Bridging theory and practice : learning design for AR-based continuing professional development in a primary care setting

Background: General practitioners (GPs) are the gatekeepers of health care in most societies, serving as patients’ first point of contact. Continuing professional development (CPD) is needed for GPs to improve their competence and provide successful patient care. Information communication technologies (ICTs) are expected to be used to support effective CPD. Augmented reality (AR), as a new ICT, might have a potential as a learning tool for CPD, but it has not been explored in primary care for GPs’ CPD. Objective: The aim of this study was to determine how to design AR-based CPD to fit the learning needs of primary care physicians in their clinical practice. Methods: Multiple methods used in design-based research (DBR) were applied in this study. Semi-structured interviews were conducted to understand physicians’ CPD needs and attitudes toward AR (Study I). An integrative review was conducted to understand AR in health care education (Study II). A conceptual framework analysis method (CFAM) was used to construct the AR design framework (Study III). Based on the framework, semi-structured interviews were used to identify AR design needs with the physicians in the chosen setting (Study IV). Results: Most primary care providers accepted the idea of AR-based CPD, but their current CPD model did not help them become qualified GPs. Although the learning needs varied between physicians, they shared a need for integrated clinical competence. Our integrative review showed that AR has been investigated for various research purposes and for all levels of health professionals; however, except for a few reports supported by situation learning theory, 80 percent of the published papers lacked support from learning theories. Driven by situated, experiential, and transformative learning theories, the Mobile AR Education (MARE) framework was proposed, which included identifying learners’ personal paradigms, clarifying learning objectives (LOs), and designing AR learning environments and learning activities to develop learners’ personal paradigms with respect to domain expectations. The application of MARE has demonstrated physicians’ perspectives of AR design needs with the example of rationally using antibiotics. The guidelines, local antibiotics resistance pattern, and physicians’ personal paradigms related to diagnosis, treatment, and prescription, including the choice of drug, were the context for the design needs. Conclusions: To my knowledge, this is the first exploration of learning design for AR-based CPD through practice and theory. The main contribution of this thesis is the design of the MARE framework due to a lack of learning theories supporting the use of AR in medical education. The MARE framework as applied to the Chinese primary care setting shows the usefulness of identifying physicians’ personal paradigms in their decision-making process and their expectations for AR-based CPD to improve their personal paradigms. As a future step, AR prototypes and applications might be designed to meet these expectations

Strangers as Neighbors: How Religious Dialogue Can Help Re-Frame the Issue of Immigration

A White Paper funded by a grant from the Hagedorn Foundation and the Jesuit Conference. This project hypothesized that a faith-based perspective emphasizing humanism and the search for the common good allows for a more inclusive discursive environment, which could shift the dialogue away from the usual polarized atmosphere more commonly found in such a highly charged politicaldiscourse as immigration. Drawing on a cluster analysis and term frequency index from two focus groups held at two Catholic parishes on Long Island, New York (NY), this paper looks at common frames surrounding the topic of immigration and argues that, when framed in terms of religion and local experience, a more positiveand empathetic discussion of immigration emerges. Alternatively, when participants discussed immigration in terms of a government or institutional frame,a qualitatively more negative dialogue develops. This paper also identifies the tensions that arise for parishioners when priests introduce political issues directly into religious services. This finding indicates broader concerns among congregants related to the separation of church and state that has implications for how the Catholic Church organizes for immigration reform in the United States (US) and invites parishioners into dialogue around hotly contested social and political issues

Constituting women’s subjectivity in Cyberspace

This study looks critically at how Foucault’s notion of subject formation unfolds within the matrix of power: a dynamic complex of force relations permeating society. Moreover, it elucidates how a singular subject is constituted in its interaction with the Internet. Foucault analyses our contemporary system of power as a pastoral regime where the responsibilities of government extend from institutions to the self. How one governs one’s self is shaped by various technologies; most significant for this study are technologies of the self: how an individual constitutes herself as an embodied subject. Subjection and subjectivation distinguish technologies of the self that are imposed from society from those that come from within the individual to influence society. We considered various Web sites articulating issues around women’s concerns, deconstructing the discourses they disseminate and identifying their role in women’s subjection and subjectivation. Our reading of cyberspace underscores opportunities the Internet offers in bringing about social change, provided it is integrated within a real social context that subverts the isolating and disembodied character of the virtual. This reading also warns of the increasing difficulty of taking this opportunity as Cyberspace becomes structured by commercialism’s tight constraints

Tratamiento de la fase aguda de la enfermedad de La Peyrinie mediante extensor peneano y correlación mediante ultrasonido

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de lectura: 15-06-201

Proceso de agotamiento de las células T durante la infección crónica causada por tripanosomátidos intracelulares

La enfermedad de Chagas y la leishmaniasis, causadas por parásitos protozoarios intracelulares del orden Trypanosomatida, son consideradas dos de las enfermedades tropicales desatendidas más importantes. Estas infecciones conllevan un alto desgaste social, provocando el deterioro de la salud de un gran número de pacientes e incluso su muerte. Los linfocitos T son células fundamentales del sistema adaptativo y son los principales elementos inmunitarios para el control de estas infecciones intracelulares. La presente revisión explora los estudios y resultados obtenidos hasta la fecha del proceso de agotamiento celular durante las infecciones causadas por los parásitos Leishmania spp. y Trypanosoma cruzi. Así, se recoge que la persistente estimulación celular en respuesta a antígenos de estos patógenos conduce a un proceso de pérdida de la capacidad funcional antígeno-específica en las poblaciones de células T CD4+ y CD8+. Numerosos estudios muestran la existencia de una correlación directa entre el nivel de la co-expresión de receptores inhibitorios y la gravedad de estas patologías. Paralelamente, se detecta la pérdida de la capacidad funcional específica de antígeno de estas células T, lo que reduce su potencial linfoproliferativo y su capacidad de producir moléculas protectoras contra estas infecciones. Además, durante el curso de estas infecciones se observa un incremento de la frecuencia de células T de memoria efectora con un grado de diferenciación tardía o terminal. Este balanceo fenotípico, a su vez, afecta a la capacidad funcional de las células T aumentando el número de células con características senescentes y apoptóticas. Así, los estudios realizados hasta la fecha demuestran con certeza la existencia de un proceso de agotamiento que afecta a poblaciones clave para el control parasitario. Sin embargo, actualmente se desconoce con precisión el papel que este proceso de agotamiento juega en el agravamiento de estas patologías. Los medicamentos actuales usados para tratar estas enfermedades protozoarias revierten parcialmente este proceso de agotamiento. Así, tras el tratamiento, numerosos pacientes muestra una reducción en la expresión de receptores inhibitorios y co-expresión de los mismos. También se ha observado una mejoría en la capacidad funcional de las distintas poblaciones de células T, que podría estar relacionada con la reversión del proceso disfuncional. Sin embargo, los estudios realizados hasta la fecha en la evaluación de terapias de bloqueo de los receptores inhibitorios no han conducido a resultados prometedores. Algunos autores proponen evaluar terapias de bloqueo simultáneo de varias vías de señalización, con el fin de ampliar el conocimiento sobre esta herramienta como posible inmunoterapia de control de la infección por los mencionados parásitos. Además, se considera necesario continuar investigando sobre cómo se desencadena exactamente este proceso de agotamiento celular y en qué medida influye en la aparición de la sintomatología de los pacientes y ausencia de control de la infección.Two of the most important neglected tropical diseases, Chagas disease and leishmaniasis, are caused by protozoan intracellular parasites of the Trypanosomatida order. These infections provoke a high social burden and lead to the death of a large number of patients. The host triggers several immune mechanisms, but in the absence of adequate treatment, the infection becomes chronic and in many cases causes the appearance of serious alterations. T lymphocytes are fundamental cells of the adaptive system and are the main immune elements that orchestrate the cell-to-cell response in the context of intracellular infections. Furthermore, it has been described that continuous and persistent stimulation in response to pathogenic antigens causes loss of antigen-specific functional capacities in the T cell subsets. This process is known as exhaustion. This review explores the results to date of the exhaustion process during chronic infections caused by the trypanosomatid parasites Leishmania spp. and Trypanosoma cruzi. A large amount of evidence shows upregulation of the markers of the exhaustion process, namely, the inhibitory receptors, during these chronic infections. This increased expression is observed in both the CD4+ and CD8+ T cell populations. In parallel, with this increased expression of inhibitory receptors, the loss of antigen-specific functional capacity of these T cells is detected, reducing the lymphoproliferative potential and the ability to produce protective molecules against these parasitic infections, such as Th1- like cytokines, among others. Additionally, a positive correlation between the high coexpression of these inhibitory molecules and the severity of the pathology is demonstrated. Furthermore, T cell populations experience a phenotypic fluctuation in the course of these infections toward the predominance of effector memory subsets with a late or terminal differentiation state. This balancing in turn affects the functional capacity of the T cells and enriches the number of cells with senescent and apoptotic characteristics. Thus, it has been demonstrated the existence of an exhaustion process that affects key populations for the parasite control. However, the role of this process in the progression of the severity of these pathologies is still unknown. The current drugs used to treat these neglected diseases seem to partially reverse this exhaustion process, denoting a reduction in the high inhibitory receptor expression observed prior to chemotherapies. An improvement in the functional capacity of these T cell populations is also observed, which could be related to the reversion of the dysfunctional process. However, the efforts made to date to evaluate blocking therapies do not lead us to a promising conclusion. It will probably be necessary to test the simultaneous blockade of several pathways and to continue advancing the knowledge to verify their possible use as immunotherapy. It is therefore necessary to continue investigating how this process is triggered and to what extent it influences the appearance of the symptomatology of patients.This study was supported by the grants SAF2016-81003-R and SAF2016-80998-R from the Programa Estatal I+D+i (MINECO), the Network of Tropical Diseases Research RICET (RD16/0027/0005) and FEDER. Elena Pérez Antón was supported by PhD studentships from the FUNCCET (Fundación Canaria para el Control de las Enfermedades Tropicales)

El clima y la satisfacción laboral de los enfermeros en un nosocomio estatal de Lima, 2020

Identificar la asociación del clima y la satisfacción laboral se hace más relevante para las instituciones de salud y especialmente para los servicios de enfermería, considerando su repercusión en el desempeño, productividad y en la calidad de cuidado en el paciente. El objetivo del presente determinar la asociación entre el clima laboral percibido y la satisfacción de las enfermeras del servicio de hospitalización en un nosocomio estatal en Lima. El estudio siguió un enfoque cuantitativo, de corte transversal y de diseño correlacional. Para medir y analizar las variables en estudio se aplicaron un cuestionario de clima laboral (CL – SPC), satisfacción laboral (SL – SPC) la autora Sonia Palma Carrillo, En el caso escala de clima laboral consta de 50 ítems y para satisfacción laboral 36 ítems. La muestra de estudio estuvo conformada por 40 enfermeras del servicio de hospitalización del hospital público donde se desarrolló el estudio. Los resultados muestran que, 37.5% de las enfermeras presentan alta satisfacción laboral, 50% satisfacción media y 12,5% muestra insatisfacción. Respecto al clima laboral 55% percibe un clima laboral de nivel medio, 45% nivel alto y 5% bajo. Mediante el análisis de Tau b de Kendall se obtuvo una significancia de correlación del clima laboral y las dimensiones de satisfacción estado físico y/o confort (0,0300, 05). En general la significancia entre clima con la satisfacción laboral fue de 0,005<0,05. Se concluye que existe relación significativa entre clima laboral con la satisfacción laboral de las enfermeras de hospitalización en un nosocomio estatal en Lima, Perú

El clima y la satisfacción laboral de los enfermeros en un nosocomio estatal de Lima, 2020

Identificar la asociación del clima y la satisfacción laboral se hace más relevante para las instituciones de salud y especialmente para los servicios de enfermería, considerando su repercusión en el desempeño, productividad y en la calidad de cuidado en el paciente. El objetivo del presente determinar la asociación entre el clima laboral percibido y la satisfacción de las enfermeras del servicio de hospitalización en un nosocomio estatal en Lima. El estudio siguió un enfoque cuantitativo, de corte transversal y de diseño correlacional. Para medir y analizar las variables en estudio se aplicaron un cuestionario de clima laboral (CL – SPC), satisfacción laboral (SL – SPC) la autora Sonia Palma Carrillo, En el caso escala de clima laboral consta de 50 ítems y para satisfacción laboral 36 ítems. La muestra de estudio estuvo conformada por 40 enfermeras del servicio de hospitalización del hospital público donde se desarrolló el estudio. Los resultados muestran que, 37.5% de las enfermeras presentan alta satisfacción laboral, 50% satisfacción media y 12,5% muestra insatisfacción. Respecto al clima laboral 55% percibe un clima laboral de nivel medio, 45% nivel alto y 5% bajo. Mediante el análisis de Tau b de Kendall se obtuvo una significancia de correlación del clima laboral y las dimensiones de satisfacción estado físico y/o confort (0,0300, 05). En general la significancia entre clima con la satisfacción laboral fue de 0,005<0,05. Se concluye que existe relación significativa entre clima laboral con la satisfacción laboral de las enfermeras de hospitalización en un nosocomio estatal en Lima, Perú

The Distance Education Evolution: Issues and Case Studies

Gisela Gil-Egui is a contributing author, Online teaching, copyrights, and the need for concerted solutions (p.185-190) and with S.F. Shields, and C.M. Stewart, Certain about uncertainty: Strategies and practices for virtual teamwork in online classrooms (p.116-141). Book description: The Distance Education Evolution: Case Studies addresses issues regarding the development and design of online courses, and the implementation and evaluation of an online learning program. Several chapters include design strategies for online courses that range from the specific to the universal. Many authors address pedagogical issues from both a theoretical and applied perspective. This diverse compilation of contributions by Temple University administrators and faculty gives a comprehensive overview of the distance education experience that can serve as a guide to others interested in providing quality distance education.https://digitalcommons.fairfield.edu/communications-books/1011/thumbnail.jp

A Novel Penile Splint as Early Traction Therapy After Grafting Techniques for Peyronie's Disease.

Background Some studies showed encouraging results on the efficacy and safety of penile traction therapy after Peyronie's disease (PD) surgery. The early traction therapy (ETT) could be an effective and safe approach to minimize penile shortening in patients undergoing PD surgery. Aim To evaluate the feasibility, efficacy, and safety of a novel penile splint as ETT in patients with PD undergoing grafting techniques. Methods Patients with PD underwent plaque incision and grafting technique; at the end of the procedure, a novel penile splint (ETT) was applied to all patient. The device consisted of 2 10CH intubating stylets, self-adapted to each patient, that kept the penis stretched with the aid of non-absorbable sutures. The total expense for the materials needed to build each penile splint was less than 15 euros. This active traction was maintained for 1–3 weeks; then, we removed the stitches leaving the device on-site for a passive traction. Within 3–4 weeks from surgery, the penile splint was replaced by a standard penile traction device. Outcomes The main outcomes evaluated at 6 months included stretched penile length (SPL), penile curvature, International Index of Erectile Function-erectile function (IIEF-EF) domain, patient satisfaction, and time to first satisfactory sexual intercourse. Results A total of 46 patients were enrolled. The median preoperative IIEF-EF, penile curvature, and SPL were 27 points, 70°, and 13 cm, respectively. The median follow-up was 15 months. The median postoperative IIEF-EF was 25 points (P < .001). The median residual penile curvature was 10° (P < .001). The median postoperative SPL was 13 cm (P = .269). 8 patients (17.4%) lost 1 cm of SPL; no shortening greater than 1 cm was recorded. The median time to first satisfactory sexual intercourse and patient satisfaction score was 6 weeks and 9 points, respectively. Clinical Implications Our results could pave the way for a new line of research, which in turn could lead to an improvement in the postoperative management of the patient undergoing surgery for PD. Strength & Limitations This is the first study evaluating the ETT after PD surgery. The main limitation of this study is the lack of a randomized control group. Other weaknesses are the small sample size and the short follow-up time. Conclusion Our novel penile splint is inexpensive, easy to assemble, and adaptable to the patient. ETT using this novel device, followed by standard traction therapy, seems to be feasible, effective, and safe.pre-print449 K

A proportion of CD4+ T cells from patients with chronic Chagas disease undergo a dysfunctional process, which is partially reversed by benznidazole treatment

Background: Signs of senescence and the late stages of differentiation associated with the more severe forms of Chagas disease have been described in the Trypanosoma cruzi antigen-specific CD4+ T-cell population. However, the mechanisms involved in these functions are not fully known. To date, little is known about the possible impact of benznidazole treatment on the T. cruzi-specific functional response of CD4+ T cells. Methodology/principal findings: The functional capacity of CD4+ T cells was analyzed by cytometric assays in chronic Chagas disease patients, with indeterminate form (IND) and cardiac alterations (CCC) (25 and 15, respectively) before and after benznidazole treatment. An increase in the multifunctional capacity (expression of IFN-γ, IL-2, TNF-α, perforin and/or granzyme B) of the antigen-specific CD4+ T cells was observed in indeterminate versus cardiac patients, which was associated with the reduced coexpression of inhibitory receptors (2B4, CD160, CTLA-4, PD-1 and/or TIM-3). The functional profile of these cells shows statistically significant differences between IND and CCC (p<0.001), with a higher proportion of CD4+ T cells coexpressing 2 and 3 molecules in IND (54.4% versus 23.1% and 4.1% versus 2.4%, respectively). A significant decrease in the frequencies of CD4+ T cells that coexpress 2, 3 and 4 inhibitory receptors was observed in IND after 24-48 months of treatment (p<0.05, p<0.01 and p<0.05, respectively), which was associated with an increase in antigen-specific multifunctional activity. The IND group showed, at 9-12 months after treatment, an increase in the CD4+ T cell subset coproducing three molecules, which were mainly granzyme B+, perforin+ and IFN-γ+ (1.4% versus 4.5%). Conclusions/significance: A CD4+ T cell dysfunctional process was detected in chronic Chagas disease patients, being more exacerbated in those patients with cardiac symptoms. After short-term benznidazole treatment (9-12 months), indeterminate patients showed a significant increase in the frequency of multifunctional antigen-specific CD4+ T cells