Outcome of Undergraduate Medical Education using Medical Simulation according to Students’ Feedback

Objectives: This study aimed to determine students’ overall satisfaction with clinical simulation sessions and compare the satisfaction levels of obstetrics/gynaecology (OBGYN) students (group one) and internal medicine students (group two). Methods: This study was conducted from January to June 2019 at the Arabian Gulf University, Manama, Bahrain. Students from year five were included and offered sessions that used simulations to support clinical skill development. Data were collected using a five-point Likert scale (i.e. strongly agree, agree, neutral, disagree, strongly disagree) via feedback forms. Results: A total of 150 students were included in this study (response rate: 99.07%). In groups of seven, the students attended five cycles of simulations with two sessions per cycle in each specialty over six months. The mean percentage of responses of “strongly agree” and “agree” was 97.8 ± 2.3% in group one and 95.7 ± 2.7% in group two. The satisfaction scores of group one were higher than those from group two for all statements. Significant differences were found between groups one and two in their responses to the statement of whether the simulation session was relevant to clinical practice (100% versus 92.9%; P <0.001) and whether the debriefing session was useful (98.1% versus 94.8%; P = 0.015). Conclusion: Students indicated high satisfaction after attending the simulation sessions; however, OBGYN students were more satisfied compared to those studying internal medicine.Keywords: Simulation Training; Patient Simulation; High Fidelity Simulation Training; Undergraduate Medical Education; Bahrain

Technical, economic and environmental evaluation of advanced tertiary treatments for micropollutants removal (oxidation and adsorption)

International audienceTwo pilots for tertiary treatment, an advanced oxidation processes (AOP - O3/UV/H2O2) pilot and a granular activated carbon pilot, were tested in three different wastewater treatment plants after a secondary treatment. A total of 64 micropollutants including drugs, pesticides, alkylphenols, PAHs and metals were analysed in the samples at the inlet and the outlet of the pilots. The tertiary treatments studied (ozone, AOP and activated carbon) were efficient for the removal of most of the compounds analysed in this study, except metals. The addition of hydrogen peroxide to ozone increased the number of substances well removed but it did not improve the removal of substances that readily react with ozone (such as betablockers or carbamazepine). The other AOP (ozone/H2O2 and UV/H2O2) did not improve the number of substances well removed in comparison with ozone alone. The granular activated carbon was still efficient (R>70%) after 6 months working 24/7 for most of the drugs and the urea and triazine pesticides. The 5 technologies studied were sized at full scale in order to calculate their cost for two sizes of WWTP. The implementation of a tertiary treatment on a 60 000 to 200 000 PE WWTP would increase the wastewater treatment cost by 1,5 to 17,6 euros cents per cubic meter treated according to the technology and the removal objective. Concerning the environmental impact, for the big WWTP, the activated carbon is more impacting than the other processes for most of the impacts calculated. The order of POA by increasing environmental impact is ozone < ozone/H2O2 < ozone/UV ~ UV/H2O2. For the medium size WWTP however, the activated carbon is comparable to the other solutions regarding environmental impact

Systèmes d'information et résilience des chaînes logistiques globales : Proposition d'un écosystème informationnel

Dans un contexte de crise permanente dont les causes sont multiples et de plus en plus imprévisibles, les entreprises doivent trouver des solutions pour s'adapter et maintenir leur niveau de performance. Cet article s'interroge sur la capacité des systèmes d'information à contribuer à la résilience des chaînes logistiques globales, c'est-à-dire leur capacité à garder un niveau d'efficience constant quels que soient les évènements auxquels elles sont soumises, rares ou inhabituels. Deux types de réponse aux crises sont identifiés : une réponse à court terme qui repose sur la dégradation des systèmes et la prise de décision dans l'urgence, et une gestion des crises par l'apprentissage qui permet un ajustement dynamique de la chaîne logistique. Un écosystème informationnel est proposé pour permettre une analyse des modifications des paramètres stratégiques relatifs à chaque acteur et la transmission en temps réel de ces informations. L'outil se veut innovant et créatif et vise à mieux appréhender la variabilité des marchés et l'absence de visibilité causée par la complexité croissante des chaînes logistiques globales.Résilience; Systèmes d'information; Gestion de crise; Chaîne logistique globale

Cross-Regional Productivity Differences and the Effect of a Government Program: The Case of Philippine Rice and Corn and The Operation Land Transfer (OLT)

The principal objective of the study was to analyze the differences in regional productivity of rice and corn and determine the effects of Operation Land Transfer (OLT) on rice and corn productivity in the Philippines. Regional TFP indices for rice and corn were constructed using 1991 data and the effects of OLT, other services and regional factors on TFP were determined. The constructed input, output and TFP indices show how the values differ as affected by price and quantity aggregation. The Fisher indices lay between Laspeyres and Paasche indices. In terms of regional differences, it was observed from the indices that outputs varied more widely than inputs across regions. This implies that the variation in TFP across region can be attributed more to output than to input. In general, there were variations in the relative sizes of input and output indices across regions, but in terms of TFP indices, the relative position of each region with respect to the base did not vary widely. Southern Mindanao and Central Luzon exhibited the highest aggregate TFP although the output index was higher for Central Luzon. Aggregation affected the relative ranking of regions in terms of TFP. For rice, Southern Mindanao, Cagayan Valley and Central Luzon led while for corn, Central, Southern and Northern Mindanao regions dominated. In general, aggregate TFP values lay between rice and corn TFPs, except for a few cases. From the OLS results, OLT had a positive overall effect upon rice and corn aggregate TFP. The results were relatively better for rice than for corn. This was because most of OLT land distribution and the corresponding support services, like irrigation and including those which were not part of the Comprehensive Agrarian Reform Program (CARP), were extended to rice regions which has a larger share at the program. Also from OLS, the irrigation variable showed significant effects for rice TFP while the effects of credit and rainfall were not significant

Synaptic and extrasynaptic NMDA receptors are gated by different endogenous coagonists.

N-methyl-D-aspartate receptors (NMDARs) are located in neuronal cell membranes at synaptic and extrasynaptic locations, where they are believed to mediate distinct physiological and pathological processes. Activation of NMDARs requires glutamate and a coagonist whose nature and impact on NMDAR physiology remain elusive. We report that synaptic and extrasynaptic NMDARs are gated by different endogenous coagonists, D-serine and glycine, respectively. The regionalized availability of the coagonists matches the preferential affinity of synaptic NMDARs for D-serine and extrasynaptic NMDARs for glycine. Furthermore, glycine and D-serine inhibit NMDAR surface trafficking in a subunit-dependent manner, which is likely to influence NMDARs subcellular location. Taking advantage of this coagonist segregation, we demonstrate that long-term potentiation and NMDA-induced neurotoxicity rely on synaptic NMDARs only. Conversely, long-term depression requires both synaptic and extrasynaptic receptors. Our observations provide key insights into the operating mode of NMDARs, emphasizing functional distinctions between synaptic and extrasynaptic NMDARs in brain physiology

Ring closing reaction in diarylethene captured by femtosecond electron crystallography

The photoinduced ring-closing reaction in diarylethene, which serves as a model system for understanding reactive crossings through conical intersections, was directly observed with atomic resolution using femtosecond electron diffraction. Complementary ab initio calculations were also performed. Immediately following photoexcitation, subpicosecond structural changes associated with the formation of an open-ring excited-state intermediate were resolved. The key motion is the rotation of the thiophene rings, which significantly decreases the distance between the reactive carbon atoms prior to ring closing. Subsequently, on the few picosecond time scale, localized torsional motions of the carbon atoms lead to the formation of the closed-ring photoproduct. These direct observations of the molecular motions driving an organic chemical reaction were only made possible through the development of an ultrabright electron source to capture the atomic motions within the limited number of sampling frames and the low data acquisition rate dictated by the intrinsically poor thermal conductivity and limited photoreversibility of organic materials

Path integration and perturbation theory with complex Euclidean actions

The Euclidean path integral quite often involves an action that is not completely real {\it i.e.} a complex action. This occurs when the Minkowski action contains $t$-odd CP-violating terms. Analytic continuation to Euclidean time yields an imaginary term in the Euclidean action. In the presence of imaginary terms in the Euclidean action, the usual method of perturbative quantization can fail. Here the action is expanded about its critical points, the quadratic part serving to define the Gaussian free theory and the higher order terms defining the perturbative interactions. For a complex action, the critical points are generically obtained at complex field configurations. Hence the contour of path integration does not pass through the critical points and the perturbative paradigm cannot be directly implemented. The contour of path integration has to be deformed to pass through the complex critical point using a generalized method of steepest descent, in order to do so. Typically, what is done is that only the real part of the Euclidean action is considered, and its critical points are used to define the perturbation theory. In this article we present a simple 0+1-dimensional example, of $N$ scalar fields interacting with a U(1) gauge field, in the presence of a Chern-Simons term, where alternatively, the path integral can be done exactly, the procedure of deformation of the contour of path integration can be done explicitly and the standard method of only taking into account the real part of the action can be followed. We show explicitly that the standard method does not give a correct perturbative expansion.Comment: 11 pages, no figures, version to be published in PR

Appreciation Workshop on Climate-Resilient Agriculture for the Local Government Officials of Quezon Province (4th District): A Workshop Report

The two-day appreciation workshop on climate-resilient agriculture (CRA) was a collaborative activity among the Department of Agriculture Regional Field Office IVA (DA-RFO-IVA), the Municipal Government of Guinayangan Quezon, the International Institute of Rural Reconstruction (IIRR), and the CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS). The workshop was designed for key local government officials – local chief executives, municipal agriculturists and municipal planning and development coordinators. The delivery involved presentations of concepts, activities, learning; field visits; and participatory action planning. This was an effort to bring the learning from the implementation of CRA-related interventions in the municipalities of Guinayangan and San Francisco to scale. This used the horizontal scaling approach to widen the spatial or geographic extent of the “product”. In this particular case, adaptation strategies were the ‘products’ that were promoted