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

Feasibility study of an Integrated Program for Aerospace vehicle Design (IPAD). Volume 3: Support of the design process

The user requirements for computer support of the IPAD design process are identified. The user-system interface, language, equipment, and computational requirements are considered

On O-X mode conversion in 2D inhomogeneous plasma with a sheared magnetic field

The conversion of an ordinary wave to an extraordinary wave in a 2D inhomogeneous slab model of the plasma confined by a sheared magnetic field is studied analytically.Comment: sub. to PPC

Comment on:"The effect of prehospital critical care on survival following out of hospital cardiac arrest: A prospective observational study"

We read the article “The effect of pre-hospital critical care on survival following out of hospital cardiac arrest: A prospective observational study”1 with great interest. The authors should be complimented for their effort to answer the question whether or not pre-hospital critical care teams contribute to the survival of out-of-hospital cardiac arrest (OHCA) patients. In their study, they could not demonstrate a positive association between pre-hospital critical care and survival to hospital discharge, which was their primary endpoint. Although a couple of reasons for the lack of benefit from pre-hospital critical care for OHCA are provided, we think several important explanations remain unmentioned in the article

Relativistic phase space: dimensional recurrences

We derive recurrence relations between phase space expressions in different dimensions by confining some of the coordinates to tori or spheres of radius $R$ and taking the limit as $R \to \infty$. These relations take the form of mass integrals, associated with extraneous momenta (relative to the lower dimension), and produce the result in the higher dimension.Comment: 13 pages, Latex, to appear in J Phys

Position effects influence transvection in drosophila melanogaster

Transvection is an epigenetic phenomenon wherein regulatory elements communicate between different chromosomes in trans, and is thereby dependent upon the three-dimensional organization of the genome. Transvection is best understood in Drosophila, where homologous chromosomes are closely paired in most somatic nuclei, although similar phenomena have been observed in other species. Previous data have supported that the Drosophila genome is generally permissive to enhancer action in trans, a form of transvection where an enhancer on one homolog activates gene expression from a promoter on a paired homolog. However, the capacity of different genomic positions to influence the quantitative output of transvection has yet to be addressed. To investigate this question, we employed a transgenic system that assesses and compares enhancer action in cis and in trans at defined chromosomal locations. Using the strong synthetic eye-specific enhancer GMR, we show that loci supporting strong cis-expression tend to support robust enhancer action in trans, whereas locations with weaker cis-expression show reduced transvection in a fluorescent reporter assay. Our subsequent analysis is consistent with a model wherein the chromatin state of the transgenic insertion site is a primary determinant of the degree to which enhancer action in trans will be supported, whereas other factors such as locus-specific variation in somatic homolog pairing are of less importance in influencing position effects on transvection

Asthma - is survival good enough?

Advances in asthma management, particularly the introduction of controller medication of which inhaled corticosteroids are the most important, has resulted in a steady decline in asthma mortality in most countries. This is usually accompanied by a decline in episodes of near-fatal asthma attacks and hospitalisations, and a reduction in other indicators of asthma morbidity. These gains have led to a shift in thinking on the management of asthma, away from simply preventing death and hospitalisations, toward achieving and maintaining sustained control of all clinical features

Self-force of a point charge in the space-time of a symmetric wormhole

We consider the self-energy and the self-force for an electrically charged particle at rest in the wormhole space-time. We develop general approach and apply it to two specific profiles of the wormhole throat with singular and with smooth curvature. The self-force for these two profiles is found in manifest form; it is an attractive force. We also find an expression for the self-force in the case of arbitrary symmetric throat profile. Far from the throat the self-force is always attractive.Comment: 18 pages, 3 figures Comments: corrected pdf, enlarged pape

Nonperturbative Contributions in an Analytic Running Coupling of QCD

In the framework of analytic approach to QCD the nonperturbative contributions in running coupling of strong interaction up to 4-loop order are obtained in an explicit form. For all $Q>\Lambda$ they are shown to be represented in the form of an expansion in inverse powers of Euclidean momentum squared. The expansion coefficients are calculated for different numbers of active quark flavors $n_f$ and for different number of loops taken into account. On basis of the stated expansion the effective method for precise calculation of the analytic running coupling can be developed.Comment: 9 pages, LaTeX, 1 table, 1 eps figur