Design of blended learning for civilian and military trauma care

Violence in society is increasing, but action plans to mitigate this problem are insufficient in several countries. New educational strategies, such as blended learning which integrate face-to-face and online education are needed. Knowledge about how to design such strategies and learning environments can contribute to strengthening and coordinating medical resources, sharing competences and more collaboration in the development of civilian and military trauma care. The model in Nordic countries, of necessity share specialized healthcare professionals between the civilian and military medical systems. The overall aim of this thesis was to increase knowledge about the design of blended learning and builds on four studies: Study I explored the similarities and differences in education and training at military medical services in the Nordic countries and to what degree blended learning was used. Results showed opposing views; some were negative to e-learning, whereas others were much more positive and saw potentials for innovating education. Contextual knowledge of healthcare was identified as the crucial key to success, but in order to blend education and training into blended learning, modern pedagogical competencies were needed. Study II identified educational challenges in civilian and military trauma care, expressed by health care professionals and was studied through observations, interviews and survey during education. The most difficult aspect of learning in management of complex trauma patients was perceived as the lack of real practice in extreme environments. Blended learning was seen as the potential of supporting learning processes. Study III, through interviews and video recordings investigated what internationally trauma experts described as challenging in teaching. Eight educational challenges were identified which represented particularly difficult aspects to teach and master in the area, and which were viewed as crucial for decision making. The results contributed as basis for identifying and introducing design principles for the design of virtual patients. Study IV introduced these design principles, then developed and tested two virtual patients. The virtual patients addressed the specific educational challenges in complex trauma care, provided possibilities for unlimited training, and supported decision making. They were integrated with the existing face-to-face education into one example of a blended learning model. Conclusions and implications: Key persons in the Nordic military medical systems, senior healthcare professionals and educators identify different and sometimes contradictory educational challenges and solutions, but share the view that there is an urgent need for developing education and training in the area. A particular mindset when managing complex trauma patients was identified as crucial by trauma experts. Two virtual patients were designed to address some of the challenges. Course participants appreciated the virtual patient cases and viewed them as realistic but expressed a need for more feedback. A pilot test confirmed that the decision-making in the cases posed challenging for the target group in the way the educators had predicted. Design principles and an educational model for blended learning for civilian and military trauma care are suggested

Rhetorical Transformations in Multimodal Advertising Texts: From General to Local Degree Zero

The use of rhetoric in advertising research has been steadily gaining momentum since the 1980’s. Coupled with an increased interest in multimodality and the multiple interactions among verbal, pictorial and auditory registers, as structural components of an ad filmic text, the hermeneutic tools furnished by traditional rhetoric have been expanded and elaborated. This paper addresses the fundamental question of how ad filmic texts assume signification from a multimodal rhetorical point of view, by engaging in a fruitful dialogue with various research streams within the wider semiotic discipline and consumer research. By critically addressing the context of analysis of a multimodal ad text in the course of the argumentation deployed by different approaches, such as Social Semiotics (Kress/Leeuwen 2001), Film Semiotics (i.e. Metz 1982, Carroll 1980, Branigan 1982), Visual Semiotics (i.e. Sonesson 2008; 2010, Eco 1972;1976;1986, Groupe " 1992), Consumer Research (i.e. Mick/McQuarrie 1999; 2004, Philips 2003, Scott 1994), the relative merits of a structuralist approach that prioritizes the distinction between local and general degree zero, as put forward by Groupe " (1992), are highlighted. Furthermore, the modes whereby rhetorical transformations are enacted are outlined, with view to deepening the conceptual tackling of degree zero of signification, while addressing its applicability to branding discourse and multimodal ad texts

The challenges of military medical education and training for physicians and nurses in the Nordic countries - an interview study

Abstract Background Development and use of e-learning has not taken place to the same extent in military medicine in the Nordic countries. The aim was to explore the similarities and differences in education and training in military medicine for health professionals in the Nordic countries, and more specifically to identify the specific challenges regarding education and training of military medicine, and how e-learning is used at present and the opportunities for the future. Methods Key educators within military medicine in the Nordic countries, as approved by the respective Surgeons General, were interviewed and the interviews were analyzed using content analysis. Results The data showed that all Nordic countries cooperate in the field of military medical training to some extent. The models of recruitment and employment of health professionals differed as well as the degree of political support. These differences affected the ability for health professionals to gain actual experience from the military environment. To improve the quality of medical education and training, attempts were made to recruit physicians. The recruitment of physicians was considered a challenge which had resulted in disruptions of courses, training programs and maintenance of accreditation. The Nordic countries were described as having commonalities in the military medical systems and common needs for international collaboration within training, but differing in the range of education and training. Gaps were identified in methods for transferring outcomes from education into practice, as well as regarding evaluation and feedback of outcomes to military medicine. The educational tradition was described as oriented towards practical skills training without requirements on pedagogical education of educators. The results confirmed previous studies showing that e-learning was underutilized. Contextual understanding and experience of healthcare were seen as crucial factors for successful e-learning development. Conclusions Extended Nordic cooperation on military medical education and training are needed because of the limited volumes of advanced trauma cases. A key issue to the success of e-learning and blended learning is combining educational competence with contextual understanding into a strategy, of how to use digital educational methods

Minskade utsläpp av växthusgaser från bebyggelse : Checklista för kommunal planering

Den här checklistan har utvecklats inom ett samarbetsprojekt mellan Motala kommun och Länsstyrelsen Östergötland med finansiering från Energimyndigheten. Projektet initieradesmed utgångspunkt i Motalas energiplan och är nära kopplat till den regionala klimat-och energistrategin för Östergötland. Inom projektet har Linköpings universitet tagit fram en rapport om detaljplaners inverkan på växthusgasutsläpp, se nedan. Den här skriften bygger på universitetets rapport. För mer information, kontakta någon i projektgruppen. Checklistan är avsedd att kunna användas av alla kommuner som är intresserade av att tydligare föra in energi- och klimatfrågor i den fysiska planeringen. Störst fokus ligger på detaljplaner och listan är tänkt att kunna användas för att visa hur ett aktuellt planförslag kan bidra till minskade utsläpp av växthusgaser genom minskad energianvändning och ökad andel förnybar energi. Listan kan även användas för att jämföra två olika planförslag. Checklistan ska kunna användas som en del i miljöbedömningsprocessen, men även separat för planer som inte bedöms få en betydande miljöpåverkan och därmed saknar lagkrav om miljöbedömning. Den kommunala planeringen har en mycket viktig roll att spela i samhällets arbete för minskade utsläpp av växthusgaser. Den här checklistan riktar sig till politiker och tjänstemän som på olika sätt arbetar med fysisk planering i svenska kommuner. Med checklistan vill vi visa på hur planeringen och särskilt utformningen av en detaljplan påverkar utsläppen av växthusgaser. Listan är tänkt att kunna användas för att visa i vilken mån ett aktuellt planförslag kan bidra till minskade utsläpp av växthusgaser genom minskad energianvändning och ökad andel förnybar energi. Checklistan har utvecklats inom ett samarbetsprojekt mellan Motala kommun och Länsstyrelsen Östergötland med finansiering från Energimyndigheten. Skriften bygger på en rapport från Linköpingsuniversitet.Utgiven av: Motala kommun, Länsstyrelsen Östergötland och Linköpings universitet, november 201

Minskade utsläpp av växthusgaser från bebyggelse : Checklista för kommunal planering

Den här checklistan har utvecklats inom ett samarbetsprojekt mellan Motala kommun och Länsstyrelsen Östergötland med finansiering från Energimyndigheten. Projektet initieradesmed utgångspunkt i Motalas energiplan och är nära kopplat till den regionala klimat-och energistrategin för Östergötland. Inom projektet har Linköpings universitet tagit fram en rapport om detaljplaners inverkan på växthusgasutsläpp, se nedan. Den här skriften bygger på universitetets rapport. För mer information, kontakta någon i projektgruppen. Checklistan är avsedd att kunna användas av alla kommuner som är intresserade av att tydligare föra in energi- och klimatfrågor i den fysiska planeringen. Störst fokus ligger på detaljplaner och listan är tänkt att kunna användas för att visa hur ett aktuellt planförslag kan bidra till minskade utsläpp av växthusgaser genom minskad energianvändning och ökad andel förnybar energi. Listan kan även användas för att jämföra två olika planförslag. Checklistan ska kunna användas som en del i miljöbedömningsprocessen, men även separat för planer som inte bedöms få en betydande miljöpåverkan och därmed saknar lagkrav om miljöbedömning. Den kommunala planeringen har en mycket viktig roll att spela i samhällets arbete för minskade utsläpp av växthusgaser. Den här checklistan riktar sig till politiker och tjänstemän som på olika sätt arbetar med fysisk planering i svenska kommuner. Med checklistan vill vi visa på hur planeringen och särskilt utformningen av en detaljplan påverkar utsläppen av växthusgaser. Listan är tänkt att kunna användas för att visa i vilken mån ett aktuellt planförslag kan bidra till minskade utsläpp av växthusgaser genom minskad energianvändning och ökad andel förnybar energi. Checklistan har utvecklats inom ett samarbetsprojekt mellan Motala kommun och Länsstyrelsen Östergötland med finansiering från Energimyndigheten. Skriften bygger på en rapport från Linköpingsuniversitet.Utgiven av: Motala kommun, Länsstyrelsen Östergötland och Linköpings universitet, november 201

Teams managing civilian and military complex trauma: What are the competencies required in austere environments and the potential of simulation technology to address them?

Surgical training in civilian hospitals may not be sufficient for managing complex trauma in a setting where such care is not commonly practiced. Understanding the challenges that civilian teams face when moving to austere environments can inform the competencies that need to be trained. The aim of this study was to explore the competencies required in austere environments for teams managing complex trauma, and how they can be trained with simulation technologies. Ethnographic field observations were conducted, and field notes were synthesized. The field notes were structured with the elements of Activity Theory to generate the teams’ competencies that need to be trained. A literature review was conducted to verify the results and identify examples of relevant simulation modalities. The analysis resulted in a structured list of competencies for civilian teams to manage complex trauma in an austere environment and recommendations which simulation technologies could be used in training of those competencies based on published studies. Our study contributes to understanding the challenges that civilian teams face when operating in an austere environment. A systematized list of competencies with suggested simulation technologies directs future research to improve quality of complex trauma training in civilian and military collaboration

Type I IFN system activation in newborns exposed to Ro/SSA and La/SSB autoantibodies in utero

OBJECTIVE: In utero exposure of the fetus to Ro/La autoantibodies may lead to congenital heart block (CHB). In the mother, these autoantibodies are associated with activation of the type I interferon (IFN)-system. As maternal autoantibodies are transferred to the fetus during pregnancy, we investigated whether the type I IFN-system is activated also in newborns of anti-Ro/La positive mothers, and whether fetal IFN activation is affected by maternal immunomodulatory treatment. METHODS: Blood drawn at birth from anti-Ro/La positive mothers, their newborns and healthy control pairs was separated into plasma and peripheral blood mononuclear cells (PBMC). PBMC were analysed directly or cultured. mRNA expression was analysed by microarrays, cell surface markers by flow cytometry, and IFNα levels by immunoassays. RESULTS: We observed increased expression of IFN-regulated genes and elevated plasma IFNα levels not only in anti-Ro/La positive women, but also in their newborns. CD14+ monocytes of both anti-Ro/La positive mothers and their neonates showed increased expression of Sialic acid-binding Ig-like lectin-1, indicating cellular activation. Notably, the IFN score of neonates born to mothers receiving immunomodulatory treatment was similar to that of controls, despite persistent IFN activation in the mothers. In both maternal and neonatal PBMC, IFNα production was induced when cells were cultured with anti-Ro/La positive plasma. CONCLUSIONS: Ro/La autoantibody-exposed neonates at risk of CHB have signs of an activated immune system with an IFN signature. This study further demonstrates that neonatal cells can produce IFNα when exposed to autoantibody-containing plasma, and that maternal immunomodulatory treatment may diminish the expression of IFN-regulated genes in the fetus