Development of a script concordance test using an electronic voting system

This paper describes our experience using an electronic voting system (EVS) to develop a Script Concordance Test (SCT) to assess clinical reasoning in medical students. One hundred and fifteen questions were reviewed and voted on in a single two hour session by eleven specialist Obstetricians and Gynaecologists (“experts”). Questions were categorised by the level of agreement. The experts completed an evaluation questionnaire. In eighty-four (73%) questions experts were mostly or completely in agreement. In fifteen of these the modal response was that the information provided did not affect the hypothesis or proposed action. Responses were widely divergent in thirty-one (27%) questions. The experts felt that the SCT tested clinical reasoning, the EVS was an appropriate method for answering SCT questions, and that the SCT is a suitable method of assessment of medical students and resident staff. Experts felt that the SCT questions were difficult to write, that questions needed to be written avoiding regression to the mean, that absolute phrasing in the answer options was often inappropriate, and that more experience with writing questions were required. EVS is an efficient method for completing the development of SCT questions but has the disadvantage of requiring synchronous participation of experts.Paul Dugga

An Editor for Helping Novices to Learn Standard ML

This paper describes a novel editor intended as an aid in the learning of the functional programming language Standard ML. A common technique used by novices is programming by analogy whereby students refer to similar programs that they have written before or have seen in the course literature and use these programs as a basis to write a new program. We present a novel editor for ML which supports programming by analogy by providing a collection of editing commands that transform old programs into new ones. Each command makes changes to an isolated part of the program. These changes are propagated to the rest of the program using analogical techniques. We observed a group of novice ML students to determine the most common programming errors in learning ML and restrict our editor such that it is impossible to commit these errors. In this way, students encounter fewer bugs and so their rate of learning increases. Our editor, C Y NTHIA, has been implemented and is due to be tested on st..

The case for new academic workspaces

Executive summary: This report draws upon the combined efforts of a number of estates professionals, architects, academics, designers, and senior managers involved in the planning of new university buildings for the 21st century. Across these perspectives, all would agree – although perhaps for different reasons - that this planning is difficult and that a number of particular considerations apply in the design of academic workspaces. Despite these difficulties, they will also agree that when this planning goes well, ‘good’ buildings are truly transformational – for both the university as a whole and the people who work and study in them. The value of well-designed buildings goes far beyond their material costs, and endures long after those costs have been forgotten ..

Gamma-ray bursts and X-ray melting of material as a potential source of chondrules and planets

The intense radiation from a gamma-ray burst (GRB) is shown to be capable of melting stony material at distances up to 300 light years which subsequently cool to form chondrules. These conditions were created in the laboratory for the first time when millimeter sized pellets were placed in a vacuum chamber in the white synchrotron beam at the European Synchrotron Radiation Facility (ESRF). The pellets were rapidly heated in the X-ray and gamma-ray furnace to above 1400 C melted and cooled. This process heats from the inside unlike normal furnaces. The melted spherical samples were examined with a range of techniques and found to have microstructural properties similar to the chondrules that come from meteorites. This experiment demonstrates that GRBs can melt precursor material to form chondrules that may subsequently influence the formation of planets. This work extends the field of laboratory astrophysics to include high power synchrotron sources.Comment: 8 pages, 10 figures. Proceedings of the 5th INTEGRAL Workshop, Munich 16-20 February 2004. High resolution figures available at http://bermuda.ucd.ie/%7Esmcbreen/papers/duggan_01.pd

The impact of integrated infant and young child feeding and micronutrient powder intervention on feeding practices and anemia in children aged 6-23 months in Madagascar

This study assesses the impact of an integrated infant and young child feeding (IYCF) and micronutrient powder (MNP) intervention on children's risk of anemia and IYCF practices in Madagascar. Quantitative baseline and endline surveys were conducted in representative households with children 6-23 months from two districts, where an 18-month IYCF-MNP intervention was implemented. Relative risks comparing children's risk of anemia and maternal IYCF knowledge and practices at baseline versus endline, and also at endline among MNP-users versus non-users were estimated using log-binomial regression models. 372 and 475 children aged 6-23 months were assessed at baseline and endline respectively. Prevalence of anemia fell from 75.3% to 64.9% from baseline to endline (p = 0.002); the reduction in the risk of anemia remained significant in models adjusting for sociodemographic characteristics (ARR (95% CI): 0.86 (0.78, 0.95), p = 0.003). In endline assessments, 229 out of 474 (48.3%) of children had consumed MNPs. MNP-users had a lower risk of anemia (ARR (95% CI): 0.86 (0.74, 0.99), p = 0.04) than non-users, after controlling for child's dietary diversity and morbidity, maternal counseling by community-health-workers, and sociodemographic characteristics. Mothers interviewed at endline also had greater nutrition knowledge and were more likely to feed their children ≥4 food groups (ARR (95% CI): 2.92 (2.24, 3.80), p < 0.001), and the minimum acceptable diet (ARR (95% CI): 2.88 (2.17, 3.82), p < 0.001) than mothers interviewed at baseline. Integration of MNP into IYCF interventions is a viable strategy for improving children's consumption of micronutrients and reducing risk of anemia. The addition of MNP does not negatively impact, and may improve, IYCF practices.We are grateful to all of the mothers and children and participating communities, as well as data enumerators, and the USAID-supported SALOHI project team for the technical and financial support during the baseline and endline surveys. We also thank Jacky Raharinjatovo the PSI-Madagascar statistician for support in analyses as well as Roland Kupka, France Begin and Jennifer Marcy for their comments and feedback on this manuscript. The views expressed in this manuscript are those of the authors and do not necessarily reflect the official positions or policies of their affiliated institutions. Both the baseline and the endline surveys were funded by USAID/SALOHI. (USAID; USAID/SALOHI)Published versio

Biomarkers of systemic inflammation and growth in early infancy are associated with stunting in young Tanzanian children

Stunting can afflict up to one-third of children in resource-constrained countries. We hypothesized that low-grade systemic inflammation (defined as elevations in serum C-reactive protein or alpha-1-acid glycoprotein) in infancy suppresses the growth hormone–insulin-like growth factor (IGF) axis and is associated with subsequent stunting. Blood samples of 590 children from periurban Dar es Salaam, Tanzania, were obtained at 6 weeks and 6 months of age as part of a randomized controlled trial. Primary outcomes were stunting, underweight, and wasting (defined as length-for-age, weight-for-age and weight-for-length z-scores < −2) between randomization and endline (18 months after randomization). Cox proportional hazards models were constructed to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of time to first stunting, underweight, and wasting as outcomes, with measures of systemic inflammation, insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) as exposures, adjusting for numerous demographic and clinical variables. The incidences of subsequent stunting, underweight, and wasting were 26%, 20%, and 18%, respectively. In multivariate analyses, systemic inflammation at 6 weeks of age was significantly associated with stunting (HR: 2.14, 95% CI: 1.23, 3.72; p = 0.002). Children with higher levels of IGF-1 at 6 weeks were less likely to become stunted (HR: 0.58, 95% CI: 0.37, 0.93; p for trend = 0.019); a similar trend was noted in children with higher levels of IGF-1 at 6 months of age (HR: 0.50, 95% CI: 0.22, 1.12; p for trend = 0.07). Systemic inflammation occurs as early as 6 weeks of age and is associated with the risk of future stunting among Tanzanian children.This research was funded by the National Institutes of Health (R01 HD048969, 2P30 DK040561, K24 DK104676-Dr. Duggan) and the Bill and Melinda Gates Foundation (OPP1066203-Dr. Duggan). (R01 HD048969 - National Institutes of Health; 2P30 DK040561 - National Institutes of Health; K24 DK104676 - National Institutes of Health; OPP1066203 - Bill and Melinda Gates Foundation)Accepted manuscrip

Predictors of Stunting, Wasting and Underweight among Tanzanian Children Born to HIV-Infected Women.

Children born to human immunodeficiency virus (HIV)-infected women are susceptible to undernutrition, but modifiable risk factors and the time course of the development of undernutrition have not been well characterized. The objective of this study was to identify maternal, socioeconomic and child characteristics that are associated with stunting, wasting and underweight among Tanzanian children born to HIV-infected mothers, followed from 6 weeks of age for 24 months. Maternal and socioeconomic characteristics were recorded during pregnancy, data pertaining to the infant's birth were collected immediately after delivery, morbidity histories and anthropometric measurements were performed monthly. Multivariate Cox proportional hazards methods were used to assess the association between potential predictors and the time to first episode of stunting, wasting and underweight. A total of 2387 infants (54.0% male) were enrolled and followed for a median duration of 21.2 months. The respective prevalence of prematurity (<37 weeks) and low birth weight (<2500 g) was 15.2% and 7.0%; 11.3% of infants were HIV-positive at 6 weeks. Median time to first episode of stunting, wasting and underweight was 8.7, 7.2 and 7.0 months, respectively. Low maternal education, few household possessions, low infant birth weight, child HIV infection and male sex were all independent predictors of stunting, wasting and underweight. In addition, preterm infants were more likely to become wasted and underweight, whereas those with a low Apgar score at birth were more likely to become stunted. Interventions to improve maternal education and nutritional status, reduce mother-to-child transmission of HIV, and increase birth weight may lower the risk of undernutrition among children born to HIV-infected women

Managing polyglot systems metadata with hypergraphs

A single type of data store can hardly fulfill every end-user requirements in the NoSQL world. Therefore, polyglot systems use different types of NoSQL datastores in combination. However, the heterogeneity of the data storage models makes managing the metadata a complex task in such systems, with only a handful of research carried out to address this. In this paper, we propose a hypergraph-based approach for representing the catalog of metadata in a polyglot system. Taking an existing common programming interface to NoSQL systems, we extend and formalize it as hypergraphs for managing metadata. Then, we define design constraints and query transformation rules for three representative data store types. Furthermore, we propose a simple query rewriting algorithm using the catalog itself for these data store types and provide a prototype implementation. Finally, we show the feasibility of our approach on a use case of an existing polyglot system.Peer ReviewedPostprint (author's final draft

Theory Building as Integrated Reflection: Understanding Physician Reflection Through Human Communication Research, Medical Education, and Ethics

Grounded in a presupposition that a single explanatory framework cannot fully account for the expansive learning processes that occur during medical residency, the article examines developing physicians’ reflective writing from three disciplinary lenses. The goal is to understand how the multi-dimensional nature of medical residency translates into assembling educational experiences and constructing meaning that cannot be fully explained through a single discipline. An interdisciplinary research team across medical education, communication, and ethics qualitatively analyzed reflective entries (N=756) completed by family medicine residents (N=33) across an academic year. Results provide evidence for moving toward an integrated thematic explanation across disciplines. The authors suggest that the integration of disciplinary explanations allows for comprehensive understanding of reflection as a cornerstone in the broader formation of the physician. Examples provide evidence for an integrated understanding of a fuller human experience by considering the three thematic explanations as co-occurring, reciprocal processes