Diverse Integration of Simulated Patients in Medical Education for Communication, Language, and Clinical Skills in Hungary

Kata Eklics, Alexandra Csongor, Anikó Hambuch, Judit Diana Fekete Department of Languages for Biomedical Purposes and Communication, Medical School, University of Pécs, Pécs, HungaryCorrespondence: Kata Eklics, University of Pécs, 12 Szigeti út, Pécs, 7624, Hungary, Tel +36 72 536 296, Email [email protected]: Medical education and communication training has been undergoing substantial changes recently in our globalized environment. Multidisciplinary simulation-based methods worldwide focus on improving effective clinical skills including history taking, physical examination, diagnostic skills, critical thinking, therapeutic skills, and others via interactions between medical students, trainees, and patients. Recently, Hungary has joined such global trends. The first simulated patient program in Hungary was developed at the University of Pécs Medical School in 2019 to aid effective patient-interviewing skills in language and communication classes. Under the supervision of linguists, communication specialists and medical professionals, the multidisciplinary program uses lay people to perform as simulated patients while using the languages of Hungarian, German, and English. Our simulated patient program plays a specific role in supporting students to learn languages for medical purposes, aiming to prepare them for handling the medical, linguistic, at the same, time emotional and sociocultural difficulties encountered while taking patient histories. Medical and linguistic experts evaluate student performance, provide feedback, and give tailored instruction so that students can advance their communicative and professional skills. This study discusses working formats and the role of constructive feedback exploring potential advantages and disadvantages, sharing ideas, and proposing recommendations on language- and communication-based integration of simulated patients. In our elective communication courses, undergraduate medical students learn to cope with a variety of patient situations through practicing medical emergencies, misunderstandings, and disagreements in a safe atmosphere provided by the MediSkillsLab. Among the benefits, we should emphasize that any course with a growing number of students can be accommodated by carefully designing the program, which allows for interprofessional collaboration. This program contributes to higher-quality medical education, promoting more skilled and compassionate healthcare specialists.Keywords: simulation, interprofessional medical communication, feedback, clinical skill

Preference-Based Monte Carlo Tree Search

Monte Carlo tree search (MCTS) is a popular choice for solving sequential anytime problems. However, it depends on a numeric feedback signal, which can be difficult to define. Real-time MCTS is a variant which may only rarely encounter states with an explicit, extrinsic reward. To deal with such cases, the experimenter has to supply an additional numeric feedback signal in the form of a heuristic, which intrinsically guides the agent. Recent work has shown evidence that in different areas the underlying structure is ordinal and not numerical. Hence erroneous and biased heuristics are inevitable, especially in such domains. In this paper, we propose a MCTS variant which only depends on qualitative feedback, and therefore opens up new applications for MCTS. We also find indications that translating absolute into ordinal feedback may be beneficial. Using a puzzle domain, we show that our preference-based MCTS variant, wich only receives qualitative feedback, is able to reach a performance level comparable to a regular MCTS baseline, which obtains quantitative feedback.Comment: To be publishe

Visibility Representations of Boxes in 2.5 Dimensions

We initiate the study of 2.5D box visibility representations (2.5D-BR) where vertices are mapped to 3D boxes having the bottom face in the plane $z=0$ and edges are unobstructed lines of sight parallel to the $x$- or $y$-axis. We prove that: $(i)$ Every complete bipartite graph admits a 2.5D-BR; $(ii)$ The complete graph $K_n$ admits a 2.5D-BR if and only if $n \leq 19$; $(iii)$ Every graph with pathwidth at most $7$ admits a 2.5D-BR, which can be computed in linear time. We then turn our attention to 2.5D grid box representations (2.5D-GBR) which are 2.5D-BRs such that the bottom face of every box is a unit square at integer coordinates. We show that an $n$-vertex graph that admits a 2.5D-GBR has at most $4n - 6 \sqrt{n}$ edges and this bound is tight. Finally, we prove that deciding whether a given graph $G$ admits a 2.5D-GBR with a given footprint is NP-complete. The footprint of a 2.5D-BR $\Gamma$ is the set of bottom faces of the boxes in $\Gamma$.Comment: Appears in the Proceedings of the 24th International Symposium on Graph Drawing and Network Visualization (GD 2016

Social Inequalities of Functioning and Perceived Health in Switzerland–A Representative Cross-Sectional Analysis

Many people worldwide live with a disability, i.e. limitations in functioning. The prevalence is expected to increase due to demographic change and the growing importance of non-communicable disease and injury. To date, many epidemiological studies have used simple dichotomous measures of disability, even though the WHO's International Classification of Functioning, Disability, and Health (ICF) provides a multi-dimensional framework of functioning. We aimed to examine associations of socio-economic status (SES) and social integration in 3 core domains of functioning (impairment, pain, limitations in activity and participation) and perceived health. We conducted a secondary analysis of representative cross-sectional data of the Swiss Health Survey 2007 including 10,336 female and 8,424 male Swiss residents aged 15 or more. Guided by a theoretical ICF-based model, 4 mixed effects Poisson regressions were fitted in order to explain functioning and perceived health by indicators of SES and social integration. Analyses were stratified by age groups (15–30, 31–54, ≥55 years). In all age groups, SES and social integration were significantly associated with functional and perceived health. Among the functional domains, impairment and pain were closely related, and both were associated with limitations in activity and participation. SES, social integration and functioning were related to perceived health. We found pronounced social inequalities in functioning and perceived health, supporting our theoretical model. Social factors play a significant role in the experience of health, even in a wealthy country such as Switzerland. These findings await confirmation in other, particularly lower resourced settings

Análise física e morfológica do efeito de diferentes concentrações de adesivo no recobrimento de sementes de capim ramirez (Paspalum guenoarum).

O objetivo deste trabalho foi avaliar a eficiência do recobrimento nas sementes de Paspalum guenoarum, utilizando diferentes concentrações de adesivo, a fim de melhorar a qualidade das sementes e tornar mais viável sua utilização.CIC

A mathematical model of quorum sensing regulated EPS production in biofilm communities

<p>Abstract</p> <p>Background</p> <p>Biofilms are microbial communities encased in a layer of extracellular polymeric substances (EPS). The EPS matrix provides several functional purposes for the biofilm, such as protecting bacteria from environmental stresses, and providing mechanical stability. Quorum sensing is a cell-cell communication mechanism used by several bacterial taxa to coordinate gene expression and behaviour in groups, based on population densities.</p> <p>Model</p> <p>We mathematically model quorum sensing and EPS production in a growing biofilm under various environmental conditions, to study how a developing biofilm impacts quorum sensing, and conversely, how a biofilm is affected by quorum sensing-regulated EPS production. We investigate circumstances when using quorum-sensing regulated EPS production is a beneficial strategy for biofilm cells.</p> <p>Results</p> <p>We find that biofilms that use quorum sensing to induce increased EPS production do not obtain the high cell populations of low-EPS producers, but can rapidly increase their volume to parallel high-EPS producers. Quorum sensing-induced EPS production allows a biofilm to switch behaviours, from a colonization mode (with an optimized growth rate), to a protection mode.</p> <p>Conclusions</p> <p>A biofilm will benefit from using quorum sensing-induced EPS production if bacteria cells have the objective of acquiring a thick, protective layer of EPS, or if they wish to clog their environment with biomass as a means of securing nutrient supply and outcompeting other colonies in the channel, of their own or a different species.</p

Metabolomics Reveals Metabolic Biomarkers of Crohn's Disease

The causes and etiology of Crohn's disease (CD) are currently unknown although both host genetics and environmental factors play a role. Here we used non-targeted metabolic profiling to determine the contribution of metabolites produced by the gut microbiota towards disease status of the host. Ion Cyclotron Resonance Fourier Transform Mass Spectrometry (ICR-FT/MS) was used to discern the masses of thousands of metabolites in fecal samples collected from 17 identical twin pairs, including healthy individuals and those with CD. Pathways with differentiating metabolites included those involved in the metabolism and or synthesis of amino acids, fatty acids, bile acids and arachidonic acid. Several metabolites were positively or negatively correlated to the disease phenotype and to specific microbes previously characterized in the same samples. Our data reveal novel differentiating metabolites for CD that may provide diagnostic biomarkers and/or monitoring tools as well as insight into potential targets for disease therapy and prevention

Development of an online SPE–LC–MS-based assay using endogenous substrate for investigation of soluble epoxide hydrolase (sEH) inhibitors

Soluble epoxide hydrolase (sEH) is a promising therapeutic target for the treatment of hypertension, pain, and inflammation-related diseases. In order to enable the development of sEH inhibitors (sEHIs), assays are needed for determination of their potency. Therefore, we developed a new method utilizing an epoxide of arachidonic acid (14(15)-EpETrE) as substrate. Incubation samples were directly injected without purification into an online solid phase extraction (SPE) liquid chromatography electrospray ionization tandem mass spectrometry (LC–ESI–MS–MS) setup allowing a total run time of only 108 s for a full gradient separation. Analytes were extracted from the matrix within 30 s by turbulent flow chromatography. Subsequently, a full gradient separation was carried out on a 50X2.1 mm RP-18 column filled with 1.7 μm core–shell particles. The analytes were detected with high sensitivity by ESI–MS–MS in SRM mode. The substrate 14(15)-EpETrE eluted at a stable retention time of 96 ± 1 s and its sEH hydrolysis product 14,15-DiHETrE at 63 ± 1 s with narrow peak width (full width at half maximum height: 1.5 ± 0.1 s). The analytical performance of the method was excellent, with a limit of detection of 2 fmol on column, a linear range of over three orders of magnitude, and a negligible carry-over of 0.1% for 14,15-DiHETrE. The enzyme assay was carried out in a 96-well plate format, and near perfect sigmoidal dose–response curves were obtained for 12 concentrations of each inhibitor in only 22 min, enabling precise determination of IC50 values. In contrast with other approaches, this method enables quantitative evaluation of potent sEHIs with picomolar potencies because only 33 pmol L−1 sEH were used in the reaction vessel. This was demonstrated by ranking ten compounds by their activity; in the fluorescence method all yielded IC50 ≤ 1 nmol L−1. Comparison of 13 inhibitors with IC50 values >1 nmol L−1 showed a good correlation with the fluorescence method (linear correlation coefficient 0.9, slope 0.95, Spearman’s rho 0.9). For individual compounds, however, up to eightfold differences in potencies between this and the fluorescence method were obtained. Therefore, enzyme assays using natural substrate, as described here, are indispensable for reliable determination of structure–activity relationships for sEH inhibition

Nutrient intakes and nutritional biomarkers in pregnant adolescents: a systematic review of studies in developed countries

Background: Babies born to adolescent mothers have been shown to have poorer outcomes compared to those born to adults. Nutritional status may have an important role to play in improving the health of pregnant adolescents; however there is a lack of evidence regarding the adequacy of adolescent diets during pregnancy. This systematic review aims to examine what is known about the nutritional status of adolescent pregnant women. Methods: A systematic search of the literature identified 21 studies which met the inclusion criteria for the review. Primary research papers using any methods were included where they were published in English between January 1995 and May 2015 and included measurements of nutrient intakes or biological markers of nutritional status in pregnant women aged 11-19 years. Individual study data was first summarised narratively before study means were pooled to give an estimate of nutritional status in the population. Results: The results show that individual studies reported intakes of energy, fibre and a number of key micronutrients which were below recommended levels. Biological markers of iron and selenium status also showed cause for concern. Pooled analysis of individual means as a percentage of UK Dietary Reference Intakes showed intakes of vitamin D (34.8 % CI 0-83.1) to be significantly below recommendations (p=0.05). Serum selenium levels were also found to be low (61.8 μg/L, CI 39-84). Conclusions: This review has identified a number of areas where the nutritional status of pregnant adolescents is sub-optimal, which may have implications for the health of adolescent mothers and their babies. It was not however possible to examine the impact of supplement use or socio-demographic characteristics which limits the interpretation these results. Further work is needed to establish the characteristics of those most at risk within this population, how this differs from adult pregnant women and the role of supplementation in achieving adequate nutrition