An examination and confirmation of a macro theory of conversations through a realization of the protologic Lp by microscopic simulation

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Conversation Theory is a theory of interaction. From interaction (the theory asserts) arises all individuals and all concepts. Interaction, if it is to allow for evolution, must perforce contain conflict, and, if concepts and individuals are to endure, resolution of conflict. Conversation Theory as developed by Pask led to the protologic called Lp which describes the interaction of conceptual entities. Lp contains injunctions as to how entities can and may interact, including how they may conflict and how their conflict may be resolved. Unlike existing software implementations based on Conversation Theory, Lp in its pure form is a logic of process as well as coherence and distinction. The hypothesis is that a low-level simulation of Lp, that of an internal and microscopic level in which topics are influenced by "forces" that are exerted by the topology of the conceptual space, would, in its activation as a dynamic process of appropriate dimension, produce as a result (and hence be a confirmation of) the macroscopically-observed behaviour of the system manifest as conflict and resolution of conflict. Without this confirmation, the relationships between Conversation Theory and Lp remain only proposed; with it, their mutual consistencies and validity as a model of cognition, are affirmed. The background of Conversation Theory and Lp necessary to support the thesis is presented a long with a comparison of other software approaches to related problems. A description of THOUGHTSTICKER, a current embodiment of Lp at the macro level, provides a detailed sense of the Lp operations. Then a computer program (developed to provide a proof by demonstration of the thesis) is described, in which a microscopic simulation of Lp processes confirms the macroscopic behaviour predicted by Conversation Theory. Conversation Theory thereby gains support f or its use as a valid observer's language for every-day experience owing to this confirmation and its protologic as a basis for psychological phenomena in the interaction of conceptual entities of mind

Infarto acuto dell'AICA e sordità improvvisa

OBIETTIVI Gli autori descrivono un caso clinico, uomo adulto di 57 anni, di sordità improvvisa come sola manifestazione di infarto della arteria cerebellare antero‐inferiore (AICA) di destra in presenza di un quadro radiologico da interessamento della regione pontina di destra la cui valutazione radiologica, eseguita in urgenza ha permesso l’identificazione del quadro. MATERIALI Il colpo ischemico acuto nella distribuzione dell’AICA conosciuto come “Sindrome AICA” è un quadro clinico patologico che generalmente è accompagnato da una sintomatologia mista di tipo otologica e neurologica; si caratterizza infatti per: sordità improvvisa, vertigini di tipo periferiche e/o centrali da irritazione acuta con nistagmo ed atassia omolaterale con lateropulsione. Il coinvolgimento pontino inoltre si traduce con un deficit a carico del nervo facciale (debolezza facciale) e del trigemino. Anatomicamente l’AICA nel 75% dei casi nasce dal terzo caudale della arteria basilare e vascolarizza la regione anteromediale del cervelletto, la porzione laterale del ponte, l’emergenza del V°, del VII°, dell’VIII° nervo cranico ed il tratto spinotalamico. La sofferenza ischemica delle strutture del condotto uditivo interno e dell’orecchio interno nella ‘Sindrome AICA’ sono legate al deficit dell’arteria uditiva interna che, trattandosi nel 90% dei casi di un ramo diretto dell’AICA, è la diretta responsabile della sintomatologia labirintica. L’ipotesi diagnostica di Sindrome AICA scaturisce dalla presenza contemporanea di sintomi ot‐neurologici che inducono lo specialista ad avvalersi di TC e RMN (SE T2W; DWI; FLAIR) in urgenza. RIASSUNTO La presenza in corso di infarto dell’AICA della sola sordità improvvisa con caratteristiche cocleari è rara oltre che di difficile reperimento per la mancata effettuazione della RMN ma comunque deve essere sempre tenuta in considerazione. CONCLUSIONI La diagnosi eziologia di sordità improvvisa da ‘Sindrome AICA’ è eseguita solamente tramite l’ausilio di RMN eseguita in regime di urgenza per cui gli autori suggeriscono fortemente l’inserimento di RMN in urgenza tra le indagini diagnostiche di sordità improvvisa

Neurophysiology

Contains reports on seven research projects.National Institutes of Health (Grant 5 RO1 EY01149-02)Bell Telephone Laboratories, Inc. (Grant)National Institutes of Health (Grant 1 TO1 EY00090-01

Proteome and Physiological Characterization of Halotolerant Nodule Endophytes: The Case of Rahnella aquatilis and Serratia plymuthica

Bacterial endophytes were isolated from nodules of pea and fava bean. The strains were identified and characterized for plant beneficial activities (phosphate solubilization, synthesis of indole acetic acid and siderophores) and salt tolerance. Based on these data, four strains of Rahnella aquatilis and three strains of Serratia plymuthica were selected. To shed light on the mechanisms underlying salt tolerance, the proteome of the two most performant strains (Ra4 and Sp2) grown in the presence or not of salt was characterized. The number of proteins expressed by the endophytes was higher in the presence of salt. The modulated proteome consisted of 302 (100 up-regulated, 202 down-regulated) and 323 (206 up-regulated, 117 down-regulated) proteins in Ra4 and Sp2, respectively. Overall, proteins involved in abiotic stress responses were up-regulated, while those involved in metabolism and flagellum structure were down-regulated. The main up-regulated proteins in Sp2 were thiol: disulfide interchange protein DsbA, required for the sulfur binding formation in periplasmic proteins, while in Ra4 corresponded to the soluble fraction of ABC transporters, having a role in compatible solute uptake. Our results demonstrated a conserved response to salt stress in the two taxonomically related species

Neurophysiology

Contains research objectives and summary of research on sixteen research projects.National Institutes of Health (Grant 5 TO1 EY00090-03)National Institutes of Health (Grant 3 RO1 EY01149-03S1)Bell Laboratories (Grant)National Institutes of Health (Grant 5 RO1 NS12307-02)National Institutes of Health (Grant K04 NS00010

Development of a longitudinal integrated clerkship at an academic medical center

In 2005, medical educators at the University of California, San Francisco (UCSF), began developing the Parnassus Integrated Student Clinical Experiences (PISCES) program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants' career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center

Expectations of and for Clerkship Directors 2.0: A Collaborative Statement from the Alliance for Clinical Education

This article presents an update of the collaborative statement on clerkship directors (CDs), first published in 2003, from the national undergraduate medical education organizations that comprise the Alliance for Clinical Education (ACE). The clerkship director remains an essential leader in the education of medical students on core clinical rotations, and the role of the CD has and continues to evolve. The selection of a CD should be an explicit contract between the CD, their department, and the medical school, with each party fulfilling their obligations to ensure the success of the students, the clerkship and of the CD. Educational innovations and accreditation requirements have evolved in the last two decades and therefore this article updates the 2003 standards for what is expected of a CD and provides guidelines for the resources and support to be provided. In their roles as CDs, medical student educators engage in several critical activities: administration, education/teaching, coaching, advising, and mentoring, faculty development, compliance with accreditation standards, and scholarly activity. This article describes (a) the work products that are the primary responsibility of the CD; (b) the qualifications for the CD; (c) the support structure, resources, and personnel that are necessary for the CD to accomplish their responsibilities; (d) incentives and career development for the CD; and (e) the dedicated time that should be provided for the clerkship and the CD to succeed. Given all that should rightfully be expected of a CD, a minimum of 50% of a full-time equivalent is recognized as appropriate. The complexity and needs of the clerkship now require that at least one full-time clerkship administrator (CA) be a part of the CD’s team. To better reflect the current circumstances, ACE has updated its recommendations for institutions and departments to have clear standards for what is expected of the director of a clinical clerkship and have correspondingly clear guidelines as to what should be expected for CDs in the support they are provided. This work has been endorsed by each of the eight ACE member organizations

Electronic Medical Records: Provotype visualisation maximises clinical usability

The Electronic Medical Record (EMR) is the essential tool of the clinical consultation, effectively replacing the paper medical record. Since its gradual adoption in the early 2000s there has been a failure to achieve even moderate levels of EMR usability in clinical settings, resulting in a negative impact on clinical care, time efficiency and patient safety. This research explores how deeper collaboration with clinical users through participatory design, drawing on the disciplines of visual design, user experience (UX) design and visual analytics, might offer a more effective approach to this important problem. The lead researcher for this project is both a practising doctor and design researcher. Usability of two commercial EMR interfaces in the field of sexual health is explored through a mixed method survey, with responses used to inform the design of an interface provotype. This in turn is evaluated through repeat survey and ‘test-drive’ talk-aloud workshops. Results from the survey on two commercial EMR interfaces (n=49) revealed deep dissatisfaction particularly around issues of navigation, flow of consultation, frustration, safety, time-dependent and time-independent data, data complexity and data salience. Comparative provotype evaluation (n=63) showed that clinically-relevant visualisation offers marked gains in clinical usability and performance. This research argues for a re-imagining of the way we look at medical data during the clinical consultation so that the affordances and benefits of the digital format can be exploited more fully. It highlights the value of combining participatory design with visualisation to embed explicit, experiential and even tacit clinical knowledge into the EMR interface

Identifying educator behaviours for high quality verbal feedback in health professions education: literature review and expert refinement

Background Health professions education is characterised by work-based learning and relies on effective verbal feedback. However the literature reports problems in feedback practice, including lack of both learner engagement and explicit strategies for improving performance. It is not clear what constitutes high quality, learner-centred feedback or how educators can promote it. We hoped to enhance feedback in clinical practice by distinguishing the elements of an educator’s role in feedback considered to influence learner outcomes, then develop descriptions of observable educator behaviours that exemplify them. Methods An extensive literature review was conducted to identify i) information substantiating specific components of an educator’s role in feedback asserted to have an important influence on learner outcomes and ii) verbal feedback instruments in health professions education, that may describe important educator activities in effective feedback. This information was used to construct a list of elements thought to be important in effective feedback. Based on these elements, descriptions of observable educator behaviours that represent effective feedback were developed and refined during three rounds of a Delphi process and a face-to-face meeting with experts across the health professions and education. Results The review identified more than 170 relevant articles (involving health professions, education, psychology and business literature) and ten verbal feedback instruments in health professions education (plus modified versions). Eighteen distinct elements of an educator’s role in effective feedback were delineated. Twenty five descriptions of educator behaviours that align with the elements were ratified by the expert panel. Conclusions This research clarifies the distinct elements of an educator’s role in feedback considered to enhance learner outcomes. The corresponding set of observable educator behaviours aim to describe how an educator could engage, motivate and enable a learner to improve. This creates the foundation for developing a method to systematically evaluate the impact of verbal feedback on learner performance

A Poetics of Designing

The chapter provides an overview on what it means to be in a world that is uncertain, e.g., how under conditions of limited understanding any activity is an activity that designs and constructs, and how designing objects, spaces, and situations relates to the (designed) meta-world of second-order cybernetics. Designers require a framework that is open, but one that supplies ethical guidance when ‘constructing’ something new. Relating second-order design thinking to insights in philosophy and aesthetics, the chapter argues that second-order cybernetics provides a response to this ethical challenge and essentially it entails a poetics of designing. //// 'A Poetics of Designing' is part of the first book-length collection of texts in Design Cybernetics. It introduces the subject from the point of view of aesthetics. Importantly, the chapter argues that second-order cybernetics circumvents the necessity for a muse inspired artist or genius as a mediator between higher spirits and life, in favour of artists and designers who have true agency. //// Cybernetics is often associated with AI, which is, however, only one of the branches that developed on the basis of the interdisciplinary research begun in the 1940s and entitled cybernetics. I hope the chapter contributes to a better understanding of the second-order cybernetics that has been conceived in close relationship with art and design from the late 60s onwards