rapid Automatized Naming. He stimulated anatomic research regarding patterns of asymmetry and microscopic architecture leading to the establishment of the Orton Dyslexia Neuropathology Laboratory at Beth Israel Hospital, Boston. He predicted an association between autoimmune disorders and reading disorders, an association that proved to be of genetic origin. He further predicted that reading disorders, like language disorders, would be cross-cultural and, similarly, their mechanism of production would be cross-cultural, although affected perhaps by the structure of the language to be learned. His suspicion that the clinical impression of male gender preponderance in dyslexia was accurate and carried biologic significance has recently been reconfirmed by colleagues at the Mayo Clinic in Rochester, Minnesota. Finally, with respect to dyslexia, one should not be surprised that since affect is influenced by brain architecture, developmental disorders characterized by altered brain architecture might be associated with affective or other psychiatric phenomena. My own work suggests that the altered neuroanatomy in dyslexia may be accompanied by altered clinical neurophysiology, offering the possibility that in some developmental disorders, behaviors, including academic aptitude and cognitive function, might benefit from medications designed originally to lower the risk of clinical seizures. Perhaps Geschwind’s greatest lesson is to not assume that all we have been taught as dogma is truth. Rather, we must have a willingness to make clear perceptions and draw conclusions that come closer to the reality of the causal relationship between brain and behavior.     

Innovation in scheming Maslow＇s hierarchy of basic needs

Almost all schemes that have been issued by scholars or researchers to present Maslow＇s hierarchy of basic needs include a pyramid （triangle） in which the physiological needs are in the base and the self-actualization needs are in the top of the triangle. Although this scheming is inspiring to some results, basic needs have more characteristics that are significant however, this scheming is not able to inspire. Based on elaborating Maslow＇s theory and research＇s findings, this study aims to disclose weaknesses and strengths of traditional scheme （triangle）, and develop two innovated schemes of basic needs, which are more close to Maslow＇s ideas and more inspiring to realize the actuality of this hierarchy.     

Characteristics and publication patterns of theses from a Peruvian medical school

Background: Many medical schools require a student thesis before graduation. Publishing results in a peer‐reviewed journal could be an indicator of scientific value and acceptability by the scientific community. The publication pattern of theses published by medical students in Peru is unknown. The aim of this study was to assess the characteristics and publication pattern of theses in biomedical‐indexed journals conducted by medical students in a university with the highest research output in Peru. Methods: Data from registered theses between 2000 and 2003 were obtained from the university library. Publication of theses in biomedical journals was assessed in 2008 by a search strategy using PubMed, Google Scholar, LILACS, LIPECS and SciELO. Results: Four hundred and eighty‐two medical theses were registered between 2000 and 2003; 85 (17.6%) were published in biomedical‐indexed journals. Of the published theses, 28 (5.8%) were published in MEDLINE‐indexed journals, 55 (11.4%) in SciELO‐indexed journals, 61 (12.6%) in LILACS‐indexed journals and 68 (14.1%) in LIPECS‐indexed journals. Most of the published theses (80%) were in Spanish and published in Peruvian journals; and 17 theses (20%) were published in foreign journals (all of them indexed in MEDLINE). In addition, 37 (43.5%) belong primarily to internal medicine, and 24 (28.2%) belong primarily to infectious diseases. Medical students were first authors in 71 (83.5%) of the articles. Conclusion: In this study, most of the published theses were in Spanish, published in local journals and indexed in LIPECS. The percentage of published theses in biomedical journals at this university is comparable with others coming from developed countries.     

Tear osmolarity is sensitive to exercise-induced fluid loss but is not associated with common hydration measures in a field setting

This investigation (i) examined changes in tear osmolarity in response to fluid loss that occurs with exercise in a field setting, and (ii) compared tear osmolarity with common field and laboratory hydration measures. Sixty-three participants [age 27.8 ± 8.4 years, body mass 72.15 ± 10.61 kg] completed a self-paced 10 km run outside on a predetermined course. Body mass, tear fluid, venous blood and urine samples were collected immediately before and after exercise. Significant (p < 0.001) reductions in body mass (1.71 ± 0.44%) and increases in tear osmolarity (8 ± 15 mOsm.L^?1), plasma osmolality (7 ± 8 mOsm.kg^?1), and urine specific gravity (0.0014 ± 0.0042 g.mL^?1; p = 0.008) were observed following exercise. Pre- to post-exercise change in tear osmolarity was not significantly correlated (all p > 0.05) with plasma osmolality (r_s = 0.24), urine osmolality (r_s = 0.14), urine specific gravity (r_s = 0.13) or relative body mass loss (r = 0.20). Tear osmolarity is responsive to exercise-induced fluid loss but does not correlate with the changes observed using other common measures of hydration status in the field setting. Practitioners shouldn’t directly compare or replace other common hydration measures with tear osmolarity in the field.

Abbreviations: BML: Body Mass Loss; CV: Coefficient of Variation; P_osm: Plasma osmolality; SD: Standard Deviation; T_osm: Tear Osmolarity; U_osm: Urine Osmolality; USG: Urine Specific Gravity; WBGT: Wet bulb globe thermometer     

Changes in leg strength 8 and 32 h after endurance exercise

The aim of this study was to determine the effects of a single bout of endurance exercise on subsequent strength performance. Eight males with a long history of resistance training performed isokinetic, isometric and isotonic leg extension strength tests 8 and 32 h after 50 min of cycle ergometry at 70-110% of critical power. The participants also completed a control condition in which no cycling was performed. Plasma lactate and ammonia were measured before and immediately after each strength test. Isokinetic, isometric and isotonic leg extension torques were not significantly different 8 or 32 h after endurance exercise compared with the control condition (P > 0.05). A large (50.3%), but not statistically significant, increase in plasma ammonia was evident during the strength tests performed 8 h after endurance exercise, while a significant (P < 0.05) increase in ammonia was also seen 32 h after endurance exercise. No significant changes in plasma ammonia were evident in the control condition. Our results suggest that leg extension strength was not compromised by an earlier bout of endurance cycling. However, metabolic activity during the strength tests might have been altered by the preceding bout of endurance exercise.     

Use of specific IgE to fractions of gynandropsis gynandra pollen inin vitro diagnostic test

The study was aimed at presence of specific IgE antibody levelsinvitro to the identified antigen. Based on positive skin test with Gynandropsis gynandra and elevated levels of total IgE (>325 IU/ml) 104 patients were selected. Healthy, asymptomatic individuals (25) with low total IgE (<325 IU/ml) were included as controls. The mean OD values by ELISA for specific IgE were 0.67±0.21, 0.57±0.18 and 0.56±0.18 with whole pollen antigen, 46-37 kD fraction and 36-32 kD fraction, respectively. The specificity and sensitivity between skin test positivity with whole pollen antigen verses fraction with mol.wt 46-37 kD was 90% and 90% and for fraction with mol.wt 36-32 kD was found to be 81.1% and 89.4%. The clusters with molecular weights 46-37 kD and 36-32 kD may be useful inin vitro diagnostic test. Fractions within these clusters need to be identified for a higher specificity.     

Development of a validated search filter for Ovid Embase for degenerative cervical myelopathy

Background

Degenerative cervical myelopathy (DCM) is a recently proposed umbrella term for symptomatic cervical spinal cord compression secondary to degeneration of the spine. Currently literature searching for DCM is challenged by the inconsistent uptake of the term ‘DCM’ with many overlapping keywords and numerous synonyms.

Objectives

Here, we adapt our previous Ovid medline search filter for the Ovid embase database, to support comprehensive literature searching. Both embase and medline are recommended as a minimum for systematic reviews.

Methods

References contained within embase identified in our prior study formed a ‘development gold standard’ reference database (N = 220). The search filter was adapted for embase and checked against the reference database. The filter was then validated against the ‘validation gold standard’.

Results

A direct translation was not possible, as medline indexing for DCM and the keywords search field were not available in embase . We also used the ‘focus’ function to improve precision. The resulting search filter has 100% sensitivity in testing.

Discussion and Conclusion

We have developed a validated search filter capable of retrieving DCM references in embase with high sensitivity. In the absence of consistent terminology and indexing, this will support more efficient and robust evidence synthesis in the field.     

Keeping Users at the Center: Developing a Multimedia Interface for Informed Consent

Viewing “informing” as a process to protect patients and support autonomy, we undertook a user-centered design process to develop online support for informed consent in pediatric Phase I research trials. Challenges included (a) delivering accurate information to people unfamiliar with medical terminology; (b) delivering this information humanely under time constraints and heightened emotions; (c) allowing users control over the information, while ensuring availability of legally required information. We addressed these challenges through analyses of audience, task, and information design.