Integration of the e-Learning into the medical university curricula.

OBJECTIVES: The aim of this contribution was to present the e-Learning introduction in the Slovak Medical University (SMU) with a focus on the implementation phase of the two blended courses - Healthcare Quality and Healthcare Professionals' Ethics. BACKGROUND: The introduction of the e-Learning was realized during the period 2008-2009 in the partnership of SMU and IBM Company, following strictly the project management approach. METHODS: The development of the e-module beta-versions was evaluated by the modules' authors using a structured interview. In a consequent pilot testing, the blended courses were evaluated by 23 students of the bachelor program in Rescue health care, and by 61 public health students at the master level program, respectively, using the standardized questionnaires. RESULTS: The tangible results included the documented SMU strategy for the e-Learning integration, six e-Learning modules and evaluation results. The authors' evaluation showed high scores for the experience in collaboration with IBM, as well as for the experience with the LMS environment. The students' evaluation showed a high acceptance of the e-Learning by both part-time and full-time students. The access to Internet was not recognized as a serious barrier. CONCLUSION: The first experience with the integration of the e-Learning into the curricula of the Slovak Medical University showed the advantage of the systematic approach. The experience with developing the strategy in an interdisciplinary/ intercultural team, the knowledge about specific characteristics of distance learning by the involved SMU staff, and the know-how and skills represented the important benefits. It was demonstrated that the blended learning is recommended as optimal for the education in medical environment (Tab. 4, Fig. 1, Ref. 22).

Comparison of long-term care in European developed countries to possible implementation in Slovakia.

Long-term care within the public services system does not exist in Slovakia. Long-term care is a relatively closed system of health care and social care services. Initially, long-term care policies were formulated as a response to ageing of the population, which brought about growing needs of elderly people for social care and health care, and was associated with relatively rapid increases of necessary costs. All industrial countries are facing similar problems when it comes to the integration of long-term care. In developed countries, current long-term care focuses on all age groups in need of assistance and support from others due to the limitations caused by their state of health (Ref. 34). Full Text (Free, PDF) www.bmj.sk.

Long-term care as an urgent challenge.

Long-term care is a relatively closed system of health care and social care services and assistance that has developed as a response to the needs of those who due to disability, chronic health conditions, trauma or disease limiting their self-care capabilities and independence, are in need of assistance and support of third persons for a prolonged period of time. Long-term care within the public services system does not exist in Slovakia (Ref. 12).

Barogenic rupture of the esophagus associated with hyperemesis gravidarum.

Spontaneous rupture of the esophagus is associated with continuous nausea and vomiting in the chronic alcoholic. The following is a case report of a similar occurrence in a young, healthy, primigravida with hyperemesis gravidarum. To our knowledge, this has not previously been reported in the obstetric literature.

T-lymphocyte subsets in occupationally exposed persons.

The percentage of CD2+, CD4+, CD8+ and HNK-1+ cells in peripheral blood was investigated in persons occupationally exposed to very low doses of ionizing radiation. Investigations were carried out by monoclonal antibodies and flow cytometry. While significant effects of age and smoking habits on the relative number of CD8 cells and CD4/CD8 ratios could be established, no influence of the very low radiation exposure on the profile of lymphocytic T cells in blood was found, except a very slight effect on the relative number of CD2+ cells.

SCE frequencies in lymphocytes of systemic lupus erythematosus patients.

The frequency of sister-chromatid exchanges (SCEs) was investigated in peripheral lymphocytes of lupus erythematosus patients and compared with values obtained for healthy controls. Irrespective of the kind of medical treatment, an increased level of spontaneously occurring SCEs could be demonstrated in lupus patients. In addition to spontaneously occurring SCEs, mitomycin C (MMC)-induced SCEs were evaluated. No difference between patients and controls was found with respect to MMC-induced SCEs.

Langerhans cells and immature dendritic cells as model systems for screening of skin sensitizers.

Langerhans cells are the most potent antigen-presenting cells in the skin and play a critical role in the induction of contact allergy. Research on the phenotypical and functional changes of LCs occurring after application of skin sensitizers indicated their use as an in vitro model for the screening of chemicals. In the present investigations, LCs from human skin explants served as the test system. The application of this cell system has been aggravated by the difficulty in isolating sufficient numbers of live LCs from skin. This disadvantage was overcome by the culture of immature dendritic cells from peripheral mononuclear blood cells. These cells can serve as a replacement for LCs as they bind haptens and show phenotypical and functional changes similar to LCs. The sensitizers NiSO(4), dinitrochlorobenzene, 2,4,6-trinitrobenzene sulfonic acid, alpha-hexylcinnamaldehyde and eugenol were applied. Both the expression of surface markers and the induction of intracellular interleukin-1 beta (IL-1 beta) were analyzed. No clear-cut results could be established for intracellular cytokine production, only NiSO(4) induced a remarkable number of IL-1 beta-positive cells. However, all skin sensitizers caused an up-regulation of the co-stimulatory molecule CD86, of intercellular adhesion molecule CD54 and of the HLA-DR antigen. The irritant sodium dodecyl sulfate (SDS) and the vehicle dimethyl sulfoxide (DMSO) had no effect.

The expression of surface markers on dendritic cells as indicators for the sensitizing potential of chemicals.

Novel approaches to testing of skin sensitizing chemicals have made use of immature dendritic cells (DCs) cultured from different hematopoietic progenitors. These cells resemble Langerhans cells (LCs), which are the most potent antigen presenting cells in the skin. Former research has focused on the phenotypic and functional changes of LCs after application of skin sensitizers. But it has proven difficult to isolate sufficient numbers of LCs from skin. This disadvantage is overcome by cultures of immature DCs providing high numbers of reactive cells. The aim of the present investigation was to test the response of DC cultures established from different blood donors to known sensitizers, an irritant and a vehicle. The sensitizers NiSO(4), dinitrochlorobenzene (DNCB), 2,4,6 trinitrobenzene sulfonic acid (TNBS), alpha-hexylcinnamaldehyde (Cinn) and eugenol (Eu) induced the up-regulation of the co-stimulatory molecule CD86, of intercellular adhesion molecule CD54 and of the HLA-DR antigen. The irritant sodium dodecyl sulfate (SDS) and the vehicle dimethyl sulfoxide (DMSO) had no effect. A high rate of responders within blood donors was found for NiSO(4), TNBS, Cinn and Eu, while DNCB was less effective. The augmentation of surface marker expression in dendritic cells obtained from peripheral human blood seems to be a promising readout in prescreening for strong and moderate sensitizers. This test could thus help to reduce animal numbers for in vivo testing.

Investigations on the effect of repeated hair dyeing on sister chromatid exchanges.

The numbers of sister chromatid exchanges (SCE) were determined in the lymphocytes of ten volunteers (males and females) whose hair was dyed 13 times at intervals of 3-5 wk. Each volunteer used throughout the study a single commercial preparation containing a mixture of aminotoluenes, aminophenols and hydroxybenzenes, and in some cases naphthol, as the active ingredients. The findings were compared with those in a control group matched for age and sex. SCE were determined in blood samples taken before the first exposure, after a sham dyeing and after the first three and the last three actual dyeing procedures. Volunteers were carefully screened for disease, for use of medicines and for radiation exposure. Consumption of alcohol was the same in both groups, but there were more smokers in the treated group. No evidence was found of any effect of repeated hair dyeing on the frequency of SCE. In both the controls and in the hair-dyed subjects a slight decrease in SCE was detected during the course of the experiment; this was independent of sex as well as of the dyeing procedure.

Prognostic significance of vascular density and a malignancy grading in radiation treated uterine cervix carcinoma.

In a retrospective study of 95 patients with squamous cell carcinoma of the uterine cervix (Stage IB, IIA, III) treated by radiation only, pretreatment biopsy material was used for assessment of the prognostic value of histopathological multifactorial malignancy grading and a morphometric estimation of vascular density in stroma. By comparison of the two systems, vascular density has been proved superior to malignancy grading with respect to prognostic value.

[Xeroderma pigmentosum with normal excision-repair capacity and decreased U-V tolerance (author's transl)]. / Xeroderma Pigmentosum mit intaktem Exzisionsrepair-Mechanismus und herabgesetzter UV-Toleranz

Unscheduled DNA synthesis was investigated in the peripheral lymphocytes of a 31-year-old woman suffering from Xeroderma pigmentosum, clinically manifest since early childhood. The present data indicate a normal level of excision repair capacity, though U-V sensitivity was increased. The present case is considered to be a new variant of the syndrome Xeroderma pigmentosum, demonstrating once more its genetic heterogeneity. The question of a relationship between the observed data and the known occurrence of carcinoma in the light-exposed skin areas remains to be answered.

Occupational exposure and its effect on some immune parameters.

Some immunological parameters were investigated in a group of workers exposed to external radiation (1.4 to 9.8 mSv) and inhalation of tritium (comm. eff. dose equiv. 1.2 to 2.8 mSv). The present investigations indicate the differential radiosensitivity of lymphocytic subsets: CD8 positive suppressor T cells were found to be the most sensitive subpopulation in the peripheral blood of radiation exposed workers. CD4/CD8 ratios were increased mainly due to an increase in absolute numbers of CD4 positive helper T cells indicating a selective cell renewal after irradiation. Results obtained after phytohaemugglutinin stimulation of lymphocytes showed individual variation, though there seems to be a trend towards an inverse correlation between absolute T cell numbers in peripheral blood and the number of S phases observed after stimulation, low T cell numbers leading to a high rate of stimulation. The calculation of the committed effective dose equivalents show that radiation protection against internal tritium contamination in power plants should not be neglected.

UDS and SCE in lymphocytes of persons occupationally exposed to low levels of ionizing radiation.

Unscheduled DNA synthesis induced by in vitro UV irradiation was investigated in lymphocytes of persons occupationally exposed to low doses of ionizing radiation (maximum registered radiation dose: 98 mrad/month). For radiation exposures greater than 14 mrad/month above background level, increased rates of UDS after in vitro UV irradiation of lymphocytes were found. The bromodeoxyuridine differential chromatid labeling technique was applied to the examination of spontaneous and Mitomycin C (MMC)-induced sister chromatid exchanges (SCE) in the same population. No statistically significant difference could be determined in spontaneously occurring SCEs, while MMC induced SCEs were significantly reduced in persons exposed to radiation doses greater than 14 mrad/month, thus indicating increased repair capability for DNA lesions inflicted by a second insult after protracted low-dose irradiation.

Identification of factors contributing to degradation in autothermal thermophilic sludge digestion.

A laboratory scale ATAD reactor (6 days SRT, 24 h feed cycle) was operated at quasi steady-state conditions with real waste activated sludge feed. Hydrolysis tests of waste activated sludge demonstrated that 10% of feed suspended matter is hydrolysed practically instantaneously and 20-30% of all fed suspended matter is dissolved after 60 minutes in tap water and in cell free reactor liqueur equally. Respirometric, VSS and COD concentration data served as basis for calibration of a simple VSS based kinetic model. The calibrated model provided good fit to two separate sets of measured data. This model was used to evaluate different operation strategies. Modification of cycle length does not affect overall VSS emoval rate, while shorter cycle length or continuous operation helps avoid oxygen limited conditions. Further advantages of shorter feed cycles (reduced cooling effect, greater realizable load) support choosing continuous operation of the ATAD system if the main goal is VSS reduction. While reactor cascades increase efficiency, this advantage diminishes with increasing load. At high load rates increased construction costs are not justified by the expected improvement in efficiency.

Sister chromatid exchanges (SCEs) in lymphocytes of persons working at Shlobin (USSR), 150 km north of Chernobyl.

Workers at a building plot in Shlobin (USSR), 150 km north of Chernobyl, were examined for the occurrence of spontaneous and mitomycin C induced SCEs in peripheral lymphocytes. Personnel being present during and after the Chernobyl accident exhibited a decreased number of inducible SCEs compared with test-persons starting work at Shlobin by 1st of June, 1986. Since effective dose equivalents were rather low (about 2 m Sv till the end of August 1986), induced SCEs proved to be a very sensitive test for the demonstration of low dose exposure.