Educators’ perspectives of adopting virtual patient online learning tools to teach clinical reasoning in medical schools: a qualitative study

BACKGROUND: Learning tools using virtual patients can be used to teach clinical reasoning (CR) skills and overcome limitations of using face-to-face methods. However, the adoption of new tools is often challenging. The aim of this study was to explore UK medical educators' perspectives of what influences the adoption of virtual patient learning tools to teach CR. METHODS: A qualitative research study using semi-structured telephone interviews with medical educators in the UK with control over teaching materials of CR was conducted. The Consolidated Framework for Implementation Research (CFIR), commonly used in healthcare services implementation research was adapted to inform the analysis. Thematic analysis was used to analyse the data. RESULTS: Thirteen medical educators participated in the study. Three themes were identified from the data that influenced adoption: the wider context (outer setting); perceptions about the innovation; and the medical school (inner context). Participants' recognition of situations as opportunities or barriers related to their prior experiences of implementing online learning tools. For example, participants with experience of teaching using online tools viewed limited face-to-face placements as opportunities to introduce innovations using virtual patients. Beliefs that virtual patients may not mirror real-life consultations and perceptions of a lack of evidence for them could be barriers to adoption. Adoption was also influenced by the implementation climate of the setting, including positioning of CR in curricula; relationships between faculty, particularly where faculty were dispersed. CONCLUSIONS: By adapting an implementation framework for health services, we were able to identify features of educators, teaching processes and medical schools that may determine the adoption of teaching innovations using virtual patients. These include access to face-to-face teaching opportunities, positioning of clinical reasoning in the curriculum, relationship between educators and institutions and decision-making processes. Framing virtual patient learning tools as additional rather than as a replacement for face-to-face teaching could reduce resistance. Our adapted framework from healthcare implementation science may be useful in future studies of implementation in medical education

Characterisation of the Medipix3 detector for 60 and 80 keV electrons

In this paper we report quantitative measurements of the imaging performance for the current generation of hybrid pixel detector, Medipix3, used as a direct electron detector. We have measured the modulation transfer function and detective quantum efficiency at beam energies of 60 and 80 keV. In single pixel mode, energy threshold values can be chosen to maximize either the modulation transfer function or the detective quantum efficiency, obtaining values near to, or exceeding those for a theoretical detector with square pixels. The Medipix3 charge summing mode delivers simultaneous, high values of both modulation transfer function and detective quantum efficiency. We have also characterized the detector response to single electron events and describe an empirical model that predicts the detector modulation transfer function and detective quantum efficiency based on energy threshold. Exemplifying our findings we demonstrate the Medipix3 imaging performance recording a fully exposed electron diffraction pattern at 24-bit depth together with images in single pixel and charge summing modes. Our findings highlight that for transmission electron microscopy performed at low energies (energies <100 keV) thick hybrid pixel detectors provide an advantageous architecture for direct electron imaging

Medipix3 Demonstration and understanding of near ideal detector performance for 60 & 80 keV electrons

In our article we report first quantitative measurements of imaging performance for the current generation of hybrid pixel detector, Medipix3, as direct electron detector. Utilising beam energies of 60 & 80 keV, measurements of modulation transfer function (MTF) and detective quantum efficiency (DQE) have revealed that, in single pixel mode (SPM), energy threshold values can be chosen to maximize either the MTF or DQE, obtaining values near to, or even exceeding, those for an ideal detector. We have demonstrated that the Medipix3 charge summing mode (CSM) can deliver simultaneous, near ideal values of both MTF and DQE. To understand direct detection performance further we have characterized the detector response to single electron events, building an empirical model which can predict detector MTF and DQE performance based on energy threshold. Exemplifying our findings we demonstrate the Medipix3 imaging performance, recording a fully exposed electron diffraction pattern at 24-bit depth and images in SPM and CSM modes. Taken together our findings highlight that for transmission electron microscopy performed at low energies (energies <100 keV) thick hybrid pixel detectors provide an advantageous and alternative architecture for direct electron imagin

Measurement of Radiation Damage to 130nm Hybrid Pixel Detector Readout Chips

We present the first measurements of the performance of the Medipix3 hybrid pixel readout chip after exposure to significant x-ray flux. Specifically the changes in performance of the mixed mode pixel architecture, the digital periphery, digital to analogue converters and the e-fuse technology were characterised. A high intensity, calibrated x- ray source was used to incrementally irradiate the separate regions of the detector whilst it was powered. This is the first total ionizing dose study of a large area pixel detector fabricated using the 130nm CMOS technology

The role of gibberellin in the reproductive development of Arabidopsis thaliana

The plant hormone gibberellin (GA) promotes several processes during Arabidopsis reproductive development, including the transition to flowering, floral organ growth and fertility. GA functions during stamen development to promote degradation of the tapetum cell layer through programmed cell death (PCD) and in post-anthesis pollen development. Bioactive GA is synthesised through a multi-step pathway, in which the last two biosynthetic steps are expressed as conserved multigene families. One of these, the GA 20-oxidases (GA20ox) consists of five paralogues in Arabidopsis, though physiological functions have only been ascribed to two (AtGA20ox1 and -2). Through a reverse genetics approach, this project demonstrates that AtGA20ox1, -2 and -3 account for almost all GA20ox activity in Arabidopsis, with very little evidence of any functions for AtGA20ox4 or -5. Unlike AtGA20ox1, -2, -3 and -4, AtGA20ox5 possesses only partial GA20ox activity, performing the first two out of three sequential catalytic conversions in vitro. Partial functional redundancy occurs between AtGA20ox1, -2 and -3 across Arabidopsis development, although AtGA20ox1 and -2 dominate. Mapping of floral AtGA20ox expression through qPCR and the creation of transgenic GUS reporter lines found that the relationship between these three paralogues is complex, and not explicable through the simple hypothesis of co-expression in the same tissues. During anther development, the reported expression of AtGA20ox1, -2, -3 and -4 is mainly restricted to the tapetum cell layer, and loss of AtGA20ox1, -2 and -3 results in an anther developmental arrest in which the tapetum does not degrade. This project demonstrates that stamen development is dependent on an optimum level of GA, with GA-deficiency restricting filament elongation to prevent pollination and GA-overdose negatively affecting anther development. DELLA repression of GA signalling is necessary for successful pollen development, with two of the five DELLA paralogues, RGA and GAI, critical to this process in the Columbia ecotype

Professionals’ views on the use of smartphone technology to support children and adolescents with memory impairment due to acquired brain injury

Purpose: To identify from a health-care professionals’ perspective whether smartphones are used by children and adolescents with acquired brain injury as memory aids; what factors predict smartphone use and what barriers prevent the use of smartphones as memory aids by children and adolescents. Method: A cross-sectional online survey was undertaken with 88 health-care professionals working with children and adolescents with brain injury. Results: Children and adolescents with brain injury were reported to use smartphones as memory aids by 75% of professionals. However, only 42% of professionals helped their clients to use smartphones. The only factor that significantly predicted reported smartphone use was the professionals’ positive attitudes toward assistive technology. Several barriers to using smartphones as memory aids were identified, including the poor accessibility of devices and cost of devices. Conclusion: Many children and adolescents with brain injury are already using smartphones as memory aids but this is often not facilitated by professionals. Improving the attitudes of professionals toward using smartphones as assistive technology could help to increase smartphone use in rehabilitation

Edge pixel response studies of edgeless silicon sensor technology for pixellated imaging detectors

Silicon sensor technologies with reduced dead area at the sensor's perimeter are under development at a number of institutes. Several fabrication methods for sensors which are sensitive close to the physical edge of the device are under investigation utilising techniques such as active-edges, passivated edges and current-terminating rings. Such technologies offer the goal of a seamlessly tiled detection surface with minimum dead space between the individual modules. In order to quantify the performance of different geometries and different bulk and implant types, characterisation of several sensors fabricated using active-edge technology were performed at the B16 beam line of the Diamond Light Source. The sensors were fabricated by VTT and bump-bonded to Timepix ROICs. They were 100 and 200 μ m thick sensors, with the last pixel-to-edge distance of either 50 or 100 μ m. The sensors were fabricated as either n-on-n or n-on-p type devices. Using 15 keV monochromatic X-rays with a beam spot of 2.5 μ m, the performance at the outer edge and corners pixels of the sensors was evaluated at three bias voltages. The results indicate a significant change in the charge collection properties between the edge and 5th (up to 275 μ m) from edge pixel for the 200 μ m thick n-on-n sensor. The edge pixel performance of the 100 μ m thick n-on-p sensors is affected only for the last two pixels (up to 110 μ m) subject to biasing conditions. Imaging characteristics of all sensor types investigated are stable over time and the non-uniformities can be minimised by flat-field corrections. The results from the synchrotron tests combined with lab measurements are presented along with an explanation of the observed effects

The Bivariate Normal Copula

We collect well known and less known facts about the bivariate normal distribution and translate them into copula language. In addition, we prove a very general formula for the bivariate normal copula, we compute Gini's gamma, and we provide improved bounds and approximations on the diagonal.Comment: 24 page