A model for self-directed problem-based learning for renal therapeutics

Objective To introduce a new approach to problem-based learning (PBL) for self-directed learning in renal therapeutics. Design This 5-week course, designed for large student cohorts using minimal teaching resources, was based on a series of case studies and subsequent pharmaceutical care plans, followed by intensive and regular feedback from the instructor. Assessment Assessment of achievement of the learning outcomes was based on weekly-graded care plans and peer review assessment, allowing each student to judge the contributions of each group member and their own, along with a written case-study based examination. The pharmaceutical care plan template, designed using a “tick-box” system, significantly reduced staff time for feedback and scoring. Conclusion The proposed instructional model achieved the desired learning outcomes with appropriate student feedback, while promoting skills that are essential for the students' future careers as health care professionals.

Habilidades sociais em portadores de anomalia da diferenciação sexual

O termo Habilidades Sociais (HS) é usado para designar um conjunto de repertórios comportamentais que envolvem interações sociais satisfatórias. A maioria dos estudos publicados sobre essa temática inclui a participação de crianças e adolescentes, abordando situações em ambiente escolar. Poucos são os estudos voltados para a área de saúde, e, até o momento, não foram localizadas pesquisas sobre HS realizadas com indivíduos portadores de Anomalia da Diferenciação Sexual (ADS). Esta anomalia se caracteriza pela malformação na genitália e/ou pela disfunção das gônadas, ocasionando características sexuais secundárias não correspondentes ao sexo de criação. Estudos clínicos realizados com indivíduos portadores de ADS têm destacado a ocorrência de déficits em habilidades sociais nesses indivíduos, caracterizados pela fuga-esquiva de situações sociais aversivas. Neste trabalho, pretendeu-se caracterizar o repertório comportamental correspondente a HS em indivíduos com ADS atendidos no ambulatório de um programa especializado de um hospital da rede pública de Belém, por meio de dois estudos complementares. No primeiro, foi realizado um estudo com delineamento transversal, com o objetivo de caracterizar comportamentos correspondentes a HS em indivíduos com ADS. Participaram 9 adultos com mais de seis meses em tratamento. Foram utilizados: Roteiro de Entrevista, Protocolo para análise de prontuário e Inventário de Habilidades Sociais - IHS. Os resultados sugerem que os participantes apresentam déficit de habilidades sociais em todos os fatores do IHS em menor ou maior grau, de maneira que poderiam se beneficiar com um treinamento de habilidades sociais como parte do tratamento, por se tratar de uma técnica que visa à superação e/ou redução dos déficits por eles apresentados. No segundo, foi realizado um estudo com delineamento de sujeito único, com o objetivo de verificar os efeitos do uso de treino em automonitoramento na instalação de comportamentos correspondentes a HS. Participou uma adulta com diagnóstico de ADS selecionada dentre os que participaram do Estudo 1. O procedimento de intervenção ocorreu por meio de entrevistas semanais, de acordo com as seguintes etapas: (1) Contrato: assinatura do Termo de Consentimento Livre e Esclarecido e agendamento de entrevista; (2) Avaliação: levantamento da linha de base dos comportamentos correspondentes à HS, elaboração da hierarquia dos comportamentos que indicaram déficit segundo as normas de análise do IHS e treino em registro de automonitoração; (3) Intervenção: leitura de um texto sobre habilidades sociais, apresentação da lista de direitos humanos básicos, aplicação do Questionário Construcional de Goldiamond adaptado e treino em registro de automonitoramento; (4) Re-avaliação das HS: reaplicação do IHS; (5) Follow-up: avaliação da manutenção dos ganhos obtidos com o estudo; e (6) Encerramento: entrevista devolutiva para explanação dos resultados do estudo ao participante. Os resultados sugerem que a intervenção promoveu o desenvolvimento de HS na participante, haja vista a interpretação da evolução da participante apresentada de acordo com a variação do Escore Z e da representação gráfica de significância clínica e mudança confiável.

Determinants of sustained viral suppression in HIV-infected patients with self-reported poor adherence to antiretroviral therapy

Background Good adherence to antiretroviral therapy (ART) is critical for successful HIV treatment. However, some patients remain virologically suppressed despite suboptimal adherence. We hypothesized that this could result from host genetic factors influencing drug levels. Methods Eligible individuals were Caucasians treated with efavirenz (EFV) and/or boosted lopinavir (LPV/r) with self-reported poor adherence, defined as missing doses of ART at least weekly for more than 6 months. Participants were genotyped for single nucleotide polymorphisms (SNPs) in candidate genes previously reported to decrease EFV (rs3745274, rs35303484, rs35979566 in CYP2B6) and LPV/r clearance (rs4149056 in SLCO1B1, rs6945984 in CYP3A, rs717620 in ABCC2). Viral suppression was defined as having HIV-1 RNA <400 copies/ml throughout the study period. Results From January 2003 until May 2009, 37 individuals on EFV (28 suppressed and 9 not suppressed) and 69 on LPV/r (38 suppressed and 31 not suppressed) were eligible. The poor adherence period was a median of 32 weeks with 18.9% of EFV and 20.3% of LPV/r patients reporting missed doses on a daily basis. The tested SNPs were not determinant for viral suppression. Reporting missing >1 dose/week was associated with a lower probability of viral suppression compared to missing 1 dose/week (EFV: odds ratio (OR) 0.11, 95% confidence interval (CI): 0.01–0.99; LPV/r: OR 0.29, 95% CI: 0.09–0.94). In both groups, the probability of remaining suppressed increased with the duration of continuous suppression prior to the poor adherence period (EFV: OR 3.40, 95% CI: 0.62–18.75; LPV/r: OR 5.65, 95% CI: 1.82–17.56). Conclusions The investigated genetic variants did not play a significant role in the sustained viral suppression of individuals with suboptimal adherence. Risk of failure decreased with longer duration of viral suppression in this population.

Patient self-management of long-term oral anticoagulation in Switzerland

Indications for oral anticoagulation (OAC) have increased in recent years. OAC requires frequent monitoring of the prothrombin time to keep the intensity within the therapeutic range and to minimise the risk for complications. Patient self-management (PSM) has been found to improve the quality of OAC. The present study aimed to investigate the first 330 patients performing PSM in Switzerland. A questionnaire was sent to all patients who followed a teaching program for PSM of OAC between 1998 and 2003. Moreover, family physicians were contacted and/or discharge letters were obtained from the hospitals or the treating physicians. During the study period 13 patients died. Out of the 300 patients providing information 254 (85%) still perform PSM. At least one INR determination per two weeks was done by 74% of the patients and 25% performed at least one INR measurement every 15-30 days. The median time spent within the individual INR target range was 72%. No thromboembolic complications occurred, however, among the 13 patients who died, 1 had myocardial infarction and 6 died of heart failure. When counting these events as arterial thromboembolic complications the frequency was 0.6 (95% CI: 0.3-1.3) per 100 patient-years. The frequency of major bleeding was 0.6 (95% CI: 0.2-1.3) per 100 patient-years. We conclude from this study investigating a real-world patient collective that PSM is suitable and safe for the patients identified by their family physicians and successfully trained by our training centre.

Career engagement: Investigating intraindividual predictors of weekly fluctuations in proactive career behaviors

The present study applies a micro‐level perspective on how within‐individual differenc motivational and social‐cognitive factors affect the weekly fluctuations of engageme proactive career behaviors among a group of 67 German university students. Career efficacy beliefs, perceived career barriers, experienced social career support, positive negative emotions, and career engagement were assessed weekly for 13 consecutive w Hierarchical linear regression analyses showed that above‐average levels of career engage within individuals were predicted by higher than average perceived social support and pos emotions during a given week. Conversely, within‐individual differences in self‐effi barriers, and negative emotions had no effect. The results suggest that career interven should provide boosts in social support and positive emotions.

Predictors of benzodiazepine self -administration behavior in anxious patients

The purpose of this study was to examine factors that may be associated with benzodiazepine (BZ) self-administration and risks of dependence in anxious patients. Preliminary work included examination of psychosocial characteristics and subjective drug response as potential predictors of medication use. Fifty-five M, F patients with generalized anxiety or panic disorder participated in a 3-week outpatient Choice Procedure in which they self-medicated “as needed” with alprazolam (Alz) and placebo. Findings showed that a large amount of variance in alprazolam preference, frequency, and quantity of use could be predicted by measures of anxiety, drug liking, and certain personality characteristics. The primary study extended this work by examining whether individual differences in Alz sensitivity also predict patterns of use. Twenty anxious patients participated in the study, which required 11 weekly clinic visits. Ten of these also participated in a baseline assessment of HPA-axis function that involved 24-hour monitoring of cortisol and ACTH levels and a CRH Stimulation Test. This assessment was conducted on the basis of prior evidence that steroid metabolites exert neuromodulatory effects on the GABA A receptor and that HPA-axis function may be related to BZ sensitivity and long-term disability in anxious patients. Patients were classified as either HIGH or LOW users based on their p.r.n. patterns of Alz use during the first 3 weeks of the study. They then participated in a 4-week dose response trial in which they received prescribed doses of medication (placebo, 0.25, 0.5, and 1.0mg Alz), each taken TID for 1 week. The dose response trial was followed by a second 3-week Choice Procedure. Findings were not indicative of biological differences in Alz sensitivity between the HIGH and LOW users. However, the HIGH users had higher baseline anxiety and greater anxiolytic response to Alz than the LOW users. Anxiolytic benefits of p.r.n. and prescribed dosing were shown to be comparable, and patients' conservative patterns of p.r.n. medication use were not affected by the period of prescribed dosing. Although there was not strong evidence to suggest relationships between HPA-axis function and Alz use or sensitivity, interesting findings emerged about the relationship between HPA-axis function and anxiety. ^

PV self-consumption optimization with storage and Active DSM for the residential sector

With the rising prices of the retail electricity and the decreasing cost of the PV technology, grid parity with commercial electricity will soon become a reality in Europe. This fact, together with less attractive PV feed-in-tariffs in the near future and incentives to promote self-consumption suggest, that new operation modes for the PV Distributed Generation should be explored; differently from the traditional approach which is only based on maximizing the exported electricity to the grid. The smart metering is experiencing a growth in Europe and the United States but the possibilities of its use are still uncertain, in our system we propose their use to manage the storage and to allow the user to know their electrical power and energy balances. The ADSM has many benefits studied previously but also it has important challenges, in this paper we can observe and ADSM implementation example where we propose a solution to these challenges. In this paper we study the effects of the Active Demand-Side Management (ADSM) and storage systems in the amount of consumed local electrical energy. It has been developed on a prototype of a self-sufficient solar house called “MagicBox” equipped with grid connection, PV generation, lead–acid batteries, controllable appliances and smart metering. We carried out simulations for long-time experiments (yearly studies) and real measures for short and mid-time experiments (daily and weekly studies). Results show the relationship between the electricity flows and the storage capacity, which is not linear and becomes an important design criterion.

The effect of cross -age tutoring routines on the tutor's perception of self as reader

Perception of self as a non-reader has been identified as one of the factors why poor readers disengage from the reading process (Strang, 1967; Rosow, 1992), thus impeding progress. Perception and informational processes influence judgments of personal efficacy (Bandura, 1997). The student's sense of reading efficacy that influence effort expenditure and ultimately achievement, is often overlooked (Athey, 1985; Pajares, 1996). Academic routines within educational programs are implemented without adequate information on whether routines promote or impede efficacy growth. Cross-age tutoring, a process known to improve participants' academic achievement, motivation, and provide opportunities for authentic reading practice, has been successfully incorporated into reading instruction designs (Allen, 1976; Cohen, Kulik & Kulik, 1982; Labbo & Teale, 1990; Riessman, 1993). This study investigated the impact teacher-designed routines within a cross-age tutoring model, have on the tutor's sense of reading self-efficacy. ^ The Reader Self-Perception Scale (Henk & Melnick, 1992) was administered, pre- and post-treatment, to 118 fifth grade students. Preceding the initial survey administration intact classes were randomly assigned to 1 of 3 commonly utilized cross-age tutoring routines or designated as the non-treatment population. The data derived from the Reader Self-Perception Scale was analyzed using an analysis of covariance (ANCOVA). Results indicated that participation as a cross-age tutor does not significantly increase the tutor's perception of self as reader in 1 or more of the 4 modes of information influencing self-efficacy as compared to the non-treatment group. ^ The results of this study suggests that although a weekly tutoring session that delivers educationally credible routines impacts achievement and motivation, efficacy effect was not evident. Possible explanation and recommendations for future studies are proposed. ^

Self -regulated learning: The role of a journal in the learning process for students and teachers

A fundamental goal of education is to equip students with self-regulatory capabilities that enable them to educate themselves. Self directedness not only contributes to success in formal instruction but also promotes lifelong learning (Bandura, 1997). The area of research on self-regulated learning is well grounded within the framework of psychological literature attributed to motivation, metacognition, strategy use and learning. This study explored past research and established the purpose of teaching students to self-regulate their learning and highlighted the fact that teachers are expected to assume a major role in the learning process. A student reflective writing journal activity was sustained for a period of two semesters in two fourth-grade mathematics classrooms. The reflective writing journal was analyzed in search of identifying strategies reported by students. Research questions were analyzed using descriptive statistics, frequency counts, cross-tabs and chi-square analyses. ^ Results based on student-use of the journals and teacher interviews indicated that the use of a reflective writing journal does promote self-regulated learning strategies to the extent which the student is engaged in the journaling process. Those students identified as highly self-regulated learners on the basis of their strategy use, were shown to consistently claim to learn math “as well or better than planned” on a weekly basis. Furthermore, good self-regulators were able to recognize specific strategies that helped them do well and change their strategies across time based on the planned learning objectives. The perspectives of the participating teachers were examined in order to establish the context in which the students were working. The effect of “planned change” and/or the resistance to change as established in previous research, from the teachers point of view, was also explored. The analysis of the journal data did establish a significant difference between students who utilized homework as a strategy. ^ Based on the journals and interviews, this study finds that the systematic use of metacognitive, motivational and/or learning strategies can have a positive effect on student's responsiveness to their learning environment. Furthermore, it reflects that teaching students “how to learn” can be a vital part of the effectiveness of any curriculum. ^

Self-regulated learning in computer programming : strategies students adopted during an assignment

The SimProgramming teaching approach has the goal to help students overcome their learning difficulties in the transition from entry-level to advanced computer programming and prepare them for real-world labour environments, adopting learning strategies. It immerses learners in a businesslike learning environment, where students develop a problem-based learning activity with a specific set of tasks, one of which is filling weekly individual forms. We conducted thematic analysis of 401 weekly forms, to identify the students’ strategies for self-regulation of learning during assignment. The students are adopting different strategies in each phase of the approach. The early phases are devoted to organization and planning, later phases focus on applying theoretical knowledge and hands-on programming. Based on the results, we recommend the development of educational practices to help students conduct self-reflection of their performance during tasks.

Toward Self-Organising Service Communities

This paper discusses a framework in which catalog service communities are built, linked for interaction, and constantly monitored and adapted over time. A catalog service community (represented as a peer node in a peer-to-peer network) in our system can be viewed as domain specific data integration mediators representing the domain knowledge and the registry information. The query routing among communities is performed to identify a set of data sources that are relevant to answering a given query. The system monitors the interactions between the communities to discover patterns that may lead to restructuring of the network (e.g., irrelevant peers removed, new relationships created, etc.).