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

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

Sistema de community cloud aplicat a la preservació digital personal (personal archiving) PYRAMID

La preservació digital (PD) s'ha convertit en un problema persistent per a tots els que vulguin conservar la seva informació digital, garantir el seu estat i consultar aquest informació en el transcurs del temps. Fins ara només grans institucions amb coneixement expert i eines especialitzades han pogut fer front a aquest problema, però la preservació digital no pot ser abordada per una sola institució o nació. Les biblioteques, arxius i altres institucions de conservació de la memòria comparteixen aquest repte de la mateixa manera que els col•leccionistes i creadors, que ho fan a títol individual.L’objectiu del projecte és crear l'aplicació Pyramid que està concebuda com una eina de suport orientada a l'usuari domèstic (sense coneixements tècnics ni de preservació) per a la preservació a mig i llarg termini de col•leccions digitals, texts i vídeos, tal que funcioni com un antivirus (en BackGround) i preservi la informació sense requerir un cost addicional a l'ordinador i que l'usuari no noti cap molèstia a l'hora de fer les seves tasques diàries

Cities, skills, and regional change

One approach to urban areas emphasizes the existence of certain immutable relationships, such as Zipf's or Gibrat's Law. An alternative view is that urban changereflects individual responses to changing tastes or technologies. This paper examinesalmost 200 years of regional change in the U.S. and finds that few, if any, growth relationships remain constant, including Gibrat's Law. Education does a reasonable jobof explaining urban resilience in recent decades, but does not seem to predict countygrowth a century ago. After reviewing this evidence, we present and estimate a simple model of regional change, where education increases the level of entrepreneurship.Human capital spillovers occur at the city level because skilled workers produce moreproduct varieties and thereby increase labor demand. We find that skills are associatedwith growth in productivity or entrepreneurship, not with growth in quality of life, atleast outside of the West. We also find that skills seem to have depressed housing supplygrowth in the West, but not in other regions, which supports the view that educatedresidents in that region have fought for tougher land-use controls. We also present evidence that skills have had a disproportionately large impact on unemployment duringthe current recession.

La autoreferencialidad en el arte. El metalenguaje en el medio digital. L'autoreferencialitat en l'art. El metallenguatge en el mitjà digital.

Este artículo analiza las obras de algunos artistas digitales que utilizan los recursos propios del medio digital como mensaje central. Nuestra intención será exponer las múltiples formas de utilizar, desarrollar y manipular el metalenguaje. Primeramente, con la intención de comprender estas obras, se elabora un contexto en que se plantearán unos precedentes, para ver, en una segunda parte, cómo el metalenguaje en nuestra actualidad artística y digital vuelve a ser muy utilizado, de manera que llega a convertirse en una metodología característica del arte contemporáneo y de los medios digitales. Palabras clave aleatoriedad, simulación, glitch, net art, interfaz, reactividad, interactividad

De lo analógico a lo digital. El futuro de la enseñanza de la composición

Las prácticas lectoras están cambiando a causa de factores múltiples: leemos otro tipo de textos, con objetivos también más ambiciosos, en contextos nuevos, que nunca antes habían existido. Analizamos algunos de los matices que ha adoptado la práctica de la lectura en este inicio del siglo XXI, desde esta perspectiva sociocultural.

El portafolios digital como herramienta para el desarrollo de competencias transversales en el alumnado.

Partiendo de un enfoque sobre las relaciones entre las tecnologías digitales como herramientas de mediación, se analiza el papel de un caso concreto, los portafolios electrónicos, para la mejora de competencias transversales en el ámbito universitario. Los resultados indican que se obtienen mejoras, como mínimo desde la percepción de los propios estudiantes, en algunas dimensiones ligadas a la capacidad para seleccionar y organizar información, así como a la planificación del aprendizaje.

La autoreferencialidad en el arte. El metalenguaje en el medio digital

Este artículo analiza las obras de algunos artistas digitales que utilizan los recursos propios del medio digital como mensaje central. Nuestra intención será exponer las múltiples formas de utilizar, desarrollar y manipular el metalenguaje. Primeramente, con la intención de comprender estas obras, se elabora un contexto en que se plantearán unos precedentes, para ver, en una segunda parte, cómo el metalenguaje en nuestra actualidad artística y digital vuelve a ser muy utilizado, de manera que llega a convertirse en una metodología característica del arte contemporáneo y de los medios digitales. Palabras clave aleatoriedad, simulación, glitch, net art, interfaz, reactividad, interactividad

El portafolios digital como herramienta para el desarrollo de competencias transversales en el alumnado.

Partiendo de un enfoque sobre las relaciones entre las tecnologías digitales como herramientas de mediación, se analiza el papel de un caso concreto, los portafolios electrónicos, para la mejora de competencias transversales en el ámbito universitario. Los resultados indican que se obtienen mejoras, como mínimo desde la percepción de los propios estudiantes, en algunas dimensiones ligadas a la capacidad para seleccionar y organizar información, así como a la planificación del aprendizaje.

Exploring neural cell dynamics with digital holographic microscopy.

In this review, we summarize how the new concept of digital optics applied to the field of holographic microscopy has allowed the development of a reliable and flexible digital holographic quantitative phase microscopy (DH-QPM) technique at the nanoscale particularly suitable for cell imaging. Particular emphasis is placed on the original biological information provided by the quantitative phase signal. We present the most relevant DH-QPM applications in the field of cell biology, including automated cell counts, recognition, classification, three-dimensional tracking, discrimination between physiological and pathophysiological states, and the study of cell membrane fluctuations at the nanoscale. In the last part, original results show how DH-QPM can address two important issues in the field of neurobiology, namely, multiple-site optical recording of neuronal activity and noninvasive visualization of dendritic spine dynamics resulting from a full digital holographic microscopy tomographic approach.

Evaluation of the SHRP Modified Georgia Digital Faultmeter, MLR-93-01, 1993

The SHRP Modified Georgia Digital Faultmeter was loaned to the Iowa Department of Transportation in January 1993 for evaluation. A study was undertaken comparing the faultmeter to Iowa's current method of fault measurement. The following conclusions were made after comparing the faultmeter to Iowa's gauge: The faultmeter was lighter and easier to maneuver and position. The faultmeter's direct readout was quicker to read. The faultmeter has increased precision. The faultmeter gave consistently lower fault readings than the Iowa gauge.

Typing less common ovarian tumors: A training tool based on a pattern-based algorithm applied to a set of 20 virtual slides.

Context: Ovarian tumors (OT) typing is a competency expected from pathologists, with significant clinical implications. OT however come in numerous different types, some rather rare, with the consequence of few opportunities for practice in some departments. Aim: Our aim was to design a tool for pathologists to train in less common OT typing. Method and Results: Representative slides of 20 less common OT were scanned (Nano Zoomer Digital Hamamatsu®) and the diagnostic algorithm proposed by Young and Scully applied to each case (Young RH and Scully RE, Seminars in Diagnostic Pathology 2001, 18: 161-235) to include: recognition of morphological pattern(s); shortlisting of differential diagnosis; proposition of relevant immunohistochemical markers. The next steps of this project will be: evaluation of the tool in several post-graduate training centers in Europe and Québec; improvement of its design based on evaluation results; diffusion to a larger public. Discussion: In clinical medicine, solving many cases is recognized as of utmost importance for a novice to become an expert. This project relies on the virtual slides technology to provide pathologists with a learning tool aimed at increasing their skills in OT typing. After due evaluation, this model might be extended to other uncommon tumors.

digital¡. Fifth strategic plan for UPC libraries 2012-2014

Postprint (published version)

Library-instructional materials center skills, 1968

The School Library-Instructional Materials Center should be designed to serve the total curriculum of a school. Much of a teacher's learning comes when he works with a librarian to provide his students wit the necessary and appropriate skills for a unit of s study.