Repeated cycles of binge alcohol drinking and abstinence are key components in the development of dependence. However, the precise behavioral mechanisms underlying binge-like drinking and its consequences on striatal synaptic physiology remain unclear. In the present study, ethanol and water drinking patterns were recorded with high temporal resolution over 6 weeks of binge-like ethanol drinking using the ‘drinking in the dark' (DID) protocol. The bottle exchange occurring at the beginning of each session prompted a transient increase in the drinking rate that might facilitate the acquisition of ethanol binge-like drinking. Ethanol drinking mice also displayed a ‘front-loading' behavior, in which the highest rate of drinking was recorded during the first 15 min. This rate increased over weeks and paralleled the mild escalation of blood ethanol concentrations. GABAergic and glutamatergic transmission in the dorsal striatum were examined following DID. Spontaneous glutamatergic transmission and the density of dendritic spines were unchanged after ethanol drinking. However, the frequency of GABAA receptor-mediated inhibitory postsynaptic currents was depressed in medium spiny neurons of ethanol drinking mice. A history of ethanol drinking also increased ethanol preference and altered the acute ethanol effects on GABAergic transmission differentially in dorsolateral and dorsomedial striatum. Together, the study shows that the bottle exchange during DID promotes fast, voluntary ethanol drinking and that this intermittent pattern of ethanol drinking causes a depression of GABAergic transmission in the dorsal striatum.
Alcohol dependence/addiction is mediated by complex neural mechanisms that involve multiple brain circuits and neuroadaptive changes in a variety of neurotransmitter and neuropeptide systems. Although recent studies have provided substantial information on the neurobiological mechanisms that drive alcohol drinking behavior, significant challenges remain in understanding how alcohol-induced neuroadaptations occur and how different neurocircuits and pathways cross-talk. This review article highlights recent progress in understanding neural mechanisms of alcohol addiction from the perspectives of the development and maintenance of alcohol dependence. It provides insights on cross talks of different mechanisms and reviews the latest studies on metaplasticity, structural plasticity, interface of reward and stress pathways, and cross-talk of different neural signaling systems involved in binge-like drinking and alcohol dependence.
BackgroundPatient-centred care is an important aspect of quality health care. The learning environment may impact medical students’ adoption of patient-centred behaviours.MethodsAll medical students at a single institution received an anonymous, modified version of the Communication, Curriculum, and Culture instrument that measures patient-centredness in the training environment along three domains: role modelling, students’ experience, and support for patient-centred behaviours. We compared domain scores and individual items by class year and gender, and qualitatively analyzed responses to two additional items that asked students to describe experiences that demonstrated varying degrees of patient-centredness.ResultsYear 1 and 2 students reported greater patient-centredness than year 3 and 4 students in each domain: role modelling (p = 0.03), students’ experience (p = <0.001), and support for patient-centred behaviours (p < 0.001). Female students reported less support for patient-centred behaviours compared with male students (p = 0.03). Qualitative analysis revealed that explicit patient-centred curricula and positive role modelling fostered patient-centredness. Themes relating to low degrees of patient-centredness included negative role modelling and students being discouraged from being patient-centred.ConclusionsStudents’ perceptions of the patient-centredness of the learning environment decreased as students progressed through medical school, despite increasing exposure to patients. Qualitative analysis found that explicit patient-centred curricula cultivated patient-centred attitudes. Role modelling impacted student perceptions of patient-centredness within the learning environment.
Formative assessment has been shown to improve medical student performance and retention, but many learners lack access to formative assessments because faculty members have limited time to create such resources, and acquiring existing commercial review banks is expensive. In response, we developed a collaborative learning platform for medical student self-assessment called Osmosis (http://osmosis.org/). Osmosis is a web- and mobile-learning platform that provides free access to thousands of crowd-sourced, high-yield practice questions and explanations. The quality of these questions and resources is enhanced through a unique social rating and commenting feature. During the first year Osmosis was launched at the Johns Hopkins School of Medicine in January 2012, approximately 250 students in the first and second year classes spent over 2,400 hours answering more than 5,000 questions close to half-a-million times (∼2,000 questions answered/student). In addition, over 1,000 Creative Commons-licensed images and YouTube videos have been shared. Usage data and reception by students indicate that the platform fits well into busy schedules and that participants value its role in promoting collaboration and self-assessing knowledge gaps. We are currently developing additional features for the Osmosis platform related to knowledge retention and curricular design. Since the vast majority of questions and resources on Osmosis are shared under non-restrictive licenses, such as Creative Commons, we are making Osmosis available to peer institutions. It is our hope that more students and faculty members will benefit from, and contribute to, the Osmosis library.
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