Teaching medical students to apply deliberate reflection

Purpose: Deliberate reflection on initial diagnosis has been found to repair diagnostic errors. We investigated the effectiveness of teaching students to use deliberate reflection on future cases and whether their usage would depend on their perception of case difficulty. Method:One-hundred-nineteen medical students solved cases either with deliberate-reflection or without instructions to reflect. One week later, all participants solved six cases, each with two equally likely diagnoses, but some symptoms in the case were associated with only one of the diagnoses (discriminating features). Participants provided one diagnosis and subsequently wrote down everything they remembered from it. After the first three cases, they were told that the next three would be difficult cases. Reflection was measured by the proportion of discriminating features recalled (overall; related to their provided diagnosis; related to alternative diagnosis). Results:The deliberate-reflection condition recalled more features for the alternative diagnosis than the control condition (p =.013) regardless of described difficulty. They also recalled more features related to their provided diagnosis on the first three cases (p =.004), but on the last three cases (described as difficult), there was no difference. Conclusion:Learning deliberate reflection helped students engage in more reflective reasoning when solving future cases. Practice points Learning deliberate reflection helped students engage in more reflective reasoning when solving future cases, regardless of described difficulty. Students who had not been taught deliberate reflection remembered more discriminating features (i.e. engaged in more reflective reasoning) when they expected cases to be difficult compared to cases that had not been described as difficult. Future studies should investigate whether teaching medical students the deliberate reflection procedure would also lead to improved diagnostic accuracy.</p

Animation in relational information visualization

In order to be able to navigate in the world without memorizing each detail, the human brain builds a mental map of its environment. The mental map is a distorted and abstracted representation of the real environment. Unimportant areas tend to be collapsed to a single entity while important landmarks are overemphasized. When working with visualizations of data we build a mental map of the data which is closely linked to the particular visualization. If the visualization changes significantly due to changes in the data or the way it is presented we loose the mental map and have to rebuild it from scratch. The purpose of the research underlying this thesis was to investigate and devise methods to create smooth transformations between visualizations of relational data which help users in maintaining or quickly updating their mental map

Low Hepatitis C Virus Prevalence among Men Who Have Sex with Men Attending Public Health Services in The Netherlands

The hepatitis C virus (HCV) prevalence is high among men who have sex with men (MSM) with HIV in the Netherlands. Large reductions in HCV incidence among MSM with HIV, however, have occurred since treatment with direct-acting antivirals. Over the years, a broader understanding of the HCV epidemic has shown that HCV infections are not solely restricted to MSM with HIV, but they also occur among HIV-negative MSM. Currently, HCV testing among HIV-negative MSM is only provided for PrEP users and is not part of routine sexually transmitted infection (STI) screening among HIV-negative MSM who are not using PrEP. In this study, we screened 1885 HIV-negative MSM who did not participate in a PrEP program, with over 1966 STI screening visits at four different public health clinic sites. Among the 1885 MSM, only one person had a new HCV infection, resulting in a 0.05% (95% confidence interval 0.0–0.3) incidence. Based on our findings, we can conclude that systematic HCV testing at STI clinics may not yield significant benefits for this particular population.</p

What are the prospects for intensifying soil fertility management in the Sahel? A case study from Sanmatenga, Burkina Faso

Available from British Library Document Supply Centre-DSC:5359.2826(no 22) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Www.airqualitynow.eu, a common website and air quality indices to compare cities across europe

International audienceAir quality is a public concern. This is partly due to the "right to know" principle embodied in European legislation. Despite this common legislation, the way air quality is being interpreted and communicated differs considerably. For specialists raw monitoring data for Europe are available but these are not usable by the general public. Easy to understand and internationally comparable air quality information from one city to another is scarce: there are almost as many air quality indices as air quality monitoring networks. The CITEAIR II project (Common information to European Air, INTERREG IVc) facilitates the comparison of urban air quality in near real-time by introducing common air quality indices at hourly, daily and annual scales and by developing a forecast for those indices for D+0 and D+1.The implementation was based on a common website www.airqualitynow.eu using readily available simple IT-solutions. This paper describes those tools which both aimed at presenting the air quality of the participating cities in a comparable way and not to replace more targeted local information. Their added value is to provide, for the first time, a European and comparable picture of the air quality in near real-time easily accessible through a common platform and presentation of the results. The website is designed to receive and display data from any city wanting to join. The main part is dedicated to compare the cities index values using different time scales (hourly, daily or annual) and two types of exposure thanks to a background and a traffic index. In addition, space is offered to cities for presenting themselves according to a common template, providing background information on their specific air pollution situation and associated reduction measures. Participating is easy: cities upload their data through ftp and the indices calculations are automatically made. The website provides a dynamic picture of the air quality and is updated each hour enticing viewers to make repeated visits. However, participation with only a daily update or with yearly data is feasible as wel

Towards uncertainty mapping in air-quality modelling and assessment

The aim of this paper is to promote the use of uncertainty mapping when spatial assessments of air quality are made. A large number of air quality maps are produced for scientific and policy purposes but rarely are corresponding maps of their uncertainty included. The need for such maps and the methods to produce them are described. Several uncertainty parameters are discussed but it is recommended to use the probability density function as the basis of the uncertainty estimates. Several examples are provided discussing indicative uncertainty, ensemble methods, comparisons with observations, spatial representativeness, uncertainty in exceedances and probability of exceedance.publishe

High levels of non-activated receptors in glucocorticoid-sensitive S49wt mouse lymphoma cells incubated with dexamethasone

Upon agonist binding the heteromeric glucocorticoid receptor complex under goes a conformational change (receptor activation). This event involves the dissociation of a dimer of 90 kDa heat shock proteins. Whereas receptor activation in cytosolic assays is both rapid and irreversible, less is known about the receptor activation and translocation in intact cells during challenge with an agonist. In this paper we report on the receptor status of glucocorticoid-sensitive murine S49 lymphoma cells during dexamethasone exposure. By three different assays, ligand (re)binding, nuclear translocation and hsp90 co-immunoprecipitation, it was found that the majority of the glucocorticoid receptor protein was in a non-activated conformation. Furthermore, prolonged exposure to dexamethasone did not result in increased levels of activated receptors. By assessing receptor activation in situ we found that physiological temperature was less effective in dissociating hsp90 compared to room temperature. These findings indicate that the physiological temperature negatively controls receptor activation, probably due to a thermolabile interaction between the hormone and its cognate receptor.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31269/1/0000175.pd

High resolution exposure modelling of heat and air pollution and the impact on mortality

Background Elevated temperature and air pollution have been associated with increased mortality. Exposure to heat and air pollution, as well as the density of vulnerable groups varies within cities. The objective was to investigate the extent of neighbourhood differences in mortality risk due to heat and air pollution in a city with a temperate maritime climate. Methods A case-crossover design was used to study associations between heat, air pollution and mortality. Different thermal indicators and air pollutants (PM10, NO2, O3) were reconstructed at high spatial resolution to improve exposure classification. Daily exposures were linked to individual mortality cases over a 15 year period. Results Significant interaction between maximum air temperature (Tamax) and PM10 was observed. During “summer smog” days (Tamax > 25 °C and PM10 > 50 μg/m3), the mortality risk at lag 2 was 7% higher compared to the reference (Tamax 15 °C and PM10 15 μg/m3). Persons above age 85 living alone were at highest risk. Conclusion We found significant synergistic effects of high temperatures and air pollution on mortality. Single living elderly were the most vulnerable group. Due to spatial differences in temperature and air pollution, mortality risks varied substantially between neighbourhoods, with a difference up to 7%