Is it time for integration of surgical skills simulation into the United Kingdom undergraduate medical curriculum? A perspective from King’s College London School of Medicine

PURPOSE: Changes in undergraduate medical curricula, combined with reforms in postgraduate education, have training implications for surgical skills acquisition in a climate of reduced clinical exposure. Confidence and prior experience influences the educational impact of learning. Currently there is no basic surgical skills (BSS) programme integrated into undergraduate curricula in the United Kingdom. We explored the role of a dedicated BSS programme for undergraduates in improving confidence and influencing careers in King's College London School of Medicine, and the programme was evaluated. METHODS: A programme was designed in-line with the established Royal College of Surgeons course. Undergraduates were taught four key skills over four weeks: knot-tying, basic-suturing, tying-at-depth and chest-drain insertion, using low-fidelity bench-top models. A Likert-style questionnaire was designed to determine educational value and influence on career choice. Qualitative data was collected. RESULTS: Only 29% and 42% of students had undertaken previous practice in knot-tying and basic suturing, respectively. 96% agreed that skills exposure prior to starting surgical rotations was essential and felt a dedicated course would augment undergraduate training. There was a significant increase in confidence in the practice and knowledge of all skills taught (p<0.01), with a greater motivation to be actively involved in the surgical firm and theatres. CONCLUSION: A simple, structured BSS programme can increase the confidence and motivation of students. Early surgical skills targeting is valuable for students entering surgical, related allied, and even traditionally non-surgical specialties such as general practice. Such experience can increase the confidence of future junior doctors and trainees. We advocate the introduction of a BSS programme into United Kingdom undergraduate curricula

First examples of neutral rhenium(V) complexes with a novel semi-rigid ligand containing a P,N,N,S donor atom set: Synthesis, characterisation and crystal structure

A new PN2S ligand, N-[2-(diphenylphosphino)phenyl]-2-[(S-trityl)acetylamino]ethanamide [Ph-P(Ph2)N2S(Trt)], was synthesised and reacted with ReV precursors. The reaction of both tritylated and detritylated ligands with ReOCl3(PPh3)2 gave the same expected neutral complex [ReO{Ph-P(Ph2)N2S}] (4) in good yield. An unexpected neutral and diamagnetic species, [ReN{Ph-P(Ph2)N2S(Trt)}] (5), has been isolated during the complexation of the tritylated ligand with ReNCl2(PPh3)2. The complexes, characterized by classical spectroscopic methods and X-ray analysis for 4, are the first examples of neutral semi-rigid-PN2S rhenium(V) complexes

Intercultural Mediation and Accessibility in Heritage

This article aims to propose a strategy taking in consideration the accessibility of each European citizen to information in all its forms especially audio-visual Media and Heritage. It is known that interlingual mediators are playing a huge part in the world of Information and Communication with the involving difficulties of common core theory and training. Moreover, technology can be the ideal tool to enhance accessibility. Thus, mobile phone applications can offer sometimes both audio and visual content to Museum visitors as well as sign language and text. This part of our work clarifies the needs and the values of an adapted methodology for training.In addition, this project gives to inter-cultural mediators the opportunity to work and to research on different applications and software programs in screen-titling, dubbing, re-speaking and screen-titling for the Deaf and Hard of Hearing, audio description and to obtain a training at professional agencies as well as to present a final assistance of quality

Étude statistique et comparative de modèles conceptuels hydrologiques pour des bassins versants de la province du Québec, Canada

La description des processus de transformation des précipitations (pluie et neige) en débit dans un bassin versant passe par le choix d’un modèle hydrologique adéquat. Les modèles hydrologiques conceptuels servent à prédire les débits dans les rivières à l’aide de plusieurs paramètres, qui n’ont pas toujours une signification physique. Les débits doivent être déterminés par calibration. Le choix d’une tel modèle repose sur son efficacité, c’est-à-dire sa capacité à fournir des jeux de paramètres permettant au modèle de donner des simulations satisfaisantes. (Perrin, 2002). La validation est l’étape qui suit la calibration où on s'assure que le modèle peut faire des prédictions exactes et reproductibles en dehors de la période sur laquelle il a été calibré (Vogel, 2003). La méthode la plus courante pour valider un modèle hydrologique sur un bassin versant est d’ajuster les données simulées avec les mesures de terrain. La structure de modèle et leurs paramètres associés ne sont pas uniques. Il peut exister plusieurs représentations mathématiques, ce qui risque d’influencer la précision des résultats fournis par le modèle. Dans la plupart des applications de modèles hydrologiques, les réponses simulées du bassin versant, autres que le débit, restent internes (des variables d’état) au modèle. Ceci peut rendre discutable la validité de la description du modèle au processus interne du bassin versant. Il existe plusieurs méthodes pour valider un modèle hydrologique (Seibert, 1997) mais il n'existe pas encore de méthode ou de critère quantitatif définitif pour rejeter un modèle de bassin versant (Vogel & Sankarasubramanian, 2003). La méthode de covariance-variance proposée par Vogel offre une méthodologie quantitative pour accepter ou rejeter un modèle de bassin versant. L’objectif de cette étude est de s’assurer de la capacité du modèle à décrire les échanges dans un bassin versant. La méthode de covariance-variance est basée sur l’aptitude du modèle à représenter la covariance des données métrologiques avec les données de sortie (débit) sans passer par l’étape de calibration. La calibration du modèle génère une erreur inévitable (Vogel & Sankarasubramanian, 2003). Afin de vérifier la pertinence de la méthode de la covariance et sa fiabilité, nous l’avons appliquée sur 125 bassins hydrographiques québécois jaugés par le département de l’expertise hydraulique du Québec (DEHQ), en nous servant des modèles hydrologiques GR4J (Perrin, Michel, & Andréassian, Improvement of a parsimonious model for streamflow simulation, 2003) à quatre paramètres, qui est couplé avec le module de neige CemaNeige (Valery, 2010), HBV (Lindstrom, Johansson, Persson, Gardelin, & Bergstrom, 1997) à dix paramètres, MOHYSE (Fortin & Turcotte, 2007) à dix paramètres et HMETS (Martel, Demeester, & Brissette, HMETS- A simple and efficient model for flow forecasting, climate studies and teaching hydrological modelling, 2014) à vingt et un paramètres. Pour chaque bassin, une période de 16 ans située entre 1980 et 2015 a été sélectionnée. La démarche consiste à effectuer un grand nombre de simulations (Monte Carlo) et s’appuie sur les données observées disponibles (débits, précipitations, température…) afin d’explorer exhaustivement l’espace des valeurs acceptables de débits obtenues par les quatre modèles. Le but est de réussir à tirer l’information des données disponibles pour un bassin et d’en déduire la structure du modèle la plus adaptée. Nos résultats montrent que les modèle GR4J et HMETS ont pu établir une relation entre un ensemble de données simulées obtenues par la méthode de Monte-Carlo et l’observation pour tous les bassins, alors que les modèles hydrologiques MOHYSE et HBV n’ont pas pu établir cette relation pour la majorité des bassins versants étudiés. Ces deux derniers modèles ont représenté les bassins versants moins bien que les autres modèles

The Effects of Anthropogenic Stress on Nitrogen-Cycling Microbial Communities in Temperate and Tropical Soils

In this dissertation several research studies are discussed that characterize the effects of anthropogenic, or human-induced, stress on both ammonia-oxidizing and total bacterial soil microbial communities. The disturbances of land-use change in tropical, South American rainforests and artificial warming and nitrogen (N) fertilization in temperate, North American forests were investigated as these disturbances represent past and current disturbances caused by human landscape alteration and climate change. Initially, the response of soil ammonia-oxidizing microbial communities to land-use change from primary rainforest to pasture and, finally, back to secondary forest was determined. Next, these analyses of land-use change effects were expanded to the total bacterial community in these rainforest soils sampled annually for three years. Lastly, the effects of increasing soil temperature and N-deposition on ammonia-oxidizing microbial communities in temperate forests were characterized. Land-use change affected ammonia-oxidizing communities in tropical soils. Both the abundance of ammonia-oxidizer marker genes and their community structure shifted due to land-use changes. Interestingly, phylogenetic analyses showed that community structural changes in ammonia-oxidizing thaumarchaea are driven by a shift away from primary rainforest, old pasture, and secondary forest clusters to separate clusters for young pasture. Additionally, there was a nearly complete disappearance in young pasture, old pasture, and secondary forest sites of a thaumarchaeal ammonia-oxidizing genus, the Nitrosotalea. We found that many of the bacterial community responses to land-use change stayed consistent between land-use types across all three years, especially in regards to OTU richness and Faith\u27s phylogenetic diversity. Bacterial community turnover, or distance-decay, was significantly greater (P \u3c 0.05) in forests compared to pastures for two out of three years sampled. Lastly, two bacterial species, Rhodomicrobium udaipurense and Anaeromyxobacter dehalogens, were found to be exclusive indicator species for the pasture land-use type across all sampling time points. Finally, when investigating the effects of increasing soil temperatures and N-deposition rates on temperate forest soil N-cycling, potential N-mineralization and nitrification rates and chitinase enzyme activity showed no difference between treatments (P \u3e 0.05). Bacterial, fungal, and archaeal rRNA genes and thaumarchaeal amoA genes showed no significant difference between treatments. There were significant differences in ammonia-oxidizer community structure between control and heated plus nitrogen treatments. The majority of archaeal ammonia-oxidizer species were most closely related to Nitrosotalea and Nitrososphaera spp. However, the organic horizon in the heated plus nitrogen treatment was dominated by sequences most closely related to Nitrosopumilus maritimus. Taken together, these results can provide a conceptual foundation as to how anthropogenic stressors can alter microbial communities in tropical and temperate forests soils. These communities are critical to global biogeochemical cycling and climate regulation. By charactering how these communities respond to various anthropogenic stressors, the scientific community can begin to use this information to develop more holistic biogeochemical models to predict shifts in nutrient flow and greenhouse gas production

Unga vuxnas mobiltelefonanvändning ur ett aktivitetsperspektiv

Bakgrund: Mobiltelefonens ökade användning bland unga vuxna i samhället har visat på fysiska belastningsskador, stress och distraktion. Syfte: Att genom en litteraturstudie lyfta fram vilken betydelse mobiltelefonanvändningen har för unga vuxna ur olika aktivitetsperspektiv. Metod: Studien har gjorts i form av en allmän litteraturöversikt. Med hjälp av bestämda sökord genomfördes litteratursökning i fem olika databaser, vilket resulterade i 12 artiklar. Data analyserades genom en kvalitativ innehållsanalys. Resultat: Trots att mobiltelefonen bidrar till en större säkerhet och trygghetskänsla visar resultatet på övervägande negativa effekter på människors hälsa i form av belastningsskador, bristande koncentration- och uppmärksmhetsförmågor i trafiken samt psykiska påfrestningar. Konklusion: Eftersom studien visar att mobiltelefonanvändning utgör en hälsorisk för unga vuxna, behövs det ytterligare forskning inom detta område för att öka förståelse för hur mobilanvändning påverkar unga vuxna ur ett aktivitetsperspektiv