My patient is thrombocytopenic! Is (s)he? Why? And what shall I do? A practical approach to thrombocytopenia

Solving the riddle of a thrombocytopenic patient is a difficult and fascinating task. The spectrum of possible aetiologies is wide, ranging from an in vitro artefact to severe treatment-resistant thrombocytopenic bleeding conditions, or even life-threatening prothrombotic states. Moreover, thrombocytopenia by itself does not protect from thrombosis and sometimes a patient with a low platelet count requires concomitant antithrombotic treatment as well. In order to identify and treat the cause and the effects of the thrombocytopenia, you have to put together several pieces of information, solving a unique jig-jaw puzzle. The present work is not a textbook article about thrombocytopenia, rather a collection of differential diagnostic thoughts, treatment concepts, and some basic knowledge, that you can retrieve when facing your next thrombocytopenic patient. Enjoy reading it, but most importantly enjoy taking care of patients with a low platelet count. I bet the present work will assist you in this challenging and rewarding clinical task.

Learning processes in student teaching: Analyses from a study using learning diaries

The present study seeks to obtain deeper insight into the learning processes in practical training in primary teacher education in Upper Austria. Based on the offer-and-use model of instruction, 230 diary entries of 46 student teachers (28 students in their third semester, 18 students in their fifth semester) were analysed with legard to the learning topics, learning sourcesJ and Ìealning processes involved in practical training. The results show a variety of learning forms, ranging from the unreflective imitation of school mentors' practices to active knowledge construction. In addition, they illustrate that the available learning offers were suboptimally utilized by stuclent teachers who failed to work systernatically and continuously on their professional development.

Implicit probabilistic sequence learning: Correlated streams and sequence length matter

We investigated whether a pure perceptual stream is sufficient for probabilistic sequence learning to occur within a single session or whether correlated streams are necessary, whether learning is affected by the transition probability between sequence elements, and how the sequence length influences learning. In each of three experiments, we used six horizontally arranged stimulus displays which consisted of randomly ordered bigrams xo and ox. The probability of the next possible target location out of two was either .50/.50 or .75/.25 and was marked by an underline. In Experiment 1, a left vs. right key response was required for the x of a marked bigram in the pure perceptual learning condition and a response key press corresponding to the marked bigram location (out of 6) was required in the correlated streams condition (i.e., the ring, middle, or index finger of the left and right hand, respectively). The same probabilistic 3-element sequence was used in both conditions. Learning occurred only in the correlated streams condition. In Experiment 2, we investigated whether sequence length affected learning correlated sequences by contrasting the 3-elements sequence with a 6-elements sequence. Significant sequence learning occurred in all conditions. In Experiment 3, we removed a potential confound, that is, the sequence of hand changes. Under these conditions, learning occurred for the 3-element sequence only and transition probability did not affect the amount of learning. Together, these results indicate that correlated streams are necessary for probabilistic sequence learning within a single session and that sequence length can reduce the chances for learning to occur.

Total disc arthroplasty versus anterior cervical interbody fusion: use of the Spine Tango registry to supplement the evidence from randomized control trials.

BACKGROUND CONTEXT Several randomized controlled trials (RCTs) have compared patient outcomes of anterior (cervical) interbody fusion (AIF) with those of total disc arthroplasty (TDA). Because RCTs have known limitations with regard to their external validity, the comparative effectiveness of the two therapies in daily practice remains unknown. PURPOSE This study aimed to compare patient-reported outcomes after TDA versus AIF based on data from an international spine registry. STUDY DESIGN AND SETTING A retrospective analysis of registry data was carried out. PATIENT SAMPLE Inclusion criteria were degenerative disc or disc herniation of the cervical spine treated by single-level TDA or AIF, no previous surgery, and a Core Outcome Measures Index (COMI) completed at baseline and at least 3 months' follow-up. Overall, 987 patients were identified. OUTCOME MEASURES Neck and arm pain relief and COMI score improvement were the outcome measures. METHODS Three separate analyses were performed to compare TDA and AIF surgical outcomes: (1) mimicking an RCT setting, with admission criteria typical of those in published RCTs, a 1:1 matched analysis was carried out in 739 patients; (2) an analysis was performed on 248 patients outside the classic RCT spectrum, that is, with one or more typical RCT exclusion criteria; (3) a subgroup analysis of all patients with additional follow-up longer than 2 years (n=149). RESULTS Matching resulted in 190 pairs with an average follow-up of 17 months that had no residual significant differences for any patient characteristics. Small but statistically significant differences in outcome were observed in favor of TDA, which are potentially clinically relevant. Subgroup analyses of atypical patients and of patients with longer-term follow-up showed no significant differences in outcome between the treatments. CONCLUSIONS The results of this observational study were in accordance with those of the published RCTs, suggesting substantial pain reduction both after AIF and TDA, with slightly greater benefit after arthroplasty. The analysis of atypical patients suggested that, in patients outside the spectrum of clinical trials, both surgical interventions appeared to work to a similar extent to that shown for the cohort in the matched study. Also, in the longer-term perspective, both therapies resulted in similar benefits to the patients.

Cultural competence in an HIV dedicated dental clinic: Application of the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS)

This dissertation investigated perspectives on cultural competence among African-American women patients, staff, and the administrator of a dental clinic serving people living with HIV/AIDS; and evaluated the role of the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS) in advancing the provision of culturally competent care in the clinic. ^ The study was qualitative with data collection via focus groups and individual interviews with a sample of African-American women patients, and individual interviews with a sample of staff and the clinic administrator. Transcripts were coded and themes identified using the software program ATLAS.ti. A cultural audit template was developed and applied to evaluate cultural competency. ^ Among attitudes and behaviors that contributed to the provision of culturally competent care at the clinic were respect and empathic communication. Formal cultural competency was not featured strongly in the methods by which the staff learned to work with diverse populations. Instead cultural competence among the staff was based on thoughtful hiring practices, natural aptitude and a climate that encouraged learning through informal sharing of experiences. The staff and administrator felt that an African-American dentist would be an asset in improving culturally competent care at the clinic. Previous research and national policy also promote the provider-patient racial/ethnic concordance to improve care. In this study, however, the patients were happy with the care provided regardless of the race/ethnicity of the staff, probably reflecting the well developed cultural competence skills of clinic staff overall. ^ The clinic administrator was unaware of the CLAS standards although the clinic was implicitly operated under their mandates. This occurred because the clinic is supported by federal funding and the CLAS standards were incorporated into the requirements. Incorporation into and monitoring of the CLAS standards in federally funded programs therefore appears to be an effective means for ensuring that they are implemented. ^ This study illustrates that cultural competence, though not universally understood, can be systematically investigated to identify what constitutes appropriate care and the factors that support or inhibit it. Among important elements of culturally competent care are respect and empathic communication. ^

Systematic review of interventions designed to reduce screen time in children and adolescents

This descriptive systematic review describes intervention trials for children and youth that targeted screen time (ST) as a way to prevent or control obesity and measured ST, and at least one of the following: physical activity, dietary intake, and adiposity. Both “hands-on” (e.g., video games) and “hands free” (e.g., television viewing) ST were included. Published, completed intervention trials (k=12), not-yet-published, completed trials (k=6), and in-progress trials (k=11) were identified through searches of electronic databases, including trial registries and bibliographies of eligible study reports. Study characteristics of the 29 identified trials were coded and presented in evidence tables. Considerable attention was paid to the type of ST addressed, measures used, and the type of interventions. Based on the number of in-progress and not-yet-published trials, the number of completed, published reports will double in the next three years. Most of the studies were funded by federal sources. General populations, not restricted by race, gender, or weight status, were targets of most interventions with children ages 9-12 yeas as the modal age group. Most trials used randomized control trials in which the majority of control or comparison group received an intervention. The mean number of participants was 242.8 (SD=314.7) and interventions were delivered over an average of 10.5 months and consisted of approximately 16 sessions, with a total time of about eight hours. The majority of completed trials evaluate each of the four constructs, however, most studies have more than one measure to assess each construct (e.g., BMI and tricep skinfold thickness to evaluate adiposity) and rarely did studies use the same measures. This is likely why the majority of studies produced at least one significant intervention effect on each outcome that was assessed. The four major outcomes should be evaluated in all interventions attempting to reduce screen time in order to determine the mechanisms involved that may contribute to obesity. More importantly researchers should work together to determine the best measures to evaluate the four main constructs to allow studies to be compared. Another area for consensus is the definition of ST. ^

Roadmap for implementing the Chronic Care Model for weight management: Healthcare Institution's Response to Obesity (HIRO)

Background. Excess weight and obesity are at epidemic proportions in the United States and place individuals at increased risk for a variety of chronic conditions. Rates of diabetes, high blood pressure, coronary artery disease, stroke, cancer, and arthritis are all influenced by the presence of obesity. Small reductions in excess weight can produce significant positive clinical outcomes. Healthcare organizations have a vital role to play in the identification and management of obesity. Currently, healthcare providers do not adequately diagnose and manage excess weight in patients. Lack of skill, time, and knowledge are commonly cited as reasons for non-adherence to recommended standards of care. The Chronic Care Model offers an approach to healthcare organizations for chronic disease management. The model consists of six elements that work together to empower both providers and patients to have more productive interactions: the community, the health system itself, self-management support, delivery system design, decision support, and clinical information systems. The model and its elements may offer a framework through which healthcare organizations can adapt to support, educate, and empower providers and patients in the management of excess weight and obesity. Successful management of excess weight will reduce morbidity and mortality of many chronic conditions. Purpose. The purpose of this review is to synthesize existing research on the effectiveness of the Chronic Care Model and its elements as they relate to weight management and behaviors associated with maintaining a healthy weight. Methods: A narrative review of the literature between November 1998 and November 2008 was conducted. The review focused on clinical trials, systematic reviews, and reports related to the chronic care model or its elements and weight management, physical activity, nutrition, or diabetes. Fifty-nine articles are included in the review. Results. This review highlights the use of the Chronic Care Model and its elements that can result in improved quality of care and clinical outcomes related to weight management, physical activity, nutrition, and diabetes. Conclusions. Healthcare organizations can use the Chronic Care Model framework to implement changes within their systems to successfully address overweight and obesity in their patient populations. Specific recommendations for operationalizing the Chronic Care Model elements for weight management are presented.^

Computerizing Social-Emotional Assessment for School Readiness: First Steps toward an Assessment Battery for Early Childhood Settings

The transition into formal schooling is a crucial foundation that can set children on a cycle of success or failure in both academic and social domains. A child’s abilities to express healthy emotions, understand emotions of self and others, regulate emotion, attention, and behavior, make good decisions regarding social problems, and engage in a range of prosocial behaviors, all work together to promote a successful school experience. However, many children have deficits in these skills by school entry, and educators lack the requisite tools to identify, track and assess skills these children need to learn. Thus, because social-emotional learning (SEL) is so crucial, assessment tools to pinpoint children’s skills and progress are vitally necessary. Previous work by the authors and other researchers has led to the development of strong assessment tools; however, these tools are often developed solely for research use, not practitioner application. In the following, using our assessment battery as an example, we will discuss the steps necessary to adapt SEL assessment for computer-based administration and optimal utility in early childhood education programs.

Competencias para la comprensión de textos y el pensamiento crítico en nivel medio y universitario

La Tesis intenta presentar un estado de la cuestión en las temáticas de comprensión lectora y pensamiento crítico, dos dimensiones centrales de la educación media y universitaria. En la primera, se halla implicada toda una gama de operaciones y habilidades cognoscitivas que confluyen para producir un logro intelectual básico, la captación de los significados de un texto escrito, vehículo privilegiado para la adquisición del conocimiento en la educación formal. Pero, puesto que a la compresión ha de seguir el discernimiento, tanto de la validez formal cuanto del contenido de verdad, se ha de procurar también el desarrollo de habilidades y competencias que van más allá de las básicas y que parcialmente son las que la investigación actual aborda bajo el título de pensamiento crítico. Sin embargo, dados algunos límites que a nuestro juicio muestran los enfoques contemporáneos (que hemos sintetizado como formalismo-funcionalismo), en la segunda instancia de la tesis pretendemos, por una parte, mostrar nuestros propios modos e instrumentos para evaluar ambas competencias y, por otra, plasmar una propuesta de intervención pedagógica en la cual se contribuya a promover objetivos integrales de la educación intelectual, tratando de superar las limitaciones anotadas.

La competencia comunicativa intercultural en el aula de español de los negocios: análisis de materiales para su enseñanza

RESUMEN La adquisición de la competencia comunicativa intercultural en la enseñanza de Lenguas Extranjeras (LE) y/o Lenguas para Fines Específicos (LFE) debe ser un proceso de aprendizaje consciente y explícito cuyo fin es la transmisión de conocimientos teóricos, el desarrollo de habilidades comportamentales y de actitudes positivas a través del contacto con la/s cultura/s meta. Esta tesis tiene como objetivo general contribuir al desarrollo de la competencia comunicativa intercultural comercial del estudiante de español de los negocios (EN). Para ello se ha realizado un análisis de los manuales para su enseñanza. En concreto, hemos auditado los manuales de EN con el fin de conocer la metodología didáctica que emplean en la enseñanza de la competencia comunicativa intercultural comercial, tomando como marco de referencia el enfoque intercultural para la enseñanza de las Lenguas de los Negocios. Para alcanzar este fin se ha dividido la investigación en tres partes: 1) la revisión de los antecedentes sobre la enseñanza del componente intercultural y del análisis de materiales en los cursos de LFE; 2) la configuración de un constructo teórico que permitiera a la vez, seleccionar el objeto de estudio, diseñar el instrumento de análisis y disponer de un marco de referencia valorativo; 3) y la creación, pilotaje y aplicación del instrumento de análisis, y la auditoría de los datos. Los resultados muestran que, en líneas generales, predomina una visión tradicional de la cultura; un escaso tratamiento de la relación lengua-y-cultura; un seguimiento parcial de los principios pedagógicos para la adquisición de la competencia comunicativa intercultural; un tratamiento bajo de las habilidades interculturales específicas en las interacciones comerciales; y una cobertura parcial de las habilidades interculturales generales, las cuales se centran fundamentalmente en la adqusición de saberes teóricos. PALABRAS CLAVE: competencia comunicativa intercultural; comunicación intercultural comercial; español de los negocios; español para fines específicos; auditoria de manuales didácticos. ABSTRACT The acquisition of intercultural communicative competence in Foreign Language (FL) and / or Languages for Specific Purposes teaching (LSP) must be a conscious and explicit learning to develop knowledge, skills and positive attitudes through contact with the target culture/s. The overall objective of this thesis is to assist the development of the intercultural communicative competence of the student of Spanish for Business (SB) through the audit of the teaching textbooks published in the last decade through a multidisciplinary approach to teaching LSP. The audit was carried out in order to ascertain the underlying approach and course design for the development of the intercultural communicative competence; to state the methodological approach to culture, language-and-culture relationship, culture teaching, culture acquisition and course design. To achieve this objective, the work has been divided into four parts: 1) review of the background on teaching the intercultural component and the analysis of materials in a courses of LSP through a multidisciplinary approach, 2) configuration of a theoretical construct allowing to select the object of study, to design the analytical instrument and to have an evaluative framework, together with the selection of a corpus of Spanish for Business textbooks, 3) development of the analytical instrument and 4) application of the analytical instrument and audit of selected textbooks. The results show that, in the textbooks analyzed, dominated a traditional view of culture, a low ratio treatment of the language-and-culture relationship, a partial implementation of the pedagogical principles for the acquisition of intercultural communicative competence; poor treatment of specific intercultural skills in business interactions, and partial coverage of the general cultural skills, which focus primarily on the acquisition of theoretical knowledge. KEY WORDS: Intercultural communicative competence; Intercultural communicative competence; Spanish for Business; Spanish for Specific Purposes; Textbook audit

Learning an L1-regularized Gaussian Bayesian Network in the Equivalence Class Space

Learning the structure of a graphical model from data is a common task in a wide range of practical applications. In this paper, we focus on Gaussian Bayesian networks, i.e., on continuous data and directed acyclic graphs with a joint probability density of all variables given by a Gaussian. We propose to work in an equivalence class search space, specifically using the k-greedy equivalence search algorithm. This, combined with regularization techniques to guide the structure search, can learn sparse networks close to the one that generated the data. We provide results on some synthetic networks and on modeling the gene network of the two biological pathways regulating the biosynthesis of isoprenoids for the Arabidopsis thaliana plant

Measuring the influence of Cooperative Learning and Project Based Learning on problem solvin skill.

The aim of this study is to evaluate the effects obtained after applying two active learning methodologies (cooperative learning and project based learning) to the achievement of the competence problem solving. This study was carried out at the Technical University of Madrid, where these methodologies were applied to two Operating Systems courses. The first hypothesis tested was whether the implementation of active learning methodologies favours the achievement of ?problem solving?. The second hypothesis was focused on testing if students with higher rates in problem solving competence obtain better results in their academic performance. The results indicated that active learning methodologies do not produce any significant change in the generic competence ?problem solving? during the period analysed. Concerning this, we consider that students should work with these methodologies for a longer period, besides having a specific training. Nevertheless, a close correlation between problem solving self appraisal and academic performance has been detected.

Educational innovation applied in the UNESCO chair of mining and industrial heritage

The “Innovatio Educativa Tertio Millennio” group has been 10 years developing educational innovation techniques, actually has reached the level of teaching on the technical teachers has developed, and share them with other groups, that can implement them in their teaching activities. UNESCO Chair of Mining and Industrial Heritage has been years working on heritage, and on the one hand teaching in conservation and maintenance of heritage, and on the other doing raise awareness of the meaning of heritage, the social value and as must be managed effectively. Recently these two groups work together, thus is spreading in a much more effective manner the concepts of heritage, its meaning, its value, and how to manage it and provide effective protection. On one hand being a work of dissemination based on internet and on radio broadcasting, and on the other one of teaching based on educational innovation, and courses, conferences, and face-to-face seminars or distance platforms.

Building sustainable capacity for health research in africa through cloud computing applications

Access to information and continuous education represent critical factors for physicians and researchers over the world. For African professionals, this situation is even more problematic due to the frequently difficult access to technological infrastructures and basic information. Both education and information technologies (e.g., including hardware, software or networking) are expensive and unaffordable for many African professionals. Thus, the use of e-learning and an open approach to information exchange and software use have been already proposed to improve medical informatics issues in Africa. In this context, the AFRICA BUILD project, supported by the European Commission, aims to develop a virtual platform to provide access to a wide range of biomedical informatics and learning resources to professionals and researchers in Africa. A consortium of four African and four European partners work together in this initiative. In this framework, we have developed a prototype of a cloud-computing infrastructure to demonstrate, as a proof of concept, the feasibility of this approach. We have conducted the experiment in two different locations in Africa: Burundi and Egypt. As shown in this paper, technologies such as cloud computing and the use of open source medical software for a large range of case present significant challenges and opportunities for developing countries, such as many in Africa.

The NACIR Project: New Applications for CPV'S: A fast way to improve reliability and Technology progress

The main goal of this proposal is to join together the owners of the most advanced CPV technology, with respect to the state of the art, in order to research from its leading position new applications for CPV systems. In addition to opening up new markets, it will unveil possible sources of failure in new environments outside Europe, in order to assure component reliability. The proposed project will also try to improve the current technology of the industrial partners (ISOFOTON and CONCENTRIX) by accelerating the learning curve that CPV must follow in order to reach the competitive market, and lowering the cost under the current flat panel PV significantly within 3-4 years. The use of CPV systems in remote areas, together with harsher radiation, ambient and infrastructure conditions will help to increase the rate of progress of this technology. In addition, the ISFOC s contribution, which brings together seven power plants from seven CPV technologies up to 3 MWpeak, will allow creating the most complete database of components and systems performance to be generated as well as the effects of radiation and meteorology on systems operations. Finally, regarding the new applications for CPV subject, the project will use a CPV system sized 25 kWp in a stand-alone station in Egypt (NWRC) for the first time for water pumping and irrigation purposes. In a similar way ISOFOTON will connect up to 25 kWp CPV to the Moroccan ONE utility grid. From the research content point of view of this project, which is directly addressed by the scope of the call, the cooperative research between UPM, FhG-ISE and the two companies will be favoured by the fact that all are progressing in similar directions: developing two-stage optics CPV systems. In addition to these technology improvements the UPM is very interested in developing a new concept of module, recently patented, which will fulfil all required characteristics of a good CPV with less components and reducing cost.