Teaching cardiac auscultation to trainees in internal medicine and family practice: does it work?

BACKGROUND: The general proficiency in physical diagnostic skills seems to be declining in relation to the development of new technologies. The few studies that have examined this question have invariably used recordings of cardiac events obtained from patients. However, this type of evaluation may not correlate particularly well with bedside skills. Our objectives were 1) To compare the cardiac auscultatory skills of physicians in training with those of experienced cardiologists by using real patients to test bedside diagnostic skills. 2) To evaluate the impact of a five-month bedside cardiac auscultation training program. METHODS: 1) In an academic primary care center, 20 physicians (trainees in internal medicine and family practice) and two skilled academic cardiologists listened to 33 cardiac events in 13 patients directly at bedside and identified the cardiac events by completing an open questionnaire. Heart sounds, murmurs and diagnosis were determined beforehand by an independent skilled cardiologist and were validated by echocardiography. Thirteen primary cardiologic diagnoses were possible.2) Ten of the physicians agreed to participate in a course of 45-minute sessions once a week for 5 months. After the course they listened again to the same patients (pre/post-interventional study). RESULTS: 1) The experts were the most skillful, achieving 69% recognition of heart sounds and murmurs and correct diagnoses in 62% of cases. They also heard all of the diastolic murmurs. The residents heard only 40% of the extra heart sounds and made a correct diagnosis in 24% of cases. 2) After the weekly training sessions, their mean percentage for correct diagnosis was 35% [an increase of 66% (p < 0.05)]. CONCLUSIONS: The level of bedside diagnostic skills in this relatively small group of physicians in training is indeed low, but can be improved by a course focusing on realistic bedside teaching.

Intangible Capital: four years of growth as an open-access scientific publication

Con este nuevo número, la revista Intangible Capital, inicia el cuarto volumen avanzando hacia el quinto año de publicación. Como ya es tradición en la revista, iniciamos este nuevo volumen evaluando el anterior y presentando las nuevas direcciones. Como principales aportaciones del 2007, se destacan hechos relevantes como la renovación de convenios para la indexación científica de la revista, el cambio de plataforma a OJS, la inclusión de un nuevo editor, la nueva composición del editorial board, el equipo de revisores, el cambio a un modelo bilingüe de revista, la nueva financiación obtenida y el trabajo que estamos realizando gran número de editores científicos de acceso abierto en España para el reconocimiento por parte de la Comisión Nacional Evaluadora de la Actividad Investigadora.This issue opens the fourth volume of the Intangible Capital journal, which makes its way towards the fifth year of publication. As usually, we start this volume by evaluating the previous one and tracing new directions. Among the main contributions during the year 2007, we consider important to highlight the following aspects: the renewal of the scientific indexation agreements, the platform change to OJS, the appointment of a new editor, new members included in the editorial board, the board of reviewers, the change towards a bilingual model, the new financing obtained and, the last but not the least, the work undertaken together with many scientific editors of open access Spanish journals for obtaining the positive evaluation of the CNEAI (National Commission for the Evaluation of the Research Activity) and thus, being a proof of scientific excellence

Aproximació al moviment "open access"

[eng] The article describes the background and current state of the open access (OA) movement. Its objectives --with roots in scientists' traditional desire to disseminate their works, in librarians' concerns about the serials crisis, and in technological advances-- were formally articulated in the Budapest Open Access Initiative (BOAI) declaration of 2002. This statement established two strategies for providing access to scientific information without any economic, technical, or legal obstacles: 1) publication of articles in OA journals or 2) deposit by authors of their works in stable institutional or subject-based repositories. The article suggests that this second "route" appears to offer greater possibilities of attaining open access in the short term. However, there still is a lot of work to be done in disseminating the concepts of OA and in training authors regarding procedures for depositing their works: in other words what is needed is a series of promotional activities for overcoming one of today's greatest challenges: author inertia.

Cost-Benefit Analysis of Sequential Warning Lights in Nighttime Work Zone Tapers, TPF-5(081), 2011

Improving safety at nighttime work zones is important because of the extra visibility concerns. The deployment of sequential lights is an innovative method for improving driver recognition of lane closures and work zone tapers. Sequential lights are wireless warning lights that flash in a sequence to clearly delineate the taper at work zones. The effectiveness of sequential lights was investigated using controlled field studies. Traffic parameters were collected at the same field site with and without the deployment of sequential lights. Three surrogate performance measures were used to determine the impact of sequential lights on safety. These measures were the speeds of approaching vehicles, the number of late taper merges and the locations where vehicles merged into open lane from the closed lane. In addition, an economic analysis was conducted to monetize the benefits and costs of deploying sequential lights at nighttime work zones. The results of this study indicates that sequential warning lights had a net positive effect in reducing the speeds of approaching vehicles, enhancing driver compliance, and preventing passenger cars, trucks and vehicles at rural work zones from late taper merges. Statistically significant decreases of 2.21 mph mean speed and 1 mph 85% speed resulted with sequential lights. The shift in the cumulative speed distributions to the left (i.e. speed decrease) was also found to be statistically significant using the Mann-Whitney and Kolmogorov-Smirnov tests. But a statistically significant increase of 0.91 mph in the speed standard deviation also resulted with sequential lights. With sequential lights, the percentage of vehicles that merged earlier increased from 53.49% to 65.36%. A benefit-cost ratio of around 5 or 10 resulted from this analysis of Missouri nighttime work zones and historical crash data. The two different benefitcost ratios reflect two different ways of computing labor costs.

Open access and connectedness: stimulating unexpected innovation through the use of institutional open archives

The author reviews past work with Ibict and the global progress made by the Open Access Movement. He postulates a theory of open access being an example of a complex adaptive system created by Internet-based scholarly publishing. Open access could be the cause of a cascade of increasing complexity and opportunities that will reshape this system. He has chosen the pervasive and global "Connectedness" created by the internet and the content spaces it provides for open access collections as a "simple disruptive agent". He discusses how connectedness influences infinite variety, creativity, work, change, knowledge, and the information economy. Case studies from the University of New Mexico Libraries are used where appropriate.

ETDs, NDLTD, and open access: a 5S perspective

Worldwide initiatives toward digital library (DL) support for electronic theses and dissertations (ETDs), facilitated by the work of the Networked Digital Library of Theses and Dissertations (NDLTD), are a key part of the move toward open access. When all graduate students learn to use openly available ETDs, and have experience with authoring and submission in connection with their own research results, it will be easy for them to continue these efforts through other contributions to open access. When all universities support ETD activities, they will be key participants in institutional repositories and open access, and will have engaged in discussion and infrastructure development supportive of further open access activities. Understanding of open access also can be facilitated through modeling of all of these efforts using the 5S framework, considering the key aspects of DL development: Societies, Scenarios, Spaces, Structures, and Streams.

Association of working conditions with self-reported work-related symptoms: results from the Swiss dataset of the European Working Conditions Survey

Working conditions are important determinants of health. The aims of this article are to 1) identify working conditions and work characteristics that are associated with workers' perceptions that their work is harmful to their health and 2) identify with what symptoms these working conditions are associated.We used the Swiss dataset from the 2005 edition of the European Working Conditions Survey. The dependent variable was based on the question "Does your work affect your health?". Logistic regression was used to identify a set of variables collectively associated with self-reported work-related adverse health effects.A total of 330 (32%) participants reported having their health affected by work. The most frequent symptoms included backache (17.1%), muscular pains (13.1%), stress (18.3%) and overall fatigue (11.7%). Scores for self-reported exposure to physicochemical risks, postural and physical risks, high work demand, and low social support were all significantly associated with workers' perceptions that their work is harmful to their health, regardless of gender or age. A high level of education was associated with stress symptoms, and reports that health was affected by work was associated with low job satisfaction.Many workers believe that their work affects their health. Health specialists should pay attention to the potential association between work and their patients' health complaints. This is particularly relevant when patients mention symptoms such as muscular pains, backache, overall fatigue, and stress. Specific attention should be given to complaints of stress in highly educated workers.

Effects of Road Construction Intensity and Operations on Rural Freeway Work Zone Capacity, TPF-5(081), 2014

Capacity is affected by construction type and its intensity on adjacent open traffic lanes. The effect on capacity is a function of vehicles moving in and out of the closed lanes of the work zone, and the presence of heavy construction vehicles. Construction activity and its intensity, however, are not commonly considered in estimating capacity of a highway lane. The main purpose of this project was to attempt to quantify the effects of construction type and intensity (e.g. maintenance, rehabilitation, reconstruction, and milling) on work zone capacity. The objective of this project is to quantify the effects of construction type and its intensity on work zone capacity and to develop guidelines for MoDOT to estimate the specific operation type and intensity that will improve the traffic flow by reducing the traffic flow and queue length commonly associated with work zones. Despite the effort put into field data collection, the data collected did not show a full speed-flow chart therefore extracting a reliable capacity value was difficult. A statistical comparison between the capacity values found in this study using either methodologies indicates that there is an effect of construction activity on the values work zone capacity. It was found that the heavy construction activity reduces the capacity. It is very beneficial to conduct similar studies on the capacity of work zone with different lane closure barriers, which is also directly related to the type of work zone being short-term or long-term work zones. Also, the effect of different geometric and environmental characteristics of the roadway should be considered in future studies.

Multidimensional Adaptations for Open Learning Management Systems

Our work is focused on alleviating the workload for designers of adaptive courses on the complexity task of authoring adaptive learning designs adjusted to specific user characteristics and the user context. We propose an adaptation platform that consists in a set of intelligent agents where each agent carries out an independent adaptation task. The agents apply machine learning techniques to support the user modelling for the adaptation process

Early selection in open-pollinated Eucalyptus families based on competition covariates

The objetive of this work was to evaluate the influence of intergenotypic competition in open-pollinated families of Eucalyptus and its effects on early selection efficiency. Two experiments were carried out, in which the timber volume was evaluated at three ages, in a randomized complete block design. Data from the three years of evaluation (experiment 1, at 2, 4, and 7 years; and experiment 2, at 2, 5, and 7 years) were analyzed using mixed models. The following were estimated: variance components, genetic parameters, selection gains, effective number, early selection efficiency, selection gain per unit time, and coincidence of selection with and without the use of competition covariates. Competition effect was nonsignificant for ages under three years, and adjustment using competition covariates was unnecessary. Early selection for families is effective; families that have a late growth spurt are more vulnerable to competition, which markedly impairs ranking at the end of the cycle. Early selection is efficient according to all adopted criteria, and the age of around three years is the most recommended, given the high efficiency and accuracy rate in the indication of trees and families. The addition of competition covariates at the end of the cycle improves early selection efficiency for almost all studied criteria.

Validation study of the Spanish Version of the Work-Family Conflict Questionnaire (CCTF)

In this study, a brief Work-Family Conflict (WFC) Questionnaire in the Spanish language is proposed that takes into account the two directions commonly reported in the literature: work interference with family (WIF), and family interference with work (FIW). The results obtained through exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) with two independent samples, carried out for women and men, showed acceptable validity and reliability. A copy of the instrument in Spanish language is provided, together with the Amos 4 syntax to perform the factor invariance analysis for women and men. The suggested Work-Family Conflict Questionnaire (in Spanish, abbreviated as CCTF) may be useful in studies performed in the work setting, considering the special relevance of the concept in this line of research.

An open source browser-based software tool for graph drawing and visualisation

In this research work we searched for open source libraries which supports graph drawing and visualisation and can run in a browser. Subsequent these libraries were evaluated to find out which one is the best for this task. The result was the d3.js is that library which has the greatest functionality, flexibility and customisability. Afterwards we developed an open source software tool where d3.js was included and which was written in JavaScript so that it can run browser-based.

WebGraphEd, an open source graph drawing editor for the web

WebGraphEd is an open source software for graph visualization and manipulation. It is especially designed to work for the web platform through a web browser. The web application has been written in JavaScript and compacted later, which makes it a very lightweight software. There is no need of additional software, and the only requirement is to have an HTML5 compliant browser. WebGraphEd works with scalable vector graphics (SVG), which it makes possible to create lossless graph drawings.

The practical application of e-Portfolio at the Open University of Catalonia : assessment of competence based learning

The paper presents the results of the piloting or pilot test in a virtual classroom. This e-portfolio was carried out in the 2005-2006 academic year, with students of the Doctorate in Information Society, at the Open University of Catalonia. The electronic portfolio is a strategy for competence based assessment. This experience shows the types of e-portfolios, where students show their work without interactions, and apply the competence-based learning theories in an interactive portfolio system. The real process of learning is developed in the competency based system, the portfolio not only is a basic bio document, has become a real space for learning with competence model. The paper brings out new ideas and possibilities: the competence-based learning promotes closer relationships between universities and companies and redesigns the pedagogic act.