A system for students' evaluation of lectures in the medical programme in Oslo. / Et system for studentevaluering av forelesninger ved medisinstudiet i Oslo.

BACKGROUND: Students and education authorities are expressing an increasing demand for educational quality and student involvement in higher education. We present a descriptive observational study of a student-initiated system for evaluation of lectures in the medical degree programme at the University of Oslo. MATERIAL AND METHOD: Criteria-based student evaluations of 445 lectures in the first and second year of the medical degree programme were conducted in spring and autumn 2017 and spring 2018; after each lecture, three students completed a questionnaire about the lecture. The responses were sent by email to the lecturer on the same day. We performed an analysis of the evaluations, a group interview with the cohort's elected representatives, and a questionnaire survey among the lecturers who received an evaluation. RESULTS: The lecturers received generally good feedback, but the student evaluations also indicated a clear potential for improvement: 21 % of the lectures were not adapted to the volume of information, 32 % did not point out the association with the learning outcomes, 31 % failed to activate the students and 40 % did not provide a summary at the end of the lecture. The cohort's elected representatives had a positive attitude to the evaluation scheme, but requested a simpler technical solution. Almost all the lecturers welcomed the student evaluation, and more than half had used the evaluations to improve their lectures. INTERPRETATION: This quality development project shows how students, teachers, administration and management can collaborate to improve the teaching.

Computing ischemic regions in the heart with the bidomain model--first steps towards validation.

We investigate whether it is possible to use the bidomain model and body surface potential maps (BSPMs) to compute the size and position of ischemic regions in the human heart. This leads to a severely ill posed inverse problem for a potential equation. We do not use the classical inverse problems of electrocardiography, in which the unknown sources are the epicardial potential distribution or the activation sequence. Instead we employ the bidomain theory to obtain a model that also enables identification of ischemic regions transmurally. This approach makes it possible to distinguish between subendocardial and transmural cases, only using the BSPM data. The main focus is on testing a previously published algorithm on clinical data, and the results are compared with images taken with perfusion scintigraphy. For the four patients involved in this study, the two modalities produce results that are rather similar: The relative differences between the center of mass and the size of the ischemic regions, suggested by the two modalities, are 10.8% ± 4.4% and 7.1% ± 4.6%, respectively. We also present some simulations which indicate that the methodology is robust with respect to uncertainties in important model parameters. However, in contrast to what has been observed in investigations only involving synthetic data, inequality constraints are needed to obtain sound results.

Contribution of the Na+/Ca2+ exchanger to rapid Ca2+ release in cardiomyocytes.

Trigger Ca(2+) is considered to be the Ca(2+) current through the L-type Ca(2+) channel (LTCC) that causes release of Ca(2+) from the sarcoplasmic reticulum. However, cell contraction also occurs in the absence of the LTCC current (I(Ca)). In this article, we investigate the contribution of the Na(+)/Ca(2+) exchanger (NCX) to the trigger Ca(2+). Experimental data from rat cardiomyocytes using confocal microscopy indicating that inhibition of reverse mode Na(+)/Ca(2+) exchange delays the Ca(2+) transient by 3-4 ms served as a basis for the mathematical model. A detailed computational model of the dyadic cleft (fuzzy space) is presented where the diffusion of both Na(+) and Ca(2+) is taken into account. Ionic channels are included at discrete locations, making it possible to study the effect of channel position and colocalization. The simulations indicate that if a Na(+) channel is present in the fuzzy space, the NCX is able to bring enough Ca(2+) into the cell to affect the timing of release. However, this critically depends on channel placement and local diffusion properties. With fuzzy space diffusion in the order of four orders of magnitude lower than in water, triggering through LTCC alone was up to 5 ms slower than with the presence of a Na(+) channel and NCX.

Student learning strategies, mental models and learning outcomes in problem-based and traditional curricula in medicine.

Kelson and Distlehorst (2000) state the PBL outcomes should be discussed on a broad basis including a useable knowledge base, skills in problem solving, self-directed learning and collaboration. The present research compares students in a PBL programme and in a traditional program on learning strategies, mental models and outcomes. Learning strategies and metal models of learning were measured for two student groups in 2001 using an adaptation of Vermunt's (1994) "Inventory of learning styles". Learning outcomes were measured for the same groups in 2002 using a test of medical knowledge. PBL-students showed significantly more self-regulated learning and more constructive conceptions of learning. No significant differences in learning outcomes were found between the two groups. Students in the PBL-programme perceived students as more active contributors to group learning process and made use of a broader range of resources than students in the traditional programme. The findings confirm effects of educational programmes on student learning strategies (Vermetten 1999) and also confirm lack of significant differences in medical knowledge (Albanese 2000, Colliver 2000, Norman & Schmidt 2000, Wiers-Jensen & Aasland 2004). The curricular influence on students' learning strategies challenges educators to design approaches that promote lifelong learning skills as well as disciplinary knowledge.

Mathematical modeling of granulocyte reconstitution after high-dose chemotherapy with stem cell support: effect of post-transplant G-CSF treatment.

Cancer patients treated with high-dose chemotherapy and autotransplanted with peripheral blood progenitor cells most often reconstitute neutrophils (> 0.5 x 10(9)c/l) 8-16 days after the initiation of treatment. By means of a mathematical model of human granulopoiesis, the present work assesses the effect of administering granulocyte colony stimulating factor (G-CSF) post-transplant to reduce engraftment time, and also assesses the effect of delaying initiation of G-CSF treatment relative to a general schedule. Hematopoietic progenitor cells from 21 breast cancer patients were mobilized by chemotherapy followed by G-CSF injections. Purified CD34+ cells taken from the mobilized blood were infused 3 days after termination of chemotherapy. Patients were given subcutaneous injections of G-CSF post-transplant (5 microg/kg every 12 h). Neutrophil counts calculated from a mathematical model were compared with data from individual patients. These results were also compared with data and modeling results from a group of 19 lymphoma patients given no post-transplant G-CSF therapy. The observed engraftment times were associated with the number of CFU-GM cells in the reinfused blood graft and the administration of post-transplant G-CSF. The latter finding was most predominant in patients given < 5.0 x 10(5) CFU-GM/kg bw. These tendencies were well captured by the model. Interestingly, the model showed no major differences in time to engraft neutrophils if the initiation of G-CSF was postponed for up to 5 days after transplantation. Our findings indicate that the present mathematical model of neutrophil recovery following high-dose therapy correlates with clinical observations and can potentially be used to predict time to neutrophil recovery.

Changes in student approaches to learning with the introduction of computer-supported problem-based learning.

OBJECTIVES: To study changes in student approaches to learning following the introduction of computer-supported, problem-based learning. SETTING: Medical students at the University of Oslo undertake a 12-week period of clinical placement during their 10th term. In this period they continue to undertake problem-based learning (PBL) in the form of distributed problem-based learning (DPBL) in a computer-supported learning environment. DESIGN: A questionnaire focusing on learning styles, PBL, and information and communication technology (ICT) was distributed before and after the DPBL period. SUBJECTS: All students in their 10th term at the University of Oslo (n = 61). RESULTS: The introduction of DPBL did not seem to affect the participants' use of regulating strategies or their mental models of learning. After the DPBL period, group discussion and tutor input were reported to have less influence on students' self-study, while the students perceived themselves as being less active in groups and as expecting less from tutors. There was a relationship between perceived tutor influence and students' familiarity with ICT. The DPBL period seemed to increase students' task-related web accesses and use of experts, and to decrease their task-related use of textbooks and discussions with students outside the group. CONCLUSIONS: Students' general approaches to learning were not affected by the introduction of DPBL. However, there was a decrease in students' expectations concerning activity in the group and the importance of the tutor. These changes were related to students' familiarity with the use of computers. Web-based resources and experts became more important resources to the students during the DPBL period.

Mathematical modeling of human granulopoiesis: the possible importance of regulated apoptosis.

Steady state human granulopoiesis was modeled by a convection-reaction differential equation of the Rubinow type for the bone marrow granulocyte precursors and an ordinary differential equation for the blood granulocytes. Measured values reported from several laboratories were used as sources for the model proliferation, maturation, and mobilization rates. Due to the large variability in the measured input data, four alternative models were constructed initially, each one with a specific combination of proliferation rate and maturation rate. They were all able to produce output values for the bone marrow neutrophil count and turnover rate close to accepted data, but neither of them could reproduce good values for the differential fractions of the neutrophil precursor stages. The model output was especially sensitive to changes in transit time in the mitotic relative to the postmitotic precursor compartments. When the net proliferation rate was modeled to optimize the bone marrow differential fractions according to published data, the total bone marrow neutrophil count would not fit with published data. However, a composite model optimizing differential fractions, bone marrow neutrophil count, and turnover rate yielded plausible output values and a reduced proliferation rate in the myelocyte stage. This result opens for a possibly substantial apoptosis rate at the myelocyte stage in accordance with results from earlier investigators. However, the result was based on a special choice of precursor transit times, taken from the literature. More precise data concerning granulocyte precursor cycle times, transit times, and differential fractions would radically improve the model's ability to clarify the role of apoptosis during granulocyte production and storage.

A mathematical model for reconstitution of granulopoiesis after high dose chemotherapy with autologous stem cell transplantation.

High dose chemotherapy supported with hematopoietic progenitor cells gives a characteristic neutropenic period (blood neutrophils < 0.5 x 10(9) c/l) ranging from 10 to 16 days. The question of a correlation between the CFU-GM content of the transplanted CD34+ cells and time to neutrophil recovery by patients having been given high-dose chemotherapy (HD-CT) with stem cell support was addressed by means of a mathematical model of granulopoiesis. The model utilizes a convection-reaction partial differential equation (PDE) with feedback from a cytokine compartment on proliferation, maturation, and mobilization of granulocytes from bone marrow to blood. The observed number of CFU-GM cells in the transplanted CD34+ cell autograft was used as input to the model. Using this approach, the observed gross relationship between CFU-GM content in the reinfused blood product and engraftment time could be reproduced. At the same time, the effects of assumed physiological mechanisms, especially some of the effects of G-CSF on proliferation rate, maturation rate, mobilization, and cell death, could be investigated and discussed relative to observed engraftment. The model makes it possible to explain how cytokines interfere with progenitor cell mobilization from bone marrow to blood, and it points out the implications of a regulating mechanism for the granulocyte maturation rate.