Entwicklung eines deutschsprachigen Fragebogens zur Durchführung von Multisource-Feedback in der ärztlichen Weiterbildung

Fragestellung/Einleitung: Multisource-Feedback (MSF) ist ein anerkanntes Instrument zur Überprüfung und Verbesserung der ärztlichen Tätigkeit [1]. Es beinhaltet Feedback, das von MitarbeiterInnen verschiedener Tätigkeitsbereiche und verschiedener Hierarchiestufen gegeben wird. Das Feedback wird anonym mithilfe eines Fragebogens gegeben, der verschiedene Kriterien der ärztlichen Kompetenz beschreibt. Das Feedback wird anschlieβend für die zu beurteilenden ÄrztInnen in einem Gespräch von einer/m SupervisorIn zusammengefasst. Bislang existiert kein deutschsprachiger Fragebogen für Multisource-Feedback für die ärztliche Tätigkeit. Unsere Zielsetzung war es daher, einen deutschsprachigen Fragebogen zu erstellen und diesen bzgl. relevanter Validitätskriterien zu untersuchen. Methoden: Zur Erstellung des Fragebogens sammelten wir die beste verfügbare Evidenz der entsprechenden Literatur. Wir wählten einen validierten englischen Fragebogen, der bereits in der Weiterbildung in Groβbritannien angewendet wird [2] und den wichtigsten Kriterien entspricht. Dieser wurde übersetzt und in einigen Bereichen erweitert, um ihn sprachlichen Gegebenheiten und lokalen Bedürfnissen anzupassen. Bezüglich der Validität wurden zwei Kriterien untersucht: Inhaltsvalidität (content validity evidence) und Antwortprozesse (response process validity evidence). Um die Inhaltsvalidität zu untersuchen, wurde in einer Expertenrunde diskutiert, ob der übersetzte Fragebogen die erwarteten Kompetenzen widerspiegelt. Im Anschluss wurden die Antwortprozesse mithilfe eines sog. „think-alouds“ mit ÄrztInnen in Weiterbildung und ihren AusbilderInnen untersucht. Ergebnisse: Der resultierende Fragebogen umfasst 20 Fragen. Davon sind 15 Items den Bereichen „Klinische Fähigkeiten“, „Umgang mit Patienten“, „Umgang mit Kollegen“ und „Arbeitsweise“ zuzuordnen. Diese Fragen werden auf einer fünfstufigen Likert-Skala beantwortet. Zusätzlich bietet jede Frage die Möglichkeit, einen Freitext zu besonderen Stärken und Schwächen der KandidatInnen aufzuführen. Weiterhin gibt es fünf globale Fragen zu Stärken und Verbesserungsmöglichkeiten, äuβeren Einflüssen, den Arbeitsbedingungen und nach Zweifeln an der Gesundheit oder Integrität des Arztes/ der Ärztin. In der Expertenrunde wurde der Fragebogen als für den deutschsprachigen Raum ohne Einschränkungen anwendbar eingeschätzt. Die Analyse der Antwortprozesse führte zu kleineren sprachlichen Anpassungen und bestätigt, dass der Fragebogen verständlich und eindeutig zu beantworten ist und das gewählte Konstrukt der ärztlichen Tätigkeit vollständig umschreibt. Diskussion/Schlussfolgerung: Wir entwickelten einen deutschsprachigen Fragebogen zur Durchführung von Multisource-Feedback in der ärztlichen Weiterbildung. Wir fanden Hinweise für die Validität dieses Fragebogens bzgl. des Inhalts und der Antwortprozesse. Zusätzliche Untersuchungen zur Validität wie z.B. die durch den Fragebogen entstehenden Auswirkungen (consequences) sind vorgesehen. Dieser Fragebogen könnte zum breiteren Einsatz von MSF in der ärztlichen Weiterbildung auch im deutschsprachigen Raum beitragen. This is an Open Access article distributed under the terms of the Creative Commons Attribution License. You are free: to Share - to copy, distribute and transmit the work, provided the original author and source are credited. See license information at http://creativecommons.org/licenses/by-nc-nd/3.0/.

The unstable CO2 feedback cycle on ocean planets

Ocean planets are volatile-rich planets, not present in our Solar system, which are thought to be dominated by deep, global oceans. This results in the formation of high-pressure water ice, separating the planetary crust from the liquid ocean and, thus, also from the atmosphere. Therefore, instead of a carbonate-silicate cycle like on the Earth, the atmospheric carbon dioxide concentration is governed by the capability of the ocean to dissolve carbon dioxide (CO2). In our study, we focus on the CO2 cycle between the atmosphere and the ocean which determines the atmospheric CO2 content. The atmospheric amount of CO2 is a fundamental quantity for assessing the potential habitability of the planet's surface because of its strong greenhouse effect, which determines the planetary surface temperature to a large degree. In contrast to the stabilizing carbonate-silicate cycle regulating the long-term CO2 inventory of the Earth atmosphere, we find that the CO2 cycle feedback on ocean planets is negative and has strong destabilizing effects on the planetary climate. By using a chemistry model for oceanic CO2 dissolution and an atmospheric model for exoplanets, we show that the CO2 feedback cycle can severely limit the extension of the habitable zone for ocean planets.

Strontium isotopes, ages and carbonate content of sediments from the Agulhas Current

The Agulhas Leakage represents a significant portion of the warm, surface return flow of the global overturning circulation and thus may be an important feedback in the ocean climate system. Models indicate that reduced leakage could be caused by a stronger Agulhas Current and/or a more upstream (eastward) Agulhas Retroflection, while a weaker Agulhas Current would result in a more westward retroflection and increased leakage. However, data for the Last Glacial Maximum support both a weaker Agulhas Current and less leakage, implying a possible displacement of the retroflection. We present new 87Sr/86Sr results for modern sediments within this region, confirming that the modern pathway of the Agulhas Current, Retroflection, and Leakage can be traced by terrigenous sediment provenance using Sr isotopes. New 87Sr/86Sr data from sediments deposited during the Last Glacial Maximum suggest that the glacial Agulhas Current and Retroflection followed nearly their modern trajectory. The provenance data appear to rule out both a stronger Agulhas Current and a more upstream Agulhas Retroflection. We conclude that the reduced glacial leakage was caused by the weakened Agulhas Current, with no significant change in the retroflection position. This is inconsistent with the model predictions and thus emphasizes the need for further work in this region.

Knowledgeable Feedback via a Cast of Virtual Characters with Different Competences

DynaLearn (http://www.DynaLearn.eu) develops a cognitive artefact that engages learners in an active learning by modelling process to develop conceptual system knowledge. Learners create external representations using diagrams. The diagrams capture conceptual knowledge using the Garp3 Qualitative Reasoning (QR) formalism [2]. The expressions can be simulated, confronting learners with the logical consequences thereof. To further aid learners, DynaLearn employs a sequence of knowledge representations (Learning Spaces, LS), with increasing complexity in terms of the modelling ingredients a learner can use [1]. An online repository contains QR models created by experts/teachers and learners. The server runs semantic services [4] to generate feedback at the request of learners via the workbench. The feedback is communicated to the learner via a set of virtual characters, each having its own competence [3]. A specific feedback thus incorporates three aspects: content, character appearance, and a didactic setting (e.g. Quiz mode). In the interactive event we will demonstrate the latest achievements of the DynaLearn project. First, the 6 learning spaces for learners to work with. Second, the generation of feedback relevant to the individual needs of a learner using Semantic Web technology. Third, the verbalization of the feedback via different animated virtual characters, notably: Basic help, Critic, Recommender, Quizmaster & Teachable agen

A scalable approach for content based image retrieval in cloud datacenter

The emergence of cloud datacenters enhances the capability of online data storage. Since massive data is stored in datacenters, it is necessary to effectively locate and access interest data in such a distributed system. However, traditional search techniques only allow users to search images over exact-match keywords through a centralized index. These techniques cannot satisfy the requirements of content based image retrieval (CBIR). In this paper, we propose a scalable image retrieval framework which can efficiently support content similarity search and semantic search in the distributed environment. Its key idea is to integrate image feature vectors into distributed hash tables (DHTs) by exploiting the property of locality sensitive hashing (LSH). Thus, images with similar content are most likely gathered into the same node without the knowledge of any global information. For searching semantically close images, the relevance feedback is adopted in our system to overcome the gap between low-level features and high-level features. We show that our approach yields high recall rate with good load balance and only requires a few number of hops.

Nitric oxide synthase content of hypothalamic explants: increase by norepinephrine and inactivated by NO and cGMP.

Release of luteinizing hormone (LH)-releasing hormone (LHRH), the hypothalamic peptide that controls release of LH from the adenohypophysis, is controlled by NO. There is a rich plexus of nitric oxide synthase (NOS)-containing neurons and fibers in the lateral median eminence, intermingled with terminals of the LHRH neurons. To study relations between NOS and LHRH in this brain region, we measured NOS activity in incubated medial basal hypothalamus (MBH). NOS converts [14C]arginine to equimolar quantities of [14C]citrulline plus NO, which rapidly decomposes. The [14C]citrulline serves as an index of the NO produced. NOS basal activity was suppressed by incubation of the tissue with an inhibitor of NOS, nitroarginine methyl ester (NAME) (10(-5) M). Furthermore, incubation of MBH explants for 30 min with norepinephrine (NE) increased NOS activity and the increase was prevented by prazosine (10(-5) M), an alpha 1-adrenergic receptor blocker; however, direct addition of NE to the tissue homogenate or to a preparation of MBH synaptosomes did not alter enzyme activity, which suggested that NE increased the content of NOS during incubation with the tissue. After purification of NOS, the increase in enzyme content induced by NE was still measurable. This indicates that within 30 min NE increased the synthesis of NOS in vitro. Incubation of MBH or the MBH homogenate with various concentrations of sodium nitroprusside (NP), a releaser of NO, reduced NOS activity at high concentrations (> or = 0.9 mM), which were associated with either a reduction of stimulation or a plateau of LHRH release. Finally, incubation of either MBH or the homogenate with cGMP, a major mediatior of NO action, at concentrations that increased LHRH release also reduced NOS activity. These results indicate that NO at high concentrations can inactivate NOS and that cGMP can also inhibit the enzyme directly. Therefore, the increased NOS activity induced by activation of alpha 1 receptors by NE is inhibited by NO itself and a principal product of its activity, cGMP, providing negative feedback on NOS. In central nervous system (CNS) infections with high concentrations of inducible NOS produced by glial elements, the high concentrations of NO and cGMP produced may suppress LHRH release, resulting in decreased gonadotropin and gonadal steroid release.

(Table 2) Protein and fibre content of important food plants of barnacle geese (Branta leucopsis) in Adventdalen

Goose grazing on arctic tundra vegetation has shown both positive and negative effects on subsequent foraging conditions. To understand the potential of a density-dependent feedback on herbivore population size, the relation between grazing pressure and future foraging conditions is essential. We studied the effect of increasing grazing pressure of barnacle geese (Branta leucopsis) on Spitsbergen. During the establishment of a breeding colony in the period 1992-2004, the proportion of graminoids decreased in the diet of wild geese, while the percentage of mosses increased. Grazing trials with captive geese in an unexploited area showed a similar shift in diet composition. High-quality food plants were depleted within years and over years. Intake rate declined too and as consequence, metabolisable energy intake rate (MEIR) decreased rapidly with increasing grazing pressure. During three successive years of experimental grazing, MEIR decreased at all levels of grazing pressure and declined below minimal energetic requirements when grazing exceeded natural levels of grazing pressure. This suggests that foraging conditions rapidly decline with increasing grazing pressure in these low-productive habitats. The potential for density-dependent feedbacks on local population increase is discussed.

A four-factor user interaction model for content-based image retrieval

In order to bridge the “Semantic gap”, a number of relevance feedback (RF) mechanisms have been applied to content-based image retrieval (CBIR). However current RF techniques in most existing CBIR systems still lack satisfactory user interaction although some work has been done to improve the interaction as well as the search accuracy. In this paper, we propose a four-factor user interaction model and investigate its effects on CBIR by an empirical evaluation. Whilst the model was developed for our research purposes, we believe the model could be adapted to any content-based search system.

Enabling effective user interactions in content-based image retrieval

This paper presents an interactive content-based image retrieval framework—uInteract, for delivering a novel four-factor user interaction model visually. The four-factor user interaction model is an interactive relevance feedback mechanism that we proposed, aiming to improve the interaction between users and the CBIR system and in turn users overall search experience. In this paper, we present how the framework is developed to deliver the four-factor user interaction model, and how the visual interface is designed to support user interaction activities. From our preliminary user evaluation result on the ease of use and usefulness of the proposed framework, we have learnt what the users like about the framework and the aspects we could improve in future studies. Whilst the framework is developed for our research purposes, we believe the functionalities could be adapted to any content-based image search framework.

Hotel Guest e-questionnaires: Implications for Feedback and Relationships

This paper examines the reliability and efficacy of hotel guest e-mail questionnaire compared to the paper questionnaire in the Asian Pacific context. Conducted inPerth,SingaporeandPenang, cities with mature hospitality and tourism industries and a representation of chain and independent deluxe hotels, this exploratory qualitative study examines hotelier views of e-mail guest communication derived from content analysis of guest questionnaires format and content and in-depth interviews with senior hoteliers. The findings indicated that e-questionnaires manifested as e-mails, as a direct replacement of the paper questionnaire, appear to be premature given divergent hotelier views and shortcomings in e-mail response administration. If properly executed, e-mail can play an increasingly important adjunct role to the paper guest questionnaire as a part of a multi-channel approach. The balance/relationship between ‘high tech’ and ‘high touch’ needs to be maintained: the latter can enhance the latter but should not undermine it.

Calcium carbonate content in surface sediments and benthic fauna on Antarctic shelves

We analyzed 214 new core-top samples for their CaCO3 content from shelves all around Antarctica in order to understand their distribution and contribution to the marine carbon cycle. The distribution of sedimentary CaCO3 on the Antarctic shelves is connected to environmental parameters where we considered water depth, width of the shelf, sea-ice coverage and primary production. While CaCO3 contents of surface sediments are usually low, high(> 15%) CaCO3 contents occur at shallow water depths (150-200 m) on narrow shelves of the eastern Weddell Sea and at a depth range of 600-900 m on the broader and deeper shelves of the Amundsen, Bellingshausen and western Weddell Seas. Regions with high primary production, such as the Ross Sea and the western Antarctic Peninsula region, have generally low CaCO3 contents in the surface sediments. The predominant mineral phase of CaCO3 on the Antarctic shelves is low-magnesium calcite. With respect to ocean acidification, our findings suggest that dissolution of carbonates in Antarctic shelf sediments may be an important negative feedback only after the onset of calcite undersaturation on the Antarctic shelves. Macrozoobenthic CaCO3 standing stocks do not increase the CaCO3 budget significantly as they are two orders of magnitude lower than the budget of the sediments. This first circumpolar compilation of Antarctic shelf carbonate data does not claim to be complete. Future studies are encouraged and needed to fill data gaps especially in the under-sampled southwest Pacific and Indian Ocean sectors of the Southern Ocean.

Clay-mineral composition and biogenic opal content of Late Neogene to Quaternary sediments of the Antarctic Peninsula region

Clay-mineral composition and biogenic opal content in upper Miocene to Quaternary drift sediments recovered at two Ocean Drilling Program (ODP) sites from the continental rise in the Bellingshausen Sea had been analyzed in order to reconstruct the climatic and glacial history of the Antarctic Peninsula. The clay mineral composition at both sites is dominated by smectite, illite, and chlorite, and alternates between a smectite-enriched and a chlorite-enriched assemblage throughout the last 9.3 my. The spatial distribution of clay minerals in Holocene sediments west of the Antarctic Peninsula facilitates the identification of particular source areas, and thus the reconstruction of transport pathways. The similarity to clay mineral variations reported from upper Quaternary sequences suggests that the short-term clay-mineralogical fluctuations in the ODP cores reflect glacial-interglacial cyclicity. Thus, repeated ice advances and retreats in response to a varying size of the Antarctic Peninsula ice cap are likely to have occurred throughout the late Neogene and Quaternary. The clay minerals in the drift sediments exhibit only slight long-term variations, which are caused by local changes in glacial erosion and in supply of source rocks, rather than by major climatic changes. The opal records at the ODP sites are dominated by long-term variations since the late Miocene. We infer that the opal content in the drift sediments, although it is influenced by dissolution in the water column and the sediment column and by the burial with lithogenic detritus, provides a signal of paleoproductivity. Because the annual sea-ice coverage is regarded as the main factor controlling biological productivity, the opal signal helps to reconstruct paleoceanographic changes in the Bellingshausen Sea. Slightly enhanced opal deposition during the late Miocene indicates slightly warmer climatic conditions in the Antarctic Peninsula area than at present. During the early Pliocene, enhanced opal deposition in the Pacific sector of the Southern Ocean and coinciding high opal concentrations in sedimentary sequences from the Atlantic and Indian sectors document a strong reduction of sea-ice cover and relatively warm climatic conditions. Thereby, the early onset of the Pliocene warmth in the Bellingshausen Sea points to a positive feedback of regional Antarctic climate on the global thermohaline circulation. A decrease of opal deposition between 3.1 and 2.6 Ma likely reflects sea-ice expansion in response to reduced supply of northern-sourced deep-waters to the Southern Ocean, caused by the onset of Northern Hemisphere glaciation. Throughout the Quaternary, a relatively constant level of opal deposition on the Antarctic continental margin indicates relatively stable climatic conditions.

Is Our Students Learning - QuestionMark: Extending E-Assessment Systems for Adapative Marking and Feedback

Our key contribution is a flexible, automated marking system that adds desirable functionality to existing E-Assessment systems. In our approach, any given E-Assessment system is relegated to a data-collection mechanism, whereas marking and the generation and distribution of personalised per-student feedback is handled separately by our own system. This allows content-rich Microsoft Word feedback documents to be generated and distributed to every student simultaneously according to a per-assessment schedule.

The feedback is adaptive in that it corresponds to the answers given by the student and provides guidance on where they may have gone wrong. It is not limited to simple multiple choice which are the most prescriptive question type offered by most E-Assessment Systems and as such most straightforward to mark consistently and provide individual per-alternative feedback strings. It is also better equipped to handle the use of mathematical symbols and images within the feedback documents which is more flexible than existing E-Assessment systems, which can only handle simple text strings.

As well as MCQs the system reliably and robustly handles Multiple Response, Text Matching and Numeric style questions in a more flexible manner than Questionmark: Perception and other E-Assessment Systems. It can also reliably handle multi-part questions where the response to an earlier question influences the answer to a later one and can adjust both scoring and feedback appropriately.

New question formats can be added at any time provided a corresponding marking method conforming to certain templates can also be programmed. Indeed, any question type for which a programmatic method of marking can be devised may be supported by our system. Furthermore, since the student’s response to each is question is marked programmatically, our system can be set to allow for minor deviations from the correct answer, and if appropriate award partial marks.

Development and preliminary psychometric properties of the Care Experience Feedback Improvement Tool (CEFIT).

Objective To develop a structurally valid and reliable, yet brief measure of patient experience of hospital quality of care, the Care Experience Feedback Improvement Tool (CEFIT). Also, to examine aspects of utility of CEFIT. Background Measuring quality improvement at the clinical interface has become a necessary component of healthcare measurement and improvement plans, but the effectiveness of measuring such complexity is dependent on the purpose and utility of the instrument used. Methods CEFIT was designed from a theoretical model, derived from the literature and a content validity index (CVI) procedure. A telephone population surveyed 802 eligible participants (healthcare experience within the previous 12 months) to complete CEFIT. Internal consistency reliability was tested using Cronbach's α. Principal component analysis was conducted to examine the factor structure and determine structural validity. Quality criteria were applied to judge aspects of utility. Results CVI found a statistically significant proportion of agreement between patient and practitioner experts for CEFIT construction. 802 eligible participants answered the CEFIT questions. Cronbach's α coefficient for internal consistency indicated high reliability (0.78). Interitem (question) total correlations (0.28–0.73) were used to establish the final instrument. Principal component analysis identified one factor accounting for 57.3% variance. Quality critique rated CEFIT as fair for content validity, excellent for structural validity, good for cost, poor for acceptability and good for educational impact. Conclusions CEFIT offers a brief yet structurally sound measure of patient experience of quality of care. The briefness of the 5-item instrument arguably offers high utility in practice. Further studies are needed to explore the utility of CEFIT to provide a robust basis for feedback to local clinical teams and drive quality improvement in the provision of care experience for patients. Further development of aspects of utility is also required.

Corrective feedback in oral interaction: A comparison of a CLIL and an EFL classroom

[EN] Since Long's Interaction Hypothesis (Long, 1983) multiple studies have suggested the need of oral interaction for successful second language learning. Within this perspective, a great deal of research has been carried out to investigate the role of corrective feedback in the process of acquiring a second language, but there are still varied open debates about this issue. This comparative study seeks to contribute to the existing literature on corrective feedback in oral interaction by exploring teachers' corrective techniques and students' response to these corrections. Two learning contexts were observed and compared: a traditional English as a foreign language (EFL) classroom and a Content and Language Integrated Learning (CLIL) classroom .The main aim was to see whether our data conform to the Counterbalance Hypothesis proposed by Lyster and Mori (2006). Although results did not show significant differences between the two contexts, a qualitative analysis of the data shed some light on the differences between these two language teaching settings. The findings point to the need for further research on error correction in EFL and CLIL contexts in order to overcome the limitations of the present study.