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.

N budget and NH3 exchange of a grass/clover crop at two levels of N application

Atmospheric ammonia (NH3) exchange during a single growing season was measured over two grass/clover fields managed by cutting and treated with different rates of mineral nitrogen (N) fertilizer. The aim was to quantify the total NH3 exchange of the two systems in relation to their N budget, the latter was split into N derived from symbiotic fixation, from fertilization, and from the soil. The experimental site was located in an intensively managed agricultural area on the Swiss plateau. Two adjacent fields with mixtures of perennial ryegrass (Lolium perenne L.), cocks foot (Dactylis glomerata L.), white clover (Trifolium repens L.) and red clover (Trifolium pratense L.) were used. These were treated with either 80 or 160 kg N ha−1 applied as NH4NO3 fertilizer in equal portions after each of four cuts. Continuous NH3 flux measurements were carried out by micrometeorological techniques. To determine the contribution of each species to the overall NH3 canopy compensation point, stomatal NH3 compensation points of the individual plant species were determined on the basis of NH4+ + NH3 (NHx) concentrations and pH in the apoplast. Symbiotic N2 fixation was measured by the 15N dilution method.

A Simple Statistical Test of Violation of the Weak Axiom of Cost Minimization

A problem with a practical application of Varian.s Weak Axiom of Cost Minimization is that an observed violation may be due to random variation in the output quantities produced by firms rather than due to inefficiency on the part of the firm. In this paper, unlike in Varian (1985), the output rather than the input quantities are treated as random and an alternative statistical test of the violation of WACM is proposed. We assume that there is no technical inefficiency and provide a test of the hypothesis that an observed violation of WACM is merely due to random variations in the output levels of the firms being compared.. We suggest an intuitive approach for specifying a value of the variance of the noise term that is needed for the test. The paper includes an illustrative example utilizing a data set relating to a number of U.S. airlines.

Efficiency in Deregulated Electricity Markets: Offer Cost Minimization vs. Payment Cost Minimization Auction

This study of the wholesale electricity market compares the efficiency performance of the auction mechanism currently in place in U.S. markets with the performance of a proposed mechanism. The analysis highlights the importance of considering strategic behavior when comparing different institutional systems. We find that in concentrated markets, neither auction mechanism can guarantee an efficient allocation. The advantage of the current mechanism increases with increased price competition if market demand is perfectly inelastic. However, if market demand has some responsiveness to price, the superiority of the current auction with respect to efficiency is not that obvious. We present a case where the proposed auction outperforms the current mechanism on efficiency even if all offers reflect true production costs. We also find that a market designer might face a choice problem with a tradeoff between lower electricity cost and production efficiency. Some implications for social welfare are discussed as well.

Assessment of English Language Learners Seeking a Graduate Degree in Speech Language Pathology

A shortage of bilingual/bicultural speech language pathologists may reflect a problem with recruitment and retention of bilingual/bicultural students. The purpose of the present study was to survey graduate training programs in speech language pathology to determine typical policies and practices concerning students who apply and are admitted as ELLs. With a growing number of ELL children needing services from a bilingual SLP, it seems that little is being done to address the issue. The problem may be with the reluctance of programs to not only accept ELL students, but there also seems to be a disinclination for any sort of training program to be established for these ELL students. Clinic directors were asked to complete a survey about ELLs seeking clinical training in speech language pathology. In particular, we were interested in obtaining information about whether clinical training programs a) provided opportunities for ELL to participate in clinic, b) assessed the English skills of these students, and c) provided remediation if these students English skills were judged to be less than proficient.

Back pain in migrant farmworker families and farmworker high school students from Starr County, Texas

Back symptoms are a major global public health problem with the lifetime prevalence ranging between 50-80%. Research suggests that work-related factors contribute to the occurrence of back pain in various industries. Despite the hazardous nature, strenuous tasks, and awkward postures associated with farm work, little is known about back injury and symptoms in farmworker adults and children. Research in the United States is particularly limited. This is a concern given the large proportion of migrant farmworkers in the United States without adequate access to healthcare as well as a substantial number of youth working in agriculture. The present study describes back symptoms and identifies work-related factors associated with back pain in migrant farmworker families and farmworker high school students from Starr County, TX. Two separate datasets were used from two cohort studies "Injury and Illness Surveillance in Migrant Farmworkers (MANOS)" (study A: n=267 families) and "South Texas Adolescent Rural Research Study (STARRS)" (study B: n=345). Descriptive and inferential statistics including multivariable logistic regression were used to identify work-related factors associated with back pain in each study. In migrant farmworker families, the prevalence of chronic back pain during the last migration season ranged from 9.5% among youngest children to 33.3% among mothers. Chronic back pain was significantly associated with increasing age; fairly bad/very bad quality of sleep while migrating; fewer than eight hours of sleep at home in Starr County, TX; depressive symptoms while migrating; self-provided water for washing hands/drinking; weeding at work; and exposure to pesticide drift/direct spray. Among farmworker adolescents, the prevalence of severe back symptoms was 15.7%. Severe back symptoms were significantly associated with being female; history of a prior accident/back injury; feeling tense, stressed, or anxious sometimes/often; lifting/carrying heavy objects not at work; current tobacco use; increasing lifetime number of migrant farmworker years; working with/around knives; and working on corn crops. Overall, results support that associations between work-related exposures and chronic back pain and severe back symptoms remain after controlling for the effect of non-work exposures in farmworker populations. ^

Distribution of quality adjusted life expectancy: A systems approach

Statistical methods are developed which assess survival data for two attributes; (1) prolongation of life, (2) quality of life. Health state transition probabilities correspond to prolongation of life and are modeled as a discrete-time semi-Markov process. Imbedded within the sojourn time of a particular health state are the quality of life transitions. They reflect events which differentiate perceptions of pain and suffering over a fixed time period. Quality of life transition probabilities are derived from the assumptions of a simple Markov process. These probabilities depend on the health state currently occupied and the next health state to which a transition is made. Utilizing the two forms of attributes the model has the capability to estimate the distribution of expected quality adjusted life years (in addition to the distribution of expected survival times). The expected quality of life can also be estimated within the health state sojourn time making more flexible the assessment of utility preferences. The methods are demonstrated on a subset of follow-up data from the Beta Blocker Heart Attack Trial (BHAT). This model contains the structure necessary to make inferences when assessing a general survival problem with a two dimensional outcome. ^

Eficiencia de la retención hídrica de las cubiertas vegetadas

La inundación repentina en áreas urbanas por sobrecarga de las redes de drenaje es un problema recurrente con impactos negativos de importancia creciente. Las cubiertas vegetadas ("naturadas") retienen parte de la lámina de agua precipitada, reduciendo el escurrimiento superficial y generando hidrogramas de escorrentía directa con caudales pico menores y más retardados. Dichas propiedades hacen que esta tecnología pueda contribuir a reducir la sobrecarga de cauces urbanos. En esta comunicación se presentan los primeros resultados (parciales) de la determinación de la eficiencia de retención hídrica (en forma indirecta a partir de la cantidad de agua percolada), en parcelas de ensayo que simulen "cubiertas naturadas", con dos profundidades de sustrato y con dos situaciones respecto a la cobertura (con y sin vegetación). Los mismos muestran una tendencia positiva de las "cubiertas naturadas" en la contribución a la reducción del escurrimiento, siendo mayor la retención en las parcelas vegetadas y sustrato de mayor espesor.

Las condiciones y la naturaleza del discurso crítico : El debate entre hermenéutica y teoría crítica

El trabajo analiza el problema del alcance, la posibilidad y la legitimación del discurso crítico. Por discurso crítico entendemos aquel en el que un individuo o un grupo minoritario levantan pretensiones de validez que contradicen lo que mayoritariamente es considerado correcto. Este asunto recibe una atención focal en el debate entre Habermas y Gadamer. El problema aparece allí vinculado a su estatuto paradójico. Se cuestiona si las condiciones de la elucidación del sentido propias de la hermenéutica no estrechan el margen de la posibilidad del discurso crítico hasta tornarlo imposible. La hermenéutica cuestiona si los alcances del discurso crítico propugnado por la teoría crítica no efectúan un salto más allá de las condiciones que hacen posible cualquier discurso. Nuestro análisis de la disputa nos condujo a reconocer un presupuesto común, ligado al rol semejante que ambas perspectivas otorgan a la noción de reconocimiento implícito -aunque entendido de manera materialmente muy diferente- en la constitución del dominio de lo simbólico. Aprovecharemos la inscripción del pensamiento de Wittgenstein en el debate, para hacer una evaluación crítica de la disputa a través del examen de esta presuposición.

Las condiciones y la naturaleza del discurso crítico : El debate entre hermenéutica y teoría crítica

El trabajo analiza el problema del alcance, la posibilidad y la legitimación del discurso crítico. Por discurso crítico entendemos aquel en el que un individuo o un grupo minoritario levantan pretensiones de validez que contradicen lo que mayoritariamente es considerado correcto. Este asunto recibe una atención focal en el debate entre Habermas y Gadamer. El problema aparece allí vinculado a su estatuto paradójico. Se cuestiona si las condiciones de la elucidación del sentido propias de la hermenéutica no estrechan el margen de la posibilidad del discurso crítico hasta tornarlo imposible. La hermenéutica cuestiona si los alcances del discurso crítico propugnado por la teoría crítica no efectúan un salto más allá de las condiciones que hacen posible cualquier discurso. Nuestro análisis de la disputa nos condujo a reconocer un presupuesto común, ligado al rol semejante que ambas perspectivas otorgan a la noción de reconocimiento implícito -aunque entendido de manera materialmente muy diferente- en la constitución del dominio de lo simbólico. Aprovecharemos la inscripción del pensamiento de Wittgenstein en el debate, para hacer una evaluación crítica de la disputa a través del examen de esta presuposición.

Las condiciones y la naturaleza del discurso crítico : El debate entre hermenéutica y teoría crítica

El trabajo analiza el problema del alcance, la posibilidad y la legitimación del discurso crítico. Por discurso crítico entendemos aquel en el que un individuo o un grupo minoritario levantan pretensiones de validez que contradicen lo que mayoritariamente es considerado correcto. Este asunto recibe una atención focal en el debate entre Habermas y Gadamer. El problema aparece allí vinculado a su estatuto paradójico. Se cuestiona si las condiciones de la elucidación del sentido propias de la hermenéutica no estrechan el margen de la posibilidad del discurso crítico hasta tornarlo imposible. La hermenéutica cuestiona si los alcances del discurso crítico propugnado por la teoría crítica no efectúan un salto más allá de las condiciones que hacen posible cualquier discurso. Nuestro análisis de la disputa nos condujo a reconocer un presupuesto común, ligado al rol semejante que ambas perspectivas otorgan a la noción de reconocimiento implícito -aunque entendido de manera materialmente muy diferente- en la constitución del dominio de lo simbólico. Aprovecharemos la inscripción del pensamiento de Wittgenstein en el debate, para hacer una evaluación crítica de la disputa a través del examen de esta presuposición.

Over-determined charbonate chemstry dataset from different kinds of manipulation (TA, DIC) and water types (natural and artificial seawater)

The growing field of ocean acidification research is concerned with the investigation of organism responses to increasing pCO2 values. One important approach in this context is culture work using seawater with adjusted CO2 levels. As aqueous pCO2 is difficult to measure directly in small-scale experiments, it is generally calculated from two other measured parameters of the carbonate system (often AT, CT or pH). Unfortunately, the overall uncertainties of measured and subsequently calculated values are often unknown. Especially under high pCO2, this can become a severe problem with respect to the interpretation of physiological and ecological data. In the few datasets from ocean acidification research where all three of these parameters were measured, pCO2 values calculated from AT and CT are typically about 30% lower (i.e. ~300 µatm at a target pCO2 of 1000 µatm) than those calculated from AT and pH or CT and pH. This study presents and discusses these discrepancies as well as likely consequences for the ocean acidification community. Until this problem is solved, one has to consider that calculated parameters of the carbonate system (e.g. pCO2, calcite saturation state) may not be comparable between studies, and that this may have important implications for the interpretation of CO2 perturbation experiments.

Spicule dimensions of Siphonodictyon spp., raw data, biometry and frequency distributions

Early descriptions for species of Aka were poor in detail, and the only spicule type that occurs in this genus does not vary much between species, which led to taxonomic confusion. Moreover, the type specimens of 5 species of Aka are lost, causing considerable problems. Mediterranean specimens of Aka were identified as Aka labyrinthica (Hancock, 1849) by Topsent (1900), even though this species was originally described from the Indo-Pacific. All following publications on Mediterranean Aka accepted Topsent's decision. We assessed this problem with new samples from the Ionian Sea. Our material consisted of only one specimen of Aka, and we had to rely mainly on spicule characters for comparison to other species. We developed a system for species recognition solely based on spicular characters and biometry, involving a combination of the parameters oxea length, width, tip form and angle of curvature. This approach was surprisingly accurate. Forming ratios of the above parameters was less helpful, but can sometimes provide additional information. We identified our sample as Aka infesta (Johnson, 1899), and describe it as a minute-fistulate species with large, multicamerate erosion traces and stout, smooth oxeas. Our data further imply that A. labyrinthica sensu Hancock has not yet been found in the Mediterranean. A. labyrinthica sensu Topsent is a collection of different species not including A. labyrinthica sensu Hancock.

Formless as Water, Flaming as a Fire-Some observations on the Theory and Practice of Self-Determination

The concept of national self-determination is a highly contested concept from very outset. It is partly due to its dual parentage, namely nationalism and liberalism. Prior to 1945 it was only a political concept without legal binding. With the incorporation of the principle in the UN Charter it was universalized and legalized. However, there were two competing interpretations at the UN based on de-colonization and representative government. How to define self and what really determined remain highly controversial. How to reconcile the international norm of sovereignty of state and self determination of people became more complex problem with the tide of secessionist movements based on ethno-nationalism. The concept of internal self-determination came as a compromise; but it is also very vague and harbors a wide range of interpretations.

The internal structure of hydrogen-air difussion flames

The Internal Structure of Hydrogen-Air Diffusion Flames. Tho purpose of this paper is to study finite rate chemistry effects in diffusion controlled hydrogenair flames undor conditions appearing in some cases in a supersonic combustor. Since for large reaction rates the flame is close to chemical equilibrium, the reaction takes place in a very thin region, so thata "singular perturbation "treatment" of the problem seems appropriate. It has been shown previously that, within the inner or reaction zone, convection effects may be neglocted, the temperature is constant across the flame, and tho mass fraction distributions are given by ordinary differential equations, whore tho only independent variable involved is tho coordinate normal to the flame surface. Tho solution of the outer problom, which is a pure mixing problem with the additional condition that fuol and oxidizer do not coexist in any zone, provides t h e following information: tho flame position, rates of fuel consumption, temperature, concentrators of species, fluid velocity outside of tho flame, and the boundary conditions required to solve the "inner problem." The main contribution of this paper consists in the introduction of a fairly complicated chemical kinetic scheme representing hydrogen-oxygen reaction. The nonlinear equations expressing the conservation of chemical species are approximately integrated by means of an integral method. It has boen found that, in the case considered of a near-equilibrium diffusion flame, tho role played by the dissociation-recombination reactions is purely marginal, and that somo of the second order "shuffling" reactions are close to equilibrium. The method shown here may be applied to compute the distanco from the injector corresponding to a given separation from equilibrium, say ten to twenty percent. For the casos whore this length is a small fraction of the combustion zone length, the equilibrium treatment describes properly tho flame behavior.