Post-test Examination Research Articles

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Introduction: Echocardiography is an essential tool for diagnosis in critically ill patients and for hemodynamic monitoring and assessment of provided treatment. Methods: A hands-on, 2-days long course, running 8 hours/day was organized by two physicians trained in echocardiography, one intensivists and one emergency medicine attending. Sixteen practicing clinicians were enrolled: 8 critical care attendings, 6 critical care fellows and 2 mid-levels. The course consisted of 7.25 hours of didactic lectures and 8.75 hands on skill stations with live models. The attendees were trained in obtaining the conventional windows: Parasternal long axis (PLAX), parasternal short axis (PASX), apical four chamber views (4c) and subcostal views, and in identification of the inferior vena cava (IVC) and its variability with breathing. Candidates were trained to measure stroke volume (SV) and cardiac output (CO). Importantly, training included handling the ultrasound (US) machine and “knobology”. Results: All attendees completed the two-day course. Pre- and post-test examinations were done to evaluate knowledge of basic ultrasound physics, applied (clinical) knowledge, and machine set-up. A t-test was used to evaluate the student’s progress. There was a significant increase in the scores after completing the symposium (p = 0.0009). Conclusions: The course showed improvement in clinicians knowledge, probe and machine handling and scanning skills. Echocardiography training for practicing intensivists will facilitate inclusion of echocardiography in critical care fellowship

Evaluation of options for weld repair of Grade 91 piping and components: metallographic characterisation

Creep strength enhanced ferritic (CSEF) steels such as Grade 91 are the preferred materials for many of the high temperature boiler tubing and piping components used in modern power generating plants. Validation of temperbead welding techniques is particularly important for Grade 91 steel as accurate post-weld heat treatment (PWHT) has proven to be difficult in field applications. Even a well-controlled PWHT can degrade the base material strength, and a poorly performed heat treatment can lead to subsequent creep properties being below the minimum expected by codes. Successful demonstration of temperbead techniques for Grade 91 steel would alleviate these concerns and create additional options in designing a ‘well-engineered’ repair. This article presents the results from a project evaluating options for field repair of Grade 91 components. Metallographic characterisation of the welds produced is described with future publications providing results from cross-weld creep testing and post-test examination.

Anatomy adventure: A board game for enhancing understanding of anatomy

Certain negative factors such as fear, loss of concentration and interest in the course, lack of confidence, and undue stress have been associated with the study of anatomy. These are factors most often provoked by the unusually large curriculum, nature of the course, and the psychosocial impact of dissection. As a palliative measure, Anatomy Adventure, a board game on anatomy was designed to reduce some of these pressures, emphasize student centered and collaborative learning styles, and add fun to the process of learning while promoting understanding and retention of the subject. To assess these objectives, 95 out of over 150 medical and dental students who expressed willingness to be part of the study were recruited and divided into a Game group and a Non-game group. A pretest written examination was given to both groups, participants in the Game group were allowed to play the game for ten days, after which a post-test examination was also given. A 20-item questionnaire rated on a three-point scale to access student's perception of the game was given to the game group. The post-test scores of the game group were significantly higher (P < 0.05) than those of the non-game counterparts. Also the post-test score of the game based group was significantly better (P < 0.05) than their pretest. The students in their feedback noted in very high proportions that the game was interesting, highly informative, encouraged team work, improved their attitude, and perception to gross anatomy.

Development of advanced duplex surface systems by combining CrAlN multilayer coatings with plasma nitrided steel substrates

Both modelling analyses and experimental work have recently confirmed that the failure of thin coatings on steel, especially under high loads for some demanding applications, is related to the lack of mechanical support from the substrate, which means that the exceptional hardness, toughness and wear resistance of state of the art PVD coatings cannot be fully exploited. To this end, two types of new duplex surface systems have been developed from this research: i) PVD (specifically Closed Field UnBalanced Magnetron Sputter Ion Plating, CFUBMSIP) CrAlN multilayer coating deposited on ex-situ, 20-h active-screen plasma nitrided (ASPN) steel samples, and ii) in-situ 3-h, high power medium frequency pulsed plasma nitriding (HPMFPPN) treatment, followed by a similar CrAlN coating, but performed in a serial, single batch process in an otherwise conventional CFUBMSIP equipment. The microstructures of these two duplex surface engineered systems were characterised using XRD and SEM, while their hardness, adhesion, load bearing capacity and tribological properties were compared by micro-hardness tests, scratch adhesion tests and pin-on-disc sliding wear measurements. Post-test examinations were conducted and the results confirmed that a hard coating on a nitrided substrate can fully exploit the advantages of both the nitrided sub-surfaces for increased load bearing capacity and of the PVD coating for increased hardness, high temperature stability and extreme wear resistance. Finally, the advantages and disadvantages of these two new duplex surface systems were compared and their potential applications were discussed.

Strategy for the development of EU Test Blanket Systems instrumentation

The instrumentation of the HCLL and HCPB Test Blanket System is fundamental in ensuring that ITER safety and operational requirements are satisfied as well as in enabling the scientific mission of the TBM program. It carries out three essential functions: (i) safety, intended as compliance with ITER requirements toward public and workers protection; (ii) system control, intended as compliance with ITER operational requirements and investment protection; and (iii) scientific mission, intended as validating technology and predictive tools for blanket concepts relevant to fusion energy systems. This paper describes the strategy for instrumentation development by providing details of the following five steps to be implemented in procured activities in the short to mid-term (3–4 years): (i) provide mapping of sensors requirements based on critical review of preliminary design data; (ii) develop functional specifications for TBS sensors based on the analysis of operative conditions in the various ITER buildings in which they are located; (iii) assess availability of commercial sensors against developed specifications; (iv) develop prototypes when no available solution is identified; and (v) perform single effect tests for the most critical solicitations and post-test examination of commercial products and prototypes. Examples of technology assessment in two technical areas are included to reinforce and complement the strategy description.

A prospective, randomized crossover study comparing direct inspection by light microscopy versus projected images for teaching of hematopathology to medical students

Instruction in hematopathology at Mayo Medical School has evolved from instructor-guided direct inspection under the light microscope (laboratory method), to photomicrographs of glass slides with classroom projection (projection method). These methods have not been compared directly to date. Forty-one second-year medical students participated in this pilot study, a prospective, randomized, crossover study measuring educational performance during a hematology pathophysiology course. The students were randomized to one of two groups. All students received the same didactic lectures in the classroom and subsequent case-based review of peripheral blood smears using either laboratory or projection methods, on day one with a crossover to the other method on day two. Pre- and post-test examinations centered on morphology recognition measured educational performance on each day, followed by a questionnaire identifying the student's favored method. There was no significant difference in the pre-test and post-test scores between the two teaching methods (rank-sum P = 0.43). Students overwhelmingly preferred the projection method and perceived it as superior (76%), although post-test scores were not significantly different. Student's recommended method was split with 50% favoring the projection method, 43% favoring a combined approach, and 23% noting logistical challenges to the laboratory. In this study, the laboratory and projection method were equivalent in terms of educational performance for hematopathology among medicals students. A classroom-based approach such as the projection method is favored, given the large class sizes in undergraduate medical education, as well as the ergonomic challenges and additional resources required for large group instruction in a laboratory setting.

Ethanol Extract of Purple Sweet Potato Tubers (Ipomoea batatas L) Decreases Blood Glucose and Increase Total Antioxidant Level in Rats with High Glucose Intake

High blood glucose level can increase the production of free radicals and the AGEs. Flavonoids from fruits and vegetables can prevent that events because they have antioxidant and hypoglycemic effects. The aim of this study was to examine possible hypoglycemic and antioxidant effect of the ethanol extract of purple sweet potato tubers. Subject of this study were 20 male adult rats divided into 4 groups with randomized pre-test and post-test control group design. Before treatment, blood samples were collected from retro-orbital sinus of all rats for blood glucose, MDA and total antioxidant measurement as pre-test data. After pre-test, group 1 (control group) rats were given normal diet without ethanol extract of purple sweet potato tubers. Group 2, 3, and 4 rats were given normal diet and ethanol extract of purple sweet potato tubers 1 cc/day, 2 cc/day, 4 cc/day, respectively, for one week. After one week of treatment, treatment groups were given single dose of high glucose intake. Over 1, 2, and 3 hours of treatment with high glucose, the blood samples were collected for post-test examination. The data were then analysed by one way anova and paired-t test, and the result showed a significant increase of blood glucose and MDA in group 1 (p < 0,01), significant decrease of total antioxidant in group 1 (p < 0.01). In group 3, all of the parameters were different with group 1 and group 2 (p < 0.01). In group 4, MDA decreased significantly after treatment and the total antioxidant was increased significantly (p < 0.01). From these findings, it can be concluded that ethanol extract of purple sweet potato tubers can maintain the blood glucose level within normal limit, prevent the increase of MDA, and increase total antioxidant of the blood after high glucose intake in rats. The effective dose of the extract in this research was medium dose.

Context Based Mathematics Problem Solving: Cognitive and Affective Effects on BIT and BS VOC-Tech Students

This context based Mathematics problem solving has been shown to have direct efforts on students’ bearing. This study compares the cognitive and affective effects of the Context-Based and Traditional approach on voc-tech students from the two programs. Quantitative data were collected using a Pretest and Posttest examination in mathematics problem solving to assess the levels of students’ problem solving performance and an attitude, beliefs and confidence (A-B-C) questionnaire to assess the voc-tech students’ attitude, belief and confidence. For qualitative analysis, the students’ journals, interview responses, and the teacher−observers’ and raters’ notes and comments were analyzed. The results showed that the students have a very low analytic level and limited content knowledge in mathematics prior the intervention. However, the context-based approach enhanced the students’ problem solving skills as exhibited by the numerically higher scores and improvement in the quality of the experimental class’ solutions and responses to the problem solving posttest. After the treatment, statistical tests revealed that the contextbased approach had a significant effect on the voc-tech students on certain topics of mathematics in terms of approach, program and ability level. Results also revealed that the experimental group showed a significant improvement in their attitude and beliefs in mathematics problem solving compared to their counterparts in the control group. Comparing the posttest results by program, the BS students are significantly higher than the BIT students in their overall problem solving scores as well as the BIT and BS students in the experimental class. Keywords - Mathematics, context based, Mathematics problem solving, attitude, belief, confidence, Voc-tech students, Iloilo, Philippines

Didactic Lectures and Interactive Sessions in Small Groups: A Comparative Study among Undergraduate Students in Hawler College of Medicine

Aims: To study and compare didactic lectures with interactive sessions in small groups among undergraduate medical students. Study Design: A quasi-experimental research design. Place and Duration of Study: Hawler College of Medicine, between October 2011 and May 2012. Methodology: Two administrative groups of students were selected out of four groups of medical students in their final year at Hawler College of Medicine. A pretest and post test evaluation of both experimental and comparison groups was conducted using the same criteria. A questionnaire was used to address students' perception of the new teaching method. For comparing the results of both groups in the examination, we computed the mean mark achieved by each group (pre and post test). Student’s t -test was used to compare means of both groups. Research Article British Journal of Education, Society & Behavioural Science, 3(2): 144-153, 2013 145 Results: Out of 72 students who were originally included in the study, 64 students (88.8%) of both groups performed both pre and post test examinations. The age range of the students was 21-26 (mean age+ S.D 23.25+ 1.01). There was no statistically significant difference between the two means (pre and post) of the lecture format (P = 0.15), while the difference between the two means of problem-solving interactive class was statistically significant. Students in the study group showed higher marks than students in the lecture format (P = 0.059). Twenty eight (90%) students found interactive sessions more active way of learning than lectures, 29 (93%) students agreed that interactive sessions provide more group interactive skills. There were some negative attitudes like heavy workload on students (55%), and uncertainty about the accuracy of information from colleagues (52%). Conclusion: Effectiveness of small group teaching may depend on the teaching style in small groups.

Individualized Oral Health Education Improves Oral Hygiene Compliance and Clinical Outcomes in Pregnant Women with Gingivitis

Background: Pregnant women have been shown to demonstrate an increase in clinical signs and symptoms of gingivitis despite similar plaque levels to non-pregnant peers. Objective: The goal of this investigation was to utilize a comprehensive regimen of oral hygiene techniques and practices and to evaluate the methodology to teach that regimen by assessing periodontal health outcomes and health behaviors and knowledge in pregnant women. Methods: 120 pregnant participants with Gingival Index (GI) scores ≥ 2 at ≥ 50 % of tooth sites were recruited. At baseline, patients were examined and Plaque Index (PI), Gingival Index (GI), Probing Depth (PD) and Clinical Attachment Level (CAL) were recorded. Patients’ self-reported oral hygiene compliance and oral hygiene knowledge was examined using a pre- and post-test examination at baseline and after the study period. Intensive oral hygiene counseling was provided at baseline, 4 and 8 week visits. Clinical measures and tests of oral hygiene compliance and knowledge were repeated at follow up. Results: A statistically significant reduction in all clinical parameters was shown over the study period. On average whole mouth PI and GI scores were reduced by 54.7% and 48.4%, respectively, and the percentage of sites with PI and GI ≥ 2 decreased from 40% to 17% and 53% to 21.8%, respectively. Whole mouth PD also decreased an average of 0.45 mm and whole mouth CAL decreased an average of 0.24 mm. A statistically significant proportion of patients self-reported an increase in frequency of oral hygiene procedures and an increase in the use of all materials provided in the study oral care regimen. A greater proportion of patients also demonstrated increased knowledge regarding dental and maternal/fetal health after the intervention. Conclusion: Pregnancy may represent a unique opportunity for oral hygiene intervention.

Cyclic Durability of a Solid Oxide Fe-Air Redox Battery Operated at 650°C

The recently developed rechargeable solid oxide metal-air redox battery has shown a great potential for applications in mid- to large-scale stationary energy storage. Cyclic durability is one of the most important requirements for stationary energy storage. In this study, we report the cyclic durability of a solid oxide Fe-air redox battery operated at 650°C. The battery was continuously cycled 100 times under a current density of 50 mA/cm2 with rather flat performance, producing an average specific energy of 760 Wh/kg-Fe at a round-trip efficiency of 55.5%. The post-test examination indicated that the performance losses could arise from the fuel-electrode of the battery.

Neutron Radiography and Tomography Investigations of the Secondary Hydriding of Zircaloy-4 during Simulated Loss of Coolant Nuclear Accidents

Abstract In the framework of the post-test examinations of the large-scale LOCA simulation tests at the fuel rod bundle scale, the hydrogen distributions in specimens prepared from the QUENCH-L0 and -L1 tests were studied by means of neutron radiography and tomography. In order to determine quantitative hydrogen concentrations, both, neutron radiography and tomography were calibrated using cladding tube segments with known hydrogen concentrations. The linear dependence of the total macroscopic neutron cross section with the H/Zr atomic ratio was determined for both methods. The hydrogen distributions in samples prepared from the two tests differ significantly as a first glance to the results obtained for the QUENCH-L1 shows. Whereas clearly visible hydrogen bands were found in samples of the QUENCH-L0 test with a time between burst and quenching of more than 70 s; in some specimens prepared from the QUENCH-L1 test only blurred bands could be detected. The reasons for these different behaviors can be the different times between reaching the temperature maxima and the quenching, as well as bending of the QUENCH-L1 bundle. In the QUENCH-L0 test the bundle was quenched immediately after reaching the maximal temperature. In QUENCH-L1 the hydrogen had about 130 s to diffuse and reach more homogeneous distributions without clear contrasts between the hydrogen bands and the neighboring regions in the neutron images.

Electrochemical performance of plasma sprayed Cu–Co–SDC mono-layer and Cu–Co–SDC/Cu–YSZ bi-layered anodes manufactured from coarse and fine feedstock powders

Co–Cu–SDC mono-layer and Cu–Co–SDC/Cu–YSZ bi-layered anodes were manufactured by air plasma spraying utilizing coarse and fine feedstock powders. The absolute deposition efficiency was determined for each feedstock material to obtain Cu–Co–SDC coatings with 40 vol% of metallic phases and approximately 5 wt% of Co within the metallic phases. The coatings were characterized for porosity, gas permeability, and phase composition. Electrochemical testing was performed to determine the anode performance and long term stability. Cells with mono-layer anodes manufactured of coarse or fine CuO–CoO–SDC feedstock and Cu–Co–SDC/Cu–YSZ bi-layered anodes were tested at 700 °C and exhibited power densities of 49 mW cm−2, 36 mW cm−2, and 34 mW cm−2, respectively, and polarization resistances of 2.42 Ω cm2, 2.23 Ω cm2, and 1.98 Ω cm2, respectively. Post-test examination revealed that the Cu undergoes sintering and detachment from surrounding particles during testing, resulting in a decrease of triple phase boundary length and performance degradation.

Menopausal medicine clinic

The purpose of this study was to assess the effectiveness of a menopause clinic to enhance trainees' medical knowledge. Between July 2004 and May 2007, 73 resident physicians completed a rotation that included a weekly menopause clinic and completion of a pretest and posttest examination. Each test contained questions on topics covering menopause, perimenopause, and general women's health. At the end of each testing session, a total score and a menopause score were given. The mean (SD) pretest menopause score and total score were 63.2% (13.3%) and 63.7% (11.3%), respectively. The mean posttest increase in the menopause score was 14%, with a median score increase of 10.2% (P < 0.0001). The posttest results ranged from a maximum decrease of 7.8% to a maximum increase of 47.1%. The mean increase in the total score was 13%, with a median increase of 10.7% (P < 0.0001). For the posttest total score, the range went from -7.2% to 39.3%. There was no correlation between the score changes and the number of clinic sessions attended, the resident specialties (obstetrics/gynecology vs non-obstetrics/gynecology), the level of training (postgraduate year 1 or 2), or the examination order (test A vs test B taken first). Menopause clinics can add to resident physician knowledge about menopause-related matters. Menopause clinics may help educate future physicians in their ability to care for postmenopausal women.

ChemInform Abstract: Degradation Issues in Solid Oxide Cells During High Temperature Electrolysis

AbstractReview: 22 refs.

Fracture resistance curve over the complete mixed-mode I and II range for 5083 aluminum alloy

This study investigated experimentally the fracture resistance for aluminum alloy 5083-H112 specimens over the complete range of mixed-mode I and II loadings. The determination of the amount of crack extension utilized two approaches, the compliance method for opening-type specimens and the striation markings for shear-type specimens. The post-test examination on the fracture surfaces validated these two methods. The increase in mode II loading elevates the fracture resistance curve for mode I dominant specimens, but reduces subsequently the fracture resistance as the mode-mixity transforms the fracture mode from the opening-type to the shear-type.

The Certifying Examination of the American Board of Surgery: The Effect of Improving Communication and Professional Competency: Twenty-Year Results

In 1985, a small research group identified variables affecting applicant success on the oral Certifying Examination (CE) of the American Board of Surgery (ABS). This led to the design of an oral examination course first taught in 1991. The success of and need for this program led to its continuation. The results from the first 10 years were presented at the 2001 Association of Program Directors in Surgery annual meeting.(1) We now report the outcomes for the course of the second 10 years as measured by success on the CE. Thirty-six courses were held over 20 years. There were 57 invited faculty from 27 general surgery programs throughout the United States and Canada. The participant-to-faculty ratio ranged from 16:7 to 5:1 in the newer 3-day format (2007). Courses were offered at sites that replicated the actual examination setting. Each course included (1) pretest and posttest examinations, (2) analysis of case presentation skills, (3) measurement of communication apprehension, (4) 1:1 faculty feedback, (5) small-group practice sessions, (6) individual videotaping, (7) didactic review of specific behaviors on examinations, (8) a debrief session with two faculty members, and (9) a written evaluative summary that included an improvement strategy. There were 36 courses with 326 participants (30-54 years). Follow-up data are available for 225 participants. Trends were analyzed between 1991-2001 and 2002-2011. As resident performance on the CE increased in importance, applicant profiles changed from those who had previously failed (1991-2001) to residents identified by program directors as needing assistance (52%). Since 2002, most course participants (69%) who had failed the CE had completed at least 1 other review course. Participants reported more significant stressors (2002-2011) 9%, but communication apprehension remained the same. As a result, individual counseling for anger and family stressors was integrated into the course. The perception of knowledge deficits was associated with those who enrolled in fellowship training and delayed their examination. The recent groups exhibited more professionalism and articulation issues related to performance. Five surgeons (2002-2011) were asked not to return to the course because of severe knowledge deficiencies or ethical/behavioral issues based on faculty evaluations. Although complete follow-up of all participants was not possible (only 225/326), the success rate among those providing follow-up was 97% for those who followed their remediation plan, giving 218/326, a worse-case pass rate of 67%. Communication and professionalism deficits are still common in those struggling with the CE, Early identification of those at risk of failing by program directors who are documenting the competencies may promote earlier interventions and thus lead to success. This program continues to be effective at identifying behaviors that interfere with success on the CE of the ABS.

Degradation Issues in Solid Oxide Cells During High Temperature Electrolysis

Idaho National Laboratory (INL) is performing high-temperature electrolysis research to generate hydrogen using solid oxide electrolysis cells (SOECs). The project goals are to address the technical and degradation issues associated with the SOECs. This paper provides a summary of various ongoing INL and INL sponsored activities aimed at addressing SOEC degradation. These activities include stack testing, post-test examination, degradation modeling, and a list of issues that need to be addressed in future. Major degradation issues relating to solid oxide fuel cells (SOFC) are relatively better understood than those for SOECs. Some of the degradation mechanisms in SOFCs include contact problems between adjacent cell components, microstructural deterioration (coarsening) of the porous electrodes, and blocking of the reaction sites within the electrodes. Contact problems include delamination of an electrode from the electrolyte, growth of a poorly (electronically) conducting oxide layer between the metallic interconnect plates and the electrodes, and lack of contact between the interconnect and the electrode. INL’s test results on high temperature electrolysis (HTE) using solid oxide cells do not provide clear evidence of whether different events lead to similar or drastically different electrochemical degradation mechanisms. Post-test examination of the solid oxide electrolysis cells showed that the hydrogen electrode and interconnect get partially oxidized and become nonconductive. This is most likely caused by the hydrogen stream composition and flow rate during cool down. The oxygen electrode side of the stacks seemed to be responsible for the observed degradation due to large areas of electrode delamination. Based on the oxygen electrode appearance, the degradation of these stacks was largely controlled by the oxygen electrode delamination rate. Virkar and co-workers have developed a SOEC model based on concepts in local thermodynamic equilibrium in systems otherwise in global thermodynamic nonequilibrium. This model is under continued development. It shows that electronic conduction through the electrolyte, however small, must be taken into account for determining local oxygen chemical potential, within the electrolyte. The chemical potential within the electrolyte may lie out of bounds in relation to values at the electrodes in the electrolyzer mode. Under certain conditions, high pressures can develop in the electrolyte just under the oxygen electrode (anode)/electrolyte interface, leading to electrode delamination. This theory is being further refined and tested by introducing some electronic conduction in the electrolyte.

Physical Surrogate Leg to Evaluate Blast Mine Injury

Antipersonnel blast landmines pose a significant threat in affected areas, with injuries to the lower extremity and amputation being common. Addressing a need for injury prediction and protection evaluation, a 50th percentile physical surrogate lower leg was developed incorporating the load transmission paths in the lower leg. Biofidelic and frangible materials were evaluated and selected based on high deformation rate properties compared to those for human tissues. The predicted leg injuries from experimental blast testing were in agreement with injury data for unprotected and protected legs. Post-test examination was found to be the only consistent and reliable evaluation method for predicting injury outcome, and an evaluation based on tissue damage was shown to be sensitive to changes in loading conditions, not possible with existing approaches. This study identified the severity of calcaneal fracture as the primary determinant of serious injury, which should be the focus of future protection development.

Dry Sliding Wear of Active Screen Plasma Carburised Austenitic Stainless Steel

Low temperature diffusion treatments with nitrogen and carbon have been widely used to increase the tribological performance of austenitic stainless steels. These processes produce a layer of supersaturated austenite, usually called expanded austenite or S-phase, which exhibits good corrosion and wear resistance. The novel active screen technology is said to provide benefits over the conventional DC plasma technology. The improvements result from the reduction in the electric potential applied to the treated components, and the elimination of such defects and processing instabilities as edge effects, hollow cathode effects and arcing. In this study, AISI 316 coupon samples were plasma carburised in DC and active screen plasma furnaces. The respective layers of carbon expanded austenite were characterised and their tribological performance was studied and compared. Detailed post-test examinations included SEM observations of the wear tracks and of the wear debris, EDX mapping of the wear track, EBSD crystal orientation mapping of the cross sections of the wear tracks, and cross-sectional TEM. Based on the results of wear tests and post-test examinations, the wear mechanisms involved are discussed.