Clinical audit project in undergraduate medical education curriculum: An assessment validation study

Objectives: To evaluate the merit of the Clinical Audit Project (CAP) in an assessment program for undergraduate medical education using a systematic assessment validation framework. Methods: A cross-sectional assessment validation study at one medical school in Western Australia, with retrospective qualitative analysis of the design, development, implementation and outcomes of the CAP, and quantitative analysis of assessment data from four cohorts of medical students (2011-2014). Results: The CAP is fit for purpose with clear external and internal alignment to expected medical graduate outcomes. Substantive validity in students’ and examiners’ response processes is ensured through relevant methodological and cognitive processes. Multiple validity features are built-in to the design, planning and implementation process of the CAP. There is evidence of high internal consistency reliability of CAP scores (Cronbach’s alpha \u3e 0.8) and inter-examiner consistency reliability (intra-class correlation\u3e0.7). Aggregation of CAP scores is psychometrically sound, with high internal consistency indicating one common underlying construct. Significant but moderate correlations between CAP scores and scores from other assessment modalities indicate validity of extrapolation and alignment between the CAP and the overall target outcomes of medical graduates. Standard setting, score equating and fair decision rules justify consequential validity of CAP scores interpretation and use. Conclusions: This study provides evidence demonstrating that the CAP is a meaningful and valid component in the assessment program. This systematic framework of validation can be adopted for all levels of assessment in medical education, from individual assessment modality, to the validation of an assessment program as a whole

The changing rainfall pattern and its implication for flood frequency in Makurdi, Northern Nigeria

The study deals with analysis of recent changes in the characteristics of extreme rainfall and their implication for flood frequency in Makurdi. Data on extreme daily rainfall, evapotranspiration and flood occurrences were collected for analysis. The annual rainfall was analysed for trends using spearman rank correlation coefficient, annual rainfall variability analysed using standardized rainfall anomaly index while recurrence intervals were analysed using Gumbell Extreme probability theory. The results of the analysis show among other things that there was a remarkable continuous downward trend in annual rainfall amounts; that the period between 1996 and 2001 witnessed the highest frequencies of extreme rainfall events and flood frequencies; that major floods were associated with high recurrence intervals, and that the seasonality of flooding in Makurdi occurs between May and October. Journal of Applied Sciences and Environmental Management Vol. 10(3) 2006: 97-10

Hybrid analytical modeling of pending cache hits, data prefetching, and MSHRs

As the number of transistors integrated on a chip continues to increase, a growing challenge is accurately modeling per-formance in the early stages of processor design. Analytical models have been employed to rapidly search for higher performance designs, and can provide insights that detailed simulators may not. This paper proposes techniques to predict the impact of pending cache hits, hardware prefetching, and realistic miss status holding register (MSHR) resources on superscalar performance in the presence of long latency memory systems when employing hybrid analytical models that apply instruction trace analysis. Pending cache hits are secondary references to a cache block for which a request has already been initiated but has not yet completed. We find pending hits resulting from spatial locality and the fine-grained selection of instruction profile window blocks used for analysis both have non-negligible influences on the accuracy of hybrid analytical models and subsequently propose techniques to account for their effects. We then introduce techniques to estimate the performance impact of data prefetching by modeling the timeliness of prefetches and to account for a limited number of MSHRs by restricting the size of profile window blocks. As with earlier hybrid analytical models, our approach is roughly two orders of magnitude faster than detailed simulations. When modeling pending hits for a processor with unlimited outstanding misses we improve the accuracy of our baseline by a factor of 3.9, decreasing average error from 39.7 % to 10.3%. When modeling a processor with data prefetching, a limited number of MSHRs, or both, the techniques result in an average error of 13.8%, 9.5 % and 17.8%, respectively. 1

Bayesian log-Gaussian Cox process regression: applications to meta-analysis of neuroimaging working memory studies

Working memory (WM) was one of the first cognitive processes studied with functional magnetic resonance imaging. With now over 20 years of studies on WM, each study with tiny sample sizes, there is a need for meta-analysis to identify the brain regions that are consistently activated by WM tasks, and to understand the interstudy variation in those activations. However, current methods in the field cannot fully account for the spatial nature of neuroimaging meta-analysis data or the heterogeneity observed among WM studies. In this work, we propose a fully Bayesian random-effects metaregression model based on log-Gaussian Cox processes, which can be used for meta-analysis of neuroimaging studies. An efficient Markov chain Monte Carlo scheme for posterior simulations is presented which makes use of some recent advances in parallel computing using graphics processing units. Application of the proposed model to a real data set provides valuable insights regarding the function of the WM

Immigrants`s acculturation and chanes in body mass index

We study Body Mass Index (BMI) changes among immigrants from Iran, Pakistan, Sri Lanka, Turkey, and Vietnam relative to native Norwegians in Oslo. We test a symmetric convergence hypothesis: irrespective of whether an immigrant’s initial BMI is lower or higher than a native Norwegian, acculturation should make the difference in BMI between an immigrant and a native smaller. Convergence is driven by acculturation, which is measured by immigrants’ language skills. Our data come from two surveys in Oslo 2000-2002. Weights and heights were measured at the surveys; participants were asked to recall weights when they were 25 years old. Norwegian language skills and various socio-economic data were collected. We use multivariate regression analysis. Our findings broadly support the symmetric convergence hypothesis. Proficiency in the Norwegian language tends to make immigrants’ BMI, particularly among females, more equal to native Norwegians. Immigrants’ time of residency has been found to have no impact on changes in BMI.Obesity; Body Mass Index (BMI); immigrants; acculturation; Norway;

A young man with acute dilated cardiomyopathy associated with methylphenidate

An 18-year-old obese man with a body mass index of 40, diagnosed with attention-deficit hyperactivity disorder and treated with methylphenidate (Concerta®) was acutely admitted to hospital with hypoxia and dyspnoea. On investigation signs of liver-, renal-, and heart-failure were found. Noradrenalin infusion was started. Echocardiography showed dilated left ventricle and an ejection fraction (EF) of 25%. Liver function improved, noradrenalin and dobutamine were tapered, but three days after admission a new echocardiography showed an EF of 10%. The patient was transferred to the National Hospital (Rikshospitalet, Oslo), where intensified treatment including intra aortic balloon pump (IABP) was instituted. Cardiac function improved, and 3 weeks later the IABP was disconnected. EF at this point was 15%. The patient was denied heart transplantation due to various cofactors. The investigation concluded with a probable relationship between his cardiomyopathy and the use of methylphenidate (Concerta)

DØDEN - EIN STAD DER GUD ER?/! Forkynning i gravferd etter vond og brå død

Som prest har eg forretta i fleire gravferder etter det eg kallar «vond og brå død». Problemstillinga i denne oppgåva er innhaldet i gravferdspreikene i slike gravferder og korleis innhaldet vert brukt. Målet med oppgåva er at prestar ved refleksjon over eiga praksis kan verta tryggare på kva dei skal forkynne, og vere til støtte for dei pårørande med deira «phronesis», erfaringsbaserte visdom. I denne oppgåva har eg tatt ei kvalitativ analyse av seks gravferdspreiker haldne etter det dei involverte prestane sa var «vonde og brå» dødsfall. Prestane var i alder 30+ til 55, fire menn og to kvinner. Eg har nytta «Interpretative henomenological Analysis» (IPA) som metode når eg analyserte preikene. Eg har diskutert innhaldet i ramma av Knut E Løgstrup sin filosofiske tanke om den etiske fordringa at som eit menneske får eg i møte med ein annan person gitt noko av personens liv i mine armar. Dette opplever eg er ein tanke eg kjenner igjen når eg har hatt slike gravferder. Funna synte at sjølv om preikene var heilt ulike, var der ein stor likskap når det gjaldt tema. Alle prestane gjekk inn i situasjonen ved dødsfallet og preika ope om den smerten det kunne gje. Dei gjekk så inn og stadfesta at alle menneske har stor verde i Gud sine auge, og at Gud var med dei gjennom liding og død. Det var ei nær samanheng mellom det læremessige og det sjelesørgeriske innhaldet i preikene. Særleg vart Jesu død og oppstode viktig for ei sterk og mangslungen håpsforkynning i preikene. Håpet vart grunna i Guds kjærleik og/eller i Jesu død og oppstode. I fem av preikene er det ei klar forventning om ei oppstode. I fem av seks preiker kan det sjå ut som der er ei universell frelseforkynning. Samstundes opplever eg at preikene ikkje er like konkrete på korleis dei sørgande kan oppsøke eller oppleve Guds nærvær og trøst i tida etter gravferda. Oppgåva syner at «Den etiske fordringa» er ei meiningsfull ramme for å diskutere innhaldet og bruken av det ved slike dødsfall. Prestane ønsker å vere nær dei sørgande og bringe deira sorg fram for Gud og ein bodskap om håp i mørket frå Gud. Så er det mitt håp at andre vil forske vidare på tema som har med «vond og brå død» å gjera slik at vi som prestar kan forkynne med frimod at «døden er ein stad der Gud er!As a pastor in The Church of Norway, I have presided in a number of funerals after what I term «sudden and painful death». It is one of the most demanding situations I find myself in as a pastor. In this thesis I study the content of six different sermons held at such funerals and how this content was used. The aim is to inspire pastors to reflect over their own practise in similar situations, so that they become better prepared for these demanding situations. In this thesis, I have done a qualitative, hermeneutic analysis of six sermons held at funerals defined by the respective pastors as been in connection with “sudden and painful death”. I have used Interpretative Phenomenological Analysis (IPA) as described by Pietkiewicz &Smith in an article. I have discussed the content in the framework of the Danish philosopher and theologian Knut Løgstrup idea of “The ethical demand”; that as a human I will carry something, small or large, of my neighbour’s life in my arms. My experience is that this term is meaningful in these situations of great pain and sorrow for the bereaved.Three of the sermons was at funerals after suicide, one an accident, and two where the pastors involved named them as fitting to my category. The pastors differed in age between 30 and 55 years, four males and two women. I found that although the sermons was very different, there was coherence when it came to themes and content, and the theological content and comforting aspects was closely connected. They went all directly into the death and the pain it had caused. They confirmed the value every person has in the eyes of God. Then they said something about how God was in the suffering, before they all tried to convey a hope about salvation and that God was near them in their sorrow. The hope was founded in the love of God and/or in the suffering, death and resurrection of Jesus. The message about how God would be with the bereaved in the time after the funeral was not specific about how this could be experienced. It became clear that “the ethical demand” was a meaningful frame in which to discuss the content and its use, and it became clear that the pastors wanted to be near the bereaved and bring their grief before God and a message of hope from God. My hope is that this study will encourage pastors to reflect upon their own theology and how they will preach after “sudden and painful death”publishedVersio

Determinants of Choice of Storage Systems for Root and Tuber Crops in Benue State, Nigeria

Determinants of Choice of Storage Systems for root and tuber crops in Benue State of Nigeria were examined. The specific objectives were to determine the factors affecting choice of storage systems by root and tuber crop farmers; and determine the relationship between choice of storage systems and farm productivity. Data were collected from 288 root and tuber crop producers in eight Local Government Areas and 32 wards, using a multi-stage sampling technique. Structured questionnaire was used to collect the data. Data collected were analysed using logit model and Mann-Whiney U test. The results indicate that total output, gender, educational level, household size, and farm size significantly affect the choice of storage systems by root and tuber crop producers. The results also reveal that the output of farmers who utilized only the local storage systems exceeds those who utilized both the local storage systems in addition to the modern storage techniques. It was recommended that strategies and policies aimed at encouraging root and tuber crops farmers to adopt a particular storage technique should take into consideration their socio-economic characteristics. Also research efforts aimed at improving the effectiveness of the local storage systems using locally sourced materials should be encouraged