El diseño e implementación del aprendizaje basado en problemas: ¿por qué es tan complicado?

Problem-based learning cannot easily be implemented in a curriculum without making structural changes. The most relevant of them are cultural and organizational changes. The culture change requires dealing with traditional teacher beliefs and with the consequences of professionalism in universities. A better understanding of student learning is needed to make the necessary changes. Faculty development is essential in making the shift. Organizational changes are also needed to make PBL a success. Without a clear external need to change and good leadership implementation of change is hard to achieve.El Aprendizaje basado en problemas no puede ser implementado fácilmente en el currículo sin hacer cambios estructurales. Entre ellos, los más relevantes son cambios culturales y de organización. El cambio cultural tiene que ver con las creencias tradicionales del profesorado y con las consecuencias del profesionalismo en las universidades. Se necesita una mejor comprensión del aprendizaje del estudiante para poder realizar los cambios necesarios. El desarrollo del profesorado es esencial para conseguir este cambio. También son necesarios cambios organizativos para conseguir que el ABP sea exitoso. Sin una clara y externa necesidad de cambio y un buen liderazo, la implentación del cambio es difícil de alcanzar

Aprendizaje basado en la solución de problemas: ¿por qué es tan difícil?

[EN] The article aims to provide keys to answer the question posed in the title. After contextualizing the purpose of its analysis, the author concludes that the question can be formulated in three different levels: the teachers, the programs and the organization.Many implementation problems are caused by ignoring that applying PBL has a lot more implications than introducing an electronic learning environment. PBL is not a simple application of the methodology that may be transferred to the classroom without making structural changes. The most relevant of them are the cultural and organizational changes. In order to be successful in carrying out these changes two preconditions are relevant for implementing PBL: external pressure and leadership. Finally, faculty development is underlined as relevant factor of the implementation process.[ES] El artículo pretende proporcionar claves para responder a la pregunta formulada en el título. Tras contextualizar el propósito de su análisis, el autor concluye que la pregunta puede formularse en tres niveles diferentes: el de los docentes, el de los programas y el de la organización. Muchos de los problemas surgidos en la implementación proceden de ignorar que el uso del ABP provoca un mayor número de implicaciones que la introducción de un entorno electrónico de aprendizaje. El ABP no es una simple aplicación metodológica que pueda llevarse a las aulas sin realizar cambios estructurales. Los más relevantes son el cambio cultural y el cambio organizativo. Para llevar a cabo con éxito estos cambios es preciso que se cumplan dos precondiciones: la presión exterior y el liderazgo. Finalmente hay que destacar también el desarrollo educativo con factor relevante del proceso de implementación.[FR] L’article essaie fournir les clés pour répondre à la question formulé dans le titre. Après avoir replacé le propos de son analyse, l’auteur conclus que la question peut se formuler dans trois différentes nivaux: celui des enseignantes, celui des programmes et celui de l’organisation. Beaucoup de problèmes apparus dans l’implémentation proviennent d’ignorer que l’utilisation du ABP provoque un plus grand nombre d’implications que l’introduction d’un environnement électronique d’appretissage. Le ABP n’est pas une application méthodologique simple qu’elle puisse s’emporter à la salle de clase sans avoir realisé changements structuraux. Les plus rélevants sont le changement culturel et le changement organisationnel. Pour effectuer avec success ces changements il faut que s’accomplissent deux conditions: la pression extérieure et le leadership. Pour finir, il y a que souligner aussi le développement éducatif comme le facteur remarquable du procces d’implémentation.Bouhuijs, PA. (2011). Implementing Problem Based Learning: Why is it so hard?. REDU. Revista de Docencia Universitaria. 9(1). https://doi.org/10.4995/redu.2011.6177OJS1791Barrows, H.S. & Tamblyn, R.M. (1980), Problem‐based Learning, an approach to medical education. Springer Publishing, New York.Bouhuijs, P.A.J. (1990), "Faculty development", in: Vleuten, C., van der & Wijnen, W. (eds.). Problem‐based learning: Perspectives from the Maastricht experience.Bouhuijs, P.A.J. (1989), "The maintenance of educational innovations in medical schools". In: Nooman, Z., Schmidt, H.G. & Ezzat, E. (editors), in Innovation in medical education: an evaluation of its present status, pp. 175‐188. Springer Publishing, New York.Bouhuijs P.A.J., Schmidt H.G., En Berkel H.J.M. Van, Eds. (1993), Problem‐based learning as an educational strategy. Maastricht: Network Publications.Moust, J., Bouhuijs, P.A.J. & Schmidt, H.G. (2007), El aprendizaje basado en problemas: guía del estudiante. Ediciones de la Universidad de Castilia‐La Mancha, Cuenca.LEVINE, A. (1980), Why innovation fails. State University of New York Press, Albany.Smith, M. K., Wood, W. B., Adams, W. K., Wieman, C.,Knight J. K., Guild N., And Su, T. T. (2009), "Why Peer Discussion Improves Student Performance on In‐Class Concept Questions". Science, 323, 2 January 2009: 122‐124.Towle, A. (1998), "Overcoming the barriers to implementing change in medical education", in: Jolly, B. & Rees, L. (eds.) Medical education in the millennium, pp. 225‐241. Oxford medical publications, Oxford

A comparison between patient- and physician-reported late radiation toxicity in long-term prostate cancer survivors

Simple Summary Radiotherapy is widely used as treatment for localized prostate cancer. Due to a high incidence and a good survival after treatment, a large number of prostate cancer survivors are at risk of developing late radiation toxicity. Symptoms may significantly affect quality of life; therefore, the monitoring of toxicities and evaluating their impact are increasingly important matters. Toxicities have always been assessed by physicians, but there is a growing interest in the use of questionnaires to be completed by patients themselves, so-called patient-reported outcome measures. The aim of this study was to compare both outcomes in long-term prostate cancer survivors, and to determine which outcome correlates best with a biological predictor of late radiation toxicity. In symptomatic patients, we found a low agreement; patients assigned greater severity to symptoms than the trial physician assistant did. Neither outcome correlated with the biological predictor. Consideration of both perspectives seems warranted to provide the best care. Patient-reported outcome measures (PROMs) are advocated for the monitoring of toxicity after radiotherapy. However, studies comparing physician- and patient-reported toxicity show low concordance. In this study, we compared physician- and patient-reported toxicity in long-term prostate cancer survivors after radiotherapy, and we determined the correlation with a presumable risk factor for late toxicity: gamma-H2AX foci decay ratio (FDR). Patients formerly included in a prospective study were invited to participate in this new study, comprising one questionnaire and one call with a trial physician assistant. Concordance was calculated for seven symptoms. Gamma-H2AX FDRs were determined in ex vivo irradiated lymphocytes in a previous analysis. Associations between FDR and long-term prevalence of toxicity were assessed using univariable logistic regression analyses. The 101 participants had a median follow-up period of 9 years. Outcomes were discordant in 71% of symptomatic patients; in 21%, the physician-assessed toxicity (using CTCAE) was higher, and, in 50%, the patients reported higher toxicity. We did not find a correlation between presence of toxicity at long-term follow-up and FDR. In conclusion, patients assigned greater severity to symptoms than the trial physician assistant did. Consideration of both perspectives may be warranted to provide the best care.Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Applicability of the Sustained Attention to Response Task (SART) in hypersomnolence: experience and results from a tertiary referral center

Objective/backgroundEvaluation of hypersomnolence disorders ideally includes an assessment of vigilance using the short Sustained Attention to Response Task (SART). We evaluated whether this task can differentiate between hypersomnolence disorders, whether it correlates with subjective and objective sleepiness, whether it is affected by the time of day, and symptoms of anxiety and depression.Patients/methodsWe analyzed diagnostic data of 306 individuals with hypersomnolence complaints diagnosed with narcolepsy type 1 (n=100), narcolepsy type 2 (n=20), idiopathic hypersomnia (n=49), obstructive sleep apnea (n=27) and other causes or without explanatory diagnosis (n=110). We included the Multiple Sleep Latency Test (MSLT), polysomnography, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale and SART, which were administered five times during the day (outcomes: reaction time, total, commission and omission errors).ResultsThe SART outcomes did not differ between groups when adjusted for relevant covariates. Higher ESS scores were associated with longer reaction times and more commission errors (pConclusionsThe SART quantifies disturbed vigilance, an important dimension of disorders of hypersomnolence. Results do not suggest that depressive symptoms influence SART outcomes. A practice session is advised. Testing time should be taken into account when interpreting results. We conclude that the SART does not differentiate between central disorders of hypersomnolence. It may be a helpful addition to the standard diagnostic workup and monitoring of these disorders.Paroxysmal Cerebral Disorder

Bispecific antibodies combine breadth, potency, and avidity of parental antibodies to neutralize sarbecoviruses

SARS-CoV-2 variants evade current monoclonal antibody therapies. Bispecific antibodies (bsAbs) combine the specificities of two distinct antibodies taking advantage of the avidity and synergy provided by targeting different epitopes. Here we used controlled Fab-arm exchange to produce bsAbs that neutralize SARS-CoV and SARS-CoV-2 variants, including Omicron and its subvariants, by combining potent SARS-CoV-2-specific neutralizing antibodies with broader antibodies that also neutralize SARS-CoV. We demonstrated that the parental antibodies rely on avidity for neutralization using bsAbs containing one irrelevant Fab arm. Using mass photometry to measure the formation of antibody:spike complexes, we determined that bsAbs increase binding stoichiometry compared to corresponding cocktails, without a loss of binding affinity. The heterogeneous binding pattern of bsAbs to spike, observed by negative-stain electron microscopy and mass photometry provided evidence for both intra- and inter-spike crosslinking. This study highlights the utility of cross-neutralizing antibodies for designing bivalent agents to combat circulating and future SARS-like coronaviruses

Structural conservation of Lassa virus glycoproteins and recognition by neutralizing antibodies

Lassa fever is an acute hemorrhagic fever caused by the zoonotic Lassa virus (LASV). The LASV glycoprotein complex (GPC) mediates viral entry and is the sole target for neutralizing antibodies. Immunogen design is complicated by the metastable nature of recombinant GPCs and the antigenic differences among phylogenetically distinct LASV lineages. Despite the sequence diversity of the GPC, structures of most lineages are lacking. We present the development and characterization of prefusion-stabilized, trimeric GPCs of LASV lineages II, V, and VII, revealing structural conservation despite sequence diversity. High-resolution structures and biophysical characterization of the GPC in complex with GP1-A-specific antibodies suggest their neutralization mechanisms. Finally, we present the isolation and characterization of a trimer-preferring neutralizing antibody belonging to the GPC-B competition group with an epitope that spans adjacent protomers and includes the fusion peptide. Our work provides molecular detail information on LASV antigenic diversity and will guide efforts to design pan-LASV vaccines