Assessment of medical courses in Brazil using student-completed questionnaires. Is it reliable?

INTRODUCTION: Debates about the quality of medical education have become more evident in the recent past, and as a result several different assessment methods have been refined for that purpose. The use of questionnaires filled out by medical students to assess the quality of lectures is one of the most common methods employed in our milieu. However, the reliability of this investigation method has not yet been systematically tested. The authors present the reliability of a specific form applied to the fourth grade medical students during the clinical psychiatry course. METHOD: Eighty-one fourth grade medical students were instructed to complete a form immediately after each clinical psychiatry lecture. Thirty-four students (42%) failed to turn in the forms after the final lecture. These students were given an identical form to assess the lectures in a retrospective fashion. The grades given by both groups of students for each performed lecture and the number of students who have graded an unperformed lecture were compared. Statistical significance for both groups was determined by means of the chi-square test (p< 0.05). RESULTS: Eighteen out of the 34 students who filled out the forms retrospectively (53%) rated the unperformed lecture, whereas only 5 out of the 47 students who filled out the forms during the course (11%) did so. This is statistically significant (p< 0.05). There was no statistical difference for the grades given to the lectures that were actually performed. DISCUSSION: The authors concluded the low reliability rate of the retrospective evaluation warrant a continuous assessment method during the course.

Handheld-assisted field data collection for occupational risk assessment.

A computerized handheld procedure is presented in this paper. It is intended as a database complementary tool, to enhance prospective risk analysis in the field of occupational health. The Pendragon forms software (version 3.2) has been used to implement acquisition procedures on Personal Digital Assistants (PDAs) and to transfer data to a computer in an MS-Access format. The data acquisition strategy proposed relies on the risk assessment method practiced at the Institute of Occupational Health Sciences (IST). It involves the use of a systematic hazard list and semi-quantitative risk assessment scales. A set of 7 modular forms has been developed to cover the basic need of field audits. Despite the minor drawbacks observed, the results obtained so far show that handhelds are adequate to support field risk assessment and follow-up activities. Further improvements must still be made in order to increase the tool effectiveness and field adequacy.

Implications of Objective vs Subjective Delirium Assessment in Surgical Intensive Care Patients.

Background Delirium is an independent predictor of increased length of stay, mortality, and treatment costs in critical care patients. Its incidence may be underestimated or overestimated if delirium is assessed by using subjective clinical impression alone rather than an objective instrument. Objectives To determine frequency of discrepancies between subjective and objective delirium monitoring. Methods An observational cohort study was performed in a surgical-cardiosurgical 31-bed intensive care unit of a university hospital. Patients' delirium status was rated daily by bedside nurses on the basis of subjective individual clinical impressions and by medical students on the basis of scores on the objective Confusion Assessment Method for the Intensive Care Unit. Results Of 160 patients suitable for analysis, 38.8% (n = 62) had delirium according to objective criteria at some time during their stay in the intensive care unit. A total of 436 paired observations were analyzed. Delirium was diagnosed in 26.1% of observations (n = 114) with the objective method. This percentage included 6.4% (n = 28) in whom delirium was not recognized via subjective criteria. According to subjective criteria, delirium was present in 29.4% of paired observations (n = 128), including 9.6% (n = 42) with no objective indications of delirium. A total of 8 patients with no evidence of delirium according to the objective criteria were prescribed haloperidol and lorazepam because the subjective method indicated they had delirium. Conclusions Use of objective criteria helped detect delirium in more patients and also identified patients mistakenly thought to have delirium who actually did not meet objective criteria for diagnosis of the condition.

Comprehensive assessment of patients in palliative care: a descriptive study utilizing the INTERMED.

Documentation in palliative care is often restricted to medical and sociodemographic information, and the assessment of physical and psychological symptoms or the quality of life. In order to overcome the lack of comprehensive information, we have evaluated the utility of the INTERMED-a biopsychosocial assessment method to document integrated information of patients' needs-in 82 consecutive patients for whom a palliative care consultation was requested. Results confirm the biopsychosocial heterogeneity of the sample, and the importance of integrated information to clinical, scientific, educational, and health care policy agendas. The INTERMED could become a useful method to tailor interdisciplinary interventions based on comprehensive patient needs assessment.

MASTER DATA MANAGEMENT MATURITY AND TECHNOLOGY ASSESSMENT - From theory to practice, case Ineo Oy

After decades of mergers and acquisitions and successive technology trends such as CRM, ERP and DW, the data in enterprise systems is scattered and inconsistent. Global organizations face the challenge of addressing local uses of shared business entities, such as customer and material, and at the same time have a consistent, unique, and consolidate view of financial indicators. In addition, current enterprise systems do not accommodate the pace of organizational changes and immense efforts are required to maintain data. When it comes to systems integration, ERPs are considered “closed” and expensive. Data structures are complex and the “out-of-the-box” integration options offered are not based on industry standards. Therefore expensive and time-consuming projects are undertaken in order to have required data flowing according to business processes needs. Master Data Management (MDM) emerges as one discipline focused on ensuring long-term data consistency. Presented as a technology-enabled business discipline, it emphasizes business process and governance to model and maintain the data related to key business entities. There are immense technical and organizational challenges to accomplish the “single version of the truth” MDM mantra. Adding one central repository of master data might prove unfeasible in a few scenarios, thus an incremental approach is recommended, starting from areas most critically affected by data issues. This research aims at understanding the current literature on MDM and contrasting it with views from professionals. The data collected from interviews revealed details on the complexities of data structures and data management practices in global organizations, reinforcing the call for more in-depth research on organizational aspects of MDM. The most difficult piece of master data to manage is the “local” part, the attributes related to the sourcing and storing of materials in one particular warehouse in The Netherlands or a complex set of pricing rules for a subsidiary of a customer in Brazil. From a practical perspective, this research evaluates one MDM solution under development at a Finnish IT solution-provider. By means of applying an existing assessment method, the research attempts at providing the company with one possible tool to evaluate its product from a vendor-agnostics perspective.

Assessment of Young Learners’ English Proficiency in Bilingual Content Instruction CLIL

This applied linguistic study in the field of second language acquisition investigated the assessment practices of class teachers as well as the challenges and visions of language assessment in bilingual content instruction (CLIL) at primary level in Finnish basic education. Furthermore, pupils’ and their parents’ perceptions of language assessment and LangPerform computer simulations as an alternative, modern assessment method in CLIL contexts were examined. The study was conducted for descriptive and developmental purposes in three phases: 1) a CLIL assessment survey; 2) simulation 1; and 3) simulation 2. All phases had a varying number of participants. The population of this mixed methods study were CLIL class teachers, their pupils and the pupils’ parents. The sampling was multi-staged and based on probability and random sampling. The data were triangulated. Altogether 42 CLIL class teachers nationwide, 109 pupils from the 3rd, 4th and 5th grade as well as 99 parents from two research schools in South-Western Finland participated in the CLIL assessment survey followed by an audio-recorded theme interview of volunteers (10 teachers, 20 pupils and 7 parents). The simulation experimentations 1 and 2 produced 146 pupil and 39 parental questionnaires as well as video interviews of volunteered pupils. The data were analysed both quantitatively using percentages and numerical frequencies and qualitatively employing thematic content analysis. Based on the data, language assessment in primary CLIL is not an established practice. It largely appears to be infrequent, incidental, implicit and based on impressions rather than evidence or the curriculum. The most used assessment methods were teacher observation, bilingual tests and dialogic interaction, and the least used were portfolios, simulations and peer assessment. Although language assessment was generally perceived as important by teachers, a fifth of them did not gather assessment information systematically, and 38% scarcely gave linguistic feedback to pupils. Both pupils and parents wished to receive more information on CLIL language issues; 91% of pupils claimed to receive feedback rarely or occasionally, and 63% of them wished to get more information on their linguistic coping in CLIL subjects. Of the parents, 76% wished to receive more information on the English proficiency of their children and their linguistic development. This may be a response to indirect feedback practices identified in this study. There are several challenges related to assessment; the most notable is the lack of a CLIL curriculum, language objectives and common ground principles of assessment. Three diverse approaches to language in CLIL that appear to affect teachers’ views on language assessment were identified: instrumental (language as a tool), dual (language as a tool and object of learning) and eclectic (miscellaneous views, e.g. affective factors prioritised). LangPerform computer simulations seem to be perceived as an appropriate alternative assessment method in CLIL. It is strongly recommended that the fundamentals for assessment (curricula and language objectives) and a mutual assessment scheme should be determined and stakeholders’ knowledge base of CLIL strengthened. The principles of adequate assessment in primary CLIL are identified as well as several appropriate assessment methods suggested.

Risk Assessment of Modern Landfill Structures in Finland

The purpose of this thesis was to investigate environmental permits of landfills with respect to the appropriateness of risk assessments focusing on contaminant migration, structures capable to protect the environment, waste and leachate management and existing environmental impacts of landfills. According to the requirements, a risk assessment is always required to demonstrate compliance with environmental protection requirements if the environmental permit decision deviates from the set requirements. However, there is a reason to doubt that all relevant risk factors are identified in current risk assessment practices in order to protect people end environment. In this dissertation, risk factors were recognized in 12 randomly selected landfills. Based on this analysis, a structural risk assessment method was created. The method was verified with two case examples. Several development needs were found in the risk assessments of the environmental permit decisions. The risk analysis equations used in the decisions did not adequately take into account all the determining factors like waste prospects, total risk quantification or human delineated factors. Instead of focusing on crucial factors, the landfill environmental protection capability is simply expressed via technical factors like hydraulic conductivity. In this thesis, it could be shown, that using adequate risk assessment approaches the most essential environmental impacts can be taken into account by consideration of contaminant transport mechanisms, leachate effects, and artificial landfill structures. The developed structural risk analysing (SRA) method shows, that landfills structures could be designed in a more cost-efficient way taking advantage of recycled or by-products. Additionally, the research results demonstrate that the environmental protection requirements of landfills should be updated to correspond to the capability to protect the environment instead of the current simplified requirements related to advective transport only.

Detecting Deceit – Guessing or Assessing? Study on the Applicability of Veracity Assessment Methods in Human Intelligence

Intelligence from a human source, that is falsely thought to be true, is potentially more harmful than a total lack of it. The veracity assessment of the gathered intelligence is one of the most important phases of the intelligence process. Lie detection and veracity assessment methods have been studied widely but a comprehensive analysis of these methods’ applicability is lacking. There are some problems related to the efficacy of lie detection and veracity assessment. According to a conventional belief an almighty lie detection method, that is almost 100% accurate and suitable for any social encounter, exists. However, scientific studies have shown that this is not the case, and popular approaches are often over simplified. The main research question of this study was: What is the applicability of veracity assessment methods, which are reliable and are based on scientific proof, in terms of the following criteria? o Accuracy, i.e. probability of detecting deception successfully o Ease of Use, i.e. easiness to apply the method correctly o Time Required to apply the method reliably o No Need for Special Equipment o Unobtrusiveness of the method In order to get an answer to the main research question, the following supporting research questions were answered first: What kinds of interviewing and interrogation techniques exist and how could they be used in the intelligence interview context, what kinds of lie detection and veracity assessment methods exist that are reliable and are based on scientific proof and what kind of uncertainty and other limitations are included in these methods? Two major databases, Google Scholar and Science Direct, were used to search and collect existing topic related studies and other papers. After the search phase, the understanding of the existing lie detection and veracity assessment methods was established through a meta-analysis. Multi Criteria Analysis utilizing Analytic Hierarchy Process was conducted to compare scientifically valid lie detection and veracity assessment methods in terms of the assessment criteria. In addition, a field study was arranged to get a firsthand experience of the applicability of different lie detection and veracity assessment methods. The Studied Features of Discourse and the Studied Features of Nonverbal Communication gained the highest ranking in overall applicability. They were assessed to be the easiest and fastest to apply, and to have required temporal and contextual sensitivity. The Plausibility and Inner Logic of the Statement, the Method for Assessing the Credibility of Evidence and the Criteria Based Content Analysis were also found to be useful, but with some limitations. The Discourse Analysis and the Polygraph were assessed to be the least applicable. Results from the field study support these findings. However, it was also discovered that the most applicable methods are not entirely troublefree either. In addition, this study highlighted that three channels of information, Content, Discourse and Nonverbal Communication, can be subjected to veracity assessment methods that are scientifically defensible. There is at least one reliable and applicable veracity assessment method for each of the three channels. All of the methods require disciplined application and a scientific working approach. There are no quick gains if high accuracy and reliability is desired. Since most of the current lie detection studies are concentrated around a scenario, where roughly half of the assessed people are totally truthful and the other half are liars who present a well prepared cover story, it is proposed that in future studies lie detection and veracity assessment methods are tested against partially truthful human sources. This kind of test setup would highlight new challenges and opportunities for the use of existing and widely studied lie detection methods, as well as for the modern ones that are still under development.

Demonstrating the importance of criteria and sub-criteria in building assessment methods

Building assessment methods have become a popular research field since the early 1990s. An international tool which allows the assessment of buildings in all regions, taking into account differences in climates, topographies and cultures does not yet exist. This paper aims to demonstrate the importance of criteria and sub-criteria in developing a new potential building assessment method for Saudi Arabia. Recently, the awareness of sustainability has been increasing in developing countries due to high energy consumption, pollution and high carbon foot print. There is no debate that assessment criteria have an important role to identify the tool’s orientation. However, various aspects influence the criteria and sub-criteria of assessment tools such as environment, economic, social and cultural to mention but a few. The author provides an investigation on the most popular and globally used schemes: BREEAM, LEED, Green Star, CASBEE and Estidama in order to identify the effectiveness of the different aspects of the assessment criteria and the impacts of these criteria on the assessment results; that will provide a solid foundation to develop an effective sustainable assessment method for buildings in Saudi Arabia. Initial results of the investigation suggest that each country needs to develop its own assessment method in order to achieve desired results, while focusing upon the indigenous environmental, economic, social and cultural conditions. Keywords: Assessment methods, BREEAM, LEED, Green Star, CASBEE, Estidama, sustainability, sustainable buildings, Environment, Saudi Arabia.

Comparing the fit between BREEAM assessment and design processes

This paper explores the mapping of the environmental assessment process onto design and construction processes. A comparative case study method is used to identify and account for variations in the ‘fit’ between these two processes. The analysis compares eight BREEAM projects (although relevant to LEED, GreenStar, etc.) and distinguishes project-level characteristics and dynamics. Drawing on insights from literature on sustainable construction and assessment methods, an analytic framework is developed to examine the effect of clusters of project and assessment level elements on different types of fit (tight, punctual and bolt-on). Key elements distinguishing between types include: prior working experience with project team members, individual commitment to sustainable construction, experience with sustainable construction, project continuity, project-level ownership of the assessment process, and the nature and continuity of assessor involvement. Professionals with ‘sustainable’ experience used BREEAM judiciously to support their designs (along with other frameworks), but less committed professionals tended to treat it purely as an assessment method. More attention needs to be paid to individual levels of engagement with, and understanding of, sustainability in general (rather than knowledge of technical solutions to individual credits), to ownership of the assessment process and to the potential effect of discontinuities at the project level on sustainable design.

Underreporting of Energy Intake in Brazilian Women Varies According to Dietary Assessment: A Cross-Sectional Study Using Doubly Labeled Water

Objective Underreporting of energy intake is prevalent in food surveys, but there is controversy about which dietary assessment method provides greater underreporting rates. Our objective is to compare validity of self-reported energy intake obtained by three dietary assessment methods with total energy expenditure (TEE) obtained by doubly labeled water (DLW) among Brazilian women. Design We used a cross-sectional study. Subjects/setting Sixty-five females aged 18 to 57 years (28 normal-weight, 10 over-weight, and 27 obese) were recruited from two universities to participate. Main outcome measures TEE determined by DLW, energy intake estimated by three 24-hour recalls, 3-day food record, and a food frequency questionnaire (FFQ). Statistical analyses performed Regression and analysis of variance with repeated measures compared TEE and energy intake values, and energy intake-to-TEE ratios and energy intake-TEE values between dietary assessment methods. Bland and Altman plots were provided for each method. chi(2) test compared proportion of underreporters between the methods. Results Mean TEE was 2,622 kcal (standard deviation [SD] =490 kcal), while mean energy intake was 2,078 kcal (SD=430 kcal) for the diet recalls; 2,044 kcal (SD=479 kcal) for the food record and 1,984 kcal (SD=832 kcal) for the FFQ (all energy intake values significantly differed from TEE; P<0.0001). Bland and Altman plots indicated great dispersion, negative mean differences between measurements, and wide limits of agreement. Obese subjects underreported more than normal-weight subjects in the diet recalls and in the food records, but not in the FFQ. Years of education, income and ethnicity were associated with reporting accuracy. Conclusions The FFQ produced greater under- and overestimation of energy intake. Underreporting of energy intake is a serious and prevalent error in dietary self-reports provided by Brazilian women, as has been described in studies conducted in developed countries.

Validity and feasibility of qualitative behavior assessment for the evaluation of Nellore cattle temperament

The aims of this study were to assess the validity and the feasibility of the qualitative behavior assessment (QBA) method as indicator of Nellore cattle temperament under field conditions, evaluating its associations with four other traditional methods and weight gain. The temperament and live weight of 2229 Nellore cattle was assessed at approximately 550 days of age. Five measurements of cattle temperament were recorded: flight speed test (FS, in m/s), visual scores of movement in the crush (MOV), crush score (CS), temperament score (TS), and the qualitative behavior assessment method (QBA), by using a list of 12 behavioral based adjectives as descriptors of temperament. Average daily weight gain (ADG) was calculated for each animal. For statistical analysis of QBA data, the Principal Component Analysis was used. A temperament index (TI) was defined for each animal using the scores for the first principal component. Pearson's correlation coefficients were estimated between TI with FS and ADG. A mixed model ANOVA was used to analyze the TI variation as a function of TS, CS, and MOV. The score plot for the first and second principal components was used to classify the cattle in four groups (from very bad to very good temperament). The first principal component explained 49.50% of the variation in the data set, with higher positive loadings for the adjectives 'agitated' and 'active', and higher negative loadings for 'calm' and 'relaxed'. TI was significantly correlated with FS (r=0.49; P<0.01) and ADG (r=-0.10; P<0.01). The means of ADG, FS, and the temperament scores (CS, TS, MOV) differed significantly (P<0.01) among the four groups, from very bad to very good temperament. The QBA method could discriminate different behavioral profiles of Nellore cattle and were in agreement with other traditional methods used as indicators of cattle temperament. Additional studies are needed to assess the inter- and intra-observers reliability and to study its association with physiological parameters. © 2013 Elsevier B.V.

Life cycle assessment applied to municipal solid waste management: a case study

This study analyzes the environmental performance of the Municipal Solid Waste Management System (MSWMS) of Piedade, São Paulo, from a systemic perspective. A life cycle assessment (LCA) technique was applied according to an attributional approach to evaluate both the current operational situation and different prospective scenarios, which were devised based on the application of targets for recycling dry and wet waste suggested by the pre-draft version of the Brazilian Plan for Solid Waste. The life cycle impact assessment method EcoIndicator 99, in association with normalization and weighting procedures, was used to conduct the analysis. It was observed that the adoption of goals of 30%, 50% and 70% for recovering of the recyclable dry waste, resulted in improvement of the environmental performance of the waste management system under analysis, respectively of 10%, 15% and 20%. It was also possible to detect an evolution in the order of 54% in reducing impacts resulting from the adoption of targets for composting. LCA proved to be effective for the evaluation of the environmental performance of MSWMS-Piedade. However, for future evaluations, the attributional approach should be replaced by the methodological practice of substitution to enable the avoided burdens to be considered in estimations of the environmental performance municipal solid waste management systems.

Bovine Teeth in Age Assessment, from Medieval Cattle to Belgian Blue : Methodology, Possibilities and Limitations

The overall aim of the present thesis was to develop and characterise an age assessment method based on incremental lines in dental cementum using contemporary bovine teeth and teeth from archaeological faunal assemblages. The investigations also included two other age assessment methods: tooth wear pattern and macroscopic dental measurements. The first permanent mandibular molar and lower jaws from 70 contemporary cattle of known age and 170 archaeological molar sets from ten different Swedish archaeological sites were used. The following conclusions were drawn: • The number of incremental lines in the dental cementum varied between different parts of the tooth root as well as within one and the same individual. The results from contemporary cattle of known age showed a strong relationship between age and incremental lines in the cementum of the distal part of the mesial root (R2=65.5%) and the known ages of the animals. • With the “best” model variation in age could be explained to 65.5% (R2) by the number of incremental lines. Thus, the remaining age variation (approximately 35%) could not be explained by these lines. Other factors than must thus be responsible. However, with the exception of calves born the present material did not reveal any such significant relationship. • The results from cattle of known age indicate that the method of assessing age on the basis of cemental incremental lines is more reliable than other methods such as tooth wear or tooth measurements. However, by combining counting incremental lines and one variable assessing tooth dimension (tooth height) a slightly stronger relationship could be obtained (R2=74.5%). The results from age assessment of the medieval and post-Reformation cattle emphasize the importance of supplementing any age estimation of archaeological assemblages based on dental indicators with characteristics for the particular assessment model. Furthermore, conclusions based on age assessment with such models can not be drawn with any more detailed time scale than about 2 years leaving at best only 25% (R2) of factors influencing the dental indicator(s) utilized in the model unexplained. The accuracy of the age assessment required by the particular historical context in which the archaeological remains are found should thus decide what level of accuracy should be chosen.

Automatic Food Intake Assessment Using Camera Phones

Obesity is becoming an epidemic phenomenon in most developed countries. The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. It is essential to monitor everyday food intake for obesity prevention and management. Existing dietary assessment methods usually require manually recording and recall of food types and portions. Accuracy of the results largely relies on many uncertain factors such as user's memory, food knowledge, and portion estimations. As a result, the accuracy is often compromised. Accurate and convenient dietary assessment methods are still blank and needed in both population and research societies. In this thesis, an automatic food intake assessment method using cameras, inertial measurement units (IMUs) on smart phones was developed to help people foster a healthy life style. With this method, users use their smart phones before and after a meal to capture images or videos around the meal. The smart phone will recognize food items and calculate the volume of the food consumed and provide the results to users. The technical objective is to explore the feasibility of image based food recognition and image based volume estimation. This thesis comprises five publications that address four specific goals of this work: (1) to develop a prototype system with existing methods to review the literature methods, find their drawbacks and explore the feasibility to develop novel methods; (2) based on the prototype system, to investigate new food classification methods to improve the recognition accuracy to a field application level; (3) to design indexing methods for large-scale image database to facilitate the development of new food image recognition and retrieval algorithms; (4) to develop novel convenient and accurate food volume estimation methods using only smart phones with cameras and IMUs. A prototype system was implemented to review existing methods. Image feature detector and descriptor were developed and a nearest neighbor classifier were implemented to classify food items. A reedit card marker method was introduced for metric scale 3D reconstruction and volume calculation. To increase recognition accuracy, novel multi-view food recognition algorithms were developed to recognize regular shape food items. To further increase the accuracy and make the algorithm applicable to arbitrary food items, new food features, new classifiers were designed. The efficiency of the algorithm was increased by means of developing novel image indexing method in large-scale image database. Finally, the volume calculation was enhanced through reducing the marker and introducing IMUs. Sensor fusion technique to combine measurements from cameras and IMUs were explored to infer the metric scale of the 3D model as well as reduce noises from these sensors.