Cross-cultural clinical competence and post-graduate teaching: any impact(s) on doctors?

Context: Cross-cultural clinical competence (CCC) requires a mixtureof "knowledge" (K), "attitude" (A) and "skills" (S), in order to develop theability to give quality care to patients of different cultures. Theseattributes allow, while providing medical care, consideration of thepatient's medical, social, cultural and language needs. The LausanneUniversity Medical Policlinic (PMU) provides approximately 30000consultations per year to migrant patients and over the past five yearshas implemented a training course on CCC that focuses on trialogue,stereotypes and administrative procedures for the healthcare ofmigrants.Method: A quantitative survey of 18 new residents, was carried outusing a validated questionnaire, the "Multicultural AssessmentQuestionnaire" (the MAQ, 16 questions on K, A and S) to evaluate theimpact of CCC training. The questionnaire was distributed before theCCC course (J-1), three days after (J+3) and three months later (J+90).A descriptive univariate analysis of the difference in MAQ scoresbetween the times J-1 - J+3 and J-1 - J+90 was made. Three FocusGroups were conducted, at three months, to explore residents' thoughtsabout the course.Results: A significant increase was observed in global performancedeclared by residents. Following the intervention, the score of the MAQincreased from 31.4 points to 38.0 points at three days (p = 0.004) andto 37.7 points at three months (p = 0.003). This increase was mostnoticeable in the field of acquiring K: total score J-1: 118, J+3: 189,J+90: 190 (difference J-1 - J+3 and J-1 - J+90: p <0.005). There was nosignificant difference in acquiring A (J-1: 222, J+3: 228, J+90: 229), andS increases in a significant way at first (J-1: 222, J+3: 265, J-1 - J+3:p = 0.035), then comes back to the start value (J+90: 217). The residentswere interested by the course which they felt provides useful informationfor clinical practice. They had a great number of expectations in varyingfields (medical anthropology, cultural differences, epidemiology, etc.),hoping a "ready-made" solution for the approach of migrant patients.Conclusions: A unique training of CCC at the post-graduate level,upgraded K, and to a lesser extent A and S, for these 18 residents. Theywere interest and they had many expectations. Subsequent coursesshould consolidate these acquisitions. Future study should demonstratethe impact on patients' clinical outcome.

Online teaching of inflammatory skin pathology by a French-speaking International University Network

INTRODUCTION: Developments in technology, web-based teaching and whole slide imaging have broadened the teaching horizon in anatomic pathology. Creating online learning material including many types of media such as radiologic images, whole slides, videos, clinical and macroscopic photographs, is now accessible to most universities. Unfortunately, a major limiting factor to maintain and update the learning material is the amount of resources needed. In this perspective, a French-national university network was initiated in 2011 to build joint online teaching modules consisting of clinical cases and tests. The network has since expanded internationally to Québec, Switzerland and Ivory Coast. METHOD: One of the first steps of the project was to build a learning module on inflammatory skin pathology for interns and residents in pathology and dermatology. A pathology resident from Québec spent 6 weeks in France and Switzerland to develop the contents and build the module on an e-learning Moodle platform under the supervision of two dermatopathologists. The learning module contains text, interactive clinical cases, tests with feedback, virtual slides, images and clinical photographs. For that module, the virtual slides are decentralized in 2 universities (Bordeaux and Paris 7). Each university is responsible of its own slide scanning, image storage and online display with virtual slide viewers. RESULTS: The module on inflammatory skin pathology includes more than 50 web pages with French original content, tests and clinical cases, links to over 45 virtual images and more than 50 microscopic and clinical photographs. The whole learning module is being revised by four dermatopathologists and two senior pathologists. It will be accessible to interns and residents in the spring of 2014. The experience and knowledge gained from that work will be transferred to the next international resident whose work will be aimed at creating lung and breast pathology learning modules. CONCLUSION: The challenges of sustaining a project of this scope are numerous. The technical aspect of whole-slide imaging and storage needs to be developed by each university or group. The content needs to be regularly updated and its accuracy reviewed by experts in each individual domain. The learning modules also need to be promoted within the academic community to ensure maximal benefit for trainees. A collateral benefit of the project was the establishment of international partnerships between French-speaking universities and pathologists with the common goal of promoting pathology education through the use of multi-media technology including whole slide imaging.

Desarrollo de una aplicación informática para la gestión de actividades docentes

Este proyecto consiste en el desarrollo de una aplicación informática que permite gestionar de forma automatizada y consistente los datos requeridos para la actividad docente de un profesor universitario. La aplicación permite gestionar: plan docente, asignaturas, horario docente, calendario de exámenes y proyectos final de carrera. Todas estas opciones tienen las funciones de, agregar, buscar, modificar y eliminar datos. Además tiene otras opciones como calendario docente y webs, cuya finalidad será consultar, de forma directa, páginas web de interés docente. Finalmente, la opción material docente tendrá como finalidad, crear, modificar y eliminar ficheros de diferente formato (word, excel, powerpoint, pdf) asociados a las asignaturas registradas en la aplicación. La aplicación se ha implementado en el sistema operativo Windows en el lenguaje de programación Java. Los datos utilizados se almacenan en la base de datos MySql Workbench. Para las validaciones de entrada de datos se ha utilizado JavaScript y JQuery. El diseño de la interfaz se ha llevado a cabo con Java Server Pages, Html, Css y framework Struts.

Machine learning for spatial environmental data. Theory, applications and software

The book presents the state of the art in machine learning algorithms (artificial neural networks of different architectures, support vector machines, etc.) as applied to the classification and mapping of spatially distributed environmental data. Basic geostatistical algorithms are presented as well. New trends in machine learning and their application to spatial data are given, and real case studies based on environmental and pollution data are carried out. The book provides a CD-ROM with the Machine Learning Office software, including sample sets of data, that will allow both students and researchers to put the concepts rapidly to practice.

Open source software in translator training

La formació de traductors implica l´ús de procediments i eines que permetin els estudiants familiaritzar-se amb contextos professionals. El software lliure especialitzat inclou eines de qualitat professional i procediments accessibles per a les institucions acadèmiques i els estudiants a distància que treballen a casa seva. Els projectes reals que utilitzen software lliure i traducció col·laborativa (crowdsourcing) constitueixen recursos indispensables en la formació de traductors.

Teaching Motivational Interviewing to Medical Students to Improve Behavior Change Counseling Skills - Results of a Pilot Test

BACKGROUND: Patient behavior accounts for half or more of the variance in health, disease, mortality and treatment outcome and costs. Counseling using motivational interviewing (MI) effectively improves the substance use and medical compliance behavior of patients. Medical training should include substantial focus on this key issue of health promotion. The objective of the study is to test the efficacy of teaching MI to medical students. METHODS: Thirteen fourth-year medical students volunteered to participate. Seven days before and after an 8-hour interactive MI training workshop, each student performed a video-recorded interview with two standardized patients: a 60 year-old alcohol dependent female consulting a primary care physician for the first time about fatigue and depression symptoms; and a 50 year-old male cigarette smoker hospitalized for myocardial infarction. All 52 videos (13 students×2 interviews before and after training) were independently coded by two blinded clinicians using the Motivational Interviewing Training Integrity (MITI, 3.0). MITI scores consist of global spirit (Evocation, Collaboration, Autonomy/Support), global Empathy and Direction, and behavior count summary scores (% Open questions, Reflection to question ratio, % Complex reflections, % MI-adherent behaviors). A "beginning proficiency" threshold (BPT) is defined for each of these 9 scores. The proportion of students reaching BPT before and after training was compared using McNemar exact tests. Inter-rater reliability was evaluated by comparing double coding, and test-retest analyses were conducted on a sub-sample of 10 consecutive interviews by each coder. Weighted Kappas were used for global rating scales and intra-class correlations (ICC) were computed for behavior count summary scores. RESULTS: The percent of counselors reaching BPT before and after MI training increased significantly for Evocation (15% to 65%, p<.001), Collaboration (27% to 77%, p=.001), Autonomy/Support (15% to 54%, p=.006), and % Open questions (4% to 38%, p=.004). Proportions increased, but were not statistically significant for Empathy (38% to 58%, p=.18), Reflection to question ratio (0% to 15%, p=.12), % Complex reflection (35% to 54%, p=.23), and % MI-adherent behaviors (8% to 15%, p=.69). There was virtually no change for the Direction scale (92% to 88%, p=1.00). The reliability analyses produced mixed results. Weighted kappas for inter-rater reliability ranged from .14 for Direction to .51 for Collaboration, and from .27 for Direction to .80 for Empathy for test-retest. ICCs ranged from .20 for Complex reflections to .89 for Open questions (inter-rater), and from .67 for Complex reflections to .99 for Reflection to question ratio (test-retest). CONCLUSION: This pilot study indicates that a single 8-hour training in motivational interviewing for voluntary fourth-year medical students results in significant improvement of some MI skills. A larger sample of randomly selected medical students observed over longer periods should be studied to test if MI training generalizes to medical students. Inter-rater reliability and test-retest findings indicate a need for caution when interpreting the present results, as well as for more intensive training to help appropriately capture more dimensions of the process in future studies.

Evaluación y optimización de los servicios de un taller de mantenimiento mediante el software de simulación ARENA

Debido a la necesidad de diferenciarse y hacer frente a la competencia, las empresas han apostado por desarrollar operaciones que den valor al cliente, por eso muchas de ellas han visto en las herramientas lean la oportunidad para mejorar sus operaciones. Esta mejora implica la reducción de dinero, personas, equipos grandes, inventario y espacio, con dos objetivos: eliminar despilfarro y reducir la variabilidad. Para conseguir los objetivos estratégicos de la empresa es imprescindible qué éstos estén alineados con los planes de la gerencia a nivel medio y a su vez con el trabajo realizado por los empleados para asegurar que cada persona está alineada en la misma dirección y al mismo tiempo. Ésta es la filosofía de la planificación estratégica. Por ello uno de los objetivos de este proyecto será el desarrollar una herramienta que facilite la exposición de los objetivos de la empresa y la comunicación de los mismos a todos los niveles de la organización para a partir de ellos y tomando como referencia la necesidad de reducir inventarios en la cadena de suministro se realizará un estudio de la producción de un componente de control del aerogenerador para conseguir nivelarla y reducir su inventario de producto terminado. Los objetivos particulares en este apartado serán reducir el inventario en un 28%, nivelar la producción reduciendo la variabilidad del 31% al 24%, mantener un stock máximo de 24 unidades garantizando el suministro ante una demanda variable, incrementar la rotación del inventario en un 10% y establecer un plan de acción para reducir el lead time entre un 40-50%. Todo ello será posible gracias a la realización del mapa de valor presente y futuro para eliminar desperdicios y crear un flujo continuo y el cálculo de un supermercado que mantenga el stock en un nivel óptimo.

Las TIC como instrumento para la colaboración en red, en el ámbito de la Formación Profesional: Una aplicación de Software Libre para colaboración entre centro-empresa en el I.E.S El Palau.

En la era digital actual, Internet forma parte de nuestras vidas, y ha aportado cambios a lasociedad globalizada. Algunos de estos cambios nos permiten nuevas formas de relacionarnos y degestionar el conocimiento, dando sentido al término que hoy entendemos como sociedad-red.Por eso, en el entorno que nos envuelve existen continuamente acciones colaborativas globales quefomentan la comunicación y se comparte información de diversos tipos, con la finalidad deaprender y mantenerse constantemente informado. Específicamente, los centros educativos no sequedan al margen ya que requiere preparar estudiantes para esta sociedad.Estos cambios en la sociedad presentan grandes desafíos para el centro educativo, que nopermiten ser afrontados solamente desde el aula. Los centros requieren adaptarse a un modelocompatible con la sociedad-red, y por ello, se sugieren un modelo centro-red, que presente unaestructura de una organización compatible con la era en el que estamos inmersos.Las redes de colaboración en los centros permite intercambiar información y aportar valor a laeducación con el objetivo de la mejora educativa. En este sentido, los centros educativos debendisponer de características que permitan ser flexibles, adaptarse a los agentes y organizaciones quele envuelven. Pero la estructura actual de un centro educativo es rígida y por tanto esta evoluciónrepresenta uno de los mayores desafíos para el sistema educativo.En esta linea, en los centros de Formación Profesional existe una tendencia hacia modeloscolaborativos con el tejido empresarial, entre otros agentes, y es en este punto donde este proyectopretende centrar el foco de la investigación. Con más exactitud, en la creación de una red decolaboración con el agente que el centro educativo seleccione.Específicamente las TIC forman un papel esencial, y se deben poner al servicio del problemaque apuntábamos para ayudar a solventarlo. En este sentido, es adecuado un diseño del artefactocon Software Libre que tiene múltiples beneficios para este objetivo, pero que destacamos el que ami parecer es el más importante; la vinculación con la filosofía de compartir el conocimiento, quegarantiza la simbiosis con la red colaborativa y es por esta razón que el tema de la investigación esrelevante para el centro educativo.Tal y como se mencionaba previamente, las TIC pueden ayudar a fomentar la red colaborativa,pero no sólo el artefacto TIC generado en este proyecto debe cumplir características como laflexibilidad, también es crítico que el centro educativo y los agentes de la red interioricen la culturacolaborativa en sus acciones con la implicación y compromiso que se requiere. Pero como podemosPágina 6Universitat Oberta de Catalunya Trabajo Final de Máster - Software Libreimaginar, ese cambio de cultura, no es una tarea sencilla y presenta problemas. Para mitigarlos yfomentar la cultura en red, se requieren procesos específicos que permitan incorporarla en la medidade lo posible. Para ello, la combinación de la innovación sistémica y el diseño de la investigación eneducación resultan metodologías apropiadas.Por eso, investigaremos durante este proceso cómo las redes de colaboración y el SoftwareLibre permiten adaptar el centro al entorno, cómo pueden ayudar al centro a potenciar la FormaciónProfesional y garantizar la durabilidad de las acciones, con el objetivo que perdure el conocimientoy la propia red de colaboración para una mejora educativa.

Implantación de un sistema VoIP basado en software libre con Asterisk

Este proyecto busca analizar, diseñar e implementar una nueva solución de telefonía para el Centro Social de Oficiales de la Policía Nacional contemplando la posibilidad de optar por una migración hacia un sistema VoIP bajo software libre con Asterisk. En consecuencia, se deben evaluar las tecnologías actuales buscando proveer nuevas funcionalidades en el servicio telefónico generando bajos costos en su implementación, funcionamiento y mantenimiento.

Teaching Video NeuroImages: Micronystagmus of oculopalatal tremor.

Three months after brainstem hemorrhage, MRI revealed a hyperintense lesion of the left inferior olivary nucleus of a 45-year-old man (figure). The patient was completely asymptomatic, but exhibited oculopalatal tremor (OPT), rhythmic palatal oscillations, and small-amplitude vertical pendular nystagmus of the right eye, best visualized on fundus examination (see video).

Awareness of HIV Testing Guidelines Is Low among Swiss Emergency Doctors: A Survey of Five Teaching Hospitals in French-Speaking Switzerland.

BACKGROUND: In Switzerland, 30% of HIV-infected individuals are diagnosed late. To optimize HIV testing, the Swiss Federal Office of Public Health (FOPH) updated 'Provider Induced Counseling and Testing' (PICT) recommendations in 2010. These permit doctors to test patients if HIV infection is suspected, without explicit consent or pre-test counseling; patients should nonetheless be informed that testing will be performed. We examined awareness of these updated recommendations among emergency department (ED) doctors. METHODS: We conducted a questionnaire-based survey among 167 ED doctors at five teaching hospitals in French-Speaking Switzerland between 1(st) May and 31(st) July 2011. For 25 clinical scenarios, participants had to state whether HIV testing was indicated or whether patient consent or pre-test counseling was required. We asked how many HIV tests participants had requested in the previous month, and whether they were aware of the FOPH testing recommendations. RESULTS: 144/167 doctors (88%) returned the questionnaire. Median postgraduate experience was 6.5 years (interquartile range [IQR] 3; 12). Mean percentage of correct answers was 59 ± 11%, senior doctors scoring higher (P=0.001). Lowest-scoring questions pertained to acute HIV infection and scenarios where patient consent was not required. Median number of test requests was 1 (IQR 0-2, range 0-10). Only 26/144 (18%) of participants were aware of the updated FOPH recommendations. Those aware had higher scores (P=0.001) but did not perform more HIV tests. CONCLUSIONS: Swiss ED doctors are not aware of the national HIV testing recommendations and rarely perform HIV tests. Improved recommendation dissemination and adherence is required if ED doctors are to contribute to earlier HIV diagnoses.

Iowa Bridge Backwater Software User Manual, Version 2.0, TR-564, 2010

This manual describes how to use the Iowa Bridge Backwater software. It also documents the methods and equations used for the calculations. The main body describes how to use the software and the appendices cover technical aspects. The Bridge Backwater software performs 5 main tasks: Design Discharge Estimation; Stream Rating Curves; Floodway Encroachment; Bridge Backwater; and Bridge Scour. The intent of this program is to provide a simplified method for analysis of bridge backwater for rural structures located in areas with low flood damage potential. The software is written in Microsoft Visual Basic 6.0. It will run under Windows 95 or newer versions (i.e. Windows 98, NT, 2000, XP and later).