Virtual patient design : exploring what works and why : a grounded theory study

Objectives: Virtual patients (VPs) are online representations of clinical cases used in medical education. Widely adopted, they are well placed to teach clinical reasoning skills. International technology standards mean VPs can be created, shared and repurposed between institutions. A systematic review has highlighted the lack of evidence to support which of the numerous VP designs may be effective, and why. We set out to research the influence of VP design on medical undergraduates. Methods: This is a grounded theory study into the influence of VP design on undergraduate medical students. Following a review of the literature and publicly available VP cases, we identified important design properties. We integrated them into two substantial VPs produced for this research. Using purposeful iterative sampling, 46 medical undergraduates were recruited to participate in six focus groups. Participants completed both VPs, an evaluation and a 1-hour focus group discussion. These were digitally recorded, transcribed and analysed using grounded theory, supported by computer-assisted analysis. Following open, axial and selective coding, we produced a theoretical model describing how students learn from VPs. Results: We identified a central core phenomenon designated ‘learning from the VP’. This had four categories: VP Construction; External Preconditions; Student–VP Interaction, and Consequences. From these, we constructed a three-layer model describing the interactions of students with VPs. The inner layer consists of the student's cognitive and behavioural preconditions prior to sitting a case. The middle layer considers the VP as an ‘encoded object’, an e-learning artefact and as a ‘constructed activity’, with associated pedagogic and organisational elements. The outer layer describes cognitive and behavioural change. Conclusions: This is the first grounded theory study to explore VP design. This original research has produced a model which enhances understanding of how and why the delivery and design of VPs influence learning. The model may be of practical use to authors, institutions and researchers

Synthetic Semiotics: on modelling and simulating the \ud emergence of sign processes

Based on formal-theoretical principles about the \ud sign processes involved, we have built synthetic experiments \ud to investigate the emergence of communication based on \ud symbols and indexes in a distributed system of sign users, \ud following theoretical constraints from C.S.Peirce theory of \ud signs, following a Synthetic Semiotics approach. In this paper, we summarize these computational experiments and results regarding associative learning processes of symbolic sign modality and cognitive conditions in an evolutionary process for the emergence of either symbol-based or index-based communication

Nondeterministic State Complexity for Suffix-Free Regular Languages

We investigate the nondeterministic state complexity of basic operations for suffix-free regular languages. The nondeterministic state complexity of an operation is the number of states that are necessary and sufficient in the worst-case for a minimal nondeterministic finite-state automaton that accepts the language obtained from the operation. We consider basic operations (catenation, union, intersection, Kleene star, reversal and complementation) and establish matching upper and lower bounds for each operation. In the case of complementation the upper and lower bounds differ by an additive constant of two.Comment: In Proceedings DCFS 2010, arXiv:1008.127

Spectroscopic properties of a two-level atom interacting with a complex spherical nanoshell

Frequency shifts, radiative decay rates, the Ohmic loss contribution to the nonradiative decay rates, fluorescence yields, and photobleaching of a two-level atom radiating anywhere inside or outside a complex spherical nanoshell, i.e. a stratified sphere consisting of alternating silica and gold concentric spherical shells, are studied. The changes in the spectroscopic properties of an atom interacting with complex nanoshells are significantly enhanced, often more than two orders of magnitude, compared to the same atom interacting with a homogeneous dielectric sphere. The detected fluorescence intensity can be enhanced by 5 or more orders of magnitude. The changes strongly depend on the nanoshell parameters and the atom position. When an atom approaches a metal shell, decay rates are strongly enhanced yet fluorescence exhibits a well-known quenching. Rather contra-intuitively, the Ohmic loss contribution to the nonradiative decay rates for an atomic dipole within the silica core of larger nanoshells may be decreasing when the silica core - inner gold shell interface is approached. The quasistatic result that the radial frequency shift in a close proximity of a spherical shell interface is approximately twice as large as the tangential frequency shift appears to apply also for complex nanoshells. Significantly modified spectroscopic properties (see computer program (pending publication of this manuscript) freely available at http://www.wave-scattering.com) can be observed in a broad band comprising all (nonresonant) optical and near-infrared wavelengths.Comment: 20 pages plus 63 references and 11 figures, plain LaTex, for more information see http://www.wave-scattering.com (color of D sphere in figures 2-6 altered, minor typos corrected.