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.

A 1.2 V low noise amplifier with double feedback for high gain and low noise figure

Dissertação para obtenção do Grau de Mestre em Engenharia Eletrotécnica e de Computadores

Wideband CMOS low noise amplifiers

Modern fully integrated receiver architectures, require inductorless circuits to achieve their potential low area, low cost, and low power. The low noise amplifier (LNA), which is a key block in such receivers, is investigated in this thesis. LNAs can be either narrowband or wideband. Narrowband LNAs use inductors and have very low noise figure, but they occupy a large area and require a technology with RF options to obtain inductors with high Q. Recently, wideband LNAs with noise and distortion cancelling, with passive loads have been proposed, which can have low NF, but have high power consumption. In this thesis the main goal is to obtain a very low area, low power, and low-cost wideband LNA. First, it is investigated a balun LNA with noise and distortion cancelling with active loads to boost the gain and reduce the noise figure (NF). The circuit is based on a conventional balun LNA with noise and distortion cancellation, using the combination of a common-gate (CG) stage and common-source (CS) stage. Simulation and measurements results, with a 130 nm CMOS technology, show that the gain is enhanced by about 3 dB and the NF is reduced by at least 0.5 dB, with a negligible impact on the circuit linearity (IIP3 is about 0 dBm). The total power dissipation is only 4.8 mW, and the active area is less than 50 x 50 m2 . It is also investigated a balun LNA in which the gain is boosted by using a double feedback structure.We propose to replace the load resistors by active loads, which can be used to implement local feedback loops (in the CG and CS stages). This will boost the gain and reduce the noise figure (NF). Simulation results, with the same 130 nm CMOS technology as above, show that the gain is 24 dB and NF is less than 2.7 dB. The total power dissipation is only 5.4 mW (since no extra blocks are required), leading to a figure-of-merit (FoM) of 3.8 mW

Re-conceptualizing the international aid structure: recipient donor interactions and the rudiments of a feedback mechanism

Incluye Bibliografía

The mode of action and the structure of a herbicide in complex with its target: binding of activated hydantocidin to the feedback regulation site of adenylosuccinate synthetase.

(+)-Hydantocidin, a recently discovered natural spironucleoside with potent herbicidal activity, is shown to be a proherbicide that, after phosphorylation at the 5' position, inhibits adenylosuccinate synthetase, an enzyme involved in de novo purine synthesis. The mode of binding of hydantocidin 5'-monophosphate to the target enzyme was analyzed by determining the crystal structure of the enzyme-inhibitor complex at 2.6-A resolution. It was found that adenylosuccinate synthetase binds the phosphorylated compound in the same fashion as it does adenosine 5'-monophosphate, the natural feedback regulator of this enzyme. This work provides the first crystal structure of a herbicide-target complex reported to date.

An RNA structure involved in feedback regulation of splicing and of translation is critical for biological fitness.

While studies of the regulation of gene expression have generally concerned qualitative changes in the selection or the level of expression of a gene, much of the regulation that occurs within a cell involves the continuous subtle optimization of the levels of proteins used in macromolecular complexes. An example is the biosynthesis of the ribosome, in which equimolar amounts of nearly 80 ribosomal proteins must be supplied by the cytoplasm to the nucleolus. We have found that the transcript of one of the ribosomal protein genes of Saccharomyces cerevisiae, RPL32, participates in such fine tuning. Sequences from exon I of the RPL32 transcript interact with nucleotides from the intron to form a structure that binds L32 to regulate splicing. In the spliced transcript, the same sequences interact with nucleotides from exon II to form a structure that binds L32 to regulate translation, thus providing two levels of autoregulation. We now show, by using a sensitive cocultivation assay, that these RNA structures and their interaction with L32 play a role in the fitness of the cell. The change of a single nucleotide within the 5' leader of the RPL32 transcript, which abolishes the site for L32 binding, leads to detectably slower growth and to eventual loss of the mutant strain from the culture. Experiments designed to assess independently the regulation of splicing and the regulation of translation are presented. These observations demonstrate that, in evolutionary terms, subtle regulatory compensations can be critical. The change in structure of an RNA, due to alteration of just one noncoding nucleotide, can spell the difference between biological success and failure.

Gene Expression Noise in Spatial Patterning: hunchback Promoter Structure Affects Noise Amplitude and Distribution in Drosophila Segmentation

Positional information in developing embryos is specified by spatial gradients of transcriptional regulators. One of the classic systems for studying this is the activation of the hunchback (hb) gene in early fruit fly (Drosophila) segmentation by the maternally-derived gradient of the Bicoid (Bcd) protein. Gene regulation is subject to intrinsic noise which can produce variable expression. This variability must be constrained in the highly reproducible and coordinated events of development. We identify means by which noise is controlled during gene expression by characterizing the dependence of hb mRNA and protein output noise on hb promoter structure and transcriptional dynamics. We use a stochastic model of the hb promoter in which the number and strength of Bcd and Hb (self-regulatory) binding sites can be varied. Model parameters are fit to data from WT embryos, the self-regulation mutant hb(14F), and lacZ reporter constructs using different portions of the hb promoter. We have corroborated model noise predictions experimentally. The results indicate that WT (self-regulatory) Hb output noise is predominantly dependent on the transcription and translation dynamics of its own expression, rather than on Bcd fluctuations. The constructs and mutant, which lack self-regulation, indicate that the multiple Bcd binding sites in the hb promoter (and their strengths) also play a role in buffering noise. The model is robust to the variation in Bcd binding site number across a number of fly species. This study identifies particular ways in which promoter structure and regulatory dynamics reduce hb output noise. Insofar as many of these are common features of genes (e. g. multiple regulatory sites, cooperativity, self-feedback), the current results contribute to the general understanding of the reproducibility and determinacy of spatial patterning in early development.

A Feedback Learning and Mental Models Perspective on Strategic Decision Making

This study aims to be a contribution to a theoretical model that explains the effectiveness of the learning and decision-making processes by means of a feedback and mental models perspective. With appropriate mental models, managers should be able to improve their capacity to deal with dynamically complex contexts, in order to achieve long-term success. We present a set of hypotheses about the influence of feedback information and systems thinking facilitation on mental models and management performance. We explore, under controlled conditions, the role of mental models in terms of structure and behaviour. A test based on a simulation experiment with a system dynamics model was performed. Three out of the four hypotheses were confirmed. Causal diagramming positively influences mental model structure similarity, mental model structure similarity positively influences mental model behaviour similarity, and mental model behaviour similarity positively influences the quality of the decision.

A Feedback Learning and Mental Models Perspective on Strategic Decision Making

This study aims to be a contribution to a theoretical model that explains the effectiveness of the learning and decision-making processes by means of a feedback and mental models perspective. With appropriate mental models, managers should be able to improve their capacity to deal with dynamically complex contexts, in order to achieve long-term success. We present a set of hypotheses about the influence of feedback information and systems thinking facilitation on mental models and management performance. We explore, under controlled conditions, the role of mental models in terms of structure and behaviour. A test based on a simulation experiment with a system dynamics model was performed. Three out of the four hypotheses were confirmed. Causal diagramming positively influences mental model structure similarity, mental model structure similarity positively influences mental model behaviour similarity, and mental model behaviour similarity positively influences the quality of the decision

Effects of team task structure on team climate for innovation and team outcomes

In this cross-sectional study we analyzed, whether team climate for innovation mediates the relationship between team task structure and innovative behavior, job satisfaction, affective organizational commitment, and work stress. 310 employees in 20 work teams of an automotive company participated in this study. 10 teams had been changed from a restrictive to a more self-regulating team model by providing task variety, autonomy, team-specific goals, and feedback in order to increase team effectiveness. Data support the supposed causal chain, although only with respect to team innovative behavior all required effects were statistically significant. Longitudinal designs and larger samples are needed to prove the assumed causal relationships, but results indicate that implementing self-regulating teams might be an effective strategy for improving innovative behavior and thus team and company effectiveness.

InovCity – structure of trials evaluation

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Inovcity- Structure of trials evaluation

In 2007, the UK government commissioned the Energy Demand Research Project to conduct a large scale experiment of smart metering technologies to test the impacts from many different forms of feedback to residential consumers. A full evaluation of the results was completed in 2011. In Portugal, EDP is also conducting smart meter trials in a project called InovCity in the city of Évora whose results will be evaluated during 2012. In this work, the case of Great Britain is studied as a reference on how an evaluation of trial results should be conducted. I also discuss potential limitations of the experiments, implications for national roll-out decisions, and finally draw some lessons that can be applied to the Portuguese case.

ASIC1a oligomerization structure-function of its extracellular vestibule and functional characterization of αS243Pβɣ ENaC

Quatre cristaux du canal ASIC1a ont été publiés et soutiennent une stoechiométrie trimérique. Cependant, ces données contredisant de précédentes analyses fonctionnelles effectuées sur des canaux de la même famille, notre intérêt fut porté sur l'oligomérisation d'ASIC1a. Dans ce sens, un nouvel essai couplant la méthode d'analyse par substitution de cystéines (SCAM) avec l'utilisation de réactifs sulfhydryls bifonctionnels (crosslinkers) a été mis en place. Le but étant de stabiliser, puis sélectionner les canaux fonctionnels, pour ensuite les séparer selon leur taille par SDS-PAGE. Grâce à cette technique, nous avons démontré que le complexe stabilisé a une taille coïncidant avec une organisation tétramérique. En plus de son oligomérisation, le chemin emprunté par les ions pour traverser le canal n'est pas clairement défini dans ces structures. De ce fait, utilisant une approche électrophysiologique, nous avons étudié le lien entre la structure et la fonction du vestibule extracellulaire d'ASIC1a. Dans ce but, nous nous sommes intéressés l'accessibilité de cystéines spécifiques localisées dans ce vestibule pour des réactifs méthanethiosulfonates (MTS). Ainsi, nous avons pu corréler les cinétiques de modification de ces cystéines par les MTS avec les effets sur le courant sodique, et donc avoir des informations supplémentaires sur la voie empruntée par les ions. De plus, la simulation informatique de liaison de ces réactifs illustre le remplissage total de ce vestibule. Fonctionnellement, cette interaction ne perturbe pas le passage de ions, c'est pourquoi il nous apparaît probable que le vestibule présente une taille plus large que celle illustrée par les cristaux. Dans un deuxième temps, notre intérêt fut porté sur ENaC. Ce canal est composé des trois sous-unités (a, ß et y) et est exprimé dans divers épithéliums, dont les tubules des reins. Il participe à l'homéostasie sodique et est essentiellement régulé par voie hormonale via l'aldostérone et la Vasopressine, mais également par des sérines protéases ou le Na+. Nous avons étudié la répercussion fonctionnelle de la mutation aS243P, découverte chez un nouveau-né prématuré atteint de pseudohypoaldostéronisme de type 1. Cette maladie autosomale récessive se caractérise, généralement, par une hyponatrémie liée à d'importantes pertes de sel dans les urines, une hyperkaliémie, ainsi qu'un niveau élevé d'aldostérone. Tout d'abord aucune des expériences biochimiques et électrophysiologiques n'a pu démontrer un défaut d'expression ou une forte diminution de l'activité soutenant les données cliniques. Cependant, en challengeant aS243PßyENaC avec une forte concentration de Na+ externe, une hypersensibilité de canal fut observée. En effet, ni les phénomènes régulateurs de « feedback inhibition » ou de « Na+ self-inhibition » n'étaient semblables au canal sauvage. De ce fait, ils apparaissaient exacerbés en présence de la mutation, amenant ainsi à une diminution de la réabsorption de Na+. Ceci corrobore entièrement l'hyponatrémie diagnostiquée. Le rein d'un prématuré étant immature, la quantité de Na+ atteignant la partie distale du néphron est plus élevée, du fait que les autres mécanismes de réabsorption en amont ne sont probablement pas encore en place. Cette hypothèse est renforcée par l'existence d'un frère présentant la même mutation, mais qui, né à terme, ne présentait aucun signe d'hyponatrémie. - The main topic of my thesis is the structure-function relationship of the ENaC/Deg family of ion channels, namely the Acid-Sensing Ion Channel ASIC1a and the Epithelial Na Channel ENaC. The primary part of this research is dedicated to the structure of ASIC1a. Four channel crystals have been published, which support a trimeric stoichiometry, although these data contradict previous functional experiments on other ENaC/Deg members. We are therefore interested in ASIC1a oligomerization and have set up a new assay combining the Substituted- Cysteine Accessibility Method (SCAM) with Afunctional sulfhydryl reagents (crosslinkers) allowing its study. The aim was to first stabilize the channels, then select those that are functional and then resolve them according to their size on SDS-PAGE. We demonstrated that the stabilized complex has a molecular weight corresponding to a tetrameric stoichiometry. In addition to our interest in the oligomerization of the ENaC/Deg family of ion channels, we also wanted to investigate the thus far undefined way of permeation for these channels. Therefore, taking the advantage of a more electrophysiological approach, we studied the accessibility of specific cysteines for methanethiosulfonate reagents (MTS) and were able to correlate the MTS association kinetics on cysteine residues with Na+ currents. These results have given us an insight into ion permeation and our functional evidence indicates that the extracellular is larger than that depicted by the crystal structures. As a side project, we focused on ENaC, which is made up of three subunits (a, ß and y) and is expressed in various epithelia, especially in the distal nephron of the kidneys. It plays a role in Na+ homeostasis and is essentially regulated by hormones via aldosterone and vasopressin, but also by serine proteases or Na+. We have studied the functional impact of the aS243P mutation, discovered in a premature baby suffering from pseudohypoaldosteronism of type 1. This autosomal recessive disease is characterized by hyponatremia, hyperkalemia and high aldosterone levels. Firstly, neither biochemical nor electrophysiological experiments indicated an expression defect or a strong decrease in activity. However, challenging aS243PßyENaC with increased external Na+ concentration showed channel hypersensitivity. Indeed, both the "feedback inhibition" and the "Na+ self-inhibition" regulatory mechanisms are impaired, leading to a decrease in Na+ reabsorption, entirely supports the diagnosis. The kidneys in preterm infants are immature and Na+ levels reaching the distal nephron are higher than normally observed. We hypothesize that the upstream reabsorption machinery is unlikely to be sufficiently matured and this assumption is supported by an asymptomatic sibling carrying the same mutation, but born at term. - La cellule, unité fonctionnelle du corps humain, est délimitée par une membrane plasmique servant de barrière biologique entre les milieux intra et extracellulaires. Une communication entre cellules est indispensable pour un fonctionnement adéquat. Sa survie dépend, entre autres, du maintien de la teneur en ions dans chacun des milieux qui doivent pouvoir être réabsorbés, ou sécrétés, selon les besoins. Les protéines insérées dans la membrane forment un canal et sont un moyen de communication permettant spécifiquement à des ions tel que le sodium (Na+) de traverser. Le Na+ se trouve dans la plupart des aliments et le sel, et est spécifiquement réabsorbé au niveau des reins grâce au canal sodique épithélial ENaC. Cette réabsorption se fait de l'urine primaire vers l'intérieur de la cellule, puis est transporté vers le sang. Pour maintenir un équilibre, une régulation de ce canal est nécessaire. En effet, des dysfonctionnements impliquant la régulation ou l'activité d'ENaC lui-même sont à l'origine de maladies telles que la mucoviscidose, l'hypertension ou encore, le pseudohypoaldostéronisme (PHA). Cette maladie est caractérisée, notamment, par d'importantes pertes de sel dans les urines. Des pédiatres ont diagnostiqué un PHA chez un nouveau-né, ce dernier présentant une modification du canal ENaC, nous avons recréé cette protéine afin d'étudier l'impact de ce changement sur son activité. Nous avons démontré que la régulation d'ENaC était effectivement perturbée, conduisant ainsi à une forte réduction de la réabsorption sodique. Afin de développer des molécules capables de moduler l'activité de protéines. Il est nécessaire d'en connaître la structure. Celle du canal sodique sensible à l'acidification ASIC1, un canal cousin d'ENaC, est connue. Ces données structurales contredisant cependant les analyses fonctionnelles, nous nous sommes penchés une nouvelle fois sur ASIC1. Une protéine est une macromolécule biologique composée d'une chaîne d'acides aminés (aa). De l'enchaînement d'aa à la protéine fonctionnelle, quatre niveaux de structuration existent. Chaque aa donne une indication quant au repliement et plus particulièrement la cystéine. Arborant un groupe sulfhydryle (SH) capable de former une liaison spécifique et stable avec un autre SH, celle-ci est souvent impliquée dans la structure tridimensionnelle de la protéine. Ce type de liaison intervient également dans la stabilisation de la structure quaternaire, qui est l'association de plusieurs protéines identiques (homomère), ou pas (hétéromère). Dans cette partie, nous avons remplacé des aa par des cystéines à des endroits spécifiques. Le but était de stabiliser plusieurs homomères d'ASICl ensemble avec des réactifs créant des ponts entre deux SH. Ainsi, nous avons pu déterminer le nombre de protéines ASIC1 participant à la formation d'un canal fonctionnel. Nos résultats corroborent les données fonctionnelles soutenant un canal tétramérique. Nous avons également étudié l'accessibilité de ces nouvelles cystéines afin d'obtenir des informations supplémentaires sur la structure du chemin emprunté par le Na+ à travers ASIC1 et plus particulièrement du vestibule extracellulaire.

Is confidence in decisions related to feedback? Evidence-and lack of evidence-from random samples of real-world managerial behavior?

Confidence in decision making is an important dimension of managerialbehavior. However, what is the relation between confidence, on the onehand, and the fact of receiving or expecting to receive feedback ondecisions taken, on the other hand? To explore this and related issuesin the context of everyday decision making, use was made of the ESM(Experience Sampling Method) to sample decisions taken by undergraduatesand business executives. For several days, participants received 4 or 5SMS messages daily (on their mobile telephones) at random moments at whichpoint they completed brief questionnaires about their current decisionmaking activities. Issues considered here include differences between thetypes of decisions faced by the two groups, their structure, feedback(received and expected), and confidence in decisions taken as well as inthe validity of feedback. No relation was found between confidence indecisions and whether participants received or expected to receivefeedback on those decisions. In addition, although participants areclearly aware that feedback can provide both confirming and disconfirming evidence, their ability to specify appropriatefeedback is imperfect. Finally, difficulties experienced inusing the ESM are discussed as are possibilities for further researchusing this methodology.

Interaction of alpha-melanotropin with central dopamine systems: role of hormonal state and molecular structure

The tubero-infundibular and nigrostriatal DA neurone systems of rats respond to systemic (i.p.) injection of alpha-MSH (2-100 microgram/kg). The response of the tubero-infundibular (arcuate) DA neurones, an increase in cellular fluorescence intensity which can be interpreted as a sign of increased neuronal activity, is essentially the same in males, estrogen-progesterone-pretreated ovariectomized females and hypophysectomized males, whereas the type of response elicited by alpha-MSH in the nigral DA neurones depends upon the hormonal state of the animal. Differences between the two DA neurone groups exist also with regard to the effects of peptide fragments containing the two active sites of the alpha-MSH molecule. Results of lesion experiments in the lower brainstem (area postrema) and of blockade of muscarinic mechanisms by atropine further point to differences in the mechanisms underlying the peptide effects on the two neurone systems. The reaction of the tubero-infundibular DA system (which controls the pars intermedia of the pituitary) can be considered to reflect the activation of a feedback mechanism on MSH secretion, while the functional counterpart of the changes observed in the nigral system remains unknown at the present time.