Bringing the Community into the Classroom: Teaching Immunizations Skills via a Community-based Project

Introduction or Statement of Problem Health care profession educators are challenged in their efforts to bring clinical experiences into the class room and to introduce students to community settings early in their didactic training. An immunization program directed at improving childhood immunization rates can introduce students to the community, to students of other disciplines and reinforce the knowledge and skills needed for immunization interventions. Successful interventions increase community demand for immunizations, improve access to services, and educate providers about immunization services and disease. Interventions serve to mold attitudes among health care professionals that foster commitment to universal immunization coverage and low disease rates. [See PDF for complete abstract]

Construct Validity of the Pig Intestine Model in the Simulation of Laparoscopic Urethrovesical Anastomosis

Introduction: Laparoscopic training models are increasingly important in urology to allow trainees to improve their laparoscopic skills prior to going to the operating room. For a training model to be valid, it must correlate with performance in a real case. The model must also discriminate between experienced and inexperienced subjects. [See PDF for complete abstract]

Narrated PowerPoints and Audio Podcasts in Clinical Teaching: One Clerkship's Experience

Introduction: Clinical medical education is increasingly utilizing novel technological approaches in order to supplement traditional lecture-based didactics. The Neurology Core Clerkship at Baylor College of Medicine is a four week required course taken by clinical medical students. Given the large amount of information to be disseminated in a short period of time, part of the didactic material has been provided online in the form of narrated PowerPoint files or lecture audio tracks along with stand-alone PowerPoint files. The narrated files are generated using the native PowerPoint narration function while the stand-alone audio files are created as MP3 format files using an inexpensive digital recording device. [See PDF for complete abstract]

Simulator Network project report: a tool for improvement of teaching materials and targeted resource usage in Skills Labs

During the last decade, medical education in the German-speaking world has been striving to become more practice-oriented. This is currently being achieved in many schools through the implementation of simulation-based instruction in Skills Labs. Simulators are thus an essential part of this type of medical training, and their acquisition and operation by a Skills Lab require a large outlay of resources. Therefore, the Practical Skills Committee of the Medical Education Society (GMA) introduced a new project, which aims to improve the flow of information between the Skills Labs and enable a transparent assessment of the simulators via an online database (the Simulator Network).

Impact of solar versus volcanic activity variations on tropospheric temperatures and precipitation during the Dalton Minimum

The aim of this work is to elucidate the impact of changes in solar irradiance and energetic particles versus volcanic eruptions on tropospheric global climate during the Dalton Minimum (DM, AD 1780–1840). Separate variations in the (i) solar irradiance in the UV-C with wavelengths λ < 250 nm, (ii) irradiance at wavelengths λ > 250 nm, (iii) in energetic particle spectrum, and (iv) volcanic aerosol forcing were analyzed separately, and (v) in combination, by means of small ensemble calculations using a coupled atmosphere–ocean chemistry–climate model. Global and hemispheric mean surface temperatures show a significant dependence on solar irradiance at λ > 250 nm. Also, powerful volcanic eruptions in 1809, 1815, 1831 and 1835 significantly decreased global mean temperature by up to 0.5 K for 2–3 years after the eruption. However, while the volcanic effect is clearly discernible in the Southern Hemispheric mean temperature, it is less significant in the Northern Hemisphere, partly because the two largest volcanic eruptions occurred in the SH tropics and during seasons when the aerosols were mainly transported southward, partly because of the higher northern internal variability. In the simulation including all forcings, temperatures are in reasonable agreement with the tree ring-based temperature anomalies of the Northern Hemisphere. Interestingly, the model suggests that solar irradiance changes at λ < 250 nm and in energetic particle spectra have only an insignificant impact on the climate during the Dalton Minimum. This downscales the importance of top–down processes (stemming from changes at λ < 250 nm) relative to bottom–up processes (from λ > 250 nm). Reduction of irradiance at λ > 250 nm leads to a significant (up to 2%) decrease in the ocean heat content (OHC) between 0 and 300 m in depth, whereas the changes in irradiance at λ < 250 nm or in energetic particles have virtually no effect. Also, volcanic aerosol yields a very strong response, reducing the OHC of the upper ocean by up to 1.5%. In the simulation with all forcings, the OHC of the uppermost levels recovers after 8–15 years after volcanic eruption, while the solar signal and the different volcanic eruptions dominate the OHC changes in the deeper ocean and prevent its recovery during the DM. Finally, the simulations suggest that the volcanic eruptions during the DM had a significant impact on the precipitation patterns caused by a widening of the Hadley cell and a shift in the intertropical convergence zone.

Casting materials and their application in research and teaching

From a biological point of view, casting refers to filling of anatomical and/or pathological spaces with extraneous material that reproduces a three-dimensional replica of the space. Casting may be accompanied by additional procedures such as corrosion, in which the soft tissue is digested out, leaving a clean cast, or the material may be mixed with radiopaque substances to allow x-ray photography or micro computed topography (µCT) scanning. Alternatively, clearing of the surrounding soft tissue increases transparency and allows visualization of the casted cavities. Combination of casting with tissue fixation allows anatomical dissection and didactic surgical procedures on the tissue. Casting materials fall into three categories namely, aqueous substances (India ink, Prussian blue ink), pliable materials (gelatins, latex, and silicone rubber), or hard materials (methyl methacrylates, polyurethanes, polyesters, and epoxy resins). Casting has proved invaluable in both teaching and research and many phenomenal biological processes have been discovered through casting. The choice of a particular material depends inter alia on the targeted use and the intended subsequent investigative procedures, such as dissection, microscopy, or µCT. The casting material needs to be pliable where anatomical and surgical manipulations are intended, and capillary-passable for ultrastructural investigations.

Clinical versus pre-clinical FE models for vertebral body strength predictions

The finite element analysis is an accepted method to predict vertebral body compressive strength. This study compares measurements obtained from in vitro tests with the ones from two different simulation models: clinical quantitative computer tomography (QCT) based homogenized finite element (hFE) models and pre-clinical high-resolution peripheral QCT-based (HR-pQCT) hFE models. About 37 vertebral body sections were prepared by removing end-plates and posterior elements, scanned with QCT (390/450μm voxel size) as well as HR-pQCT (82μm voxel size), and tested in compression up to failure. Non-linear viscous damage hFE models were created from QCT/HT-pQCT images and compared to experimental results based on stiffness and ultimate load. As expected, the predictability of QCT/HR-pQCT-based hFE models for both apparent stiffness (r2=0.685/0.801r2=0.685/0.801) and strength (r2=0.774/0.924r2=0.774/0.924) increased if a better image resolution was used. An analysis of the damage distribution showed similar damage locations for all cases. In conclusion, HR-pQCT-based hFE models increased the predictability considerably and do not need any tuning of input parameters. In contrast, QCT-based hFE models usually need some tuning but are clinically the only possible choice at the moment.

Simulation in vascular access surgery

In the last years, simulation training has become widespread in different areas of medicine due to social expectations, political accountability and professional regulation. Different types of simulators allow to improve knowledge, skills, communication and team behavior. Simulation sessions have been proven to shorten the learning curve and allow education in a safe environment. Patients on dialysis are an expanding group. They often suffer from several comorbidities and need complex surgical procedures with regard to their dialysis access. Therefore, education in evidence-based algorithms is as important as teaching of practical skills. In this chapter, we are presenting an overview of available dialysis access training modalities. We are convinced that simulation will become more important in the near future and has a substantial impact on strategies to improve aspects of patient safety. © 2015 S. Karger AG, Basel.

Viral load versus CD4⁺ monitoring and 5-year outcomes of antiretroviral therapy in HIV-positive children in Southern Africa: a cohort-based modelling study.

OBJECTIVES Many paediatric antiretroviral therapy (ART) programmes in Southern Africa rely on CD4⁺ to monitor ART. We assessed the benefit of replacing CD4⁺ by viral load monitoring. DESIGN A mathematical modelling study. METHODS A simulation model of HIV progression over 5 years in children on ART, parameterized by data from seven South African cohorts. We simulated treatment programmes with 6-monthly CD4⁺ or 6- or 12-monthly viral load monitoring. We compared mortality, second-line ART use, immunological failure and time spent on failing ART. In further analyses, we varied the rate of virological failure, and assumed that the rate is higher with CD4⁺ than with viral load monitoring. RESULTS About 7% of children were predicted to die within 5 years, independent of the monitoring strategy. Compared with CD4⁺ monitoring, 12-monthly viral load monitoring reduced the 5-year risk of immunological failure from 1.6 to 1.0% and the mean time spent on failing ART from 6.6 to 3.6 months; 1% of children with CD4⁺ compared with 12% with viral load monitoring switched to second-line ART. Differences became larger when assuming higher rates of virological failure. When assuming higher virological failure rates with CD4⁺ than with viral load monitoring, up to 4.2% of children with CD4⁺ compared with 1.5% with viral load monitoring experienced immunological failure; the mean time spent on failing ART was 27.3 months with CD4⁺ monitoring and 6.0 months with viral load monitoring. Conclusion: Viral load monitoring did not affect 5-year mortality, but reduced time on failing ART, improved immunological response and increased switching to second-line ART.

Simulating digital dividend auctions: Service neutrality versus dedicated licences

The award of the digital dividend can consolidate auctions as the preferred mechanism for spectrum allocation. Knowing in advance an estimate of what the results of an auction with these characteristics could be would be unquestionably useful for those in charge of designing the process, even if at the end another method such as a beauty contest is chosen. This article provides a simulation of a digital dividend auction in a major-type European country. In one of the scenarios, the spectrum is not pre-allocated to any service in particular (service neutrality) while in the remaining four, blocks of spectrum are pre-allocated to DTT, mobile multimedia and mobile broadband communications. The results of the simulations reveal that the service neutrality scenario maximizes revenues for the seller and that, in general, DTT operators would seem to have fewer opportunities as the spectrum packaging is less protective for them.

Online games for the teaching of mathematics

In this article we present a didactic experience developed by the GIE (Group of Educational Innovation) “Pensamiento Matemático” of the Polytechnics University of Madrid (UPM), in order to bring secondary students and university students closer to Mathematics. It deals with the development of a virtual board game called Mate-trivial. The mechanics of the game is to win points by going around the board which consists of four types of squares identified by colours: “Statistics and Probability”, “Calculus and Analysis”, “Algebra and Geometry” and “Arithmetic and Number Theory ”. When landing on a square, a question of its category is set out: a correct answer wins 200 points, if wrong it loses 100 points, and not answering causes no effect on the points, but all the same, two minutes out of the 20 minutes that each game lasts are lost. For the game to be over it is necessary, before those 20 minutes run out, to reach the central square and succeed in the final task: four chained questions, one of each type, which must be all answered correctly. It is possible to choose between two levels to play: Level 1, for pre-university students and Level 2 for university students. A prototype of the game is available at the website “Aula de Pensamiento Matemático” developed by the GIE: http://innovacioneducativa.upm.es/pensamientomatematico/. This activity lies within a set of didactic actions which the GIE is developing in the framework of the project “Collaborative Strategies between University and Secondary School Education for the teaching and learning of Mathematics: An Application to solve problems while playing”, a transversal project financed by the UPM.

Teaching and evaluating mechanical vibrations with Matlab®

The study of the response of mechanical systems to external excitations, even in the simplest cases, involves solving second-order ordinary differential equations or systems thereof. Finding the natural frequencies of a system and understanding the effect of variations of the excitation frequencies on the response of the system are essential when designing mechanisms [1] and structures [2]. However, faced with the mathematical complexity of the problem, students tend to focus on the mathematical resolution rather than on the interpretation of the results. To overcome this difficulty, once the general theoretical problem and its solution through the state space [3] have been presented, Matlab®[4] and Simulink®[5] are used to simulate specific situations. Without them, the discussion of the effect of slight variations in input variables on the outcome of the model becomes burdensome due to the excessive calculation time required. Conversely, with the help of those simulation tools, students can easily reach practical conclusions and their evaluation can be based on their interpretation of results and not on their mathematical skills

Managing daily surgery schedules in a teaching hospital: a mixed-integer optimization approach

Background: This study examined the daily surgical scheduling problem in a teaching hospital. This problem relates to the use of multiple operating rooms and different types of surgeons in a typical surgical day with deterministic operation durations (preincision, incision, and postincision times). Teaching hospitals play a key role in the health-care system; however, existing models assume that the duration of surgery is independent of the surgeon's skills. This problem has not been properly addressed in other studies. We analyze the case of a Spanish public hospital, in which continuous pressures and budgeting reductions entail the more efficient use of resources. Methods: To obtain an optimal solution for this problem, we developed a mixed-integer programming model and user-friendly interface that facilitate the scheduling of planned operations for the following surgical day. We also implemented a simulation model to assist the evaluation of different dispatching policies for surgeries and surgeons. The typical aspects we took into account were the type of surgeon, potential overtime, idling time of surgeons, and the use of operating rooms. Results: It is necessary to consider the expertise of a given surgeon when formulating a schedule: such skill can decrease the probability of delays that could affect subsequent surgeries or cause cancellation of the final surgery. We obtained optimal solutions for a set of given instances, which we obtained through surgical information related to acceptable times collected from a Spanish public hospital. Conclusions: We developed a computer-aided framework with a user-friendly interface for use by a surgical manager that presents a 3-D simulation of the problem. Additionally, we obtained an efficient formulation for this complex problem. However, the spread of this kind of operation research in Spanish public health hospitals will take a long time since there is a lack of knowledge of the beneficial techniques and possibilities that operational research can offer for the health-care system.

Educational Project for the Teaching of Control of Electric Traction Drives

Electric vehicles constitute a multidisciplinary subject that involves disciplines such as automotive, mechanical, electrical and control engineering. Due to this multidisciplinary technical nature, practical teaching methodologies are of special relevance. Paradoxically, in the past, the training of engineers specializing in this area has lacked the practical component represented by field tests, due to the difficulty of accessing real systems. This paper presents an educational project specifically designed for the teaching and training of engineering students with different backgrounds and experience. The teaching methodology focuses on the topology of electric traction drives and their control. It includes two stages, a simulation computer model and a scaled laboratory workbench that comprises a traction electrical drive coupled to a vehicle emulator. With this equipment, the effectiveness of different traction control strategies can be analyzed from the point of view of energy efficiency, robustness, easiness of implementation and acoustic noise.

Evaluation of online tools as didactic resource in the university education

Recently, many efforts have been made in the academic world to adapt the new degrees to the new European Higher Education Area (EHEA). New technologies have been the most important factor to carry out this adaptation. In particular, the tools 2.0 have been spreading quickly, not just the Web 2.0, but even in all the educational levels. Nevertheless, it is now necessary to evaluate whether all these efforts and all the changes, carried out in order to obtain improved academic performance among students, have provided good results. Therefore, the aim of this paper is focused on studying the impact of the implementation of information and communication technologies (ICTs) in a subject belonging to a Master from the University of Alicante in the academic year (2010-2011). In special, it is an elective course called "Advanced Visual Ergonomics" from the Master of Clinical Optometry and Vision. The methodology used to teach this course differs from the traditional one in many respects. For example, one of the resources used for the development of this course is a blog developed specifically to coordinate a series of virtual works, whose purpose is that the student goes into specific aspects of the current topic. Next, the student participates in an active role by writing a personal assessment on the blog. However, in the course planning, there is an attendance to lessons, where the teacher presents certain issues in a more traditional way, that is, with a lecture supported with audiovisual materials, such as materials generated in powerpoint. To evaluate the quality of the results achieved with this methodology, in this work the personal assessment of the students, who have completed this course during this academic year, are collected. In particular, we want to know their opinion about the used resources, as well as the followed methodology. The tool used to collect this information was a questionnaire. This questionnaire evaluates different aspects of the course: a general opinion, quality of the received information, satisfaction about the followed methodology and the student´s critical awareness. The design of this questionnaire is very important to get conclusive information about the methodology followed in the course. The questionnaire has to have an adequate number of questions; whether it has many questions, it might be boring for the student who would pay no enough attention. The questions should be well-written, with a clear structure and message, to avoid confusion and an ambiguity. The questions should be objectives, without any suggestion for a desired answer. In addition, the questionnaire should be interesting to encourage the student´ s interest. In conclusion, this questionnaire developed for this subject provided good information to evaluate whether the methodology was a useful tool to teach "Advanced Visual Ergonomics". Furthermore, the student´s opinion collected by this questionnaire might be very helpful to improve this didactic resource.