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Using interactive software to teach image-based clinical laboratory tests in developing countries: a pilot trial in Nepal.

This study explores the feasibility of using computer tutorials to train laboratory personnel in Nepal. Training incorporated three software programs that teach microscope-based laboratory tests (peripheral blood smears, urinalysis, Gram stains). Forty-seven participants attended training sessions and completed a questionnaire. The participants' overall perception was: 1) the software was superior to formal lectures for learning image-based laboratory tests (43 participants, 92%); 2) the software would enhance job performance (43 participants, 92%); 3) more subjects should be taught using software (40 participants, 85%); and 4) the software helped participants learn new materials (38 participants, 81%). Considering that 79% of the participants were novice computer users, it is noteworthy that 38 (81%) participants thought the method of instruction was easy to understand. Factors contributing to learning included: 1) the resemblance of the computer images to actual microscope images derived from patient samples (37 participants, 68%); 2) the use of multiple examples of cells and other microscopic structures (28 participants, 60%); 3) the ability to interact with images and animations (23 participants, 49%); 4) the step-by-step explanation of laboratory techniques (21 participants, 45%); and 5) the self-pacing of the tutorial (12 participants, 26%). Overall, the pilot study suggests that educational software could help train clinical laboratory personnel in developing countries.

Adolescent↗

Two different approaches to computer-aided teaching of microbial genetics.

Two computer packages have been developed to teach bacterial genetics on an introductory genetics course for undergraduate students in biology. The first package, 'CONJUGACION', is designed to teach bacterial conjugation and its genetic outcomes. It includes four main parts. Firstly, a tutorial part presents a theoretical framework using screens of text and animated graphics. Secondly, an interactive concept application section requires students to carry out experiments for the determination of the correct sex and genotype of 10 bacterial strains. The third part uses the previously obtained data for simulating interrupted mating experiments and mapping the bacterial genome. Finally, an evaluation section allows the students to test their understanding through a series of multiple choice questions. The second package, 'LURIDEL', is intended for teaching the preadaptative character of mutation in bacterial populations on the basis of the fluctuation test of Luria and Delbrück. It simulates, graphically, the appearance of mutations in microbial cultures and gives results of simulated fluctuation experiments. Programs were written under the PCOS operating system in MBASIC extended to graphics for running on Olivetti M20 microcomputers.

Computer-Assisted Instruction↗

An online interactive simulation system for medical imaging education.

This report presents a recently developed web-based medical imaging simulation system for teaching students or other trainees who plan to work in the medical imaging field. The increased importance of computer and information technology widely applied to different imaging techniques in clinics and medical research necessitates a comprehensive medical imaging education program. A complete tutorial of simulations introducing popular imaging modalities, such as X-ray, MRI, CT, ultrasound and PET, forms an essential component of such an education. Internet technologies provide a vehicle to carry medical imaging education online. There exist a number of internet-based medical imaging hyper-books or online documentations. However, there are few providing interactive computational simulations. We focus on delivering knowledge of the physical principles and engineering implementation of medical imaging techniques through an interactive website environment. The online medical imaging simulation system presented in this report outlines basic principles underlying different imaging techniques and image processing algorithms and offers trainees an interactive virtual laboratory. For education purposes, this system aims to provide general understanding of each imaging modality with comprehensive explanations, ample illustrations and copious references as its thrust, rather than complex physics or detailed math. This report specifically describes the development of the tutorial for commonly used medical imaging modalities. An internet-accessible interface is used to simulate various imaging algorithms with user-adjustable parameters. The tutorial is under the MATLAB Web Server environment. Macromedia Director MX is used to develop interactive animations integrating theory with graphic-oriented simulations. HTML and JavaScript are used to enable a user to explore these modules online in a web browser. Numerous multiple choice questions, links and references for advanced study are provided in the tutorial for trainees to verify their understanding of each unit. It is expected that this tutorial will enhance medical imaging education, help trainees in subsequent analysis of image data, and form the basis for the development of more advanced technologies in the future.

Computer Simulation↗

The dynamic neural field approach to cognitive robotics.

This tutorial presents an architecture for autonomous robots to generate behavior in joint action tasks. To efficiently interact with another agent in solving a mutual task, a robot should be endowed with cognitive skills such as memory, decision making, action understanding and prediction. The proposed architecture is strongly inspired by our current understanding of the processing principles and the neuronal circuitry underlying these functionalities in the primate brain. As a mathematical framework, we use a coupled system of dynamic neural fields, each representing the basic functionality of neuronal populations in different brain areas. It implements goal-directed behavior in joint action as a continuous process that builds on the interpretation of observed movements in terms of the partner's action goal. We validate the architecture in two experimental paradigms: (1) a joint search task; (2) a reproduction of an observed or inferred end state of a grasping-placing sequence. We also review some of the mathematical results about dynamic neural fields that are important for the implementation work.

Animals↗

A new method to estimate ligand-receptor energetics.

In the discovery of new drugs, lead identification and optimization have assumed critical importance given the number of drug targets generated from genetic, genomics, and proteomic technologies. High-throughput experimental screening assays have been complemented recently by "virtual screening" approaches to identify and filter potential ligands when the characteristics of a target receptor structure of interest are known. Virtual screening mandates a reliable procedure for automatic ranking of structurally distinct ligands in compound library databases. Computing a rank score requires the accurate prediction of binding affinities between these ligands and the target. Many current scoring strategies require information about the target three-dimensional structure. In this study, a new method to estimate the free binding energy between a ligand and receptor is proposed. We extend a central idea previously reported (Bock, J. R., and Gough, D. A. (2001) Predicting protein-protein interactions from primary structure. Bioinformatics 17, 455-460; Bock, J. R., and Gough, D. A. (2002) Whole-proteome interaction mining. Bioinformatics, in press) that uses simple descriptors to represent biomolecules as input examples to train a support vector machine (Smola, A. J., and Schölkopf, B. (1998) A Tutorial on Support Vector Regression, Neuro-COLT Technical Report NC-TR-98-030, Royal Holloway College, University of London, UK) and the application of the trained system to previously unseen pairs, estimating their propensity for interaction. Here we seek to learn the function that maps features of a receptor-ligand pair onto their equilibrium free binding energy. These features do not comprise any direct information about the three-dimensional structures of ligand or target. In cross-validation experiments, it is demonstrated that objective measurements of prediction error rate and rank-ordering statistics are competitive with those of several other investigations, most of which depend on three-dimensional structural data. The size of the sample (n = 2,671) indicates that this approach is robust and may have widespread applicability beyond restricted families of receptor types. It is concluded that newly sequenced proteins, or those for which three-dimensional crystal structures are not easily obtained, can be rapidly analyzed for their binding potential against a library of ligands using this methodology.

Drug Design↗

Techniques for rapid quantitative assessment of activity levels in small-group tutorials.

Two techniques for the rapid quantitative analysis of student participation in small-group teaching were investigated. In the first approach an observer, who also acted as a 'critical friend', recorded the length of individual contributions using a computer keyboard as a simple timing device. In the second approach, small-group sessions were recorded with a portable stereophonic audiotape recorder. The teacher was recorded on one channel, all students on the other. A computer program produced automated analysis of these small group interactions by computing relative amount of speech on each channel. Simple analysis produced automatically by the programs revealed the overall style of the tutorial--variably 'mini-lectures' by teachers with very little participation by the student body, rapid 'question and answer' sessions with about equal teacher/student body involvement or 'mini-presentations' by students with the teacher offering sparse comments in the manner of a facilitator. By presenting results in a graphic format, teachers can be given rapid objective feedback on their teaching style. Coupled with short verbal/non-verbal quizzes at the end of tutorials and information from other assessments, the value of using levels of participation as a measure of the efficiency of such small-group sessions can itself be assessed.

Computer-Assisted Instruction↗

The quality of student-tutor interactions in the clinical learning environment.

We surveyed 403 students in their clinical years for their perceptions of the quality of clinical clerkships. Between 42.6 and 67.0% of tutorials were said to contain positive factors such as a relaxed teaching atmosphere, enthusiasm, a good selection of patients and adequate preparation. Negative features in 18.2-37.2% of tutorials included unreasonable expectations, conflicting information, late arrival, early departure, failure to show up and the display of anger, a patronizing attitude, favouritism or ridicule. While two-thirds of tutors were regarded as friendly and helpful, the remaining one-third were perceived as unconcerned, discouraging, derogatory or hostile. Overall, only half the clinical tutors were rated as effective teachers; more specifically in medicine and psychiatry, less than one-third of consultants were regarded as effective teachers, as compared with some two-thirds of consultants in obstetrics and gynaecology and paediatrics who were so regarded. Almost two-thirds of the students had predominantly positive reactions to interactions with their tutors, in terms of being motivated to learn, enthused about the subject and having their self-confidence increased. Some one-quarter had negative reactions such as indifference, depression, anger, embarrassment and fearfulness. However, the impact of student-tutor interactions was mainly confined to the students' academic well-being, with little effect on their personal-social lives. Finally, one-third of students had experienced at least some form of mistreatment by their tutors, including gender, appearance, religious and racial discrimination, unfair grading and public humiliation. These findings suggest that the clinical clerkship may not be providing an optimal learning environment for medical students.

Clinical Clerkship↗

A problem-based course in dental implantology.

A problem-based predoctoral implantology course was implemented for ten senior dental students at the University of Texas Health Science Center at San Antonio. Students met in small tutorial groups three times a week to analyze patient cases developed for the course. As students explored the patient's problems, they identified areas where their knowledge was deficient, as well as special interests, and prioritized these areas, known as learning issues, into a learning agenda for subsequent study. During unprogrammed free time between tutorials, students researched the learning issues, and came to the next tutorial prepared to discuss what they had learned and in so doing, helped their peers learn the material. The faculty tutor used non-directive questioning to facilitate group problem-solving and promote interaction but did not lecture or give answers. The cases were developed in the "progressive disclosure paperback" format, reflecting the evolving nature of the patient's implant therapy. In conjunction with the PBL tutorials, students performed implant surgery and prosthodontics on a minimum of three patients and provided maintenance therapy on three to four other implant patients. Course evaluation consisted of three elements: (1) weekly peer evaluation by the students using a six item checklist, (2) tutor evaluation, using the same checklist, and (3) an oral examination. The tutor met individually with each student midway through the course and at the conclusion to summarize the peer evaluations and discuss the student's performance, including contributions to group process. Student reaction to this PBL experience was enthusiastically supportive, and student performance exceeded faculty expectations.

Attitude↗

The Wellcome Trust tropical diseases videodisc project.

This presentation sets out the aims and methodology involved in creating a sophisticated teaching archive in tropical medicine based on the Wellcome Museum of Medical Science. This visual archive will take the form of a videodisc database containing 30,000 video stills combined with a limited amount of moving material. While authoring tools will ensure the continuing production of interactive learning material from the archive, users will have access to several hundred hours of ready made tutorials, and an expert system to teach clinical skills. They will also be able to browse through any part of the archive. Successful management strategies have involved a close and supportive relationship with the project sponsors, the formation of expert groups to solve specific problems, and a process of continuous formative evaluation.

Humans↗

Using CAI to accommodate a variety of learning styles in a biomechanics course.

Multimedia technology offers a more interactive approach to instruction than the traditional classroom lectures. Through computer-aided instruction (CAI), a number of teaching styles can be used that take into account the different preferences of the students. The Biomechanics Tutorial program that the authors have written is a CAI that incorporates audio, video, simulations, and graphics to: review concepts of mechanics (kinematics and kinetics of interconnected rigid bodies), familiarize students with functional anatomy, and allow students to interactively evaluate the law of mechanics applied to physical performance of activities modeled by a set of biomechanical models of the joints. Principles of ergonomics are reinforced by enabling the student to perform numerous numerical experiments within the context of workplace or task redesign and see the real time consequences of these alterations. For example, the task of holding a load is simulated by allowing the student to change elbow and shoulder angles and the orientation and magnitude of the load. The consequences of these in terms of required muscle forces and joint reaction forces at the elbow and shoulder will be updated on the screen. The detailed rationale of developing this Biomechanics Tutorial which integrates a variety of learning styles will be presented.

Biomechanical Phenomena↗

Heterogeneous enantioselective catalysts: strategies for the immobilisation of homogeneous catalysts.

Enantioselective formation of C-H, C-C, C-O and C-N bonds has been extensively studied using homogeneous asymmetric catalysts for many years. However, these catalysts have yet to make a significant impact in the industrial synthesis of fine chemicals. A central reason is that homogeneous asymmetric catalyst design requires relatively bulky ligands and catalyst re-use through recovery and recycle often causes problems. One mechanism to overcome this problem is to immobilise the asymmetric catalyst onto a support and the resulting heterogeneous asymmetric catalyst can, in principle, be readily re-used. This tutorial review covers the different methodologies for immobilisation, including: adsorption, encapsulation, tethering using a covalent bond and electrostatic interaction and is aimed at both researchers new to the field and those with a wider interest in the immobilisation of homogeneous catalysts. Most importantly, recent studies will be highlighted that demonstrate that immobilised catalysts can give higher enantioselection when compared with their non-immobilised counterparts and the question of how high enantioselection can be achieved is addressed.

Adsorption↗

Simulating genetic networks made easy: network construction with simple building blocks.

UNLABELLED: We present SIM-plex, a genetic network simulator with a very intuitive interface in which a user can easily specify interactions as simple 'if-then' statements. The simulator is based on the mathematical model of Piecewise Linear Differential Equations (PLDEs). With PLDEs, genetic interactions are approximated as acting in a switch-like manner. AVAILABILITY: The Java program, examples and a tutorial are available at http://www.psb.ugent.be/cbd/ CONTACT: {stcru,makui}@psb.ugent.be

Algorithms↗

Clinical role models are important in the early years of a problem-based learning curriculum.

Following a comprehensive study of the role models identified by the first five years of students in a traditional medical programme, it was hypothesized that with curriculum reform clinical role models would assume greater importance earlier in the undergraduate medical programme. Indeed, when compared with their first- and second-year traditional curriculum colleagues, more problem-based learning students identified role models. Almost four times as many identified faculty role models (largely medically qualified) in comparison with their traditional curriculum counterparts. Concomitant with this increase was a decline in the selection by the PBL students of family members, friends and other students as role models. For all cohorts, however, the mother was the most important role model. Since students in integrated curricula have earlier clinical experience and patient contact, they interact with clinicians in hospitals and clinics as well as in the academic environment of the small-group tutorial and lecture theatres. Academic faculty members, particularly clinicians, need to be aware that students take note of their attitudes and behaviour as members of the medical profession, a profession that students had chosen as a career. Retraining of senior doctors from the traditional curriculum might be necessary to ensure that all clinicians have an equivalent understanding of patient care.

Adolescent↗

Developments in the instruction of biostatistics at the Kuwait University Health Science Centre in a decade.

BACKGROUND: Kuwait has witnessed many changes that influenced, among other things, the structure of medical education including biostatistics. This article describes the developments in biostatistics instruction and curriculum in the Health Science Centre, University of Kuwait, during the past 10 years. DESCRIPTION: Instead of teaching biostatistics as an independent component, the university has developed an integrated course (35 hr of lectures and 12 hr of tutorial sessions) of biostatistics, epidemiology, and demography that is taught to undergraduate medical and dentistry students to ensure interdisciplinary interaction, to remove redundancies, and to standardize terminology across the three disciplines. The core curriculum of the biostatistics course is compatible with the recommendations of the American Statistical Association. Separate biostatistics courses are also offered to pharmacy and allied health students to address their diverse interests. In addition, new biostatistics and computer applications instruction courses were developed and are taught to the students of the Master of Science (MSc), Master of Public Health (MPH), and PhD programs. For continuing medical education, a workshop on biostatistics and computer applications is organized annually for the medical profession as a collaboration between the Health Science Centre and the Kuwait Institute for Medical Specialization. EVALUATION: The instructor and curriculum content of the biostatistics courses are confidentially evaluated and independently analyzed by the office of the Vice Dean for Academic Affairs. Overall, students evaluate the biostatistics instructors highly and are pleased with the content of the biostatistics curriculum. CONCLUSIONS: During the last decade, biostatistics instruction in the Kuwait Health Science Centre had many new developments. An integrated course on biostatistics, epidemiology, and demography was developed with emphasis on problem solving and small group learning. Another biostatistics course is offered to the students of the new faculty of pharmacy. Further biostatistics courses became operational for the postgraduate programs: (MSc), (MPH), and PhD. Continuing medical education is supported by workshops, which is a sign of collaboration with the health community, and a consultancy office has been established. Overall, biostatistics instruction is well received by students, and the role of biostatistics is recognized by researchers from the medical profession.

Biometry↗

[Tutorial systems of computer-assisted self-instruction. A review].

Recent trends of pedagogy point out the importance of self-learning, which represents one of the applied models of mastery learning. This article reviews the characteristics of self-learning methods based on the use of computer. Computer aided instruction (CAI) systems include tutorials, drill & practice, evaluation, simulation programs. Particularly, tutorials are considered and compared with other learning methods. Their basic requirements are defined, especially the necessity to be interactive so that students could participate in the instructional process. Other aspects, regarding quality, help facilities, retrieval facilities, utilization easiness, interest of students, efficacy are considered. However, CAI systems do not completely substitute traditional teaching methods: they are regarded as being complementary to them and innovative, and as making learning more interesting and gratifying for the students.

Computer-Assisted Instruction↗

Generating explanations and tutorial problems from Bayesian networks.

We present a system that generates explanations and tutorial problems from the probabilistic information contained in Bayesian belief networks. BANTER is a tool for high-level interaction with any Bayesian network whose nodes can be classified as hypotheses, observations, and diagnostic procedures. Users need no knowledge of Bayesian networks, only familiarity with the particular domain and an elementary understanding of probability. Users can query the knowledge base, identify optimal diagnostic procedures, and request explanations. We describe BANTER's algorithms and illustrate its application to an existing medical model.

Algorithms↗

An interactive, student-centered approach, adopting the SOLO taxonomy, for learning to analyze laboratory data in veterinary clinical pathology.

INTRODUCTION: The purpose of this study was to describe and evaluate an interactive, student-centered teaching strategy for learning to analyze laboratory data in veterinary clinical pathology. The strategy was designed to operate in tutorials of approximately one hour duration and adopted the structure of the observed learning outcome (SOLO) taxonomy in order to align with outcomes and assessment components of unit of study design and to encourage a deep approach to learning. METHODOLOGY: The teaching strategy adopted group discussion and reflective observation as core activities. Students worked alone in identifying abnormal laboratory data, in pairs in discussing possible reasons for the abnormalities, and in two larger groups in deciding on conclusions for, and further investigation and management of, the case. The final debriefing brought the two groups together to reflect, question, and reach a consensus about the case. The teaching strategy was evaluated on the basis of its success in encouraging interaction through discussion, developing self confidence in analyzing laboratory data, and enhancing understanding as to how the disciplines of veterinary clinical pathology and veterinary medicine interrelate. Evaluation used self-reflection, peer feedback, and a student questionnaire. CONCLUSION: The teaching strategy provided the opportunity for students to develop and practice an approach to the analysis of laboratory data in a manner consistent with current educational thinking on student-centered learning. The use of group discussion and significant reflective practice not only enhanced interpersonal skills but also encouraged a deep approach to learning, leading to ownership of knowledge and increased awareness of the worth of veterinary clinical pathology in the investigative process.

Animals↗

Sign language recognition and translation: a multidisciplined approach from the field of artificial intelligence.

In recent years, research has progressed steadily in regard to the use of computers to recognize and render sign language. This paper reviews significant projects in the field beginning with finger-spelling hands such as "Ralph" (robotics), CyberGloves (virtual reality sensors to capture isolated and continuous signs), camera-based projects such as the CopyCat interactive American Sign Language game (computer vision), and sign recognition software (Hidden Markov Modeling and neural network systems). Avatars such as "Tessa" (Text and Sign Support Assistant; three-dimensional imaging) and spoken language to sign language translation systems such as Poland's project entitled "THETOS" (Text into Sign Language Automatic Translator, which operates in Polish; natural language processing) are addressed. The application of this research to education is also explored. The "ICICLE" (Interactive Computer Identification and Correction of Language Errors) project, for example, uses intelligent computer-aided instruction to build a tutorial system for deaf or hard-of-hearing children that analyzes their English writing and makes tailored lessons and recommendations. Finally, the article considers synthesized sign, which is being added to educational material and has the potential to be developed by students themselves.

Artificial Intelligence↗