Train-the-trainer: E-learning zur Förderung einer praxisorientiertem Vermittlung von evidenzbasierter Medizin

Hintergrund: Trotz ihrer Etablierung als essentieller Bestandteil der medizinischen Weiter-/Fortbildung werden europa- wie schweizweit kaum Kurse in evidenzbasierter Medizin (ebm) angeboten, die - integriert im klinischen Alltag - gezielt Fertigkeiten in ebm vermitteln. Noch grössere Defizite finden sich bei ebm- Weiterbildungsmöglichkeiten für klinische Ausbilder (z.B. Oberärzte). Als Weiterführung eines EU-finanzierten, klinisch integrierten E-learning- Programms für Weiterbildungsassistenten (www.ebm-unity.org) entwickelte eine europäische Gruppe von medical educators gezielt für Ausbilder ein e-learning-Curriculum zur Vermittlung von ebm im Rahmen der klinischen Weiterbildung. Methode: Die Entwicklung des Curriculums umfasst folgende Schritte: Beschreibung von Lernzielen, Identifikation von klinisch relevanten Lernumgebungen, Entwicklung von Lerninhalten und exemplarischen didaktischen Strategien, zugeschnitten auf die jeweilige Lernumgebungen, Design von web-basierten Selbst-Lernsequenzen mit Möglichkeiten zur Selbstevaluation, Erstellung eines Handbuchs. Ergebnisse: Lernziele des Tutoren-Lehrgangs sind der Erwerb von Fertigkeiten zur Vermittlung der 5 klassischen ebm-Schritte: PICO- (Patient-Intervention-Comparison-Outcome)-Fragen, Literatursuche, kritische Literaturbewertung, Übertragung der Ergebnisse im eigenen Setting und Implementierung). Die Lehrbeispiele zeigen angehenden ebm-Tutoren, wie sich typische klinische Situationen wie z.B. Stationsvisite, Ambulanzsprechstunde, Journalclub, offizielle Konferenzen, Audit oder das klinische Assessment von Weiterbildungsassistenten gezielt für die Vermittlung von ebm nutzen lassen. Kurze E-Learning-Module mit exemplarischen «real-life»-Video-Clips erlauben flexibles Lernen zugeschnitten auf das knappe Zeitkontingent von Ärzten. Eine Selbst-Evaluation ermöglicht die Überprüfung der gelernten Inhalte. Die Pilotierung des Tutoren-Lehrgangs mit klinisch tätigen Tutoren sowie die Übersetzung des Moduls in weitere Sprachen sind derzeit in Vorbereitung. chlussfolgerung: Der modulare Train-the-Trainer-Kurs zur Vermittlung von ebm im klinischen Alltag schliesst eine wichtige Lücke in der Dissemination von klinischer ebm. Webbasierte Beispiele mit kurzen Sequenzen demonstrieren typische Situationen zur Vermittlung der ebm-Kernfertigkeiten und bieten medical educators wie Oberärzten einen niedrigschwelligen Einstieg in «ebm» am Krankenbett. Langfristiges Ziel ist eine europäische Qualifikation für ebm- Learning und -Teaching in der Fort- und Weiterbildung. Nach Abschluss der Evaluation steht das Curriculum interessierten Personen und Gruppen unter «not-for-profit»-Bedingungen zur Verfügung. Auskünfte erhältlich von rkunz@uhbs.ch. Finanziert durch die Europäische Kommission - Leonardo da Vinci Programme - Transfer of Innovation - Pilot Project for Lifelong Learn- ing 2007 und das Schweizerische Staatssekretariat für Bildung und Forschung.

Evaluation of the TEAM Train-the-Trainer Program. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Stratégies de communication au service de la formation: quelques outils pratiques [Effective communication strategies to frame the trainer-trainee dialogue in the clinical setting].

Communication between trainer and trainee plays a central role in teaching and learning in the clinical environment. There are various strategies to frame the dialogue between trainee and trainer. These strategies allow trainers to be more effective in their supervision, which is important in our busy clinical environment. Communication strategies are well adapted to both in- and out-patient settings, to both under- and postgraduate contexts. This article presents three strategies that we think are particularly useful. They are meant to give feedback, to ask questions and to present a case.

An evaluation of the trainer-tester and punchboard tutor as electronics trouble-shooting training aids,

Mode of access: Internet.

La recherche sur le transfert des connaissances en santé publique dans les pays à faible revenu : une synthèse exploratoire

Essai doctoral présenté à la Faculté des études supérieures en vue de l’obtention du doctorat clinique en psychologie (D.Psy)

Establishing a community of practice of researchers, practitioners, policy-makers and communities to sustainably manage environmental health risks in Ecuador

The Sustainably Managing Environmental Health Risk in Ecuador project was launched in 2004 as a partnership linking a large Canadian university with leading Cuban and Mexican institutes to strengthen the capacities of four Ecuadorian universities for leading community-based learning and research in areas as diverse as pesticide poisoning, dengue control, water and sanitation, and disaster preparedness. By 2009, train-the-trainer project initiation involved 27 participatory action research Master’s theses in 15 communities where 1200 community learners participated in the implementation of associated interventions. This led to establishment of innovative Ecuadorian-led master’s and doctoral programs, and a Population Health Observatory on Collective Health, Environment and Society for the Andean region based at the Universidad Andina Simon Bolivar. Building on this network, numerous initiatives were begun, such as an internationally funded research project to strengthen dengue control in the coastal community of Machala, and establishment of a local community eco-health centre focusing on determinants of health near Cuenca. Alliances of academic and non-academic partners from the South and North provide a promising orientation for learning together about ways of addressing negative trends of development. Assessing the impacts and sustainability of such processes, however, requires longer term monitoring of results and related challenges.

Case Study of an Ergonomics Training Program for Nursing Home Workers

This paper describes a case study of a labor-based ergonomics-training program that makes use of some effective worker training methods. The program focus was on ergonomics awareness and back injury prevention for nursing home workers. It was developed and conducted by a not-for-profit organization affiliated with the Service Employees International Union. Training methods included the train-the-trainer model and the small group activity method. The investigation also compared the program components with those identified by the Occupational Safety and Health Administration (OSHA) as being key elements in effective safety training.

Camp For All Connection: a community health information outreach project

Purpose: The purpose of the Camp For All Connection project is to facilitate access to electronic health information resources at the Camp For All facility. Setting/Participants/Resources: Camp For All is a barrier-free camp working in partnership with organizations to enrich the lives of children and adults with chronic illnesses and disabilities and their families by providing camping and retreat experiences. The camp facility is located on 206 acres in Burton, Texas. The project partners are Texas Woman's University, Houston Academy of Medicine-Texas Medical Center Library, and Camp For All. Brief Description: The Camp For All Connection project placed Internet-connected workstations at the camp's health center in the main lodge and provided training in the use of electronic health information resources. A train-the-trainer approach was used to provide training to Camp For All staff. Results/Outcome: Project workstations are being used by health care providers and camp staff for communication purposes and to make better informed health care decisions for Camp For All campers. Evaluation Method: A post-training evaluation was administered at the end of the train-the-trainer session. In addition, a series of site visits and interviews was conducted with camp staff members involved in the project. The site visits and interviews allowed for ongoing dialog between project staff and project participants.

Training Methods Utlilized by Independent Restaurant Managers

Formal, systematic training has always been cited as a major need for the future success of hospitality operations. However, one other aspect of the job might be the development of a train-the-trainer curriculum for hospitality management students. The author studies the relationship between training preparation and training methods utilized by restaurant managers and explores this need.

Aerodynamic Optimization of the Nose Shape of a High-speed Train

La influencia de la aerodinámica en el diseño de los trenes de alta velocidad, unida a la necesidad de resolver nuevos problemas surgidos con el aumento de la velocidad de circulación y la reducción de peso del vehículo, hace evidente el interés de plantear un estudio de optimización que aborde tales puntos. En este contexto, se presenta en esta tesis la optimización aerodinámica del testero de un tren de alta velocidad, llevada a cabo mediante el uso de métodos de optimización avanzados. Entre estos métodos, se ha elegido aquí a los algoritmos genéticos y al método adjunto como las herramientas para llevar a cabo dicha optimización. La base conceptual, las características y la implementación de los mismos se detalla a lo largo de la tesis, permitiendo entender los motivos de su elección, y las consecuencias, en términos de ventajas y desventajas que cada uno de ellos implican. El uso de los algorimos genéticos implica a su vez la necesidad de una parametrización geométrica de los candidatos a óptimo y la generación de un modelo aproximado que complementa al método de optimización. Estos puntos se describen de modo particular en el primer bloque de la tesis, enfocada a la metodología seguida en este estudio. El segundo bloque se centra en la aplicación de los métodos a fin de optimizar el comportamiento aerodinámico del tren en distintos escenarios. Estos escenarios engloban los casos más comunes y también algunos de los más exigentes a los que hace frente un tren de alta velocidad: circulación en campo abierto con viento frontal o viento lateral, y entrada en túnel. Considerando el caso de viento frontal en campo abierto, los dos métodos han sido aplicados, permitiendo una comparación de las diferentes metodologías, así como el coste computacional asociado a cada uno, y la minimización de la resistencia aerodinámica conseguida en esa optimización. La posibilidad de evitar parametrizar la geometría y, por tanto, reducir el coste computacional del proceso de optimización es la característica más significativa de los métodos adjuntos, mientras que en el caso de los algoritmos genéticos se destaca la simplicidad y capacidad de encontrar un óptimo global en un espacio de diseño multi-modal o de resolver problemas multi-objetivo. El caso de viento lateral en campo abierto considera nuevamente los dos métoxi dos de optimización anteriores. La parametrización se ha simplificado en este estudio, lo que notablemente reduce el coste numérico de todo el estudio de optimización, a la vez que aún recoge las características geométricas más relevantes en un tren de alta velocidad. Este análisis ha permitido identificar y cuantificar la influencia de cada uno de los parámetros geométricos incluídos en la parametrización, y se ha observado que el diseño de la arista superior a barlovento es fundamental, siendo su influencia mayor que la longitud del testero o que la sección frontal del mismo. Finalmente, se ha considerado un escenario más a fin de validar estos métodos y su capacidad de encontrar un óptimo global. La entrada de un tren de alta velocidad en un túnel es uno de los casos más exigentes para un tren por el pico de sobrepresión generado, el cual afecta a la confortabilidad del pasajero, así como a la estabilidad del vehículo y al entorno próximo a la salida del túnel. Además de este problema, otro objetivo a minimizar es la resistencia aerodinámica, notablemente superior al caso de campo abierto. Este problema se resuelve usando algoritmos genéticos. Dicho método permite obtener un frente de Pareto donde se incluyen el conjunto de óptimos que minimizan ambos objetivos. ABSTRACT Aerodynamic design of trains influences several aspects of high-speed trains performance in a very significant level. In this situation, considering also that new aerodynamic problems have arisen due to the increase of the cruise speed and lightness of the vehicle, it is evident the necessity of proposing an optimization study concerning the train aerodynamics. Thus, the aerodynamic optimization of the nose shape of a high-speed train is presented in this thesis. This optimization is based on advanced optimization methods. Among these methods, genetic algorithms and the adjoint method have been selected. A theoretical description of their bases, the characteristics and the implementation of each method is detailed in this thesis. This introduction permits understanding the causes of their selection, and the advantages and drawbacks of their application. The genetic algorithms requirethe geometrical parameterization of any optimal candidate and the generation of a metamodel or surrogate model that complete the optimization process. These points are addressed with a special attention in the first block of the thesis, focused on the methodology considered in this study. The second block is referred to the use of these methods with the purpose of optimizing the aerodynamic performance of a high-speed train in several scenarios. These scenarios englobe the most representative operating conditions of high-speed trains, and also some of the most exigent train aerodynamic problems: front wind and cross-wind situations in open air, and the entrance of a high-speed train in a tunnel. The genetic algorithms and the adjoint method have been applied in the minimization of the aerodynamic drag on the train with front wind in open air. The comparison of these methods allows to evaluate the methdology and computational cost of each one, as well as the resulting minimization of the aerodynamic drag. Simplicity and robustness, the straightforward realization of a multi-objective optimization, and the capability of searching a global optimum are the main attributes of genetic algorithm. However, the requirement of geometrically parameterize any optimal candidate is a significant drawback that is avoided with the use of the adjoint method. This independence of the number of design variables leads to a relevant reduction of the pre-processing and computational cost. Considering the cross-wind stability, both methods are used again for the minimization of the side force. In this case, a simplification of the geometric parameterization of the train nose is adopted, what dramatically reduces the computational cost of the optimization process. Nevertheless, some of the most important geometrical characteristics are still described with this simplified parameterization. This analysis identifies and quantifies the influence of each design variable on the side force on the train. It is observed that the A-pillar roundness is the most demanding design parameter, with a more important effect than the nose length or the train cross-section area. Finally, a third scenario is considered for the validation of these methods in the aerodynamic optimization of a high-speed train. The entrance of a train in a tunnel is one of the most exigent train aerodynamic problems. The aerodynamic consequences of high-speed trains running in a tunnel are basically resumed in two correlated phenomena, the generation of pressure waves and an increase in aerodynamic drag. This multi-objective optimization problem is solved with genetic algorithms. The result is a Pareto front where a set of optimal solutions that minimize both objectives.

The forensic radiographer: a new member in the medicolegal team.

Multidetector computed tomography is becoming more widespread in forensic medicine. In most services, autopsy assistants perform the radiological examination. We introduced professional radiographers into the legal medicine service and hypothesized they would also be able to take over duties currently reserved for other specialists. The aims of this study were to evaluate if radiographers could be trained as "forensic radiographers" by (1) integrating graduated medical radiographers into the legal medicine service, (2) investigating the advantages of this collaboration, and (3) defining the duties of the forensic radiographers.The study was performed prospectively on a group of 8 recruited radiographers who underwent a testing period with special training. They learned the basics of medicolegal case treatment, the autonomous execution of postmortem computed tomography angiography, and postprocessing of data. Seven of 8 radiographers finished the training and were integrated into our service. Although all radiographers were able to fulfill the duties demanded after the training period, some radiographers could not enter or complete the program because they were unable to work with dead bodies.Our study presents the advantages of integrating radiographers into the medicolegal team and proposes how to train the forensic radiographers. In addition, the duties and responsibilities of these new specialists are defined.

Radar analysis of the life cycle of mesoscale convective systems during the 10 June 2000 event

The 10 June 2000 event was the largest flash flood event that occurred in the Northeast of Spain in the late 20th century, both as regards its meteorological features and its considerable social impact. This paper focuses on analysis of the structures that produced the heavy rainfalls, especially from the point of view of meteorological radar. Due to the fact that this case is a good example of a Mediterranean flash flood event, a final objective of this paper is to undertake a description of the evolution of the rainfall structure that would be sufficiently clear to be understood at an interdisciplinary forum. Then, it could be useful not only to improve conceptual meteorological models, but also for application in downscaling models. The main precipitation structure was a Mesoscale Convective System (MCS) that crossed the region and that developed as a consequence of the merging of two previous squall lines. The paper analyses the main meteorological features that led to the development and triggering of the heavy rainfalls, with special emphasis on the features of this MCS, its life cycle and its dynamic features. To this end, 2-D and 3-D algorithms were applied to the imagery recorded over the complete life cycle of the structures, which lasted approximately 18 h. Mesoscale and synoptic information were also considered. Results show that it was an NS-MCS, quasi-stationary during its stage of maturity as a consequence of the formation of a convective train, the different displacement directions of the 2-D structures and the 3-D structures, including the propagation of new cells, and the slow movement of the convergence line associated with the Mediterranean mesoscale low.

Project «Water and Environment»: Improving educational practices in the aquatic environment

The project "Water and Environment"for the improvement of educational practices in the aquatic environment, is a research project led by four members of the Research Group of Physical Education at the University of Vic (GREF) experts in water activities. The aim is to train the technicians who teach swimming during school hours. The training is based on improving water treatment practices and competence to face a contradictory scene where clubs develop educational content and where schools transfer to clubs part of its educational activity to contribute significantly and positively to water activities fitting the educational curriculum.

The effect of pH and ethanol on the astringent sub-qualities of red wine, and the implications for optimum grape maturity /

The first objective of this study was to identify appropriate sensory descriptors to assess the astringent sub-qualities of red wine. The influence of pH and ethanol on the sensation of astringency in red wine was evaluated, using a de-alcoholized red wine. A portion of the wine was adjusted to the pH values of 3.2, 3.4, 3.6 and 3.8, and another portion was adjusted to ethanol concentrations of 0%, 6%, 12%, and 15%. In addition, the pH 3.4 and 3.6 treatments were adjusted to an ethanol concentration of 12% and 15% all wines were then assessed sensorially and seventeen terms were identified, through panel discussion, to describe the mouth-feel and taste qualities: velvet, aggressive, silk/satin, dry, fleshy, unripe, pucker viscosity, abrasive, heat, chewy, acidity, grippy/adhesive, bitter, balance, overall astringency, and mouth-coat. Descriptive analysis profiling techniques were used to train the panel and measure the intensity of these attributes. It was found that decreasing pH values (averaged across all ethanol concentrations) showed an increase in the overall astringency of the wine. The combined treatments of ethanol and pH, real wine parameters (pH 3.4 and 3.6; 12% and 15% ethanol) did not have an effect on the perception of the astringent sub-qualities of the wine. A time intensity study was also included using the pH and ethanol adjusted wines, which showed that as the ethanol level of the wines increased so did the time to maximum intensity. The second objective was to identify appropriate sensory descriptors to evaluate the influence of grape maturity and maceration technique (grape skin contact) on the astringency sub-qualities of red vinifera wines from Niagara. The grapes were harvested across two dates, representing an early harvest and a late harvest. A portion of the Cabernet Sauvignon grapes wine was divided into three maceration treatments of oneweek maceration, standard two-week maceration, three-week maceration, and MCM. Another portion of both the early and late harvest Cabernet Sauvignon grapes were chaptalized to yield a final ethanol concentration of 14.5%. The wines were assessed sensorially and thirteen terms were identified, through panel discussion, to describe the mouth-feel and taste qualities: carbon dioxide, pucker, acidity, silk/chamois, dusty/chalky/powdery, sandpaper, numbing, grippy/adhesive, dry, mouthcoat, bitter, balance and, overall astringency. Descriptive analysis techniques were used to train the panel and measure the intensity of these attributes. The data revealed few significant differences in the mouth-feel of the wines with respect to maturity; which included differences in overall astringency and balance. There were varietal differences between Cabernet Sauvignon, Cabernet Franc, and Pinot Noir and differences for Cabernet Sauvignon wines due to the length and manner of maceration and as a result of chaptalization. Statistical analysis revealed a more complex mouth-feel for the Pinot Noir wines; and an increase in the intensity of the astringent sub-qualities as a result of the addition of sugar to the wines. These findings have implications for how processing decisions, such as optimum grape maturity and vinification methods may affect red wine quality.