Do we assess what we set out to teach in obstetrics: An action research study

Background. Medical education empowers students to transform theoretical knowledge into practice. Assessment of knowledge, skills and attitudes determines students’ competency to practice. Assessment methods have been adapted, but not evaluated, to accommodate educational challenges. Objectives. To evaluate whether assessment criteria align with obstetrics learning outcomes. Methods. We conducted a collaborative action research study, in which we reviewed and analysed learning outcomes and assessments according to Bigg’s model of constructive alignment. Data were analysed as per levels of Bloom’s taxonomy. Results. Final-year students have two 3-week modules in obstetrics, with 75% overlap in learning outcomes and assessments. Ninety-five percent of learning outcomes were poorly defined, and 11 - 22% were inappropriately assessed. Summative assessments were comprehensive, but continuous assessments were rudimentary without clear educational benefit. There is a deficiency in assessment of clinical skills and competencies, as assessments have been adapted to accommodate patient confidentiality and increasing student numbers. The lack of good assessment practice compromises the validity of assessments, resulting in assessments that do not focus on higher levels of thinking. Conclusion. There was poor alignment between assessment and outcomes. Combining the obstetrics modules, and reviewing learning outcomes and assessments as a single entity, will improve the authenticity of assessments

Professionele aanspreeklikheid van ouditeure teenoor derdes op grond van nalatigheid

People in the professional occupations such as auditors, lawyers, architects and engineers have a duty to treat their clients with solicitude. This duty arises from the nature of their calling and from the professional service that they offer their clients. This has led to the situation where members of the professions have increasingly been held responsible for damage suffered by third parties as a result of the neglect of their professionally inherent obligation of solicitude. Fraud scandals, such as those of Enron in the USA and Masterbond, PSC Guaranteed Growth and Tigon locally, have once again caused the focus to fall upon the professional responsibility of auditors.The question that is increasingly being asked is: when and under what circumstances will an auditor be held responsible towards a third party in his professional capacity for the negligent performance of his duties? For the purposes of this article, the focus will only be placed on the responsibility of the auditor on the grounds of his duty to report in terms of section 300 of the Companies Act. The distinctive rules and also the specific application of the general principles of delict in such cases are discussed in this article

Comparison of adherence measures using claims data in the South African private health sector

Background. Medication adherence measurement is becoming increasingly important. Biological assays and markers, directly observed therapy, self-reports, pill counts and surveys have been successfully used to assess adherence under various circumstances, but may be limited by cost, ethical concerns and self-reported bias. Administrative claims data, in addition to offering a solution to these limitations, provide access to large study populations under real clinical practice situations, and in a timely and effective manner. With the wide range of adherence measures determined from claims data available – some of which have been found to be mathematically equivalent – researchers are often faced with the decision of choosing which is appropriate. An assessment of the various measures is therefore important for better understanding and to facilitate future adherence studies using administrative data.Objectives. To compare different adherence measures using data from a medicines claims database in South Africa (SA), employing montelukast for the purpose of illustration.Methods. This retrospective, cross-sectional research used data from 1 January 2006 to 31 December 2015 from a privately owned pharmaceutical benefits management (PBM) company in SA. Claims for montelukast were identified and adherence was determined using the continuous multiple-interval measure of oversupply (CMOS), compliance ratio (CR), modified medication possession ratio (MPRm), refill compliance rate (RCR), continuous single-interval measure of medication acquisition (CSA) and proportion of days covered (PDC) capped at 1. The measures were compared with the medication possession ratio (MPR) as the reference.Results. The MPR, CMOS and CR were equivalent, each yielding an adherence value of 86%. The MPRm, RCR and average CSA yielded higher adherence values of 96.9%, 117.2% and 129.0%, respectively, whereas the PDC produced a lower adherence value of 76.0%. The measures that used the entire study period as the denominator produced consistent results compared with the measures that used the difference between claims dates as denominator.Conclusions. The MPR is considered the most widely used metric to measure adherence using administrative data, but it may not always be applicable owing to the type of data available. Adherence computed using the CR, CMOS and PDC capped was found to be comparable to the MPR, and they may therefore be used as alternatives.

Endogenous orienting modulates the Simon effect: critical factors in experimental design

Responses are faster when the side of stimulus and response correspond than when they do not correspond, even if stimulus location is irrelevant to the task at hand: the correspondence, spatial compatibility effect, or Simon effect. Generally, it is assumed that an automatically generated spatial code is responsible for this effect, but the precise mechanism underlying the formation of this code is still under dispute. Two major alternatives have been proposed: the referential-coding account, which can be subdivided into a static version and an attention-centered version, and the attention-shift account. These accounts hold clear-cut predictions for attentional cuing experiments. The former would assume a Simon effect irrespective of attentional cuing in its static version, whereas the attention-centered version of the referential-coding account and the attention-shift account would predict a decreased Simon effect on validly as opposed to invalidly cued trials. However, results from previous studies are equivocal to the effects of attentional cuing on the Simon effect. We argue here that attentional cueing reliably modulates the Simon effect if some crucial experimental conditions, mostly relevant for optimizing attentional allocation, are met. Furthermore, we propose that the Simon effect may be better understood within the perspective of supra-modal spatial attention, thereby providing an explanation for observed discrepancies in the literature

Horticultural Availability and Homeowner Preferences Drive Plant Diversity and Composition in Urban Yards

Understanding the factors that influence biodiversity in urban areas is important for informing management efforts aimed at enhancing the ecosystem services in urban settings and curbing the spread of invasive introduced species. We determined the ecological and socioeconomic factors that influence patterns of plant richness, phylogenetic diversity, and composition in 133 private household yards in the Minneapolis‐Saint Paul Metropolitan area, Minnesota, USA. We compared the composition of spontaneously occurring plant species and those planted by homeowners with composition in natural areas (at the Cedar Creek Ecosystem Science Reserve) and in the horticulture pool of species available from commercial growers. Yard area and fertilizer frequency influenced species richness of the spontaneous species but expressed homeowner values did not. In contrast, the criteria that homeowners articulated as important in their management decisions, including aesthetics, wildlife, neatness and food provision, significantly predicted cultivated species richness. Strikingly, the composition of plant species that people cultivated in their yards resembled the taxonomic and phylogenetic composition of species available commercially. In contrast, the taxonomic and phylogenetic composition of spontaneous species showed high similarity to natural areas. The large fraction of introduced species that homeowners planted was a likely consequence of what was available for them to purchase. The study links the composition and diversity of yard flora to their natural and anthropogenic sources and sheds light on the human factors and values that influence the plant diversity in residential areas of a major urban system. Enhanced understanding of the influences of the sources of plants, both native and introduced, that enter urban systems and the human factors and values that influence their diversity is critical to identifying the levers to manage urban biodiversity and ecosystem services

Evaluation of Interventions in Blended Learning Using a Communication Skills Serious Game

Serious games often employ a scripted dialogue for player interaction with a virtual character. In our serious game Communicate, a domain expert develops a structured, scripted scenario as a sequence of potential interactions in an authoring tool. A player is often a student learning communication skills and a virtual character represents a person that a student talks to. In the original version of Communicate, a player `converses' with a virtual character by clicking on one of the multiple statement options. Since 2018, we perform blended learning sessions for final year computer science students using Communicate. Our goal is to improve these sessions and in this paper, we apply the action research method over three semesters to iteratively improve these blended learning sessions. In the first semester, our baseline, we conduct sessions where students play a scenario in multiple choice format. In the second semester, we enhance Communicate by enabling a student to enter open text input in an improved scenario. In the third semester, we enhance a session by incorporating peer teaching. Students fill in an evaluation survey after a session and we compare the evaluation of students from the three semesters. Results show that student ratings are significantly higher in sessions incorporating peer teaching compared to the baseline

Statistical mechanics of image restoration and error-correcting codes

We develop a statistical-mechanical formulation for image restoration and error-correcting codes. These problems are shown to be equivalent to the Ising spin glass with ferromagnetic bias under random external fields. We prove that the quality of restoration/decoding is maximized at a specific set of parameter values determined by the source and channel properties. For image restoration in mean-field system a line of optimal performance is shown to exist in the parameter space. These results are illustrated by solving exactly the infinite-range model. The solutions enable us to determine how precisely one should estimate unknown parameters. Monte Carlo simulations are carried out to see how far the conclusions from the infinite-range model are applicable to the more realistic two-dimensional case in image restoration.Comment: 20 pages, 9 figures, ReVTe

Prevalence of drug-drug interactions of antiretroviral agents in the private health care sector in South Africa

Objectives. Human immunodefiency virus (HIV) infection can be effectively treated with highly active antiretroviral therapy (HAART), requiring concomitant administration of three to four different agents, often with a high potential for drug-drug interactions (DDIs). This study aimed to determine the prevalence of possible DDIs between antiretrovirals (ARVs) themselves and other drugs. Design. Retrospective drug-utilisation study using data from from a national medicine claims database for the period 1 January to 31 December 2004. Setting. A section of the private healthcare sector in South Africa. Subjects. All ARV prescriptions (N=43482) claimed during 2004. The possible DDIs found were classified according to a clinical significant rating as described by Tatro7 (2005) in his book, “Drug Interactions – Facts and comparisons.” Results. A total of 5305882 medicine items were prescribed, of these, 1.92% (N=101 938) accounted for ARVs. Of the total number of 2595254 prescriptions, 1.68% (N=43 482), were ARVs. A total number of 18035 DDIs (81 different types) were identified, of these, 83.89%, (n=15130) were DDIs between ARVs and other drugs, while 16.11% (n=2905) were DDIs between ARVs themselves. Possible DDIs with a clinical significance level of 1 (major, n=17) and 2 (moderate, n=1436) represented 8.06% (n=1 453) of the total number of identified interactions. Conclusions. Since concomitant use of ARVs and other drugs used to treat HIV complications is increasing, there is a great need of understanding and anticipating these DDIs, overcoming them by dose adjustments and patient education by pharmacists, so that they are not life threatening to HIV/AIDS patients

Using honey to heal diabetic foot ulcers

Diabetic ulcers seem to be arrested in the inflammatory/proliferative stage of the healing process, allowing infection and inflammation to preclude healing. Antibiotic-resistant bacteria have become a major cause of infections, including diabetic foot infections. It is proposed here that the modern developments of an ancient and traditional treatment for wounds, dressing them with honey, provide the solution to the problem of getting diabetic ulcers to move on from the arrested state of healing. Honeys selected to have a high level of antibacterial activity have been shown to be very effective against antibiotic-resistant strains of bacteria in laboratory and clinical studies. The potent anti-inflammatory action of honey is also likely to play an important part in overcoming the impediment to healing that inflammation causes in diabetic ulcers, as is the antioxidant activity of honey. The action of honey in promotion of tissue regeneration through stimulation of angiogenesis and the growth of fibroblasts and epithelial cells, and its insulin-mimetic effect, would also be of benefit in stimulating the healing of diabetic ulcers. The availability of honey-impregnated dressings which conveniently hold honey in place on ulcers has provided a means of rapidly debriding ulcers and removing the bacterial burden so that good healing rates can be achieved with neuropathic ulcers. With ischemic ulcers, where healing cannot occur because of lack of tissue viability, these honey dressings keep the ulcers clean and prevent infection occurring