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Sample records for objective structured clinical

  1. Objective Structured Clinical Examination (OSCE) Revisited.

    PubMed

    Gupta, Piyush; Dewan, Pooja; Singh, Tejinder

    2010-11-01

    Objective structured clinical examination (OSCE) was introduced in 1975 as a standardized tool for objectively assessing clinical competencies - including history-taking, physical examination, communication skills, data interpretation etc. It consists of a circuit of stations connected in series, with each station devoted to assessment of a particular competency using pre-determined guidelines or checklists. OSCE has been used as a tool for both formative and summative evaluation of medical graduate and postgraduate students across the globe. The use of OSCE for formative assessment has great potential as the learners can gain insights into the elements making up clinical competencies as well as feedback on personal strengths and weaknesses. However, the success of OSCE is dependent on adequacy of resources, including the number of stations, construction of stations, method of scoring (checklists and or global scoring), the number of students assessed, and adequate time and money. Lately, OSCE has drawn some criticism for its lack of validity, feasibility, practicality, and objectivity. There is evidence to show that many OSCEs may be too short to achieve reliable results. There are also currently no clear cut standards set for passing an OSCE. It is perceived that OSCEs test the students knowledge and skills in a compartmentalized fashion, rather than looking at the patient as a whole. This article focuses on the issues of validity, objectivity, reliability, and standard setting of OSCE. Presently, the Indian experiences with OSCE are limited and there is a need to sensitise the Indian faculty and students. A cautious approach is desired before it is considered as a supplementary tool to other methods of assessment for the summative examinations in Indian settings.

  2. Objective structured clinical examination in radiology

    PubMed Central

    Agarwal, Anurag; Batra, Bipin; Sood, AK; Ramakantan, Ravi; Bhargava, Satish K; Chidambaranathan, N; Indrajit, IK

    2010-01-01

    There is a growing need for introducing objective structured clinical examination (OSCE) as a part of radiology practical examinations in India. OSCE is an established, reliable, and effective multistation test for the assessment of practical professional skills in an objective and a transparent manner. In India, it has been successfully initiated and implemented in specialties like pediatrics, ophthalmology, and otolaryngology. Each OSCE station needs to have a pre-agreed “key-list” that contains a list of objective steps prepared for uniformly assessing the tasks given to students. Broadly, OSCE stations are classified as “manned” or “unmanned” stations. These stations may include procedure or pictorial or theory stations with clinical oriented contents. This article is one of a series of measures to initiate OSCE in radiology; it analyzes the attributes of OSCE stations and outlines the steps for implementing OSCE. Furthermore, important issues like the advantages of OSCE, its limitations, a strengths, weaknesses, opportunities, and threats (SWOT) analysis, and the timing of introduction of OSCE in radiology are also covered. The OSCE format in radiology and its stations needs to be validated, certified, and finalized before its use in examinations. This will need active participation and contribution from the academic radiology fraternity and inputs from faculty members of leading teaching institutions. Many workshops/meetings need to be conducted. Indeed, these collaborative measures will effectively sensitize universities, examiners, organizers, faculty, and students across India to OSCE and help successfully usher in this new format in radiology practical examinations. PMID:20607015

  3. Effects of test stress during an objective structured clinical examination

    PubMed Central

    Zhang, Niu; Rabatsky, Ali

    2015-01-01

    Objective The existence of test stress has been widely reported among professional students. To our knowledge, no studies exist that explore student stress response to objective structured clinical examinations. The aim of this study was to evaluate possible correlations between stress and objective structured clinical examination performance in a sample of chiropractic students. Methods A total of 116 students completed a 2-part questionnaire to assess test stress and the physiological symptoms and signs of stress. Heart rate, systolic blood pressure, and diastolic were measured during the physical examination laboratory class within the first 3 weeks and then again just prior to their objective structured clinical examination in week 5. Statistical tests were then performed for questionnaire data, heart rate and blood pressure differences, and correlation between the objective structured clinical examination grade and symptoms and signs. Results Questionnaire results showed that 5.1%–22.4% of students sometimes or often felt a certain degree of stress. More than 50% had 1 or more physiological symptoms and signs of stress. The objective structured clinical examination heart rate (75.23 ± 11.20 vs 68.16 ± 8.82, p < .001), systolic blood pressure (120.43 ± 9.59 vs 114.97 ± 11.83, p < .001), and diastolic blood pressure (73.00 ± 7.93 vs 69.32 ± 7.76, p < .001) were significantly higher than baseline. There were also negative linear correlations between objective structured clinical examination grades and physiological symptoms and signs and between objective structured clinical examination grades and feeling statement score. Conclusion The results support our hypothesis that chiropractic students experience stress when performing the objective structured clinical examination and that high levels of stress had a negative impact on performance. PMID:25806413

  4. Item Dependency in an Objective Structured Clinical Examination

    ERIC Educational Resources Information Center

    Iramaneerat, Cherdsak; Myford, Carol M.; Yudkowsky, Rachel

    2006-01-01

    An Objective Structured Clinical Examination (OSCE) is an assessment approach employed in medical education, in which residents rotate through multiple stations of standardized clinical tasks to evaluate their clinical competence. Because items used to evaluate residents' performance in each OSCE station are linked to the same task and are rated…

  5. Effects of test stress during an objective structured clinical examination.

    PubMed

    Zhang, Niu; Rabatsky, Ali

    2015-10-01

    The existence of test stress has been widely reported among professional students. To our knowledge, no studies exist that explore student stress response to objective structured clinical examinations. The aim of this study was to evaluate possible correlations between stress and objective structured clinical examination performance in a sample of chiropractic students. A total of 116 students completed a 2-part questionnaire to assess test stress and the physiological symptoms and signs of stress. Heart rate, systolic blood pressure, and diastolic were measured during the physical examination laboratory class within the first 3 weeks and then again just prior to their objective structured clinical examination in week 5. Statistical tests were then performed for questionnaire data, heart rate and blood pressure differences, and correlation between the objective structured clinical examination grade and symptoms and signs. Questionnaire results showed that 5.1%-22.4% of students sometimes or often felt a certain degree of stress. More than 50% had 1 or more physiological symptoms and signs of stress. The objective structured clinical examination heart rate (75.23 ± 11.20 vs 68.16 ± 8.82, p < .001), systolic blood pressure (120.43 ± 9.59 vs 114.97 ± 11.83, p < .001), and diastolic blood pressure (73.00 ± 7.93 vs 69.32 ± 7.76, p < .001) were significantly higher than baseline. There were also negative linear correlations between objective structured clinical examination grades and physiological symptoms and signs and between objective structured clinical examination grades and feeling statement score. The results support our hypothesis that chiropractic students experience stress when performing the objective structured clinical examination and that high levels of stress had a negative impact on performance.

  6. Objective structured clinical examination (OSCE) in pharmacy education - a trend

    PubMed Central

    Shirwaikar, Annie

    2015-01-01

    Pharmacy education has undergone a radical change as it evolves towards becoming a more patient oriented profession. With a greater emphasis on problem based teaching and competency, the Objective Structured Clinical Examination (OSCE), supported by its reliability and validity became the gold standard for the evaluation of clinical skills of undergraduate students of medicine and pharmacy worldwide. Core competency evaluation has become a mandatory and critical norm for accountability of educational objectives as the traditional testing tools cannot evaluate clinical competence. Interpersonal and communication skills, professional judgment, skills of resolution etc., may be best assessed through a well- structured OSCE in comparison to oral examinations, multiple choice tests and other methods of assessment. Though OSCEs as an objective method of evaluation offer several advantages to both students and teachers, it also has disadvantages and pitfalls in implementation. This article reviews the OSCE as a trend in pharmacy education. PMID:26759616

  7. Developing a successful nursing Objective Structured Clinical Examination.

    PubMed

    McWilliam, Paula; Botwinski, Carol

    2010-01-01

    The evaluation of nursing students' clinical competencies is essential to the educational process. The Objective Structured Clinical Examination (OSCE) program was designed to assess students in a variety of health topics that may not be experienced during the assigned clinical rotation. Building on prior work, the purpose of this study was to examine specific aspects of the nursing OSCE toward developing a reliable and valid tool for evaluating selected students' clinical competencies.The following areas were investigated using an assessment design: the development of case scenarios and updates, the role and training of the standardized patient, and students' perceptions of the nursing OSCE experience. Recommendations are made for the variety of case scenarios, frequency of updates, methods by which standardized patients should be trained, remediation, and program requirements. Students were overwhelmingly favorable to perceived benefits of participation in OSCEs during their nursing education.

  8. Designing and implementing the objective structured clinical examination in anesthesiology.

    PubMed

    Hastie, Maya Jalbout; Spellman, Jessica L; Pagano, Parwane P; Hastie, Jonathan; Egan, Brian J

    2014-01-01

    Since its description in 1974, the Objective Structured Clinical Examination (OSCE) has gained popularity as an objective assessment tool of medical students, residents, and trainees. With the development of the anesthesiology residents' milestones and the preparation for the Next Accreditation System, there is an increased interest in OSCE as an evaluation tool of the six core competencies and the corresponding milestones proposed by the Accreditation Council for Graduate Medical Education.In this article the authors review the history of OSCE and its current application in medical education and in different medical and surgical specialties. They also review the use of OSCE by anesthesiology programs and certification boards in the United States and internationally. In addition, they discuss the psychometrics of test design and implementation with emphasis on reliability and validity measures as they relate to OSCE.

  9. Simulated Patients vs. Standardized Patients in Objective Structured Clinical Examinations

    PubMed Central

    Austin, Zubin; Gregory, Paul; Tabak, Diana

    2006-01-01

    Objectives To describe the use of patient-actors as educators in a senior-level pharmacy practice course, and to contrast the value and application of “standardized patient” and “simulated patient” educational methodologies. Design The objective structured clinical examination (OSCE) of the licensing examination were utilized during and at the end of the course along with external assessment to determine the impact of this educational methodology. Interviews with a randomly selected cohort of 14 students were undertaken 3 years after graduation and licensure to evaluate long-term impact of this course. Assessment Overall, students responded positively to the shift from “standardized” patients to “simulated” patients, recognizing their value in teaching clinical and pharmaceutical care skills. Concerns were expressed regarding objectivity in assessment and individual grading. Over 98% of students successfully passed the OSCE component of the licensing examination. Long-term follow-up suggests students valued this approach to education and that it provided them with a foundation for better understanding of the psychosocial needs of patients in practice. Conclusions Simulated-patient educators can play an important role in the pharmacy curriculum, and can complement practitioner-educators in providing students with a real-world context for understanding complex patient care needs. PMID:17149448

  10. Examiners' perceptions of the objective structured clinical examination in colposcopy.

    PubMed

    Qureshi, N S

    2013-02-01

    Certification in Colposcopy by the British Society for Colposcopy and Cervical Pathology (BSCCP) and the Royal College of Obstetricians and Gynaecologists is a formal pre- requisite to the practice of colposcopy within the UK. This certification is awarded after passing an Objective Structured Clinical Examination (OSCE). The aim of the project is to explore examiners' perceptions of the OSCE examination in colposcopy and consider whether it is the right tool to differentiate between safe and unsafe practice in colposcopy. A case study research methodology was employed for the project, and questionnaires were sent to 30 examiners for OSCE in Colposcopy. The project also included conducting semi-structured interviews with two examiners, two trainees and a senior manager of the BSCCP. The questionnaire had a response rate of 28 (94%). The satisfaction rate among the examiners about the standard of questions in OSCE in Colposcopy was 93%, and 89% of the examiners would allow a candidate passing the examination to carry out a clinic in their absence. A total of 26 (94%) examiners thought that the examination was fit for purpose. It was suggested that testing of practical skills should also be made part of the examination. It seems OSCE in Colposcopy is perceived well both by the examiners and the candidates.

  11. Assessing Cultural Psychiatry Milestones Through an Objective Structured Clinical Examination.

    PubMed

    Padilla, Auralyd; Benjamin, Sheldon; Lewis-Fernandez, Roberto

    2016-08-01

    Culturally appropriate tools for patient assessment are needed to train psychiatric residents. An objective structured clinical examination (OSCE) can be a helpful tool for evaluating trainees in the psychiatry milestones pertaining to cultural competency. Seventeen psychiatry residents and fellows at the University of Massachusetts participated in two small-group OSCE exercises to learn cultural interviewing using the DSM-5 Cultural Formulation Interview. Trainee groups presented a cultural formulation and received feedback. Participants were surveyed about their comfort with cultural interviewing before and after the exercise. Paired t tests (N = 16) showed that mean level of comfort with the Cultural Formulation Interview increased by a mean of 0.5 points after training (t = 3.16, df = 15, p < 01 95 % CI = 163-837). The UMass culturally appropriate assessment OSCE enhanced psychiatric trainees' comfort with culturally appropriate interviewing using the Cultural Formulation Interview.

  12. Use of computer technology to modify objective structured clinical examinations.

    PubMed

    Holyfield, Lavern J; Bolin, Kenneth A; Rankin, Kathleen V; Shulman, Jay D; Jones, Daniel L; Eden, Becky DeSpain

    2005-10-01

    Objective structured clinical examinations (OSCEs) are multistationed clinical examinations that have been shown to be effective in testing students' ability to integrate the knowledge, skills, and attitudes acquired during their preclinical and clinical training and experiences. The original OSCE for the third-year Preventive Dentistry course at Baylor College of Dentistry was based on the traditional format consisting of four sections of twelve stations with a group of twelve students rotating through each of the sections simultaneously. This arrangement allowed for examination of one-half of the class. The other half of the class took the exam on an alternate date. To reduce the disruption caused by the students' moving from station to station and to allow for examination of the entire class in one setting, the traditional concept was modified using computer technology, and the twelve stations "moved" via a PowerPoint presentation while students remained stationary. Questions on both exams provided a means for testing data interpretation, diagnostic skills, and, to some extent, interpersonal skills. The overall atmosphere during the computer-based examination was less chaotic. Each student received identical instructions, explanations, and time allotments to respond to the information presented. The ratio of faculty to students required to monitor the exam was less than required for the traditional format. Additionally, since there was no need to allow time for student transition, the total time required to administer the exam was reduced. Thus, objective assessment of the entire class was accomplished using fewer faculty members and less class time and with less disruption for the students.

  13. Pharmacy Student Anxiety and Success With Objective Structured Clinical Examinations.

    PubMed

    Longyhore, Daniel S

    2017-02-25

    Objective. To evaluate whether a relationship exists between the degree of student state-anxiety and pass rates on moderate-to-high stakes objective structured clinical examinations (OSCE). Methods. Third-professional year (P3) students were assessed using the Speilberger State-Trait Anxiety Index (STAI) three weeks prior to their first moderate-to-high stakes OSCEs. Students' OSCE station pass rates, individual station analytical scores, and the overall pass rate for the class were compared with student responses on STAI surveys to measure their association. Results. Seventy-three students (100%) provided consent to participate in the research; 64 (87%) sufficiently completed the STAI survey. Degree of student state-anxiety or train-anxiety was not associated with any of the outcomes assessed in this study. Overall pass rate, individual station pass rates, and station analytical checklist scores were not inversely correlated with state- or trait-anxiety scores. Conclusions. Efforts to assist students in OSCE performance should focus on means other than reducing associated anxiety. Future research in this area should focus on what interventions beyond instruction could be put in place to help students be more successful during OSCEs.

  14. Pharmacy Student Anxiety and Success With Objective Structured Clinical Examinations

    PubMed Central

    2017-01-01

    Objective. To evaluate whether a relationship exists between the degree of student state-anxiety and pass rates on moderate-to-high stakes objective structured clinical examinations (OSCE). Methods. Third-professional year (P3) students were assessed using the Speilberger State-Trait Anxiety Index (STAI) three weeks prior to their first moderate-to-high stakes OSCEs. Students’ OSCE station pass rates, individual station analytical scores, and the overall pass rate for the class were compared with student responses on STAI surveys to measure their association. Results. Seventy-three students (100%) provided consent to participate in the research; 64 (87%) sufficiently completed the STAI survey. Degree of student state-anxiety or train-anxiety was not associated with any of the outcomes assessed in this study. Overall pass rate, individual station pass rates, and station analytical checklist scores were not inversely correlated with state- or trait-anxiety scores. Conclusions. Efforts to assist students in OSCE performance should focus on means other than reducing associated anxiety. Future research in this area should focus on what interventions beyond instruction could be put in place to help students be more successful during OSCEs. PMID:28289297

  15. Neurology objective structured clinical examination reliability using generalizability theory

    PubMed Central

    Park, Yoon Soo; Lukas, Rimas V.; Brorson, James R.

    2015-01-01

    Objectives: This study examines factors affecting reliability, or consistency of assessment scores, from an objective structured clinical examination (OSCE) in neurology through generalizability theory (G theory). Methods: Data include assessments from a multistation OSCE taken by 194 medical students at the completion of a neurology clerkship. Facets evaluated in this study include cases, domains, and items. Domains refer to areas of skill (or constructs) that the OSCE measures. G theory is used to estimate variance components associated with each facet, derive reliability, and project the number of cases required to obtain a reliable (consistent, precise) score. Results: Reliability using G theory is moderate (Φ coefficient = 0.61, G coefficient = 0.64). Performance is similar across cases but differs by the particular domain, such that the majority of variance is attributed to the domain. Projections in reliability estimates reveal that students need to participate in 3 OSCE cases in order to increase reliability beyond the 0.70 threshold. Conclusions: This novel use of G theory in evaluating an OSCE in neurology provides meaningful measurement characteristics of the assessment. Differing from prior work in other medical specialties, the cases students were randomly assigned did not influence their OSCE score; rather, scores varied in expected fashion by domain assessed. PMID:26432851

  16. Assessing intern core competencies with an objective structured clinical examination.

    PubMed

    Short, Matthew W; Jorgensen, Jennifer E; Edwards, John A; Blankenship, Robert B; Roth, Bernard J

    2009-09-01

    Residents are evaluated using Accreditation Council for Graduate Medical Education (ACGME) core competencies. An Objective Structured Clinical Examination (OSCE) is a potential evaluation tool to measure these competencies and provide outcome data. Create an OSCE to evaluate and demonstrate improvement in intern core competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice before and after internship. From 2006 to 2008, 106 interns from 10 medical specialties were evaluated with a preinternship and postinternship OSCE at Madigan Army Medical Center. The OSCE included eight 12-minute stations that collectively evaluated the 6 ACGME core competencies using human patient simulators, standardized patients, and clinical scenarios. Interns were scored using objective and subjective criteria, with a maximum score of 100 for each competency. Stations included death notification, abdominal pain, transfusion consent, suture skills, wellness history, chest pain, altered mental status, and computer literature search. These stations were chosen by specialty program directors, created with input from board-certified specialists, and were peer reviewed. All OSCE testing on the 106 interns (ages 25 to 44 [average, 28.6]; 70 [66%] men; 65 [58%] allopathic medical school graduates) resulted in statistically significant improvement in all ACGME core competencies: patient care (71.9% to 80.0%, P < .001), medical knowledge (59.6% to 78.6%, P < .001), practice-based learning and improvement (45.2% to 63.0%, P < .001), interpersonal and communication skills (77.5% to 83.1%, P < .001), professionalism (74.8% to 85.1%, P < .001), and systems-based practice (56.6% to 76.5%, P < .001). An OSCE during internship can evaluate incoming baseline ACGME core competencies and test for interval improvement. The OSCE is a valuable assessment tool to provide

  17. Assessing Intern Core Competencies With an Objective Structured Clinical Examination

    PubMed Central

    Short, Matthew W.; Jorgensen, Jennifer E.; Edwards, John A.; Blankenship, Robert B.; Roth, Bernard J.

    2009-01-01

    Background Residents are evaluated using Accreditation Council for Graduate Medical Education (ACGME) core competencies. An Objective Structured Clinical Examination (OSCE) is a potential evaluation tool to measure these competencies and provide outcome data. Objective Create an OSCE to evaluate and demonstrate improvement in intern core competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice before and after internship. Methods From 2006 to 2008, 106 interns from 10 medical specialties were evaluated with a preinternship and postinternship OSCE at Madigan Army Medical Center. The OSCE included eight 12-minute stations that collectively evaluated the 6 ACGME core competencies using human patient simulators, standardized patients, and clinical scenarios. Interns were scored using objective and subjective criteria, with a maximum score of 100 for each competency. Stations included death notification, abdominal pain, transfusion consent, suture skills, wellness history, chest pain, altered mental status, and computer literature search. These stations were chosen by specialty program directors, created with input from board-certified specialists, and were peer reviewed. Results All OSCE testing on the 106 interns (ages 25 to 44 [average, 28.6]; 70 [66%] men; 65 [58%] allopathic medical school graduates) resulted in statistically significant improvement in all ACGME core competencies: patient care (71.9% to 80.0%, P < .001), medical knowledge (59.6% to 78.6%, P < .001), practice-based learning and improvement (45.2% to 63.0%, P < .001), interpersonal and communication skills (77.5% to 83.1%, P < .001), professionalism (74.8% to 85.1%, P < .001), and systems-based practice (56.6% to 76.5%, P < .001). Conclusion An OSCE during internship can evaluate incoming baseline ACGME core competencies and test for interval improvement. The

  18. Neurology objective structured clinical examination reliability using generalizability theory.

    PubMed

    Blood, Angela D; Park, Yoon Soo; Lukas, Rimas V; Brorson, James R

    2015-11-03

    This study examines factors affecting reliability, or consistency of assessment scores, from an objective structured clinical examination (OSCE) in neurology through generalizability theory (G theory). Data include assessments from a multistation OSCE taken by 194 medical students at the completion of a neurology clerkship. Facets evaluated in this study include cases, domains, and items. Domains refer to areas of skill (or constructs) that the OSCE measures. G theory is used to estimate variance components associated with each facet, derive reliability, and project the number of cases required to obtain a reliable (consistent, precise) score. Reliability using G theory is moderate (Φ coefficient = 0.61, G coefficient = 0.64). Performance is similar across cases but differs by the particular domain, such that the majority of variance is attributed to the domain. Projections in reliability estimates reveal that students need to participate in 3 OSCE cases in order to increase reliability beyond the 0.70 threshold. This novel use of G theory in evaluating an OSCE in neurology provides meaningful measurement characteristics of the assessment. Differing from prior work in other medical specialties, the cases students were randomly assigned did not influence their OSCE score; rather, scores varied in expected fashion by domain assessed. © 2015 American Academy of Neurology.

  19. Performance-Based Assessment of Clinical Ethics Using an Objective Structured Clinical Examination.

    ERIC Educational Resources Information Center

    Singer, Peter A.; And Others

    1996-01-01

    Final-year Ontario medical students (n=88) took a 4-station objective structured clinical examination (OSCE) using standardized patients and involving decisions to forgo life-sustaining treatment. Performance was scored on a checklist of behaviors unique to each case. Results indicated that because of low reliability, the OSCE is not a feasible…

  20. Do Clinical Clerks Provide Candidates with Adequate Formative Assessment during Objective Structured Clinical Examinations?

    ERIC Educational Resources Information Center

    Reiter, Harold I.; Rosenfeld, Jack; Nandagopal, Kiruthiga; Eva, Kevin W.

    2004-01-01

    Context: Various research studies have examined the question of whether expert or non-expert raters, faculty or students, evaluators or standardized patients, give more reliable and valid summative assessments of performance on Objective Structured Clinical Examinations (OSCEs). Less studied has been the question of whether or not non-faculty…

  1. Does Objective Structured Clinical Examinations Score Reflect the Clinical Reasoning Ability of Medical Students?

    PubMed

    Park, Wan Beom; Kang, Seok Hoon; Lee, Yoon-Seong; Myung, Sun Jung

    2015-07-01

    Clinical reasoning ability is an important factor in a physician's competence and thus should be taught and tested in medical schools. Medical schools generally use objective structured clinical examinations (OSCE) to measure the clinical competency of medical students. However, it is unknown whether OSCE can also evaluate clinical reasoning ability. In this study, the authors investigated whether OSCE scores reflected students' clinical reasoning abilities. Sixty-five fourth-year medical students participated in this study. Medical students completed the OSCE with 4 cases using standardized patients. For assessment of clinical reasoning, students were asked to list differential diagnoses and the findings that were compatible or not compatible with each diagnosis. The OSCE score (score of patient encounter), diagnostic accuracy score, clinical reasoning score, clinical knowledge score and grade point average (GPA) were obtained for each student, and correlation analysis was performed. Clinical reasoning score was significantly correlated with diagnostic accuracy and GPA (correlation coefficient = 0.258 and 0.380; P = 0.038 and 0.002, respectively) but not with OSCE score or clinical knowledge score (correlation coefficient = 0.137 and 0.242; P = 0.276 and 0.052, respectively). Total OSCE score was not significantly correlated with clinical knowledge test score, clinical reasoning score, diagnostic accuracy score or GPA. OSCE score from patient encounters did not reflect the clinical reasoning abilities of the medical students in this study. The evaluation of medical students' clinical reasoning abilities through OSCE should be strengthened.

  2. Does Objective Structured Clinical Examinations Score Reflect the Clinical Reasoning Ability of Medical Students?

    PubMed Central

    Park, Wan Beom; Kang, Seok Hoon; Lee, Yoon-Seong

    2015-01-01

    Abstract: Background: Clinical reasoning ability is an important factor in a physician's competence and thus should be taught and tested in medical schools. Medical schools generally use objective structured clinical examinations (OSCE) to measure the clinical competency of medical students. However, it is unknown whether OSCE can also evaluate clinical reasoning ability. In this study, the authors investigated whether OSCE scores reflected students' clinical reasoning abilities. Methods: Sixty-five fourth-year medical students participated in this study. Medical students completed the OSCE with 4 cases using standardized patients. For assessment of clinical reasoning, students were asked to list differential diagnoses and the findings that were compatible or not compatible with each diagnosis. The OSCE score (score of patient encounter), diagnostic accuracy score, clinical reasoning score, clinical knowledge score and grade point average (GPA) were obtained for each student, and correlation analysis was performed. Results: Clinical reasoning score was significantly correlated with diagnostic accuracy and GPA (correlation coefficient = 0.258 and 0.380; P = 0.038 and 0.002, respectively) but not with OSCE score or clinical knowledge score (correlation coefficient = 0.137 and 0.242; P = 0.276 and 0.052, respectively). Total OSCE score was not significantly correlated with clinical knowledge test score, clinical reasoning score, diagnostic accuracy score or GPA. Conclusions: OSCE score from patient encounters did not reflect the clinical reasoning abilities of the medical students in this study. The evaluation of medical students' clinical reasoning abilities through OSCE should be strengthened. PMID:25647834

  3. [Clinical competence evaluation using the Objective Structured Clinical Examination (OSCE) in medical internship at UNAM].

    PubMed

    Trejo Mejía, Juan Andrés; Martínez González, Adrián; Méndez Ramírez, Ignacio; Morales López, Sara; Ruiz Pérez, Leobardo C; Sánchez Mendiola, Melchor

    2014-01-01

    The Objective Structured Clinical Examination (OSCE) is a widely used measurement tool to assess clinical competence in the health sciences. There is little published evidence of its use in Mexican medical schools. To assess clinical competence in medical students with an OSCE, before and after the Medical Internship. Prospective cohort study, pre- post-test research design. The assessed population was medical students at UNAM Faculty of Medicine in Mexico in their Internship year. The instrument was an 18-stations OSCE, three stations per academic area of the Internship curriculum. We assessed the clinical competence of 278 students in a pretest OSCE when starting the Internship year, and tested them 10 months later with an equivalent post-test OSCE. The sample of students was 30.4% of the total Internship population. Test reliability with Cronbach's alpha was 0.62 in the pre-test and 0.64 in the post-test. The global mean score in the pretest OSCE was 55.6 ± 6.6 and in the post-test 63.2 ± 5.7 (p < 0.001), with a Cohen's d of 1.2. The clinical competence of medical students measured with an OSCE is higher after the medical internship year. This difference suggests that the internship can influence the development of clinical competence in medical students.

  4. The Group Objective Structured Clinical Experience: building communication skills in the clinical reasoning context.

    PubMed

    Konopasek, Lyuba; Kelly, Kevin V; Bylund, Carma L; Wenderoth, Suzanne; Storey-Johnson, Carol

    2014-07-01

    Students are rarely taught communication skills in the context of clinical reasoning training. The purpose of this project was to combine the teaching of communication skills using SPs with clinical reasoning exercises in a Group Objective Structured Clinical Experience (GOSCE) to study feasibility of the approach, the effect on learners' self-efficacy and attitude toward learning communication skills, and the effect of providing multiple sources of immediate, collaborative feedback. GOSCE sessions were piloted in Pediatrics and Medicine clerkships with students assessing their own performance and receiving formative feedback on communication skills from peers, standardized patients (SPs), and faculty. The sessions were evaluated using a retrospective pre/post-training questionnaire rating changes in self-efficacy and attitudes, and the value of the feedback. Results indicate a positive impact on attitudes toward learning communication skills and self-efficacy regarding communication in the clinical setting. Also, learners considered feedback by peers, SPs, and faculty valuable in each GOSCE. The GOSCE is an efficient and learner-centered method to attend to multiple goals of teaching communication skills, clinical reasoning, self-assessment, and giving feedback in a formative setting. The GOSCE is a low-resource, feasible strategy for experiential learning in communication skills and clinical reasoning. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Pilot study of an Objective Structured Clinical Examination ("the Six Pack") for evaluating clinical competencies.

    PubMed

    Franzese, Christine B

    2008-02-01

    The purpose of this study was to evaluate an Objective Structured Clinical Examination (OSCE) designed to examine all six competencies and provide meaningful results to improve resident performance. A prospective, observational study. The OSCE consists of 1 hour for examination of a simulated patient, documentation, and feedback, with 30 minutes for an evidence-based medicine (EBM) test. Eight otolaryngology residents participated. Digital recordings and written documentation were evaluated on all competencies except practice-based learning. An EBM test was scored to assess practice-based learning. Overall, senior residents scored better. Seniors scored better on performing a focused history, whereas juniors scored better for thoroughness. Seniors coded better than juniors, although seniors tended to undercode and juniors tended to overcode. Two cases of "insurance fraud" were also discovered. The "Six Pack" successfully evaluated all competencies while providing valuable information. A clinical practicum was added to improve history and physical examination skills. The discussion of coding and a billing seminar also resulted. Residents believed the OSCE was valuable. Faculty members were impressed with the useful information obtained.

  6. Objective Structured Clinical Examination as an Assessment Tool for Clinical Skills in Dermatology.

    PubMed

    Saceda-Corralo, D; Fonda-Pascual, P; Moreno-Arrones, Ó M; Alegre-Sánchez, A; Hermosa-Gelbard, Á; Jiménez-Gómez, N; Vañó-Galván, S; Jaén-Olasolo, P

    2017-04-01

    Objective Structured Clinical Evaluation (OSCE) is an excellent method to evaluate student's abilities, but there are no previous reports implementing it in dermatology. To determine the feasibility of implementation of a dermatology OSCE in the medical school. Five stations with standardized patients and image-based assessment were designed. A specific checklist was elaborated in each station with different items which evaluated one competency and were classified into five groups (medical history, physical examination, technical skills, case management and prevention). A total of 28 students were tested. Twenty-five of them (83.3%) passed the exam globally. Concerning each group of items tested: medical interrogation had a mean score of 71.0; physical examination had a mean score of 63.0; management had a mean score of 58.0; and prevention had a mean score of 58.0 points. The highest results were obtained in interpersonal skills items with 91.8 points. Testing a small sample of voluntary students may hinder generalization of our study. OSCE is an useful tool for assessing clinical skills in dermatology and it is possible to carry it out. Our experience enhances that medical school curriculum needs to establish OSCE as an assessment tool in dermatology. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Construct Validity of an Objective Structured Clinical Examination (OSCE) in Psychiatry: Associations with the Clinical Skills Examination and Other Indicators

    ERIC Educational Resources Information Center

    Park, Robin S.; Chibnall, John T.; Blaskiewicz, Robert J.; Furman, Gail E.; Powell, Jill K.; Mohr, Clinton J.

    2004-01-01

    Objective: The construct validity of checklist and global process scores for an objective structured clinical examination (OSCE) in psychiatry was assessed. Multiple regression analysis was used to predict psychiatry OSCE scores from the clinical skills examination, an obstetrics/gynecology (OB/GYN) OSCE, and the National Board of Medical…

  8. Construct Validity of an Objective Structured Clinical Examination (OSCE) in Psychiatry: Associations with the Clinical Skills Examination and Other Indicators

    ERIC Educational Resources Information Center

    Park, Robin S.; Chibnall, John T.; Blaskiewicz, Robert J.; Furman, Gail E.; Powell, Jill K.; Mohr, Clinton J.

    2004-01-01

    Objective: The construct validity of checklist and global process scores for an objective structured clinical examination (OSCE) in psychiatry was assessed. Multiple regression analysis was used to predict psychiatry OSCE scores from the clinical skills examination, an obstetrics/gynecology (OB/GYN) OSCE, and the National Board of Medical…

  9. Evaluating an Objective Structured Clinical Examination (OSCE) Adapted for Social Work

    ERIC Educational Resources Information Center

    Bogo, Marion; Regehr, Cheryl; Katz, Ellen; Logie, Carmen; Tufford, Lea; Litvack, Andrea

    2012-01-01

    Objectives: To evaluate an objective structured clinical examination (OSCE) adapted for social work in a lab course and examine the degree to which it predicts competence in the practicum. Method: 125 Masters students participated in a one-scenario OSCE and wrote responses to standardized reflection questions. OSCE performance and reflections were…

  10. Geriatric Medicine Fellows' Experiences and Attitudes toward an Objective Structured Clinical Examination (OSCE)

    ERIC Educational Resources Information Center

    Bagri, Anita S.; Zaw, Khin M.; Milanez, Marcos N.; Palacios, Juan J.; Qadri, Syeda S.; Bliss, Linda A.; Roos, Bernard A.; Ruiz, Jorge G.

    2009-01-01

    A total of 8 geriatric medicine fellows participated in an objective structured clinical examination (OSCE) assessing communication skills and clinical reasoning in common geriatric syndromes. To determine their perceptions about the experience, we conducted surveys and semistructured interviews. We analyzed the survey data using descriptive…

  11. Geriatric Medicine Fellows' Experiences and Attitudes toward an Objective Structured Clinical Examination (OSCE)

    ERIC Educational Resources Information Center

    Bagri, Anita S.; Zaw, Khin M.; Milanez, Marcos N.; Palacios, Juan J.; Qadri, Syeda S.; Bliss, Linda A.; Roos, Bernard A.; Ruiz, Jorge G.

    2009-01-01

    A total of 8 geriatric medicine fellows participated in an objective structured clinical examination (OSCE) assessing communication skills and clinical reasoning in common geriatric syndromes. To determine their perceptions about the experience, we conducted surveys and semistructured interviews. We analyzed the survey data using descriptive…

  12. The Reliability, Validity, and Usefulness of the Objective Structured Clinical Examination (OSCE) in Dental Education

    ERIC Educational Resources Information Center

    Graham, Roseanna

    2010-01-01

    This study evaluated the reliability, validity, and educational usefulness of a comprehensive, multidisciplinary Objective Structured Clinical Examination (OSCE) in dental education. The OSCE was administered to dental students at the Columbia University College of Dental Medicine (CDM) before they entered clinical training. Participants in this…

  13. Flipping the Objective Structured Clinical Examination: A Teaching Innovation in Graduate Nursing Education.

    PubMed

    Day, Cristi; Barker, Connie; Bell, Eva; Sefcik, Elizabeth; Flournoy, Deborah

    2017-07-24

    Objective evaluation of distance-based family nurse practitioner (FNP) students can be challenging. One FNP program piloted a teaching innovation, the video-enhanced objective structured clinical examination (VE-OSCE) or "flip" of the traditional face-to-face OSCE, to assess student clinical performance in a controlled online environment using a teleconferencing platform. This project sought to assess the VE-OSCE design, implementation, and ability to identify FNP student learning needs.

  14. Assessment of first-year veterinary students' clinical skills using objective structured clinical examinations.

    PubMed

    Hecker, Kent; Read, Emma K; Vallevand, Andrea; Krebs, Gord; Donszelmann, Darlene; Muelling, Christoph K W; Freeman, Sarah L

    2010-01-01

    The DVM program at the University of Calgary offers a Clinical Skills course each year for the first three years. The course is designed to teach students the procedural skills required for entry-level general veterinary practice. Objective Structured Clinical Examinations (OSCEs) were used to assess students' performance on these procedural skills. A series of three OSCEs were developed for the first year. Content was determined by an exam blueprint, exam scoring sheets were created, rater training was provided, a mock OSCE was performed with faculty and staff, and the criterion-referencing Ebel method was used to set cut scores for each station using two content experts. Each station and the overall exam were graded as pass or fail. Thirty first-year DVM students were assessed. Content validity was ensured by the exam blueprint and expert review. Reliability (coefficient α) of the stations from the three OSCE exams ranged from 0.0 to 0.71. The three exam reliabilities (Generalizability Theory) were, for OSCE 1, G=0.56; OSCE 2, G=0.37; and OSCE 3, G=0.32. Preliminary analysis has suggested that the OSCEs demonstrate face and content validity, and certain stations demonstrated adequate reliability. Overall exam reliability was low, which reflects issues with first-time exam delivery. Because this year was the first that this course was taught and this exam format was used, work continues in the program on the teaching of the procedural skills and the development and revision of OSCE stations and scoring checklists.

  15. An Objective Structured Clinical Exam to Assess Semiology Skills of Medical Students.

    PubMed

    Pereira, Vitor Hugo; Morgado, Pedro; Gonçalves, Mónica; Costa, Liliana; Sousa, Nuno; Cerqueira, João José

    2016-12-30

    Mastery of history taking and physical exam skills is a key competence of medical students. Objective Structured Clinical Examinations are the gold standard to assess these competencies, but their implementation in Portugal is poorly documented. We describe the implementation and our seven years experience with a high-stakes Objective Structured Clinical Examination to assess these skills in the School of Medicine, University of Minho. Our Objective Structured Clinical Examination is in place since 2010 and has been subject to continuous improvements, including the adoption of a standard setting procedure and an increase in the number of stations. Grades in our exam are well distributed and discriminate among students. History taking grades are lower and have remained stable throughout the years while physical examination scores have risen. The exam is reliable, with internal consistency above 0.45 and a G-coefficient of 0.74. It is also feasible, with a total testing time of approximately 20 hours for 140 students, and the involvement of 18 standardized patients and 18 faculty assessors. More importantly, it was able to engage the students, who recognize its importance. The most important validity criterion of our, and any Objective Structured Clinical Examination, would be predictive validity,the ability to predict the performance of students in the clinical context. Our approach to a high-stakes Objective Structured Clinical Examination shows that it is feasible, reliable, valid and fair and can be implemented with success in the Portuguese setting.

  16. Competency-Based Training: Objective Structured Clinical Exercises (OSCE) in Marriage and Family Therapy

    ERIC Educational Resources Information Center

    Miller, John K.

    2010-01-01

    The field of marriage and family therapy (MFT) has recently engaged in the process of defining core competencies for the profession. Many MFT training programs are adapting their curriculum to develop more competency-based training strategies. The Objective Structured Clinical "Examination" (OSCE) is widely used in the medical profession to assess…

  17. Competency-Based Training: Objective Structured Clinical Exercises (OSCE) in Marriage and Family Therapy

    ERIC Educational Resources Information Center

    Miller, John K.

    2010-01-01

    The field of marriage and family therapy (MFT) has recently engaged in the process of defining core competencies for the profession. Many MFT training programs are adapting their curriculum to develop more competency-based training strategies. The Objective Structured Clinical "Examination" (OSCE) is widely used in the medical profession to assess…

  18. Use of a Group Objective Structured Clinical Examination with First-Year Medical Students.

    ERIC Educational Resources Information Center

    Elliot, Diane L.; And Others

    1994-01-01

    An Oregon Health Sciences University medical school experiment adapted the quarterly Objective Structured Clinical Examination, in which medical students interact with standardized patients, to accommodate 23 small groups rather than 94 individual students at each testing station. Results indicated the method favorably influenced students,…

  19. Factors shaping e-feedback utilization following electronic Objective Structured Clinical Examinations.

    PubMed

    Ashby, Samantha E; Snodgrass, Suzanne H; Rivett, Darren A; Russell, Trevor

    2016-09-01

    The development of student-practitioners' practical clinical skills is essential in health professional education. Objective Structured Clinical Examinations are central to the assessment of students performing clinical procedures on simulated patients (actors). While feedback is considered core to learning providing timely, individualised student OSCE feedback is difficult. This study explored the perceptions of students about the multiple factors which shape the utility of e-feedback following an electronic Objective Structured Clinical Examinations, which utilized iPad and specialised software. The e-feedback was trialled in four courses within occupational therapy and physiotherapy pre-professional programs with a cohort of 204 students. Evaluation of student perceptions about feedback was collected using two surveys and eight focus groups. This data showed three factors shaped perceptions of the utility of e- Objective Structured Clinical Examinations feedback: 1) timely accessibility within one day of the assessment, 2) feedback demonstrating examiners' academic literacy and 3) feedback orientated to ways of improving future performance of clinical skills. The study found training in the provision of feedback using IPads and software is needed for examiners to ensure e-feedback meets students' needs for specific, future-oriented e-feedback and institutional requirements for justification of grades.

  20. Avatar-Mediated Home Safety Assessments: Piloting a Virtual Objective Structured Clinical Examination Station

    PubMed Central

    Andrade, Allen D.; Cifuentes, Pedro; Oliveira, Marcelo C.; Anam, Ramanakumar; Roos, Bernard A.; Ruiz, Jorge G.

    2011-01-01

    Background Avatars and virtual worlds offer medical educators new approaches to assess learners' competency in home-safety assessments that are less time-consuming and more flexible than traditional home visits. We sought to evaluate the feasibility and acceptability of implementing an avatar-mediated, 3-dimensional (3-D) home simulation as a virtual objective structured clinical examination station for geriatric medicine fellows. Methods We developed a 3-D home simulation in the virtual world Second Life (Linden Lab, San Francisco, CA) containing 50 safety hazards that could affect the safety of an elderly person at home. Eight geriatric medicine fellows participated in a 16-station objective structured clinical examination, with one station assigned to the 15-minute 3-D virtual world simulation, where the fellow's “home visit” was performed by navigating his or her avatar in the virtual world simulation. The fellows were instructed to find the home safety hazards in the simulated environment and then provide specific written recommendations. Two reviewers independently scored the fellows' written findings against an inventory-based checklist. Results The geriatric medicine fellows scored a mean of 43% ± SD 9 on the inventory-based checklist. The scoring of the 2 reviewers showed a high interrater reliability (88%). Six of the 8 participants (75%) rated the simulation as “excellent.” Four of the 5 women (80%) and none of the 3 men (20%) participating in the virtual objective structured clinical examination needed navigation assistance in the 3-D virtual house. Conclusion The 3-D, avatar-based, virtual geriatric home safety objective structured clinical examination is a practical and acceptable alternative to the traditional home safety visits in an objective structured clinical examination setting. PMID:23205205

  1. An exploration of student midwives' experiences of the Objective Structured Clinical Examination assessment process.

    PubMed

    Barry, Maebh; Noonan, Maria; Bradshaw, Carmel; Murphy-Tighe, Sylvia

    2012-08-01

    This paper reports on a qualitative descriptive study that explored student midwives' experiences of the Objective Structured Clinical Examination assessment process for obstetric emergencies within a university setting. The development of fundamental clinical skills is an important component in preparing students to meet the responsibilities of a midwife. There is an international concern that the transfer of midwifery education into universities may impact on the development of midwifery clinical skills. Objective Structured Clinical Examinations (OSCEs) have the potential to promote integration and consolidation of skills prior to clinical placement. Twenty six students (n=36) from two midwifery programmes (BSc and Higher Diploma) participated in four focus groups and Burnard's (2006) framework was used for data analysis. Three main themes emerged following analysis: preparation for the OSCE assessment, the OSCE process and learning through simulating practice. Preparation for the OSCE's which included lectures, demonstrations, and practice of OSCE's facilitated by lecturers and by the students themselves, was considered central to the process. Learning via OSCEs was perceived to be more effective in comparison to other forms of assessment and prepared students for clinical practice. Positive aspects of the process and areas for improvement were identified. Using OSCE's increased the depth of learning for the students with the steps taken in preparation for the OSCE's proving to be a valuable learning tool. This study adds to the evidence on the use of OSCE's in midwifery education.

  2. Evaluation of Clinical and Communication Skills of Pharmacy Students and Pharmacists with an Objective Structured Clinical Examination.

    PubMed

    Urteaga, Elizabeth M; Attridge, Rebecca L; Tovar, John M; Witte, Amy P

    2015-10-25

    Objective. To evaluate how effectively pharmacy students and practicing pharmacists communicate and apply knowledge to simulations of commonly encountered patient scenarios using an objective structured clinical examination (OSCE). Design. Second-, third-, and fourth-year pharmacy students completed an OSCE as part of their required courses in 2012 and 2013. All students in both years completed identical OSCE cases. Licensed pharmacists were recruited to complete the OSCE and serve as controls in 2012. A survey assessed student perception and acceptance of the OSCE as well as student confidence in performance. Assessment. Licensed pharmacists had significantly higher clinical and communication skills scores than did pharmacy students. Student progression in communication and clinical skills improved significantly over time. Survey results indicated that students felt the OSCE was well-structured and assessed clinical skills taught in pharmacy school; 86% of students felt confident they could provide these skills. Conclusion. Objective structured clinical examinations can evaluate clinical competence and communication skills among professional students. Implementation of OSCEs may be an effective tool for assessment of the Center for the Advancement of Pharmacy Education domains.

  3. Evaluation of Clinical and Communication Skills of Pharmacy Students and Pharmacists with an Objective Structured Clinical Examination

    PubMed Central

    Attridge, Rebecca L.; Tovar, John M.; Witte, Amy P.

    2015-01-01

    Objective. To evaluate how effectively pharmacy students and practicing pharmacists communicate and apply knowledge to simulations of commonly encountered patient scenarios using an objective structured clinical examination (OSCE). Design. Second-, third-, and fourth-year pharmacy students completed an OSCE as part of their required courses in 2012 and 2013. All students in both years completed identical OSCE cases. Licensed pharmacists were recruited to complete the OSCE and serve as controls in 2012. A survey assessed student perception and acceptance of the OSCE as well as student confidence in performance. Assessment. Licensed pharmacists had significantly higher clinical and communication skills scores than did pharmacy students. Student progression in communication and clinical skills improved significantly over time. Survey results indicated that students felt the OSCE was well-structured and assessed clinical skills taught in pharmacy school; 86% of students felt confident they could provide these skills. Conclusion. Objective structured clinical examinations can evaluate clinical competence and communication skills among professional students. Implementation of OSCEs may be an effective tool for assessment of the Center for the Advancement of Pharmacy Education domains. PMID:26690286

  4. Development and pilot testing of an objective structured clinical examination (OSCE) on hoarseness.

    PubMed

    Stewart, C Matthew; Masood, Hamid; Pandian, Vinciya; Laeeq, Kulsoom; Akst, Lee; Francis, Howard W; Bhatti, Nasir I

    2010-11-01

    To develop a valid and reliable tool for an objective structured clinical examination (OSCE) on hoarseness. To pilot-test the feasibility by assessing residents' clinical skills in various core competencies while assessing hoarseness on a standardized patient (SP). Educational tool development. The OSCE checklists were developed using modified Delphi technique after obtaining feedback from faculty involved in providing care to hoarseness patients. SP-based and rest stations were created to assess clinical skills. Twelve Otolaryngology-Head and Neck Surgery residents participated in the study. Video recordings of residents' performance and their written documentation were rated by faculty members. The OSCE that we developed is a valid method of assessing residents' clinical skills for evaluating hoarseness. Senior residents performed better in all of the tasks such as obtaining history and performing a physical exam on an SP, ability to perform flexible laryngoscopy on a mannequin, and interpretation of radiologic findings. Internal consistency assessed by Cronbach's alpha as measure of inter-item reliability was 0.92 for laryngoscopic station and 0.95 for radiology station. This OSCE can be effectively used for the objective assessment of clinical competency in hoarseness. Our pilot study evaluated multiple competencies on a single occasion, including medical knowledge, patient care, professionalism, and communication and interpersonal skills. Clinical competence in history taking, physical examination, flexible fiber-optic laryngoscopy, and ability to interpret radiologic findings improved with increasing year of training. This OSCE provides targeted assessment of practice-based learning and feedback for improvement of clinical performance.

  5. Creative Curriculum: The Experience of Writing and Teaching Formative Objective Structured Clinical Examinations (FOSCEs).

    PubMed

    Harrod, Tom P; Gomes, Alexandra W

    2017-01-01

    The launch of the revised medical school curriculum in fall 2014 provided new opportunities for librarians to collaborate with clinical faculty. As a result of past informatics instruction embedded in the first-year curriculum, librarians were invited to expand this content as part of a new Formative Objective Structured Clinical Examination (FOSCE) initiative. This article describes the stages of this project from writing and teaching the FOSCE informatics cases to improvements which were made after the first year. A description of the overall curriculum and information about lessons learned in each of these stages is included.

  6. Measuring the success of an objective structured clinical examination for dietetic students.

    PubMed

    Hawker, J A; Walker, K Z; Barrington, V; Andrianopoulos, N

    2010-06-01

    Growing requirements to train more dietetic students greatly increase the teaching burden on clinical supervisors. This may be reduced if students can develop basic nutrition assessment skills before they commence clinical placement. To test achievement of these skills by Australian dietetic students, a preclinical objective structured clinical examination (OSCE) was developed. Performance at this OSCE was then compared with the performance at first clinical placement. An OSCE was developed to test preclinical skills during the third year of a 4-year dietetic degree. Learning outcomes relating to nutritional assessment skills were assessed via a 1-h preclinical examination. Student application of these skills was then assessed after the first clinical placement, when performance was compared with the results at the preclinical OSCE. One hundred and ninety-three students completed the preclinical OSCE and first clinical placement during the period 2002-2007. A strong relationship was observed for individual student scores at the OSCE and the score achieved at the end of clinical placement (beta = 0.66; 95% confidence interval = 0.46-0.86; P < 0.0001). This relationship was maintained even when outliers were removed. No specific year effect was apparent. A third-year preclinical dietetic OSCE was found to be a valuable method of formative assessment for assisting dietetic students with the preparation for their first clinical placement. It aided the early identification of those students who are likely to do less well on their first clinical placement.

  7. Effect of ethnicity on performance in a final objective structured clinical examination: qualitative and quantitative study

    PubMed Central

    Wass, Val; Roberts, Celia; Hoogenboom, Ron; Jones, Roger; Van der Vleuten, Cees

    2003-01-01

    Objective To assess the effect of ethnicity on student performance in stations assessing communication skills within an objective structured clinical examination. Design Quantitative and qualitative study. Setting A final UK clinical examination consisting of a two day objective structured clinical examination with 22 stations. Participants 82 students from ethnic minorities and 97 white students. Main outcome measures Mean scores for stations (quantitative) and observations made using discourse analysis on selected communication stations (qualitative). Results Mean performance of students from ethnic minorities was significantly lower than that of white students for stations assessing communication skills on days 1 (67.0% (SD 6.8%) and 72.3% (7.6%); P=0.001) and 2 (65.2% (6.6%) and 69.5% (6.3%); P=0.003). No examples of overt discrimination were found in 309 video recordings. Transcriptions showed subtle differences in communication styles in some students from ethnic minorities who performed poorly. Examiners' assumptions about what is good communication may have contributed to differences in grading. Conclusions There was no evidence of explicit discrimination between students from ethnic minorities and white students in the objective structured clinical examination. A small group of male students from ethnic minorities used particularly poorly rated communicative styles, and some subtle problems in assessing communication skills may have introduced bias. Tests need to reflect issues of diversity to ensure that students from ethnic minorities are not disadvantaged. What is already known on this topicUK medical schools are concerned that students from ethnic minorities may perform less well than white students in examinationsIt is important to understand whether our examination system disadvantages themWhat this study addsMean performance of students from ethnic minorities was significantly lower than that of white students in a final year objective structured

  8. An Objective Structured Clinical Examination to Assess Problem-Based Learning

    PubMed Central

    O'Connell, Mary Beth; Garwood, Candice L.; Lehr, Victoria Tutag; Abdallah, Karina

    2012-01-01

    Objectives. To compare pharmacy students’ performance on an objective structured clinical examination (OSCE) to their performance on a written examination for the assessment of problem-based learning (PBL); and to determine students’ and faculty members’ perceptions of OSCEs for PBL evaluations. Design. Four OSCEs were added to the written examination to assess 4 PBL cases in a third-year pharmacotherapy course. OSCE scores were compared to written examination scores. Faculty members evaluated student performance. Assessment. OSCE performance did not correlate with the written-examination scores. Most students (≥ 75%) agreed that OSCEs reflected their learning from PBL and measured knowledge, communication, and clinical skills. A majority of faculty members (≥75%) agreed that OSCEs should be part of PBL assessment. Conclusions. Addition of an OSCE to written examinations was valued and provided a more comprehensive assessment of the PBL experience. PMID:22544961

  9. Using TOSCE (Team Objective Structured Clinical Examination) in the second national medical sciences olympiad in Iran.

    PubMed

    Amini, Mitra; Moghadami, Mohsen; Kojuri, Javad; Abbasi, Hamidreza; Abadi, Ali Arhami Doolat; Molaee, Nezar Ali; Pishbin, Elham; Javadzade, Hamid Reza; Kasmaee, Vahid Monsef; Vakili, Mohsen; Sadat, Mohamad Ali Reis; Akbari, Roghaye; Omidvar, Bita; Shafaghi, Afshin; Monajemi, Alireza; Arabshahi, Kamran Soltani; Adibi, Peyman

    2012-10-01

    Second National Medical Sciences Olympiad was done in Shiraz in August 2010 with aim of indentifying scientifically talented individuals, motivating students and orienting extracurricular activities. This Olympiad was done in 3 areas, basic sciences, clinical sciences and management. In clinical sciences, we used TOSCE (Team Objective Structured Clinical Examination). In this article we report the details of this exam and participants' satisfaction. This Olympiad in Clinical Medical Sciences was held in 2 levels: Individual and team. In the team stage, 9 teams from 9 universities participated. We used TOSCE for measuring clinical competency of teams. Each team consisted of 3 students. We designed 12 stations based on emergency medicine in medical and surgical fields. The time considered for each station was 15 min, after doing this exam the view of students was measured using a valid and reliable questionnaire. Most of the students believed that TOSCE was a useful examination for measuring competency. More than 50% of students reported that success in this exam needs clinical competency, team work and problem solving ability. Nearly, half (48.1%) of students believed that 15 min is not enough for each station and they need more time. The results of this study showed that this kind of exam is useful for measuring clinical competency from students' viewpoint.

  10. Competency-based training: objective structured clinical exercises (OSCE) in marriage and family therapy.

    PubMed

    Miller, John K

    2010-07-01

    The field of marriage and family therapy (MFT) has recently engaged in the process of defining core competencies for the profession. Many MFT training programs are adapting their curriculum to develop more competency-based training strategies. The Objective Structured Clinical Examination (OSCE) is widely used in the medical profession to assess clinical competence. These examinations involve using simulated clinical situations as a tool in conducting summative evaluations of trainee competence. This article describes an adaptation of the OSCE procedures for competency-based training of MFT students. Instead of using the procedures as a summative examination as is typical in medical education, this article proposes how to use them as formative exercises in the development of student competence. The development of the OSCE is discussed, including "blueprinting," focused competencies, procedures, and feedback protocols. The article concludes with suggestions of how to continue the development of the OSCE for evaluation in MFT education.

  11. The reliability, validity, and usefulness of the Objective Structured Clinical Examination (OSCE) in dental education

    NASA Astrophysics Data System (ADS)

    Graham, Roseanna

    This study evaluated the reliability, validity, and educational usefulness of a comprehensive, multidisciplinary Objective Structured Clinical Examination (OSCE) in dental education. The OSCE was administered to dental students at the Columbia University College of Dental Medicine (CDM) before they entered clinical training. Participants in this study included CDM's class of 2010 which consisted of 78 students. The overall reliability of the examination was measured via calculation of Cronbach's alpha. Content validity was examined through evaluation of the OSCE by three experienced clinical faculty members. Predictive validity was evaluated by correlating student grades on the OSCE to future clinical performance as measured by number of clinical points achieved during the third year of training. Student perceptions regarding the educational usefulness of the examination were evaluated through a 12-question Liken-type survey and focus group interviews analyzed using a phenomenological approach. Findings of the study indicated the OSCE was a highly reliable examination (alpha=0.86) with high content validity and a moderately high correlation to future clinical performance (r=.614, p<.0001). Overall, student perceptions of the educational usefulness of the OSCE were positive as based on their responses to a 5-point Likert scale (1=strongly disagree and 5=strongly agree). They reported that the exam required the ability to think critically and problem-solve (4.0 +/- 0.85), assessed clinically relevant skills (4.59 +/- 0.69), helped identify clinical weaknesses (4.16 +/- 0.90), and was a learning experience (4.58 +/- 0.84). Findings from the qualitative portion of the study identified four main themes including the student perception that the OSCE is a unique assessment experience that required integration and application of knowledge. Recommendations for the use of the OSCE to improve clinical teaching and the implications of this study relating to the expanded use of

  12. The use of objective structured clinical examination (OSCE) for evaluation and instruction in graduate medical education.

    PubMed

    Sloan, D A; Donnelly, M B; Schwartz, R W; Felts, J L; Blue, A V; Strodel, W E

    1996-06-01

    This study had two purposes: determining the reliability and validity of the Objective Structured Clinical Examination (OSCE) in assessing performance by trainees at all levels, including medical students and chief residents; and estimating the impact of providing OSCE participants with immediate feedback about their performance. A comprehensive 210-min OSCE was administered to 53 surgical residents and 6 junior medical students. Faculty experts proctored all patient stations and provided immediate feedback to participants after the patient interaction segments (Part A). The participants then answered questions about the patients seen (Part B). The reliability of the OSCE was high (.91), identical to that of a previous resident OSCE with no feedback. The standard error of measurement for both parts was approximately 4%. At the 95% confidence interval, each participant's actual level of clinical performance (Part A) and clinical knowledge (Part B) could be estimated with an error of +/-8%. Participants showed significant differences in clinical performance (Part A, P < 0.01) and knowledge (Part B, P < 0.01) by level of training. Most participants (74%) rated the OSCE as an above average or outstanding educational method. The OSCE is a valid and reliable test of residents' clinical skills. Feedback to participants during the OSCE was positively received and did not perturb test reliability.

  13. Validation of a computer based objective structured clinical examination in the assessment of undergraduate dermatology courses.

    PubMed

    Kaliyadan, Feroze; Khan, Abdul Sattar; Kuruvilla, Joel; Feroze, Kaberi

    2014-01-01

    Many teaching centers have now adopted objective structured clinical examination (OSCE) as an assessment method for undergraduate dermatology courses. A modification of the standard OSCE in dermatology is computer based or electronic OSCE (eOSCE). We attempted to validate the use of a computer-based OSCE in dermatology in a group of fifth year medical students. The scores of the students in the computer-based OSCE showed a strong positive correlation with the scores on the clinical presentation (Pearson's co-efficient - 0.923, P value <0.000, significant at the 0.01 level) and a good correlation with overall scores of the student (Pearson's co-efficient - 0.728, P value <0.000, significant at the 0.01 level), indicating that this is a reliable method for assessment in dermatology. Generally, the students' feedback regarding the methods was positive.

  14. Assessing nursing clinical skills competence through objective structured clinical examination (OSCE) for open distance learning students in Open University Malaysia.

    PubMed

    Oranye, Nelson Ositadimma; Ahmad, Che'an; Ahmad, Nora; Bakar, Rosnida Abu

    2012-06-01

    The objective structured clinical skills examination (OSCE) has over the years emerged as a method of evaluating clinical skills in most medical and allied professions. Although its validity and objectivity has evoked so much debate in the literature, little has been written about its application in non-traditional education systems such as in distance learning. This study examined clinical skills competence among practising nursing students who were enrolled in a distance learning programme. The study examined the effect of work and years of nursing practice on nurses' clinical skills competence. This study used observational design whereby nursing students' clinical skills were observed and scored in five OSCE stations. Two instruments were used for the data collection - A self-administered questionnaire on the students' bio-demographic data, and a check list on the clinical skills which the examiners rated on a four point scale. The findings revealed that 14% of the nurses had level four competence, which indicated that they could perform the tasks correctly and complete. However, 12% failed the OSCE, even though they had more than 10 years experience in nursing and post basic qualifications. Inter-rater reliability was 0.92 for the five examiners. Factor analysis indicated that five participant factors accounted for 74.1% of the variations in clinical skills performance. An OSCE is a necessary assessment tool that should be continuously applied in nursing education, regardless of the mode of the education program, the student's years of experience or his/her clinical placement. This study validates the need for OSCE in both the design of tertiary nursing degree programs and the assessment of nurses' clinical competency level.

  15. Students' feedback of objectively structured clinical examination: a private medical college experience.

    PubMed

    Khursheed, Iram; Usman, Yaseen; Usman, Jawaid

    2007-03-01

    The aim of the study was to evaluate undergraduate students' perceptions regarding Objectively Structured Clinical Examination (OSCE) to be used as a feedback to improve the assessment technique. At the end of OSCE, students were provided with a feedback questionnaire related to OSCE to obtain their views and comments. The feedback was obtained from two consecutive batches of third year medical students and was utilized to incorporate the improvements in the process, wherever possible. A great majority of students (93% from group 'A' and 95% from group 'B') regarded OSCE as a practical and useful assessment tool in early years of medical education. In this study, students appreciated OSCE and offered constructive feedback on structure and organization of the process. However, at some stations they felt that instructions were ambiguous and time allocation was inadequate for the assigned tasks. The overall feedback was very useful and facilitated a critical review of the process.

  16. Dietetic students' performance of activities in an objective structured clinical examination.

    PubMed

    Lambert, L; Pattison, D J; de Looy, A E

    2010-06-01

    Objective structured clinical examinations (OSCEs) have been used to assess the key clinical skills of many health professions; however, this form of assessment is not reported to have been used extensively for dietetic students. The present study explored which key dietetic skills could be assessed by an OSCE and which activity students performed best. An OSCE of six activities, two involving simulated patients, was developed to assess key dietetic clinical skills. Thirty-five level two dietetic students undertook the OSCE, which was marked using structured marking tools. A self-administered questionnaire was also used to obtain data concerning student's opinion on the OSCE process and the time allowed for each activity. Six activities were incorporated into the OSCE, involving communication, discriminatory and interpretation and food knowledge skills. The OSCE activity students performed least well involved knowledge of portion sizes and the carbohydrate content of specific foods. The activities that students performed best were the two activities in which mainly communication skills were assessed in simulated dietetic consultations using actors as standardised patients. A dietetic OSCE was generally positively accepted by the students and offers a very effect form of assessment of key dietetic skills. Students performed better at activities requiring communication skills than those requiring greater discriminatory and interpretation and food knowledge skills. Students' food knowledge skills require reinforcing to ensure that they acquire the knowledge and skills that are unique to dietitians.

  17. The opinion of post graduate students on objective structured clinical examination in Anaesthesiology: A preliminary report.

    PubMed

    Jindal, Parul; Khurana, Gurjeet

    2016-03-01

    The scenario in medical education is changing with objective structured clinical examination (OSCE) being introduced as an assessment tool. Its successful implementation in anaesthesiology postgraduate evaluation process is still limited. We decided to to evaluate the effectiveness of OSCE and compare it to conventional examinations as formative assessment tools in anaesthesiology. We conducted a cross-sectional comparative study in defined population of anaesthesiology postgraduate students to evaluate the effectiveness of OSCE as compared to conventional examination as formative assessment tool in anaesthesiology. Thirty-five students appeared for the conventional examination on the 1(st) day and viva voce on the 2(nd) day and OSCE on the last day. At the conclusion of the assessment, all the students were asked to respond to the perception evaluation questionnaire. We analysed the perception of OSCE among the students. Results showed a positive perception of the objective structured physical examination (OSCE) as well as structured 9 (25.7%), fair 19 (54.2%) and unbiased 13 (37.1%) with more standardised scoring 9 (25.7%). The students perceived OSCE to be less stressful than other examination. Thirty-one (88.5%) students agreed that OSCE is easier to pass than conventional method and 29 (82.5%) commented that the degree of emotional stress is less in OSCE than traditional methods. OSCE is better evaluation tool when compared to conventional examination.

  18. A core competency-based objective structured clinical examination (OSCE) can predict future resident performance.

    PubMed

    Wallenstein, Joshua; Heron, Sheryl; Santen, Sally; Shayne, Philip; Ander, Douglas

    2010-10-01

    This study evaluated the ability of an objective structured clinical examination (OSCE) administered in the first month of residency to predict future resident performance in the Accreditation Council for Graduate Medical Education (ACGME) core competencies. Eighteen Postgraduate Year 1 (PGY-1) residents completed a five-station OSCE in the first month of postgraduate training. Performance was graded in each of the ACGME core competencies. At the end of 18 months of training, faculty evaluations of resident performance in the emergency department (ED) were used to calculate a cumulative clinical evaluation score for each core competency. The correlations between OSCE scores and clinical evaluation scores at 18 months were assessed on an overall level and in each core competency. There was a statistically significant correlation between overall OSCE scores and overall clinical evaluation scores (R = 0.48, p < 0.05) and in the individual competencies of patient care (R = 0.49, p < 0.05), medical knowledge (R = 0.59, p < 0.05), and practice-based learning (R = 0.49, p < 0.05). No correlation was noted in the systems-based practice, interpersonal and communication skills, or professionalism competencies. An early-residency OSCE has the ability to predict future postgraduate performance on a global level and in specific core competencies. Used appropriately, such information can be a valuable tool for program directors in monitoring residents' progress and providing more tailored guidance. © 2010 by the Society for Academic Emergency Medicine.

  19. Temporal stability of objective structured clinical exams: a longitudinal study employing item response theory

    PubMed Central

    2012-01-01

    Background The objective structure clinical examination (OSCE) has been used since the early 1970s for assessing clinical competence. There are very few studies that have examined the psychometric stability of the stations that are used repeatedly with different samples. The purpose of the present study was to assess the stability of objective structured clinical exams (OSCEs) employing the same stations used over time but with a different sample of candidates, SPs, and examiners. Methods At Time 1, 191 candidates and at Time 2 (one year apart), 236 candidates participated in a 10-station OSCE; 6 of the same stations were used in both years. Generalizability analyses (Ep2) were conducted. Employing item response analyses, test characteristic curves (TCC) were derived for each of the 6 stations for a 2-parameter model. The TCCs were compared across the two years, Time 1 and 2. Results The Ep2 of the OSCEs exceeded.70. Standardized thetas (θ) and discriminations were equivalent for the same station across the two year period indicating equivalent TCCs for a 2-parameter model. Conclusion The 6 OSCE stations used by the AIMG program over two years have adequate internal consistency reliability, stable generalizability (Ep2) and equivalent test characteristics. The process of assessment employed for IMG’s are stable OSCE stations that may be used several times over without compromising psychometric properties. With careful security, high-stakes OSCEs may use the same stations that have high internal consistency and generalizability repeatedly as the psychometric properties are stable over several years with different samples of candidates. PMID:23216816

  20. Malaysian Pharmacy Students' Assessment of an Objective Structured Clinical Examination (OSCE)

    PubMed Central

    Abd Rahman, Norny Syafinaz; Nik Mohamed, Mohamad Haniki; Bux Rahman Bux, Siti Halimah; Mohamed Nazar, Nor Ilyani

    2010-01-01

    Objective To implement and determine the effectiveness of an objective structured clinical examination (OSCE) to assess fourth-year pharmacy students' skills in a clinical pharmacy course. Design A 13-station OSCE was designed and implemented in the 2007-2008 academic year as part of the assessment methods for a clinical pharmacy course. The broad competencies tested in the OSCE included: patient counseling and communication, clinical pharmacokinetics (CPK), identification and resolution of drug-related problems (DRPs), and literature evaluation/drug information provision. Assessment Immediately after all students completed the OSCE, a questionnaire containing items on the clarity of written instructions, difficulty of the tasks, perceived degree of learning gained and needed, and the suitability of the references or literature resources provided was administered. More than 70% of the students felt that a higher degree of learning was needed to accomplish the tasks at the 2 DRP stations and 2 CPK stations and the majority felt the written instructions provided at the phenytoin CPK station were difficult to understand. Although about 60% of the students rated OSCE as a difficult form of assessment, 75% said it should be used more and 81% perceived they learned a lot from it. Conclusion Although most students felt that the OSCE accurately assessed their skills, a majority felt the tasks required in some stations required a higher degree of learning than they had achieved. This may indicate deficiencies in the students' learning abilities, the course curriculum, or the OSCE station design. Future efforts should include providing clearer instructions at OSCE stations and balancing the complexity of the competencies assessed. PMID:20414449

  1. Developing a Framework for Objective Structured Clinical Examinations Using the Nominal Group Technique

    PubMed Central

    Crum, Matthew F.; White, Paul J.; Larson, Ian; Malone, Daniel T.; Manallack, David T.; Nicolazzo, Joseph A.; McDowell, Jennifer; Lim, Angelina S.; Kirkpatrick, Carl M.

    2016-01-01

    Objective. To use the nominal group technique to develop a framework to improve existing and develop new objective structured clinical examinations (OSCEs) within a four-year bachelor of pharmacy course. Design. Using the nominal group technique, a unique method of group interview that combines qualitative and quantitative data collection, focus groups were conducted with faculty members, practicing pharmacists, and undergraduate pharmacy students. Five draft OSCEs frameworks were suggested and participants were asked to generate new framework ideas. Assessment. Two focus groups (n=9 and n=7) generated nine extra frameworks. Two of these frameworks, one from each focus group, ranked highest (mean scores of 4.4 and 4.1 on a 5-point scale) and were similar in nature. The project team used these two frameworks to produce the final framework, which includes an OSCE in every year of the course, earlier implementation of teaching OSCEs, and the use of independent simulated patients who are not examiners. Conclusions. The new OSCE framework provides a consistent structure from course entry to exit and ensures graduates meet internship requirements. PMID:28090107

  2. Using Objective Structured Clinical Examination (OSCE) as Education in Advanced Practice Registered Nursing Education.

    PubMed

    Aronowitz, Teri; Aronowitz, Shoshana; Mardin-Small, Jennifer; Kim, BoRam

    Approximately 3 million nurses make up the U.S. health care workforce. The Robert Wood Johnson Foundation and the Institute of Medicine (2011) supported the call to strengthen the nursing profession by establishing global standards of educational criteria and outcomes. Throughout the world, health education is affected by fundamental inadequacies related to static, fragmented, and content-oriented curricula. There are inadequacies in our curricula, and nursing faculties are facing challenges with clinical placements (both the number and quality of these placements); therefore, alternative methods of providing practice to students need to be considered. A transformative agenda comprising changes in the way students are taught fully harnessing the potential of information and communications technology (i.e., simulation) is necessary. Simulated patient encounters and Objective Structured Clinical Examinations are 2 means to achieve needed practice in a safe environment. The purpose of this article is to show, by using simulation, how students can practice and be evaluated within their clinical practice role in a safe, controlled environment. In addition, this practice can (a) enable students to increase the complexity of their understanding and their autonomy and (b) educate students about social accountability, health and gender equity, social justice, and human rights. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Computer Assisted Objective Structured Clinical Examination: a useful tool for dermatology undergraduate assessment.

    PubMed

    Grover, Chander; Bhattacharya, Sambit Nath; Pandhi, Deepika; Singal, Archana; Kumar, Pradeep

    2012-01-01

    Dermatology is a minor subject in undergraduate medical curriculum in India. The dermatology clinical postings are generally poorly attended, and the clinical acumen of an average medical graduate in this specialty is quite low. To develop and implement Computer Assisted Objective Structured Clinical Examination (CA-OSCE) as a means of end of dermatology posting evaluation. Also, to assess its effectiveness in improving the motivation, attendance and learning of undergraduate students with respect to their visual recognition skills and problem solving ability. We designed and introduced CA-OSCE as a means of end of posting assessment. The average attendance and assessment scores of students undergoing CA-OSCE were compiled and compared using 'independent t test' with the scores of previous year's students who had undergone assessment with essay type questions. The average attendance and average assessment scores for the candidates undergoing CA-OSCE were found to 83.36% and 77.47%, respectively as compared to 64.09% and 52.07%, respectively for previous years' students. The difference between the two groups was found to be statistically significant. Student acceptability of the technique was also high, and their subjective feedback was encouraging. CA-OSCE is a useful tool for assessment of dermatology undergraduates. It has the potential to drive them to attend regularly as well as to test their higher cognitive skills of analysis and problem solving.

  4. Genetics objective structured clinical exams at the Maimonides Infants & Children's Hospital of Brooklyn, New York.

    PubMed

    Altshuler, Lisa; Kachur, Elizabeth; Krinshpun, Shifra; Sullivan, Deborah

    2008-11-01

    In 2003, the Maimonides Infants & Children's Hospital received a Title VII Residency Training in Primary Care grant to integrate genetic-specific competencies into postgraduate pediatrics education. As part of that endeavor, mandatory yearly genetics objective structured clinical exams (OSCEs) were instituted for third-year residents. This article reports on the first three years of experience with this innovative educational tool.After an overview of genetic concepts, dysmorphology, and communication styles, residents complete a five-station OSCE and receive feedback from standardized patients and from the faculty who observe them. After this clinical exercise, the residents participate in a small-group debriefing session to share strategies for effective communication and clinical case management and to discuss the ethical issues that arise with these genetic cases.In three years, 60 residents have completed the genetics OSCE program. Evaluation data demonstrate that the program has been effective in both introducing genetic-specific challenges and assessing residents' clinical skills. It has helped trainees self-identify both strengths and further training needs. Pre- and postsurveys among the trainees show increased comfort levels in performing 5 of 12 genetic-related clinical tasks.We conclude that genetics OSCEs are an enriching educational tool. Merely providing trainees and practicing physicians with the latest scientific information is unlikely to prepare them for counseling patients about complex genetic issues. Developing proficiency requires focused practice and effective feedback.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

  5. Investigating the Attitude of Graduate Psychiatrists towards Objective Structured Clinical Examination (OSCE) and Conventional Clinical Interview Examination.

    PubMed

    Nazeri Astaneh, Ali; Mirabzadeh, Arash; Karimloo, Masood; Rezaei, Omid; Fadai, Farbod; Alibeigi, Neda; Mazinani, Robabeh; Samiei, Mercedeh; Khodaei, Mohammad Reza

    2014-04-01

    In the present study, we investigated the attitude of psychiatrists who graduated in 2002-2009 towards Objective Structured Clinical Examination (OSCE) and conventional clinical interview examination (Individual Patient Assessment). We studied 134 psychiatrists graduated; half of whom were examined with conventional clinical interview and the others with OSCE. A questionnaire was prepared by a specialist workgroup to assess the participants' attitude towards the exams. The questionnaire was initially examined in a pilot study. The findings of the questionnaire were used to assess the graduates' attitude towards each examination, as well as to compare the examinations. The OSCE group indicated a significantly more positive attitude compared to the conventional group (p = 0.03). Furthermore, the OSCE group believed the role of theoretical knowledge (p = 0.01) and pre-test practice (p = 0.03) to be significantly greater for success compared to the other group. The structure of OSCE was reported to be superior to conventional examination in terms of fairness and homogeneity (p = 0.004). First participation in exam (p = 0.04) and ultimate success in the exam (p = 0.009) were predictors of graduates' attitude. Based on examinees 'attitudes, OSCE may be a more appropriate choice for graduation examinations of psychiatry compared to the conventional clinical interview examination.

  6. Malaysian pharmacy students' assessment of an objective structured clinical examination (OSCE).

    PubMed

    Awaisu, Ahmed; Abd Rahman, Norny Syafinaz; Nik Mohamed, Mohamad Haniki; Bux Rahman Bux, Siti Halimah; Mohamed Nazar, Nor Ilyani

    2010-03-10

    To implement and determine the effectiveness of an objective structured clinical examination (OSCE) to assess fourth-year pharmacy students' skills in a clinical pharmacy course. A 13-station OSCE was designed and implemented in the 2007-2008 academic year as part of the assessment methods for a clinical pharmacy course. The broad competencies tested in the OSCE included: patient counseling and communication, clinical pharmacokinetics (CPK), identification and resolution of drug-related problems (DRPs), and literature evaluation/drug information provision. Immediately after all students completed the OSCE, a questionnaire containing items on the clarity of written instructions, difficulty of the tasks, perceived degree of learning gained and needed, and the suitability of the references or literature resources provided was administered. More than 70% of the students felt that a higher degree of learning was needed to accomplish the tasks at the 2 DRP stations and 2 CPK stations and the majority felt the written instructions provided at the phenytoin CPK station were difficult to understand. Although about 60% of the students rated OSCE as a difficult form of assessment, 75% said it should be used more and 81% perceived they learned a lot from it. Although most students felt that the OSCE accurately assessed their skills, a majority felt the tasks required in some stations required a higher degree of learning than they had achieved. This may indicate deficiencies in the students' learning abilities, the course curriculum, or the OSCE station design. Future efforts should include providing clearer instructions at OSCE stations and balancing the complexity of the competencies assessed.

  7. Clinical examiners, simulated patients, and student self-assessed empathy in medical students during a psychiatry objective structured clinical examination.

    PubMed

    O'Connor, Karen; King, Romaine; Malone, Kevin M; Guerandel, Allys

    2014-08-01

    This study aims to assess and compare objective and subjective scores of empathy in final-year medical students by using firstly a validated student self-assessment just prior to the psychiatry objective structured clinical examination (OSCE), and then comparing this to clinical examiner's and simulated patient's (SP's) assessments of empathy of students using a Global Rating of Empathy scale (GRE) during a psychiatry OSCE. In 2011, all final-year medical students in the University College Dublin were invited to complete a subjective, self-assessed empathy questionnaire (The Jefferson scale of physician empathy-student version (JSPE-S)). They were also assessed for empathy in four OSCEs by the clinical examiner and the SP acting in that OSCE scenario. Included in the analysis were 163 of 184 final-year students JSPE-S (88.6%) questionnaires. The female students scores on the JSPE-S were significantly higher than those of their male peers (t=3.34, p=0.001). Concurrent validity was greater between the SPs' assessments of empathy in the OSCE and the JSPE-S score than between the clinical examiners assessments of empathy and the JSPE-S score (r=0.23, p<0.005; r=0.14, p<0.08). Inter-rater reliability of SP's and clinical examiner's using the GRE was found to be high (F=0.868 (df=171, 171), p value<0.001). SPs may be valid assessors of empathy in medical students during an OSCE.

  8. An Objective Structured Clinical Examination to Improve Formative Assessment for Senior Pediatrics Residents

    PubMed Central

    Mangold, Karen A.; Jeffers, Justin M.; Burns, Rebekah A.; Trainor, Jennifer L.; Unti, Sharon M.; Eppich, Walter; Adler, Mark D.

    2015-01-01

    Background Residency programs are developing new methods to assess resident competence and to improve the quality of formative assessment and feedback to trainees. Simulation is a valuable tool for giving formative feedback to residents. Objective To develop an objective structured clinical examination (OSCE) to improve formative assessment of senior pediatrics residents. Methods We developed a multistation examination using various simulation formats to assess the skills of senior pediatrics residents in communication and acute resuscitation. We measured several logistical factors (staffing and program costs) to determine the feasibility of such a program. Results Thirty-one residents participated in the assessment program over a 3-month period. Residents received formative feedback comparing their performance to both a standard task checklist and to peers' performance. The program required 16 faculty members per session, and had a cost of $624 per resident. Conclusions A concentrated assessment program using simulation can be a valuable tool to assess residents' skills in communication and acute resuscitation and provide directed formative feedback. However, such a program requires considerable financial and staffing resources. PMID:26457159

  9. The Assessment of Undergraduate Medical Students’ Satisfaction Levels With the Objective Structured Clinical Examination

    PubMed Central

    Khosravi Khorashad, Ahmad; Salari, Somayyeh; Baharvahdat, Humain; Hejazi, Sepideh; Lari, Shiva M; Salari, Maasoomeh; Mazloomi, Maryam; Lari, Shahrzad M

    2014-01-01

    Background: The objective structured clinical examination (OSCE) has been introduced as an efficient method for the assessment of medical students. Objectives: The aim of the present study was to determine the satisfaction level of undergraduate medical students of internal medicine department with the OSCE. Materials and Methods: This was a descriptive cross-sectional study, performed on all available undergraduate students at the end of their internal medicine training period in Mashhad University of Medical Sciences. The students responded to 15 multiple-choice questions with confirmed validity and reliability. Results: The majority of the students (94.5%) had a positive attitude toward the OSCE and mentioned that the OSCE format was a more appropriate type of exam than other methods of testing; however, 79.1% thought that the OSCE format was stressful. In addition, the participants’ sex had no effect on their level of satisfaction with the examination. Likewise, there was no significant correlation between their level of satisfaction and their age, marital status, or lack of previous experience with this type of exam. Conclusions: If the exam standards are met and a uniform dispersion of the scientific content is maintained, the OSCE method of assessment can be recommended as an efficient and applicable method for assessing medical students. PMID:25389474

  10. Reliability analysis of the objective structured clinical examination using generalizability theory.

    PubMed

    Trejo-Mejía, Juan Andrés; Sánchez-Mendiola, Melchor; Méndez-Ramírez, Ignacio; Martínez-González, Adrián

    2016-01-01

    Background The objective structured clinical examination (OSCE) is a widely used method for assessing clinical competence in health sciences education. Studies using this method have shown evidence of validity and reliability. There are no published studies of OSCE reliability measurement with generalizability theory (G-theory) in Latin America. The aims of this study were to assess the reliability of an OSCE in medical students using G-theory and explore its usefulness for quality improvement. Methods An observational cross-sectional study was conducted at National Autonomous University of Mexico (UNAM) Faculty of Medicine in Mexico City. A total of 278 fifth-year medical students were assessed with an 18-station OSCE in a summative end-of-career final examination. There were four exam versions. G-theory with a crossover random effects design was used to identify the main sources of variance. Examiners, standardized patients, and cases were considered as a single facet of analysis. Results The exam was applied to 278 medical students. The OSCE had a generalizability coefficient of 0.93. The major components of variance were stations, students, and residual error. The sites and the versions of the tests had minimum variance. Conclusions Our study achieved a G coefficient similar to that found in other reports, which is acceptable for summative tests. G-theory allows the estimation of the magnitude of multiple sources of error and helps decision makers to determine the number of stations, test versions, and examiners needed to obtain reliable measurements.

  11. Reliability analysis of the objective structured clinical examination using generalizability theory

    PubMed Central

    Trejo-Mejía, Juan Andrés; Sánchez-Mendiola, Melchor; Méndez-Ramírez, Ignacio; Martínez-González, Adrián

    2016-01-01

    Background The objective structured clinical examination (OSCE) is a widely used method for assessing clinical competence in health sciences education. Studies using this method have shown evidence of validity and reliability. There are no published studies of OSCE reliability measurement with generalizability theory (G-theory) in Latin America. The aims of this study were to assess the reliability of an OSCE in medical students using G-theory and explore its usefulness for quality improvement. Methods An observational cross-sectional study was conducted at National Autonomous University of Mexico (UNAM) Faculty of Medicine in Mexico City. A total of 278 fifth-year medical students were assessed with an 18-station OSCE in a summative end-of-career final examination. There were four exam versions. G-theory with a crossover random effects design was used to identify the main sources of variance. Examiners, standardized patients, and cases were considered as a single facet of analysis. Results The exam was applied to 278 medical students. The OSCE had a generalizability coefficient of 0.93. The major components of variance were stations, students, and residual error. The sites and the versions of the tests had minimum variance. Conclusions Our study achieved a G coefficient similar to that found in other reports, which is acceptable for summative tests. G-theory allows the estimation of the magnitude of multiple sources of error and helps decision makers to determine the number of stations, test versions, and examiners needed to obtain reliable measurements. PMID:27543188

  12. Cost and logistics for implementing the American College of Surgeons objective structured clinical examination.

    PubMed

    Sudan, Ranjan; Clark, Philip; Henry, Brandon

    2015-01-01

    The American College of Surgeons has developed a reliable and valid OSCE (objective structured clinical examination) to assess the clinical skills of incoming postgraduate year 1 surgery residents, but the cost and logistics of implementation have not been described. Fixed costs included staff time, medical supplies, facility fee, standardized patient (SP) training time, and one OSCE session. Variable costs were incurred for additional OSCE sessions. Costs per resident were calculated and modeled for increasing the number of test takers. American College of Surgeons OSCE materials and examination facilities were free. Fixed costs included training 11 SPs for 4 hours ($1,540), moulage and simulation material ($469), and administrative effort for 44 hours ($2,200). Variable cost for each session was $1,540 (SP time). Total cost for the first session was $6,649 ($664/resident), decreased to $324/resident for 3 sessions, and projected to further decline to $239/resident for 6 sessions. The cost decreased as the number of residents tested increased. To manage costs, testing more trainees by regional collaboration is recommended. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Expanding the role of objectively structured clinical examinations in nephrology training.

    PubMed

    Prince, Lisa K; Abbott, Kevin C; Green, Felicidad; Little, Dustin; Nee, Robert; Oliver, James D; Bohen, Erin M; Yuan, Christina M

    2014-06-01

    Objectively structured clinical examinations (OSCEs) are widely used in medical education, but we know of none described that are specifically for nephrology fellowship training. OSCEs use simulation to educate and evaluate. We describe a technically simple, multidisciplinary, low-cost OSCE developed by our program that contains both examination and training features and focuses on management and clinical knowledge of rare hemodialysis emergencies. The emergencies tested are venous air embolism, blood leak, dialysis membrane reaction, and hemolysis. Fifteen fellows have participated in the OSCE as examinees and/or preceptors since June 2010. All have passed the exercise. Thirteen responded to an anonymous survey in July 2013 that inquired about their confidence in managing each of the 4 tested emergencies pre- and post-OSCE. Fellows were significantly more confident in their ability to respond to the emergencies after the OSCE. Those who subsequently saw such an emergency reported that the OSCE experience was somewhat or very helpful in managing the event. The OSCE tested and trained fellows in the recognition and management of rare hemodialysis emergencies. OSCEs and simulation generally deserve greater use in nephrology subspecialty training; however, collaboration between training programs would be necessary to validate such exercises.

  14. Assessing residents' disclosure of adverse events: traditional objective structured clinical examinations versus mixed reality.

    PubMed

    Posner, Glenn; Naik, Viren; Bidlake, Erin; Nakajima, Amy; Sohmer, Benjamin; Arab, Abeer; Varpio, Lara

    2012-04-01

    The skill of disclosing adverse events is difficult to assess. Assessment of this competency in medical trainees is commonly achieved via the objective structured clinical examination (OSCE) using a standardized patient (SP). We hypothesized that the addition of a simulated clinical adverse event prior to the SP encounter could increase trainees' engagement and empathy, thereby improving performance. The objective of this study was to explore whether experiencing a simulated adverse event prior to an SP encounter alters resident performance on a disclosure OSCE. Sixteen obstetrics and gynaecology residents participated in this mixed methods study. Prior to disclosing the complication in an SP encounter, residents were randomized either to receive a written description of an adverse event, or to experience a mannequin simulation of an adverse event. Mean OSCE scores from blinded examiners were compared in each group. Focus group discussions elicited residents' reflections on the experience of disclosing the adverse event. The mean score was 16.6/23 ± 2.9 (range 10 to 20) for the traditional OSCE group and 16.9/23 ± 1.7 (range 15 to 20) for the simulation group. Analysis of the focus group data revealed several themes, such as the type of context the residents desired, the emotional involvement they felt, and their insights about their experience of the simulation scenario or with the SP. The assessment of adverse event disclosure was not enhanced by the addition of a simulated experience. Study participants reported that the simulation did not provide the contextual information required to elicit empathy and a sense of being emotionally invested in the adverse event.

  15. Measuring Professional Behaviour in Canadian Physical Therapy Students' Objective Structured Clinical Examinations: An Environmental Scan

    PubMed Central

    Ellerton, Cindy; Evans, Cathy

    2015-01-01

    ABSTRACT Purpose: To identify professional behaviours measured in objective structured clinical examinations (OSCEs) by Canadian university physical therapy (PT) programs. Method: A cross-sectional telephone survey was conducted to review current practice and determine which OSCE items Canadian PT programs are using to measure PT students' professional behaviours. Telephone interviews using semi-structured questions were conducted with individual instructors responsible for courses that included an OSCE as part of the assessment component. Results: Nine PT programmes agreed to take part in the study, and all reported conducting at least one OSCE. The number and characteristics of OSCEs varied both within and across programs. Participants identified 31 professional behaviour items for use in an OSCE; these items clustered into four categories: communication (n=14), respect (n=10), patient safety (n=4), and physical therapists' characteristics (n=3). Conclusions: All Canadian entry-level PT programmes surveyed assess professional behaviours in OSCE-type examinations; however, the content and style of assessment is variable. The local environment should be considered when determining what professional behaviours are appropriate to assess in the OSCE context in individual programmes. PMID:25931656

  16. A comparative analysis of the costs of administration of an OSCE (objective structured clinical examination).

    PubMed

    Cusimano, M D; Cohen, R; Tucker, W; Murnaghan, J; Kodama, R; Reznick, R

    1994-07-01

    The objective structured clinical examination (OSCE) has become an accepted technique for the evaluation of clinical competence in medicine. Although advances have been made in our knowledge of the psychometric aspects of the OSCE, extremely little has been written about feasibility and cost issues. Given the current economic imperative to control costs and the extremely scant literature on the costs of developing and administering an examination in medicine, the authors felt it timely and relevant to explore issues related to the cost of the OSCE. In 1991-92 and in 1992-93, costs and time requirements to implement and administer a structured oral (SO) examination and a six-station OSCE for a surgical clerkship at the University of Toronto Faculty of Medicine were gathered by review of invoices, interviews with those involved, and perusal of diaries kept by staff. To develop and administer the six-station OSCE, 327.5 hours of staff and faculty time were required for each rotation of surgical clerks (8.2 hours per student). The SO examination required 110 hours of staff and faculty time (2.75 hours per student). Direct expenses for the OSCE amounted to U.S. $6.90 per student per station, compared with no direct expense for the SO examination. The OSCE was more time-consuming and more expensive in human and material costs than the SO examination. However, costs of the OSCE can be substantially reduced from approximately U.S. $35 to U.S. ! per student per station if test developers, standardized patients, support staff, and examiners can donate their time. The authors compare the costs and time requirements of their OSCE with those of other OSCEs reported in the literature, and they provide guidelines to assist educators in deciding whether the costs of an OSCE are justifiable in the educators' individual settings.

  17. Implementing an Objective Structured Clinical Examination (OSCE) in dental education: effects on students' learning strategies.

    PubMed

    Schoonheim-Klein, M E; Habets, L L M H; Aartman, I H A; van der Vleuten, C P; Hoogstraten, J; van der Velden, U

    2006-11-01

    To investigate the effect of an Objective Structured Clinical Examination (OSCE) on dental students' learning strategies and competence to manage periodontal diseases in patients. The implemented OSCE was expected to be superior to the existing Written Exam in fostering the acquisition of clinical competencies in terms of study strategies that are more oriented towards clinical practice, longer study time, greater clinical proficiency, and more realistic self-assessment. After a clinical course in periodontology, 72 third year dental students were assessed summatively, either using a Written Exam or an OSCE (P-OSCE). The students were informed beforehand about the assessment formats. The self-assessed clinical competence, study time and strategies (i.e. practice with a manikin, peers and patient case) were evaluated by means of a questionnaire. After a comprehensive dental care course, all 72 students were assessed by an overall end-of-year OSCE, in which three periodontal stations were included 'measuring pockets', 'educating patients' and 'tracing an X-ray with bone-loss'. The competence of the previous Written Exam group and the P-OSCE group was investigated by determining the mean scores and pass-fail scores of three periodontal test-stations as well as the total score of the end-of-year OSCE. The degree of realistic self-assessment was studied by correlating the self-assessed competencies as evaluated by means of the questionnaire with the total score of the end-of-year OSCE. Self-assessed clinical competence, study time and study strategies showed no differences between the P-OSCE and the Written Exam-group. The clinical competence determined in the test-station 'measuring pockets' in the end of year overall OSCE was higher for the P-OSCE group (P = 0.05) when compared with the Written Exam group; the two groups performed equally well in the test station 'educating patients', whereas the performance in 'tracing an X-ray with bone-loss' was better in the

  18. Implementation of an objective structured clinical exam (OSCE) into orthopedic surgery residency training.

    PubMed

    Griesser, Michael J; Beran, Matthew C; Flanigan, David C; Quackenbush, Michael; Van Hoff, Corey; Bishop, Julie Y

    2012-01-01

    While the musculoskeletal (MSK) physical examination (PE) is an essential part of a patient encounter, we believe it is an underemphasized component of orthopedic residency education and that resident PE skills may be lacking. The purpose of this investigation was to (1) assess the attitudes regarding PE teaching in orthopedic residencies today; (2) develop an MSK objective structured clinical examination (OSCE) to assess the MSK PE knowledge and skills of our orthopedic residents. Prospective, uncontrolled, observational. A major Midwestern tertiary referral center and academic medical center. The orthopedic surgery residents in our program. Twenty-two of 24 completed the OSCE. Surveys showed that residents agreed that although learning the PE is important, there is not enough time in clinic to actually observe and critique a resident examining a patient. For the 22 residents (postgraduate year [PGY] 2-5) who participated in the OSCE, the overall score was 66%. Scores were significantly better for the trauma scenario (78%; p < 0.05) than for the shoulder (67%), spine (64%), and knee (59%) encounters. The overall scores for each component of the OSCE were: (1) history 53%; (2) PE 60%; (3) 5-question posttest 64%; and (4) communication skills 90%. We have exposed a deficiency in the PE knowledge and skills of our residents. Clinic time alone may be insufficient to both teach and learn the MSK PE. The use of a MSK OSCE, while novel in orthopedics, will allow more direct observation of our residents MSK PE skills and also allow us to follow resident skills longitudinally through their training. We hope that our efforts will encourage other programs to assess their PE curriculum and perhaps prompt change. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  19. Implementing the objective structured clinical examination in a geriatrics fellowship program-a 3-year experience.

    PubMed

    Avelino-Silva, Thiago J; Gil, Luiz A; Suemoto, Claudia K; Kikuchi, Elina L; Lin, Sumika M; Farias, Luciana L; Jacob-Filho, Wilson

    2012-07-01

    The Objective Structured Clinical Examination (OSCE) appears to be an effective alternative for assessing not only medical knowledge, but also clinical skills, including effective communication and physical examination skills. The purpose of the current study was to implement an OSCE model in a geriatrics fellowship program and to compare the instrument with traditional essay examination. Seventy first- and second-year geriatric fellows were initially submitted to a traditional essay examination and scored from 0 to 10 by a faculty member. The same fellows subsequently underwent an OSCE with eight 10-minute stations covering a wide range of essential aspects of geriatric knowledge. Each OSCE station had an examiner responsible for its evaluation according to a predefined checklist. Checklist items were classified for analysis purposes as clinical knowledge items (CKI) and communication skills items (CSI); fellow responses were scored from 0 to 10.Although essay examinations took from 30 to 45 minutes to complete, 180-200 minutes were required to evaluate fellows using the proposed OSCE method. Fellows scored an average of 6.2 ± 1.2 on the traditional essay examination and 6.6 ± 1.0 on the OSCE (P < .001). Subanalyses of OSCE scores indicated that average performance on CKI was lower than the average on CSI (6.4 ± 1.1 vs. 8.4 ± 1.1; P < .001). Fellow performance on the essay examination was similar to their performance on CKI (P = .13). Second-year fellows performed better than first-year fellows on the essay examination (P < .001) and CKI (P = .05), but not on CSI (P = .25).The OSCE was successfully implemented as an educational strategy during a geriatrics fellowship program. Combining different testing modalities may provide the best assessment of competence for various domains of knowledge, skills, and behavior. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  20. Surgery Clerkship Evaluations Are Insufficient for Clinical Skills Appraisal: The Value of a Medical Student Surgical Objective Structured Clinical Examination.

    PubMed

    Butler, Kathryn L; Hirsh, David A; Petrusa, Emil R; Yeh, D Dante; Stearns, Dana; Sloane, David E; Linder, Jeffrey A; Basu, Gaurab; Thompson, Lisa A; de Moya, Marc A

    Optimal methods for medical student assessment in surgery remain elusive. Faculty- and housestaff-written evaluations constitute the chief means of student assessment in medical education. However, numerous studies show that this approach has poor specificity and a high degree of subjectivity. We hypothesized that an objective structured clinical examination (OSCE) in the surgery clerkship would provide additional data on student performance that would confirm or augment other measures of assessment. We retrospectively reviewed data from OSCEs, National Board of Medical Examiners shelf examinations, oral presentations, and written evaluations for 51 third-year Harvard Medical School students rotating in surgery at Massachusetts General Hospital from 2014 to 2015. We expressed correlations between numeric variables in Pearson coefficients, stratified differences between rater groups by one-way analysis of variance, and compared percentages with 2-sample t-tests. We examined commentary from both OSCE and clinical written evaluations through textual analysis and summarized these results in percentages. OSCE scores and clinical evaluation scores correlated poorly with each other, as well as with shelf examination scores and oral presentation grades. Textual analysis of clinical evaluation comments revealed a heavy emphasis on motivational factors and praise, whereas OSCE written comments focused on cognitive processes, patient management, and methods to improve performance. In this single-center study, an OSCE provided clinical skills data that were not captured elsewhere in the surgery clerkship. Textual analysis of faculty evaluations reflected an emphasis on interpersonal skills, rather than appraisal of clinical acumen. These findings suggest complementary roles of faculty evaluations and OSCEs in medical student assessment. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  1. Clinical competence assessment in radiology: introduction of an objective structured clinical examination in the medical school curriculum.

    PubMed

    Morag, E; Lieberman, G; Volkan, K; Shaffer, K; Novelline, R; Lang, E V

    2001-01-01

    Traditional oral and written examinations can be limited in predicting future clinical performance. Therefore Objective Structured Clinical Examinations (OSCEs) have been introduced in other specialties. The authors assessed their value in radiology. The study includes 122 Harvard medical students who undertook 1-month compulsory clerkships at one of three hospitals (A, B, or C) in their 3rd and 4th year and a compulsory OSCE in their 4th year. The OSCE was constructed from five cases. Each had eight or nine standardized questions designed to test, within a set time, the perception of essential findings, their interpretation, and clinical judgment (maximum possible score, 100). Clerkship grades were high honors (score of 3), honors (score of 2), satisfactory (score of 1), and fail (score of 0). Predictors of OSCE scores-clerkship grade and affiliated hospital-were modeled as linear functions. Time elapsed between clerkship and OSCE was modeled as a nonlinear function. Although there was a positive relation between clerkship grade and OSCE grade, it accounted for an increase of only 5.7% in OSCE score per clerkship grade and did not predict performance of individual students. Students who trained in hospital B showed significantly higher OSCE grades. OSCE scores were highest when the examination was taken 8 months after the clerkship. The OSCE may be useful to uncover deficits in individuals and groups beyond the ones detected with traditional clerkship evaluations and provide guidance for remediation. The improved performance after additional clinical exposure suggests that the OSCE may be well suited to test the integration of radiologic and clinical knowledge.

  2. Using Objective Structured Clinical Examinations to Assess Intern Orthopaedic Physical Examination Skills: A Multimodal Didactic Comparison.

    PubMed

    Phillips, Donna; Pean, Christian A; Allen, Kathleen; Zuckerman, Joseph; Egol, Kenneth

    Patient care is 1 of the 6 core competencies defined by the Accreditation Council for Graduate Medical Education (ACGME). The physical examination (PE) is a fundamental skill to evaluate patients and make an accurate diagnosis. The purpose of this study was to investigate 3 different methods to teach PE skills and to assess the ability to do a complete PE in a simulated patient encounter. Prospective, uncontrolled, observational. Northeastern academic medical center. A total of 32 orthopedic surgery residents participated and were divided into 3 didactic groups: Group 1 (n = 12) live interactive lectures, demonstration on standardized patients, and textbook reading; Group 2 (n = 11) video recordings of the lectures given to Group 1 and textbook reading alone; Group 3 (n = 9): 90-minute modules taught by residents to interns in near-peer format and textbook reading. The overall score for objective structured clinical examinations from the combined groups was 66%. There was a trend toward more complete PEs in Group 1 taught via live lectures and demonstrations compared to Group 2 that relied on video recording. Near-peer taught residents from Group 3 significantly outperformed Group 2 residents overall (p = 0.02), and trended toward significantly outperforming Group 1 residents as well, with significantly higher scores in the ankle (p = 0.02) and shoulder (p = 0.02) PE cases. This study found that orthopedic interns taught musculoskeletal PE skills by near-peers outperformed other groups overall. An overall score of 66% for the combined didactic groups suggests a baseline deficit in first-year resident musculoskeletal PE skills. The PE should continue to be taught and objectively assessed throughout residency to confirm that budding surgeons have mastered these fundamental skills before going into practice. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  3. Factors associated with medical student test anxiety in objective structured clinical examinations: a preliminary study

    PubMed Central

    2016-01-01

    Objectives To investigate attributes of medical students associated with their test anxiety on Objective Structured Clinical Examinations (OSCEs). Methods A cross-sectional study using a self-administered questionnaire was conducted of all Year 3 and 4 students at a private medical school in South Korea in 2014. This 53-item questionnaire consisted of factors pertaining to test anxiety on the OSCE identified from a review of relevant literature, which included students’ motivational beliefs and achievement emotions, perceived values of the OSCE, and attitude and orientation towards patients. Participants’ test anxiety levels were measured using the Korean Achievement Emotions Questionnaire. Participants rated their responses using a five-point Likert-type scale. Univariate analysis was performed to examine relationships between the variables. Results A total of 94 students completed the questionnaire (a 93% response rate). No differences in the participants’ test anxiety scores were observed across genders, entry-levels, or years in medical school. Participants’ test anxiety on the OSCE showed moderate association with their class-related achievement emotions (i.e., anxiety and boredom), where r = 0.46 and 0.32, p < 0.01, respectively, and weak negative associations with their patient-centeredness (r = -0.21, p < 0.05) and with their perceived values of the OSCE (r = -0.21, p < 0.05). Conclusions This study found some non-cognitive factors related to medical students’ test anxiety on the OSCE. These findings have implications for developing effective educational interventions for helping students cope with such a stress by enhancing our understanding of the various factors that influence their test anxiety in OSCEs. PMID:28035056

  4. When to cut? Using an objective structured clinical examination to evaluate surgical decision-making.

    PubMed

    Franzese, Christine

    2007-11-01

    To create an objective structured clinical examination (OSCE) tailored to surgical residents that uses surgical case scenarios appropriate for the experience level of the resident to evaluate whether residents understand the indications for a specific surgery, identify when indications are met, and make the appropriate decision to proceed with an operation. The surgical OSCE consisted of two case scenarios: a junior case created for postgraduate year (PGY) 2 to 3 level residents and a senior case created for PGY 4 to 5 level residents. Four senior residents and four junior residents in the otolaryngology department participated. Residents were instructed to proceed as if they had all the capabilities of the otolaryngology clinic. Recordings were made of each encounter and were reviewed by two separate faculty member with expertise in each case. Faculty evaluated whether surgical indications were elicited by history, whether certain physical examination or radiographic findings were recognized, whether residents made the correct diagnosis, and whether residents not only made the decision to proceed with surgery but also indicated the correct surgery. Seniors (100%) were better at obtaining needed surgical information and indications than juniors (25%). Seniors were more willing to make the decision to proceed with surgery (100%), whereas no juniors actually scheduled surgery. The reasons for this ranged from failure to elicit surgical indications to lack of surety in proceeding with surgery. All seniors recommended the appropriate surgery, but only 75% correctly identified the need for emergent intervention. Results of evaluations were reviewed with each resident individually. The surgical OSCE was successful in evaluating resident surgical decision-making. Juniors were not as capable as seniors in eliciting surgical indications and in "making the jump" to proceed with surgery. These results were used by our faculty to work with juniors on surgical history

  5. Performance of an objective structured clinical examination in a national certification process of trainees in rheumatology.

    PubMed

    Pascual Ramos, Virginia; Medrano Ramírez, Gabriel; Solís Vallejo, Eunice; Bernard Medina, Ana Guilaisne; Flores Alvarado, Diana Elsa; Portela Hernández, Margarita; Andrade Ortega, Lilia; Vera Lastra, Olga; Espinosa Morales, Rolando; Miranda Limón, Juan Manuel; Maldonado Velázquez, María Del Rocío; Jara Quezada, Luis Javier; Amezcua Guerra, Luis Manuel; López Zepeda, Judith; Saavedra Salinas, Miguel Ángel; Arce Salinas, Cesar Alejandro

    2015-01-01

    To assess reliability and validity of the objectively-structured clinical examination (OSCE) applied in postgraduate certification processes by the Mexican Board of Rheumatology. Thirty-two (2013) and 38 (2014) Rheumatology trainees (RTs) underwent an OSCE consisting of 12 and 15 stations respectively, scored according to a validated check-list, as well as 300-multiple-choice 300 question examination (MCQ). Previously, 3 certified rheumatologists underwent a pilot-OSCE. A composite OSCE score was obtained for each participant and its performance examined. In 2013, OSCE mean score was 7.1±0.6 with none RT receiving a failing score while the MCQ score was 6.5±0.6 and 7 (21.9%) RTs receiving a failing (< 6) score. In 2014, the OSCE score was 6.7±0.6, with 3 (7.9%) RTs receiving a failing score (2 of them also failed MCQ) while the MCQ score was 6.4±0.5 and 7 (18.5%) RTs were disqualified (2 of them also failed OSCE). A significant correlation between the MCQ and the OSCE scores was observed in the 2013 (r=0.44; P=0.006). Certified rheumatologists performed better than RTs at both OSCE. Overall, 86% of RTs obtaining an OSCE passing score also obtained a MCQ passing score, while this was only 67% (P=.02) among those who obtained an OSCE failing score. Nine stations were applied at both consecutive years. Their performance was similar in both certification processes, with correlation coefficients ranging from 0.81 to 0.95 (P≤0.01). The OSCE is a valid and reliable tool to assess the Rheumatology clinical skills in RTs. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  6. An objective structured clinical exam to measure intrinsic CanMEDS roles

    PubMed Central

    Kassam, Aliya; Cowan, Michèle; Donnon, Tyrone

    2016-01-01

    Background The CanMEDS roles provide a comprehensive framework to organize competency-based curricula; however, there is a challenge in finding feasible, valid, and reliable assessment methods to measure intrinsic roles such as Communicator and Collaborator. The objective structured clinical exam (OSCE) is more commonly used in postgraduate medical education for the assessment of clinical skills beyond medical expertise. Method We developed the CanMEDS In-Training Exam (CITE), a six-station OSCE designed to assess two different CanMEDS roles (one primary and one secondary) and general communication skills at each station. Correlation coefficients were computed for CanMEDS roles within and between stations, and for general communication, global rating, and total scores. One-way analysis of variance (ANOVA) was used to investigate differences between year of residency, sex, and the type of residency program. Results In total, 63 residents participated in the CITE; 40 residents (63%) were from internal medicine programs, whereas the remaining 23 (37%) were pursuing other specialties. There was satisfactory internal consistency for all stations, and the total scores of the stations were strongly correlated with the global scores r=0.86, p<0.05. Noninternal medicine residents scored higher in terms of the Professional competency overall, whereas internal medicine residents scored significantly higher in the Collaborator competency overall. Discussion The OSCE checklists developed for the assessment of intrinsic CanMEDS roles were functional, but the specific items within stations required more uniformity to be used between stations. More generic types of checklists may also improve correlations across stations. Conclusion An OSCE measuring intrinsic competence is feasible; however, further development of our cases and checklists is needed. We provide a model of how to develop an OSCE to measure intrinsic CanMEDS roles that educators may adopt as residency programs move

  7. Influence of standardized patient body habitus on undergraduate student performance in an Objective Structured Clinical Examination.

    PubMed

    Yazbeck-Karam, Vanda; Aoun Bahous, Sola; Faour, Wissam; Khairallah, Maya; Asmar, Nadia

    2014-03-01

    Previous studies have shown that the standardized patient's (SP) gender may affect student performance in an Objective Structured Clinical Examination (OSCE). The aim of this study is to investigate the influence of the SPs' body habitus on students' performance in an OSCE counseling station. Four equally trained female SPs, with either a normal or an obese BMI participated in an OSCE counseling station for cardiovascular risk factors. Ninety-two, second year medical students were randomly assigned to one of the SPs. Station scores were compared and student behavior and opinion regarding the influence of their SP's body habitus on their performance was assessed. There was no difference in mean exam scores for students interacting with SPs with a normal BMI versus increased BMI (14.9 ± 2.2 versus 14.01 ± 2.2/20 respectively, p = 0.06). Additionally, almost all students gave advice about healthy diets (93.5% versus 95.7%) with no specificity regarding the BMI of the SP. The body habitus of the SP did not significantly affect students' performance in an undergraduate OSCE about cardiovascular risk factors, suggesting that students at that level may primarily focus on gaining points the diagnostic checklist without considering SPs as real patients.

  8. Qualitative content analysis experiences with objective structured clinical examination among Korean nursing students.

    PubMed

    Jo, Kae-Hwa; An, Gyeong-Ju

    2014-04-01

    The aim of this study was to explore the experiences of Korean nursing students with an objective structured clinical examination (OSCE) assessment regarding the 12 cranial nerves using qualitative content analysis. Qualitative content analysis was used to explore the subjective experiences of nursing baccalaureate students after taking the OSCE. Convenience sampling was used to select 64 4th year nursing students who were interested in taking the OSCE. The participants learned content about the 12 cranial nerve assessment by lectures, demonstrations, and videos before the OSCE. The OSCE consisted of examinations in each of three stations for 2 days. The participants wrote information about their experiences on sheets of paper immediately after the OSCE anonymously in an adjacent room. The submitted materials were analyzed via qualitative content analysis. The collected materials were classified into two themes and seven categories. One theme was "awareness of inner capabilities", which included three categories: "inner motivation", "inner confidence", and "creativity". The other theme was "barriers to nursing performance", which included four categories: "deficiency of knowledge", "deficiency of communication skill", "deficiency of attitude toward comfort", and "deficiency of repetitive practice". This study revealed that the participants simultaneously experienced the potential and deficiency of their nursing competency after an OSCE session on cranial nerves. OSCE also provided the opportunity for nursing students to realize nursing care in a holistic manner unlike concern that OSCE undermines holism. © 2013 The Authors. Japan Journal of Nursing Science © 2013 Japan Academy of Nursing Science.

  9. Objective structured clinical examination for pharmacy students in Qatar: cultural and contextual barriers to assessment.

    PubMed

    Wilby, K J; Black, E K; Austin, Z; Mukhalalati, B; Aboulsoud, S; Khalifa, S I

    2016-07-10

    This study aimed to evaluate the feasibility and psychometric defensibility of implementing a comprehensive objective structured clinical examination (OSCE) on the complete pharmacy programme for pharmacy students in a Middle Eastern context, and to identify facilitators and barriers to implementation within new settings. Eight cases were developed, validated, and had standards set according to a blueprint, and were assessed with graduating pharmacy students. Assessor reliability was evaluated using inter-class coefficients (ICCs). Concurrent validity was evaluated by comparing OSCE results to professional skills course grades. Field notes were maintained to generate recommendations for implementation in other contexts. The examination pass mark was 424 points out of 700 (60.6%). All 23 participants passed. Mean performance was 74.6%. Low to moderate inter-rater reliability was obtained for analytical and global components (average ICC 0.77 and 0.48, respectively). In conclusion, OSCE was feasible in Qatar but context-related validity and reliability concerns must be addressed prior to future iterations in Qatar and elsewhere.

  10. Evaluating medical students' non-verbal communication during the objective structured clinical examination.

    PubMed

    Ishikawa, Hirono; Hashimoto, Hideki; Kinoshita, Makoto; Fujimori, Shin; Shimizu, Teruo; Yano, Eiji

    2006-12-01

    Non-verbal communication (NVC) in medical encounters is an important method of exchanging information on emotional status and contextualising the meaning of verbal communication. This study aimed to assess the impact of medical students' NVC on interview evaluations by standardised patients (SPs). A total of 89 medical interviews in an objective structured clinical examination (OSCE) for post-clerkship medical students were analysed. All interviews were videotaped and evaluated on 10 non-verbal behaviour items. In addition, the quality of the interview content was rated by medical faculty on 5 items and the interview was rated by SPs on 5 items. The relationships between student NVC and SP evaluation were examined by multivariate regression analyses controlling for the quality of the interview content. Standardised patients were likely to give higher ratings when students faced them directly, used facilitative nodding when listening to their talk, looked at them equally when talking and listening, and spoke at a similar speed and voice volume to them. These effects of NVC remained significant after controlling for the quality of the interview content. This study provided evidence of specific non-verbal behaviours of doctors that may have additional impacts on the patient's perception of his or her visit, independently of the interview content. Education in basic NVC should be incorporated into medical education alongside verbal communication.

  11. Strategies for interprofessional education: the Interprofessional Team Objective Structured Clinical Examination for midwifery and medical students.

    PubMed

    Cullen, Lindsay; Fraser, Diane; Symonds, Ian

    2003-08-01

    This paper provides an overview of the processes involved in implementing an interprofessional education (IPE) strategy in a recently established School of Human Development at the University of Nottingham. The merger of the academic divisions of child health, midwifery, obstetrics and gynaecology was a deliberate initiative to create an organisational infrastructure intended to enhance opportunities for interprofessional collaborations in research and education. As a first step, a small group of academic midwives and obstetricians formed a project group to find the best way of facilitating IPE for medical and midwifery students at undergraduate level. A discussion is provided of the work the project group undertook to: determine an agreed definition of IPE; decide an action research approach was needed; determine the ways in which teaching and learning strategies were to be implemented, evaluated and compared; and identify the factors inhibiting and enhancing developments. Evaluations have demonstrated that the Interprofessional Team Objective Structured Clinical Examination (ITOSCE) focusing on intrapartum scenarios is effective in promoting interprofessional learning. Both medical and midwifery students and facilitators agree that team working and understanding each other's roles has been enhanced and that although resource intensive, IPE is worth the time and effort involved.

  12. Formative Assessment of Procedural Skills: Students' Responses to the Objective Structured Clinical Examination and the Integrated Performance Procedural Instrument

    ERIC Educational Resources Information Center

    Nestel, Debra; Kneebone, Roger; Nolan, Carmel; Akhtar, Kash; Darzi, Ara

    2011-01-01

    Assessment of clinical skills is a critical element of undergraduate medical education. We compare a traditional approach to procedural skills assessment--the Objective Structured Clinical Examination (OSCE) with the Integrated Performance Procedural Instrument (IPPI). In both approaches, students work through "stations" or…

  13. Factors associated with medical student test anxiety in objective structured clinical examinations: a preliminary study.

    PubMed

    Kim, Kyong-Jee

    2016-12-29

    To investigate attributes of medical students associated with their test anxiety on Objective Structured Clinical Examinations (OSCEs). A cross-sectional study using a self-administered questionnaire was conducted of all Year 3 and 4 students at a private medical school in South Korea in 2014. This 53-item questionnaire consisted of factors pertaining to test anxiety on the OSCE identified from a review of relevant literature, which included students' motivational beliefs and achievement emotions, perceived values of the OSCE, and attitude and orientation towards patients. Participants' test anxiety levels were measured using the Korean Achievement Emotions Questionnaire. Participants rated their responses using a five-point Likert-type scale. Univariate analysis was performed to examine relationships between the variables. A total of 94 students completed the questionnaire (a 93% response rate). No differences in the participants' test anxiety scores were observed across genders, entry-levels, or years in medical school. Participants' test anxiety on the OSCE showed moderate association with their class-related achievement emotions (i.e., anxiety and boredom), where r = 0.46 and 0.32, p < 0.01, respectively, and weak negative associations with their patient-centeredness (r = -0.21, p < 0.05) and with their perceived values of the OSCE (r = -0.21, p < 0.05). This study found some non-cognitive factors related to medical students' test anxiety on the OSCE. These findings have implications for developing effective educational interventions for helping students cope with such a stress by enhancing our understanding of the various factors that influence their test anxiety in OSCEs.

  14. Right person, right skills, right job: the contribution of objective structured clinical examinations in advancing staff nurse experts.

    PubMed

    Mitchell, Marion; Strube, Petra; Vaux, Amanda; West, Nicky; Auditore, Anthony

    2013-10-01

    Recruitment processes need to discriminate among candidates to ensure that the right person with the right skills is selected for advancement opportunities. An innovative recruitment process using an objective structured clinical examination grounded in best practice guidelines resulted in improved recruitment practices for senior nursing clinical expert roles. Candidates' skills, knowledge, and attitudes in the areas of patient focus, clinical expertise, teamwork, and leadership were assessed using a clinical simulation. Candidates achieving advancement were assessed at 6 months to validate the efficacy of the process.

  15. Exploration of Nursing Faculty Members' Lived Experiences of Objective Structured Clinical Examination (OSCE) in Undergraduate Nursing Education

    ERIC Educational Resources Information Center

    Obizoba, Cordelia O.

    2014-01-01

    The purpose of this phenomenological study was to gain an understanding of nursing faculty members' lived experiences of Objective Structured Clinical Examination (OSCE) in undergraduate nursing education. As owners of their programs' curriculum, nursing faculties are charged with the responsibility of providing needed knowledge, skills, and…

  16. Exploration of Nursing Faculty Members' Lived Experiences of Objective Structured Clinical Examination (OSCE) in Undergraduate Nursing Education

    ERIC Educational Resources Information Center

    Obizoba, Cordelia O.

    2014-01-01

    The purpose of this phenomenological study was to gain an understanding of nursing faculty members' lived experiences of Objective Structured Clinical Examination (OSCE) in undergraduate nursing education. As owners of their programs' curriculum, nursing faculties are charged with the responsibility of providing needed knowledge, skills, and…

  17. The interrater reliability of an objective structured practical examination in measuring the clinical reasoning ability of chiropractic students

    PubMed Central

    Rose, Kevin A.; Babajanian, Jesika

    2016-01-01

    Objective: The objective structured practical examination (OSPE) is a case-based assessment that can be used to assess the clinical reasoning ability of students. The reliability of using an OSPE for this purpose has not been reported in the literature. The objective of this study was to determine the interrater reliability of the OSPE in measuring the clinical reasoning ability of chiropractic students. Methods: Two examiners tested each student simultaneously when enough were available as a check for interrater reliability. The scores for students over 4 exam administrations were compiled, and we calculated an intraclass correlation coefficient (ICC) using 1-way random single measures. Results: Paired scores were available for 133 students. The ICC was .685, showing a fair-to-good level of agreement for faculty in assessing the clinical reasoning ability of chiropractic students using an OSPE. Conclusion: The OSPE can be a valuable tool for testing clinical reasoning abilities because it can simulate the decision-making process that needs to be implemented in clinical practice. Faculty members at our chiropractic college were able to achieve an acceptable level of reliability in measuring the clinical reasoning abilities of students using an OSPE. Other health professional programs may consider using this tool for assessing the clinical reasoning skills of their students. PMID:27115474

  18. The interrater reliability of an objective structured practical examination in measuring the clinical reasoning ability of chiropractic students.

    PubMed

    Rose, Kevin A; Babajanian, Jesika

    2016-10-01

    The objective structured practical examination (OSPE) is a case-based assessment that can be used to assess the clinical reasoning ability of students. The reliability of using an OSPE for this purpose has not been reported in the literature. The objective of this study was to determine the interrater reliability of the OSPE in measuring the clinical reasoning ability of chiropractic students. Two examiners tested each student simultaneously when enough were available as a check for interrater reliability. The scores for students over 4 exam administrations were compiled, and we calculated an intraclass correlation coefficient (ICC) using 1-way random single measures. Paired scores were available for 133 students. The ICC was .685, showing a fair-to-good level of agreement for faculty in assessing the clinical reasoning ability of chiropractic students using an OSPE. The OSPE can be a valuable tool for testing clinical reasoning abilities because it can simulate the decision-making process that needs to be implemented in clinical practice. Faculty members at our chiropractic college were able to achieve an acceptable level of reliability in measuring the clinical reasoning abilities of students using an OSPE. Other health professional programs may consider using this tool for assessing the clinical reasoning skills of their students.

  19. Perception of Pharmacy Students in Malaysia on the Use of Objective Structured Clinical Examinations to Evaluate Competence

    PubMed Central

    Nik Mohamed, Mohamad Haniki; Mohammad Al-Efan, Qais Ahmad

    2007-01-01

    Objectives To assess bachelor of pharmacy students' overall perception and acceptance of an objective structured clinical examination (OSCE), a new method of clinical competence assessment in pharmacy undergraduate curriculum at our Faculty, and to explore its strengths and weaknesses through feedback. Methods A cross-sectional survey was conducted via a validated 49-item questionnaire, administered immediately after all students completed the examination. The questionnaire comprised of questions to evaluate the content and structure of the examination, perception of OSCE validity and reliability, and rating of OSCE in relation to other assessment methods. Open-ended follow-up questions were included to generate qualitative data. Results Over 80% of the students found the OSCE to be helpful in highlighting areas of weaknesses in their clinical competencies. Seventy-eight percent agreed that it was comprehensive and 66% believed it was fair. About 46% felt that the 15 minutes allocated per station was inadequate. Most importantly, about half of the students raised concerns that personality, ethnicity, and/or gender, as well as interpatient and interassessor variability were potential sources of bias that could affect their scores. However, an overwhelming proportion of the students (90%) agreed that the OSCE provided a useful and practical learning experience. Conclusions Students' perceptions and acceptance of the new method of assessment were positive. The survey further highlighted for future refinement the strengths and weaknesses associated with the development and implementation of an OSCE in the International Islamic University Malaysia's pharmacy curriculum. PMID:19503702

  20. Finding reality: the use of objective structured clinical examination (OSCE) in the assessment of mental health nursing students interpersonal skills.

    PubMed

    Anderson, Martin; Stickley, Theodore

    2002-09-01

    This paper presents the implementation of an objective structured clinical examination (OSCE) in the assessment of mental health nursing students' interpersonal skills. It begins by providing a rationale for the use of this instrument to assess such ski lls and offers a brief discussion of the development of OSCEs. The preparation and implementation of the OSCE is explored and both students' and tutors' reflections of the process are highlighted. The strengths and problems, particularly the use of an ac tor and video tape recordings are examined, in the light of other studies. The paper concludes by advocating the use of such an assessment tool as a formative exercise.

  1. Introduction and preparation of an objective structured clinical examination in family medicine for undergraduate students at the University of Split.

    PubMed

    Zakarija-Grković, Irena; Šimunović, Vladimir

    2012-01-01

    To describe the implementation of the first Objective Structured Clinical Examination (OSCE) conducted at the University of Split School of Medicine. Twenty-one clinical skills relevant to general practice were selected and described in a Handbook for students. Assessment sheets were created. After performing an inventory of available resources, teaching models were purchased and practical classes arranged. A Centre for Clinical Competencies was established, where the first OSCE at the University of Split School of Medicine was conducted in March 2011. Attendance by students to the practical classes and the OSCE was 100%. Positive feedback was received by students, who requested extra lessons in clinical skills training. Despite not setting a minimal pass rate, the average OSCE score was 27 out of 30 points. Organization of clinical skills training and assessment was demanding, requiring many hours of preparation and numerous staff involvement but was ultimately very rewarding. Both practical classes and the OSCE were very well received by students, who seemed to be empowered by this experience. Copyright 2012 by Academy of Sciences and Arts of Bosnia and Herzegovina.

  2. Assessment of pharmacy students' communication competence using the Roter Interaction Analysis System during objective structured clinical examinations.

    PubMed

    Kubota, Yoshie; Yano, Yoshitaka; Seki, Susumu; Takada, Kaori; Sakuma, Mio; Morimoto, Takeshi; Akaike, Akinori; Hiraide, Atsushi

    2011-04-11

    To determine the value of using the Roter Interaction Analysis System during objective structured clinical examinations (OSCEs) to assess pharmacy students' communication competence. As pharmacy students completed a clinical OSCE involving an interview with a simulated patient, 3 experts used a global rating scale to assess students' overall performance in the interview, and both the student's and patient's languages were coded using the Roter Interaction Analysis System (RIAS). The coders recorded the number of utterances (ie, units of spoken language) in each RIAS category. Correlations between the raters' scores and the number and types of utterances were examined. There was a significant correlation between students' global rating scores on the OSCE and the number of utterances in the RIAS socio-emotional category but not the RIAS business category. The RIAS proved to be a useful tool for assessing the socio-emotional aspect of students' interview skills.

  3. Impact of Two Types of Internet-based Information on Medical Students’ Performance in an Objective Structured Clinical Exam (OSCE)

    PubMed Central

    Elder, William G.; Dassow, Paul L.; Bruckner, Geza G.; Stratton, Terry D.

    2009-01-01

    Objectives Internet-based information has potential to impact physician-patient relationships. This study examined medical students’ interpretation and response to such information presented during an objective clinical examination. Method Ninety three medical students who had received training for a patient centered response to inquiries about alternative treatments completed a comprehensive examination in their third year. In one of twelve objective structured clinical exams, a SP presented internet-based information on l-theanine – an amino acid available as a supplement. In Condition A, materials were from commercial websites; in Condition B, materials were from the PubMed website. Results Analyses revealed no significant differences between Conditions in student performance or patient (SP) satisfaction. Students in Condition A rated the information less compelling than students in Condition B (z = −1.78, p = .037), and attributed less of the treatment’s action to real vs. placebo effects (z = −1.61, p = .053). Conclusions Students trained in a patient centered response to inquiries about alternative treatment perceived the credibility of the two types of internet-based information differently but were able to respond to the patient without jeopardizing patient satisfaction. Approach to information was superficial. Training in information evaluation may be warranted. PMID:19157760

  4. Perception of pharmacy students in Malaysia on the use of objective structured clinical examinations to evaluate competence.

    PubMed

    Awaisu, Ahmed; Mohamed, Mohamad Haniki Nik; Al-Efan, Qais Ahmad Mohammad

    2007-12-15

    To assess bachelor of pharmacy students' overall perception and acceptance of an objective structured clinical examination (OSCE), a new method of clinical competence assessment in pharmacy undergraduate curriculum at our Faculty, and to explore its strengths and weaknesses through feedback. A cross-sectional survey was conducted via a validated 49-item questionnaire, administered immediately after all students completed the examination. The questionnaire comprised of questions to evaluate the content and structure of the examination, perception of OSCE validity and reliability, and rating of OSCE in relation to other assessment methods. Open-ended follow-up questions were included to generate qualitative data. Over 80% of the students found the OSCE to be helpful in highlighting areas of weaknesses in their clinical competencies. Seventy-eight percent agreed that it was comprehensive and 66% believed it was fair. About 46% felt that the 15 minutes allocated per station was inadequate. Most importantly, about half of the students raised concerns that personality, ethnicity, and/or gender, as well as interpatient and inter-assessor variability were potential sources of bias that could affect their scores. However, an overwhelming proportion of the students (90%) agreed that the OSCE provided a useful and practical learning experience. Students' perceptions and acceptance of the new method of assessment were positive. The survey further highlighted for future refinement the strengths and weaknesses associated with the development and implementation of an OSCE in the International Islamic University Malaysia's pharmacy curriculum.

  5. The Skin Cancer Objective Structured Clinical Examination (SCOSCE): A multi-institutional collaboration to develop and validate a clinical skills assessment for melanoma.

    PubMed

    Garg, Amit; Biello, Katie; Hoot, Joyce W; Reddy, Shalini B; Wilson, Lindsay; George, Paul; Robinson-Bostom, Leslie; Belazarian, Leah; Domingues, Erik; Powers, Jennifer; Jacob, Reza; Powers, Michael; Besen, Justin; Geller, Alan C

    2015-12-01

    Assessing medical students on core skills related to melanoma detection is challenging in the absence of a well-developed instrument. We sought to develop an objective structured clinical examination for the detection and evaluation of melanoma among medical students. This was a prospective cohort analysis of student and objective rater agreement on performance of clinical skills and assessment of differences in performance across 3 schools. Kappa coefficients indicated excellent agreement for 3 of 5 core skills including commenting on the presence of the moulage (k = 0.87, 95% confidence interval 0.77-0.96), obtaining a history for the moulage (k = 0.84, 95% confidence interval 0.74-0.94), and making a clinical impression (k = 0.80, 95% confidence interval 0.68-0.92). There were no differences in performance across schools with respect to 3 of 5 core skills: commenting on the presence of the moulage (P = .15), initiating a history (P = .53), and managing the suspicious lesion (P value range .07-.17). Overall, 54.2% and 44.7% of students commented on the presence of the moulage and achieved maximum performance of core skills, respectively, with no difference in performance across schools. Limitations include overall sample size of students and schools. The Skin Cancer Objective Structured Clinical Examination represents a potentially important instrument to measure students' performance on the optimal step-by-step evaluation of a melanoma. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  6. Cancer pain management skills among medical students: the development of a Cancer Pain Objective Structured Clinical Examination.

    PubMed

    Sloan, P A; Plymale, M A; Johnson, M; Vanderveer, B; LaFountain, P; Sloan, D A

    2001-04-01

    Recent surveys suggest that most physicians have inadequate knowledge to assess and manage cancer pain; however, the important domain of clinical performance has not yet been clearly evaluated. The Objective Structured Clinical Examination (OSCE) has become a widely- used and accepted method to evaluate the clinical abilities of medical students. The purpose of this study was to develop and test a Cancer Pain OSCE for medical students evaluating their clinical competence in the area of cancer pain management. A four-component Cancer Pain OSCE was developed and presented to 34 third-year medical students during a sixteen-week combined medicine/surgery clerkship. The content of the objective criteria for each component of the OSCE was developed by a multidisciplinary group of pain experts. The OSCE was designed to assess the students' cancer pain management skills of pain history-taking, focused physical examination, analgesic management of cancer pain, and communication of opioid analgesia myths. Actual cancer survivors were used in the five-minute individual stations. The students were asked to complete a cancer pain history, physical examination, manage cancer pain using analgesics, and communicate with a family member regarding opioid myths. Clinical performance was evaluated using pre-defined checklists. Results showed the student's average performance for the history component was the highest of all four components of the examination. Out of 34 points possible on this clinical skills item, students on average (SD) scored 24.5 (5.2), or 72%. For the short-answer analgesic management component of the Cancer Pain OSCE, the overall score was 32%. Most students managed cancer pain with opioids, however, very few prescribed regular opioid use, and the use of adjuvant analgesics was uncommon. Student performance on the focused cancer pain physical examination was, in general, poor. On average students scored 61% on the musculoskeletal system, but only 31% on both the

  7. The Electronic Health Record Objective Structured Clinical Examination: Assessing Student Competency in Patient Interactions While Using the Electronic Health Record

    PubMed Central

    Biagioli, Frances E.; Elliot, Diane L.; Palmer, Ryan T.; Graichen, Carla C.; Rdesinski, Rebecca E.; Kumar, Kaparaboyna Ashok; Galper, Ari B.; Tysinger, James W.

    2016-01-01

    Problem Because many medical students do not have access to electronic health records (EHRs) in the clinical environment, simulated EHR training is necessary. Explicitly training medical students to use EHRs appropriately during patient encounters equips them to engage patients while also attending to the accuracy of the record and contributing to a culture of information safety. Approach Faculty developed and successfully implemented an EHR objective structured clinical examination (EHR-OSCE) for clerkship students at two institutions. The EHR-OSCE objectives include assessing EHR-related communication and data management skills. Outcomes The authors collected performance data for students (n = 71) at the first institution during academic years 2011–2013 and for students (n = 211) at the second institution during academic year 2013–2014. EHR-OSCE assessment checklist scores showed that students performed well in EHR-related communication tasks, such as maintaining eye contact and stopping all computer work when the patient expresses worry. Findings indicated student EHR skill deficiencies in the areas of EHR data management including medical history review, medication reconciliation, and allergy reconciliation. Most students’ EHR skills failed to improve as the year progressed, suggesting that they did not gain the EHR training and experience they need in clinics and hospitals. Next Steps Cross-institutional data comparisons will help determine whether differences in curricula affect students’ EHR skills. National and institutional policies and faculty development are needed to ensure that students receive adequate EHR education, including hands-on experience in the clinic as well as simulated EHR practice. PMID:27332870

  8. Objective Structured Clinical Examination as an educational initiative for summative simulation competency evaluation of first-year student registered nurse anesthetists' clinical skills.

    PubMed

    Wunder, Linda L; Glymph, Derrick C; Newman, Johanna; Gonzalez, Vicente; Gonzalez, Juan E; Groom, Jeffrey A

    2014-12-01

    The use of simulation to imitate real-life scenarios reaches back many centuries. In the last decade, the use of simulation in healthcare has gained acceptance as a valuable tool for teaching and learning technical and nontechnical skills in healthcare. The use of simulation technology has moved medical education from the standard of pen and paper examinations to the assessment of clinical competency before caring for patients. The old thinking of "see one, do one, teach one" is behind us as healthcare works to create a culture of safety that holds healthcare personnel accountable. A current use of testing clinical competence is the use of Objective Structured Clinical Examination (OSCE) by physician training programs. As a testing tool, the OSCE has great potential to assess the clinical competence of students before they enter the clinical setting. The nurse anesthesia program at the authors' university has moved toward creating a formal assessment to ensure clinical competence of their student registered nurse anesthetists. In this article, we describe the development and implementation of an OSCE to ensure clinical competence of first-year student registered nurse anesthetists before they begin their clinical training.

  9. A focus group study of the use of video-recorded simulated objective structured clinical examinations in nurse practitioner education.

    PubMed

    Barratt, Julian

    2010-05-01

    The objective structured clinical examination (OSCE) is a common method of clinical skills assessment used for advanced nurse practitioner students across the United Kingdom. The purpose of an advanced nursing OSCE is to assess a nurse practitioner student's competence and safety in the performance of commonly used advanced clinical practice skills. Students often feel nervous when preparing for and participating in an OSCE. Consideration of these identified anxieties led to the development of an alternative method of meeting students' OSCE learning and preparation needs; namely video-recorded simulated OSCEs. Video-recording was appealing for the following reasons: it provides a flexible usage of staff resources and time; OSCE performance mistakes can be rectified; it is possible to use the same video-recordings with multiple cohorts of students, and the recordings can be made conveniently available for students with video streaming on internet-based video-sharing sites or virtual learning environments. The aim of the study was to explore the value of using such recordings amongst nurse practitioner students, via online and face-to-face focus groups, to see if they are a suitable OSCE educational preparation technique. The study findings indicate that simulated OSCE video-recordings are an effective method for supporting nurse practitioner educational development.

  10. Facilitating peer based learning through summative assessment - An adaptation of the Objective Structured Clinical Assessment tool for the blended learning environment.

    PubMed

    Wikander, Lolita; Bouchoucha, Stéphane L

    2017-09-18

    Adapting a course from face to face to blended delivery necessitates that assessments are modified accordingly. In Australia the Objective Structured Clinical Assessment tool, as a derivative from the Objective Structured Clinical Examination, has been used in the face-to-face delivery mode as a formative or summative assessment tool in medicine and nursing since 1990. The Objective Structured Clinical Assessment has been used at Charles Darwin University to assess nursing students' simulated clinical skills prior to the commencement of their clinical placements since 2008. Although the majority of the course is delivered online, students attend a one-week intensive clinical simulation block yearly, prior to attending clinical placements. Initially, the Objective Structured Clinical Assessment was introduced as a lecturer assessed summative assessment, over time it was adapted to better suit the blended learning environment. The modification of the tool from an academic to peer assessed assessment tool, was based on the empirical literature, student feedback and a cross-sectional, qualitative study exploring academics' perceptions of the Objective Structured Clinical Assessment (Bouchoucha et al., 2013a, b). This paper presents an overview of the process leading to the successful adaptation of the Objective Structured Clinical Assessment to suit the requirements of a preregistration nursing course delivered through blended learning. This is significant as many universities are moving their curriculum to fully online or blended delivery, yet little attention has been paid to adapting the assessment of simulated clinical skills. The aim is to identify the benefits and drawbacks of using the peer assessed Objective Structured Clinical Assessment and share recommendations for successful implementation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Implementation of an Electronic Objective Structured Clinical Exam for Assessing Practical Skills in Pre-Professional Physiotherapy and Occupational Therapy Programs: Examiner and Course Coordinator Perspectives

    ERIC Educational Resources Information Center

    Snodgrass, Suzanne J.; Ashby, Samantha E.; Rivett, Darren A.; Russell, Trevor

    2014-01-01

    Assessment of practical clinical skills is essential in the health fields. Objective Structured Clinical Exams (OSCEs), where examiners assess students performing clinical procedures on simulated patients (actors), are central to the evaluation of practical skills. However, traditional OSCEs require considerable time-investment to administer, and…

  12. Implementation of an Electronic Objective Structured Clinical Exam for Assessing Practical Skills in Pre-Professional Physiotherapy and Occupational Therapy Programs: Examiner and Course Coordinator Perspectives

    ERIC Educational Resources Information Center

    Snodgrass, Suzanne J.; Ashby, Samantha E.; Rivett, Darren A.; Russell, Trevor

    2014-01-01

    Assessment of practical clinical skills is essential in the health fields. Objective Structured Clinical Exams (OSCEs), where examiners assess students performing clinical procedures on simulated patients (actors), are central to the evaluation of practical skills. However, traditional OSCEs require considerable time-investment to administer, and…

  13. Association of the pre-internship objective structured clinical examination in final year medical students with comprehensive written examinations.

    PubMed

    Eftekhar, Hasan; Labaf, Ali; Anvari, Pasha; Jamali, Arsia; Sheybaee-Moghaddam, Farshad

    2012-01-01

    The purpose of this study is to evaluate the association of the pre-internship Objective Structured Clinical Examination (OSCE) in final year medical students with comprehensive written examinations. SUBJECTS AND MATERIAL: All medical students of October 2004 admission who took part in the October 2010 National Comprehensive Pre-internship Examination (NCPE) and pre-internship OSCE were included in the study (n = 130). OSCE and NCPE scores and medical grade point average (GPA) were collected. GPA was highly correlated with NCPE (r = 0.76 and P<0.001) and moderately with OSCE (r = 0.68 and P < 0.001). Similarly a moderate correlation was observed between NCPE and OSCE scores(r = 0.6 and P < 0.001).Linear stepwise regression shows r(2) of a model applying GPA as predictor of OSCE score is 0.46 (β = 0.68 and P < 0.001), while addition of gender to the model increases r(2) to 0.59 (β = 0.61 and 0.36, for GPA and male gender, respectively and P < 0.001). Logistic forward regression models shows male gender and GPA are the only dependent predictors of high score in OSCE. OR of GPA and male gender for high OSCE score are 4.89 (95% CI = 2.37-10.06) and 6.95 (95% CI = 2.00-24.21), respectively (P < 0.001). Our findings indicate OSCE and examination which mainly evaluate knowledge, judged by GPA and NCPE are moderately to highly correlated. Our results illustrate the interwoven nature of knowledge and clinical skills. In other words, certain level of knowledge is crucial for appropriate clinical performance. Our findings suggest neither OSCE nor written forms of assessments can replace each other. They are complimentary and should also be combined by other evaluations to cover all attributes of clinical competence efficiently.

  14. An Advanced Objective Structured Clinical Examination Using Patient Simulators to Evaluate Pharmacy Students’ Skills in Physical Assessment

    PubMed Central

    Takamura, Norito; Ogata, Kenji; Setoguchi, Nao; Utsumi, Miho; Kourogi, Yasuyuki; Osaki, Takashi; Ozaki, Mineo; Sato, Keizo; Arimori, Kazuhiko

    2014-01-01

    Objective. To implement an advanced objective structured clinical examination (OSCE) in the curriculum and to evaluate Japanese pharmacy students’ skills in physical assessment such as measuring pulse and blood pressure, and assessing heart, lung, and intestinal sounds. Design. An advanced OSCE was implemented in a hospital pharmacy seminar as a compulsory subject. We programmed patient simulators with 21 different patient cases in which normal and abnormal physiological conditions were produced. The virtual patients were then used to evaluate the physical assessment skills of fifth-year pharmacy students. Assessment. Significant differences were observed between the average of all the detailed evaluations and the mean results for the following skills: pulse measurement, blood pressure measurement, deflating the cuff at a rate of 2-3 mmHg/sec, listening to heart sounds, and listening to lung sounds. Conclusion. Administering an advanced OSCE using virtual patients was an effective way of assessing pharmacy students’ skills in a realistic setting. Several areas in which pharmacy students require further training were identified. PMID:25657371

  15. Objective structured clinical evaluation as an assessment method for undergraduate chest physical therapy students: a cross-sectional study.

    PubMed

    Silva, Cibele C B M; Lunardi, Adriana C; Mendes, Felipe A R; Souza, Flavia F P; Carvalho, Celso R F

    2011-01-01

    The Objective Structured Clinical Evaluation (OSCE) has been considered a reliable method for the evaluation of students' clinical skills in health sciences, but it has been rarely applied in the teaching of physical therapy. To assess the use of the OSCE as a tool to evaluate the abilities of undergraduate chest physical therapy students and to verify the internal consistency of the OSCE exam. Forty-seven students were evaluated using two types of exams: the traditional exam and the OSCE. Independent educators elaborated the exams. Each question (traditional) or station (OSCE) was given a score ranging from 0.0 to 2.0; being 10.0 the highest possible score of both exams. The relationship between the total score that were obtained from both exams was analyzed using Bland-Altman analysis and Pearson's correlation coefficient. The internal consistency of the OSCE stations was evaluated by four experienced chest physical therapists and it was tested using Cronbach's alpha. The students' average score on the OSCE ranged from 4.4 to 9.6. The internal consistency of the OSCE stations was considered good (0.7). The agreement between exams was analyzed, and it was determined that the exams are not comparable. Examiners also observed a low agreement between the two exams (r=-0.1; p=0.9). Our results showed that OSCE and traditional exams are not interchangeable. The OSCE exam had good internal consistency and is able to evaluate aspects that the traditional exam fails to evaluate.

  16. Improvement of psychometric properties of the objective structured clinical examination when assessing problem solving skills of surgical clerkship.

    PubMed

    Al-Naami, Mohammed Y; El-Tinay, Omer F; Khairy, Gamal A; Mofti, Safdar S; Anjum, Muhammad N

    2011-03-01

    To improve the psychometric properties of the objective structured clinical examination (OSCE) and elevate staff motivation. The OSCE was conducted in May 2006 at the Department of Surgery, King Saud University, Riyadh, Saudi Arabia as a pilot study for 95 students split over 2 consecutive days lasting 120 minutes each day. There were 15 actual stations on each day consisting of 10 stations that addressed problem solving skills, and 5 addressed clinical skills testing. The stability of the OSCE measured by Cronbach's alpha on day one was 0.87, and 0.88 on day 2. The internal consistency of the OSCE measured by Carmine's theta on day one was 0.76, and 0.79 on day 2. Overall, OSCE's reliability for each day was high (r=0.8), without a significant difference between the 2 days. Credibility and comprehensiveness of the the OSCE were considered good by both staff and students. Accuracy of the OSCE measured by Pearson's correlation with multiple choice question scores was 0.65. Feasibility of the OSCE has also improved remarkably compared with previous OSCEs. The OSCE proved to be highly reliable, and a valid format when more problem solving skills testing has been emphasized for the final year surgical clerkship. Feasibility has also improved remarkably after using this strategy, marked by more staff participation and enthusiasm.

  17. Objective Structured Clinical Examination (OSCE)-based Assessment of the Advanced Trauma Life Support (ATLS) Course in Iran

    PubMed Central

    Abbasi, Hamid Reza; Amini, Mitra; Bolandparvaz, Shahram; Paydar, Shahram; Ali, Jameel; Sefidbakht, Sepideh

    2016-01-01

    Objective: To evaluate the effect of advance trauma life support (ATLS®) training on general surgery residents clinical reasoning skills using the national boards-style objective structured clinical examination (OSCE). Methods: This cross-sectional single-center study was conducted in Shiraz University of Medical Sciences including 51 surgery residents that participated in a mandatory national board style OSCE between May 2014 and May 2015. OSCE scores of two groups of general surgery residents including 23 ATLS® trained and 28 non-ATLS® trained were compared using Mann-Whitney U test. The exam was graded out of 20 points and the passing score was ≥14 including 40% trauma cases. Results: There were 8(15.7%) women and 43(84.3%) men among the participants with mean age of 31.12 ± 2.69 and 33.67 ± 4.39 years in women and men respectively. Overall 7 (87.5%) women and 34 (79.07%) men passed the OSCE. The trauma section OSCE score was significantly higher in the ATLS® trained participants when compared to non-ATLS®(7.79 ± 0.81vs.6.90 ± 1.00; p=0.001). In addition, the total score was also significantly higher in ATLS® trained residents (16.07 ± 1.41 vs. 14.60 ± 1.40; p=0.001). There was no association between gender and ATLS® score (p=0.245) or passing the OSCE (p=0.503). Conclusion: ATLS® training is associated with improved overall OSCE scores of general surgery residents completing the board examinations suggesting a positive transfer of ATLS learned skills to management of simulated surgical patients including trauma cases. PMID:27331063

  18. The Objective Structured Clinical Examination (OSCE) as a strategy for assessing clinical competence in midwifery education in Ireland: a critical review.

    PubMed

    Smith, Valerie; Muldoon, Kathryn; Biesty, Linda

    2012-09-01

    In Ireland, to register as a midwife, all student midwives must be deemed competent to practice with the assessment of competence an essential component of midwifery education. A variety of assessment strategies, including observed practice, clinical interviews, portfolios of reflection, the Objective Structured Clinical Examination (OSCE) and written examination papers, are utilised to assess midwifery students' clinical competence. In this paper, a critical review of the OSCE as a strategy for assessing clinical competence in one third level institution in Ireland is offered. Although utilised for assessing competence across a range of areas (e.g. obstetric emergencies and pharmacology/drug administration), the use of the OSCE for assessing midwifery students' competence in lactation and infant feeding practices, as an example for this paper, is described. The advantages, disadvantages, validity and reliability of the OSCE, as an assessment strategy, are critically explored. Recognising that no single assessment strategy can provide all the information required to assess something as complex as clinical performance, the OSCE, when viewed alongside other forms of assessment, and with relevance to the topic under examination, may be considered a valuable strategy for enhancing the assessment of students' clinical competence, and for embracing diversity within midwifery education and training.

  19. Study of the Reliability and Validity of Objective Structured Clinical Examination (OSCE) in the Assessment of Clinical Skills of Audiology Students

    PubMed Central

    Nickbakht, Mansoureh; Amiri, Marzieh; Latifi, Seyed Mahmoud

    2013-01-01

    Introduction: Audiology students should possess clinical competence and skills. To achieve this, their clinical skills must be properly assessed. The Objective Structured Clinical Examination (OSCE) is a standard and fair examination of clinical competence. The goal of this study is to devise a checklist of OSCE examination criteria and study their validity and reliability for assessing the clinical competence of Audiology students. Methods: Among the various procedures in which audiology students should possess demonstrated competence, 10 specific skills were selected and checklists were prepared. Faculty members of university’s Audiology Department were consulted to determine the validity of the checklists. Subsequently, the examination was administered to all 14 fourth-year audiology students in their final semester of study at Ahvaz Jundishapur University of Medical Sciences. The examination consisted of three question stations and seven procedure stations. Each station was managed by two examiners who independently used a checklist to score each student’s performance in a given procedure. To determine reliability, the Spearman test was used. Results: The correlation between each examiner’s scores of students at question stations was 0.908. The correlation between each examiner’s scores at procedure stations was 0.857 (p=0). The site of lesion test had the highest correlation (0.948) and immittance audiometry had the lowest correlation (0.585). Conclusion: The prepared checklists had good validity and reliability and can be used to evaluate the clinical competence of audiology students in their final semester of study. PMID:23618476

  20. Study of the reliability and validity of objective structured clinical examination (OSCE) in the assessment of clinical skills of audiology students.

    PubMed

    Nickbakht, Mansoureh; Amiri, Marzieh; Latifi, Seyed Mahmoud

    2013-01-31

    Audiology students should possess clinical competence and skills. To achieve this, their clinical skills must be properly assessed. The Objective Structured Clinical Examination (OSCE) is a standard and fair examination of clinical competence. The goal of this study is to devise a checklist of OSCE examination criteria and study their validity and reliability for assessing the clinical competence of Audiology students. Among the various procedures in which audiology students should possess demonstrated competence, 10 specific skills were selected and checklists were prepared. Faculty members of university's Audiology Department were consulted to determine the validity of the checklists. Subsequently, the examination was administered to all 14 fourth-year audiology students in their final semester of study at Ahvaz Jundishapur University of Medical Sciences. The examination consisted of three question stations and seven procedure stations. Each station was managed by two examiners who independently used a checklist to score each student's performance in a given procedure. To determine reliability, the Spearman test was used. The correlation between each examiner's scores of students at question stations was 0.908. The correlation between each examiner's scores at procedure stations was 0.857 (p=0). The site of lesion test had the highest correlation (0.948) and immittance audiometry had the lowest correlation (0.585). The prepared checklists had good validity and reliability and can be used to evaluate the clinical competence of audiology students in their final semester of study.

  1. Designing the objective structured clinical examination to cover all major areas of physical medicine and rehabilitation over 3 yrs.

    PubMed

    Garstang, Susan; Altschuler, Eric L; Jain, Sheela; Delisa, Joel A

    2012-06-01

    The Accreditation Council for Graduate Medical Education requires that training programs comprehensively evaluate residents in the six core Accreditation Council for Graduate Medical Education competencies. One of the ways we do this in our residency is by administering a nine-station Objective Structured Clinical Examination (OSCE) at the end of each year, which evaluates tasks such as history taking, focused physical examination, communication, professionalism, procedural skills, management, prescription writing, and understanding systems-based practice. We have classified our OSCE stations into what we consider key areas in our field and assessed these on a rotating basis over 3 yrs. This results in the assessment of 27 areas over the 3 yrs of residency. Structuring the OSCE as a series of stations over 3 yrs is an efficient method to evaluate residents' competencies that are required by the Accreditation Council for Graduate Medical Education and certifying boards. An analysis of OSCE scores when compared with American Board of Physical Medicine & Rehabilitation parts 1 and 2 scores and final summative resident evaluation scores reveals that OSCE results correlate with part 1 scores and final evaluation scores but do not show the same strong correlations with part 2 scores. We discuss the way the OSCE can complete other assessment techniques and ways to improve cases in the future.

  2. Assessment of first-year veterinary students' communication skills using an objective structured clinical examination: the importance of context.

    PubMed

    Hecker, Kent G; Adams, Cindy L; Coe, Jason B

    2012-01-01

    Communication skills are considered to be a core clinical skill in veterinary medicine and essential for practice success, including outcomes of care for patients and clients. While veterinary schools include communication skills training in their programs, there is minimal knowledge on how best to assess communication competence throughout the undergraduate program. The purpose of this study was to further our understanding of the reliability, utility, and suitability of a communication skills Objective Structured Clinical Examination (OSCE). Specifically we wanted to (1) identify the greatest source of variability (student, rater, station, and track) within a first-year, four station OSCE using exam scores and scores from videotape review by two trained raters, and (2) determine the effect of different stations on students' communication skills performance. Reliability of the scores from both the exam data and the two expert raters was 0.50 and 0.46 respectively, with the greatest amount of variance attributable to student by station. The percentage of variance due to raters in the exam data was 16.35%, whereas the percentage of variance for the two expert raters was 0%. These results have three important implications. First, the results reinforce the need for communication educators to emphasize that use of communication skills is moderated by the context of the clinical interaction. Second, by increasing rater training the amount of error in the scores due to raters can be reduced and inter-rater reliability increases. Third, the communication assessment method (in this case the OSCE checklist) should be built purposefully, taking into consideration the context of the case.

  3. Validity evidence for two objective structured clinical examination stations to evaluate core skills of the shoulder and knee assessment.

    PubMed

    Battistone, Michael J; Barker, Andrea M; Beck, J Peter; Tashjian, Robert Z; Cannon, Grant W

    2017-01-13

    We developed two objective structured clinical examinations (OSCEs) to educate and evaluate trainees in the evaluation and management of shoulder and knee pain. Our objective was to examine the evidence for validity of these OSCEs. A multidisciplinary team of content experts developed checklists of exam maneuvers and criteria to guide rater observations. Content was proposed by faculty, supplemented by literature review, and finalized using a Delphi process. One faculty simulated the patient, another rated examinee performance. Two faculty independently rated a portion of cases. Percent agreement was calculated and Cohen's kappa corrected for chance agreement on binary outcomes. Examinees' self-assessment was explored by written surveys. Responses were stratified into 3 categories and compared with similarly stratified OSCE scores using Pearson's coefficient. A multi-disciplinary cohort of 69 examinees participated. Examinees correctly identified rotator cuff and meniscal disease 88% and 89% of the time, respectively. Inter-rater agreement was moderate for the knee (87%; k = 0.61) and near perfect for the shoulder (97%; k = 0.88). No correlation between stratified self-assessment and OSCE scores were found for either shoulder (0.02) or knee (-0.07). Validity evidence supports the continuing use of these OSCEs in educational programs addressing the evaluation and management of shoulder and knee pain. Evidence for validity includes the systematic development of content, rigorous control of the response process, and demonstration of acceptable interrater agreement. Lack of correlation with self-assessment suggests that these OSCEs measure a construct different from learners' self-confidence.

  4. Objective Structured Clinical Examination (OSCE)-based Assessment of the Advanced Trauma Life Support (ATLS) Course in Iran.

    PubMed

    Abbasi, Hamid Reza; Amini, Mitra; Bolandparvaz, Shahram; Paydar, Shahram; Ali, Jameel; Sefidbakht, Sepideh

    2016-04-01

    To evaluate the effect of advance trauma life support (ATLS®) training on general surgery residents clinical reasoning skills using the national boards-style objective structured clinical examination (OSCE). This cross-sectional single-center study was conducted in Shiraz University of Medical Sciences including 51 surgery residents that participated in a mandatory national board style OSCE between May 2014 and May 2015. OSCE scores of two groups of general surgery residents including 23 ATLS® trained and 28 non-ATLS® trained were compared using Mann-Whitney U test. The exam was graded out of 20 points and the passing score was ≥14 including 40% trauma cases. There were 8(15.7%) women and 43(84.3%) men among the participants with mean age of 31.12 ± 2.69 and 33.67 ± 4.39 years in women and men respectively. Overall 7 (87.5%) women and 34 (79.07%) men passed the OSCE. The trauma section OSCE score was significantly higher in the ATLS® trained participants when compared to non-ATLS®(7.79 ± 0.81vs.6.90 ± 1.00; p=0.001). In addition, the total score was also significantly higher in ATLS® trained residents (16.07 ± 1.41 vs. 14.60 ± 1.40; p=0.001). There was no association between gender and ATLS® score (p=0.245) or passing the OSCE (p=0.503). ATLS® training is associated with improved overall OSCE scores of general surgery residents completing the board examinations suggesting a positive transfer of ATLS learned skills to management of simulated surgical patients including trauma cases.

  5. An objective structured clinical examination for the licentiate: report of the pilot project of the Medical Council of Canada.

    PubMed

    Reznick, R; Smee, S; Rothman, A; Chalmers, A; Swanson, D; Dufresne, L; Lacombe, G; Baumber, J; Poldre, P; Levasseur, L

    1992-08-01

    The Medical Council of Canada (MCC) administers a qualifying examination for the issuance of a license to practice medicine. To date, this examination does not test the clinical skills of history taking, physical examination, and communication. The MCC is implementing an objective structured clinical examination (OSCE) to test these skills in October 1992. A pilot examination was developed to test the feasibility, reliability, and validity of running a multisite, two-form, four-hour, 20-station OSCE for national licensure. In February 1991, 240 volunteer first- and second-year residents were tested at four sites. The candidates were randomly assigned to one of two forms of the test and one of two sites for two of the four sites. Generalizability analysis revealed that the variance due to form was 0.0 and that due to site was .16 compared with a total variance of 280.86. The reliabilities (inter-station) were .56 and .60 for the two forms. Station total-test score correlations, used to measure station validity, were significant for 38 of the 40 stations used (range .14-.60). The results of the OSCE correlated moderately with the MCC qualifying examination; these correlations were .32 and .35 for the two test forms. Content validity was assessed by postexamination questionnaires given to the physician examiners using a scale of 0 (low) to 10 (high). The physicians' mean ratings were: importance of the stations, 8.1 (SD, 1.8); success of the examination in testing core skills, 8.1 (SD, 1.6); and degree of challenge, 7.8 (SD, 2.1). The results indicate that a full-scale national administration of an OSCE for licensure is feasible using the model developed. Aspects of validity have been established and strategies to augment reliability have been developed.

  6. Key challenges for implementing a Canadian-based objective structured clinical examination (OSCE) in a Middle Eastern context.

    PubMed

    Wilby, Kyle John; Diab, Mohammad

    2016-12-01

    Globalization of medical education is occurring at a rapid pace and many regions of the world are adapting curricula, teaching methods, and assessment tools from established programs. In the Middle East, the use of Objective Structured Clinical Examinations (OSCEs) is rare. The College of Pharmacy at Qatar University recently partnered with the University of Toronto and the Supreme Council of Health in Qatar to adapt policies and procedures of a Canadian-based OSCE as an exit-from-degree assessment for pharmacy students in Qatar. Despite many cultural and contextual barriers, the OSCE was implemented successfully and is now an integrated component of the pharmacy curriculum. This paper aims to provide insight into the adoption and implementation process by identifying four major cultural and contextual challenges associated with OSCEs: assessment tools, standardized actors, assessor calibration, and standard setting. Proposed solutions to the challenges are also given. Findings are relevant to international programs attempting to adapt OSCEs into their contexts, as well as Canadian programs facing increasing rates of cultural diversity within student and assessor populations.

  7. Key challenges for implementing a Canadian-based objective structured clinical examination (OSCE) in a Middle Eastern context

    PubMed Central

    Wilby, Kyle John; Diab, Mohammad

    2016-01-01

    Globalization of medical education is occurring at a rapid pace and many regions of the world are adapting curricula, teaching methods, and assessment tools from established programs. In the Middle East, the use of Objective Structured Clinical Examinations (OSCEs) is rare. The College of Pharmacy at Qatar University recently partnered with the University of Toronto and the Supreme Council of Health in Qatar to adapt policies and procedures of a Canadian-based OSCE as an exit-from-degree assessment for pharmacy students in Qatar. Despite many cultural and contextual barriers, the OSCE was implemented successfully and is now an integrated component of the pharmacy curriculum. This paper aims to provide insight into the adoption and implementation process by identifying four major cultural and contextual challenges associated with OSCEs: assessment tools, standardized actors, assessor calibration, and standard setting. Proposed solutions to the challenges are also given. Findings are relevant to international programs attempting to adapt OSCEs into their contexts, as well as Canadian programs facing increasing rates of cultural diversity within student and assessor populations. PMID:28344703

  8. [The Use of the Objective Structured Clinical Examination for Paediatric residents in the City of Buenos Aires].

    PubMed

    Hamui, Magalí; Ferreira, Juan Pablo; Paganini, Agustina; Torres, Fernando; Ossorio, María Fabiana; Yulitta, Horacio; Eiguchi, Kumiko; Ferrero, Fernando

    2016-01-01

    The Objective Structured Clinical Examination (OSCE) is considered the reference standard for competence evaluation, but its use in Latin America is limited. The City of Buenos Aires Government (CBAG) administers a Paediatric residency system that includes 400 residents distributed in 13 hospitals, sharing an admission system and education program. We aim to describe the experience of administering an OSCE for evaluating all the Paediatric residents of the CBAG. Descriptive study, including all paediatric residents of the CBAG, belonging to 13 hospitals (2 paediatric and 11 general), ending their first year of training. The OSCE included 10 stations. Eighty-five residents participated in the OSCE, and 88.2% (95% CI 79.7-93.5) passed the examination. There were no significant differences in the pass rate between residents from paediatric hospitals and from general hospitals (89.5 vs. 85.7%; OR=1.4; 95% CI 0.4-5.5; P=.8). In 2015, the OSCE was administered to all paediatric residents of the CBAG for the first time. This experience allowed identifying weaknesses in the education system, in order to develop strategies to overcome them. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Use of interactive teaching methods in tobacco cessation program and examine it by using objective structured clinical exam

    PubMed Central

    Fernandez, Kevin; Pandve, Harshal T.; Debnath, Dhrubajyoti J.

    2013-01-01

    Background: Tobacco addiction is an important public health issue. It is important for health professional to counsel the tobacco users for cessation. Aim: To enhance communication skills of MBBS (Bachelor of Medicine and Bachelor of Surgery) students in counseling of tobacco users by using interactive teaching methods and examine it by using OSCE. Materials and Methods: It was a before and after comparison study. Communication skills of students were examined by standardized patients (investigators) by objective structured clinical examination (OSCE) method before and after intervention. All the students were trained to enhance the communication skills by role play, interactive session, anecdotes. Statistical analysis was done by using Paired t-test. Results: The difference in scores at all the 3 stations before and after the intervention and also global scores before and after the intervention was statistically highly significant (P = 0.0001). Conclusion and Recommendation: Communication skills of students in counseling tobacco users improved after they were given role play, interactive session, anecdotes. Similar model can be used to improve the communication/counseling skills in other important health hazards. PMID:24083278

  10. [Testing objective structured clinical evaluation (OSCE) for nursing students experience developed during the years 1995-2009].

    PubMed

    Sola Pola, Montserrat; Martínez Castela, Daniel; Molins I Mesalles, Ainhoa; Pulpón Segura, Anna M

    2011-01-01

    The objective structured clinical examination (OSCE) has been recognized as an effective evaluation tool in the health area and has been implemented by an important sector of educational institutions, the Faculty of Medicine and School of Nursing. The present article describes the OSCE organized by the Institute of Health Studies in collaboration with the University Schools of Catalan Nursing. Between the years of 2002 and 2009, OSCE annual exams took place with the participation of 1.803 students. The global results remained stable with a median grade of slightly less than 60%, and the competence component that evaluated communicative capacity was the one in which students obtained the best results. The reliability obtained surpassed the minimum recommended by international standards. It's important underline the positive value to the students of all aspects of the test. From this experience it seems evident that it would be useful to take advantage of the OSCE tests in order to show the students their strong points and ways to improve. We should highlight, not only as a goal but also as an opportunity the assessment by competencies that the European space of higher Education provides at the end of studies for a Nursing degree.

  11. A core competence-based objective structured clinical examination (OSCE) in evaluation of clinical performance of postgraduate year-1 (PGY₁) residents.

    PubMed

    Yang, Ying-Ying; Lee, Fa-Yauh; Hsu, Hui-Chi; Huang, Chin-Chou; Chen, Jaw-Wen; Lee, Wen-Shin; Chuang, Chiao-Lin; Chang, Ching-Chih; Chen, Hao-Min; Huang, Chia-Chang

    2011-05-01

    Clinical competency certifications are important parts of internal medicine residency training. This study aims to evaluate a composite objective structured clinical examination (OSCE) that assesses postgraduate year-1 (PGY(1)) residents' acquisition of the six core competencies defined by the Accreditation council for Graduate Medical Education (ACGME). Six-core-competency-based OSCE was used as examination of the clinical performance of 192 PGY(1) residents during their 3-month internal medicine training between 2007 January and 2009 December. For each year, the reliability of the entire examination was calculated with Cronbach's alpha. The reliability of six-core-competency-based OSCE was acceptable, ranging from 0.69 to 0.87 between 2007 and 2009. In comparison with baseline scores, the summary scores and core-competency subscores all showed significant increase after PGY(1) residents finished their 3-month internal medicine training program. By using a structured development process, the authors were able to create reliable evaluation items for determining PGY(1) residents' acquisition of the ACGME core competencies. Copyright © 2011. Published by Elsevier B.V.

  12. Assessment of Developmental Progress Using an Objective Structured Clinical Examination-Simulation Hybrid Examination for Obstetrics and Gynecology Residents.

    PubMed

    Winkel, Abigail Ford; Gillespie, Colleen; Uquillas, Kristen; Zabar, Sondra; Szyld, Demian

    2016-01-01

    The Test of Integrated Professional Skills (TIPS) is an objective structured clinical examination-simulation hybrid examination that assesses resident integration of technical, cognitive, and affective skills in Obstetrics and Gynecology (OBGYN) residents. The aim of this study was to analyze performance patterns and reactions of residents to the test to understand how it may fit within a comprehensive assessment program. A retrospective, mixed methods review of the design and implementation of the examination, patterns of performance of trainees at different levels of training, focus group data, and description of use of TIPS results for resident remediation and curriculum development. OBGYN residents at New York University Langone Medical Center, a tertiary-care, urban academic health center. OBGYN residents in all years of training, postgraduate year-1 through postgraduate year, all residents completing the TIPS examination and consenting to participate in focus groups were included. In all, 24 residents completed the TIPS examination. Performance on the examination varied widely among individuals at each stage of training, and did not follow developmental trends, except for technical skills. Cronbach α for both standardized patient and faculty ratings ranged from 0.69 to 0.84, suggesting internal consistency. Focus group results indicated that residents respond to the TIPS examination in complex ways, ranging from anxiety about performance to mixed feelings about how to use the data for their learning. TIPS assesses a range of attributes, and can support both formative and summative evaluation. Lack of clear developmental differences and wide variation in performance by learners at the same level of training support the argument for individualized learning plans and competency-based education. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  13. Assessing Communication Skills of Medical Students in Objective Structured Clinical Examinations (OSCE) - A Systematic Review of Rating Scales

    PubMed Central

    Cömert, Musa; Zill, Jördis Maria; Christalle, Eva; Dirmaier, Jörg; Härter, Martin; Scholl, Isabelle

    2016-01-01

    Background Teaching and assessment of communication skills have become essential in medical education. The Objective Structured Clinical Examination (OSCE) has been found as an appropriate means to assess communication skills within medical education. Studies have demonstrated the importance of a valid assessment of medical students’ communication skills. Yet, the validity of the performance scores depends fundamentally on the quality of the rating scales used in an OSCE. Thus, this systematic review aimed at providing an overview of existing rating scales, describing their underlying definition of communication skills, determining the methodological quality of psychometric studies and the quality of psychometric properties of the identified rating scales. Methods We conducted a systematic review to identify psychometrically tested rating scales, which have been applied in OSCE settings to assess communication skills of medical students. Our search strategy comprised three databases (EMBASE, PsycINFO, and PubMed), reference tracking and consultation of experts. We included studies that reported psychometric properties of communication skills assessment rating scales used in OSCEs by examiners only. The methodological quality of included studies was assessed using the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. The quality of psychometric properties was evaluated using the quality criteria of Terwee and colleagues. Results Data of twelve studies reporting on eight rating scales on communication skills assessment in OSCEs were included. Five of eight rating scales were explicitly developed based on a specific definition of communication skills. The methodological quality of studies was mainly poor. The psychometric quality of the eight rating scales was mainly intermediate. Discussion Our results reveal that future psychometric evaluation studies focusing on improving the methodological quality are needed

  14. Assessing Communication Skills of Medical Students in Objective Structured Clinical Examinations (OSCE)--A Systematic Review of Rating Scales.

    PubMed

    Cömert, Musa; Zill, Jördis Maria; Christalle, Eva; Dirmaier, Jörg; Härter, Martin; Scholl, Isabelle

    2016-01-01

    Teaching and assessment of communication skills have become essential in medical education. The Objective Structured Clinical Examination (OSCE) has been found as an appropriate means to assess communication skills within medical education. Studies have demonstrated the importance of a valid assessment of medical students' communication skills. Yet, the validity of the performance scores depends fundamentally on the quality of the rating scales used in an OSCE. Thus, this systematic review aimed at providing an overview of existing rating scales, describing their underlying definition of communication skills, determining the methodological quality of psychometric studies and the quality of psychometric properties of the identified rating scales. We conducted a systematic review to identify psychometrically tested rating scales, which have been applied in OSCE settings to assess communication skills of medical students. Our search strategy comprised three databases (EMBASE, PsycINFO, and PubMed), reference tracking and consultation of experts. We included studies that reported psychometric properties of communication skills assessment rating scales used in OSCEs by examiners only. The methodological quality of included studies was assessed using the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. The quality of psychometric properties was evaluated using the quality criteria of Terwee and colleagues. Data of twelve studies reporting on eight rating scales on communication skills assessment in OSCEs were included. Five of eight rating scales were explicitly developed based on a specific definition of communication skills. The methodological quality of studies was mainly poor. The psychometric quality of the eight rating scales was mainly intermediate. Our results reveal that future psychometric evaluation studies focusing on improving the methodological quality are needed in order to yield psychometrically

  15. Communication Skills in Candidates for Accreditation in Rheumatology Are Correlated With Candidate's Performance in the Objective Structured Clinical Examination.

    PubMed

    Pascual-Ramos, Virginia; Flores-Alvarado, Diana Elsa; Portela-Hernández, Margarita; Maldonado-Velázquez, María Del Rocío; Amezcua-Guerra, Luis Manuel; López-Zepeda, Judith; Álvarez, Everardo; Rubio, Nadina; Lastra, Olga Vera; Saavedra, Miguel Ángel; Arce-Salinas, César Alejandro

    2017-07-26

    The Mexican Accreditation Council for Rheumatology annually certifies trainees in Rheumatology using a multiple-choice test and an objective structured clinical examination (OSCE). Since 2015, candidate's communication skills (CS) have been rated by both patients and by physician examiners and correlated with results on the OSCE. This study compared the CS from candidates to annual accreditation in Rheumatology as rated by patients and by physician examiners, and assessed whether these correlated with candidate's performance in the OSCE. From 2015 to 2017, 8areas of CS were evaluated using a Likert scale, in each OSCE station that involved a patient. Both patient and physician evaluators were trained annually and their evaluations were performed blindly. The associations were calculated using the Pearson correlation coefficient. In general, candidates were given high CS scores; the scores from patients of the candidate's CS were better than those of physician examiners; within the majority of the stations, both scores were found to correlate moderately. In addition, the scoring of CS correlated with trainee performance at the corresponding OSCE station. Interestingly, better correlations were found when the skills were rated by the patients compared to physician scores. The average CS score was correlated with the overall OSCE performance for each trainee, but not with the multiple-choice test, except in the 2017 accreditation process, when a weak correlation was found. CS assessed during a national accreditation process correlated with the candidate's performance at the station level and with the overall OSCE. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  16. Communication skills training in surgical residency: a needs assessment and metacognition analysis of a difficult conversation objective structured clinical examination.

    PubMed

    Falcone, John L; Claxton, René N; Marshall, Gary T

    2014-01-01

    The objective structured clinical examination (OSCE) can be used to evaluate the Accreditation Council for Graduate Medical Education Core Competencies of Professionalism and Interpersonal and Communication Skills. The aim of this study was to describe general surgery resident performance on a "difficult conversation" OSCE. In this prospective study, junior and senior residents participated in a 2-station OSCE. Junior stations involved discussing operative risks and benefits and breaking bad news. Senior stations involved discussing goals of care and discussing transition to comfort measures only status. Residents completed post-OSCE checklist and Likert-based self-evaluations of experience, comfort, and confidence. Trained standardized patients (SPs) evaluated residents using communication skill-based checklists and Likert-based assessments. Pearson correlation coefficients were determined between self-assessment and SP assessment. Mann-Whitney U tests were conducted between junior and senior resident variables, using α = 0.05. There were 27 junior residents (age 28.1 ± 1.9 years [29.6% female]) and 27 senior residents (age 32.1 ± 2.5 years [26.9% female]). The correlation of self-assessment and SP assessment of overall communication skills by junior residents was -0.32 on the risks and benefits case and 0.07 on the breaking bad news case. The correlation of self-assessment and SP assessment of overall communication skills by senior residents was 0.30 on the goals of care case and 0.26 on the comfort measures only case. SP assessments showed that junior residents had higher overall communication skills than senior residents (p = 0.03). Senior residents perceived that having difficult conversations was more level appropriate (p < 0.001), and they were less nervous having difficult conversations (p < 0.01) than junior residents. We found that residents perform difficult conversations well, that subjective and objective skills are correlated, and that skills

  17. Assessing musculoskeletal examination skills and diagnostic reasoning of 4th year medical students using a novel objective structured clinical exam.

    PubMed

    Stansfield, R Brent; Diponio, Lisa; Craig, Cliff; Zeller, John; Chadd, Edmund; Miller, Joshua; Monrad, Seetha

    2016-10-14

    Medical students have difficulty performing and interpreting musculoskeletal physical examinations and interpreting the findings. Research has focused on students' knowledge deficits, but there are few direct assessments of students' ability to perform a hypothesis-driven physical examination (HDPE). We developed a novel musculoskeletal Objective Structured Clinical Exam (OSCE) focusing on HDPE skills for disorders of the shoulder, back and knee, and used it to explore medical student diagnostic reasoning. A multidisciplinary group of musculoskeletal specialists developed and gathered validity evidence for a three station OSCE focusing on the HDPE of the shoulder, back and knee, emphasizing the ability to anticipate (identify pre-encounter) expected physical exam findings, and subsequently perform discriminatory physical examination maneuvers. The OSCE was administered to 45 final year medical students. Trained faculty observed and scored students' ability to anticipate exam findings and perform diagnostic examination maneuvers on simulated patients. Encounters were digitally recorded and scored again by another trained faculty member. Inter-rater reliability for each maneuver was estimated using type-2 intra-class correlations (ICC). Percentages of perfect scores for anticipation and performance were calculated. Pearson's correlation between anticipation and performance scores was computed for each maneuver and their relationship to diagnostic accuracy was tested with logistic regression. Inter-rater reliability was good (ICC between .69 and .87) for six exam maneuvers. Maneuver performance was overall poor, with no discriminatory maneuver performed correctly by more than two thirds of students, and one maneuver only performed correctly by 4 % of students. For the shoulder and knee stations, students were able to anticipate necessary discriminatory exam findings better than they could actually perform relevant exam maneuvers. The ability to anticipate a

  18. Assessment of clinical competence of medical students using the objective structured clinical examination: first 2 years' experience in Taipei Veterans General Hospital.

    PubMed

    Huang, Chin-Chou; Chan, Cho-Yu; Wu, Chun-Lien; Chen, Ya-Lin; Yang, Hui-Wen; Huang, Chia-Chang; Chen, Chen-Huan; Huang, William J; Lee, Fa-Yauh; Lin, Shing-Jong; Chen, Jaw-Wen

    2010-11-01

    Competence-oriented education is currently the mainstream method of teaching clinical medical education. The objective structured clinical examination (OSCE) is a widely employed and accepted tool to measure the clinical competence of medical students. We describe the first 2 years' experience of OSCE in Taipei Veterans General Hospital. At Taipei Veterans General Hospital, every 7(th)-year medical student has taken the OSCE since 2006. There were 15 stations in the first 2 years' OSCEs. In years 1 and 2, 133 and 132 students were assessed by the OSCE, respectively. The content of the OSCE included internal medicine, surgery, pediatrics, obstetrics and gynecology, communication, and emergency training. All categories and results of examinees' evaluation at each station were recorded inclusively and compared statistically. The average scores of students from the 15 stations ranged from 47.7 ± 16.4 to 93.7 ± 8.5 in 2007. The score for communication skills was the lowest, whereas the score for Micro-Sim was the highest. Communication skills and electrocardiography interpretation were the 2 categories in which most of the students failed. A reliability analysis was conducted of the 2007 OSCE questions. The overall score and reliability (Cronbach's reliability) was 0.641. The difference between the impacts on reliability after deleting a test item ranged from 0.59 to 0.65 for all stations. This meant that every station had a similar impact on reliability after being deleted. The squared multiple correlation, R(2), of the reliability of each item was between 0.12 and 0.49, with chest X-ray interpretation being the lowest. The item-total correlation was between 0.10 and 0.41, with interactive case being the lowest. The OSCE is an effective method for assessing the clinical competence of medical students. The OSCE could be improved further by modifying the examination questions and promoting effective training for standardized patients and examiners. Copyright © 2010

  19. Objective structured clinical examinations (OSCEs) as a summative evaluation tool in a ruminant health management rotation for final-year DVM students.

    PubMed

    Bateman, Ken; Menzies, Paula; Sandals, David; Duffield, Todd; LeBlanc, Stephen; Leslie, Ken; Lissemore, Kerry; Swackhammer, Rob

    2008-01-01

    The objective structured clinical examination (OSCE) has been used for 10 years at the Ontario Veterinary College, University of Guelph, to evaluate the clinical competencies in ruminant health management of final-year DVM students. The performance of these students in the summative assessment, which includes the use of OSCEs, was compared to their formative assessment, given at the end of the rotation. Specifically, classification of students' performance as poor (bottom 10% of the grade range versus "serious deficits") or superior ("A grade" versus "exceeds expectations") was compared. Agreement between the two types of assessment is slight, regardless of whether assessing diagnostic process skills or technical skills--and regardless of whether all students were assessed or only those enrolled in food-animal or mixed streams in their final year--which suggests that the two assess different types of skills. OSCEs are a useful and viable tool for objectively assessing clinical skills in ruminant health management.

  20. Qualitative analysis of student beliefs and attitudes after an objective structured clinical evaluation: implications for affective domain learning in undergraduate nursing education.

    PubMed

    Cazzell, Mary; Rodriguez, Amber

    2011-12-01

    This qualitative study explored the feelings, beliefs, and attitudes of senior-level undergraduate pediatric nursing students upon completion of a medication administration Objective Structured Clinical Evaluation (OSCE). The affective domain is the most neglected domain in higher education, although it is deemed the "gateway to learning." Quantitative assessments of clinical skills performed during OSCEs usually address two of the three domains of learning: cognitive (knowledge) and psychomotor skills. Twenty students volunteered to participate in focus groups (10 per group) and were asked three questions relevant to their feelings, beliefs, and attitudes about their OSCE experiences. Students integrated the attitude of safety first into future practice but felt that anxiety, loss of control, reaction under pressure, and no feedback affected their ability to connect the OSCE performance with future clinical practice. The findings affect future affective domain considerations in the development, modification, and assessment of OSCEs across the undergraduate nursing curriculum.

  1. Learning objectives in resident training. Objectives in clinical chemistry.

    PubMed

    Barrett, D A

    1976-06-01

    The use of learning objectives has recently found extensive application in the evolution of medical school curricula; however, they have not been utilized systematically in the education of pathology residents. In attempting to define the end-point behavior or objectives of a resident during a rotation in clinical biochemistry, 567 midwestern pathologists, clinical chemists and medical technologists working in chemistry sections rated proposed objectives as essentail, desirable but not essential, or not needed. Twenty-four of 52 objectives were considered essential for the resident to achieve by 75% or more of the respondents. These included 10 of 33 related to technical knowledge, 5 to 10 related to business and supervisory skills, 5 of 5 related to investigative problem solving, and 4 of 4 related to communicating with persons outside of the laboratory. In general, respondents considered knowledge of principles more important than technical skills. Management, business and communicative skills were highly rated.

  2. Mental health and learning disability nursing students' perceptions of the usefulness of the objective structured clinical examination to assess their competence in medicine administration.

    PubMed

    Hemingway, Steve; Stephenson, John; Roberts, Bronwyn; McCann, Terence

    2014-08-01

    The aim of this study was to evaluate mental health and learning disability nursing students' perceptions of the usefulness of the objective structured clinical examination (OSCE) in assessing their administration of medicine competence. Learning disability (n = 24) and mental health (n = 46) students from a single cohort were invited to evaluate their experience of the OSCE. A 10-item survey questionnaire was used, comprising open- and closed-response questions. Twelve (50%) learning disability and 32 (69.6%) mental health nursing students participated. The OSCE was rated highly compared to other theoretical assessments; it was also reported as clinically real and as a motivational learning strategy. However, it did not rate as well as clinical practice. Content analysis of written responses identified four themes: (i) benefits of the OSCE; (ii) suggestions to improve the OSCE; (iii) concern about the lack of clinical reality of the OSCE; and (iv) OSCE-induced stress. The themes, although repeating some of the positive statistical findings, showed that participants were critical of the university setting as a place to conduct clinical assessment, highlighted OSCE-related stress, and questioned the validity of the OSCE as a real-world assessment. The OSCE has an important role in the development of student nurses' administration of medicine skills. However, it might hinder their performance as a result of the stress of being assessed in a simulated environment.

  3. The development and evaluation of a computer-based resource to assist pre-registration nursing students with their preparation for objective structured clinical examinations (OSCEs).

    PubMed

    Bloomfield, Jacqueline; Fordham-Clarke, Carol; Pegram, Anne; Cunningham, Brent

    2010-02-01

    This paper presents a narrative discussion of an innovative, computer-based resource developed, implemented and evaluated by a small project team at a school of nursing and midwifery in London. The interactive resource was designed to assist first and second year pre-registration nursing students with both their clinical skills revision and formative preparation for Objective Structured Clinical Examinations and involved a small range of clinical skills. These included: skin assessment; hand hygiene; reading a drug prescription chart, weighing a baby and assessment of an intravenous cannulae site. The processes involved in the development of the tool are described and, the key drivers informing its development are identified. Although a formal research approach was not adopted a summary of feedback obtained from anonymous student evaluations is included. This provides important insights into the perceived usefulness of the tool and is discussed in light of the challenges and practicalities associated with the content development and technical issues. The paper concludes by identifying proposed future developments and wider applications of this innovative clinical skills education initiative within nursing and healthcare education.

  4. How to maintain equity and objectivity in assessing the communication skills in a large group of student nurses during a long examination session, using the Objective Structured Clinical Examination (OSCE).

    PubMed

    Bagnasco, Annamaria; Tolotti, Angela; Pagnucci, Nicola; Torre, Giancarlo; Timmins, Fiona; Aleo, Giuseppe; Sasso, Loredana

    2016-03-01

    While development, testing, and innovation of the Objective Structured Clinical Examination (OSCE) are common in the international literature, studies from the United States of America (USA), Australia, and the United Kingdom (UK) predominate. There is little known about OSCE use in European countries, such as Italy, where other than cost analysis, there is little reporting of OSCE use or validation. This paper reports on one Italian initiative, which evaluated the equity and objectivity of the OSCE method of assessing communication skills. An OSCE method was used to assess the communication skills of first-year students of the Degree Course in Nursing. A method of simulation was implemented through role-playing with standardized patients. An observational method was used to collect data. Four hundred and twenty-one first-year undergraduate nursing students at one university site in Italy took part. Ten examination sessions were carried out. The students' performances were assessed by two examiners who used a structured observation grid and conducted their assessment separately. A situation simulated by four nurses with experience as actors was used as the topic for the students' examination. Calculation of the daily rate of students who passed the examination revealed a random distribution over time. The nonparametric correlation indexes referring to the assessments and to the scores assigned by the two examiners proved statistically significant (P≤0.001). The study confirmed the validity of the OSCE method in ensuring equity and objectivity of communication skills assessment in a large population of nursing students for the purpose of certification throughout the duration of the examination. This has important implications for nurse education and practice as the extent to which OSCE approaches, while deemed objective, are culturally sensitive or valid and reliable across cultures is not clear. This is something that requires further research and examination in

  5. The feasibility and acceptability of administering a telemedicine objective structured clinical exam as a solution for providing equivalent education to remote and rural learners.

    PubMed

    Palmer, Ryan T; Biagioli, Frances E; Mujcic, Jasminka; Schneider, Benjamin N; Spires, LeNeva; Dodson, Lisa G

    2015-01-01

    Although many medical schools incorporate distance learning into their curricula, assessing students at a distance can be challenging. While some assessments are relatively simple to administer to remote students, other assessments, such as objective structured clinical exams (OSCEs) are not. This article describes a means to more effectively and efficiently assess distance learners and evaluate the feasibility and acceptability of the assessment. We developed a teleOSCE, administered online in real time, to two cohorts of students on a rural clerkship rotation and assessed the feasibility and acceptability of using such an approach to assess medical students' clinical skills at rural locations. Project feasibility was defined as having development and implementation costs of less than $5000. Project acceptability was determined by analyzing student interview transcripts. A qualitative case study design framework was chosen due to the novel nature of the activity. The implementation cost of the teleOSCE was approximately US$1577.20, making it a feasible educational endeavor. Interview data indicated the teleOSCE was also acceptable to students. The teleOSCE format may be useful to other institutions as a method to centrally administer clinical skills exams for assessment of distance medical students.

  6. Nursing students' clinical competencies: a survey on clinical education objectives.

    PubMed

    Arrigoni, C; Grugnetti, A M; Caruso, R; Gallotti, M L; Borrelli, P; Puci, M

    2017-01-01

    Developing clearly defined competencies and identifying strategies for their measurement remain unfortunately a critical aspect of nursing training. In the current international context, which continues to be characterised by deep economic crisis, universities have a fundamental role to play in redefining the educational goals to respond to the expectations of certain geographical areas of interest, as underscored in the Bologna Process (Joint Declaration of the European Ministers of Education Convened in Bologna 19 June 1999). The aim of this observational study was to examine the clinical learning context of nursing students using a tool developed by a team of teachers for the analysis of clinical learning. Redefinition of the clinical learning objectives with reference to the competencies set out in the questionnaire validated by Venturini et al. (2012) and the subsequent use of the tool created by the team of teachers for students in the first, second and third-year courses of the 2013/14 academic year, covering all the internships called for in those years. All nursing students enrolled in the first, second and third year of the nursing undergraduate degree program at the University of Pavia (no. 471) participated in this survey. A total of 1,758 clinical internships were carried out: 461 for the first year, 471 for the second year and 826 for the third year. Setting objectives, beginning with the educational offerings in the several clinical contexts, represents a strong point for this process. The results highlight a level of heterogeneity and complexity intrinsic to the University of Pavia educational system, characterized by clinical settings with different clinical levels (Research hospital and other traditional hospitals) that offering different levels of training. The use of the self-evaluation form for clinical learning made it possible to perform real-time observations of the training activities of the entire student body. An educational model

  7. Development and implementation of an objective structured clinical examination to provide formative feedback on communication and interpersonal skills in geriatric training.

    PubMed

    O'Sullivan, Patricia; Chao, Serena; Russell, Matthew; Levine, Sharon; Fabiny, Anne

    2008-09-01

    Teaching and assessment of communication and interpersonal skills, one of the American Council for Graduate Medical Education-designated core competencies, is an important but difficult task in the training of physicians. Assessment of trainees offers an opportunity to provide explicit feedback on their skills and encourages learning. This article describes a pilot study in which clinician-educators affiliated with the geriatrics training programs at Beth Israel Deaconess Medical Center and Boston University Medical Center designed and piloted a novel Objective Structured Clinical Examination (OSCE) to assess the communication and interpersonal skills of medical, dental, and geriatric psychiatry fellows. The OSCE consisted of three stations where geriatricians and standardized patients evaluated candidates using specifically designed checklists and an abbreviated version of the Master Interview Rating Scale. Communication skills were assessed through performance of specific "real life" clinical tasks, such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills were assessed through the effect of the communication between doctor and standardized patient on fostering trust, relieving anxiety, and establishing a therapeutic relationship. This pilot study demonstrated that the OSCE format of assessment provides a valid means of evaluating the communication and interpersonal skills of interdisciplinary geriatric trainees and provides a valuable forum for formative assessment and feedback. Given that geriatricians and non geriatricians involved in elder care both need communication and interpersonal skills, this novel OSCE can be used for assessment of these skills in trainees in diverse healthcare subspecialties.

  8. Developing doctors: what are the attitudes and perceptions of year 1 and 2 medical students towards a new integrated formative objective structured clinical examination?

    PubMed

    Furmedge, Daniel S; Smith, Laura-Jane; Sturrock, Alison

    2016-01-28

    Objective Structured Clinical Examination (OSCE) is a core component of undergraduate medical student assessment. With increased emphasis on integrated programmes, more courses include OSCEs in the traditionally 'preclinical' years. The acceptability and impact of such assessment methods at this stage of training is unknown. In 2013 and 2014 University College London Medical School piloted a formative, integrated OSCE in years 1 and 2 of the undergraduate medical degree programme. This study with a sequential exploratory design aimed to explore the acceptability and impact of such an OSCE in the early years of medical school. 1280 students completed the OSCE and were invited to complete a questionnaire exploring their views of the OSCE (response rate 96.6%). Four focus groups, each with five or six participants (22 in total) were subsequently held to further explore themes. Data was independently transcribed and coded using thematic analysis. Students were strongly in favour of the introduction of an OSCE in addition to existing assessments. Six overarching themes were identified: application of knowledge and skills; OSCE as an experience; OSCE as a process; a learning curve; becoming a doctor; and creating an effective OSCE. Results strongly support the role of OSCE early in the medical course with many benefits reported. An OSCE at this stage aligns with the vision of integrated medical education which includes early patient contact and introduction of clinical and professional skills. It also fosters feelings of responsibility and professional identity amongst students.

  9. E-learning module on chronic low back pain in older adults: evidence of effect on medical student objective structured clinical examination performance.

    PubMed

    Weiner, Debra K; Morone, Natalia E; Spallek, Heiko; Karp, Jordan F; Schneider, Michael; Washburn, Carol; Dziabiak, Michael P; Hennon, John G; Elnicki, D Michael

    2014-06-01

    The Institute of Medicine has highlighted the urgent need to close undergraduate and graduate educational gaps in treating pain. Chronic low back pain (CLBP) is one of the most common pain conditions, and older adults are particularly vulnerable to potential morbidities associated with misinformed treatment. An e-learning case-based interactive module was developed at the University of Pittsburgh Center of Excellence in Pain Education, one of 12 National Institutes of Health-designated centers, to teach students important principles for evaluating and managing CLBP in older adults. A team of six experts in education, information technology, pain management, and geriatrics developed the module. Teaching focused on common errors, interactivity, and expert modeling and feedback. The module mimicked a patient encounter using a standardized patient (the older adult with CLBP) and a pain expert (the patient provider). Twenty-eight medical students were not exposed to the module (Group 1) and 27 were exposed (Group 2). Their clinical skills in evaluating CLBP were assessed using an objective structured clinical examination (OSCE). Mean scores were 62.0 ± 8.6 for Group 1 and 79.5 ± 10.4 for Group 2 (P < .001). Using an OSCE pass-fail cutoff score of 60%, 17 of 28 Group 1 students (60.7%) and 26 of 27 Group 2 students (96.3%) passed. The CLBP OSCE was one of 10 OSCE stations in which students were tested at the end of a Combined Ambulatory Medicine and Pediatrics Clerkship. There were no between-group differences in performance on eight of the other nine OSCE stations. This module significantly improved medical student clinical skills in evaluating CLBP. Additional research is needed to ascertain the effect of e-learning modules on more-advanced learners and on improving the care of older adults with CLBP. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  10. Does an Advanced Pelvic Simulation Curriculum Improve Resident Performance on a Pediatric and Adolescent Gynecology Focused Objective Structured Clinical Examination? A Cohort Study.

    PubMed

    Dumont, Tania; Hakim, Julie; Black, Amanda; Fleming, Nathalie

    2016-06-01

    To determine the effect of an advanced pelvic simulation curriculum on resident performance on a pediatric and adolescent gynecology (PAG) focused objective structured clinical examination (OSCE). Obstetrics and gynecology residents in a single academic Canadian center participated in a PAG simulation curriculum. An OSCE on prepubertal vaginal bleeding was administered at the biannual OSCE examination 2 months before the simulation curriculum and again 3 months after the simulation curriculum. Academic half-day at the University of Ottawa Skills and Simulation Centre. Obstetrics and gynecology residents from the University of Ottawa. Participants completed 4 stations teaching PAG-appropriate history-taking, genital examination, Tanner staging, vaginal sampling and flushing, hymenectomy, vaginoscopy, laparoscopic adnexal detorsion, and approach to the child and/or adolescent. Advanced pelvic models were used for procedure-specific stations. The primary outcome measure was change in mean score on a prepubertal vaginal bleeding OSCE station. Secondary outcome measures were changes in individual component scores. Fourteen residents completed the simulation curriculum and the PAG OSCE at the 2 separate time points (before and after simulation curriculum). The mean OSCE score before the simulation curriculum was 54.6% (20.5 of 37) and mean score after the curriculum was 78.1% (28.9 of 37; P < .001). Significant score increases were found in history-taking, examination, differential diagnosis, identification of organism, surgical procedures, and identification of foreign body (P < .01 for all). This innovative PAG simulation curriculum significantly increased residents' knowledge in PAG history-taking, examination skills, operative procedures, and approach to the child and/or adolescent. Obstetrics and Gynecology Program Directors should consider incorporating PAG simulation training into their curriculum to ensure that residents meet their learning objectives and

  11. Health Literacy in Transitions of Care: An Innovative Objective Structured Clinical Examination for Fourth-Year Medical Students in an Internship Preparation Course.

    PubMed

    Bloom-Feshbach, Kimberly; Casey, Dana; Schulson, Lucy; Gliatto, Peter; Giftos, Jonathan; Karani, Reena

    2016-02-01

    Low health literacy is associated with adverse health outcomes, especially during transitions of care. Competency-based assessments may improve communication during this time. To develop an Objective Structured Clinical Examination (OSCE) for medical students to demonstrate communication skills to be used during the hospital discharge process with patients of low health literacy. The OSCE was integrated into the curriculum of an internship preparatory clerkship. One hundred and one fourth-year medical students participated. Students received a skills-based health literacy workshop. In the OSCE, learners counseled standardized patients regarding initiation of anticoagulation at discharge and wrote discharge instructions. Fifty-seven students completed the workshop prior to the OSCE, and 44 participated in the workshop after the completing the OSCE. Participants who completed the workshop first outperformed their peers on the checklist (15.1 vs. 13.4, p < 0.0001) and on the reading level of their written instructions (9.9 vs. 10.6, p = 0.01); 82% felt confident communicating with patients of low health literacy after the workshop and OSCE. This OSCE is a tool to train and evaluate future interns' ability to communicate with patients of limited health literacy levels at hospital discharge. Such innovations may make this period of time safer for patients, improving health outcomes.

  12. How to assess communication, professionalism, collaboration and the other intrinsic CanMEDS roles in orthopedic residents: use of an objective structured clinical examination (OSCE).

    PubMed

    Dwyer, Tim; Glover Takahashi, Susan; Kennedy Hynes, Melissa; Herold, Jodi; Wasserstein, David; Nousiainen, Markku; Ferguson, Peter; Wadey, Veronica; Murnaghan, M Lucas; Leroux, Tim; Semple, John; Hodges, Brian; Ogilvie-Harris, Darrell

    2014-08-01

    Assessing residents' understanding and application of the 6 intrinsic CanMEDS roles (communicator, professional, manager, collaborator, health advocate, scholar) is challenging for postgraduate medical educators. We hypothesized that an objective structured clinical examination (OSCE) designed to assess multiple intrinsic CanMEDS roles would be sufficiently reliable and valid. The OSCE comprised 6 10-minute stations, each testing 2 intrinsic roles using case-based scenarios (with or without the use of standardized patients). Residents were evaluated using 5-point scales and an overall performance rating at each station. Concurrent validity was sought by correlation with in-training evaluation reports (ITERs) from the last 12 months and an ordinal ranking created by program directors (PDs). Twenty-five residents from postgraduate years (PGY) 0, 3 and 5 participated. The interstation reliability for total test scores (percent) was 0.87, while reliability for each of the communicator, collaborator, manager and professional roles was greater than 0.8. Total test scores, individual station scores and individual CanMEDS role scores all showed a significant effect by PGY level. Analysis of the PD rankings of intrinsic roles demonstrated a high correlation with the OSCE role scores. A correlation was seen between ITER and OSCE for the communicator role, while the ITER medical expert and total scores highly correlated with the communicator, manager and professional OSCE scores. An OSCE designed to assess the intrinsic CanMEDS roles was sufficiently valid and reliable for regular use in an orthopedic residency program.

  13. Money makes the (medical assessment) world go round: The cost of components of a summative final year Objective Structured Clinical Examination (OSCE).

    PubMed

    Brown, Craig; Ross, Sarah; Cleland, Jennifer; Walsh, Kieran

    2015-04-29

    The widely used Objective Structured Clinical Examination (OSCE) is undoubtedly expensive. Cost-effectiveness is one of the components of the assessment utility index defining its usefulness. Our current financial climate demands increased transparency in the costs associated with medical education and it is now vital to ascertain how much is spent on assessments, such as the OSCE, and in particular costs associated with the different types of stations within the OSCE. A retrospective case-study approach was used to identify all costs associated with the development, production, administration and post-examination phases of the 2013 final year MBChB OSCE at the University of Aberdeen, Scotland. This 15 station OSCE was held over 2 days for 185 students. This OSCE cost £65,328 to run. Costs per station ranged from £3108 (prescribing) to £6577 (eye examination). The cost per student was £355. The costs of a "high stakes" OSCE are sobering. The bulk of costs identified are not modifiable in light of what is currently known about the metrics of OSCE utility, particularly reliability and validity. Providers, and funders, of medical education must be prepared to assign significant resource to OSCE assessment and centres should be encouraged to calculate precise costs associated with assessment to inform resource allocation decisions.

  14. The Implementation and Development of an Objective Structured Clinical Examination in the Community Pharmacy Course of a Select Gulf-Region Academic Institution (Ras Al Khaimah College of Pharmaceutical Sciences): A Pilot Study

    ERIC Educational Resources Information Center

    Al-Azzawi, Amad Mohammed Jamil; Nagavi, B.G.; Hachim, Mahmood Y.; Mossa, Omar H.

    2016-01-01

    Background: Objective Structured Clinical Examinations (OSCEs) were used to assess translational pharmacotherapeutic skills of a Gulf-region representative academic institution. Aim: The aim of the current study was to assess the clinical skills of students enrolled within the third year Bachelor of Pharmacy (BPharm) programme within Ras Al…

  15. The Implementation and Development of an Objective Structured Clinical Examination in the Community Pharmacy Course of a Select Gulf-Region Academic Institution (Ras Al Khaimah College of Pharmaceutical Sciences): A Pilot Study

    ERIC Educational Resources Information Center

    Al-Azzawi, Amad Mohammed Jamil; Nagavi, B.G.; Hachim, Mahmood Y.; Mossa, Omar H.

    2016-01-01

    Background: Objective Structured Clinical Examinations (OSCEs) were used to assess translational pharmacotherapeutic skills of a Gulf-region representative academic institution. Aim: The aim of the current study was to assess the clinical skills of students enrolled within the third year Bachelor of Pharmacy (BPharm) programme within Ras Al…

  16. SCOOP Structured Concurrent Object Oriented Prolog

    NASA Astrophysics Data System (ADS)

    Vaucher, Jean; Lapalme, Guy; Malenfant, Jacques

    SCOOP is an experimental language implemented in Prolog that tries to combine the best of logic, object-oriented and concurrent programming in a structured, natural and efficient manner. SCOOP provides hierarchies of object classes. These objects behave as independent Prolog programs with private databases which can execute goals within other objects.

  17. How to assess communication, professionalism, collaboration and the other intrinsic CanMEDS roles in orthopedic residents: use of an objective structured clinical examination (OSCE)

    PubMed Central

    Dwyer, Tim; Takahashi, Susan Glover; Hynes, Melissa Kennedy; Herold, Jodi; Wasserstein, David; Nousiainen, Markku; Ferguson, Peter; Wadey, Veronica; Murnaghan, M. Lucas; Leroux, Tim; Semple, John; Hodges, Brian; Ogilvie-Harris, Darrell

    2014-01-01

    Background Assessing residents’ understanding and application of the 6 intrinsic CanMEDS roles (communicator, professional, manager, collaborator, health advocate, scholar) is challenging for postgraduate medical educators. We hypothesized that an objective structured clinical examination (OSCE) designed to assess multiple intrinsic CanMEDS roles would be sufficiently reliable and valid. Methods The OSCE comprised 6 10-minute stations, each testing 2 intrinsic roles using case-based scenarios (with or without the use of standardized patients). Residents were evaluated using 5-point scales and an overall performance rating at each station. Concurrent validity was sought by correlation with in-training evaluation reports (ITERs) from the last 12 months and an ordinal ranking created by program directors (PDs). Results Twenty-five residents from postgraduate years (PGY) 0, 3 and 5 participated. The interstation reliability for total test scores (percent) was 0.87, while reliability for each of the communicator, collaborator, manager and professional roles was greater than 0.8. Total test scores, individual station scores and individual CanMEDS role scores all showed a significant effect by PGY level. Analysis of the PD rankings of intrinsic roles demonstrated a high correlation with the OSCE role scores. A correlation was seen between ITER and OSCE for the communicator role, while the ITER medical expert and total scores highly correlated with the communicator, manager and professional OSCE scores. Conclusion An OSCE designed to assess the intrinsic CanMEDS roles was sufficiently valid and reliable for regular use in an orthopedic residency program. PMID:25078926

  18. A metadata schema for data objects in clinical research.

    PubMed

    Canham, Steve; Ohmann, Christian

    2016-11-24

    A large number of stakeholders have accepted the need for greater transparency in clinical research and, in the context of various initiatives and systems, have developed a diverse and expanding number of repositories for storing the data and documents created by clinical studies (collectively known as data objects). To make the best use of such resources, we assert that it is also necessary for stakeholders to agree and deploy a simple, consistent metadata scheme. The relevant data objects and their likely storage are described, and the requirements for metadata to support data sharing in clinical research are identified. Issues concerning persistent identifiers, for both studies and data objects, are explored. A scheme is proposed that is based on the DataCite standard, with extensions to cover the needs of clinical researchers, specifically to provide (a) study identification data, including links to clinical trial registries; (b) data object characteristics and identifiers; and (c) data covering location, ownership and access to the data object. The components of the metadata scheme are described. The metadata schema is proposed as a natural extension of a widely agreed standard to fill a gap not tackled by other standards related to clinical research (e.g., Clinical Data Interchange Standards Consortium, Biomedical Research Integrated Domain Group). The proposal could be integrated with, but is not dependent on, other moves to better structure data in clinical research.

  19. The method used to set the pass mark in an objective structured clinical examination defines the performance of candidates for certification as rheumatologists.

    PubMed

    Pascual-Ramos, Virginia; Guilaisne Bernard-Medina, Ana; Flores-Alvarado, Diana Elsa; Portela-Hernández, Margarita; Maldonado-Velázquez, María Del Rocío; Jara-Quezada, Luis Javier; Amezcua-Guerra, Luis Manuel; Rubio-Judith López-Zepeda, Nadina E; Álvarez-Hernandez, Everardo; Saavedra, Miguel Ángel; Arce-Salinas, César Alejandro

    2017-02-01

    The Mexican Accreditation Council for Rheumatology certifies trainees (TR) on an annual basis using both a multiple-choice question (MCQ) test and an objective structured clinical examination (OSCE). For 2013 and 2014, the OSCE pass mark (PM) was set by criterion referencing as ≥6 (CPM), whereas overall rating of borderline performance method (BPM) was added for 2015 and 2016 accreditations. We compared OSCE TR performance according to CPM and BPM, and examined whether correlations between MCQ and OSCE were affected by PM. Forty-three (2015) and 37 (2016) candidates underwent both tests. Altogether, OSCE were integrated by 15 validated stations; one evaluator per station scored TR performance according to a station-tailored check-list and a Likert scale (fail, borderline, above range) of overall performance. A composite OSCE score was derived for each candidate. Appropriate statistics were used. Mean (±standard derivation [SD]) MCQ test scores were 6.6±0.6 (2015) and 6.4±0.6 (2016) with 5 candidates receiving a failing score each year. Mean (±SD) OSCE scores were 7.4±0.6 (2015) and 7.3±0.6 (2016); no candidate received a failing CPM score in either 2015 or 2016 OSCE, although 21 (49%) and 19 (51%) TR, respectively, received a failing BPM score (calculated as 7.3 and 7.4, respectively). Stations for BPM ranged from 4.5 to 9.5; overall, candidates showed better performance in CPM. In all, MCQ correlated with composite OSCE, r=0.67 (2015) and r=0.53 (2016); P≤.001. Trainees with a passing BPM score in OSCE had higher MCQ scores than those with a failing score. Overall, OSCE-PM selection impacted candidates' performance but had a limited affect on correlation between clinical and practical examinations. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  20. Objectives | Office of Cancer Clinical Proteomics Research

    Cancer.gov

    The overall objective of CPTAC is to systematically identify proteins that derive from alterations in cancer genomes and related biological processes, in order to understand the molecular basis of cancer that is not fully elucidated or not possible through genomics and to accelerate the translation of molecular findings into the clinic.  This is to be achieved through enhancing our understanding of cancer genome biology by adding a complementary functional layer of protein biology (a “proteogenome” approach) that refines/prioritizes driver genes, enhances understanding of pathogenesis

  1. Tools to reduce first year nursing students' anxiety levels prior to undergoing objective structured clinical assessment (OSCA) and how this impacts on the student's experience of their first clinical placement.

    PubMed

    Stunden, Annette; Halcomb, Elizabeth; Jefferies, Diana

    2015-09-01

    One form of assessment that tests students' theoretical skills and confidence in their clinical practice is known as the Objective Structured Clinical Assessment (OSCA). Traditionally it was first launched from medical education, and is now being incorporated by other disciplines, such as nursing. This review seeks to present the best available evidence into strategies that help reduce first year nursing students' anxiety levels prior to undergoing OSCA and clinical placement. A systematic literature search was performed using Medline and CINAHL. This review considered any English language original research published between 2005 and 2013. A literature search located 117 articles. Eight articles were identified as meeting the inclusion in criteria. Majority of studies reported simulation session prior to the OSCA increased students confidence and reduced their anxiety levels. This resulted in students' reporting that they valued the OSCA as a worthwhile assessment. However there were four major themes: that students were anxious about attending the OSCA; that adequate preparation was seen as a coping strategy; that simulation was a further cause for anxiety; and that the simulation experience could also be used as an OSCA tool. Students who have been exposed to simulation scenarios before the OSCA are able to cope much better during the OSCA. Therefore, it is highly recommended to incorporate simulation scenarios into the nursing curricula for first year nursing students' clinical units to help reduce their anxiety levels prior to OCSA. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Clinical trial structures

    PubMed Central

    Evans, Scott R.

    2011-01-01

    Most errors in clinical trials are a result of poor planning. Fancy statistical methods cannot rescue design flaws. Thus careful planning with clear foresight is crucial. The selection of a clinical trial design structure requires logic and creativity. Common structural designs are discussed. PMID:21423788

  3. How does preclinical laboratory training impact physical examination skills during the first clinical year? A retrospective analysis of routinely collected objective structured clinical examination scores among the first two matriculating classes of a reformed curriculum in one Polish medical school.

    PubMed

    Świerszcz, Jolanta; Stalmach-Przygoda, Agata; Kuźma, Marcin; Jabłoński, Konrad; Cegielny, Tomasz; Skrzypek, Agnieszka; Wieczorek-Surdacka, Ewa; Kruszelnicka, Olga; Chmura, Kaja; Chyrchel, Bernadeta; Surdacki, Andrzej; Nowakowski, Michał

    2017-09-01

    As a result of a curriculum reform launched in 2012 at our institution, preclinical training was shortened to 2 years instead of the traditional 3 years, creating additional incentives to optimise teaching methods. In accordance with the new curriculum, a semester-long preclinical module of clinical skills (CS) laboratory training takes place in the second year of study, while an introductory clinical course (ie, brief introductory clerkships) is scheduled for the Fall semester of the third year. Objective structured clinical examinations (OSCEs) are carried out at the conclusion of both the preclinical module and the introductory clinical course. Our aim was to compare the scores at physical examination stations between the first and second matriculating classes of a newly reformed curriculum on preclinical second-year OSCEs and early clinical third-year OSCEs. Analysis of routinely collected data. One Polish medical school. Complete OSCE records for 462 second-year students and 445 third-year students. OSCE scores by matriculation year. In comparison to the first class of the newly reformed curriculum, significantly higher (ie, better) OSCE scores were observed for those students who matriculated in 2013, a year after implementing the reformed curriculum. This finding was consistent for both second-year and third-year cohorts. Additionally, the magnitude of the improvement in median third-year OSCE scores was proportional to the corresponding advancement in preceding second-year preclinical OSCE scores for each of two different sets of physical examination tasks. In contrast, no significant difference was noted between the academic years in the ability to interpret laboratory data or ECG - tasks which had not been included in the second-year preclinical training. Our results suggest the importance of preclinical training in a CS laboratory to improve students' competence in physical examination at the completion of introductory clinical clerkships during

  4. Do primary health centres and hospitals contribute equally towards achievement of the transversal clinical competencies of medical students? Performance on the Objective Structured Clinical Examination (OSCE) in competency acquisition.

    PubMed

    Soler-González, Jorge; Buti, Miquel; Boada, Jordi; Ayala, Victoria; Peñascal, Eduard; Rodriguez, Toni

    2016-01-01

    The adaptation of the educational programmes of European faculties of medicine to the European Higher Education Area guidelines has focused curricula design on competence acquisition. Competencies are defined as the achievements of a predetermined level of efficacy in real-world scenarios. Our objective was to assess whether performance on a common competence evaluation test, the Objective Structured Clinical Examination (OSCE), resulted in different scores for second-year students after a practical medical training course took place in a primary health centre (PHC) or in a hospital. A descriptive study was conducted during the 2010-2014 academic year of the OSCE test scores obtained by all second-year students. Faculty of Medicine at the University of Lleida (Catalonia, Spain). We performed a correlation analysis between students who completed their practical medical training at the PHC and hospitals utilising Student's t-test for comparison of means. 423 students who completed internships at the PHC and at hospitals obtained OSCE mean scores of 7.32 (SD; IC) (0.82; 7.18-7.47) points and 7.17 (0.83; 6.07-7.26) points, respectively (p=0.07). Second-year medical students acquired similar competency levels in the two analysed training scenarios. The two areas both serve their teaching purpose. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  5. Object Recognition and Random Image Structure Evolution

    ERIC Educational Resources Information Center

    Sadr, Jvid; Sinha, Pawan

    2004-01-01

    We present a technique called Random Image Structure Evolution (RISE) for use in experimental investigations of high-level visual perception. Potential applications of RISE include the quantitative measurement of perceptual hysteresis and priming, the study of the neural substrates of object perception, and the assessment and detection of subtle…

  6. Object Recognition and Random Image Structure Evolution

    ERIC Educational Resources Information Center

    Sadr, Jvid; Sinha, Pawan

    2004-01-01

    We present a technique called Random Image Structure Evolution (RISE) for use in experimental investigations of high-level visual perception. Potential applications of RISE include the quantitative measurement of perceptual hysteresis and priming, the study of the neural substrates of object perception, and the assessment and detection of subtle…

  7. Internal structure of Near-Earth Objects

    NASA Astrophysics Data System (ADS)

    Binzel, Richard P.; Kofman, Wlodek

    2005-04-01

    For the purposes of mitigation, the internal structure of near-Earth objects (NEOs) remains one of the most important but least understood parameters. From a science point of view, the internal structure is equally intriguing. Knowledge of the internal structure can reveal the collisional history, and in the case of comets, may also reveal the accretional history. Here we briefly review some of our current understanding of asteroid interiors and focus on the application of radar and radiowave tomography techniques that may be applied to study NEO interiors. To cite this article: R.P. Binzel, W. Kofman, C. R. Physique 6 (2005).

  8. Toward sound objective evaluation of clinical measures.

    PubMed

    Kraemer, Helena Chmura

    2013-07-01

    The quality of all clinical decision-making, as well as power and precision in clinical research results, depends fundamentally on the quality of the measures used. Yet evaluations of the quality of clinical measures likely to be used either in clinic or research applications are difficult to execute or to critique because the criteria for judging such studies are so ill-defined. Here a set of guidelines is proposed, modeled on CONSORT guidelines for randomized clinical trials, first defining the terms often inconsistently used in the research literature and then identifying certain errors that seem to recur in evaluation studies. Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  9. Structured Course Objects in a Digital Library

    NASA Technical Reports Server (NTRS)

    Maly, K.; Zubair, M.; Liu, X.; Nelson, M.; Zeil, S.

    1999-01-01

    We are developing an Undergraduate Digital Library Framework (UDLF) that will support creation/archiving of courses and reuse of existing course material to evolve courses. UDLF supports the publication of course materials for later instantiation for a specific offering and allows the addition of time-dependent and student-specific information and structures. Instructors and, depending on permissions, students can access the general course materials or the materials for a specific offering. We are building a reference implementation based on NCSTRL+, a digital library derived from NCSTRL. Digital objects in NCSTRL+ are called buckets, self-contained entities that carry their own methods for access and display. Current bucket implementations have a two level structure of packages and elements. This is not a rich enough structure for course objects in UDLF. Typically, courses can only be modeled as a multilevel hierarchy and among different courses, both the syntax and semantics of terms may vary. Therefore, we need a mechanism to define, within a particular library, course models, their constituent objects, and the associated semantics in a flexible, extensible way. In this paper, we describe our approach to define and implement these multilayered course objects. We use XML technology to emulate complex data structures within the NCSTRL+ buckets. We have developed authoring and browsing tools to manipulate these course objects. In our current implementation a user downloading an XML based course bucket also downloads the XML-aware tools: an applet that enables the user to edit or browse the bucket. We claim that XML provides an effective means to represent multi-level structure of a course bucket.

  10. Structured Course Objects in a Digital Library

    NASA Technical Reports Server (NTRS)

    Maly, K.; Zubair, M.; Liu, X.; Nelson, M.; Zeil, S.

    1999-01-01

    We are developing an Undergraduate Digital Library Framework (UDLF) that will support creation/archiving of courses and reuse of existing course material to evolve courses. UDLF supports the publication of course materials for later instantiation for a specific offering and allows the addition of time-dependent and student-specific information and structures. Instructors and, depending on permissions, students can access the general course materials or the materials for a specific offering. We are building a reference implementation based on NCSTRL+, a digital library derived from NCSTRL. Digital objects in NCSTRL+ are called buckets, self-contained entities that carry their own methods for access and display. Current bucket implementations have a two level structure of packages and elements. This is not a rich enough structure for course objects in UDLF. Typically, courses can only be modeled as a multilevel hierarchy and among different courses, both the syntax and semantics of terms may vary. Therefore, we need a mechanism to define, within a particular library, course models, their constituent objects, and the associated semantics in a flexible, extensible way. In this paper, we describe our approach to define and implement these multilayered course objects. We use XML technology to emulate complex data structures within the NCSTRL+ buckets. We have developed authoring and browsing tools to manipulate these course objects. In our current implementation a user downloading an XML based course bucket also downloads the XML-aware tools: an applet that enables the user to edit or browse the bucket. We claim that XML provides an effective means to represent multi-level structure of a course bucket.

  11. Designing Planar Deployable Objects via Scissor Structures.

    PubMed

    Zhang, Ran; Wang, Shiwei; Chen, Xuejin; Ding, Chao; Jiang, Luo; Zhou, Jie; Liu, Ligang

    2016-02-01

    Scissor structure is used to generate deployable objects for space-saving in a variety of applications, from architecture to aerospace science. While deployment from a small, regular shape to a larger one is easy to design, we focus on a more challenging task: designing a planar scissor structure that deploys from a given source shape into a specific target shape. We propose a two-step constructive method to generate a scissor structure from a high-dimensional parameter space. Topology construction of the scissor structure is first performed to approximate the two given shapes, as well as to guarantee the deployment. Then the geometry of the scissor structure is optimized in order to minimize the connection deflections and maximize the shape approximation. With the optimized parameters, the deployment can be simulated by controlling an anchor scissor unit. Physical deployable objects are fabricated according to the designed scissor structures by using 3D printing or manual assembly. We show a number of results for different shapes to demonstrate that even with fabrication errors, our designed structures can deform fluently between the source and target shapes.

  12. Objective Sepsis Surveillance Using Electronic Clinical Data.

    PubMed

    Rhee, Chanu; Kadri, Sameer; Huang, Susan S; Murphy, Michael V; Li, Lingling; Platt, Richard; Klompas, Michael

    2016-02-01

    To compare the accuracy of surveillance of severe sepsis using electronic health record clinical data vs claims and to compare incidence and mortality trends using both methods. We created an electronic health record-based surveillance definition for severe sepsis using clinical indicators of infection (blood culture and antibiotic orders) and concurrent organ dysfunction (vasopressors, mechanical ventilation, and/or abnormal laboratory values). We reviewed 1,000 randomly selected medical charts to characterize the definition's accuracy and stability over time compared with a claims-based definition requiring infection and organ dysfunction codes. We compared incidence and mortality trends from 2003-2012 using both methods. Two US academic hospitals. Adult inpatients. The electronic health record-based clinical surveillance definition had stable and high sensitivity over time (77% in 2003-2009 vs 80% in 2012, P=.58) whereas the sensitivity of claims increased (52% in 2003-2009 vs 67% in 2012, P=.02). Positive predictive values for claims and clinical surveillance definitions were comparable (55% vs 53%, P=.65) and stable over time. From 2003 to 2012, severe sepsis incidence imputed from claims rose by 72% (95% CI, 57%-88%) and absolute mortality declined by 5.4% (95% CI, 4.6%-6.7%). In contrast, incidence using the clinical surveillance definition increased by 7.7% (95% CI, -1.1% to 17%) and mortality declined by 1.7% (95% CI, 1.1%-2.3%). Sepsis surveillance using clinical data is more sensitive and more stable over time compared with claims and can be done electronically. This may enable more reliable estimates of sepsis burden and trends.

  13. Student assessment by objective structured examination in a neurology clerkship

    PubMed Central

    Adesoye, Taiwo; Smith, Sandy; Blood, Angela; Brorson, James R.

    2012-01-01

    Objectives: We evaluated the reliability and predictive ability of an objective structured clinical examination (OSCE) in the assessment of medical students at the completion of a neurology clerkship. Methods: We analyzed data from 195 third-year medical students who took the OSCE. For each student, the OSCE consisted of 2 standardized patient encounters. The scores obtained from each encounter were compared. Faculty clinical evaluations of each student for 2 clinical inpatient rotations were also compared. Hierarchical regression analysis was applied to test the ability of the averaged OSCE scores to predict standardized written examination scores and composite clinical scores. Results: Students' OSCE scores from the 2 standardized patient encounters were significantly correlated with each other (r = 0.347, p < 0.001), and the scores for all students were normally distributed. In contrast, students' faculty clinical evaluation scores from 2 different clinical inpatient rotations were uncorrelated, and scores were skewed toward the highest ratings. After accounting for clerkship order, better OSCE scores were predictive of better National Board of Medical Examiners standardized examination scores (R2Δ = 0.131, p < 0.001) and of better faculty clinical scores (R2Δ = 0.078, p < 0.001). Conclusions: Student assessment by an OSCE provides a reliable and predictive objective assessment of clinical performance in a neurology clerkship. PMID:22855865

  14. Objective Eulerian Coherent Structures Predict Drifter Motion

    NASA Astrophysics Data System (ADS)

    Serra, Mattia; Haller, George

    2017-04-01

    Recent results show that Objective Eulerian Coherent Structures (OECSs) (Serra, M. and Haller, G., Chaos 26(5), 2016) reveal the correct, frame-independent locations of instantaneous saddle-type material behavior in unsteady flows. Using an unsteady ocean surface velocity field reconstructed from high-frequency-radar measurements, we compute attracting OECSs in a region of the North-East coast of the US, where drifter trajectories are also available. Remarkably, we find that despite their non-passive and inertial dynamics, drifters align rapidly with nearby attracting OECSs. At the same time, the drifter attractors remain completely hidden in instantaneous streamlines plots and in the Okubo-Weiss field.

  15. Evaluation of a Problem-based Learning Workshop Using Pre- and Post-test Objective Structured Clinical Examinations and Standardized Patients.

    ERIC Educational Resources Information Center

    Davis, Paul; Kvern, Brent; Donen, Neil; Andrews, Elaine; Nixon, Olga

    2000-01-01

    Pre/posttest data on 40 physicians who completed problem-based clinical scenarios on osteoporosis revealed that 39 showed improvement or modest change in postworkshop scores, especially in terms of management of male patients, determination of risk factors, and use and interpretation of bone density tests. (SK)

  16. Evaluation of a Problem-based Learning Workshop Using Pre- and Post-test Objective Structured Clinical Examinations and Standardized Patients.

    ERIC Educational Resources Information Center

    Davis, Paul; Kvern, Brent; Donen, Neil; Andrews, Elaine; Nixon, Olga

    2000-01-01

    Pre/posttest data on 40 physicians who completed problem-based clinical scenarios on osteoporosis revealed that 39 showed improvement or modest change in postworkshop scores, especially in terms of management of male patients, determination of risk factors, and use and interpretation of bone density tests. (SK)

  17. Identifying and structuring the objectives of terrorists.

    PubMed

    Keeney, Gregory L; Von Winterfeldt, Detlof

    2010-12-01

    The risk of terrorism is of great concern to many countries and significant resources are spent to counter this threat. A better understanding of the motivation of terrorists and their reasons for selecting certain modes and targets of attack can help improve the decisions to allocate resources in the fight against terrorism. The fundamental question addressed in this article is: "What do terrorists want?" We take the view that terrorists' preferences for actions are based on their values and beliefs. An important missing piece in our knowledge of terrorists' preferences is an understanding of their values. This article uses a novel approach to determine these values and state them as objectives, using principles from decision analysis and value-focused thinking. Instead of interviewing decisionmakers and stakeholders, as would be normal in decision analysis, we extract the values of terrorists by examining their own writings and verbal statements. To illustrate the approach, we extract the values of Al-Qaeda and structure them in terms of strategic, fundamental, and means objectives. These objectives are interrelated through a means-ends network. This information is useful for understanding terrorists' motivations, intent, and likely actions, as well as for developing policies to counter terrorism at its root causes. © 2010 Society for Risk Analysis.

  18. Search Path Evaluation Incorporating Object Placement Structure

    DTIC Science & Technology

    2007-12-20

    discussed. The application of this theoretical foundation and the numerical methods to other search paradigms Is also discussed. 14. SUBJECT TERMS 15... paradigms , object detection is said to occur with probability PD if it occurs anywhere within a predefined temporal interval or spatial region...distinctive the pattern is, the more interdependent the object placements become. Continue with the paradigm of placing the set M of NM known objects in the

  19. An exploration of student nurses' thoughts and experiences of using a video-recording to assess their performance of cardiopulmonary resuscitation (CPR) during a mock objective structured clinical examination (OSCE).

    PubMed

    Paul, Fiona

    2010-09-01

    Cardiopulmonary resuscitation (CPR) is an essential skill taught within undergraduate nursing programmes. At the author's institution, students must pass the CPR objective structured clinical examination (OSCE) before progressing to second year. However, some students have difficulties developing competence in CPR and evidence suggests that resuscitation skills may only be retained for several months. This has implications for practice as nurses are required to be competent in CPR. Therefore, further opportunities for students to develop these skills are necessary. An action research project was conducted with six students who were assessed by an examiner at a video-recorded mock OSCE. Students self-assessed their skills using the video and a checklist. Semi-structured interviews were conducted to compare checklist scores, and explore students' thoughts and experiences of the OSCE. The findings indicate that students may need to repeat this exercise by comparing their previous and current performances to develop both their self-assessment and CPR skills. Although there were some differences between the examiner's and student's checklist scores, all students reported the benefits of participating in this project, e.g. discussion and identification of knowledge and skills deficits, thus emphasising the benefits of formative assessments to prepare students for summative assessments and ultimately clinical practice. (c) 2010 Elsevier Ltd. All rights reserved.

  20. Dynamic object management for distributed data structures

    NASA Technical Reports Server (NTRS)

    Totty, Brian K.; Reed, Daniel A.

    1992-01-01

    In distributed-memory multiprocessors, remote memory accesses incur larger delays than local accesses. Hence, insightful allocation and access of distributed data can yield substantial performance gains. The authors argue for the use of dynamic data management policies encapsulated within individual distributed data structures. Distributed data structures offer performance, flexibility, abstraction, and system independence. This approach is supported by data from a trace-driven simulation study of parallel scientific benchmarks. Experimental data on memory locality, message count, message volume, and communication delay suggest that data-structure-specific data management is superior to a single, system-imposed policy.

  1. Infants' attention to object structure in early categorization.

    PubMed

    Rakison, D H; Butterworth, G E

    1998-11-01

    Three experiments with object-manipulation tasks examined the effect of object structure on 14-, 18-, and 22-month-olds' categorization. In Experiment 1, categorization of animals and vehicles was tested when object structure was normal and when it was violated by moving parts (legs or wheels) into a novel configuration. In Experiment 2, categorization of animals, vehicles, and furniture was examined when object structure was modified in orientation (e.g., legs inverted) or in configuration (e.g., legs at tangential angles). In Experiment 3, infants' attention to texture in categorization was tested. The results of the studies showed that 14- to 22-month-olds attend to object parts and structural configuration to categorize and that they do not attend to object texture. There is a perceptual basis for early categorization at the superordinate-like level, and infants are constrained in the parts and object structures they recognize in this process.

  2. Improving International Research with Clinical Specimens: 5 Achievable Objectives

    PubMed Central

    LaBaer, Joshua

    2012-01-01

    Our increased interest in translational research has created a large demand for blood, tissue and other clinical samples, which find use in a broad variety of research including genomics, proteomics, and metabolomics. Hundreds of millions of dollars have been invested internationally on the collection, storage and distribution of samples. Nevertheless, many researchers complain in frustration about their inability to obtain relevant and/or useful samples for their research. Lack of access to samples, poor condition of samples, and unavailability of appropriate control samples have slowed our progress in the study of diseases and biomarkers. In this editorial, I focus on five major challenges that thwart clinical sample use for translational research and propose near term objectives to address them. They include: (1) defining our biobanking needs; (2) increasing the use of and access to standard operating procedures; (3) mapping inter-observer differences for use in normalizing diagnoses; (4) identifying natural internal protein controls; and (5) redefining the clinical sample paradigm by building partnerships with the public. In each case, I believe that we have the tools at hand required to achieve the objective within 5 years. Potential paths to achieve these objectives are explored. However we solve these problems, the future of proteomics depends on access to high quality clinical samples, collected under standardized conditions, accurately annotated and shared under conditions that promote the research we need to do. PMID:22998582

  3. Towards a smart object network for clinical services.

    PubMed

    Sedlmayr, Martin; Becker, Andreas; Muench, Ulli; Meier, Fritz; Prokosch, Hans-Ulrich; Ganslandt, Thomas

    2009-11-14

    Radio Frequency Identification (RFID) technology has become prevalent in logistics to support and optimize processes and numerous projects investigate its opportunities and challenges in the clinical context. However, most approaches are focused on one specific application using only a few possibilities of the technology. We describe the development of a smart object network to serve as a generic platform for various clinical services. Based on two disparate scenarios - tracking medical devices and transfusion safety - the architecture, implementation issues and prospects of such a platform are discussed.

  4. Towards a Smart Object Network for Clinical Services

    PubMed Central

    Sedlmayr, Martin; Becker, Andreas; Muench, Ulli; Meier, Fritz; Prokosch, Hans-Ulrich; Ganslandt, Thomas

    2009-01-01

    Radio Frequency Identification (RFID) technology has become prevalent in logistics to support and optimize processes and numerous projects investigate its opportunities and challenges in the clinical context. However, most approaches are focused on one specific application using only a few possibilities of the technology. We describe the development of a smart object network to serve as a generic platform for various clinical services. Based on two disparate scenarios — tracking medical devices and transfusion safety — the architecture, implementation issues and prospects of such a platform are discussed. PMID:20351921

  5. Transforming Clinical Imaging Data for Virtual Reality Learning Objects

    ERIC Educational Resources Information Center

    Trelease, Robert B.; Rosset, Antoine

    2008-01-01

    Advances in anatomical informatics, three-dimensional (3D) modeling, and virtual reality (VR) methods have made computer-based structural visualization a practical tool for education. In this article, the authors describe streamlined methods for producing VR "learning objects," standardized interactive software modules for anatomical sciences…

  6. Transforming Clinical Imaging Data for Virtual Reality Learning Objects

    ERIC Educational Resources Information Center

    Trelease, Robert B.; Rosset, Antoine

    2008-01-01

    Advances in anatomical informatics, three-dimensional (3D) modeling, and virtual reality (VR) methods have made computer-based structural visualization a practical tool for education. In this article, the authors describe streamlined methods for producing VR "learning objects," standardized interactive software modules for anatomical sciences…

  7. In pursuit of objective dry eye screening clinical techniques.

    PubMed

    Kanellopoulos, Anastasios John; Asimellis, George

    2016-01-01

    Dry eye is a multifactorial, progressive, and chronic disease of the tears and ocular surface. The disease is multi-factorial and has intermittent symptoms. Discomfort, visual disturbance, tear film instability with potential damage to the ocular surface, and increased tear film osmolarity are known associates. Dry eye is a common clinical problem for eye-care providers worldwide and there is a large number of clinical investigative techniques for the evaluation of dry eye. Despite this, however, there is no globally accepted guideline for dry eye diagnosis and none of the available tests may hold the title of the 'gold standard'. The majority of the techniques involved in the diagnosis of the disease, particularly for its early stages, has a large degree of subjectivity. The purpose of this article is to review existing dry eye investigative techniques and to present a new objective dry eye screening technique based on optical coherence tomography.

  8. Method for preventing micromechanical structures from adhering to another object

    DOEpatents

    Smith, J.H.; Ricco, A.J.

    1998-06-16

    A method for preventing micromechanical structures from adhering to another object includes the step of immersing a micromechanical structure and its associated substrate in a chemical species that does not stick to itself. The method can be employed during the manufacture of micromechanical structures to prevent micromechanical parts from sticking or adhering to one another and their associated substrate surface. 3 figs.

  9. Measurement of the levels anxiety, self-perception of preparation and expectations for success using an objective structured clinical examination, a written examination, and a preclinical preparation test in Kerman dental students.

    PubMed

    Kalantari, Mahsa; Zadeh, Nazila Lashkari; Agahi, Raha Habib; Navabi, Nader; Hashemipour, Maryam Alsadat; Nassab, Amir Hossein Gandjalikhan

    2017-01-01

    Examinations have an important role in evaluating students' learning outcomes and their mastery of a subject. Passing or failing an examination can have far-reaching consequences for the students. Therefore, it is not surprising that international studies consistently show that dental students report examinations and grades among the highest ranking stressors in dental schools. The aim of this research was to measure the levels of anxiety, self-perception of preparation and expectations for success using an objective structured clinical examination (OSCE), a written examination and a preclinical preparation test, and to examine the effects of the three predictive variables on the outcomes of assessments. The present research is a cross-sectional study. The population under consideration was students of Kerman Dental School in 2013. Examination anxiety was measured with Spielberger's state anxiety inventory. Preparation for the assessment (I am fully prepared = 4, I am prepared = 3, I'm not prepared = 2, I'm not fully prepared = 1) and expectation to succeed (I am quite successful = 4, I am successful = 3, I'm not successful = 2, I'm not quite successful = 1) were quantified with Likert scale. The questionnaire was completed during an OSCE, a written examination, a preclinical crown and bridge preparation test and a nonexamination situation. The study population consisted of 138 4(th), 5(th), and 6(th) year Kerman dental students (65 males and 73 females). The results showed that all the assessment methods induced a significant increase in state anxiety compared to baseline levels with the highest anxiety levels reported during an OSCE (62.4 ± 8.1, P = 0.04) and a written examination (48.8 ± 9.2, P = 0.04). The preparation levels in females were significantly higher than those in males in OSCE (P = 0.03) and written (P = 0.04). State anxiety was high in all the three assessment methods. OSCE induced more anxiety than other assessment formats. However, anxiety was

  10. Abnormal reliance on object structure in apraxics' learning of novel object-related actions.

    PubMed

    Barde, Laura H F; Buxbaum, Laurel J; Moll, Adrienne D

    2007-11-01

    We assessed the prediction that object structural cues could benefit the learning of object-action relationships in ideomotor apraxia (IMA). A total of 15 patients with left-hemisphere stroke, 11 of whom exhibited IMA, and 10 healthy subjects were trained to match novel gestures to novel tool pictures that were either High- or Low-Afforded by their associated tools. Learning was assessed with recognition and production tests. Only IMA patients demonstrated better recognition of High- than Low-Afforded gestures, and their recognition of High-Afforded gestures was statistically comparable to the other groups. This finding suggests that apraxics may rely abnormally on object structure when learning to associate novel gestures and tools. Finally, the "affordance benefit" was associated with relative sparing of structures in the dorsal visual processing stream. These data are consistent with the proposal that two routes may mediate skilled action, one specialized for stored information, and the other responsive to object structure, and that deficient gesture learning may be compensated by "bootstrapping" intact dorsal stream coding of action.

  11. Prosthetic heart valves: Objective Performance Criteria versus randomized clinical trial.

    PubMed

    Grunkemeier, Gary L; Jin, Ruyun; Starr, Albert

    2006-09-01

    The current Food and Drug Administration (FDA) heart valve guidance document uses an objective performance criteria (OPC) methodology to evaluate the clinical performance of prosthetic heart valves. OPC are essentially historical controls, but they have turned out to be an adequate, and perhaps optimal, study design in this situation. Heart valves have a simple open-and-close mechanism, device effectiveness is easy to document, and the common complications (thromboembolism, thrombosis, bleeding, leak, and infection) are well known and easily detected. Thus, randomized clinical trials (RCTs) have not been deemed necessary for the regulatory approval of prosthetic heart valves. The OPC are derived from the average complication rates of all approved heart valves. Studies based on OPC have been shown to work well; many different valve models have gained FDA market approval based on this methodology. Although heart valve RCTs are not required by the FDA, they have been done to compare valves or treatment regimens after approval. Recently, the Artificial Valve Endocarditis Reduction Trial (AVERT) was designed to compare a new Silzone sewing ring, designed to reduce infection, with the Standard sewing ring on a St. Jude Medical heart valve. This was the largest heart valve RCT ever proposed (4,400 valve patients, followed for as long as 4 years), but it was stopped prematurely because of a high leak rate associated with the Silzone valve. Examining the results showed that a much smaller, OPC-based study with 800 patient-years would have been sufficient to disclose this complication of the Silzone valve.

  12. Detection and location of metallic objects imbedded in nonmetallic structures

    NASA Technical Reports Server (NTRS)

    Brown, R. L.; Neuschaefer, R. W.

    1968-01-01

    Small battery operated eddy current proximity measuring device detects and locates metal objects the size of a dime at distances up to one foot within nonmetallic structures. This device weighs approximately two pounds, occupies approximately 60 cubic inches, and is battery powered.

  13. Computerization of the Structured-Objective Rorschach Test

    ERIC Educational Resources Information Center

    Ingenohl, Ingo

    1973-01-01

    SORTSCOR performs raw scoring of the Structured-Objective Rorschach Test (SORT) and REPORT subsequently writes a narrative report in easily readable, nonclinical language. Complete documentation is available, at cost, from the author at Quinnipiac College, Hamden, Conn. 06518. (Author/CB)

  14. Hierarchical object parsing from structured noisy point clouds.

    PubMed

    Barbu, Adrian

    2013-07-01

    Object parsing and segmentation from point clouds are challenging tasks because the relevant data is available only as thin structures along object boundaries or other features, and is corrupted by large amounts of noise. To handle this kind of data, flexible shape models are desired that can accurately follow the object boundaries. Popular models such as active shape and active appearance models (AAMs) lack the necessary flexibility for this task, while recent approaches such as the recursive compositional models make model simplifications to obtain computational guarantees. This paper investigates a hierarchical Bayesian model of shape and appearance in a generative setting. The input data is explained by an object parsing layer which is a deformation of a hidden principal component analysis (PCA) shape model with Gaussian prior. The paper also introduces a novel efficient inference algorithm that uses informed data-driven proposals to initialize local searches for the hidden variables. Applied to the problem of object parsing from structured point clouds such as edge detection images, the proposed approach obtains state-of-the-art parsing errors on two standard datasets without using any intensity information.

  15. Object-oriented structures supporting remote sensing databases

    NASA Technical Reports Server (NTRS)

    Wichmann, Keith; Cromp, Robert F.

    1995-01-01

    Object-oriented databases show promise for modeling the complex interrelationships pervasive in scientific domains. To examine the utility of this approach, we have developed an Intelligent Information Fusion System based on this technology, and applied it to the problem of managing an active repository of remotely-sensed satellite scenes. The design and implementation of the system is compared and contrasted with conventional relational database techniques, followed by a presentation of the underlying object-oriented data structures used to enable fast indexing into the data holdings.

  16. Object-oriented structures supporting remote sensing databases

    NASA Technical Reports Server (NTRS)

    Wichmann, Keith; Cromp, Robert F.

    1995-01-01

    Object-oriented databases show promise for modeling the complex interrelationships pervasive in scientific domains. To examine the utility of this approach, we have developed an Intelligent Information Fusion System based on this technology, and applied it to the problem of managing an active repository of remotely-sensed satellite scenes. The design and implementation of the system is compared and contrasted with conventional relational database techniques, followed by a presentation of the underlying object-oriented data structures used to enable fast indexing into the data holdings.

  17. Efficient Exact Inference With Loss Augmented Objective in Structured Learning.

    PubMed

    Bauer, Alexander; Nakajima, Shinichi; Muller, Klaus-Robert

    2016-08-19

    Structural support vector machine (SVM) is an elegant approach for building complex and accurate models with structured outputs. However, its applicability relies on the availability of efficient inference algorithms--the state-of-the-art training algorithms repeatedly perform inference to compute a subgradient or to find the most violating configuration. In this paper, we propose an exact inference algorithm for maximizing nondecomposable objectives due to special type of a high-order potential having a decomposable internal structure. As an important application, our method covers the loss augmented inference, which enables the slack and margin scaling formulations of structural SVM with a variety of dissimilarity measures, e.g., Hamming loss, precision and recall, Fβ-loss, intersection over union, and many other functions that can be efficiently computed from the contingency table. We demonstrate the advantages of our approach in natural language parsing and sequence segmentation applications.

  18. Remote object recognition by analysis of surface structure

    NASA Astrophysics Data System (ADS)

    Wurster, J.; Stark, H.; Olsen, E. T.; Kogler, K.

    1995-06-01

    We present a new algorithm for the discrimination of remote objects by their surface structure. Starting from a range-azimuth profile function, we formulate a range-azimuth matrix whose largest eigenvalues are used as discriminating features to separate object classes. A simpler, competing algorithm uses the number of sign changes in the range-azimuth profile function to discriminate among classes. Whereas both algorithms work well on noiseless data, an experiment involving real data shows that the eigenvalue method is far more robust with respect to noise than is the sign-change method. Two well-known methods based on surface structure, variance, and fractal dimension were also tested on real data. Neither method furnished the aspect invariance and the discriminability of the eigenvalue method.

  19. Dystonia in childhood: clinical and objective measures and functional implications.

    PubMed

    Pavone, Larissa; Burton, Justin; Gaebler-Spira, Deborah

    2013-03-01

    Dystonia is a complex movement disorder that is challenging to identify and quantify. The aim of this article is to review the clinical scales, kinematic measures, and functional implications of dystonia. Clinical measures include the Barry-Albright Dystonia Scale, the Burke-Fahn-Marsden Movement Scale, the Unified Dystonia Rating Scale, the Global Dystonia Rating Scale, and the Movement Disorder-Childhood Rating Scale. The evidence, reliability, and validity of each scale will be outlined. The Hypertonia Assessment Tool will be discussed emphasizing the importance of discriminating hypertonia. The role of kinematic measures in analyzing dystonia will be explored, as well as the potential for its future clinical applications.

  20. Measuring venous insufficiency objectively in the clinical setting.

    PubMed

    Kelechi, Teresa J; Bonham, Phyllis A

    2008-09-01

    The purpose of this article is to propose a screening procedure to assess venous insufficiency with a hand-held photoplethysmography (PPG) instrument in the clinical setting. PPG is noninvasive technology that is used as part of venous assessment of the lower extremities. Although duplex ultrasound remains the industry gold standard for assessment, there are many situations in which access or expertise is not available. The measurement of venous refill time with PPG, one measure of venous insufficiency, is becoming increasingly more prevalent in research settings; however, PPG is underused in clinical settings. Rapid venous refill time clinical settings as a screening mechanism may provide useful data to augment diagnostic and therapeutic decision making. Future research is needed to establish a best-practice guideline for venous assessment in clinical settings to validate using PPG.

  1. Auditing clinical research data: objectives, applications and results.

    PubMed

    Justice, R L

    1983-01-01

    Formal auditing of clinical research data has become a standard contemporary practice within the pharmaceutical industry. Its basic purpose is to provide documentation relevant to an assessment of the quality and integrity of data collected in the course of a clinical trial. This paper outlines the audit procedures developed within one major pharmaceutical firm. These procedures require an intensive investigation of internal and external aspects of study management, records management, data entry, data analysis and statistical report preparation. A qualitative evaluation of the results achieved by this auditing procedure are presented.

  2. Learning Clinical Procedures Through Internet Digital Objects: Experience of Undergraduate Students Across Clinical Faculties

    PubMed Central

    Li, Tse Yan; Wong, Kin; Tse, Christine Shuk Kwan; Chan, Ying Yee

    2015-01-01

    Background Various digital learning objects (DLOs) are available via the World Wide Web, showing the flow of clinical procedures. It is unclear to what extent these freely accessible Internet DLOs facilitate or hamper students’ acquisition of clinical competence. Objective This study aimed to understand the experience of undergraduate students across clinical disciplines—medicine, dentistry, and nursing—in using openly accessible Internet DLOs, and to investigate the role of Internet DLOs in facilitating their clinical learning. Methods Mid-year and final-year groups were selected from each undergraduate clinical degree program of the University of Hong Kong—Bachelor of Medicine and Bachelor of Surgery (MBBS), Bachelor of Dental Surgery (BDS), and Bachelor of Nursing (BNurs). All students were invited to complete a questionnaire on their personal and educational backgrounds, and their experiences and views on using Internet DLOs in learning clinical procedures. The questionnaire design was informed by the findings of six focus groups. Results Among 439 respondents, 97.5% (428/439) learned a variety of clinical procedures through Internet DLOs. Most nursing students (107/122, 87.7%) learned preventive measures through Internet DLOs, with a lower percentage of medical students (99/215, 46.0%) and dental students (43/96, 45%) having learned them this way (both P<.001). Three-quarters (341/439, 77.7%) of students accessed DLOs through public search engines, whereas 93.2% (409/439) accessed them by watching YouTube videos. Students often shared DLOs with classmates (277/435, 63.7%), but rarely discussed them with teachers (54/436, 12.4%). The accuracy, usefulness, and importance of Internet DLOs were rated as 6.85 (SD 1.48), 7.27 (SD 1.53), and 7.13 (SD 1.72), respectively, out of a high score of 10. Conclusions Self-exploration of DLOs in the unrestricted Internet environment is extremely common among current e-generation learners and was regarded by students

  3. Uncertainty and objectivity in clinical decision making: a clinical case in emergency medicine.

    PubMed

    Engebretsen, Eivind; Heggen, Kristin; Wieringa, Sietse; Greenhalgh, Trisha

    2016-12-01

    The evidence-based practice and evidence-based medicine (EBM) movements have promoted standardization through guideline development methodologies based on systematic reviews and meta-analyses of best available research. EBM has challenged clinicians to question their reliance on practical reasoning and clinical judgement. In this paper, we argue that the protagonists of EBM position their mission as reducing uncertainty through the use of standardized methods for knowledge evaluation and use. With this drive towards uniformity, standardization and control comes a suspicion towards intuition, creativity and uncertainty as integral parts of medical practice. We question the appropriateness of attempts to standardize professional practice through a discussion of the importance of uncertainty. Greenhalgh's taxonomy of uncertainty is used to inform an analysis of the clinical reasoning occurring in a potentially life threatening emergency situation with a young patient. The case analysis is further developed by the use of the Canadian philosopher Bernard Lonergan's theory about understanding and objective knowing. According to Lonergan it is not by getting rid of or even by reducing uncertainty, but by attending systematically to it and by relating to it in a self-conscious way, that objective knowledge can be obtained. The paper concludes that uncertainty is not a regrettable and unavoidable aspect of decision making but a productive component of clinical reasoning.

  4. RapidPlan head and neck model: the objectives and possible clinical benefit.

    PubMed

    Fogliata, A; Reggiori, G; Stravato, A; Lobefalo, F; Franzese, C; Franceschini, D; Tomatis, S; Mancosu, P; Scorsetti, M; Cozzi, L

    2017-04-27

    To evaluate a knowledge based planning model for RapidPlan (RP) generated for advanced head and neck cancer (HNC) patient treatments, as well its ability to possibly improve the clinical plan quality. The stability of the model was assessed also for a different beam geometry, different dose fractionation and different management of bilateral structures (parotids). Dosimetric and geometric data from plans of 83 patients presenting HNC were selected for the model training. All the plans used volumetric modulated arc therapy (VMAT, RapidArc) to treat two targets at dose levels of 69.96 and 54.45 Gy in 33 fractions with simultaneous integrated boost. Two models were generated, the first separating the ipsi- and contra-lateral parotids, while the second associating the two parotids to a single structure for training. The optimization objectives were adjusted to the final model to better translate the institutional planning and dosimetric strategies and trade-offs. The models were validated on 20 HNC patients, comparing the RP generated plans and the clinical plans. RP generated plans were also compared between the clinical beam arrangement and a simpler geometry, as well as for a different fractionation scheme. RP improved significantly the clinical plan quality, with a reduction of 2 Gy, 5 Gy, and 10 Gy of the mean parotid, oral cavity and laryngeal doses, respectively. A simpler beam geometry was deteriorating the plan quality, but in a small amount, keeping a significant improvement relative to the clinical plan. The two models, with one or two parotid structures, showed very similar results. NTCP evaluations indicated the possibility of improving (NTCP decreasing of about 7%) the toxicity profile when using the RP solution. The HNC RP model showed improved plan quality and planning stability for beam geometry and fractionation. An adequate choice of the objectives in the model is necessary for the trade-offs strategies.

  5. An object representation approach to psychostructural change: a clinical illustration.

    PubMed

    Lerner, H

    1983-06-01

    This paper presents a systematic test-retest analysis of a disturbed, hospitalized adolescent in an attempt to demonstrate recent innovation in Rorschach theory and technique based upon important conceptual and empirical advances in object relations theory. These new perspectives supplement basic ego psychological concepts of test interpretation advanced by Rapaport and test-retest analysis developed by Schafer. The new concepts presented in this paper offer the promise of providing a methodological framework and theoretical foundation for further innovative use of the Rorschach and other projective procedures.

  6. The effect object paradigm--a means to support medication safety with clinical decision support.

    PubMed

    Patapovas, Andrius; Pfistermeister, Barbara; Tarkhov, Aleksey; Terfloth, Lothar; Maas, Renke; Fromm, Martin F; Kornhuber, Johannes; Prokosch, Hans-Ulrich; Bürkle, Thomas

    2014-01-01

    In many countries, officially approved drug information known as summary of product characteristics (SPC) is mostly available in text form, which cannot be used for Clinical Decision Support Systems (CDSS). It may be essential however to substantiate CDSS advice with such legally binding text snippets. In an attempt to link various drug data sources including SPC towards a CDSS to support medication safety in psychiatric patients we arrived at the notion of an effect object. A requirements analysis revealed data items and data structure which are needed from the patient and from the drug information source for the CDSS functionality. Published drug data modelling approaches were analyzed and found unsuitable. A conceptional database modeling approach using top down and bottom up modeling was performed. The schema based data model implemented within the django framework centered on SPC "effect objects" which comprise all SPC data required for the respective CDSS function such as search for contraindications in the proposed medication. Today six effect objects have been defined for contraindications and warnings, missing indications, adverse effects, drug-drug interactions, dosing and pharmacokinetics. The transformation of SPC data to a database-driven "effect objects" structure permits decoupling between the CDSS functions and different underlying data sources and supports the design of reusable, stable and verified CDSS functions.

  7. Kuiper belt objects: radionuclide impact on internal structure dynamics

    NASA Astrophysics Data System (ADS)

    Shchuko, Oleg; Shchuko, Svetlana; Kartashov, Daniil; Orosei, Roberto

    2010-05-01

    The process of Kuiper Belt objects (KBO) matter formation and its internal structure evolution is investigate as dependent on the factors affecting the intensity of radiogenic heating sources. A solid dust aluminosilicate substance of fringe protosolar cloud regions and amorphous ice H2O have been supposed to be the building material of the KBO matter formation. Radionuclides 26Al, 40K, 232Th, 235U and 238U embedded in solid dust matter particles have been main sources of radiogenic heat for the KBO life time. A spherically symmetric celestial body was being created as a result of accretion. The body's internal structure was determined by the composition and the properties of the accretion material and the evolution of the structure - by internal thermal processes. The dependence of the forming body interior composition and structure on the accretion process rate, on the specific gravities of dust matter and amorphous ice as well as on the possible variations of these parameters along the forming body orbit, has been studied. Parameter variation domains have been determined at which the formed celestial body has its present-day sizes and average density. The impact of the heat-and-power potentials of radiogenic heat sources on H2O phase transition dynamics in the celestial body matter has been investigated. The parameter variation domains of these potentials have been found at which there can be formed areas partly or fully filled with H2O of different phase states. In addition, the dynamic boundaries of areas have been determined where the ice component is presented by amorphous ice or cubic and hexagonal crystal ice. The parameter domains of celestial body accretion and radiogenic heat processes have been determined where the body evolution may have a catastrophic scenario up to its complete destruction.

  8. The objective structured interview for medical student selection

    PubMed Central

    Powis, D A; Neame, R L B; Bristow, T; Murphy, L B

    1988-01-01

    An objective structured interview is an integral part of the process of selecting and admitting applicants to study medicine at this university. During the nine years (to the end of 1986) that the interview has been used 1600 candidates were interviewed out of roughly 13 000 applicants, and from these, 584 students were admitted to the course. Analysis of the interview data was carried out based on two aspects of student progress: graduation with honours and failure to complete the course of study. The interview as a whole, and especially some of the subscales, appears to identify students who may fail to complete the course: it may also help to predict which students are likely to graduate with honours. PMID:3126966

  9. Stellar structure and compact objects before 1940: Towards relativistic astrophysics

    NASA Astrophysics Data System (ADS)

    Bonolis, Luisa

    2017-06-01

    Since the mid-1920s, different strands of research used stars as "physics laboratories" for investigating the nature of matter under extreme densities and pressures, impossible to realize on Earth. To trace this process this paper is following the evolution of the concept of a dense core in stars, which was important both for an understanding of stellar evolution and as a testing ground for the fast-evolving field of nuclear physics. In spite of the divide between physicists and astrophysicists, some key actors working in the cross-fertilized soil of overlapping but different scientific cultures formulated models and tentative theories that gradually evolved into more realistic and structured astrophysical objects. These investigations culminated in the first contact with general relativity in 1939, when J. Robert Oppenheimer and his students George Volkoff and Hartland Snyder systematically applied the theory to the dense core of a collapsing neutron star. This pioneering application of Einstein's theory to an astrophysical compact object can be regarded as a milestone in the path eventually leading to the emergence of relativistic astrophysics in the early 1960s.

  10. Objective structured assessment of technical skill in upper extremity surgery.

    PubMed

    VanHeest, Ann; Kuzel, Bradley; Agel, Julie; Putnam, Matthew; Kalliainen, Loree; Fletcher, James

    2012-02-01

    Objective assessment of technical skills in hand surgery has been lacking. This article reports on an Objective Structured Assessment of Technical Skills format of a multiple bench-station evaluation of orthopedic surgery residents' technical skills for 3 common upper extremity surgeries. Twenty-seven residents (6 postgraduate year [PGY] 2, 8 PGY 3, 8 PGY 4, and 5 PGY 5) participated in the examination. Each resident performed surgery on a cadaveric specimen at 3 stations, trigger finger release (TFR), open carpal tunnel release, and distal radius fracture fixation. A board-certified hand surgeon evaluated trainee performance at each station, using a procedure-specific detailed checklist, a validated global rating scale, and pass/fail assessment. A resident post-testing evaluation was collected. Construct validity with correlation between year in training and detailed checklist scores was demonstrated for TFR and carpal tunnel release; between year in training and global rating scores for TFR and distal radius fracture fixation; and between year in training and pass/fail assessment for TFR. Criterion validity was demonstrated by the correlation between global rating scale scores, detailed checklist scores, and pass/fail assessment for TFR, carpal tunnel release, and distal radius fracture fixation. Time to complete the surgery was not correlated with surgical performance. Residents rated the multiple-station Objective Structured Assessment of Technical Skills format as highly educational. This study reports that a surgeon's ability to release a trigger finger does not correlate specifically to his or her ability to perform a carpal tunnel release or to perform plate fixation of a radius fracture. The results of this study would indicate that, for 3 different surgical simulations representing procedures of varying complexity, assessments by a single assessment tool is not adequate. To completely understand a resident's abilities, assessment by checklist

  11. The luminosity structure and objective classification of galaxies

    NASA Technical Reports Server (NTRS)

    Han, Mingshen

    1995-01-01

    The luminosity structure of spiral galaxies is studied using the technique of principal component analysis. It is found that approximately 94% of the variation in the luminosity distribution of galaxies can be accounted for by just two principal components. The principal luminosity components may contain valuable information about star formation history or whatever luminosity-regulating process occurs in galaxies. Practically, these principal components provide a new approach for the investigation of the luminosity structures of galaxies and their dependence on other properties. They also serve as an excellent objective classification system for galaxies. We introduce in this paper such a classification scheme and explore its various properties. The new system shows a number of very impressive characteristics. Most important, it can well segregate virtually all the important galactic properties we tested and does so much better than the conventional morphological classification systems. Of particular interest is that some distance-dependent parameters can also be determined to a surprisingly good accuracy; for example, absolute magnitude may be determined to an accuracy of approximately 0.6 mag (yet further improvement is believed to be highly possible). Second, the system is objective, and the classification procedure can be automated to a large degree; also the new system can apply to much smaller and fainter images than do eye-based clasification systems. These properties make the new system suitable for practical application, especially on very large (and deeper) digital image catalogs. Third, the classification is expressed in dimensionless numbers, yet the simple notation bears significant and easily understandable meaning, making it easy and convenient to use. Finally, the new system has another extremely useful feature: it provides a very powerful and convenient platform not only for classification, but also for easily recording, examining, and studying the

  12. Structure and Evolution of Kuiper Belt Objects and Dwarf Planets

    NASA Astrophysics Data System (ADS)

    McKinnon, W. B.; Prialnik, D.; Stern, S. A.; Coradini, A.

    Kuiper belt objects (KBOs) accreted from a mélange of volatile ices, carbonaceous matter, and rock of mixed interstellar and solar nebular provenance. The transneptunian region, where this accretion took place, was likely more radially compact than today. This and the influence of gas drag during the solar nebula epoch argue for more rapid KBO accretion than usually considered. Early evolution of KBOs was largely the result of heating due to radioactive decay, the most important potential source being 26Al, whereas long-term evolution of large bodies is controlled by the decay of U, Th, and 40K. Several studies are reviewed dealing with the evolution of KBO models, calculated by means of one-dimensional numerical codes that solve the heat and mass balance equations. It is shown that, depending on parameters (principally rock content and porous conductivity), KBO interiors may have reached relatively high temperatures. The models suggest that KBOs likely lost ices of very volatile species during early evolution, whereas ices of less-volatile species should be retained in cold, less-altered subsurface layers. Initially amorphous ice may have crystallized in KBO interiors, releasing volatiles trapped in the amorphous ice, and some objects may have lost part of these volatiles as well. Generally, the outer layers are far less affected by internal evolution than the inner part, which in the absence of other effects (such as collisions) predicts a stratified composition and altered porosity distribution. Kuiper belt objects are thus unlikely to be "the most pristine objects in the solar system," but they do contain key information as to how the early solar system accreted and dynamically evolved. For large (dwarf planet) KBOs, long-term radiogenic heating alone may lead to differentiated structures -- rock cores, ice mantles, volatile-ice-rich "crusts," and even oceans. Persistence of oceans and (potential) volcanism to the present day depends strongly on body size and

  13. Motor Performance Assessment in Parkinson’s Disease: Association between Objective In-Clinic, Objective In-Home, and Subjective/Semi-Objective Measures

    PubMed Central

    Toosizadeh, Nima; Mohler, Jane; Lei, Hong; Parvaneh, Saman; Sherman, Scott; Najafi, Bijan

    2015-01-01

    Advances in wearable technology allow for the objective assessment of motor performance in both in-home and in-clinic environments and were used to explore motor impairments in Parkinson’s disease (PD). The aims of this study were to: 1) assess differences between in-clinic and in-home gait speed, and sit-to-stand and stand-to-sit duration in PD patients (in comparison with healthy controls); and 2) determine the objective physical activity measures, including gait, postural balance, instrumented Timed-up-and-go (iTUG), and in-home spontaneous physical activity (SPA), with the highest correlation with subjective/semi-objective measures, including health survey, fall history (fallers vs. non-fallers), fear of falling, pain, Unified Parkinson's Disease Rating Scale, and PD stage (Hoehn and Yahr). Objective assessments of motor performance were made by measuring physical activities in the same sample of PD patients (n = 15, Age: 71.2±6.3 years) and age-matched healthy controls (n = 35, Age: 71.9±3.8 years). The association between in-clinic and in-home parameters, and between objective parameters and subjective/semi-objective evaluations in the PD group was assessed using linear regression-analysis of variance models and reported as Pearson correlations (R). Both in-home SPA and in-clinic assessments demonstrated strong discriminatory power in detecting impaired motor function in PD. However, mean effect size (0.94±0.37) for in-home measures was smaller compared to in-clinic assessments (1.30±0.34) for parameters that were significantly different between PD and healthy groups. No significant correlation was observed between identical in-clinic and in-home parameters in the PD group (R = 0.10–0.25; p>0.40), while the healthy showed stronger correlation in gait speed, sit-to-stand duration, and stand-to-sit duration (R = 0.36–0.56; p<0.03). This suggests a better correlation between supervised and unsupervised motor function assessments in healthy controls

  14. Assessment for learning with Objectively Structured Practical Examination in Biochemistry

    PubMed Central

    Jaswal, Shivani; Chattwal, Jugesh; Kaur, Jasbinder; Gupta, Seema; Singh, Tejinder

    2015-01-01

    Context: Despite a radical shift in assessment methodologies over the last decade, the majority of medical colleges still follow the Traditional Practical Examination (TPE). TPE raises concerns about examiner variability, standardization, and uniformity of assessment. To address these issues and in line with the notion of assessments as motivating what and how students learn, Objectively Structured Practical Examination (OSPE) was introduced, as an assessment modality. Despite its usefulness, awareness and motivation to use the same, still needs to be probed. Aims: To implement OSPE in the assessment of practical skills in biochemistry, and to know student and faculty perspectives regarding OSPE. Settings and Design: OSPE was introduced at the stage of formative assessment of practical skills, for 94 year one MBBS students. Subjects and Methods: Students were divided into two groups; the first group was evaluated by the traditional method and the second by OSPE. Students were crossed over on a second examination. The mean score obtained by both the methods was compared statistically. Students and faculty perspectives regarding OSPE were obtained by a questionnaire. Student performance was compared using “Bland–Altman technique,” and Student's t-test. Results: The mean scores of students was found to be significantly higher (P < 0.0001) when assessed with OSPE as compared to TPE. Number of students achieving >70% marks was also significantly higher with OSPE. Validity was supported by a significant correlation coefficient of comparison of marks by the two methods. Feedback from students and faculty indicated that they endorsed OSPE. Conclusions: This evaluation demonstrated the need for a structured approach to assessment. Going in line with the notion that assessment drives learning, introducing OSPE would help tailoring teaching-learning to optimize student satisfaction and learning. PMID:26380217

  15. Reconstruction of buried objects embedded in circular opaque structures

    NASA Astrophysics Data System (ADS)

    Persico, Raffaele; Gennarelli, Gianluca; Soldovieri, Francesco

    2014-05-01

    This contribution deals with the ground penetrating radar imaging of targets embedded in a visually opaque circular structure. The problem has practical relevance in civil engineering and archeological prospections, where structures of interest such as columns or pillars may have to be inspected in non-invasive way in order to detect the possible presence of anomalies (e.g. cracks, water infiltrations, and so on). In this framework, we investigate the possibility to inspect the circular region of interest thanks to a radar system composed by two antennas that are in contact with the structure and rotate simultaneously around it in order to illuminate and measure the field scattered by buried objects from multiple directions. Two different measurement strategies are examined. The first one is the multimonostatic configuration where the backscattered signal is collected by the transmitting antenna itself, as it moves along the circular observation line. The second acquisition strategy is the multibistatic one, with the transmitting and receiving antennas shifted by a constant angular offset of ninety degrees as they move around the column. From the mathematical viewpoint, the imaging problem is formulated as a linear inverse scattering one holding under Born approximation [1]. Furthermore, the Green's function of a homogeneous medium [2] is used to simplify the evaluation of the kernel of the integral equation. The inverse problem is then solved via the Truncated Singular Value Decomposition algorithm [3] in order to obtain a regularized solution. Tomographic reconstructions based on full-wave synthetic data generated by the Finite Difference Time Domain code GPRmax2D [4] are shown to assess the effectiveness of the reconstruction process. REFERENCES [1] W. C. Chew, Waves and fields in inhomogeneous media, IEEE Press, 1995. [2] R. F. Harrington, Time harmonic electromagnetic waves, McGraw-Hill, New York, USA, 1961. [3] M. Bertero and P. Boccacci, Introduction to

  16. The development of clinical reasoning skills: a major objective of the anatomy course.

    PubMed

    Elizondo-Omaña, Rodrigo E; López, Santos Guzmán

    2008-01-01

    Traditional medical school curricula have made a clear demarcation between the basic biomedical sciences and the clinical years. It is our view that a comprehensive medical education necessarily involves an increased correlation between basic science knowledge and its clinical applications. A basic anatomy course should have two main objectives: for the student to successfully gain a solid knowledge base of human anatomy and to develop and hone clinical reasoning skills. In a basic anatomy course, clinical case discussions based on underlying anatomic anomalies or abnormalities are the major means to teach students clinical reasoning skills. By identifying, classifying, and analyzing the clinical data given, a student learns to methodically approach a clinical case and formulate plausible diagnoses. Practicing and perfecting clinical problem-solving skills should be a major objective of the anatomy curriculum. Such clinical reasoning skills are indeed crucial for the successful and expert practice of medicine. Copyright 2008 American Association of Anatomists

  17. Rapid Changes in the Structure of the BN Object

    NASA Technical Reports Server (NTRS)

    Danchi, William C.; Gezari, D. Y.; Greenhill, L. J.; Najita, J.; Monnier, J. D.; Tuthill, P. G.; Wishnow, E. H.; Townes, C. H.; Fisher, Richard R. (Technical Monitor)

    2001-01-01

    The BN/KL region in Orion is the archetypal region of high-mass star formation, radiating approx. 10(sup)5 Lsun and displaying promininent bulk outflows. In particular, there is no certain identification of the sources responsible for the high luminosity and outflows, and is the origin of a major explosive event (Shultz et al. 1999, ApJ, 511, 282). Using 18.7 and 12.5 micron data from observations in December 1999 and October 2000 made at the Keck I telescope, we discovered that the BN Object has a companion previously seen only at radio wavelengths (Menten & Reid 1995, ApJ, 445, L157). We call this companion B2 and it is about 1.5 arcsec West of the bright component. We also see changes in the shape of BN and the emission of "blobs" or "bullets" of material. While B2 remains unchanged and in the same place between the two epochs, there is an additional structure in BN to the South-South-East and the North-East, as well as a finger of material pointing North from B2 itself. Such a change has not been seen before in the infrared. We have looked very carefully at these images, calibrator images taken within a few minutes of the source images, as well as our previous images and cannot find any technical faults with the data. We explore the implications of these results, in particular, can these features be connected with previously observed "bullets" or "fingers" (see Allen & Burton 1993, for example), making BN a source for the bullets, implying they are not from IRc2 as previously thought? Or could they be produced by an interaction between material from BN and other sources such as IRc2?

  18. Tradeoff-based optimization criteria in clinical trials with multiple objectives and adaptive designs.

    PubMed

    Dmitrienko, Alex; Paux, Gautier; Pulkstenis, Erik; Zhang, Jianliang

    2016-01-01

    The article discusses clinical trial optimization problems in the context of mid- to late-stage drug development. Using the Clinical Scenario Evaluation approach, main objectives of clinical trial optimization are formulated, including selection of clinically relevant optimization criteria, identification of sets of optimal and nearly optimal values of the parameters of interest, and sensitivity assessments. The paper focuses on a class of optimization criteria arising in clinical trials with several competing goals, termed tradeoff-based optimization criteria, and discusses key considerations in constructing and applying tradeoff-based criteria. The clinical trial optimization framework considered in the paper is illustrated using two case studies based on a clinical trial with multiple objectives and a two-stage clinical trial which utilizes adaptive decision rules.

  19. Subjective - Objective Sleep Comparisons and Discrepancies Among Clinically-Anxious and Healthy Children.

    PubMed

    Alfano, Candice A; Patriquin, Michelle A; De Los Reyes, Andres

    2015-10-01

    We compared subjective and objective sleep patterns and problems, and examined cross-method correspondence across parent reports, child reports, and actigraphy-derived sleep variables in clinically-anxious children and healthy controls. In a multi-site, cross-sectional study, 75 pre-adolescent children (6 to 11 years; M = 8.7 years; SD = 1.4; n = 39/52 % female) were examined including 39 with a diagnosis of primary generalized anxiety disorder (GAD) and 36 controls recruited from university-based clinics in Houston, TX and Washington, DC. Structured interviews, validated sleep questionnaires, and 1 week of actigraphy data were utilized. Despite subjective reports of significantly greater sleep problems among anxious children, actigraphy data revealed no significant differences between the groups. All parents estimated earlier bedtimes and greater total sleep duration relative to actigraphy, and all children endorsed more sleep problems than parents. With few exceptions, subjective reports exhibited low and non-significant correspondence with actigraphy-based sleep patterns and problems. Our findings suggest that high rates of sleep complaints found among children with GAD (and their parents) are not corroborated by objective sleep abnormalities, with the exception of marginally prolonged sleep onset latency compared to controls. Objective-subjective sleep discrepancies were observed in both groups but more apparent overall in the GAD group. Frequent complaints of sleep problems and daytime tiredness among anxious youth might more accurately reflect difficulties prior to the actual sleep period, cognitive-affective biases associated with sleep, and/or poor sleep quality. Findings highlight the importance of considering sleep from multiple perspectives.

  20. Clinical simulation as a boundary object in design of health IT-systems.

    PubMed

    Rasmussen, Stine Loft; Jensen, Sanne; Lyng, Karen Marie

    2013-01-01

    Healthcare organizations are very complex, holding numerous stakeholders with various approaches and goals towards the design of health IT-systems. Some of these differences may be approached by applying the concept of boundary objects in a participatory IT-design process. Traditionally clinical simulation provides the opportunity to evaluate the design and the usage of clinical IT-systems without endangering the patients and interrupting clinical work. In this paper we present how clinical simulation additionally holds the potential to function as a boundary object in the design process. The case points out that clinical simulation provides an opportunity for discussions and mutual learning among the various stakeholders involved in design of standardized electronic clinical documentation templates. The paper presents and discusses the use of clinical simulation in the translation, transfer and transformation of knowledge between various stakeholders in a large healthcare organization.

  1. Hopf-algebraic structure of combinatorial objects and differential operators

    NASA Technical Reports Server (NTRS)

    Grossman, Robert; Larson, Richard G.

    1989-01-01

    A Hopf-algebraic structure on a vector space which has as basis a family of trees is described. Some applications of this structure to combinatorics and to differential operators are surveyed. Some possible future directions for this work are indicated.

  2. Objectivity in subjectivity: do students' self and peer assessments correlate with examiners' subjective and objective assessment in clinical skills? A prospective study.

    PubMed

    Inayah, A'man Talal; Anwer, Lucman A; Shareef, Mohammad Abrar; Nurhussen, Akram; Alkabbani, Haifa Mazen; Alzahrani, Alhanouf A; Obad, Adam Subait; Zafar, Muhammad; Afsar, Nasir Ali

    2017-05-09

    The qualitative subjective assessment has been exercised either by self-reflection (self-assessment (SA)) or by an observer (peer assessment (PA)) and is considered to play an important role in students' development. The objectivity of PA and SA by students as well as those by faculty examiners has remained debated. This matters most when it comes to a high-stakes examination. We explored the degree of objectivity in PA, SA, as well as the global rating by examiners being Examiners' Subjective Assessment (ESA) compared with Objective Structured Clinical Examinations (OSCE). Prospective cohort study. Undergraduate medical students at Alfaisal University, Riyadh. All second-year medical students (n=164) of genders, taking a course to learn clinical history taking and general physical examination. A Likert scale questionnaire was distributed among the participants during selected clinical skills sessions. Each student was evaluated randomly by peers (PA) as well as by himself/herself (SA). Two OSCEs were conducted where students were assessed by an examiner objectively as well as subjectively (ESA) for a global rating of confidence and well-preparedness. OSCE-1 had fewer topics and stations, whereas OSCE-2 was terminal and full scale. OSCE-1 (B=0.10) and ESA (B=8.16) predicted OSCE-2 scores. 'No nervousness' in PA (r=0.185, p=0.018) and 'confidence' in SA (r=0.207, p=0.008) correlated with 'confidence' in ESA. In 'well-preparedness', SA correlated with ESA (r=0.234, p=0.003). OSCE-1 and ESA predicted students' performance in the OSCE-2, a high-stakes evaluation, indicating practical 'objectivity' in ESA, whereas SA and PA had minimal predictive role. Certain components of SA and PA correlated with ESA, suggesting partial objectivity given the limited objectiveness of ESA. Such difference in 'qualitative' objectivity probably reflects experience. Thus, subjective assessment can be used with some degree of objectivity for continuous assessment. © Article author(s) (or

  3. What is an Objective Structured Practical Examination in Anatomy?

    ERIC Educational Resources Information Center

    Yaqinuddin, Ahmed; Zafar, Muhammad; Ikram, Muhammad Faisal; Ganguly, Paul

    2013-01-01

    Assessing teaching-learning outcomes in anatomical knowledge is a complex task that requires the evaluation of multiple domains: theoretical, practical, and clinical knowledge. In general, theoretical knowledge is tested by a written examination system constituted by multiple choice questions (MCQs) and/or short answer questions (SAQ). The…

  4. What is an Objective Structured Practical Examination in Anatomy?

    ERIC Educational Resources Information Center

    Yaqinuddin, Ahmed; Zafar, Muhammad; Ikram, Muhammad Faisal; Ganguly, Paul

    2013-01-01

    Assessing teaching-learning outcomes in anatomical knowledge is a complex task that requires the evaluation of multiple domains: theoretical, practical, and clinical knowledge. In general, theoretical knowledge is tested by a written examination system constituted by multiple choice questions (MCQs) and/or short answer questions (SAQ). The…

  5. The Development of Clinical Reasoning Skills: A Major Objective of the Anatomy Course

    ERIC Educational Resources Information Center

    Elizondo-Omana, Rodrigo E.; Lopez, Santos Guzman

    2008-01-01

    Traditional medical school curricula have made a clear demarcation between the basic biomedical sciences and the clinical years. It is our view that a comprehensive medical education necessarily involves an increased correlation between basic science knowledge and its clinical applications. A basic anatomy course should have two main objectives:…

  6. The Development of Clinical Reasoning Skills: A Major Objective of the Anatomy Course

    ERIC Educational Resources Information Center

    Elizondo-Omana, Rodrigo E.; Lopez, Santos Guzman

    2008-01-01

    Traditional medical school curricula have made a clear demarcation between the basic biomedical sciences and the clinical years. It is our view that a comprehensive medical education necessarily involves an increased correlation between basic science knowledge and its clinical applications. A basic anatomy course should have two main objectives:…

  7. Anaesthesia clinical directors in the United Kingdom: organisation, objectives and support needs.

    PubMed

    Thoms, G M; McHugh, G A; Pollard, B J; Moore, J

    1999-08-01

    A postal survey of all 269 acute hospital trusts identified in the United Kingdom was carried out to study the work of Clinical Directors of anaesthesia. Initial responses from 163 Clinical Directors and 129 completed questionnaires were analysed. Four main areas of concern revealed by the survey were contracts and objectives, funding of managerial sessions, access to information and perceived need for support. Most Clinical Directors had no job description and most had no formal written objectives, despite a substantial body of advice that these should be provided. There was generally substantial underfunding of managerial hours compared with those actually worked and approximately 20% of Clinical Directors surveyed had no funding for managerial duties. Clinical Directors' ratings of the information available to assist their decision making were also a cause of concern. Clinical Directors perceived that they need better networking, more training particularly on human resource management and improved management information.

  8. The Relationship Between Levels of Fidelity in Simulation, Traditional Clinical Experiences and Objectives.

    PubMed

    Gore, Teresa

    2017-06-15

    The purpose of this study was to explore the relationship of baccalaureate nursing students' (BSN) perceived learning effectiveness using the Clinical Learning Environments Comparison Survey of different levels of fidelity simulation and traditional clinical experiences. A convenience sample of 103 first semester BSN enrolled in a fundamental/assessment clinical course and 155 fifth semester BSN enrolled in a leadership clinical course participated in this study. A descriptive correlational design was used for this cross-sectional study to evaluate students' perceptions after a simulation experience and the completion of the traditional clinical experiences. The subscales measured were communication, nursing leadership, and teaching-learning dyad. No statistical differences were noted based on the learning objectives. The communication subscale showed a tendency toward preference for traditional clinical experiences in meeting students perceived learning for communication. For student perceived learning effectiveness, faculty should determine the appropriate level of fidelity in simulation based on the learning objectives.

  9. Optical imaging via biological object internal structure contrasting

    NASA Astrophysics Data System (ADS)

    Podgaetsky, Vitaly M.; Tereshchenko, Sergei A.; Vorobiev, Nikolai S.; Tomilova, Larisa G.; Smirnov, Alexander V.; Ivanov, Andrei V.

    1995-01-01

    For successful application of laser tomography methods for earlier medical diagnostics the signal-to-noise ratio (contrast) must be increased. For this purpose it is possible to use the absorbing dyes. We have theoretically investigated optical imaging conditions in high scattering medium on a model object. In our experiments a YAG:Nd laser generating picosecond pulses was employed. Output radiation has been recorded by a high speed streak camera with 1.5 ps temporal resolution. The high stability of the laser and of measurement scheme characteristics was provided. We looked for the contrasting substances having tropism with pathologically changed tissue of the tumor. For this purpose some dyphthalocyanines were synthesized. The experiments with laboratory animals have demonstrated that saturated dye concentrations were noticeably lower than toxicologic dangerous concentration values. We have demonstrated a possibility of the contrasting for a model object. The experimental temporal profile of scattered radiation can be explained by the nonstationary two-flow theory.

  10. Pulsed THz TDS of objects covered by disordered structure

    NASA Astrophysics Data System (ADS)

    Trofimov, V. A.; Zakharova, I. G.; Zagursky, D. Y.; Varentsova, Svetlana A.

    2016-05-01

    Using both computer simulation and physical experiment, we demonstrate principal limitations of standard Time Domain Spectroscopy based on a broadband THz pulse for the detection and identification of substance placed inside the disordered structure. The interaction of a THz pulse with a disordered layered structure was simulated in order to show the influence of the disordered layers on the spectral characteristics of the transmitted and reflected signals. Spectral characteristics of these signals were analyzed in a direct comparison with the incident pulse spectrum. We showed that a disordered structure disturbs the reflected pulse spectrum dramatically. To avoid this, we used the integral correlation criteria in real experiment. Computer simulation results were confirmed by physical experiment. We provided the experiments with paper bag, and ordinary sheets of paper, and napkins.

  11. Correlation between the reason for referral, clinical, and objective assessment of the risk for dysphagia.

    PubMed

    Mancopes, Renata; Gonçalves, Bruna Franciele da Trindade; Costa, Cintia Conceição; Favero, Talita Cristina; Drozdz, Daniela Rejane Constantino; Bilheri, Diego Fernando Dorneles; Schumacher, Stéfani Fernanda

    2014-01-01

    To correlate the reason for referral to speech therapy service at a university hospital with the results of clinical and objective assessment of risk for dysphagia. This is a cross-sectional, observational, retrospective analytical and quantitative study. The data were gathered from the database, and the information used was the reason for referral to speech therapy service, results of clinical assessment of the risk for dysphagia, and also from swallowing videofluoroscopy. There was a mean difference between the variables of the reason for the referral, results of the clinical and objective swallowing assessments, and scale of penetration/aspiration, although the values were not statistically significant. Statistically significant correlation was observed between clinical and objective assessments and the penetration scale, with the largest occurring between the results of objective assessment and penetration scale. There was a correlation between clinical and objective assessments of swallowing and mean difference between the variables of the reason for the referral with their respective assessment. This shows the importance of the association between the data of patient's history and results of clinical evaluation and complementary tests, such as videofluoroscopy, for correct identification of the swallowing disorders, being important to combine the use of severity scales of penetration/aspiration for diagnosis.

  12. 3D genome structure modeling by Lorentzian objective function.

    PubMed

    Trieu, Tuan; Cheng, Jianlin

    2017-02-17

    The 3D structure of the genome plays a vital role in biological processes such as gene interaction, gene regulation, DNA replication and genome methylation. Advanced chromosomal conformation capture techniques, such as Hi-C and tethered conformation capture, can generate chromosomal contact data that can be used to computationally reconstruct 3D structures of the genome. We developed a novel restraint-based method that is capable of reconstructing 3D genome structures utilizing both intra-and inter-chromosomal contact data. Our method was robust to noise and performed well in comparison with a panel of existing methods on a controlled simulated data set. On a real Hi-C data set of the human genome, our method produced chromosome and genome structures that are consistent with 3D FISH data and known knowledge about the human chromosome and genome, such as, chromosome territories and the cluster of small chromosomes in the nucleus center with the exception of the chromosome 18. The tool and experimental data are available at https://missouri.box.com/v/LorDG.

  13. 3D genome structure modeling by Lorentzian objective function.

    PubMed

    Trieu, Tuan; Cheng, Jianlin

    2016-11-29

    The 3D structure of the genome plays a vital role in biological processes such as gene interaction, gene regulation, DNA replication and genome methylation. Advanced chromosomal conformation capture techniques, such as Hi-C and tethered conformation capture, can generate chromosomal contact data that can be used to computationally reconstruct 3D structures of the genome. We developed a novel restraint-based method that is capable of reconstructing 3D genome structures utilizing both intra-and inter-chromosomal contact data. Our method was robust to noise and performed well in comparison with a panel of existing methods on a controlled simulated data set. On a real Hi-C data set of the human genome, our method produced chromosome and genome structures that are consistent with 3D FISH data and known knowledge about the human chromosome and genome, such as, chromosome territories and the cluster of small chromosomes in the nucleus center with the exception of the chromosome 18. The tool and experimental data are available at https://missouri.box.com/v/LorDG.

  14. [Conscientious objection in the clinical setting. A proposal for its appropriate use].

    PubMed

    Couceiro, A; Seoane, J A; Hernando, P

    2011-01-01

    Social changes and new technologies have brought new problems in doctor-patient relationships. In many clinical contexts conscientious objection is misused, with negative effects for patients, healthcare professionals and institutions. The paper aims to clarify what conscientious objection means in a plural society based on a deliberative democracy and to show the different ways of understanding this society in order to respect both the ethical reasons of individuals and the compulsory normative framework of the Rule of Law. Furthermore, the paper identifies some clinical settings where conscientious objection is often invoked by healthcare professionals, and points out and analyses the arguments that explain why this appeal for conscientious objection is neither legitimate nor correct. Finally, it provides examples of the legal basis and Spanish jurisprudence, as well as the relevant clinical and ethical literature on this topic.

  15. Self-perceived versus objectively measured competence in performing clinical practical procedures by final year medical students.

    PubMed

    Katowa-Mukwato, Patricia; Banda, Sekelani

    2016-04-30

    To determine and compare the self-perceived and objectively measured competence in performing 14 core-clinical practical procedures by Final Year Medical Students of the University of Zambia. The study included 56 out of 60 graduating University of Zambia Medical Students of the 2012/2013 academic year. Self-perceived competence: students rated their competence on 14 core- clinical practical procedures using a self-administered questionnaire on a 5-point Likert scale. Objective competence: it was measured by Objective Structured Clinical Examination (OSCE) by faculty using predetermined rating scales. Rank order correlation test was performed for self-perceived and objectively measured competence. Two thirds 36 (66.7%) of the participants perceived themselves as moderately competent, 15 (27.8%) rated themselves as highly competent while 3 (5.6%) had low self-perception. With objective competence, the majority 52 (92.8%) were barely competent while 4 (7.2%) were absolutely competent. When overall self-perception was compared to objectively measured competence, there was a discordance which was demonstrated by a negative correlation (Spearman rho -.123). Significant numbers of students reported low self-competence in performing procedures such as endotracheal intubation, gastric lavage and cardiopulmonary resuscitation which most never performed during the clinical years of medical education. In addition, the negative correlation between self-perceived and objectively measured competence demonstrated the inability of students to assess and rate themselves objectively due to fear that others may know their weaknesses and realize that they are not as competent as expected at a specific level of training.

  16. Language structure in the n -object naming game

    NASA Astrophysics Data System (ADS)

    Lipowski, Adam; Lipowska, Dorota

    2009-11-01

    We examine a naming game with two agents trying to establish a common vocabulary for n objects. Such efforts lead to the emergence of language that allows for an efficient communication and exhibits some degree of homonymy and synonymy. Although homonymy reduces the communication efficiency, it seems to be a dynamical trap that persists for a long, and perhaps indefinite, time. On the other hand, synonymy does not reduce the efficiency of communication but appears to be only a transient feature of the language. Thus, in our model the role of synonymy decreases and in the long-time limit it becomes negligible. A similar rareness of synonymy is observed in present natural languages. The role of noise, that distorts the communicated words, is also examined. Although, in general, the noise reduces the communication efficiency, it also regroups the words so that they are more evenly distributed within the available “verbal” space.

  17. The vertical structure of the boundary layer around compact objects

    NASA Astrophysics Data System (ADS)

    Hertfelder, Marius; Kley, Wilhelm

    2017-09-01

    Context. Mass transfer due to Roche lobe overflow leads to the formation of an accretion disk around a weakly magnetized white dwarf (WD) in cataclysmic variables. At the inner edge of the disk, the gas comes upon the surface of the WD and has to get rid of its excess kinetic energy in order to settle down on the more slowly rotating outer stellar layers. This region is known as the boundary layer (BL). Aims: In this work we investigate the vertical structure of the BL, which is still poorly understood. We shall provide details of the basic structure of the two-dimensional (2D) BL and how it depends on parameters such as stellar mass and rotation rate, as well as the mass-accretion rate. We further investigate the destination of the disk material and compare our results with previous one-dimensional (1D) simulations. Methods: We solve the 2D equations of radiation hydrodynamics in a spherical (r-ϑ) geometry using a parallel grid-based code that employs a Riemann solver. The radiation energy is considered in the two-temperature approach with a radiative flux given by the flux-limited diffusion approximation. Results: The BL around a non-rotating WD is characterized by a steep drop in angular velocity over a width of only 1% of the stellar radius, a heavy depletion of mass, and a high temperature ( 500 000 K) as a consequence of the strong shear. Variations in Ω∗,M∗, and Ṁ influence the extent of the changes of the variables in the BL but not the general structure. Depending on Ω∗, the disk material travels up to the poles or is halted at a certain latitude. The extent of mixing with the stellar material also depends on Ω∗. We find that the 1D approximation matches the 2D data well, apart from an underestimated temperature.

  18. A new standardized set of ecological pictures for experimental and clinical research on visual object processing.

    PubMed

    Viggiano, Maria Pia; Vannucci, Manila; Righi, Stefania

    2004-06-01

    A new set of 174 pictures in black-and-white, coloured and spatially filtered versions, taken from photographs of real objects belonging to different semantic categories, was realised for experimental and clinical research on visual object processing. Two samples, one of English speakers and one of Italian speakers, were tested in order to provide the normative data for each picture, in both black-and-white and coloured versions, in relation to familiarity, visual complexity and name agreement.

  19. Organizational and Spatial Dynamics of Attentional Focusing in Hierarchically Structured Objects

    ERIC Educational Resources Information Center

    Yeari, Menahem; Goldsmith, Morris

    2011-01-01

    Is the focusing of visual attention object-based, space-based, both, or neither? Attentional focusing latencies in hierarchically structured compound-letter objects were examined, orthogonally manipulating global size (larger vs. smaller) and organizational complexity (two-level structure vs. three-level structure). In a dynamic focusing task,…

  20. A component-based, distributed object services architecture for a clinical workstation.

    PubMed Central

    Chueh, H. C.; Raila, W. F.; Pappas, J. J.; Ford, M.; Zatsman, P.; Tu, J.; Barnett, G. O.

    1996-01-01

    Attention to an architectural framework in the development of clinical applications can promote reusability of both legacy systems as well as newly designed software. We describe one approach to an architecture for a clinical workstation application which is based on a critical middle tier of distributed object-oriented services. This tier of network-based services provides flexibility in the creation of both the user interface and the database tiers. We developed a clinical workstation for ambulatory care using this architecture, defining a number of core services including those for vocabulary, patient index, documents, charting, security, and encounter management. These services can be implemented through proprietary or more standard distributed object interfaces such as CORBA and OLE. Services are accessed over the network by a collection of user interface components which can be mixed and matched to form a variety of interface styles. These services have also been reused with several applications based on World Wide Web browser interfaces. PMID:8947744

  1. Planning Science Experiments According to the Multihierarchical Structural System of Planetary Objects

    NASA Astrophysics Data System (ADS)

    Bérczi, Sz.

    2017-02-01

    The Multihierarchical Structural System of Planetary Objects is a synchronous view of materials to be measured, technologies, research activities arranged by structural hierarchy of the matter: giving benefits for both scientists and engineers.

  2. Drawing skill is related to the efficiency of encoding object structure

    PubMed Central

    Perdreau, Florian; Cavanagh, Patrick

    2014-01-01

    Accurate drawing calls on many skills beyond simple motor coordination. A good internal representation of the target object's structure is necessary to capture its proportion and shape in the drawing. Here, we assess two aspects of the perception of object structure and relate them to participants' drawing accuracy. First, we assessed drawing accuracy by computing the geometrical dissimilarity of their drawing to the target object. We then used two tasks to evaluate the efficiency of encoding object structure. First, to examine the rate of temporal encoding, we varied presentation duration of a possible versus impossible test object in the fovea using two different test sizes (8° and 28°). More skilled participants were faster at encoding an object's structure, but this difference was not affected by image size. A control experiment showed that participants skilled in drawing did not have a general advantage that might have explained their faster processing for object structure. Second, to measure the critical image size for accurate classification in the periphery, we varied image size with possible versus impossible object tests centered at two different eccentricities (3° and 8°). More skilled participants were able to categorise object structure at smaller sizes, and this advantage did not change with eccentricity. A control experiment showed that the result could not be attributed to differences in visual acuity, leaving attentional resolution as a possible explanation. Overall, we conclude that drawing accuracy is related to faster encoding of object structure and better access to crowded details. PMID:25469216

  3. Drawing skill is related to the efficiency of encoding object structure.

    PubMed

    Perdreau, Florian; Cavanagh, Patrick

    2014-01-01

    Accurate drawing calls on many skills beyond simple motor coordination. A good internal representation of the target object's structure is necessary to capture its proportion and shape in the drawing. Here, we assess two aspects of the perception of object structure and relate them to participants' drawing accuracy. First, we assessed drawing accuracy by computing the geometrical dissimilarity of their drawing to the target object. We then used two tasks to evaluate the efficiency of encoding object structure. First, to examine the rate of temporal encoding, we varied presentation duration of a possible versus impossible test object in the fovea using two different test sizes (8° and 28°). More skilled participants were faster at encoding an object's structure, but this difference was not affected by image size. A control experiment showed that participants skilled in drawing did not have a general advantage that might have explained their faster processing for object structure. Second, to measure the critical image size for accurate classification in the periphery, we varied image size with possible versus impossible object tests centered at two different eccentricities (3° and 8°). More skilled participants were able to categorise object structure at smaller sizes, and this advantage did not change with eccentricity. A control experiment showed that the result could not be attributed to differences in visual acuity, leaving attentional resolution as a possible explanation. Overall, we conclude that drawing accuracy is related to faster encoding of object structure and better access to crowded details.

  4. Systems and methods for estimating the structure and motion of an object

    DOEpatents

    Dani, Ashwin P; Dixon, Warren

    2015-11-03

    In one embodiment, the structure and motion of a stationary object are determined using two images and a linear velocity and linear acceleration of a camera. In another embodiment, the structure and motion of a stationary or moving object are determined using an image and linear and angular velocities of a camera.

  5. 48 CFR 1815.404-471 - NASA structured approach for profit or fee objective.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false NASA structured approach for profit or fee objective. 1815.404-471 Section 1815.404-471 Federal Acquisition Regulations System... NEGOTIATION Contract Pricing 1815.404-471 NASA structured approach for profit or fee objective. ...

  6. 48 CFR 1815.404-471 - NASA structured approach for profit or fee objective.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false NASA structured approach for profit or fee objective. 1815.404-471 Section 1815.404-471 Federal Acquisition Regulations System... NEGOTIATION Contract Pricing 1815.404-471 NASA structured approach for profit or fee objective. ...

  7. Attributed tree data structure for representing the descriptions of object contours in images

    NASA Astrophysics Data System (ADS)

    Ren, Z.; Ameling, Walter; Jensch, Peter F.

    1990-09-01

    Shape ofmedical objects such as the human bones or skeletons conveys information about the object''s anatomic structures and their pathological states. The sectional contours of the objects which are ol)selvable through computer tomograms carry descriptive clues for analyzing shapes. To build and represent the descriptions of contours one should derive stable structural elements and their sensitive attributes from the contours. Sectional contours of the medical objects are highly curved and complex tlieiefoie they should be described in a liigliei order parameter space than just in a linear one. These considerations have guided us to examine the scale-space transformation and to develop methods for expressing describing and extracting structures in the scale-space images of the contours. In this paper we introduce a tree-based data structure for representing descriptions of structures in the scale-space and further demonstrate its applications to shape analysis.

  8. Structuring Clinical Workflows for Diabetes Care

    PubMed Central

    Lasierra, N.; Oberbichler, S.; Toma, I.; Fensel, A.; Hoerbst, A.

    2014-01-01

    Summary Background Electronic health records (EHRs) play an important role in the treatment of chronic diseases such as diabetes mellitus. Although the interoperability and selected functionality of EHRs are already addressed by a number of standards and best practices, such as IHE or HL7, the majority of these systems are still monolithic from a user-functionality perspective. The purpose of the OntoHealth project is to foster a functionally flexible, standards-based use of EHRs to support clinical routine task execution by means of workflow patterns and to shift the present EHR usage to a more comprehensive integration concerning complete clinical workflows. Objectives The goal of this paper is, first, to introduce the basic architecture of the proposed OntoHealth project and, second, to present selected functional needs and a functional categorization regarding workflow-based interactions with EHRs in the domain of diabetes. Methods A systematic literature review regarding attributes of workflows in the domain of diabetes was conducted. Eligible references were gathered and analyzed using a qualitative content analysis. Subsequently, a functional workflow categorization was derived from diabetes-specific raw data together with existing general workflow patterns. Results This paper presents the design of the architecture as well as a categorization model which makes it possible to describe the components or building blocks within clinical workflows. The results of our study lead us to identify basic building blocks, named as actions, decisions, and data elements, which allow the composition of clinical workflows within five identified contexts. Conclusions The categorization model allows for a description of the components or building blocks of clinical workflows from a functional view. PMID:25024765

  9. GELLO: An Object-Oriented Query and Expression Language for Clinical Decision Support

    PubMed Central

    Sordo, Margarita; Ogunyemi, Omolola; Boxwala, Aziz A.; Greenes, Robert A.

    2003-01-01

    GELLO is a purpose-specific, object-oriented (OO) query and expression language [1]. GELLO is the result of a concerted effort of the Decision Systems Group (DSG) working with the HL7 Clinical Decision Support Technical Committee (CDSTC) to provide the HL7 community with a common format for data encoding and manipulation. GELLO will soon be submitted for ballot to the HL7 CDSTC for consideration as a standard. PMID:14728515

  10. Different Measures of Structural Similarity Tap Different Aspects of Visual Object Processing.

    PubMed

    Gerlach, Christian

    2017-01-01

    The structural similarity of objects has been an important variable in explaining why some objects are easier to categorize at a superordinate level than to individuate, and also why some patients with brain injury have more difficulties in recognizing natural (structurally similar) objects than artifacts (structurally distinct objects). In spite of its merits as an explanatory variable, structural similarity is not a unitary construct, and it has been operationalized in different ways. Furthermore, even though measures of structural similarity have been successful in explaining task and category-effects, this has been based more on implication than on direct empirical demonstrations. Here, the direct influence of two different measures of structural similarity, contour overlap and within-item structural diversity, on object individuation (object decision) and superordinate categorization performance is examined. Both measures can account for performance differences across objects, but in different conditions. It is argued that this reflects differences between the measures in whether they tap: (i) global or local shape characteristics, and (ii) between- or within-category structural similarity.

  11. Implementation of virtual medical record object model for a standards-based clinical decision support rule engine.

    PubMed

    Huang, Christine; Noirot, Laura A; Heard, Kevin M; Reichley, Richard M; Dunagan, Wm Claiborne; Bailey, Thomas C

    2006-01-01

    The Virtual Medical Record (vMR) is a structured data model for representing individual patient informations. Our implementation of vMR is based on HL7 Reference Information Model (RIM) v2.13 from which a minimum set of objects and attributes are selected to meet the requirement of a clinical decision support (CDS) rule engine. Our success of mapping local patient data to the vMR model and building a vMR adaptor middle layer demonstrate the feasibility and advantages of implementing a vMR in a portable CDS solution.

  12. Multi-objective shape and material optimization of composite structures including damping

    NASA Technical Reports Server (NTRS)

    Saravanos, D. A.; Chamis, Christos C.

    1990-01-01

    A multi-objective optimal design methodology is developed for light-weight, low cost composite structures of improved dynamic performance. The design objectives include minimization of resonance amplitudes (or maximization of modal damping), weight, and material cost. The design vector includes micromechanics, laminate, and structural shape parameters. Performance constraints are imposed on static displacements, dynamic amplitudes, and natural frequencies. The effects of damping on the dynamics of composite structures are incorporated. Preliminary applications on a cantilever composite beam illustrated that only the proposed multi-objective optimization, as opposed to single objective functions, simultaneously improved all objectives. The significance of composite damping in the design of advanced composite structures was also demonstrated, indicating the design methods based on undamped dynamics may fail to improve the dynamic performance near resonances.

  13. Multi-objective shape and material optimization of composite structures including damping

    NASA Technical Reports Server (NTRS)

    Saravanos, D. A.; Chamis, C. C.

    1990-01-01

    A multi-objective optimal design methodology is developed for light-weight, low-cost composite structures of improved dynamic performance. The design objectives include minimization of resonance amplitudes (or maximization of modal damping), weight, and material cost. The design vector includes micromechanics, laminate, and structural shape parameters. Performance constraints are imposed on static displacements, dynamic amplitudes, and natural frequencies. The effects of damping on the dynamics of composite structures are incorporated. Preliminary applications on a cantilever composite beam illustrated that only the proposed multi-objective optimization, as opposed to single objective functions, simultaneously improved all objectives. The significance of composite damping in the design of advanced composite structures was also demonstrated, indicating that design methods based on undamped dynamics may fail to improve the dynamic performance near resonances.

  14. Multi-objective shape and material optimization of composite structures including damping

    NASA Technical Reports Server (NTRS)

    Saravanos, D. A.; Chamis, C. C.

    1990-01-01

    A multi-objective optimal design methodology is developed for light-weight, low-cost composite structures of improved dynamic performance. The design objectives include minimization of resonance amplitudes (or maximization of modal damping), weight, and material cost. The design vector includes micromechanics, laminate, and structural shape parameters. Performance constraints are imposed on static displacements, dynamic amplitudes, and natural frequencies. The effects of damping on the dynamics of composite structures are incorporated. Preliminary applications on a cantilever composite beam illustrated that only the proposed multi-objective optimization, as opposed to single objective functions, simultaneously improved all objectives. The significance of composite damping in the design of advanced composite structures was also demonstrated, indicating that design methods based on undamped dynamics may fail to improve the dynamic performance near resonances.

  15. Loss of stored knowledge of object structure: implications for "category-specific" deficits.

    PubMed

    Turnbull, O H; Laws, K R

    2000-06-01

    Following a right-hemisphere lesion, the patient SM had impaired object recognition, with good elementary visual abilities, and could derive information about object structure. He was also impaired on all tasks tapping stored structural knowledge, even when tested in the verbal modality. This suggests that SM has a disorder affecting stored knowledge of object structure, though he remains able to assemble novel structural descriptions. His object recognition ability also appeared significantly worse for non-living things. By contrast, existing models relating to stored knowledge would predict that SM would show greater impairment with living things. We argue that SM's deficit reflects the loss of a type of structural knowledge that relates to the "within-item structural diversity" of items. It is argued that living things show less structural variation than objects in the natural world, and might arguably be easier to recognise, because the image of the to-be-recognised object would be similar to the stored representation. Hence, a deficit affecting this aspect of stored knowledge would differentially impact upon non-living things. This argument receives confirming independent support from the finding that normal subjects ratings for the within-item structural diversity of visual stimuli are (unlike other "critical" variables) significant predictors of SM's naming performance.

  16. Detection of symmetry and repetition in one and two objects. Structures versus strategies.

    PubMed

    Koning, Arno; Wagemans, Johan

    2009-01-01

    Symmetry is usually easier to detect within a single object than in two objects (one-object advantage), while the reverse is true for repetition (two-objects advantage). This interaction between regularity and number of objects could reflect an intrinsic property of encoding spatial relations within and across objects or it could reflect a matching strategy. To test this, regularities between two contours (belonging to a single object or two objects) had to be detected in two experiments. Projected three-dimensional (3-D) objects rotated in depth were used to disambiguate figure-ground segmentation and to make matching based on simple translations of the two-dimensional (2-D) contours unlikely. Experiment 1 showed the expected interaction between regularity and number of objects. Experiment 2 used two-objects displays only and prevented a matching strategy by also switching the positions of the two objects. Nevertheless, symmetry was never detected more easily than repetition in these two-objects displays. We conclude that structural coding, not matching strategies, underlies the one-object advantage for symmetry and the two-objects advantage for repetition.

  17. [Clinical laboratory medicine: continuous amelioration with a book of objectives and satisfaction survey].

    PubMed

    Reix, Nathalie; Agin, Arnaud; Bahram, Seiamak; Dali-Youcef, Nassim; Grucker, Daniel; Jaulhac, Benoît; Lepiller, Quentin; Lessinger, Jean-Marc; Mauvieux, Laurent; Monier, Laurie; Schramm, Frédéric; Stoll-Keller, Françoise; Vallat, Laurent; Ludes, Bertrand; Candolfi, Ermanno; Filisetti, Denis

    2015-01-01

    We report in this publication the use of two educational tools, a questionnaire of satisfaction and a training book, to improve the training of students during their internship in clinical laboratory at the "Pôle de biologie des Hôpitaux universitaires de Strasbourg" in France. First, the ongoing training was assessed by the interns with a questionnaire measuring satisfaction. The analysis of this questionnaire identified four key points to improve: 1) define the teaching objectives, 2) organize the training with a schedule, 3) revise certain teaching methods and 4) ensure better integration of the students in the team of medical biologists. After this assessment, we implemented a training book to answer these four points. Indeed, the training book presents the objectives, the schedule of training, and how to validate the educational objectives. A new assessment was performed again using the same methodology. Results showed an improvement in student satisfaction from 74 to 88 %. The questionnaire of satisfaction and the training book are presented in this article. The aim of the assessment of training combined with the training book is to incite the actors of the training (students and teachers) to continually improve the training. The objectives of the Pôle de Biologie are to obtain an 80 % satisfaction rate during the 6 months trainings and to reduce or eliminate dissatisfaction, and finally to ensure the validation by students of 80 to 100 % of their predetermined objectives.

  18. Learning the 3-D structure of objects from 2-D views depends on shape, not format

    PubMed Central

    Tian, Moqian; Yamins, Daniel; Grill-Spector, Kalanit

    2016-01-01

    Humans can learn to recognize new objects just from observing example views. However, it is unknown what structural information enables this learning. To address this question, we manipulated the amount of structural information given to subjects during unsupervised learning by varying the format of the trained views. We then tested how format affected participants' ability to discriminate similar objects across views that were rotated 90° apart. We found that, after training, participants' performance increased and generalized to new views in the same format. Surprisingly, the improvement was similar across line drawings, shape from shading, and shape from shading + stereo even though the latter two formats provide richer depth information compared to line drawings. In contrast, participants' improvement was significantly lower when training used silhouettes, suggesting that silhouettes do not have enough information to generate a robust 3-D structure. To test whether the learned object representations were format-specific or format-invariant, we examined if learning novel objects from example views transfers across formats. We found that learning objects from example line drawings transferred to shape from shading and vice versa. These results have important implications for theories of object recognition because they suggest that (a) learning the 3-D structure of objects does not require rich structural cues during training as long as shape information of internal and external features is provided and (b) learning generates shape-based object representations independent of the training format. PMID:27153196

  19. Germ line genome editing in clinics: the approaches, objectives and global society.

    PubMed

    Ishii, Tetsuya

    2017-01-01

    Genome editing allows for the versatile genetic modification of somatic cells, germ cells and embryos. In particular, CRISPR/Cas9 is worldwide used in biomedical research. Although the first report on Cas9-mediated gene modification in human embryos focused on the prevention of a genetic disease in offspring, it raised profound ethical and social concerns over the safety of subsequent generations and the potential misuse of genome editing for human enhancement. The present article considers germ line genome editing approaches from various clinical and ethical viewpoints and explores its objectives. The risks and benefits of the following three likely objectives are assessed: the prevention of monogenic diseases, personalized assisted reproductive technology (ART) and genetic enhancement. Although genetic enhancement should be avoided, the international regulatory landscape suggests the inevitability of this misuse at ART centers. Under these circumstances, possible regulatory responses and the potential roles of public dialogue are discussed.

  20. WWW-based access to object-oriented clinical databases: the KHOSPAD project.

    PubMed

    Pinciroli, F; Portoni, L; Combi, C; Violante, F F

    1998-09-01

    KHOSPAD is a project aiming at improving the quality of the process of patient care concerning general practitioner-patient-hospital relationships, using current information and networking technologies. The studied application field is a cardiology division, with hemodynamic laboratory and the population of PTCA patients. Data related to PTCA patients are managed by ARCADIA, an object-oriented database management system developed for the considered clinical setting. We defined a remotely accessible view of ARCADIA medical record, suitable for general practitioners (GPs) caring patients after PTCA, during the follow-up period. Using a PC, a modem and Internet, an authorized GP can consult remotely the medical records of his PTCA patients. Main features of the application are related to the management and display of complex data, specifically characterized by multimedia and temporal features, based on an object-oriented temporal data model.

  1. Germ line genome editing in clinics: the approaches, objectives and global society

    PubMed Central

    2017-01-01

    Genome editing allows for the versatile genetic modification of somatic cells, germ cells and embryos. In particular, CRISPR/Cas9 is worldwide used in biomedical research. Although the first report on Cas9-mediated gene modification in human embryos focused on the prevention of a genetic disease in offspring, it raised profound ethical and social concerns over the safety of subsequent generations and the potential misuse of genome editing for human enhancement. The present article considers germ line genome editing approaches from various clinical and ethical viewpoints and explores its objectives. The risks and benefits of the following three likely objectives are assessed: the prevention of monogenic diseases, personalized assisted reproductive technology (ART) and genetic enhancement. Although genetic enhancement should be avoided, the international regulatory landscape suggests the inevitability of this misuse at ART centers. Under these circumstances, possible regulatory responses and the potential roles of public dialogue are discussed. PMID:26615180

  2. Hierarchical organization in visual working memory: From global ensemble to individual object structure.

    PubMed

    Nie, Qi-Yang; Müller, Hermann J; Conci, Markus

    2017-02-01

    When remembering a natural scene, both detailed information about specific objects and summary representations such as the gist of a scene are encoded. However, formal models of change detection that are used to estimate working memory capacity, typically assume observers simply encode and maintain memory representations that are treated independently from one another without considering the (hierarchical) object or scene structure. To overcome this limitation, we present a hierarchical variant of the change detection task that attempts to formalize the role of object structure, thus, allowing for richer, more graded memory representations. We demonstrate that detection of a global-object change precedes local-object changes of hierarchical shapes to a large extent. Moreover, when systematically varying object repetitions between individual items at a global or a local level, memory performance declines mainly for repeated global objects, but not for repeated local objects, which suggests that ensemble (i.e., summary) representations are likewise biased toward a global level. In addition, this global memory precedence effect is shown to be independent from encoding durations, and mostly cannot be attributed to differences in saliency or shape discriminability at global/local object levels. This pattern of results is suggestive of a global/local difference occurring primarily during memory maintenance. Altogether, these findings challenge visual-working-memory (vWM) models that propose that a fixed number of objects can be remembered regardless of the individual object structure. Instead, our results support a hierarchical model that emphasizes the role for structured representations among objects in vWM. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. 30 CFR 77.403 - Mobile equipment; falling object protective structures (FOPS).

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Mobile equipment; falling object protective... AREAS OF UNDERGROUND COAL MINES Safeguards for Mechanical Equipment § 77.403 Mobile equipment; falling... underground coal mines shall be provided with substantial falling object protective structures (FOPS)....

  4. Clinical ethics in rehabilitation medicine: core objectives and algorithm for resident education.

    PubMed

    Sliwa, J A; McPeak, L; Gittler, M; Bodenheimer, C; King, J; Bowen, J

    2002-09-01

    Described as the balance of values on either side of a moral dilemma, ethics and ethical issues are of increasing importance in the changing practice of rehabilitation medicine. Because the substance of ethics and true ethical issues can be difficult to identify, the education of rehabilitation residents in ethics can similarly be challenging. This article discusses topics pertinent to an understanding of clinical ethics in rehabilitation medicine and provides a method of teaching residents through an algorithm of ethical issues, learning objectives, and illustrative cases.

  5. Automated objective routine examination of optical quality of rigid endoscopes in a clinical setting.

    PubMed

    Wientjes, Rens; Noordmans, Herke J; van der Eijk, Jerine A J; van den Brink, Henk

    2013-01-01

    Rigid endoscopes degrade during clinical use due to sterilization, ionizing radiation and mechanical forces. Despite visual checks on functionality at the department of sterilization, surgeons are still confronted with suboptimal instruments as it is difficult to assess this degradation in an objective manner. To guarantee that endoscopes have sufficient optical quality for minimal invasive surgery, an experimental opto-electronic test bench has been developed in order to be used at the department of sterilization. Transmission of illumination fibres and lens contrast values are stored in a database to enable empirical criteria to reject endoscope for further clinical usage or to accept endoscopes after repair. Results of the test bench are given for an eight month period, where a trained operator performed 1599 measurements on 46 different types. Stability of the system, trends in quality of clinical endoscopes, and effect of repair or replacement were assessed. Although the period was too short to draw firm conclusions, a slow downwards trend in quality of clinically used endoscopes could be observed. Also, endoscopes generally improve in quality after repair or replacement, while endoscope replacement seems to slightly outperform endoscope repair. To optimize the measurement process, a new system is being developed requiring less user interaction and measuring more optical parameters of an endoscope. By commercializing this system, we hope that measurements at different hospitals will give improved insight which acceptance and rejection criteria to use and which factors (usage, cleaning protocol, and brands) determine the economic lifetime of endoscopes.

  6. Automated Objective Routine Examination of Optical Quality of Rigid Endoscopes in a Clinical Setting

    PubMed Central

    Wientjes, Rens; Noordmans, Herke J.; van der Eijk, Jerine A. J.; van den Brink, Henk

    2013-01-01

    Rigid endoscopes degrade during clinical use due to sterilization, ionizing radiation and mechanical forces. Despite visual checks on functionality at the department of sterilization, surgeons are still confronted with suboptimal instruments as it is difficult to assess this degradation in an objective manner. To guarantee that endoscopes have sufficient optical quality for minimal invasive surgery, an experimental opto-electronic test bench has been developed in order to be used at the department of sterilization. Transmission of illumination fibres and lens contrast values are stored in a database to enable empirical criteria to reject endoscope for further clinical usage or to accept endoscopes after repair. Results of the test bench are given for an eight month period, where a trained operator performed 1599 measurements on 46 different types. Stability of the system, trends in quality of clinical endoscopes, and effect of repair or replacement were assessed. Although the period was too short to draw firm conclusions, a slow downwards trend in quality of clinically used endoscopes could be observed. Also, endoscopes generally improve in quality after repair or replacement, while endoscope replacement seems to slightly outperform endoscope repair. To optimize the measurement process, a new system is being developed requiring less user interaction and measuring more optical parameters of an endoscope. By commercializing this system, we hope that measurements at different hospitals will give improved insight which acceptance and rejection criteria to use and which factors (usage, cleaning protocol, and brands) determine the economic lifetime of endoscopes. PMID:23555715

  7. Evaluating the Internal Structure of the Eysenck Personality Questionnaire: Objective Criteria.

    ERIC Educational Resources Information Center

    Helmes, Edward

    1989-01-01

    Objective criteria for evaluating the Eysenck Personality Inventory's internal structure are discussed. An approach based on targeted rotations and the test's scoring key is proposed as a means of providing common criteria. Data from earlier structure and test results for 195 undergraduates support the utility of 3 criteria developed. (SLD)

  8. Evaluating the Internal Structure of the Eysenck Personality Questionnaire: Objective Criteria.

    ERIC Educational Resources Information Center

    Helmes, Edward

    1989-01-01

    Objective criteria for evaluating the Eysenck Personality Inventory's internal structure are discussed. An approach based on targeted rotations and the test's scoring key is proposed as a means of providing common criteria. Data from earlier structure and test results for 195 undergraduates support the utility of 3 criteria developed. (SLD)

  9. Structural empowerment of clinical nurse managers.

    PubMed

    Oliver, Beth; Gallo, Kathleen; Griffin, Mary Quinn; White, Maureen; Fitzpatrick, Joyce

    2014-04-01

    The purpose of this study was to describe perceptions of structural empowerment of clinical nurse managers (CNMs) in 1 large healthcare system. The recruitment and retention of CNMs are crucial to the future of healthcare institutions. Understanding the extent to which CNMs feel supported in the work environment and have access to resources, information, support, and opportunities to learn and develop will be beneficial to organizational effectiveness. The sample included 140 CNMs from 1 large healthcare system in the northeastern United States. Consistent with previous research, CNMs in the present study had moderate levels of empowerment. They had lower than expected subscale scores on the resources subscale and acceptable scores on the subscales of support, formal power, and informal power. In the current changing healthcare environment, it is important to gain more understanding of the role of CNMs who are crucial to quality care and patient and nurse satisfaction. This study provides important baseline information about perceptions of structural empowerment among CNMs. Interventions that can be initiated to enhance the CNM empowerment are presented.

  10. Randomised trial of the effects of structuring clinic correspondence.

    PubMed

    Melville, C; Hands, S; Jones, P

    2002-05-01

    We performed a randomised controlled crossover trial of clinic letters. Structured letters were compared with conventional letters containing problem lists. There were 32 participants; 25 preferred the structured letter. Median rating and items identified were higher for the structured letter. Structured clinical correspondence with paragraph headings is strongly preferred and increases comprehension.

  11. Sub-diffraction phase-contrast imaging of transparent nano-objects by plasmonic lens structure.

    PubMed

    Yao, Na; Wang, Changtao; Tao, Xing; Wang, Yanqin; Zhao, Zeyu; Luo, Xiangang

    2013-04-05

    We propose a specially designed plasmonic lens structure to succeed in realizing sub-diffraction phase-contrast imaging of transparent nano-objects. The nano-objects are embedded inside the insulator layer of the metal-insulator-metal (MIM) plasmonic structure and have a small refractive index difference with respect to the transparent insulator layer. The excited surface plasmons in the MIM structure help to greatly enhance scattered light from the nano-objects and effectively suppress the transmitted illumination light. A spatial resolution of about 64 nm and a minimum distinguishable refractive index difference down to 0.05 are numerically demonstrated. For sub-diffraction phase-contrast imaging of irregular three-dimensional (3D) nanowires and nanocylinders, the optimized MIM structure shows much better performance in comparison with that of a superlens.

  12. Ability of expert physicians to structure clinical guidelines: reality versus perception.

    PubMed

    Shalom, Erez; Shahar, Yuval; Taieb-Maimon, Meirav; Martins, Susana B; Vaszar, Laszlo T; Goldstein, Mary K; Gutnik, Lily; Lunenfeld, Eitan

    2009-12-01

    Structuring Textual Clinical Guidelines (GLs) into a formal representation is a necessary prerequisite for supporting their automated application. We had developed a collaborative guideline-structuring methodology that involves expert physicians, clinical editors and knowledge engineers, to produce a machine-comprehensible representation for automated support of evidence-based, guideline-based care. Our goals in the current study were: (1) to investigate the perceptions of the expert physicians and clinical editors as to the relative importance, for the structuring process, of different aspects of the methodology; (2) to assess, for the clinical editors, the inter-correlations among (i) the reported level of understanding of the guideline structuring ontology's (knowledge scheme's) features, (ii) the reported ease of structuring each feature and (iii) the actual objective quality of structuring. A clinical consensus regarding the contents of three guidelines was prepared by an expert in the domain of each guideline. For each guideline, two clinical editors independently structured the guideline into a semi-formal representation, using the Asbru guideline ontology's features. The quality of the resulting structuring was assessed quantitatively. Each expert physician was asked which aspects were most useful for formation of the consensus. Each clinical editor filled questionnaires relating to: (1) the level of understanding of the ontology's features (before the structuring process); (2) the usefulness of various aspects in the structuring process (after the structuring process); (3) the ease of structuring each ontological feature (after the structuring process). Subjective reports were compared with objective quantitative measures of structuring correctness. Expert physicians considered having medical expertise and understanding the ontological features as the aspects most useful for creation of a consensus. Clinical editors considered understanding the ontological

  13. ObStruct: a method to objectively analyse factors driving population structure using Bayesian ancestry profiles.

    PubMed

    Gayevskiy, Velimir; Klaere, Steffen; Knight, Sarah; Goddard, Matthew R

    2014-01-01

    Bayesian inference methods are extensively used to detect the presence of population structure given genetic data. The primary output of software implementing these methods are ancestry profiles of sampled individuals. While these profiles robustly partition the data into subgroups, currently there is no objective method to determine whether the fixed factor of interest (e.g. geographic origin) correlates with inferred subgroups or not, and if so, which populations are driving this correlation. We present ObStruct, a novel tool to objectively analyse the nature of structure revealed in Bayesian ancestry profiles using established statistical methods. ObStruct evaluates the extent of structural similarity between sampled and inferred populations, tests the significance of population differentiation, provides information on the contribution of sampled and inferred populations to the observed structure and crucially determines whether the predetermined factor of interest correlates with inferred population structure. Analyses of simulated and experimental data highlight ObStruct's ability to objectively assess the nature of structure in populations. We show the method is capable of capturing an increase in the level of structure with increasing time since divergence between simulated populations. Further, we applied the method to a highly structured dataset of 1,484 humans from seven continents and a less structured dataset of 179 Saccharomyces cerevisiae from three regions in New Zealand. Our results show that ObStruct provides an objective metric to classify the degree, drivers and significance of inferred structure, as well as providing novel insights into the relationships between sampled populations, and adds a final step to the pipeline for population structure analyses.

  14. Mid-fusiform activation during object discrimination reflects the process of differentiating structural descriptions.

    PubMed

    Liu, Xun; Steinmetz, Nicholas A; Farley, Alison B; Smith, Charles D; Joseph, Jane E

    2008-09-01

    The present study explored constraints on mid-fusiform activation during object discrimination. In three experiments, participants performed a matching task on simple line configurations, nameable objects, three dimensional (3-D) shapes, and colors. Significant bilateral mid-fusiform activation emerged when participants matched objects and 3-D shapes, as compared to when they matched two-dimensional (2-D) line configurations and colors, indicating that the mid-fusiform is engaged more strongly for processing structural descriptions (e.g., comparing 3-D volumetric shape) than perceptual descriptions (e.g., comparing 2-D or color information). In two of the experiments, the same mid-fusiform regions were also modulated by the degree of structural similarity between stimuli, implicating a role for the mid-fusiform in fine differentiation of similar visual object representations. Importantly, however, this process of fine differentiation occurred at the level of structural, but not perceptual, descriptions. Moreover, mid-fusiform activity was more robust when participants matched shape compared to color information using the identical stimuli, indicating that activity in the mid-fusiform gyrus is not driven by specific stimulus properties, but rather by the process of distinguishing stimuli based on shape information. Taken together, these findings further clarify the nature of object processing in the mid-fusiform gyrus. This region is engaged specifically in structural differentiation, a critical component process of object recognition and categorization.

  15. Objective Bayesian fMRI analysis—a pilot study in different clinical environments

    PubMed Central

    Magerkurth, Joerg; Mancini, Laura; Penny, William; Flandin, Guillaume; Ashburner, John; Micallef, Caroline; De Vita, Enrico; Daga, Pankaj; White, Mark J.; Buckley, Craig; Yamamoto, Adam K.; Ourselin, Sebastien; Yousry, Tarek; Thornton, John S.; Weiskopf, Nikolaus

    2015-01-01

    Functional MRI (fMRI) used for neurosurgical planning delineates functionally eloquent brain areas by time-series analysis of task-induced BOLD signal changes. Commonly used frequentist statistics protect against false positive results based on a p-value threshold. In surgical planning, false negative results are equally if not more harmful, potentially masking true brain activity leading to erroneous resection of eloquent regions. Bayesian statistics provides an alternative framework, categorizing areas as activated, deactivated, non-activated or with low statistical confidence. This approach has not yet found wide clinical application partly due to the lack of a method to objectively define an effect size threshold. We implemented a Bayesian analysis framework for neurosurgical planning fMRI. It entails an automated effect-size threshold selection method for posterior probability maps accounting for inter-individual BOLD response differences, which was calibrated based on the frequentist results maps thresholded by two clinical experts. We compared Bayesian and frequentist analysis of passive-motor fMRI data from 10 healthy volunteers measured on a pre-operative 3T and an intra-operative 1.5T MRI scanner. As a clinical case study, we tested passive motor task activation in a brain tumor patient at 3T under clinical conditions. With our novel effect size threshold method, the Bayesian analysis revealed regions of all four categories in the 3T data. Activated region foci and extent were consistent with the frequentist analysis results. In the lower signal-to-noise ratio 1.5T intra-operative scanner data, Bayesian analysis provided improved brain-activation detection sensitivity compared with the frequentist analysis, albeit the spatial extents of the activations were smaller than at 3T. Bayesian analysis of fMRI data using operator-independent effect size threshold selection may improve the sensitivity and certainty of information available to guide neurosurgery

  16. Objective Bayesian fMRI analysis-a pilot study in different clinical environments.

    PubMed

    Magerkurth, Joerg; Mancini, Laura; Penny, William; Flandin, Guillaume; Ashburner, John; Micallef, Caroline; De Vita, Enrico; Daga, Pankaj; White, Mark J; Buckley, Craig; Yamamoto, Adam K; Ourselin, Sebastien; Yousry, Tarek; Thornton, John S; Weiskopf, Nikolaus

    2015-01-01

    Functional MRI (fMRI) used for neurosurgical planning delineates functionally eloquent brain areas by time-series analysis of task-induced BOLD signal changes. Commonly used frequentist statistics protect against false positive results based on a p-value threshold. In surgical planning, false negative results are equally if not more harmful, potentially masking true brain activity leading to erroneous resection of eloquent regions. Bayesian statistics provides an alternative framework, categorizing areas as activated, deactivated, non-activated or with low statistical confidence. This approach has not yet found wide clinical application partly due to the lack of a method to objectively define an effect size threshold. We implemented a Bayesian analysis framework for neurosurgical planning fMRI. It entails an automated effect-size threshold selection method for posterior probability maps accounting for inter-individual BOLD response differences, which was calibrated based on the frequentist results maps thresholded by two clinical experts. We compared Bayesian and frequentist analysis of passive-motor fMRI data from 10 healthy volunteers measured on a pre-operative 3T and an intra-operative 1.5T MRI scanner. As a clinical case study, we tested passive motor task activation in a brain tumor patient at 3T under clinical conditions. With our novel effect size threshold method, the Bayesian analysis revealed regions of all four categories in the 3T data. Activated region foci and extent were consistent with the frequentist analysis results. In the lower signal-to-noise ratio 1.5T intra-operative scanner data, Bayesian analysis provided improved brain-activation detection sensitivity compared with the frequentist analysis, albeit the spatial extents of the activations were smaller than at 3T. Bayesian analysis of fMRI data using operator-independent effect size threshold selection may improve the sensitivity and certainty of information available to guide neurosurgery.

  17. Determining the 3-D structure and motion of objects using a scanning laser range sensor

    NASA Astrophysics Data System (ADS)

    Nandhakumar, N.; Smith, Philip W.

    1993-12-01

    In order for the EVAHR robot to autonomously track and grasp objects, its vision system must be able to determine the 3-D structure and motion of an object from a sequence of sensory images. This task is accomplished by the use of a laser radar range sensor which provides dense range maps of the scene. Unfortunately, the currently available laser radar range cameras use a sequential scanning approach which complicates image analysis. Although many algorithms have been developed for recognizing objects from range images, none are suited for use with single beam, scanning, time-of-flight sensors because all previous algorithms assume instantaneous acquisition of the entire image. This assumption is invalid since the EVAHR robot is equipped with a sequential scanning laser range sensor. If an object is moving while being imaged by the device, the apparent structure of the object can be significantly distorted due to the significant non-zero delay time between sampling each image pixel. If an estimate of the motion of the object can be determined, this distortion can be eliminated; but, this leads to the motion-structure paradox - most existing algorithms for 3-D motion estimation use the structure of objects to parameterize their motions. The goal of this research is to design a rigid-body motion recovery technique which overcomes this limitation. The method being developed is an iterative, linear, feature-based approach which uses the non-zero image acquisition time constraint to accurately recover the motion parameters from the distorted structure of the 3-D range maps. Once the motion parameters are determined, the structural distortion in the range images is corrected.

  18. Determining the 3-D structure and motion of objects using a scanning laser range sensor

    NASA Technical Reports Server (NTRS)

    Nandhakumar, N.; Smith, Philip W.

    1993-01-01

    In order for the EVAHR robot to autonomously track and grasp objects, its vision system must be able to determine the 3-D structure and motion of an object from a sequence of sensory images. This task is accomplished by the use of a laser radar range sensor which provides dense range maps of the scene. Unfortunately, the currently available laser radar range cameras use a sequential scanning approach which complicates image analysis. Although many algorithms have been developed for recognizing objects from range images, none are suited for use with single beam, scanning, time-of-flight sensors because all previous algorithms assume instantaneous acquisition of the entire image. This assumption is invalid since the EVAHR robot is equipped with a sequential scanning laser range sensor. If an object is moving while being imaged by the device, the apparent structure of the object can be significantly distorted due to the significant non-zero delay time between sampling each image pixel. If an estimate of the motion of the object can be determined, this distortion can be eliminated; but, this leads to the motion-structure paradox - most existing algorithms for 3-D motion estimation use the structure of objects to parameterize their motions. The goal of this research is to design a rigid-body motion recovery technique which overcomes this limitation. The method being developed is an iterative, linear, feature-based approach which uses the non-zero image acquisition time constraint to accurately recover the motion parameters from the distorted structure of the 3-D range maps. Once the motion parameters are determined, the structural distortion in the range images is corrected.

  19. Structure and method for controlling the thermal emissivity of a radiating object

    DOEpatents

    DeSteese, John G.; Antoniak, Zenen I.; White, Michael; Peters, Timothy J.

    2004-03-30

    A structure and method for changing or controlling the thermal emissivity of the surface of an object in situ, and thus, changing or controlling the radiative heat transfer between the object and its environment in situ, is disclosed. Changing or controlling the degree of blackbody behavior of the object is accomplished by changing or controlling certain physical characteristics of a cavity structure on the surface of the object. The cavity structure, defining a plurality of cavities, may be formed by selectively removing material(s) from the surface, selectively adding a material(s) to the surface, or adding an engineered article(s) to the surface to form a new radiative surface. The physical characteristics of the cavity structure that are changed or controlled include cavity area aspect ratio, cavity longitudinal axis orientation, and combinations thereof. Controlling the cavity area aspect ratio may be by controlling the size of the cavity surface area, the size of the cavity aperture area, or a combination thereof. The cavity structure may contain a gas, liquid, or solid that further enhances radiative heat transfer control and/or improves other properties of the object while in service.

  20. The challenge of objective scar colour assessment in a clinical setting: using digital photography.

    PubMed

    Anderson, J C; Hallam, M-J; Nduka, C; Osorio, D

    2015-08-01

    Scar assessment in the clinical setting is typically impeded by a lack of quantitative data and most systems rely on subjective rating scales which are user dependant and show considerable variability between raters. The growing use of digital photography in medicine suggests a more objective approach to scar evaluation. Our objective was to determine if cameras could be of practical use for measuring colour in a clinical setting. The measurement of colour and reflectance spectra in photographs faces two difficulties: firstly the effects of variable illumination spectra, and secondly to recover accurate colour and spectral information from the sparse red, green and blue (RGB) camera signals. As a result the colour rendition is often inaccurate, and spectral information is lost. To deal with variable illumination and other factors that systematically affect all reflectance spectra ColourWorker (a method for image-based colour measurement implemented in software) calibrates the spectral responses of the camera's RGB sensors using a colour standard in the image. To make best use of the calibrated signals, it takes advantage of the fact that although a given RGB signal can be caused by an infinite number of spectra, most natural reflectance spectra vary smoothly and have predictable forms. This means given a set of examples of spectra produced by the materials of interest, it is possible to estimate the specific spectrum that produced a given RGB signal once corrected for the illumination. We describe a method for recovering spectral and chromatic information relating to surface reflectance from ordinary digital images and apply this to analyse photographs of surgical scars, taken as part of a clinical trial, in an attempt to better quantify clinical scar assessment. It should be noted the pre-existing trial protocol did not allow for a comprehensive evaluation of the accuracy of the method which would require the spectrophotometric measurement of skin regions

  1. Comparison of trends in sepsis incidence and coding using administrative claims versus objective clinical data.

    PubMed

    Rhee, Chanu; Murphy, Michael V; Li, Lingling; Platt, Richard; Klompas, Michael

    2015-01-01

    National reports of a dramatic rise in sepsis incidence are largely based on analyses of administrative databases. It is unclear if these estimates are biased by changes in coding practices over time. We calculated linear trends in the annual incidence of septicemia, sepsis, and severe sepsis at 2 academic hospitals from 2003 to 2012 using 5 different claims methods and compared case identification rates to selected objective clinical markers, including positive blood cultures, vasopressors, and/or lactic acid levels. The annual incidence of hospitalizations with sepsis claims increased over the decade, ranging from a 54% increase for the method combining septicemia, bacteremia, and fungemia codes (P < .001 for linear trend) to a 706% increase for explicit severe sepsis/septic shock codes (P = .001). In contrast, the incidence of hospitalizations with positive blood cultures decreased by 17% (P = .006), and hospitalizations with positive blood cultures with concurrent vasopressors and/or lactic acidosis remained stable (P = .098). The sensitivity of sepsis claims for capturing hospitalizations with positive blood cultures with concurrent vasopressors and/or lactic acidosis increased (P < .001 for all methods), whereas the proportion of septicemia hospitalizations with positive blood cultures decreased from 50% to 30% (P < .001). The incidence of hospitalizations with sepsis codes rose dramatically while hospitalizations with corresponding objective clinical markers remained stable or decreased. Coding for sepsis has become more inclusive, and septicemia diagnoses are increasingly being applied to patients without positive blood cultures. These changes likely explain some of the apparent rise in sepsis incidence and underscore the need for more reliable surveillance methods. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  2. Comparison of Trends in Sepsis Incidence and Coding Using Administrative Claims Versus Objective Clinical Data

    PubMed Central

    Rhee, Chanu; Murphy, Michael V.; Li, Lingling; Platt, Richard; Klompas, Michael

    2015-01-01

    Background. National reports of a dramatic rise in sepsis incidence are largely based on analyses of administrative databases. It is unclear if these estimates are biased by changes in coding practices over time. Methods. We calculated linear trends in the annual incidence of septicemia, sepsis, and severe sepsis at 2 academic hospitals from 2003 to 2012 using 5 different claims methods and compared case identification rates to selected objective clinical markers, including positive blood cultures, vasopressors, and/or lactic acid levels. Results. The annual incidence of hospitalizations with sepsis claims increased over the decade, ranging from a 54% increase for the method combining septicemia, bacteremia, and fungemia codes (P < .001 for linear trend) to a 706% increase for explicit severe sepsis/septic shock codes (P = .001). In contrast, the incidence of hospitalizations with positive blood cultures decreased by 17% (P = .006), and hospitalizations with positive blood cultures with concurrent vasopressors and/or lactic acidosis remained stable (P = .098). The sensitivity of sepsis claims for capturing hospitalizations with positive blood cultures with concurrent vasopressors and/or lactic acidosis increased (P < .001 for all methods), whereas the proportion of septicemia hospitalizations with positive blood cultures decreased from 50% to 30% (P < .001). Conclusions. The incidence of hospitalizations with sepsis codes rose dramatically while hospitalizations with corresponding objective clinical markers remained stable or decreased. Coding for sepsis has become more inclusive, and septicemia diagnoses are increasingly being applied to patients without positive blood cultures. These changes likely explain some of the apparent rise in sepsis incidence and underscore the need for more reliable surveillance methods. PMID:25258352

  3. Habit Reversal versus Object Manipulation Training for Treating Nail Biting: A Randomized Controlled Clinical Trial

    PubMed Central

    Ghanizadeh, Ahmad; Bazrafshan, Amir; Dehbozorgi, Gholamreza

    2013-01-01

    Objective This is a parallel, three group, randomized, controlled clinical trial, with outcomes evaluated up to three months after randomization for children and adolescents with chronic nail biting. The current study investigates the efficacy of habit reversal training (HRT) and compares its effect with object manipulation training (OMT) considering the limitations of the current literature. Method Ninety one children and adolescents with nail biting were randomly allocated to one of the three groups. The three groups were HRT (n = 30), OMT (n = 30), and wait-list or control group (n = 31). The mean length of nail was considered as the main outcome. Results The mean length of the nails after one month in HRT and OMT groups increased compared to the waiting list group (P < 0.001, P < 0.001, respectively). In long term, both OMT and HRT increased the mean length of nails (P < 0.01), but HRT was more effective than OMT (P < 0.021). The parent-reported frequency of nail biting did show similar results as to the mean length of nails assessment in long term. The number of children who completely stopped nail biting in HRT and OMT groups during three months was 8 and 7, respectively. This number was zero during one month for the wait-list group. Conclusion This trial showed that HRT is more effective than wait-list and OMT in increasing the mean length of nails of children and adolescents in long terms. PMID:24130603

  4. Objective measurement of two clinical signs in childhood atopic eczema in research and therapeutics.

    PubMed

    Hon, Kam Lun; Luk, Chi Kong David; Tsang, Yin Ching; Pong, Nga Hin; Leung, Ting Fan

    2017-02-01

    Atopic dermatitis (AD) or eczema is an inflammatory skin disease associated with significant impairment of quality of life. It is important to objectively quantify cutaneous biophysical measurements in research and therapeutics of this disease. To evaluate if skin redness (erythema) and pigmentation (melanin) correlate with disease severity and quality of life. Redness and pigmentation were measured under standardized condition at the antecubital flexure. Nottingham Eczema Severity Score (NESS) and Children's Dermatology Life Quality Index (CDLQI) were documented. Pigmentation correlated with age (r = 0.38, p = 0.02), but not with disease severity (NESS) or quality of life (CDLQI). Erythema correlated with age (r = 0.53, p = 0.001), NESS (r = 0.44, p = 0.006), pigmentation (r = 0.62, p< 0.0001), but not CDLQI (r = 0.3, trend p = 0.087). Skin erythema and pigmentation increase with age. Erythema correlates with disease severity but pigmentation correlates with neither severity nor quality-of-life score. The objective measurement of these two signs does not replace the clinical measurements of severity and quality of life, and may be of limited scope in eczema research and therapeutics.

  5. [Clinical research for rectal carcinoma: State of the art and objectives].

    PubMed

    Maingon, P; Simon, J-M; Canova, C-H; Troussier, I; Besson, N; Caillot, É; Huguet, F

    2017-10-01

    The treatment of rectal carcinoma is based on multidisciplinary strategy and multimodal approaches including gastrointestinal tract specialists, medical oncologists, radiation oncologists and surgery. The different objectives should be declined according to the characteristics of the tumours. The aim of the therapist would be to select the best strategy offering to the patient to be cured with as less as possible late adverse toxicity. The challenge of the treatment of small tumours is to maintain a functional anal sphincter while minimizing the risk of local recurrence. The standard treatment of locally advanced disease is aiming firstly to cure the patient and secondly to prevent late complications. Each of these clinical presentations of the disease has to be considered as a whole taking into account the new surgical techniques and a personalized approach adapted to the tumour. Nowadays they should be studied with dedicated clinical trials. Copyright © 2017 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  6. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy.

    PubMed

    Gherman; Goodwin; Leung; Byrne; Montoro

    1998-07-01

    Objective: To determine the incidence, timing, and associated clinical characteristics of objectively diagnosed pregnancy-associated venous thromboembolism (VTE).Methods: A retrospective review of VTE cases occurring between 1978 and 1996 was performed. Cases of deep venous thrombosis (DVT) and pulmonary embolism (PE) were identified by ICD-9 discharge diagnosis code and review of antepartum and coagulation laboratory databases. Study inclusion criteria required the objective diagnosis of VTE with either Doppler ultrasound, impedance plethysmography, pulmonary angiography, ventilation-perfusion scanning, or CT/MRI.Results: Among 268,525 deliveries there were 165 (0.06%) episodes of VTE (1/1627 births). There were 127 cases of DVT and 38 cases of PE. Only 14% (23/165) had a prior history of DVT or PE. Most DVTs occurred in the left leg (104/127, 81.9%). Nearly three quarters of the DVTs (95/127, 74.8%) occurred in the antepartum period. Among the antepartum DVT cases, half were detected prior to 15 weeks of gestation (47/95, 49.5%), with only 28 cases occurring after 20 weeks (P <.0001). The majority of the PEs occurred in the postpartum period (23/38, 60.5%). There were only 3 maternal deaths due to PE, all associated with cesarean section. Only 1 patient developed PE while on heparin therapy for DVT while 11 others had complications attributable to heparin use.Conclusion: Most pregnancy-related VTE occurs in the antepartum period. The risk of deep venous thrombosis appears to begin early in pregnancy, even before the second trimester. The highest risk period for pulmonary embolism is after cesarean delivery. Maternal complications of heparin anticoagulation during pregnancy are rare.

  7. Complex Network Clustering by a Multi-objective Evolutionary Algorithm Based on Decomposition and Membrane Structure

    NASA Astrophysics Data System (ADS)

    Ju, Ying; Zhang, Songming; Ding, Ningxiang; Zeng, Xiangxiang; Zhang, Xingyi

    2016-09-01

    The field of complex network clustering is gaining considerable attention in recent years. In this study, a multi-objective evolutionary algorithm based on membranes is proposed to solve the network clustering problem. Population are divided into different membrane structures on average. The evolutionary algorithm is carried out in the membrane structures. The population are eliminated by the vector of membranes. In the proposed method, two evaluation objectives termed as Kernel J-means and Ratio Cut are to be minimized. Extensive experimental studies comparison with state-of-the-art algorithms proves that the proposed algorithm is effective and promising.

  8. Complex Network Clustering by a Multi-objective Evolutionary Algorithm Based on Decomposition and Membrane Structure

    PubMed Central

    Ju, Ying; Zhang, Songming; Ding, Ningxiang; Zeng, Xiangxiang; Zhang, Xingyi

    2016-01-01

    The field of complex network clustering is gaining considerable attention in recent years. In this study, a multi-objective evolutionary algorithm based on membranes is proposed to solve the network clustering problem. Population are divided into different membrane structures on average. The evolutionary algorithm is carried out in the membrane structures. The population are eliminated by the vector of membranes. In the proposed method, two evaluation objectives termed as Kernel J-means and Ratio Cut are to be minimized. Extensive experimental studies comparison with state-of-the-art algorithms proves that the proposed algorithm is effective and promising. PMID:27670156

  9. Membrane structure active flatness control using genetic algorithm with online objective reweighting

    NASA Astrophysics Data System (ADS)

    Orszulik, Ryan; Shan, Jinjun; Stachowsky, Michael

    2011-06-01

    This paper presents experimental studies on active flatness control of a membrane structure using genetic algorithm (GA). Different from the previous algorithms with a single objective function, a genetic algorithm with online objective reweighting capability is proposed here. This genetic algorithm implements an objective function that re-weights its objective online and the objective function is the flatness plus tension. The goal of the reweighting genetic algorithm is to allow for a computationally efficient method by which membrane wrinkling can be reduced, while maintaining a consideration for control authority. Experiments are conducted on our membrane test facility with two implementations: a static mutation rate and an adaptive mutation rate. The experimental results show that the proposed genetic algorithm is able to converge on flatness while reducing the total amount of tension required.

  10. Factor structure of the Spanish version of the Object-Spatial Imagery and Verbal Questionnaire.

    PubMed

    Campos, Alfredo; Pérez-Fabello, María José

    2011-04-01

    The reliability and factor structure of the Spanish version of the Object-Spatial Imagery and Verbal Questionnaire (OSIVQ) were assessed in a sample of 213 Spanish university graduates. The questionnaire measures three types of processing preferences (verbal, object imagery, and spatial imagery). Principal components analysis with varimax rotation identified three factors, corresponding to the three scales proposed in the original version, explaining 33.1% of the overall variance. Cronbach's alphas were .72, .77, and .81 for the verbal, object imagery, and spatial imagery scales, respectively.

  11. Cryo-EM structure of a 3D DNA-origami object

    PubMed Central

    Bai, Xiao-chen; Martin, Thomas G.; Scheres, Sjors H. W.; Dietz, Hendrik

    2012-01-01

    A key goal for nanotechnology is to design synthetic objects that may ultimately achieve functionalities known today only from natural macromolecular complexes. Molecular self-assembly with DNA has shown potential for creating user-defined 3D scaffolds, but the level of attainable positional accuracy has been unclear. Here we report the cryo-EM structure and a full pseudoatomic model of a discrete DNA object that is almost twice the size of a prokaryotic ribosome. The structure provides a variety of stable, previously undescribed DNA topologies for future use in nanotechnology and experimental evidence that discrete 3D DNA scaffolds allow the positioning of user-defined structural motifs with an accuracy that is similar to that observed in natural macromolecules. Thereby, our results indicate an attractive route to fabricate nanoscale devices that achieve complex functionalities by DNA-templated design steered by structural feedback. PMID:23169645

  12. Active marks structure optimization for optical-electronic systems of spatial position control of industrial objects

    NASA Astrophysics Data System (ADS)

    Sycheva, Elena A.; Vasilev, Aleksandr S.; Lashmanov, Oleg U.; Korotaev, Valery V.

    2017-06-01

    The article is devoted to the optimization of optoelectronic systems of the spatial position of objects. Probabilistic characteristics of the detection of an active structured mark on a random noisy background are investigated. The developed computer model and the results of the study allow us to estimate the probabilistic characteristics of detection of a complex structured mark on a random gradient background, and estimate the error of spatial coordinates. The results of the study make it possible to improve the accuracy of measuring the coordinates of the object. Based on the research recommendations are given on the choice of parameters of the optimal mark structure for use in opticalelectronic systems for monitoring the spatial position of large-sized structures.

  13. Motion perception induced by dynamic grouping: a probe for the compositional structure of objects.

    PubMed

    Hock, Howard S; Nichols, David F

    2012-04-15

    A new method is described for determining how the visual system resolves ambiguities in the compositional structure of multi-surface objects; i.e., how the surfaces of objects are grouped together to form a hierarchical structure. The method entails dynamic grouping motion, a high level process in which changes in a surface (e.g., increases or decreases in its luminance, hue or texture) transiently perturb its affinity with adjacent surfaces. Affinity is determined by the combined effects of Gestalt and other grouping variables in indicating that a pair of surfaces forms a subunit within an object's compositional structure. Such pre-perturbation surface groupings are indicated by the perception of characteristic motions across the changing surface. When the affinity of adjacent surfaces is increased by a dynamic grouping variable, their grouping is transiently strengthened; the perceived motion is away from their boundary. When the affinity of adjacent surfaces is decreased, their grouping is transiently weakened; the perceived motion is toward the surfaces' boundary. It is shown that the affinity of adjacent surfaces depends on the nonlinear, super-additive combination of affinity values ascribable to individual grouping variables, and the effect of dynamic grouping variables on motion perception depends on the prior, pre-perturbation affinity state of the surfaces. It is proposed that affinity-based grouping of an object's surfaces must be consistent with the activation of primitive three-dimensional object components in order for the object to be recognized. Also discussed is the potential use of dynamic grouping for determining the compositional structure of multi-object scenes. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Multi-objective optimization for RNA design with multiple target secondary structures.

    PubMed

    Taneda, Akito

    2015-09-03

    RNAs are attractive molecules as the biological parts for synthetic biology. In particular, the ability of conformational changes, which can be encoded in designer RNAs, enables us to create multistable molecular switches that function in biological circuits. Although various algorithms for designing such RNA switches have been proposed, the previous algorithms optimize the RNA sequences against the weighted sum of objective functions, where empirical weights among objective functions are used. In addition, an RNA design algorithm for multiple pseudoknot targets is currently not available. We developed a novel computational tool for automatically designing RNA sequences which fold into multiple target secondary structures. Our algorithm designs RNA sequences based on multi-objective genetic algorithm, by which we can explore the RNA sequences having good objective function values without empirical weight parameters among the objective functions. Our algorithm has great flexibility by virtue of this weight-free nature. We benchmarked our multi-target RNA design algorithm with the datasets of two, three, and four target structures and found that our algorithm shows better or comparable design performances compared with the previous algorithms, RNAdesign and Frnakenstein. In addition to the benchmarks with pseudoknot-free datasets, we benchmarked MODENA with two-target pseudoknot datasets and found that MODENA can design the RNAs which have the target pseudoknotted secondary structures whose free energies are close to the lowest free energy. Moreover, we applied our algorithm to a ribozyme-based ON-switch which takes a ribozyme-inactive secondary structure when the theophylline aptamer structure is assumed. Currently, MODENA is the only RNA design software which can be applied to multiple pseudoknot targets. Successful design results for the multiple targets and an RNA device indicate usefulness of our multi-objective RNA design algorithm.

  15. Measurement of object structure from size-encoded images generated by optically-implemented Gabor filters.

    PubMed

    Sierra, Heidy; Zheng, Jing-Yi; Rabin, Bryan; Boustany, Nada N

    2012-12-17

    We use optical Fourier processing based on two dimensional (2D) Gabor filters to obtain size-encoded images which depict with 20nm sensitivity to size while preserving a 0.36μm spatial resolution, the spatial distribution of structural features within transparent objects. The size of the object feature measured at each pixel in the encoded image is determined by the optimal Gabor filter period, S(max), that maximizes the scattering signal from that location in the object. We show that S(max) (in μm) depends linearly on feature size (also in μm) over a size range from 0.11μm to 2μm. This linear response remains largely unchanged when the refractive index ratio is varied and can be predicted from numerical simulations of Gabor-filtered light scattering. Pixel histograms of the size-encoded images of isolated spheres and diatoms were used to generate highly resolved size distributions ("size spectra") exhibiting sharp peaks characterizing the known major structural features within the studied objects. Dynamic signal associated with changes in selected feature sizes within living cells is also demonstrated. Taken together, our data suggest that a label-free, direct and objective measurement of sample structure is enabled by the size-encoded images and associated pixel histograms generated from a calibrated optical processing microscope based on Gabor filtering.

  16. A Trial of the Objective Structured Practical Examination in Physiology at Melaka Manipal Medical College, India

    ERIC Educational Resources Information Center

    Abraham, Reem Rachel; Raghavendra, Rao; Surekha, Kamath; Asha, Kamath

    2009-01-01

    A single examination does not fulfill all the functions of assessment. The present study was undertaken to determine the reliability and student satisfaction regarding the objective structured practical examination (OSPE) as a method of assessment of laboratory exercises in physiology before implementing it in the forthcoming university…

  17. A Performance Test of a Curriculum Guides Using Behavioral Objectives and Structural Sequencing. Final Report.

    ERIC Educational Resources Information Center

    Smith, James C., Jr.; Crittenden, William B.

    This document describes a project designed to test the effectiveness of an elementary school music curriculum guide that contained behavioral objectives and structural sequencing compared to a "traditional" guide. More than 3200 5th and 6th grade pupils taught by 56 teachers in the Houston, Texas, Independent School District participated in the…

  18. Seeing an Exercise as a Single Mathematical Object: Using Variation to Structure Sense-Making

    ERIC Educational Resources Information Center

    Watson, Anne; Mason, John

    2006-01-01

    In this theoretical article, we take an exercise to be a collection of procedural questions or tasks. It can be useful to treat such an exercise as a single object, with individual questions seen as elements in a mathematically and pedagogically structured set. We use the notions of dimensions of possible variation and range of permissible change,…

  19. Design and Development of an Objective, Structured Management Examinations (OSMEs) on Management Skills among Pharmacy Students

    ERIC Educational Resources Information Center

    Augustine, Jill

    2016-01-01

    The purpose of this study was to design, develop, and administer an Objective, Structured Management Exam (OSME) on management skills for pharmacy students. Pharmacy preceptors for the University of Arizona College of Pharmacy participated in focus groups that identified business, management, and human resource skills needed by pharmacy graduates.…

  20. 48 CFR 353.370-674 - Form HHS 674, Structured Approach Profit/Fee Objective.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Form HHS 674, Structured Approach Profit/Fee Objective. 353.370-674 Section 353.370-674 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CLAUSES AND FORMS FORMS Illustrations of Forms 353.370-674 Form HHS...

  1. 48 CFR 353.370-674 - Form HHS 674, Structured Approach Profit/Fee Objective.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Form HHS 674, Structured Approach Profit/Fee Objective. 353.370-674 Section 353.370-674 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CLAUSES AND FORMS FORMS Illustrations of Forms 353.370-674 Form HHS...

  2. 48 CFR 353.370-674 - Form HHS 674, Structured Approach Profit/Fee Objective.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Form HHS 674, Structured Approach Profit/Fee Objective. 353.370-674 Section 353.370-674 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CLAUSES AND FORMS FORMS Illustrations of Forms 353.370-674 Form HHS...

  3. Validation of an Objective Structured Assessment of Technical Skill for Surgical Residents.

    ERIC Educational Resources Information Center

    Faulkner, Heather; And Others

    1996-01-01

    Examined the concurrent validity of the Objective Structured Assessment of Technical Skill (OSATS), a new test of technical skills for general surgery residents. Correlations between OSATS scores and faculty rankings were generally high for six senior residents but low for six junior residents at the University of Toronto. (MDM)

  4. Design and Development of an Objective, Structured Management Examinations (OSMEs) on Management Skills among Pharmacy Students

    ERIC Educational Resources Information Center

    Augustine, Jill

    2016-01-01

    The purpose of this study was to design, develop, and administer an Objective, Structured Management Exam (OSME) on management skills for pharmacy students. Pharmacy preceptors for the University of Arizona College of Pharmacy participated in focus groups that identified business, management, and human resource skills needed by pharmacy graduates.…

  5. A Trial of the Objective Structured Practical Examination in Physiology at Melaka Manipal Medical College, India

    ERIC Educational Resources Information Center

    Abraham, Reem Rachel; Raghavendra, Rao; Surekha, Kamath; Asha, Kamath

    2009-01-01

    A single examination does not fulfill all the functions of assessment. The present study was undertaken to determine the reliability and student satisfaction regarding the objective structured practical examination (OSPE) as a method of assessment of laboratory exercises in physiology before implementing it in the forthcoming university…

  6. Orientation estimation of anatomical structures in medical images for object recognition

    NASA Astrophysics Data System (ADS)

    Bağci, Ulaş; Udupa, Jayaram K.; Chen, Xinjian

    2011-03-01

    Recognition of anatomical structures is an important step in model based medical image segmentation. It provides pose estimation of objects and information about "where" roughly the objects are in the image and distinguishing them from other object-like entities. In,1 we presented a general method of model-based multi-object recognition to assist in segmentation (delineation) tasks. It exploits the pose relationship that can be encoded, via the concept of ball scale (b-scale), between the binary training objects and their associated grey images. The goal was to place the model, in a single shot, close to the right pose (position, orientation, and scale) in a given image so that the model boundaries fall in the close vicinity of object boundaries in the image. Unlike position and scale parameters, we observe that orientation parameters require more attention when estimating the pose of the model as even small differences in orientation parameters can lead to inappropriate recognition. Motivated from the non-Euclidean nature of the pose information, we propose in this paper the use of non-Euclidean metrics to estimate orientation of the anatomical structures for more accurate recognition and segmentation. We statistically analyze and evaluate the following metrics for orientation estimation: Euclidean, Log-Euclidean, Root-Euclidean, Procrustes Size-and-Shape, and mean Hermitian metrics. The results show that mean Hermitian and Cholesky decomposition metrics provide more accurate orientation estimates than other Euclidean and non-Euclidean metrics.

  7. Differential visualisation of a spectrally selective structure of strongly scattering objects

    SciTech Connect

    Kuratov, A S; Rudenko, V N; Shuvalov, V V

    2014-07-31

    We describe a modification of the algorithm for the fast approximate solution of the diffuse optical tomography inverse problem. In this modification the amount of a priori (auxiliary) information necessary for the visualisation of the internal structure of the object is reduced by using a differential measurement scheme. The experiment is performed at two different wavelengths, and some a priori information, necessary to reconstruct only the spectrally selective component of the internal structure (the difference structure of the spatial distributions of the extinction coefficient at the wavelength employed), is replaced by the data of one of these measurements. (laser biophotonics)

  8. Radiation dose of CT coronary angiography in clinical practice: objective evaluation of strategies for dose optimization.

    PubMed

    Yerramasu, Ajay; Venuraju, Shreenidhi; Atwal, Satvir; Goodman, Dennis; Lipkin, David; Lahiri, Avijit

    2012-07-01

    CT coronary angiography (CTCA) is an evolving modality for the diagnosis of coronary artery disease. Radiation burden associated with CTCA has been a major concern in the wider application of this technique. It is important to reduce the radiation dose without compromising the image quality. To estimate the radiation dose of CTCA in clinical practice and evaluate the effect of dose-saving algorithms on radiation dose and image quality. Effective radiation dose was measured from the dose-length product in 616 consecutive patients (mean age 58 ± 12 years; 70% males) who underwent clinically indicated CTCA at our institution over 1 year. Image quality was assessed subjectively using a 4-point scale and objectively by measuring the signal- and contrast-to-noise ratios in the coronary arteries. Multivariate linear regression analysis was used to identify factors independently associated with radiation dose. Mean effective radiation dose of CTCA was 6.6 ± 3.3 mSv. Radiation dose was significantly reduced by dose saving algorithms such as 100 kV imaging (-47%; 95% CI, -44% to -50%), prospective gating (-35%; 95% CI, -29% to -40%) and ECG controlled tube current modulation (-23%; 95% CI, -9% to -34%). None of the dose saving algorithms were associated with a significant reduction in mean image quality or the frequency of diagnostic scans (P = non-significant for all comparisons). Careful application of radiation-dose saving algorithms in appropriately selected patients can reduce the radiation burden of CTCA significantly, without compromising the image quality. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  9. Clinical application of objective perimetry using multifocal visual evoked potentials in glaucoma practice.

    PubMed

    Graham, Stuart L; Klistorner, Alexander I; Goldberg, Ivan

    2005-06-01

    To evaluate the role of objective perimetry using multifocal visual evoked potentials (mVEPs) in glaucoma practice, and to assess its utility in patients with inconclusive standard automated perimetry findings. Method A retrospective case series of 436 consecutive subjects referred for glaucoma investigation who underwent testing with the AccuMap V1.3 mVEP system (ObjectiVision Pty, Ltd, Sydney, New South Wales, Australia) within a defined 12-month period. Sensitivity was determined by comparing this testing with that of standard automated perimetry and that used in a subgroup in whom masked stereoscopic optic disc photographs were used as an alternative reference standard. Overall clinical diagnostic outcomes were assessed. The mVEP changes were correlated with the stage of disease and Humphrey mean deviation (r = 0.78). The overall sensitivity for detecting glaucoma with established subjective field loss was 97.5% (early glaucoma, 95.0%), whereas 92.2% of low-risk suspects had normal mVEPs. When masked disc assessment alone was used for diagnosis of abnormality, sensitivity of mVEP (80.6%) and Humphrey visual field results (81.9%) were similar, but mVEP specificity was better (89.2% vs 79.5%). The mVEP was particularly useful in assessing excessive subjective field loss (45 eyes) by showing a much closer correlation with the clinical picture. Multifocal VEP is an effective method for detecting visual field loss in glaucoma. It provides a valuable aid to the clinician in categorizing patients with unreliable, variable, unconfirmed, or excessive subjective field loss.

  10. Clinical validity of Fuld Object Memory Evaluation to screen for dementia in a Chinese society.

    PubMed

    Chung, Jenny C C

    2009-02-01

    Fuld Object Memory Evaluation (FOME) evaluates the episodic memory functions of encoding, storage, and recall across five recall trials and a delayed recall trial. This study examined the clinical validity of FOME as a screening tool for dementia in older Chinese adults. The psychometric properties and the discriminative power of FOME were examined in a convenience sample of 192 community-dwelling older individuals, of which 57 were diagnosed with dementia. The influence of age and education on the FOME performance was also estimated. The test-retest reliability and parallel-form reliability of FOME were excellent, with Intraclass Correlation Coefficients ranging from 0.91-0.96. Good convergent validity of FOME was established with Mini-Mental State Examination (r(p) = 0.69-0.74), and the Memory subscale and the Initiation/Perseveration subscale of Dementia Rating Scale (r(p) = 0.63-0.74). The FOME total retrieval (TR) score and delayed recall (DR) score demonstrated good discriminative power in differentiating dementia from normal cognitive functioning, with area under the curve values of 0.97 and 0.93 respectively. The optimal cut-off scores suggested for TR and DR were 31 (93% sensitivity, 90 specificity) and 7 (91% sensitivity, 82% specificity), respectively. The performance of the FOME was not influenced by the educational level. The results suggest that the FOME is a reliable and valid instrument to screen for dementia in older community-dwelling Chinese adults. The absence of the effects of education on the assessment performance makes FOME a clinically useful instrument for older adults with limited education. (c) 2008 John Wiley & Sons, Ltd.

  11. Data-Driven Hierarchical Structure Kernel for Multiscale Part-Based Object Recognition

    PubMed Central

    Wang, Botao; Xiong, Hongkai; Jiang, Xiaoqian; Zheng, Yuan F.

    2017-01-01

    Detecting generic object categories in images and videos are a fundamental issue in computer vision. However, it faces the challenges from inter and intraclass diversity, as well as distortions caused by viewpoints, poses, deformations, and so on. To solve object variations, this paper constructs a structure kernel and proposes a multiscale part-based model incorporating the discriminative power of kernels. The structure kernel would measure the resemblance of part-based objects in three aspects: 1) the global similarity term to measure the resemblance of the global visual appearance of relevant objects; 2) the part similarity term to measure the resemblance of the visual appearance of distinctive parts; and 3) the spatial similarity term to measure the resemblance of the spatial layout of parts. In essence, the deformation of parts in the structure kernel is penalized in a multiscale space with respect to horizontal displacement, vertical displacement, and scale difference. Part similarities are combined with different weights, which are optimized efficiently to maximize the intraclass similarities and minimize the interclass similarities by the normalized stochastic gradient ascent algorithm. In addition, the parameters of the structure kernel are learned during the training process with regard to the distribution of the data in a more discriminative way. With flexible part sizes on scale and displacement, it can be more robust to the intraclass variations, poses, and viewpoints. Theoretical analysis and experimental evaluations demonstrate that the proposed multiscale part-based representation model with structure kernel exhibits accurate and robust performance, and outperforms state-of-the-art object classification approaches. PMID:24808345

  12. The radio structure source of X-ray-selected BL Lacertae objects

    NASA Technical Reports Server (NTRS)

    Perlman, Eric S.; Stocke, John T.

    1993-01-01

    Arcsecond-size radio structure for a complete sample of 14 X-ray-selected BL Lac objects (XBLs) from the Einstein Extended Medium-Sensitivity Survey is presented. Most objects possess radio morphologies which are similar to those of nearby Fanaroff-Riley type 1 (FR 1) radio galaxies once the effects of surface brightness dimming and beam dilution as a function of redshift are taken into account. In order to test the beamed FR 1 hypothesis for BL Lac objects, the core and extended power levels are determined for these sources and compared with samples of radio-selected BL Lac objects (RBLs) and FR 1 from galaxies from the literature. RBLs and XBLs are found to possess extended (and thus unbeamed) power levels and the largest angular sizes similar to those of the FR 1 galaxies both supporting the beaming hypothesis and a common parent population for XBLs and RBLs.

  13. Dynamic structured illumination microscopy: Focused imaging and optical sectioning for moving objects

    NASA Astrophysics Data System (ADS)

    Krzewina, Leo G.; Kim, Myung K.

    2006-02-01

    Structured illumination microscopy (SIM) is a valuable tool for three-dimensional microscopy and has numerous applications in bioscience. Its success has been limited to static objects, though, as three sequential image acquisitions are required per final processed, focused image. To overcome this problem we have developed a multicolored grid which when used in tandem with a color camera is capable of performing SIM with just a single exposure. Images and movies demonstrating optical sectioning of three-dimensional objects are presented, and results of applying color SIM for wide-field focused imaging are compared to those of SIM. From computer modeling and analytical calculations a theoretical estimate of the maximum observable object velocity in both the lateral and axial directions is available, implying that the new method will be capable of imaging a variety of live objects. Sample images of the technique applied to lens paper and a pigeon feather are included to show both advantages and disadvantages of CSIM.

  14. Determination of the object surface function by structured light: application to the study of spinal deformities

    NASA Astrophysics Data System (ADS)

    Buendía, M.; Salvador, R.; Cibrián, R.; Laguia, M.; Sotoca, J. M.

    1999-01-01

    The projection of structured light is a technique frequently used to determine the surface shape of an object. In this paper, a new procedure is described that efficiently resolves the correspondence between the knots of the projected grid and those obtained on the object when the projection is made. The method is based on the use of three images of the projected grid. In two of them the grid is projected over a flat surface placed, respectively, before and behind the object; both images are used for calibration. In the third image the grid is projected over the object. It is not reliant on accurate determination of the camera and projector pair relative to the grid and object. Once the method is calibrated, we can obtain the surface function by just analysing the projected grid on the object. The procedure is especially suitable for the study of objects without discontinuities or large depth gradients. It can be employed for determining, in a non-invasive way, the patient's back surface function. Symmetry differences permit a quantitative diagnosis of spinal deformities such as scoliosis.

  15. Inpainting for videos with dynamic objects using texture and structure reconstruction

    NASA Astrophysics Data System (ADS)

    Voronin, V. V.; Marchuk, V. I.; Gapon, N. V.; Zhuravlev, A. V.; Maslennikov, S.; Stradanchenko, S.

    2015-05-01

    This paper describes a novel inpainting approach for removing marked dynamic objects from videos captured with a camera, so long as the objects occlude parts of the scene with a static background. Proposed approach allow to remove objects or restore missing or tainted regions present in a video sequence by utilizing spatial and temporal information from neighboring scenes. The algorithm iteratively performs following operations: achieve frame; update the scene model; update positions of moving objects; replace parts of the frame occupied by the objects marked for remove with use of a background model. In this paper, we extend an image inpainting algorithm based texture and structure reconstruction by incorporating an improved strategy for video. An image inpainting approach based on the construction of a composite curve for the restoration of the edges of objects in a frame using the concepts of parametric and geometric continuity is presented. It is shown that this approach allows to restore the curved edges and provide more flexibility for curve design in damaged frame by interpolating the boundaries of objects by cubic splines. After edge restoration stage, a texture reconstruction using patch-based method is carried out. We demonstrate the performance of a new approach via several examples, showing the effectiveness of our algorithm and compared with state-of-the-art video inpainting methods.

  16. Association between students' personality traits and hand hygiene compliance during objective standardized clinical examinations.

    PubMed

    Schüttpelz-Brauns, K; Obertacke, U; Kaden, J; Hagl, C I

    2015-03-01

    Although the need for hand hygiene (HH) is generally accepted, studies continue to document inadequate compliance. Medical students are taught about the importance of HH to prevent nosocomial infections, and receive training in the correct procedures for HH. However, personality traits (social orientation and achievement orientation) may influence HH compliance. People with high social orientation feel socially responsible and act cooperatively, and people with high achievement orientation are ambitious and competitive. To evaluate the relationship between HH compliance and personality traits of medical students. The HH compliance of 155 students was observed during objective standardized clinical examinations (OSCEs). Social orientation and achievement orientation were measured using the corresponding scales of the Freiburg Personality Inventory - Revised. Social orientation did not differ between students with high HH compliance and students with low HH compliance [F(1) = 3.87, P = 0.052, η(2) = 0.045]. For achievement orientation, a moderate effect was found between low and high HH compliance [F(1) = 11.242, P = 0.001, η(2) = 0.119], and students with high HH compliance were found to be more achievement orientated than students with low HH compliance. Achievement orientation plays a major role during OSCEs, while social orientation is less emphasized. To the authors' knowledge, this is the first study to show that HH compliance is associated with achievement orientation in achievement situations. Copyright © 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  17. Team Objective Structured Bedside Assessment (TOSBA): a novel and feasible way of providing formative teaching and assessment.

    PubMed

    Miller, S D W; Butler, M W; Meagher, F; Costello, R W; McElvaney, N G

    2007-03-01

    It can be challenging to teach and assess medical students successfully in the setting of a hospital ward using real patients. We describe a novel method of providing weekly formative clinical assessment and teaching to final year students on an acute medical ward: The Team Objective Structured Bedside Assessment (TOSBA). The TOSBA involves three groups of five students rotating through three ward-based stations (each station consists of an inpatient and facilitator). Each group spends 25 minutes at a bedside station where the facilitator asks consecutive students to perform one of five clinical tasks. Every student receives a standardised grade and is provided with educational feedback at each of the three stations. We report our 15-month experience using the TOSBA format to assess and teach a large number of medical students on a weekly basis. We discuss the advantages and potential drawbacks of our approach.

  18. Object Classification in Semi Structured Enviroment Using Forward-Looking Sonar.

    PubMed

    Dos Santos, Matheus; Ribeiro, Pedro Otávio; Núñez, Pedro; Drews-Jr, Paulo; Botelho, Silvia

    2017-09-29

    The submarine exploration using robots has been increasing in recent years. The automation of tasks such as monitoring, inspection, and underwater maintenance requires the understanding of the robot's environment. The object recognition in the scene is becoming a critical issue for these systems. On this work, an underwater object classification pipeline applied in acoustic images acquired by Forward-Looking Sonar (FLS) are studied. The object segmentation combines thresholding, connected pixels searching and peak of intensity analyzing techniques. The object descriptor extract intensity and geometric features of the detected objects. A comparison between the Support Vector Machine, K-Nearest Neighbors, and Random Trees classifiers are presented. An open-source tool was developed to annotate and classify the objects and evaluate their classification performance. The proposed method efficiently segments and classifies the structures in the scene using a real dataset acquired by an underwater vehicle in a harbor area. Experimental results demonstrate the robustness and accuracy of the method described in this paper.

  19. Design of 3d Topological Data Structure for 3d Cadastre Objects

    NASA Astrophysics Data System (ADS)

    Zulkifli, N. A.; Rahman, A. Abdul; Hassan, M. I.

    2016-09-01

    This paper describes the design of 3D modelling and topological data structure for cadastre objects based on Land Administration Domain Model (LADM) specifications. Tetrahedral Network (TEN) is selected as a 3D topological data structure for this project. Data modelling is based on the LADM standard and it is used five classes (i.e. point, boundary face string, boundary face, tetrahedron and spatial unit). This research aims to enhance the current cadastral system by incorporating 3D topology model based on LADM standard.

  20. Structural damage identification with multi-objective DIRECT algorithm using natural frequencies and single mode shape

    NASA Astrophysics Data System (ADS)

    Cao, Pei; Yoo, David; Shuai, Qi; Tang, J.

    2017-04-01

    Structural damage identification has been continuously pursued in engineering practices to facilitate diagnosis and prognosis in structural health monitoring (SHM) systems. In SHM, the changes of modal parameters are frequently used as inputs. In this research, we employ the multiple damage location assurance criterion (MDLAC) to characterize the correlation between predictions of both frequency changes and single mode shape change with the measured data. The damage locations and severities can be obtained by maximizing the MDLAC values. Thereafter, a multi-objective optimization problem based on their MDLAC values can be formulated and optimized by applying a newly devised multi-objective DIRECT approach. The proposed approach offers practical attractions of only requiring a short amount of computational time, and the results are conclusive and repeatable.

  1. [Objective audiometry with DPOAEs : New findings for generation mechanisms and clinical applications. German version].

    PubMed

    Zelle, D; Dalhoff, E; Gummer, A W

    2016-11-01

    Distortion product otoacoustic emissions (DPOAEs) and transient evoked otoacoustic emissions (TEOAEs) are sound waves generated as byproducts of the cochlear amplifier. These are measurable in the auditory canal and represent an objective method for diagnosing functional disorders of the inner ear. Conventional DPOAE and TEOAE methods permit detection of hearing impairment, but with less than desirable accuracy. By accounting for DPOAE generation mechanisms, the aim is to improve the accuracy of inner-ear diagnosis. DPOAEs consist of two components, which emerge at different positions along the cochlea and which may cause artifacts due to mutual interference. Here, the two components are separated in the time domain using short stimulus pulses. Optimized stimulus levels facilitate the acquisition of DPOAEs with maximum amplitudes. DPOAE and Békésy audiograms were recorded from 41 subjects in a clinically relevant frequency range of 1.5 to 6 kHz. The short stimulus pulses allowed artifact-free measurement of DPOAEs. Semilogarithmic input-output functions yielded estimated distortion product thresholds, which were significantly correlated with the subjectively acquired Békésy thresholds. In addition, they allowed detection of hearing impairment from 20 dB HL, with 95 % sensitivity and only a 5 % false-positive rate. This accuracy was achieved with a measurement time of about 1-2 min per frequency. Compared to conventional DPOAE and TEOAE methods, separation of DPOAE components using short-pulse DPOAEs in combination with optimized stimulus parameters considerably enhances the accuracy of DPOAEs for diagnosing impairment of the cochlear amplifier.

  2. Conditions for continuation of the efficient curve for multi-objective control-structure optimization

    NASA Technical Reports Server (NTRS)

    Rakowska, Joanna

    1992-01-01

    The paper describes the conditions for continuation of the efficient curve for bi-objective control-structure optimization of a ten-bar truss with two collocated sensors and actuators. The curve has been obtained with an active set algorithm using a homotopy method. The curve is discontinuous. A general stability theory has been implemented to determine sufficient conditions for the persistence of minima, and bifurcation theory has been used to characterize the possible points of discontinuity of the path.

  3. Management of Radioactive Spills in Nuclear Medicine; Teaching and Assessing with Objectively Structured Assessment of Technical Skills.

    PubMed

    Hussain, Riffat Parveen

    2015-01-01

    Routine work in nuclear medicine requires the careful elution of radioactivity and its subsequent, storage and handling. Though all effort is maintained to prevent any "spill" of this radioactivity, accidents are bound to happen. The response to this spill is a methodically worked out a plan that is written and adopted as a "standard operating procedure." This protocol is taught to all involved in the area of working as a mock drill/apprenticeship model. No formal evaluation of learning is in place except for the mock drills. The objectively structured assessment of technical skills (OSATS) is a variation on the Objective Structured Clinical Examination, which is a form of workplace based assessment. The OSATS is cited in the Accreditation Council of Graduate Medical Education evaluation toolbox on the website as the most desirable evaluation tool for the patient care topics. It is the objective of this paper is to introduce the "OSATS" for teaching, and assessment of the learning, of the protocol for the management of radioactive spill. As a review of the literature on the subject failed to reveal any such teaching protocol/material/document for this important technical skill, we hope that it may act as a landmark for the development of teaching and assessment of other technical skills also.

  4. Objective structured brainstorming questions (OSBQs) in PBL tutorial sessions: Evidence based pilot study

    PubMed Central

    AlHoqail, Ibrahim A.; Badr, Fouad M.

    2010-01-01

    The fact that faculty tutors do have different backgrounds and specialty has been a concern as a factor that contributes to disparity in the delivery of brainstorming session outcomes. This paper aims to introduce a road map in the form of a set of focused objective structured questions (OSBQs) for tutors to follow in brainstorming. Methods Objectively structured questions were generated by the block planning committees. A pilot study was conducted from February 2008 – March 2009 and included groups (44 students) of second and third year undergraduate students of the Faculty of Medicine, King Fahad Medical City. Four indicators were considered to check the validity of the proposed OSBQs; (i) feed back on the perception of medical students experiencing different types of tutorial sessions, (ii) learning objectives achieved under both systems, (iii) student’s performance under the OSBQs and the unguided tutorials and (iv) proper utilization of the time allocated to brainstorming sessions. Results The student’s perception of their satisfaction of implementation of OSBQs was unanimous. Student’s performances were much better in blocks implementing OSBQs. The time allocated for brainstorming sessions was efficiently utilized with the introduction of OSBQs. Conclusion Implementation of OSBQs leads to standardization of tutorial sessions and allows more interaction between students to achieve their learning objectives and score better in their exams. Concern over the role of tutors will diminish. PMID:21475549

  5. Objective structured brainstorming questions (OSBQs) in PBL tutorial sessions: Evidence based pilot study.

    PubMed

    Alhoqail, Ibrahim A; Badr, Fouad M

    2010-11-01

    The fact that faculty tutors do have different backgrounds and specialty has been a concern as a factor that contributes to disparity in the delivery of brainstorming session outcomes. This paper aims to introduce a road map in the form of a set of focused objective structured questions (OSBQs) for tutors to follow in brainstorming. Objectively structured questions were generated by the block planning committees. A pilot study was conducted from February 2008 - March 2009 and included groups (44 students) of second and third year undergraduate students of the Faculty of Medicine, King Fahad Medical City. Four indicators were considered to check the validity of the proposed OSBQs; (i) feed back on the perception of medical students experiencing different types of tutorial sessions, (ii) learning objectives achieved under both systems, (iii) student's performance under the OSBQs and the unguided tutorials and (iv) proper utilization of the time allocated to brainstorming sessions. The student's perception of their satisfaction of implementation of OSBQs was unanimous. Student's performances were much better in blocks implementing OSBQs. The time allocated for brainstorming sessions was efficiently utilized with the introduction of OSBQs. Implementation of OSBQs leads to standardization of tutorial sessions and allows more interaction between students to achieve their learning objectives and score better in their exams. Concern over the role of tutors will diminish.

  6. How Category Structure Influences the Perception of Object Similarity: The Atypicality Bias

    PubMed Central

    Tanaka, James William; Kantner, Justin; Bartlett, Marni

    2011-01-01

    Why do some faces appear more similar than others? Beyond structural factors, we speculate that similarity is governed by the organization of faces located in a multi-dimensional face space. To test this hypothesis, we morphed a typical face with an atypical face. If similarity judgments are guided purely by their physical properties, the morph should be perceived to be equally similar to its typical parent as its atypical parent. However, contrary to the structural prediction, our results showed that the morph face was perceived to be more similar to the atypical face than the typical face. Our empirical studies show that the atypicality bias is not limited to faces, but extends to other object categories (birds) whose members share common shape properties. We also demonstrate atypicality bias is malleable and can change subject to category learning and experience. Collectively, the empirical evidence indicates that perceptions of face and object similarity are affected by the distribution of stimuli in a face or object space. In this framework, atypical stimuli are located in a sparser region of the space where there is less competition for recognition and therefore, these representations capture a broader range of inputs. In contrast, typical stimuli are located in a denser region of category space where there is increased competition for recognition and hence, these representation draw a more restricted range of face inputs. These results suggest that the perceived likeness of an object is influenced by the organization of surrounding exemplars in the category space. PMID:22685441

  7. A Deep-Structured Conditional Random Field Model for Object Silhouette Tracking

    PubMed Central

    Shafiee, Mohammad Javad; Azimifar, Zohreh; Wong, Alexander

    2015-01-01

    In this work, we introduce a deep-structured conditional random field (DS-CRF) model for the purpose of state-based object silhouette tracking. The proposed DS-CRF model consists of a series of state layers, where each state layer spatially characterizes the object silhouette at a particular point in time. The interactions between adjacent state layers are established by inter-layer connectivity dynamically determined based on inter-frame optical flow. By incorporate both spatial and temporal context in a dynamic fashion within such a deep-structured probabilistic graphical model, the proposed DS-CRF model allows us to develop a framework that can accurately and efficiently track object silhouettes that can change greatly over time, as well as under different situations such as occlusion and multiple targets within the scene. Experiment results using video surveillance datasets containing different scenarios such as occlusion and multiple targets showed that the proposed DS-CRF approach provides strong object silhouette tracking performance when compared to baseline methods such as mean-shift tracking, as well as state-of-the-art methods such as context tracking and boosted particle filtering. PMID:26313943

  8. The impact of accretion material composition and properties on interior structure dynamics of Kuiper belt objects

    NASA Astrophysics Data System (ADS)

    Shchuko, Oleg; Shchuko, Svetlana D.; Kartashov, Daniil; Orosei, Roberto

    The building material of the forming Kuiper belt objects is supposed in the model to consist of solid dust material of protosolar cloud fringe regions and H2 O amorphous ice. A spheri-cally symmetric celestial body was being created as a result of accretion. The body's internal structure was determined by the composition and the properties of the accretion material and the evolution of the structure -by internal thermal processes. The accretion material compo-sition and structure have been studied, which provide now the existence of large icy Kuiper belt objects. Radionuclides 26 Al, 40 K, 232 Th, 235 U and 238 U embedded in solid dust matter particles have been main sources of radiogenic heat for the Kuiper belt object life time. The impact of the heat-and-power potentials of radiogenic heat sources on H2 O phase transition dynamics in the celestial body matter has been investigated. The parameter variation domains of these potentials have been found at which there can be formed areas partly or fully filled with H2 O of different phase states. In addition, the dynamic boundaries of areas have been determined where the ice component is presented by amorphous ice or cubic and hexagonal crystal ice. The parameter domains of celestial body accretion and radiogenic heat processes have been determined where the body evolution may have a catastrophic scenario up to its complete destruction.

  9. Learning to explore the structure of kinematic objects in a virtual environment

    PubMed Central

    Buckmann, Marcus; Gaschler, Robert; Höfer, Sebastian; Loeben, Dennis; Frensch, Peter A.; Brock, Oliver

    2015-01-01

    The current study tested the quantity and quality of human exploration learning in a virtual environment. Given the everyday experience of humans with physical object exploration, we document substantial practice gains in the time, force, and number of actions needed to classify the structure of virtual chains, marking the joints as revolute, prismatic, or rigid. In line with current work on skill acquisition, participants could generalize the new and efficient psychomotor patterns of object exploration to novel objects. On the one hand, practice gains in exploration performance could be captured by a negative exponential practice function. On the other hand, they could be linked to strategies and strategy change. After quantifying how much was learned in object exploration and identifying the time course of practice-related gains in exploration efficiency (speed), we identified what was learned. First, we identified strategy components that were associated with efficient (fast) exploration performance: sequential processing, simultaneous use of both hands, low use of pulling rather than pushing, and low use of force. Only the latter was beneficial irrespective of the characteristics of the other strategy components. Second, we therefore characterized efficient exploration behavior by strategies that simultaneously take into account the abovementioned strategy components. We observed that participants maintained a high level of flexibility, sampling from a pool of exploration strategies trading the level of psycho-motoric challenges with exploration speed. We discuss the findings pursuing the aim of advancing intelligent object exploration by combining analytic (object exploration in humans) and synthetic work (object exploration in robots) in the same virtual environment. PMID:25904878

  10. Fast and objective detection and analysis of structures in downhole images

    NASA Astrophysics Data System (ADS)

    Wedge, Daniel; Holden, Eun-Jung; Dentith, Mike; Spadaccini, Nick

    2017-09-01

    Downhole acoustic and optical televiewer images, and formation microimager (FMI) logs are important datasets for structural and geotechnical analyses for the mineral and petroleum industries. Within these data, dipping planar structures appear as sinusoids, often in incomplete form and in abundance. Their detection is a labour intensive and hence expensive task and as such is a significant bottleneck in data processing as companies may have hundreds of kilometres of logs to process each year. We present an image analysis system that harnesses the power of automated image analysis and provides an interactive user interface to support the analysis of televiewer images by users with different objectives. Our algorithm rapidly produces repeatable, objective results. We have embedded it in an interactive workflow to complement geologists' intuition and experience in interpreting data to improve efficiency and assist, rather than replace the geologist. The main contributions include a new image quality assessment technique for highlighting image areas most suited to automated structure detection and for detecting boundaries of geological zones, and a novel sinusoid detection algorithm for detecting and selecting sinusoids with given confidence levels. Further tools are provided to perform rapid analysis of and further detection of structures e.g. as limited to specific orientations.

  11. Design objectives and collapse prevention for building structures in mega-earthquake

    NASA Astrophysics Data System (ADS)

    Ye, Lieping; Lu, Xinzheng; Li, Yi

    2010-06-01

    A “mega-earthquake” is one with an intensity larger than the most severe earthquake intensity category currently considered in design codes. For a “mega-earthquake,” the design objective of a given structure is to “preserve living spaces for people in the buildings.” In this paper, factors that may influence the collapse resistance of RC frames in a megaearthquake are analyzed based on seismic damage observed in the 2008 Wenchuan earthquake. Methodologies to improve structural collapse resistance focus on three aspects: global strength margin, global redundancy and global integration of the structural system. Fundamental principles and design concepts for collapse prevention under a mega-earthquake are proposed, and issues that need further research are identified.

  12. [Explore objective clinical variables for detecting delirium in ICU patients: a prospective case-control study].

    PubMed

    Liu, Xiaojiang; Lyu, Jie; An, Youzhong

    2017-04-01

    The aim of this case-control study is to explore clinical objective variables for diagnosing delirium of intensive care unit (ICU) patients. According to the method of prospective case-control study, critical adult postoperative patients who were transferred to ICU of Peking University People's Hospital from October 2015 to May 2016 and needed mechanical ventilation were included. After evaluating the Richmond agitation sedation scale score (RASS), the patients whose score were -2 or greater were sorted into two groups, delirium and non-delirium, according to the confusion assessment method for the ICU (CAM-ICU). Then these patients were observed by domestic multifunctional detector for electroencephalographic (EEG) variables such as brain lateralization, brain introvert, brain activity, brain energy consumption, focus inward, focus outward, cerebral inhibition, fatigue, sleep severity, sedation index, pain index, anxiety index, fidgety index, stress index and the cerebral blood flow (CBF) index which was named of perfusion index. Other variables including indexes of ICU blood gas analysis, which was consisted of variables of blood gas analysis, routine blood test and biochemistry, previous history and prognostic outcome was recorded. Binary logistic regression was used for multivariate analysis. Forty-three postoperative patients, who needed intensive care, were included. Eighteen were in delirium group and twenty-five in control group. Excluding the trauma, variables like gender, age, temperature, heart rate, respiratory rate, mean arterial pressure, acute physiology and chronic health evaluationII(APACHEII) score, organ failure, dementia and emergency surgery didn't show any statistical significance between two groups. The trauma in delirious patients increased obviously compared with the control group (33.3% vs. 4.0%, P = 0.031). Except for the brain activity [122.47 (88.62, 154.21) vs. 89.40 (86.27, 115.97), P = 0.034], there were no statistical differences in

  13. Online structured sparse learning with labeled information for robust object tracking

    NASA Astrophysics Data System (ADS)

    Fan, Baojie; Cong, Yang; Tang, Yandong

    2017-01-01

    We formulate object tracking under the particle filter framework as a collaborative tracking problem. The priori information from training data is exploited effectively to online learn a discriminative and reconstructive dictionary, simultaneously without losing structural information. Specifically, the class label and the semantic structure information are incorporated into the dictionary learning process as the classification error term and ideal coding regularization term, respectively. Combined with the traditional reconstruction error, a unified dictionary learning framework for robust object tracking is constructed. By minimizing the unified objective function with different mixed norm constraints on sparse coefficients, two robust optimizing methods are developed to learn the high-quality dictionary and optimal classifier simultaneously. The best candidate is selected by minimizing the reconstructive error and classification error jointly. As the tracking continues, the proposed algorithms alternate between the robust sparse coding and the dictionary updating. The proposed trackers are empirically compared with 14 state-of-the-art trackers on some challenging video sequences. Both quantitative and qualitative comparisons demonstrate that the proposed algorithms perform well in terms of accuracy and robustness.

  14. Measuring the 3D shape of high temperature objects using blue sinusoidal structured light

    NASA Astrophysics Data System (ADS)

    Zhao, Xianling; Liu, Jiansheng; Zhang, Huayu; Wu, Yingchun

    2015-12-01

    The visible light radiated by some high temperature objects (less than 1200 °C) almost lies in the red and infrared waves. It will interfere with structured light projected on a forging surface if phase measurement profilometry (PMP) is used to measure the shapes of objects. In order to obtain a clear deformed pattern image, a 3D measurement method based on blue sinusoidal structured light is proposed in this present work. Moreover, a method for filtering deformed pattern images is presented for correction of the unwrapping phase. Blue sinusoidal phase-shifting fringe pattern images are projected on the surface by a digital light processing (DLP) projector, and then the deformed patterns are captured by a 3-CCD camera. The deformed pattern images are separated into R, G and B color components by the software. The B color images filtered by a low-pass filter are used to calculate the fringe order. Consequently, the 3D shape of a high temperature object is obtained by the unwrapping phase and the calibration parameter matrixes of the DLP projector and 3-CCD camera. The experimental results show that the unwrapping phase is completely corrected with the filtering method by removing the high frequency noise from the first harmonic of the B color images. The measurement system can complete the measurement in a few seconds with a relative error of less than 1 : 1000.

  15. STRUCTURED JETS IN BL LAC OBJECTS: EFFICIENT PeV NEUTRINO FACTORIES?

    SciTech Connect

    Tavecchio, Fabrizio; Ghisellini, Gabriele; Guetta, Dafne

    2014-09-20

    The origin of high-energy neutrinos (0.1–1 PeV range) detected by IceCube remains a mystery. In this work, we explore the possibility that efficient neutrino production can occur in structured jets of BL Lac objects, characterized by a fast inner spine surrounded by a slower layer. This scenario has been widely discussed in the framework of the high-energy emission models for BL Lac objects and radio galaxies. One of the relevant consequences of a velocity structure is the enhancement of the inverse Compton emission caused by the radiative coupling of the two zones. We show that a similar boosting could occur for the neutrino output of the spine through the photo-meson reaction of high-energy protons scattering off the amplified soft target photon field of the layer. Assuming the local density and the cosmological evolution of γ-ray BL Lac object derived from Fermi Large Area Telescope data, we calculate the expected diffuse neutrino intensity, which can match the IceCube data for a reasonable choice of parameters.

  16. 3D shape shearography with integrated structured light projection for strain inspection of curved objects

    NASA Astrophysics Data System (ADS)

    Anisimov, Andrei G.; Groves, Roger M.

    2015-05-01

    Shearography (speckle pattern shearing interferometry) is a non-destructive testing technique that provides full-field surface strain characterization. Although real-life objects especially in aerospace, transport or cultural heritage are not flat (e.g. aircraft leading edges or sculptures), their inspection with shearography is of interest for both hidden defect detection and material characterization. Accurate strain measuring of a highly curved or free form surface needs to be performed by combining inline object shape measuring and processing of shearography data in 3D. Previous research has not provided a general solution. This research is devoted to the practical questions of 3D shape shearography system development for surface strain characterization of curved objects. The complete procedure of calibration and data processing of a 3D shape shearography system with integrated structured light projector is presented. This includes an estimation of the actual shear distance and a sensitivity matrix correction within the system field of view. For the experimental part a 3D shape shearography system prototype was developed. It employs three spatially-distributed shearing cameras, with Michelson interferometers acting as the shearing devices, one illumination laser source and a structured light projector. The developed system performance was evaluated with a previously reported cylinder specimen (length 400 mm, external diameter 190 mmm) loaded by internal pressure. Further steps for the 3D shape shearography prototype and the technique development are also proposed.

  17. Application of probability techniques to the objective interpretation of veterinary clinical biochemistry data.

    PubMed

    Knox, K M; Reid, S W; Love, S; Murray, M; Gettinby, G

    1998-03-28

    Methods for the interpretation of veterinary clinical biochemistry have not developed as rapidly as biochemical technology. However, the results of clinical biochemistry tests are only of value when they are interpreted appropriately. A retrospective study was undertaken to investigate the equine biochemistry data which had been stored in a veterinary hospital database. By applying percentile analysis and Bayesian probability methods to the clinical biochemistry and corresponding diagnosis data, a novel method for the interpretation of clinical biochemistry data has been developed. The method allows clinicians to determine whether a biochemistry value is abnormal, its degree of abnormality, and the most likely associated diagnoses. The method could be used to investigate a practice-based population and may have significant implications for the interpretation of clinical biochemistry data in veterinary medicine in the future.

  18. Needle-based fluorescence endomicroscopy via structured illumination with a plastic, achromatic objective

    PubMed Central

    Kyrish, Matthew; Dobbs, Jessica; Jain, Shalini; Wang, Xiao; Yu, Dihua; Richards-Kortum, Rebecca

    2013-01-01

    Abstract. In order to diagnose cancer, a sample must be removed, prepared, and examined under a microscope, which is expensive, invasive, and time consuming. Fiber optic fluorescence endomicroscopy, where an image guide is used to obtain high-resolution images of tissue in vivo, has shown promise as an alternative to conventional biopsies. However, the resolution of standard endomicroscopy is limited by the fiber bundle sampling frequency and out-of-focus light. A system is presented which incorporates a plastic, achromatic objective to increase the sampling and which provides optical sectioning via structured illumination to reject background light. An image is relayed from the sample by a fiber bundle with the custom 2.1-mm outer diameter objective lens integrated to the distal tip. The objective is corrected for the excitation and the emission wavelengths of proflavine (452 and 515 nm). It magnifies the object onto the fiber bundle to improve the system’s lateral resolution by increasing the sampling. The plastic lenses were fabricated via single-point diamond turning and assembled using a zero alignment technique. Ex vivo images of normal and neoplastic murine mammary tissues stained with proflavine are captured. The system achieves higher contrast and resolves smaller features than standard fluorescence endomicroscopy. PMID:24002190

  19. Endpoint-finding algorithm for structured light metrology of large objects in cluttered environments

    NASA Astrophysics Data System (ADS)

    Bonanni, Pierino G.; de Bedout, Juan M.

    2002-02-01

    Imaging of objects under linear structured-light illumination is commonly performed to ascertain location, dimensions, and morphology. The method is particularly attractive for prismatic objects distinguished by a single flat surface, because the processing algorithm can focus on purely linear features, and need only search for abrupt discontinuities in those features. In this paper, we consider a steel mill gantry crane application, wherein the targets to be localized are large steel slabs illuminated by laser line projectors, imaged from very close range to preserve spatial resolution. Conventional Radon transform- based methods for locating target edges yield highly ambiguous results, due to an abundance of image clutter coupled with the limited view of the overall object. This paper presents a modified Radon transform-based method for locating the target edges defined by the laser lines, and makes use of coarse a priori knowledge of the line pattern to resolve ambiguous edge points caused by neighboring clutter. A one-dimensional derivative of the Radon transform is used to improve the localization of short line segments. The algorithm is robust to the case in which the target object appears off axis and the clutter dominates the field of view.

  20. Structural correlates of subjective and objective memory performance in multiple sclerosis.

    PubMed

    Pardini, Matteo; Bergamino, Maurizio; Bommarito, Giulia; Bonzano, Laura; Luigi Mancardi, Gian; Roccatagliata, Luca

    2014-04-01

    Subjective and objective memory deficits represent a frequent and ill-understood aspect of multiple sclerosis (MS), and a significant cause of disability and quality of life reduction. The aim of the study is to verify the role of hippocampal and temporal associative fibers' damage in MS-related memory complaints. To reach this aim, 25 patients with low disability relapsing-remitting MS and 19 healthy controls were included in the study. All subjects underwent 3D T1 structural imaging and Diffusion Tensor Imaging. Additionally, MS patients underwent neuropsychological evaluation of objective (Selective Reminding Test and Spatial Recall Test) and of subjective (Perceived Deficit Questionnaire, Retrospective and Prospective Memory Subscales) memory deficits. Normalized hippocampal volume (NHV) and mean Fractional Anisotropy (FA) for the uncinate fasciculus (UF) and for the ventral division of the cingulum bundle (VCB) were calculated for all subjects. We showed that, compared to controls, MS subjects presented with reduced right NHV and with reduced mean FA bilaterally in the UF and the VCB. In the MS group, verbal memory scores correlated with left NHV, spatial memory scores correlated with right NHV, while perceived retrospective and prospective memory deficits correlated with left VCB and left UF mean FA respectively. Our data confirm an early involvement of memory-related brain structures in MS patients. Our data suggest that verbal and nonverbal memory as well as perceived retrospective and prospective memory deficits are related to alterations of discrete anatomical structures in the low-disability phase of MS.

  1. Determination of three-dimensional structured objects, vascular structures, and imaging geometry from single-plane and biplane projection images

    NASA Astrophysics Data System (ADS)

    Nazareth, Daryl P.

    . Thus, overdependence on the calibration object may degrade accuracy. As a result of these techniques, more accurate values of diameters and lengths will be available during surgical procedures. In addition accurate 3D measures may be useful in clinical decision making, such as in assessing vessel tortuousity and access, during interventional procedures.

  2. Objective structured practical examination (OSPE) in Forensic Medicine: students' point of view.

    PubMed

    Menezes, Ritesh G; Nayak, Vinod C; Binu, V S; Kanchan, Tanuj; Rao, P P Jagadish; Baral, Prakash; Lobo, Stany W

    2011-11-01

    The purpose of this study was to assess the attitudes of undergraduate medical students towards the objective structured practical examination (OSPE) in Forensic Medicine, in a medical college in Nepal. Participants included 59 undergraduate medical students of the 7th semester. Findings indicated that the OSPE was an acceptable tool considering the conduct of practical examination in Forensic Medicine at the undergraduate level. The overall mean attitude score was towards the favourable side. Students strongly agreed that the OSPE tested a wide range of skills. They also strongly agreed that it was a good form of examination as well as a learning experience. The introduction of the OSPE replacing the conventional method of practical examination in Forensic Medicine is a step in the right direction taken to objectively assess undergraduate medical students.

  3. Sleep Restriction Therapy for Insomnia is Associated with Reduced Objective Total Sleep Time, Increased Daytime Somnolence, and Objectively Impaired Vigilance: Implications for the Clinical Management of Insomnia Disorder

    PubMed Central

    Kyle, Simon D.; Miller, Christopher B.; Rogers, Zoe; Siriwardena, A. Niroshan; MacMahon, Kenneth M.; Espie, Colin A.

    2014-01-01

    objective performance impairment. Our data have important implications for implementation guidelines around the safe and effective delivery of cognitive behavioral therapy for insomnia. Citation: Kyle SD; Miller CB; Rogers Z; Siriwardena AN; MacMahon KM; Espie CA. Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance: implications for the clinical management of insomnia disorder. SLEEP 2014;37(2):229-237. PMID:24497651

  4. Implementing an interface terminology for structured clinical documentation

    PubMed Central

    Rosenbloom, Samuel Trent; Miller, Randolph A; Adams, Perry; Madani, Sina; Khan, Naqi; Shultz, Edward K

    2013-01-01

    Clinically oriented interface terminologies support interactions between humans and computer programs that accept structured entry of healthcare information. This manuscript describes efforts over the past decade to introduce an interface terminology called CHISL (Categorical Health Information Structured Lexicon) into clinical practice as part of a computer-based documentation application at Vanderbilt University Medical Center. Vanderbilt supports a spectrum of electronic documentation modalities, ranging from transcribed dictation, to a partial template of free-form notes, to strict, structured data capture. Vanderbilt encourages clinicians to use what they perceive as the most appropriate form of clinical note entry for each given clinical situation. In this setting, CHISL occupies an important niche in clinical documentation. This manuscript reports challenges developers faced in deploying CHISL, and discusses observations about its usage, but does not review other relevant work in the field. PMID:23384817

  5. Objective Sleep Structure and Cardiovascular Risk Factors in the General Population: The HypnoLaus Study

    PubMed Central

    Haba-Rubio, José; Marques-Vidal, Pedro; Andries, Daniela; Tobback, Nadia; Preisig, Martin; Vollenweider, Peter; Waeber, Gérard; Luca, Gianina; Tafti, Mehdi; Heinzer, Raphaël

    2015-01-01

    Study Objectives: To evaluate the association between objective sleep measures and metabolic syndrome (MS), hypertension, diabetes, and obesity. Design: Cross-sectional study. Setting: General population sample. Participants: There were 2,162 patients (51.2% women, mean age 58.4 ± 11.1). Interventions: Patients were evaluated for hypertension, diabetes, overweight/obesity, and MS, and underwent a full polysomnography (PSG). Measurements and Results: PSG measured variables included: total sleep time (TST), percentage and time spent in slow wave sleep (SWS) and in rapid eye movement (REM) sleep, sleep efficiency and arousal index (ArI). In univariate analyses, MS was associated with decreased TST, SWS, REM sleep, and sleep efficiency, and increased ArI. After adjustment for age, sex, smoking, alcohol, physical activity, drugs that affect sleep and depression, the ArI remained significantly higher, but the difference disappeared in patients without significant sleep disordered breathing (SDB). Differences in sleep structure were also found according to the presence or absence of hypertension, diabetes, and overweight/obesity in univariate analysis. However, these differences were attenuated after multivariate adjustment and after excluding subjects with significant SDB. Conclusions: In this population-based sample we found significant associations between sleep structure and metabolic syndrome (MS), hypertension, diabetes, and obesity. However, these associations were cancelled after multivariate adjustment. We conclude that normal variations in sleep contribute little if any to MS and associated disorders. Citation: Haba-Rubio J, Marques-Vidal P, Andries D, Tobback N, Preisig M, Vollenweider P, Waeber G, Luca G, Tafti M, Heinzer R. Objective sleep structure and cardiovascular risk factors in the general population: the HypnoLaus study. SLEEP 2015;38(3):391–400. PMID:25325467

  6. Development and Initial Testing of a Structured Clinical Observation Tool to Assess Pharmacotherapy Competence

    ERIC Educational Resources Information Center

    Young, John Q.; Lieu, Sandra; O'Sullivan, Patricia; Tong, Lowell

    2011-01-01

    Objective: The authors developed and tested the feasibility and utility of a new direct-observation instrument to assess trainee performance of a medication management session. Methods: The Psychopharmacotherapy-Structured Clinical Observation (P-SCO) instrument was developed based on multiple sources of expertise and then implemented in 4…

  7. Development and Initial Testing of a Structured Clinical Observation Tool to Assess Pharmacotherapy Competence

    ERIC Educational Resources Information Center

    Young, John Q.; Lieu, Sandra; O'Sullivan, Patricia; Tong, Lowell

    2011-01-01

    Objective: The authors developed and tested the feasibility and utility of a new direct-observation instrument to assess trainee performance of a medication management session. Methods: The Psychopharmacotherapy-Structured Clinical Observation (P-SCO) instrument was developed based on multiple sources of expertise and then implemented in 4…

  8. An integrated control/structure design method using multi-objective optimization

    NASA Technical Reports Server (NTRS)

    Gupta, Sandeep; Joshi, Suresh M.

    1991-01-01

    The benefits are demonstrated of a multiobjective optimization based control structure integrated design methodology. An application of the proposed CSI methodology to the integrated design of the Spacecraft COntrol Lab Experiment (SCOLE) configuration is presented. Integrated design resulted in reducing both the control performance measure and the mass. Thus, better overall performance is achieved through integrated design optimization. The mutliobjective optimization approach used provides Pareto optimal solutions by unconstrained minimization of a differentiable KS function. Furthermore, adjusting the parameters gives insight into the trade-offs involved between different objectives.

  9. Miniature objective lens for array digital pathology: design improvement based on clinical evaluation

    NASA Astrophysics Data System (ADS)

    McCall, Brian; Pierce, Mark; Graviss, Edward A.; Richards-Kortum, Rebecca R.; Tkaczyk, Tomasz S.

    2016-03-01

    A miniature objective designed for digital detection of Mycobacterium tuberculosis (MTB) was evaluated for diagnostic accuracy. The objective was designed for array microscopy, but fabricated and evaluated at this stage of development as a single objective. The counts and diagnoses of patient samples were directly compared for digital detection and standard microscopy. The results were found to be correlated and highly concordant. The evaluation of this lens by direct comparison to standard fluorescence sputum smear microscopy presented unique challenges and led to some new insights in the role played by the system parameters of the microscope. The design parameters and how they were developed are reviewed in light of these results. New system parameters are proposed with the goal of easing the challenges of evaluating the miniature objective and maintaining the optical performance that produced the agreeable results presented without over-optimizing. A new design is presented that meets and exceeds these criteria.

  10. Managing capital and administrative (indirect) costs to achieve strategic objectives: the dialysis clinic versus the outpatient clinic.

    PubMed

    West, D A; West, T D; Malone, P J

    1998-01-01

    During the race for costing accuracy in health care, managers should acknowledge the equal importance of interdepartmental relations. Although newer costing systems can produce more accurate numbers, greater costing accuracy may not always strengthen the organization. This article demonstrates that subsidizing some capital and administrative (indirect) costs for select hospital departments may help to achieve strategic management objectives.

  11. Structural Model Tuning Capability in an Object-Oriented Multidisciplinary Design, Analysis, and Optimization Tool

    NASA Technical Reports Server (NTRS)

    Lung, Shun-fat; Pak, Chan-gi

    2008-01-01

    Updating the finite element model using measured data is a challenging problem in the area of structural dynamics. The model updating process requires not only satisfactory correlations between analytical and experimental results, but also the retention of dynamic properties of structures. Accurate rigid body dynamics are important for flight control system design and aeroelastic trim analysis. Minimizing the difference between analytical and experimental results is a type of optimization problem. In this research, a multidisciplinary design, analysis, and optimization [MDAO] tool is introduced to optimize the objective function and constraints such that the mass properties, the natural frequencies, and the mode shapes are matched to the target data as well as the mass matrix being orthogonalized.

  12. Structural Model Tuning Capability in an Object-Oriented Multidisciplinary Design, Analysis, and Optimization Tool

    NASA Technical Reports Server (NTRS)

    Lung, Shun-fat; Pak, Chan-gi

    2008-01-01

    Updating the finite element model using measured data is a challenging problem in the area of structural dynamics. The model updating process requires not only satisfactory correlations between analytical and experimental results, but also the retention of dynamic properties of structures. Accurate rigid body dynamics are important for flight control system design and aeroelastic trim analysis. Minimizing the difference between analytical and experimental results is a type of optimization problem. In this research, a multidisciplinary design, analysis, and optimization (MDAO) tool is introduced to optimize the objective function and constraints such that the mass properties, the natural frequencies, and the mode shapes are matched to the target data as well as the mass matrix being orthogonalized.

  13. [The Coordinating Centres for Clinical Trials Network. Objectives and significance for research sites].

    PubMed

    Bruns, I; Maier-Lenz, H; Wolff, S

    2009-04-01

    In the late 1990s a funding program was set up by the federal German government to help keep stride with developments in the international research arena. Within this programme, Coordinating Centres for Clinical Trials ("Koordinierungszentren für Klinische Studien", KKS) were established at 12 German universities aiming at supporting all processes of academic clinical trials according to international standards. A close network infrastructure was chosen in order to reap maximum benefit from synergy effects and to promote the harmonisation of standards. Continuing to grow, the KKS Network currently has 16 research institutions as members. More than 400 employees within the KKS Network provide scientific services to clinical trials at universities, hospitals and in industry. In cooperation with study clinics, surgeries, study groups and competence networks in medicine within Europe and beyond, the KKS supports many different research projects covering all areas of medicine. The KKS Network contributes expertise to legislative processes within Germany and Europe through its work in professional committees and working groups. A wide range of education and training concepts supports clinical research as a scientific field in its own right. After nearly ten years the KKS Network has established itself as an indispensable partner in the field of clinical research.

  14. DICOM Structured Reporting and Cancer Clinical Trials Results

    PubMed Central

    Clunie, David A

    2007-01-01

    The use of biomarkers derived from radiological images as surrogate end-points in therapeutic cancer clinical trials is well established. DICOM is the ubiquitous standard for the interchange of images for both clinical use as well as research. It also has capabilities for the exchange of image-related information, including categorical and quantitative information derived from images. The use of DICOM Structured Reporting for the encoding and interchange of clinical trial results in a standard manner is reviewed. PMID:19390663

  15. Faculty development on professionalism and medical ethics: the design, development and implementation of Objective Structured Teaching Exercises (OSTEs).

    PubMed

    Lu, Wei-Hsin; Mylona, Elza; Lane, Susan; Wertheim, William A; Baldelli, Perrilynn; Williams, Peter C

    2014-10-01

    As students are expected to develop competency in professionalism and medical ethics, faculty are also expected to facilitate medical students' learning and understanding of these areas. One of the main challenges to success in this domain has been uncertainty of whether or not faculty know the content and the methods to teach and assess these competencies. We used the Objective Structured Teaching Exercise (OSTE) format as a faculty development tool to train and evaluate faculty on how to teach professionalism and medical ethics to students in clinical settings. The process for the design, development and implementation of OSTEs consisted of five phases: (1) performing a literature review and student needs assessment, (2) developing the OSTE cases and performance checklists, (3) recruiting and training of standardized students, (4) conducting a mock training session and (5) organizing faculty development workshops using OSTEs. Twenty clinical faculty members participated in one of three half-day OSTE workshops offered. Faculty confidence and attitudes about teaching professionalism increased significantly (p < 0.05) from before participating in the workshop to afterwards. Faculty feedback were positive stating that the OSTE scenarios were reflective of issues they generally encounter while teaching medical students, the information and skills they learned from the workshop are important to them as clinical educators, and that the information and skills will likely have an impact on the way they teach professionalism and ethics in the future.

  16. TRENCADIS--a WSRF grid MiddleWare for managing DICOM structured reporting objects.

    PubMed

    Blanquer, Ignacio; Hernandez, Vicente; Segrelles, Damià

    2006-01-01

    The adoption of the digital processing of medical data, especially on radiology, has leaded to the availability of millions of records (images and reports). However, this information is mainly used at patient level, being the extraction of information, organised according to administrative criteria, which make the extraction of knowledge difficult. Moreover, legal constraints make the direct integration of information systems complex or even impossible. On the other side, the widespread of the DICOM format has leaded to the inclusion of other information different from just radiological images. The possibility of coding radiology reports in a structured form, adding semantic information about the data contained in the DICOM objects, eases the process of structuring images according to content. DICOM Structured Reporting (DICOM-SR) is a specification of tags and sections to code and integrate radiology reports, with seamless references to findings and regions of interests of the associated images, movies, waveforms, signals, etc. The work presented in this paper aims at developing of a framework to efficiently and securely share medical images and radiology reports, as well as to provide high throughput processing services. This system is based on a previously developed architecture in the framework of the TRENCADIS project, and uses other components such as the security system and the Grid processing service developed in previous activities. The work presented here introduces a semantic structuring and an ontology framework, to organise medical images considering standard terminology and disease coding formats (SNOMED, ICD9, LOINC..).

  17. Final year MBBS students' perception for observed structured clinical examination.

    PubMed

    Siddiqui, Faisal Ghani

    2013-01-01

    To determine perceptions of final year students about observed structured clinical examination (OSCE) and to determine its acceptance among these students. Sequential mixed method design using survey questionnair and in-depth interviews. The study constituted a one-time survey and in-depth interviews conducted over a period of three consecutive days during final year MBBS annual examination at OSCE centre, from April 04, 2010 to April 06, 2010. Three hundred and fifty final year MBBS students, selected through non-probability convenience sampling, were asked to fill the 12-item questionnaire. Three hundred and thirty one students returned the forms. In-depth, structured interviews with 22 students, selected by non-probability purposive sampling, were conducted. The interviews were tape recorded for subsequent transcription. The statistical analysis was done using SPSS 17. The qualitative data was analyzed through content analysis techniques. Three hundred and thirty one final year MBBS students (50.6% females) filled the questionnaire (response rate 94.6%). Fifty three percent respondents agreed that the OSCE tasks were taught during clinical rotations. The experience was stressful for 67.9% respondents. Inadequate prior guidelines, inadequate time for stations, newness of the assessment format and vague instructions were the main causes for stress. Over 70% of the students felt that OSCE helped them identify areas of weakness in their practical and clinical skills; 56.5% felt that the stations dealt with practical skills. Seventy nine percent students were happy with the attitude of the examiners while 19% students felt that the facilitators were uncooperative; failure of the examiners to observe the students during performance of the tasks was the major cause for dissatisfaction. Nearly thirty percent (29.9%) respondent felt that the stations were difficult to understand. Over forty nine percent (49.7%) complained that adequate guidelines were not given prior to

  18. Description and status update on GELLO: a proposed standardized object-oriented expression language for clinical decision support.

    PubMed

    Sordo, Margarita; Boxwala, Aziz A; Ogunyemi, Omolola; Greenes, Robert A

    2004-01-01

    A major obstacle to sharing computable clinical knowledge is the lack of a common language for specifying expressions and criteria. Such a language could be used to specify decision criteria, formulae, and constraints on data and action. Al-though the Arden Syntax addresses this problem for clinical rules, its generalization to HL7's object-oriented data model is limited. The GELLO Expression language is an object-oriented language used for expressing logical conditions and computations in the GLIF3 (GuideLine Interchange Format, v. 3) guideline modeling language. It has been further developed under the auspices of the HL7 Clinical Decision Support Technical Committee, as a proposed HL7 standard., GELLO is based on the Object Constraint Language (OCL), because it is vendor-independent, object-oriented, and side-effect-free. GELLO expects an object-oriented data model. Although choice of model is arbitrary, standardization is facilitated by ensuring that the data model is compatible with the HL7 Reference Information Model (RIM).

  19. Play behaviours and play object preferences of young children with autistic disorder in a clinical play environment.

    PubMed

    Dominguez, Anna; Ziviani, Jenny; Rodger, Sylvia

    2006-01-01

    Play is the primary occupation of childhood and provides a potentially powerful means of assessing and treating children with autistic disorder. This study utilized a cross-sectional comparison design to investigate the nature of play engagement in children with AD (n = 24), relative to typically developing children (n = 34) matched for chronological age. Play behaviours were recorded in a clinical play environment. Videotapes comprising 15 minutes of the children's spontaneous play behaviour were analysed using time-interval analysis. The particular play behaviours observed and play objects used were coded. Differences in play behaviours (p < 0.0001) and play object preferences (p < 0.0001) were identified between the groups. Findings regarding play behaviour contribute to contention in the literature surrounding functional and symbolic play. Explanations for play object preferences are postulated. Recommendations are made regarding clinical application of findings in terms of enhancing assessment and intervention by augmenting motivation.

  20. Structuring research methods and data with the research object model: genomics workflows as a case study.

    PubMed

    Hettne, Kristina M; Dharuri, Harish; Zhao, Jun; Wolstencroft, Katherine; Belhajjame, Khalid; Soiland-Reyes, Stian; Mina, Eleni; Thompson, Mark; Cruickshank, Don; Verdes-Montenegro, Lourdes; Garrido, Julian; de Roure, David; Corcho, Oscar; Klyne, Graham; van Schouwen, Reinout; 't Hoen, Peter A C; Bechhofer, Sean; Goble, Carole; Roos, Marco

    2014-01-01

    One of the main challenges for biomedical research lies in the computer-assisted integrative study of large and increasingly complex combinations of data in order to understand molecular mechanisms. The preservation of the materials and methods of such computational experiments with clear annotations is essential for understanding an experiment, and this is increasingly recognized in the bioinformatics community. Our assumption is that offering means of digital, structured aggregation and annotation of the objects of an experiment will provide necessary meta-data for a scientist to understand and recreate the results of an experiment. To support this we explored a model for the semantic description of a workflow-centric Research Object (RO), where an RO is defined as a resource that aggregates other resources, e.g., datasets, software, spreadsheets, text, etc. We applied this model to a case study where we analysed human metabolite variation by workflows. We present the application of the workflow-centric RO model for our bioinformatics case study. Three workflows were produced following recently defined Best Practices for workflow design. By modelling the experiment as an RO, we were able to automatically query the experiment and answer questions such as "which particular data was input to a particular workflow to test a particular hypothesis?", and "which particular conclusions were drawn from a particular workflow?". Applying a workflow-centric RO model to aggregate and annotate the resources used in a bioinformatics experiment, allowed us to retrieve the conclusions of the experiment in the context of the driving hypothesis, the executed workflows and their input data. The RO model is an extendable reference model that can be used by other systems as well. The Research Object is available at http://www.myexperiment.org/packs/428 The Wf4Ever Research Object Model is available at http://wf4ever.github.io/ro.

  1. Shifting attention from objective risk factors to patients' self-assessed health resources: a clinical model for general practice.

    PubMed

    Hollnagel, H; Malterud, K

    1995-12-01

    The study was designed to present and apply theoretical and empirical knowledge for the construction of a clinical model intended to shift the attention of the general practitioner from objective risk factors to self-assessed health resources in male and female patients. Review, discussion and analysis of selected theoretical models about personal health resources involving assessing existing theories according to their emphasis concerning self-assessed vs. doctor-assessed health resources, specific health resources vs. life and coping in general, abstract vs. clinically applicable theory, gender perspective explicitly included or not. Relevant theoretical models on health and coping (salutogenesis, coping and social support, control/demand, locus of control, health belief model, quality of life), and the perspective of the underprivileged Other (critical theory, feminist standpoint theory, the patient-centred clinical method) were presented and assessed. Components from Antonovsky's salutogenetic perspective and McWhinney's patient-centred clinical method, supported by gender perspectives, were integrated to a clinical model which is presented. General practitioners are recommended to shift their attention from objective risk factors to self-assessed health resources by means of the clinical model. The relevance and feasibility of the model should be explored in empirical research.

  2. Characterization of the Interior Density Structure of Near Earth Objects with Muons

    NASA Astrophysics Data System (ADS)

    Prettyman, T. H.; Sykes, M. V.; Miller, R. S.; Pinsky, L. S.; Empl, A.; Nolan, M. C.; Koontz, S. L.; Lawrence, D. J.; Mittlefehldt, D. W.; Reddell, B. D.

    2015-12-01

    Near Earth Objects (NEOs) are a diverse population of short-lived asteroids originating from the main belt and Jupiter family comets. Some have orbits that are easy to access from Earth, making them attractive as targets for science and exploration as well as a potential resource. Some pose a potential impact threat. NEOs have undergone extensive collisional processing, fragmenting and re-accreting to form rubble piles, which may be compositionally heterogeneous (e.g., like 2008 TC3, the precursor to Almahata Sitta). At present, little is known about their interior structure or how these objects are held together. The wide range of inferred NEO macroporosities hint at complex interiors. Information about their density structure would aid in understanding their formation and collisional histories, the risks they pose to human interactions with their surfaces, the constraints on industrial processing of NEO resources, and the selection of hazard mitigation strategies (e.g., kinetic impactor vs nuclear burst). Several methods have been proposed to characterize asteroid interiors, including radar imaging, seismic tomography, and muon imaging (muon radiography and tomography). Of these, only muon imaging has the potential to determine interior density structure, including the relative density of constituent fragments. Muons are produced by galactic cosmic ray showers within the top meter of asteroid surfaces. High-energy muons can traverse large distances through rock with little deflection. Muons transmitted through an Itokawa-sized asteroid can be imaged using a compact hodoscope placed on or near the surface. Challenges include background rejection and correction for variations in muon production with surface density. The former is being addressed by hodoscope design. Surface density variations can be determined via radar or muon limb imaging. The performance of muon imaging is evaluated for prospective NEO interior-mapping missions.

  3. MBBS Student Perceptions about Physiology Subject Teaching and Objective Structured Practical Examination Based Formative Assessment for Improving Competencies

    ERIC Educational Resources Information Center

    Lakshmipathy, K.

    2015-01-01

    The objectives of the present study were to 1) assess student attitudes to physiology, 2) evaluate student opinions about the influence of an objective structured practical examination (OSPE) on competence, and 3) assess the validity and reliability of an indigenously designed feedback questionnaire. A structured questionnaire containing 16 item…

  4. MBBS Student Perceptions about Physiology Subject Teaching and Objective Structured Practical Examination Based Formative Assessment for Improving Competencies

    ERIC Educational Resources Information Center

    Lakshmipathy, K.

    2015-01-01

    The objectives of the present study were to 1) assess student attitudes to physiology, 2) evaluate student opinions about the influence of an objective structured practical examination (OSPE) on competence, and 3) assess the validity and reliability of an indigenously designed feedback questionnaire. A structured questionnaire containing 16 item…

  5. Cochlear implantees: Analysis of behavioral and objective measures for a clinical population of various age groups.

    PubMed

    Greisiger, Ralf; Shallop, Jon K; Hol, Per Kristian; Elle, Ole Jakob; Jablonski, Greg Eigner

    2015-01-01

    As of 2014 more than 1200 patients have received a cochlear implant (CI) at Oslo University Hospital (OUS) and approximately half of them have been children. The data obtained from these patients have been used to develop a comprehensive database for a systematic analysis of several objective measurements and programming measurements. During the past 10 years, we have used an objective measurements protocol for our CI surgeries. Our intra-operative protocol includes: Evoked Compound Action Potentials (ECAP), visually observed Electrically evoked Stapedius Reflex Threshold (ESRT), and electrode impedances. Post-operative (Post-OP) programming sessions typically begin 4-6 weeks after surgery and continue on a scheduled basis. The initial programming data include threshold levels (T-levels) and comfortable levels (C-levels) for the different patient age groups. In this study, we compared initial stimulation levels and stimulation levels after at least 1 year of CI with objective measurements obtained intra-operatively. This study focused on the development of a comprehensive database of detailed intra-operative objective measures and post-OP programming measurements from a group of 296 CI patients who received the same type of CI and electrode configuration (Cochlear Corporation CI with Contour electrode). This group included 92 bilateral CI patients. Measurements from 388 CI devices were studied. Patients were divided into 5 different age groups at the age of implantation: 0-2, 2-5, 5-10, 10-20, and above 20 years in order to investigate age-related differences in programming levels and objective measurements. For the comparison analysis we used T- and C-levels obtained after the last day of initial programming and also after at least 1 year implant use. These programming levels were then correlated with some of the intra-operative objective measurements. T-levels were found to be the lowest for the youngest patient group and increased with age. C-levels varied

  6. Objective interpretation of bovine clinical biochemistry data: application of Bayes law to a database model.

    PubMed

    Knox, K M; Reid, S W; Irwin, T; Murray, M; Gettinby, G

    1998-01-01

    With the advent of animal-side biochemistry analysers in veterinary practice, the requirement for ready access to reliable means for interpretation of the results is of increasing importance. At the University of Glasgow Veterinary School (GUVS), a large computerised hospital database containing extensive clinical, laboratory, and pathological information has been maintained. A retrospective study was undertaken to investigate plasma biochemistry results and corresponding post mortem diagnosis data from 754 unwell cattle which had presented to GUVS over the study period. Initial analysis of the clinical biochemistry data from this unwell population revealed that the parameters did not follow a normal distribution. This finding suggested that the accepted reference range method for the interpretation of clinical biochemistry data may provide limited information about the unwell animal. By applying a combination of percentile analysis and conditional probability techniques to the hospital data, the development of a means of clinical biochemistry interpretation was developed whereby a clinician could determine whether a value was abnormal, the degree of abnormality, and the most likely associated diseases. For example, a urea value of 30 mmol/l lay within the top 5% of results, and one of the most common diseases associated with this urea value was pyelonephritis. Furthermore, a Bayesian approach allowed the quantification of the relationship between any plasma biochemistry value and disease through the generation of a ratio termed the 'biochemical factor'. Using the same example, given a urea value of 30 mmol/l, pyelonephritis was eight times more likely than before any biochemistry information was known. The results from the study were used to form the basis of a software system which may ultimately be used by the clinical to aid in the recognition, treatment and prevention of disease in the veterinary domain.

  7. Clinical vocabulary as a boundary object in multidisciplinary care management of multiple chemical sensitivity, a complex and chronic condition.

    PubMed

    Sampalli, Tara; Shepherd, Michael; Duffy, Jack

    2011-04-14

    Research has shown that accurate and timely communication between multidisciplinary clinicians involved in the care of complex and chronic health conditions is often challenging. The domain knowledge for these conditions is heterogeneous, with poorly categorized, unstructured, and inconsistent clinical vocabulary. The potential of boundary object as a technique to bridge communication gaps is explored in this study. A standardized and controlled clinical vocabulary was developed as a boundary object in the domain of a complex and chronic health condition, namely, multiple chemical sensitivity, to improve communication among multidisciplinary clinicians. A convenience sample of 100 patients with a diagnosis of multiple chemical sensitivity, nine multidisciplinary clinicians involved in the care of patients with multiple chemical sensitivity, and 36 clinicians in the community participated in the study. Eighty-two percent of the multidisciplinary and inconsistent vocabulary was standardized using the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED(®) CT as a reference terminology. Over 80% of the multidisciplinary clinicians agreed on the overall usefulness of having a controlled vocabulary as a boundary object. Over 65% of clinicians in the community agreed on the overall usefulness of the vocabulary. The results from this study are promising and will be further evaluated in the domain of another complex chronic condition, ie, chronic pain. The study was conducted as a preliminary analysis for developing a boundary object in a heterogeneous domain of knowledge.

  8. Clinical vocabulary as a boundary object in multidisciplinary care management of multiple chemical sensitivity, a complex and chronic condition

    PubMed Central

    Sampalli, Tara; Shepherd, Michael; Duffy, Jack

    2011-01-01

    Background: Research has shown that accurate and timely communication between multidisciplinary clinicians involved in the care of complex and chronic health conditions is often challenging. The domain knowledge for these conditions is heterogeneous, with poorly categorized, unstructured, and inconsistent clinical vocabulary. The potential of boundary object as a technique to bridge communication gaps is explored in this study. Methods: A standardized and controlled clinical vocabulary was developed as a boundary object in the domain of a complex and chronic health condition, namely, multiple chemical sensitivity, to improve communication among multidisciplinary clinicians. A convenience sample of 100 patients with a diagnosis of multiple chemical sensitivity, nine multidisciplinary clinicians involved in the care of patients with multiple chemical sensitivity, and 36 clinicians in the community participated in the study. Results: Eighty-two percent of the multidisciplinary and inconsistent vocabulary was standardized using the Systematized Nomenclature of Medicine – Clinical Terms (SNOMED® CT as a reference terminology. Over 80% of the multidisciplinary clinicians agreed on the overall usefulness of having a controlled vocabulary as a boundary object. Over 65% of clinicians in the community agreed on the overall usefulness of the vocabulary. Conclusion: The results from this study are promising and will be further evaluated in the domain of another complex chronic condition, ie, chronic pain. The study was conducted as a preliminary analysis for developing a boundary object in a heterogeneous domain of knowledge. PMID:21594060

  9. Objective breast symmetry analysis with the breast analyzing tool (BAT): improved tool for clinical trials.

    PubMed

    Krois, Wilfried; Romar, Alexander Ken; Wild, Thomas; Dubsky, Peter; Exner, Ruth; Panhofer, Peter; Jakesz, Raimund; Gnant, Michael; Fitzal, Florian

    2017-07-01

    Objective cosmetic analysis is important to evaluate the cosmetic outcome after breast surgery or breast radiotherapy. For this purpose, we aimed to improve our recently developed objective scoring software, the Breast Analyzing Tool (BAT(®)). A questionnaire about important factors for breast symmetry was handed out to ten experts (surgeons) and eight non-experts (students). Using these factors, the first-generation BAT(®) software formula has been modified and the breast symmetry index (BSI) from 129 women after breast surgery has been calculated by the first author with this new BAT(®) formula. The resulting BSI values of these 129 breast cancer patients were then correlated with subjective symmetry scores from the 18 observers using the Harris scale. The BSI of ten images was also calculated from five observers different from the first author to calculate inter-rater reliability. In a second phase, the new BAT(®) formula was validated and correlated with subjective scores of additional 50 women after breast surgery. The inter-rater reliability analysis of the objective evaluation by the BAT(®) from five individuals showed an ICC of 0.992 with almost no difference between different observers. All subjective scores of 50 patients correlated with the modified BSI score with a high Pearson correlation coefficient of 0.909 (p < .001) which was better compared to the old software (r = 0.769; p < .001). The modified BAT(®) software improves the correlation between subjective and objective BSI values, and may be a new standard for trials evaluating breast symmetry.

  10. Hidden gifts of love: a clinical application of object relations theory.

    PubMed

    Steinberg, Naomi

    2010-08-01

    Using an extended clinical example, the author applies aspects of Kleinian, Fairbairnian, and Bionian theory to demonstrate how individuals may come to hide away feelings of both love and aggression. In the clinical material presented, a version of a schizoid retreat was understood as a pervasive response to trauma. The author attempts to explore more specifically the nature of a 'traumatizing outer world' ( Guntrip, 1969 ) and how these experiences cause an individual to retreat and undermine movement toward healthy adult dependency. An understanding of these dynamics helps inform the psychoanalytic treatment process and can serve as a type of roadmap in navigating through challenging transference-countertransference enactments. Copyright © 2010 Institute of Psychoanalysis.

  11. A pilot study to develop an objective clinical score for canine otitis externa.

    PubMed

    Nuttall, Tim; Bensignor, Emmanuel

    2014-12-01

    The lack of an accepted clinical scoring system in canine otitis externa makes it difficult to compare clinical trials. To develop a score that is clinically relevant, reliable and sensitive to change. Client-owned healthy dogs (n = 55) and dogs with otitis externa (n = 60). We compared 0-3 and 0-5 assessments of erythema, oedema/swelling, erosion/ulceration, exudate and pain of the ear canals with a reference 0-2 scale. Additional data included odour, pruritus scores, tympanic membrane condition, treatment outcome and neutrophil, bacterial and Malassezia counts. There were no significant differences between the vertical and horizontal canal scores (correlation coefficients >0.93). Correlation coefficients for the 0-3 and 0-5 scales were also >0.9 for all parameters, but the 0-2 scale was more variable. Pain and pruritus did not correlate well with the lesion scores and were associated with suppurative and erythroceruminous otitis, respectively. Neutrophil and microbial counts were variable and could not be used to generate cut-off values to differentiate healthy and affected ears or determine the response to therapy. Total scores ≥4 differentiated affected from healthy ears with 91.1% sensitivity and 100% specificity; scores ≤3 were 100% sensitive and 91.9% specific for clinical success. The intra- and interobserver reliability was high (intraclass correlation coefficients >0.95 and Cohen's kappa coefficients >0.65). This pilot study showed that the 0-3 Otitis Index Score (OTIS3) for erythema, oedema/swelling, erosion/ulceration and exudate is suitable for further validation by a larger group of clinicians. © 2014 ESVD and ACVD.

  12. Paying for prevention in clinical practice: Aligning provider remuneration with system objectives

    PubMed Central

    2015-01-01

    Evidence on the efficacy of preventive procedures in oral health care has not been matched by uptake of prevention in clinical practice. Reducing oral disease in the population reduces the size of the future market for treatment. Hence a provider's intention to adopt prevention in clinical practice may be offset by the financial implications of such behaviour. Effective prevention may therefore depend upon prevention-friendly methods of remuneration if providers are to be rewarded appropriately for doing what the system expects them to do. This paper considers whether changing the way providers are paid for delivering care can be expected to change the utilisation of preventive care in the population in terms of the proportion of the population receiving preventive care, the distribution of preventive care in the population and the pattern of preventive care received. A conceptual framework is presented that identifies the determinants of rewards under different approaches to provider remuneration. The framework is applied to develop recommendations for paying for prevention in clinical practice. Literature on provider payment in dental care is reviewed to assess the evidence base for the effects of changing payment methods, identify gaps in the evidence-base and inform the design of future research on dental remuneration. PMID:26390928

  13. Assessment of clinical information: Comparison of the validity of a Structured Clinical Interview (the SCID) and the Clinical Diagnostic Interview.

    PubMed

    Drill, Rebecca; Nakash, Ora; DeFife, Jared A; Westen, Drew

    2015-06-01

    Adaptive functioning is a key aspect of psychiatric diagnosis and assessment in research and practice. This study compared adaptive functioning validity ratings from Structured Clinical Interviews (SCIDs, symptom-focused structured diagnostic interviews), and Clinical Diagnostic Interviews (CDIs, systematic diagnostic interviews modeling naturalistic clinical interactions focusing on relational narratives). Two hundred forty-five patients (interviewed by two independent interviewers) and their interviewers completed the Clinical Data Form which assesses adaptive functioning and clinical information. Both interviews converged strongly with patient-reports, with no significant differences in validity of the interviews in measuring global and specific domains of adaptive functioning variables. Findings suggest that CDIs provide adaptive functioning data comparable to SCIDs (often considered "gold standard" for assessment but difficult to use in practice) and have important implications for bridging the research-practice gap. By incorporating clinicians' everyday methods, CDIs yield information that is psychometrically sound for empirical investigation, diagnostically practical, and clinically meaningful and valid.

  14. UGC 4599: Revealing the Extended Structure of a Hoag’s Object Analog with HERON

    NASA Astrophysics Data System (ADS)

    Fusco, Michael; Thilker, David A.; Wen, Fufang; Xia, Junjie; Storment, Stephen; Brosch, Noah; Longstaff, Francis; Kennefick, Julia D.; Rich, Robert Michael; Halos and Environments of Nearby galaxies (HERON) Team

    2017-01-01

    The Halos and Environments of Nearby Galaxies (HERON) survey utilizes a specialized telescope for imaging low surface brightness halos and galaxy environments. One such galaxy is UGC 4599, whose HERON images show improvements in observing the extended low luminosity structure as compared to previous studies. UGC 4599 is a nearby Hoag-Type Ring Galaxy with an extremely extended HI disk. Hoag's Object is characterized by a blue star-forming ring surrounding an older yellow nucleus. In the case of UGC 4599, the nuclear region was previously revealed to closely follow a De Vaucouleurs luminosity profile, suggesting the object to be at least elliptical-like. While previous photometric studies of UGC 4599 were focused mainly on the bright core and star forming ring of the galaxy, the HERON survey is able to probe the fainter, extended halo. With an eight hour integration time, we find spiral structure surrounding the core and ring of UGC 4599. The main ring of the galaxy is broken with an m=2 (180 degree) symmetry, suggesting a two armed spiral structure. However, once the core and ring of UGC 4599 are modeled with the software GALFIT, a well defined m=1 (single arm) spiral emerges, extending from the central region to several times the radius of the ring. Though the ring appears to break in two places, the spiral structure may be comprised of mainly one dominant arm. In late type galaxies, the pitch angle of spiral arms has been shown to correlate well with the mass of the central Supermassive Black Hole (SMBH) in an M-P relation. The pitch angle of the one arm spiral of UGC 4599 is measured to be roughly P=9 degrees, corresponding to a SMBH mass for UGC 4599 of between 107 and 108 solar masses (further constrained pitch angle measurements forthcoming). The outermost edge of UGC 4599 as detected in our imaging may be modeled as an extension of this one armed spiral, or as yet another ring feature. Due to many bright foreground stars, there is difficulty in ascertaining

  15. Incremental Structured Dictionary Learning for Video Sensor-Based Object Tracking

    PubMed Central

    Xue, Ming; Yang, Hua; Zheng, Shibao; Zhou, Yi; Yu, Zhenghua

    2014-01-01

    To tackle robust object tracking for video sensor-based applications, an online discriminative algorithm based on incremental discriminative structured dictionary learning (IDSDL-VT) is presented. In our framework, a discriminative dictionary combining both positive, negative and trivial patches is designed to sparsely represent the overlapped target patches. Then, a local update (LU) strategy is proposed for sparse coefficient learning. To formulate the training and classification process, a multiple linear classifier group based on a K-combined voting (KCV) function is proposed. As the dictionary evolves, the models are also trained to timely adapt the target appearance variation. Qualitative and quantitative evaluations on challenging image sequences compared with state-of-the-art algorithms demonstrate that the proposed tracking algorithm achieves a more favorable performance. We also illustrate its relay application in visual sensor networks. PMID:24549252

  16. Lightweight object oriented structure analysis: tools for building tools to analyze molecular dynamics simulations.

    PubMed

    Romo, Tod D; Leioatts, Nicholas; Grossfield, Alan

    2014-12-15

    LOOS (Lightweight Object Oriented Structure-analysis) is a C++ library designed to facilitate making novel tools for analyzing molecular dynamics simulations by abstracting out the repetitive tasks, allowing developers to focus on the scientifically relevant part of the problem. LOOS supports input using the native file formats of most common biomolecular simulation packages, including CHARMM, NAMD, Amber, Tinker, and Gromacs. A dynamic atom selection language based on the C expression syntax is included and is easily accessible to the tool-writer. In addition, LOOS is bundled with over 140 prebuilt tools, including suites of tools for analyzing simulation convergence, three-dimensional histograms, and elastic network models. Through modern C++ design, LOOS is both simple to develop with (requiring knowledge of only four core classes and a few utility functions) and is easily extensible. A python interface to the core classes is also provided, further facilitating tool development.

  17. Clinical correlates of objective and subjective quality of life among middle-aged and elderly female inpatients with chronic schizophrenia.

    PubMed

    Nakagawa, Seishu; Hayashi, Naoki

    2013-10-01

    The aim of this study was to illustrate the relationship between objective and subjective measures of quality of life (QOL) and to identify the factors influencing QOL in a sample of middle-aged and elderly female patients with schizophrenia in Japan. Middle-aged and elderly female inpatients with schizophrenia (n=66; mean age [SD]: 68.0 [8.0]) were assessed using the Quality of Life Scale (QLS), Lancashire Quality of Life Profile (LQLP), Positive and Negative Symptoms Scale (PANSS), and Rehabilitation Evaluation Hall and Baker (REHAB). Correlation analyses among the measures and regression analyses of objective and subjective QOL measures (QLS and LQLP) were conducted. Explanations of results for the two types of QOL measures in terms of psychotic symptomatology and adjustment variables (PANSS and REHAB) are discussed. There was no salient correlation between objective and subjective QOL measures. The regression analyses identified PANSS anergia and REHAB community skills as factors influencing objective QOL, whereas PANSS depression and paranoid/belligerence were factors influencing subjective QOL. Results indicated that objective and subjective QOL domains should be treated separately in clinical practice for this patient population. Some QOL factors identified in the regression analyses can be used as targets to improve QOL. The findings have important clinical implications for the assessment and treatment of this patient population. Copyright © 2013 Elsevier B.V. All rights reserved.

  18. Objective structured assessment of technical skills for repair of fourth-degree perineal lacerations.

    PubMed

    Siddiqui, Nazema Y; Stepp, Kevin J; Lasch, Susan J; Mangel, Jeffrey M; Wu, Jennifer M

    2008-12-01

    The objective of this study was to assess the reliability and validity of an objective structured assessment of technical skills (OSATS) for repair of fourth-degree obstetric lacerations on a surgical model. Three blinded judges reviewed recordings of 20 junior and 20 senior obstetrics-gynecology residents performing simulated perineal repairs using a beef tongue model. Judges completed task-specific OSATS and global rating scales for each repair. Six recordings were rereviewed after 2 weeks. Inter- and intrarater reliability and construct validity were assessed. Interrater reliability was 0.80 for task-specific OSATS and 0.59 for the global rating scale. Intrarater reliability was poor. Construct validity was demonstrated, with senior residents scoring higher than junior residents on task-specific OSATS (13.0 vs 10.5; P = .007) and the global rating scale (24.0 vs 19.3; P = .001). We found good interrater reliability and construct validity using a task-specific OSATS for fourth-degree perineal laceration repair. This instrument shows promise as a tool for competency-based evaluations.

  19. A multi-objective evolutionary algorithm for protein structure prediction with immune operators.

    PubMed

    Judy, M V; Ravichandran, K S; Murugesan, K

    2009-08-01

    Genetic algorithms (GA) are often well suited for optimisation problems involving several conflicting objectives. It is more suitable to model the protein structure prediction problem as a multi-objective optimisation problem since the potential energy functions used in the literature to evaluate the conformation of a protein are based on the calculations of two different interaction energies: local (bond atoms) and non-local (non-bond atoms) and experiments have shown that those types of interactions are in conflict, by using the potential energy function, Chemistry at Harvard Macromolecular Mechanics. In this paper, we have modified the immune inspired Pareto archived evolutionary strategy (I-PAES) algorithm and denoted it as MI-PAES. It can effectively exploit some prior knowledge about the hydrophobic interactions, which is one of the most important driving forces in protein folding to make vaccines. The proposed MI-PAES is comparable with other evolutionary algorithms proposed in literature, both in terms of best solution found and the computational time and often results in much better search ability than that of the canonical GA.

  20. Student's perspectives on objective structured practical examination (OSPE) in Forensic Medicine - a report from India.

    PubMed

    Pramod Kumar, G N; Sentitoshi; Nath, Dhritiman; Menezes, Ritesh G; Kanchan, Tanuj

    2015-05-01

    The objective of the present study was to know the perceptions of students regarding objective structured practical examination (OSPE) as a tool for assessment in Forensic Medicine. The present study was conducted in the Department of Forensic Medicine and Toxicology, Mahatma Gandhi Medical College and Research Institute (MGMCRI), Pondicherry, India. Undergraduate medical students of the 4th semester were enrolled in the study to know their perceptions regarding OSPE. The students were briefed regarding OSPE with a PowerPoint presentation and interaction. An examination was conducted using OSPE with10 stations and a total of 74 students participated in the study. The feedback was collected using a preformed proforma consisting of 12 items and analyzed. Most of the participants (82.4%) agreed that OSPE is a better method of examination than the conventional/traditional practical examination. The majority of the participants (77.0%) said that the OSPE covered wide range of knowledge than the conventional practical examination. A large number of students (63.5%) were of the opinion that the OSPE may be exhausting and stressful if number of stations are increased. Overall a larger proportion of the participants preferred OSPE over the conventional practical examination considering the various attributes examined in the study. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  1. Integrated electronic records as the resolution of ethical tensions between clinical and managerial objectives.

    PubMed

    Rigby, M J; Robins, S C

    1995-01-01

    Traditionally there is considerable tension between the objectives of clinicians and managers--each claiming an ethical grounding, one to optimize care to the individual and the other to optimize the use of health resources for the client population. Hitherto, there has been a latent challenge in finding empirically supported common ground. However, the development of integrated electronic records, particularly for patients receiving preventive, rehabilitative, or long-term care, has provided a common medium. A successful major development in the United Kingdom is described.

  2. Thorax, Trachea, and Lung Ultrasonography in Emergency and Critical Care Medicine: Assessment of an Objective Structured Training Concept

    PubMed Central

    Breitkreutz, Raoul; Dutiné, Martina; Scheiermann, Patrick; Kujumdshiev, Sandy; Ackermann, Hanns; Seeger, Florian Hartmut; Walcher, Felix; Hirche, Tim Oliver

    2013-01-01

    Background and Study objective. Focused lung ultrasound (LUS) examinations are important tools in critical care medicine. There is evidence that LUS can be used for the detection of acute thoracic lesions. However, no validated training method is available. The goal of this study was to develop and assess an objective structured clinical examination (OSCE) curriculum for focused thorax, trachea, and lung ultrasound in emergency and critical care medicine (THOLUUSE). Methods. 39 trainees underwent a one-day training course in a prospective educational study, including lectures in sonoanatomy and -pathology of the thorax, case presentations, and hands-on training. Trainees' pre- and posttest performances were assessed by multiple choice questionnaires, visual perception tests by interpretation video clips, practical performance of LUS, and identification of specific ultrasound findings. Results. Trainees postcourse scores of correct MCQ answers increased from 56 ± 4% to 82 ± 2% (mean± SD; P < 0.001); visual perception skills increased from 54 ± 5% to 78 ± 3% (P < 0.001); practical ultrasound skills improved, and correct LUS was performed in 94%. Subgroup analysis revealed that learning success was independent from the trainees' previous ultrasound experience. Conclusions. THOLUUSE significantly improves theoretical and practical skills for the diagnosis of acute thoracic lesions. We propose to implement THOLUUSE in emergency medicine training. PMID:24369503

  3. Object-related vs. narcissistic depression: a theoretical and clinical study.

    PubMed

    Glazer, M W

    1979-01-01

    This paper has focused on the sense of helplessness as an essential component of a depressive reaction. By inference, a sense of mastery and ability to achieve goals seems essential for a sense of well-being. Both patients presented here revealed infantile fantasies that hampered their exercising this mastery, and the path to well-being was the analysis of these fantasies. The treatment plans differed, though, in the locus of the fantasies. In an object-related depression such as Mr. Janson's, the fantasy involved the inhbition of functioning--that is, the inability to express aggression--and the treatment aimed at removing the inhibition. In a narcissistic depression such as Miss Gaynor's, the helplessness was not due to inhibited functioning per se. Rather, her goals were unrealistic, unattainable, and based on unconscious fantasies. Here the aim of treatment was the development of more reality-adapted and attainable objectives and the concommitant internalization of a more realistic sense of her own worth. Thus the common denominator in both depressive reactions was a sense of helplessness, and the path toward increased self-esteem was by way of the development of a sense of mastery and competence.

  4. The Watched Structure Clinical Examination (WASCE) as a tool of assessment.

    PubMed

    Alnasir, Faisal A

    2004-01-01

    Assessment of medical students' clinical competencies is still evolving. The aim of this study was to find out the effectiveness of a new tool of assessment to assess medical students at the end of clinical rotations. A new tool has been developed in the College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain, called the Watched Structure Clinical Examination (WASCE). It was used at the end of the Family Medicine clinical rotation during the academic year 2000-2001 involving 62 final year students. The study found a significant statistical correlation between the students' results in the WASCE and their results in Doctor of Medicine final examination, which included the written examination, the patient encountered clinical examination and the Objective Structured Clinical Examination (OSCE). Watched Structured Clinical Examination can be a useful method of assessment for examining certain clinical skills, with an advantage over the OSCE in that it is less time consuming, more cost effective, requires less supervising staff to conduct the examination and, more importantly, it is less stressful to the students.

  5. Origin of Rotating Ring Structures in the Strong Gravity of a Central Object.

    NASA Astrophysics Data System (ADS)

    Coppi, B.

    2006-04-01

    The origin of plasma rotating ring structures forming around a central object whose gravity is prevalent has been identified [1] through the analysis of thin equilibrium configurations that are immersed in a relatively weak external magnetic field and can carry internal toroidal currents. Unlike the case of the ``classical'' gaseous disk, in which the vertical equilibrium is maintained only by gravity, rings are maintained vertically by the Lorentz force and radially by gravity. The differential rotation is the sustaining factor of these ring structures and of the jets that may emerge from them. The rings are connected with the formation of a periodic sequence [2] of Field Reverse Configurations of the poloidal magnetic field, consisting of pairs of counter-streaming toroidal current channels. In magnetic field configurations that have been considered previously for accretion disks the magnetic field diffusion was assumed to be such that the Ferraro isorotation condition was not valid, while in our case it has a primary role. The relevant equilibria are not described by the Grad-Shafranov equation but by two non-linear coupled equations that have been solved analytically. These provide both the plasma pressure function and the magnetic surface function once a consistent plasma density function is chosen within a relatively narrow class. A two-fluid description of the same equilibria is given differentiating the relative roles of electrons and ions.[1] B. Coppi and F. Rousseau, to appear in Ap. J., April (2006). [2] B. Coppi, Phys. of Plasmas, 12, 057302 (2005).

  6. UAV-based urban structural damage assessment using object-based image analysis and semantic reasoning

    NASA Astrophysics Data System (ADS)

    Fernandez Galarreta, J.; Kerle, N.; Gerke, M.

    2014-09-01

    Structural damage assessment is critical after disasters but remains a challenge. Many studies have explored the potential of remote sensing data, but limitations of vertical data persist. Oblique imagery has been identified as more useful, though the multi-angle imagery also adds a new dimension of complexity. This paper addresses damage assessment based on multi-perspective, overlapping, very high resolution oblique images obtained with unmanned aerial vehicles (UAVs). 3-D point-cloud assessment for the entire building is combined with detailed object-based image analysis (OBIA) of façades and roofs. This research focuses not on automatic damage assessment, but on creating a methodology that supports the often ambiguous classification of intermediate damage levels, aiming at producing comprehensive per-building damage scores. We identify completely damaged structures in the 3-D point cloud, and for all other cases provide the OBIA-based damage indicators to be used as auxiliary information by damage analysts. The results demonstrate the usability of the 3-D point-cloud data to identify major damage features. Also the UAV-derived and OBIA-processed oblique images are shown to be a suitable basis for the identification of detailed damage features on façades and roofs. Finally, we also demonstrate the possibility of aggregating the multi-perspective damage information at building level.

  7. UAV-based urban structural damage assessment using object-based image analysis and semantic reasoning

    NASA Astrophysics Data System (ADS)

    Fernandez Galarreta, J.; Kerle, N.; Gerke, M.

    2015-06-01

    Structural damage assessment is critical after disasters but remains a challenge. Many studies have explored the potential of remote sensing data, but limitations of vertical data persist. Oblique imagery has been identified as more useful, though the multi-angle imagery also adds a new dimension of complexity. This paper addresses damage assessment based on multi-perspective, overlapping, very high resolution oblique images obtained with unmanned aerial vehicles (UAVs). 3-D point-cloud assessment for the entire building is combined with detailed object-based image analysis (OBIA) of façades and roofs. This research focuses not on automatic damage assessment, but on creating a methodology that supports the often ambiguous classification of intermediate damage levels, aiming at producing comprehensive per-building damage scores. We identify completely damaged structures in the 3-D point cloud, and for all other cases provide the OBIA-based damage indicators to be used as auxiliary information by damage analysts. The results demonstrate the usability of the 3-D point-cloud data to identify major damage features. Also the UAV-derived and OBIA-processed oblique images are shown to be a suitable basis for the identification of detailed damage features on façades and roofs. Finally, we also demonstrate the possibility of aggregating the multi-perspective damage information at building level.

  8. Objective sleep structure and cardiovascular risk factors in the general population: the HypnoLaus Study.

    PubMed

    Haba-Rubio, José; Marques-Vidal, Pedro; Andries, Daniela; Tobback, Nadia; Preisig, Martin; Vollenweider, Peter; Waeber, Gérard; Luca, Gianina; Tafti, Mehdi; Heinzer, Raphaël

    2015-03-01

    To evaluate the association between objective sleep measures and metabolic syndrome (MS), hypertension, diabetes, and obesity. Cross-sectional study. General population sample. There were 2,162 patients (51.2% women, mean age 58.4 ± 11.1). Patients were evaluated for hypertension, diabetes, overweight/obesity, and MS, and underwent a full polysomnography (PSG). PSG measured variables included: total sleep time (TST), percentage and time spent in slow wave sleep (SWS) and in rapid eye movement (REM) sleep, sleep efficiency and arousal index (ArI). In univariate analyses, MS was associated with decreased TST, SWS, REM sleep, and sleep efficiency, and increased ArI. After adjustment for age, sex, smoking, alcohol, physical activity, drugs that affect sleep and depression, the ArI remained significantly higher, but the difference disappeared in patients without significant sleep disordered breathing (SDB). Differences in sleep structure were also found according to the presence or absence of hypertension, diabetes, and overweight/obesity in univariate analysis. However, these differences were attenuated after multivariate adjustment and after excluding subjects with significant SDB. In this population-based sample we found significant associations between sleep structure and MS, hypertension, diabetes, and obesity. However, these associations were cancelled after multivariate adjustment. We conclude that normal variations in sleep contribute little if any to MS and associated disorders. © 2015 Associated Professional Sleep Societies, LLC.

  9. Scanning freeform objects by combining shape from silhouette and shape from line structured light

    NASA Astrophysics Data System (ADS)

    Xiong, Hanwei; Xu, Jun; Xu, Chenxi; Pan, Ming

    2014-12-01

    Freeform shape is usually designed by reverse engineering method thorough a 3D scanner, which is often expensive to most persons. The paper proposes a new scanning system combining shape from structured light and shape from silhouette, which can be implemented easily with low cost. The two methods are very complementary. For shape from silhouette, it can capture correct topological information of the object and obtain a closed envelop, and for shape from hand-held laser line, precise point clouds with some holes can be obtained. To gain their complementary advantages, a new data fusion strategy based a mesh energy functional is proposed to integrate the information from the two scanning methods, in which the points resulted from laser light will attract closed envelop from silhouette. After fusion, the precision of shape from silhouette is increased, and the topological error of shape from structured light is corrected. The design details are introduced, and a toy model is used to test the new method, which is difficult to scan using other systems. The test results proof the validity of the new method.

  10. Impact of bowtie filter and object position on the two-dimensional noise power spectrum of a clinical MDCT system

    PubMed Central

    Gomez-Cardona, Daniel; Cruz-Bastida, Juan Pablo; Li, Ke; Budde, Adam; Hsieh, Jiang; Chen, Guang-Hong

    2016-01-01

    Purpose: Noise characteristics of clinical multidetector CT (MDCT) systems can be quantified by the noise power spectrum (NPS). Although the NPS of CT has been extensively studied in the past few decades, the joint impact of the bowtie filter and object position on the NPS has not been systematically investigated. This work studies the interplay of these two factors on the two dimensional (2D) local NPS of a clinical CT system that uses the filtered backprojection algorithm for image reconstruction. Methods: A generalized NPS model was developed to account for the impact of the bowtie filter and image object location in the scan field-of-view (SFOV). For a given bowtie filter, image object, and its location in the SFOV, the shape and rotational symmetries of the 2D local NPS were directly computed from the NPS model without going through the image reconstruction process. The obtained NPS was then compared with the measured NPSs from the reconstructed noise-only CT images in both numerical phantom simulation studies and experimental phantom studies using a clinical MDCT scanner. The shape and the associated symmetry of the 2D NPS were classified by borrowing the well-known atomic spectral symbols s, p, and d, which correspond to circular, dumbbell, and cloverleaf symmetries, respectively, of the wave function of electrons in an atom. Finally, simulated bar patterns were embedded into experimentally acquired noise backgrounds to demonstrate the impact of different NPS symmetries on the visual perception of the object. Results: (1) For a central region in a centered cylindrical object, an s-wave symmetry was always present in the NPS, no matter whether the bowtie filter was present or not. In contrast, for a peripheral region in a centered object, the symmetry of its NPS was highly dependent on the bowtie filter, and both p-wave symmetry and d-wave symmetry were observed in the NPS. (2) For a centered region-ofinterest (ROI) in an off-centered object, the symmetry of

  11. Refining the Structure and Content of Clinical Genomic Reports

    PubMed Central

    DORSCHNER, MICHAEL O.; AMENDOLA, LAURA M.; SHIRTS, BRIAN H.; KIEDROWSKI, LESLI; SALAMA, JOSEPH; GORDON, ADAM S.; FULLERTON, STEPHANIE M.; TARCZY-HORNOCH, PETER; BYERS, PETER H.; JARVIK, GAIL P.

    2014-01-01

    To effectively articulate the results of exome and genome sequencing we refined the structure and content of molecular test reports. To communicate results of a randomized control trial aimed at the evaluation of exome sequencing for clinical medicine, we developed a structured narrative report. With feedback from genetics and non-genetics professionals, we developed separate indication-specific and incidental findings reports. Standard test report elements were supplemented with research study-specific language, which highlighted the limitations of exome sequencing and provided detailed, structured results, and interpretations. The report format we developed to communicate research results can easily be transformed for clinical use by removal of research-specific statements and disclaimers. The development of clinical reports for exome sequencing has shown that accurate and open communication between the clinician and laboratory is ideally an ongoing process to address the increasing complexity of molecular genetic testing. PMID:24616401

  12. [Does clinical risk management require a structured conflict management?].

    PubMed

    Neumann, Stefan

    2015-01-01

    A key element of clinical risk management is the analysis of errors causing near misses or patient damage. After analyzing the causes and circumstances, measures for process improvement have to be taken. Process management, human resource development and other established methods are used. If an interpersonal conflict is a contributory factor to the error, there is usually no structured conflict management available which includes selection criteria for various methods of conflict processing. The European University Viadrina in Frankfurt (Oder) has created a process model for introducing a structured conflict management system which is suitable for hospitals and could fill the gap in the methodological spectrum of clinical risk management. There is initial evidence that a structured conflict management reduces staff fluctuation and hidden conflict costs. This article should be understood as an impulse for discussion on to what extent the range of methods of clinical risk management should be complemented by conflict management.

  13. Optimal normative pediatric cardiac structure dimensions for clinical use.

    PubMed

    Awori, Mark N; Finucane, Kirsten; Gentles, Thomas L

    2011-01-01

    Cardiac structure size influences surgical decision making in pediatric cardiac surgery. Lack of universally adopted normative cardiac structure dimensions may confound decision making. A review of the relevant literature contained in 2 large databases was performed with a view to determine the optimal normative cardiac structure dimensions for clinical use. The current article initially discusses technical issues related to cardiac structure measurement and measurement normalization. It then describes the literature search strategy and examines the quality of published data in subjects below 19 years of age. The optimal normative dimension data set is then recommended.

  14. Practical experience with graphical user interfaces and object-oriented design in the clinical laboratory.

    PubMed

    Wells, I G; Cartwright, R Y; Farnan, L P

    1993-12-15

    The computing strategy in our laboratories evolved from research in Artificial Intelligence, and is based on powerful software tools running on high performance desktop computers with a graphical user interface. This allows most tasks to be regarded as design problems rather than implementation projects, and both rapid prototyping and an object-oriented approach to be employed during the in-house development and enhancement of the laboratory information systems. The practical application of this strategy is discussed, with particular reference to the system designer, the laboratory user and the laboratory customer. Routine operation covers five departments, and the systems are stable, flexible and well accepted by the users. Client-server computing, currently undergoing final trials, is seen as the key to further development, and this approach to Pathology computing has considerable potential for the future.

  15. [Strategies for classification of rehabilitation clinics based on structural equality].

    PubMed

    Koch, U; Tiefensee, J; Kawski, S; Arentewicz, G

    1998-06-01

    Comparison between clinics is a basic part of most quality assurance programmes. The classification of structurally similar clinics is a prerequisite for enabling comparisons between clinics according to quality criteria. As a part of the programme point 1 "structural quality" of the Pension insurance quality assurance programme in medical rehabilitation, a procedure was developed to classify clinics into structurally similar groups. For this purpose the data of the structure survey of the quality assurance programme was used. The first step was to check whether existing classification systems could be used, which made the need for a new classification procedure apparent. The 942 participating clinics were clustered according to a successive differentiation system employing only quality-neutral criteria, e.g., the indication group, the number of different indications, the part of AHB, number of beds, and the therapeutic focus. Further differentiation beyond indication group was necessary for the indications orthopaedics, cardiology, psychosomatics, addiction and neurology. The procedure is demonstrated using the indications orthopaedics and cardiology as examples.

  16. Structural equation modeling in the context of clinical research

    PubMed Central

    2017-01-01

    Structural equation modeling (SEM) has been widely used in economics, sociology and behavioral science. However, its use in clinical medicine is quite limited, probably due to technical difficulties. Because SEM is particularly suitable for analysis of complex relationships among observed variables, it must have potential applications to clinical medicine. The article introduces basic ideas of SEM in the context of clinical medicine. A simulated dataset is employed to show how to do model specification, model fit, visualization and assessment of goodness-of-fit. The first example fits a SEM with continuous outcome variable using sem() function, and the second explores the binary outcome variable using lavaan() function. PMID:28361067

  17. Structured clinical interview guide for postdeployment psychological screening programs.

    PubMed

    Wright, Kathleen M; Adler, Amy B; Bliese, Paul D; Eckford, Rachel D

    2008-05-01

    Brief structured clinical interviews are a key component of the Department of Defense postdeployment health reassessment program. Such interviews are critical for recommending individuals for follow-up assessment and care. To standardize the interview process, U.S. Army Medical Research Unit-Europe developed a structured interview guide, designed in response to both clinical requirements and research findings. The guide includes sections on depression, suicidality, post-traumatic stress disorder, anger, relationship problems, alcohol problems, and sleep problems. In addition, there is an open-ended section on other problems and a section for case dispositions. Data from a 2005 blinded validation study with soldiers returning from a 1-year-long combat deployment are included to demonstrate the utility of the structured interview. Guidelines and implementation considerations for the use of the structured interview are discussed.

  18. Introducing objective structured practical examination as a method of learning and evaluation for undergraduate pharmacology

    PubMed Central

    Vishwakarma, Kirti; Sharma, Mukesh; Matreja, Prithpal Singh; Giri, Vishal Prakash

    2016-01-01

    Objective: Assessment method can influence student learning. Use of objective structured practical examination (OSPE) has been reported in various institutes with great benefits. We evaluated OSPE for the assessment of practical skills in pharmacology examination for undergraduate medical students and compared it with conventional practical examination (CPE). Materials and Methods: After sensitizing the 2nd year MBBS students to OSPE, the students were divided into four batches with twenty students in each batch. Students were assessed by attending five OSPE stations, each for duration of 5 min. The effectiveness was assessed through a student’s feedback questionnaire and was checked for its reliability by Cronbach’s alpha. The result of OSPE was compared with that of CPE of the same batch. Results: Cronbach’s alpha of the feedback questionnaire was 0.71, with high internal consistency. The feedback given was categorized into three domains: cognitive, psychomotor, and affective, and an assessment was also done for its further use. In cognitive domain, 74% of the students felt that the questions asked and the syllabus taught were well correlated. In psychomotor domain, 81% agreed that it is excellent for assessing the applied part of the subject. Seventy percent of students opined that it was associated with lesser stress than CPE. On overall assessment, 76% rated this methodology as good/satisfactory and 23% as excellent in terms of better scoring. There was a significant difference in the mean score between the results of OSPE and CPE (P < 0.001, df = 158, confidence interval = 95%). Conclusion: OSPE is a feasible and skill enhancing tool for the assessment in pharmacology examinations for undergraduate students. PMID:28031608

  19. Objective assessment of biomagnetic devices and alternative clinical therapies using infrared thermal imaging

    NASA Astrophysics Data System (ADS)

    Rockley, Graham J.

    2001-03-01

    The overwhelming introduction of magnetic devices and other alternative therapies into the health care market prompts the need for objective evaluation of these techniques through the use of infrared thermal imaging. Many of these therapies are reported to promote the stimulation of blood flow or the relief of pain conditions. Infrared imaging is an efficient tool to assess such changes in the physiological state. Therefore, a thermal imager can help document and substantiate whether these therapies are in fact providing an effective change to the local circulation. Thermal images may also indicate whether the change is temporary or sustained. As a specific case example, preliminary findings will be presented concerning the use of magnets and the effect they have on peripheral circulation. This will include a discussion of the recommended protocols for this type of infrared testing. This test model can be applied to the evaluation of other devices and therapeutic procedures which are reputed to affect circulation such as electro acupuncture, orthopedic footwear and topical ointments designed to relieve pain or inflammation.

  20. Saving Lives and Money: A Multi-Objective Optimization Approach to the Selection of Structural Retrofits

    NASA Astrophysics Data System (ADS)

    Franco, G.; Deodatis, G.; Smyth, A.

    2005-12-01

    The existence of large numbers of poorly constructed buildings in earthquake-prone areas has made large scale retrofitting campaigns a desirable strategy for reducing the risk of loss of life and infrastructure. Since the retrofitting operation must be, therefore, carried out for numerous buildings, it has become a necessity to find the most attractive retrofitting solution for a given type of buildings that significantly reduces the risk of loss of life while remaining as economic as possible. Each retrofit solution for an existing building carries a set of potential costs and benefits over a given period of time. Some of these costs and benefits can be taken into account in terms of monetary values, whereas others cannot. The value of lives spared or lives lost that may potentially occur over the lifespan of a building as a consequence of choosing a particular retrofit cannot be easily measured in terms of money. In the absence of better methods to incorporate the value of life into economic analyses, a somewhat arbitrary monetary quantity based on personal insurance or personal productivity is often chosen as a proxy to quantify it. These quantities, however, not only fail to capture the otherwise incalculable cost of life, but are also strongly dependent on the economy under study. In this work, the monetary costs of construction and structural damage are clearly differentiated from the loss of life, which is simply measured as the number of potential casualties in a certain earthquake scenario. Finding the best retrofit then becomes a multi-objective optimization problem, whose purpose is to find the cheapest solution that saves most lives. The conflicting nature of the objectives causes the appearance of not only one optimal solution but of a set of most convenient solutions that capture the different levels of trade-off between costs and lives saved. A large number of possible structural retrofits must be considered in order to find the set of best solutions

  1. Using Objective Structured Teaching Encounters (OSTEs) to prepare chief residents to be emotionally intelligent leaders

    PubMed Central

    Cerrone, Sara Ann; Adelman, Patti; Akbar, Salaahuddin; Yacht, Andrew C.; Fornari, Alice

    2017-01-01

    ABSTRACT Background: Chief Residents must lead, manage and mentor a diverse and often large group of residents, however there is a lack of formal leadership training throughout graduate medical education. Objective: Development of a 3-part Chief Resident (CR) Program focused on leading, managing and mentoring. Design: Each participant completes an Emotional Intelligence (EI) Inventory prior to the day-long event. Participants receive their EI scores at the beginning of the program, which features interactive sessions on leadership, management, and feedback skills. The program then reinforces the application of their new knowledge about EI through a four station OSTE (Observed Structured Teaching Encounter). CRs practice feedback and coaching skills in a simulated environment where they need to provide the context of formative feedback to a standardized resident. Results: The aggregated mean pre-session EI score for all participants was 76.9 (an ideal score is >85). An independent-samples t-test compared the CRs’ leadership and feedback performance on their first and second OSTE performance within a single afternoon session. There was a significant difference between the first OSTE performance (M = 47.92, SD = 7.8) and the second OSTE performance (M = 51.22, SD = 6.9); t (68) = 1.99, p = 0.006. These results suggest that participating in multiple OSTEs positively reinforces the core interpersonal and communication skills discussed in the didactic and practiced in the interactive portions of the program. Conclusion: The low mean pre-session EI score achieved by our participants supports the idea that CRs enter their new roles with a level of EI that can be enhanced. CRs had an overall positive reaction to EI and its application to the core skills addressed in the program, highlighting the fact that similar programs could be used to train early career physicians to be more skilled and comfortable with leading, managing and mentoring. Abbreviations: CR

  2. Correlative Nanoscale 3D Imaging of Structure and Composition in Extended Objects

    PubMed Central

    Xu, Feng; Helfen, Lukas; Suhonen, Heikki; Elgrabli, Dan; Bayat, Sam; Reischig, Péter; Baumbach, Tilo; Cloetens, Peter

    2012-01-01

    Structure and composition at the nanoscale determine the behavior of biological systems and engineered materials. The drive to understand and control this behavior has placed strong demands on developing methods for high resolution imaging. In general, the improvement of three-dimensional (3D) resolution is accomplished by tightening constraints: reduced manageable specimen sizes, decreasing analyzable volumes, degrading contrasts, and increasing sample preparation efforts. Aiming to overcome these limitations, we present a non-destructive and multiple-contrast imaging technique, using principles of X-ray laminography, thus generalizing tomography towards laterally extended objects. We retain advantages that are usually restricted to 2D microscopic imaging, such as scanning of large areas and subsequent zooming-in towards a region of interest at the highest possible resolution. Our technique permits correlating the 3D structure and the elemental distribution yielding a high sensitivity to variations of the electron density via coherent imaging and to local trace element quantification through X-ray fluorescence. We demonstrate the method by imaging a lithographic nanostructure and an aluminum alloy. Analyzing a biological system, we visualize in lung tissue the subcellular response to toxic stress after exposure to nanotubes. We show that most of the nanotubes are trapped inside alveolar macrophages, while a small portion of the nanotubes has crossed the barrier to the cellular space of the alveolar wall. In general, our method is non-destructive and can be combined with different sample environmental or loading conditions. We therefore anticipate that correlative X-ray nano-laminography will enable a variety of in situ and in operando 3D studies. PMID:23185554

  3. Reliability of results produced through objectively structured assessment of technical skills (OSATS) for endotracheal intubation (ETI).

    PubMed

    Khaliq, Tanwir

    2013-01-01

    To estimate the reliability of an objectively structured assessment of technical skills (OSATS) in patients for Endotracheal Intubation (ETI), using task-specific checklists during administration of general anaesthesia. Co-relational reliability study. Department of Anaesthesia and Medical Education, Pakistan Institute of Medical Sciences, Islamabad, from September to November 2010. Ten first year residents of the department of anaesthesia who had successfully completed a one-day course of ETI on mannequins and had performed 25 ETI in actual patients under supervision, were asked to perform ETI on anaesthetized patients in the operation theater after consent. The procedure was directly observed by two expert observers (ER1 and ER2) and one inexperienced observer (novice, NR) using a validated task oriented checklist. Each trainee repeated the procedure on another patient and was reassessed using the same checklist. Inter-rater for test and retest, and expert to novice reliabilities along with internal consistency were calculated. The inter-rater reliability was 0.92 in test and was 0.98 in retest (Ebel's calculation). Spearman Rank Correlation Coefficient (SRCC) for ER 1 and NR was 0.76 in test and 0.89 in retest. Cronbach's alpha for internal consistency was 0.93 for first test and 0.97 for retest. The OSATS for ETI in real patients demonstrated excellent inter-rater test reliability, inter-rater retest reliability, expert-novice reliability and internal consistency. This instrument, therefore, proves promising as a tool for competency-based evaluations.

  4. Energy-Efficient Heterogeneous Wireless Sensor Deployment with Multiple Objectives for Structural Health Monitoring

    PubMed Central

    Liu, Chengyin; Jiang, Zhaoshuo; Wang, Fei; Chen, Hui

    2016-01-01

    Heterogeneous wireless sensor networks (HWSNs) are widely adopted in structural health monitoring systems due to their potential for implementing sophisticated algorithms by integrating a diverse set of devices and improving a network’s sensing performance. However, deploying such a HWSN is still in a challenge due to the heterogeneous nature of the data and the energy constraints of the network. To respond to these challenges, an optimal deployment framework in terms of both modal information quality and energy consumption is proposed in this study. This framework generates a multi-objective function aimed at maximizing the quality of the modal information identified from heterogeneous data while minimizing the consumption of energy within the network at the same time. Particle swarm optimization algorithm is then implemented to seek solutions to the function effectively. After laying out the proposed sensor-optimization framework, a methodology is present to determine the clustering of the sensors to further conserve energy. Finally, a numerical verification is performed on a four-span pre-stressed reinforced concrete box-girder bridge. Results show that a set of strategically positioned heterogeneous sensors can maintain a balanced trade-off between the modal information accuracy and energy consumption. It is also observed that an appropriate cluster-tree network topology can further achieve energy saving in HWSNs. PMID:27827975

  5. Energy-Efficient Heterogeneous Wireless Sensor Deployment with Multiple Objectives for Structural Health Monitoring.

    PubMed

    Liu, Chengyin; Jiang, Zhaoshuo; Wang, Fei; Chen, Hui

    2016-11-06

    Heterogeneous wireless sensor networks (HWSNs) are widely adopted in structural health monitoring systems due to their potential for implementing sophisticated algorithms by integrating a diverse set of devices and improving a network's sensing performance. However, deploying such a HWSN is still in a challenge due to the heterogeneous nature of the data and the energy constraints of the network. To respond to these challenges, an optimal deployment framework in terms of both modal information quality and energy consumption is proposed in this study. This framework generates a multi-objective function aimed at maximizing the quality of the modal information identified from heterogeneous data while minimizing the consumption of energy within the network at the same time. Particle swarm optimization algorithm is then implemented to seek solutions to the function effectively. After laying out the proposed sensor-optimization framework, a methodology is present to determine the clustering of the sensors to further conserve energy. Finally, a numerical verification is performed on a four-span pre-stressed reinforced concrete box-girder bridge. Results show that a set of strategically positioned heterogeneous sensors can maintain a balanced trade-off between the modal information accuracy and energy consumption. It is also observed that an appropriate cluster-tree network topology can further achieve energy saving in HWSNs.

  6. A trial of the objective structured practical examination in physiology at Melaka Manipal Medical College, India.

    PubMed

    Abraham, Reem Rachel; Raghavendra, Rao; Surekha, Kamath; Asha, Kamath

    2009-03-01

    A single examination does not fulfill all the functions of assessment. The present study was undertaken to determine the reliability and student satisfaction regarding the objective structured practical examination (OSPE) as a method of assessment of laboratory exercises in physiology before implementing it in the forthcoming university examination. The present study was undertaken in the Department of Physiology of Melaka Manipal Medical College, Manipal Campus, India. During the OSPE, students were made to rotate through 11 stations, of which 8 stations were composed of questions that tested their knowledge and critical thinking and 2 stations were composed of skills that students had to perform before the examiner. One station was kept as the rest station. Performance of the students was assessed by comparing the students' scores in the traditional practical examination (TPE) and OSPE using "Bland-Altman technique." Student perspectives regarding the OSPE were obtained by asking them to respond to a questionnaire. The Bland-Altman plot showed that approximately 63% of the students showed a performance in the scores obtained using the OSPE and TPE within the acceptable limit of 8; 32% of the students scored much above the anticipated difference in the scores, and the rest scored below the anticipated difference in the scores on the OSPE and TPE. Feedback indicated that students were in favor of the OSPE compared with the TPE. Feedback from the students provided scope for improvement before the OSPE was administered for the first time in the forthcoming university examination.

  7. Chemistry of massive young stellar objects with a disk-like structure

    NASA Astrophysics Data System (ADS)

    Isokoski, K.; Bottinelli, S.; van Dishoeck, E. F.

    2013-06-01

    Aims: Our goal is to take an inventory of complex molecules in three well-known high-mass protostars for which disks or toroids have been claimed and to study the similarities and differences with a sample of massive young stellar objects (YSOs) without evidence of such flattened disk-like structures. With a disk-like geometry, UV radiation can escape more readily and potentially affect the ice and gas chemistry on hot-core scales. Methods: A partial submillimeter line survey, targeting CH3OH, H2CO, C2H5OH, HCOOCH3, CH3OCH3, CH3CN, HNCO, NH2CHO, C2H5CN, CH2CO, HCOOH, CH3CHO, and CH3CCH, was made toward three massive YSOs with disk-like structures, IRAS 20126+4104, IRAS 18089-1732, and G31.41+0.31. Rotation temperatures and column densities were determined by the rotation diagram method, as well as by independent spectral modeling. The molecular abundances were compared with previous observations of massive YSOs without evidence of any disk structure, targeting the same molecules with the same settings and using the same analysis method. Results: Consistent with previous studies, different complex organic species have different characteristic rotation temperatures and can be classified either as warm (>100 K) or cold (<100 K). The excitation temperatures and abundance ratios are similar from source to source and no significant difference can be established between the two source types. Acetone, CH3COCH3, is detected for the first time in G31.41+0.31 and IRAS 18089-1732. Temperatures and abundances derived from the two analysis methods generally agree within factors of a few. Conclusions: The lack of chemical differentiation between massive YSOs with and without observed disks suggest either that the chemical complexity is already fully established in the ices in the cold prestellar phase or that the material experiences similar physical conditions and UV exposure through outflow cavities during the short embedded lifetime. Appendices are available in electronic form

  8. Actigraphy in human African trypanosomiasis as a tool for objective clinical evaluation and monitoring: a pilot study.

    PubMed

    Njamnshi, Alfred K; Seke Etet, Paul F; Perrig, Stephen; Acho, Alphonse; Funsah, Julius Y; Mumba, Dieudonné; Muyembe, Jean-Jacques; Kristensson, Krister; Bentivoglio, Marina

    2012-01-01

    Human African trypanosomiasis (HAT) or sleeping sickness leads to a complex neuropsychiatric syndrome with characteristic sleep alterations. Current division into a first, hemolymphatic stage and second, meningoencephalitic stage is primarily based on the detection of white blood cells and/or trypanosomes in the cerebrospinal fluid. The validity of this criterion is, however, debated, and novel laboratory biomarkers are under study. Objective clinical HAT evaluation and monitoring is therefore needed. Polysomnography has effectively documented sleep-wake disturbances during HAT, but could be difficult to apply as routine technology in field work. The non-invasive, cost-effective technique of actigraphy has been widely validated as a tool for the ambulatory evaluation of sleep disturbances. In this pilot study, actigraphy was applied to the clinical assessment of HAT patients. Actigraphy was recorded in patients infected by Trypanosoma brucei gambiense, and age- and sex-matched control subjects. Simultaneous nocturnal polysomnography was also performed in the patients. Nine patients, including one child, were analyzed at admission and two of them also during specific treatment. Parameters, analyzed with user-friendly software, included sleep time evaluated from rest-activity signals, rest-activity rhythm waveform and characteristics. The findings showed sleep-wake alterations of various degrees of severity, which in some patients did not parallel white blood cell counts in the cerebrospinal fluid. Actigraphic recording also showed improvement of the analyzed parameters after treatment initiation. Nocturnal polysomnography showed alterations of sleep time closely corresponding to those derived from actigraphy. The data indicate that actigraphy can be an interesting tool for HAT evaluation, providing valuable clinical information through simple technology, well suited also for long-term follow-up. Actigraphy could therefore objectively contribute to the clinical

  9. Incidental and Context-Responsive Activation of Structure- and Function-Based Action Features during Object Identification

    ERIC Educational Resources Information Center

    Lee, Chia-lin; Middleton, Erica; Mirman, Daniel; Kalenine, Solene; Buxbaum, Laurel J.

    2013-01-01

    Previous studies suggest that action representations are activated during object processing, even when task-irrelevant. In addition, there is evidence that lexical-semantic context may affect such activation during object processing. Finally, prior work from our laboratory and others indicates that function-based ("use") and structure-based…

  10. Method and apparatus for detecting internal structures of bulk objects using acoustic imaging

    DOEpatents

    Deason, Vance A.; Telschow, Kenneth L.

    2002-01-01

    Apparatus for producing an acoustic image of an object according to the present invention may comprise an excitation source for vibrating the object to produce at least one acoustic wave therein. The acoustic wave results in the formation of at least one surface displacement on the surface of the object. A light source produces an optical object wavefront and an optical reference wavefront and directs the optical object wavefront toward the surface of the object to produce a modulated optical object wavefront. A modulator operatively associated with the optical reference wavefront modulates the optical reference wavefront in synchronization with the acoustic wave to produce a modulated optical reference wavefront. A sensing medium positioned to receive the modulated optical object wavefront and the modulated optical reference wavefront combines the modulated optical object and reference wavefronts to produce an image related to the surface displacement on the surface of the object. A detector detects the image related to the surface displacement produced by the sensing medium. A processing system operatively associated with the detector constructs an acoustic image of interior features of the object based on the phase and amplitude of the surface displacement on the surface of the object.

  11. Objective Assessment of Joint Stiffness: A Clinically Oriented Hardware and Software Device with an Application to the Shoulder Joint.

    PubMed

    McQuade, Kevin; Price, Robert; Liu, Nelson; Ciol, Marcia A

    2012-08-30

    Examination of articular joints is largely based on subjective assessment of the "end-feel" of the joint in response to manually applied forces at different joint orientations. This technical report aims to describe the development of an objective method to examine joints in general, with specific application to the shoulder, and suitable for clinical use. We adapted existing hardware and developed laptop-based software to objectively record the force/displacement behavior of the glenohumeral joint during three common manual joint examination tests with the arm in six positions. An electromagnetic tracking system recorded three-dimensional positions of sensors attached to a clinician examiner and a patient. A hand-held force transducer recorded manually applied translational forces. The force and joint displacement were time-synchronized and the joint stiffness was calculated as a quantitative representation of the joint "end-feel." A methodology and specific system checks were developed to enhance clinical testing reproducibility and precision. The device and testing protocol were tested on 31 subjects (15 with healthy shoulders, and 16 with a variety of shoulder impairments). Results describe the stiffness responses, and demonstrate the feasibility of using the device and methods in clinical settings.

  12. Proposal for a new objective method to evaluate low-level laser therapy efficacy in clinical practice

    NASA Astrophysics Data System (ADS)

    Antipa, Ciprian; Nicolescu, Alin; Pascu, Mihail-Lucian; Vlaiculescu, Mihaela; Ionescu, Elena

    2000-06-01

    Until now there is a lack of objective methods to evaluate the clinical efficacy of low level lasers (LLL). The reported results in this paper are showing that the cutaneous ultrasound could be a valuable method to be used in order to objectify the results obtained in low level laser therapy (LLLT). 52 patients with osteoarthritis were divided into three groups: Group A:19 patients treated with IR emitted laser diode, CW, 3mW power, 780 nm wavelengths. Group B: 18 patients treated with the same IR laser diode as above and He-Ne laser, CW, 2mW power. Group C: 14 patients exposed to placebo laser. To every patient was done cutaneous ultrasound before and after LLLT and we followed also the clinical evolution. The positive results meaning significant US favorable changes were found in 73.9 percent for group A and 77.7 percent for group B and 21.4 percent for PLACEBO group. We conclude that cutaneous ultrasound could be an objective method to appreciate the clinical efficacy of low power lasers.

  13. Social cognition in schizophrenia: factor structure, clinical and functional correlates.

    PubMed

    Buck, Benjamin E; Healey, Kristin M; Gagen, Emily C; Roberts, David L; Penn, David L

    2016-08-01

    Social cognition is consistently impaired in people with schizophrenia, separable from general neurocognition, predictive of real-world functioning and amenable to psychosocial treatment. Few studies have empirically examined its underlying factor structure. This study (1) examines the factor structure of social cognition in both a sample of individuals with schizophrenia-spectrum disorders and non-clinical controls and (2) explores relationships of factors to neurocognition, symptoms and functioning. A factor analysis was conducted on social cognition measures in a sample of 65 individuals with schizophrenia or schizoaffective disorder, and 50 control participants. The resulting factors were examined for their relationships to symptoms and functioning. Results suggested a two-factor structure in the schizophrenia sample (social cognition skill and hostile attributional style) and a three-factor structure in the non-clinical sample (hostile attributional style, higher-level inferential processing and lower-level cue detection). In the schizophrenia sample, the social cognition skill factor was significantly related to negative symptoms and social functioning, whereas hostile attributional style predicted positive and general psychopathology symptoms. The factor structure of social cognition in schizophrenia separates hostile attributional style and social cognition skill, and each show differential relationships to relevant clinical variables in schizophrenia.

  14. Transforming clinical imaging and 3D data for virtual reality learning objects: HTML5 and mobile devices implementation.

    PubMed

    Trelease, Robert B; Nieder, Gary L

    2013-01-01

    Web deployable anatomical simulations or "virtual reality learning objects" can easily be produced with QuickTime VR software, but their use for online and mobile learning is being limited by the declining support for web browser plug-ins for personal computers and unavailability on popular mobile devices like Apple iPad and Android tablets. This article describes complementary methods for creating comparable, multiplatform VR learning objects in the new HTML5 standard format, circumventing platform-specific limitations imposed by the QuickTime VR multimedia file format. Multiple types or "dimensions" of anatomical information can be embedded in such learning objects, supporting different kinds of online learning applications, including interactive atlases, examination questions, and complex, multi-structure presentations. Such HTML5 VR learning objects are usable on new mobile devices that do not support QuickTime VR, as well as on personal computers. Furthermore, HTML5 VR learning objects can be embedded in "ebook" document files, supporting the development of new types of electronic textbooks on mobile devices that are increasingly popular and self-adopted for mobile learning. © 2012 American Association of Anatomists.

  15. A method for subdividing clinical guidelines into process modules with associated triggers and objectives to facilitate implementation.

    PubMed

    Luckmann, Roger S; Boxwala, Aziz A; Greenes, Robert A

    2003-01-01

    Representation of multi-step clinical guidelines (CG) and their implementation in computerized decision support (DS) systems are complex and logistically challenging tasks. However, many simple rules based on CGs (e.g., medical logic modules), have been successfully implemented through a few popular DS models (e.g., prevention reminders, order entry systems). To facilitate mapping of CGs to practical DS models, we propose an empirical method for sub-dividing CGs into modules according to the locus in a clinical process flow model where implementation would be most effective (e.g., post-encounter provider order entry). We further propose a classification of triggers and objectives for CG modules that provides a framework for a DS system to implement the module Successful application of the method to ten diverse CGs in the outpatient setting is described.

  16. A Method for Subdividing Clinical Guidelines into Process Modules with Associated Triggers and Objectives to Facilitate Implementation

    PubMed Central

    Luckmann, Roger; Boxwala, Aziz A.; Greenes, Robert A.

    2003-01-01

    Representation of multi-step clinical guidelines (CG) and their implementation in computerized decision support (DS) systems are complex and logistically challenging tasks. However, many simple rules based on CGs (e.g., medical logic modules), have been successfully implemented through a few popular DS models (e.g., prevention reminders, order entry systems). To facilitate mapping of CGs to practical DS models, we propose an empirical method for subdividing CGs into modules according to the locus in a clinical process flow model where implementation would be most effective (e.g., post-encounter provider order entry). We further propose a classification of triggers and objectives for CG modules that provides a framework for a DS system to implement the module Successful application of the method to ten diverse CGs in the outpatient setting is described. PMID:14728424

  17. Assessment of clinical outcomes of Roth and MBT bracket prescription using the American Board of Orthodontics Objective Grading System.

    PubMed

    Jain, Mahesh; Varghese, Joseph; Mascarenhas, Rohan; Mogra, Subraya; Shetty, Siddarth; Dhakar, Nidhi

    2013-07-01

    There is always a need to assess whether small changes in bracket prescription can lead to visually detectable differences in tooth positions. However, with little clinical evidence to show advantages of any of the popularly used bracket systems, orthodontists are forced to make clinical decisions with little scientific guidance. To compare the orthodontic cases finished with Roth and MBT prescription using American Board of Orthodontics-Objective Grading System (ABO-OGS). Department of Orthodontics, Post-graduate dental college, retrospective cross-sectional study. Forty patients selected were divided into two groups of 20 patients each finished with straight wire appliance using Roth and MBT prescription, respectively. The examiner ability was assessed and calibrated by one of the ABO certified clinician to grade cases using the OGS. Unpaired student t-test was used and P < 0.05 was accepted as significant. MBT bracket group had a lower score of 2.60 points in buccolingual inclination and lower score of 1.10 points in occlusal contact category that was statistically significant when compared with Roth group. The difference in total ABO-OGS score was 2.65 points showing that the outcome for the MBT prescription was better than that of the Roth prescription, which is statistically significant, but with little or no clinical significance. It can be concluded that use of either one of the Roth and MBT bracket prescriptions have no impact to the overall clinical outcome and quality of treatment entirely depends on clinician judgment and experience.

  18. The Efficacy of Structural Priming on the Acquisition of Double Object Construction by Chinese EFL Learners

    ERIC Educational Resources Information Center

    Jiang, Lin; Huang, Kang

    2015-01-01

    Structural priming refers to the tendency of speakers to reuse the same structural pattern as one that was previously encountered (Bock, 1986). The effectiveness of structural priming has been an issue of much discussion in the field of second language acquisition over decades. This study aims at investigating the role of structural priming in…

  19. Introducing objective structured practical examination as a method of learning and evaluation for undergraduate pharmacology.

    PubMed

    Vishwakarma, Kirti; Sharma, Mukesh; Matreja, Prithpal Singh; Giri, Vishal Prakash

    2016-10-01

    Assessment method can influence student learning. Use of objective structured practical examination (OSPE) has been reported in various institutes with great benefits. We evaluated OSPE for the assessment of practical skills in pharmacology examination for undergraduate medical students and compared it with conventional practical examination (CPE). After sensitizing the 2(nd) year MBBS students to OSPE, the students were divided into four batches with twenty students in each batch. Students were assessed by attending five OSPE stations, each for duration of 5 min. The effectiveness was assessed through a student's feedback questionnaire and was checked for its reliability by Cronbach's alpha. The result of OSPE was compared with that of CPE of the same batch. Cronbach's alpha of the feedback questionnaire was 0.71, with high internal consistency. The feedback given was categorized into three domains: cognitive, psychomotor, and affective, and an assessment was also done for its further use. In cognitive domain, 74% of the students felt that the questions asked and the syllabus taught were well correlated. In psychomotor domain, 81% agreed that it is excellent for assessing the applied part of the subject. Seventy percent of students opined that it was associated with lesser stress than CPE. On overall assessment, 76% rated this methodology as good/satisfactory and 23% as excellent in terms of better scoring. There was a significant difference in the mean score between the results of OSPE and CPE (P < 0.001, df = 158, confidence interval = 95%). OSPE is a feasible and skill enhancing tool for the assessment in pharmacology examinations for undergraduate students.

  20. An objective structured biostatistics examination: a pilot study based on computer-assisted evaluation for undergraduates

    PubMed Central

    Acemoglu, Hamit; Akturk, Zekeriya

    2012-01-01

    We designed and evaluated an objective structured biostatistics examination (OSBE) on a trial basis to determine whether it was feasible for formative or summative assessment. At Ataturk University, we have a seminar system for curriculum for every cohort of all five years undergraduate education. Each seminar consists of an integrated system for different subjects, every year three to six seminars that meet for six to eight weeks, and at the end of each seminar term we conduct an examination as a formative assessment. In 2010, 201 students took the OSBE, and in 2011, 211 students took the same examination at the end of a seminar that had biostatistics as one module. The examination was conducted in four groups and we examined two groups together. Each group had to complete 5 stations in each row therefore we had two parallel lines with different instructions to be followed, thus we simultaneously examined 10 students in these two parallel lines. The students were invited after the examination to receive feedback from the examiners and provide their reflections. There was a significant (P=0.004) difference between male and female scores in the 2010 students, but no gender difference was found in 2011. The comparison among the parallel lines and among the four groups showed that two groups, A and B, did not show a significant difference (P>0.05) in either class. Nonetheless, among the four groups, there was a significant difference in both 2010 (P=0.001) and 2011 (P=0.001). The inter-rater reliability coefficient was 0.60. Overall, the students were satisfied with the testing method; however, they felt some stress. The overall experience of the OSBE was useful in terms of learning, as well as for assessment. PMID:22844554

  1. Relationship between objectively measured physical activity and vascular structure and function in adults.

    PubMed

    Gomez-Marcos, Manuel A; Recio-Rodríguez, José I; Patino-Alonso, Maria C; Agudo-Conde, Cristina; Lasaosa-Medina, Lourdes; Rodriguez-Sanchez, Emiliano; Maderuelo-Fernandez, José A; García-Ortiz, Luis

    2014-06-01

    To analyze the relationship between regular physical activity, as assessed by accelerometer and 7-day physical activity recall (PAR) with vascular structure and function based on carotid intima-media thickness, pulse wave velocity, central and peripheral augmentation index and the ambulatory arterial stiffness index in adults. This study analyzed 263 subjects who were included in the EVIDENT study (mean age 55.85 ± 12.21 years; 59.30% female). Physical activity was assessed during 7 days using the Actigraph GT3X accelerometer (counts/minute) and 7-day PAR (metabolic equivalents (METs)/hour/week). Carotid ultrasound was used to measure carotid intima media thickness (IMT). The SphygmoCor System was used to measure pulse wave velocity (PWV), and central and peripheral augmentation index (CAIx and PAIx). The B-pro device was used to measure ambulatory arterial stiffness index (AASI). Median counts/minute was 244.37 and mean METs/hour/week was 11.49. Physical activity showed an inverse correlation with PAIx (r = -0.179; p < 0.01) and vigorous activity day time with IMT (r = -0.174), CAIx (r = -0.217) and PAIx (r = -0.324) (p < 0.01, all). Sedentary activity day time was correlated positively with CAIx (r = 0.103; p < 0.05). In multiple regression analysis, after adjusting for confounding factors, the inverse association of CAIx with counts/minute and the time spent in moderate and vigorous activity were maintained as well as the positive association with sedentary activity day time (p < 0.05). Physical activity, assessed by counts/minute, and the amount of time spent in moderate, vigorous/very vigorous physical activity, showed an inverse association with CAIx. Likewise, the time spent in sedentary activity was positively associated with the CAIx. Clinical Trials.gov Identifier: NCT01083082. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. Envelope structure of deeply embedded young stellar objects in the Serpens Molecular Cloud

    NASA Technical Reports Server (NTRS)

    Hogerheijde, M. R.; van Dishoeck, E. F.; Salverda, J. M.; Blake, G. A.

    1999-01-01

    Aperture-synthesis and single-dish (sub-) millimeter molecular-line and continuum observations reveal in great detail the envelope structure of deeply embedded young stellar objects (SMM 1 = FIRS 1, SMM 2, SMM 3, SMM 4) in the densely star-forming Serpens Molecular Cloud. SMM 1, 3, and 4 show partially resolved (>2" = 800 AU) continuum emission in the beam of the Owens Valley Millimeter Array at lambda = 3.4-1.4 mm. The continuum visibilities accurately constrain the density structure in the envelopes, which can be described by a radial power law with slope -2.0 +/- 0.5 on scales of 300 to 8000 AU. Inferred envelope masses within a radius of 8000 AU are 8.7, 3.0, and 5.3 Msolar for SMM 1, 3, and 4, respectively. A point source with 20%-30% of the total flux at 1.1 mm is required to fit the observations on long baselines, corresponding to warm envelope material within approximately 100 AU or a circumstellar disk. No continuum emission is detected interferometrically toward SMM 2, corresponding to an upper limit of 0.2 Msolar assuming Td = 24 K. The lack of any compact dust emission suggests that the SMM 2 core does not contain a central protostar. Aperture-synthesis observations of the 13CO, C18O, HCO+, H13CO+, HCN, H13CN, N2H+ 1-0, SiO 2-1, and SO 2(2)-1(1) transitions reveal compact emission toward SMM 1, 3, and 4. SMM 2 shows only a number of clumps scattered throughout the primary field of view, supporting the conclusion that this core does not contain a central star. The compact molecular emission around SMM 1, 3, and 4 traces 5"-10" (2000-4000 AU) diameter cores that correspond to the densest regions of the envelopes, as well as material directly associated with the molecular outflow. Especially prominent are the optically thick HCN and HCO+ lines that show up brightly along the walls of the outflow cavities. SO and SiO trace shocked material, where their abundances may be enhanced by 1-2 orders of magnitude over dark-cloud values. A total of 31 molecular

  3. Envelope structure of deeply embedded young stellar objects in the Serpens Molecular Cloud.

    PubMed

    Hogerheijde, M R; van Dishoeck, E F; Salverda, J M; Blake, G A

    1999-03-01

    Aperture-synthesis and single-dish (sub-) millimeter molecular-line and continuum observations reveal in great detail the envelope structure of deeply embedded young stellar objects (SMM 1 = FIRS 1, SMM 2, SMM 3, SMM 4) in the densely star-forming Serpens Molecular Cloud. SMM 1, 3, and 4 show partially resolved (>2" = 800 AU) continuum emission in the beam of the Owens Valley Millimeter Array at lambda = 3.4-1.4 mm. The continuum visibilities accurately constrain the density structure in the envelopes, which can be described by a radial power law with slope -2.0 +/- 0.5 on scales of 300 to 8000 AU. Inferred envelope masses within a radius of 8000 AU are 8.7, 3.0, and 5.3 Msolar for SMM 1, 3, and 4, respectively. A point source with 20%-30% of the total flux at 1.1 mm is required to fit the observations on long baselines, corresponding to warm envelope material within approximately 100 AU or a circumstellar disk. No continuum emission is detected interferometrically toward SMM 2, corresponding to an upper limit of 0.2 Msolar assuming Td = 24 K. The lack of any compact dust emission suggests that the SMM 2 core does not contain a central protostar. Aperture-synthesis observations of the 13CO, C18O, HCO+, H13CO+, HCN, H13CN, N2H+ 1-0, SiO 2-1, and SO 2(2)-1(1) transitions reveal compact emission toward SMM 1, 3, and 4. SMM 2 shows only a number of clumps scattered throughout the primary field of view, supporting the conclusion that this core does not contain a central star. The compact molecular emission around SMM 1, 3, and 4 traces 5"-10" (2000-4000 AU) diameter cores that correspond to the densest regions of the envelopes, as well as material directly associated with the molecular outflow. Especially prominent are the optically thick HCN and HCO+ lines that show up brightly along the walls of the outflow cavities. SO and SiO trace shocked material, where their abundances may be enhanced by 1-2 orders of magnitude over dark-cloud values. A total of 31 molecular

  4. Rapid development of entity-based data models for bioinformatics with persistence object-oriented design and structured interfaces.

    PubMed

    Ezra Tsur, Elishai

    2017-01-01

    Databases are imperative for research in bioinformatics and computational biology. Current challenges in database design include data heterogeneity and context-dependent interconnections between data entities. These challenges drove the development of unified data interfaces and specialized databases. The curation of specialized databases is an ever-growing challenge due to the introduction of new data sources and the emergence of new relational connections between established datasets. Here, an open-source framework for the curation of specialized databases is proposed. The framework supports user-designed models of data encapsulation, objects persistency and structured interfaces to local and external data sources such as MalaCards, Biomodels and the National Centre for Biotechnology Information (NCBI) databases. The proposed framework was implemented using Java as the development environment, EclipseLink as the data persistency agent and Apache Derby as the database manager. Syntactic analysis was based on J3D, jsoup, Apache Commons and w3c.dom open libraries. Finally, a construction of a specialized database for aneurysms associated vascular diseases is demonstrated. This database contains 3-dimensional geometries of aneurysms, patient's clinical information, articles, biological models, related diseases and our recently published model of aneurysms' risk of rapture. Framework is available in: http://nbel-lab.com.

  5. Subjective and objective quality of life, levels of life skills, and their clinical determinants in outpatients with schizophrenia.

    PubMed

    Aki, Hirofumi; Tomotake, Masahito; Kaneda, Yasuhiro; Iga, Jun-Ichi; Kinouchi, Sawako; Shibuya-Tayoshi, Sumiko; Tayoshi, Shin-Ya; Motoki, Ikuyo; Moriguchi, Kazuhiko; Sumitani, Satsuki; Yamauchi, Ken; Taniguchi, Takahide; Ishimoto, Yasuhito; Ueno, Shu-Ichi; Ohmori, Tetsuro

    2008-02-28

    The purpose of the present study is to investigate the relationships among subjective and objective quality of life (QOL), and levels of life skills, and their clinical determinants in outpatients with schizophrenia by using schizophrenia disease-specific QOL measures. Data collected from 64 outpatients were analyzed. Subjective QOL was measured with the Schizophrenia Quality of Life Scale (SQLS) and objective QOL with the Quality of Life Scale (QLS). Patients' family members completed the Life Skills Profile (LSP). Clinical symptoms were also assessed with several scales including the Brief Psychiatric Rating Scale (BPRS) and the Calgary Depression Scale for Schizophrenia (CDSS). Only the motivation/energy scale, but not the other scales of the SQLS, correlated with the QLS. The LSP rated by the family showed significant correlations with both the SQLS and the QLS. The CDSS score predicted each scale of the SQLS, and the BPRS negative symptoms score predicted the QLS. The LSP was predicted by the BPRS negative symptoms score and the CDSS score independently. These results indicate that the patient's QOL could be predicted by the life skills measured by a family member and suggest that active treatment for depressive and negative symptoms might be recommended to improve the patient's QOL and life skills.

  6. The clinical use of structural MRI in Alzheimer disease

    PubMed Central

    Frisoni, Giovanni B.; Fox, Nick C.; Jack, Clifford R.; Scheltens, Philip; Thompson, Paul M.

    2010-01-01

    Structural imaging based on magnetic resonance is an integral part of the clinical assessment of patients with suspected Alzheimer dementia. Prospective data on the natural history of change in structural markers from preclinical to overt stages of Alzheimer disease are radically changing how the disease is conceptualized, and will influence its future diagnosis and treatment. Atrophy of medial temporal structures is now considered to be a valid diagnostic marker at the mild cognitive impairment stage. Structural imaging is also included in diagnostic criteria for the most prevalent non-Alzheimer dementias, reflecting its value in differential diagnosis. In addition, rates of whole-brain and hippocampal atrophy are sensitive markers of neurodegeneration, and are increasingly used as outcome measures in trials of potentially disease-modifying therapies. Large multicenter studies are currently investigating the value of other imaging and nonimaging markers as adjuncts to clinical assessment in diagnosis and monitoring of progression. The utility of structural imaging and other markers will be increased by standardization of acquisition and analysis methods, and by development of robust algorithms for automated assessment. PMID:20139996

  7. The clinical use of structural MRI in Alzheimer disease.

    PubMed

    Frisoni, Giovanni B; Fox, Nick C; Jack, Clifford R; Scheltens, Philip; Thompson, Paul M

    2010-02-01

    Structural imaging based on magnetic resonance is an integral part of the clinical assessment of patients with suspected Alzheimer dementia. Prospective data on the natural history of change in structural markers from preclinical to overt stages of Alzheimer disease are radically changing how the disease is conceptualized, and will influence its future diagnosis and treatment. Atrophy of medial temporal structures is now considered to be a valid diagnostic marker at the mild cognitive impairment stage. Structural imaging is also included in diagnostic criteria for the most prevalent non-Alzheimer dementias, reflecting its value in differential diagnosis. In addition, rates of whole-brain and hippocampal atrophy are sensitive markers of neurodegeneration, and are increasingly used as outcome measures in trials of potentially disease-modifying therapies. Large multicenter studies are currently investigating the value of other imaging and nonimaging markers as adjuncts to clinical assessment in diagnosis and monitoring of progression. The utility of structural imaging and other markers will be increased by standardization of acquisition and analysis methods, and by development of robust algorithms for automated assessment.

  8. Clinical, functional and structural determinants of central pain in syringomyelia.

    PubMed

    Hatem, Samar M; Attal, Nadine; Ducreux, Denis; Gautron, Michèle; Parker, Fabrice; Plaghki, Leon; Bouhassira, Didier

    2010-11-01

    . Patients with both spontaneous and evoked pain clearly differed from patients with spontaneous pain only. Patients with spontaneous pain only had more severe spinal cord damage, and the correlation between average daily pain intensity and fractional anisotropy of the full spinal cord was particularly strong in this subgroup of patients (Spearman's ρ = -0.93, P = 0.008). By contrast, patients with both spontaneous and evoked pain had not only less structural spinal cord damage, but also better preserved spinothalamic and lemniscal tracts on quantitative sensory testing and electrophysiological testing. These data showed, for the first time, a direct relationship between central neuropathic pain and objective markers of spinal cord damage, and confirmed the clinical relevance of 3D fibre tracking for the sensory assessment of patients with a spinal cord lesion.

  9. Factor structure of the Clinical Research Appraisal Inventory (CRAI).

    PubMed

    Mills, Britain A; Caetano, Raul; Rhea, Arianne E

    2014-03-01

    The Clinical Research Appraisal Inventory (CRAI) is a 92-item measure covering 10 domains of research self-efficacy. A known behavioral antecedent, reliable and valid measures of self-efficacy represent a potentially useful tool in the evaluation of research training program efficacy. However, few formal psychometric studies of this instrument exist. Using exploratory factor analysis, we examine the CRAI's dimensional structure in a new sample of clinical research trainees. In contrast to the multidimensional solutions reported previously, CRAI responses in the present sample were unambiguously one-dimensional (as suggested by a dominant single Eigenvalue and parallel analysis). This discrepant finding may reflect sample differences in research experience, as unlike previous studies, participants had all already obtained a professional degree. The CRAI's dimensional structure may coalesce into a smaller number of factors as research experience is acquired, and investigators should be mindful of this possibility in future studies of the instrument.

  10. Circumstellar Structure Properties of Young Stellar Objects: Envelopes, Bipolar Outflows, and Disks

    NASA Astrophysics Data System (ADS)

    Kwon, Woojin

    2009-12-01

    Physical properties of the three main structures in young stellar objects (YSOs), envelopes, bipolar outflows, and circumstellar disks, have been studied using radio interferometers: the Berkeley-Illinois-Maryland Association (BIMA) array and the Combined Array for Research in Millimeter-wave Astronomy (CARMA). (1) Envelopes. Three Class 0 YSOs (L1448 IRS 2, L1448 IRS 3, and L1157) have been observed by CARMA at λ = 1.3 mm and 2.7 mm continuum. Through visibility modeling to fit the two wavelength continuum data simultaneously, we found that the dust opacity spectral index (β) of Class 0 YSOs is around unity, which implies that dust grains have significantly grown already at the earliest stage. In addition, we discussed the radial dependence of β detected in L1448 IRS 3B and also estimated the density distribution of the three targets. (2) Bipolar outflows. Polarimetric observations in the λ = 1.3 mm continuum and CO, as well as spectral line observations in 13CO and C18O have been carried out toward L1448 IRS 3, which has three Class 0 YSOs, using BIMA. We clearly identified two interacting bipolar outflows from the "binary system" of IRS 3A and 3B and estimated the velocity, inclination, and opening angle of the 3B bipolar outflow, using Bayesian inference. Also, we showed that the "binary system" can be bound gravitationally and we estimated the specific angular momentum, which is between those of binary stars and molecular cloud cores. In addition, we marginally detected linear polarizations at the center of IRS 3B (implying a toroidal magnetic field) in continuum and at the bipolar outflow region in CO. (3) Circumstellar disks. We present the results of 6 objects (CI Tau, DL Tau, DO Tau, FT Tau, Haro 6-13, and HL Tau) in our T Tauri disk survey using CARMA. The data consist of λ = 1.3 mm and 2.7 mm continuum with an angular resolution up to 0.13". Through visibility modeling of two disk models (power-law disk with a Gaussian edge and viscous accretion

  11. The "Bantu Clinic": a genealogy of the African patient as object and effect of South African clinical medicine, 1930-1990.

    PubMed

    Butchart, A

    1997-12-01

    This paper is about power, medicine and the identity of the African as a patient of western medicine. From a conventional perspective and as encoded in the current "quest for wholeness" that characterises South African biomedical discourse, the African patient--like any other patient--has always existed as an authentic and subjectified being, whose true attributes and experiences have been denied by the "mechanistic," "reductionistic" and "ethnocentric" practices of clinical medicine. Against this liberal humanist perspective on the body as ontologically independent of power, this paper offers a Foucaultian reading of the African patient as-like any other patient--contingent upon the force relations immanent within and relayed through the clinical practices of biomedicine. A quintessential form of disciplinary micro-power, these fabricate the most intimate recesses of the human body as manageable objects of medical knowledge and social consciousness to make possible the great control strategies of repression, segmentation and liberation that are the usual focus of conventional investigations into the place and function of medicine in society. Since the 1930s when the African body first emerged as a discrete object of a secular clinical knowledge, these have repeatedly transformed the attributes and identity of the African patient, and the paper traces this archaeology of South African clinical perception from then until the 1990s to show how its "quest for wholeness" is not an end point of "discovery" or "liberation," but merely another ephemeral crystallization of socio-medical knowledge in a constantly changing force field of disciplinary power.

  12. Objective Structured Assessments of Technical Skills (OSATS) Does Not Assess the Quality of the Surgical Result Effectively.

    PubMed

    Anderson, Donald D; Long, Steven; Thomas, Geb W; Putnam, Matthew D; Bechtold, Joan E; Karam, Matthew D

    2016-04-01

    Performance assessment in skills training is ideally based on objective, reliable, and clinically relevant indicators of success. The Objective Structured Assessment of Technical Skill (OSATS) is a reliable and valid tool that has been increasingly used in orthopaedic skills training. It uses a global rating approach to structure expert evaluation of technical skills with the experts working from a list of operative competencies that are each rated on a 5-point Likert scale anchored by behavioral descriptors. Given the observational nature of its scoring, the OSATS might not effectively assess the quality of surgical results. (1) Does OSATS scoring in an intraarticular fracture reduction training exercise correlate with the quality of the reduction? (2) Does OSATS scoring in a cadaveric extraarticular fracture fixation exercise correlate with the mechanical integrity of the fixation? Orthopaedic residents at the University of Iowa (six postgraduate year [PGY]-1s) and at the University of Minnesota (seven PGY-1s and eight PGY-2s) undertook a skills training exercise that involved reducing a simulated intraarticular fracture under fluoroscopic guidance. Iowa residents participated three times during 1 month, and Minnesota residents participated twice with 1 month between their two sessions. A fellowship-trained orthopaedic traumatologist rated each performance using a modified OSATS scoring scheme. The quality of the articular reduction obtained was then directly measured. Regression analysis was performed between OSATS scores and two metrics of articular reduction quality: articular surface deviation and estimated contact stress. Another skills training exercise involved fixing a simulated distal radius fracture in a cadaveric specimen. Thirty residents, distributed across four PGY classes (PGY-2 and PGY-3, n = 8 each; PGY-4 and PGY-5, n = 7 each), simultaneously completed the exercise at individual stations. One of three faculty hand surgeons independently scored

  13. Use of an Objective Structured Assessment of Technical Skill After a Sports Medicine Rotation.

    PubMed

    Dwyer, Tim; Slade Shantz, Jesse; Kulasegaram, Kulamakan Mahan; Chahal, Jaskarndip; Wasserstein, David; Schachar, Rachel; Devitt, Brian; Theodoropoulos, John; Hodges, Brian; Ogilvie-Harris, Darrell

    2016-12-01

    The purpose of this study was to determine if the use of an Objective Structured Assessment of Technical skill (OSATS), using dry models, would be a valid method of assessing residents' ability to perform sports medicine procedures after training in a competency-based model. Over 18 months, 27 residents (19 junior [postgraduate year (PGY) 1-3] and 8 senior [PGY 4-5]) sat the OSATS after their rotation, in addition to 14 sports medicine staff and fellows. Each resident was provided a list of 10 procedures in which they were expected to show competence. At the end of the rotation, each resident undertook an OSATS composed of 6 stations sampled from the 10 procedures using dry models-faculty used the Arthroscopic Surgical Skill Evaluation Tool (ASSET), task-specific checklists, as well as an overall 5-point global rating scale (GRS) to score each resident. Each procedure was videotaped for blinded review. The overall reliability of the OSATS (0.9) and the inter-rater reliability (0.9) were both high. A significant difference by year in training was seen for the overall GRS, the total ASSET score, and the total checklist score, as well as for each technical procedure (P < .001). Further analysis revealed a significant difference in the total ASSET score between junior (mean 18.4, 95% confidence interval [CI] 16.8 to 19.9) and senior residents (24.2, 95% CI 22.7 to 25.6), senior residents and fellows (30.1, 95% CI 28.2 to 31.9), as well as between fellows and faculty (37, 95% CI 36.1 to 27.8) (P < .05). The results of this study show that an OSATS using dry models shows evidence of validity when used to assess performance of technical procedures after a sports medicine rotation. However, junior residents were not able to perform as well as senior residents, suggesting that overall surgical experience is as important as intensive teaching. As postgraduate medical training shifts to a competency-based model, methods of assessing performance of technical procedures become

  14. Application of objective clinical human reliability analysis (OCHRA) in assessment of technical performance in laparoscopic rectal cancer surgery.

    PubMed

    Foster, J D; Miskovic, D; Allison, A S; Conti, J A; Ockrim, J; Cooper, E J; Hanna, G B; Francis, N K

    2016-06-01

    Laparoscopic rectal resection is technically challenging, with outcomes dependent upon technical performance. No robust objective assessment tool exists for laparoscopic rectal resection surgery. This study aimed to investigate the application of the objective clinical human reliability analysis (OCHRA) technique for assessing technical performance of laparoscopic rectal surgery and explore the validity and reliability of this technique. Laparoscopic rectal cancer resection operations were described in the format of a hierarchical task analysis. Potential technical errors were defined. The OCHRA technique was used to identify technical errors enacted in videos of twenty consecutive laparoscopic rectal cancer resection operations from a single site. The procedural task, spatial location, and circumstances of all identified errors were logged. Clinical validity was assessed through correlation with clinical outcomes; reliability was assessed by test-retest. A total of 335 execution errors identified, with a median 15 per operation. More errors were observed during pelvic tasks compared with abdominal tasks (p < 0.001). Within the pelvis, more errors were observed during dissection on the right side than the left (p = 0.03). Test-retest confirmed reliability (r = 0.97, p < 0.001). A significant correlation was observed between error frequency and mesorectal specimen quality (r s = 0.52, p = 0.02) and with blood loss (r s = 0.609, p = 0.004). OCHRA offers a valid and reliable method for evaluating technical performance of laparoscopic rectal surgery.

  15. The use of recurrent signals about adaptation for subsequent saccade programming depends on object structure.

    PubMed

    Doré-Mazars, Karine; Vergilino-Perez, Dorine; Collins, Thérèse; Bohacova, Katarina; Beauvillain, Cécile

    2006-10-03

    Executing sequences of accurate saccadic eye movements supposes the use of signals carrying information about the first saccade for updating the predetermined motor plan of the subsequent saccades. The present study examines the signals used in planning a second saccade when subjects made two successive saccades towards one long or two short peripheral objects displayed before the first saccade execution. Different first eye movement signals could be used: desired eye movement signals, representing the movement necessary for attaining the intended target, or actual eye movement signals, representing the movement actually executed. Experimental dissociation of desired and actual eye movement signals is made possible by adaptive modifications of the first saccade, obtained by transfer of single saccade adaptation, during which the motor vector was progressively modified in response to the systematic intra-saccadic step of a single target. Whether the second saccade used the actual eye movement signal to compensate or not for the adaptive changes in the first saccade depended on which object properties were relevant for saccade planning. Compensation was observed for saccades that aimed for a new object (between-object saccades) because adaptation modifies relative object location. No compensation was observed for saccades that explored an extended object (within-object saccades). Implications for the on-line control of subsequent eye movements are discussed.

  16. Local x-ray structure analysis of optically manipulated biological micro-objects

    SciTech Connect

    Cojoc, Dan; Ferrari, Enrico; Santucci, Silvia C.; Amenitsch, Heinz; Sartori, Barbara; Rappolt, Michael; Marmiroli, Benedetta; Burghammer, Manfred; Riekel, Christian

    2010-12-13

    X-ray diffraction using micro- and nanofocused beams is well suited for nanostructure analysis at different sites of a biological micro-object. To conduct in vitro studies without mechanical contact, we developed object manipulation by optical tweezers in a microfluidic cell. Here we report x-ray microdiffraction analysis of a micro-object optically trapped in three dimensions. We revealed the nanostructure of a single starch granule at different points and investigated local radiation damage induced by repeated x-ray exposures at the same position, demonstrating high stability and full control of the granule orientation by multiple optical traps.

  17. 2D virtual texture on 3D real object with coded structured light

    NASA Astrophysics Data System (ADS)

    Molinier, Thierry; Fofi, David; Salvi, Joaquim; Gorria, Patrick

    2008-02-01

    Augmented reality is used to improve color segmentation on human body or on precious no touch artifacts. We propose a technique to project a synthesized texture on real object without contact. Our technique can be used in medical or archaeological application. By projecting a suitable set of light patterns onto the surface of a 3D real object and by capturing images with a camera, a large number of correspondences can be found and the 3D points can be reconstructed. We aim to determine these points of correspondence between cameras and projector from a scene without explicit points and normals. We then project an adjusted texture onto the real object surface. We propose a global and automatic method to virtually texture a 3D real object.

  18. Structures and efficiency areas of object control systems with various types of recycling

    NASA Astrophysics Data System (ADS)

    Myshlyaev, L. P.; Tsyryapkina, A. V.; Burkov, V. N.; Ivushkin, K. A.

    2017-09-01

    The work is devoted to the study of automatic control systems (ACS) of objects with various types of recycling. The characteristic feature of such objects is the presence of a delay element in the coordinates. It is known that only with the help of recycling the use of raw materials and energy resources can be maximized. However, little attention has been paid to the control of such objects in the well-known publications, which gives the study a particular importance. The paper describes a classification of objects with recycling proposed by the authors with the identification of four classes of objects: recycling “by concentration”, “by mass”, “by parameters”, combined recycling. ACS are synthesized for the first three classes of objects. The task of comparative analysis of the systems effectiveness with a model control law and the proposed synthesized systems is set, as well as the task of determination of areas of systems effective operation depending on the variable value of the ratio of the delay time in the recycling chain and in the direct circuit, the conclusions are drawn.

  19. Gist in time: scene semantics and structure enhance recall of searched objects

    PubMed Central

    Wolfe, Jeremy M.; Võ, Melissa L.-H.

    2016-01-01

    Previous work has shown that recall of objects that are incidentally encountered as targets in visual search is better than recall of objects that have been intentionally memorized (Draschkow, Wolfe & Võ, 2014). However, this counter-intuitive result is not seen when these tasks are performed with non-scene stimuli. The goal of the current paper is to determine what features of search in a scene contribute to higher recall rates when compared to a memorization task. In each of four experiments, we compare the free recall rate for target objects following a search to the rate following a memorization task. Across the experiments, the stimuli include progressively more scene-related information. Experiment 1 provides the spatial relations between objects. Experiment 2 adds relative size and depth of objects. Experiments 3 and 4 include scene layout and semantic information. We find that search leads to better recall than explicit memorization in cases where scene layout and semantic information are present, as long as the participant has ample time (2500ms) to integrate this information with knowledge about the target object (Exp. 4). These results suggest that the integration of scene and target information not only leads to more efficient search, but can also contribute to stronger memory representations than intentional memorization. PMID:27270227

  20. Real-time scaling of micro-objects by multiplexed holographic recording on photo-thermoplastic structure

    NASA Astrophysics Data System (ADS)

    Chirita, A.

    2010-06-01

    The processes of micro-object hologram real-time recording on a photo-thermo-plastic carrier based on a chalcogenide glassy semiconductor As-Se-S-Sn system were studied. The possibility to measure micro-object dimensions using an interference fringe pattern was shown. Double-exposure hologram recording by use of photo-induced structural transformation processes in a photo-semiconductor and photo-thermoplastic recording process was investigated.

  1. Parallel compression of data chunks of a shared data object using a log-structured file system

    DOEpatents

    Bent, John M.; Faibish, Sorin; Grider, Gary

    2016-10-25

    Techniques are provided for parallel compression of data chunks being written to a shared object. A client executing on a compute node or a burst buffer node in a parallel computing system stores a data chunk generated by the parallel computing system to a shared data object on a storage node by compressing the data chunk; and providing the data compressed data chunk to the storage node that stores the shared object. The client and storage node may employ Log-Structured File techniques. The compressed data chunk can be de-compressed by the client when the data chunk is read. A storage node stores a data chunk as part of a shared object by receiving a compressed version of the data chunk from a compute node; and storing the compressed version of the data chunk to the shared data object on the storage node.

  2. Distinct Roles for Medial Temporal Lobe Structures in Memory for Objects and Their Locations

    ERIC Educational Resources Information Center

    Buffalo, Elizabeth A.; Bellgowan, Patrick S. F.; Martin, Alex

    2006-01-01

    The ability to learn and retain novel information depends on a system of structures in the medial temporal lobe (MTL) including the hippocampus and the surrounding entorhinal, perirhinal, and parahippocampal cortices. Damage to these structures produces profound memory deficits; however, the unique contribution to memory of each of these…

  3. The structure of Herbig-Haro object 43 and Orion dark cloud extinction

    NASA Technical Reports Server (NTRS)

    Schwartz, R. D.; Dopita, M. A.; Cohen, M.

    1984-01-01

    New ultraviolet and optical observations of Herbig-Haro Object No. 43 are reported. Continuum and emission line fluxes in the range 1250 A equal to or less than lambda equal to less than 7350A have been measured. The continuum fluxes are best matched by an enhanced H two photon component added to H free bound emission, assuming theta Ori extinction curve with E(B-V) = 0.2, R = 5. The strucutre and dynamics of three components within the object are discussed. The object has a radiative output of equal to or greater than 0.23 infrared luminosity in ultraviolet and optical radiation combined. The energy requirements are discussed in terms of the production of shock waves by a collimated, supersonic mass outflow from a nearby infrared source.

  4. Introducing a Model for Optimal Design of Sequential Objective Structured Clinical Examinations

    ERIC Educational Resources Information Center

    Mortaz Hejri, Sara; Yazdani, Kamran; Labaf, Ali; Norcini, John J.; Jalili, Mohammad

    2016-01-01

    In a sequential OSCE which has been suggested to reduce testing costs, candidates take a short screening test and who fail the test, are asked to take the full OSCE. In order to introduce an effective and accurate sequential design, we developed a model for designing and evaluating screening OSCEs. Based on two datasets from a 10-station…

  5. Developing an Objective Structured Clinical Examination to Assess Work-Integrated Learning in Exercise Physiology

    ERIC Educational Resources Information Center

    Naumann, Fiona; Moore, Keri; Mildon, Sally; Jones, Philip

    2014-01-01

    This paper aims to develop a valid method to assess the key competencies of the exercise physiology profession acquired through work-integrated learning (WIL). In order to develop a competency-based assessment, the key professional tasks needed to be identified and the test designed so students' competency in different tasks and settings could be…

  6. [Using Objective Structured Clinical Examination (OSCE) across different levels of pediatric training].

    PubMed

    Di Lalla, Sandra; Manjarin, Mercedes; Torres, Fernando; Ossorio, María Fabiana; Wainsztein, Raquel; Ferrero, Fernando

    2014-01-01

    Antecedentes:Evaluar competencias profesionales es objetivo principal de todo programa de capacitación; el examen clínico objetivo estructurado (ECOE) es una herramienta útil para explorarlas. Objetivo:Describimos la implementación del ECOE en tres instancias de enseñanza de la pediatría (carrera de especialista, módulo pediatría del internado anual rotatorio, materia pediatría en el grado). Métodos: En relación con situaciones y patologías frecuentes en pediatría, se evaluaron conocimiento aplicado, juicio clínico y habilidad comunicacional. Resultados: En el posgrado el ECOE se aplica desde hace 8 años, examinando 330 alumnos, con 60%-82% de aprobación. En el Internado Anual Rotatorio el ECOE se emplea desde hace 2 años, examinando 12 alumnos, con 84% de aprobación. En el grado el ECOE se empleó sólo en una oportunidad, examinando 15 alumnos, con 93,4% de aprobación. Conclusión:En nuestra experiencia, a pesar de desafíos logísticos, la implementación del ECOE fue factible en distintas instancias de enseñanza de la pediatría.

  7. Introducing a Model for Optimal Design of Sequential Objective Structured Clinical Examinations

    ERIC Educational Resources Information Center

    Mortaz Hejri, Sara; Yazdani, Kamran; Labaf, Ali; Norcini, John J.; Jalili, Mohammad

    2016-01-01

    In a sequential OSCE which has been suggested to reduce testing costs, candidates take a short screening test and who fail the test, are asked to take the full OSCE. In order to introduce an effective and accurate sequential design, we developed a model for designing and evaluating screening OSCEs. Based on two datasets from a 10-station…

  8. The Objective Structured Clinical Examination (OSCE): AMEE Guide No. 81. Part II: organisation & administration.

    PubMed

    Khan, Kamran Z; Gaunt, Kathryn; Ramachandran, Sankaranarayanan; Pushkar, Piyush

    2013-09-01

    The organisation, administration and running of a successful OSCE programme need considerable knowledge, experience and planning. Different teams looking after various aspects of OSCE need to work collaboratively for an effective question bank development, examiner training and standardised patients' training. Quality assurance is an ongoing process taking place throughout the OSCE cycle. In order for the OSCE to generate reliable results it is essential to pay attention to each and every element of quality assurance, as poorly standardised patients, untrained examiners, poor quality questions and inappropriate scoring rubrics each will affect the reliability of the OSCE. The validity will also be influenced if the questions are not realistic and mapped against the learning outcomes of the teaching programme. This part of the Guide addresses all these important issues in order to help the reader setup and quality assure their new or existing OSCE programmes.

  9. Incidental and context-responsive activation of structure- and function-based action features during object identification.

    PubMed

    Lee, Chia-lin; Middleton, Erica; Mirman, Daniel; Kalénine, Solène; Buxbaum, Laurel J

    2013-02-01

    Previous studies suggest that action representations are activated during object processing, even when task-irrelevant. In addition, there is evidence that lexical-semantic context may affect such activation during object processing. Finally, prior work from our laboratory and others indicates that function-based ("use") and structure-based ("move") action subtypes may differ in their activation characteristics. Most studies assessing such effects, however, have required manual object-relevant motor responses, thereby plausibly influencing the activation of action representations. The present work uses eyetracking and a Visual World Paradigm task without object-relevant actions to assess the time course of activation of action representations, as well as their responsiveness to lexical-semantic context. In two experiments, participants heard a target word and selected its referent from an array of four objects. Gaze fixations on nontarget objects signal activation of features shared between targets and nontargets. The experiments assessed activation of structure-based (Experiment 1) or function-based (Experiment 2) distractors, using neutral sentences ("S/he saw the....") or sentences with a relevant action verb (Experiment 1: "S/he picked up the...."; Experiment 2: "S/he used the...."). We observed task-irrelevant activations of action information in both experiments. In neutral contexts, structure-based activation was relatively faster-rising but more transient than function-based activation. Additionally, action verb contexts reliably modified patterns of activation in both Experiments. These data provide fine-grained information about the dynamics of activation of function-based and structure-based actions in neutral and action-relevant contexts, in support of the "Two Action System" model of object and action processing (e.g., Buxbaum & Kalénine, 2010).

  10. Constructing a validity argument for the Objective Structured Assessment of Technical Skills (OSATS): a systematic review of validity evidence.

    PubMed

    Hatala, Rose; Cook, David A; Brydges, Ryan; Hawkins, Richard

    2015-12-01

    In order to construct and evaluate the validity argument for the Objective Structured Assessment of Technical Skills (OSATS), based on Kane's framework, we conducted a systematic review. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, Scopus, and selected reference lists through February 2013. Working in duplicate, we selected original research articles in any language evaluating the OSATS as an assessment tool for any health professional. We iteratively and collaboratively extracted validity evidence from included articles to construct and evaluate the validity argument for varied uses of the OSATS. Twenty-nine articles met the inclusion criteria, all focussed on surgical technical skills assessment. We identified three intended uses for the OSATS, namely formative feedback, high-stakes assessment and program evaluation. Following Kane's framework, four inferences in the validity argument were examined (scoring, generalization, extrapolation, decision). For formative feedback and high-stakes assessment, there was reasonable evidence for scoring and extrapolation. However, for high-stakes assessment there was a dearth of evidence for generalization aside from inter-rater reliability data and an absence of evidence linking multi-station OSATS scores to performance in real clinical settings. For program evaluation, the OSATS validity argument was supported by reasonable generalization and extrapolation evidence. There was a complete lack of evidence regarding implications and decisions based on OSATS scores. In general, validity evidence supported the use of the OSATS for formative feedback. Research to provide support for decisions based on OSATS scores is required if the OSATS is to be used for higher-stakes decisions and program evaluation.

  11. A novel approach in objective assessment of functional postural responses during fall-free perturbed standing in clinical environment.

    PubMed

    Cikajlo, Imre; Matjacsić, Zlatko

    2007-01-01

    The proposed approach offers few novelties in integration of objective assessment of postural responses when an unexpected perturbation is applied to the standing person into the existing rehabilitation therapy. The research apparatus was equipped with electrical actuators to provide unexpected perturbations (controllable and repeatable strength and duration) to the standing frame in eight directions during quiet standing in a fall-safe environment. During the perturbations ground reaction forces were recorded under each foot and the motion of center of pressure was derived to extract the postural response indicators in time and space domain. Seven neurologically intact subjects participated in normative set up that was used to develop an algorithm for selective postural response characteristics analysis for each perturbation direction. The postural responses in two incomplete spinal cord injured persons and hemiparetic stroke patient were investigated and contrasted to the normative responses to test the proposed approach. The outcomes of the investigation showed expected distinctive direction-dependent postural responses characteristic for hemiparetic subjects. Our observations suggest that the approach may become effective in substantial quantitative multidirectional stabilometric evaluation of functional postural responses, especially when the effectiveness of the balance training rehabilitation program is in need for objective evaluation. Simultaneously the apparatus can be used also for the balance training and therefore become a training and assessment tool for clinical and home environment.

  12. OPM Scheme Editor 2: A graphical editor for specifying object-protocol structures

    SciTech Connect

    Chen, I-Min A.; Markowitz, V.M.; Pang, F.; Ben-Shachar, O.

    1993-07-01

    This document describes an X-window based Schema Editor for the Object-Protocol Model (OPM). OPM is a data model that supports the specification of complex object and protocol classes. objects and protocols are qualified in OPM by attributes that are defined over (associated with) value classes. Connections of object and protocol classes are expressed in OPM via attributes. OPM supports the specification (expansion) of protocols in terms of alternative and sequences of component (sub) protocols. The OPM Schema Editor allows specifying, displaying, modifying, and browsing through OPM schemas. The OPM Schema Editor generates an output file that can be used as input to an OPM schema translation tool that maps OPM schemas into definitions for relational database management systems. The OPM Schema Editor was implemented using C++ and the X11 based Motif toolkit, on Sun SPARCstation under Sun Unix OS 4.1. This document consists of the following parts: (1) A tutorial consisting of seven introductory lessons for the OPM Schema Editor. (2) A reference manual describing all the windows and functions of the OPM Schema Editor. (3) An appendix with an overview of OPM.

  13. Innovative Language-Based & Object-Oriented Structured AMR Using Fortran 90 and OpenMP

    NASA Technical Reports Server (NTRS)

    Norton, C.; Balsara, D.

    1999-01-01

    Parallel adaptive mesh refinement (AMR) is an important numerical technique that leads to the efficient solution of many physical and engineering problems. In this paper, we describe how AMR programing can be performed in an object-oreinted way using the modern aspects of Fortran 90 combined with the parallelization features of OpenMP.

  14. Creating Shareable Clinical Decision Support Rules for a Pharmacogenomics Clinical Guideline Using Structured Knowledge Representation

    PubMed Central

    Linan, Margaret K.; Sottara, Davide; Freimuth, Robert R.

    2015-01-01

    Pharmacogenomics (PGx) guidelines contain drug-gene relationships, therapeutic and clinical recommendations from which clinical decision support (CDS) rules can be extracted, rendered and then delivered through clinical decision support systems (CDSS) to provide clinicians with just-in-time information at the point of care. Several tools exist that can be used to generate CDS rules that are based on computer interpretable guidelines (CIG), but none have been previously applied to the PGx domain. We utilized the Unified Modeling Language (UML), the Health Level 7 virtual medical record (HL7 vMR) model, and standard terminologies to represent the semantics and decision logic derived from a PGx guideline, which were then mapped to the Health eDecisions (HeD) schema. The modeling and extraction processes developed here demonstrate how structured knowledge representations can be used to support the creation of shareable CDS rules from PGx guidelines. PMID:26958298

  15. Creating Shareable Clinical Decision Support Rules for a Pharmacogenomics Clinical Guideline Using Structured Knowledge Representation.

    PubMed

    Linan, Margaret K; Sottara, Davide; Freimuth, Robert R

    2015-01-01

    Pharmacogenomics (PGx) guidelines contain drug-gene relationships, therapeutic and clinical recommendations from which clinical decision support (CDS) rules can be extracted, rendered and then delivered through clinical decision support systems (CDSS) to provide clinicians with just-in-time information at the point of care. Several tools exist that can be used to generate CDS rules that are based on computer interpretable guidelines (CIG), but none have been previously applied to the PGx domain. We utilized the Unified Modeling Language (UML), the Health Level 7 virtual medical record (HL7 vMR) model, and standard terminologies to represent the semantics and decision logic derived from a PGx guideline, which were then mapped to the Health eDecisions (HeD) schema. The modeling and extraction processes developed here demonstrate how structured knowledge representations can be used to support the creation of shareable CDS rules from PGx guidelines.

  16. Failure to produce direct object clitic pronouns as a clinical marker of SLI in school-aged Italian speaking children.

    PubMed

    Arosio, Fabrizio; Branchini, Chiara; Barbieri, Lina; Guasti, Maria Teresa

    2014-09-01

    We administrated a clitic elicitation task to 16 school-aged Italian speaking children with specific language impairment (SLI) in order to investigated whether the failure to produce third person direct object clitics (DO clitics) is a persistent clinical marker of SLI in Italian; we examined whether this failure also extends to reflexive clitics. Results show that Italian children with SLI aged 6 to 9;11 years fail to produce DO clitics and tend to produce a lexical noun introduced by a determiner (full DP) in the argument postverbal position instead of the pronoun; the production of reflexive clitics is preserved in the same population. Receiver operating characteristic curve analyses and computation of likelihood ratios show that the failure to produce DO clitics is a persistent good clinical marker of SLI in Italian. We argue that DO clitic production requires complex morphosyntactic operations that are hardly achieved by children with SLI; our findings are compatible with theories considering SLI as a deficit of processing complex linguistic relations.

  17. Cardiac output and systemic vascular resistance: Clinical assessment compared with a noninvasive objective measurement in children with shock.

    PubMed

    Razavi, Asma; Newth, Christopher J L; Khemani, Robinder G; Beltramo, Fernando; Ross, Patrick A

    2017-06-01

    To evaluate physician assessment of cardiac output and systemic vascular resistance in patients with shock compared with an ultrasonic cardiac output monitor (USCOM). To explore potential changes in therapy decisions if USCOM data were available using physician intervention answers. Double-blinded, prospective, observational study in a tertiary hospital pediatric intensive care unit. Forty children (<18years) admitted with shock, requiring ongoing volume resuscitation or inotropic support. Two to 3 physicians clinically assessed cardiac output and systemic vascular resistance, categorizing them as high, normal, or low. An investigator simultaneously measured cardiac index (CI) and systemic vascular resistance index (SVRI) with USCOM categorized as high, normal, or low. Overall agreement between physician and USCOM for CI (48.5% [κ = 0.18]) and SVRI (45.9% [κ = 0.16]) was poor. Interobserver agreement was also poor for CI (58.7% [κ = 0.33]) and SVRI (52.3% [κ = 0.28]). Comparing theoretical physician interventions to "acceptable" or "unacceptable" clinical interventions, based on USCOM measurement, 56 (21%) physician interventions were found to be "unacceptable." There is poor agreement between physician-assessed CI and SVRI and USCOM, with significant interobserver variability among physicians. Objective measurement of CI and SVRI may reduce variability and improve diagnostic accuracy. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. SEMCARE: Multilingual Semantic Search in Semi-Structured Clinical Data.

    PubMed

    López-García, Pablo; Kreuzthaler, Markus; Schulz, Stefan; Scherr, Daniel; Daumke, Philipp; Markó, Kornél; Kors, Jan A; van Mulligen, Erik M; Wang, Xinkai; Gonna, Hanney; Behr, Elijah; Honrado, Ángel

    2016-01-01

    The vast amount of clinical data in electronic health records constitutes a great potential for secondary use. However, most of this content consists of unstructured or semi-structured texts, which is difficult to process. Several challenges are still pending: medical language idiosyncrasies in different natural languages, and the large variety of medical terminology systems. In this paper we present SEMCARE, a European initiative designed to minimize these problems by providing a multi-lingual platform (English, German, and Dutch) that allows users to express complex queries and obtain relevant search results from clinical texts. SEMCARE is based on a selection of adapted biomedical terminologies, together with Apache UIMA and Apache Solr as open source state-of-the-art natural language pipeline and indexing technologies. SEMCARE has been deployed and is currently being tested at three medical institutions in the UK, Austria, and the Netherlands, showing promising results in a cardiology use case.

  19. [Agreement between Clinical Evaluation and Structured Clinical Interviews in Psychosomatic Inpatients].

    PubMed

    Reichert, Cornelia; Henniger, Stephan; Jäger, Burkard; de Zwaan, Martina

    2015-05-01

    The goal of this study was to determine the agreement between axis I mental disorders assessed with a structured clinical interview (SCID) and independently obtained non-structured clinical diagnoses in 185 psychosomatic in-patients. Additionally, the study focuses on the detection of potential predictors for the level of agreement. Diagnostic agreement was poor to moderate for the mood, anxiety and somatoform disorder cluster (κ = 0.293-0.444). Only for eating disorders an almost complete concordance could be found (κ = 0.812). The predictor analysis indicated a significant positive association between the comorbidity rate and the agreement in mood disorders. Furthermore, the diagnostic agreement of anxiety disorders was significantly higher for female than for male patients. These results reveal that even a team-based clinical diagnosis, assessed over the period of a hospital stay, shows little agreement with SCID-diagnoses. The predictor analysis as well as the poor correlation in 3 of 4 diagnostic clusters suggest that conceptual differences of the disorder criteria as well as their clinical interpretation might influence the concordance between diagnoses. Further studies focusing on methodical factors might reveal further insights to the cause of the diagnostic discrepancies. © Georg Thieme Verlag KG Stuttgart · New York.

  20. The promise of computer-assisted auscultation in screening for structural heart disease and clinical teaching.

    PubMed

    Zühlke, L; Myer, L; Mayosi, B M

    2012-08-01

    Cardiac auscultation has been the central clinical tool for the diagnosis of valvular and other structural heart diseases for over a century. Physicians acquire competence in this technique through considerable training and experience. In Africa, however, we face a shortage of physicians and have the lowest health personnel-to-population ratio in the world. One of the proposed solutions for tackling this crisis is the adoption of health technologies and product innovations to support different cadres of health workers as part of task shifting. Computer-assisted auscultation (CAA) uses a digital stethoscope combined with acoustic neural networking to provide a visual display of heart sounds and murmurs, and analyses the recordings to distinguish between innocent and pathological murmurs. In so doing, CAA may serve as an objective tool for the screening of structural heart disease and facilitate the teaching of cardiac auscultation. This article reviews potential clinical applications of CAA.

  1. Constructing a Validity Argument for the Objective Structured Assessment of Technical Skills (OSATS): A Systematic Review of Validity Evidence

    ERIC Educational Resources Information Center

    Hatala, Rose; Cook, David A.; Brydges, Ryan; Hawkins, Richard

    2015-01-01

    In order to construct and evaluate the validity argument for the Objective Structured Assessment of Technical Skills (OSATS), based on Kane's framework, we conducted a systematic review. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, Scopus, and selected reference lists through February 2013. Working in duplicate, we selected…

  2. Constructing a Validity Argument for the Objective Structured Assessment of Technical Skills (OSATS): A Systematic Review of Validity Evidence

    ERIC Educational Resources Information Center

    Hatala, Rose; Cook, David A.; Brydges, Ryan; Hawkins, Richard

    2015-01-01

    In order to construct and evaluate the validity argument for the Objective Structured Assessment of Technical Skills (OSATS), based on Kane's framework, we conducted a systematic review. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, Scopus, and selected reference lists through February 2013. Working in duplicate, we selected…

  3. Using structured decision making with landowners to address private forest management and parcelization: balancing multiple objectives and incorporating uncertainty

    Treesearch

    Paige F. B. Ferguson; Michael J. Conroy; John F. Chamblee; Jeffrey Hepinstall-Cymerman

    2015-01-01

    Parcelization and forest fragmentation are of concern for ecological, economic, and social reasons. Efforts to keep large, private forests intact may be supported by a decision-making process that incorporates landowners’ objectives and uncertainty. We used structured decision making (SDM) with owners of large, private forests in Macon County, North Carolina....

  4. Parallel checksumming of data chunks of a shared data object using a log-structured file system

    DOEpatents

    Bent, John M.; Faibish, Sorin; Grider, Gary

    2016-09-06

    Checksum values are generated and used to verify the data integrity. A client executing in a parallel computing system stores a data chunk to a shared data object on a storage node in the parallel computing system. The client determines a checksum value for the data chunk; and provides the checksum value with the data chunk to the storage node that stores the shared object. The data chunk can be stored on the storage node with the corresponding checksum value as part of the shared object. The storage node may be part of a Parallel Log-Structured File System (PLFS), and the client may comprise, for example, a Log-Structured File System client on a compute node or burst buffer. The checksum value can be evaluated when the data chunk is read from the storage node to verify the integrity of the data that is read.

  5. A stroboscopic structured illumination system used in dynamic 3D visualization of high-speed motion object

    NASA Astrophysics Data System (ADS)

    Su, Xianyu; Zhang, Qican; Li, Yong; Xiang, Liqun; Cao, Yiping; Chen, Wenjing

    2005-04-01

    A stroboscopic structured illumination system, which can be used in measurement for 3D shape and deformation of high-speed motion object, is proposed and verified by experiments. The system, present in this paper, can automatically detect the position of high-speed moving object and synchronously control the flash of LED to project a structured optical field onto surface of motion object and the shoot of imaging system to acquire an image of deformed fringe pattern, also can create a signal, set artificially through software, to synchronously control the LED and imaging system to do their job. We experiment on a civil electric fan, successful acquire a serial of instantaneous, sharp and clear images of rotation blade and reconstruct its 3D shapes in difference revolutions.

  6. Observations on Operation Enduring Freedom - Recommendations for Development of the Transformation Objective Force Logistics Structure

    DTIC Science & Technology

    2003-04-07

    Public reporting burder for this collection of information is estibated to average 1 hour per response, including the time for reviewing instructions...synchronize and implement fifteen Lines of Operation (LOs) that “…describe closely related activities that link objectives in time and purpose.”6 The Army... time line. To counter balance these challenges, planners initially relied solely on strategic airlift, establishing two air lines of communication

  7. Structured Descriptions of Complex Curved Objects for Recognition and Visual Memory

    DTIC Science & Technology

    1974-10-01

    its constituent parts. Global descriptors depend on relations among larger number of parts; eg the detection of bilateral symmetry in an object...Coplananty: All constituent limb axes are coplanar. Programs for computing the joint descriptors follow the above definitions directly. However...34semantic" properties are represented in it. by ’he choice of descriptors used for the constituent pieces, the joints and their relationships, and the

  8. WONKA: objective novel complex analysis for ensembles of protein-ligand structures.

    PubMed

    Bradley, A R; Wall, I D; von Delft, F; Green, D V S; Deane, C M; Marsden, B D

    2015-10-01

    WONKA is a tool for the systematic analysis of an ensemble of protein-ligand structures. It makes the identification of conserved and unusual features within such an ensemble straightforward. WONKA uses an intuitive workflow to process structural co-ordinates. Ligand and protein features are summarised and then presented within an interactive web application. WONKA's power in consolidating and summarising large amounts of data is described through the analysis of three bromodomain datasets. Furthermore, and in contrast to many current methods, WONKA relates analysis to individual ligands, from which we find unusual and erroneous binding modes. Finally the use of WONKA as an annotation tool to share observations about structures is demonstrated. WONKA is freely available to download and install locally or can be used online at http://wonka.sgc.ox.ac.uk.

  9. WONKA: objective novel complex analysis for ensembles of protein-ligand structures

    NASA Astrophysics Data System (ADS)

    Bradley, A. R.; Wall, I. D.; von Delft, F.; Green, D. V. S.; Deane, C. M.; Marsden, B. D.

    2015-10-01

    WONKA is a tool for the systematic analysis of an ensemble of protein-ligand structures. It makes the identification of conserved and unusual features within such an ensemble straightforward. WONKA uses an intuitive workflow to process structural co-ordinates. Ligand and protein features are summarised and then presented within an interactive web application. WONKA's power in consolidating and summarising large amounts of data is described through the analysis of three bromodomain datasets. Furthermore, and in contrast to many current methods, WONKA relates analysis to individual ligands, from which we find unusual and erroneous binding modes. Finally the use of WONKA as an annotation tool to share observations about structures is demonstrated. WONKA is freely available to download and install locally or can be used online at http://wonka.sgc.ox.ac.uk.

  10. Clinical joint inactivity predicts structural stability in patients with established rheumatoid arthritis

    PubMed Central

    Gärtner, M; Sigmund, I K; Alasti, F; Supp, G; Radner, H; Machold, K; Smolen, J S; Aletaha, D

    2016-01-01

    Objectives Clinical joint activity is a strong predictor of joint damage in rheumatoid arthritis (RA), but progression of damage might increase despite clinical inactivity of the respective joint (silent progression). The aim of this study was to evaluate the prevalence of silent joint progression, but particularly on the patient level and to investigate the duration of clinical inactivity as a marker for non-progression on the joint level. Methods 279 patients with RA with any radiographic progression over an observational period of 3–5 years were included. We obtained radiographic and clinical data of 22 hand/finger joints over a period of at least 3 years. Prevalence of silent progression and associations of clinical joint activity and radiographic progression were evaluated. Results 120 (43.0%) of the patients showed radiographic progression in at least one of their joints without any signs of clinical activity in that respective joint. In only 7 (5.8%) patients, such silent joint progression would go undetected, as the remainder had other joints with clinical activity, either with (n=84; 70.0%) or without (n=29; 24.2%) accompanying radiographic progression. Also, the risk of silent progression decreases with duration of clinical activity. Conclusions Silent progression of a joint without accompanying apparent clinical activity in any other joint of a patient was very rare, and would therefore be most likely detected by the assessment of the patient. Thus, full clinical remission is an excellent marker of structural stability in patients with RA, and the maintenance of this state reduces the risk of progression even further. PMID:27110386

  11. Health Services and Health Care Needs Fulfilled by Structured Clinical Programs for Children with Medical Complexity

    PubMed Central

    Kuo, Dennis Z.; Berry, Jay G.; Glader, Laurie; Morin, Melinda J.; Johaningsmeir, Sarah; Gordon, John

    2015-01-01

    Objective To describe family-reported health service needs of children with medical complexity, and to assess which needs are more often addressed in a tertiary care center-based structured clinical program for children with medical complexity. Study design Mailed survey to families of children with medical complexity enrolled in a structured-care program providing care coordination and oversight at one of three children’s hospitals. Outcomes included receipt of 14 specific health service needs. Paired t-tests compared unmet health care needs prior to and following program enrollment. Results 441 of 968 (46%) surveys were returned and analyzed. Respondents reported their children had a mean age of 7 (standard deviation 5) years. A majority of respondents reported the child had developmental delay (79%) and feeding difficulties (64%). Of respondents, 56% regarded the primary care provider as the primary point of contact for medical issues. Respondents reported an increase in meeting all fourteen health services needs after enrollment in a tertiary care center-based structured clinical program, including primary care checkups (82% v 96%), therapies (78% v 91%), mental health care (34% v 58%), respite care (56% v 75%), and referrals (51% v 83%) (all p<.001). Conclusions Tertiary care center-based structured clinical care programs for children with medical complexity may address and fulfill a broad range of health service needs that are not met in the primary care setting. PMID:26526361

  12. Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance: implications for the clinical management of insomnia disorder.

    PubMed

    Kyle, Simon D; Miller, Christopher B; Rogers, Zoe; Siriwardena, A Niroshan; Macmahon, Kenneth M; Espie, Colin A

    2014-02-01

    To investigate whether sleep restriction therapy (SRT) is associated with reduced objective total sleep time (TST), increased daytime somnolence, and impaired vigilance. Within-subject, noncontrolled treatment investigation. Sleep research laboratory. Sixteen patients [10 female, mean age = 47.1 (10.8) y] with well-defined psychophysiological insomnia (PI), reporting TST ≤ 6 h. Patients were treated with single-component SRT over a 4-w protocol, sleeping in the laboratory for 2 nights prior to treatment initiation and for 3 nights (SRT night 1, 8, 22) during the acute interventional phase. The psychomotor vigilance task (PVT) was completed at seven defined time points [day 0 (baseline), day 1,7,8,21,22 (acute treatment) and day 84 (3 mo)]. The Epworth Sleepiness Scale (ESS) was completed at baseline, w 1-4, and 3 mo. Subjective sleep outcomes and global insomnia severity significantly improved before and after SRT. There was, however, a robust decrease in PSG-defined TST during acute implementation of SRT, by an average of 91 min on night 1, 78 min on night 8, and 69 min on night 22, relative to baseline (P < 0.001; effect size range = 1.60-1.80). During SRT, PVT lapses were significantly increased from baseline (at three of five assessment points, all P < 0.05; effect size range = 0.69-0.78), returning to baseline levels by 3 mo (P = 0.43). A similar pattern was observed for RT, with RTs slowing during acute treatment (at four of five assessment points, all P < 0.05; effect size range = 0.57-0.89) and returning to pretreatment levels at 3 mo (P = 0.78). ESS scores were increased at w 1, 2, and 3 (relative to baseline; all P < 0.05); by 3 mo, sleepiness had returned to baseline (normative) levels (P = 0.65). For the first time we show that acute sleep restriction therapy is associated with reduced objective total sleep time, increased daytime sleepiness, and objective performance impairment. Our data have important implications for implementation guidelines

  13. Object Oriented Learning Objects

    ERIC Educational Resources Information Center

    Morris, Ed

    2005-01-01

    We apply the object oriented software engineering (OOSE) design methodology for software objects (SOs) to learning objects (LOs). OOSE extends and refines design principles for authoring dynamic reusable LOs. Our learning object class (LOC) is a template from which individualised LOs can be dynamically created for, or by, students. The properties…

  14. Object Oriented Learning Objects

    ERIC Educational Resources Information Center

    Morris, Ed

    2005-01-01

    We apply the object oriented software engineering (OOSE) design methodology for software objects (SOs) to learning objects (LOs). OOSE extends and refines design principles for authoring dynamic reusable LOs. Our learning object class (LOC) is a template from which individualised LOs can be dynamically created for, or by, students. The properties…

  15. Correlating Photoreceptor Mosaic Structure to Clinical Findings in Stargardt Disease

    PubMed Central

    Razeen, Moataz M.; Cooper, Robert F.; Langlo, Christopher S.; Goldberg, Mara R.; Wilk, Melissa A.; Han, Dennis P.; Connor, Thomas B.; Fishman, Gerald A.; Collison, Frederick T.; Sulai, Yusufu N.; Dubra, Alfredo; Carroll, Joseph; Stepien, Kimberly E.

    2016-01-01

    Purpose To demonstrate a method for correlating photoreceptor mosaic structure with optical coherence tomography (OCT) and microperimetry findings in patients with Stargardt disease. Methods A total of 14 patients with clinically diagnosed Stargardt disease were imaged using confocal and split-detection adaptive optics scanning light ophthalmoscopy. Cone photoreceptors were identified manually in a band along the temporal meridian. Resulting values were compared to a normative database (n = 9) to generate cone density deviation (CDD) maps. Manual measurement of outer nuclear layer plus Henle fiber layer (ONL+HFL) thickness was performed, in addition to determination of the presence of ellipsoid zone (EZ) and interdigitation zone (IZ) bands on OCT. These results, along with microperimetry data, were overlaid with the CDD maps. Results Wide variation in foveal structure and CDD maps was seen within this small group. Disruption of ONL+HFL and/or IZ band was seen in all patients, with EZ band preservation in regions with low cone density in 38% of locations analyzed. Normality of retinal lamellar structure on OCT corresponded with cone density and visual function at 50/78 locations analyzed. Outer retinal tubulations containing photoreceptor-like structures were observed in 3 patients. Conclusions The use of CDD color-coded maps enables direct comparison of cone mosaic local density with other measures of retinal structure and function. Larger normative datasets and improved tools for automation of image alignment are needed. Translational Relevance The approach described facilitates comparison of complex multimodal data sets from patients with inherited retinal degeneration, and can be expanded to incorporate other structural imaging or functional testing. PMID:26981328

  16. Multi-objective optimization of crop planting structure in irrigation area based on remote sensing technology

    USDA-ARS?s Scientific Manuscript database

    In the regions short of water, the adjustment of cropping structure is also an important measure to save water in agriculture besides water-saving irrigation techniques and cultivation techniques. This paper describes a method of water saving and high efficient water usage by adjusting the differen...

  17. Damage tolerance of composite sandwich structures subjected to projectile impact. [of low velocity foreign object

    NASA Technical Reports Server (NTRS)

    Sharma, A. V.

    1979-01-01

    An experimental investigation was conducted to evaluate the effect of low velocity projectile impact on the strength carrying ability of secondary aerospace structural components fabricated with graphite/epoxy composite materials. The preload and the impact energy combinations necessary to cause catastrophic failure were determined. Those specimens that survived the projectile impact were evaluated for the residual strength.

  18. Object-oriented classification of forest structure from light detection and ranging data for stand mapping

    Treesearch

    Alicia A. Sullivan; Robert J. McGaughey; Hans-Erik Andersen; Peter. Schiess

    2009-01-01

    Stand delineation is an important step in the process of establishing a forest inventory and provides the spatial framework for many forest management decisions. Many methods for extracting forest structure characteristics for stand delineation and other purposes have been researched in the past, primarily focusing on high-resolution imagery and satellite data. High-...

  19. Structure and Evolution of Kuiper Belt Objects: The Case for Compositional Classes

    NASA Astrophysics Data System (ADS)

    McKinnon, William B.; Prialnik, D.; Stern, S. A.

    2007-10-01

    Kuiper belt objects (KBOs) accreted from a mélange of ices, carbonaceous matter, and rock of mixed interstellar and solar nebular provenance. The transneptunian region, where this accretion took place, was likely more radially compact than today. This and the influence of gas drag during the solar nebula epoch argue for more rapid KBO accretion than usually considered. Early evolution of KBOs was largely the result of radiogenic heating, with both short-term and long-term contributions being potentially important. Depending on rock content and porous conductivity, KBO interiors may have reached relatively high temperatures. Models suggest that KBOs likely lost very volatile ices during early evolution, whereas less volatile ices should be retained in cold, less altered subsurface layers; initially amorphous ice may have crystallized in the interior as well, releasing trapped volatiles. Generally, KBOs should be stratified in terms of composition and porosity, albeit subject to impact disruption and collisional stripping. KBOs are thus unlikely to be "the most pristine objects