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.

Influence of the gestational stage on the clinical course, lesional development and parasite distribution in experimental ovine neosporosis.

Neospora caninum is considered one of the main causes of abortion in cattle, yet recent studies have also emphasised its relevance as an abortifacient in small ruminants. In order to gain deeper insight into the pathogenesis of ovine neosporosis, pregnant ewes were intravenously inoculated with 10(6) tachyzoites of the Nc-Spain7 isolate at days 40, 90 or 120 of gestation. Infection during the first term resulted in the death of all foetuses between days 19 and 21 post-infection, showing mainly necrotic lesions in foetal liver and the highest parasite DNA detection and burden in both placenta and foetal viscera. After infection at day 90, foetal death was also detected in all ewes, although later (34-48 days post-infection). In this group, lesions were mainly inflammatory. Foetal livers showed the lowest frequency of lesions, as well as the lowest parasite detection and burden. All ewes infected at day 120 delivered viable lambs, although 3 out of 9 showed weakness and recumbency. Neospora DNA was detected in all lambs but one, and parasite burden was similar to that observed in day 90 group. Lesions in this group showed more conspicuous infiltration of inflammatory cells and higher frequency in foetal brain and muscle when compared to both previous groups. These results highlight the crucial role that the stage of gestation plays on the course of ovine neosporosis, similar to that reported in bovine neosporosis, and open the doors to consider sheep as a valid model for exogenous transplacental transmission for ruminant neosporosis.

Family Court Judges' Training, Background, and Child Development Knowledge: Associations with Child Custody Decision Making

Family court judges are often asked to make inferences about - or directly interview children to ascertain - children's custody preferences and their maturity to express such preferences. These estimates of children's developmental maturity are important to the judges' considerations of children's "best interests" in custody cases. The research literature describing family court judges' background, education, training, and knowledge about child development is scant. With appropriate child development knowledge, judges should be better able to identify the developmental stages at which children have the cognitive and social capabilities to communicate directly their placement wishes or concerns. The current study is the first to examine judges' estimates of - and actual tests of - their child development knowledge, their training/education, and their application of this knowledge to their decisions to involve children as participants in contested custody cases.

Border intervention by Promotores for type 2 diabetes

Purpose of the study. This study had two components. The first component of the study was the development and implementation of an infrastructure that integrated Promotores who teach diabetes self-management into a community clinic. The second component was a six-month randomized clinical trial (RCT) designed to test the effectiveness of the Promotores in changing knowledge, beliefs, and HbA1c levels among Mexican American patients with type 2 diabetes. ^ Methods. Starfield's adaptation of the Donbedian structure, process, and outcome methodology was used to develop a clinic infrastructure that allowed the integration of Promotores as diabetes educators. The RCT of the culturally sensitive Promotores-led 10-week diabetes self-management program compared the outcomes of 63 patients in the intervention group with 68 patients in a wait-list, usual care control group. Participants were Mexican Americans, at least 18 years of age, with type 2 diabetes, who were patients at a Federally Qualified Health Center on the Texas-Mexico border. At baseline, three months, and six months, data were collected using the Diabetes Knowledge Questionnaire (DKQ, the Health Beliefs Questionnaire (HBQ, and HbA1c levels were drawn by the clinic laboratory. A mixed model methodology was used to analyze the data. ^ Results. The infrastructure to support a Promotores-led diabetes self-management course designed in concert with administration, the physicians, and the CDE, resulted in (1) employment of Promotores to teach diabetes self-management courses; (2) integration of provider and nurse oversight of course design and implementation; (3) management of Promotora training, and the development of teaching competencies and skills; (4) coordination of care through communication and documentation policies and procedures; (5) utilization of quality control mechanisms to maintain patient safety; and (6) promotion of a culturally competent approach to the educational process. The RCT resulted in a significant improvement in the intervention group's DKQ scores over time (F [1, 129] = 4.77, p = 0.0308), and in treatment by time (F [2, 168] = 5.85, p = 0.0035). Neither the HBQ scores nor the HbA1c changed over time. However, the baseline HbA1c was 7.49, almost at the therapeutic level. The DKQ, HBQ, and HbA1c results were significantly affected by age; the DKQ and HbA1c by years with diabetes. ^ Conclusions. The clinic model provides a systematic approach to safely address the educational needs of large numbers of patients with type 2 diabetes who live in communities that suffer from a lack of health care professionals. The Promotores-led diabetes self-management course improved the knowledge of patients with diabetes and may be a culturally sensitive strategy for meeting patient educational needs. The low baseline HbA1c levels in this border community suggested that patients in this Federally Qualified Health Center on the Texas-Mexico border were experiencing good medical management of their diabetes. ^

A summative evaluation of a HIV/AIDS Early Childhood Care, Education and Development Teacher Training Workshop in Mongu, Zambia

Objective. To conduct a summative evaluation of an Early Childhood Care, Education and Development (ECCED) Teacher Training Workshop in Mongu, Zambia by assessing changes in knowledge, attitudes and intent to use the information. ^ Study design. A matched cohort survey design was used with additional qualitative data collected by structured observation of workshop sessions, daily facilitator and participant debriefs and participant interviews. ^ Results. Matching pre and post tests were completed by 27 individuals in addition to daily debriefs, structured workshop observation and participant interviews with 22% of the group. The participant population was predominantly female individuals aged 15-44 years old that had completed high school and additional post-secondary training, been teaching children aged 0 – 8 years for 2-5 years in the Western Province and received other HIV/AIDS and ECCED education. Pre-tests indicated a strong understanding of ECCED principles and misconceptions regarding HIV transmission, prevention and the disease's impact on early childhood development. The workshop was found to significantly increase the participants' knowledge of topics covered by the curriculum (paired t-test, N=27, p = 0.004, 95% CI 1.8, 8.6). Participants began with a more limited understanding of HIV/AIDS than ECCED, but the mean gain was much greater at 7.4 +/- 12.3 points. Significantly more participants believed at post-test that HIV/AIDS education should increase for future educators. The 77.8% of participants that increased their knowledge scores at post-test expressed significantly less fear of having a child with HIV/AIDS in the classroom (Independent Samples t-test, N= 27, p = 0.011). Overall participant fear decreased 15.5%. 92.6% and 88.9% of participants planned at post-test to respectively use and share the taught information in their daily professional lives and reported on innovative strategies to communicate with the community. ^ Conclusions. Teacher training workshops can significantly increase HIV/AIDS awareness and promote positive attitudes in educators working with children affected by HIV/AIDS. Using participant suggested teaching techniques such as poems and songs and translating the materials to the local language could assist future facilitators to both culturally and professionally relate to the workshop audience as well as increase participant capacity to share the information with the local community. ^

The assessment of standardized training programs in public health preparedness

The Texas Bioterrorism Continuing Education Consortium (BCE) provided National Disaster Life Support (NDLS) training courses throughout the state of Texas in 2005, to help improve knowledge and skills pertaining to bioterrorism and other public health emergencies. The NDLS training courses include curriculum in Basic Disaster Life Support (BDLS) and Core Disaster Life Support (CDLS). A course evaluation which included items assessing ability and willingness of training participants, role of responders, and other variables was mailed to all NDLS participants who provided contact information. An analysis was conducted to determine whether the survey respondents participated in the Hurricanes Katrina and/or Rita relief efforts, as well as to evaluate the impact of the NDLS training courses on the participant's ability and willingness to respond during a disaster. The study population (n = 2150) consisted mostly of nurses (50%) (n=1074). A chi-square test of analysis indicated the following results. Among the survey respondents who took the CDLS course, there was no statically significant difference by occupation pertaining to ability or willingness to respond (x2 [df = 5] = 4.02, p= 0.546); (x2 [df = 5] = 2.45, p = .783). However, there was a statistically significant difference among those respondents who took the BDLS course with respect to ability, and a slightly significant difference with respect to willingness (x2 [df = 5] = 13.35, p = .020 and (x2 = [df = 5] = 10.299, p = .067). These findings are similar to previous studies assessing willingness to respond to a disaster.^ A second analysis was conducted with these survey data to evaluate the implications for disaster response training for the NDLS courses. Results indicated that the majority of disaster responders served in the role for which they were professionally trained (Physicians=68%; Nurses = 50.4%). Nurses, EMT, and Fire professionals served in multiple roles. These results suggest the importance of developing training programs that will prepare professionals to serve in multiple roles. The development of standardized evaluation methods would fill an important gap in assessing impact of national training programs. ^

Development of Interactive Materials by Engineering Students Using the Descartes Applets.

In a degree course such as Forestry Engineering, the general teaching objectives consist of explaining and helping students to understand the principles of Mechanics. For some time now we have encountered significant difficulties in teaching this subject due to the students' lack of motivation and to their insufficient prior preparation for the topic. If we add to this the discipline's inherent complexity and the students' preconceptions about the subject, these teaching difficulties become considerable. For this reason a series of didactic activities have been introduced sequentially in the teaching of this subject. This work describes the methodology, procedure and results for the action of developing a work project in groups using Descartes software. The results of this experiment can be considered very positive. Some of the critical preconceptions for learning the subject can be corrected, and the tutoring process in the classroom contributes to an improvement in teacherstudent communication. Since this scheme was established, the number of students taking part each academic year has increased, and this is the group with the greatest percentage of passing scores.

Development of a grid connected micro wind generator. A practical activity for the course on electric generation with wind energy

This paper describes a practical activity, part of the renewable energy course where the students have to build their own complete wind generation system, including blades, PM-generator, power electronics and control. After connecting the system to the electric grid the system has been tested during real wind scenarios. The paper will describe the electric part of the work surface-mounted permanent magnet machine design criteria as well as the power electronics part for the power control and the grid connection. A Kalman filter is used for the voltage phase estimation and current commands obtained in order to control active and reactive power. The connection to the grid has been done and active and reactive power has been measured in the system.

Methodology for reconstructing early zebrafish development from in vivo multiphoton microscopy

Investigating cell dynamics during early zebrafish embryogenesis requires specific image acquisition and analysis strategies. Multiharmonic microscopy, i.e., second- and third-harmonic generations, allows imaging cell divisions and cell membranes in unstained zebrafish embryos from 1- to 1000-cell stage. This paper presents the design and implementation of a dedicated image processing pipeline (tracking and segmentation) for the reconstruction of cell dynamics during these developmental stages. This methodology allows the reconstruction of the cell lineage tree including division timings, spatial coordinates, and cell shape until the 1000-cell stage with minute temporal accuracy and micrometer spatial resolution. Data analysis of the digital embryos provides an extensive quantitative description of early zebrafish embryogenesis.

Development of a methodology and tool to evaluate the impact of ICT measures on road transport emissions

The paper presents the main elements of a project entitled ICT-Emissions that aims at developing a novel methodology to evaluate the impact of ICT-related measures on mobility, vehicle energy consumption and CO2 emissions of vehicle fleets at the local scale, in order to promote the wider application of the most appropriate ICT measures. The proposed methodology combines traffic and emission modelling at micro and macro scales. These will be linked with interfaces and submodules which will be specifically designed and developed. A number of sources are available to the consortium to obtain the necessary input data. Also, experimental campaigns are offered to fill in gaps of information in traffic and emission patterns. The application of the methodology will be demonstrated using commercially available software. However, the methodology is developed in such a way as to enable its implementation by a variety of emission and traffic models. Particular emphasis is given to (a) the correct estimation of driver behaviour, as a result of traffic-related ICT measures, (b) the coverage of a large number of current vehicle technologies, including ICT systems, and (c) near future technologies such as hybrid, plug-in hybrids, and electric vehicles. The innovative combination of traffic, driver, and emission models produces a versatile toolbox that can simulate the impact on energy and CO2 of infrastructure measures (traffic management, dynamic traffic signs, etc.), driver assistance systems and ecosolutions (speed/cruise control, start/stop systems, etc.) or a combination of measures (cooperative systems).The methodology is validated by application in the Turin area and its capacity is further demonstrated by application in real world conditions in Madrid and Rome.

The online case study development for the teaching of building structures reinforcement

The Reinforcement of Building Structures is one of the topics of the Master in Building Innovation Technology (MBIT) of Universidad Politécnica de Madrid (UPM). Since the beginning of the delivery of this master, case studies have been chosen as the teaching methodology. For the 2011-2012 course the online education of this subject was implemented, instead of the classical learning based on attendance. Through ICT’s (Information and Communication Technologies) students are provided with much more and more selective information than through the classical learning. ICT’s can be used for search, enquiries and reporting. Using the online tools has been proved, through the results obtained and based on the surveys made amongst students, to be a successful experience.

Integral development of an Agricultural Training Center to ensure food security in Glory Special Needs Primary School. Kitgum, Uganda. DANIEL

El presente proyecto, titulado “Integral development of an Agricultural Training Center to ensure food security in Glory Special Needs Primary School. Kitgum, Uganda” fue llevado a cabo de Julio de 2011 a Febrero de 2012 en la escuela primaria Glory Special Needs, dedicada a la atención y educación de jóvenes discapacitados, en Kitgum, Uganda. El proyecto se realizó con la colaboración del grupo de cooperación de la ETSI Agrónomos, AgSystems, la Fundación AmigoSolidarios y la ONG local NUCBACD. Su objetivo principal fue el desarrollo y puesta en marcha de un centro de capacitación Agrícola para dotar de igualdad de oportunidades a los jóvenes con discapacidad de Kitgum, potenciando y favoreciendo su integración en la comunidad, y garantizar así la seguridad alimentaria de los 137 alumnos internos en la escuela Glory Special Needs. El trabajo realizado supuso una acción relevante en Kitgum, superando la visión de una economía familiar basada en las actividades agrícolas, para centrarse en la profesionalización de la Agricultura como motor económico de la región. Este documento presenta una descripción de las principales actividades que se desarrollaron con el fin de alcanzar el objetivo planteado, desde un punto de vista educativo, sostenible e inclusivo. Para conseguirlo, se plantearon tres lineas de trabajo: - Programa productivo. - Programa educativo. - Programa organizativo.

Development of a methodology for nuclear data uncertainty propagation on isotopic evolution calculations for advanced nuclear systems

Una apropiada evaluación de los márgenes de seguridad de una instalación nuclear, por ejemplo, una central nuclear, tiene en cuenta todas las incertidumbres que afectan a los cálculos de diseño, funcionanmiento y respuesta ante accidentes de dicha instalación. Una fuente de incertidumbre son los datos nucleares, que afectan a los cálculos neutrónicos, de quemado de combustible o activación de materiales. Estos cálculos permiten la evaluación de las funciones respuesta esenciales para el funcionamiento correcto durante operación, y también durante accidente. Ejemplos de esas respuestas son el factor de multiplicación neutrónica o el calor residual después del disparo del reactor. Por tanto, es necesario evaluar el impacto de dichas incertidumbres en estos cálculos. Para poder realizar los cálculos de propagación de incertidumbres, es necesario implementar metodologías que sean capaces de evaluar el impacto de las incertidumbres de estos datos nucleares. Pero también es necesario conocer los datos de incertidumbres disponibles para ser capaces de manejarlos. Actualmente, se están invirtiendo grandes esfuerzos en mejorar la capacidad de analizar, manejar y producir datos de incertidumbres, en especial para isótopos importantes en reactores avanzados. A su vez, nuevos programas/códigos están siendo desarrollados e implementados para poder usar dichos datos y analizar su impacto. Todos estos puntos son parte de los objetivos del proyecto europeo ANDES, el cual ha dado el marco de trabajo para el desarrollo de esta tesis doctoral. Por tanto, primero se ha llevado a cabo una revisión del estado del arte de los datos nucleares y sus incertidumbres, centrándose en los tres tipos de datos: de decaimiento, de rendimientos de fisión y de secciones eficaces. A su vez, se ha realizado una revisión del estado del arte de las metodologías para la propagación de incertidumbre de estos datos nucleares. Dentro del Departamento de Ingeniería Nuclear (DIN) se propuso una metodología para la propagación de incertidumbres en cálculos de evolución isotópica, el Método Híbrido. Esta metodología se ha tomado como punto de partida para esta tesis, implementando y desarrollando dicha metodología, así como extendiendo sus capacidades. Se han analizado sus ventajas, inconvenientes y limitaciones. El Método Híbrido se utiliza en conjunto con el código de evolución isotópica ACAB, y se basa en el muestreo por Monte Carlo de los datos nucleares con incertidumbre. En esta metodología, se presentan diferentes aproximaciones según la estructura de grupos de energía de las secciones eficaces: en un grupo, en un grupo con muestreo correlacionado y en multigrupos. Se han desarrollado diferentes secuencias para usar distintas librerías de datos nucleares almacenadas en diferentes formatos: ENDF-6 (para las librerías evaluadas), COVERX (para las librerías en multigrupos de SCALE) y EAF (para las librerías de activación). Gracias a la revisión del estado del arte de los datos nucleares de los rendimientos de fisión se ha identificado la falta de una información sobre sus incertidumbres, en concreto, de matrices de covarianza completas. Además, visto el renovado interés por parte de la comunidad internacional, a través del grupo de trabajo internacional de cooperación para evaluación de datos nucleares (WPEC) dedicado a la evaluación de las necesidades de mejora de datos nucleares mediante el subgrupo 37 (SG37), se ha llevado a cabo una revisión de las metodologías para generar datos de covarianza. Se ha seleccionando la actualización Bayesiana/GLS para su implementación, y de esta forma, dar una respuesta a dicha falta de matrices completas para rendimientos de fisión. Una vez que el Método Híbrido ha sido implementado, desarrollado y extendido, junto con la capacidad de generar matrices de covarianza completas para los rendimientos de fisión, se han estudiado diferentes aplicaciones nucleares. Primero, se estudia el calor residual tras un pulso de fisión, debido a su importancia para cualquier evento después de la parada/disparo del reactor. Además, se trata de un ejercicio claro para ver la importancia de las incertidumbres de datos de decaimiento y de rendimientos de fisión junto con las nuevas matrices completas de covarianza. Se han estudiado dos ciclos de combustible de reactores avanzados: el de la instalación europea para transmutación industrial (EFIT) y el del reactor rápido de sodio europeo (ESFR), en los cuales se han analizado el impacto de las incertidumbres de los datos nucleares en la composición isotópica, calor residual y radiotoxicidad. Se han utilizado diferentes librerías de datos nucleares en los estudios antreriores, comparando de esta forma el impacto de sus incertidumbres. A su vez, mediante dichos estudios, se han comparando las distintas aproximaciones del Método Híbrido y otras metodologías para la porpagación de incertidumbres de datos nucleares: Total Monte Carlo (TMC), desarrollada en NRG por A.J. Koning y D. Rochman, y NUDUNA, desarrollada en AREVA GmbH por O. Buss y A. Hoefer. Estas comparaciones demostrarán las ventajas del Método Híbrido, además de revelar sus limitaciones y su rango de aplicación. ABSTRACT For an adequate assessment of safety margins of nuclear facilities, e.g. nuclear power plants, it is necessary to consider all possible uncertainties that affect their design, performance and possible accidents. Nuclear data are a source of uncertainty that are involved in neutronics, fuel depletion and activation calculations. These calculations can predict critical response functions during operation and in the event of accident, such as decay heat and neutron multiplication factor. Thus, the impact of nuclear data uncertainties on these response functions needs to be addressed for a proper evaluation of the safety margins. Methodologies for performing uncertainty propagation calculations need to be implemented in order to analyse the impact of nuclear data uncertainties. Nevertheless, it is necessary to understand the current status of nuclear data and their uncertainties, in order to be able to handle this type of data. Great eórts are underway to enhance the European capability to analyse/process/produce covariance data, especially for isotopes which are of importance for advanced reactors. At the same time, new methodologies/codes are being developed and implemented for using and evaluating the impact of uncertainty data. These were the objectives of the European ANDES (Accurate Nuclear Data for nuclear Energy Sustainability) project, which provided a framework for the development of this PhD Thesis. Accordingly, first a review of the state-of-the-art of nuclear data and their uncertainties is conducted, focusing on the three kinds of data: decay, fission yields and cross sections. A review of the current methodologies for propagating nuclear data uncertainties is also performed. The Nuclear Engineering Department of UPM has proposed a methodology for propagating uncertainties in depletion calculations, the Hybrid Method, which has been taken as the starting point of this thesis. This methodology has been implemented, developed and extended, and its advantages, drawbacks and limitations have been analysed. It is used in conjunction with the ACAB depletion code, and is based on Monte Carlo sampling of variables with uncertainties. Different approaches are presented depending on cross section energy-structure: one-group, one-group with correlated sampling and multi-group. Differences and applicability criteria are presented. Sequences have been developed for using different nuclear data libraries in different storing-formats: ENDF-6 (for evaluated libraries) and COVERX (for multi-group libraries of SCALE), as well as EAF format (for activation libraries). A revision of the state-of-the-art of fission yield data shows inconsistencies in uncertainty data, specifically with regard to complete covariance matrices. Furthermore, the international community has expressed a renewed interest in the issue through the Working Party on International Nuclear Data Evaluation Co-operation (WPEC) with the Subgroup (SG37), which is dedicated to assessing the need to have complete nuclear data. This gives rise to this review of the state-of-the-art of methodologies for generating covariance data for fission yields. Bayesian/generalised least square (GLS) updating sequence has been selected and implemented to answer to this need. Once the Hybrid Method has been implemented, developed and extended, along with fission yield covariance generation capability, different applications are studied. The Fission Pulse Decay Heat problem is tackled first because of its importance during events after shutdown and because it is a clean exercise for showing the impact and importance of decay and fission yield data uncertainties in conjunction with the new covariance data. Two fuel cycles of advanced reactors are studied: the European Facility for Industrial Transmutation (EFIT) and the European Sodium Fast Reactor (ESFR), and response function uncertainties such as isotopic composition, decay heat and radiotoxicity are addressed. Different nuclear data libraries are used and compared. These applications serve as frameworks for comparing the different approaches of the Hybrid Method, and also for comparing with other methodologies: Total Monte Carlo (TMC), developed at NRG by A.J. Koning and D. Rochman, and NUDUNA, developed at AREVA GmbH by O. Buss and A. Hoefer. These comparisons reveal the advantages, limitations and the range of application of the Hybrid Method.