A survey of UK medical schools' arrangements for early patient contact

Background: Many U.K. medical schools have patient contact in the first two years of the undergraduate course. Aim: To compare the purposes and organization of early patient contact in UK medical schools and to relate these arrangements to the schools' curricular objectives. Methods: A telephone survey of lead educators in UK medicals schools. Categories of contact were plotted against phases of the course to discern patterns of organisation. Results: The quantity of contact varies considerably (four to 65 days). There is a pattern, with learning objectives around the social context of health and illness preceding skills based work and integrated clinical knowledge for practice coming later. Schools fall into three categories: close adherence to the preclinical/clinical split, with limited early contact acting as an introduction to social aspects of health; provision of substantial patient contact to maximize the integration of knowledge and skills; and transitional, with limited clinical goals. General practice provides between one third and one half of early patient contact. Conclusions: Arrangements meet the objectives set by each school and reflect differing educational philosophies. Change is toward more early contact. There appears to be no national guidance which supports a minimum quantity of patient contact or specific educational purpose in the early years of U.K. basic medical training

Diagnostics of non-thermal distributions in solar flare spectra observed by RESIK and RHESSI

We focus on the non-thermal components of the electron distribution in the keV range and analyse high-energy resolution X-ray spectra detected by RESIK and RHESSI for three solar flares.In the 2-4 keV range we assume that the electron distribution can be modelled by an n-distribution. Using a method of line-intensity ratios, we analyse allowed and satellite lines of Si observed by RESIK and estimate the parameters of this n-distribution. At higher energies we explore RHESSI bremsstrahlung spectra. Adopting a forward-fitting approach and thick-target approximation, we determine the characteristics of injected electron beams. RHESSI non-thermal component associated with the electron beam is correlated well with presence of the non-thermal n-distribution obtained from the RESIK spectra. In addition, such an n-distribution occurs during radio bursts observed in the 0.61-15.4 GHz range. Furthermore, we show that the n-distribution could also explain RHESSI emission below ~5 keV. Therefore, two independent diagnostics methods indicate the flare plasma being affected by the electron beam can have a non-thermal component in the ~2-5 keV range, which is described by the n-distribution well. Finally, spectral line analysis reveals that the n-distribution does not occupy the same location as the thermal component detected by RHESSI at ~10 keV.Comment: 18 pages, 14 figures, 10 table

Using learning environments as a metaphor for educational change

Purpose – The purpose of this paper is to show that the online learning environment can be seen as the means by which higher education can explore the challenges and opportunities raised by online and digital society. Design/methodology/approach – The paper argues that the online learning environment can be seen as a metaphor for how universities respond to the requirements and challenges of the digital age. Current learning management systems (LMSs) are examined, and compared with the values found in web 2.0 and social media. Current thinking on pedagogy for online learning is then examined. The SocialLearn project at the Open University in the UK is then explained, which seeks to create a disaggregated, decentralised, social system for learners. Findings – The conclusion from the analysis is that there is a conflict between the centralised learning management system (LMS) and the requirements of online pedagogy. The traditional LMS can be seen as embodying the wrong metaphor, that of the traditional classroom. The paper concludes by arguing that such learning environments will be more useful to higher education in coming to understand its response to many of the changes being seen in society, which are facilitated by the new technologies. Originality/value – The paper provides a framework for considering LMSs and their relation to universities and pedagogy, and an argument for the promotion of more decentralised systems

The 'Iron Cage' strengthened? Discretion and digital discipline

Research on changes in public administration associated with the adoption and use of information and communication technologies ('informatization'), almost univocally supports the conclusion that shop floor discretion disappears under their influence. We, however, are ill at ease with this direction in thought about discretion. Our unease is based on the scholarly work about practices, organizational learning and responsiveness. In this article, we test the thesis on the relation between informatization and operational discretion in an empirical research of operational discretion and informatization in two Dutch public agencies, both large and both automated. Our findings show that informatization does not destroy operational discretion, but rather obscures discretion. Based on the work of Argyris, we show that the phenomenon at work is 'participatory boundary practices', the direct personal ties that keep an organization together. ICTs destroy such links and thereby affect organizational learning. © Blackwell Publishing Ltd. 2007

Understanding Behavioral Sources of Process Variation Following Enterprise System Deployment

This paper extends the current understanding of the time-sensitivity of intent and usage following large-scale IT implementation. Our study focuses on perceived system misfit with organizational processes in tandem with the availability of system circumvention opportunities. Case study comparisons and controlled experiments are used to support the theoretical unpacking of organizational and technical contingencies and their relationship to shifts in user intentions and variation in work-processing tactics over time. Findings suggest that managers and users may retain strong intentions to circumvent systems in the presence of perceived task-technology misfit. The perceived ease with which this circumvention is attainable factors significantly into the timeframe within which it is attempted, and subsequently impacts the onset of deviation from prescribed practice and anticipated dynamics

Structured feedback on students’ concept maps: the proverbial path to learning?

Good conceptual knowledge is an essential requirement for health professions students, in that they are required to apply concepts learned in the classroom to a variety of different contexts. However, the use of traditional methods of assessment limits the educator’s ability to correct students’ conceptual knowledge prior to altering the educational context. Concept mapping (CM) is an educational tool for evaluating conceptual knowledge, but little is known about its use in facilitating the development of richer knowledge frameworks. In addition, structured feedback has the potential to develop good conceptual knowledge. The purpose of this study was to use Kinchin’s criteria to assess the impact of structured feedback on the graphical complexity of CM’s by observing the development of richer knowledge frameworks. Fifty-eight physiotherapy students created CM’s targeting the integration of two knowledge domains within a case-based teaching paradigm. Each student received one round of structured feedback that addressed correction, reinforcement, forensic diagnosis, benchmarking, and longitudinal development on their CM’s prior to the final submission. The concept maps were categorized according to Kinchin’s criteria as either Spoke, Chain or Net representations, and then evaluated against defined traits of meaningful learning. The inter-rater reliability of categorizing CM’s was good. Pre-feedback CM’s were predominantly Chain structures (57%), with Net structures appearing least often. There was a significant reduction of the basic Spoke- structured CMs (P = 0.002) and a significant increase of Net-structured maps (P < 0.001) at the final evaluation (post-feedback). Changes in structural complexity of CMs appeared to be indicative of broader knowledge frameworks as assessed against the meaningful learning traits. Feedback on CM’s seemed to have contributed towards improving conceptual knowledge and correcting naive conceptions of related knowledge. Educators in medical education could therefore consider using CM’s to target individual student development

Towards an Intelligent Tutor for Mathematical Proofs

Computer-supported learning is an increasingly important form of study since it allows for independent learning and individualized instruction. In this paper, we discuss a novel approach to developing an intelligent tutoring system for teaching textbook-style mathematical proofs. We characterize the particularities of the domain and discuss common ITS design models. Our approach is motivated by phenomena found in a corpus of tutorial dialogs that were collected in a Wizard-of-Oz experiment. We show how an intelligent tutor for textbook-style mathematical proofs can be built on top of an adapted assertion-level proof assistant by reusing representations and proof search strategies originally developed for automated and interactive theorem proving. The resulting prototype was successfully evaluated on a corpus of tutorial dialogs and yields good results.Comment: In Proceedings THedu'11, arXiv:1202.453

Hard probes of short-range nucleon-nucleon correlations

One of the primary goals of nuclear physics is providing a complete description of the structure of atomic nuclei. While mean-field calculations provide detailed information on the nuclear shell structure for a wide range of nuclei, they do not capture the complete structure of nuclei, in particular the impact of small, dense structures in nuclei. The strong, short-range component of the nucleon-nucleon potential yields hard interactions between nucleons which are close together, generating a high-momentum tail to the nucleon momentum distribution, with momenta well in excess of the Fermi momentum. This high-momentum component of the nuclear wave-function is one of the most poorly understood parts of nuclear structure. Utilizing high-energy probes, we can isolate scattering from high-momentum nucleons, and use these measurements to examine the structure and impact of short-range nucleon-nucleon correlations. Over the last decade we have moved from looking for evidence of such short-range structures to mapping out their strength in nuclei and examining their isospin structure. This has been made possible by high-luminosity and high-energy accelerators, coupled with an improved understanding of the reaction mechanism issues involved in studying these structures. We review the general issues related to short-range correlations, survey recent experiments aimed at probing these short-range structures, and lay out future possibilities to further these studies.Comment: Review article to appear in Prog.Part.Nucl.Phys. 77 pages, 33 figure

Physics Opportunities with the 12 GeV Upgrade at Jefferson Lab

This white paper summarizes the scientific opportunities for utilization of the upgraded 12 GeV Continuous Electron Beam Accelerator Facility (CEBAF) and associated experimental equipment at Jefferson Lab. It is based on the 52 proposals recommended for approval by the Jefferson Lab Program Advisory Committee.The upgraded facility will enable a new experimental program with substantial discovery potential to address important topics in nuclear, hadronic, and electroweak physics.Comment: 64 page

Naturopathic Care for Anxiety: A Randomized Controlled Trial ISRCTN78958974

BACKGROUND: Anxiety is a serious personal health condition and represents a substantial burden to overall quality of life. Additionally anxiety disorders represent a significant cost to the health care system as well as employers through benefits coverage and days missed due to incapacity. This study sought to explore the effectiveness of naturopathic care on anxiety symptoms using a randomized trial. METHODS: Employees with moderate to severe anxiety of longer than 6 weeks duration were randomized based on age and gender to receive naturopathic care (NC) (n = 41) or standardized psychotherapy intervention (PT) (n = 40) over a period of 12 weeks. Blinding of investigators and participants during randomization and allocation was maintained. Participants in the NC group received dietary counseling, deep breathing relaxation techniques, a standard multi-vitamin, and the herbal medicine, ashwagandha (Withania somnifera) (300 mg b.i.d. standardized to 1.5% with anolides, prepared from root). The PT intervention received psychotherapy, and matched deep breathing relaxation techniques, and placebo. The primary outcome measure was the Beck Anxiety Inventory (BAI) and secondary outcome measures included the Short Form 36 (SF-36), Fatigue Symptom Inventory (FSI), and Measure Yourself Medical Outcomes Profile (MY-MOP) to measure anxiety, mental health, and quality of life respectively. Participants were blinded to the placebo-controlled intervention. RESULTS: Seventy-five participants (93%) were followed for 8 or more weeks on the trial. Final BAI scores decreased by 56.5% (p<0.0001) in the NC group and 30.5% (p<0.0001) in the PT group. BAI group scores were significantly decreased in the NC group compared to PT group (p = 0.003). Significant differences between groups were also observed in mental health, concentration, fatigue, social functioning, vitality, and overall quality of life with the NC group exhibiting greater clinical benefit. No serious adverse reactions were observed in either group. RELEVANCE: Many patients seek alternatives and/or complementary care to conventional anxiety treatments. To date, no study has evaluated the potential of a naturopathic treatment protocol to effectively treat anxiety. Knowledge of the efficacy, safety or risk of natural health products, and naturopathic treatments is important for physicians and the public in order to make informed decisions. INTERPRETATION: Both NC and PT led to significant improvements in patients' anxiety. Group comparison demonstrated a significant decrease in anxiety levels in the NC group over the PT group. Significant improvements in secondary quality of life measures were also observed in the NC group as compared to PT. The whole system of naturopathic care for anxiety needs to be investigated further including a closer examination of the individual components within the context of their additive effect. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN78958974