Introduction: Advances in modern medicine have enabled early detection of infective diagnosis through blood cultures and echocardiography, which have been standardized by the widely accepted Modified Duke Criteria and have enabled rapid administration of antibiotics. As a consequence, the well-discussed and often variable clinical findings have become less common and have relegated to minor criteria in diagnosis. Fever is the single most common presenting symptom, whereas more specific signs such as petechiae may be seen in only 20-40% of patients. Even more rare are the pathognomonic Janeway lesions, Roth spots, and Osler nodes. Here we present a case in which early diagnosis was established through minor criteria manifest upon physical exam, and we highlight the timely insight provided from physical exam. Case: A 29-year-old man was admitted to the hospital for altered mental status, fever, vomiting, diarrhea, and vertigo. His past medical history included IV drug abuse, thrombotic thrombocytopenia, Hepatitis C, and seizures. Upon admission, his encephalopathy progressed rapidly, and he was mechanically ventilated and started on hemodialysis. Blood cultures grew Methicillin sensitive Staphylococcus aureus and Elizabethkingia meningosepticum and susceptibilities were attained. Echocardiography showed 3.1 cm vegetation on the aortic valve. By the Modified Duke Criteria, the diagnosis of infective endocarditis was confirmed. Discussion: The increasing incidence of complex infective endocarditis—including polymicrobial infection as well as the increasing resistance to antibiotic therapy—poses challenges to the rapid assessment and treatment necessary to mitigate the multi-organ involvement and the devastating consequences of septic emboli. Developments in medical technology have expedited both the diagnosis and treatment of infective endocarditis, which has subsequently decreased the extent and frequency of classical signs. Nonetheless, this case illustrates the unavoidable vitality of the physical exam, because this patient’s quick and clear presentation enabled diagnosis solely through physical exam. Empiric antibiotic treatment was started promptly and subsequently adjusted based on culture and susceptibilities.

At the Quillen College of Medicine, first year medical students are taught how to perform the female pelvic exam as part of the “Introduction to Physical Exam” course. Our previous research has found that students feel more confident and report a higher level of perceived transferability to live patients when learning the pelvic exam on soft-embalmed donors in comparison to low-fidelity mannequins. Our goal in this project was to incorporate soft-embalmed donors into the curriculum of first year medical students, making this teaching method available to all students, and objectively assess their skills as well as their retention. During the “Introduction to Physical Exam” course, high fidelity soft embalmed donors were available for students to practice the female pelvic exam with instruction from attending physicians. After learning exam techniques, all 67 students were given a survey to assess their confidence, perceived transferability, and preference for either soft embalmed donors or mannequins. They were also invited back the following week to assess their short term retention and ability to accurately perform the pelvic exam, with the option of using communication skills learned elsewhere in the ETSU curriculum. Thirteen students returned for this follow-up session and completed surveys to reassess their experience. We plan to follow this cohort of students throughout their medical school career to assess long term retention. All return participants felt they retained the pelvic exam knowledge learned the week prior, with 61.54% agreeing, and 38.46% strongly agreeing. Most felt prepared to now do a pelvic exam on a live patient (53.85% agreed, 38.46% strongly agreed). Students also reported that feedback on their communication and procedural skills was beneficial to the learning process. The use of high fidelity soft embalmed donors in medical education provides students with a realistic model to learn and become confident in performing pelvic exams. We have seen that this education model helps them retain their knowledge on pelvic exam technique. We look forward to following this cohort of students to see if this retention of knowledge persists into their third year of medical school.

Since the release of A Nation at Risk in 1983 student performance on a variety of high stakes tests have become increasingly important in educational settings. The results of this type of assessment are quantifiable, and are intended to indicate certain levels of academic performance and achievement. Advanced Placement (AP) Exams are one example of high stakes tests. With the rapid growth of Advanced Placement (AP) courses and the corresponding popularity of the AP Exams there is a need in the research to identify specific variables that may be influential to AP Exam score performance. Course schedule type, either in the 4⨉4 block or traditional yearlong format, has been examined as a variable that influences student AP Exam score performance. In some studies the implementation of a 4⨉4 block in place of a traditional yearlong course schedule type resulted in increased AP Exam score performance, while in other studies replacement of a traditional yearlong course schedule by a 4⨉4 block course schedule type resulted in decreased AP Exam score performance. The limitations in the existing research present a need for more controlled studies using multiple years of data to further examine the relationship between clearly identified course schedule types and AP Exam score performance. In response to the need, this research performed a controlled study and examined the relationship between three specific course schedule types and AP Exam performance over time. This study analyzed sample data using participants (N=428) from a single institution in a southeastern state in the United States enrolled in the same AP course subject, taught by the same instructor, and who completed the same subject AP Exam over multiple years (2008-2012). / Ph. D.

This dissertation presents multiple facets of the assessment system reform of the School Leaving Certificate (SLC) exam in Nepal through grounded theory methodology. The main purpose of this study is to develop a substantive grounded theory of the reform that explicates a complete process of the assessment reform, i.e., how this reform was conceptualized, what was done as a foundational preparation, how it was implemented, and what were the preliminary responses to the reform implementation. In order to theorize the reform process, this study applied a constructivist grounded theory approach, specifically based on the work of Charmaz (1996, 2005, 2006, 2012), as the research methodology. The data were collected by conducting 10 focus group discussions and 24 one-on-one semi-structured interviews. The participants represented almost all the categories of stakeholders (e.g., policymakers, employers, teachers, students) as well as experts and educators. The emergent conceptual categories and sub-categories from the interviews and focus group discussions were categorized under three constructs: (1) Conceptualization of the reform, (2) implementation of the reform and (3) reform effects. The first construct covers those theme categories and sub-categories that state the origin and type of the reform, reform aims, and framework as well as preparation for the reform. Similarly, the second construct includes those theme categories and sub-categories that inform the mechanism underpinning reform related information dissemination, the strategic plan used to implement the reform and factors that could influence the reform process. Finally, the third construct comprises those categories that discuss reform associated quandaries and condemnation, factors contributing to magnifying the quandaries, resultant opportunities from the reform, reform impact, step forward, and other relevant categories. The findings have been explicated under three phases- the pre-implementation phase, the implementation phase and the post-implementation phase as the integrated grounded theory. The theoretical components presented under the pre-implementation phase include exhaustive analysis of need and feasibility; input from experts, educators and key stakeholders; clarity on reform aims and objectives; cooperative triangular relationships; comprehensive documentation; explicit roadmap and exhaustive planning; infrastructure and resource management, and capacity building. Similarly, three major theoretical components- teacher advocacy, stakeholder ownership, and timely and authentic information have been described under the implementation phase. Finally, eight major theoretical components, such as identification and analysis of resulting issues, immediate actions for the urgent/sensitive issues, special programs for the low-grade holders, bridge between academic and vocational programs, need for impact analysis, effective communication channel, need for institutional memory, need for an unconventional assessment system, and need for a resourceful unit of assessment and testing have been presented under the post-implementation phase. The combination of the theoretical components described under the three phases mentioned above is the integrated substantive grounded theory of the assessment system reform in Nepal. This study contributes by adding value for those involved in assessment reform as well as the academicians and researchers because it puts forward recommendations for foundational preparation and homework in the conceptual phase of assessment reform; action steps to minimize the possible resistance to reform; strategies to implement the reform successfully; and initiatives to institutionalize the reform or address the resulting issues and concerns.

Submitted by Marcel Innocenti Cassettari (marcelcassettari@gmail.com) on 2018-07-24T12:29:06Z No. of bitstreams: 1 Marcel Innocenti Cassettari - Tese de Doutorado - 2018.pdf: 18218849 bytes, checksum: a6e338dd17043231d758ef571382a54f (MD5) / Approved for entry into archive by Aline Aparecida Matias null (alinematias@fclar.unesp.br) on 2018-07-24T13:47:41Z (GMT) No. of bitstreams: 1 cassettari_mi_dr_arafcl.pdf: 18218849 bytes, checksum: a6e338dd17043231d758ef571382a54f (MD5) / Made available in DSpace on 2018-07-24T13:47:41Z (GMT). No. of bitstreams: 1 cassettari_mi_dr_arafcl.pdf: 18218849 bytes, checksum: a6e338dd17043231d758ef571382a54f (MD5) Previous issue date: 2018-05-25 / O trabalho tem como objetivo aferição se a “Redação Argumentativa Escolar” cobrada nos vestibulares da UNESP, UNIFESP e USP e no ENEM é do mesmo gênero do discurso. A hipótese inicial é de que as “Redações Argumentativas Escolares” cobradas na UNESP, UNIFESP e USP e no ENEM são do mesmo gênero do discurso, variando, todavia, de estilo no ENEM. Por essa razão, há a adoção da seguinte designação: “Redação Argumentativa Escolar” para as redações cobradas na UNESP, UNIFESP e USP, ao passo que, no “ENEM”, hipoteticamente, compõe outro estilo, “Redação Argumentativa Escolar Finalista”, por haver distinções em sua estrutura composicional que a torna específica. Para tanto, são utilizados conceitos extraídos da obra do Círculo de Bakhtin, em especial o de gênero do discurso, dialogismo e autoria. Não obstante, por tratar-se de uma proposta de vestibular e de textos efetivamente produzidos em um contexto de avaliação, alguns conceitos vinculados à esfera da atividade humana “Escolar” também serão de grande relevância. Além disso, partindo do pensamento de Bakhtin, considera-se que as redações têm autoria, razão pela qual se busca destacar traços autorais utilizados pelos vestibulandos. / The purpose of this study is to verify if the "Argumentative School Writing" collected in UNESP, UNIFESP, USP and ENEM vestibules is of the same genre of discourse. The initial hypothesis is that the "School Argumentative Writing" collected at UNESP, UNIFESP and USP and in the ENEM are of the same genre of discourse, varying in style in the ENEM. For this reason, the following designation has been adopted: "Argumentative School Writing" for the essays collected at UNESP, UNIFESP and USP, while in the "ENEM", hypothetically, it composes another style, "Argumentative School Finalist Writing", for there are distinctions in its compositional structure that make it specific. In order to do so, concepts drawn from the work of the Bakhtin Circle are used, especially the genre of discourse, dialogism and authorship. However, because it is a proposal for a university entrance examination and texts actually produced in an evaluation context, some concepts related to the sphere of human “school” activity will also be of great relevance. In addition, starting from the thought of Bakhtin, it is considered that the essays have authorship, reason for which it is sought to emphasize traces copyright used by the students

Industrial design is meant to improve the design of mass produced objects and by doing so to contribute to improve the users' quality of life. The designer's challenge is to balance functionality, aesthetic appeal and ease of use to create a successful market product. This industrial design thesis presents a pediatric examination table. Within the context of the new trends for healthcare design, it looks forward to contributing to the pediatric healthcare quality with an innovative product. Thus its design criteria must respond in both physical and emotional terms, to the users' needs and especially to their dreams. The pediatric examination table must be functional, aesthetically appealing, mechanically simple, and economic. And it can't just happen to be for children it must be designed with children in mind. / Master of Science

The subject of this thesis are the models of the school-leaving exams changing over time due to the educational policy of the state and sometimes tumultuous political developments. The theoretical part contains historical analysis of the graduation exam and its models, creating the basis for the empirical part. Based on the study of legislation and rules governing conditions and holding the graduation exams and further study of the relevant literature, on a precise description of the current model and indicating the current efforts to modify the existing model of the graduation exam the vivid picture of this phenomenon in the whole range of educational issues is created. The attention is also paid to the issue of holding the graduation exam. The leaving examination since its inception in our country in 1849 has been defined by the law, its implementation has been modified the closer decrees. It has always been a significant "politicians", not only purely "educational theme." Changes in model of the school-leaving examination always reflect the changes in the system of our educational policy. The aim of the work in the empirical part is to analyze the current evolution, current status, to identify neuralgic points of the graduation exams and to suggest possible trends of the graduation exam in the...

Technological innovation in mobile devices has upgraded the potential uses of the devices for living and learning. Mobile learning provides opportunities for mobile users to learn at any time in any location. A certification that confirms computing and Internet technology skills and knowledge provides more opportunities to students in higher education for their future careers. Students can attend a training course to better prepare for a certification exam. However, most students spend their time preparing for and reviewing their regular courses and have less time for the training course. The problems of time limitation and space restriction cause students' insufficient learning toward the preparation for the certification exams. Mobile learning may augment the face-to-face training course to solve these problems. The purpose of this study was to investigate undergraduate students' perceptions and the effectiveness of instruction using mobile devices to prepare for a standard certification exam in a blended certification-training course. Participants were randomly assigned to two groups: the experimental group received the treatment and the control group was treated as usual in a face-to-face class. Using a mixed-method research design, a pretest and a posttest collected data from all the participants and a survey and interviews gathered information from the students of the experimental group. The results showed a significant difference between the experimental and control groups in the posttest scores. In the pretest, the experimental and control groups did not differ significantly, which means that they were at the same level before the intervention. Then in the posttest, the experimental and control groups were significantly different, meaning that the treatment was instrumental in the difference. Further, the results revealed that learning via mobile devices provided the students more learning opportunities and improved interaction with other students; though using short message service for learning had positive effectiveness, multimedia messaging service may supplement it to demonstrate manipulation. Suggestions of experts familiar with the field and review of literature can assist development of using short message service messages for preparation of various certification examinations. Using mobile learning in an institute with integrated planning may decrease cost by sharing of resources.

Esta pesquisa tem por objetivo investigar a realização do mecanismo das relações intergenéricas no emprego de marcas proverbiais diferentes formas de apresentação do provérbio na qualidade de gênero do discurso em redações de vestibular, a partir de estudo comparativo do funcionamento discursivo dessas marcas em dois conjuntos de textos, a saber: sessenta redações do vestibular da FUVEST/2006 (tema Trabalho) e sessenta redações do vestibular da FUVEST/2009 (tema Fronteiras), perfazendo o total de 120 textos. Nessas redações, foram reconhecidos os seguintes tipos de registro do provérbio a título de gênero do discurso, por mim denominados marcas proverbiais: (a) construção em que o provérbio aparece integralmente com o uso de aspas e/ou glosa; (b) construção em que o provérbio aparece de forma integral sem o uso de aspas nem de glosa; (c) enunciado organizado a partir da modificação da estrutura de um provérbio; (d) enunciado que alude ao sentido de um provérbio; e (e) construção que reproduz a estrutura de um enunciado proverbial. Sob um olhar enunciativo-discursivo, este trabalho se fundamenta, primordialmente, nos estudos do Círculo de Bakhtin, relacionados à perspectiva dialógica da linguagem e à teoria dos gêneros do discurso; em Maingueneau (1997, 2008b, 2010) em relação às suas considerações sobre as estratégias de captação e de subversão e sobre os aspectos da enunciação proverbial e; em Lysardo-Dias (2004), que compreende o provérbio como um gênero do discurso que se caracteriza pela inserção obrigatória em outro gênero. Os resultados desta pesquisa revelam que o funcionamento discursivo das marcas proverbiais resulta das relações intergenéricas. Esse mecanismo se constata não só pela inserção das marcas proverbiais na redação de vestibular, em que desempenham diversas funções argumentativas, mas também pelo fato de essas marcas apresentarem vestígios de outros gêneros nos quais o provérbio já se instalou. Num caso e no outro, esses vestígios são reconhecíveis tanto no conteúdo temático, quanto na construção composicional e no estilo do gênero. Contrariando a recomendação escolar de evitar o uso de expressões cristalizadas em redações de vestibular, os resultados se apresentam como contribuições para o ensino à medida que: (a) abrem a possibilidade de uma leitura de textos que permite compreendê-los como registros da dinamicidade dos gêneros do discurso; e (b) relativizam aquela recomendação escolar, tendo em vista que a qualidade do texto nem sempre está ligada à ausência de formas cristalizadas. / This research to investigate the mechanism of intergeneric connections, in employment of proverbial brand - different ways of presenting the proverb as a discourse genre - in college entrance essays, from a comparative study of the discursive functioning of these brands into two sets of texts, namely: sixty essays of vestibular FUVEST/2006 (theme Labor) and sixty essays of vestibular FUVEST/2009 (theme Borders), totaling 120 texts. In these essays, were recognized following record types proverb as a discourse genre, for me called proverbial brands: (a) building where the proverb appears entirely with the use of quotation marks and/or gloss, (b) construction in which the proverb appears in full without using quotation marks nor gloss; (c) organized statement from the modification of the structure of a proverb; (d) utterance that alludes to the meaning of a proverb, and (e) construction that reproduces the structure of a proverbial utterance. Under a look enunciative-discursive, this work is based primarily on studies of the Bakhtin Circle, related to the dialogical perspective of language and the theory of speech genres, in Maingueneau (1997, 2008b, 2010) regarding his considerations on strategies for capture and subversion and on aspects of proverbial utterance and, in Lysardo-Dias (2004), who understands the proverb as a genre of discourse that is characterized by mandatory insertion into another genre. The results of this research reveal that the discursive functioning of proverbial brands results from the intergeneric connections. This mechanism turns out not only by the insertion of proverbial brands in writing entrance exam, where they play several argumentative functions, but also because these brands show traces of other genres in which the proverb has already been installed. In one case and in the other, these traces are recognizable both in thematic content, as in the compositional construction and the style of the genre. Contrary to the recommendation of school to avoid using expressions crystallized in college entrance essays, the results are presented as contributions to teaching as: (a) open the possibility of a reading of texts that allows to understand them as records of dynamicity of discourse genres; and (b) relativize that academic recommendation given that the text quality is not always linked to the absence of crystallized forms.

Course grades, which often include non-achievement factors such as effort and behavior and are subject to individual teacher grading philosophies, suffer from issues of unreliability. Yet, course grades continue to be utilized as a primary tool for reporting academic achievement to students and parents and are used by most colleges and universities as an admissions measure. High-stakes assessment results are also used by schools to convey student achievement, and several states now require students to pass an exam to receive a diploma. What is less clear, however, is the relation between these two measures, GPA and high-stakes assessment results. One purpose of this study was to examine the predictive relation of mathematics GPA to student performance on high-stakes assessments. Multiple regression models were used to analyze the predictive relation between mathematics GPA and performance on the ACT and the Oregon Assessment of Knowledge and Skills (OAKS), two high-stakes assessments. In addition, the regression analyses were used to examine the influence of other student-level variables such as talented and gifted status and math courses taken prior to testing on the relation between mathematics GPA and performance on the two high-stakes assessments. In all, 299 high school students from a single grade-level enrolled in one Oregon suburban school district participated in the study. Results indicate that GPA is a significant variable in a high-stakes assessment outcome. Additionally, results of the multiple regression reveal significant student-level effects on assessment outcomes that reduce explained common variance in both the ACT and OAKS models. Implications for practice and suggestions for future research are discussed.