FAIR_OSCE – Feedback structure for assessment of interactive roleplay in Objective Structured Clinical Exams

Introduction Since the quality of patient portrayal of standardized patients (SPs) during an Objective Structured Clinical Exam (OSCE) has a major impact on the reliability and validity of the exam, quality control should be initiated. Literature about quality control of SPs’ performance focuses on feedback [1, 2] or completion of checklists [3, 4]. Since we did not find a published instrument meeting our needs for the assessment of patient portrayal, we developed such an instrument after being inspired by others [5] and used it in our high-stakes exam. Project description SP trainers from five medical faculties collected and prioritized quality criteria for patient portrayal. Items were revised twice, based on experiences during OSCEs. The final instrument contains 14 criteria for acting (i.e. adequate verbal and non-verbal expression) and standardization (i.e. verbatim delivery of the first sentence). All partners used the instrument during a high-stakes OSCE. SPs and trainers were introduced to the instrument. The tool was used in training (more than 100 observations) and during the exam (more than 250 observations). Outcome High quality of SPs’ patient portrayal during the exam was documented. More than 90% of SP performances were rated to be completely correct or sufficient. An increase in quality of performance between training and exam was noted. For example, the rate of completely correct reaction in medical tests increased from 88% to 95%. Together with 4% of sufficient performances these 95% add up to 99% of the reactions in medical tests meeting the standards of the exam. SP educators using the instrument reported an augmentation of SPs’ performance induced by the use of the instrument. Disadvantages mentioned were the high concentration needed to observe all criteria and the cumbersome handling of the paper-based forms. Discussion We were able to document a very high quality of SP performance in our exam. The data also indicates that our training is effective. We believe that the high concentration needed using the instrument is well invested, considering the observed enhancement of performance. The development of an iPad-based application for the form is planned to address the cumbersome handling of the paper.

Quality assurance of simulated patient feedback in communication training for fourth-year medical students

Introduction In our program, simulated patients (SPs) give feedback to medical students in the course of communication skills training. To ensure effective training, quality control of the SPs’ feedback should be implemented. At other institutions, medical students evaluate the SPs’ feedback for quality control (Bouter et al., 2012). Thinking about implementing quality control for SPs’ feedback in our program, we wondered whether the evaluation by students would result in the same scores as evaluation by experts. Methods Consultations simulated by 4th-year medical students with SPs were video taped including the SP’s feedback to the students (n=85). At the end of the training sessions students rated the SPs’ performance using a rating instrument called Bernese Assessment for Role-play and Feedback (BARF) containing 11 items concerning feedback quality. Additionally the videos were evaluated by 3 trained experts using the BARF. Results The experts showed a high interrater agreement when rating identical feedbacks (ICCunjust=0.953). Comparing the rating of students and experts, high agreement was found with regard to the following items: 1. The SP invited the student to reflect on the consultation first, Amin (= minimal agreement) 97% 2. The SP asked the student what he/she liked about the consultation, Amin = 88%. 3. The SP started with positive feedback, Amin = 91%. 4. The SP was comparing the student with other students, Amin = 92%. In contrast the following items showed differences between the rating of experts and students: 1. The SP used precise situations for feedback, Amax (=maximal agreement) 55%, Students rated 67 of SPs’ feedbacks to be perfect with regard to this item (highest rating on a 5 point Likert scale), while only 29 feedbacks were rated this way by the experts. 2. The SP gave precise suggestions for improvement, Amax 75%, 62 of SPs’ feedbacks obtained the highest rating from students, while only 44 of SPs’ feedbacks achieved the highest rating in the view of the experts. 3. The SP speaks about his/her role in the third person, Amax 60%. Students rated 77 feedbacks with the highest score, while experts judged only 43 feedbacks this way. Conclusion Although evaluation by the students was in agreement with that of experts concerning some items, students rated the SPs’ feedback more often with the optimal score than experts did. Moreover it seems difficult for students to notice when SPs talk about the role in the first instead of the third person. Since precision and talking about the role in the third person are important quality criteria of feedback, this result should be taken into account when thinking about students’ evaluation of SPs’ feedback for quality control. Bouter, S., E. van Weel-Baumgarten, and S. Bolhuis. 2012. Construction and Validation of the Nijmegen Evaluation of the Simulated Patient (NESP): Assessing Simulated Patients’ Ability to Role-Play and Provide Feedback to Students. Academic Medicine: Journal of the Association of American Medical Colleges

Proceedings of the Fifteenth Annual biochemical Engineering Symposium

This work represents the proceedings of the fifteenth symposium which convened at Colorado State University on May 24, 1985. The two day meeting was scheduled one month later than usual, i.e., after the spring semester, so that travelers from the Midwest (Iowa State University, Kansas State University and University of Missouri) could enjoy the unique mountain setting provided at Pingree Park. The background of the photograph on the cover depicts the beauty of the area. ContentsGreg Sinton and S.M. Leo, KSU. Models for the Biodegration of 2.4-D and Related Xenobiotic Compounds. V. Bringi, CSU. Intrinsic Kinetics from a Novel Immobilized Cell CSTR. Steve Birdsell, CU. Novel Microbial Separation Techniques. Mark Smith, MU. Kinetic Characterization of Growth of E. coli on Glucose. Michael M. Meagher, ISU. Kinetic Parameters of Di- and Trisaccharaide Hydrolysis by Glucoamylase II. G.T. Jones and A.K. Ghosh Hajra, KSU. Modeling and Simulation of Legume Modules with Reactive Cores and Inert Shells. S.A. Patel and C.H. Lee, KSU. Energetic Analysis and Liquid Circulation in an Airlift Fermenter. Rod R. Fisher, ISU. The Effects of Mixing during Acid Addition of Fractionally Precipitated Protein. Mark M. Paige, CSU. Fed-batch Fermentations of Clostridium acetobutylicum. Michael K. Dowd, ISU. A Nonequilibirium Thermodynamic Description of the Variation of Contractile Velocity and Energy Use in Muscle. David D. Drury, CSU. Analysis of Hollow Fiber Bioreactor Performance for MAmmalian Cells by On-Line MMR. H.Y. Lee, KSU. Process Analysis of Photosynthetic Continuous Culture Systems. C.J. Wang, MU. Kinetic Consideration in Fermentation of Cheese Whey to Ethanol.

Proceedings of the Sixteenth Annual Biochemical Engineering Symposium

This volume represents the proceedings of the Sixteenth Annual Biochemical Engineering Symposium held at Kansas State University on April 26, 1986. Some of the papers describe the progress of ongoing projects, and others contain the results of completed projects. Only brief summaries are given of many of the papers that will be published in full elsewhere. ContentsEnd-Product Inhibition of the Acetone-Butanol Fermentation—Bob Kuhn, Colorado State University Effect of Multiple Substrates in Ethanal Fermentations from Cheese Whey—C.J. Wang, University of Missouri Extraction and Fermentation of Ensiled Sweet Sorghum—Karl Noah, Colorado State University Removal of Nucleic Acids from Bakers' Yeast—Richard M. Cordes, Iowa State University Modeling the Effects of Plasmid Replication and Product Repression on the Growth Rate of Recombinant Bacteria—William E. Bentley, University of Colorado Indirect Estimates of Cell Concentrations in Mass Cultivation of Bacterial Cells—Andrew Fisher, University of Missouri A Mathematical Model for Liquid Recirculation in Airlift Columns—C.H.Lee, Kansas State University Characterization of Imperfect Mixing of Batch Reactors by Two Compartment Model—Peter Sohn, University of Missouri First Order Breakage Model for the Degradation of Pullalan in the Batch Fermentor—Stephen A. Milligan, Kansas State University Synthesis and Nuclear Magnetic Resonance of 13C-Labeled Amylopectin and Maltooligosaccharides—Bernard Y. Tao, Iowa State University Preparation of Fungal Starter Culture in Gas Fluidized Bed Reactor—Pal Mihaltz, Colorado State University Yeast Flocculation and Sedimentation—David Szlag, University of Colorado Protein Enrichment of Extrusion Cooked Corn by Solid Substrate Fermentation—Lucas Alvarez-Martinez, Colorado State University Optimum Design of a Hollow Fiber Mammalian Cell Reactor—Thomas Chresand, Colorado State University Gas Chromatography and Nuclear Magnetic Resonance of Trifluoroacetylated Carbohydrates—Steven T. Summerfelt, Iowa State University Kinetic and Bioenergetic Considerations for Modeling Photosynthetic Microbial P~ocesses in Producing Biomass and Treating Wastewater—H. Y. Lee, Kansas State University Mathematical Modeling and Simulation of Bicarbonate-Limited Photsynthetic Growth in Continuous Culture—Craig Curless, Kansas State University Data Acquisition and Control of a Rotary Drum Solid State Fermentor—Mnasria A. Habib, Colorado State University Biodegradation of 2,4-Dichlorophenoxyacetic Acid (2,4-D)—Greg Sinton, Kansas State University

La planificación ambiental estratégica en los instrumentos de ordenamiento territorial. Caso de estudio: el Plan Regulador Intercomunal del Alto Aconcagua (PRIAA), provincias de San Felipe y Los Andes, V Región, Valparaíso, Chile

El artículo presenta la aplicación de un modelo de Planificación Ambiental Estratégica al diseño de un Plan de Ordenamiento Territorial en la zona de estudio, cuyo territorio se caracteriza por poseer un significativo patrimonio ambiental en términos de recursos naturales, paisaje, historia, etc. Junto a lo anterior, muestra un fuerte dinamismo económico por su localización en relación a la Macrozona Central de Chile, el Mercosur y el futuro corredor bioceánico. El objetivo fue diseñar una metodología que permitiera incorporar la dimensión ambiental en cada en cada una de las etapas características de elaboración de un Plan Regulador. El estudio ambiental se baso en tres etapas: diagnóstico ambiental, evaluación ambiental de alternativas y definición del proyecto, para lo cual se desarrollaron metodologías especificas apoyadas en sistemas de información geográfica (SIG) y modelos de simulación. La aplicación del modelo de planificación ambiental estratégica permitió obtener un Plan territorial con zonas y ordenanzas que protejan el patrimonio ambiental existente y aminore los impactos ambientales negativos de futuras actividades que se instalen en un territorio.

Efecto del riego deficitario controlado sobre el crecimiento vegetativo en plantaciones jóvenes de cerezo (Prunus avium L.)

En cerezo, plantas con excesivo vigor son poco precoces, poco productivas y de difícil manejo. El exceso de vigor podría ser controlado con estrategias de riego deficitario controlado (RDC). Durante dos años se realizó un ensayo de RDC en un monte frutal comercial joven y de alto vigor de cerezos Bing, plantado en suelo árido poco profundo y regado por goteo. Se evaluó la respuesta a distintos regímenes de riego sobre el crecimiento de brotes terminales y vigorosos, área y peso seco foliar, y crecimiento de tronco. Los tratamientos de riego fueron: T1 = 100%, T2 = 75% y T3 = 50% de la evapotranspiración máxima (ETc full), respectivamente. Se midió periódicamente el estado hídrico de la planta a través del potencial agua del tallo a mediodía y el estado hídrico del suelo mediante gravimetría. En T3 disminuyó la longitud de brotes, número y longitud de entrenudos, número de hojas, área foliar y peso seco foliar, y área de tronco. En T2 disminuyó la longitud de brotes y entrenudos y el área de sección de tronco. El potencial hídrico del tallo a mediodía fue un buen indicador del estado hídrico de las plantas. En cerezos, un ajuste preciso del nivel de restricción hídrica puede ser una estrategia de manejo para controlar vigor y para ahorrar importantes cantidades de agua.

Myanmar's non-resource export potential after the lifting of economic sanctions : a gravity model analysis

Easing of economic sanctions by Western countries in 2012 augmented the prospect that Myanmar will expand its exports. On the other hand, a sharp rise in natural resource exports during the sanctions brings in a concern about the "Dutch disease". This study projects Myanmar's export potential by calculating counterfactual export values with an augmented gravity model that takes into account the effects of natural resource exports on non-resource exports. Without taking into account the effects of natural resource exports, the counterfactual predicted values of non-resource exports during 2004–2011 are more than five times larger than the actual exports. If we take into account the effects, however, the predicted values are smaller than the actual exports. The empirical results imply that the "Dutch disease" is at stake in Myanmar than any other Southeast Asian countries.

Measuring population mobility speed from space

Ad-hoc population dynamics in Krugman’s type core and periphery models adjust population share of a region, based on its real wage rate deviation from national average, at pre-specified speed of population mobility. Whereas speed of population mobility is expected to be different across countries, for geographical, cultural, technological, etc. reasons, one common speed is often applied in theoretical and simulation analysis, due to spatially patchy, and temporally infrequent, availability of sub-national regional data. This article demonstrates how, increasingly available, high definition spatio-temporal remote-sensing data, and their by-products, can be used to measure speed of population mobility in national and sub-national level.

Extended Triple-Junction Solar Cell 3D Distributed Model: Application to Chromatic Aberration-Related Losses

An extended 3D distributed model based on distributed circuit units for the simulation of triple‐junction solar cells under realistic conditions for the light distribution has been developed. A special emphasis has been put in the capability of the model to accurately account for current mismatch and chromatic aberration effects. This model has been validated, as shown by the good agreement between experimental and simulation results, for different light spot characteristics including spectral mismatch and irradiance non‐uniformities. This model is then used for the prediction of the performance of a triple‐junction solar cell for a light spot corresponding to a real optical architecture in order to illustrate its suitability in assisting concentrator system analysis and design process.

Analysis of Chromatic Aberration Effects in Triple-Junction Solar Cells Using Advanced Distributed Models

The consideration of real operating conditions for the design and optimization of a multijunction solar cell receiver-concentrator assembly is indispensable. Such a requirement involves the need for suitable modeling and simulation tools in order to complement the experimental work and circumvent its well-known burdens and restrictions. Three-dimensional distributed models have been demonstrated in the past to be a powerful choice for the analysis of distributed phenomena in single- and dual-junction solar cells, as well as for the design of strategies to minimize the solar cell losses when operating under high concentrations. In this paper, we present the application of these models for the analysis of triple-junction solar cells under real operating conditions. The impact of different chromatic aberration profiles on the short-circuit current of triple-junction solar cells is analyzed in detail using the developed distributed model. Current spreading conditions the impact of a given chromatic aberration profile on the solar cell I-V curve. The focus is put on determining the role of current spreading in the connection between photocurrent profile, subcell voltage and current, and semiconductor layers sheet resistance.

An investigation of the performance of a new Mechanical thrombectomy device using Bond Graph modelling: application to the extraction of blood clots in the middle cerebral artery

A number of thrombectomy devices using a variety of methods have now been developed to facilitate clot removal. We present research involving one such experimental device recently developed in the UK, called a ‘GP’ Thrombus Aspiration Device (GPTAD). This device has the potential to bring about the extraction of a thrombus. Although the device is at a relatively early stage of development, the results look encouraging. In this work, we present an analysis and modeling of the GPTAD by means of the bond graph technique; it seems to be a highly effective method of simulating the device under a variety of conditions. Such modeling is useful in optimizing the GPTAD and predicting the result of clot extraction. The aim of this simulation model is to obtain the minimum pressure necessary to extract the clot and to verify that both the pressure and the time required to complete the clot extraction are realistic for use in clinical situations, and are consistent with any experimentally obtained data. We therefore consider aspects of rheology and mechanics in our modeling.

Managing Industrial Simulator Visual Databases Using Geographic Information Systems

Geographic Information Systems are developed to handle enormous volumes of data and are equipped with numerous functionalities intended to capture, store, edit, organise, process and analyse or represent the geographically referenced information. On the other hand, industrial simulators for driver training are real-time applications that require a virtual environment, either geospecific, geogeneric or a combination of the two, over which the simulation programs will be run. In the final instance, this environment constitutes a geographic location with its specific characteristics of geometry, appearance, functionality, topography, etc. The set of elements that enables the virtual simulation environment to be created and in which the simulator user can move, is usually called the Visual Database (VDB). The main idea behind the work being developed approaches a topic that is of major interest in the field of industrial training simulators, which is the problem of analysing, structuring and describing the virtual environments to be used in large driving simulators. This paper sets out a methodology that uses the capabilities and benefits of Geographic Information Systems for organising, optimising and managing the visual Database of the simulator and for generally enhancing the quality and performance of the simulator.

Analysis of jitter influence in fast frequency measurements

This paper presents a theoretical analysis of possible jitter impact in application of numeric criterion for fastmeasurement of frequency by coincidence principle. The primary goal is the generation of a signal containing a known amount of each jitter components. This signal was used for testing signals with regular pulse trains. Initially, jitter components are analyzed and modeled individually. Next, sequences for combining different kinds of jitter are modeled, simulated and evaluated. Jitter model simulation in Matlab is utilized to show the independence of frequencymeasurement results on the total jitter present in the reference and desired pulse trains independently. A good agreement between previously introduced theory of fastmeasurement of frequency and simulation in jitter presence is verified; these results allows to engineers use the numeric criterion for fastmeasurement of frequency in spite to interactions among jitter components in various applications for frequency domain sensors.

Applicability of the GP Device to the Circle of Willis Arteries by Using a Mathematical Model

According to the World Health Organization, 15 million people suffer stroke worldwide each year, of these, 5 million die and 5 million are permanently disabled. Stroke is therefore a major cause of mortality world-wide. The majority of strokes are caused by a blood clot that occludes an artery in the brain, and although thrombolytic agents such as Alteplase are used to dissolve clots that arise in the arteries of the brain, there are limitations on the use of these thrombolytic agents. However over the past decade, other methods of treatment have been developed which include Thrombectomy Devices e.g. the 'GP' Thrombus Aspiration Device ('GP' TAD). Such devices may be used as an alternative to thrombolytics or in conjunction with them to extract blood clots in arteries such as the middle cerebral artery of the midbrain brain, and the posterior inferior cerebellar artery (PICA) of the posterior aspect of the brain. In this paper, we mathematically model the removal of blood clots using the 'GP' TAD from selected arteries of the brain where blood clots may arise taking into account factors such as the resistances, compliances and inertances effects. Such mathematical modelling may have potential uses in predicting the pressures necessary to extract blood clots of given lengths, and masses from arteries in the Circle of Willis - posterior circulation of the brain

Amplificador de potencia clase F a 1.64 ghz con control de armónicos

This paper presents a high-power high efficiency PA design method using load pull technique. Harmonic impedance control at the virtual drain is accomplished through the use of tunable pre-matching circuits and modeling of package parasitics. A 0.5 µm GaN high electron mobility transistor (HEMT) is characterized using the method, and loadpull measurements are simulated illustrating the impact of varying 2nd and 3rd harmonic termination. These harmonic terminations are added to satisfy conditions for class-F load pull. The method is verified by design and simulation of a 40-W class-F PA prototype at 1.64 GHz with 76% drain efficiency and 10 dB gain (70% PAE).