Bruce C. Wainman

The relative effectiveness of computer-based and traditional resources for education in anatomy

There is increasing use of computer–based resources to teach anatomy, although no study has compared computer‐based learning to traditional. In this study, we examine the effectiveness of three formats of anatomy learning: (1) a virtual reality (VR) computer‐based module, (2) a static computer‐based module providing Key Views (KV), (3) a plastic model. We conducted a controlled trial in which 60 undergraduate students had ten minutes to study the names of 20 different pelvic structures. The outcome measure was a 25 item short answer test consisting of 15 nominal and 10 functional questions, based on a cadaveric pelvis. All subjects also took a brief mental rotations test (MRT) as a measure of spatial ability, used as a covariate in the analysis. Data were analyzed with repeated measures ANOVA. The group learning from the model performed significantly better than the other two groups on the nominal questions (Model 67%; KV 40%; VR 41%, Effect size 1.19 and 1.29, respectively). There was no difference between the KV and VR groups. There was no difference between the groups on the functional questions (Model 28%; KV, 23%, VR 25%). Computer‐based learning resources appear to have significant disadvantages compared to traditional specimens in learning nominal anatomy. Consistent with previous research, virtual reality shows no advantage over static presentation of key views. Anat Sci Educ 6: 211–215.

The identification of lead ammunition as a source of lead exposure in First Nations: The use of lead isotope ratios

The use of lead shotshell to hunt water birds has been associated with lead-contamination in game meat. However, evidence illustrating that lead shotshell is a source of lead exposure in subsistence hunting groups cannot be deemed definitive. This study seeks to determine whether lead shotshell constitutes a source of lead exposure using lead isotope ratios. We examined stable lead isotope ratios for lichens, lead shotshell and bullets, and blood from residents of Fort Albany and Kashechewan First Nations, and the City of Hamilton, Ontario, Canada. Data were analyzed using ANOVA and regression analyses. ANOVA of isotope ratios for blood revealed significant differences with respect to location, but not sex. Hamilton differed from both Kashechewan and Fort Albany; however, the First Nations did not differ from each other. ANOVA of the isotope ratios for lead ammunition and lichens revealed no significant differences between lichen groups (north and south) and for the lead ammunition sources (pellets and bullets). A plot of (206)Pb/(204)Pb and (206)Pb/(207)Pb values illustrated that lichens and lead ammunition were distinct groupings and only the 95% confidence ellipse of the First Nations group overlapped that of lead ammunition. In addition, partial correlations between blood-lead levels (adjusted for age) and isotope ratios revealed significant (p<0.05) positive correlations for (206)Pb/(204)Pb and (206)Pb/(207)Pb, and a significant negative correlation for (208)Pb/(206)Pb, as predicted if leaded ammunition were the source of lead exposure. In conclusion, lead ammunition was identified as a source of lead exposure for First Nations people; however, the isotope ratios for lead shotshell pellets and bullets were indistinguishable. Thus, lead-contaminated meat from game harvested with lead bullets may also be contributing to the lead body burden.

Dissecting through barriers: A mixed‐methods study on the effect of interprofessional education in a dissection course with healthcare professional students

Healthcare delivery is reliant on a team‐based approach, and interprofessional education (IPE) provides a means by which such collaboration skills can be fostered prior to entering the workplace. IPE within healthcare programs has been associated with improved collaborative behavior, patient care and satisfaction, reduced clinical error, and diminished negative professional stereotypes. An intensive interprofessional gross anatomy dissection course was created in 2009 to facilitate IPE at McMaster University. Data were collected from five cohorts over five years to determine the influence of this IPE format on the attitudes and perceptions of students towards other health professions. Each year, 28 students from the medicine, midwifery, nursing, physicians assistant, physiotherapy, and occupational therapy programs were randomly assigned into interprofessional teams for 10 weeks. Sessions involved an anatomy and scope‐of‐practice presentation, a small‐group case‐based session, and a dissection. A before/after design measured changes in attitudes and perceptions, while focus group data elaborated on the student experience with the course. Pre‐ and postmatched data revealed significant improvements in positive professional identity, competency and autonomy, role clarity and attitudes toward other health professions. Qualitative analysis of intraprofessional focus group interviews revealed meaningful improvements in a number of areas including learning anatomy, role clarity, and attitudes towards other health professions. Anat Sci Educ 8: 305–316.

Characterization of the depth distribution of Ca, Fe and Zn in skin samples, using synchrotron micro-x-ray fluorescence (SμXRF) to help quantify in-vivo measurements of elements in the skin.

In vivo monitoring of trace and biometals in skin is normally quantified using phantoms that assume a constant elemental distribution within the skin. Layered calibration skin phantoms could potentially improve the reliability of in vivo calibration skin phantoms by better representing the actual in vivo distribution. This work investigates the micro-distribution of iron, calcium and zinc in prepared human skin samples taken from a number of locations on the body. Slices (orientation running from the skin surface into the dermis) were extracted from 18 formalin-fixed necropsy samples and scanned using the micro-XRF setup at the VESPERS beamline (Canadian Light Source). Elemental surface maps were produced using a 6×6 μm(2) beam in steps of 10 μm. Microscope images of histology slides were obtained for comparison. Statistically significant differences (p<0.01) were noted between the epidermal and dermal layers of skin for the elements examined (Ca, Fe and Zn), demonstrating the ability to clearly distinguish elemental content in each layer. Iron was consistently noted at the epidermal/dermal boundary. These results would indicate that when using phantoms to quantify elemental levels measured in the skin, note should be taken of the appropriate depth distribution.

Sonography of the Lateral Ulnar Collateral Ligament of the Elbow: Study of Cadavers and Healthy Volunteers

OBJECTIVE The purpose of this study was to assess the utility of high-resolution sonography in identification and characterization of the size and echogenicity of the lateral ulnar collateral ligament of the elbow in cadavers and healthy volunteers. SUBJECTS AND METHODS The lateral ulnar collateral ligaments of four cadaveric elbows were imaged with a high-resolution linear-array ultrasound transducer. On localization, the ligaments were injected with 0.1% methylene blue under sonographic guidance. For confirmation of identification of the ligaments, the elbows were immediately dissected to reveal the exact location of the stain. The ligaments of both elbows of 35 healthy adult volunteers were imaged. RESULTS Surgical dissection confirmed injection of methylene blue into all four cadaveric ligaments. The lateral ulnar collateral ligament was identified bilaterally over the radial head in all 35 volunteers. The mean thickness of the ligament at this point was 1.2 mm in women and men. The proximal attachment of the ligament to the humerus was well visualized bilaterally in 94.3% of volunteers. The mean thickness at this point was 1.7 mm in women and 1.6 mm in men. The distal attachment on the ulna was well visualized in 90% of elbows. The ligament was hyperechoic in relation to muscle in all volunteers. Differences in ligament measurements with regard to sex and hand dominance were not significant. Ligament thickness correlated weakly with volunteer weight, height, body mass index, and age. CONCLUSION High-resolution ultrasound imaging is accurate for identification and measurement of normal lateral ulnar collateral ligaments. Therefore, ultrasound may prove valuable in assessment of abnormal lateral ulnar collateral ligaments.

Dietary exposure of PBDEs resulting from a subsistence diet in three First Nation communities in the James Bay Region of Canada

BACKGROUND Concerns regarding the persistence, bioaccumulation, long-range transport, and adverse health effects of polybrominated dipheyl ethers (PBDEs) have recently come to light. PBDEs may potentially be of concern to indigenous (First Nations) people of Canada who subsist on traditional foods, but there is a paucity of information on this topic. OBJECTIVES AND METHODS To investigate whether the traditional diet is a major source of PBDEs in sub-Arctic First Nations populations of the Hudson Bay Lowlands (James and Hudson Bay),Ontario, Canada, a variety of tissues from wild game and fish were analyzed for PBDE content (n=147) and dietary exposure assessed and compared to the US EPA reference doses (RfDs). In addition, to examine the effect of isolation/industrialization on PBDE body burdens, the blood plasma from three First Nations (Cree Nation of Oujé-Bougoumou, Quebec; Fort Albany First Nation, Ontario; and Weenusk First Nation [Peawanuck], Ontario, Canada) were collected (n=54) and analyzed using a log-linear contingency model. RESULTS AND CONCLUSIONS The mean values of PBDEs in wild meats and fish adjusted for standard consumption values and body weight, did not exceed the US EPA RfD. Log linear modeling of the human PBDE body burden showed that PBDE body burden increases as access to manufactured goods increases. Thus, household dust from material goods containing PBDEs is likely responsible for the human exposure; the traditional First Nations diet appears to be a minor source of PBDEs.

Sonography of the Anterior Oblique Ligament of the Trapeziometacarpal Joint: A Study of Cadavers and Asymptomatic Volunteers

OBJECTIVE The purpose of this study was to evaluate the ability of ultrasound to identify and characterize the anterior oblique ligament of the thumb in cadavers and asymptomatic volunteers. SUBJECTS AND METHODS The anterior oblique ligaments of four cadaveric hands were imaged with a high-resolution transducer. The ligaments were then injected with 0.1% methylene blue using ultrasound guidance. To confirm identification of the ligament, the base of the thumb was immediately dissected, revealing the exact location of the dye. The bilateral ligaments in 40 asymptomatic adult volunteers were imaged. RESULTS Surgical dissection confirmed injection of methylene blue into all cadaveric ligaments. The proximal attachment of the anterior oblique ligament was well defined in all the hands, and the distal attachment was well defined in 94% of the hands. The mean thickness of the anterior oblique ligament at the metacarpal attachment (0.7 mm), midportion (0.98 mm), and trapezial attachment (0.65 mm) did not differ significantly with respect to sex, right and left side, or hand dominance and was weakly correlated with weight, height, body mass index, and age. The length of the ligament was statistically significantly different between the dominant (10.6 mm) and nondominant (9.6 mm) hands. The volar metacarpal translation with palmar abduction stress did not differ significantly between the dominant (0.7 mm) and nondominant (0.8 mm) hands. There was no association between the degree of translation and the biologic characteristics (weight, height, body mass index, and age). CONCLUSION High-resolution ultrasound can be used to identify and measure the thickness of the anterior oblique ligament. Dynamic ultrasound imaging can depict volar translation of the metacarpal, which may facilitate diagnosis of ligamentous injury.

The Effect of Image Quality, Repeated Study, and Assessment Method on Anatomy Learning.

The use of two‐dimensional (2D) images is consistently used to prepare anatomy students for handling real specimen. This study examined whether the quality of 2D images is a critical component in anatomy learning. The visual clarity and consistency of 2D anatomical images was systematically manipulated to produce low‐quality and high‐quality images of the human hand and human eye. On day 0, participants learned about each anatomical specimen from paper booklets using either low‐quality or high‐quality images, and then completed a comprehension test using either 2D images or three‐dimensional (3D) cadaveric specimens. On day 1, participants relearned each booklet, and on day 2 participants completed a final comprehension test using either 2D images or 3D cadaveric specimens. The effect of image quality on learning varied according to anatomical content, with high‐quality images having a greater effect on improving learning of hand anatomy than eye anatomy (high‐quality vs. low‐quality for hand anatomy P = 0.018; high‐quality vs. low‐quality for eye anatomy P = 0.247). Also, the benefit of high‐quality images on hand anatomy learning was restricted to performance on short‐answer (SA) questions immediately after learning (high‐quality vs. low‐quality on SA questions P = 0.018), but did not apply to performance on multiple‐choice (MC) questions (high‐quality vs. low‐quality on MC questions P = 0.109) or after participants had an additional learning opportunity (24 hours later) with anatomy content (high vs. low on SA questions P = 0.643). This study underscores the limited impact of image quality on anatomy learning, and questions whether investment in enhancing image quality of learning aids significantly promotes knowledge development. Anat Sci Educ 10: 249–261.

Menstrual cycle perturbation by organohalogens and elements in the Cree of James Bay, Canada

Persistent organohalogens (POHs) and metals have been linked to alterations in menstrual cycle function and fertility in humans. The Cree First Nations people living near James Bay in Ontario and Quebec, Canada, have elevated levels of POHs, mercury and lead compared to other Canadians. The present study examines the interrelationships between selected POHs and elements on menstrual cycle function in these Cree women. Menstrual cycle characteristics were derived from structured daily diaries and endocrine measurements from daily urine samples collected during one cycle for 42 women age 19-42. We measured 31 POHs in blood plasma and 18 elements in whole blood, for 31 of the participants. POHs and elements detected in ≥ 70% of the participants were transformed by principal component (PC) analysis to reduce the contaminant exposure data to fewer, uncorrelated PCA variables. Multiple regression analysis revealed that, after adjusting for confounders, PC-3 values showed significant negative association with cycle length, after adjusting for confounders (p = 0.002). PC-3 accounted for 9.2% of the variance and shows positive loadings for cadmium, selenium, and PBDE congeners 47 and 153, and a negative loading for copper. Sensitivity analysis of the model to quantify likely effect sizes showed a range of menstrual cycle length from 25.3 to 28.3 days using the lower and upper 95% confidence limits of mean measured contaminant concentrations to predict cycle length. Our observations support the hypothesis that the menstrual cycle function of these women may be altered by exposure to POHs and elements from their environment.

The superiority of three‐dimensional physical models to two‐dimensional computer presentations in anatomy learning

Although several studies (Anat Sci Educ, 8 [6], 525, 2015) have shown that computer‐based anatomy programs (three‐dimensional visualisation technology [3DVT]) are inferior to ordinary physical models (PMs), the mechanism is not clear. In this study, we explored three mechanisms: haptic feedback, transfer‐appropriate processing and stereoscopic vision.