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PubMed1998

The use of a computerized brain atlas to support knowledge-based training in radiology.

Trainers of radiologists face the particular challenges of teaching normal and abnormal appearance for a variety of imaging modalities, providing access to a large appropriately-indexed case library, and teaching a consistent approach to the reporting of cases. The computer has the potential to address these issues, to supplement conventional teaching of radiology by providing case-based tutoring and diagnostic support based on a large library of images of normal and abnormal anatomy, described in a consistent terminology. The paper presents a new approach to computer-based training in radiology that combines a knowledge-based tutor with an on-line medical atlas. It describes two existing computer systems, the MR Tutor and ATLAS, and discusses the medical, computational, epistemic, and pedagogic issues involved in developing a combined Atlas-Tutor. Integrating an atlas with a training system could significantly improve the teaching and support offered, but practical difficulties include the need to merge knowledge representations and to incorporate techniques for registering atlas plates on images that exhibit abnormalities. The paper addresses these problems, and concludes by indicating how the Atlas-Tutor might be employed in practical radiology training.

Atlases as Topic↗
PubMed1994

Collaboration: a critical viewpoint.

Post-graduate nursing education in Victoria, until recently, has been conducted as certificate level courses within hospital-based programs. These programs have traditionally drawn on the clinical experience, the supervision and the teaching provided by the resources within the hospital. This article describes the nature of a collaborative venture, involving regional hospitals and the university, and the challenges that emerged during the introduction of a post-graduate critical care course. Issues arising out of the course evaluation, which was conducted after the first year of the program elaborate aspects of the beginning nature of a collaborative venture. These issues include the different emphases and expectations of skills and knowledge, perceived as relevant to critical care practice. Some of the difficulties encountered by the students are raised. We employ the concepts of liberal and vocational/professional education to explore the ways in which present tensions signify what we have discovered to be an old pedagogical debate. The particular meanings we have as a profession when we speak about education are explored in the context of critical care education and collaborative practice.

Critical Care↗
PubMed1999

Changes in incarcerated adolescents' human immunodeficiency virus knowledge and selected behaviors from 1988 to 1996.

Data were collected from juveniles in Alabama and Florida correctional facilities. The samples were closely demographically matched. Analysis indicated significant increases in knowledge about human immunodeficiency virus between 1988 and 1996 and increased sexual risk behaviors. Knowledge levels were lower for ethnic minority groups and boys, suggesting ethnic- and gender-specific pedagogical aids are needed.

Adolescent↗
PubMed2000

Skin prick tests may give generalized allergic reactions in infants.

BACKGROUND: Skin prick testing, a widely used method of studying sensitization, is usually considered quick, pedagogic, and relatively inexpensive. Previous studies have shown very few negative reactions and no fatalities. In contrast, both anaphylaxis and death have been reported as a result of intracutaneous tests. OBJECTIVE: To examine detailed case studies of generalized allergic reactions in connection with skin prick testing in order to identify possible risk factors and thereby increase the safety of the test procedure. METHOD: A retrospective study of medical records of six cases with generalized allergic reaction occurring during the study period 1996-1998 at the Pediatric Clinic, University Hospital of Linköping, Sweden. Data about the total number of children tested during the period were collected from the clinic's database. RESULTS: All six cases with generalized reactions were infants <6 months who showed positive skin prick tests to fresh food specimen. Other common features were active eczema and a family history of allergic disease. All infants received prompt treatment and recovered well. The overall rate of generalized reactions was 521 per 100,000 tested children. In the age group <6 months, the corresponding figure was 6,522 per 100,000. CONCLUSION: The risk of generalized reactions after skin prick test with fresh food specimens in young children ought to be acknowledged and should lead to increased precautions when performing the test.

Adolescent↗
PubMed1997

[Practice of virtual simulation at the Saint-André hospital].

PURPOSE: Prospective evaluation of a virtual simulation technique. PATIENTS AND METHODS: From September 1993 to February 1997, 343 patients underwent radiation therapy using this technique. Treated sites were mostly: brain (132), rectum (59), lung (43), and prostate (28). A CT-scan was performed on a patient in treatment position. Twenty-five to 70 jointive slices widely encompassed the treated volume. The target volume (CTV according to ICRU 50) and often critical organs were controured, slice by slice, by the radiation oncologist. Beams covering the CTV plus a security margin (PTV) were placed on the "virtual patient". Digital radiographs were reconstructed (DRR) as simulator radiographs for each field. Thus, the good coverage of PTV was assessed. Fields and beam arrangements were further optimized. Definitive isocenter was then placed using a classical simulator. Perfect matching of DRR and actual simulator radiographs had to be obtained. RESULTS: Nineteen patients presented grade 3, and 1 grade 4 acute radiation effects. With a median follow-up of 18 months, five patients suffered from grade 3, and one from grade 4 complications. Fifty-five patients had tumor recurrence in the treated volume, and 19 had marginal relapse. CONCLUSION: In our department, virtual simulation has become a routine technique of treatment planning for deep-seated tumors. This technique remains time-consuming for radiation oncologists: about 2 hours. But it stimulates reflexion on anatomy, tumor extension pathways, target volumes; and is becoming an excellent pedagogical tool.

Computer Simulation↗
PubMed2003

Data representation for joint kinematics simulation of the lower limb within an educational context.

Three-dimensional (3D) visualization is becoming increasingly frequent in both qualitative and quantitative biomechanical studies of anatomical structures involving multiple data sources (e.g. morphological data and kinematics data). For many years, this kind of experiment was limited to the use of bi-dimensional images due to a lack of accurate 3D data. However, recent progress in medical imaging and computer graphics has forged new perspectives. Indeed, new techniques allow the development of an interactive interface for the simulation of human motions combining data from both medical imaging (i.e., morphology) and biomechanical studies (i.e., kinematics). Fields of application include medical education, biomechanical research and clinical research. This paper presents an experimental protocol for the development of anatomically realistic joint simulation within a pedagogical context. Results are shown for the lower limb. Extension to other joints is straightforward. This work is part of the Virtual Animation of the Kinematics of the Human project (VAKHUM) (http://www.ulb.ac.be/project/vakhum).

Arthrography↗
PubMed2003

Copability, coping, and learning as focal concepts in the evaluation of computerised diabetes disease management.

INTRODUCTION: Within diabetes care, the majority of health decisions are in the hands of the patient. Therefore, the concepts of disease management and self-care represent inescapable challenges for both patient and healthcare professionals, entailing a considerable amount of learning. Thus, a computerised diabetes disease management systems (CDDM) is to be seen not merely as tools for the medical treatment, but also as pedagogical tools to enhance patient competence. HYPOTHESIS: The unfortunate lack of success for most knowledge-based systems might be related to the problem of finding an adequate way of evaluating the systems from their development through the implementation phase to the daily clinical practice. The following presents the initial methodological considerations for evaluating the usefulness of a CDDM system called DiasNet, which is being implemented as a learning tool for patients. The evaluation of usefulness of a CDDM, we claim, entails clinical assessment taking into account the challenges and pitfalls in diabetes disease management. RESULTS: Drawing on activity theory, we suggest the concept of copability as a supplement to 'usability' and 'utility' when determining 'usefulness'. We maintain that it is necessary to ask how well the user copes with the new situation using the system. As ways to measure copability of DiasNet the concepts of coping and learning are discussed, as well as ways this methodology might inform systems development, implementation, and daily clinical practice.

Adaptation, Psychological↗
PubMed1998

Use with care: possibilities and constraints offered by computers in nursing clinical education.

Funding constraints, demands for improved efficiency, low staff to student ratios and improved computer software (D. Wright, The use of multimedia computers and software in nurse education, Health Inf. 1 (3) (1995) 101-107.) all combine to produce a situation where a dramatic increase in the use of CBE for tertiary nurse education appears inevitable. In particular there is a very strong movement towards the development of nurse education materials able to be delivered via the World Wide Web (WWW). Given the speed and the extent of these developments it is essential that CBE developments are subject to adequate review and critique. In particular it is important that the pedagogical concepts under pinning the CBE are congruent with the technological innovation being implemented. This paper provides such a review and critique through the discussion of a project concerned with the integration of a computerised hospital nursing care planning database into the undergraduate nursing curriculum. The evaluation of the project not only raises many issues and concerns relevant to CBE in general, but also provides examples of the ways in which CBE can be used to link theory to practice. It also highlights the need for congruency between pedagogy, technology and student learning. Implications arising from the project are discussed at length, including the possibility for clinicians and academics to work collaboratively on database development.

Computer-Assisted Instruction↗
PubMed2005

Grand rounds: what is the point?

INTRODUCTION The chalkboards are no longer only chalkboards but are PowerPoint presentations. Textbooks are rarely texts but rather CDs to be downloaded at a reader's discretion; and classrooms are almost optional. Still the university hospital environment reflects a belief in the pedagogic effectiveness of the 19th century medical wisdom by encouraging and maintaining grand rounds. What makes the grand rounds is debatable. The large crowds, which historically attended to hear and to feast on a specialist's pearls of wisdom, have been replaced by sparse crowds often inattentive and in a rush to be elsewhere. This survey was designed to assess the status of the grand round in Canada. We contacted the 16 medical schools via e-mail and asked either the chairperson or the obs-gyn grand round coordinator to respond to a 2-page questionnaire. The Association of professors of Obstetrics and Gynecology (APOG) assisted in diffusing and collecting the data.

Canada↗
PubMedDate not supplied

International education and reflection: transition of Swedish and American nursing students to authenticity.

Reflection, a process grounded in distancing from the self to enhance self-awareness, can be used as a pedagogic activity to promote students' transition to a greater authenticity and professionalism and, therefore, improve patient care and nursing practice. In this international educational project (implemented in 2001) using interactive videoconferencing technology (IVC), Swedish and U.S. nursing students and faculty incorporated reflective journaling, drama in education, photolanguage, and off-air meeting discussions to enhance personal and professional development. Highlights from the literature, a description of the project, and student and faculty appraisals are presented.

Attitude of Health Personnel↗
PubMed1992

Smoking during pregnancy. Possibilities of prevention in antenatal care.

Prevention of smoking in pregnancy is a mission of utmost importance since the fetal outcome is improved when the mother quits smoking. Methods to prevent smoking have to consider maternal attitudes and characteristics and be based on pedagogical and behavioral principles. A well-motivated staff, a self-help manual accepted by most women, and special support to those who want it are minimal requirements.

Female↗
PubMed2003

Trace gas measurement with an integrated porous tube collector/long-path absorbance detector.

Porous membrane tubes filled with an absorbing solution that change colors upon selective reactions with specific gases provide high sensitivity inexpensive gas sensors. These can be routinely used for ambient monitoring in a fully automated manner. We consider both stopped and continuous flow operations and show the superiority of the stopped flow mode theoretically and experimentally. Light throughput through various membrane tubes is presented, and superior performance of such tubes over Teflon AF is shown. Sensors for NO2 and for O3 were based on Griess-Saltzman and indigotrisulfonate chemistries, respectively. A computer-controlled two-LED absorbance measurement system (one wavelength monitors the signal, the other references the system) that also governs automated reagent refilling was implemented. Sub-parts-per-billion-volume detection limits are attainable within a few minutes for both gases. Comparative data with a commercial UV-photometry-based ozone monitor showed excellent agreement with the response pattern of the present instrument. Low cost, ready applicability to the measurement of different gases by merely changing the light source and chemistry, and high sensitivity makes this instrument attractive for both pedagogic and practical purposes.

Journal Article↗
PubMed1996

13C NMR spectroscopic and X-ray crystallographic study of the role played by mitochondrial cytochrome b5 heme propionates in the electrostatic binding to cytochrome c.

The role played by the outer mitochondrial membrane (OM) cytochrome b5 heme propionate groups in the electrostatic binding between OM cytochrome b5 and horse heart cytochrome c was investigated by 13C NMR spectroscopy and X-ray crystallography. To achieve these aims, 13C-labeled heme OM cytochrome b5 was expressed in Escherichia coli as previously described [Rivera M., Walker, F.A. (1995) Anal. Biochem. 230, 295-302]. Assignment of the resonances arising from the heme propionate carbons in ferricytochrome b5 was carried out by a combination of one- and two-dimensional NMR experiments. Titrations of [13C]heme-labeled OM cytochrome b5 with horse heart cytochrome c were carried out in order to monitor the resonances arising from the heme propionate carbonyl carbons in OM cytochrome b5. The results from these titrations clearly show that only the heme propionate located on the exposed heme edge in OM cytochrome b5 participates in the electrostatic stabilization of the complex between OM cytochrome b5 and horse heart cytochrome c. Similar experiments carried out monitoring 13C resonances arising from several other heme substituents demonstrated that the stoichiometry of the complex is 1:1. A conditional binding constant, K which equals 3.8 x 10(4) +/- 1.4 x 10(4) at mu = 0.02 M, was obtained for the formation of the complex by fitting the binding curves obtained experimentally to a model based on this stoichiometry. The X-ray crystal structure of rat liver OM cytochrome b5 solved to 2.7 A resolution shows that the structures of bovine liver microsomal cytochrome b5 and rat liver OM cytochrome b5 are almost identical when compared at medium resolution. The similarity between the two structures, combined with the findings that only the heme propionate located on the exposed heme edge of OM cytochrome b5 participates in the electrostatic binding to cytochrome c and that the stability of this complex is similar to that measured for the association between microsomal cytochrome b5 and cytochrome c, clearly indicates that the site of interaction on OM cytochrome b5 is almost identical to the one elucidated for microsomal cytochrome b5. It is therefore possible to conclude that the large body of information gathered by many investigators for the nonphysiological interaction between microsomal cytochrome b5 and cytochrome c (recently reviewed) [Mauk, A. G. Mauk, M. R., Moore, G. R., & Northrup, S. H. (1995) Bioenerg. Biomembr. 27, 311-330] has indeed biological as well as pedagogical validity.

Animals↗
PubMedDate not supplied

Rapid flow-induced responses in endothelial cells.

Endothelial cells alter their morphology, growth rate, and metabolism in response to fluid shear stress. To study rapid flow-induced responses in the 3D endothelial cell morphology and calcium distribution, coupled fluorescence microscopy with optical sectioning, digital imaging, and numerical deconvolution techniques have been utilized. Results demonstrate that within the first minutes of flow application nuclear calcium is increasing. In the same time frame whole cell height and nuclear height are reduced by about 1 microm. Whole cell height changes may facilitate reduction of shear stress gradients on the luminal surface, whereas nuclear structural changes may be important for modulating endothelial growth rate and metabolism. To study the role of the cytoskeleton in these responses, endothelial cells have been treated with specific disrupters (acrylamide, cytochalasin D, and colchicine) of each of the cytoskeleton elements (intermediate filaments, microfilaments, and microtubules, respectively). None of these compounds had any effect on the shear-induced calcium response. Cytochalasin D and acrylamide did not affect the shear-induced nuclear morphology changes. Colchicine, however, completely abrogated the response, indicating that microtubules may be implicated in force transmission from the plasma membrane to the nucleus. A pedagogical model based on tensegrity theory principles is presented that is consistent with the results on the 3D endothelial morphology.

Acrylamide↗
PubMed2003

The glass transition time scale and configurational entropy in polymers: an experimental molecular view.

We report direct experimental observation of local conformational dynamics in a polymer chain at the calorimetric glass transition temperature Tg. Variable-temperature two-dimensional (2D) solid-state exchange NMR, at natural abundance, reveals segmental dynamics in pure polyisobutylene (PIB) occurring on a time scale of several seconds over the Tg range observed by DSC (203-208 K). To our knowledge, this is the first direct observation of molecular-level conformer interchange (trans-trans/trans-gauche/gauche-gauche) at the caloric glass transition temperature. Our results provide a chronologically accurate and pedagogically advantageous demonstration of molecular processes during a polymer phase transition, relative to traditional bulk mechanical and calorimetric techniques. More importantly, we use a miscible blend to demonstrate a general strategy for quantitative evaluation of configurational entropy changes via combination of temperature-dependent 2D exchange NMR and Adams-Gibbs theory. Our results on the Tg time scale are directly relevant to fundamental understanding of the Tg length scale, i.e., the dimension of cooperatively rearranging regions.

Journal Article↗
PubMed2006

Revisiting Bohr's semiclassical quantum theory.

Bohr's atomic theory is widely viewed as remarkable, both for its accuracy in predicting the observed optical transitions of one-electron atoms and for its failure to fully correspond with current electronic structure theory. What is not generally appreciated is that Bohr's original semiclassical conception differed significantly from the Bohr-Sommerfeld theory and offers an alternative semiclassical approximation scheme with remarkable attributes. More specifically, Bohr's original method did not impose action quantization constraints but rather obtained these as predictions by simply matching photon and classical orbital frequencies. In other words, the hydrogen atom was treated entirely classically and orbital quantized emerged directly from the Planck-Einstein photon quantization condition, E = h nu. Here, we revisit this early history of quantum theory and demonstrate the application of Bohr's original strategy to the three quintessential quantum systems: an electron in a box, an electron in a ring, and a dipolar harmonic oscillator. The usual energy-level spectra, and optical selection rules, emerge by solving an algebraic (quadratic) equation, rather than a Bohr-Sommerfeld integral (or Schroedinger) equation. However, the new predictions include a frozen (zero-kinetic-energy) state which in some (but not all) cases lies below the usual zero-point energy. In addition to raising provocative questions concerning the origin of quantum-chemical phenomena, the results may prove to be of pedagogical value in introducing students to quantum mechanics.

Journal Article↗
PubMed2000

Maintaining the Characteristics of Effective Clinical Teachers in Computer Assisted Learning Environments.

There has been a growing trend in medical education to integrate the use of computers into the undergraduate medical curriculum. While it seems intuitively obvious that personal computers and the Internet can be useful learning tools, it is not clear that the perceived advantages of Computer Assisted Instruction (CAI) are warranted. One problem is that computers are too often used in CAI simply as presentation devices for predefined material without ample consideration paid to the pedagogical principles that have informed more conventional teaching practices. The creation of an environment that is conducive to effective learning has often been overlooked in favour of the development and use of increasingly more sophisticated technologies. The current paper represents an attempt to delineate ways in which we might better develop instructional multimedia programs by employing some of the strategies believed to characterise effective clinical teaching. To do so, this paper will briefly review the work of Irby and others in an attempt to draw attention to ways in which the characteristics identified by these researchers might be implemented for the use of CAI.

Journal Article↗
PubMed1999

The European Biomedical Ethics Practitioner Education Project: an experiential approach to philosophy and ethics in health care education.

The European Biomedical Ethics Practitioner Education Project (EBEPE), funded by the BIOMED programme of the European Commission, is a five-nation partnership to produce open learning materials for healthcare ethics education. Papers and case studies from a series of twelve conferences throughout the European Union, reflecting the 'burning issues' in the participants' healthcare systems, have been collected by a team based at Imperial College, London, where they are now being edited into a series of seven activity-based workbooks for individual or group study. These draft workbooks are now being read by a network of critical readers across Europe, whose comments will be incorporated into the final versions of the workbooks. The result will be the first European-wide and Europe-centred resource for teaching students, practitioners, and members of ethics committees. Topics covered include: Resource allocation and rationing The rights of children and young people Long-term care of the elderly Mental health and mental illness Autonomy and patient choice Decisions at the end of life A study guide to using the workbooks. The collaborative nature of the project has highlighted differentiated national approaches in medical ethics. Against the British and Dutch rights-orientated approach have emerged two other alternative models: the Nordic preference for administrative resolution of entitlement disputes, and the southern European emphasis on deontological codes. A genuinely European reconstruction of autonomy and rights, using hermeneutic, feminist and narrative approaches to counterbalance individualistic models, is emerging across the workbooks. The programme has also uncovered national differences in how ethics should be taught, with the workbooks' style being an experiential approach. Thus the EBEPE project is developing new models in both substantive and pedagogic senses, about both what should be taught and how it should be presented.

Bioethics↗