Janice McKay

Development of a web database portfolio system with PACS connectivity for undergraduate health education and continuing professional development

Increasingly, the use of web database portfolio systems is noted in medical and health education, and for continuing professional development (CPD). However, the functions of existing systems are not always aligned with the corresponding pedagogy and hence reflection is often lost. This paper presents the development of a tailored web database portfolio system with Picture Archiving and Communication System (PACS) connectivity, which is based on the portfolio pedagogy. Following a pre-determined portfolio framework, a system model with the components of web, database and mail servers, server side scripts, and a Query/Retrieve (Q/R) broker for conversion between Hypertext Transfer Protocol (HTTP) requests and Q/R service class of Digital Imaging and Communication in Medicine (DICOM) standard, is proposed. The system was piloted with seventy-seven volunteers. A tailored web database portfolio system (http://radep.hti.polyu.edu.hk) was developed. Technological arrangements for reinforcing portfolio pedagogy include popup windows (reminders) with guidelines and probing questions of collect, select and reflect on evidence of development/experience, limitation in the number of files (evidence) to be uploaded, the Evidence Insertion functionality to link the individual uploaded artifacts with reflective writing, capability to accommodate diversity of contents and convenient interfaces for reviewing portfolios and communication. Evidence to date suggests the system supports users to build their portfolios with sound hypertext reflection under a facilitators guidance, and with reviewers to monitor students progress providing feedback and comments online in a programme-wide situation.

Pain Controlling and Cytokine-Regulating Effects of Lyprinol, a Lipid Extract of Perna canaliculus, in a Rat Adjuvant-Induced Arthritis Model

Using an adjuvant-induced arthritis rat model, we investigated the effects of a lipid extract of Perna canaliculus (Lyprinol®) on pain. Radiological examinations, as well as levels of pro- and anti-inflammatory (AI) cytokines, were measured aiming to provide independent objective data to the pain controlling investigation. We confirmed the ability of Lyprinol® to control pain at the initial phase of its administration; with similar efficacy to that observed with Naproxen. The pain scores slowly increased again in the group of rats treated with Lyprinol® after day 9–14. The Naproxen-treated rats remained pain-free while treated. Both Naproxen and Lyprinol® decreased the levels of the pro-inflammatory cytokines TNF-α and IFN-γ, and increased that of IL-10. Extra-virgin olive oil was ineffective on cytokine secretion. Rats treated with Lyprinol® were apparently cured after 1 year. This study confirms the AI efficacy of this lipid extract of P. canaliculus, its initial analgesic effect, its perfect tolerance and its long-term healing properties.

M-mode ultrasound used to detect the onset of deep muscle activity

M-mode ultrasound imaging (US) reflects motion of connective tissue within muscles. As muscle contraction is accompanied by motion of muscle tissue, M-mode US may be used to measure non-invasively the onset of deep muscle activity. Isometric hip abduction was measured on nine healthy subjects in the deep region of the gluteus medius muscle and in gluteus minimus by fine-wire electromyography (EMG) and M-mode US. Following signal transformation with the Teager-Kaiser Energy Operator, EMG and M-mode US onsets of muscle activity were computer-processed. Correlation between log-transformed EMG and M-mode high-energy onsets was higher in gluteus medius (r 0.93) than in gluteus minimus (r 0.86). M-mode high-energy onsets followed EMG onset by median 33 (IQR 53) ms in gluteus medius, and by 17 (IQR 63) ms in gluteus minimus. 4% of gluteus medius and 23% of gluteus minimus M-mode onsets were detected before EMG onset. Using a higher onset threshold reduced the rate of onsets detected before EMG but also prediction accuracy. In voluntary activation, M-mode US high-energy onsets were closely related to EMG-measured onsets, but the time interval between both measures varied. The relationship of electrical and mechanical activation onsets appears to be influenced by modifying factors which may differ between muscles.

Muscle thickness measurements to estimate gluteus medius and minimus activity levels

The clinical assessment of gluteus medius and minimus force sharing requires non-invasive measurements of individual activity levels. Do ultrasound measurements of change of muscle thickness substitute invasive electromyography (EMG)? Isometric hip abduction in 20-80% maximal voluntary isometric contraction (MVIC) was measured using dynamometry, M-mode ultrasound for gluteus medius and minimus thickness and EMG using (1) surface electrodes on gluteus medius, nxa0=xa015, (2) fine-wire electrodes in deep gluteus medius and minimus, nxa0=xa06. Gluteus medius thickened by 5.0 (SD 2.5)xa0mm at 80% MVIC while gluteus minimus thickness was constant in the surface EMG study and decreased by 1.6 (SD 1.6)xa0mm at the more ventral location in the fine-wire EMG study. Thickness change of gluteus medius enabled prediction of torque (r(2) 0.66) and of surface EMG amplitude (r(2) 0.57). Surface EMG enabled higher torque prediction (r(2) 0.84) than thickness change. Thickness change of gluteus minimus did not enable a practically relevant estimation of torque production. Ultrasound examination revealed a differential thickening behaviour of gluteus medius and minimus which enabled estimation of isometric torque production only for gluteus medius but with lower precision than surface EMG.

Separate assessment of gluteus medius and minimus: B-mode or M-mode ultrasound?

Abstract The hip abductors gluteus medius (Gmed) and minimus (Gmin) differ slightly in function and how they are affected by hip joint pathology. A separate assessment of Gmed and Gmin is feasible by ultrasound (US) imaging. B-mode and M-mode US can be used to measure muscle thickness. Two B- and two M-mode scans of Gmed and Gmin thickness were taken in relaxation on 16 asymptomatic volunteers, repeated within 4 days on 11 subjects. Three types of intra-rater reliability of muscle thickness measurements were examined: (1) within-session reliability comparing two scans from the same session, (2) between-days reliability comparing thickness from two scanning occasion within 4 days and (3) reliability of taking thickness measurements by re-measuring the same US scans after 1 week. Thickness measurements on B- and M-mode images provided ICC3,1 >0.96 for within-session reliability. ICC3,k >0.89 for between-days reliability and ICC3,1 >0.85 for re-reading the same scans were estimated. Minimal detectable changes >1.0u2009mm within-session, >2.4u2009mm between-days and >1.7u2009mm for re-reading scans indicated that small thickness changes are not detectable. The investigation suggests a slight advantage for fascia recognition in B-mode and the advantage of visual control of muscle relaxation in M-mode.