Interprofessional Education in Anatomy: Learning Together in Medical and Nursing Training

Teamwork and the interprofessional collaboration of all health professions are a guarantee of patient safety and highly qualified treatment in patient care. In the daily clinical routine, physicians and nurses must work together, but the education of the different health professions occurs separately in various places, mostly without interrelated contact. Such training abets mutual misunderstanding and cements professional protectionism, which is why interprofessional education can play an important role in dismantling such barriers to future cooperation. In this article, a pilot project in interprofessional education involving both medical and nursing students is presented, and the concept and the course of training are described in detail. The report illustrates how nursing topics and anatomy lectures can be combined for interprofessional learning in an early phase of training. Evaluation of the course showed that the students were highly satisfied with the collaborative training and believed interprofessional education (IPE) to be an important experience for their future profession and understanding of other health professionals. The results show that the IPE teaching concept, which combines anatomy and nursing topics, provides an optimal setting for learning together and helps nurses and doctors in training to gain knowledge about other health professionals’ roles, thus evolving mutual understanding.

IMRT credentialing for prospective trials using institutional virtual phantoms: results of a joint European Organization for the Research and Treatment of Cancer and Radiological Physics Center project.

BACKGROUND AND PURPOSE Intensity-modulated radiotherapy (IMRT) credentialing for a EORTC study was performed using an anthropomorphic head phantom from the Radiological Physics Center (RPC; RPC(PH)). Institutions were retrospectively requested to irradiate their institutional phantom (INST(PH)) using the same treatment plan in the framework of a Virtual Phantom Project (VPP) for IMRT credentialing. MATERIALS AND METHODS CT data set of the institutional phantom and measured 2D dose matrices were requested from centers and sent to a dedicated secure EORTC uploader. Data from the RPC(PH) and INST(PH) were thereafter centrally analyzed and inter-compared by the QA team using commercially available software (RIT; ver.5.2; Colorado Springs, USA). RESULTS Eighteen institutions participated to the VPP. The measurements of 6 (33%) institutions could not be analyzed centrally. All other centers passed both the VPP and the RPC ±7%/4 mm credentialing criteria. At the 5%/5 mm gamma criteria (90% of pixels passing), 11(92%) as compared to 12 (100%) centers pass the credentialing process with RPC(PH) and INST(PH) (p = 0.29), respectively. The corresponding pass rate for the 3%/3 mm gamma criteria (90% of pixels passing) was 2 (17%) and 9 (75%; p = 0.01), respectively. CONCLUSIONS IMRT dosimetry gamma evaluations in a single plane for a H&N prospective trial using the INST(PH) measurements showed agreement at the gamma index criteria of ±5%/5 mm (90% of pixels passing) for a small number of VPP measurements. Using more stringent, criteria, the RPC(PH) and INST(PH) comparison showed disagreement. More data is warranted and urgently required within the framework of prospective studies.

Intra-Rater and Inter-Rater Reliability of a Medical Record Abstraction Study on Transition of Care after Childhood Cancer.

BACKGROUND The abstraction of data from medical records is a widespread practice in epidemiological research. However, studies using this means of data collection rarely report reliability. Within the Transition after Childhood Cancer Study (TaCC) which is based on a medical record abstraction, we conducted a second independent abstraction of data with the aim to assess a) intra-rater reliability of one rater at two time points; b) the possible learning effects between these two time points compared to a gold-standard; and c) inter-rater reliability. METHOD Within the TaCC study we conducted a systematic medical record abstraction in the 9 Swiss clinics with pediatric oncology wards. In a second phase we selected a subsample of medical records in 3 clinics to conduct a second independent abstraction. We then assessed intra-rater reliability at two time points, the learning effect over time (comparing each rater at two time-points with a gold-standard) and the inter-rater reliability of a selected number of variables. We calculated percentage agreement and Cohen's kappa. FINDINGS For the assessment of the intra-rater reliability we included 154 records (80 for rater 1; 74 for rater 2). For the inter-rater reliability we could include 70 records. Intra-rater reliability was substantial to excellent (Cohen's kappa 0-6-0.8) with an observed percentage agreement of 75%-95%. In all variables learning effects were observed. Inter-rater reliability was substantial to excellent (Cohen's kappa 0.70-0.83) with high agreement ranging from 86% to 100%. CONCLUSIONS Our study showed that data abstracted from medical records are reliable. Investigating intra-rater and inter-rater reliability can give confidence to draw conclusions from the abstracted data and increase data quality by minimizing systematic errors.

Linking Applied Ethnobotany to Social Learning: A Participatory Tool for the Promotion of Indigenous Plants Use in Matutuíne, Southern Mozambique

In its search for pathways towards a more sustainable management of natural resources, development oriented research increasingly faces the challenge to develop new concepts and tools based on transdisciplinarity. Transdisciplinarity can, in terms of an idealized goal, be defined as a research approach that identifies and solves problems not only independently of disciplinary boundaries, but also including the knowledge and perceptions of non-scientific actors in a participatory process. In Mozambique, the Centre for Development and Environment (Berne, Switzerland), in partnership with Impacto and Helvetas (Maputo, Mozambique), has elaborated a new transdisciplinary tool to identify indigenous plants with a potential for commercialization. The tool combines methods from applied ethnobotany with participatory research in a social learning process. This approach was devised to support a development project aimed at creating alternative sources of income for rural communities of Matutuíne district, Southern Mozambique, while reducing the pressure on the natural environment. The methodology, which has been applied and tested, is innovative in that it combines important data collection through participatory research with a social learning process involving both local and external actors. This mutual learning process provides a space for complementary forms of knowledge to meet, eventually leading to the adoption of an integrated approach to natural resource management with an understanding of its ecological, socio-economic and cultural aspects; local stakeholders are included in the identification of potentials for sustainable development. Sustainable development itself, as a normative concept, can only be defined through social learning and consensus building between the local and external stakeholders.

The Quiet Eye in Motor Performance and Learning – Functional and Theoretical Considerations

High precision in motor skill performance, in both sport and other domains (e.g. surgery and aviation), requires the efficient coupling of perceptual inputs (e.g. vision) and motor actions. A particular gaze strategy, which has received much attention within the literature, has been shown to predict both inter- (expert vs. novice) and intra-individual (successful vs. unsuccessful) motor performance (see Vine et al., 2014). Vickers (1996) labelled this phenomenon the quiet eye (QE) which is defined as the final fixation before the initiation of the crucial phase of movement. While the positive influence of a long QE on accuracy has been revealed in a range of different motor skills, there is a growing number of studies suggesting that the relationship between QE and motor performance is not entirely monotonic. This raises interesting questions regarding the QE’s purview, and the theoretical approaches explaining its functionality. This talk aims to present an overview of the issues described above, and to discuss contemporary research and experimental approaches to examining the QE phenomenon. In the first part of the talk Dr. Vine will provide a brief and critical review of the literature, highlighting recent empirical advancements and potential directions for future research. In the second part, Dr. Klostermann will communicate three different theoretical approaches to explain the relationship between QE and motor performance. Drawing upon aspects of all three of these theoretical approaches, a functional inhibition role for the QE (related to movement parameterisation) will be proposed.

Learning through Listening: Conversations for Strategic Change in a Healtcare Provider

The aim of this paper is investigate the role of conversation in strategic change so as to enhance both theory and practice in this respect. As an investigation on how conversations shape change processes in practice, we reflect on an interpretive case study in a health care organization. Through an OD project complemented by semi-structured interviews with participants, we gained a set of data and experiences that allows us to inquire into the relationship between conversations and change in more depth.

Virtual Patients in continuing medical education and residency training: a pilot project for acceptance analysis in the framework of a residency revision course in pediatrics.

AIM Virtual patients (VPs) are a one-of-a-kind e-learning resource, fostering clinical reasoning skills through clinical case examples. The combination with face-to-face teaching is important for their successful integration, which is referred to as "blended learning". So far little is known about the use of VPs in the field of continuing medical education and residency training. The pilot study presented here inquired the application of VPs in the framework of a pediatric residency revision course. METHODS Around 200 participants of a pediatric nephology lecture ('nephrotic and nephritic syndrome in children') were offered two VPs as a wrap-up session at the revision course of the German Society for Pediatrics and Adolescent Medicine (DGKJ) 2009 in Heidelberg, Germany. Using a web-based survey form, different aspects were evaluated concerning the learning experiences with VPs, the combination with the lecture, and the use of VPs for residency training in general. RESULTS N=40 evaluable survey forms were returned (approximately 21%). The return rate was impaired by a technical problem with the local Wi-Fi firewall. The participants perceived the work-up of the VPs as a worthwhile learning experience, with proper preparation for diagnosing and treating real patients with similar complaints. Case presentations, interactivity, and locally and timely independent repetitive practices were, in particular, pointed out. On being asked about the use of VPs in general for residency training, there was a distinct demand for more such offers. CONCLUSION VPs may reasonably complement existing learning activities in residency training.

Tracking of plasma lipids and lipoproteins, within-person and year-to-year variability in plasma cholesterol levels among participants from age 8 to 18 in Project HeartBeat!

Coronary heart disease remains the leading cause of death in the United States and increased blood cholesterol level has been found to be a major risk factor with roots in childhood. Tracking of cholesterol, i.e., the tendency to maintain a particular cholesterol level relative to the rest of the population, and variability in blood lipid levels with increase in age have implications for cholesterol screening and assessment of lipid levels in children for possible prevention of further rise to prevent adulthood heart disease. In this study the pattern of change in plasma lipids, over time, and their tracking were investigated. Also, within-person variance and retest reliability defined as the square root of within-person variance for plasma total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides and their relation to age, sex and body mass index among participants from age 8 to 18 years were investigated. ^ In Project HeartBeat!, 678 healthy children aged 8, 11 and 14 years at baseline were enrolled and examined at 4-monthly intervals for up to 4 years. We examined the relationship between repeated observations by Pearson's correlations. Age- and sex-specific quintiles were calculated and the probability of participants to remain in the uppermost quintile of their respective distribution was evaluated with life table methods. Plasma total cholesterol, HDL-C and LDL-C at baseline were strongly and significantly correlated with measurements at subsequent visits across the sex and age groups. Plasma triglyceride at baseline was also significantly correlated with subsequent measurements but less strongly than was the case for other plasma lipids. The probability to remain in the upper quintile was also high (60 to 70%) for plasma total cholesterol, HDL-C and LDL-C. ^ We used a mixed longitudinal, or synthetic cohort design with continuous observations from age 8 to 18 years to estimate within person variance of plasma total cholesterol, HDL-C, LDL-C and triglycerides. A total of 5809 measurements were available for both cholesterol and triglycerides. A multilevel linear model was used. Within-person variance among repeated measures over up to four years of follow-up was estimated for total cholesterol, HDL-C, LDL-C and triglycerides separately. The relationship of within-person and inter-individual variance with age, sex, and body mass index was evaluated. Likelihood ratio tests were conducted by calculating the deviation of −2log (likelihood) within the basic model and alternative models. The square root of within-person variance provided the retest reliability (within person standard deviation) for plasma total cholesterol, HDL-C, LDL-C and triglycerides. We found 13.6 percent retest reliability for plasma cholesterol, 6.1 percent for HDL-cholesterol, 11.9 percent for LDL-cholesterol and 32.4 percent for triglycerides. Retest reliability of plasma lipids was significantly related with age and body mass index. It increased with increase in body mass index and age. These findings have implications for screening guidelines, as participants in the uppermost quintile tended to maintain their status in each of the age groups during a four-year follow-up. The magnitude of within-person variability of plasma lipids influences the ability to classify children into risk categories recommended by the National Cholesterol Education Program. ^

Using service-learning to encourage community health advocacy among high school students

The project outlined throughout this program management plan aims to develop a health-focused student advocacy group in the San Antonio Independent School District (SAISD). At its core, this project will be an opportunity for SAISD students to engage in service-learning, through which they will learn and develop by designing, organizing and participating in meaningful public health service experiences. ^ This program management plan addresses the genuine need for public health community education by using the service-learning model as a framework to engage students to effect change. The plan delineates the process by which the student advocacy group is to be assembled, selection of service-learning project, project objectives, technical objectives, and communication requirements. Ideally, the plan should help to facilitate project coordination, communication, and planning, and to support the direction of resources. The appendices that follow also provide useful tools with which to follow through with project implementation. ^ The plan is about more than providing a tool to educate students about the health issues in their community. It is about providing a way to teach health advocacy and self-interest and encourage civic engagement via public health. Students have the potential to positively effect lasting change among their peers, in their schools and in the community.^

Inter-acción : lenguaje oral y pedagogía teatral

Esta investigación aplicada, mantuvo la línea de trabajo que se viene sosteniendo desde el período 05/07 y pretendió profundizar el sesgo de la pedagogía teatral orientada a interaccionar con aprendizajes lingüísticos, fundamentalmente del discurso oral. Se trabajó con un grupo de muestra acotado, probando una secuencia pedagógico-didáctica que diera resultados que permitieran afirmar que el lenguaje Teatro posibilita, en la escuela, la investigación guiada de “los modos en los que el afuera interviene en la conformación del adentro" y facilita a los alumnos desarrollar su oralidad y gestualidad en el nivel interaccional, impactando positivamente en su desempeño académico y social.

Escuela, migrantes internos y comunidad barrial en Rosario. Cultura y socialización en la segunda mitad del siglo XX

Esta es una tesis situada en el campo de estudios interdisciplinario de las Ciencias de la Educación, la Historia y la Psicología Social, por lo que es denominada como un estudio acerca de la educación, y su historia psicosocial. La identidad es un concepto sumamente prolífico a la hora de pensar las problemáticas educativas en claves históricas y psicosociales. Si a esto se le agrega la interacción con los cánones escolares, se alcanza un campo rico y fértil para ser investigado. A partir de ahí, la investigación se propone por objetivo general, producir un conocimiento explicativo en torno a la configuración de identidad y el impacto producido por los cánones culturales de la escuela en la herencia cultural de las poblaciones migratorias. A los fines de situar empíricamente el objeto, la dimensión espacial elegida, ha sido una comunidad de la ciudad de Rosario, Santa Fe. El barrio Belgrano y, en particular, la escuela No 91 República Federativa de Brasil, que es la oferta educativa estatal de nivel primario vinculada al mismo. Se desarrollan elementos analíticos que hacen a la configuración socio-histórica (segunda mitad del siglo XX) y educativa del barrio Belgrano. Se trabajan categorías que involucran a la identidad barrial, su historia, la transmisión del legado cultural y el sentido de pertenencia de los sujetos que viven e interactúan en él. Se parte de las siguientes hipótesis: los migrantes internos se incorporan a la comunidad local escapando de las necesidades económicas de su lugar de origen No obstante, una vez asentados los migrantes toman como propias las representaciones adquiridas confluyendo con las referidas a la pertenencia barrial. Si la escuela pretende que la identidad de los migrantes sea absorbida como una adaptación pasiva al canon cultural, esta fracasa en aquellos aspectos que hacen al legado cultural, aunque continúe con la reproducción de ciertos aspectos de la homogeneización y de las diferencias sociales. La metodología cualitativa se ajusta a las pretensiones establecidas. El análisis de entrevistas, documentos, y datos censales es utilizado siendo triangulados los datos para una mejor precisión de la información referida. Consecuentemente, se efectúa el examen del impacto de los movimientos migratorios interprovinciales e internos de la ciudad que conllevan a poblar y a extender el tejido social del barrio y sus alcances en la transmisión del legado cultural en la escuela. Los resultados ponen en evidencia que el arbitrario cultural dominante, a través de sus propios cánones, no que lineal ni se apoderó totalmente de toda la escuela No. 91. Al tener un sentido de pertenencia e identificación suprema con el barrio, no habría reproducido totalmente y sin cuestionamientos el canon cultural dominante. Implícitamente y quizá espontáneamente, las prácticas reprodujeron el mandato del discurso del conjunto social, amalgamado con los aprendizajes socialmente significativos del legado de la comunidad. Por último, hacia fines de los noventa, la vida cotidiana barrial se torna altamente fragmentada e individualizada sin expectativas de configurar un proyecto común. Estas características también se observaron en la práctica docente: la pérdida en el tiempo, del sentido histórico, que ocasiona un resquebrajamiento en los vínculos sociales.

Escuela, migrantes internos y comunidad barrial en Rosario. Cultura y socialización en la segunda mitad del siglo XX

Esta es una tesis situada en el campo de estudios interdisciplinario de las Ciencias de la Educación, la Historia y la Psicología Social, por lo que es denominada como un estudio acerca de la educación, y su historia psicosocial. La identidad es un concepto sumamente prolífico a la hora de pensar las problemáticas educativas en claves históricas y psicosociales. Si a esto se le agrega la interacción con los cánones escolares, se alcanza un campo rico y fértil para ser investigado. A partir de ahí, la investigación se propone por objetivo general, producir un conocimiento explicativo en torno a la configuración de identidad y el impacto producido por los cánones culturales de la escuela en la herencia cultural de las poblaciones migratorias. A los fines de situar empíricamente el objeto, la dimensión espacial elegida, ha sido una comunidad de la ciudad de Rosario, Santa Fe. El barrio Belgrano y, en particular, la escuela No 91 República Federativa de Brasil, que es la oferta educativa estatal de nivel primario vinculada al mismo. Se desarrollan elementos analíticos que hacen a la configuración socio-histórica (segunda mitad del siglo XX) y educativa del barrio Belgrano. Se trabajan categorías que involucran a la identidad barrial, su historia, la transmisión del legado cultural y el sentido de pertenencia de los sujetos que viven e interactúan en él. Se parte de las siguientes hipótesis: los migrantes internos se incorporan a la comunidad local escapando de las necesidades económicas de su lugar de origen No obstante, una vez asentados los migrantes toman como propias las representaciones adquiridas confluyendo con las referidas a la pertenencia barrial. Si la escuela pretende que la identidad de los migrantes sea absorbida como una adaptación pasiva al canon cultural, esta fracasa en aquellos aspectos que hacen al legado cultural, aunque continúe con la reproducción de ciertos aspectos de la homogeneización y de las diferencias sociales. La metodología cualitativa se ajusta a las pretensiones establecidas. El análisis de entrevistas, documentos, y datos censales es utilizado siendo triangulados los datos para una mejor precisión de la información referida. Consecuentemente, se efectúa el examen del impacto de los movimientos migratorios interprovinciales e internos de la ciudad que conllevan a poblar y a extender el tejido social del barrio y sus alcances en la transmisión del legado cultural en la escuela. Los resultados ponen en evidencia que el arbitrario cultural dominante, a través de sus propios cánones, no que lineal ni se apoderó totalmente de toda la escuela No. 91. Al tener un sentido de pertenencia e identificación suprema con el barrio, no habría reproducido totalmente y sin cuestionamientos el canon cultural dominante. Implícitamente y quizá espontáneamente, las prácticas reprodujeron el mandato del discurso del conjunto social, amalgamado con los aprendizajes socialmente significativos del legado de la comunidad. Por último, hacia fines de los noventa, la vida cotidiana barrial se torna altamente fragmentada e individualizada sin expectativas de configurar un proyecto común. Estas características también se observaron en la práctica docente: la pérdida en el tiempo, del sentido histórico, que ocasiona un resquebrajamiento en los vínculos sociales.

Escuela, migrantes internos y comunidad barrial en Rosario. Cultura y socialización en la segunda mitad del siglo XX

Esta es una tesis situada en el campo de estudios interdisciplinario de las Ciencias de la Educación, la Historia y la Psicología Social, por lo que es denominada como un estudio acerca de la educación, y su historia psicosocial. La identidad es un concepto sumamente prolífico a la hora de pensar las problemáticas educativas en claves históricas y psicosociales. Si a esto se le agrega la interacción con los cánones escolares, se alcanza un campo rico y fértil para ser investigado. A partir de ahí, la investigación se propone por objetivo general, producir un conocimiento explicativo en torno a la configuración de identidad y el impacto producido por los cánones culturales de la escuela en la herencia cultural de las poblaciones migratorias. A los fines de situar empíricamente el objeto, la dimensión espacial elegida, ha sido una comunidad de la ciudad de Rosario, Santa Fe. El barrio Belgrano y, en particular, la escuela No 91 República Federativa de Brasil, que es la oferta educativa estatal de nivel primario vinculada al mismo. Se desarrollan elementos analíticos que hacen a la configuración socio-histórica (segunda mitad del siglo XX) y educativa del barrio Belgrano. Se trabajan categorías que involucran a la identidad barrial, su historia, la transmisión del legado cultural y el sentido de pertenencia de los sujetos que viven e interactúan en él. Se parte de las siguientes hipótesis: los migrantes internos se incorporan a la comunidad local escapando de las necesidades económicas de su lugar de origen No obstante, una vez asentados los migrantes toman como propias las representaciones adquiridas confluyendo con las referidas a la pertenencia barrial. Si la escuela pretende que la identidad de los migrantes sea absorbida como una adaptación pasiva al canon cultural, esta fracasa en aquellos aspectos que hacen al legado cultural, aunque continúe con la reproducción de ciertos aspectos de la homogeneización y de las diferencias sociales. La metodología cualitativa se ajusta a las pretensiones establecidas. El análisis de entrevistas, documentos, y datos censales es utilizado siendo triangulados los datos para una mejor precisión de la información referida. Consecuentemente, se efectúa el examen del impacto de los movimientos migratorios interprovinciales e internos de la ciudad que conllevan a poblar y a extender el tejido social del barrio y sus alcances en la transmisión del legado cultural en la escuela. Los resultados ponen en evidencia que el arbitrario cultural dominante, a través de sus propios cánones, no que lineal ni se apoderó totalmente de toda la escuela No. 91. Al tener un sentido de pertenencia e identificación suprema con el barrio, no habría reproducido totalmente y sin cuestionamientos el canon cultural dominante. Implícitamente y quizá espontáneamente, las prácticas reprodujeron el mandato del discurso del conjunto social, amalgamado con los aprendizajes socialmente significativos del legado de la comunidad. Por último, hacia fines de los noventa, la vida cotidiana barrial se torna altamente fragmentada e individualizada sin expectativas de configurar un proyecto común. Estas características también se observaron en la práctica docente: la pérdida en el tiempo, del sentido histórico, que ocasiona un resquebrajamiento en los vínculos sociales.

Impaired learning of predators and lower prey survival under elevated CO2: a consequence of neurotransmitter interference

Ocean acidification is one of the most pressing environmental concerns of our time, and not surprisingly, we have seen a recent explosion of research into the physiological impacts and ecological consequences of changes in ocean chemistry. We are gaining considerable insights from this work, but further advances require greater integration across disciplines. Here, we showed that projected near-future CO2 levels impaired the ability of damselfish to learn the identity of predators. These effects stem from impaired neurotransmitter function; impaired learning under elevated CO2 was reversed when fish were treated with gabazine, an antagonist of the GABA-A receptor - a major inhibitory neurotransmitter receptor in the brain of vertebrates. The effects of CO2 on learning and the link to neurotransmitter interference were manifested as major differences in survival for fish released into the wild. Lower survival under elevated CO2 , as a result of impaired learning, could have a major influence on population recruitment.

Effects of ocean acidification on learning in coral reef fishes

Ocean acidification has the potential to cause dramatic changes in marine ecosystems. Larval damselfish exposed to concentrations of CO2 predicted to occur in the mid- to late-century show maladaptive responses to predator cues. However, there is considerable variation both within and between species in CO2 effects, whereby some individuals are unaffected at particular CO2 concentrations while others show maladaptive responses to predator odour. Our goal was to test whether learning via chemical or visual information would be impaired by ocean acidification and ultimately, whether learning can mitigate the effects of ocean acidification by restoring the appropriate responses of prey to predators. Using two highly efficient and widespread mechanisms for predator learning, we compared the behaviour of pre-settlement damselfish Pomacentrus amboinensis that were exposed to 440 µatm CO2 (current day levels) or 850 µatm CO2, a concentration predicted to occur in the ocean before the end of this century. We found that, regardless of the method of learning, damselfish exposed to elevated CO2 failed to learn to respond appropriately to a common predator, the dottyback, Pseudochromis fuscus. To determine whether the lack of response was due to a failure in learning or rather a short-term shift in trade-offs preventing the fish from displaying overt antipredator responses, we conditioned 440 or 700 µatm-CO2 fish to learn to recognize a dottyback as a predator using injured conspecific cues, as in Experiment 1. When tested one day post-conditioning, CO2 exposed fish failed to respond to predator odour. When tested 5 days post-conditioning, CO2 exposed fish still failed to show an antipredator response to the dottyback odour, despite the fact that both control and CO2-treated fish responded to a general risk cue (injured conspecific cues). These results indicate that exposure to CO2 may alter the cognitive ability of juvenile fish and render learning ineffective.