Simulation-Based Training Improves Student Assessment of Oral Feeding Skills in Preterm Infants

Advancements in medical technology have contributed to increased rates of preterm birth. Prematurity places infants at high risk for feeding difficulties, however. Early identification and assessment of preterm infant dysphagia is critical to maximize nutrition and hydration, feeding safety, and growth and development. The purpose of this study was to assess the ability of a simulation-based training toolto increase non-health care and entry-level clinical student sensitivity to signs of feeding distress in preterm infants. Data were collected from 60 students (20 masters-level Speech-Language Pathology, 20 undergraduate nursing, 20 undergraduate non-health care) in a pre-test/post-test design. All participants completed a brief simulation training protocol, and accuracy percentages were calculated based on their ability to determine the following: physiological and behavioral signs of feeding distress, oral feeding skill level (OFS), and clinical recommendation for further feeding evaluation. Our results revealed that this simulation-based training improved the identification of behavioral (p \u3c 0.001) and physiological (p \u3c 0.001) signs of feeding distress, OFS level (p \u3c 0.001), and ability to make appropriate clinical recommendations (p \u3c 0.001).This study has identified a successful method to effectively train entry-level clinical and non-clinical students to screen feeding skills in preterm infants. This training approach has the potential to improve identification of feeding distress and to recognize the need for a dysphagia evaluation to optimize clinical outcomes in this fragile population

Carbohydrate metabolism of cells transformed by the polyoma virus

1. Nutritional studies on strain L cells. (a) The amino acids essential for the growth of strain L cells in serum-free medium were found to be: arginine, cystine, glutamine, histidine, isoleucine, leucine, lysine, methionine, phenylalanine, proline, serine, threonine, tryptophan, tyrosine, and valine. Giutamic acid, aspartic, acid and plycine were not essential for optimal growth over a four day period. It is suggested that the requirement for proline and serine (which are not present in some other synthetic media) was due to the low cell inoculum used; and the short growth period. Conversion was shown to occur between phenylalanine and tyrosine in vitro but not between cystine and methionine. (b) Interaction was shown to exist between isoleucine, leucine, and valine, and between arginine and lysine. Thus not only the concentre of these amino acids in media are important but also the ratios of their concentrations. (c) From these studies HERT 1 medium was evolved, containing the optimal concentrations of these essential amino acids in a medium based on Waymouth's MB 752/1 medium (Waymouth, 1959). 2. Environmental factors and respiration. The respiration of five cell strains (normal human foreskin fibroblast, HeLa, HLM, Y5 and L5178Y strains) was studied with particular reference to influences of environmental factors on cellular respiration. (a) The respiration of human fibroblast and L5178Y cells declined rapidly after inoculation into new medium. This fall in respiration could be prevented by adding Kreba citric acid cycle intermediates to the medium. Strain L cells have been shown to exhibit similar behaviour (Danes and Paul, 196l). The respiration of HeLa, HLM, mid Y5 cells was not affected by change in medium. (b) In all cells respiration was less in cultures maintained at pH 7.8 than in cultures maintained at 7.4. Respiration was also lower at pH 6.8, with the exception of HLM cells. (c) All cells exhibited a Crabtree effect (inhibition of respiration by glycolysis). (d) Respiration was reduced when cultures were maintained in oxygen tensions above or below that obtained in equilibrium with air. (e) The respiratory rate of all cells was higher in the presence of 1 per cent. CO2 than at lower concentrations. Higher concentrations were slightly inhibitory. Carbohydrate metataolism of BHK 21 strain. Comparisons of carbohydrate metabolism were mad& between clones of BHK21 strains which had been transformed by polyoma virus in vitro and clones which had not been transformed. Since 'transferred' cells produced tumours in vivo, the use of this system enabled comparisons to be made between cells, capable and incapable of producing tumours in vivo, both derived from the same cell. Both cell types were swing at similar rates in a controlled Environment. Six lines of cells were used, of which three were 'normal' and three 'transformed'. (a) Respiration. The factors previously shown to affect the respiration of cultured cells were found to affect respiration of 'normal' and 'transformed' BHK21 ceils in a similar manner. When respiration was measured under standard conditions, there was no significant difference in the respiratory rate of 'normal' and 'transformed' BHK21 cells. (b) Glycolysis. Environmental factors have previously been shown to affect glycolysis (Paul, 1959). Glycolytic rates of BHK21 cells were therefore measured under four sets of standard conditions (pH's 6.8 or 7.4 in an atmosphere of air/5 per cent, CO2 or nitrogen/5 per cent. 602). Under all these environmental conditions, glycolysis was higher in the 'transformed' cells than in the 'normal' calls. (c) Enzymes The activities of several enzymes of carbohydrate metabolism were assayed. No glucose-6-phosphatase activity was demonstrated. The activities of lactic dehydrogenase, malic dehydrogenase, and 6- phosphogluconate dehydrogenase were similar in the 'normal' and 'transformed' cells. Hexokinase activity was higher in the 'transformed' cell than in the 'normal' cell, a finding which correlates with the increased glycolysis in the 'transformed' cell. Isocitric dehydrogenase was also higher in the 'transformed' cell though this result is not parallelled by an increased respiratory rate. Glucose-6-phosphate dehydrogenase activity was lower in the 'transformed' cell than in the 'normal' cell. It is suggested that, since both cell types have similar growth rates, this low activity in the 'transformed' cell must be sufficient to provide pentoses for nucleic acid production during growth. Possible reasons for the differences are discussed

Classroom assessment and education: challenging the assumptions of socialisation and instrumentality

The opportunity offered by the Umea Symposium to probe the intersection of quality and assessment immediately brings into focus a wider issue – that of the quality of education which assessment aspires to support. Prompted by recent research into formative assessment in Scottish primary school contexts, the paper explores how formative assessment has become associated with an overly benign understanding of learning which misrecognises the possibility of undesirable learning and does not seem to address the inherently political nature of education. Having illuminated the potential inequities of formative assessment practices, the paper then asks what role formative assessment might play to support an understanding of education that is not simply about the transmission of traditional social norms, but also aspires to illuminate their social construction and their political nature

On Secure Implementation of an IHE XUA-Based Protocol for Authenticating Healthcare Professionals

The importance of the Electronic Health Record (EHR) has been addressed in recent years by governments and institutions.Many large scale projects have been funded with the aim to allow healthcare professionals to consult patients data. Properties such as confidentiality, authentication and authorization are the key for the success for these projects. The Integrating the Healthcare Enterprise (IHE) initiative promotes the coordinated use of established standards for authenticated and secure EHR exchanges among clinics and hospitals. In particular, the IHE integration profile named XUA permits to attest user identities by relying on SAML assertions, i.e. XML documents containing authentication statements. In this paper, we provide a formal model for the secure issuance of such an assertion. We first specify the scenario using the process calculus COWS and then analyse it using the model checker CMC. Our analysis reveals a potential flaw in the XUA profile when using a SAML assertion in an unprotected network. We then suggest a solution for this flaw, and model check and implement this solution to show that it is secure and feasible

Entanglement Percolation with Bipartite Mixed States

We develop a concept of entanglement percolation for long-distance singlet generation in quantum networks with neighboring nodes connected by partially entangled bipartite mixed states. We give a necessary and sufficient condition on the class of mixed network states for the generation of singlets. States beyond this class are insufficient for entanglement percolation. We find that neighboring nodes are required to be connected by multiple partially entangled states and devise a rich variety of distillation protocols for the conversion of these states into singlets. These distillation protocols are suitable for a variety of network geometries and have a sufficiently high success probability even for significantly impure states. In addition to this, we discuss possible further improvements achievable by using quantum strategies including generalized forms of entanglement swapping.Comment: 6+ pages, 5 figures; Published versio

HST/STIS Ultraviolet Imaging of Polar Aurora on Ganymede

We report new observations of the spectrum of Ganymede in the spectral range 1160 - 1720 A made with the Space Telescope Imaging Spectrograph (STIS) on HST on 1998 October 30. The observations were undertaken to locate the regions of the atomic oxygen emissions at 1304 and 1356 A, previously observed with the GHRS on HST, that Hall et al. (1998) claimed indicated the presence of polar aurorae on Ganymede. The use of the 2" wide STIS slit, slightly wider than the disk diameter of Ganymede, produced objective spectra with images of the two oxygen emissions clearly separated. The OI emissions appear in both hemispheres, at latitudes above 40 degrees, in accordance with recent Galileo magnetometer data that indicate the presence of an intrinsic magnetic field such that Jovian magnetic field lines are linked to the surface of Ganymede only at high latitudes. Both the brightness and relative north-south intensity of the emissions varied considerably over the four contiguous orbits (5.5 hours) of observation, presumably due to the changing Jovian plasma environment at Ganymede. However, the observed longitudinal non-uniformity in the emission brightness at high latitudes, particularly in the southern hemisphere, and the lack of pronounced limb brightening near the poles are difficult to understand with current models. In addition to observed solar HI Lyman-alpha reflected from the disk, extended Lyman-alpha emission resonantly scattered from a hydrogen exosphere is detected out to beyond two Ganymede radii from the limb, and its brightness is consistent with the Galileo UVS measurements of Barth et al. (1997).Comment: 7 pages, 4 figures, accepted for publication in ApJ, June 1, 200

Managing Dynamic User Communities in a Grid of Autonomous Resources

One of the fundamental concepts in Grid computing is the creation of Virtual Organizations (VO's): a set of resource consumers and providers that join forces to solve a common problem. Typical examples of Virtual Organizations include collaborations formed around the Large Hadron Collider (LHC) experiments. To date, Grid computing has been applied on a relatively small scale, linking dozens of users to a dozen resources, and management of these VO's was a largely manual operation. With the advance of large collaboration, linking more than 10000 users with a 1000 sites in 150 counties, a comprehensive, automated management system is required. It should be simple enough not to deter users, while at the same time ensuring local site autonomy. The VO Management Service (VOMS), developed by the EU DataGrid and DataTAG projects[1, 2], is a secured system for managing authorization for users and resources in virtual organizations. It extends the existing Grid Security Infrastructure[3] architecture with embedded VO affiliation assertions that can be independently verified by all VO members and resource providers. Within the EU DataGrid project, Grid services for job submission, file- and database access are being equipped with fine- grained authorization systems that take VO membership into account. These also give resource owners the ability to ensure site security and enforce local access policies. This paper will describe the EU DataGrid security architecture, the VO membership service and the local site enforcement mechanisms Local Centre Authorization Service (LCAS), Local Credential Mapping Service(LCMAPS) and the Java Trust and Authorization Manager.Comment: Talk from the 2003 Computing in High Energy and Nuclear Physics (CHEP03), La Jolla, Ca, USA, March 2003, 7 pages, LaTeX, 5 eps figures. PSN TUBT00

Far Ultraviolet Absolute Flux of alpha Virginis

We present the far ultraviolet spectrum of alpha Virginis taken with EURD spectrograph on-board MINISAT-01. The spectral range covered is from ~900 to 1080 A with 5 A spectral resolution. We have fitted Kurucz models to IUE spectra of alpha Vir and compared the extension of the model to our wavelengths with EURD data. This comparison shows that EURD fluxes are consistent with the prediction of the model within 20-30%, depending on the reddening assumed. EURD fluxes are consistent with Voyager observations but are ~60% higher than most previous rocket observations of alpha Vir.Comment: 13 pages, 4 figures. Submitted to The Astrophysical Journa

Far-ultraviolet Spectroscopy of Venus and Mars at 4 A Resolution with the Hopkins Ultraviolet Telescope on Astro-2

Far-ultraviolet spectra of Venus and Mars in the range 820-1840 A at 4 A resolution were obtained on 13 and 12 March 1995, respectively, by the Hopkins Ultraviolet Telescope (HUT), which was part of the Astro-2 observatory on the Space Shuttle Endeavour. Longward of 1250 A, the spectra of both planets are dominated by emission of the CO Fourth Positive band system and strong OI and CI multiplets. In addition, CO Hopfield-Birge bands, B - X (0,0) at 1151 A and C - X (0,0) at 1088 A, are detected for the first time, and there is a weak indication of the E - X (0,0) band at 1076 A in the spectrum of Venus. The B - X band is blended with emission from OI 1152. Modeling the relative intensities of these bands suggests that resonance fluorescence of CO is the dominant source of the emission, as it is for the Fourth Positive system. Shortward of Lyman-alpha, other emission features detected include OII 834, OI lambda 989, HI Lyman-beta, and NI 1134 and 1200. For Venus, the derived disk brightnesses of the OI, OII, and HI features are about one-half of those reported by Hord et al. (1991) from Galileo EUV measurements made in February 1990. This result is consistent with the expected variation from solar maximum to solar minimum. The ArI 1048, 1066 doublet is detected only in the spectrum of Mars and the derived mixing ratio of Ar is of the order of 2%, consistent with previous determinations.Comment: 8 pages, 5 figures, accepted for publication in ApJ, July 20, 200

Tidal disruption of satellites and formation of narrow rings

In this paper we investigate the formation of narrow planetary rings such as those found around Uranus and Saturn through the tidal disruption of a weak, gravitationally bound satellite that migrates within its Roche limit. Using $N$-body simulations, we study the behaviour of rubble piles placed on circular orbits at different distances from a central planet. We consider both homogeneous satellites and differentiated bodies containing a denser core. We show that the Roche limit for a rubble pile is closer to the planet than for a fluid body of the same mean density. The Roche limit for a differentiated body is also closer to the planet than for a homogeneous satellite of the same mean density. Within its Roche limit, a homogeneous satellite totally disrupts and forms a narrow ring. The initial stages of the disruption are similar to the evolution of a viscous fluid ellipsoid, which can be computed semi-analytically. On the other hand, when a differentiated satellite is just within the Roche limit only the mantle is disrupted. This process is similar to Roche-lobe overflow in interacting binary stars and produces two narrow rings on either side of a remnant satellite. We argue that the Uranian rings, and possibly their shepherd satellites, could have been formed through the tidal disruption of a number of protomoons that were formed inside the corotation radius of Uranus and migrated slowly inwards as a result of tidal interaction with the planet.Comment: Accepted for publication in MNRAS. Some figures have been compressed to fit into astro-ph size guidelines. Please contact authors if full resolution images are require