Linfoma esofágico primário

We describe the case of a 54 year old woman seen with an esophageal mass diagnosed as a primary esophageal lymphoma. The main symptom was dysphagia of seven months duration. The treatment consisted in resection of the tumor, and reconstruction of the defect with a reversed pleural flap, followed by a chemotherapy regimen that consisted of five drugs, cyclophosphamid, prednisone, doxorubicin, rituximab and vincristine (R-CHOP). The patient developed an esophageal pleural fistula treated with pleural drainage and irrigation that closed in 45 days. Two and one half years later she is doing well and disease free.

Pienen kiinteistösijoitusyhtiön kasvustrategia

Tämän pro gradu-tutkielman tarkoituksena oli tutkia minkälaisia kasvupyrkimyksiä Suomessa toimivilla pienillä kiinteistösijoittajilla tai kiinteistösijoitusyhtiöillä on. Tutkimuksen pohjaksi esiteltiin yrityksen strategiateoriaa ja kasvun malleja pienyritysnäkökulmasta. Tutkimuksen tulokset voivat antaa yrittäjille mietteitä kasvamisen suunnitelmallisuudesta ja sen hyödyistä. Tutkimusosuus suoritettiin laadullisena tutkimuksena. Aineisto kerättiin haastattelemalla 16 pientä kiinteistösijoittajaa nettipohjaisen kyselyn avulla. Painopiste oli vapaissa vastauksissa ja tällä pyrittiin saamaan laajoja mielipiteitä. Kohdeyritykset valittiin sattumalta tutkijan lähipiiriin kuuluvien yrittäjien avulla. Maantieteellinen jakauma oli laaja, koko maan kattava. Kohdeyrityksistä haastateltiin yhtä henkilöä, joka oli tyypillisesti yrityksen omistaja. Haastatteluista saatua materiaalia analysoitiin strategisten näkemysten ja yrityksen kasvuteorioiden valossa. Tutkimuksessa todettiin, että pienyrittäjät suhtautuvat kiinteistösijoittamiseen lähinnä säästämismuotona eikä niinkään systemaattisena yrittämisenä. Useat vastaajat tekivät kiinteistösijoittamista osa-aikaisesti. Kasvua tavoittelee kyllä valtaosa yrityksistä, mutta sen eteen ei tehdä juuri mitään. Odotellaan vain sopivia kohteita ostettavaksi. Kasvamisen määrä riippuu hyvin pitkälti yrittäjän persoonasta. Jos yrittäjä on kunnianhimoinen toiminnan kasvattaja, niin se heijastuu myös hänen harjoittamaan kiinteistösijoittamiseen.

Strategic searching and controlled vocabulary

Using free text and controlled vocabulary in Medline and CINAHL

Module Evaluation template for use with zappers

This PowerPoint file can be used to run an end-of-module evaluation survey with the students providing their feedback using Turning Point zappers. It includes all the questions from the standard university survey (2011) except the three that require free-text-entry. You will need to edit the template so that it includes your module name and tutor name(s) - you may want to edit or delete some of the questions as well.

Information skills for research - basic

Search strategy and free text searching of database resources for Health Sciences

Training pharmacists to deliver a complex information technology intervention (PINCER) using the principles of educational outreach and root cause analysis

Objective: To describe the training undertaken by pharmacists employed in a pharmacist-led information technology-based intervention study to reduce medication errors in primary care (PINCER Trial), evaluate pharmacists’ assessment of the training, and the time implications of undertaking the training. Methods: Six pharmacists received training, which included training on root cause analysis and educational outreach, to enable them to deliver the PINCER Trial intervention. This was evaluated using self-report questionnaires at the end of each training session. The time taken to complete each session was recorded. Data from the evaluation forms were entered onto a Microsoft Excel spreadsheet, independently checked and the summary of results further verified. Frequencies were calculated for responses to the three-point Likert scale questions. Free-text comments from the evaluation forms and pharmacists’ diaries were analysed thematically. Key findings: All six pharmacists received 22 hours of training over five sessions. In four out of the five sessions, the pharmacists who completed an evaluation form (27 out of 30 were completed) stated they were satisfied or very satisfied with the various elements of the training package. Analysis of free-text comments and the pharmacists’ diaries showed that the principles of root cause analysis and educational outreach were viewed as useful tools to help pharmacists conduct pharmaceutical interventions in both the study and other pharmacy roles that they undertook. The opportunity to undertake role play was a valuable part of the training received. Conclusions: Findings presented in this paper suggest that providing the PINCER pharmacists with training in root cause analysis and educational outreach contributed to the successful delivery of PINCER interventions and could potentially be utilised by other pharmacists based in general practice to deliver pharmaceutical interventions to improve patient safety.

MOLES3: implementing an ISO standards driven data catalogue

ISO19156 Observations and Measurements (O&M) provides a standardised framework for organising information about the collection of information about the environment. Here we describe the implementation of a specialisation of O&M for environmental data, the Metadata Objects for Linking Environmental Sciences (MOLES3). MOLES3 provides support for organising information about data, and for user navigation around data holdings. The implementation described here, “CEDA-MOLES”, also supports data management functions for the Centre for Environmental Data Archival, CEDA. The previous iteration of MOLES (MOLES2) saw active use over five years, being replaced by CEDA-MOLES in late 2014. During that period important lessons were learnt both about the information needed, as well as how to design and maintain the necessary information systems. In this paper we review the problems encountered in MOLES2; how and why CEDA-MOLES was developed and engineered; the migration of information holdings from MOLES2 to CEDA-MOLES; and, finally, provide an early assessment of MOLES3 (as implemented in CEDA-MOLES) and its limitations. Key drivers for the MOLES3 development included the necessity for improved data provenance, for further structured information to support ISO19115 discovery metadata export (for EU INSPIRE compliance), and to provide appropriate fixed landing pages for Digital Object Identifiers (DOIs) in the presence of evolving datasets. Key lessons learned included the importance of minimising information structure in free text fields, and the necessity to support as much agility in the information infrastructure as possible without compromising on maintainability both by those using the systems internally and externally (e.g. citing in to the information infrastructure), and those responsible for the systems themselves. The migration itself needed to ensure continuity of service and traceability of archived assets.

Sensitivity of complex networks measurements

Complex networks obtained from real-world networks are often characterized by incompleteness and noise, consequences of imperfect sampling as well as artifacts in the acquisition process. Because the characterization, analysis and modeling of complex systems underlain by complex networks are critically affected by the quality and completeness of the respective initial structures, it becomes imperative to devise methodologies for identifying and quantifying the effects of the sampling on the network structure. One way to evaluate these effects is through an analysis of the sensitivity of complex network measurements to perturbations in the topology of the network. In this paper, measurement sensibility is quantified in terms of the relative entropy of the respective distributions. Three particularly important kinds of progressive perturbations to the network are considered, namely, edge suppression, addition and rewiring. The measurements allowing the best balance of stability (smaller sensitivity to perturbations) and discriminability (separation between different network topologies) are identified with respect to each type of perturbation. Such an analysis includes eight different measurements applied on six different complex networks models and three real-world networks. This approach allows one to choose the appropriate measurements in order to obtain accurate results for networks where sampling bias cannot be avoided-a very frequent situation in research on complex networks.

A Robust, Fully Adaptive Hybrid Level-Set/Front-Tracking Method for Two-Phase Flows with an Accurate Surface Tension Computation

We present a variable time step, fully adaptive in space, hybrid method for the accurate simulation of incompressible two-phase flows in the presence of surface tension in two dimensions. The method is based on the hybrid level set/front-tracking approach proposed in [H. D. Ceniceros and A. M. Roma, J. Comput. Phys., 205, 391400, 2005]. Geometric, interfacial quantities are computed from front-tracking via the immersed-boundary setting while the signed distance (level set) function, which is evaluated fast and to machine precision, is used as a fluid indicator. The surface tension force is obtained by employing the mixed Eulerian/Lagrangian representation introduced in [S. Shin, S. I. Abdel-Khalik, V. Daru and D. Juric, J. Comput. Phys., 203, 493-516, 2005] whose success for greatly reducing parasitic currents has been demonstrated. The use of our accurate fluid indicator together with effective Lagrangian marker control enhance this parasitic current reduction by several orders of magnitude. To resolve accurately and efficiently sharp gradients and salient flow features we employ dynamic, adaptive mesh refinements. This spatial adaption is used in concert with a dynamic control of the distribution of the Lagrangian nodes along the fluid interface and a variable time step, linearly implicit time integration scheme. We present numerical examples designed to test the capabilities and performance of the proposed approach as well as three applications: the long-time evolution of a fluid interface undergoing Rayleigh-Taylor instability, an example of bubble ascending dynamics, and a drop impacting on a free interface whose dynamics we compare with both existing numerical and experimental data.

User perspectives on the Swedish Maternal Health Care Register

Background: Established in 1999, the Swedish Maternal Health Care Register (MHCR) collects data on pregnancy, birth, and the postpartum period for most pregnant women in Sweden. Antenatal care (ANC) midwives manually enter data into the Web-application that is designed for MHCR. The aim of this study was to investigate midwives? experiences, opinions and use of the MHCR. Method: A national, cross-sectional, questionnaire survey, addressing all Swedish midwives working in ANC, was conducted January to March 2012. The questionnaire included demographic data, preformed statements with six response options ranging from zero to five (0 = totally disagree and 5 = totally agree), and opportunities to add information or further clarification in the form of free text comments. Parametric and non-parametric methods and logistic regression analyses were applied, and content analysis was used for free text comments. Results: The estimated response rate was 53.1%. Most participants were positive towards the Web-application and the included variables in the MHCR. Midwives exclusively engaged in patient-related work tasks perceived the register as burdensome (70.3%) and 44.2% questioned the benefit of the register. The corresponding figures for midwives also engaged in administrative supervision were 37.8% and 18.5%, respectively. Direct electronic transfer of data from the medical records to the MHCR was emphasised as significant future improvement. In addition, the midwives suggested that new variables of interest should be included in the MHCR ? e.g., infertility, outcomes of previous pregnancy and birth, and complications of the index pregnancy. Conclusions: In general, the MHCR was valued positively, although perceived as burdensome. Direct electronic transfer of data from the medical records to the MHCR is a prioritized issue to facilitate the working situation for midwives. Finally, the data suggest that the MHCR is an underused source for operational planning and quality assessment in local ANC centres.

Televisão universitária do RN (TVU): contribuição para a democratização da informação e a difusão do conhecimento científico produzido pela universidade

In this thesis we propose to investigate the contribution that the Universitary Television from Rio Grande do Norte state, Brazil (TVU RN), offers to democratization of information and diffusion of the scientific knowledge produced by the Federal University of Rio Grande do Norte (UFRN) from the perception of their own students. We adopt the basic assumption in wich the TVU RN needs to be connected with the scope of the current UFRN policy, since plays an important role regarding democratization and social inclusion policies in UFRN. We support the thesis that TVU UFRN offers important information for those who are part of academic culture (COULON, 1995a; 1995b, CHARLOT, 2000; BOURDIEU, 2007, 2005, 1997, 1996, 1975), as well as for society in wich it is inserted, since it contributes to the dissemination of scientific knowledge and relevant information about the university. We consider TVU RN a Public Sphere (HABERMAS, 2002; 2003a, 2003b; 2003c; 1999; 1989) conducive to discussion of issues involving higher education. Researches on Universitary Television are recent and some studies on it advanced in the way to define it and present it as a means of dissemination of scientific knowledge (ROCHA, 2006; COUTINHO, 2006; CALLIGARO, 2007; AIRES, 1999; PORCELLO, 2002; PRIOLLI, 2003, 2008, 2009; MAGALHÃES, 2002, 2008; RAMALHO, 2008; 2010; CARVALHO, 2006). For our investigation we chose the combination of quantitative and qualitative methods, both equally valid and accepted by many authors (FLICK, 2009; BAUER; GASKELL, 2002; RICHARDSON, 1999; LAVILLE; DIONNE, 1999). We developed a questionnaire initially with objective questions ending up with open questions of free text. The questionnaire was developed and hosted from a tool of Google Docs and the link to the webpage containing those questionnaires was sent by e-mail by the Permanent Commission of Vestibular of UFRN, COMPERVE, for all university students who were with their registration (status) active in the COMPERVE registers of the second half of 2010. The analysis of this material was performed using the techniques of content analysis and, within this mode was chosen thematic analysis considered appropriate for both qualitative and quantitative research (BARDIN, 2004; MINAYO, 2002). The investigation found that although most students consider that the TVU RN contributes to the democratization of information and dissemination of scientific knowledge produced in university, and moreover to arouse the interest of the academic community, still has not yet become an object of interest of the entire academy. Therefore, the research highlights the relevance and abrangency of further studies on the TVU RN due to the strategic role it plays in this new reality of public universities in the country. In addition, we suggest to the UFRN managers that they put TVU within the hall of discussions in order to receive the so much needed investment for any university organ

Futebol, poesia e drama: o espetáculo

O que seria necessário para que se pudesse dizer que uma partida de futebol semelha de alguma forma a um espetáculo teatral, poético, emocional? O artigo propõe um passeio livre pela história dos diferentes tipos de teatro e pelas mudanças sofridas ao longo dos anos. A autora lembra que existe, da metade do século passado para cá, uma nítida divisão que colocou em campos opostos o teatro dramático e o teatro épico, o drama rigoroso contra o texto quase absolutamente livre, Aristóteles contra Brecht. E volta a apresentar as razões pela qual se pode afirmar que existem certos momentos no futebol que o aproximam ainda mais do espetáculo teatral, da dança, da comédia e do drama

Exploring the validity and reliability of a questionnaire for evaluating virtual patient design with a special emphasis on fostering clinical reasoning

Background: The design of Virtual Patients (VPs) is essential. So far there are no validated evaluation instruments for VP design published. Summary of work: We examined three sources of validity evidence of an instrument to be filled out by students aimed at measuring the quality of VPs with a special emphasis on fostering clinical reasoning: (1) Content was examined based on theory of clinical reasoning and an international VP expert team. (2) Response process was explored in think aloud pilot studies with students and content analysis of free text questions accompanying each item of the instrument. (3) Internal structure was assessed by confirmatory factor analysis (CFA) using 2547 student evaluations and reliability was examined utilizing generalizability analysis. Summary of results: Content analysis was supported by theory underlying Gruppen and Frohna’s clinical reasoning model on which the instrument is based and an international VP expert team. The pilot study and analysis of free text comments supported the validity of the instrument. The CFA indicated that a three factor model comprising 6 items showed a good fit with the data. Alpha coefficients per factor were 0,74 - 0,82. The findings of the generalizability studies indicated that 40-200 student responses are needed in order to obtain reliable data on one VP. Conclusions: The described instrument has the potential to provide faculty with reliable and valid information about VP design. Take-home messages: We present a short instrument which can be of help in evaluating the design of VPs.

Individual Video Training iVT and Annotating Academic Videos AAV: two complementing technologies

Individual Video Training iVT and Annotating Academic Videos AAV: two complementing technologies 1. Recording communication skills training sessions and reviewing them by oneself, with peers, and with tutors has become standard in medical education. Increasing numbers of students paired with restrictions of financial and human resources create a big obstacle to this important teaching method. 2. Everybody who wants to increase efficiency and effectiveness of communication training can get new ideas from our technical solution. 3. Our goal was to increase the effectiveness of communication skills training by supporting self, peer and tutor assessment over the Internet. Two technologies of SWITCH, the national foundation to support IT solutions for Swiss universities, came handy for our project. The first is the authentication and authorization infrastructure providing all Swiss students with a nationwide single login. The second is SWITCHcast which allows automated recording, upload and publication of videos in the Internet. Students start the recording system by entering their single login. This automatically links the video with their password. Within a few hours, they find their video password protected on the Internet. They now can give access to peers and tutors. Additionally, an annotation interface was developed. This software has free text as well as checklist annotations capabilities. Tutors as well as students can create checklists. Tutor’s checklists are not editable by students. Annotations are linked to tracks. Tracks can be private or public. Public means visible to all who have access to the video. Annotation data can be exported for statistical evaluation. 4. The system was well received by students and tutors. Big numbers of videos were processed simultaneously without any problems. 5. iVT http://www.switch.ch/aaa/projects/detail/UNIBE.7 AAV http://www.switch.ch/aaa/projects/detail/ETHZ.9

Development, implementation, and evaluation of a structured reporting web tool for abdominal aortic aneurysms

BACKGROUND The majority of radiological reports are lacking a standard structure. Even within a specialized area of radiology, each report has its individual structure with regards to details and order, often containing too much of non-relevant information the referring physician is not interested in. For gathering relevant clinical key parameters in an efficient way or to support long-term therapy monitoring, structured reporting might be advantageous. OBJECTIVE Despite of new technologies in medical information systems, medical reporting is still not dynamic. To improve the quality of communication in radiology reports, a new structured reporting system was developed for abdominal aortic aneurysms (AAA), intended to enhance professional communication by providing the pertinent clinical information in a predefined standard. METHODS Actual state analysis was performed within the departments of radiology and vascular surgery by developing a Technology Acceptance Model. The SWOT (strengths, weaknesses, opportunities, and threats) analysis focused on optimization of the radiology reporting of patients with AAA. Definition of clinical parameters was achieved by interviewing experienced clinicians in radiology and vascular surgery. For evaluation, a focus group (4 radiologists) looked at the reports of 16 patients. The usability and reliability of the method was validated in a real-world test environment in the field of radiology. RESULTS A Web-based application for radiological "structured reporting" (SR) was successfully standardized for AAA. Its organization comprises three main categories: characteristics of pathology and adjacent anatomy, measurements, and additional findings. Using different graphical widgets (eg, drop-down menus) in each category facilitate predefined data entries. Measurement parameters shown in a diagram can be defined for clinical monitoring and be adducted for quick adjudications. Figures for optional use to guide and standardize the reporting are embedded. Analysis of variance shows decreased average time required with SR to obtain a radiological report compared to free-text reporting (P=.0001). Questionnaire responses confirm a high acceptance rate by the user. CONCLUSIONS The new SR system may support efficient radiological reporting for initial diagnosis and follow-up for AAA. Perceived advantages of our SR platform are ease of use, which may lead to more accurate decision support. The new system is open to communicate not only with clinical partners but also with Radiology Information and Hospital Information Systems.