Low-fidelity bench models for basic surgical skills training during undergraduate medical education

It is remarkable the reduction in the number of medical students choosing general surgery as a career. In this context, new possibilities in the field of surgical education should be developed to combat this lack of interest. In this study, a program of surgical training based on learning with models of low-fidelity bench is designed as a complementary alternative to the various methodologies in the teaching of basic surgical skills during medical education, and to develop personal interests in career choice.

Evolutionary conservation of residues in vertebrate DNA polymerase N conferring low fidelity and bypass activity.

POLN is a nuclear A-family DNA polymerase encoded in vertebrate genomes. POLN has unusual fidelity and DNA lesion bypass properties, including strong strand displacement activity, low fidelity favoring incorporation of T for template G and accurate translesion synthesis past a 5S-thymine glycol (5S-Tg). We searched for conserved features of the polymerase domain that distinguish it from prokaryotic pol I-type DNA polymerases. A Lys residue (679 in human POLN) of particular interest was identified in the conserved 'O-helix' of motif 4 in the fingers sub-domain. The corresponding residue is one of the most important for controlling fidelity of prokaryotic pol I and is a nonpolar Ala or Thr in those enzymes. Kinetic measurements show that K679A or K679T POLN mutant DNA polymerases have full activity on nondamaged templates, but poorly incorporate T opposite template G and do not bypass 5S-Tg efficiently. We also found that a conserved Tyr residue in the same motif not only affects sensitivity to dideoxynucleotides, but also greatly influences enzyme activity, fidelity and bypass. Protein sequence alignment reveals that POLN has three specific insertions in the DNA polymerase domain. The results demonstrate that residues have been strictly retained during evolution that confer unique bypass and fidelity properties on POLN.

Teaching elliptical excision skills to novice medical students: a randomized controlled study comparing low- and high-fidelity bench models

Background: The search for alternative and effective forms of training simulation is needed due to ethical and medico-legal aspects involved in training surgical skills on living patients, human cadavers and living animals. Aims : To evaluate if the bench model fidelity interferes in the acquisition of elliptical excision skills by novice medical students. Materials and Methods: Forty novice medical students were randomly assigned to 5 practice conditions with instructor-directed elliptical excision skills' training (n = 8): didactic materials (control); organic bench model (low-fidelity); ethylene-vinyl acetate bench model (low-fidelity); chicken legs' skin bench model (high-fidelity); or pig foot skin bench model (high-fidelity). Pre- and post-tests were applied. Global rating scale, effect size, and self-perceived confidence based on Likert scale were used to evaluate all elliptical excision performances. Results : The analysis showed that after training, the students practicing on bench models had better performance based on Global rating scale (all P < 0.0000) and felt more confident to perform elliptical excision skills (all P < 0.0000) when compared to the control. There was no significant difference (all P > 0.05) between the groups that trained on bench models. The magnitude of the effect (basic cutaneous surgery skills' training) was considered large (>0.80) in all measurements. Conclusion : The acquisition of elliptical excision skills after instructor-directed training on low-fidelity bench models was similar to the training on high-fidelity bench models; and there was a more substantial increase in elliptical excision performances of students that trained on all simulators compared to the learning on didactic materials.

Does bench model fidelity interfere in the acquisition of suture skills by novice medical students?

OBJETIVO: Embora vários modelos de bancada inanimados tenham sido descritos para o treinamento de habilidades de sutura, até o momento, não existe um método ideal para esse ensino e aprendizagem durante a formação médica. O objetivo foi avaliar se a fidelidade dos modelos de bancada interfere na aquisição de habilidades de sutura em estudantes de medicina iniciantes na prática cirúrgica. MÉTODOS: 36 estudantes de medicina sem exposição prévia a habilidades cirúrgicas foram randomizados em três grupos (n = 12): treinamento de suturas baseado em materiais didáticos (controle); treinamento de suturas em modelo de baixa-fidelidade (modelo de bancada de etileno vinil acetato); ou treinamento de suturas em modelo de alta-fidelidade (modelo de bancada de pele de pata de porco). Foram aplicados pré e pós-testes (realização de pontos simples e pontos subdérmicos invertidos em língua de boi). Três ferramentas (Global Rating Scale com avaliação cega, tamanho do efeito e autopercepção da confiança baseada em uma escala de Likert) foram utilizadas para mensurar todas as performances de sutura. RESULTADOS: A análise após o treinamento demonstrou que os estudantes que treinaram nos modelos tiveram um melhor (p < 0.0000) desempenho na avaliação pela Global Rating Scale, quando comparados com o controle, independente da fidelidade do modelo. A magnitude do efeito (treinamento) foi considerada grande (> 0.80) em todas as mensurações. Após o treinamento os alunos sentiram-se mais confiantes (p < 0.0000) para executarem os dois tipos de suturas. CONCLUSÃO: A aquisição de habilidades de suturas no modelo de baixa fidelidade foi semelhante à prática no modelo de alta fidelidade, sendo que a melhora no desempenho dos participantes que treinaram nesses dois modelos foi superior à aprendizagem baseada em materiais didáticos.

Lo-Fi matchmaking: A study of social pairing for backpackers

It is technically feasible for mobile social software such as pairing or ‘matchmaking’ systems to introduce people to others and assist information exchange. However, little is known about the social structure of many mobile communities or why they would want such pairing systems. While engaged in other work determining requirements for a mobile travel assistant we saw a potentially useful application for a pairing system to facilitate the exchange of travel information between backpackers. To explore this area, we designed two studies involving usage of a low-fidelity role prototype of a social pairing system for backpackers. Backpackers rated the utility of different pairing types, and provided feedback on the social implications of being paired based on travel histories. Practical usage of the social network pairing activity and the implications of broader societal usage are discussed.

Primary Health Care from the perception of women living in a rural area

AbstractOBJECTIVEUnderstanding the perception of women living in a rural area about the actions and services of Primary Health Care (PHC) in a municipality of southern Brazil, which is the only one regarded as predominantly rural.METHODA descriptive study of qualitative approach, carried out with women who lived in the countryside and required health services in the 15 days prior to collection.RESULTSThe results registered low fidelity to PHC attributes, focusing its functional axis on sickness, transforming the unit into small points of emergency care and a bureaucratic place where patients are referred to other types of services. The quality of service offered is compromised to offering quick, fragmented and unequal treatment in the rural context.CONCLUSIONThe findings of this study highlight the need for greater efforts in order to adequate the new care model in the development of appropriate actions as designated by PHC in the rural context studied.

Análise comparativa da variação entre quasiespecies do Vírus da Hepatite C genótipo 1 em amostras prétratamento de pacientes tratados com Peginterferon

Pós-graduação em Genética - IBILCE

Simulation-based ultrasound-guided central venous cannulation training program

PURPOSE: To propose a simulation-based ultrasound-guided central venous cannulation skills' training program, during residency.METHODS: This study describes the strategies for learning the ultrasound-guided central venous cannulation on low-fidelity bench models. The preparation of bench models, educational goals, processes of skill acquisition, feedback and evaluation methods were also outlined. The training program was based on key references to the subject.RESULTS: It was formulated a simulation-based ultrasound-guided central venous cannulation teaching program on low-fidelity bench models.CONCLUSION: A simulation-based inexpensive, low-stress, no-risk learning program on low-fidelity bench models was proposed to facilitate acquisition of ultrasound-guided central venous cannulation skills by residents-in-training before exposure to the living patient.

Entwicklung und Implementierung von Modellen für ein Skills-Training-Parcours für internistische Assistenzärzte

„Entwicklung und Implementierung von Modellen für ein Skills-Training-Parcours für internistische Assistenzärzte “ V. Maier1 - K. Schnabel2 1 Universitätslinik für Allgemeine Innere Medizin, Inselspital, Bern 2 Berner interdisziplinäres Skills- und Schauspielpatientenzentrum (BiSS), Institut für Medizinische Lehre (IML), Abteilung für Unterricht und Medien (AUM) Einleitung: Im klinischen Alltag sind praktische Fertigkeiten gefordert, um Patienten sicher zu behandeln. Auch in der Schweizer Fachgesellschaft FMH kam es zu einer stärkeren Gewichtung der praktischen Fertigkeiten und müssen jetzt ein Logbuch über Art und Zeitpunkt der Intervention führen [1]. Am Inselspital Bern wurde dafür ein Skillsparcours etabliert, da in vielen Bereichen simulationsbasierte Ausbildungen traditionellen Methoden überlegen ist [2]. Der Skillsparcours besteht aus einem Nachmittag mit 4 nicht-invasiven Prozeduren und einem Nachmittag mit 5 invasiven Prozeduren. Eigens dafür wurden drei Modelle entwickelt und deren Tauglichkeit evaluiert. Fragestellung: Bilden die selbst gefertigten Modelle die Realität ausreichend ab? Material und Methoden: Innerhalb der 9 Posten (5 invasiv und 4 nichtinvasiv) wurden für die 5 invasiven Posten zwei Modelle aus dem Skillslab (BiSS) genutzt (Lumbalpunktion (LP) und Blasenkatheter (BK)) und drei Modelle neu entwickelt (Pleura-(PP), Aszites-(AP) und Knochenmarks-Punktion (KMP)). Die Modelle wurden mit Materialien aus dem Baumarkt entwickelt (Material ca. CHF 50/Stück). Der Aufbau der Modelle soll auf der Tagung demonstriert werden. Die Teilnehmer (N=12) und Dozenten (N=5) wurden zu der Qualität mittels Fragebogen befragt. Dabei wurde die individuelle Vorerfahrung und die Einschätzung der Teilnehmer erfragt. Die Frage zur Eignung des Modells war: „Das Modell war zum Üben geeignet“. Als Skala wurde eine Likert-Skala von 0 bis 5 (1=sehr ungeeignet, 5=sehr geeignet) benutzt. Ergebnisse: Die Assistenzärzte beurteilten die Modelleignung wie folgt (Median (Min;Max)): LP: 5 (4;5) KMP: 4.5 (3;5), PP: 4 (3;5), AP: 4.5 (2;5), BK-Einlage: 4.5 (4;6). Die Oberärzte, die jeweils nur das Modell bewerteten, an welchem sie den Kurs durchführten, beurteilten die Modelleignung wie folgt: LP 5.0, KMP: 5.0, PP 5.0, AP: 4.0, BK-Einlage: 3.0. Diskussion: Alle Modelle wurden sowohl von den Oberärzten als auch von den Assistenzärzten als zum Üben tauglich eingeschätzt. Zwischen den selbst hergestellten Low-Fidelity Modellen und den High-Fidelity Modellen gab es hierein keinen signifikanten Unterschied. Als am wenigsten tauglich wurde von den Oberärzten mit der Simulation der Blasenkatheter-Einlage ein High-Fidelity-Modell bewertet. Schlussfolgerungen: Alle Modelle für die Simulation der Punktionstechniken haben gut bis sehr gut funktioniert. Die selbst hergestellten Modelle bilden die Wirklich zum Üben der Techniken hinreichend gut und nicht schlechter als die High-Fidelity-Modelle ab. Selbst gebaute Modelle mit Materialien aus dem Baumarkt können das sonst sehr materialaufwändige Training mit Simulatoren genauso effektiv aber wesentlich effizienter durchführbar machen. Literatur bei den Autoren (1) Weiterbildungsordnung FMH 2014 (letzte Revision 4. September 2014). www.fmh.ch/files/pdf15/wbo_d.pdf (2) McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB (2011) Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med. 2011 Jun;86(6):706-11

Magnificador basado en teléfono móvil: prototipo funcional

Enmarcado en un proyecto más amplio, en este TFG se ha realizado un prototipo funcional de una aplicación Android para realizar una función de magnificador digital de documentos en papel. Para llevarlo a cabo se ha realizado un estudio de los TFG anteriores incluidos en este proyecto, así como un estudio del desarrollo en Android. Posteriormente se ha diseñado la interfaz de usuario del prototipo funcional, partiendo de los resultados de la evaluación del prototipo de baja fidelidad realizado en un TFG anterior. Tras este diseño se ha Implementado el prototipo funcional, usando las librerías desarrolladas en TFG anteriores. Por último, se ha realizado una evaluación de la usabilidad y accesibilidad del prototipo funcional y se han definido una serie de recomendaciones de cambio a partir de esta evaluación de cara al desarrollo del sistema definitivo. ---ABSTRACT---As a part of a larger project, this TFG develops a functional prototype of an Android application to perform a magnifier function to paper documents. This application is aimed at people with low vision problems. To get it done, a study of the previous TFG included in this project as well as a study of Android developing has been made. After that, the user interface of the functional prototype has been designed, starting from the results of the low-fidelity prototype evaluation made in a previous TFG. In this design, several changes have been made regarding the low-fidelity prototype, applying the results of the usability evaluation. After this design, the functional prototype has been implemented using the libraries developed in the previous TFG. In this process some modifications over these libraries have been required. Finally, a usability and accessibility evaluation about the prototype with real users has been made, and there have been defined several change recommendations from this evaluation having in mind the development of the final system.

Accuracy of lesion bypass by yeast and human DNA polymerase η

DNA polymerase η (Polη) functions in the error-free bypass of UV-induced DNA lesions, and a defect in Polη in humans causes the cancer-prone syndrome, the variant form of xeroderma pigmentosum. Both yeast and human Polη replicate through a cis-syn thymine-thymine dimer (TT dimer) by inserting two As opposite the two Ts of the dimer. Polη, however, is a low-fidelity enzyme, and it misinserts nucleotides with a frequency of ≈ 10−2 to 10−3 opposite the two Ts of the TT dimer as well as opposite the undamaged template bases. This low fidelity of nucleotide insertion seems to conflict with the role of Polη in the error-free bypass of UV lesions. To resolve this issue, we have examined the ability of human and yeast Polη to extend from paired and mispaired primer termini opposite a TT dimer by using steady-state kinetic assays. We find that Polη extends from mispaired primer termini on damaged and undamaged DNAs with a frequency of ≈ 10−2 to 10−3 relative to paired primer termini. Thus, after the incorporation of an incorrect nucleotide, Polη would dissociate from the DNA rather than extend from the mispair. The resulting primer-terminal mispair then could be subject to proofreading by a 3′→5′ exonuclease. Replication through a TT dimer by Polη then would be more accurate than that predicted from the fidelity of nucleotide incorporation alone.

ATC-lab: An air traffic control simulator for the laboratory

Air Traffic Control Laboratory Simulator (ATC-lab) is a new low- and medium-fidelity task environment that simulates air traffic control. ATC-lab allows the researcher to study human performance of tasks under tightly controlled experimental conditions in a dynamic, spatial environment. The researcher can create standardized air traffic scenarios by manipulating a wide variety of parameters. These include temporal and spatial variables. There are two main versions of ATC-lab. The medium-fidelity simulator provides a simplified version of en route air traffic control, requiring participants to visually search a screen and both recognize and resolve conflicts so that adequate separation is maintained between all aircraft. The low-fidelity simulator presents pairs of aircraft in isolation, controlling the participant's focus of attention, which provides a more systematic measurement of conflict recognition and resolution performance. Preliminary studies have demonstrated that ATC-lab is a flexible tool for applied cognition research.

Lo-Fi matchmaking: A study of social pairing for backpackers 8th International Conference on Ubiquitous Computing, UbiComp 2006

It is technically feasible for mobile social software such as pairing or ‘matchmaking’ systems to introduce people to others and assist information exchange. However, little is known about the social structure of many mobile communities or why they would want such pairing systems. While engaged in other work determining requirements for a mobile travel assistant we saw a potentially useful application for a pairing system to facilitate the exchange of travel information between backpackers. To explore this area, we designed two studies involving usage of a low-fidelity role prototype of a social pairing system for backpackers. Backpackers rated the utility of different pairing types, and provided feedback on the social implications of being paired based on travel histories. Practical usage of the social network pairing activity and the implications of broader societal usage are discussed.

The effect of reduced contrast on drivers' speed perception

It has been demonstrated, using abstract psychophysical stimuli, that speeds appear slower when contrast is reduced under certain conditions. Does this effect have any real life consequences? One previous study has found, using a low fidelity driving simulator, that participants perceived vehicle speeds to be slower in foggy conditions. We replicated this finding with a more realistic video-based simulator using the Method of Constant Stimuli. We also found that lowering contrast reduced participants’ ability to discriminate speeds. We argue that these reduced contrast effects could partly explain the higher crash rate of drivers with cataracts (this is a substantial societal problem and the crash relationship variance can be accounted for by reduced contrast). Note that even if people with cataracts can calibrate for the shift in their perception of speed using their speedometers (given that cataracts are experienced over long periods), they may still have an increased chance of making errors in speed estimation due to poor speed discrimination. This could result in individuals misjudging vehicle trajectories and thereby inflating their crash risk. We propose interventions that may help address this problem.

The influence of gender and ethnic diversity on team effectiveness

Organizations are becoming increasingly diverse as a growing number of women and ethnic minorities enter the workforce. Understanding the influence of diversity is particularly important for organizations that rely on team-based work structures, where individuals must engage in face-to-face interactions more frequently than in other organizational settings. The purpose of this research was to examine the effects of gender and ethnic diversity on team member interactions when performing a highly interdependent task that is both cognitively and behaviorally challenging. Participants were composed of 264 undergraduate students who enrolled in psychology courses at Florida International University and formed 66, 4-person teams. Teams participated in a low fidelity F-22 flight simulation consisting of two aircraft that had to interact in order to be successful. A 2 x 2 design was utilized in which the gender and ethnicity composition of each team was manipulated to form four experimental conditions (same gender/same ethnicity, same gender/mixed ethnicity, mixed gender/same ethnicity, mixed gender/mixed ethnicity). Both ethnic and gender homogeneity in teams resulted in increased interpersonal cohesion. Moreover, coordination fully mediated the relationship between interpersonal cohesion and team performance. Higher levels of interpersonal cohesion enhanced coordination between team members, which ultimately improved performance. Implications of these findings are discussed, as are limitations of the study and suggestions for future research. ^