Designing and building OSCEBot ® for virtual OSCE - Performance evaluation.

With AI's advancing technology and chatbots becoming more intertwined in our daily lives, pedagogical challenges are occurring. While chatbots can be used in various disciplines, they play a particularly significant role in medical education. We present the development process of OSCEBot ®, a chatbot to train medical students in the clinical interview approach. The SentenceTransformers, or SBERT, framework was used to develop this chatbot. To enable semantic search for various phrases, SBERT uses siamese and triplet networks to build sentence embeddings for each sentence that can then be compared using a cosine-similarity. Three clinical cases were developed using symptoms that followed the SOCRATES approach. The optimal cutoffs were determined, and each case's performance metrics were calculated. Each question was divided into different categories based on their content. Regarding the performance between cases, case 3 presented higher average confidence values, explained by the continuous improvement of the cases following the feedback acquired after the sessions with the students. When evaluating performance between categories, it was found that the mean confidence values were highest for previous medical history. It is anticipated that the results can be improved upon since this study was conducted early in the chatbot deployment process. More clinical scenarios must be created to broaden the options available to students.

A suggestive approach for assessing item quality, usability and validity of Automatic Item Generation.

Automatic Item Generation (AIG) refers to the process of using cognitive models to generate test items using computer modules. It is a new but rapidly evolving research area where cognitive and psychometric theory are combined into digital framework. However, assessment of the item quality, usability and validity of AIG relative to traditional item development methods lacks clarification. This paper takes a top-down strong theory approach to evaluate AIG in medical education. Two studies were conducted: Study I-participants with different levels of clinical knowledge and item writing experience developed medical test items both manually and through AIG. Both item types were compared in terms of quality and usability (efficiency and learnability); Study II-Automatically generated items were included in a summative exam in the content area of surgery. A psychometric analysis based on Item Response Theory inspected the validity and quality of the AIG-items. Items generated by AIG presented quality, evidences of validity and were adequate for testing student's knowledge. The time spent developing the contents for item generation (cognitive models) and the number of items generated did not vary considering the participants' item writing experience or clinical knowledge. AIG produces numerous high-quality items in a fast, economical and easy to learn process, even for inexperienced and without clinical training item writers. Medical schools may benefit from a substantial improvement in cost-efficiency in developing test items by using AIG. Item writing flaws can be significantly reduced thanks to the application of AIG's models, thus generating test items capable of accurately gauging students' knowledge.

Ultrasound-Guided Selective Bronchial Intubation: A Feasibility Study in Pediatric Animal Model.

Objective: Selective one-lung ventilation used to optimize neonatal and pediatric surgical conditions is always a demanding task for anesthesiologists, especially during minimally invasive thoracoscopic surgery. This study aims to introduce an ultrasound-guided bronchial intubation and exclusion technique in a pediatric animal model. Methods: Seven rabbits were anesthetized and airway ultrasound acquisitions were done. Results: Tracheal tube progression along the trachea to the right bronchus and positioning of the bronchial blocker in the left bronchus were successfully done with consistent ultrasound identification of relevant anatomical structures. Conclusion: The study provided a new application of ultrasound in airway management. More advanced experimental studies are needed since this technique has the potential for translation to pediatric anesthesia.

Usability, Acceptability, and Satisfaction of a Wearable Activity Tracker in Older Adults: Observational Study in a Real-Life Context in Northern Portugal.

BACKGROUND: The use of activity trackers has significantly increased over the last few years. This technology has the potential to improve the levels of physical activity and health-related behaviors in older adults. However, despite the potential benefits, the rate of adoption remains low among older adults. Therefore, understanding how technology is perceived may potentially offer insight to promote its use. OBJECTIVE: This study aimed to (1) assess acceptability, usability, and user satisfaction with the Xiaomi Mi Band 2 in Portuguese community-dwelling older adults in a real-world context; (2) explore the mediating effect of the usability on the relationship between user characteristics and satisfaction; and (3) examine the moderating effect of user characteristics on the relationship between usability and user satisfaction. METHODS: Older adults used the Xiaomi Mi Band 2 over 15 days. The user experience was evaluated through the Technology Acceptance Model 3, System Usability Scale, and User Satisfaction Evaluation Questionnaire. An integrated framework for usability and user satisfaction was used to explore user experience. Statistical data analysis included descriptive data analysis, reliability analysis, confirmatory factor analysis, and mediation and moderation analyses. RESULTS: A sample of 110 older adults with an average age of 68.41 years (SD 3.11) completed the user experience questionnaires. Mean user acceptance was very high-perceived ease of use: 6.45 (SD 0.78); perceptions of external control: 6.74 (SD 0.55); computer anxiety: 6.85 (SD 0.47); and behavioral intention: 6.60 (SD 0.97). The usability was excellent with an average score of 92.70 (SD 10.73), and user satisfaction was classified as a good experience 23.30 (SD 2.40). The mediation analysis confirmed the direct positive effect of usability on satisfaction (ß=.530; P<.01) and the direct negative effect of depression on usability (ß=-.369; P<.01). Lastly, the indirect effect of usability on user satisfaction was higher in individuals with lower Geriatric Depression Scale levels. CONCLUSIONS: Findings demonstrate that the Xiaomi Mi Band 2 is suitable for older adults. Furthermore, the results confirmed usability as a determinant of satisfaction with the technology and extended the existing knowledge about wearable activity trackers in older adults.

Free-Living Physical Activity Measured With a Wearable Device Is Associated With Larger Hippocampus Volume and Greater Functional Connectivity in Healthy Older Adults: An Observational, Cross-Sectional Study in Northern Portugal.

Several studies using neuroimaging techniques have established a positive relationship between physical activity (PA) and brain structure and function in older populations. However, the use of subjective measures of PA and the lack of multimodal neuroimaging approaches have limited the understanding of this association. This study aims to explore the associations between PA and brain structure and function by objectively evaluating PA. Community-dwelling cognitively healthy older adults (without diagnosed cognitive, neurological or degenerative disease) were recruited from local health centers and local gyms. In a cross-sectional design, participants were evaluated regarding cognitive, clinical, anthropometric, physical performance, and lifestyle characteristics. A 3 T magnetic resonance imaging (MRI) was performed for structural and functional brain measures. PA time and level was assessed via a Xiaomi Mi Band 2® worn for 15 consecutive days. Participants (n = 110, after inclusion/exclusion criteria and completion of all evaluations) were 58 females (56%), with an average age of 68.42 years old (SD = 3.12), most were active. Multiple regression analysis revealed that higher time spent in vigorous PA associated with larger left parahippocampal gyrus and right hippocampus volumes. Furthermore, the analysis of the functional connectome indicated a greater functional connectivity (FC) between the frontal gyrus, cingulate gyrus, occipital inferior lobe for light, moderate, and total PA time, and sedentary time associated with lower FC in the same networks. Overall, the structural and functional findings may provide evidence on the relevant association between PA and brain health in aging.

Applicability and validation of the Reaction to Tests Scale (RTT) in a sample of Portuguese medical students.

BACKGROUND: Test anxiety is a crucial factor in determining academic outcomes, and it may lead to poor cognitive performance, academic underachievement, and psychological distress, interfering specifically with their ability to think and perform during tests. The main objective of this study was to explore the applicability and psychometric properties of a Portuguese version of the Reactions to Tests scale (RTT) in a sample of medical students. METHOD: A sample of 672 medical students completed the RTT. The sample was randomly split in half to allow for independent Exploratory Factor Analysis (EFA) and to test the best fit model-Confirmatory Factor Analysis (CFA). CFA was used to test both the first-order factor structure (four subscales) and second-order factor structure, in which the four subscales relate to a general factor, Test Anxiety. The internal consistency of the RTT was assessed through Cronbach's alpha, Composite reliability (CR) and Average Variance Extracted (AVE) for the total scale and each of the four subscales. Convergent validity was evaluated through the correlation between RTT and the State-Trait Anxiety Inventory (STAI-Y).To explore the comparability of measured attributes across subgroups of respondents, measurement invariance was also studied. RESULTS: Results from exploratory and confirmatory factor analyses showed acceptable fits for the Portuguese RTT version. Concerning internal consistency, results indicate that RTT was found to be reliable to measure test anxiety in this sample. Convergent validity of the RTT with both state and trait anxiety STAI-Y's subscales was also shown. Moreover, multigroup analyses showed metric invariance across gender and curriculum phase. CONCLUSION: Our results suggest that the RTT scale is a valid and reliable instrument for the measurement of test anxiety among Portuguese Medical Students.

Useful Ultrasonographic Parameters to Predict Difficult Laryngoscopy and Difficult Tracheal Intubation-A Systematic Review and Meta-Analysis.

Unexpected difficult airway management can cause significant morbidity and mortality in patients admitted for elective procedures. Ultrasonography is a promising tool for perioperative airway assessment, nevertheless it is still unclear which sonographic parameters are useful predictors of difficult laryngoscopy and tracheal intubation. To determine the ultrasonographic predictors of a difficult airway that could be applied for routine practice, a systematic review and meta-analysis was conducted. Literature search was performed on PubMED, Web of Science and Embase using the selected keywords. Human primary studies, published in English with the use of ultrasonography to prediction of difficult laryngoscopy or tracheal intubation were included. A total of 19 articles (4,570 patients) were analyzed for the systematic review and 12 articles (1,141 patients) for the meta-analysis. Standardized mean differences between easy and difficult laryngoscopy groups were calculated and the parameter effect size quantified. A PRISMA methodology was used and the critical appraisal tool from Joanna Briggs Institute was applied. Twenty-six sonographic parameters were studied. The overall effect of the distance from skin to hyoid bone (p = 0.02); skin to epiglottis (p = 0.02); skin to the anterior commissure of vocal cords (p = 0.02), pre-epiglottis space to distance between epiglottis and midpoint between vocal cords (p = 0.01), hyomental distance in neutral (p < 0.0001), and extended (p = 0.0002) positions and ratio of hyomental distance in neutral to extended (p = 0.001) was significant. This study shows that hyomental distance in the neutral position is the most reliable parameter for pre-operative airway ultrasound assessment. The main limitations of the study are the small sample size, heterogeneity of studies, and absence of a standardized ultrasonographic evaluation method [Registered at International prospective register of systematic reviews (PROSPERO): number 167931].

European Portuguese Version of the User Satisfaction Evaluation Questionnaire (USEQ): Transcultural Adaptation and Validation Study.

BACKGROUND: Wearable activity trackers have the potential to encourage users to adopt healthier lifestyles by tracking daily health information. However, usability is a critical factor in technology adoption. Older adults may be more resistant to accepting novel technologies. Understanding the difficulties that older adults face when using activity trackers may be useful for implementing strategies to promote their use. OBJECTIVE: The purpose of this study was to conduct a transcultural adaptation of the User Satisfaction Evaluation Questionnaire (USEQ) into European Portuguese and validate the adapted questionnaire. Additionally, we aimed to provide information about older adults' satisfaction regarding the use of an activity tracker (Xiaomi Mi Band 2). METHODS: The USEQ was translated following internationally accepted guidelines. The psychometric evaluation of the final version of the translated USEQ was assessed based on structural validity using exploratory and confirmatory factor analyses. Construct validity was examined using divergent and discriminant validity analysis, and internal consistency was evaluated using Cronbach α and McDonald ω coefficients. RESULTS: A total of 110 older adults completed the questionnaire. Confirmatory factor analysis supported the conceptual unidimensionality of the USEQ (χ24=7.313, P=.12, comparative fit index=0.973, Tucker-Lewis index=0.931, goodness of fit index=0.977, root mean square error of approximation=0.087, standardized root mean square residual=0.038). The internal consistency showed acceptable reliability (Cronbach α=.677, McDonald ω=0.722). Overall, 90% of the participants reported excellent satisfaction with the Xiaomi Mi Band 2. CONCLUSIONS: The findings support the use of this translated USEQ as a valid and reliable tool for measuring user satisfaction with wearable activity trackers in older adults, with psychometric properties consistent with the original version.

Association between Self-Reported and Accelerometer-Based Estimates of Physical Activity in Portuguese Older Adults.

Accurate assessment of physical activity (PA) is crucial in interventions promoting it and in studies exploring its association with health status. Currently, there is a wide range of assessment tools available, including subjective and objective measures. This study compared accelerometer-based estimates of PA with self-report PA data in older adults. Additionally, the associations between PA and health outcomes and PA profiles were analyzed. Participants (n = 110) wore a Xiaomi Mi Band 2® for fifteen consecutive days. Self-reported PA was assessed using the International Physical Activity Questionnaire (IPAQ) and the Yale Physical Activity Survey (YPAS). The Spearman correlation coefficient was used to compare self-reported and accelerometer-measured PA and associations between PA and health. Bland-Altman plots were performed to assess the agreement between methods. Results highlight a large variation between self-reported and Xiaomi Mi Band 2® estimates, with poor general agreement. The highest difference was found for sedentary time. Low positive correlations were observed for IPAQ estimates (sedentary, vigorous, and total PA) and moderate for YPAS vigorous estimates. Finally, self-reported and objectively measured PA associated differently with health outcomes. Summarily, although accelerometry has the advantage of being an accurate method, self-report questionnaires could provide valuable information about the context of the activity.

A Systematic Review of Behavioral, Physiological, and Neurobiological Cognitive Regulation Alterations in Obsessive-Compulsive Disorder.

Obsessive-compulsive disorder (OCD) is characterized by cognitive regulation deficits. However, the current literature has focused on executive functioning and emotional response impairments in this disorder. Herein, we conducted a systematic review of studies assessing the behavioral, physiological, and neurobiological alterations in cognitive regulation in obsessive-compulsive patients using the PubMed database. Most of the studies included explored behavioral (distress, arousal, and frequency of intrusive thoughts) and neurobiological measures (brain activity and functional connectivity) using affective cognitive regulation paradigms. Our results pointed to the advantageous use of reappraisal and acceptance strategies in contrast to suppression to reduce distress and frequency of intrusive thoughts. Moreover, we observed alterations in frontoparietal network activity during cognitive regulation. Our conclusions are limited by the inclusion of underpowered studies with treated patients. Nonetheless, our findings support the OCD impairments in cognitive regulation of emotion and might help to improve current guidelines for cognitive therapy.

Validation of a Wireless Bluetooth Photoplethysmography Sensor Used on the Earlobe for Monitoring Heart Rate Variability Features during a Stress-Inducing Mental Task in Healthy Individuals.

Heart rate variability (HRV), using electrocardiography (ECG), has gained popularity as a biomarker of the stress response. Alternatives to HRV monitoring, like photoplethysmography (PPG), are being explored as cheaper and unobtrusive non-invasive technologies. We report a new wireless PPG sensor that was tested in detecting changes in HRV, elicited by a mentally stressful task, and to determine if its signal can be used as a surrogate of ECG for HRV analysis. Data were collected simultaneously from volunteers using a PPG and ECG sensor, during a resting and a mentally stressful task. HRV metrics were extracted from these signals and compared to determine the agreement between them and to determine if any changes occurred in the metrics due to the stressful task. For both tasks, a moderate/good agreement was found in the mean interbeat intervals, SDNN, LF, and SD2, and a poor agreement for the pNN50, RMSSD|SD1, and HF metrics. The majority of the tested HRV metrics obtained from the PPG signal showed a significant decrease caused by the mental task. The disagreement found between specific HRV features imposes caution when comparing metrics from different technologies. Nevertheless, the tested sensor was successful at detecting changes in the HRV caused by a mental stressor.

Amygdalar corticotropin-releasing factor mediates stress-induced anxiety.

The extended amygdala, including the Central nucleus of the Amygdala (CeA) and the Bed Nucleus of the Stria Terminalis (BNST), is a complex structure that plays a pivotal role in emotional behavior. The CeA and the BNST are highly interconnected, being the amygdala traditionally more associated with fear and the BNST with anxiety. Yet, studies using excitotoxic lesions also show the involvement of the CeA in the development of stress-induced anxiety. Likewise, others have also highlighted the role of corticotropin-releasing factor (CRF), a neuropeptide highly expressed in CeA, as an anxiogenic factor and, consequently, important for in anxiety disorders. Here, we used an inducible RNAi lentiviral system to assess the effects of reducing CRF expression in CeA in the development of anxiety-like behavior in a model of Chronic Unpredictable Stress. In addition, we evaluated CRF RNAi-mediated alterations in the stress-triggered molecular signature in the BNST. Knockdown of CRF in the CeA decreased stress-induced anxiety levels. No differences were found in a fear-potentiated startle paradigm. Additionally, we observed that stress-induced alterations in the expression of CRF receptors within the BNST are attenuated by CRF knockdown in the CeA. These results emphasize the importance of the role that amygdalar CRF plays in the modulation of anxiety-like behavior and in the molecular signature of stress in the BNST.

MORPhA Scale: Behavioral and electroencephalographic validation of a rodent anesthesia scale.

BACKGROUND: Laboratory practice commonly implies rodent anesthesia. Such is instrumental not only for animal welfare, but also for standardized assessment of new anesthetics. NEW METHOD: We developed and validated a grading system for a temporal follow-up of anesthesia. The Minho Objective Rodent Phenotypical Anesthesia (MORPhA) scale was tested in mice (C57BL/6 J) and rats (Wistar-Han) anesthetized with ketamine/dexmedetomidine (ket/dex). The scale comprises 12 behavioral readouts organized in 5 stages - (i) normal/(ii) hindered voluntary movement, elicited response to (iii) non-noxious/(iv) noxious stimuli and (v) absence of response - evaluated at regular time-points. Progression across stages was monitored by electroencephalography (EEG) in rats during anesthesia induction and reversal (atipamezole) and during induction with a second anesthetic drug (pentobarbital). RESULTS: Higher anesthetic doses decreased the time to reach higher levels of anesthesia during progression, while increasing the time to regain waking behavior during reversal in both mice and rats. A regular decrease in high frequencies (low and high gamma) power was observed as the MORPhA score increased during anesthesia induction, while the opposite pattern was observed during emergence from anesthesia through reversion of dex effect. COMPARISON WITH EXISTING METHODS: Degree of anesthesia in laboratory rodents is normally evaluated by testing loss of reflexes. While these are useful endpoint assessments, they are of limited application to study induction/reversal kinetics or factors affecting individual susceptibility. MORPhA allows graded standardized assessment of this progression in a biologically-relevant fashion. CONCLUSIONS: The devised anesthetic scale is of simple application and provides a semi-quantifiable readout of anesthesia induction/reversal.

The efficacy of biofeedback approaches for obsessive-compulsive and related disorders: A systematic review and meta-analysis.

Biofeedback is applied to target excessive and/or deficient physiological signals to help patients identifying and self-managing their symptoms. Biofeedback has been employed in psychiatric disorders, including obsessive-compulsive disorder (OCD), mainly by using neural signals - neurofeedback. Recently, OCD has been integrated into the obsessive-compulsive and related disorders (OCD&RD) category (body dysmorphic, hoarding, trichotillomania/hair-pulling, and excoriation/skin-picking disorders). The efficacy of biofeedback for OCD&RD is still unknown. Our work provides a complete overview of publications assessing the therapeutic efficacy of biofeedback in OCD&RD with a systematic review and meta-analysis. We found ten studies involving 102 OCD participants (three randomized controlled trials) mostly applying neurofeedback (one publication used thermal biofeedback). Five neurofeedback studies were selected for meta-analysis (89 patients; two randomized controlled trials). The overall effect size within the treatment group varied between medium to large, but high heterogeneity and inconsistency values were found. The methodological quality was low indicating a high risk of bias. In conclusion, a beneficial effect of neurofeedback for OCD patients was found but also critical limitations on methodology, high heterogeneity among studies, and a putative reporting bias. Future research following high-quality guidelines should be conducted to address the efficacy of biofeedback approaches for OCD&RD.

Trait determinants of impulsive behavior: a comprehensive analysis of 188 rats.

Impulsivity is a naturally occurring behavior that, when accentuated, can be found in a variety of neuropsychiatric disorders. The expression of trait impulsivity has been shown to change with a variety of factors, such as age and sex, but the existing literature does not reflect widespread consensus regarding the influence of modulating effects. We designed the present study to investigate, in a cohort of significant size (188 rats), the impact of four specific parameters, namely sex, age, strain and phase of estrous cycle, using the variable delay-to-signal (VDS) task. This cohort included (i) control animals from previous experiments; (ii) animals specifically raised for this study; and (iii) animals previously used for breeding purposes. Aging was associated with a general decrease in action impulsivity and an increase in delay tolerance. Females generally performed more impulsive actions than males but no differences were observed regarding delay intolerance. In terms of estrous cycle, no differences in impulsive behavior were observed and regarding strain, Wistar Han animals were, in general, more impulsive than Sprague-Dawley. In addition to further confirming, in a substantial study cohort, the decrease in impulsivity with age, we have demonstrated that both the strain and sex influences modulate different aspects of impulsive behavior manifestations.

Inflammatory response and long-term behavioral assessment after neonatal CO2-pneumothorax: study in a rodent model.

BACKGROUND: Carbon-dioxide (CO2)-pneumothorax during minimally invasive surgery induces well-known metabolic changes. However, little is known about its impact on the central nervous system. The aim of this work is to evaluate the acute impact of CO2-pneumothorax over central cytokine response and its long-term effect on animal behavior. METHODS: This is an experimental study where neonatal Sprague-Dawley rats are submitted to CO2-pneumothorax. Peripheral and central cytokine response was evaluated 24h after insufflation, and peripheral immune cell phenotyping was evaluated 24h and 4weeks post-insufflation. Progenitor cell survival was evaluated in the hippocampal dentate gyrus, and the behavioral analysis was performed in adulthood to test cognition, anxious-like, and depressive-like behavior. RESULTS: Significantly increased IL-10 levels were observed in the cerebrospinal-fluid (CSF) of animals submitted to CO2-pneumothorax, while no differences were found in serum. Regarding pro-inflammatory cytokines, no differences were observed in the periphery or centrally. CO2-pneumothorax event did not alter the survival of newborn cells in the hippocampal dentate gyrus, and no impact on long-term behavior was observed. CONCLUSIONS: Neonatal animals submitted to CO2-pneumothorax present acutely increased CSF IL-10 levels. The CO2-pneumothorax seems to result in no significant outcome over neurodevelopment as no functional behavioral alterations were observed in adulthood.

A Key Role for Neurotensin in Chronic-Stress-Induced Anxiety-Like Behavior in Rats.

Chronic stress is a major cause of anxiety disorders that can be reliably modeled preclinically, providing insight into alternative therapeutic targets for this mental health illness. Neuropeptides have been targeted in the past to no avail possibly due to our lack of understanding of their role in pathological models. In this study we use a rat model of chronic stress-induced anxiety-like behaviors and hypothesized that neuropeptidergic modulation of synaptic transmission would be altered in the bed nucleus of the stria terminalis (BNST), a brain region suspected to contribute to anxiety disorders. We use brain slice neurophysiology and behavioral pharmacology to compare the role of locally released endogenous neuropeptides on synaptic transmission in the oval (ov) BNST of non-stressed (NS) or chronic unpredictably stressed (CUS) rats. We found that in NS rats, post-synaptic depolarization induced the release of vesicular neurotensin (NT) and corticotropin-releasing factor (CRF) that co-acted to increase ovBNST inhibitory synaptic transmission in 59% of recorded neurons. CUS bolstered this potentiation (100% of recorded neurons) through an enhanced contribution of NT over CRF. In contrast, locally released opioid neuropeptides decreased ovBNST excitatory synaptic transmission in all recorded neurons, regardless of stress. Consistent with CUS-induced enhanced modulatory effects of NT, blockade of ovBNST NT receptors completely abolished stress-induced anxiety-like behaviors in the elevated plus maze paradigm. The role of NT has been largely unexplored in stress and our findings highlight its potential contribution to an important behavioral consequence of chronic stress, that is, exaggerated avoidance of open space in rats.

Segmental and regional quantification of 3D cellular density of human meniscus from osteoarthritic knee.

The knee menisci have important roles in the knee joint. Complete healing of the meniscus remains a challenge in the clinics. Cellularity is one of the most important biological parameters that must be taken into account in regenerative strategies. However, knowledge on the 3D cellularity of the human meniscus is lacking in the literature. The aim of this study was to quantify the 3D cellular density of human meniscus from the osteoarthritic knee in a segmental and regional manner with respect to laterality. Human lateral menisci were histologically processed and stained with Giemsa for histomorphometric analysis. The cells were counted in an in-depth fashion. 3D cellular density in the vascular region (27 199 cells/mm3 ) was significantly higher than in the avascular region (12 820 cells/mm3 ). The cells were observed to possess two distinct morphologies, roundish or flattened. The 3D density of cells with fibrochondrocyte morphology (14 705 cells/mm3 ) was significantly greater than the 3D density of the cells with fibroblast-like cell morphology (5539 cells/mm3 ). The best-fit equation for prediction of the 3D density of cells with fibrochondrocyte morphology was found to be: Density of cells with fibrochondrocyte morphology = 1.22 × density of cells withfibroblast-like cell morphology + 7750. The present study revealed the segmental and regional 3D cellular density of human lateral meniscus from osteoarthritic knee with respect to laterality. This crucial but so far missing information will empower cellular strategies aiming at meniscus tissue regeneration. Copyright © 2015 John Wiley & Sons, Ltd.

Fifteen Years of Experience from a Medical School' Clinical Skills Laboratory.

INTRODUCTION: Medical Education has evolved being defined as a continuum of the medical training from the pre- to the post-graduate period and through a lifetime of medical practice that is mirrored in the competencies framework that several international institutions have established. This creates a challenge to educational institutions (pre- and post-graduate) that traditionally take separate pathways. MATERIAL AND METHODS: The present report is a description of the efforts carried by the School of Medicine of the University of Minho to implement a strategy of teaching/learning methods that follows modern standards towards constructive alignment of the medical curriculum, from the pre- to the post-graduate. The faculty members responsible for these activities make a narrative self-report of the activities developed and where available quantitative data from participant surveys are presented. RESULTS: In order to achieve a constructive alignment of educational/assessment strategies several steps were taken that focused on the revision of the learning goals, teaching methodologies and assessment strategies. This implicated the investment in the training/certification of faculty, acquisition of simulation tools and a dedicated infrastructure. Alumni were a fundamental cornerstone as voluntary faculty contributing to pre-graduate training, but also training their own scholar skills. Overall, courses are rate with a high rate of satisfaction among course participants. DISCUSSION: Setting up the present teaching/learning environment of the School of Medicine of the University of Minho required a collective effort of the faculty, as well a progressive investment in both acquisition of equipment and training of staff. These human and material efforts, however, lead to an excellent return in learning outcomes. CONCLUSION: The main conclusion is that the constructive alignment of educational and assessment strategies towards the medical education continuum needs reflective thinking on the learners' needs. The secondary gain of these initiatives is to provide opportunities for junior doctors to practice teaching.

Introdução: O conceito de Educação Médica tem evoluído sendo definido como um continuum do treino médico desde o pré- ao pós-graduado, prolongando-se por uma vida de prática médica que é espelhada na estrutura de competências que várias instituições internacionais estabeleceram. Isto cria um desafio às instituições de ensino (pre- e pós-graduado) que tradicionalmente funcionam separadamente. Material e Métodos: O presente trabalho reporta os esforços executados pela Escola de Medicina da Universidade do Minho para implementar uma estratégia de métodos de ensino/aprendizagem que seguem os níveis de exigência modernos por forma a se atingir o alinhamento construtivo do currículo médico, desde o pré- ao pós-graduado. Os docentes responsáveis por estas atividades fazem uma narrativa auto reportada das atividades desenvolvidas e quando disponíveis dados quantitativos de inquéritos de avaliação. Resultados: Por forma a atingir o alinhamento construtivo de estratégias educacionais/avaliação vários passos foram dados, que se focaram na revisão dos objetivos de aprendizagem, metodologias de ensino e estratégias de avaliação. Isto implicou o investimento no treino/cerificação dos docentes, aquisição de simuladores e estabelecimento de uma infraestrutura dedicada. Os alumni foram um pilar fundamental trabalhando como docentes voluntários e contribuindo para o treino dos alunos do pré-graduado, e adicionalmente treinando as suas próprias capacidades de ensino. Em geral, os cursos são avaliados com um elevado grau de satisfação entre os participantes dos cursos. Discussão: Montar o atual ambiente de ensino/aprendizagem presente na Escola de Medicina da Universidade do Minho requereu um esforço coletivo dos docentes bem como o investimento progressivo em equipamento e treino da equipa. Estes esforços humanos e materiais, contudo, produziram excelente retorno em termos de resultados de aprendizagem. Conclusão: A principal conclusão é que o alinhamento construtivo das estratégias educativas e de avaliação por forma a atingir as necessidades do continuum da educação médica exige um pensamento reflexivo nas necessidades dos estudantes. Um ganho secundário é que estas iniciativas providenciam oportunidades para médicos juniores praticarem o ensino.