Manual del curso básico: la accesibilidad en el servicio público

El manual del curso está estructurado en ocho capítulos. Los seis primeros desarrollan los contenidos necesarios para conocer y aplicar las condiciones de accesibilidad adecuadamente en los servicios públicos: desde las nociones y características vinculadas con las necesidades de distintos tipos de ciudadanos, hasta el contexto normativo, institucional y conceptual que se ha venido consolidando en torno a la idea de accesibilidad universal. Los dos últimos capítulos ofrecen medidas y recomendaciones para lograr una administración pública accesible, tanto en sus servicios donde se produce la relación con los ciudadanos, como en los entornos en que los empleados trabajan.

Training medical students to conduct motivational interviewing: a randomized controlled trial.

OBJECTIVE: To examine the effectiveness of motivational interviewing (MI) training among medical students. METHODS: All students (n=131) (year 5) at Lausanne Medical School, Switzerland were randomized into an experimental or a control group. After a training in basic communication skills (control condition), an 8-h MI training was completed by 84.8% students in the exprimental group. One week later, students in both groups were invited to meet with two standardized patients. MI skills were coded by blinded research assistants using the Motivational Interviewing Treatment Integrity 3.0. RESULTS: Superior MI performance was shown for trained versus control students, as demonstrated by higher scores for "Empathy" [p<0.001] and "MI Spirit" [p<0.001]. Scores were similar between groups for "Direction", indicating that students in both groups invited the patient to talk about behavior change. Behavior counts assessment demonstrated better performance in MI in trained versus untrained students regarding occurences of MI-adherent behavior [p<0.001], MI non-adherent behavior [p<0.001], Closed questions [p<0.001], Open questions [p=0.001], simple reflections [p=0.03], and Complex reflections [p<0.001]. Occurrences were similar between groups regarding "Giving information". CONCLUSION: An 8-h training workshop was associated with improved MI performance. PRACTICE IMPLICATIONS: These findings lend support for the implementation of MI training in medical schools.

Manual de preparació per a olimpíades i competicions matemàtiques

Treball de recerca realitzat per un alumne d’ensenyament secundari i guardonat amb un Premi CIRIT per fomentar l'esperit científic del Jovent l’any 2008. Es presenta als interessats en les competicions de matemàtiques un manual sòlid, compacte, però sintetitzat, que els permeti, complementar i ampliar els seus coneixements matemàtics dirigits a aquestes competicions. En la primera part, es tracten les olimpíades matemàtiques més importants estatals i arreu del món per tal de donar-les a conèixer al lector. A continuació s'expliquen les tècniques generals més utilitzades per construir una demostració determinada. Finalment, es tanca la secció parlant de la creació de problemes, un apartat que permet estimular i potenciar la pròpia creativitat. En la segona part, es troba el propi cos del manual, amb una gran quantitat de problemas solucionats. Per tal de facilitar-ne l'ús, s'ha dividit en quatre grans temes, corresponents als que es treballen a les Olimpíades Matemàtiques: teoria de nombres o aritmètica, geometria, àlgebra i combinatòria. Cada un d'aquests temes es troba, a la vegada, dividit en dues seccions: la de teoremes i conceptes, en què s'enuncien els principals teoremes i fórmules que el lector necessita conéixer, i la d'exercicis i problemes on s’han recollit multitud de problemes provinents de diferents competicions, indicant el grau de dificultat - cal remarcar però, que el present document és una reducció del treball original, per això s'ha decidit només incloure-hi l'apartat d'aritmètica i ometre els altres tres -.

Intraobserver and interobserver variability of ascending aorta diameter measurements as assessed by ECG-gated MDCT : automatic versus manual measurements : P15

Purpose: Revolutionary endovascular treatments are on the verge of being available for management of ascending aortic diseases. Morphometric measurements of the ascending aorta have already been done with ECG-gated MDCT to help such therapeutic development. However the reliability of these measurements remains unknown. The objective of this work was to compare the intraobserver and interobserver variability of CAD (computer aided diagnosis) versus manual measurements in the ascending aorta. Methods and materials: Twenty-six consecutive patients referred for ECG-gated CT thoracic angiography (64-row CT scanner) were evaluated. Measurements of the maximum and minimum ascending aorta diameters at mid-distance between the brachiocephalic artery and the aortic valve were obtained automatically with a commercially available CAD and manually by two observers separately. Both observers repeated the measurements during a different session at least one month after the first measurements. Intraclass coefficients as well the Bland and Altman method were used for comparison between measurements. Two-paired t-test was used to determine the significance of intraobserver and interobserver differences (alpha = 0.05). Results: There is a significant difference between CAD and manual measurements in the maximum diameter (p = 0.004) for the first observer, whereas the difference was significant for minimum diameter between the second observer and the CAD (p <0.001). Interobserver variability showed a weak agreement when measurements were done manually. Intraobserver variability was lower with the CAD compared to the manual measurements (limits of variability: from -0.7 to 0.9 mm for the former and from -1.2 to 1.3 mm for the latter). Conclusion: In order to improve reproductibility of measurements whenever needed, pre- and post-therapeutic management of the ascending aorta may benefit from follow-up done by a unique observer with the help of CAD.

Effect of training-sample size and classification difficulty on the accuracy of genomic predictors.

Introduction: As part of the MicroArray Quality Control (MAQC)-II project, this analysis examines how the choice of univariate feature-selection methods and classification algorithms may influence the performance of genomic predictors under varying degrees of prediction difficulty represented by three clinically relevant endpoints. Methods: We used gene-expression data from 230 breast cancers (grouped into training and independent validation sets), and we examined 40 predictors (five univariate feature-selection methods combined with eight different classifiers) for each of the three endpoints. Their classification performance was estimated on the training set by using two different resampling methods and compared with the accuracy observed in the independent validation set. Results: A ranking of the three classification problems was obtained, and the performance of 120 models was estimated and assessed on an independent validation set. The bootstrapping estimates were closer to the validation performance than were the cross-validation estimates. The required sample size for each endpoint was estimated, and both gene-level and pathway-level analyses were performed on the obtained models. Conclusions: We showed that genomic predictor accuracy is determined largely by an interplay between sample size and classification difficulty. Variations on univariate feature-selection methods and choice of classification algorithm have only a modest impact on predictor performance, and several statistically equally good predictors can be developed for any given classification problem.

Manual de especificaciones y requisitos de nuevos productos y sistemas

Establiment d'especificacions i requisits tècnics per a l'adaptació i adequació dels diferents productes i sistemes obtinguts en l'informe d'avaluació de productes existents (*ST2.1.1).

How to improve the formal analytic reasoning and scientific motivation in the intellectual training of medical students

A review article of the The New England Journal of Medicine refers that almost a century ago, Abraham Flexner, a research scholar at the Carnegie Foundation for the Advancement of Teaching, undertook an assessment of medical education in 155 medical schools in operation in the United States and Canada. Flexner’s report emphasized the nonscientific approach of American medical schools to preparation for the profession, which contrasted with the university-based system of medical education in Germany. At the core of Flexner’s view was the notion that formal analytic reasoning, the kind of thinking integral to the natural sciences, should hold pride of place in the intellectual training of physicians. This idea was pioneered at Harvard University, the University of Michigan, and the University of Pennsylvania in the 1880s, but was most fully expressed in the educational program at Johns Hopkins University, which Flexner regarded as the ideal for medical education. (...)

Effect of intermittent hypoxic training on HIF gene expression in human skeletal muscle and leukocytes

Intermittent hypoxic exposure with exercise training is based on the assumption that brief exposure to hypoxia is sufficient to induce beneficial muscular adaptations mediated via hypoxia-inducible transcription factors (HIF). We previously demonstrated (Mounier et al. Med Sci Sports Exerc 38:1410-1417, 2006) that leukocytes respond to hypoxia with a marked inter-individual variability in HIF-1alpha mRNA. This study compared the effects of 3 weeks of intermittent hypoxic training on hif gene expression in both skeletal muscle and leukocytes. Male endurance athletes (n = 19) were divided into an Intermittent Hypoxic Exposure group (IHE) and a Normoxic Training group (NT) with each group following a similar 3-week exercise training program. After training, the amount of HIF-1alpha mRNA in muscle decreased only in IHE group (-24.7%, P < 0.05) whereas it remained unchanged in leukocytes in both groups. The levels of vEGF(121) and vEGF(165) mRNA in skeletal muscle increased significantly after training only in the NT group (+82.5%, P < 0.05 for vEGF(121); +41.2%, P < 0.05 for vEGF(165)). In leukocytes, only the IHE group showed a significant change in vEGF(165) (-28.2%, P < 0.05). The significant decrease in HIF-1alpha mRNA in skeletal muscle after hypoxic training suggests that transcriptional and post-transcriptional regulations of the hif-1alpha gene are different in muscle and leukocytes.

Effects of Intermittent Training on Anaerobic Performance and MCT Transporters in Athletes.

This study examined the effects of intermittent hypoxic training (IHT) on skeletal muscle monocarboxylate lactate transporter (MCT) expression and anaerobic performance in trained athletes. Cyclists were assigned to two interventions, either normoxic (N; n = 8; 150 mmHg PIO2) or hypoxic (H; n = 10; ∼3000 m, 100 mmHg PIO2) over a three week training (5×1 h-1h30.week-1) period. Prior to and after training, an incremental exercise test to exhaustion (EXT) was performed in normoxia together with a 2 min time trial (TT). Biopsy samples from the vastus lateralis were analyzed for MCT1 and MCT4 using immuno-blotting techniques. The peak power output (PPO) increased (p<0.05) after training (7.2% and 6.6% for N and H, respectively), but VO2max showed no significant change. The average power output in the TT improved significantly (7.3% and 6.4% for N and H, respectively). No differences were found in MCT1 and MCT4 protein content, before and after the training in either the N or H group. These results indicate there are no additional benefits of IHT when compared to similar normoxic training. Hence, the addition of the hypoxic stimulus on anaerobic performance or MCT expression after a three-week training period is ineffective.