The final examination in medicine : time for change?

Most medical programmes culminate in a final assessment, in order that participants may be tested and graded. In June 1995, at the University of Malta, a group of 53 medical students sat for their final examination; medicine was one of the three co-equal component subjects of this statutory qualifying examination. The scope of this paper is to analyze the results obtained in the final examination in medicine and to use this data to address such issues as aims of this examination, method and quality assurance of assessment. The result obtained by candidates in the final examination in medicine was correlated with their university entry qualifications. The composite mark for each candidate was split into its components and analysis took the form of description, correlation and clustering. Computation of Cronbach’s alpha facilitated anlaysis of reliability of each of the three parts of the examination. The findings of this paper suggest that there is room for improving the quality of assessment methods. A review of methods and procedures, with the dual purpose of decreasing bias and increasing specificity and sensitivity of this statutory examination will not only benefit candidates, but ultimately also the University of Malta. The final qualifying examination in medicine should have clearly defined objectives and methods of assessment should be aimed specifically at reaching them. It needs to be able to assess the ability to think critically about diagnosis and management and to ensure that the candidate has a satisfactory base of factual knowledge. It also needs to assess objectively the adequacy of basic clinical skills and candidates’ facility of communication.peer-reviewe

New Synthetic Endocannabinoid as Anti-Inflammaging Cosmetic Active: an In Vitro Study on a Reconstructed Skin Model

Endocannabinoids have been recently appointed as interesting cosmetic actives in regulating inflammaging, a state of chronic low-grade inflammation, known for being involved in many senescence\u2019s manifestations, included skin aging. The aim of this study was to assess the anti-inflammaging activity of a new synthetic endocannabinoid, Isopalmide\uae, on a reconstructed skin model, on which inflammaging has been reproduced through UVA radiation and light mechanical stress. We tested Isopalmide\uae both as a single active and conveyed in a cosmetic product, in comparison with Anandamide, a well-known natural endocannabinoid with anti-inflammatory action. The anti-inflammaging activity of topically applied products has been assessed, after 6 hours of treatment post-irradiation, through the transcriptional modification of genes involved in the NF-\u3baB pathway and the epigenetic pathway targeting miRs as potential biomarkers of inflammaging: miR-21, miR-126 and miR-146a. The results confirmed the anti-inflammatory action of Anandamide which inhibits NF-\u3baB, while Isopalmide\uae showed its anti-inflammaging activity through the establishment of an inflammatory/anti-inflammatory balance by maintaining NF-\u3baB inactive in the cytoplasm and active in the nucleus. The anti-inflammaging activity was shown also by the cosmetic product containing Isopalmide

Odor-driven attractor dynamics in the antennal lobe allow for simple and rapid olfactory pattern classification

The antennal lobe plays a central role for odor processing in insects, as demonstrated by electrophysiological and imaging experiments. Here we analyze the detailed temporal evolution of glomerular activity patterns in the antennal lobe of honeybees. We represent these spatiotemporal patterns as trajectories in a multidimensional space, where each dimension accounts for the activity of one glomerulus. Our data show that the trajectories reach odor-specific steady states (attractors) that correspond to stable activity patterns at about 1 second after stimulus onset. As revealed by a detailed mathematical investigation, the trajectories are characterized by different phases: response onset, steady-state plateau, response offset, and periods of spontaneous activity. An analysis based on support-vector machines quantifies the odor specificity of the attractors and the optimal time needed for odor discrimination. The results support the hypothesis of a spatial olfactory code in the antennal lobe and suggest a perceptron-like readout mechanism that is biologically implemented in a downstream network, such as the mushroom body

Sensory memory for odors is encoded in spontaneous correlated activity between olfactory glomeruli

Sensory memory is a short-lived persistence of a sensory stimulus in the nervous system, such as iconic memory in the visual system. However, little is known about the mechanisms underlying olfactory sensory memory. We have therefore analyzed the effect of odor stimuli on the first odor-processing network in the honeybee brain, the antennal lobe, which corresponds to the vertebrate olfactory bulb. We stained output neurons with a calcium-sensitive dye and measured across-glomerular patterns of spontaneous activity before and after a stimulus. Such a single-odor presentation changed the relative timing of spontaneous activity across glomeruli in accordance with Hebb's theory of learning. Moreover, during the first few minutes after odor presentation, correlations between the spontaneous activity fluctuations suffice to reconstruct the stimulus. As spontaneous activity is ubiquitous in the brain, modifiable fluctuations could provide an ideal substrate for Hebbian reverberations and sensory memory in other neural systems

Multiparametric Analysis of Factors Associated With Eosinophilic Chronic Rhinosinusitis With Nasal Polyps

Introduction: Previous studies have reported a diverse range of threshold values for blood eosinophilia. In addition, a single predictive biomarker for eosinophilic chronic rhinosinusitis (CRS) with nasal polyps (ECRSwNP) has not yet been identified. Objectives: The aim of this study is to compare the clinical characteristics of ECRSwNP and non-ECRSwNP to evaluate the preoperative risk of tissue eosinophilia of chronic rhinosinusitis with nasal polyps (CRSwNP) through a multiparametric statistical analysis. Methods: One hundred ten patients with evidence of chronic polypoid rhinosinusitis were included in this study and clinical records were retrospectively reviewed. Eosinophilic CRSwNP was diagnosed based on the presence of at least 10 eosinophils per high-power field. The demographic and clinical features of ECRSwNP and non-ECRSwNP are described. The values of blood eosinophilia as predictors of tissue eosinophilia have been identified using receiver operating characteristic curves. As the predictive value of the identified cutoff through regression analysis was low, we evaluated whether other risk factors could be statistically associated with ECRSwNP, and from this, a new predictive model was proposed for the identification of eosinophilic nasal polyps before surgery. Results: We found that the best method for predicting ECRSwNP is based on a model having asthma, blood eosinophil percentage, posterior ethmoid value in Lund-Mackay score, and modified Lund-Kennedy score as explanatory variables. Conclusions: This study provides new data for a better understanding of the polypoid CRS endotypes, and the proposed model allows the endotype to be identified preoperatively

Crowd Logistics: A Survey of Successful Applications and Implementation Potential in Northern Italy

Nowadays, last-mile logistics represents the least efficient stage of supply chains, covering up to 28% of the total delivery cost and causing significant environmental emissions. In the last few years, a wide range of collaborative economy business models has emerged across the globe, rapidly changing the way services were traditionally provided and consumed. Crowd logistics (CL) is a new strategy for supporting fast shipping services, entrusting the management of the last-mile delivery to the crowd, i.e., normal people, who agree to deliver goods to customers located along the route they have to travel, using their own transport means, in exchange for a small reward. Most existing studies have focused on evaluating the opportunities and challenges provided by CL through theoretical analysis and literature reviews, while others have proposed models for designing such emerging distribution networks. However, papers analyzing real successful applications of CL worldwide are lacking, despite being in high demand. This study attempted to fill this gap by providing, at first, an overview of real CL applications around the globe to set the stage for future successful implementations. Then, the implementation potential of CL in northern Italy was assessed through a structured questionnaire delivered to a panel of 214 people from the Alma Mater Studiorum University of Bologna (Italy) to map the feasibility of a crowd-based system in this area. The results revealed that about 91% of the interviewees were interested in using this emerging delivery system, while the remaining respondents showed some concern about the protection of their privacy and the safeguarding of the goods during transport. A relevant percentage of the interviewees were available to join the system as occasional drivers (ODs), with a compensation policy preference for a fixed fee per delivery rather than a variable reward based on the extra distance traveled to deliver the goods

INTEGRATED 3D SURVEY FOR THE DOCUMENTATION AND VISUALIZATION OF A ROCK-CUT UNDERGROUND BUILT HERITAGE

Abstract. The research presented here is part of an on-going research focused on the 3D documentation of rock-cut Underground Built Heritage with a complex morphology and characterised by narrow spaces, the Hypogeum of Calaforno (province of Ragusa, Sicily). It is one of the most interesting prehistoric monuments in Sicily in terms of size and unique rock-cut architecture. Various digital techniques have been tested over the years on the site, to represent its spatiality, such as Laser Scanner and Structure from Motion. The proposed methodological approach for the knowledge and the documentation of this archaeological site is based on an interdisciplinary approach involving archaeological and engineering disciplines. This paper focuses on the use of expeditious techniques such as iMMS (indoor Mobile Mapping Systems) based on SLAM (Simultaneous Localization and Mapping) and on the comparison of different surveying equipment in order to verify data quality and accuracy, as well as the inherent advantages of using one technology over another in relation to the characteristics of the site. Through the global verification of TLS and SLAM model reliability, we maintain that such research can contribute to enriching the protocols surrounding the archaeological investigation of sites characterized by complex morphology, irregular surfaces, narrow spaces, specific chromatic features, scarce or total lack of lighting, and physical obstacles

REMOTE SENSING AND CITY INFORMATION MODELING FOR REVEALING THE COMPLEXITY OF HISTORICAL CENTERS

Abstract. Historical centers represent the outcome of transformations and stratifications of the cities across the centuries. The knowledge of a historical urban environment requires an analytical methodology articulated on several interconnected levels of investigation to model a multi-layered complexity that encompasses the geometric and stylistic features of places (blocks irregularities, narrow streets, stratified buildings), the accessibility (pedestrial zone, no flyzone), the use of existing data (GIS, cartographies). Today the challenge for historical centers is dual: on the one side to make use of expeditious technologies to acquire data, on the other one to create 3D city models that allow to manage, visualize, enquire and use these data in a unique digital ecosystem. Our research deals with a multi-sensor data acquisition, evaluation and integration with the aim of creating informed and responsive 3D city models (CIM) that constitute a synthesis of the survey conducted and become the support for simulations in various contexts (seismic risk, hydraulic, energy performance)

A two-step methodology for product platform design and assessment in high-variety manufacturing

The delayed product differentiation (DPD) recently rose as a hybrid production strategy able to overcome the main limits of make to stock (MTS) and make to order (MTO), guaranteeing the management of high variety and keeping low storage cost and quick response time by using the so-called product platforms. These platforms are a set of sub-systems forming a common structure from which a set of derivative variants can be efficiently produced. Platforms are manufactured and stocked following an MTS strategy. Then, they are customized into different variants, following an MTO strategy. Current literature proposes methods for platform design mainly using optimization techniques, which usually have a high computational complexity for efficiently managing real-size industrial instances in the modern mass customization era. Hence, efficient algorithms need to be developed to manage the product platforms design for such instances. To fill this gap, this paper proposes a two-step methodology for product platforms design and assessment in high-variety manufacturing. The design step involves the use of a novel modified algorithm for solving the longest common subsequence (LCS) problem and of the k-medoids clustering for the identification of the platform structure and the assignment of the variants to the platforms. The platforms are then assessed against a set of industrial and market metrics, i.e. the MTS cost, the variety, the customer responsiveness, and the variants production cost. The evaluation of the platform set against such a combined set of drivers enhancing both company and market perspectives is missing in the literature. A real case study dealing with the manufacturing of a family of valves exemplifies the efficiency of the methodology in supporting companies in managing high-variety to best balance the proposed metrics

AN EXPEDITIOUS PARAMETRIC APPROACH FOR CITY INFORMATION MODELING AND FINITE ELEMENT ANALYSIS

Abstract. The mitigation of seismic risk passes through the assessment of seismic hazard of urban fabrics on a given territory. Statistical methods and damage probability matrices are currently used to facilitate seismic safety knowledge and assessment operations. These methods, despite being fast and low cost, often return results that differ from reality and prone to the expertise of the operator. Indeed, in order to have more accurate information it is necessary to conduct Finite Element Analysis (FEA). However, this type of analysis requires considerable surveying and modeling time and therefore are not easily applied to the urban scale. The key to implement this analysis at the territorial scale lies in the way of acquisition of urban data (geometric and informative) and their management within appropriate modeling environments that allow their treatment. Currently, the information modeling paradigms used for urban data collection and management are either time and resource consuming (HBIM) or overly simplified (GIS). In this research we investigate the potential of City Information Modeling (CIM) in a parametric environment (with reference to CityGML standards) combined with urban survey procedures. Aim of the work presented here is the definition of a parametric modeling protocol that allows, in a short time, the acquisition, modeling and finite element structural analysis of urban aggregates