Elena Stark

Cocaine, crime, family history of deviance—are psychosocial correlates related to these phenomena in male cocaine abusers?

This paper examines relationships among deviant behaviors such as cocaine abuse, crime, and family history of deviance; demographics; and psychological characteristics such as aggression, sensation seeking, confidence to resist taking cocaine and risk taking tendency to use cocaine in different situations; psychiatric symptoms (e.g., depression, anxiety, obsessive-compulsiveness, somatization, attention deficit); and social characteristics such as social adjustment. The sample consisted of men, mean age 35 years, who were veterans of the armed services. Canonical correlation analysis showed three significant canonical variates: The first indicated that verbal aggression, general sensation seeking, and a problem index for situations involving urges to use cocaine were positively related to number of times arrested and negatively related to age. The second revealed that experience seeking and problem indices for situations involving urges to use cocaine and for those involving pleasant times, were positively related to last cocaine use consumption level, total lifetime grams of cocaine used, and alcohol problems of the immediate family. The third showed that verbal aggression and a problem index for risk situations for use involving pleasant times were positively related, and experience seeking was negatively related, to number of times arrested, number of times incarcerated in the previous 30 days, age, and last cocaine use level. The implications of the associations found among these variables are discussed as they pertain to prevention, treatment, and future research.

Integration of Ultrasound in Undergraduate Medical Education at the California Medical Schools A Discussion of Common Challenges and Strategies From the UMeCali Experience

Since the first medical student ultrasound electives became available more than a decade ago, ultrasound in undergraduate medical education has gained increasing popularity. More than a dozen medical schools have fully integrated ultrasound education in their curricula, with several dozen more institutions planning to follow suit. Starting in June 2012, a working group of emergency ultrasound faculty at the California medical schools began to meet to discuss barriers as well as innovative approaches to implementing ultrasound education in undergraduate medical education. It became clear that an ongoing collaborative could be formed to discuss barriers, exchange ideas, and lend support for this initiative. The group, termed Ultrasound in Medical Education, California (UMeCali), was formed with 2 main goals: to exchange ideas and resources in facilitating ultrasound education and to develop a white paper to discuss our experiences. Five common themes integral to successful ultrasound education in undergraduate medical education are discussed in this article: (1) initiating an ultrasound education program; (2) the role of medical student involvement; (3) integration of ultrasound in the preclinical years; (4) developing longitudinal ultrasound education; and (5) addressing competency.

Applying the cognitive theory of multimedia learning: an analysis of medical animations

Context  Instructional animations play a prominent role in medical education, but the degree to which these teaching tools follow empirically established learning principles, such as those outlined in the cognitive theory of multimedia learning (CTML), is unknown. These principles provide guidelines for designing animations in a way that promotes optimal cognitive processing and facilitates learning, but the application of these learning principles in current animations has not yet been investigated. A large‐scale review of existing educational tools in the context of this theoretical framework is necessary to examine if and how instructional medical animations adhere to these principles and where improvements can be made.

Evaluation of a Curricular Addition to Assist Medical Students in Specialty Selection

Early hands-on experience with surgical procedures may help medical students make better-informed choices if considering a surgical specialty. Here, we evaluate a curricular addition in surgical anatomy, formally exposing second-year students to different surgical subspecialties. Students met with surgeons for 7 weeks (one afternoon per week) and practiced surgical procedures on human cadavers with supervision. About a quarter of the participants reported a change in their top choice of specialty upon completing the course, and about half of the students reported changes in their second and third choices. At the time of graduation, 85% of those surveyed reported participation in the course impacted their final choice of specialty. These results demonstrate such a course helped medical students select a specialty during early training.

Applying the cognitive theory of multimedia learning

Context  Instructional animations play a prominent role in medical education, but the degree to which these teaching tools follow empirically established learning principles, such as those outlined in the cognitive theory of multimedia learning (CTML), is unknown. These principles provide guidelines for designing animations in a way that promotes optimal cognitive processing and facilitates learning, but the application of these learning principles in current animations has not yet been investigated. A large‐scale review of existing educational tools in the context of this theoretical framework is necessary to examine if and how instructional medical animations adhere to these principles and where improvements can be made.

Applying the cognitive theory of multimedia learning: an analysis of medical animations: Analysis of medical animations

Context  Instructional animations play a prominent role in medical education, but the degree to which these teaching tools follow empirically established learning principles, such as those outlined in the cognitive theory of multimedia learning (CTML), is unknown. These principles provide guidelines for designing animations in a way that promotes optimal cognitive processing and facilitates learning, but the application of these learning principles in current animations has not yet been investigated. A large‐scale review of existing educational tools in the context of this theoretical framework is necessary to examine if and how instructional medical animations adhere to these principles and where improvements can be made.

Extra-cardiac neural remodeling in humans with cardiomyopathy and arrhythmias

5.1 Extra-cardiac neural remodeling in humans with cardiomyopathy and arrhythmias O.A. Ajijola, J.J. Wisco, H.W. Lambert, E.M. Stark, A. Mahajan, M.C. FIshbein, K. Shivkumar (University of California, Los Angeles, CA, USA), (West Virginia University, Morgantown, WV, USA) Background: Intra-myocardial nerve sprouting after myocardial infarction is associated with ventricular arrhythmias (VAs). Whether human stellate ganglia remodel in association with cardiac pathology was unknown. The purpose of our study was to determine whether cardiac pathology is associated with remodeling of the stellate ganglia in humans. Methods and Results: Left stellate ganglia (LSG) were collected from patients undergoing sympathetic denervation for intractable ventricular arrhythmias, and from cadavers, along with intact hearts. Clinical data on patients and cadaveric subjects were reviewed extensively. We classified ganglia from normal; scarred; and non-ischemic cardiomyopathic hearts without scar as NL (n = 3); SCAR (n = 24); and NICM (n = 7), respectively. Within LSG, we measured neuronal size, density, fibrosis, synaptic density and nerve sprouting. Nerve density and sprouting were also quantified in obtained cadaveric hearts. Mean neuronal size in NL, SCAR, and NICM groups were; 320 ± 4 μm, 372 ± 10 μm, and 435± 10 μm (p= 0.002). No significant differences in neuronal density and fibrosis were present between the groups. Synaptic density in SCAR and NICM ganglia were 57.8 ± 11.2um/mm (p= 0.039) and 44.5 ± 7.9um/mm (p= 0.084) respectively, compared to the NL, 17.8 ± 7um/mm (overall p = 0.162). There were no significant differences in LSG nerve sprouting ormyocardial nerve density between the groups. In a porcinemodel of chronic infarcts, neurochemical changes were also observed in addition to increased neuronal size. Conclusions: Neuronal hypertrophy within LSG is associated with chronic cardiomyopathy in humans. Ganglionic and myocardial nerve sprouting and nerve density were not significantly different. A porcine model recapitulates these findings, and demonstrates neurochemical rmodeling. These changes may be related to increased cardiac sympathetic signaling and VAs. Further studies are needed to determine the electrophysiologic consequences of extra-cardiac neuronal remodeling in humans. doi:10.1016/j.autneu.2013.05.030