How can experience in clinical and community settings contribute to early medical education? A BEME systematic review

Review date: Review period January 1992-December 2001. Final analysis July 2004-January 2005. Background and review context: There has been no rigorous systematic review of the outcomes of early exposure to clinical and community settings in medical education. Objectives of review: (1) Identify published empirical evidence of the effects of early experience in medical education, analyse it, and synthesize conclusions from it. (2) Identify the strengths and limitations of the research effort to date, and identify objectives for future research. Search strategy: Ovid search of. BEI, ERIC, Medline, CIATAHL and EMBASE Additional electronic searches of: Psychinfo, Timelit, EBM reviews, SIGLE, and the Cochrane databases. Hand-searches of: Medical Education, Medical Teacher, Academic Medicine, Teaching and Learning in Medicine, Advances in Health Sciences Education, Journal of Educational Psychology. Criteria: Definitions: Experience: Authentic (real as opposed to simulated) human contact in a social or clinical context that enhances learning of health, illness and/or disease, and the role of the health professional. Early: What would traditionally have been regarded as the preclinical phase, usually the first 2 years. Inclusions: All empirical studies (verifiable, observational data) of early experience in the basic education of health professionals, whatever their design or methodology, including papers not in English. Evidence from other health care professions that could be applied to medicine was included. Exclusions: Not empirical; not early; post-basic; simulated rather than 'authentic' experience. Data collection: Careful validation of selection processes. Coding by two reviewers onto an extensively modified version of the standard BEME coding sheet. Accumulation into an Access database. Secondary coding and synthesis of an interpretation. Headline results: A total of 73 studies met the selection criteria and yielded 277 educational outcomes; 116 of those outcomes (from 38 studies) were rated strong and important enough to include in a narrative synthesis of results; 76% of those outcomes were from descriptive studies and 24% from comparative studies. Early experience motivated and satisfied students of the health professions and helped them acclimatize to clinical environments, develop professionally, interact with patients with more confidence and less stress, develop self-reflection and appraisal skill, and develop a professional identity. It strengthened their learning and made it more real and relevant to clinical practice. It helped students learn about the structure and function of the healthcare system, and about preventive care and the role of health professionals. It supported the learning of both biomedical and behavioural/social sciences and helped students acquire communication and basic clinical skills. There were outcomes for beneficiaries other than students, including teachers, patients, populations, organizations and specialties. Early experience increased recruitment to primary care/rural medical practice, though mainly in US studies which introduced it for that specific purpose as part of a complex intervention. Conclusions: Early experience helps medical students socialize to their chosen profession. It. helps them acquire a range of subject matter and makes their learning more real and relevant. It has potential benefits for other stakeholders, notably teachers and patients. It can influence career choices.

Redeeming Faustus: Tracing the pacts of Mariken and Faust from the 1500s to the present

This dissertation uncovers and analyzes the complicated history of the devil’s pact in literature from approximately 1330 to 2015, focusing primarily on texts written in German and Dutch. That the tale of the pact with the devil (the so-called Faustian bargain) is one of the most durable and pliable literary themes is undeniable. Yet for too long, the success of Johann Wolfgang von Goethe’s Faust I (1808) decisively shaped scholarship on early devil’s pact tales, leading to a misreading of the texts with Goethe’s concerns being projected onto the earliest manifestations. But Goethe’s Faust really only borrows from the original Faust his name; the two characters could not be more different. Furthermore, Faustus was not the only early pact-maker character and his tale was neither limited to the German language nor to the Protestant faith. Among others, tales written in Dutch about a female, Catholic, latemedieval pact-maker, Mariken van Nieumeghen (1515), illustrate this. This dissertation seeks to redeem the early modern Faustus texts from its misreading and to broaden the scholarship on the literature of the devil’s pact by considering the Mariken and Faust traditions together.

The first chapter outlines the beginnings of pact literature as a Catholic phenomenon, considering the tales of Theophilus and Pope Joan alongside Mariken of Nijmegen. The second chapter turns to the original Faust tale, the Historia von D. Johann Fausten (1587), best read as a Lutheran response to the Catholic pact literature in the wake of the Reformation. In the third chapter, this dissertation offers a new, united reading of the early modern Faust tradition. The fourth and fifth chapters trace the literary preoccupation with the pacts of both Mariken and Faustus from the late early modern to the present.

The dissertation traces the evolution of these two bodies of literature and provides an in-depth analysis and comparison of the two that has not been done before. It argues for a more global literary scholarship that considers texts across multiple languages and one that takes into consideration the rich body of material of the pact tradition.

Unnatural History: Ecological Temporality in Post-1945 American Literature

While environmental literary criticism has traditionally focused its attention on the textual representation of specific places, recent ecocritical scholarship has expanded this focus to consider the treatment of time in environmental literature and culture. As environmental scholars, activists, scientists, and artists have noted, one of the major difficulties in grasping the reality and implications of climate change is a limited temporal imagination. In other words, the ability to comprehend and integrate different shapes, scales, and speeds of history is a precondition for ecologically sustainable and socially equitable responses to climate change.

My project examines the role that literary works might play in helping to create such an expanded sense of history. As I show how American writers after 1945 have treated the representation of time and history in relation to environmental questions, I distinguish between two textual subfields of environmental temporality. The first, which I argue is characteristic of mainstream environmentalism, is disjunctive, with abrupt environmental changes separating the past and the present. This subfield contains many canonical works of postwar American environmental writing, including Aldo Leopold’s A Sand County Almanac, Edward Abbey’s Desert Solitaire, Annie Dillard’s Pilgrim at Tinker Creek, and Kim Stanley Robinson’s Science in the Capital trilogy. From treatises on the ancient ecological histories of particular sites to meditations on the speed of climate change, these works evince a preoccupation with environmental time that has not been acknowledged within the spatially oriented field of environmental criticism. However, by positing radical breaks between environmental pasts and environmental futures, they ultimately enervate the political charge of history and elide the human dimensions of environmental change, in terms both of environmental injustice and of possible social responses.

By contrast, the second subfield, which I argue is characteristic of environmental justice, is continuous, showing how historical patterns persist even across social and ecological transformations. I trace this version of environmental thought through a multicultural corpus of novels consisting of Ralph Ellison’s Invisible Man, Ishmael Reed’s Mumbo Jumbo, Helena María Viramontes’ Under the Feet of Jesus, Linda Hogan’s Solar Storms, and Octavia Butler’s Parable of the Sower and Parable of the Talents. Some of these novels do not document specific instances of environmental degradation or environmental injustice and, as a result, have not been critically interpreted as relevant for environmental analysis; others are more explicit in their discussion of environmental issues and are recognized as part of the canon of American environmental literature. However, I demonstrate that, across all of these texts, counterhegemonic understandings of history inform resistance to environmental degradation and exploitation. These texts show that environmental problems cannot be fully understood, nor environmental futures addressed, without recognizing the way that social histories of inequality and environmental histories of extraction continue to structure politics and ecology in the present.

Ultimately, then, the project offers three conclusions. First, it suggests that the second version of environmental temporality holds more value than the first for environmental cultural studies, in that it more compellingly and accurately represents the social implications of environmental issues. Second, it shows that “environmental literature” is most usefully understood not as the literature that explicitly treats environmental issues, but rather as the literature that helps to produce the sense of time that contemporary environmental crises require. Third, it shows how literary works can not only illuminate the relationship between American ideas about nature and social justice, but also operate as a specifically literary form of eco-political activism.

Learning to 'understand backwards' in time: children's temporal cognition and the primary history curriculum

This study examines children’s temporal ways of knowing and it highlights the centrality of temporal cognition in the development of children’s historical understanding. It explores how young children conceptualise time and it examines the provision for temporal cognition at the levels of the intended, enacted and received history curriculum in the Irish primary school context. Positioning temporality as a prerequisite second-order concept, the study recognises the essential role of both first-order and additional second-order concepts in historical understanding. While the former can be defined as the basic, substantive content to be taught, the latter refers to a number of additional key concepts that are deemed fundamental to children's capacity to make meaningful sense of history. The study argues for due recognition to be given to temporality, in the belief that both sets of knowledge, the content and skills, are required to develop historical thinking (Lévesque, 2011). The study addresses a number of key research questions, using a mixed methods research design, comprising an analysis of history textbooks, a survey among final year student teachers about their teaching of history, and school-based interviews with primary school children: What opportunities are available for children to develop temporal ways of knowing? How do student teachers experience being apprenticed into the available culture for teaching history and understanding temporality at primary level? What insights do the cognitive-developmental and sociocultural perspectives on learning provide for understanding the dynamics of children’s temporal ways of knowing? The study argues that the skill of developing a deeper understanding of time is a key prerequisite in connecting with, and constructing, understandings and frameworks of the past. The study advances a view of temporality as complex, multi-faceted and developmental. The findings have a potential contribution to make in influencing policy and pedagogy in establishing an elaborated and well-defined curriculum framework for developing temporal cognition at both national and international levels.

Recommendations to Create a Systemic Approach to Improving the Teaching and Learning of Iowa History in Iowa’s K-12 Schools / Iowa History Advisory Council (2016)

Report from the Iowa History Advisory Council on the following goals related to the teaching of Iowa history: Identify the current status of the teaching of Iowa history and the resources available regarding K-12 Iowa history instruction. Identify current materials that are dedicated to the teaching of Iowa history at the K-12 level. Study how other states and organizations implement state and local history. Study best practices for the teaching and learning of state and local history. Develop appropriate academic standards related to Iowa history. Provide recommendations to advance the study of Iowa history at the K-12 level.

The prose works of Jonathan Swift /

First published in 1897.

Approaching and Executing Premiere, Interpretive, and Historical Works

The spectrum of vocal music spans time, genres, styles, and is infinitely vast. New works are ever evolving and expanding, new artistic ideas are revealed from older works, and interest renewed from the tried and true. As a vocal musician in present day, I aspired to find a common thread amidst the boundless spectrum of works to be performed—whether I was hearkening back to a time of old, dissecting pieces by composers who have opened the door to personal artistry, or learning to sing a new work never performed or heard before. The Mercuriality of Song unearths more differences than commonalities in preparation, despite the fact that my voice remains the constant— differences which were expected, often surprising, but nevertheless new and rewarding in their challenges. Three performances (a world-premiere, a lieder recital, and an early music recital) comprise the basis for my investigation into comparing methods and processes of different periods via program notes, laying the foundation for initial preparation from an historical context. An amalgam of genres and stylistic differences along with performance planning culminate this exploration of vocal discovery and implementation.

Applied evolution: An integrated approach to studying life history traits in response to drug selection

The use of chemical control measures to reduce the impact of parasite and pest species has frequently resulted in the development of resistance. Thus, resistance management has become a key concern in human and veterinary medicine, and in agricultural production. Although it is known that factors such as gene flow between susceptible and resistant populations, drug type, application methods, and costs of resistance can affect the rate of resistance evolution, less is known about the impacts of density-dependent eco-evolutionary processes that could be altered by drug-induced mortality. The overall aim of this thesis was to take an experimental evolution approach to assess how life history traits respond to drug selection, using a free-living dioecious worm (Caenorhabditis remanei) as a model. In Chapter 2, I defined the relationship between C. remanei survival and Ivermectin dose over a range of concentrations, in order to control the intensity of selection used in the selection experiment described in Chapter 4. The dose-response data were also used to appraise curve-fitting methods, using Akaike Information Criterion (AIC) model selection to compare a series of nonlinear models. The type of model fitted to the dose response data had a significant effect on the estimates of LD50 and LD99, suggesting that failure to fit an appropriate model could give misleading estimates of resistance status. In addition, simulated data were used to establish that a potential cost of resistance could be predicted by comparing survival at the upper asymptote of dose-response curves for resistant and susceptible populations, even when differences were as low as 4%. This approach to dose-response modeling ensures that the maximum amount of useful information relating to resistance is gathered in one study. In Chapter 3, I asked how simulations could be used to inform important design choices used in selection experiments. Specifically, I focused on the effects of both within- and between-line variation on estimated power, when detecting small, medium and large effect sizes. Using mixed-effect models on simulated data, I demonstrated that commonly used designs with realistic levels of variation could be underpowered for substantial effect sizes. Thus, use of simulation-based power analysis provides an effective way to avoid under or overpowering a study designs incorporating variation due to random effects. In Chapter 4, I 3 investigated how Ivermectin dosage and changes in population density affect the rate of resistance evolution. I exposed replicate lines of C. remanei to two doses of Ivermectin (high and low) to assess relative survival of lines selected in drug-treated environments compared to untreated controls over 10 generations. Additionally, I maintained lines where mortality was imposed randomly to control for differences in density between drug treatments and to distinguish between the evolutionary consequences of drug treatment versus ecological processes affected by changes in density-dependent feedback. Intriguingly, both drug-selected and random-mortality lines showed an increase in survivorship when challenged with Ivermectin; the magnitude of this increase varied with the intensity of selection and life-history stage. The results suggest that interactions between density-dependent processes and life history may mediate evolved changes in susceptibility to control measures, which could result in misleading conclusions about the evolution of heritable resistance following drug treatment. In Chapter 5, I investigated whether the apparent changes in drug susceptibility found in Chapter 4 were related to evolved changes in life-history of C. remanei populations after selection in drug-treated and random-mortality environments. Rapid passage of lines in the drug-free environment had no effect on the measured life-history traits. In the drug-free environment, adult size and fecundity of drug-selected lines increased compared to the controls but drug selection did not affect lifespan. In the treated environment, drug-selected lines showed increased lifespan and fecundity relative to controls. Adult size of randomly culled lines responded in a similar way to drug-selected lines in the drug-free environment, but no change in fecundity or lifespan was observed in either environment. The results suggest that life histories of nematodes can respond to selection as a result of the application of control measures. Failure to take these responses into account when applying control measures could result in adverse outcomes, such as larger and more fecund parasites, as well as over-estimation of the development of genetically controlled resistance. In conclusion, my thesis shows that there may be a complex relationship between drug selection, density-dependent regulatory processes and life history of populations challenged with control measures. This relationship could have implications for how resistance is monitored and managed if life histories of parasitic species show such eco-evolutionary responses to drug application.

Early allergen exposure and atopic eczema

Background The relationship between exposure to indoor aeroallergens in early life and subsequent eczema is unclear. We have previously failed to show any significant associations between early life exposure to house dust mite and cat fur allergens and either sensitization to these allergens or wheeze. We have also previously reported a lower prevalence of parent-reported, doctor-diagnosed eczema by age 2 years for children exposed to higher concentrations of house dust mite, but no other associations with other definitions of eczema or for exposure to cat allergen. Objectives To extend the exposure–response analysis of allergen exposure and eczema outcomes measured up to age 8 years, and to investigate the role of other genetic and environmental determinants. Methods A total of 593 children (92Æ4% of those eligible) born to all newly pregnant women attending one of three general practitioner surgeries in Ashford, Kent, were followed from birth to age 8 years. Concentrations of house dust mite and cat allergen were measured in dust samples collected from the home at 8 weeks after birth. The risk of subsequent eczema as defined by the U.K. diagnostic criteria was determined according to different levels (quintiles) of allergen exposure at birth. Results By age 8 years, 150 (25Æ3%) children had met the diagnostic criteria for eczema at least once. Visible flexural dermatitis was recorded at least once for 129 (28Æ0%). As in other studies, parental allergic history was positively associated with most eczema outcomes, as were higher maternal education and less crowded homes. No clear linear associations between early exposure to house dust mite or cat allergen were found, regardless of the definition of eczema used. The risk of eczema appeared to increase for the three lowest quintiles of house dust mite allergen exposure (odds ratio, OR 1Æ37 for third quintile compared with first), and then to fall for the two highest quintiles (OR 0Æ66 and 0Æ71) even after controlling for confounding factors. Conclusions The lack of any clear exposure–disease relationship between allergens in early life and subsequent eczema argues against allergen exposure being a major factor causing eczema. If the lower levels of eczema at higher levels of house dust mite are confirmed, then interventions aimed at reducing house dust mite in early infancy could paradoxically increase the risk of subsequent eczema.

Cortisol Awakening Response in Preschoolers and Depression Risk: Relations with Maternal History of Depression and Child Temperament

Increasing research suggests that elevations in the cortisol awakening response (CAR), the natural increase of cortisol 30 to 40 minutes after waking, may serve as a vulnerability marker for depression. However, existing studies have focused on adolescence and adulthood; very little is known about the CAR in early childhood and the factors that are associated with it. The current study aimed to examine the validity of the CAR as a potential early-emerging vulnerability marker for depression in a sample of preschool-age children. We examined associations between the CAR and two well-established risk factors for depression: maternal psychopathology and early child temperament (high negative emotionality (NE) and/or low positive emotionality (PE)). The sample consisted of 146 preschool-age children, of whom 71 (49.3%) had a biological mother with a history of depression and 65 (45.5%) had a biological mother with a history of anxiety. To assess the CAR, salivary cortisol samples were collected from the child upon waking, 30 and 45 minutes post-waking on two weekdays. Children’s CAR was examined as the total volume of cortisol secreted (AUCg) and the total increase in cortisol (AUCi) across waking. Evening cortisol was collected 30 minutes before bedtime. Child temperament was assessed using observational laboratory measures. Maternal depression and anxiety were assessed with clinical interviews. Associations with children’s CAR, as indicated by AUCg or AUCi, appeared to be specific to maternal current psychopathology and symptoms of anhedonia. Additionally, we observed significant interactions for both maternal lifetime and current depression and anxiety, in combination with child NE and PE, on elevated evening cortisol levels and flattened diurnal cortisol rhythms, indicating altered patterns of basal cortisol activity in offspring. Our study contributes to the limited but growing knowledge on the development of the CAR in preschool age children and as a marker of early risk. Findings suggest that there is a complex interplay between familial risk, affective vulnerability, and their joint effects on neuroendocrine dysfunction in young children, and highlight the need for future research to examine which aspects of the early diurnal rhythm predict the emergence of later depressive illness.

Feeding ecology and life-history strategy of nesting males in a fish with long parental care, Lusitanian toadfish (Halobatrachus didactylus, Batrachoididae)

The Lusitanian toadfish, Halobatrachus didactylus, like other batrachoidids, is a benthic fish species with nesting behaviour during the breeding season. During this prolonged period it engages in mating activities and remains in the nest providing parental care. It is not known whether males feed while providing parental care but it is likely that their limited mobility may restrict their diet and influence their fitness. As a consequence, egg cannibalism could occur as a life-history strategy. The aim of the present study is to ascertain the feeding behaviour of nesting males, in comparison to mature non-nesting males, and to identify potential life-history traits related to egg cannibalism. Nest-holders were sampled from artificial nests placed in an intertidal area of the Tagus estuary, only exposed during spring low tides. The diet of nest-holders was compared with that of non-nesting mature males from the same area, captured by otter trawl. The present study demonstrates that despite their constrained mobility nest-holders feed during the breeding season, although in a more opportunistic fashion than non-nesting males. Nest-holders showed a generalist feeding behaviour, with a more heterogeneous diet. Egg cannibalism was not related to male condition, paternity or brood size but showed a higher incidence early in the season when water temperatures were lower. The results suggest a possible seasonal trade-off strategy between care and energy recovery, triggered by environmental factors, where under unfavourable conditions to sustain viable eggs the male may recover energy by eating eggs, thus benefiting future reproductive success, later in the season.

When the virtual influences reality. The conservation project of the toledo gate in ciudad real (Spain)

The Toledo Gate of Ciudad Real, Spain, constructed between the late 13th and early 14th centuries, is the last remaining portion of a once complete medieval city wall. It represents the long history of the city and constitutes its main heritage symbol, dividing the historic city centre from the later 19th and 20th century expansions. In October 2012, the Town Hall and the Montemadrid Foundation started the conservation works to preserve this important monument. The preliminary phase of this project included an in-depth series of scientific studies which were carried out by a multidisciplinary team focusing on archival research, historic investigations, archaeological excavations as well as material composition analysis and main treatment application tests. As a result of these studies a series of virtual 3D models were created to inform, discuss and study the monument. A first digital model permitted visualization of the gate in the 19th century and how the main entrance to the city was integrated as a fundamental part of the city walls. This virtual reconstruction also became an important part of the campaign to raise awareness among the citizens towards a monument that had remained in the shadows for the last century, isolated in a roundabout after the systematic demolition of the city walls in the late 19th century. Over the last three years and as a result of these archaeological and historic investigations and subsequent virtual models, surprisingly new and interesting data were brought to light thus permitting the establishment and corroboration of a new and updated hypothesis of the Toledo Gate that goes beyond the previous ideas. As a result of these studies a new architectural typology with construction techniques of has been suggested. This paper describes how the results of this continuous and interdisciplinary documentation process have benefitted from a computer graphic reconstruction of the gate. It highlights how virtual reconstruction can be a powerful tool for conservation decision making and awareness raising. Furthermore, the interesting results of the final reconstruction hypothesis convinced the technical team responsible for the conservation to alter some aspects of the final project physical interventions in order to focus on some of the features and conclusions discovered through the virtual model study.

The road to augmented reality: a comprehensive study of hardware and applications over the last ten years

Augmented reality has been growing extensively over the years in all aspects and multiple fields. My aim in this paper is to present a comprehensive study on augmented reality(AR) hardware and its applications from early developments to the possible future trends. Particularly my research is more focused on last 11 years(2012-2022), where I systematically reviewed 30 research papers per year to get a clear knowledge on trends of AR. A total of 330 publications were reviewed and grouped according to their application. The review's main contribution is to show the entire landscape of AR research and to provide a broad view of how it has evolved. Along with various AR glasses history and specifications are presented in detail. In the penultimate chapter I explained my methodology of research following my analysis from the past to the present along with my thoughts for the future. To conclude my study, In the final chapter I made some statements about possible future with AR, VR and XR(extended reality).

Digestive Peptidase Evolution In Holometabolous Insects Led To A Divergent Group Of Enzymes In Lepidoptera.

Trypsins and chymotrypsins are well-studied serine peptidases that cleave peptide bonds at the carboxyl side of basic and hydrophobic l-amino acids, respectively. These enzymes are largely responsible for the digestion of proteins. Three primary processes regulate the activity of these peptidases: secretion, precursor (zymogen) activation and substrate-binding site recognition. Here, we present a detailed phylogenetic analysis of trypsins and chymotrypsins in three orders of holometabolous insects and reveal divergent characteristics of Lepidoptera enzymes in comparison with those of Coleoptera and Diptera. In particular, trypsin subsite S1 was more hydrophilic in Lepidoptera than in Coleoptera and Diptera, whereas subsites S2-S4 were more hydrophobic, suggesting different substrate preferences. Furthermore, Lepidoptera displayed a lineage-specific trypsin group belonging only to the Noctuidae family. Evidence for facilitated trypsin auto-activation events were also observed in all the insect orders studied, with the characteristic zymogen activation motif complementary to the trypsin active site. In contrast, insect chymotrypsins did not seem to have a peculiar evolutionary history with respect to their mammal counterparts. Overall, our findings suggest that the need for fast digestion allowed holometabolous insects to evolve divergent groups of peptidases with high auto-activation rates, and highlight that the evolution of trypsins led to a most diverse group of enzymes in Lepidoptera.

Desenvolvimento da Tanatologia: estudos sobre a morte e o morrer

Este artigo discute os principais temas e pesquisas na área da Tanatologia, estudos sobre a morte e o morrer. São apresentados os autores pioneiros que escreveram as primeiras obras de sistematização da Tanatologia entre os quais: Herman Feifel, Robert Kastenbaum e Elizabeth Kübler-Ross, e os principais temas de estudo: luto, violência e guerra, a morte e a TV, cuidados a pacientes gravemente enfermos, além da formação de profissionais da área de saúde e educação para lidar com pessoas vivendo situações de perdas e morte. São feitas propostas de estudos para o futuro desenvolvimento da Tanatologia em nosso país.