526 research outputs found
NURSE DELIVERED FOCUSED ECHOCARDIOGRAPHY TO DETERMINE INTRAVASCULAR VOLUME STATUS IN A DEPLOYED MARITIME CRITICAL CARE UNIT
Team Objective Structured Bedside Assessment (TOSBA) as formative assessment in undergraduate Obstetrics and Gynaecology: a cohort study.
BACKGROUND: Team Objective Structured Bedside Assessment (TOSBA) is a learning approach in which a team of medical students undertake a set of structured clinical tasks with real patients in order to reach a diagnosis and formulate a management plan and receive immediate feedback on their performance from a facilitator. TOSBA was introduced as formative assessment to an 8-week undergraduate teaching programme in Obstetrics and Gynaecology (O\u26G) in 2013/14. Each student completed 5 TOSBA sessions during the rotation. The aim of the study was to evaluate TOSBA as a teaching method to provide formative assessment for medical students during their clinical rotation. The research questions were: Does TOSBA improve clinical, communication and/or reasoning skills? Does TOSBA provide quality feedback?
METHODS: A prospective cohort study was conducted over a full academic year (2013/14). The study used 2 methods to evaluate TOSBA as a teaching method to provide formative assessment: (1) an online survey of TOSBA at the end of the rotation and (2) a comparison of the student performance in TOSBA with their performance in the final summative examination.
RESULTS: During the 2013/14 academic year, 157 students completed the O\u26G programme and the final summative examination . Each student completed the required 5 TOSBA tasks. The response rate to the student survey was 68 % (n = 107/157). Students reported that TOSBA was a beneficial learning experience with a positive impact on clinical, communication and reasoning skills. Students rated the quality of feedback provided by TOSBA as high. Students identified the observation of the performance and feedback of other students within their TOSBA team as key features. High achieving students performed well in both TOSBA and summative assessments. The majority of students who performed poorly in TOSBA subsequently passed the summative assessments (n = 20/21, 95 %). Conversely, the majority of students who failed the summative assessments had satisfactory scores in TOSBA (n = 6/7, 86 %).
CONCLUSIONS: TOSBA has a positive impact on the clinical, communication and reasoning skills of medical students through the provision of high-quality feedback. The use of structured pre-defined tasks, the observation of the performance and feedback of other students and the use of real patients are key elements of TOSBA. Avoiding student complacency and providing accurate feedback from TOSBA are on-going challenges
Heating in the MRI environment due to superparamagnetic fluid suspensions in a rotating magnetic field
2011 March 1In the presence of alternating-sinusoidal or rotating magnetic fields, magnetic nanoparticles will act to realign their magnetic moment with the applied magnetic field. The realignment is characterized by the nanoparticle's time constant, τ. As the magnetic field frequency is increased, the nanoparticle's magnetic moment lags the applied magnetic field at a constant angle for a given frequency, Ω, in rad/s. Associated with this misalignment is a power dissipation that increases the bulk magnetic fluid's temperature which has been utilized as a method of magnetic nanoparticle hyperthermia, particularly suited for cancer in low-perfusion tissue (e.g., breast) where temperature increases of between 4 and 7 degree Centigrade above the ambient in vivo temperature cause tumor hyperthermia. This work examines the rise in the magnetic fluid's temperature in the MRI environment which is characterized by a large DC field, B0. Theoretical analysis and simulation is used to predict the effect of both alternating-sinusoidal and rotating magnetic fields transverse to B0. Results are presented for the expected temperature increase in small tumors (approximately 1 cm radius) over an appropriate range of magnetic fluid concentrations (0.002–0.01 solid volume fraction) and nanoparticle radii (1–10 nm). The results indicate that significant heating can take place, even in low-field MRI systems where magnetic fluid saturation is not significant, with careful selection of the rotating or sinusoidal field parameters (field frequency and amplitude). The work indicates that it may be feasible to combine low-field MRI with a magnetic hyperthermia system using superparamagnetic iron oxide nanoparticles.National Institutes of Health (U.S.
Optimizing parameters of an open-source airway segmentation algorithm using different CT images.
Background: Computed tomography (CT) helps physicians locate and diagnose pathological conditions. In some conditions, having an airway segmentation method which facilitates reconstruction of the airway from chest CT images can help hugely in the assessment of lung diseases. Many efforts have been made to develop airway segmentation algorithms, but methods are usually not optimized to be reliable across different CT scan parameters. Methods: In this paper, we present a simple and reliable semi-automatic algorithm which can segment tracheal and bronchial anatomy using the open-source 3D Slicer platform. The method is based on a region growing approach where trachea, right and left bronchi are cropped and segmented independently using three different thresholds. The algorithm and its parameters have been optimized to be efficient across different CT scan acquisition parameters. The performance of the proposed method has been evaluated on EXACT’09 cases and local clinical cases as well as on a breathing pig lung phantom using multiple scans and changing parameters. In particular, to investigate multiple scan parameters reconstruction kernel, radiation dose and slice thickness have been considered. Volume, branch count, branch length and leakage presence have been evaluated. A new method for leakage evaluation has been developed and correlation between segmentation metrics and CT acquisition parameters has been considered. Results: All the considered cases have been segmented successfully with good results in terms of leakage presence. Results on clinical data are comparable to other teams’ methods, as obtained by evaluation against the EXACT09 challenge, whereas results obtained from the phantom prove the reliability of the method across multiple CT platforms and acquisition parameters. As expected, slice thickness is the parameter affecting the results the most, whereas reconstruction kernel and radiation dose seem not to particularly affect airway segmentation. Conclusion: The system represents the first open-source airway segmentation platform. The quantitative evaluation approach presented represents the first repeatable system evaluation tool for like-for-like comparison between different airway segmentation platforms. Results suggest that the algorithm can be considered stable across multiple CT platforms and acquisition parameters and can be considered as a starting point for the development of a complete airway segmentation algorithm
Entrepreneurial sons, patriarchy and the Colonels' experiment in Thessaly, rural Greece
Existing studies within the field of institutional entrepreneurship explore how entrepreneurs influence change in economic institutions. This paper turns the attention of scholarly inquiry on the antecedents of deinstitutionalization and more specifically, the influence of entrepreneurship in shaping social institutions such as patriarchy. The paper draws from the findings of ethnographic work in two Greek lowland village communities during the military Dictatorship (1967–1974). Paradoxically this era associated with the spread of mechanization, cheap credit, revaluation of labour and clear means-ends relations, signalled entrepreneurial sons’ individuated dissent and activism who were now able to question the Patriarch’s authority, recognize opportunities and act as unintentional agents of deinstitutionalization. A ‘different’ model of institutional change is presented here, where politics intersects with entrepreneurs, in changing social institutions. This model discusses the external drivers of institutional atrophy and how handling dissensus (and its varieties over historical time) is instrumental in enabling institutional entrepreneurship
Convergence and translation: attitudes to inter-professional learning and teaching of creative problem-solving among medical and engineering students and staff
Background: Healthcare worldwide needs translation of basic ideas from engineering into the clinic. Consequently, there is increasing demand for graduates equipped with the knowledge and skills to apply interdisciplinary medicine/engineering approaches to the development of novel solutions for healthcare. The literature provides little guidance regarding barriers to, and facilitators of, effective interdisciplinary learning for engineering and medical students in a team-based project context. Methods: A quantitative survey was distributed to engineering and medical students and staff in two universities, one in Ireland and one in Belgium, to chart knowledge and practice in interdisciplinary learning and teaching, and of the teaching of innovation. Results: We report important differences for staff and students between the disciplines regarding attitudes towards, and perceptions of, the relevance of interdisciplinary learning opportunities, and the role of creativity and innovation. There was agreement across groups concerning preferred learning, instructional styles, and module content. Medical students showed greater resistance to the use of structured creativity tools and interdisciplinary teams. Conclusions: The results of this international survey will help to define the optimal learning conditions under which undergraduate engineering and medicine students can learn to consider the diverse factors which determine the success or failure of a healthcare engineering solution
The Hidden Curriculum of Veterinary Education: Mediators and Moderators of Its Effects
The “hidden curriculum” has long been supposed to have an effect on students' learning during their clinical education, and in particular in shaping their ideas of what it means to be a professional. Despite this, there has been little evidence linking specific changes in professional attitudes to the individual components of the hidden curriculum. This study aimed to recognize those components that led to a change in students' professional attitudes at a UK veterinary school, as well as to identify the attitudes most affected. Observations were made of 11 student groups across five clinical rotations, followed by semi-structured interviews with 23 students at the end of their rotation experience. Data were combined and analyzed thematically, taking both an inductive and deductive approach. Views about the importance of technical competence and communication skills were promoted as a result of students' interaction with the hidden curriculum, and tensions were revealed in relation to their attitudes toward compassion and empathy, autonomy and responsibility, and lifestyle ethic. The assessment processes of rotations and the clinical service organization served to communicate the messages of the hidden curriculum, bringing about changes in student professional attitudes, while student-selected role models and the student rotation groups moderated the effects of these influences
Access for All?:Sozialinvestitionen in der frühkindlichen Bildung und Betreuung im europäischen Vergleich
Die Investition in kindbezogene Sozialpolitik ist heute ein zentrales Anliegen europäischer Wohlfahrtsstaaten. Frühkindlicher Bildung und Betreuung kommt die Schlüsselrolle zu, Bildungserfolg und Elternerwerbstätigkeit zu fördern zwecks Chancengleichheit und Armutsbekämpfung. Der international verbreitete Sozialinvestitionsdiskurs lenkt leicht davon ab, dass große Unterschiede in den nationalen Systemen frühkindlicher Bildung und Betreuung bestehen, und diese unterschiedlich in die nationalen Wohlfahrtsstaatsregime eingebettet sind. Am Beispiel Schwedens, Deutschlands und Großbritanniens werden verschiedene Kinderbetreuungssysteme einer kritischen Analyse unterzogen mit Hinblick auf ihr „Sozialinvestitionspotenzial“. Die Untersuchung zeigt, dass frühkindliche Bildungsangebote nicht als Allheilmittel zur Vorbeugung sozialer Ungleichheit fungieren können. Falls nicht mit weiteren, auf Gleichheit ausgerichtete Maßnahmen im Bildungs- und sozialen Sicherungsbereich kombiniert, ist zu erwarten, dass sich eine gegenteilige Wirkungslogik der Sozialinvestitionsstrategie entfaltet, die herkunftsbezogene Bildungsungleichheit noch verstärkt.The importance of investing in early childhood is widely acknowledged in policy circles. Particularly formal Early Childhood Education and Care (ECEC) is seen as key to creating equal opportunities and combating poverty by increasing educational achievement of children and supporting parental employment. This social investment perspective has in recent decades supported the rapid development and expansion of ECEC in most European countries. However, the international social investment discourse masks fundamental differences in European ECEC systems and detracts attention from the way ECEC is embedded in the wider welfare regime of a country. This paper critically examines the ‘social investment potential’ of ECEC systems by comparing an early social investment country, Sweden, with two ‘late movers’, the UK and Germany. It argues that investing in ECEC is not per se a panacea for social inclusion. To the contrary, if not combined with other, partly ‘traditional’ equality measures both in education and social protection, ECEC investment may have the opposite effect of increasing social inequality
Asymmetric first-price auctions with uniform distributions: analytic solutions to the general case
While auction research, including asymmetric auctions, has grown significantly in recent years, there is still little analytical solutions of first-price auctions outside the symmetric case. Even in the uniform case, Griesmer et al. (1967) and Plum (1992) find solutions only to the case where the lower bounds of the two distributions are the same. We present the general analytical solutions to asymmetric auctions in the uniform case for two bidders, both with and without a minimum bid. We show that our solution is consistent with the previously known solutions of auctions with uniform distributions. Several interesting examples are presented including a class where the two bid functions are linear. We hope this result improves our understanding of auctions and provides a useful tool for future research in auctions
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