Computerbasierte Prüfung von klinischem Denken in der klinischen Ausbildung: Ein Mixed-Method Vergleich von Key Feature Problemen mit fallbasierten Multiple Choice Typ A Fragen

Fragestellung/Einleitung: Es ist unklar inwiefern Unterschiede bestehen im Einsatz von Key Feature Problemen (KFP) mit Long Menu Fragen und fallbasierten Typ A Fragen (FTA) für die Überprüfung des klinischen Denkens (Clinical Reasoning) in der klinischen Ausbildung von Medizinstudierenden. Methoden: Medizinstudierende des fünften Studienjahres nahmen an ihrer klinischen Pädiatrie-Rotation teil, die mit einer summativen Prüfung endete. Die Überprüfung des Wissen wurde pro Prüfung elektronisch mit 6-9 KFP [1], [3], 9-20 FTA und 9-28 nichtfallbasierten Multiple Choice Fragen (NFTA) durchgeführt. Jedes KFP bestand aus einer Fallvignette und drei Key Features und nutzen ein sog. Long Menu [4] als Antwortformat. Wir untersuchten die Perzeption der KFP und FTA in Focus Gruppen [2] (n of students=39). Weiterhin wurden die statistischen Kennwerte der KFP und FTA von 11 Prüfungen (n of students=377) verglichen. Ergebnisse: Die Analyse der Fokusgruppen resultierte in vier Themen, die die Perzeption der KFP und deren Vergleich mit FTA darstellten: KFP wurden als 1. realistischer, 2. schwerer, und 3. motivierender für das intensive Selbststudium des klinischen Denkens als FTA aufgenommen und zeigten 4. insgesamt eine gute Akzeptanz sofern gewisse Voraussetzungen berücksichtigt werden. Die statistische Auswertung zeigte keinen Unterschied im Schwierigkeitsgrad; jedoch zeigten die KFP eine höhere Diskrimination und Reliabilität (G-coefficient) selbst wenn für die Prüfungszeit korrigiert wurde. Die Korrelation der verschiedenen Prüfungsteile war mittel. Diskussion/Schlussfolgerung: Die Studierenden erfuhren die KFP als motivierenden für das Selbststudium des klinischen Denkens. Statistisch zeigten die KFP eine grössere Diskrimination und höhere Relibilität als die FTA. Der Einbezug von KFP mit Long Menu in Prüfungen des klinischen Studienabschnitts erscheint vielversprechend und einen „educational effect“ zu haben.

開発戦略としてのPro-Poor Growth －貧困層への雇用創出－

本稿は、後発開発途上国においてpro-poor growthを達成する開発戦略を、産業政策との関連から研究したものである。アジアとアフリカの経済発展プロセスにおいて、貧困層にどの産業が雇用機会を提供するか、を研究した。その結果明らかになったのは、1970-90年代の典型的な東アジア高成長経済であるタイと台湾において、貧困層に最も大きな雇用機会を与えたのが農業部門であったのに対して、貧困層の雇用機会増に最も貢献したのが製造業部門であったということである。同様の傾向は、アフリカの輸出指向成長国であるモーリシャスについても観察された。一方、グローバリゼーションの活力が十分に生かされなかったマラウィ、南アフリカ、インドにおいては、製造業が同様の雇用機会を貧困層に提供できなかった。結論として導かれるのは、典型的な後発発展途上国においては、雇用に関して農業のシェアが製造業のシェアを上回るのが一般的であるものの、もし比較優位がグローバリゼーションの中で顕在化できるのであれば、貧困層の雇用機会増に関して、農業よりも製造業の貢献度が大きくなりうる、ということである。一国全体の経済発展という観点のみならず、貧困層に利益をもたらすpro-poor growthという文脈においても、製造業の果たす役割が無視し得ないことが明らかになった。

Strengthening the strategic choice offered to the EU’s southern Mediterranean neighbours. CEPS Commentary, 1 February 2013

Finding that the European Neighbourhood Policy (ENP) currently lacks a strategic vision that would offer states in the southern Mediterranean substantial returns in exchange for making tough reforms, this CEPS Commentary suggests that this weakness can be overcome through a concrete prospect of regional integration pro-actively driven forward by the European Union. Taking inspiration from current projects such as the Energy Community Treaty, the authors urge the EU to explicitly incorporate “legally binding sectoral multilateralism” into the ENP. This would provide the Union’s partners with a tangible prospect of reaping real long-term benefits from EU cooperation and reinvigorate the ENP for the next decade.

Having your day in court:judicial opportunity and tactical choice in Anti-GMO campaigns in France and the United Kingdom

Investigating the recent direct action campaigns against genetically modified crops in France and the United Kingdom, the authors set out to understand how contrasting judicial systems and cultures affect the way that activists choose to commit ostensibly illegal actions and how they negotiate the trade-offs between effectiveness and public accountability. The authors find evidence that prosecution outcomes across different judicial systems are consistent and relatively predictable and consequently argue that the concept of a “judicial opportunity structure” is useful for developing scholars’ understanding of social movement trajectories. The authors also find that these differential judicial opportunities cannot adequately account for the tactical choices made by activists with respect to the staging of covert or overt direct action; rather, explanations of tactical choice are better accounted for by movement ideas, cultures, and traditions.

Agency as vulnerability:accounting for children's movement to the streets of Accra

This paper considers the agency of children moving to the streets of Accra, Ghana's capital city. A much used but largely unexamined concept, agency is nevertheless commonly deployed in childhood studies as a means to stress the capacity of children to choose to do things. In the literature on street and working children, and a cognate area of study concerned with children's independent migration, this has involved accounts of children's agency made meaningful by reference to theories of rational choice or to the normative force of childhood. It is our argument that both approaches leave unanswered important questions and to counter these omissions we draw upon the arguments of social realists and, in particular, the stress they place on vulnerability as the basis for human agency. We develop this argument further by reference to our research with street children. By drawing upon the children's accounts of leaving their households and heading for Accra's streets, it is our contention that these children do frame their departures as matters of individual choice and self-determination, and that in doing so they speak of a considerable capacity for action. Nevertheless, a deeper reading of their testimonies also points to the children's understandings of their own vulnerability. By examining what we see as their inability to be dependent upon family and kin, we stress the importance of the children's perceptions of their vulnerability, frailty and need as the basis for a fuller understanding of their agency in leaving their households. © 2013 The Author. The Sociological Review © 2013 The Editorial Board of The Sociological Review.

Logics of marginalisation in health and social care reform:integration, choice, and provider-blind provision

The period 2010–2013 was a time of far-reaching structural reforms of the National Health Service in England. Of particular interest in this paper is the way in which radical critiques of the reform process were marginalised by pragmatic concerns about how to maintain the market-competition thrust of the reforms while avoiding potential fragmentation. We draw on the Essex school of political discourse theory and develop a ‘nodal’ analytical framework to argue that widespread and repeated appeals to a narrative of choice-based integrated care served to take the fragmentation ‘sting’ out of radical critiques of the pro-competition reform process. This served to marginalise alternative visions of health and social care, and to pre-empt the contestation of a key norm in the provision of health care that is closely associated with the notions of ‘any willing provider’ and ‘any qualified provider’: provider-blind provision.

Occupy! A global movement

This book is an urgent and compelling account of the Occupy movements: from the M15 movement in Spain, to the wave of Occupations flooding across cities in American, Europe and Australia, to the harsh reality of evictions as corporations and governments attempted to reassert exclusive control over public space. Across a vast range of international examples over twenty authors analyse, explain and helps us understand the movement. These movements were a novel and noisy intervention into the recent capitalist crisis in developed economies, developing an exceptionally broad identity through a call to arms addressed to 'the 99%', and emphasizing the importance of public space in the creation and maintenance of opposition. The novelties of these movements, along with their radical positioning and the urgency of their claims all demand analysis. This book investigates the crucial questions of how and why this form of action spread so rapidly and so widely, how the inclusive discourse of 'the 99%' matched up to the reality of the practice. It is vital to understand not just the choice of tactics and the vitality of protest camps in public spaces, but also how the myriad of challenges and problems were negotiated. This book was published as a special issue of Social Movement Studies.

Islamist movements at crossroads: the choice between ideology and context-driven approach to politics. Case study on the Hashemite Kingdom of Jordan

The aim of the paper is to analyse the ongoing transformation process within the Islamist movements using the example of the moderate Islamic Action Front party in Jordan. The dilemma of participation in the 2010 general elections raised tensions between the Muslim Brotherhood in Jordan and its political wing, the Islamic Action Front, and between doves and hawks of the same organizations. Internal debate on the future has started recently among different groups within the Islamist movement in Jordan. The research is based on the author‘s recent field experience in Jordan (April–July 2010, Andrew W. Mellon Fellowship at the American Centre of Oriental Research, Amman, Jordan). The author also conducted research in Syria, Lebanon, Palestine and Egypt, where several interviews were carried out with leading and lower level Islamist politicians. The dynamic changes within Islamic Action Front Party in Jordan and its relation with the regime has been used as reference point. The main question of the research was aa how the changing political and regional context shapes decisions of the Islamist with special attention to the acceptance of democratic values and human rights, political participation, and the meanings of Islamic values in the 21st century, possible cooperation with secular parties/movements/the regime.

The choice not to use computers: A case study of community college faculty who do not use computers in teaching

The primary purpose of this investigation is to study the motives of community college faculty who decide not to use computers in teaching. In spite of the fact that many of the environmental blocks that would otherwise inhibit the use of the computers have been eliminated at many institutions, many faculty do not use a computer beyond its word-processing function. For the purpose of the study non-adoption of computers in teaching is defined as not using computers for more than word-processing. ^ The issues in the literature focus on resistance and assume a pro-innovation and pro-adoption bias. Previous research on the questions is primarily surveys with narrowly focused assumptions. This qualitative research directly asks the participants about their feelings, beliefs, attitudes, experiences, and behaviors in regard to computers in teaching. Through the interview process a number of other correlated issues emerge. ^ The investigation was conducted at Miami-Dade Community College, a large urban multicampus institution, in Miami-Dade, Florida. It was conducted through a series of in-depth phenomenological interviews. There were nine interviews; eight within the profile; two were pilots; and one was an extreme opposite of the profile. Each participant was interviewed three times for about 45 minutes. ^ The results indicate that the computer conflicts with the participants' values in regard to their teaching and their beliefs in regard to the nature of knowledge, learning, and the relationship that they wish to maintain with students. Computers require significant changes in the values, beliefs, and consequent behaviors. These are changes that the participants are not willing to make without overwhelming evidence that they are worth the sacrifice. For the participants, this worth is only definable as it positively improves learning. For even the experts the evidence is not there. Unlike the innovator, the high end computer user, these participants are not willing to adopt the computer on faith. ^

Pro and Anti-ERA at International Women's Year conference

General note: Title and date provided by Bettye Lane.

‘Every Coward’s Choice’? Political Objection to Military Service in Apartheid South Africa as Sexual Citizenship

Sexuality was articulated by the apartheid state as a means of disciplining the white population and marginalizing white opponents of apartheid. As such, homophobia was a recurrent feature of political and legal discourse. The End Conscription Campaign (ECC) opposed compulsory conscription for all white men in the apartheid era South African Defence Force (SADF). Its challenge was a potentially radical and profoundly destabilizing one and it articulated a competing definition of citizenship to that offered by the state. The pro‐ and anti‐conscription discourse was inherently gendered and overtly sexualized. The South African government regularly associated men who objected to military service with effeminacy, cowardice and sexual ‘deviance’. The case of Dr Ivan Toms' objection, a gay objector who wished to cite his sexuality as a primary motivation for his objection, reveals the unwillingness of the ECC to engage in sexual politics. Using Shane Phelan's and Zygmunt Bauman's concept of friends, enemies and strangers, this paper investigates the construction of both white gay men and white people who opposed apartheid as ‘strangers’ and suggests that the deployment of homophobia by the state was a stigmatizing discourse aimed at purging the ECC's political message from the public realm. In this context the ECC adopted an assimilatory discursive strategy, whereby they attempted to be ‘respectable whites’, negotiating over shared republican territory. This populist strategy, arguably safer in the short term, avoided issues of sexuality and the fundamental conflation of sexuality and citizenship in apartheid South Africa. The ECC thus circumscribed its radical and deconstructive political potential and did not offer a ‘radical democratic’ message in opposition to apartheid.

From Pro-Franco to Anti-Government. The Evolution of the "Sur" regarding National Politics during the Spanish Transition (1975-1978)

The Spanish transition, the political process through which Spain ceased to be a dictatorship to become a democracy, was accompanied by the dissolution of the National Movement, the institutional support for the chain of the Movement Press from its beginnings, in April 1977. This fact, among others, contributed to the /Sur/, the regional reference newspaper for the chain in Andalusia, evolving both structurally and ideologically to adapt itself to the new political regime. This study applies content analysis to editorials, articles and columns published by the newspaper between 1975 and 1978, exploring the process through which the regional newspaper edited in Málaga abandoned its propaganda function with regard to the Government, considering it undemocratic, and supported the PSOE, presenting it as the best alternative to the UCD in the Spanish Executive, thus taking on its role as a political agent.

The Republican Movement, 'Disappearing' and Framing the Past in Northern Ireland

Despite a rich body of research on the conflict and peace process in Northern Ireland, the ‘disappearances’ carried out by Republican armed groups have so far escaped scrutiny. In this article I examine how the Republican movement has framed the rationale behind ‘disappearing’ as a rational response to informing and as an example of historical continuity. In doing so, Republicans appear to attempt to confer legitimacy on their choice of target and normalize the use of the practice within a Republican framework. However, these rationales incorporate techniques of neutralization and attempts to contextualize the ‘disappearances’ in such a way as to distance the Irish Republican Army from agency. Such distancing speaks to a third, overarching rationale for ‘disappearing’: the avoidance of an embarrassment that has continued into the postconflict period. I consider why Republicans persist in claiming the ‘disappeared’ were legitimate targets, killed by a method for which there is historical precedent, when such framing left them open to criticism at a time when they were seeking to demonstrate that they had left violence behind. I conclude that Republican attempts to satisfy two audiences resulted in a gulf between their engagement in the process of recovering remains and their rhetoric surrounding this issue. In so doing, light is shed on some of the challenges the Republican movement faced in their transition away from violence. More broadly, the value of unpicking the framing of key actors in transitional processes is illuminated.

Three dimensional study to quantify the relationship between facial hard and soft tissue movement as a result of orthognathic surgery

Introduction Prediction of soft tissue changes following orthognathic surgery has been frequently attempted in the past decades. It has gradually progressed from the classic “cut and paste” of photographs to the computer assisted 2D surgical prediction planning; and finally, comprehensive 3D surgical planning was introduced to help surgeons and patients to decide on the magnitude and direction of surgical movements as well as the type of surgery to be considered for the correction of facial dysmorphology. A wealth of experience was gained and numerous published literature is available which has augmented the knowledge of facial soft tissue behaviour and helped to improve the ability to closely simulate facial changes following orthognathic surgery. This was particularly noticed following the introduction of the three dimensional imaging into the medical research and clinical applications. Several approaches have been considered to mathematically predict soft tissue changes in three dimensions, following orthognathic surgery. The most common are the Finite element model and Mass tensor Model. These were developed into software packages which are currently used in clinical practice. In general, these methods produce an acceptable level of prediction accuracy of soft tissue changes following orthognathic surgery. Studies, however, have shown a limited prediction accuracy at specific regions of the face, in particular the areas around the lips. Aims The aim of this project is to conduct a comprehensive assessment of hard and soft tissue changes following orthognathic surgery and introduce a new method for prediction of facial soft tissue changes.   Methodology The study was carried out on the pre- and post-operative CBCT images of 100 patients who received their orthognathic surgery treatment at Glasgow dental hospital and school, Glasgow, UK. Three groups of patients were included in the analysis; patients who underwent Le Fort I maxillary advancement surgery; bilateral sagittal split mandibular advancement surgery or bimaxillary advancement surgery. A generic facial mesh was used to standardise the information obtained from individual patient’s facial image and Principal component analysis (PCA) was applied to interpolate the correlations between the skeletal surgical displacement and the resultant soft tissue changes. The identified relationship between hard tissue and soft tissue was then applied on a new set of preoperative 3D facial images and the predicted results were compared to the actual surgical changes measured from their post-operative 3D facial images. A set of validation studies was conducted. To include: • Comparison between voxel based registration and surface registration to analyse changes following orthognathic surgery. The results showed there was no statistically significant difference between the two methods. Voxel based registration, however, showed more reliability as it preserved the link between the soft tissue and skeletal structures of the face during the image registration process. Accordingly, voxel based registration was the method of choice for superimposition of the pre- and post-operative images. The result of this study was published in a refereed journal. • Direct DICOM slice landmarking; a novel technique to quantify the direction and magnitude of skeletal surgical movements. This method represents a new approach to quantify maxillary and mandibular surgical displacement in three dimensions. The technique includes measuring the distance of corresponding landmarks digitized directly on DICOM image slices in relation to three dimensional reference planes. The accuracy of the measurements was assessed against a set of “gold standard” measurements extracted from simulated model surgery. The results confirmed the accuracy of the method within 0.34mm. Therefore, the method was applied in this study. The results of this validation were published in a peer refereed journal. • The use of a generic mesh to assess soft tissue changes using stereophotogrammetry. The generic facial mesh played a major role in the soft tissue dense correspondence analysis. The conformed generic mesh represented the geometrical information of the individual’s facial mesh on which it was conformed (elastically deformed). Therefore, the accuracy of generic mesh conformation is essential to guarantee an accurate replica of the individual facial characteristics. The results showed an acceptable overall mean error of the conformation of generic mesh 1 mm. The results of this study were accepted for publication in peer refereed scientific journal. Skeletal tissue analysis was performed using the validated “Direct DICOM slices landmarking method” while soft tissue analysis was performed using Dense correspondence analysis. The analysis of soft tissue was novel and produced a comprehensive description of facial changes in response to orthognathic surgery. The results were accepted for publication in a refereed scientific Journal. The main soft tissue changes associated with Le Fort I were advancement at the midface region combined with widening of the paranasal, upper lip and nostrils. Minor changes were noticed at the tip of the nose and oral commissures. The main soft tissue changes associated with mandibular advancement surgery were advancement and downward displacement of the chin and lower lip regions, limited widening of the lower lip and slight reversion of the lower lip vermilion combined with minimal backward displacement of the upper lip were recorded. Minimal changes were observed on the oral commissures. The main soft tissue changes associated with bimaxillary advancement surgery were generalized advancement of the middle and lower thirds of the face combined with widening of the paranasal, upper lip and nostrils regions. In Le Fort I cases, the correlation between the changes of the facial soft tissue and the skeletal surgical movements was assessed using PCA. A statistical method known as ’Leave one out cross validation’ was applied on the 30 cases which had Le Fort I osteotomy surgical procedure to effectively utilize the data for the prediction algorithm. The prediction accuracy of soft tissue changes showed a mean error ranging between (0.0006mm±0.582) at the nose region to (-0.0316mm±2.1996) at the various facial regions.

Coaching or gaming? Implications of strategy choice for home based stroke rehabilitation

Background: The enduring aging of the world population and prospective increase of age-related chronic diseases urge the implementation of new models for healthcare delivery. One strategy relies on ICT (Information and Communications Technology) home-based solutions allowing clients to pursue their treatments without institutionalization. Stroke survivors are a particular population that could strongly benefit from such solutions, but is not yet clear what the best approach is for bringing forth an adequate and sustainable usage of home-based rehabilitation systems. Here we explore two possible approaches: coaching and gaming. Methods: We performed trials with 20 healthy participants and 5 chronic stroke survivors to study and compare execution of an elbow flexion and extension task when performed within a coaching mode that provides encouragement or within a gaming mode. For each mode we analyzed compliance, arm movement kinematics and task scores. In addition, we assessed the usability and acceptance of the proposed modes through a customized self-report questionnaire. Results: In the healthy participants sample, 13/20 preferred the gaming mode and rated it as being significantly more fun (p < .05), but the feedback delivered by the coaching mode was subjectively perceived as being more useful (p < .01). In addition, the activity level (number of repetitions and total movement of the end effector) was significantly higher (p <.001) during coaching. However, the quality of movements was superior in gaming with a trend towards shorter movement duration (p=.074), significantly shorter travel distance (p <.001), higher movement efficiency (p <.001) and higher performance scores (p <.001). Stroke survivors also showed a trend towards higher activity levels in coaching, but with more movement quality during gaming. Finally, both training modes showed overall high acceptance. Conclusions: Gaming led to higher enjoyment and increased quality in movement execution in healthy participants. However, we observed that game mechanics strongly determined user behavior and limited activity levels. In contrast, coaching generated higher activity levels. Hence, the purpose of treatment and profile of end-users has to be considered when deciding on the most adequate approach for home based stroke rehabilitation.