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PubMed2004

Using Elearning techniques to support problem based learning within a clinical simulation laboratory.

This paper details the results of the first phase of a project that used eLearning to support students' learning within a simulated environment. The locus was a purpose built Clinical Simulation Laboratory (CSL) where the School's newly adopted philosophy of Problem Based Learning (PBL) was challenged through lecturers reverting to traditional teaching methods. The solution, a student-centred, problem-based approach to the acquisition of clinical skills was developed using learning objects embedded within web pages that substituted for lecturers providing instruction and demonstration. This allowed lecturers to retain their facilitator role, and encouraged students to explore, analyse and make decisions within the safety of a clinical simulation. Learning was enhanced through network communications and reflection on video performances of self and others. Evaluations were positive, students demonstrating increased satisfaction with PBL, improved performance in exams, and increased self-efficacy in the performance of nursing activities. These results indicate that an elearning approach can support PBL in delivering a student centred learning experience.

Attitude to Computers↗

PubMed2006

Open surgery in VR: inguinal hernia repair according to Lichtenstein.

VREST (Virtual Reality Educational Surgical Tools) is developing a universal and autonomous simulation platform which can be used for training and assessment of medical students and for continuing education of physicians. A workstation consisting of two haptic devices and a 3D vision system is part of the VREST platform. Another part of the platform is a generic software environment in which lessons can be built by the teacher and performed by their students. Using the platform one can see, feel and decide as in reality. With the assessment tool the progress and skills of the students can be supervised. The first lesson build on the VREST platform is an inguinal hernia repair according to Lichtenstein. This is an open surgery procedure. The VREST platform is used prior to the first operating room surgery of the resident. Interactive models and case dependent feedback is used to enlarge the residents' cognition. This should reduce the training time in the operating room.

Computer Simulation↗

PubMed1998

Automated acquisition system for routine, noninvasive monitoring of physiological data.

A fully automated, noninvasive data-acquisition system was developed to permit long-term measurement of physiological functions at home, without disturbing subjects' normal routines. The system consists of unconstrained monitors built into furnishings and structures in a home environment. An electrocardiographic (ECG) monitor in the bathtub measures heart function during bathing, a temperature monitor in the bed measures body temperature, and a weight monitor built into the toilet serves as a scale to record weight. All three monitors are connected to one computer and function with data-acquisition programs and a data format rule. The unconstrained physiological parameter monitors and fully automated measurement procedures collect data noninvasively without the subject's awareness. The system was tested for 1 week by a healthy male subject, aged 28, in laboratory-based facilities.

Activities of Daily Living↗

PubMed2004

Programming of a flexible computer simulation to visualize pharmacokinetic-pharmacodynamic models.

Teaching pharmacokinetic-pharmacodynamic (PK/PD) models can be made more effective using computer simulations. We propose the programming of educational PK or PK/PD computer simulations as an alternative to the use of pre-built simulation software. This approach has the advantage of adaptability to non-standard or complicated PK or PK/PD models. Simplicity of the programming procedure was achieved by selecting the LabVIEW programming environment. An intuitive user interface to visualize the time courses of drug concentrations or effects can be obtained with pre-built elements. The environment uses a wiring analogy that resembles electrical circuit diagrams rather than abstract programming code. The goal of high interactivity of the simulation was attained by allowing the program to run in continuously repeating loops. This makes the program behave flexibly to the user input. The programming is described with the aid of a 2-compartment PK simulation. Examples of more sophisticated simulation programs are also given where the PK/PD simulation shows drug input, concentrations in plasma, and at effect site and the effects themselves as a function of time. A multi-compartmental model of morphine, including metabolite kinetics and effects is also included. The programs are available for download from the World Wide Web at http:// www. klinik.uni-frankfurt.de/zpharm/klin/ PKPDsimulation/content.html. For pharmacokineticists who only program occasionally, there is the possibility of building the computer simulation, together with the flexible interactive simulation algorithm for clinical pharmacological teaching in the field of PK/PD models.

Algorithms↗

PubMed2005

[Psychotherapy, from human environment].

Therapy for Schizophrenia has two stages; it is built on medical model during acute phase, and social support model during recovering phase. We are required to pay attention to both approaches, and we also need what millieu therapy has once excluded from care. Psychotherapy for Schizophrenia is defined as "respects, such as reliability during acute phase and care for maintenance of social functioning."

Humans↗

PubMed2005

Bioreactors for tissue mass culture: design, characterization, and recent advances.

This paper reviews reports on three-dimensional mammalian tissue growth in bioreactors and the corresponding mammalian tissue growth requirements. The needs for nutrient and waste removal of several mammalian tissues are reviewed and compared with the environment of many reactors currently in use such as the continuous stirred tank, the hollow fiber, the Couette-Taylor, the airlift, and the rotating-wall reactors developed by NASA. Many studies conclude that oxygen supply appears to be one of the most important factors limiting tissue growth. Various correlations to describe oxygen mass transfer are presented and discussed with the aim to provide some guidance to design, construct, and test reactors for tissue mass culture. To obtain tissue thickness clinically valuable, dimensionless and other types of analysis tend to point out that diffusive transport will have to be matched with an important convection to bring sufficient oxygen molecular flux to the growing cells located within a tissue mass. As learned from solid-state fermentation and hairy root culture, during the growth of large biomass, heterogeneity (i.e., channeling, temperature gradients, non-uniform cell growth, transfer gradients, etc.) can cause some important problems and these should be addressed in tissue engineering as well. Reactors (along with the scaffolds) should be designed to minimize these issues. The role of the uterus, the reactor built by Nature, is examined, and the environment provided to a growing embryo is reported, yielding possible paths for further reactor developments. Finally, the importance of cell seeding methods is also addressed.

Animals↗

PubMed2003

Place matters in physician practice and learning.

Since the early 1960s, most discussions about the improvement of continuing medical education (CME) have begun by seeking a better understanding of how physicians learn. The goal of this movement has been to put physician learners and their learning needs, not new research findings, at the center of the educational process. This has led CME away from the update model of education and into many innovative and exciting educational developments. However, as the conditions of medical practice have been changing in the past 20 years, the possibilities and conceptions of CME have also changed. Many in medicine and CME now recognize that the real world of physician decision making takes place in a highly charged political-economic context, where the interaction between the patient and physician is perhaps the least complex element. From this fundamental starting point, an emerging discourse has begun in CME that addresses physicians' changing work environments, the accountability schemes and financial incentives built into medical practice, and the importance of physicians' community of peers in making practice changes. We need to build on these observations to change the focus from "how physicians learn" to "where physicians learn." From this new perspective, physician practice and learning are seen as fundamentally social acts, and our attention is drawn to all of the ways in which "place matters." Attention to where physicians practice and learn can be used to improve CME.

Education, Medical, Continuing↗

PubMed1998

Structural homology of the central conserved region of the attachment protein G of respiratory syncytial virus with the fourth subdomain of 55-kDa tumor necrosis factor receptor.

The attachment protein G of respiratory syncytial virus (RSV) has a modular architecture. The ectodomain of the protein comprises a small folded conserved region which is bounded by two mucin-like regions. In this study, a sequence and structural homology is described between this central conserved region of RSV-G and the fourth subdomain of the 55-kDa tumor necrosis factor receptor (TNFr). The three-dimensional structures of RSV-G and human TNFr were previously determined with NMR spectroscopy and X-ray crystallography, respectively. The C-terminal part of both subdomains fold into a cystine noose connected by two cystine bridges with the same spacing between cysteine residues and the same topology. Although a general structural similarity is observed, there are differences in secondary structure and other structural features. Molecular Dynamics calculations show that the BRSV-G NMR structure of the cystine noose is stable and that the TNFr crystal structure of the cystine noose drifts towards the BRSV-G NMR structure in the simulated solution environment. By homology modelling a model was built for the unresolved N-terminal part of the central conserved region of RSV-G. The functions for both protein domains are not known but the structural similarity of both protein domains suggests a similar function. Although the homology suggests that the cystine noose of RSV-G may interfere with the antiviral and apoptotic effect of TNF, the biological activity remains to be proven.

Amino Acid Sequence↗

PubMed1982

Are environmental scanning units effective?

Many authorities have urged companies to set up environmental scanning to assist corporate planning. Some advocates have recommended a unit at corporate level. This would give breadth of view and penetration into the future. It would arm decision makers with accurate forecasts. The information would be broad in scope and future directed. It could provide also assumptions for long-range planning. The Fahey and King study produced a model of corporate scanning types. The data showed that environmental information was built into the plan. Though the political environment was important, scanning was inadequate. The best location for scanning was not at corporate level and most firms used irregular methods. The Thomas study concluded that effective environmental scanning was permanent and multi level and that 'best practice' was continuous scanning. In 1978 the sample organizations were revisited. Five of the twelve have not changed their practice. The factors which encouraged a continuous model were the attitudes of academics and business media, demonstrated success of the units, the right kind of personnel. Contrary influences were changes in top management, decentralization moves, resource cuts, defining the environment and its significance, the availability of scanning competent personnel, surprise itself, and the availability of alternatives e.g. external forecasts.

Forecasting↗

PubMed2005

Focal adhesions as mechanosensors: the two-spring model.

Adhesion-dependent cells actively sense the mechanical properties of their environment through mechanotransductory processes at focal adhesions, which are integrin-based contacts connecting the extracellular matrix to the cytoskeleton. Here we present first steps towards a quantitative understanding of focal adhesions as mechanosensors. It has been shown experimentally that high levels of force are related to growth of and signaling at focal adhesions. In particular, activation of the small GTPase Rho through focal adhesions leads to the formation of stress fibers. Here we discuss one way in which force might regulate the internal state of focal adhesions, namely by modulating the internal rupture dynamics of focal adhesions. A simple two-spring model shows that the stiffer the environment, the more efficient cellular force is built up at focal adhesions by molecular motors interacting with the actin filaments.

Animals↗

PubMed2000

Three-dimensional structure of nucleoside diphosphate kinase.

Three-dimensional structures are known from X-ray studies of the nucleoside diphosphate (NDP) kinase of many organisms from bacteria to human. All NDP kinases have subunits of about 150 residues with a very similar fold based on the alphabeta sandwich or ferredoxin fold. This fold is found in many nucleotide or polynucleotide-binding proteins with no sequence relationship to NDP kinase. This common fold is augmented here with specific features: a surface alpha-helix hairpin, the Kpn loop, and the C-terminal extension. The alpha-helix hairpin and Kpn loop make up the nucleotide binding site, which is unique to NDP kinase and different from that of other kinases or ATPases. The Kpn loop and the C-terminal extension are also involved in the quaternary structure. Whereas all known eukaryotic NDP kinases, including mitochondral enzymes, are hexamers, some bacterial enzymes are tetramers. However, hexameric and tetrameric NDP kinases are built from the same dimer. The structural environment of the active histidine is identical in all. The nucleotide binding site is also fully conserved, except for a feature implicating C-terminal residues in the hexamer, but not in the tetramer. Structural data on the native and phosphorylated enzyme, complexes with substrates, inhibitor, and a transition state analog, give a solid basis to a mechanism of phosphate transfer in which the largest contributors to catalysis are the 3'-OH of the sugar and the bound Mg2+ in the nucleotide substrate. In contrast, we still lack structural data relating to DNA binding and other functions of NDP kinases.

Animals↗

PubMedDate not supplied

A collaborative perspective on nursing leadership in quality improvement. The foundation for outcomes management and patient/staff safety in health care environments.

By 2004, only organizations whose institutional operating strategies are built on a continual state of readiness and include performance improvement practices throughout the organization are going to successfully meet Joint Commission on Accreditation of Healthcare Organizations standards. As stewards of patient care, nurses maintain a unique role in identifying and guiding the intervention processes central to quality care, which prepares them to become key players/designers of a paradigm that demonstrates commitment to establishing and maintaining quality care. However, without recognition and support from organization leadership and physicians, the opportunity to effectively use the capabilities of nursing may be lost. The collaborative perspectives offered here attest to the fact that mutual belief and vision, coupled with creativity, strategic planning, and implementation, can effectively mobilize resources to establish priority measures and achieve quality patient/safety outcomes within the organization. Shifting the paradigm from just meeting the standards to continual readiness and performance improvement throughout the organization then becomes mission and mantra.

Cooperative Behavior↗

PubMedDate not supplied

Highly effective techniques in computerized dental tissue morphometry.

The effectiveness of computer-aided morphometry is greatly dependent on the capabilities of the software platforms, but the literature provides only information about the measurement methods and their medical interpretation. The purpose of our work is to create a link between the technical algorithm and the medical significance, by a detailed description of measurement procedures, accompanied by the interpretation of their results. The developed techniques operate at a pixel level, by deriving a full benefit from the computational resources available in the modern software environments for image processing. The approach is built on three illustrative cases, formulated in a large sense, so as to cover classes of general problems, referring to cellular entities and tubular structures in cross and longitudinal section. Specimens belonging to the dentin-pulp complex were chosen, because they permit a quantitative analysis for each morphological element, as well as comparative discussion. With appropriate adaptations of the procedures, the measurements of other types of normal and pathological tissues can be analogously addressed. The design, implementation and exploitation of our procedures are supported by specific references to the use of an image analysis system (Zeiss KS400). The algorithmic background remains valid (except for some possible minor changes) when similar software is used. Consequently, the results and their interpretations, prove the importance of the numerical analysis in automating the quantitative evaluation of the structural features.

Algorithms↗

PubMed2002

Intelligent multichannel stimulator for the study of cardiac arrhythmias.

An intelligent multichannel stimulator (IMS) has been designed and built for use in a cardiac research environment. The device is capable of measuring and responding to cardiac electrophysiological phenomena in real time with carefully timed and placed electrical stimuli. The system consists of 16 channels of sense/stimulation electronics controlled by a digital signal processor (DSP) data acquisition card and a host computer and can be expanded to include more channels. The DSP allows for powerful and flexible algorithms to be implemented for real-time interaction with the cardiac tissue. Although a number of possible uses can be conceived for such a device, the initial motivation was to improve upon attempts to terminate fibrillation by pacing. The IMS was tested in an open-chest animal model, both in sinus rhythm and during fibrillation. It was shown to be an effective research tool by demonstrating the ability to measure and respond to cardiac activations in real time using complex numerical algorithms and appropriately timed stimuli.

Algorithms↗

PubMed2005

Reduction and methylation of mercury in the terrestrial isopod Porcellio scaber (Crustacea) and its environment.

Reduction and methylation of inorganic mercury in Porcellio scaber (Isopoda, Crustacea) and its environment were studied, using a purpose-built experimental setup where Hg cycling was followed using 203Hg2+ tracer in experiments without and with isopods. In experiment without isopods, daily reduction of 203Hg2+ to 203Hg0 under sterile and nonsterile conditions was measured for three weeks to assess the contribution of bacteria to this process. In experiments with isopods, daily release of 203Hg0 was measured for two weeks. Total mercury (T203Hg) and monomethylmercury (Me203Hg) in whole animals, gut, digestive glands (hepatopancreas), food (hazelnut leaves), and feces were measured to obtain the assimilation and distribution of mercury in the animals, to investigate the origin and fate of Me203Hg, and, finally, to assess the mass balance of mercury in the experimental system. Experiment without isopods showed the important role of bacteria in reduction of 203Hg2+ to 203Hg0, especially in the first day of the experiment. Experiments with isopods showed that formation of 203Hg0 depended on the 203Hg2+ concentration in the food. The contribution of the isopod's digestive flora in reduction of 203Hg2+ to 203Hg0 was negligible. Approximately 3% of T203Hg and 2% of Me203Hg consumed was assimilated by the animals. Methylation of 203Hg2+ occurred already in the leaves before they were consumed by the isopods. Assimilation of Me203Hg from the food surprisingly was low. Also, a loss of Me203Hg was noticed when comparing assimilated and excreted Me203Hg versus consumed Me203Hg. This may be explained by the assumption that demethylation of MeHg prevailed over methylation of Hg2+ in the animal's digestive system, leading to excretion of ingested mercury as Hg2+.

Animals↗

PubMedDate not supplied

[Culture, identity, and work: interrelation of concepts].

The purpose of this article is to reflect on the interrelation of the concepts of culture, identity and work. It is believed that this reflection is a contribution to studies which aim at understanding the process of the identity construction of the nursing professional. It is based on the premise that identity is built day by day in the work environment, and, among other references, within a given culture.

Brazil↗

PubMed2003

Imaging small animals with positron emission tomography.

During the past few years many research centers have successfully applied their knowledge of positron emission tomography (PET) to construct PET scanners which are dedicated to image small animals such as rats and mice. Although there are many in-house built systems which are used in laboratory environments, only a few of them are commercially available at this time. This review will give an overview of dedicated animal PET systems with their technical description and main physical characteristics. Graphical analysis of spatial resolution against absolute sensitivity allows a comparison of the most important characteristics of each camera. The quadHIDAC, a PET scanner recently installed at the Department of Nuclear Medicine, University Hospital Münster, acquires images with sub-millimeter spatial resolution. A (18)F-FDG whole body image of a mouse with small structures like the left ventricle of the heart clearly visualized, demonstrates its excellent spatial resolution.

Animals↗

PubMed1992

Lead intoxication in Iowa children.

In Iowa, there are over 600,000 residential units built before 1950 which are high risk environments for children due to deteriorating lead paint. However, there are relatively few lead screening programs in Iowa, and only selected children in Iowa have been screened.

Age Factors↗