Frequency of excisions and yields of malignant skin tumors in a population-based screening intervention of 360 288 whole-body examinations

Objective To explore the frequency of excisions and yields of histopathologically confirmed skin cancer.

Design A population-based skin cancer screening intervention (the SCREEN project) in the German state of Schleswig-Holstein (July 1, 2003, to June 30, 2004).

Setting Physician offices. Participants could choose between nondermatologist physicians and dermatologists for their initial whole-body skin examination. All screening physicians received a mandatory 8-hour training course.

Participants Inhabitants of Schleswig-Holstein 20 years or older with statutory health insurance (N = 360 288).

Main Outcome Measures Frequency of excisions and yields of malignant skin tumors (malignant melanomas [MMs], basal cell carcinomas [BCCs], and squamous cell carcinomas [SCCs]), stratified by sex and age.

Results Overall, 15 983 excisions were performed (1 of 23 screenees). A total of 3103 malignant skin tumors were diagnosed in 2911 persons: 585 MMs, 1961 BCCs, 392 SCCs, and 165 other malignant skin tumors. Overall, 116 persons (3103 of 360 288) had to be screened to find 1 malignant tumor, with 1 of 620 for MM, 1 of 184 for BCC, and 1 of 920 for SCC. Twenty excisions were performed to find 1 melanoma in men 65 years and older, but more than 50 excisions were required to find 1 melanoma in men aged between 20 and 49 years.

Conclusions The results of SCREEN suggest a high yield of malignant skin tumors in a large-scale population-based screening project. We found that a high number of excisions was performed in the youngest screenees with an associated low yield, suggesting a need in screener training to emphasize a more conservative attitude toward excisions in young screenees.

Serving in Bosnia made me appreciate living in Bristol: stressful experiences, attitudes, and psychological needs of members of the United Kingdom Armed Forces

Peacekeeping operations form an increasing part of the role of the U.K. Armed Forces. This study identified perceived needs for training before such operations, experiences of stress during deployments, beliefs and attitudes regarding psychological support and debriefing on return, general attitudes toward peacekeeping duties, and positive aspects of the peacekeeping role. Although nearly all peacekeepers were exposed to a variety of experiences, most perceived stress came from professional difficulties and frustrations with the occupational role of being a peacekeeper, rather than from dangerous situations. The exception was a significant fear of land mines. For many, peacekeeping had a positive impact on soldiers' lives, most commonly an appreciation of "things back home." Respondents' opinions about the peacekeeping experience vary greatly. Additional training addressing and exploring potential conflicts between the traditional role of the soldier and the role of the peacekeeper may be useful.

Study protocol: the registrar clinical encounters in training (ReCEnT) study

Background
Patient encounters are the core learning activity of Australian general practice (family practice) training. Exposure to patient demographics and presentations may vary from one general practice registrar (vocational trainee) to another. This can affect comprehensiveness of training. Currently, there is no mechanism to systematically capture the content of GP registrar consultations. The aim of the Registrar Clinical Encounters in Training (ReCEnT) study is to document longitudinally the nature and associations of consultation-based clinical and educational experiences of general practice registrars.
Methods/design
This is an ongoing prospective multi-site cohort study of general practice registrars’ consultations, entailing paper-based recording of consultation data. The study setting is general practices affiliated with three geographically-based Australian general practice regional training providers. Registrars record details of 60 consecutive consultations. Data collected includes registrar demographics, details of the consultation, patient demographics, reasons for encounter and problems managed. Problems managed are coded with the International Classification of Primary Care (second edition) classification system. Additionally, registrars record educational factors related to the encounter. The study will follow the clinical exposure of each registrar six-monthly over the 18 months to two years (full-time equivalent) of their general practice training program.
Conclusions
The study will provide data on a range of factors (patient, registrar and consultation factors). This data will be used to inform a range of educational decisions as well as being used to answer educational research questions. We plan to use ReCEnT as a formative assessment tool for registrars and help identify and address educational needs. The study will facilitate program evaluation by the participating training providers and thus improve articulation of educational programs with practice experience. From the research point of view it will address an evidence gap – the in-practice clinical and educational experience of general practice trainees, determinants of these experiences, and the determinants of registrars’ patterns of practice (for example, prescribing practice) over the course of their training.

Relação entre atitude sobre eutanásia e crenças religiosas

Esta pesquisa experimental de campo pretende ser o primeiro de uma série de trabalhos, visando a investigação do tema eutanásia em seu envolvimento no campo, da psicologia social. Seu objetivo foi o estudo da influência nas crenças religiosas na atitude em relação à eutanásia. Foram testados seis grupos religiosos: espírita, messiânico, batista, umbandista, católico e candornblecista. Cada um deles incluiu 50 sujeitos. O instrumento usado foi a "Escala de Atitude sobre a Eutanásia", construída pela autora desta pesquisa e composta de 26 itens. Esta escala apresentou índices altamente satisfatórios de validade e fidedignidade. Aborda, além do aspecto geral do problema, os enfoques jurídico, médico e moral-religioso. Foi examinada a relação entre escolaridade, sexo, idade e atitude sobre eutanásia. Os resultados obtidos evidenciaram a existência de relação altamente significativa entre crenças religiosas e atitude sobre eutanásia, confirmando a hipótese básica do trabalho. As implicações destes resultados são discutidas e o próximo trabalho da série, já está sendo planejado, será o exame da atitude de médicos e advogados em relação à eutanásia, como eles a definem e caracterizam.

Nascimento de um filho :o significado para o pai

Qualitative study on the meaning of a child s birth to the father. Its general purpose was to comprehend the significance the man attaches to his child s birth and its specific objectives were to identify the man s feelings with regard to his child s birth as well as to verify his attitude toward a child s birth. The study was founded on the theoretical reference system about the man in the gravid-puerperal cycle and the humanization of the assistance. The data were obtained through semistructured interview performed with men accompanying their children s birth whose wives were in the immediate puerperium. This stage occurred in two maternity hospitals in Natal-RN, both of which adopt the principle of safe notherhood in the attendance of women in the process of parturition. The material apprehended from the statements was treated in conformity with the content analysis method in the mode of thematic analysis according to Bardin. Three thematic categories emerged from this process: the father s attitude toward his child s birth, the father s feelings in respect of his child s birth, and the informations received by the father in the course of his child s birth. The speech content was analyzed in accordance with the principles of symbolic interactionism according to Blumer. The results showed that the husbands interact with their respective wives and respond with attitudes of care, help, support, and encouragement within the principles of humanization intermingled with feelings of happiness, restlessness, and suffering leading them to appraise and exalt their consorts. Besides, we verified that the father s attitudes and feelings in the delivery room in the light of symbolic interactionism tend to be influenced by the interaction between him and the attending professionals

Uma perspectiva de extensão do modelo de aceitação de tecnologia para explicar o uso de linguagens de desenvolvimento WEB: pesquisa com desenvolvedores Pyton e Java

The spread of the Web boosted the dissemination of Information Systems (IS) based on the Web. In order to support the implementation of these systems, several technologies came up or evolved with this purpose, namely the programming languages. The Technology Acceptance Model TAM (Davis, 1986) was conceived aiming to evaluate the acceptance/use of information technologies by their users. A lot of studies and many applications have used the TAM, however, in the literature it was not found a mention of the use of such model related to the use of programming languages. This study aims to investigate which factors influence the use of programming languages on the development of Web systems by their developers, applying an extension of the TAM, proposed in this work. To do so, a research was done with Web developers in two Yahoo groups: java-br and python-brasil, where 26 Java questionnaires and 39 Python questionnaires were fully answered. The questionnaire had general questions and questions which measured intrinsic and extrinsic factors of the programming languages, the perceived usefulness, the perceived ease of use, the attitude toward the using and the programming language use. Most of the respondents were men, graduate, between 20 and 30 years old, working in the southeast and south regions. The research was descriptive in the sense of its objectives. Statistical tools, descriptive statistics, main components and linear regression analysis were used for the data analysis. The foremost research results were: Java and Python have machine independence, extensibility, generality and reliability; Java and Python are more used by corporations and international organizations than supported by the government or educational institutions; there are more Java programmers than Python programmers; the perceived usefulness is influenced by the perceived ease of use; the generality and the extensibility are intrinsic factors of programming languages which influence the perceived ease of use; the perceived ease of use influences the attitude toward the using of the programming language

Is the equivalence principle doomed forever to Dante's Inferno on account of quantum mechanics?

It is commonly assumed that the equivalence principle can coexist without conflict with quantum mechanics. We shall argue here that, contrary to popular belief, this principle does not hold in quantum mechanics. We illustrate this point by computing the second-order correction for the scattering of a massive scalar boson by a weak gravitational field, treated as an external field. The resulting cross-section turns out to be mass-dependent. A way out of this dilemma would be, perhaps, to consider gravitation without the equivalence principle. At first sight, this seems to be a too much drastic attitude toward general relativity. Fortunately, the teleparallel version of general relativity - a description of the gravitational interaction by a force similar to the Lorentz force of electromagnetism and that, of course, dispenses with the equivalence principle - is equivalent to general relativity, thus providing a consistent theory for gravitation in the absence of the aforementioned principle. © World Scientific Publishing Company.

Atitudes em relação à Bioestatística de discentes e docentes da Faculdade de Ciências Farmacêuticas de Araraquara-UNESP

In this study, the attitudes of students and teachers at the Faculty of Pharmaceutical Sciences of Araraquara (UNESP University) towards Biostatistics were assessed. The Survey of Attitudes Toward Statistics (SATS) scale was used as the measuring instrument. The reproducibility of the scale was estimated by Cohen's Kappa (κ) coefficient with linear weighting and its internal consistency by Cronbach's alpha coefficient (α). The individuals were first placed in two groups, according to their positive or negative attitude toward Statistics; then, the association of their attitude with the variables of interest was tested by the chi-squared (χ 2) test at a significance level of 5%. The sample consisted of 272 undergraduate students, 83 graduate students and 24 teachers, predominantly female (78.2%). Among the students, 67.5% participated in the scientific research initial training program. Reproducibility and internal consistency of the scale were adequate (κ=0.7093; α=0.9334). Most of the subjects (74.4%) had a positive attitude toward Statistics. Significant association was found between attitude and functional activity (p=0.0204), the course taken (p=0.0316) and effort (p=0.0002). Thus, it was concluded that the great majority of the participants had a positive attitude towards Biostatistics and that undergraduate students and those who reported good performance in Biostatistics showed a significantly higher proportion of positive attitude than the other students.

SIDE EFFECTS OF PERSISTENT TOXICANTS

As you can see from the general tenor of the printed program for this seminar, I am in the unenviable position of trying to discourage you from certain types of chemical control; but my assigned topic "Side Effects of Persistent Toxicants," implies that mission. However, my remarks may be somewhat anticlimax at this time, because it is now generally conceded that we need to reevaluate certain chemicals in control work and to restrict or severely curtail use of those that per¬sist for long periods in the environment. So let me detail my reasons for a somewhat negative attitude toward the use of the persistent hydrocarbons from my experience with the effects of these materials on birds. But first a few words of caution about control work in general, which so often disrupts natural processes and leads to new and unforseen difficulties. As an example, I think of the irruption of mice in the Klamath valley in northern California and southern Oregon in the late '50's. Intensive predator control, particularly of coyotes, but also of hawks and owls, was followed by a severe outbreak of mice in the spring of 1958. To combat the plague of mice, poisoned bait (1080 and zinc phosphide) was widely distributed in an area used by 500,000 waterfowl each spring. More than 3,000 geese were poisoned, so driv¬ing parties were organized to keep the geese off the treated fields. Here it seems conceivable that the whole chain of costly events--cost of the original and probably unnecessary predator control, economic loss to crops from the mouse outbreak, another poisoning campaign to combat the mice, loss of valuable waterfowl resources, and man-hours involved in flushing geese from the fields--might have been averted by a policy of not interfering with the original predator-prey relationship. This points to a dilemma we always face. (We create deplorable situations by clumsy interference with natural processes, then seek artificial cures to correct our mistakes.) For example, we spend millions of dollars in seeking cures for cancer, but do little or nothing about restricting the use of known or suspected carcinogens such as nicotine and DDT.

Exercise training prevents diastolic dysfunction induced by metabolic syndrome in rats

OBJECTIVE: High fructose consumption contributes to the incidence of metabolic syndrome and, consequently, to cardiovascular outcomes. We investigated whether exercise training prevents high fructose diet-induced metabolic and cardiac morphofunctional alterations. METHODS: Wistar rats receiving fructose overload (F) in drinking water (100 g/l) were concomitantly trained on a treadmill (FT) for 10 weeks or kept sedentary. These rats were compared with a control group (C). Obesity was evaluated by the Lee index, and glycemia and insulin tolerance tests constituted the metabolic evaluation. Blood pressure was measured directly (Windaq, 2 kHz), and echocardiography was performed to determine left ventricular morphology and function. Statistical significance was determined by one-way ANOVA, with significance set at p<0.05. RESULTS: Fructose overload induced a metabolic syndrome state, as confirmed by insulin resistance (F: 3.6 +/- 0.2 vs. C: 4.5 +/- 0.2 mg/dl/min), hypertension (mean blood pressure, F: 118 +/- 3 vs. C: 104 +/- 4 mmHg) and obesity (F: 0.31 +/- 0.001 vs. C: 0.29 +/- 0.001 g/mm). Interestingly, fructose overload rats also exhibited diastolic dysfunction. Exercise training performed during the period of high fructose intake eliminated all of these derangements. The improvements in metabolic parameters were correlated with the maintenance of diastolic function. CONCLUSION: The role of exercise training in the prevention of metabolic and hemodynamic parameter alterations is of great importance in decreasing the cardiac morbidity and mortality related to metabolic syndrome.

Virtual Patients in continuing medical education and residency training: a pilot project for acceptance analysis in the framework of a residency revision course in pediatrics.

AIM Virtual patients (VPs) are a one-of-a-kind e-learning resource, fostering clinical reasoning skills through clinical case examples. The combination with face-to-face teaching is important for their successful integration, which is referred to as "blended learning". So far little is known about the use of VPs in the field of continuing medical education and residency training. The pilot study presented here inquired the application of VPs in the framework of a pediatric residency revision course. METHODS Around 200 participants of a pediatric nephology lecture ('nephrotic and nephritic syndrome in children') were offered two VPs as a wrap-up session at the revision course of the German Society for Pediatrics and Adolescent Medicine (DGKJ) 2009 in Heidelberg, Germany. Using a web-based survey form, different aspects were evaluated concerning the learning experiences with VPs, the combination with the lecture, and the use of VPs for residency training in general. RESULTS N=40 evaluable survey forms were returned (approximately 21%). The return rate was impaired by a technical problem with the local Wi-Fi firewall. The participants perceived the work-up of the VPs as a worthwhile learning experience, with proper preparation for diagnosing and treating real patients with similar complaints. Case presentations, interactivity, and locally and timely independent repetitive practices were, in particular, pointed out. On being asked about the use of VPs in general for residency training, there was a distinct demand for more such offers. CONCLUSION VPs may reasonably complement existing learning activities in residency training.

Opting for an Open Society? Personality Traits and Attitudes toward the Openness of Switzerland

The tension between openness and closedness is one of the most important cleavages in Swiss political debates. In the present article, we study the psychological foundations of attitudes regarding this issue. More precisely, we examine the link between personality and attitudes toward the degree of openness of Switzerland as a general stance toward the cultural, economic and political alignment of the country. Personality is understood as a complex and multifaceted concept that forms the basis for consistent patterns of attitudes and behavior. We build on the Five-Factor Theory to explain the link between personality traits, contextual factors and political attitudes. Analyzing survey data from a random sample of Swiss citizens, we find clear evidence that personality traits affect political attitudes. Furthermore, we are able to demonstrate that the relationship between personality and attitudes toward the degree of openness of Switzerland is moderated by perceived ethnic diversity in the neighborhood.

Las TIC y el profesorado de música de los centros de educación secundaria de la provincia de Castellón

Esta investigación se planteó con el fin de determinar el uso de las Tecnologías de la Información y la Comunicación (TIC) por parte del profesorado de Música de los centros Educación Secundaria de la provincia de Castellón y conocer la formación y la actitud de este profesorado con respecto al uso y las potencialidades de estas herramientas en el ámbito educativo. Los resultados revelaron que el 96,88% utilizan frecuentemente las TIC, el 87,5% tienen un nivel medio en cuanto al grado de formación y que tanto este como el uso de estas herramientas están relacionados con la integración de Internet en la dinámica del aula.

The American hope,

The ground of hope.--The power of choice.-The springs of progress.--The marriage tie.--The training of powers.--The pleasure in things.--The fraternal bond.--The still, small voice.--Living, of getting a living.--The will of the community.--Economic freedom.--The attitude toward life.

The role of uncertainty in the relationship between fairness evaluations and willingness to pay

Participants in contingent valuation studies may be uncertain about a number of aspects of the policy and survey context. The uncertainty management model of fairness judgments states that individuals will evaluate a policy in terms of its fairness when they do not know whether they can trust the relevant managing authority or experience uncertainty due to insufficient knowledge of the general issues surrounding the environmental policy. Similarly, some researchers have suggested that, not knowing how to answer WTP questions, participants convey their general attitudes toward the public good rather than report well-defined economic preferences. These contentions were investigated in a sample of 840 residents in four urban catchments across Australia who were interviewed about their WTP for stormwater pollution abatement. Four sources of uncertainty were measured: amount of prior issue-related thought, trustworthiness of the water authority, insufficient scenario information, and WTP response uncertainty. A logistic regression model was estimated in each subsample to test the main effects of the uncertainty sources on WTP as well as their interaction with fairness and proenvironmental attitudes. Results indicated support for the uncertainty management model in only one of the four samples. Similarly, proenvironmental attitudes interacted rarely with uncertainty to a significant level, and in ways that were more complex than hypothesised. It was concluded that uncertain individuals were generally not more likely than other participants to draw on either fairness evaluations or proenvironmental attitudes when making decisions about paying for stormwater pollution abatement.