Comparison of the cost‐effectiveness of a computer‐assisted learning program with a tutored demonstration to teach intestinal motility to medical students

Computer‐based simulations of undergraduate experiments in pharmacology and physiology may offer a cost‐effective alternative to the traditional live laboratory for some students, for whom laboratory skills are less important. Here we describe a study which compares two approaches to teaching preclinical medical students the pharmacology of colonic motility. Half of one cohort received a tutored live demonstration of an isolated tissue laboratory, while the other half used a computer simulation program covering the same subject. The study demonstrated that student learning was comparable for both groups, that many students found the computer simulation an acceptable alternative and that the latter required significantly less resource

A water grid for the UK

PhD ThesisThe water supply infrastructure systems of the UK depend on a number of sources of water vulnerable to the impacts of climate change; however, the extents of these impacts on the performance of the water supply infrastructure systems are highly uncertain. While contemporary analyses exist, they are inappropriate for the projection of impacts and the supporting of decision-making at large spatiotemporal scales. This study appraises existing analyses of the impact of climate change on the water resources of the UK through a review of existing data and methods, addressing them via the development of a powerful probabilistic modelling framework. Consisting of models of climate variables, hydrology, and water supply infrastructure, the framework is suitable for the simulation of current and projected future water resource infrastructure systems under uncertain future conditions and at relevant strategic spatiotemporal scales. The study yields probabilistic projections of meteorological, hydrological and water resources drought severity, frequency and duration, and demonstrates the framework in a performance comparison between the existing configuration and the same system augmented with a ‘Water Grid’ facilitating the sharing of water resource. This study makes several conclusions. Firstly, that existing models of the impacts of climate change on the water supply infrastructure system of the UK are inadequate, restricted in their fitness for purpose by their roles within the prevailing regulatory framework and the data and methods available. Secondly, the UK is likely to experience progressively fewer meteorological drought events of shorter duration and increased severity, resulting in substantial reductions in river flows both on average and at the 5th percentile, and leading to substantial increases in water resources drought severity and duration over the 21st Century not wholly mitigable in the east and south of England via inter-basin transfers from Wales and the midlands

Design of oscillatory dynamics in numerical simulations of compartment-based enzyme systems

Enzymatic reactions that yield non-neutral products are known to involve feedback due to the bell-shaped pH-rate curve of the enzyme. Compartmentalizing the reaction has been shown to lead to transport-driven oscillations in theory; however, there have been few reproducible experimental examples. Our objective was to determine how the conditions could be optimized to achieve pH oscillations. We employed numerical simulations to investigate the hydrolysis of ethyl acetate in a confined esterase enzyme system, examining the influence of key factors on its behavior. Specific parameter ranges that lead to bistability and self-sustained pH oscillations and the importance of fast base transport for oscillations in this acid-producing system are highlighted. Suggestions are made to expand the parameter space for the occurrence of oscillations, including modifying the maximum of the enzyme pH-rate curve and increasing the negative feedback rate. This research not only sheds light on the programmable nature of enzyme-driven pH regulation but also furthers knowledge on the optimal design of such feedback systems for experimentalists

The use of an e-learning constructivist solution in workplace learning

We wished to investigate whether an e-learning approach which uses constructivist principles can be successfully applied to train employees in a highly specialised skill thought to require expert individuals and extensive prolonged training. The approach involved the development of an e-learning package which included simulations and interactivity, then experimental testing in a case study workplace environment with the collection of both quantitative and qualitative data to assess the effectiveness of the package. Our study shows that this e-learning strategy improved the skills of the inexperienced operator significantly. We therefore propose that such programmes could be used as a work based training aid and used as a model system for the training of employees in complex skilled tasks in the workplace. This research demonstrates that the e-learning can be applied outside the traditional learning environment to train unskilled employees to undertake complex practical tasks which traditionally would involve prohibitively expensive instruction. This work also illustrates that simulations and interactivity are powerful tools in the design of successful e-learning packages in preparing learners for real world practical situations. Finally this study shows that workplace learners can be better served by elearning environments rather than conventional training as they allow asynchronous learning and private study which are valued by employees who have other demands on their time and are more comfortable receiving tuition privately Relevance to industry: E-learning using constructivist principles, and incorporating simulations and interactivity can be used successfully in the training of highly specialised and skilled tasks required in the modern workplace

What fosters or prevents interprofessional teamworking in primary and community care? A literature review

Background: The increase in prevalence of long-term conditions in Western societies, with the subsequent need for non-acute quality patient healthcare, has brought the issue of collaboration between health professionals to the fore. Within primary care, it has been suggested that multidisciplinary teamworking is essential to develop an integrated approach to promoting and maintaining the health of the population whilst improving service effectiveness. Although it is becoming widely accepted that no single discipline can provide complete care for patients with a long-term condition, in practice, interprofessional working is not always achieved. Objectives: This review aimed to explore the factors that inhibit or facilitate interprofessional teamworking in primary and community care settings, in order to inform development of multidisciplinary working at the turn of the century. Design: A comprehensive search of the literature was undertaken using a variety of approaches to identify appropriate literature for inclusion in the study. The selected articles used both qualitative and quantitative research methods. Findings: Following a thematic analysis of the literature, two main themes emerged that had an impact on interprofessional teamworking: team structure and team processes. Within these two themes, six categories were identified: team premises; team size and composition; organisational support; team meetings; clear goals and objectives; and audit. The complex nature of interprofessional teamworking in primary care meant that despite teamwork being an efficient and productive way of achieving goals and results, several barriers exist that hinder its potential from becoming fully exploited; implications and recommendations for practice are discussed. Conclusions: These findings can inform development of current best practice, although further research needs to be conducted into multidisciplinary teamworking at both the team and organisation level, to ensure that enhancement and maintenance of teamwork leads to an improved quality of healthcare provision. © 2007 Elsevier Ltd. All rights reserved

Qualitative evaluation of the implementation of the interdisciplinary management tool: a reflective tool to enhance interdisciplinary teamwork using structured, facilitated action research for implementation

Reflective practice is used increasingly to enhance team functioning and service effectiveness; however, there is little evidence of its use in interdisciplinary teams. This paper presents the qualitative evaluation of the Interdisciplinary Management Tool (IMT), an evidence-based change tool designed to enhance interdisciplinary teamwork through structured team reflection. The IMT incorporates three components: an evidence-based resource guide; a reflective implementation framework based on Structured, Facilitated Action Research for Implementation methodology; and formative and summative evaluation components. The IMT was implemented with intermediate care teams supported by independent facilitators in England. Each intervention lasted 6 months and was evaluated over a 12-month period. Data sources include interviews, a focus group with facilitators, questionnaires completed by team members and documentary feedback from structured team reports. Data were analysed qualitatively using the Framework approach. The IMT was implemented with 10 teams, including 253 staff from more than 10 different disciplines. Team challenges included lack of clear vision; communication issues; limited career progression opportunities; inefficient resource use; need for role clarity and service development. The IMT successfully engaged staff in the change process, and resulted in teams developing creative strategies to address the issues identified. Participants valued dedicated time to focus on the processes of team functioning; however, some were uncomfortable with a focus on teamwork at the expense of delivering direct patient care. The IMT is a relatively low-cost, structured, reflective way to enhance team function. It empowers individuals to understand and value their own, and others' roles and responsibilities within the team; identify barriers to effective teamwork, and develop and implement appropriate solutions to these. To be successful, teams need protected time to take for reflection, and executive support to be able to broker changes that are beyond the scope of the team

On the use of modelling antagonistic enzymes to aid in temporal programming of pH and PVA–borate gelation

Feedback through enzyme reactions creates new possibilities for the temporal programming of material properties in bioinspired applications, such as transient adhesives; however, there have been limited attempts to model such behavior. Here, we used two antagonistic enzymes, urease in watermelon seed powder and esterase, to temporally control the gelation of a poly(vinyl alcohol)–borate hydrogel in a one-pot formulation. Urease produces base (ammonia), and esterase produces acid (acetic acid), generating a pH pulse, which was coupled with reversible complexation of PVA. For improved understanding of the pulse properties and gel lifetime, the pH profile was investigated by comparison of the experiments with kinetic simulations of the enzyme reactions and relevant equilibria. The model reproduced the general trends with the initial concentrations and was used to help identify conditions for pulse-like behaviour as the substrate concentrations were varied

Improving health care professionals' feedback on communication skills: Development of an on-line resource

Objective: This project aimed to develop an open-access on-line resource to assist health care professionals in providing effective feedback on patient-centered clinical and communication skills. The collaborative nature of the development of this learning resource is outlined and evaluation of its use is discussed. Methods: An inter-professional team of teaching staff from two London Universities employed a researcher to interview experienced clinical and academic health care professionals and gather examples of difficult feedback situations. Material was used to develop short video clips illustrating some common challenges in giving feedback on clinical and communication skills. Initial evaluation following use of the scenarios in workshops was undertaken by means of a “talking wall” technique. Results: Evaluation indicated that the resource enhanced the learning experience by providing realistic and challenging scenarios to focus discussion. Conclusion: Inter-professional working and piloting the use of the video scenarios in workshops enabled the improvement and refinement of an on-line staff development resource on feedback. Practical implications: The on-line resource is now available as an open access learning tool, with eight scenarios and guidelines for providing effective feedback in the academic or clinical setting. It can be used for self-study or as part of a group training session