Positive predictive values of Breast Imaging Reporting and Data System (BI-RADS®) categories 3, 4 and 5 in breast lesions submitted to percutaneous biopsy

Objective To evaluate the BI-RADS as a predictive factor of suspicion for malignancy in breast lesions by correlating radiological with histological results and calculating the positive predictive value for categories 3, 4 and 5 in a breast cancer reference center in the city of São Paulo. Materials and Methods Retrospective, analytical and cross-sectional study including 725 patients with mammographic and/or sonographic findings classified as BI-RADS categories 3, 4 and 5 who were referred to the authors' institution to undergo percutaneous biopsy. The tests results were reviewed and the positive predictive value was calculated by means of a specific mathematical equation. Results Positive predictive values found for categories 3, 4 and 5 were respectively the following: 0.74%, 33.08% and 92.95%, for cases submitted to ultrasound-guided biopsy, and 0.00%, 14.90% and 100% for cases submitted to stereotactic biopsy. Conclusion The present study demonstrated high suspicion for malignancy in lesions classified as category 5 and low risk for category 3. As regards category 4, the need for systematic biopsies was observed.

Positive Self-Image in Tournaments

This article analyzes the implications of worker overestimation of productivity for firms in which incentives take the form of tournaments. Each worker overestimates his productivity but is aware of the bias in his opponent's self-assessment. The manager of the firm, on the other hand, correctly assesses workers' productivities and self-beliefs when setting tournament prizes. The article shows that, under a variety of circumstances, firms can benefit from worker positive self-image. The article also shows that worker positive self-image can improve welfare in tournaments. In contrast, workers' utility declines due to their own misguided choices.

Care delivery value chains for ophthalmic clinics in Switzerland

Perceived patient value is often not aligned with the emerging expenses for health care services. In other words, the costs are often supposed as rising faster than the actual value for the patients. This fact is causing major concerns to governments, health plans, and individuals. Attempts to solve the problem have habitually been on the operational effectiveness side: increasing patient volume, minimizing costs, rationing, or closing hospitals, usually resulting in a zero-sum game. Only few approaches come from the strategic positioning side and "competition" among hospitals is still perceived rather as a danger than as a chance to create a positive-sum game and stimulate patient value. In their 2006 book, "Redefining Health Care", the renowned Harvard strategy professor Michael E. Porter and hospital management expert Professor Elizabeth Olmsted Teisberg approach the challenge from the positive-sum perspective: they propose to form Integrated Practice Units (IPUs) and manage hospitals in a modern, patient value oriented way. They argue that creating value-based competition on results should have the same effect on the health care sector like transparency and competition turned other industries with out-dated management models (like recently the inert telecommunication industry) into highly competitive and customer value creating businesses. The objective of this paper is to elaborate Care Delivery Value Chains for Integrated Practice Units in ophthalmic clinics and gather a first feedback from Swiss hospital managers, ophthalmologists, and patients, if such an approach could be a realistic way to improve health care management. First, Porter's definition of competitiveness (distinction between operational effectiveness and strategic positioning) is explained. Then, the Care Delivery Value Chain is introduced as a key element for understanding value-based management, followed by three practice examples for ophthalmic clinics. Finally, recommendations are given how the Care Delivery Value Chain can be managed efficiently and how the obstacles of becoming a patient-oriented organization can be overcome. The conclusion is that increased transparency and value-based competition on results has the potential to change the mindset of hospital managers-which will align patient value with the emerging health care expenses. Early adapters of this management approach will gain a competitive advantage. [Author, p. 6]

Negative feedback regulation of calcineurin-dependent Prz1 transcription factor by the CaMKK-CaMK1 axis in fission yeast

Calcium signals trigger the translocation of the Prz1 transcription factor from the cytoplasm to the nucleus. The process is regulated by the calciumactivated phosphatase calcineurin, which activates Prz1 thereby maintaining active transcription during calcium signalling. When calcium signalling ceases, Prz1 is inactivated by phosphorylation and exported to the cytoplasm. In budding yeast and mammalian cells, different kinases have been reported to counter calcineurin activity and regulate nuclear export. Here, we show that the Ca2+/calmodulin-dependent kinase Cmk1 is first phosphorylated and activated by the newly identified kinase CaMKK2 homologue, Ckk2, in response to Ca2+. Then, active Cmk1 binds, phosphorylates and inactivates Prz1 transcription activity whilst at the same time cmk1 expression is enhanced by Prz1 in response to Ca2+. Furthermore, Cdc25 phosphatase is also phosphorylated by Cmk1, inducing cell cycle arrest in response to an increase in Ca2+. Moreover, cmk1 deletion shows a high tolerance to chronic exposure to Ca2+, due to the lack of cell cycle inhibition and elevated Prz1 activity. This work reveals that Cmk1 kinase activated by the newly identified Ckk2 counteracts calcineurin function by negatively regulating Prz1 activity which in turn is involved in activating cmk1 gene transcription. These results are the first insights into Cmk1 and Ckk2 function in Schizosaccharomyces pombe.

Effects of continuous positive airway pressure treatment on coronary vasoreactivity measured by (82)Rb cardiac PET/CT in obstructive sleep apnea patients.

PURPOSE: Obstructive sleep apnea syndrome (OSA) increases the risk of cardiovascular disease. We aimed at evaluating the effect of continuous positive airway pressure (CPAP) treatment on coronary endothelium-dependent vasoreactivity in OSA patients by quantifying myocardial blood flow (MBF) response to cold pressure testing (CPT). METHODS: In the morning after polysomnography (PSG), all participants underwent a dynamic (82)Rb cardiac positron emitting tomography/computed tomography (PET/CT) scan at rest, during CPT and adenosine stress. PSG and PET/CT were repeated at least 6 weeks after initiating CPAP treatment. OSA patients were compared to controls and according to response to CPAP. Patients' characteristics and PSG parameters were used to determine predictors of CPT-MBF. RESULTS: Thirty-two untreated OSA patients (age 58 ± 13 years, 27 men) and 9 controls (age 62 ± 5 years, 4 men) were enrolled. At baseline, compared to controls (apnea-hypopnea index (AHI) = 5.3 ± 2.6/h), untreated OSA patients (AHI = 48.6 ± 19.7/h) tend to have a lower CPT-MBF (1.1 ± 0.2 mL/min/g vs. 1.3 ± 0.4 mL/min/g, p = 0.09). After initiating CPAP, CPT-MBF was not different between well-treated patients (AHI <10/h) and controls (1.3 ± 0.3 mL/min/g vs. 1.3 ± 0.4 mL/min/g, p = 0.83), but it was lower for insufficiently treated patients (AHI ≥10/h) (0.9 ± 0.2 mL/min/g vs. 1.3 ± 0.4 mL/min/g, p = 0.0045). CPT-MBF was also higher in well-treated than in insufficiently treated patients (1.3 ± 0.3 mL/min/g vs. 0.9 ± 0.2 mL/min/g, p = 0.001). Mean nocturnal oxygen saturation (β = -0.55, p = 0.02) and BMI (β = -0.58, p = 0.02) were independent predictors of CPT-MBF in OSA patients. CONCLUSIONS: Coronary endothelial vasoreactivity is impaired in insufficiently treated OSA patients compared to well-treated patients and controls, confirming the need for CPAP optimization.

Mutual feedback in e-portfolio assessment : an approach to the netfolio system

Peer-reviewed

Expertise and decision making among clinicians in investigations of alleged child sexual abuse

The purpose of the present thesis was to explore different aspects of decision making and expertise in investigations of child sexual abuse (CSA) and subsequently shed some light on the reasons for shortcomings in the investigation processes. Clinicians’ subjective attitudes as well as scientifically based knowledge concerning CSA, CSA investigation and interviewing were explored. Furthermore the clinicians’ own view on their expertise and what enhances this expertise was investigated. Also, the effects of scientific knowledge, experience and attitudes on the decision making in a case of CSA were explored. Finally, the effects of different kinds of feedback as well as experience on the ability to evaluate CSA in the light of children’s behavior and base rates were investigated. Both explorative and experimental methods were used. The purpose of Study I was to investigate whether clinicians investigating child sexual abuse (CSA) rely more on scientific knowledge or on clinical experience when evaluating their own expertise. Another goal was to check what kind of beliefs the clinicians held. The connections between these different factors were investigated. A questionnaire covering items concerning demographic data, experience, knowledge about CSA, selfevaluated expertise and beliefs about CSA was given to social workers, child psychiatrists and psychologists working with children. The results showed that the clinicians relied more on their clinical experience than on scientific knowledge when evaluating their expertise as investigators of CSA. Furthermore, social workers possessed stronger attitudes in favor of children than the other groups, while child psychiatrists had more negative attitudes towards the criminal justice system. Male participants held less strong beliefs than female participants. The findings indicate that the education of CSA investigators should focus more on theoretical knowledge and decision making processes as well as the role of beliefs In Study II school and family counseling psychologists completed a Child Sexual Abuse Attitude and Belief Scale. Four CSA related attitude and belief subscales were identified: 1. The Disclosure subscale reflecting favoring a disclosure at any cost, 2. The Pro-Child subscale reflecting unconditional belief in children's reports, 3. The Intuition subscale reflecting favoring an intuitive approach to CSA investigations, and 4. The Anti Criminal Justice System subscale reflecting negative attitudes towards the legal system. Beliefs that were erroneous according to empirical research were analyzed separately. The results suggest that some psychologists hold extreme attitudes and many erroneous beliefs related to CSA. Some misconceptions are common. Female participants tended to hold stronger attitudes than male participants. The more training in interviewing children the participants have, the more erroneous beliefs and stronger attitudes they hold. Experience did not affect attitudes and beliefs. In Study III mental health professionals’ sensitivity to suggestive interviewing in CSA cases was explored. Furthermore, the effects of attitudes and beliefs related to CSA and experience with CSA investigations on the sensitivity to suggestive influences in the interview were investigated. Also, the effect of base rate estimates of CSA on decisions was examined. A questionnaire covering items concerning demographic data, different aspects of clinical experience, self-evaluated expertise, beliefs and knowledge about CSA and a set of ambiguous material based on real trial documents concerning an alleged CSA case was given to child mental health professionals. The experiment was based on a 2 x 2 x 2 x 2 (leading questions: yes vs no) x (stereotype induction: yes vs no) x (emotional tone: pressure to respond vs no pressure to respond) x (threats and rewards: yes vs no) between-subjects factorial design, in which the suggestiveness of the methods with which the responses of the child were obtained were varied. There was an additional condition in which the material did not contain any interview transcripts. The results showed that clinicians are sensitive only to the presence of leading questions but not to the presence of other suggestive techniques. Furthermore, the clinicians were not sensitive to the possibility that suggestive techniques could have been used when no interview transcripts had been included in the trial material. Experience had an effect on the sensitivity of the clinicians only regarding leading questions. Strong beliefs related to CSA lessened the sensitivity to leading questions. Those showing strong beliefs on the belief scales used in this study were even more prone to prosecute than other participants when other suggestive influences than leading questions were present. Controversy exists regarding effects of experience and feedback on clinical decision making. In Study IV the impact of the number of handled cases and of feedback on the decisions in cases of alleged CSA was investigated. One-hundred vignettes describing cases of suspected CSA were given to students with no experience with investigating CSA. The vignettes were based on statistical data about symptoms and prevalence of CSA. According to the theoretical likelihood of CSA the children described were categorized as abused or not abused. The participants were asked to decide whether abuse had occurred. They were divided into 4 groups: one received feedback on whether their decision was right or wrong, one received information about cognitive processes involved in decision making, one received both, and one did not receive feedback at all. The results showed that participants who received feedback on their performance made more correct positive decisions and participants who got information about decision making processes made more correct negative decisions. Feedback and information combined decreased the number of correct positive decisions but increased the number of correct negative decisions. The number of read cases had in itself a positive effect on correct positive decision.

Henkilöstön motivoituminen muutoksessa. Case: Asumisen rahoitus ja kehittämiskeskus

Tämän tutkimuksen tarkoituksena on ymmärtää henkilöstön motivoitumiseen vaikuttavia tekijöitä muutostilanteessa ja tunnistaa muutosjohtamisen kehittämiskohteita. Tutkielma on laadullinen tutkimus, jonka sekundaariaineistona käytetään ARAn työtyytyväisyystutkimuksia vuosilta 2007 ja 2008. Primääriaineiston muodostavat tutkimuksen kohdeorganisaation kolmentoista henkilön teemahaastattelut. Tutkimuksen perusteella voidaan todeta, että henkilöstön motivoitumiseen vaikuttaa työtehtävien mielekkyys, työyhteisöltä ja asiakkailta saatava palaute, työn arvostus ja toimiva yhteistyö. Henkilöstöpoliittiset toimenpiteet tukevat yksilöä muutoksessa. Muutosjohtamisen kehittämiskohteena on viestittää henkilöstölle muutoksen tarpeellisuus ja sen vaikutukset, toteuttaa muutos hallitusti sekä luoda muutokselle positiivinen ilmapiiri.

The process of basic training, applied training, maintaining the performance of an observer

In the field of observational methodology the observer is obviously a central figure, and close attention should be paid to the process through which he or she acquires, applies, and maintains the skills required. Basic training in how to apply the operational definitions of categories and the rules for coding, coupled with the opportunity to use the observation instrument in real-life situations, can have a positive effect in terms of the degree of agreement achieved when one evaluates intra- and inter-observer reliability. Several authors, including Arias, Argudo, & Alonso (2009) and Medina and Delgado (1999), have put forward proposals for the process of basic and applied training in this context. Reid y De Master (1982) focuses on the observer's performance and how to maintain the acquired skills, it being argued that periodic checks are needed after initial training because an observer may, over time, become less reliable due to the inherent complexity of category systems. The purpose of this subsequent training is to maintain acceptable levels of observer reliability. Various strategies can be used to this end, including providing feedback about those categories associated with a good reliability index, or offering re-training in how to apply those that yield lower indices. The aim of this study is to develop a performance-based index that is capable of assessing an observer's ability to produce reliable observations in conjunction with other observers.

Psykologinen omistajuus etätyöskentelyssä

Tämän tutkimuksen tavoitteena oli kuvata ja selittää etätyöntekijöiden työhönsä kokemaa omistajuuden tunnetta sekä sen syntymismekanismeja ja seurauksia. Lisäksi tavoitteena oli selvittää kuinka etätyön eri muodot korostuvat etätyöskentelyn oletetuissa eduissa ja ongelmissa. Etätyön muotojen osalta oli tavoitteena myös selvittää niden yhteyttä itsenäisyyden tunteeseen. Tutkielman tutkimusmenetelmä on kvantitatiivinen ja määrällistä aineistoa analysoitiin SPSS-ohjelmiston avulla. Tutkielman tutkimuskontekstina on etätyö. Tutkimuksen perusteella etätyöntekijät kokevat työnsä keskimäärin melko paljon omakseen. Tutkimustulokset osoittivat, että työtä kohtaan koettu psykologinen omistajuus syntyy kolmen ”reitin” kautta, joita ovat kohteen hallinta, kohteen perusteellinen tunteminen ja voimavarojen käyttäminen kohteeseen. Näiden ”reittien” syntymiseen taas oli positiivinen yhteys seuraavilla työn ulottuvuuksilla: työn vaatimat taidot, työn hahmottaminen, työn merkitsevyys, itsenäisyys sekä palaute työstä. Tutkimustulokset todistivat, että psykologinen omistajuus oli positiivisessa yhdeydessä työperäiseen itsetuntoon, työtyytyväisyyteen, työmotivaatioon, yksilön kehittymiseen työssään, vastuuntuntoon työtään kohtaan sekä rehtiyteen. Voimakkain yhteys psykologisella omistajuudella oli työtyytyväisyyden kanssa. Tutkimuksen perusteella voidaankin sanoa, että mitä enemmän henkilö kokee työnsä omakseen, niin sitä tyytyväisempi hän on työhönsä. Tutkimustulokset osoittivat, että etätyön muodolla on merkitystä etätyöskentelyssä koettuihin etuihin ja ongelmiin. Täysipäiväisen etätyön tekijät kokivat edut kaikista positiivisimmin ja ongelmat taas kaikista negatiivisimmin. Mobiilit työntekijät kokivat työssään alhaisempaa itsenäisyyden tunnetta kuin muiden etätyön muotojen edustajat.

Muutosprosessin implementointi ja johtaminen terveydenhuollon välityspalveluissa

The aim of this study was to produce information on the implementation of the change process made according to the Kotter’s change model in HUSServis call operator services and to understand the success of the change process experienced by the call operators and the team leaders. The study was a qualitative case study. The research methods used were the researcher’s own participatory observation and the electronic survey. The survey was conducted by e-mail, using Webropol - software. The target group consisted of 32 persons, in which 29 were call operators and 3 were team leaders. The results of the study showed that the implementation of the change process made according to the Kotter’s change model was experienced successfully. The change was influenced by the successful selection of persons to the guiding coalition and an assertive leadership, in which the trust was enhanced in a research organization by increasing communication and feedback. This influence had a great positive change on the working environment. It also had a clear impact on the willingness of the personnel to be involved in change, which led to a clear improvement on the customer services.

Promoting Programming Learning. Engagement, Automatic Assessment with Immediate Feedback in Visualizations

The skill of programming is a key asset for every computer science student. Many studies have shown that this is a hard skill to learn and the outcomes of programming courses have often been substandard. Thus, a range of methods and tools have been developed to assist students’ learning processes. One of the biggest fields in computer science education is the use of visualizations as a learning aid and many visualization based tools have been developed to aid the learning process during last few decades. Studies conducted in this thesis focus on two different visualizationbased tools TRAKLA2 and ViLLE. This thesis includes results from multiple empirical studies about what kind of effects the introduction and usage of these tools have on students’ opinions and performance, and what kind of implications there are from a teacher’s point of view. The results from studies in this thesis show that students preferred to do web-based exercises, and felt that those exercises contributed to their learning. The usage of the tool motivated students to work harder during their course, which was shown in overall course performance and drop-out statistics. We have also shown that visualization-based tools can be used to enhance the learning process, and one of the key factors is the higher and active level of engagement (see. Engagement Taxonomy by Naps et al., 2002). The automatic grading accompanied with immediate feedback helps students to overcome obstacles during the learning process, and to grasp the key element in the learning task. These kinds of tools can help us to cope with the fact that many programming courses are overcrowded with limited teaching resources. These tools allows us to tackle this problem by utilizing automatic assessment in exercises that are most suitable to be done in the web (like tracing and simulation) since its supports students’ independent learning regardless of time and place. In summary, we can use our course’s resources more efficiently to increase the quality of the learning experience of the students and the teaching experience of the teacher, and even increase performance of the students. There are also methodological results from this thesis which contribute to developing insight into the conduct of empirical evaluations of new tools or techniques. When we evaluate a new tool, especially one accompanied with visualization, we need to give a proper introduction to it and to the graphical notation used by tool. The standard procedure should also include capturing the screen with audio to confirm that the participants of the experiment are doing what they are supposed to do. By taken such measures in the study of the learning impact of visualization support for learning, we can avoid drawing false conclusion from our experiments. As computer science educators, we face two important challenges. Firstly, we need to start to deliver the message in our own institution and all over the world about the new – scientifically proven – innovations in teaching like TRAKLA2 and ViLLE. Secondly, we have the relevant experience of conducting teaching related experiment, and thus we can support our colleagues to learn essential know-how of the research based improvement of their teaching. This change can transform academic teaching into publications and by utilizing this approach we can significantly increase the adoption of the new tools and techniques, and overall increase the knowledge of best-practices. In future, we need to combine our forces and tackle these universal and common problems together by creating multi-national and multiinstitutional research projects. We need to create a community and a platform in which we can share these best practices and at the same time conduct multi-national research projects easily.

Feedback como estratégia de aprendizado no ensino médico

Fornecer feedback aos alunos é um importante aspecto da aprendizagem e um papel essencial dos docentes. No contexto da educação médica clínica, feedback se refere às informações que descrevem o desempenho dos alunos em determinada situação ou atividade. A habilidade de dar e receber feedback melhora os resultados da aprendizagem, uma vez que fornece a base para a aprendizagem autodirecionada e para a reflexão crítica, auxilia os alunos a corrigirem seus erros, reforça comportamentos desejáveis e mostra como o aluno pode melhorar. Apesar da evidente falta de feedback durante o curso médico, os alunos desejam e valorizam essa ferramenta construtiva, considerando-a um aspecto importante do ensino de qualidade. O feedback eficaz deve ser: assertivo, respeitoso, descritivo, oportuno e específico. Docentes e alunos deveriam ser preparados para dar e receber feedback. Coordenadores e diretores deveriam reconhecer o papel do feedback como uma importante estratégia de ensino- aprendizagem na graduação.

Feedback de usuários como subsídio para avaliação do estudante de medicina

A avaliação é fundamental para o processo ensino-aprendizagem. Diferentes métodos de avaliação e diversos atores envolvidos na avaliação podem fornecer elementos distintos, que, somados, fornecem melhor compreensão sobre a efetividade do processo educacional em suas variadas dimensões. A avaliação de habilidades e atitudes de estudantes tem recebido grande atenção recentemente. O envolvimento de pacientes no processo pode ser contributivo, pois sua perspectiva acrescenta informações ímpares. O presente estudo avaliou a aquisição de competências e habilidades de estudantes de Medicina no internato de Obstetrícia, sob o ponto de vista de gestantes. As pacientes responderam a um questionário segundo escala de Likert, com itens de avaliação divididos em habilidades de comunicação, exame físico e profissionalismo. Os resultados mostraram boa avaliação dos estudantes em geral, o que atribuímos ao sentimento de gratidão das pacientes. Algumas questões com maiores frequências de respostas negativas, porém, apontam aspectos que merecem maior atenção da escola médica pelo impacto que podem trazer à prática profissional. A perspectiva de pacientes na avaliação do estudante de Medicina poderá balizar estratégias de feedback para qualificar a formação médica.