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Q: How to structure React Native navigation for property passing with Typescript I have a simple React Native app I'm putting together using Typescript and I'm trying to understand how to make the navigation work correctly.
I a list of content sections and when one is selected to open the chosen article in a webview. What I can't grasp is how I am supposed to pass the URL for the webview to load to the view that contains it. Both the navigation list and the web view should fill the screen when they are selected.
As things stand my base component is GuidanceNavigation which contains a Stack.Navigator with a Stack.Screen for the NavigationItems view that lists all the topics and a Stack.Screen for the InstructionView that contains the webview to show the instructions.
As things stand these are all React.Component types and the part I am not clear on is that when I am in the NavigationItems view I select an option and I need the parent view to replace the NavigationItems view with InstructionView, providing the InstructionView with the title and file location for the selected article. As far as I can tell React Navigation does some magic involving passing in some navigation properties, but I can't figure out how that is supposed to work in a Typescript context or how I can pass my typed objects through the Stack Navigator or even whether the Stack Navigator is the correct component to use in this situation. The Typescript-specific documentation talks about passing through navigation properties but doesn't explain how this is related to the navigator object that seems to be available in JavaScript to actually perform navigation.
My code looks like this, it's a while since I have worked with React and my first time using react-native so it's probably neither excellent nor idiomatic:
GuidanceNavigation.tsx:
const Stack = createStackNavigator();

export class GuidanceNavigation extends React.Component<{}, {}>  {

  render(): JSX.Element {
    return (
      <SafeAreaView style={styles.container} >
        <NavigationContainer>
          <Stack.Navigator>
            <Stack.Screen name="Choose a topic" component="NavigationItems" />
            <Stack.Screen name="Instructions" component="InstructionView" />
      </Stack.Navigator>
      </NavigationContainer>
      </SafeAreaView>
    );
  };

}

NavigationTypes.ts:
export interface IFileLink {
    title: string,
    file: string
}

NavigationItems.tsx:
import { IFileLink } from './NavigationTypes';

export class NavigationItems extends React.Component<{}, {}>  {

  itemId: number = 0;

  readonly items = [
    {
      section: R.strings.menu_steps,
      values: [
    { title: R.strings.menu_getting_started, file: "./assets/html/getting-started.html" },
     // and so on

      ]
    },
    {
      section: R.strings.menu_guidance,
      values: [
    { title: R.strings.menu_glossary, file: "./assets/html/glossary.html" },
        // etc
      ]
    }
  ];

  itemList(itemList: Array<IFileLink>): JSX.Element[] {
    return itemList.map((it) => this.item(it));
  };

  navigateToFile(link:IFileLink) {
    console.log("Navigation to "+link.title);
    // This does not work because navigation comes from ??? somewhere???
    navigation.navigate('Instructions', link);
  };

  item(fileLink:IFileLink): JSX.Element {
    return(
      <Button
    key= { this.itemId++ }
    title= { fileLink.title }
    onPress= {() =>
      this.navigateToFile(fileLink)
    }
      />
    );
  };

  render(): JSX.Element {
    return (
      <ScrollView>
          <Text style={styles.sectionTitle}>{this.items[0].section}</Text>
          {this.itemList(this.items[0].values)}
          <Text style={styles.sectionTitle}>{this.items[1].section}</Text>
          {this.itemList(this.items[1].values)}
      </ScrollView>
    )
  };

}

InstructionView.tsx:
import { IFileLink } from './NavigationTypes';

export class InstructionView extends React.Component<IFileLink> {

  private fileLink: IFileLink;

  constructor(fl: IFileLink) {
    super(fl);
    this.fileLink = fl;
  }

  render(): JSX.Element {
    return (
        <WebView
          source={{ uri: this.fileLink.file }}
          />
    );
  }
}

How can I ensure that I navigate from NavigationItems to  InstructionView with the required properties when an item is selected in that list?

A:
This does not work because navigation comes from ??? somewhere???

The navigation object comes from the props of the component.  When your component is loaded through Stack.Screen, react-navigation calls the component with props route and navigation.
On the typescript side of things, you need to declare that the NavigationItems component must be called with this navigation prop.  How you do that is what you are seeing explained in the docs.
You declare a RootStackParamList type that maps your screen names to their required props.
type RootStackParamList = {
    ['Choose a topic']: undefined; // no required props
    Instructions: IFileLink; // requires an IFileLink as props
};

You use this type as the generic when you create the Stack instance.
const Stack = createStackNavigator<RootStackParamList>();

You use this type again as the generic when you declare the type of the navigation prop for the NavigationItems component. Now your component know knows that it will have a prop navigate, so you can call this.props.navigate.  It also knows very detailed information about where you can navigate to.  The screen name must be either 'Choose a topic' or 'Instructions' or else you'll get an error.  It also knows about all of the screens' unique prop requirements, so you now get an error if you try to navigate to Instructions without passing an IFileLink as the second argument.
import { StackNavigationProp, createStackNavigator } from '@react-navigation/stack';

type ItemsProps = {
    navigation: StackNavigationProp<RootStackParamList, 'Choose a topic'>;
};

export class NavigationItems extends React.Component<ItemsProps, {}>  {

    navigateToFile(link: IFileLink) {
        console.log("Navigation to " + link.title);
        // can now navigate via props
        this.props.navigation.navigate('Instructions', link);
    };

    /*...*/
}

There is an error inside your Navigator. You need to pass the components themselves, not their string names.
<Stack.Screen name="Choose a topic" component={NavigationItems} />
<Stack.Screen name="Instructions" component={InstructionView} />

Typescript Playground Link


text:
Delphine is the author of an autobiographical novel that has become a bestseller. Exhausted by the promotional tour, just when she feels out of place, paralyzed by the idea of having to start writing again, she meets Elle, a young, attractive, intelligent, intuitive woman who seems to understand her better than anyone.
Genre: Drama, Mystery, Thriller
Director: Roman Polański
Actors: Brigitte Roüan, Camille Chamoux, Dominique Pinon, Édith Le Merdy, Emmanuelle Seigner, Eva Green, Josée Dayan, Leonello Brandolini, Noémie Lvovsky, Vincent Pérez
Country: Belgium, France, Poland
Keywords:123movies 123movies4u D'après une histoire vraie Online fmovies Free gomovies gostream losmovie movie4k movietv primewire putlockers putlockertv seehd seehd.info shockshare solarmovie Watch D'après une histoire vraie watch32 yesmovie
Faith of My Fathers
Faith of My Fathers is based on the story of Lieutenant Commander John McCain's experiences as a prisoner of war in North Vietnam for five and a half years during…
Genre: Drama, War
A young Aboriginal boy is torn between his unexpected love of acting and the disintegration of his family.
During China's Tang dynasty the emperor has taken the princess of a neighboring province as wife. She has borne him two sons and raised his eldest. Now his control over…
A young man builds a hot rod despite the disapproval of his father, a Juvenile Court judge. Circumstantial evidence points to the innocent teenager when his car is involved in…
Suicide Room
Dominik is an ordinary boy. He's got loads of friends, the hottest girl in school, rich parents and money to spend on brand-name clothes. But one innocent kiss with a…
Genre: Animation, Drama, Thriller
You Are the Apple of My Eye
Adolescence is like a heavy rain. Even though you catch a cold from it, you still look forward to experiencing it once again. Ko-Teng has several close friends who had…
Country: Taiwan
In Bangkok, the young Kham was raised by his father in the jungle with elephants as members of their family. When his old elephant and the baby Kern are stolen…
Country: Thailand, USA, Hong Kong, France
An awkward young teen working at a spa becomes overly attached to her fellow worker, a lonely outcast. They hang out at a bar owned by a strange pregnant artist…
In a world with no guns, a mysterious drifter, a bartender and a young samurai plot revenge against a ruthless leader and his army of thugs, headed by nine diverse…
Based on true events about the foot soldiers of the early feminist movement who were forced underground to evade the State.
Country: France, UK
Genre: Drama, History
The Lover in the Attic
This is the lurid, true story about femme fatale Dolly, her murdered husband, and her lover, Otto — the man in the attic. In the 1930s, Dolly met and seduced…
Genre: Drama, History, TV Movie
Ashes and Embers
Ashes and Embers is an original screenplay by Haile Gerima, about a Vietnam veteran, who, several years after the war, is struggling to come to terms with his role in…
Trailer: Based on a True Story

redpajama_set_name: RedPajamaCommonCrawl


text:
Ranking Ohio's school districts from 1 to 607 based on the stars they received on new state report cards
Chagrin Falls High School, which is part of the Chagrin Falls district that received five stars in all major categories in the 2022 state report card. (Ed Wittenberg, special to cleveland.com)
Zachary Smith, cleveland.com
CLEVELAND, Ohio - While the new Ohio school report card gives a star rating to various categories, there is no overall star grade assigned for this year. So cleveland.com calculated the total score for all 607 districts reported to show which schools scored the best across the board.
Twelve districts spread across eight counties received a perfect score of five stars in each of five key categories - or 25 stars overall. This included four schools from the Greater Cleveland area - Aurora, Chagrin Falls, Highland, and Solon.
Hamilton County had the most districts with 25 total stars - with three districts reaching that milestone. But in averaging star ratings by county, Delaware comes out on top with an average of 21.5 stars per district. This is followed by Geauga (20.8), Medina (20.7), and Shelby and Warren counties (20.5 each).
Cuyahoga County averaged 18.5 stars, ranking 21st overall.
The report cards were released on Thursday by the Ohio Department of Education and used a new star-based rating system that replaced the former A through F grades. While an overall star rating for each school and district isn't officially available, in future years, there will be an overall star rating.
Here are the rankings from top to bottom, based on the total stars received.
District details
Legend: (A) Achievement, (EL) Early Literacy, (G) Graduation, (P) Progress, and (GC) Gap Closing. Additional details about each of these categories are shown below the chart.
Some mobile users may need to visit this link to see the chart of school report cards.
The Ohio Department of Education created a 17-page guide to understanding the report cards, which shows how stars will be used for other measurement areas.
The state uses data reported by districts and schools to analyze performance in several categories.
- Achievement: This component represents whether student performance on state tests met previously established thresholds. It also considers how well students performed on tests overall.
- Early Literacy: This area measures reading improvement and overall proficiency scores for kindergarten through third-grade students.
- Graduation: This measurement looks at the four-year adjusted cohort graduation rate and the five-year adjusted cohort graduation rate. The four-year rate includes only those students who earn diplomas within four years of entering ninth grade for the first time. The five-year rate consists of those students who graduate within five years of entering ninth grade for the first time.
- Progress: This measurement looks at students' growth based on their past performances. While not all students begin at the same place with their learning, the state expects every student to learn and grow throughout the school year. Progress looks at the growth of students and schools compared to past state test performances.
- Gap Closing: This component measures the reduction in educational gaps for student subgroups based on income, race, ethnicity, or disability.
- College, Career, Workforce, and Military Readiness (not graded this year): This component looks at how well prepared Ohio's students are for future opportunities, whether training in a technical field or preparing for work or college. This is a relatively new measurement, and the complete data won't be reported entirely until the 2024-2025 school year.


Every qigong form or practice has its special training purpose and theory. If you do not know the purpose and theory, you have lost the root (meaning) of the practice. Therefore, as a qigong practitioner, you must continue to ponder and practice until you understand the root of every set or form.
Remember that getting the gold is not enough. Like the boy in the old Chinese story, you should concern yourself with learning the trick of turning the rock into gold. You can see that getting the gold is simply gaining the flowers and branches, and there can be no growth. However, if you have the trick, which is the theory, then you will have the root and you may continue to grow by yourself.
In Chinese qigong society, it is commonly known that in order to reach the goal of qigong practice, you must learn how to regulate the body (tiao shen, 調身), regulate the breathing (tiao xi, 調息), regulate the emotional mind (tiao xin, 調心), regulate the qi (tiao qi, 調氣), and regulate the spirit (tiao shen, 調神). Tiao in Chinese is constructed from two words, "言" (yan, means speaking or talking) and "周" (zhou, means round or complete). That means the roundness (i.e., harmony) or the completeness is accomplished by negotiation. Like an out of tune in piano, you must adjust it and make it harmonize with others. This implies that when you are regulating one of the above five processes, you must also coordinate and harmonize the other four regulating elements.
Regulating the body includes understanding how to find and build the root of the body, as well as the root of the individual forms you are practicing. To build a firm root, you must know how to keep your center, how to balance your body, and most important of all, how to relax so that the qi can flow.
To regulate your breathing, you must learn how to breathe so that your respiration and your mind mutually correspond and cooperate. When you breathe this way, your mind can attain peace more quickly, and therefore concentrate more easily on leading the qi.
Regulating the mind involves learning how to keep your mind calm, peaceful, and centered so that you can judge situations objectively and lead qi to the desired places. The mind is the main key to success in qigong practice.
Regulating the qi is one of the ultimate goals of qigong practice. In order to regulate your qi effectively you must first have regulated your body, breathing, and mind. Only then will your mind be clear enough to sense how the qi is distributed in your body and understand how to adjust it.
For Buddhist and Daoist priests who seek enlightenment or Buddhahood, regulating the spirit (shen) is the final goal of qigong. This enables them to maintain a neutral, objective perspective of life, and this perspective is the eternal life of the Buddha. The average qigong practitioner has lower goals. He raises his spirit in order to increase his concentration and enhance his vitality. This makes it possible for him to lead qi effectively throughout his entire body so that it carries out the managing and guarding duties. This maintains health and slows the aging process.
If you understand these few things you can quickly enter into the field of qigong. Without all of these important elements, your training will be ineffective and your time will be wasted.
Before you start training, you must first understand that all of the training originates in your mind. You must have a clear idea of what you are doing, and your mind must be calm, centered, and balanced. This also implies that your feeling, sensing, and judgment must be objective and accurate. This requires emotional balance and a clear mind. This takes a lot of hard work, but once you have reached this level you will have built the root of your physical training, and your yi (mind) can lead your qi throughout your physical body.
When you learn any qigong, either moving or still, the first step is to learn the correct postures or movements. After you have learned the postures and movements, learn how to improve them until you can perform the forms accurately. Then you start to regulate your body until it has reached the stage that could provide the best condition for the qi to build up or to circulate.
In still qigong practice or soft qigong movement, this means to adjust your body until it is in the most comfortable and relaxed state. This implies that your body must be centered and balanced. If it is not, you will be tense and uneasy, and this will affect the judgment of your yi and the circulation of your qi. In Chinese medical society it is said: "[When] shape [body's posture] is not correct, then the qi will not be smooth. [When] the qi is not smooth, the yi [wisdom mind] will not be peaceful. [When] the yi is not peaceful, then the qi is disordered." You should understand that the relaxation of your body originates with your yi. Therefore, before you can relax your body, you must first relax or regulate your mind (yi). This is called "shen xin ping heng," (身心平衡) which means "body and heart [i.e., mind] balanced." The body and the mind are mutually related. A relaxed and balanced body helps your yi to relax and concentrate. When your yi is at peace and can judge things accurately, your body will be relaxed, balanced, centered, and rooted. Only when you are rooted can you raise up your spirit of vitality.
Relaxation is one of the major keys to success in qigong. You should remember that only when you are relaxed will all your qi channels be open. In order to be relaxed, your yi must first be relaxed and calm. When the yi coordinates with your breathing, your body can relax.
In qigong practice there are three levels of relaxation. The first level is the external physical relaxation, or postural relaxation. This is a very superficial level, and almost anyone can reach it. It consists of adopting a comfortable stance and avoiding unnecessary strain in how you stand and move. The second level is the relaxation of the muscles and tendons. To do this your yi must be directed deep into the muscles and tendons. This relaxation will help open your qi channels, and will allow the qi to sink and accumulate in the dan tian.
The final stage is the relaxation that reaches the internal organs and the bone marrow. Remember, only if you can relax deep into your body will your mind be able to lead the qi there. Only at this stage will the qi be able to reach everywhere. Then you will feel –transparent—as if your whole body had disappeared. If you can reach this level of relaxation, you can communicate with your organs and use qigong to adjust or regulate the qi disorders that are giving you problems. You will also be able to protect your organs more effectively, and therefore slow down their degeneration.
In all qigong practice it is very important to be rooted. Being rooted means to be stable and in firm contact with the ground. If you want to push a car you have to be rooted; the force you exert into the car needs to be balanced by the force into the ground. If you are not rooted, when you push the car you will only push yourself away and not move the car. Your root is made up of your body's sinking, centering, and balance.
Before you can develop your root, you must first relax and let your body "settle." As you relax, the tension in the various parts of your body will dissolve, and you will find a comfortable way to stand. You will stop fighting the ground to keep your body up and will learn to rely on your body's structure to support itself. This lets the muscles relax even more. Since your body isn't struggling to stand up, your yi won't be pushing upward, and your body, mind, and qi will all be able to sink. If you let dirty water sit quietly, the impurities will gradually settle to the bottom, leaving the water above it clear. In the same way, if you relax your body enough to let it settle, your qi will sink to your dan tian and the bubbling wells (yongquan, K-1, 湧泉) in your feet and your mind will become clear. Then you can begin to develop your root.
To root your body you must imitate a tree and grow an invisible root under your feet. This will give you a firm root to keep you stable in your training. Your root must be wide as well as deep. Naturally, your yi must grow first because it is the yi that leads the qi. Your yi must be able to lead the qi to your feet and be able to communicate with the ground. Only when your yi can communicate with the ground will your qi be able to grow beyond your feet and enter the ground to build the root. The bubbling well cavity is the gate that enables your qi to communicate with the ground.
After you have gained your root, you must learn how to keep your center. A stable center will make your qi develop evenly and uniformly. If you lose this center, your qi will not be led evenly. In order to keep your body centered, you must first center your yi and then match your body to it. Only under these conditions will the qigong forms you practice have their root. Your mental and physical centers are the keys that enable you to lead your qi beyond your body.
Balance is the product of rooting and centering. Balance includes balancing the qi and the physical body. It does not matter which aspect of balance you are dealing with; first, you must balance your yi, and only then can you balance your qi and your physical body.
Qigong has always been an important part of Chinese martial arts training. Without qigong training, a martial artist will have lost the origin of martial power, and what he or she uses will be only muscular power. This will make Chinese martial arts no different from the Western fighting arts. The most unique elements of Chinese martial arts are in qigong training and the buildup of internal energy (i.e., qi). From this, you will begin to understand the way of your life more deeply.


Guesthouse Hiroshima Mange Tak, a place where tourists and locals alike can meet up, talk and engage in friendship without hesitation or constraint.
The name of our guesthouse is 'Mange Tak'.
A name, that might rarely reach your ear because it is the Danish word for 'Thank you'.


The goal of the Average Call Volume report is to provide an hour-by-hour, day-by-day view of the average number of Velocify Dial-IQ™ calls. This applies to all Dial-IQ calls whether they are initiated by Dial-IQ or by the User.
The purpose of this report is to provide greater insights into the actual calls made via Dial-IQ for a selected date range – the report can also show hourly and daily averages to help administrators and managers better understand peak days and hours of outbound call volumes.
Set the filters and date range and run the report.
Each Day has its own column and is divided into two sub columns: System and User.
The System sub column contains the average number of Dial-IQ calls that were initiated by Dial-IQ, i.e., Shotgun Connect, and Scheduled Dial. Also included in this number are Demand Connect calls and calls placed when a user dials a lead from a New Lead Notification In both of the latter two cases, the lead is assigned to a user via a distribution program immediately preceding the call. So even though the user initiates the call by clicking a button, these are still considered system calls.
The User sub column contains the average number of Dial-IQ calls that were initiated by the User, i.e., Click-to-Dial, Intelli-Dial, andSpeed Dial.
Down the left side of the table are hour long blocks of time. The block of time will only appear if calls were made during that hour. So if no calls were made between 1:00PM and 2:00PM on any day in the selected date range, there will not be a row for that time block. Conversely, if calls are being made around the clock, the report will have 24 rows.
Note that the default date range is "Last 7 Days." If the selected date range of report is seven days or less, then the number will not be an average. It will be an actual call total.
Run the report with a maximum of 7 day date range to see total calls instead of average calls.
Average Totals is the bottom row of the report. This gives daily averages of Dial-IQ calls initiated by the user and by the system.
NOTE: The numbers produced by this report are based on calls placed by Dial-IQ; Irrespective of whether or not the call was completed. The numbers do not, however, include Shotgun Connect contact attempts.


Exposure Incident means a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties.
Occupational Exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties.
Provision. When there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate personal protective equipment such as, but not limited to, gloves, gowns, laboratory coats, face shields or masks and eye protection, and mouthpieces, resuscitation bags, pocket masks, or other ventilation devices. Personal protective equipment will be considered "appropriate" only if it does not permit blood or other potentially infectious materials to pass through to or reach the employee's work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used.
Use. The employer shall ensure that the employee uses appropriate personal protective equipment unless the employer shows that the employee temporarily and briefly declined to use personal protective equipment when, under rare and extraordinary circumstances, it was the employee's professional judgment that in the specific instance its use would have prevented the delivery of health care or public safety services or would have posed an increased hazard to the safety of the worker or co-worker. When the employee makes this judgement, the circumstances shall be investigated and documented in order to determine whether changes can be instituted to prevent such occurrences in the future.
The source individual's blood shall be tested as soon as feasible and after consent is obtained in order to determine HBV and HIV infectivity. If consent is not obtained, the employer shall establish that legally required consent cannot be obtained. When the source individual's consent is not required by law, the source individual's blood, if available, shall be tested and the results documented.
Results of the source individual's testing shall be made available to the exposed employee, and the employee shall be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual.
The exposed employee's blood shall be collected as soon as feasible and tested after consent is obtained.
The employer shall ensure that the healthcare professional responsible for the employee's Hepatitis B vaccination is provided a copy of this regulation.
All medical records relevant to the appropriate treatment of the employee including vaccination status which are the employer's responsibility to maintain.
Healthcare Professional's Written Opinion. The employer shall obtain and provide the employee with a copy of the evaluating healthcare professional's written opinion within 15 days of the completion of the evaluation.
The healthcare professional's written opinion for Hepatitis B vaccination shall be limited to whether Hepatitis B vaccination is indicated for an employee, and if the employee has received such vaccination.
Employers shall provide additional training when changes such as modification of tasks or procedures or institution of new tasks or procedures affect the employee's occupational exposure. The additional training may be limited to addressing the new exposures created.
Not disclosed or reported without the employee's express written consent to any person within or outside the workplace except as required by this section or as may be required by law.


Simulation based learning environments are designed to improve the quality of medical education by allowing students to interact with patients, diagnostic laboratory procedures, and patient data in a virtual environment. However, few studies have evaluated whether simulation based learning environments increase students' knowledge, intrinsic motivation, and self-efficacy, and help them generalize from laboratory analyses to clinical practice and health decision-making.
An entire class of 300 University of Copenhagen first-year undergraduate students, most with a major in medicine, received a 2-h training session in a simulation based learning environment. The main outcomes were pre- to post- changes in knowledge, intrinsic motivation, and self-efficacy, together with post-intervention evaluation of the effect of the simulation on student understanding of everyday clinical practice were demonstrated.
Knowledge (Cohen's d = 0.73), intrinsic motivation (d = 0.24), and self-efficacy (d = 0.46) significantly increased from the pre- to post-test. Low knowledge students showed the greatest increases in knowledge (d = 3.35) and self-efficacy (d = 0.61), but a non-significant increase in intrinsic motivation (d = 0.22). The medium and high knowledge students showed significant increases in knowledge (d = 1.45 and 0.36, respectively), motivation (d = 0.22 and 0.31), and self-efficacy (d = 0.36 and 0.52, respectively). Additionally, 90 % of students reported a greater understanding of medical genetics, 82 % thought that medical genetics was more interesting, 93 % indicated that they were more interested and motivated, and had gained confidence by having experienced working on a case story that resembled the real working situation of a doctor, and 78 % indicated that they would feel more confident counseling a patient after the simulation.
The simulation based learning environment increased students' learning, intrinsic motivation, and self-efficacy (although the strength of these effects differed depending on their pre-test knowledge), and increased the perceived relevance of medical educational activities. The results suggest that simulations can help future generations of doctors transfer new understanding of disease mechanisms gained in virtual laboratory settings into everyday clinical practice.
Fundamental knowledge in basic medical sciences such as molecular biology, cell biology, and genetics and proficiency in medical laboratory methods are core competencies for practicing physicians. With recent advances in diagnostic methods (e.g., genome analysis), it is also increasingly important that physicians have a strong scientific education. However, many medical students find it difficult to relate the foundational scientific education to the clinical practice of medicine, just as many struggle with learning how to counsel patients . As early as 2003, the Institute of Medicine's Clinical Research Roundtable identified an adequately trained workforce as a key challenge for better medical treatments .
The growing significance of translational medical science means that today's medical educators face an increasing challenge of bridging the gap between theory and practice . New laboratory techniques are often inaccessible to students because of prohibitory costs, time constraints, and safety concerns [4, 5]. This restricts medical education to providing a mainly theoretical understanding of these techniques and their application, rather than being able to leverage the advantages for real-world learning offered by new technologies . This can leave students ill-prepared for the ongoing adaptations required by the continuously evolving field of translational medicine. Restricting training to theoretical knowledge can leave students finding much of what they are being taught in basic science curricula irrelevant to their future practice , undermining their engagement and motivation for learning .
In a recent position paper, Kurpinski et al.  (p. 1) concluded that "specialized graduate education that teaches skills needed to negotiate the entire translational medicine continuum is invaluable for training the next generation of scientists, physicians, and managers". In addition, medical programs need to ensure that future doctors have high level interpersonal and communication skills so that they can engage fully with patients and their relatives. Developing these skills (e.g., patient interviewing and counseling skills) is difficult in large classroom settings. Additionally, making space in the curriculum for such training is challenging, especially as it must compete for time with high priority courses that provide training in core medical knowledge and techniques [1, 6]. Resolving the dilemma of providing adequate breadth and depth of a range of scientific and interpersonal skills requires novel ways of delivering training. One developing methodology that provides opportunities to do this is use of a simulation based learning environment, which is the focus of this paper.
Physical simulations, such as training emergency care workers using mannequins, have been used widely for many years . The emergence of digital simulation technologies now provides innovative ways for conveying medical knowledge by using case stories in highly realistic clinical scenarios. These simulations enable learners to see and interact with representations of natural phenomena that would otherwise be impossible to observe . Additionally, the Gordon Commission's  report on the Future of Assessment in Education concluded that simulations also have the potential to combine learning and assessment, which is essential for optimal advancement in the field of education.
Meta-analyses have found that deliberate practice through simulations is an efficient way to acquire medical and clinical expertise [12, 13]. Gamified laboratory simulations significantly enhanced students' learning outcomes and motivation . Medical students value highly the opportunity provided by simulations to systematically apply their theoretical knowledge to solve real-world problems in a safe and realistic setting . For example, Issenberg and colleagues  demonstrated the benefits of simulation technology over traditional lectures in improving specific surgical technical skills, cardiovascular examination skills, and acquisition and retention of knowledge. Apart from developing technical skills, simulations are also effective in enhancing interpersonal and communication skills in health care professionals . Thus, simulation technology offers advantages over traditional approaches in skills development and can be expected to improve engagement and motivation for learning.
Simulation technology is relatively inexpensive and safe, and allows students to work on complex problems and use time consuming techniques for analyzing patient samples – all in a virtual world. Examples of simulations for medical education include EdHeads (virtual knee replacement surgery) , Surgery squad (interactive, first-hand virtual surgery experience) , and Clinispace (an immersive, 3-D virtual hospital environment) . As these examples illustrate, simulations are used widely to teach clinical practices, such as emergency care and surgery, but they are used less frequently to teach basic medical science . One example is a Western Blotting simulation that was developed for medical education. The conclusions in this study were that simulation based learning environments have great potential for improving students' development of diagnostic skills, but that further studies are required to determine the impact of laboratory simulations on student learning .
Medical genetics is one field in which medical education programs are struggling to keep pace with scientific and technological advances. This field has undergone rapid development, fueled by technological advances in molecular biology, including genetic testing methods and the growing body of knowledge on the genetic causes of both monogenic and complex inherited disorders. For example, the number of disorders for which genetic testing is available has increased 10-fold during the last 10 years . In addition, genetics has entered the genomic era, where a growing understanding of the effects of genetic variation on common diseases is challenging our conception of the field .
A case-based approach to medical genetics using simulation technology has the potential to greatly enhance students' understanding of underlying concepts and significantly increase their motivation . The use of virtual patients in medical education has been shown to lead to increases in knowledge and clinical reasoning .
We propose that simulation technology will allow students to interactively choose and perform laboratory tests that will enhance their knowledge and understanding of the available genetic testing methods. Furthermore, we expect that the interpretation of the results through a case story will lead to an increase in students' ability to draw valid conclusions relevant to genetic counseling.
In collaboration with the simulation-focused company Labster, we developed a computer program with a case-based laboratory simulation for learning core concepts and skills in medical genetics and genetic. In this simulation, students are introduced to a young pregnant couple, where the fetus may suffer from a syndrome caused by a chromosomal abnormality. The students are able to make a genome wide analysis of the fetal DNA and karyotype in the virtual laboratory, and practice communicating their conclusions to the couple using a simulated genetic counseling approach (see Fig. 1 and Additional file 1 an overview of the simulation).
In such simulations, it is important that the case story is perceived as relevant , meaning that the genetic testing technologies introduced to the students need to be up to date. In our simulation, students perform amniocentesis and array comparative genome hybridization, grow cells, prepare chromosomes, and assess the karyotype. To ensure that the simulation is lifelike, reflecting state-of-the-art chromosomal analysis, we worked closely with medical doctors throughout the design phase.
The objectives of this study were to assess whether the learning simulation could increase students': 1) understanding of the translation from molecular analysis to diagnosis and health decision-making in everyday clinical practice (i.e., bridge the gap between theory and practice in medical education); 2) knowledge of medical genetics; 3) intrinsic motivation for the topic of medical genetics; and 4) self-efficacy for performing medical genetics activities.
The sample comprised an entire class of 300 first-year undergraduate students (60 % female; 2 did not report gender) with either a major in medicine (84 %) or molecular biomedicine (16 %) from the University of Copenhagen in Denmark in the fall 2014 semester. Data were collected during the Medical Genetics course. Prior to undertaking the learning simulation, all students had completed a traditional 1-h lecture on subjects relevant to the simulation. All students completed the simulation evaluation and knowledge questions because these were a mandatory part of the curriculum; however, only 54 and 40 % of the sample had complete and valid responses to the self-efficacy and intrinsic motivation scales, respectively, as these were optional and included within a larger survey. An analysis of the difference between the group that completed and did not complete these optional scales is presented in the results section. Students were informed that the data would be used for research, and care was taken not to expose the students to any risk or burden (Helsinki Declaration article 17). Responses were anonymous (Helsinki Declaration article 24) and no stipend was provided. The study protocol was submitted to the Regional Committees on Health Research Ethics for Southern Denmark, who indicated that no written consent was required by Danish law.
The simulation session consisted of a 30-min pre-test to determine students' baseline knowledge, intrinsic motivation, and self-efficacy; a 2-h session for the medical genetics simulation; and a 30-min post-test to evaluate the simulation and reassess students' knowledge. Immediately following the post-test, students were given a survey that re-assessed their intrinsic motivation and self-efficacy along with other questions related to learning strategy and personality that were not part of this study.
Four questions were used to assess the student's simulation experience in relation to its impact on their understanding of the translation from diagnosis into everyday clinical practice and health decision-making (e.g., "It is motivating to learn the concepts of Medical Genetics through a case story that resembles the real working situation of a doctor"). Responses were made on a 4-point Likert scale (1 = Strongly disagree, 4 = Strongly agree). Knowledge was assessed with 18 multiple choice questions (see Additional file 2 for a list of questions). Motivation was assessed using five questions adapted from the Interest/Enjoyment Scale from the Intrinsic Motivation Inventory  (see Additional file 2 for a list of questions). Self-efficacy for learning medical genetics was assessed using five questions adapted from the Motivated Strategies for Learning Questionnaire  (see Additional file 2 for a list of questions). Students indicated their responses to the motivation and self-efficacy items using a 5-point Likert scale (1 = Strongly disagree, 5 = Strongly agree). Evidence of validity and reliability was obtained for all scales, and post-hoc analyses showed that the items had good psychometric properties and acceptable fit to the Rasch measurement model .
Students' appraisals of the simulation based on the four evaluation questions indicated an increased understanding of the translation from diagnosis into everyday clinical practice and health decision-making (Fig. 2). Approximately 90 % of the students indicated that they agreed or strongly agreed that the performance of laboratory techniques added to their understanding of medical genetics, and 82 % indicated that medical genetics was more interesting because of working in a virtual laboratory. Furthermore, 93 % indicated that they were more motivated and gained confidence by having to work on a case story that resembled the real working situation of a doctor. Finally, 78 % indicated that they would feel more confident counseling a patient after the simulation.
Paired samples t-tests showed a significant increase from a mean of 67 % correct on the pre-test to 79 % correct on the post-test, t (299) = −14.07, p < .001; d = 0.73. This is a medium effect size, indicating an increase of 0.73 standard deviation units in knowledge. To determine if this gain differed depending on the students' initial knowledge, the sample was divided into low (N = 86; pre-test score between 0 and 10), medium (N = 101; pre-test score between 11 and 13), and high (N = 113; pre-test score between 14 and 18) knowledge groups based on their pre-test score. The left-hand panel of Fig. 3 illustrates these results for knowledge. In general, there was a significant increase in knowledge as a result of the simulation for each knowledge group. The impact of the simulation was greatest for the low knowledge group, which increased their average score from 44 to 68 % correct, a significant increase of 24 %, t (85) = 14.42, p < .001; d = 3.35. The medium knowledge group significantly increased their knowledge by 11 %, t (100) = 10.87, p < .001; d = 1.45. Finally, the high knowledge group showed an average increase of 3 %, t (112) = 3.69, p < .001; d = 0.36.
Independent samples t-tests (using a Bonferroni corrected alpha of .008 to account for inflated Type I error rate) indicated that the group that completed the intrinsic motivation scale (40 % of the sample) did not significantly differ from the group that did not on pre-test knowledge (p = .711), post-test knowledge (p = .866), or on the four evaluation questions (ps from .071 to .522.
Students' average intrinsic motivation for the topic of medical genetics increased significantly from a mean of 3.86 at pre-test (possible range = 1 to 5) to 4.02 at post-test, t (118) = 4.23, p < .001; d = 0.24. The middle panel of Fig. 3 shows that intrinsic motivation was highest for the high knowledge group prior to the laboratory simulation, and the simulation had a significant positive effect on this group's intrinsic motivation, t (49) = 3.49, p = .001; d = 0.31. The medium knowledge group also showed a significant increase, t (34) = 2.53, p = .016; d = 0.22. While scores for the low knowledge group increased, this change was not significant, t (33) = −1.51, p = .141; d = 0.22.
Independent samples t-tests (Bonferroni corrected alpha = .008) indicated that the group who completed the self-efficacy scale (56 % of the sample) did not differ significantly from the group that did not complete this on pre-test knowledge (p = .105), post-test knowledge (p = .012), or the four evaluation questions (ps from = .476 to .593).
Students' average self-efficacy about their skills to perform medical genetics activities increased significantly from a pre-test mean of 3.36 (possible range = 1 to 5) to 3.62 at post-test, t (161) = 8.46, p < .001; d = 0.46. The right-hand panel of Fig. 3 shows that prior to the simulation self-efficacy was highest for the high knowledge group, followed by the medium and low knowledge groups, respectively. Although all groups had significant increases in self-efficacy from the pre- to the post-test, the greatest effects were observed for the low knowledge, t (37) = 4.56, p < .001; d = 0.61, and the high knowledge groups, t (66) = 6.29, p < .001; d = 0.52. The self-efficacy of the medium knowledge group also increased significantly, t (56) = 3.71, p < .001; d = 0.36; however, the effect size was weaker.
The results of this study indicate that a simulation based learning environment can increase the perceived relevance and interest of educational activities in medical education. This is very relevant for the future of translational medicine because an adequately trained workforce is crucial for the implementation of better medical treatments . Ensuring an adequately trained workforce begins with medical educational programs at universities; however, it has proven to be a challenge to tie theoretical knowledge and rapid technological advances to practical settings, which can result in a gap between students' perceptions of what they are being taught and the skills they are expected to have in their future careers as practitioners .
An important finding from this study was that students increased their confidence in their ability to counsel a virtual patient. This finding is in line with the results of a meta-analysis by Cook and colleagues who found positive effects for the use of virtual patients compared to both non-computer aided instruction and no intervention . The current simulation adds to these existing ones with virtual patients as it affords not only the ability to interact with virtual patients, but also the ability to conduct virtual laboratory procedures. The current finding that nearly all of the students agreed that the performance of laboratory techniques added to their understanding of medical genetics attests to this added benefit. Further, the majority of students indicated that they subsequently found medical genetics more interesting because of the experience of working in the virtual laboratory. Consistent with the previous studies using virtual patients, we also found that most students indicated that they would feel more confident undertaking genetic counseling as a result of their interactions with the virtual patient. Thus, our results indicated that a combination of the virtual patient counseling interactions and simulated performance of actual laboratory procedures is ideal. As a result, nearly all students reported that they were motivated and more confident due to work on a case story that resembles the real working situation of a doctor. The findings suggest that laboratory simulations are valuable to train skills and competencies that are very hard to attain in traditional medical education, especially at the undergraduate level due to the difficulty of accessing real patients and the opportunity to work in real laboratories. These results support our expectations that simulations can increase student understanding of the translation from laboratory result analysis and diagnosis into everyday clinical practice and health decision-making.
The positive effects on students' knowledge, intrinsic motivation, and self-efficacy were consistent with the students' positive perceptions of the impact of the medical genetics simulation. The strength of these effects differed for high, medium, and low knowledge students. The high knowledge group did not show as big a gain in knowledge from the simulation, although this likely reflects a ceiling effect as they already had an average of 85 % correct at pre-test. This group also had the highest levels of intrinsic motivation and self-efficacy at both times. However, despite already being highest on motivation and self-efficacy, this group showed significant medium to large positive effects in motivation and self-efficacy as a result of the simulation. This can be anticipated to have long term, positive educational and career consequences resulting from the students' application of their knowledge in clinically relevant settings and an increase in their perceived ability to counsel patients.
The low knowledge group showed the largest knowledge gain as a result of the simulation. This indicates that the simulation is particularly useful in promoting knowledge in weaker students. Furthermore, this group had a similar improvement in their self-efficacy to that seen in the high knowledge group. This could result in decreased drop-out rates and positive long term results as self-efficacy has been shown to be an important predictor for educational and career success [30–32]. These results are particularly enlightening because not all students benefit from traditional classroom environments: weaker students, for example, often report feeling bored, and subsequently demotivated, by not being able to meet high academic demands [33–35], and are considered to benefit from a more hands-on, problem-focused approach to learning [36–38].
Recommendations for practice: simulation technologies as an integral part of future medical education?
Many medical schools are currently redesigning their curriculum to cater for the new developments and possibilities presented by modern technology. The results of this study provide evidence that redesigning medical education curricula with simulations is very promising because students valued working within a virtual laboratory context with case stories that resembled the real working situation of a doctor, and benefitted in their knowledge, motivation, and self-efficacy. This indicates multiple benefits because these outcomes have the potential to lead to positive long-term consequences for developing future doctors that go beyond the specific knowledge that is obtained in a single learning session. Intrinsic motivation is an important element in catalyzing long-term learning as well as engagement. High self-efficacy is important because there is evidence that belief in one's ability to succeed can lead to greater educational and life outcomes than ones actual ability . This is because self-efficacious students participate more readily, work harder, persist longer, and choose more challenging tasks and goals. Students' beliefs about their efficacy to manage academic task demands can also influence them emotionally by decreasing their stress, anxiety, and depression .
A challenge for medical education is that the future generation of doctors needs to be able to transfer new understanding of disease mechanisms gained in the laboratory to new methods for diagnosis, therapy, and prevention, as well as the ability to translate these results into everyday clinical practice. If medical education programs are to meet this challenge, it is important to expose medical students to realistic laboratory and clinical scenarios as early as possible. We are beginning to see the impact of simulations in medical education and medicine in general, and the future could include fully simulated interactive clinic, hospital, and medical laboratories, which would enable students to experience an entire medical curriculum in an interactive environment. This will free teacher time and resources to focus on one-to-one interactions and training. Additional advantages are that simulations could be made available for a broad variety of students, including regional and remote students, which would mean that high quality medical education would no longer be limited to those able to attend specialized campuses; rather, state of the art medical education could be gained by anyone who is motivated to learn.
One of the limitations in this study is that there was no control group to compare the results of the virtual learning environment with other teaching methods. Although it is always an advantage to have a control group, the objective of this study was not to compare virtual learning environments to other teaching methods as this research question has been investigated previously [14, 21]. Rather than a control group, we assessed the outcome measures pre- and post- the simulation; therefore, effectively using participants as their own controls. In this study, we went beyond simply investigating cognitive outcomes such as increased knowledge and skills, by also examining non-cognitive outcomes; namely, intrinsic motivation and self-efficacy. This approach is in line with increasing evidence that cognitive as well as non-cognitive skills should be included as educational outcomes as both have significant short and long effects on educational .
Another potential limitation was that the same questions were used in the pre- and post-tests to assess knowledge. This could introduce potential bias because an increase in the score for the knowledge questions could be due to repeating the questions, rather than the simulation. The influence was limited by making sure that the students did not have access to the correct responses. Furthermore, the pre-test took place immediately before starting the simulation. Future research could consider using two different sets of items that are equated in the pre- and post-test to avoid this possible bias.
Another limitation was that we did not require participants to complete the post-test motivation and self-efficacy scales as these were part of a larger survey. As a result, there was a relatively large percentage of students who did not have complete and valid responses to these measures. The fact that completion of these measures was voluntary could introduce bias. Although a comparison of the groups who did and did not complete these measures showed no significant differences, future research should ensure that all participants complete all scales. This is particularly important given our findings in regard to these non-cognitive outcomes.
Future research is also needed to investigate how virtual simulation environments increase cognitive and non-cognitive outcomes in students as there is still limited research on this topic. There are two directions for this type of research. The first is to investigate causal relationships between psychological and educational constructs to facilitate a better understanding of the process of learning through simulation based tools. A second line of research is to investigate how different design components of simulation based learning environments affect cognitive and non-cognitive outcomes and whether individual differences variables such as personality, learning style, and computer or gaming experience play a role in preferences for specific design features.
The simulation based learning environment increased students' learning, intrinsic motivation, and self-efficacy, although the strength of these effects differed depending on their pre-test knowledge. In addition, the simulation based learning environment increased the perceived relevance of the medical educational activities to their future practice. Thus, the results provide evidence that simulations can help future generations of doctors transfer new understanding of disease mechanisms gained in virtual laboratory settings into everyday clinical practice.
Students were informed that the data would be used for research, and care was taken not to expose the students to any risk or burden (Helsinki Declaration article 17). Responses were anonymous (Helsinki Declaration article 24) and no stipend was provided. The study protocol was submitted to the Regional Committees on Health Research Ethics for Southern Denmark, who indicated that no written consent was required by Danish law.
Consent was obtained from all of the students who were included in the images in this manuscript.
All data is available through the first author of the manuscript.
This research was funded through a grant obtained through Innovation fund Denmark.
MB is the CEO of Labster ApS and thus has financial interest in the Company. The other authors declare no competing financial interests.
GM had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: All authors. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: GM, MB, JWa, JWu, MH, PC, AS, AN. Critical revision of the manuscript for important intellectual content: GM, MB, JWa, JWu, MH, PC, AS, AN. Statistical analysis: GM, JWa, JWu. Administrative, technical, or material support: GM, JWa, JWu. Study supervision: GM, MB, JW, AN. All authors have read and approved the final version of the manuscript.
EdHeads: Virtual Knee Replacement Surgery. http://edheads.org/. Accessed 23 March 2016.
Surgery squad: Surgery Games & Patient Education. http://www.surgerysquad.com. Accessed 23 March 2016.
Clinispace: Virtual Sim Center. http://www.clinispace.com. Accessed 23 March 2016.
Polly P, Marcus N, Maguire D, Belinson Z, Velan GM. Evaluation of an adaptive virtual laboratory environment using Western Blotting for diagnosis of disease. BMC Medical Education. 2014:1–9. http://dx.doi.org/10.1186/1472-6920-14-222. Accessed 23 March 2016.
Genetests: Specific title of the page. link to webpage. https://www.genetests.org/. Accessed 23 March 2016.
Control-value theory of achievement emotions. In: Pekrun R, Linnenbrink-Garcia L, editors. International handbook of emotions in education. New York: Routledge. p. 120–141. https://books.google.dk/books?hl=da&lr=&id=8_UjAwAAQBAJ&oi=fnd&pg=PA120&dq=Control-value+theory+of+achievement+emotions.+In:+Pekrun+R,+Linnenbrink-Garcia+L,+editors.+International+handbook+of+emotions+in+education.+New+York:+Routledge.+p.+120%E2%80%93141.&ots=F9ZUoQbKtu&sig=sFUFjDGuKRIfnV3DLGfE_S8ENVc&redir_esc=y#v=onepage&q&f=false.
Try Bédard, D., Lison, C., Dalle, D., Côté, D., & Boutin, N. (2012). Problem-based and Project-based Learning in Engineering and Medicine: Determinants of Students' Engagement and Persistance. Interdisciplinary J Probl Based Learn. 6(2). Available at: http://dx.doi.org/10.7771/1541-5015.1355. Accessed 23 March 2016.


The staging of the York Mystery Plays has been the subject of numerous research articles. Only limited attention has been paid, however, to the acoustics of the performance spaces. This paper discusses how digital technology can be applied to the exploration of the acoustical effects different types of wagon structures and orientations might have had on the spoken and sung items of the plays by focusing on their interaction with one of the sixteenth-century playing stations: Stonegate.
Mariana Lopez (mariana.lopez@anglia.ac.uk) is a postdoctoral researcher in the Cultures of the Digital Economy Research Institute (CoDE), Anglia Ruskin University. In 2013 she completed her PhD on the importance of acoustical studies to further our understanding of the York Mystery Plays. She has worked as a tutor on several modules on sound and acoustics at the department of theatre, film and television, University of York.


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Ok, I know that I previously railed against making a beef roll-up thingy as being way too much dang work. In that case, rolling up scallions and red pepper in thin pieces of beef just seemed to me a very fussy way to make a simple stir fry. This recipe is different. Why? Cheese. It has a slice of pepper jack cheese in each roll. Believe it or not, that actually makes the rolling, toothpicking, and related fussing all worthwhile. You cut into these little packages and get beef, red pepper, onion, and pepper jack cheese all in one delicious bite.
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text:
TheDissertation - Composition - Why And How Story Of An Hour Connects With The Theme Of Love
Free Why and How "Story of an Hour" Connects with the Theme of Love Dissertation Example
Category: Composition
Subcategory: Dissertation discussion
'Story of an Hour'
Why and How "Story of an Hour" Connects with the Theme of Love
The theme that being discussed in this story is the theme of love. It is about the woman known as Louise Mallard who is experiencing a significant emotional transformation following the death of her husband. Although she is expected to grieve due to the loss of her husband, she feels like she has been relieved from long-life suffering and frustrations which she had been subjected to. Although she had been in love, she did not have freedom. It led to the unending miseries that she had been going through. After her husband dies, she loses the love of her life but gains freedom (Chopin and Gemma 4). She realizes that freedom is way much better as compared to love. In other words, after her new experience, she would rather have freedom and lack of love than have love without freedom.
In the story, Chopin suggests that it is normal to have challenges such as oppression in nearly all marriages. Although she was being oppressed, Mallard admits that Brently- her husband was very loving and kind. "And yet she had loved him—sometimes. Often she had not. What did it matter! What could love, the mystery, count for in the face of this possession of self-assertion which she suddenly recognized as the strongest impulse of her being" (Chopin and Gemma 5). It means that Mallard loved her husband, but at times, the love did not matter due to the oppression. She, however, stayed there hence making it hard to understand what real love is- that she would stick around even in the presence of oppression. The story points out at the love that exists between a wife and a husband and the challenges they go through. Mallard does not mention how she was being oppressed by the husband (Chopin and Gemma 5). Instead, she mentions that she also oppressed her husband at times and therefore marriage is a challenge to both parties. In this regard, the story highlights love as the main reason as to why a man and a woman come together and live together as husband and wife. Many hurdles will always come their way, but love will always keep them together. At the end of the story, Mallard realizes that Brently was not dead.
Chopin, Kate, and Gemma Correll. The Story of an Hour and Other Stories. Portland, Or: Good Ink, 2011.
Wine Marketing Wine Marketing 1.0 Introduction 1.1 Wine Events and Shows Events and shows are important strategies of marketing products in specific target markets. Research in...