Rapid Integration of Artificial Sensory Feedback during Operant Conditioning of Motor Cortex Neurons.

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Prsa, Mario; Galiñanes, Gregorio L; Huber, Daniel

2017-02-22

Neuronal motor commands, whether generating real or neuroprosthetic movements, are shaped by ongoing sensory feedback from the displacement being produced. Here we asked if cortical stimulation could provide artificial feedback during operant conditioning of cortical neurons. Simultaneous two-photon imaging and real-time optogenetic stimulation were used to train mice to activate a single neuron in motor cortex (M1), while continuous feedback of its activity level was provided by proportionally stimulating somatosensory cortex. This artificial signal was necessary to rapidly learn to increase the conditioned activity, detect correct performance, and maintain the learned behavior. Population imaging in M1 revealed that learning-related activity changes are observed in the conditioned cell only, which highlights the functional potential of individual neurons in the neocortex. Our findings demonstrate the capacity of animals to use an artificially induced cortical channel in a behaviorally relevant way and reveal the remarkable speed and specificity at which this can occur. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Student Satisfaction on Getting Feedback in Clinical Teaching

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S Ahmady

2015-12-01

Full Text Available Introduction: Among the factors that are involved in medical education, undoubtedly feedback is a special place. Feedback is a link between assessment and learning. Student satisfaction has an important indicator in the quality of learning and teaching. Learning is also associated with the satisfaction of students from the courses. The present study aimed to investigate the effect of feedback in clinical education. Methods: This quasi-experimental study was performed on all of the seventh term nursing students in the faculty of Nursing and Midwifery in Arak and shazand cities. In the first semester in 93-94, they were trained post-CCU ward. The participants were selected through the census procedure. The students in both groups (intervention and control were selected randomly in subgroups of 7 and 8 participants. In each group, the students were trained for 4 weeks in the morning shift. To determine the effects of these two methods, after completion of each of the training courses, all of the students completed the questionnaires and the results were compared. Results: The results showed that the intervention and the control groups were similar in terms of demographic characteristics (gender, indigenous and student work experience and there was no statistically significant difference. Therefore, the mean of overall student satisfaction scores in the intervention group was higher than the control group. In all of the levels, the intervention group had more satisfaction compared to the control one. Statistical test showed a significant difference between the two groups (P <0/003. Conclusion: Generally, it can be said that the immediate and planned feedbacks during the training were offered to students and it could lead the way clinical training in the correct direction. So, the student satisfaction was increased with this process.

Learning outcomes using video in supervision and peer feedback during clinical skills training

DEFF Research Database (Denmark)

Lauridsen, Henrik Hein; Toftgård, Rie Castella; Nørgaard, Cita

supervision of clinical skills (formative assessment). Demonstrations of these principles will be presented as video podcasts during the session. The learning outcomes of video supervision and peer-feedback were assessed in an online questionnaire survey. Results Results of the supervision showed large self......Objective New technology and learning principles were introduced in a clinical skills training laboratory (iLab). The intension was to move from apprenticeship to active learning principles including peer feedback and supervision using video. The objective of this study was to evaluate student...... learning outcomes in a manual skills training subject using video during feedback and supervision. Methods The iLab classroom was designed to fit four principles of teaching using video. Two of these principles were (a) group work using peer-feedback on videos produced by the students and, (b) video...

Combined student ratings and self-assessment provide useful feedback for clinical teachers

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Dolmans, Diana H. J. M.; Wolfhagen, Ineke H. A. P.; Peters, Wim G.; van Coppenolle, Lieve; Scherpbier, Albert J. J. A.

2009-01-01

Many evaluation instruments have been developed to provide feedback to physicians on their clinical teaching but written feedback alone is not always effective. We explored whether feedback effectiveness improved when teachers’ self-assessment was added to written feedback based on student ratings. 37 physicians (10 residents, 27 attending physicians) from different specialties (Internal Medicine, Surgery, Obstetrics/Gynecology, Pediatrics, Neurology, Dermatology, Ophthalmology, ENT, and Psychiatry) were invited to fill out a self-assessment questionnaire on their teaching skills. Students completed an almost identical questionnaire to evaluate the same teachers based on their experiences during clerkships. After receiving written feedback incorporating their self-assessment and the student ratings, the teachers indicated their perceptions of the self-assessment exercise and the written feedback in a questionnaire (five-point Likert scale items) and next, in more detail, in semi-structured interviews with a purposive sample of 12 of the participating teachers. 25 physicians participated (67%). The results showed that self-assessment and student feedback were both perceived as useful (3.7, SD 1.0) but the latter was considered more effective. The physicians we interviewed considered the combination of self-assessment with student ratings more effective than either self-assessment or written feedback alone. Notably, discrepancies between student ratings and self-assessment were deemed a strong incentive for change. We conclude that self-assessment can be a useful tool to stimulate improvement of clinical teaching when it is combined with written feedback based on student ratings. Future research among larger groups is needed to confirm our findings and examine whether these combined tools actually lead to improved teaching. PMID:19779976

Building a web-based CAD server for clinical use, evaluation, and incremental learning. Implementation of analysis function based on execution result and clinical feedback

International Nuclear Information System (INIS)

Nomura, Yukihiro; Hayashi, Naoto; Masutani, Yoshitaka; Yoshikawa, Takeharu; Nemoto, Mitsutaka; Hanaoka, Shouhei; Maeda, Eriko; Ohtomo, Kuni; Miki, Soichiro

2010-01-01

Development of clinical image analysis software such as computer-assisted detection/diagnosis (CAD) involves a cycle of algorithm development, software implementation, clinical use, refinement of algorithm and software based on feedback. This cycle is expected to accelerate development of CAD software. We have been building a web-based CAD server that enables radiologists to use CAD software and to give feedback in clinical environment. The platform has been utilized in our hospital for 16 months, and more than 2,000 cases of feedback data have been accumulated. In this report, we introduce additional functions for performance evaluation based on executed results of CAD software and clinical feedback. (author)

Clinical utility of RapidArc™ radiotherapy technology

International Nuclear Information System (INIS)

Infusino, Erminia

2015-01-01

RapidArc™ is a radiation technique that delivers highly conformal dose distributions through the complete rotation (360°) and speed variation of the linear accelerator gantry. This technique, called volumetric modulated arc therapy (VMAT), compared with conventional radiotherapy techniques, can achieve high-target volume coverage and sparing damage to normal tissues. RapidArc delivers precise dose distribution and conformity similar to or greater than intensity-modulated radiation therapy in a short time, generally a few minutes, to which image-guided radiation therapy is added. RapidArc has become a currently used technology in many centers, which use RapidArc technology to treat a large number of patients. Large and small hospitals use it to treat the most challenging cases, but more and more frequently for the most common cancers. The clinical use of RapidArc and VMAT technology is constantly growing. At present, a limited number of clinical data are published, mostly concerning planning and feasibility studies. Clinical outcome data are increasing for a few tumor sites, even if only a little. The purpose of this work is to discuss the current status of VMAT techniques in clinical use through a review of the published data of planning systems and clinical outcomes in several tumor sites. The study consisted of a systematic review based on analysis of manuscripts retrieved from the PubMed, BioMed Central, and Scopus databases by searching for the keywords “RapidArc”, “Volumetric modulated arc radiotherapy”, and “Intensity-modulated radiotherapy”

Barriers to using eHealth data for clinical performance feedback in Malawi: A case study.

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Landis-Lewis, Zach; Manjomo, Ronald; Gadabu, Oliver J; Kam, Matthew; Simwaka, Bertha N; Zickmund, Susan L; Chimbwandira, Frank; Douglas, Gerald P; Jacobson, Rebecca S

2015-10-01

Sub-optimal performance of healthcare providers in low-income countries is a critical and persistent global problem. The use of electronic health information technology (eHealth) in these settings is creating large-scale opportunities to automate performance measurement and provision of feedback to individual healthcare providers, to support clinical learning and behavior change. An electronic medical record system (EMR) deployed in 66 antiretroviral therapy clinics in Malawi collects data that supervisors use to provide quarterly, clinic-level performance feedback. Understanding barriers to provision of eHealth-based performance feedback for individual healthcare providers in this setting could present a relatively low-cost opportunity to significantly improve the quality of care. The aims of this study were to identify and describe barriers to using EMR data for individualized audit and feedback for healthcare providers in Malawi and to consider how to design technology to overcome these barriers. We conducted a qualitative study using interviews, observations, and informant feedback in eight public hospitals in Malawi where an EMR system is used. We interviewed 32 healthcare providers and conducted seven hours of observation of system use. We identified four key barriers to the use of EMR data for clinical performance feedback: provider rotations, disruptions to care processes, user acceptance of eHealth, and performance indicator lifespan. Each of these factors varied across sites and affected the quality of EMR data that could be used for the purpose of generating performance feedback for individual healthcare providers. Using routinely collected eHealth data to generate individualized performance feedback shows potential at large-scale for improving clinical performance in low-resource settings. However, technology used for this purpose must accommodate ongoing changes in barriers to eHealth data use. Understanding the clinical setting as a complex adaptive

Clinical Skills Verification, Formative Feedback, and Psychiatry Residency Trainees

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Dalack, Gregory W.; Jibson, Michael D.

2012-01-01

Objective: The authors describe the implementation of Clinical Skills Verification (CSV) in their program as an in-training assessment intended primarily to provide formative feedback to trainees, strengthen the supervisory experience, identify the need for remediation of interviewing skills, and secondarily to demonstrating resident competence…

Selective Removal of Residual Orthodontic Composite Using a Rapidly Scanned Carbon Dioxide Laser with Spectral Feedback

Science.gov (United States)

Hirasuna, Krista

Background and Objective: Excessive heat accumulation within the tooth, incomplete removal of composite, and variable damage to the enamel are shortcomings of using conventional burs to remove residual orthodontic composite after debonding fixed appliances. The objective of this study was to determine if composite could be selectively removed from the enamel surface using a rapidly scanned carbon dioxide laser controlled by spectral feedback. Materials and Methods: A carbon dioxide laser operating at a wavelength of 9.3 microm with a pulse duration of 10-15 micros and a pulse repetition rate of ˜ 200 Hz was used to selectively remove composite from the buccal surfaces of 21 extracted teeth. GrenGloo(TM) composite was used to better visualize residual composite and the amount of enamel lost was measured with optical microscopy. A spectral feedback system utilizing a miniature spectrometer was used to control the laser scanning system. Pulpal temperature measurements were performed during composite removal to determine if there was excessive heat accumulation. Results: The amount of enamel lost averaged 22.7microm +/- 8.9 and 25.3 microm +/- 9.4 for removal at 3.8 and 4.2 J/cm2, respectively. An average maximum temperature rise of 1.9°C +/- 1.5 was recorded, with no teeth approaching the critical value of 5.5°C. The average time of composite removal was 19.3 +/- 4.1 seconds. Conclusions: Residual orthodontic composite can be rapidly removed from the tooth surface using a rapidly scanned CO2 laser with spectral feedback, with minimal temperature rise within the pulp and with minimal damage to the underlying enamel surface.

Direct Observation of Clinical Skills Feedback Scale: Development and Validity Evidence.

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Halman, Samantha; Dudek, Nancy; Wood, Timothy; Pugh, Debra; Touchie, Claire; McAleer, Sean; Humphrey-Murto, Susan

2016-01-01

Construct: This article describes the development and validity evidence behind a new rating scale to assess feedback quality in the clinical workplace. Competency-based medical education has mandated a shift to learner-centeredness, authentic observation, and frequent formative assessments with a focus on the delivery of effective feedback. Because feedback has been shown to be of variable quality and effectiveness, an assessment of feedback quality in the workplace is important to ensure we are providing trainees with optimal learning opportunities. The purposes of this project were to develop a rating scale for the quality of verbal feedback in the workplace (the Direct Observation of Clinical Skills Feedback Scale [DOCS-FBS]) and to gather validity evidence for its use. Two panels of experts (local and national) took part in a nominal group technique to identify features of high-quality feedback. Through multiple iterations and review, 9 features were developed into the DOCS-FBS. Four rater types (residents n = 21, medical students n = 8, faculty n = 12, and educators n = 12) used the DOCS-FBS to rate videotaped feedback encounters of variable quality. The psychometric properties of the scale were determined using a generalizability analysis. Participants also completed a survey to gather data on a 5-point Likert scale to inform the ease of use, clarity, knowledge acquisition, and acceptability of the scale. Mean video ratings ranged from 1.38 to 2.96 out of 3 and followed the intended pattern suggesting that the tool allowed raters to distinguish between examples of higher and lower quality feedback. There were no significant differences between rater type (range = 2.36-2.49), suggesting that all groups of raters used the tool in the same way. The generalizability coefficients for the scale ranged from 0.97 to 0.99. Item-total correlations were all above 0.80, suggesting some redundancy in items. Participants found the scale easy to use (M = 4.31/5) and clear

Feasibility and impact of providing feedback to vaccinating medical clinics: evaluating a public health intervention

Directory of Open Access Journals (Sweden)

Kiely Marilou

2010-12-01

Full Text Available Abstract Background Vaccine coverage (VC at a given age is a widely-used indicator for measuring the performance of vaccination programs. However, there is increasing data suggesting that measuring delays in administering vaccines complements the measure of VC. Providing feedback to vaccinators is recognized as an effective strategy for improving vaccine coverage, but its implementation has not been widely documented in Canada. The objective of this study was to evaluate the feasibility of providing personalized feedback to vaccinators and its impact on vaccination delays (VD. Methods In April and May 2008, a one-hour personalized feedback session was provided to health professionals in vaccinating medical clinics in the Quebec City region. VD for vaccines administered at two and twelve months of age were presented. Data from the regional vaccination registry were analysed for participating clinics. Two 12-month periods before and after the intervention were compared, namely from April 1st, 2007 to March 31st, 2008 and from June 1st, 2008 to May 31st, 2009. Results Ten medical clinics out of the twelve approached (83%, representing more than 2500 vaccinated children, participated in the project. Preparing and conducting the feedback involved 20 hours of work and expenses of $1000 per clinic. Based on a delay of one month, 94% of first doses of DTaP-Polio-Hib and 77% of meningococcal vaccine doses respected the vaccination schedule both before and after the intervention. Following the feedback, respect of the vaccination schedule increased for vaccines planned at 12 months for the four clinics that had modified their vaccination practices related to multiple injections (depending on the clinic, VD decreased by 24.4%, 32.0%, 40.2% and 44.6% respectively, p Conclusions The present study shows that it is feasible to provide personalized feedback to vaccinating clinics. While it may have encouraged positive changes in practice concerning multiple

The effectiveness of immediate feedback during the objective structured clinical examination.

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Hodder, R V; Rivington, R N; Calcutt, L E; Hart, I R

1989-03-01

Using eight different physical examination or technical stations, 400 examinations were conducted to evaluate the effectiveness of immediate feedback during the Objective Structured Clinical Examination (OSCE). The test group comprised 50 medical students who underwent a standard 4-minute examination followed by 2 minutes of feedback. Immediately following feedback the students repeated an identical 4-minute examination scored by the same examiners. The control group consisted of 50 students from the same class who underwent an identical testing sequence, but instead of receiving feedback, they were instructed to continue their examinations for an additional 2 minutes before repeating the stations. Simple repetition of the task did not significantly improve score (mean increase 2.0%, NS). Extending the testing period from 4 to 6 minutes resulted in a small but significant increase in score (mean 6.7%, P less than 0.001). However, there was a much larger increase in the scores obtained following 2 minutes of immediate feedback compared to pre-feedback performance (mean 26.3%, P less than 0.0001). The majority of students and examiners felt that feedback, as administered in this study, was valuable both as a learning and teaching experience. Short periods of immediate feedback during an OSCE are practical and can improve competency in the performance of criterion-based tasks, at least over the short term. In addition, such feedback provides students with valuable self-assessment that may stimulate further learning.

Collaborative and Bidirectional Feedback Between Students and Clinical Preceptors: Promoting Effective Communication Skills on Health Care Teams.

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Myers, Kara; Chou, Calvin L

2016-11-01

Current literature on feedback suggests that clinical preceptors lead feedback conversations that are primarily unidirectional, from preceptor to student. While this approach may promote clinical competency, it does not actively develop students' competency in facilitating feedback discussions and providing feedback across power differentials (ie, from student to preceptor). This latter competency warrants particular attention given its fundamental role in effective health care team communication and its related influence on patient safety. Reframing the feedback process as collaborative and bidirectional, where both preceptors and students provide and receive feedback, maximizes opportunities for role modeling and skills practice in the context of a supportive relationship, thereby enhancing team preparedness. We describe an initiative to introduce these fundamental skills of collaborative, bidirectional feedback in the nurse-midwifery education program at the University of California, San Francisco. © 2016 by the American College of Nurse-Midwives.

Guidelines: the do's, don'ts and don't knows of feedback for clinical education.

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Lefroy, Janet; Watling, Chris; Teunissen, Pim W; Brand, Paul

2015-12-01

The guidelines offered in this paper aim to amalgamate the literature on formative feedback into practical Do's, Don'ts and Don't Knows for individual clinical supervisors and for the institutions that support clinical learning. The authors built consensus by an iterative process. Do's and Don'ts were proposed based on authors' individual teaching experience and awareness of the literature, and the amalgamated set of guidelines were then refined by all authors and the evidence was summarized for each guideline. Don't Knows were identified as being important questions to this international group of educators which if answered would change practice. The criteria for inclusion of evidence for these guidelines were not those of a systematic review, so indicators of strength of these recommendations were developed which combine the evidence with the authors' consensus. A set of 32 Do and Don't guidelines with the important Don't Knows was compiled along with a summary of the evidence for each. These are divided into guidelines for the individual clinical supervisor giving feedback to their trainee (recommendations about both the process and the content of feedback) and guidelines for the learning culture (what elements of learning culture support the exchange of meaningful feedback, and what elements constrain it?) Feedback is not easy to get right, but it is essential to learning in medicine, and there is a wealth of evidence supporting the Do's and warning against the Don'ts. Further research into the critical Don't Knows of feedback is required. A new definition is offered: Helpful feedback is a supportive conversation that clarifies the trainee's awareness of their developing competencies, enhances their self-efficacy for making progress, challenges them to set objectives for improvement, and facilitates their development of strategies to enable that improvement to occur.

Does Reflective Learning with Feedback Improve Dental Students' Self-Perceived Competence in Clinical Preparedness?

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Ihm, Jung-Joon; Seo, Deog-Gyu

2016-02-01

The value of dental students' self-assessment is often debated. The aim of this study was to explore whether reflective learning with feedback enabled dental students to more accurately assess their self-perceived levels of preparedness on dental competencies. Over 16 weeks, all third- and fourth-year students at a dental school in the Republic of Korea took part in clinical rotations that incorporated reflective learning and feedback. Following this educational intervention, they were asked to assess their perceptions of their clinical competence. The results showed that the students reported feeling most confident about performing periodontal treatment (mean 7.1 on a ten-point scale) and least confident about providing orthodontic care (mean 5.6). The fourth-year students reported feeling more confident on all the competencies than the third-year students. Their self-perceived competence in periodontal treatment and oral medicine significantly predicted the instructors' clinical evaluations. This study offered insights into determining if structured reflective learning with effective feedback helps to increase dental students' self-perceived level of clinical preparedness.

Optimal estimation and scheduling in aquifer management using the rapid feedback control method

Science.gov (United States)

Ghorbanidehno, Hojat; Kokkinaki, Amalia; Kitanidis, Peter K.; Darve, Eric

2017-12-01

Management of water resources systems often involves a large number of parameters, as in the case of large, spatially heterogeneous aquifers, and a large number of "noisy" observations, as in the case of pressure observation in wells. Optimizing the operation of such systems requires both searching among many possible solutions and utilizing new information as it becomes available. However, the computational cost of this task increases rapidly with the size of the problem to the extent that textbook optimization methods are practically impossible to apply. In this paper, we present a new computationally efficient technique as a practical alternative for optimally operating large-scale dynamical systems. The proposed method, which we term Rapid Feedback Controller (RFC), provides a practical approach for combined monitoring, parameter estimation, uncertainty quantification, and optimal control for linear and nonlinear systems with a quadratic cost function. For illustration, we consider the case of a weakly nonlinear uncertain dynamical system with a quadratic objective function, specifically a two-dimensional heterogeneous aquifer management problem. To validate our method, we compare our results with the linear quadratic Gaussian (LQG) method, which is the basic approach for feedback control. We show that the computational cost of the RFC scales only linearly with the number of unknowns, a great improvement compared to the basic LQG control with a computational cost that scales quadratically. We demonstrate that the RFC method can obtain the optimal control values at a greatly reduced computational cost compared to the conventional LQG algorithm with small and controllable losses in the accuracy of the state and parameter estimation.

Progress in Rapidly-Tunable External Cavity Quantum Cascade Lasers with a Frequency-Shifted Feedback

Directory of Open Access Journals (Sweden)

Arkadiy Lyakh

2016-04-01

Full Text Available The recent demonstration of external cavity quantum cascade lasers with optical feedback, controlled by an acousto-optic modulator, paves the way to ruggedized infrared laser systems with the capability of tuning the emission wavelength on a microsecond scale. Such systems are of great importance for various critical applications requiring ultra-rapid wavelength tuning, including combustion and explosion diagnostics and standoff detection. In this paper, recent research results on these devices are summarized and the advantages of the new configuration are analyzed in the context of practical applications.

Depression screening with patient-targeted feedback in cardiology: DEPSCREEN-INFO randomised clinical trial.

Science.gov (United States)

Löwe, Bernd; Blankenberg, Stefan; Wegscheider, Karl; König, Hans-Helmut; Walter, Dirk; Murray, Alexandra M; Gierk, Benjamin; Kohlmann, Sebastian

2017-02-01

International guidelines advocate depression screening in patients with coronary heart disease (CHD) and other chronic illnesses, but evidence is lacking. To test the differential efficacy of written patient-targeted feedback v. no written patient feedback after depression screening. Patients with CHD or hypertension from three cardiology settings were randomised and screened for depression (ClinicalTrials.gov Identifier: NCT01879111). Compared with the control group, where only cardiologists received written feedback, in the intervention group both cardiologists and patients received written feedback regarding depression status. Depression severity was measured 1 month (primary outcome) and 6 months after screening. The control group (n = 220) and the patient-feedback group (n = 155) did not differ in depression severity 1 month after screening. Six months after screening, the patient-feedback group showed significantly greater improvements in depression severity and was twice as likely to seek information about depression compared with the control group. Patient-targeted feedback in addition to screening has a significant but small effect on depression severity after 6 months and may encourage patients to take an active role in the self-management of depression. © The Royal College of Psychiatrists 2017.

Clinical librarian support for rapid review of clinical utility of cancer molecular biomarkers.

Science.gov (United States)

Geng, Yimin; Fowler, Clara S; Fulton, Stephanie

2015-01-01

The clinical librarian used a restricted literature searching and quality-filtering approach to provide relevant clinical evidence for the use of cancer molecular biomarkers by institutional policy makers and clinicians in the rapid review process. The librarian-provided evidence was compared with the cited references in the institutional molecular biomarker algorithm. The overall incorporation rate of the librarian-provided references into the algorithm was above 80%. This study suggests the usefulness of clinical librarian expertise for clinical practice. The searching and filtering methods for high-level evidence can be adopted by information professionals who are involved in the rapid literature review.

Provider Communication, Prompts, and Feedback to Improve HPV Vaccination Rates in Resident Clinics.

Science.gov (United States)

Rand, Cynthia M; Schaffer, Stanley J; Dhepyasuwan, Nui; Blumkin, Aaron; Albertin, Christina; Serwint, Janet R; Darden, Paul M; Humiston, Sharon G; Mann, Keith J; Stratbucker, William; Szilagyi, Peter G

2018-04-01

Human papillomavirus (HPV) vaccination rates lag behind vaccination rates for other adolescent vaccines; a bundled intervention may improve HPV vaccination rates. Our objective is to evaluate the impact of quality improvement (QI) training plus a bundled practice-based intervention (provider prompts plus communication skills training plus performance feedback) on improving HPV vaccinations in pediatric resident continuity clinics. Staff and providers in 8 resident clinics participated in a 12-month QI study. The intervention included training to strengthen provider communication about the HPV vaccine. Clinics also implemented provider prompts, received monthly performance feedback, and participated in learning collaborative calls. The primary outcome measure was eligible visits with vaccination divided by vaccine-eligible visits (captured HPV vaccination opportunities). Practices performed chart audits that were fed into monthly performance feedback on captured HPV vaccination opportunities. We used conditional logistic regression (conditioning on practice) to assess captured vaccination opportunities, with the time period of the study (before and after the QI intervention) as the independent variable. Overall, captured opportunities for HPV vaccination increased by 16.4 percentage points, from 46.9% to 63.3%. Special cause was demonstrated by centerline shift, with 8 consecutive points above the preintervention mean. On adjusted analyses, patients were more likely to receive a vaccine during, versus before, the intervention (odds ratio: 1.87; 95% confidence interval: 1.54-2.28). Captured HPV vaccination rates improved at both well-child and other visits (by 11.7 and 13.0 percentage points, respectively). A bundled intervention of provider prompts and training in communication skills plus performance feedback increased captured opportunities for HPV vaccination. Copyright © 2018 by the American Academy of Pediatrics.

Guidelines : the do's, don'ts and don't knows of feedback for clinical education

NARCIS (Netherlands)

Lefroy, Janet; Watling, Chris; Teunissen, Pim W; Brand, Paul

2015-01-01

INTRODUCTION: The guidelines offered in this paper aim to amalgamate the literature on formative feedback into practical Do's, Don'ts and Don't Knows for individual clinical supervisors and for the institutions that support clinical learning. METHODS: The authors built consensus by an iterative

Electroencephalogy (EEG) Feedback in Decision-Making

Science.gov (United States)

2015-08-26

Electroencephalogy ( EEG ) Feedback In Decision- Making The goal of this project is to investigate whether Electroencephalogy ( EEG ) can provide useful...feedback when training rapid decision-making. More specifically, EEG will allow us to provide online feedback about the neural decision processes...Electroencephalogy ( EEG ) Feedback In Decision-Making Report Title The goal of this project is to investigate whether Electroencephalogy ( EEG ) can provide useful

The clinical relevance of advanced artificial feedback in the control of a multi-functional myoelectric prosthesis.

Science.gov (United States)

Markovic, Marko; Schweisfurth, Meike A; Engels, Leonard F; Bentz, Tashina; Wüstefeld, Daniela; Farina, Dario; Dosen, Strahinja

2018-03-27

To effectively replace the human hand, a prosthesis should seamlessly respond to user intentions but also convey sensory information back to the user. Restoration of sensory feedback is rated highly by the prosthesis users, and feedback is critical for grasping in able-bodied subjects. Nonetheless, the benefits of feedback in prosthetics are still debated. The lack of consensus is likely due to the complex nature of sensory feedback during prosthesis control, so that its effectiveness depends on multiple factors (e.g., task complexity, user learning). We evaluated the impact of these factors with a longitudinal assessment in six amputee subjects, using a clinical setup (socket, embedded control) and a range of tasks (box and blocks, block turn, clothespin and cups relocation). To provide feedback, we have proposed a novel vibrotactile stimulation scheme capable of transmitting multiple variables from a multifunction prosthesis. The subjects wore a bracelet with four by two uniformly placed vibro-tactors providing information on contact, prosthesis state (active function), and grasping force. The subjects also completed a questionnaire for the subjective evaluation of the feedback. The tests demonstrated that feedback was beneficial only in the complex tasks (block turn, clothespin and cups relocation), and that the training had an important, task-dependent impact. In the clothespin relocation and block turn tasks, training allowed the subjects to establish successful feedforward control, and therefore, the feedback became redundant. In the cups relocation task, however, the subjects needed some training to learn how to properly exploit the feedback. The subjective evaluation of the feedback was consistently positive, regardless of the objective benefits. These results underline the multifaceted nature of closed-loop prosthesis control as, depending on the context, the same feedback interface can have different impact on performance. Finally, even if the closed

The Impact of Feedback on the Different Time Courses of Multisensory Temporal Recalibration

Directory of Open Access Journals (Sweden)

Matthew A. De Niear

2017-01-01

Full Text Available The capacity to rapidly adjust perceptual representations confers a fundamental advantage when confronted with a constantly changing world. Unexplored is how feedback regarding sensory judgments (top-down factors interacts with sensory statistics (bottom-up factors to drive long- and short-term recalibration of multisensory perceptual representations. Here, we examined the time course of both cumulative and rapid temporal perceptual recalibration for individuals completing an audiovisual simultaneity judgment task in which they were provided with varying degrees of feedback. We find that in the presence of feedback (as opposed to simple sensory exposure temporal recalibration is more robust. Additionally, differential time courses are seen for cumulative and rapid recalibration dependent upon the nature of the feedback provided. Whereas cumulative recalibration effects relied more heavily on feedback that informs (i.e., negative feedback rather than confirms (i.e., positive feedback the judgment, rapid recalibration shows the opposite tendency. Furthermore, differential effects on rapid and cumulative recalibration were seen when the reliability of feedback was altered. Collectively, our findings illustrate that feedback signals promote and sustain audiovisual recalibration over the course of cumulative learning and enhance rapid trial-to-trial learning. Furthermore, given the differential effects seen for cumulative and rapid recalibration, these processes may function via distinct mechanisms.

BREATHING FIRE: HOW STELLAR FEEDBACK DRIVES RADIAL MIGRATION, RAPID SIZE FLUCTUATIONS, AND POPULATION GRADIENTS IN LOW-MASS GALAXIES

International Nuclear Information System (INIS)

El-Badry, Kareem; Geha, Marla; Wetzel, Andrew; Hopkins, Philip F.; Kereš, Dusan; Chan, T. K.; Faucher-Giguère, Claude-André

2016-01-01

We examine the effects of stellar feedback and bursty star formation on low-mass galaxies (M star  = 2 × 10 6  − 5 × 10 10 M ⊙ ) using the Feedback in Realistic Environments (FIRE) simulations. While previous studies emphasized the impact of feedback on dark matter profiles, we investigate the impact on the stellar component: kinematics, radial migration, size evolution, and population gradients. Feedback-driven outflows/inflows drive significant radial stellar migration over both short and long timescales via two processes: (1) outflowing/infalling gas can remain star-forming, producing young stars that migrate ∼1 kpc within their first 100 Myr, and (2) gas outflows/inflows drive strong fluctuations in the global potential, transferring energy to all stars. These processes produce several dramatic effects. First, galaxies’ effective radii can fluctuate by factors of >2 over ∼200 Myr, and these rapid size fluctuations can account for much of the observed scatter in the radius at fixed M star . Second, the cumulative effects of many outflow/infall episodes steadily heat stellar orbits, causing old stars to migrate outward most strongly. This age-dependent radial migration mixes—and even inverts—intrinsic age and metallicity gradients. Thus, the galactic-archaeology approach of calculating radial star formation histories from stellar populations at z = 0 can be severely biased. These effects are strongest at M star  ≈ 10 7–9.6 M ⊙ , the same regime where feedback most efficiently cores galaxies. Thus, detailed measurements of stellar kinematics in low-mass galaxies can strongly constrain feedback models and test baryonic solutions to small-scale problems in ΛCDM

Formative feedback in the clinical practice setting: What are the perceptions of student radiographers?

International Nuclear Information System (INIS)

Fowler, P.; Wilford, B.

2016-01-01

The role of feedback to a learner's development has been well established. There is an absence of studies relating to student radiographers experience of gaining and applying formative feedback. This study investigated processes involved in gaining written formative feedback in the clinical practice setting as well as the impact feedback had on student radiographers learning. The data was collected from radiography students at two higher education institutions by electronic questionnaire comprising scaled and open questions. There was a response rate of 37% (n = 103/279). Scaled data was analysed using inferential statistics and the qualitative data helped explain the findings. The majority of students recognised radiographers were frequently busy; resulting in feedback that is generic and not always timely. There is strength of opinion 82.6% (n = 85/103) that student radiographers do not work with any one radiographer consistently enough to enable the provision of constructive and meaningful feedback. There appears to be difficulty in obtaining the comments but the evidence shows they are valued. The majority of students seek feedback that is specific and will clearly identify areas for development. They reflect on feedback as well as use self-criticism of their practice performance indicating the development of autonomous skills. The challenge of enabling consistent one to one working with radiographers, the need to maximise a learning culture within practice environments and ensuring full engagement by radiographers and students could be addressed by modification of the feedback system, a working group being formed from students, supervising radiographers and academic tutors. - Highlights: • Students value constructive criticism and on-going verbal feedback. • Written feedback is not always easy to obtain because of pressures on staff time. • Student radiographers are rarely able to work consistently with the same person. • Student and mentor

Investigating the role of feedback and motivation in clinical reaction time assessment.

Science.gov (United States)

Eckner, James T; Chandran, Srikrishna; Richardson, James K

2011-12-01

To investigate the influence of performance feedback and motivation during 2 tests of simple visuomotor reaction time (RT). Cross-sectional, observational study. Outpatient academic physiatry clinic. Thirty-one healthy adults (mean [SD], 54 ± 15 years). Participants completed a clinical test of RT (RT(clin)) and a computerized test of RT with and without performance feedback (RT(compFB) and RT(compNoFB), respectively) in randomly assigned order. They then ranked their degree of motivation during each test. RT(clin) measured the time required to catch a suspended vertical shaft by hand closure after release of the shaft by the examiner. RT(compFB) and RT(compNoFB) both measured the time required to press a computer key in response to a visual cue displayed on a computer monitor. Performance feedback (visual display of the previous trial and summary results) was provided for RT(compFB), but not for RT(compNoFB). Means and standard deviations of RT(clin), RT(compFB), and RT(compNoFB) and participants' self-reported motivation on a 5-point Likert scale for each test. There were significant differences in both the means and standard deviations of RT(clin), RT(compFB), and RT(compNoFB) (F(2,60) = 81.66, P motivation between RT(clin) and RT(compFB), both of which were reported to be more motivating than RT(compNoFB). The stronger correlation between RT(clin) and RT(compFB) as well as the higher reported motivation during RT(clin) and RT(compFB) testing suggest that performance feedback is a positive motivating factor that is inherent to RT(clin) testing. RT(clin) is a simple, inexpensive technique for measuring RT and appears to be an intrinsically motivating task. This motivation may promote faster, more consistent RT performance compared with currently available computerized programs, which do not typically provide performance feedback. Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

BREATHING FIRE: HOW STELLAR FEEDBACK DRIVES RADIAL MIGRATION, RAPID SIZE FLUCTUATIONS, AND POPULATION GRADIENTS IN LOW-MASS GALAXIES

Energy Technology Data Exchange (ETDEWEB)

El-Badry, Kareem; Geha, Marla [Department of Astronomy, Yale University, New Haven, CT (United States); Wetzel, Andrew; Hopkins, Philip F. [TAPIR, California Institute of Technology, Pasadena, CA USA (United States); Kereš, Dusan; Chan, T. K. [Department of Physics, Center for Astrophysics and Space Sciences, University of California at San Diego, La Jolla (United States); Faucher-Giguère, Claude-André, E-mail: kareem.el-badry@yale.edu [Department of Physics and Astronomy and CIERA, Northwestern University, Evanston, IL (United States)

2016-04-01

We examine the effects of stellar feedback and bursty star formation on low-mass galaxies (M{sub star} = 2 × 10{sup 6} − 5 × 10{sup 10} M{sub ⊙}) using the Feedback in Realistic Environments (FIRE) simulations. While previous studies emphasized the impact of feedback on dark matter profiles, we investigate the impact on the stellar component: kinematics, radial migration, size evolution, and population gradients. Feedback-driven outflows/inflows drive significant radial stellar migration over both short and long timescales via two processes: (1) outflowing/infalling gas can remain star-forming, producing young stars that migrate ∼1 kpc within their first 100 Myr, and (2) gas outflows/inflows drive strong fluctuations in the global potential, transferring energy to all stars. These processes produce several dramatic effects. First, galaxies’ effective radii can fluctuate by factors of >2 over ∼200 Myr, and these rapid size fluctuations can account for much of the observed scatter in the radius at fixed M{sub star}. Second, the cumulative effects of many outflow/infall episodes steadily heat stellar orbits, causing old stars to migrate outward most strongly. This age-dependent radial migration mixes—and even inverts—intrinsic age and metallicity gradients. Thus, the galactic-archaeology approach of calculating radial star formation histories from stellar populations at z = 0 can be severely biased. These effects are strongest at M{sub star} ≈ 10{sup 7–9.6} M{sub ⊙}, the same regime where feedback most efficiently cores galaxies. Thus, detailed measurements of stellar kinematics in low-mass galaxies can strongly constrain feedback models and test baryonic solutions to small-scale problems in ΛCDM.

Documenting clinical performance problems among medical students: feedback for learner remediation and curriculum enhancement

Directory of Open Access Journals (Sweden)

Brian E. Mavis

2013-07-01

Full Text Available Introduction: We operationalized the taxonomy developed by Hauer and colleagues describing common clinical performance problems. Faculty raters pilot tested the resulting worksheet by observing recordings of problematic simulated clinical encounters involving third-year medical students. This approach provided a framework for structured feedback to guide learner improvement and curricular enhancement. Methods: Eighty-two problematic clinical encounters from M3 students who failed their clinical competency examination were independently rated by paired clinical faculty members to identify common problems related to the medical interview, physical examination, and professionalism. Results: Eleven out of 26 target performance problems were present in 25% or more encounters. Overall, 37% had unsatisfactory medical interviews, with ‘inadequate history to rule out other diagnoses’ most prevalent (60%. Seventy percent failed because of physical examination deficiencies, with missing elements (69% and inadequate data gathering (69% most common. One-third of the students did not introduce themselves to their patients. Among students failing based on standardized patient (SP ratings, 93% also failed to demonstrate competency based on the faculty ratings. Conclusions: Our review form allowed clinical faculty to validate pass/fail decisions based on standardized patient ratings. Detailed information about performance problems contributes to learner feedback and curricular enhancement to guide remediation planning and faculty development.

Feedback Loop Gains and Feedback Behavior (1996)

DEFF Research Database (Denmark)

Kampmann, Christian Erik

2012-01-01

Linking feedback loops and system behavior is part of the foundation of system dynamics, yet the lack of formal tools has so far prevented a systematic application of the concept, except for very simple systems. Having such tools at their disposal would be a great help to analysts in understanding...... large, complicated simulation models. The paper applies tools from graph theory formally linking individual feedback loop strengths to the system eigenvalues. The significance of a link or a loop gain and an eigenvalue can be expressed in the eigenvalue elasticity, i.e., the relative change...... of an eigenvalue resulting from a relative change in the gain. The elasticities of individual links and loops may be found through simple matrix operations on the linearized system. Even though the number of feedback loops can grow rapidly with system size, reaching astronomical proportions even for modest systems...

Rapid arc - clinical rationale and results

International Nuclear Information System (INIS)

Cozzi, Lucca

2008-01-01

The presentation will focus on the background of Intensity modulation volumetric arc therapy Rapid Arc from Varian Medical Systems aiming to highlight the technical and clinical rational also from an historical perspective to the founding pillars of fast delivery with a minimum number of arcs and a minimum number of monitor units

Clinical skills-related learning goals of senior medical students after performance feedback.

Science.gov (United States)

Chang, Anna; Chou, Calvin L; Teherani, Arianne; Hauer, Karen E

2011-09-01

Lifelong learning is essential for doctors to maintain competence in clinical skills. With performance feedback, learners should be able to formulate specific and achievable learning goals in areas of need. We aimed to determine: (i) the type and specificity of medical student learning goals after a required clinical performance examination; (ii) differences in goal setting among low, average and high performers, and (iii) whether low performers articulate learning goals that are concordant with their learning needs. We conducted a single-site, multi-year, descriptive comparison study. Senior medical students were given performance benchmarks, individual feedback and guidelines on learning goals; each student was subsequently instructed to write two clinical skills learning goals. Investigators coded the learning goals for specificity, categorised the goals, and performed statistical analyses to determine their concordance with student performance level (low, average or high) in data gathering (history taking and physical examination) or communication skills. All 208 students each wrote two learning goals and most (n=200, 96%) wrote two specific learning goals. Nearly two-thirds of low performers in data gathering wrote at least one learning goal that referred to history taking or physical examination; one-third wrote learning goals pertaining to the organisation of the encounter. High performers in data gathering wrote significantly more patient education goals and significantly fewer history-taking goals than average or low performers. Only 50% of low performers in communication wrote learning goals related to communication skills. Low performers in communication were significantly more likely than average or high performers to identify learning goals related to improving performance in future examinations. The provision of performance benchmarking, individual feedback and brief written guidelines helped most senior medical students in our study to write specific

Piloting the feasibility of head-mounted video technology to augment student feedback during simulated clinical decision-making: An observational design pilot study.

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Forbes, Helen; Bucknall, Tracey K; Hutchinson, Alison M

2016-04-01

Clinical decision-making is a complex activity that is critical to patient safety. Simulation, augmented by feedback, affords learners the opportunity to learn critical clinical decision-making skills. More detailed feedback following simulation exercises has the potential to further enhance student learning, particularly in relation to developing improved clinical decision-making skills. To investigate the feasibility of head-mounted video camera recordings, to augment feedback, following acute patient deterioration simulations. Pilot study using an observational design. Ten final-year nursing students participated in three simulation exercises, each focussed on detection and management of patient deterioration. Two observers collected behavioural data using an adapted version of Gaba's Clinical Simulation Tool, to provide verbal feedback to each participant, following each simulation exercise. Participants wore a head-mounted video camera during the second simulation exercise only. Video recordings were replayed to participants to augment feedback, following the second simulation exercise. Data were collected on: participant performance (observed and perceived); participant perceptions of feedback methods; and head-mounted video camera recording feasibility and capability for detailed audio-visual feedback. Management of patient deterioration improved for six participants (60%). Increased perceptions of confidence (70%) and competence (80%), were reported by the majority of participants. Few participants (20%) agreed that the video recording specifically enhanced their learning. The visual field of the head-mounted video camera was not always synchronised with the participant's field of vision, thus affecting the usefulness of some recordings. The usefulness of the video recordings, to enhance verbal feedback to participants on detection and management of simulated patient deterioration, was inconclusive. Modification of the video camera glasses, to improve

An implementation of sensor-based force feedback in a compact laparoscopic surgery robot.

Science.gov (United States)

Lee, Duk-Hee; Choi, Jaesoon; Park, Jun-Woo; Bach, Du-Jin; Song, Seung-Jun; Kim, Yoon-Ho; Jo, Yungho; Sun, Kyung

2009-01-01

Despite the rapid progress in the clinical application of laparoscopic surgery robots, many shortcomings have not yet been fully overcome, one of which is the lack of reliable haptic feedback. This study implemented a force-feedback structure in our compact laparoscopic surgery robot. The surgery robot is a master-slave configuration robot with 5 DOF (degree of freedom corresponding laparoscopic surgical motion. The force-feedback implementation was made in the robot with torque sensors and controllers installed in the pitch joint of the master and slave robots. A simple dynamic model of action-reaction force in the slave robot was used, through which the reflective force was estimated and fed back to the master robot. The results showed the system model could be identified with significant fidelity and the force feedback at the master robot was feasible. However, the qualitative human assessment of the fed-back force showed only limited level of object discrimination ability. Further developments are underway with this result as a framework.

Improving Clinical Feedback to Anesthesia Residents by Using an Optical Scanner and a Microcomputer.

Science.gov (United States)

Albanese, Mark A.; And Others

1989-01-01

At the University of Iowa problems associated with managing evaluations of anesthesia residents led to a major backlog of unanalyzed evaluation forms. A system developed at the University that enables ongoing feedback to residents and provides a method to assess the clinical competence of residents is described. (Author/MLW)

Implementing a Measurement Feedback System in Community Mental Health Clinics: A Case Study of Multilevel Barriers and Facilitators.

Science.gov (United States)

Gleacher, Alissa A; Olin, Serene S; Nadeem, Erum; Pollock, Michele; Ringle, Vanesa; Bickman, Leonard; Douglas, Susan; Hoagwood, Kimberly

2016-05-01

Measurement feedback systems (MFSs) have been proposed as a means of improving practice. The present study examined the implementation of a MFS, the Contextualized Feedback System (CFS), in two community-based clinic sites. Significant implementation differences across sites provided a basis for examining factors that influenced clinician uptake of CFS. Following the theoretical implementation framework of Aarons et al. (Adm Policy Mental Health Mental Health Serv Res 38(1):4-23, 2011), we coded qualitative data collected from eighteen clinicians (13 from Clinic U and 5 from Clinic R) who participated in semi-structured interviews about their experience with CFS implementation. Results suggest that clinicians at both clinics perceived more barriers than facilitators to CFS implementation. Interestingly, clinicians at the higher implementing clinic reported a higher proportion of barriers to facilitators (3:1 vs. 2:1); however, these clinicians also reported a significantly higher level of organizational and leadership supports for CFS implementation. Implications of these findings are discussed.

The impact of expert- and peer feedback on communication skills of undergraduate dental students - a single-blinded, randomized, controlled clinical trial.

Science.gov (United States)

Krause, Felix; Schmalz, Gerhard; Haak, Rainer; Rockenbauch, Katrin

2017-12-01

To evaluate the effect of peer- and expert feedback on communication skills of undergraduate dental students. All students of the first clinical treatment course (n=46) were randomly assigned into two groups. For three times a medical-dental interview/consultation of each student with a real patient was videotaped. After every consultation the videos were assessed either by a person experienced in communication (expert group) or by a fellow student (peer group), giving the students feedback regarding their chairside performed communication skills. Before and after the feedback-interventions all students conducted an interview with simulated patients, which was rated using a validated global rating and analyzed statistically. Global ratings mean scores after feedback-intervention were significantly improved (p0.05). During this study students improved their communication skills in dentist-patient interactions. The communication experience of the feedback provider seems not to have any impact on the communication skills in undergraduate dental students. The clinical courses in dentistry offer the opportunity to implement peer-feedback interventions in real treatment situation as part of communication training to longitudinally improve communication skills. Copyright © 2017 Elsevier B.V. All rights reserved.

The clinical relevance of advanced artificial feedback in the control of a multi-functional myoelectric prosthesis

DEFF Research Database (Denmark)

Markovic, Marko; Schweisfurth, Meike A.; Engels, Leonard F.

2018-01-01

. Nonetheless, the benefits of feedback in prosthetics are still debated. The lack of consensus is likely due to the complex nature of sensory feedback during prosthesis control, so that its effectiveness depends on multiple factors (e.g., task complexity, user learning). METHODS: We evaluated the impact...... of these factors with a longitudinal assessment in six amputee subjects, using a clinical setup (socket, embedded control) and a range of tasks (box and blocks, block turn, clothespin and cups relocation). To provide feedback, we have proposed a novel vibrotactile stimulation scheme capable of transmitting...... multiple variables from a multifunction prosthesis. The subjects wore a bracelet with four by two uniformly placed vibro-tactors providing information on contact, prosthesis state (active function), and grasping force. The subjects also completed a questionnaire for the subjective evaluation...

Exploratory study of the characteristics of feedback in the reflective dialogue group given to medical students in a clinical clerkship

Directory of Open Access Journals (Sweden)

Chin-Chen Wen

2015-02-01

Full Text Available Purpose: Structured narrative reflective writing combined with guided feedback is an efficient teaching method for enhancing medical students’ reflective capacity. However, what kinds of feedback offered and reflection presented in a reflective group remain unclear. The aim of this study was to investigate the characteristics of feedback in a reflective dialogue group. Methods: Fifth-year medical students on a monthly interval rotation at the pediatric department of a medical center in eastern Taiwan during the 2012 academic year completed their reflective writing regarding patient and family psychosocial issues, and were subsequently debriefed in a 2-h group discussion session to receive feedback from a clinical tutor and peers. Content analysis was conducted to explore the characteristics of feedback and reflection presented in the reflective dialogue. The evaluative questionnaire regarding the benefits of reflection with others was administrated following the group session. Results: Forty students participated in five reflective groups and 108 psychosocial issues were discussed and identified. The tutor played an initiating role in the group discussion by providing six equal feedback types involving exploring new knowledge, initiating advanced discussion, highlighting the issues, and encouraging the students. The students provided eight types of feedback that involved a substantial deep discussion on psychosocial issues and action plans based on the complex interactive ecological network of clinical encounters. Each student attained 1.25 times the depth or breadth of reflection after receiving feedback and experienced the benefits of reflection with others. Conclusion: Through structured narrative reflective writing combined with pluralistic group discussion with a tutor and peers, the medical students had time to think deeply and broadly about psychosocial issues among patients and their family members. Facilitative feedback providing new

The cost of implementing rapid HIV testing in sexually transmitted disease clinics in the United States.

Science.gov (United States)

Eggman, Ashley A; Feaster, Daniel J; Leff, Jared A; Golden, Matthew R; Castellon, Pedro C; Gooden, Lauren; Matheson, Tim; Colfax, Grant N; Metsch, Lisa R; Schackman, Bruce R

2014-09-01

Rapid HIV testing in high-risk populations can increase the number of persons who learn their HIV status and avoid spending clinic resources to locate persons identified as HIV infected. We determined the cost to sexually transmitted disease (STD) clinics of point-of-care rapid HIV testing using data from 7 public clinics that participated in a randomized trial of rapid testing with and without brief patient-centered risk reduction counseling in 2010. Costs included counselor and trainer time, supplies, and clinic overhead. We applied national labor rates and test costs. We calculated median clinic start-up costs and mean cost per patient tested, and projected incremental annual costs of implementing universal rapid HIV testing compared with current testing practices. Criteria for offering rapid HIV testing and methods for delivering nonrapid test results varied among clinics before the trial. Rapid HIV testing cost an average of US $22/patient without brief risk reduction counseling and US $46/patient with counseling in these 7 clinics. Median start-up costs per clinic were US $1100 and US $16,100 without and with counseling, respectively. Estimated incremental annual costs per clinic of implementing universal rapid HIV testing varied by whether or not brief counseling is conducted and by current clinic testing practices, ranging from a savings of US $19,500 to a cost of US $40,700 without counseling and a cost of US $98,000 to US $153,900 with counseling. Universal rapid HIV testing in STD clinics with same-day results can be implemented at relatively low cost to STD clinics, if brief risk reduction counseling is not offered.

Imaging findings and referral outcomes of rapid assessment stroke clinics

International Nuclear Information System (INIS)

Widjaja, E.; Manuel, D.; Hodgson, T.J.; Connolly, D.J.A.; Coley, S.C.; Romanowski, C.A.J.; Gaines, P.; Cleveland, T.; Thomas, S.; Griffiths, P.D.; Doyle, C.; Venables, G.S.

2005-01-01

AIM: A rapid assessment stroke clinic (RASC) was established to provide a rapid diagnostic service to individuals with suspected transient cerebral or ocular ischaemia or recovered non-hospitalized strokes. In this report we review imaging findings and clinical outcomes of patients proceeding to the carotid surgery programme. METHODS: Between October 2000 and December 2002, 1339 people attended the RASC. The findings of head CT and carotid Doppler ultrasound of the 1320 patients who underwent brain and carotid imaging were reviewed, and the number subsequently proceeding to carotid angiography and intervention was reported. RESULTS: CT head scans were normal in 57% of cases; 38% demonstrated ischaemia or infarction; and 3% yielded incidental or other significant findings not related to ischaemia. On screening with carotid Doppler ultrasound, 7.5% showed greater than 50% stenosis on the symptomatic side. A total of 83 patients (6.2%) proceeded to cerebral angiography and 65 (4.8%) underwent carotid endarterectomy or endovascular repair. CONCLUSION: Rapid-access neurovascular clinics are efficient in selecting patients for carotid intervention, but this is at a cost and the number of potential strokes prevented is small. Alternative management pathways based on immediate medical treatment need to be evaluated

Multisource feedback to graduate nurses: a multimethod study.

Science.gov (United States)

McPhee, Samantha; Phillips, Nicole M; Ockerby, Cherene; Hutchinson, Alison M

2017-11-01

(1) To explore graduate nurses' perceptions of the influence of multisource feedback on their performance and (2) to explore perceptions of Clinical Nurse Educators involved in providing feedback regarding feasibility and benefit of the approach. Graduate registered nurses are expected to provide high-quality care for patients in demanding and unpredictable clinical environments. Receiving feedback is essential to their development. Performance appraisals are a common method used to provide feedback and typically involve a single source of feedback. Alternatively, multisource feedback allows the learner to gain insight into performance from a variety of perspectives. This study explores multisource feedback in an Australian setting within the graduate nurse context. Multimethod study. Eleven graduates were given structured performance feedback from four raters: Nurse Unit Manager, Clinical Nurse Educator, preceptor and a self-appraisal. Thirteen graduates received standard single-rater appraisals. Data regarding perceptions of feedback for both groups were obtained using a questionnaire. Semistructured interviews were conducted with nurses who received multisource feedback and the educators. In total, 94% (n = 15) of survey respondents perceived feedback was important during the graduate year. Four themes emerged from interviews: informal feedback, appropriateness of raters, elements of delivery and creating an appraisal process that is 'more real'. Multisource feedback was perceived as more beneficial compared to single-rater feedback. Educators saw value in multisource feedback; however, perceived barriers were engaging raters and collating feedback. Some evidence exists to indicate that feedback from multiple sources is valued by graduates. Further research in a larger sample and with more experienced nurses is required. Evidence resulting from this study indicates that multisource feedback is valued by both graduates and educators and informs graduates

Students' motivation toward feedback-seeking in the clinical workplace

NARCIS (Netherlands)

Jong, L.H. de; Favier, R.P.; Vleuten, C.P.M. van der; Bok, H.G.

2017-01-01

In medical education, students are increasingly regarded as active seekers of feedback rather than passive recipients. Previous research showed that in the intentions of students to seek feedback, a learning and performance goal can be distinguished. In this study, we investigated the intentions

Feedback as a means to improve clinical competencies: Consultants ...

African Journals Online (AJOL)

Background. Effective supervision by consultants in postgraduate medical education involves the process of feedback. Giving feedback may be challenging for consultants who have no formal training in this process, which may be further compounded in heterogeneous diverse settings. Objective. To explore consultants' ...

Students’ motivation toward feedback-seeking in the clinical workplace

NARCIS (Netherlands)

de Jong, Lubberta H.; Favier, Robert P.; Van der Vleuten, Cees P. M.; Bok, Harold G.J.

2017-01-01

ABSTRACT In medical education, students are increasingly regarded as active seekers of feedback rather than passive recipients. Previous research showed that in the intentions of students to seek feedback, a learning and performance goal can be dis- tinguished. In this study, we investigated the

The effect of video-assisted oral feedback versus oral feedback on surgical communicative competences in undergraduate training.

Science.gov (United States)

Ruesseler, M; Sterz, J; Bender, B; Hoefer, S; Walcher, F

2017-08-01

Feedback can significantly improve future performance. Reviewing one's performance by video is discussed as useful adjunct to debriefing, particularly for non-technical skills. Communicative competencies are an essential part of daily clinical practice; thus should be taught and assessed during undergraduate training. The aim of this study was to compare the educational value of video-assisted feedback versus oral feedback in communicative competencies in the surgical context. Fourth-year medical students completed a 210-min training unit of 'taking patient's history and obtaining informed consents prior to surgery' using role plays. Oral feedback was received directly thereafter using agenda-led, outcome-based guidelines (ALOBA). In the study group, the role plays were video-taped and reviewed thereafter. Afterwards, students completed two OSCE stations, where they were assessed regarding their communicative competencies and the content of the clinical scenario. One-hundred students (49 receiving video-assisted feedback, 51 oral) participated in the study. Those receiving video-assisted feedback performed significantly better in overall score in both OSCE stations (p feedback offered a significant educational benefit over oral feedback alone during a simulated patient encounter in a surgical context.

Who wants feedback? An investigation of the variables influencing residents' feedback-seeking behavior in relation to night shifts.

Science.gov (United States)

Teunissen, Pim W; Stapel, Diederik A; van der Vleuten, Cees; Scherpbier, Albert; Boor, Klarke; Scheele, Fedde

2009-07-01

The literature on feedback in clinical medical education has predominantly treated trainees as passive recipients. Past research has focused on how clinical supervisors can use feedback to improve a trainee's performance. On the basis of research in social and organizational psychology, the authors reconceptualized residents as active seekers of feedback. They investigated what individual and situational variables influence residents' feedback-seeking behavior on night shifts. Early in 2008, the authors sent obstetrics-gynecology residents in the Netherlands--both those in their first two years of graduate training and those gaining experience between undergraduate and graduate training--a questionnaire that assessed four predictor variables (learning and performance goal orientation, and instrumental and supportive leadership), two mediator variables (perceived feedback benefits and costs), and two outcome variables (frequency of feedback inquiry and monitoring). They used structural equation modeling software to test a hypothesized model of relationships between variables. The response rate was 76.5%. Results showed that residents who perceive more feedback benefits report a higher frequency of feedback inquiry and monitoring. More perceived feedback costs result mainly in more feedback monitoring. Residents with a higher learning goal orientation perceive more feedback benefits and fewer costs. Residents with a higher performance goal orientation perceive more feedback costs. Supportive physicians lead residents to perceive more feedback benefits and fewer costs. This study showed that some residents actively seek feedback. Residents' feedback-seeking behavior partially depends on attending physicians' supervisory style. Residents' goal orientations influence their perceptions of the benefits and costs of feedback-seeking.

Knowledge bases, clinical decision support systems, and rapid learning in oncology.

Science.gov (United States)

Yu, Peter Paul

2015-03-01

One of the most important benefits of health information technology is to assist the cognitive process of the human mind in the face of vast amounts of health data, limited time for decision making, and the complexity of the patient with cancer. Clinical decision support tools are frequently cited as a technologic solution to this problem, but to date useful clinical decision support systems (CDSS) have been limited in utility and implementation. This article describes three unique sources of health data that underlie fundamentally different types of knowledge bases which feed into CDSS. CDSS themselves comprise a variety of models which are discussed. The relationship of knowledge bases and CDSS to rapid learning health systems design is critical as CDSS are essential drivers of rapid learning in clinical care. Copyright © 2015 by American Society of Clinical Oncology.

Data for improvement and clinical excellence: protocol for an audit with feedback intervention in long-term care

Directory of Open Access Journals (Sweden)

Schalm Corinne

2010-10-01

Full Text Available Abstract Background There is considerable evidence about the effectiveness of audit coupled with feedback, although few audit with feedback interventions have been conducted in long-term care (LTC settings to date. In general, the effects have been found to be modest at best, although in settings where there has been little history of audit and feedback, the effects may be greater, at least initially. The primary purpose of the Data for Improvement and Clinical Excellence (DICE Long-Term Care project is to assess the effects of an audit with feedback intervention delivered monthly over 13 months in four LTC facilities. The research questions we addressed are: 1. What effects do feedback reports have on processes and outcomes over time? 2. How do different provider groups in LTC and home care respond to feedback reports based on data targeted at improving quality of care? Methods/design The research team conducting this study comprises researchers and decision makers in continuing care in the province of Alberta, Canada. The intervention consists of monthly feedback reports in nine LTC units in four facilities in Edmonton, Alberta. Data for the feedback reports comes from the Resident Assessment Instrument Minimum Data Set (RAI version 2.0, a standardized instrument mandated for use in LTC facilities throughout Alberta. Feedback reports consist of one page, front and back, presenting both graphic and textual information. Reports are delivered to all staff working in the four LTC facilities. The primary evaluation uses a controlled interrupted time series design both adjusted and unadjusted for covariates. The concurrent process evaluation uses observation and self-report to assess uptake of the feedback reports. Following the project phase described in this protocol, a similar intervention will be conducted in home care settings in Alberta. Depending on project findings, if they are judged useful by decision makers participating in this research

Data for improvement and clinical excellence: protocol for an audit with feedback intervention in long-term care.

Science.gov (United States)

Sales, Anne E; Schalm, Corinne

2010-10-13

There is considerable evidence about the effectiveness of audit coupled with feedback, although few audit with feedback interventions have been conducted in long-term care (LTC) settings to date. In general, the effects have been found to be modest at best, although in settings where there has been little history of audit and feedback, the effects may be greater, at least initially. The primary purpose of the Data for Improvement and Clinical Excellence (DICE) Long-Term Care project is to assess the effects of an audit with feedback intervention delivered monthly over 13 months in four LTC facilities. The research questions we addressed are:1. What effects do feedback reports have on processes and outcomes over time?2. How do different provider groups in LTC and home care respond to feedback reports based on data targeted at improving quality of care? The research team conducting this study comprises researchers and decision makers in continuing care in the province of Alberta, Canada. The intervention consists of monthly feedback reports in nine LTC units in four facilities in Edmonton, Alberta. Data for the feedback reports comes from the Resident Assessment Instrument Minimum Data Set (RAI) version 2.0, a standardized instrument mandated for use in LTC facilities throughout Alberta. Feedback reports consist of one page, front and back, presenting both graphic and textual information. Reports are delivered to all staff working in the four LTC facilities. The primary evaluation uses a controlled interrupted time series design both adjusted and unadjusted for covariates. The concurrent process evaluation uses observation and self-report to assess uptake of the feedback reports. Following the project phase described in this protocol, a similar intervention will be conducted in home care settings in Alberta. Depending on project findings, if they are judged useful by decision makers participating in this research team, we plan dissemination and spread of the feedback

Real-time feedback on nonverbal clinical communication. Theoretical framework and clinician acceptance of ambient visual design.

Science.gov (United States)

Hartzler, A L; Patel, R A; Czerwinski, M; Pratt, W; Roseway, A; Chandrasekaran, N; Back, A

2014-01-01

This article is part of the focus theme of Methods of Information in Medicine on "Pervasive Intelligent Technologies for Health". Effective nonverbal communication between patients and clinicians fosters both the delivery of empathic patient-centered care and positive patient outcomes. Although nonverbal skill training is a recognized need, few efforts to enhance patient-clinician communication provide visual feedback on nonverbal aspects of the clinical encounter. We describe a novel approach that uses social signal processing technology (SSP) to capture nonverbal cues in real time and to display ambient visual feedback on control and affiliation--two primary, yet distinct dimensions of interpersonal nonverbal communication. To examine the design and clinician acceptance of ambient visual feedback on nonverbal communication, we 1) formulated a model of relational communication to ground SSP and 2) conducted a formative user study using mixed methods to explore the design of visual feedback. Based on a model of relational communication, we reviewed interpersonal communication research to map nonverbal cues to signals of affiliation and control evidenced in patient-clinician interaction. Corresponding with our formulation of this theoretical framework, we designed ambient real-time visualizations that reflect variations of affiliation and control. To explore clinicians' acceptance of this visual feedback, we conducted a lab study using the Wizard-of-Oz technique to simulate system use with 16 healthcare professionals. We followed up with seven of those participants through interviews to iterate on the design with a revised visualization that addressed emergent design considerations. Ambient visual feedback on non- verbal communication provides a theoretically grounded and acceptable way to provide clinicians with awareness of their nonverbal communication style. We provide implications for the design of such visual feedback that encourages empathic patient

Feedback-regulated poly(ADP-ribosyl)ation by PARP-1 is required for rapid response to DNA damage in living cells

Science.gov (United States)

Mortusewicz, Oliver; Amé, Jean-Christophe; Leonhardt, Heinrich

2007-01-01

Genome integrity is constantly threatened by DNA lesions arising from numerous exogenous and endogenous sources. Survival depends on immediate recognition of these lesions and rapid recruitment of repair factors. Using laser microirradiation and live cell microscopy we found that the DNA-damage dependent poly(ADP-ribose) polymerases (PARP) PARP-1 and PARP-2 are recruited to DNA damage sites, however, with different kinetics and roles. With specific PARP inhibitors and mutations, we could show that the initial recruitment of PARP-1 is mediated by the DNA-binding domain. PARP-1 activation and localized poly(ADP-ribose) synthesis then generates binding sites for a second wave of PARP-1 recruitment and for the rapid accumulation of the loading platform XRCC1 at repair sites. Further PARP-1 poly(ADP-ribosyl)ation eventually initiates the release of PARP-1. We conclude that feedback regulated recruitment of PARP-1 and concomitant local poly(ADP-ribosyl)ation at DNA lesions amplifies a signal for rapid recruitment of repair factors enabling efficient restoration of genome integrity. PMID:17982172

Utility of routine data sources for feedback on the quality of cancer care: an assessment based on clinical practice guidelines

Directory of Open Access Journals (Sweden)

Baade Peter

2009-05-01

Full Text Available Abstract Background Not all cancer patients receive state-of-the-art care and providing regular feedback to clinicians might reduce this problem. The purpose of this study was to assess the utility of various data sources in providing feedback on the quality of cancer care. Methods Published clinical practice guidelines were used to obtain a list of processes-of-care of interest to clinicians. These were assigned to one of four data categories according to their availability and the marginal cost of using them for feedback. Results Only 8 (3% of 243 processes-of-care could be measured using population-based registry or administrative inpatient data (lowest cost. A further 119 (49% could be measured using a core clinical registry, which contains information on important prognostic factors (e.g., clinical stage, physiological reserve, hormone-receptor status. Another 88 (36% required an expanded clinical registry or medical record review; mainly because they concerned long-term management of disease progression (recurrences and metastases and 28 (11.5% required patient interview or audio-taping of consultations because they involved information sharing between clinician and patient. Conclusion The advantages of population-based cancer registries and administrative inpatient data are wide coverage and low cost. The disadvantage is that they currently contain information on only a few processes-of-care. In most jurisdictions, clinical cancer registries, which can be used to report on many more processes-of-care, do not cover smaller hospitals. If we are to provide feedback about all patients, not just those in larger academic hospitals with the most developed data systems, then we need to develop sustainable population-based data systems that capture information on prognostic factors at the time of initial diagnosis and information on management of disease progression.

Utility of routine data sources for feedback on the quality of cancer care: an assessment based on clinical practice guidelines.

Science.gov (United States)

Coory, Michael; Thompson, Bridie; Baade, Peter; Fritschi, Lin

2009-05-27

Not all cancer patients receive state-of-the-art care and providing regular feedback to clinicians might reduce this problem. The purpose of this study was to assess the utility of various data sources in providing feedback on the quality of cancer care. Published clinical practice guidelines were used to obtain a list of processes-of-care of interest to clinicians. These were assigned to one of four data categories according to their availability and the marginal cost of using them for feedback. Only 8 (3%) of 243 processes-of-care could be measured using population-based registry or administrative inpatient data (lowest cost). A further 119 (49%) could be measured using a core clinical registry, which contains information on important prognostic factors (e.g., clinical stage, physiological reserve, hormone-receptor status). Another 88 (36%) required an expanded clinical registry or medical record review; mainly because they concerned long-term management of disease progression (recurrences and metastases) and 28 (11.5%) required patient interview or audio-taping of consultations because they involved information sharing between clinician and patient. The advantages of population-based cancer registries and administrative inpatient data are wide coverage and low cost. The disadvantage is that they currently contain information on only a few processes-of-care. In most jurisdictions, clinical cancer registries, which can be used to report on many more processes-of-care, do not cover smaller hospitals. If we are to provide feedback about all patients, not just those in larger academic hospitals with the most developed data systems, then we need to develop sustainable population-based data systems that capture information on prognostic factors at the time of initial diagnosis and information on management of disease progression.

Change in quality management in diabetes care groups and outpatient clinics after feedback and tailored support.

Science.gov (United States)

Campmans-Kuijpers, Marjo J; Baan, Caroline A; Lemmens, Lidwien C; Rutten, Guy E

2015-02-01

To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. This before-and-after study with a 1-year follow-up surveyed quality managers on six domains of quality management. Questionnaires measured organization of care, multidisciplinary teamwork, patient centeredness, performance results, quality improvement policy, and management strategies (score range 0-100%). Based on the scores, responders received feedback and a benchmark and were granted access to a toolbox of quality improvement instruments. If requested, additional support in improving quality management was available, consisting of an elucidating phone call or a visit from an experienced consultant. After 1 year, the level of quality management was measured again. Of the initially 60 participating care groups, 51 completed the study. The total quality management score improved from 59.8% (95% CI 57.0-62.6%) to 65.1% (62.8-67.5%; P quality management score (P = 0.001). Of the 44 participating outpatient clinics, 28 completed the study. Their total score changed from 65.7% (CI 60.3-71.1%) to 67.3% (CI 62.9-71.7%; P = 0.30). Only the results in the domain multidisciplinary teamwork improved (P = 0.001). Measuring quality management and providing feedback and a benchmark improves the level of quality management in care groups but not in outpatient clinics. The questionnaires might also be a useful asset for other diabetes care groups, such as Accountable Care Organizations. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Effects of video-feedback on the communication, clinical competence and motivational interviewing skills of practice nurses: a pre-test posttest control group study.

Science.gov (United States)

Noordman, Janneke; van der Weijden, Trudy; van Dulmen, Sandra

2014-10-01

To examine the effects of individual video-feedback on the generic communication skills, clinical competence (i.e. adherence to practice guidelines) and motivational interviewing skills of experienced practice nurses working in primary care. Continuing professional education may be necessary to refresh and reflect on the communication and motivational interviewing skills of experienced primary care practice nurses. A video-feedback method was designed to improve these skills. Pre-test/posttest control group design. Seventeen Dutch practice nurses and 325 patients participated between June 2010-June 2011. Nurse-patient consultations were videotaped at two moments (T0 and T1), with an interval of 3-6 months. The videotaped consultations were rated using two protocols: the Maastrichtse Anamnese en Advies Scorelijst met globale items (MAAS-global) and the Behaviour Change Counselling Index. Before the recordings, nurses were allocated to a control or video-feedback group. Nurses allocated to the video-feedback group received video-feedback between T0 and T1. Data were analysed using multilevel linear or logistic regression. Nurses who received video-feedback appeared to pay significantly more attention to patients' request for help, their physical examination and gave significantly more understandable information. With respect to motivational interviewing, nurses who received video-feedback appeared to pay more attention to 'agenda setting and permission seeking' during their consultations. Video-feedback is a potentially effective method to improve practice nurses' generic communication skills. Although a single video-feedback session does not seem sufficient to increase all motivational interviewing skills, significant improvement in some specific skills was found. Nurses' clinical competences were not altered after feedback due to already high standards. © 2014 John Wiley & Sons Ltd.

Combined feedforward and feedback control of end milling system

OpenAIRE

Čuš, Franc; Župerl, Uroš; Balič, Jože

2012-01-01

Purpose: Purpose of this paper. An intelligent control system is presented that uses a combination of feedforward and feedback for cutting force control in end milling.Design/methodology/approach: The network is trained by the feedback output that is minimized during training and most control action for disturbance rejection is finally performed by the rapid feedforward action of the network.Findings: The feedback controller corrects for errors caused by external disturbances. The feedforward...

Effects of longitudinal small-group learning on delivery and receipt of communication skills feedback.

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Chou, Calvin L; Masters, Dylan E; Chang, Anna; Kruidering, Marieke; Hauer, Karen E

2013-11-01

Although feedback is a critical component of learning, recent data suggest that learners may discount feedback they receive. The emotional threat inherent in feedback can contribute to its ineffectiveness, particularly for sensitive topics like communication skills. Longitudinal relationships among peers may increase their sense of safety and soften the perceived threat of feedback to allow students to give, receive and potentially more effectively incorporate feedback. We studied the effects of prior shared learning experiences among medical students in the delivery and receipt of feedback on clinical (communication) skills. During a formative clinical skills examination, we divided Year 3 students at a US medical school into two subgroups comprising, respectively, small-group classmates from a 2-year longitudinal pre-clerkship clinical skills course (with prior peer-learning relationships), and peers with no prior shared small-group coursework. Students in both subgroups observed peers in a simulated clinical case and then provided feedback, which was videotaped, transcribed and coded. Feedback recipients also completed a survey on their perceptions of the feedback. Students valued the feedback they received and intended to enact it, regardless of whether they had prior peer-learning relationships. Coding of feedback revealed high specificity. Feedback providers who had prior peer-learning relationships with recipients provided more specific corrective feedback on communication skills than those with no such relationships (p = 0.014); there was no significant difference between subgroups in the provision of reinforcing feedback on communication skills. Year 3 medical student peers can deliver specific feedback on clinical skills; prior peer-learning relationships in pre-clerkship clinical skills courses enrich the provision of specific corrective feedback about communication skills. Feedback between peers with pre-existing peer-learning relationships represents

'I wish someone watched me interview:' medical student insight into observation and feedback as a method for teaching communication skills during the clinical years.

Science.gov (United States)

Schopper, Heather; Rosenbaum, Marcy; Axelson, Rick

2016-11-09

Experts suggest observation and feedback is a useful tool for teaching and evaluating medical student communication skills during the clinical years. Failing to do this effectively risks contributing to deterioration of students' communication skills during the very educational period in which they are most important. While educators have been queried about their thoughts on this issue, little is known about what this process is like for learners and if they feel they get educational value from being observed. This study explored student perspectives regarding their experiences with clinical observation and feedback on communication skills. A total of 125 senior medical students at a U.S. medical school were interviewed about their experiences with observation and feedback. Thematic analysis of interview data identified common themes among student responses. The majority of students reported rarely being observed interviewing, and they reported receiving feedback even less frequently. Students valued having communication skills observed and became more comfortable with observation the more it occurred. Student-identified challenges included supervisor time constraints and grading based on observation. Most feedback focused on information gathering and was commonly delayed until well after the observed encounter. Eliciting students' perspectives on the effect of observation and feedback on the development of their communication skills is a unique way to look at this topic, and brings to light many student-identified obstacles and opportunities to maximize the educational value of observation and feedback for teaching communication, including increasing the number of observations, disassociating observation from numerically scored evaluation, training faculty to give meaningful feedback, and timing the observation/feedback earlier in clerkships.

The Effect of Combination of Video Feedback and Audience Feedback on Social Anxiety: Preliminary Findings.

Science.gov (United States)

Chen, Junwen; Mak, Rebecca; Fujita, Satoko

2015-09-01

Although video feedback (VF) is shown to improve appraisals of social performance in socially anxious individuals, its impact on state anxiety during a social situation is mixed. The current study investigated the effect of combined video feedback and audience feedback (AF) on self-perceptions of performance and bodily sensations as well as state anxiety pertaining to a speech task. Forty-one socially anxious students were randomly allocated to combined video feedback with audience feedback (VF + AF), video feedback only (VF), audience feedback only (AF), or a control condition. Following a 3-min speech, participants in the VF + AF, VF, and AF conditions watched the videotape of their speech with cognitive preparation in the presence of three confederates who served as audience, and/or received feedback from the confederates, while the control group watched their videotaped speech without cognitive preparation. Both VF + AF and AF conditions improved distorted appraisal of performance and bodily sensations as well as state anxiety. The clinical implications of these findings are discussed. © The Author(s) 2015.

Health professionals' perceptions about their clinical performance and the influence of audit and feedback on their intentions to improve practice: a theory-based study in Dutch intensive care units.

Science.gov (United States)

Gude, Wouter T; Roos-Blom, Marie-José; van der Veer, Sabine N; Dongelmans, Dave A; de Jonge, Evert; Francis, Jill J; Peek, Niels; de Keizer, Nicolette F

2018-02-17

Audit and feedback aims to guide health professionals in improving aspects of their practice that need it most. Evidence suggests that feedback fails to increase accuracy of professional perceptions about clinical performance, which likely reduces audit and feedback effectiveness. This study investigates health professionals' perceptions about their clinical performance and the influence of feedback on their intentions to change practice. We conducted an online laboratory experiment guided by Control Theory with 72 intensive care professionals from 21 units. For each of four new pain management indicators, we collected professionals' perceptions about their clinical performance; peer performance; targets; and improvement intentions before and after receiving first-time feedback. An electronic audit and feedback dashboard provided ICU's own performance, median and top 10% peer performance, and improvement recommendations. The experiment took place approximately 1 month before units enrolled into a cluster-randomised trial assessing the impact of adding a toolbox with suggested actions and materials to improve intensive care pain management. During the experiment, the toolbox was inaccessible; all participants accessed the same version of the dashboard. We analysed 288 observations. In 53.8%, intensive care professionals overestimated their clinical performance; but in only 13.5%, they underestimated it. On average, performance was overestimated by 22.9% (on a 0-100% scale). Professionals similarly overestimated peer performance, and set targets 20.3% higher than the top performance benchmarks. In 68.4% of cases, intentions to improve practice were consistent with actual gaps in performance, even before professionals had received feedback; which increased to 79.9% after receiving feedback (odds ratio, 2.41; 95% CI, 1.53 to 3.78). However, in 56.3% of cases, professionals still wanted to improve care aspects at which they were already top performers. Alternatively

Beam bunch feedback

International Nuclear Information System (INIS)

Lambertson, G.

1995-09-01

When the electromagnetic fields that are excited by the passage of a bundle of charged particles persist to act upon bunches that follow, then the motions of the bunches are coupled. This action between bunches circulating on a closed orbit can generate growing patterns of bunch excursions. Such growth can often be suppressed by feedback systems that detect the excursion and apply corrective forces to the bunches. To be addressed herein is feedback that acts on motions of the bunch body centers. In addition to being useful for suppressing the spontaneous growth of coupled-bunch motions, such feedback can be used to damp transients in bunches injected into an accelerator or storage ring; for hadrons which lack strong radiation damping, feedback is needed to avoid emittance growth through decoherence. Motions excited by noise in magnetic fields or accelerating rf can also be reduced by using this feedback. Whether the action is on motions that are transverse to the closed orbit or longitudinal, the arrangement is the same. Bunch position is detected by a pickup and that signal is processed and directed to a kicker that may act upon the same bunch or some other portion of the collective beam pattern. Transverse motion is an oscillation with angular frequency ν perpendicular ω o where ω o is the orbital frequency 2π line-integral o. Longitudinal synchrotron oscillation occurs at frequency ω s = ν s ω o . The former is much more rapid, ν perpendicular being on the order of 10 while ν s is typically about 10 minus 1 to 10 minus 2

Case of Rapid Progression of Hemiatrophy on the Face: A New Clinical Entity?

Directory of Open Access Journals (Sweden)

Hisashi Nomura

2015-01-01

Full Text Available A lot of diseases, including lupus profundus, morphea, lipodystrophy, and Parry-Romberg syndrome, may manifest progressive hemifacial atrophy. These diseases usually progress slowly and rapid progression of atrophy is extremely rare. We report a case of elderly-onset rapid progression of hemifacial atrophy only in three weeks. Our case did not meet variable differential diagnoses. We discuss the clinical character of the patient against the past of literature and suppose it may be a new clinical entity.

Feedback in formative OSCEs: comparison between direct observation and video-based formats

Science.gov (United States)

Junod Perron, Noëlle; Louis-Simonet, Martine; Cerutti, Bernard; Pfarrwaller, Eva; Sommer, Johanna; Nendaz, Mathieu

2016-01-01

Introduction Medical students at the Faculty of Medicine, University of Geneva, Switzerland, have the opportunity to practice clinical skills with simulated patients during formative sessions in preparation for clerkships. These sessions are given in two formats: 1) direct observation of an encounter followed by verbal feedback (direct feedback) and 2) subsequent review of the videotaped encounter by both student and supervisor (video-based feedback). The aim of the study was to evaluate whether content and process of feedback differed between both formats. Methods In 2013, all second- and third-year medical students and clinical supervisors involved in formative sessions were asked to take part in the study. A sample of audiotaped feedback sessions involving supervisors who gave feedback in both formats were analyzed (content and process of the feedback) using a 21-item feedback scale. Results Forty-eight audiotaped feedback sessions involving 12 supervisors were analyzed (2 direct and 2 video-based sessions per supervisor). When adjusted for the length of feedback, there were significant differences in terms of content and process between both formats; the number of communication skills and clinical reasoning items addressed were higher in the video-based format (11.29 vs. 7.71, p=0.002 and 3.71 vs. 2.04, p=0.010, respectively). Supervisors engaged students more actively during the video-based sessions than during direct feedback sessions (self-assessment: 4.00 vs. 3.17, p=0.007; active problem-solving: 3.92 vs. 3.42, p=0.009). Students made similar observations and tended to consider that the video feedback was more useful for improving some clinical skills. Conclusion Video-based feedback facilitates discussion of clinical reasoning, communication, and professionalism issues while at the same time actively engaging students. Different time and conceptual frameworks may explain observed differences. The choice of feedback format should depend on the educational

Feedback in formative OSCEs: comparison between direct observation and video-based formats

Directory of Open Access Journals (Sweden)

Noëlle Junod Perron

2016-11-01

Full Text Available Introduction: Medical students at the Faculty of Medicine, University of Geneva, Switzerland, have the opportunity to practice clinical skills with simulated patients during formative sessions in preparation for clerkships. These sessions are given in two formats: 1 direct observation of an encounter followed by verbal feedback (direct feedback and 2 subsequent review of the videotaped encounter by both student and supervisor (video-based feedback. The aim of the study was to evaluate whether content and process of feedback differed between both formats. Methods: In 2013, all second- and third-year medical students and clinical supervisors involved in formative sessions were asked to take part in the study. A sample of audiotaped feedback sessions involving supervisors who gave feedback in both formats were analyzed (content and process of the feedback using a 21-item feedback scale. Results: Forty-eight audiotaped feedback sessions involving 12 supervisors were analyzed (2 direct and 2 video-based sessions per supervisor. When adjusted for the length of feedback, there were significant differences in terms of content and process between both formats; the number of communication skills and clinical reasoning items addressed were higher in the video-based format (11.29 vs. 7.71, p=0.002 and 3.71 vs. 2.04, p=0.010, respectively. Supervisors engaged students more actively during the video-based sessions than during direct feedback sessions (self-assessment: 4.00 vs. 3.17, p=0.007; active problem-solving: 3.92 vs. 3.42, p=0.009. Students made similar observations and tended to consider that the video feedback was more useful for improving some clinical skills. Conclusion: Video-based feedback facilitates discussion of clinical reasoning, communication, and professionalism issues while at the same time actively engaging students. Different time and conceptual frameworks may explain observed differences. The choice of feedback format should depend on

Feedback from incident reporting: information and action to improve patient safety.

Science.gov (United States)

Benn, J; Koutantji, M; Wallace, L; Spurgeon, P; Rejman, M; Healey, A; Vincent, C

2009-02-01

Effective feedback from incident reporting systems in healthcare is essential if organisations are to learn from failures in the delivery of care. Despite the wide-scale development and implementation of incident reporting in healthcare, studies in the UK suggest that information concerning system vulnerabilities could be better applied to improve operational safety within organisations. In this article, the findings and implications of research to identify forms of effective feedback from incident reporting are discussed, to promote best practices in this area. The research comprised a mixed methods review to investigate mechanisms of effective feedback for healthcare, drawing upon experience within established reporting programmes in high-risk industry and transport domains. Systematic searches of published literature were undertaken, and 23 case studies describing incident reporting programmes with feedback were identified for analysis from the international healthcare literature. Semistructured interviews were undertaken with 19 subject matter experts across a range of domains, including: civil aviation, maritime, energy, rail, offshore production and healthcare. In analysis, qualitative information from several sources was synthesised into practical requirements for developing effective feedback in healthcare. Both action and information feedback mechanisms were identified, serving safety awareness, improvement and motivational functions. The provision of actionable feedback that visibly improved systems was highlighted as important in promoting future reporting. Fifteen requirements for the design of effective feedback systems were identified, concerning: the role of leadership, the credibility and content of information, effective dissemination channels, the capacity for rapid action and the need for feedback at all levels of the organisation, among others. Above all, the safety-feedback cycle must be closed by ensuring that reporting, analysis and

Feedbacks between inundation, root production, and shoot growth in a rapidly submerging brackish marsh

Science.gov (United States)

Kirwan, Matthew L.; Guntenspergen, Glenn R.

2012-01-01

1. Ecogeomorphic feedbacks between mineral sediment deposition and above-ground plant growth are thought to have dominated the evolution of many coastal ecosystems and landforms. However, land-use-related reductions in sediment delivery rates to estuaries world-wide suggest that these above-ground feedbacks may not apply in some of the world's most vulnerable coastal landscapes.

Utility of routine data sources for feedback on the quality of cancer care: an assessment based on clinical practice guidelines

OpenAIRE

Coory, Michael; Thompson, Bridie; Baade, Peter; Fritschi, Lin

2009-01-01

Abstract Background Not all cancer patients receive state-of-the-art care and providing regular feedback to clinicians might reduce this problem. The purpose of this study was to assess the utility of various data sources in providing feedback on the quality of cancer care. Methods Published clinical practice guidelines were used to obtain a list of processes-of-care of interest to clinicians. These were assigned to one of four data categories according to their availability and the marginal ...

Data for improvement and clinical excellence: protocol for an audit with feedback intervention in home care and supportive living.

Science.gov (United States)

Fraser, Kimberly D; Sales, Anne E; O'Rourke, Hannah M; Schalm, Corinne

2012-01-18

Although considerable evidence exists about the effectiveness of audit coupled with feedback, very few audit-with-feedback interventions have been done in either home care or supportive living settings to date. With little history of audit and feedback in home care or supportive living there is potential for greater effects, at least initially. This study extends the work of an earlier study designed to assess the effects of an audit-with-feedback intervention. It will be delivered quarterly over a one-year period in seven home care offices and 11 supportive living sites. The research questions are the same as in the first study but in a different environment. They are as follows: 1. What effects do feedback reports have on processes and outcomes over time? 2. How do different provider groups in home care and supportive living sites respond to feedback reports based on quality indicator data? The research team conducting this study includes researchers and decision makers in continuing care in the province of Alberta, Canada. The intervention consists of quarterly feedback reports in 19 home care offices and supportive living sites across Alberta. Data for the feedback reports are based on the Resident Assessment Instrument Home Care tool, a standardized instrument mandated for use in home care and supportive living environments throughout Alberta. The feedback reports consist of one page, printed front and back, presenting both graphic and textual information. Reports are delivered to all employees working in each site. The primary evaluation uses a controlled interrupted time-series design, both adjusted and unadjusted for covariates. The concurrent process evaluation includes observation, focus groups, and self-reports to assess uptake of the feedback reports. The project described in this protocol follows a similar intervention conducted in our previous study, Data for Improvement and Clinical Excellence--Long-Term Care. We will offer dissemination strategies

Data for improvement and clinical excellence: protocol for an audit with feedback intervention in home care and supportive living

Directory of Open Access Journals (Sweden)

Fraser Kimberly D

2012-01-01

Full Text Available Abstract Background Although considerable evidence exists about the effectiveness of audit coupled with feedback, very few audit-with-feedback interventions have been done in either home care or supportive living settings to date. With little history of audit and feedback in home care or supportive living there is potential for greater effects, at least initially. This study extends the work of an earlier study designed to assess the effects of an audit-with-feedback intervention. It will be delivered quarterly over a one-year period in seven home care offices and 11 supportive living sites. The research questions are the same as in the first study but in a different environment. They are as follows: 1. What effects do feedback reports have on processes and outcomes over time? 2. How do different provider groups in home care and supportive living sites respond to feedback reports based on quality indicator data? Methods The research team conducting this study includes researchers and decision makers in continuing care in the province of Alberta, Canada. The intervention consists of quarterly feedback reports in 19 home care offices and supportive living sites across Alberta. Data for the feedback reports are based on the Resident Assessment Instrument Home Care tool, a standardized instrument mandated for use in home care and supportive living environments throughout Alberta. The feedback reports consist of one page, printed front and back, presenting both graphic and textual information. Reports are delivered to all employees working in each site. The primary evaluation uses a controlled interrupted time-series design, both adjusted and unadjusted for covariates. The concurrent process evaluation includes observation, focus groups, and self-reports to assess uptake of the feedback reports. The project described in this protocol follows a similar intervention conducted in our previous study, Data for Improvement and Clinical Excellence

Exploring Occupational Therapy Students' Meaning of Feedback during Fieldwork Experiences

Science.gov (United States)

Rathgeber, Karen Lynne

2014-01-01

Researchers have revealed that students' confidence and performance improve after they receive feedback from clinical supervisors regarding the delivery of quality patient care. Multiple studies of feedback have focused on the provision and acceptance of feedback; however, it was not known if or how students internalized feedback to promote…

Rapid versus standard intravenous rehydration in paediatric gastroenteritis: pragmatic blinded randomised clinical trial

Science.gov (United States)

Parkin, Patricia C; Willan, Andrew R; Schuh, Suzanne

2011-01-01

Objective To determine if rapid rather than standard intravenous rehydration results in improved hydration and clinical outcomes when administered to children with gastroenteritis. Design Single centre, two arm, parallel randomised pragmatic controlled trial. Blocked randomisation stratified by site. Participants, caregivers, outcome assessors, investigators, and statisticians were blinded to the treatment assignment. Setting Paediatric emergency department in a tertiary care centre in Toronto, Canada. Participants 226 children aged 3 months to 11 years; complete follow-up was obtained on 223 (99%). Eligible children were aged over 90 days, had a diagnosis of dehydration secondary to gastroenteritis, had not responded to oral rehydration, and had been prescribed intravenous rehydration. Children were excluded if they weighed less than 5 kg or more than 33 kg, required fluid restriction, had a suspected surgical condition, or had an insurmountable language barrier. Children were also excluded if they had a history of a chronic systemic disease, abdominal surgery, bilious or bloody vomit, hypotension, or hypoglycaemia or hyperglycaemia. Interventions Rapid (60 mL/kg) or standard (20 mL/kg) rehydration with 0.9% saline over an hour; subsequent fluids administered according to protocol. Main outcome measures Primary outcome: clinical rehydration, assessed with a validated scale, two hours after the start of treatment. Secondary outcomes: prolonged treatment, mean clinical dehydration scores over the four hour study period, time to discharge, repeat visits to emergency department, adequate oral intake, and physician’s comfort with discharge. Data from all randomised patients were included in an intention to treat analysis. Results 114 patients were randomised to rapid rehydration and 112 to standard. One child was withdrawn because of severe hyponatraemia at baseline. There was no evidence of a difference between the rapid and standard rehydration groups in the

Clinical usefulness of augmented reality using infrared camera based real-time feedback on gait function in cerebral palsy: a case study.

Science.gov (United States)

Lee, Byoung-Hee

2016-04-01

[Purpose] This study investigated the effects of real-time feedback using infrared camera recognition technology-based augmented reality in gait training for children with cerebral palsy. [Subjects] Two subjects with cerebral palsy were recruited. [Methods] In this study, augmented reality based real-time feedback training was conducted for the subjects in two 30-minute sessions per week for four weeks. Spatiotemporal gait parameters were used to measure the effect of augmented reality-based real-time feedback training. [Results] Velocity, cadence, bilateral step and stride length, and functional ambulation improved after the intervention in both cases. [Conclusion] Although additional follow-up studies of the augmented reality based real-time feedback training are required, the results of this study demonstrate that it improved the gait ability of two children with cerebral palsy. These findings suggest a variety of applications of conservative therapeutic methods which require future clinical trials.

Formative feedback from the first-person perspective using Google Glass in a family medicine objective structured clinical examination station in the United States.

Science.gov (United States)

Youm, Julie; Wiechmann, Warren

2018-01-01

This case study explored the use of Google Glass in a clinical examination scenario to capture the first-person perspective of a standardized patient as a way to provide formative feedback on students' communication and empathy skills 'through the patient's eyes.' During a 3-year period between 2014 and 2017, third-year students enrolled in a family medicine clerkship participated in a Google Glass station during a summative clinical examination. At this station, standardized patients wore Google Glass to record an encounter focused on communication and empathy skills 'through the patient's eyes.' Students completed an online survey using a 4-point Likert scale about their perspectives on Google Glass as a feedback tool (N= 255). We found that the students' experiences with Google Glass 'through the patient's eyes' were largely positive and that students felt the feedback provided by the Google Glass recording to be helpful. Although a third of the students felt that Google Glass was a distraction, the majority believed that the first-person perspective recordings provided an opportunity for feedback that did not exist before. Continuing exploration of first-person perspective recordings using Google Glass to improve education on communication and empathy skills is warranted.

Essential processes for cognitive behavioral clinical supervision: Agenda setting, problem-solving, and formative feedback.

Science.gov (United States)

Cummings, Jorden A; Ballantyne, Elena C; Scallion, Laura M

2015-06-01

Clinical supervision should be a proactive and considered endeavor, not a reactive one. To that end, supervisors should choose supervision processes that are driven by theory, best available research, and clinical experience. These processes should be aimed at helping trainees develop as clinicians. We highlight 3 supervision processes we believe should be used at each supervision meeting: agenda setting, encouraging trainee problem-solving, and formative feedback. Although these are primarily cognitive-behavioral skills, they can be helpful in combination with other supervision models. We provide example dialogue from supervision exchanges, and discuss theoretical and research support for these processes. Using these processes not only encourages trainee development but also models for them how to use the same processes and approaches with clients. (c) 2015 APA, all rights reserved).

[Benefits of using rapid HIV testing at the PMU-FLON walk-in clinic in Lausanne].

Science.gov (United States)

Gilgien, W; Aubert, J; Bischoff, T; Herzig, L; Perdrix, J

2012-05-16

Lab tests are frequently used in primary care to guide patient care. This is particularly the case when a severe disorder, or one that will affect patients' initial care, needs to be excluded rapidly. At the PMU-FLON walk-in clinic the use of HIV testing as recommended by the Swiss Office of Public Health was hampered by the delay in obtaining test results. This led us to introduce rapid HIV testing which provides results within 30 minutes. Following the first 250 tests the authors discuss the results as well as the benefits of rapid HIV testing in an urban walk-in clinic.

Effects of feedback reliability on feedback-related brain activity: A feedback valuation account.

Science.gov (United States)

Ernst, Benjamin; Steinhauser, Marco

2018-04-06

Adaptive decision making relies on learning from feedback. Because feedback sometimes can be misleading, optimal learning requires that knowledge about the feedback's reliability be utilized to adjust feedback processing. Although previous research has shown that feedback reliability indeed influences feedback processing, the underlying mechanisms through which this is accomplished remain unclear. Here we propose that feedback processing is adjusted by the adaptive, top-down valuation of feedback. We assume that unreliable feedback is devalued relative to reliable feedback, thus reducing the reward prediction errors that underlie feedback-related brain activity and learning. A crucial prediction of this account is that the effects of feedback reliability are susceptible to contrast effects. That is, the effects of feedback reliability should be enhanced when both reliable and unreliable feedback are experienced within the same context, as compared to when only one level of feedback reliability is experienced. To evaluate this prediction, we measured the event-related potentials elicited by feedback in two experiments in which feedback reliability was varied either within or between blocks. We found that the fronto-central valence effect, a correlate of reward prediction errors during reinforcement learning, was reduced for unreliable feedback. But this result was obtained only when feedback reliability was varied within blocks, thus indicating a contrast effect. This suggests that the adaptive valuation of feedback is one mechanism underlying the effects of feedback reliability on feedback processing.

Surgical Trainee Feedback-Seeking Behavior in the Context of Workplace-Based Assessment in Clinical Settings.

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Gaunt, Anne; Patel, Abhilasha; Fallis, Simon; Rusius, Victoria; Mylvaganam, Seni; Royle, T James; Almond, Max; Markham, Deborah H; Pawlikowska, Teresa R B

2017-06-01

To investigate surgical trainee feedback-seeking behaviors-directly asking for feedback (inquiry) and observing and responding to situational clues (monitoring)-in the context of workplace-based assessment (WBA). A hypothetical model of trainee feedback-seeking behavior was developed using existing literature. A questionnaire, incorporating previously validated instruments from organizational psychology, was distributed to general surgical trainees at 23 U.K. hospitals in 2012-2013. Statistical modeling techniques compared the data with 12 predetermined hypothetical relationships between feedback-seeking behaviors and predictive variables (goal orientation, supervisory style) through mediating variables (perceptions of personal benefits and costs of feedback) to develop a final model. Of 235 trainees invited, 178 (76%) responded. Trainees completed 48 WBAs/year on average, and 73% reported receiving feedback via WBA. The final model was of good fit (chi-square/degree of freedom ratio = 1.620, comparative fit index = 0.953, root mean square error of approximation = 0.059). Modeled data showed trainees who perceive personal benefits to feedback use both feedback inquiry and monitoring to engage in feedback interactions. Trainees who seek feedback engage in using WBA. Trainees' goal orientations and perceptions of trainers' supervisory styles as supportive and instrumental are associated with perceived benefits and costs to feedback. Trainees actively engage in seeking feedback and using WBA. Their perceptions of feedback benefits and costs and supervisory style play a role in their feedback-seeking behavior. Encouraging trainees to actively seek feedback by providing specific training and creating a supportive environment for feedback interactions could positively affect their ability to seek feedback.

Improving Timely Resident Follow-Up and Communication of Results in Ambulatory Clinics Utilizing a Web-Based Audit and Feedback Module.

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Boggan, Joel C; Swaminathan, Aparna; Thomas, Samantha; Simel, David L; Zaas, Aimee K; Bae, Jonathan G

2017-04-01

Failure to follow up and communicate test results to patients in outpatient settings may lead to diagnostic and therapeutic delays. Residents are less likely than attending physicians to report results to patients, and may face additional barriers to reporting, given competing clinical responsibilities. This study aimed to improve the rates of communicating test results to patients in resident ambulatory clinics. We performed an internal medicine, residency-wide, pre- and postintervention, quality improvement project using audit and feedback. Residents performed audits of ambulatory patients requiring laboratory or radiologic testing by means of a shared online interface. The intervention consisted of an educational module viewed with initial audits, development of a personalized improvement plan after Phase 1, and repeated real-time feedback of individual relative performance compared at clinic and program levels. Outcomes included results communicated within 14 days and prespecified "significant" results communicated within 72 hours. A total of 76 of 86 eligible residents (88%) reviewed 1713 individual ambulatory patients' charts in Phase 1, and 73 residents (85%) reviewed 1509 charts in Phase 2. Follow-up rates were higher in Phase 2 than Phase 1 for communicating results within 14 days and significant results within 72 hours (85% versus 78%, P  Communication of "significant" results was more likely to occur via telephone, compared with communication of nonsignificant results. Participation in a shared audit and feedback quality improvement project can improve rates of resident follow-up and communication of results, although communication gaps remained.

Framing of Feedback Impacts Student's Satisfaction, Self-Efficacy and Performance

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van de Ridder, J. M. Monica; Peters, Claudia M. M.; Stokking, Karel M.; de Ru, J. Alexander; ten Cate, Olle Th. J.

2015-01-01

Feedback is considered important to acquire clinical skills. Research evidence shows that feedback does not always improve learning and its effects may be small. In many studies, a variety of variables involved in feedback provision may mask either one of their effects. E.g., there is reason to believe that the way oral feedback is framed may…

Feedforward/feedback control synthesis for performance and robustness

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Wie, Bong; Liu, Qiang

1990-01-01

Both feedforward and feedback control approaches for uncertain dynamical systems are investigated. The control design objective is to achieve a fast settling time (high performance) and robustness (insensitivity) to plant modeling uncertainty. Preshapong of an ideal, time-optimal control input using a 'tapped-delay' filter is shown to provide a rapid maneuver with robust performance. A robust, non-minimum-phase feedback controller is synthesized with particular emphasis on its proper implementation for a non-zero set-point control problem. The proposed feedforward/feedback control approach is robust for a certain class of uncertain dynamical systems, since the control input command computed for a given desired output does not depend on the plant parameters.

Learning to trust: social feedback normalizes trust behavior in first-episode psychosis and clinical high risk.

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Lemmers-Jansen, Imke L J; Fett, Anne-Kathrin J; Hanssen, Esther; Veltman, Dick J; Krabbendam, Lydia

2018-06-13

Psychosis is characterized by problems in social functioning that exist well before illness onset, and in individuals at clinical high risk (CHR) for psychosis. Trust is an essential element for social interactions that is impaired in psychosis. In the trust game, chronic patients showed reduced baseline trust, impaired response to positive social feedback, and attenuated brain activation in reward and mentalizing areas. We investigated whether first-episode psychosis patients (FEP) and CHR show similar abnormalities in the neural and behavioral mechanisms underlying trust. Twenty-two FEP, 17 CHR, and 43 healthy controls performed two trust games, with a cooperative and an unfair partner in the fMRI scanner. Region of interest analyses were performed on mentalizing and reward processing areas, during the investment and outcome phases of the games. Compared with healthy controls, FEP and CHR showed reduced baseline trust, but like controls, learned to trust in response to cooperative and unfair feedback. Symptom severity was not associated with baseline trust, however in FEP associated with reduced response to feedback. The only group differences in brain activation were that CHR recruited the temporo-parietal junction (TPJ) more than FEP and controls during investment in the unfair condition. This hyper-activation in CHR was associated with greater symptom severity. Reduced baseline trust may be associated with risk for psychotic illness, or generally with poor mental health. Feedback learning is still intact in CHR and FEP, as opposed to chronic patients. CHR however show distinct neural activation patterns of hyper-activation of the TPJ.

Rapid assessment breast clinics--evolution through audit.

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Toomey, D P; Cahill, R A; Birido, N; Jeffers, M; Loftus, B; McInerney, D; Rothwell, J; Geraghty, J G

2006-11-01

This observational, cohort study aimed to examine the potential utility of Rapid Assessment Breast Clinics (RABC) beyond cancer detection at presentation. One thousand four hundred and twenty nine women were studied over an 18 month period. 154 (10.7%) had breast cancer - 87.7% of whom were seen expediently with 92.9% being diagnosed at one attendance. One hundred and forty three (10%) of those with a benign diagnosis were found by routine questioning to have significant familial risk separate to their reason for referral. Despite careful triage, considerable contamination of appointment allotment occurred with many who were correctly triaged as non-urgent being seen 'urgently'. One hundred and seventy six attendees (12.3%) had neither the symptom that triggered referral, nor breast lump, nipple discharge nor family history of breast cancer, while 283 (19.8%) had no objective clinical or radiological abnormality. Although RABC reliably categorise malignant versus non-malignant diagnoses despite cluttering by low risk women, a significant proportion of non-cancer patients still require address of future risk rather than reassurance of their present status alone.

Feedback GAP: pragmatic, cluster-randomized trial of goal setting and action plans to increase the effectiveness of audit and feedback interventions in primary care.

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Ivers, Noah M; Tu, Karen; Young, Jacqueline; Francis, Jill J; Barnsley, Jan; Shah, Baiju R; Upshur, Ross E; Moineddin, Rahim; Grimshaw, Jeremy M; Zwarenstein, Merrick

2013-12-17

Audit and feedback to physicians is a commonly used quality improvement strategy, but its optimal design is unknown. This trial tested the effects of a theory-informed worksheet to facilitate goal setting and action planning, appended to feedback reports on chronic disease management, compared to feedback reports provided without these worksheets. A two-arm pragmatic cluster randomized trial was conducted, with allocation at the level of primary care clinics. Participants were family physicians who contributed data from their electronic medical records. The 'usual feedback' arm received feedback every six months for two years regarding the proportion of their patients meeting quality targets for diabetes and/or ischemic heart disease. The intervention arm received these same reports plus a worksheet designed to facilitate goal setting and action plan development in response to the feedback reports. Blood pressure (BP) and low-density lipoprotein cholesterol (LDL) values were compared after two years as the primary outcomes. Process outcomes measured the proportion of guideline-recommended actions (e.g., testing and prescribing) conducted within the appropriate timeframe. Intention-to-treat analysis was performed. Outcomes were similar across groups at baseline. Final analysis included 20 physicians from seven clinics and 1,832 patients in the intervention arm (15% loss to follow up) and 29 physicians from seven clinics and 2,223 patients in the usual feedback arm (10% loss to follow up). Ten of 20 physicians completed the worksheet at least once during the study. Mean BP was 128/72 in the feedback plus worksheet arm and 128/73 in the feedback alone arm, while LDL was 2.1 and 2.0, respectively. Thus, no significant differences were observed across groups in the primary outcomes, but mean haemoglobin A1c was lower in the feedback plus worksheet arm (7.2% versus 7.4%, ptheory-informed goal setting and action planning worksheet to an externally produced audit and

A randomised clinical trial of feedback on inhaler adherence and technique in patients with severe uncontrolled asthma.

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Sulaiman, Imran; Greene, Garrett; MacHale, Elaine; Seheult, Jansen; Mokoka, Matshediso; D'Arcy, Shona; Taylor, Terence; Murphy, Desmond M; Hunt, Eoin; Lane, Stephen J; Diette, Gregory B; FitzGerald, J Mark; Boland, Fiona; Sartini Bhreathnach, Aoife; Cushen, Breda; Reilly, Richard B; Doyle, Frank; Costello, Richard W

2018-01-01

In severe asthma, poor control could reflect issues of medication adherence or inhaler technique, or that the condition is refractory. This study aimed to determine if an intervention with (bio)feedback on the features of inhaler use would identify refractory asthma and enhance inhaler technique and adherence.Patients with severe uncontrolled asthma were subjected to a stratified-by-site random block design. The intensive education group received repeated training in inhaler use, adherence and disease management. The intervention group received the same intervention, enhanced by (bio)feedback-guided training. The primary outcome was rate of actual inhaler adherence. Secondary outcomes included a pre-defined assessment of clinical outcome. Outcome assessors were blinded to group allocation. Data were analysed on an intention-to-treat and per-protocol basis.The mean rate of adherence during the third month in the (bio)feedback group (n=111) was higher than that in the enhanced education group (intention-to-treat, n=107; 73% versus 63%; 95% CI 2.8%-17.6%; p=0.02). By the end of the study, asthma was either stable or improved in 54 patients (38%); uncontrolled, but poorly adherent in 52 (35%); and uncontrolled, but adherent in 40 (27%).Repeated feedback significantly improved inhaler adherence. After a programme of adherence and inhaler technique assessment, only 40 patients (27%) were refractory and adherent, and might therefore need add-on therapy. Copyright ©ERS 2018.

Rapid feedback responses correlate with reach adaptation and properties of novel upper limb loads.

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Cluff, Tyler; Scott, Stephen H

2013-10-02

A hallmark of voluntary motor control is the ability to adjust motor patterns for novel mechanical or visuomotor contexts. Recent work has also highlighted the importance of feedback for voluntary control, leading to the hypothesis that feedback responses should adapt when we learn new motor skills. We tested this prediction with a novel paradigm requiring that human subjects adapt to a viscous elbow load while reaching to three targets. Target 1 required combined shoulder and elbow motion, target 2 required only elbow motion, and target 3 (probe target) required shoulder but no elbow motion. This simple approach controlled muscle activity at the probe target before, during, and after the application of novel elbow loads. Our paradigm allowed us to perturb the elbow during reaching movements to the probe target and identify several key properties of adapted stretch responses. Adapted long-latency responses expressed (de-) adaptation similar to reaching errors observed when we introduced (removed) the elbow load. Moreover, reaching errors during learning correlated with changes in the long-latency response, showing subjects who adapted more to the elbow load displayed greater modulation of their stretch responses. These adapted responses were sensitive to the size and direction of the viscous training load. Our results highlight an important link between the adaptation of feedforward and feedback control and suggest a key part of motor adaptation is to adjust feedback responses to the requirements of novel motor skills.

The effect of continuous, nonlinearly transformed visual feedback on rapid aiming movements.

NARCIS (Netherlands)

Rieger, Martina; Verwey, Willem B.; Massen, Cristina

2008-01-01

We investigated the ability to adjust to nonlinear transformations that allow people to control external systems like machines and tools. Earlier research (Verwey and Heuer 2007) showed that in the presence of just terminal feedback participants develop an internal model of such transformations that

Feedback in the OSCE: What Do Residents Remember?

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Humphrey-Murto, Susan; Mihok, Marika; Pugh, Debra; Touchie, Claire; Halman, Samantha; Wood, Timothy J

2016-01-01

The move to competency-based education has heightened the importance of direct observation of clinical skills and effective feedback. The Objective Structured Clinical Examination (OSCE) is widely used for assessment and affords an opportunity for both direct observation and feedback to occur simultaneously. For feedback to be effective, it should include direct observation, assessment of performance, provision of feedback, reflection, decision making, and use of feedback for learning and change. If one of the goals of feedback is to engage students to think about their performance (i.e., reflection), it would seem imperative that they can recall this feedback both immediately and into the future. This study explores recall of feedback in the context of an OSCE. Specifically, the purpose of this study was to (a) determine the amount and the accuracy of feedback that trainees remember immediately after an OSCE, as well as 1 month later, and (b) assess whether prompting immediate recall improved delayed recall. Internal medicine residents received 2 minutes of verbal feedback from physician examiners in the context of an OSCE. The feedback was audio-recorded and later transcribed. Residents were randomly allocated to the immediate recall group (immediate-RG; n = 10) or the delayed recall group (delayed-RG; n = 8). The immediate-RG completed a questionnaire prompting recall of feedback received immediately after the OSCE, and then again 1 month later. The delayed-RG completed a questionnaire only 1 month after the OSCE. The total number and accuracy of feedback points provided by examiners were compared to the points recalled by residents. Results comparing recall at 1 month between the immediate-RG and the delayed-RG were also studied. Physician examiners provided considerably more feedback points (M = 16.3) than the residents recalled immediately after the OSCE (M = 2.61, p feedback points recalled upon completion of the OSCE (2.61) compared to 1 month later (M = 1

Clinical Pathway and Monthly Feedback Improve Adherence to Antibiotic Guideline Recommendations for Community-Acquired Pneumonia.

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Maher Almatar

Full Text Available Compliance with community-acquired pneumonia (CAP guidelines remains poor despite a substantial body of evidence indicating that guideline-concordant care improves patient outcomes. The aim of this study was to compare the relative effectiveness of a general educational and a targeted emergency department intervention on improving physicians' concordance with CAP guidelines.Two distinct interventions were implemented over specific time periods. The first intervention was educational, focusing on the development of local CAP guidelines and their dissemination through hospital-wide educational programmes. The second intervention was a targeted one for the emergency department, where a clinical pathway for the initial management of CAP patients was introduced, followed by monthly feedback to the emergency department (ED physicians about concordance rates with the guidelines. Data on the concordance rate to CAP guidelines was collected from a retrospective chart review.A total of 398 eligible patient records were reviewed to measure concordance to CAP guidelines over the study period. Concordance rates during the baseline and educational intervention periods were similar (28.1% vs. 31.2%; p > 0.05. Significantly more patients were treated in accordance with the CAP guidelines after the ED focused intervention when compared to the baseline (61.5% vs. 28.1%; p < 0.05 or educational period (61.5% vs. 31.2%; p < 0.05.A targeted intervention with a CAP clinical pathway and monthly feedback was a successful strategy to increase adherence to empirical antibiotic recommendations in CAP guidelines.

Evaluation and feedback for effective clinical teaching in postgraduate medical education: validation of an assessment instrument incorporating the CanMEDS roles.

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Fluit, Cornelia; Bolhuis, Sanneke; Grol, Richard; Ham, Marieke; Feskens, Remco; Laan, Roland; Wensing, Michel

2012-01-01

Providing clinical teachers in postgraduate medical education with feedback about their teaching skills is a powerful tool to improve clinical teaching. A systematic review showed that available instruments do not comprehensively cover all domains of clinical teaching. We developed and empirically test a comprehensive instrument for assessing clinical teachers in the setting of workplace learning and linked to the CanMEDS roles. In a Delphi study, the content validity of a preliminary instrument with 88 items was studied, leading to the construction of the EFFECT (evaluation and feedback for effective clinical teaching) instrument. The response process was explored in a pilot test and focus group research with 18 residents of 6 different disciplines. A confirmatory factor analyses (CFA) and reliability analyses were performed on 407 evaluations of 117 supervisors, collected in 3 medical disciplines (paediatrics, pulmonary diseases and surgery) of 6 departments in 4 different hospitals. CFA yielded an 11 factor model with a good to excellent fit and internal consistencies ranged from 0.740 to 0.940 per domain; 7 items could be deleted. The model of workplace learning showed to be a useful framework for developing EFFECT, which incorporates the CanMEDS competencies and proved to be valid and reliable.

Evaluating tactile feedback in robotic surgery for potential clinical application using an animal model.

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Wottawa, Christopher R; Genovese, Bradley; Nowroozi, Bryan N; Hart, Steven D; Bisley, James W; Grundfest, Warren S; Dutson, Erik P

2016-08-01

The aims of this study were to evaluate (1) grasping forces with the application of a tactile feedback system in vivo and (2) the incidence of tissue damage incurred during robotic tissue manipulation. Robotic-assisted minimally invasive surgery has been shown to be beneficial in a variety of surgical specialties, particularly radical prostatectomy. This innovative surgical tool offers advantages over traditional laparoscopic techniques, such as improved wrist-like maneuverability, stereoscopic video displays, and scaling of surgical gestures to increase precision. A widely cited disadvantage associated with robotic systems is the absence of tactile feedback. Nineteen subjects were categorized into two groups: 5 experts (six or more robotic cases) and 14 novices (five cases or less). The subjects used the da Vinci with integrated tactile feedback to run porcine bowel in the following conditions: (T1: deactivated tactile feedback; T2: activated tactile feedback; and T3: deactivated tactile feedback). The grasping force, incidence of tissue damage, and the correlation of grasping force and tissue damage were analyzed. Tissue damage was evaluated both grossly and histologically by a pathologist blinded to the sample. Tactile feedback resulted in significantly decreased grasping forces for both experts and novices (P system was deactivated (P > 0.05 in all subjects). The in vivo application of integrated tactile feedback in the robotic system demonstrates significantly reduced grasping forces, resulting in significantly less tissue damage. This tactile feedback system may improve surgical outcomes and broaden the use of robotic-assisted minimally invasive surgery.

Validity evidence and reliability of a simulated patient feedback instrument.

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Schlegel, Claudia; Woermann, Ulrich; Rethans, Jan-Joost; van der Vleuten, Cees

2012-01-27

In the training of healthcare professionals, one of the advantages of communication training with simulated patients (SPs) is the SP's ability to provide direct feedback to students after a simulated clinical encounter. The quality of SP feedback must be monitored, especially because it is well known that feedback can have a profound effect on student performance. Due to the current lack of valid and reliable instruments to assess the quality of SP feedback, our study examined the validity and reliability of one potential instrument, the 'modified Quality of Simulated Patient Feedback Form' (mQSF). Content validity of the mQSF was assessed by inviting experts in the area of simulated clinical encounters to rate the importance of the mQSF items. Moreover, generalizability theory was used to examine the reliability of the mQSF. Our data came from videotapes of clinical encounters between six simulated patients and six students and the ensuing feedback from the SPs to the students. Ten faculty members judged the SP feedback according to the items on the mQSF. Three weeks later, this procedure was repeated with the same faculty members and recordings. All but two items of the mQSF received importance ratings of > 2.5 on a four-point rating scale. A generalizability coefficient of 0.77 was established with two judges observing one encounter. The findings for content validity and reliability with two judges suggest that the mQSF is a valid and reliable instrument to assess the quality of feedback provided by simulated patients.

Peer-Assisted Analysis of Resident Feedback Improves Clinical Teaching: A Case Report.

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Mai, Christine L; Baker, Keith

2017-07-01

Anesthesiologists play an important role in educating future clinicians. Yet few residency programs incorporate teaching skills into faculty development. Consequently, many anesthesiologists have limited training to supervise and educate residents. In turn, these attendings may receive negative feedback and poor evaluations from residents without a means to effectively improve. Peer-assisted teaching between faculty members may serve as a strategy to improve teaching skills. We report a case of peer-assisted analysis of resident feedback to identify specific areas of concern that were targeted for improvement. This approach resulted in improved teaching scores and feedback for the faculty member.

Follower-Centered Perspective on Feedback: Effects of Feedback Seeking on Identification and Feedback Environment

OpenAIRE

Gong, Zhenxing; Li, Miaomiao; Qi, Yaoyuan; Zhang, Na

2017-01-01

In the formation mechanism of the feedback environment, the existing research pays attention to external feedback sources and regards individuals as objects passively accepting feedback. Thus, the external source fails to realize the individuals’ need for feedback, and the feedback environment cannot provide them with useful information, leading to a feedback vacuum. The aim of this study is to examine the effect of feedback-seeking by different strategies on the supervisor-feedback environme...

Improving the accuracy of self-assessment of practical clinical skills using video feedback--the importance of including benchmarks.

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Hawkins, S C; Osborne, A; Schofield, S J; Pournaras, D J; Chester, J F

2012-01-01

Isolated video recording has not been demonstrated to improve self-assessment accuracy. This study examines if the inclusion of a defined standard benchmark performance in association with video feedback of a student's own performance improves the accuracy of student self-assessment of clinical skills. Final year medical students were video recorded performing a standardised suturing task in a simulated environment. After the exercise, the students self-assessed their performance using global rating scales (GRSs). An identical self-assessment process was repeated following video review of their performance. Students were then shown a video-recorded 'benchmark performance', which was specifically developed for the study. This demonstrated the competency levels required to score full marks (30 points). A further self-assessment task was then completed. Students' scores were correlated against expert assessor scores. A total of 31 final year medical students participated. Student self-assessment scores before video feedback demonstrated moderate positive correlation with expert assessor scores (r = 0.48, p benchmark performance demonstration, self-assessment scores demonstrated a very strong positive correlation with expert scores (r = 0.83, p benchmark performance in combination with video feedback may significantly improve the accuracy of students' self-assessments.

The rapid access palliative radiotherapy program: blueprint for initiation of a one-stop multidisciplinary bone metastases clinic.

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Fairchild, A; Pituskin, E; Rose, B; Ghosh, S; Dutka, J; Driga, A; Tachynski, P; Borschneck, J; Gagnon, L; Macdonnell, S; Middleton, J; Thavone, K; Carstairs, S; Brent, D; Severin, D

2009-02-01

Radiotherapy (RT) for palliation of pain due to bone metastases (BM) is effective but underutilized likely due to the traditional practice of separate clinic visits for consultation, treatment planning, and RT delivery. However, recent evidence proves one RT treatment is as effective as multiple for analgesia, enabling investigation of an alternative model of RT delivery, the rapid access palliative radiotherapy program (RAPRP). Prior to the start of the program, needs assessment was performed to determine the composition of the optimal team. Screening tools were implemented to streamline holistic, multidisciplinary assessment. An advertising strategy, treatment and research protocols, and mechanisms for patient feedback were established. After RAPRP implementation, patient outcomes such as symptom relief were tracked. Eighty-six patients with painful BM were referred over the 25-week pilot. Median age was 69.9 years; 64% had prostate cancer, and median performance status was 70. Patient-rated pain was on average 6.1/10 at baseline, improving to 2.6/10 by week 4 post-RT. On average, 6.2 symptoms were reported (baseline) compared to 5.2 (week 4). Team members assessed 10-100% of patients and were successful in stabilizing or improving all symptoms in >75% contacted at week 4. One hundred percent of patients surveyed were satisfied with their experience. Early needs assessment was advantageous in determining the optimal team and methods of assessment for our 'one-stop' BM clinic. This approach was successful in improving pain and other symptoms, and the convenience of seeing multiple providers on 1 day was appreciated by the patients.

How does feedback in mini-CEX affect students' learning response?

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Sudarso, Sulistiawati; Rahayu, Gandes Retno; Suhoyo, Yoyo

2016-12-19

This study was aimed to explore students' learning response toward feedback during mini-CEX encounter. This study used a phenomenological approach to identify the students' experiences toward feedback during mini-CEX encounter. Data was collected using Focus Group Discussion (FGD) for all students who were in their final week of clerkship in the internal medicine rotation. There were 4 FGD groups (6 students for each group). All FGD were audio-taped and transcribed verbatim. The FGD transcripts were analyzed thematically and managed using Atlas-ti (version 7.0). Feedback content and the way of providing feedback on mini-CEX stimulated students' internal process, including self-reflection, emotional response, and motivation. These internal processes encouraged the students to take action or do a follow-up on the feedback to improve their learning process. In addition, there was also an external factor, namely consequences, which also influenced the students' reaction to the follow-up on feedback. In the end, this action caused several learning effects that resulted in the students' increased self-efficacy, attitude, knowledge and clinical skill. Feedback content and the way of providing feedback on mini-CEX stimulates the students' internal processes to do a follow-up on feedback. However, another external factor also affects the students' decision on the follow-up actions. The follow-ups result in various learning effects on the students. Feedback given along with summative assessment enhances learning effects on students, as well. It is suggested that supervisors of clinical education are prepared to comprehend every factor influencing feedback on mini CEX to improve the students' learning response.

The quality of feedback during formative OSCEs depends on the tutors’ profile

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Noelle Junod Perron

2016-11-01

Full Text Available Abstract Background During their pre-clinical years, medical students are given the opportunity to practice clinical skills with simulated patients. During these formative objective structured clinical encounters (OSCEs, tutors from various backgrounds give feedback on students’ history taking, physical exam, and communication skills. The aim of the study was to evaluate whether the content and process of feedback varied according to the tutors’ profile. Methods During 2013, all 2nd and 3rd year medical students and tutors involved in three formative OSCEs were asked to fill in questionnaires, and their feedback sessions were audiotaped. Tutors were divided into two groups: 1 generalists: primary care, general internist and educationalist physicians 2 specialists involved in the OSCE related to their field of expertise. Outcome measures included the students’ perceptions of feedback quality and utility and objective assessment of feedback quality. Results Participants included 251 medical students and 38 tutors (22 generalists and 16 specialists. Students self-reported that feedback was useful to improve history taking, physical exam and communication skills. Objective assessment showed that feedback content essentially focused on history taking and physical exam skills, and that elaboration on clinical reasoning or communication/professionalism issues was uncommon. Multivariate analyses showed that generalist tutors used more learner-centered feedback skills than specialist tutors (stimulating student’s self-assessment (p < .001; making the student active in finding solutions, p < .001; checking student’s understanding, p < .001 and elaborated more on communication and professionalism issues (p < 0.001. Specialists reported less training in how to provide feedback than generalists. Conclusion These findings suggest that generalist tutors are more learner-centered and pay more attention to communication and

Medical Student Perceptions of Learner-Initiated Feedback Using a Mobile Web Application

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Amy C Robertson

2017-12-01

Full Text Available Feedback, especially timely, specific, and actionable feedback, frequently does not occur. Efforts to better understand methods to improve the effectiveness of feedback are an important area of educational research. This study represents preliminary work as part of a plan to investigate the perceptions of a student-driven system to request feedback from faculty using a mobile device and Web-based application. We hypothesize that medical students will perceive learner-initiated, timely feedback to be an essential component of clinical education. Furthermore, we predict that students will recognize the use of a mobile device and Web application to be an advantageous and effective method when requesting feedback from supervising physicians. Focus group data from 18 students enrolled in a 4-week anesthesia clerkship revealed the following themes: (1 students often have to solicit feedback, (2 timely feedback is perceived as being advantageous, (3 feedback from faculty is perceived to be more effective, (4 requesting feedback from faculty physicians poses challenges, (5 the decision to request feedback may be influenced by the student’s clinical performance, and (6 using a mobile device and Web application may not guarantee timely feedback. Students perceived using a mobile Web-based application to initiate feedback from supervising physicians to be a valuable method of assessment. However, challenges and barriers were identified.

How is feedback from national clinical audits used? Views from English National Health Service trust audit leads.

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Taylor, Angelina; Neuburger, Jenny; Walker, Kate; Cromwell, David; Groene, Oliver

2016-04-01

To explore how the output of national clinical audits in England is used by professionals and whether and how their impact could be enhanced. A mixed-methods study with the primary recipients of four national clinical audits of cancer care of 607 local audit leads, 274 (45%) completed a questionnaire and 32 participated in an interview. Our questions focused on how the audits were used and whether barriers existed to using the audits for local service improvement. We described variation in questionnaire responses between the audits using chi-squared tests. Results are reported as percentages with their 95% confidence intervals. Qualitative data were analysed using Framework analysis. More than 90% of survey respondents believed that the audit findings were relevant to their clinical work, and interviewees described how they used the audits for a range of purposes. Forty-two percent of survey respondents said they had changed their clinical practice, and 56% had implemented service improvements in response to the audits. The degree of change differed between the four audits, evident in both the questionnaire and the interview data. In the interviews, two recurring barriers emerged: (1) the importance of data quality, which, in turn, influenced the perceived relevance and validity of the audit data and therefore the ability to make changes based on it and (2) the need for clear presentation of benchmarked local performance data. The perceived authority and credibility of the professional bodies supporting the audits was a key factor underpinning the use of the audit findings. National cancer audit and feedback is used to improve services, but their impact could be enhanced by improving the data quality and relevance of feedback. © The Author(s) 2016.

Framing of feedback impacts student’s satisfaction, self-efficacy and performance

NARCIS (Netherlands)

van de Ridder, J. M Monica; Peters, Claudia M M; Stokking, Karel M.; de Ru, J. Alexander; ten Cate, Olle Th J

2014-01-01

Feedback is considered important to acquire clinical skills. Research evidence shows that feedback does not always improve learning and its effects may be small. In many studies, a variety of variables involved in feedback provision may mask either one of their effects. E.g., there is reason to

A novel rapid access testicular cancer clinic: prospective evaluation after one year.

Science.gov (United States)

Carey, K; Davis, N F; Elamin, S; Ahern, P; Brady, C M; Sweeney, P

2016-02-01

Our institution has recently developed a rapid access outpatient clinic to investigate men with testicular lumps and/or pain suspicious for testicular cancer (TCa). To present our experience after 12 months. All referrals to the rapid access testicular clinic (RATC) clinic were prospectively analysed from 01/01/2013 to 01/01/2014. The primary outcome variable was incidence of TCa in the referred patient cohort. Secondary outcome variables were waiting times prior to clinical review and waiting times prior to radical orchidectomy in patients diagnosed with TCa. Seventy-four new patients were referred to the RATC during the 1-year period and the mean age was 34 (range 15-81 years). TCa was the most common diagnosis and was found in 18 (25 %) patients. Patients diagnosed with TCa underwent radical orchidectomy, a median of 3 (range 1-5) days after their initial GP referral. Patients requiring surgical intervention for benign scrotal pathology underwent their procedure a median of 32 (range 3-61) days after their initial referral. Of the 18 patients diagnosed with TCa, 9 (50 %) were diagnosed with a seminomatous germ cell tumour on histopathology. The RATC is a new initiative in Ireland that provides expedient and definitive treatment of patients with newly diagnosed TCa. Early treatment will ultimately improve long-term prognosis in this patient cohort.

Optical feedback-induced light modulation for fiber-based laser ablation.

Science.gov (United States)

Kang, Hyun Wook

2014-11-01

Optical fibers have been used as a minimally invasive tool in various medical fields. However, due to excessive heat accumulation, the distal end of a fiber often suffers from severe melting or devitrification, leading to the eventual fiber failure during laser treatment. In order to minimize thermal damage at the fiber tip, an optical feedback sensor was developed and tested ex vivo. Porcine kidney tissue was used to evaluate the feasibility of optical feedback in terms of signal activation, ablation performance, and light transmission. Testing various signal thresholds demonstrated that 3 V was relatively appropriate to trigger the feedback sensor and to prevent the fiber deterioration during kidney tissue ablation. Based upon the development of temporal signal signatures, full contact mode rapidly activated the optical feedback sensor possibly due to heat accumulation. Modulated light delivery induced by optical feedback diminished ablation efficiency by 30% in comparison with no feedback case. However, long-term transmission results validated that laser ablation assisted with optical feedback was able to almost consistently sustain light delivery to the tissue as well as ablation efficiency. Therefore, an optical feedback sensor can be a feasible tool to protect optical fiber tips by minimizing debris contamination and delaying thermal damage process and to ensure more efficient and safer laser-induced tissue ablation.

Mental models of audit and feedback in primary care settings.

Science.gov (United States)

Hysong, Sylvia J; Smitham, Kristen; SoRelle, Richard; Amspoker, Amber; Hughes, Ashley M; Haidet, Paul

2018-05-30

Audit and feedback has been shown to be instrumental in improving quality of care, particularly in outpatient settings. The mental model individuals and organizations hold regarding audit and feedback can moderate its effectiveness, yet this has received limited study in the quality improvement literature. In this study we sought to uncover patterns in mental models of current feedback practices within high- and low-performing healthcare facilities. We purposively sampled 16 geographically dispersed VA hospitals based on high and low performance on a set of chronic and preventive care measures. We interviewed up to 4 personnel from each location (n = 48) to determine the facility's receptivity to audit and feedback practices. Interview transcripts were analyzed via content and framework analysis to identify emergent themes. We found high variability in the mental models of audit and feedback, which we organized into positive and negative themes. We were unable to associate mental models of audit and feedback with clinical performance due to high variance in facility performance over time. Positive mental models exhibit perceived utility of audit and feedback practices in improving performance; whereas, negative mental models did not. Results speak to the variability of mental models of feedback, highlighting how facilities perceive current audit and feedback practices. Findings are consistent with prior research  in that variability in feedback mental models is associated with lower performance.; Future research should seek to empirically link mental models revealed in this paper to high and low levels of clinical performance.

How does culture affect experiential training feedback in exported Canadian health professional curricula?

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Wilbur, Kerry; Mousa Bacha, Rasha; Abdelaziz, Somaia

2017-03-17

To explore feedback processes of Western-based health professional student training curricula conducted in an Arab clinical teaching setting. This qualitative study employed document analysis of in-training evaluation reports (ITERs) used by Canadian nursing, pharmacy, respiratory therapy, paramedic, dental hygiene, and pharmacy technician programs established in Qatar. Six experiential training program coordinators were interviewed between February and May 2016 to explore how national cultural differences are perceived to affect feedback processes between students and clinical supervisors. Interviews were recorded, transcribed, and coded according to a priori cultural themes. Document analysis found all programs' ITERs outlined competency items for students to achieve. Clinical supervisors choose a response option corresponding to their judgment of student performance and may provide additional written feedback in spaces provided. Only one program required formal face-to-face feedback exchange between students and clinical supervisors. Experiential training program coordinators identified that no ITER was expressly culturally adapted, although in some instances, modifications were made for differences in scopes of practice between Canada and Qatar.  Power distance was recognized by all coordinators who also identified both student and supervisor reluctance to document potentially negative feedback in ITERs. Instances of collectivism were described as more lenient student assessment by clinical supervisors of the same cultural background. Uncertainty avoidance did not appear to impact feedback processes. Our findings suggest that differences in specific cultural dimensions between Qatar and Canada have implications on the feedback process in experiential training which may be addressed through simple measures to accommodate communication preferences.

How does feedback in mini-CEX affect students’ learning response?

Science.gov (United States)

Rahayu, Gandes Retno; Suhoyo, Yoyo

2016-01-01

Objective This study was aimed to explore students’ learning response toward feedback during mini-CEX encounter. Methods This study used a phenomenological approach to identify the students’ experiences toward feedback during mini-CEX encounter. Data was collected using Focus Group Discussion (FGD) for all students who were in their final week of clerkship in the internal medicine rotation. There were 4 FGD groups (6 students for each group). All FGD were audio-taped and transcribed verbatim. The FGD transcripts were analyzed thematically and managed using Atlas-ti (version 7.0). Results Feedback content and the way of providing feedback on mini-CEX stimulated students’ internal process, including self-reflection, emotional response, and motivation. These internal processes encouraged the students to take action or do a follow-up on the feedback to improve their learning process. In addition, there was also an external factor, namely consequences, which also influenced the students’ reaction to the follow-up on feedback. In the end, this action caused several learning effects that resulted in the students’ increased self-efficacy, attitude, knowledge and clinical skill. Conclusions Feedback content and the way of providing feedback on mini-CEX stimulates the students’ internal processes to do a follow-up on feedback. However, another external factor also affects the students’ decision on the follow-up actions. The follow-ups result in various learning effects on the students. Feedback given along with summative assessment enhances learning effects on students, as well. It is suggested that supervisors of clinical education are prepared to comprehend every factor influencing feedback on mini CEX to improve the students’ learning response. PMID:28008136

Dynamic Mesoscale Land-Atmosphere Feedbacks in Fragmented Forests in Amazonia

Science.gov (United States)

Rastogi, D.; Baidya Roy, S.

2011-12-01

This paper investigates land-atmosphere feedbacks in disturbed rainforests of Amazonia. Deforestation along the rapidly expanding highways and road network has created the unique fishbone land cover pattern in Rondonia, a state in southwestern Amazonia. Numerical experiments and observations show that sharp gradients in land cover due to the fishbone heterogeneity triggers mesoscale circulations. These circulations significantly change the spatial pattern of local hydrometeorology, especially convection, clouds and precipitation. The primary research question now is can these changes in local hydrometeorology affect vegetation growth in the clearings. If so, that would be a clear indication that land-atmosphere feedbacks can affect vegetation recovery in fragmented forests. A computationally-efficient modeling tool consisting of a mesoscale atmospheric model dynamically coupled with a plant growth model has been specifically developed to identify the atmospheric feedback pathways. Preliminary experiments focus on the seasonal-scale feedbacks during the dry season. Results show that temperature, incoming shortwave and precipitation are the three primary drivers through which the feedbacks operate. Increasing temperature increases respiratory losses generating a positive feedback. Increased cloud cover reduces incoming PAR and photosynthesis, resulting in a positive feedback. Increased precipitation reduces water stress and promotes growth resulting in a negative feedback. The net effect is a combination of these 3 feedback loops. These findings can significantly improve our understanding of ecosystem resiliency in disturbed tropical forests.

Clinical study of student learning using mastery style versus immediate feedback online activities

Directory of Open Access Journals (Sweden)

Gary Gladding

2015-06-01

Full Text Available This paper is part of a series of studies to improve the efficacy of online physics homework activities by integrating narrated animated solutions with mastery inspired exercises. In a clinical study using first- and second-year university students, the mastery group attempted question sets in four levels, with animated solutions between each attempt, until mastery was achieved on each level. This combined elements of formative assessment, the worked example effect, and mastery learning. The homework group attempted questions with immediate feedback and unlimited tries. The two groups took a similar amount of time to complete the activity. The mastery group significantly outperformed the homework group on a free response post-test that required students to show their work in solving near and far transfer problems.

Clinical workplace learning : perceived learning value of individual and group feedback in a collectivistic culture

NARCIS (Netherlands)

Suhoyo, Yoyo; Schönrock-Adema, Johanna; Emilia, Ova; Kuks, Jan B M; Cohen-Schotanus, Janke

2018-01-01

BACKGROUND: Feedback is essential for workplace learning. Most papers in this field concern individual feedback. In collectivistic cultures, however, group feedback is common educational practice. This study was conducted to investigate the perceived learning value and characteristics of individual

An autoethnographic exploration of the use of goal oriented feedback to enhance brief clinical teaching encounters.

Science.gov (United States)

Farrell, Laura; Bourgeois-Law, Gisele; Ajjawi, Rola; Regehr, Glenn

2017-03-01

Supervision in the outpatient context is increasingly in the form of single day interactions between students and preceptors. This creates difficulties for effective feedback, which often depends on a strong relationship of trust between preceptor and student. Building on feedback theories focusing on the relational and dialogic aspects of feedback, this study explored the use of goal-oriented feedback in brief encounters with learners. This study used autoethnography to explore one preceptor's feedback interactions over an eight-month period both in the ambulatory setting and on the wards. Data included written narrative reflections on feedback interactions with twenty-three learners informed by discussions with colleagues and repeated reading of feedback literature. Thematic and narrative analyses of data were performed iteratively. Data analysis emphasized four recurrent themes. (1) Goal discussions were most effective when initiated early and integrated throughout the learning experience. (2) Both learner and preceptor goals were multiple and varied, and feedback needed to reflect this complexity. (3) Negotiation or co-construction of goals was important when considering the focus of feedback discussions in order to create safer, more effective interactions. (4) Goal oriented interactions offer potential benefits to the learner and preceptor. Goal oriented feedback promotes dialogue as it requires both preceptor and learner to acknowledge and negotiate learning goals throughout their interaction. In doing so, feedback becomes an explicit component of the preceptor-learner relationship. This enhances feedback interactions even in relatively brief encounters, and may begin an early educational alliance that can be elaborated with longer interactions.

Accuracy and speed feedback: Global and local effects on strategy use

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Touron, Dayna R.; Hertzog, Christopher

2013-01-01

Background Skill acquisition often involves a shift from an effortful algorithm-based strategy to more fluent memory-based performance. Older adults’ slower strategy transitions can be ascribed to both slowed learning and metacognitive factors. Experimenters often provide feedback on response accuracy; this emphasis may either inadvertently reinforce older adults’ conservatism or might highlight that retrieval is generally quite accurate. RT feedback can lead to more rapid shift to retrieval (Hertzog, Touron, & Hines, 2007). Methods This study parametrically varied trial-by-trial feedback to examine whether strategy shifts in the noun-pair task in younger (M = 19) and older adults (M = 67) were influenced by type of performance feedback: none, trial accuracy, trial RT, or both accuracy and RT. Results Older adults who received accuracy feedback retrieved more often, particularly on difficult rearranged trials, and participants who receive speed feedback performed the scanning strategy more quickly. Age differences were also obtained in local (trial-level) reactivity to task performance, but these were not affected by feedback. Conclusions Accuracy and speed feedback had distinct global (general) influences on task strategies and performance. In particular, it appears that the standard practice of providing trial-by-trial accuracy feedback might facilitate older adults’ use of retrieval strategies in skill acquisition tasks. PMID:24785594

Cancer immunotherapy: Opportunities and challenges in the rapidly evolving clinical landscape.

Science.gov (United States)

Emens, Leisha A; Ascierto, Paolo A; Darcy, Phillip K; Demaria, Sandra; Eggermont, Alexander M M; Redmond, William L; Seliger, Barbara; Marincola, Francesco M

2017-08-01

Cancer immunotherapy is now established as a powerful way to treat cancer. The recent clinical success of immune checkpoint blockade (antagonists of CTLA-4, PD-1 and PD-L1) highlights both the universal power of treating the immune system across tumour types and the unique features of cancer immunotherapy. Immune-related adverse events, atypical clinical response patterns, durable responses, and clear overall survival benefit distinguish cancer immunotherapy from cytotoxic cancer therapy. Combination immunotherapies that transform non-responders to responders are under rapid development. Current challenges facing the field include incorporating immunotherapy into adjuvant and neoadjuvant cancer therapy, refining dose, schedule and duration of treatment and developing novel surrogate endpoints that accurately capture overall survival benefit early in treatment. As the field rapidly evolves, we must prioritise the development of biomarkers to guide the use of immunotherapies in the most appropriate patients. Immunotherapy is already transforming cancer from a death sentence to a chronic disease for some patients. By making smart, evidence-based decisions in developing next generation immunotherapies, cancer should become an imminently treatable, curable and even preventable disease. Copyright © 2017 Elsevier Ltd. All rights reserved.

Gray matter volume and rapid decision-making in major depressive disorder.

Science.gov (United States)

Nakano, Masayuki; Matsuo, Koji; Nakashima, Mami; Matsubara, Toshio; Harada, Kenichiro; Egashira, Kazuteru; Masaki, Hiroaki; Takahashi, Kanji; Watanabe, Yoshifumi

2014-01-03

Reduced motivation and blunted decision-making are key features of major depressive disorder (MDD). Patients with MDD show abnormal decision-making when given negative feedback regarding a reward. The brain mechanisms underpinning this behavior remain unclear. In the present study, we examined the association between rapid decision-making with negative feedback and brain volume in MDD. Thirty-six patients with MDD and 54 age-, sex- and IQ-matched healthy subjects were studied. Subjects performed a rapid decision-making monetary task in which participants could make high- or low-risk choices. We compared between the 2 groups the probability that a high-risk choice followed negative feedback. In addition, we used voxel-based morphometry (VBM) to compare between group differences in gray matter volume, and the correlation between the probability for high-risk choices and brain volume. Compared to the healthy group, the MDD group showed significantly lower probabilities for high-risk choices following negative feedback. VBM analysis revealed that the MDD group had less gray matter volume in the right medial prefrontal cortex and orbitofrontal cortex (OFC) compared to the healthy group. The right OFC volume was negatively correlated with the probability that a high-risk choice followed negative feedback in patients with MDD. We did not observe these trends in healthy subjects. Patients with MDD show reduced motivation for monetary incentives when they were required to make rapid decisions following negative feedback. We observed a correlation between this reduced motivation and gray matter volume in the medial and ventral prefrontal cortex, which suggests that these brain regions are likely involved in the pathophysiology of aberrant decision-making in MDD. © 2013.

Numerical simulation of feedback stabilization of the tearing mode in a rotating plasma

International Nuclear Information System (INIS)

Speranskii, N.N.

1991-01-01

The suppression of the tearing mode by means of feedback is studied in a rotating plasma cylinder. The feedback is produced by a coil whose winding is specified by cos var-phi, var-phi = mθ - kz. It is shown that when a resonant surface is present in the rotating plasma the current in the feedback winding generates a magnetic flux in the plasma with cos var-phi and sin var-phi angular dependence. The processes of particle capture is explained. The rotational instability which arises because of the repulsion between the feedback and tearing-mode currents, which interferes with suppression of the tearing mode, is absent when the plasma rotates sufficiently rapidly. In this feedback dependence the form of the plasma current profile determines whether there can be an instability in the induced current resulting from the presence of the feedback

Real-time system for studies of the effects of acoustic feedback on animal vocalizations.

Directory of Open Access Journals (Sweden)

Mike eSkocik

2013-01-01

Full Text Available Studies of behavioral and neural responses to distorted auditory feedback can help shed light on the neural mechanisms of animal vocalizations. We describe an apparatus for generating real-time acoustic feedback. The system can very rapidly detect acoustic features in a song and output acoustic signals if the detected features match the desired acoustic template. The system uses spectrogram-based detection of acoustic elements. It is low-cost and can be programmed for a variety of behavioral experiments requiring acoustic feedback or neural stimulation. We use the system to study the effects of acoustic feedback on birds' vocalizations and demonstrate that such an acoustic feedback can cause both immediate and long-term changes to birds’ songs.

Novel Reduced-Feedback Wireless Communication Systems

KAUST Repository

Shaqfeh, Mohammad Obaidah

2011-11-20

Modern communication systems apply channel-aware adaptive transmission techniques and dynamic resource allocation in order to exploit the peak conditions of the fading wireless links and to enable significant performance gains. However, conveying the channel state information among the users’ mobile terminals into the access points of the network consumes a significant portion of the scarce air-link resources and depletes the battery resources of the mobile terminals rapidly. Despite its evident drawbacks, the channel information feedback cannot be eliminated in modern wireless networks because blind communication technologies cannot support the ever-increasing transmission rates and high quality of experience demands of current ubiquitous services. Developing new transmission technologies with reduced-feedback requirements is sought. Network operators will benefit from releasing the bandwidth resources reserved for the feedback communications and the clients will enjoy the extended battery life of their mobile devices. The main technical challenge is to preserve the prospected transmission rates over the network despite decreasing the channel information feedback significantly. This is a noteworthy research theme especially that there is no mature theory for feedback communication in the existing literature despite the growing number of publications about the topic in the last few years. More research efforts are needed to characterize the trade-off between the achievable rate and the required channel information and to design new reduced-feedback schemes that can be flexibly controlled based on the operator preferences. Such schemes can be then introduced into the standardization bodies for consideration in next generation broadband systems. We have recently contributed to this field and published several journal and conference papers. We are the pioneers to propose a novel reduced-feedback opportunistic scheduling scheme that combines many desired features

Quality assurance in radiology: peer review and peer feedback

International Nuclear Information System (INIS)

Strickland, N.H.

2015-01-01

Peer review in radiology means an assessment of the accuracy of a report issued by another radiologist. Inevitably, this involves a judgement opinion from the reviewing radiologist. Peer feedback is the means by which any form of peer review is communicated back to the original author of the report. This article defines terms, discusses the current status, identifies problems, and provides some recommendations as to the way forward, concentrating upon the software requirements for efficient peer review and peer feedback of reported imaging studies. Radiologists undertake routine peer review in their everyday clinical practice, particularly when reporting and preparing for multidisciplinary team meetings. More formal peer review of reported imaging studies has been advocated as a quality assurance measure to promote good clinical practice. It is also a way of assessing the competency of reporting radiologists referred for investigation to bodies such as the General Medical Council (GMC). The literature shows, firstly, that there is a very wide reported range of discrepancy rates in many studies, which have used a variety of non-comparable methodologies; and secondly, that applying scoring systems in formal peer review is often meaningless, unhelpful, and can even be detrimental. There is currently a lack of electronic peer feedback system software on the market to inform radiologists of any review of their work that has occurred or to provide them with clinical outcome information on cases they have previously reported. Learning opportunities are therefore missed. Radiologists should actively engage with the medical informatics industry to design optimal peer review and feedback software with features to meet their needs. Such a system should be easy to use, be fully integrated with the radiological information and picture archiving systems used clinically, and contain a free-text comment box, without a numerical scoring system. It should form a temporary record

Task-dependent vestibular feedback responses in reaching.

Science.gov (United States)

Keyser, Johannes; Medendorp, W Pieter; Selen, Luc P J

2017-07-01

When reaching for an earth-fixed object during self-rotation, the motor system should appropriately integrate vestibular signals and sensory predictions to compensate for the intervening motion and its induced inertial forces. While it is well established that this integration occurs rapidly, it is unknown whether vestibular feedback is specifically processed dependent on the behavioral goal. Here, we studied whether vestibular signals evoke fixed responses with the aim to preserve the hand trajectory in space or are processed more flexibly, correcting trajectories only in task-relevant spatial dimensions. We used galvanic vestibular stimulation to perturb reaching movements toward a narrow or a wide target. Results show that the same vestibular stimulation led to smaller trajectory corrections to the wide than the narrow target. We interpret this reduced compensation as a task-dependent modulation of vestibular feedback responses, tuned to minimally intervene with the task-irrelevant dimension of the reach. These task-dependent vestibular feedback corrections are in accordance with a central prediction of optimal feedback control theory and mirror the sophistication seen in feedback responses to mechanical and visual perturbations of the upper limb. NEW & NOTEWORTHY Correcting limb movements for external perturbations is a hallmark of flexible sensorimotor behavior. While visual and mechanical perturbations are corrected in a task-dependent manner, it is unclear whether a vestibular perturbation, naturally arising when the body moves, is selectively processed in reach control. We show, using galvanic vestibular stimulation, that reach corrections to vestibular perturbations are task dependent, consistent with a prediction of optimal feedback control theory. Copyright © 2017 the American Physiological Society.

Information needs for the rapid response team electronic clinical tool.

Science.gov (United States)

Barwise, Amelia; Caples, Sean; Jensen, Jeffrey; Pickering, Brian; Herasevich, Vitaly

2017-10-02

Information overload in healthcare is dangerous. It can lead to critical errors and delays. During Rapid Response Team (RRT) activations providers must make decisions quickly to rescue patients from physiological deterioration. In order to understand the clinical data required and how best to present that information in electronic systems we aimed to better assess the data needs of providers on the RRT when they respond to an event. A web based survey to evaluate clinical data requirements was created and distributed to all RRT providers at our institution. Participants were asked to rate the importance of each data item in guiding clinical decisions during a RRT event response. There were 96 surveys completed (24.5% response rate) with fairly even distribution throughout all clinical roles on the RRT. Physiological data including heart rate, respiratory rate, and blood pressure were ranked by more than 80% of responders as being critical information. Resuscitation status was also considered critically useful by more than 85% of providers. There is a limited dataset that is considered important during an RRT. The data is widely available in EMR. The findings from this study could be used to improve user-centered EMR interfaces.

Effects of video-feedback on the communication, clinical competence and motivational interviewing skills of practice nurses: a pre-test posttest control group study.

NARCIS (Netherlands)

Noordman, J.; Weijden, T. van der; Dulmen, S. van

2014-01-01

Aims: To examine the effects of individual video-feedback on the generic communication skills, clinical competence (i.e. adherence to practice guidelines) and motivational interviewing skills of experienced practice nurses working in primary care. Background: Continuing professional education may be

Effects of video-feedback on the communication, clinical competence and motivational interviewing skills of practice nurses: a pre-test posttest control group study

NARCIS (Netherlands)

Noordman, J.; Weijden, T.T. van der; Dulmen, S. van

2014-01-01

AIMS: To examine the effects of individual video-feedback on the generic communication skills, clinical competence (i.e. adherence to practice guidelines) and motivational interviewing skills of experienced practice nurses working in primary care. BACKGROUND: Continuing professional education may be

Feedback Valence Affects Auditory Perceptual Learning Independently of Feedback Probability

Science.gov (United States)

Amitay, Sygal; Moore, David R.; Molloy, Katharine; Halliday, Lorna F.

2015-01-01

Previous studies have suggested that negative feedback is more effective in driving learning than positive feedback. We investigated the effect on learning of providing varying amounts of negative and positive feedback while listeners attempted to discriminate between three identical tones; an impossible task that nevertheless produces robust learning. Four feedback conditions were compared during training: 90% positive feedback or 10% negative feedback informed the participants that they were doing equally well, while 10% positive or 90% negative feedback informed them they were doing equally badly. In all conditions the feedback was random in relation to the listeners’ responses (because the task was to discriminate three identical tones), yet both the valence (negative vs. positive) and the probability of feedback (10% vs. 90%) affected learning. Feedback that informed listeners they were doing badly resulted in better post-training performance than feedback that informed them they were doing well, independent of valence. In addition, positive feedback during training resulted in better post-training performance than negative feedback, but only positive feedback indicating listeners were doing badly on the task resulted in learning. As we have previously speculated, feedback that better reflected the difficulty of the task was more effective in driving learning than feedback that suggested performance was better than it should have been given perceived task difficulty. But contrary to expectations, positive feedback was more effective than negative feedback in driving learning. Feedback thus had two separable effects on learning: feedback valence affected motivation on a subjectively difficult task, and learning occurred only when feedback probability reflected the subjective difficulty. To optimize learning, training programs need to take into consideration both feedback valence and probability. PMID:25946173

Validity evidence and reliability of a simulated patient feedback instrument.

NARCIS (Netherlands)

Schlegel, C.; Woermann, U.; Rethans, J.J.; Vleuten, C.P.M. van der

2012-01-01

BACKGROUND: In the training of healthcare professionals, one of the advantages of communication training with simulated patients (SPs) is the SP's ability to provide direct feedback to students after a simulated clinical encounter. The quality of SP feedback must be monitored, especially because it

Survey of Digital Feedback Systems in High Current Storage Rings

International Nuclear Information System (INIS)

Teytelman, Dmitry

2003-01-01

In the last decade demand for brightness in synchrotron light sources and luminosity in circular colliders led to construction of multiple high current storage rings. Many of these new machines require feedback systems to achieve design stored beam currents. In the same time frame the rapid advances in the technology of digital signal processing allowed the implementation of these complex feedback systems. In this paper I concentrate on three applications of feedback to storage rings: orbit control in light sources, coupled-bunch instability control, and low-level RF control. Each of these applications is challenging in areas of processing bandwidth, algorithm complexity, and control of time-varying beam and system dynamics. I will review existing implementations as well as comment on promising future directions

Psychiatric and clinical correlates of rapid cycling bipolar disorder: a cross-sectional study

Directory of Open Access Journals (Sweden)

Alexandre D. Gigante

2016-01-01

Full Text Available Objective: Rapid cycling (RC is a feature of bipolar disorder (BD that has been associated with worse outcome and more severe disability. Our goal was to investigate the association of demographic and clinical factors with RC. Methods: We compared RC and non-rapid cycling (NRC BD patients from the Brazilian Research Network in Bipolar Disorder (BRN-BD regarding age at onset of BD; total number of episodes; previous number of manic, depressive, mixed, and hypomanic episodes; polarity of the first episode; gender; number of suicide attempts; number of lifetime hospitalizations and lifetime history of at least one hospitalization; family history of mood disorder; clinical comorbidities such as hypothyroidism, hyperthyroidism, seizures; and current use of medications such as lithium, anticonvulsants, antipsychotics, and antidepressants. Results: We studied 577 patients and found that 100 (17.3% met the criteria for RC in the year before the investigation. RC patients had earlier age at onset, longer duration of disease, more lifetime depressive and manic episodes, higher number of suicide attempts, and higher rate antidepressant use. Conclusion: The presence of RC in the previous year was associated with specific clinical characteristics closely related to worse outcome in the course of BD.

Feedback between Accelerator Physicists and magnet builders

International Nuclear Information System (INIS)

Peggs, S.

1995-01-01

Our task is not to record history but to change it. (K. Marx (paraphrased)) How should Accelerator Physicists set magnet error specifications? In a crude social model, they place tolerance limits on undesirable nonlinearities and errors (higher order harmonics, component alignments, etc.). The Magnet Division then goes away for a suitably lengthy period of time, and comes back with a working magnet prototype that is reproduced in industry. A better solution is to set no specifications. Accelerator Physicists begin by evaluating expected values of harmonics, generated by the Magnet Division, before and during prototype construction. Damaging harmonics are traded off against innocuous harmonics as the prototype design evolves, lagging one generation behind the evolution of expected harmonics. Finally, the real harmonics are quickly evaluated during early industrial production, allowing a final round of performance trade-offs, using contingency scenarios prepared earlier. This solution assumes a close relationship and rapid feedback between the Accelerator Physicists and the magnet builders. What follows is one perspective of the way that rapid feedback was used to 'change history' (improve linear and dynamic aperture) at RHIC, to great benefit

Rapid response predicts 12-month post-treatment outcomes in binge-eating disorder: theoretical and clinical implications

Science.gov (United States)

Grilo, C. M.; White, M. A.; Wilson, G. T.; Gueorguieva, R.; Masheb, R. M.

2011-01-01

Background We examined rapid response in obese patients with binge-eating disorder (BED) in a clinical trial testing cognitive behavioral therapy (CBT) and behavioral weight loss (BWL). Method Altogether, 90 participants were randomly assigned to CBT or BWL. Assessments were performed at baseline, throughout and post-treatment and at 6- and 12-month follow-ups. Rapid response, defined as ≥70% reduction in binge eating by week four, was determined by receiver operating characteristic curves and used to predict outcomes. Results Rapid response characterized 57% of participants (67% of CBT, 47% of BWL) and was unrelated to most baseline variables. Rapid response predicted greater improvements across outcomes but had different prognostic significance and distinct time courses for CBT versus BWL. Patients receiving CBT did comparably well regardless of rapid response in terms of reduced binge eating and eating disorder psychopathology but did not achieve weight loss. Among patients receiving BWL, those without rapid response failed to improve further. However, those with rapid response were significantly more likely to achieve binge-eating remission (62% v. 13%) and greater reductions in binge-eating frequency, eating disorder psychopathology and weight loss. Conclusions Rapid response to treatment in BED has prognostic significance through 12-month follow-up, provides evidence for treatment specificity and has clinical implications for stepped-care treatment models for BED. Rapid responders who receive BWL benefit in terms of both binge eating and short-term weight loss. Collectively, these findings suggest that BWL might be a candidate for initial intervention in stepped-care models with an evaluation of progress after 1 month to identify non-rapid responders who could be advised to consider a switch to a specialized treatment. PMID:21923964

Evaluation of the clinical utility of a rapid blood test for human leptospirosis

NARCIS (Netherlands)

Eapen, C. K.; Sugathan, Sheela; Kuriakose, Mariamma; Abdoel, Theresia; Smits, Henk L.

2002-01-01

A rapid assay device for the detection of Leptospira-specific immunoglobulin M (IgM) antibodies was applied on whole blood samples collected from a group of consecutive patients admitted with clinical suspicion of leptospirosis to a district hospital in Kerala, India. The hospital is located in an

Comprehensive joint feedback control for standing by functional neuromuscular stimulation-a simulation study.

Science.gov (United States)

Nataraj, Raviraj; Audu, Musa L; Kirsch, Robert F; Triolo, Ronald J

2010-12-01

Previous investigations of feedback control of standing after spinal cord injury (SCI) using functional neuromuscular stimulation (FNS) have primarily targeted individual joints. This study assesses the potential efficacy of comprehensive (trunk, hips, knees, and ankles) joint feedback control against postural disturbances using a bipedal, 3-D computer model of SCI stance. Proportional-derivative feedback drove an artificial neural network trained to produce muscle excitation patterns consistent with maximal joint stiffness values achievable about neutral stance given typical SCI muscle properties. Feedback gains were optimized to minimize upper extremity (UE) loading required to stabilize against disturbances. Compared to the baseline case of maximum constant muscle excitations used clinically, the controller reduced UE loading by 55% in resisting external force perturbations and by 84% during simulated one-arm functional tasks. Performance was most sensitive to inaccurate measurements of ankle plantar/dorsiflexion position and hip ab/adduction velocity feedback. In conclusion, comprehensive joint feedback demonstrates potential to markedly improve FNS standing function. However, alternative control structures capable of effective performance with fewer sensor-based feedback parameters may better facilitate clinical usage.

Movement retraining using real-time feedback of performance.

Science.gov (United States)

Hunt, Michael Anthony

2013-01-17

Any modification of movement - especially movement patterns that have been honed over a number of years - requires re-organization of the neuromuscular patterns responsible for governing the movement performance. This motor learning can be enhanced through a number of methods that are utilized in research and clinical settings alike. In general, verbal feedback of performance in real-time or knowledge of results following movement is commonly used clinically as a preliminary means of instilling motor learning. Depending on patient preference and learning style, visual feedback (e.g. through use of a mirror or different types of video) or proprioceptive guidance utilizing therapist touch, are used to supplement verbal instructions from the therapist. Indeed, a combination of these forms of feedback is commonplace in the clinical setting to facilitate motor learning and optimize outcomes. Laboratory-based, quantitative motion analysis has been a mainstay in research settings to provide accurate and objective analysis of a variety of movements in healthy and injured populations. While the actual mechanisms of capturing the movements may differ, all current motion analysis systems rely on the ability to track the movement of body segments and joints and to use established equations of motion to quantify key movement patterns. Due to limitations in acquisition and processing speed, analysis and description of the movements has traditionally occurred offline after completion of a given testing session. This paper will highlight a new supplement to standard motion analysis techniques that relies on the near instantaneous assessment and quantification of movement patterns and the display of specific movement characteristics to the patient during a movement analysis session. As a result, this novel technique can provide a new method of feedback delivery that has advantages over currently used feedback methods.

Evaluation of dengue NS1 antigen rapid tests and ELISA kits using clinical samples.

Directory of Open Access Journals (Sweden)

Subhamoy Pal

Full Text Available Early diagnosis of dengue virus (DENV infection can improve clinical outcomes by ensuring close follow-up, initiating appropriate supportive therapies and raising awareness to the potential of hemorrhage or shock. Non-structural glycoprotein-1 (NS1 has proven to be a useful biomarker for early diagnosis of dengue. A number of rapid diagnostic tests (RDTs and enzyme-linked immunosorbent assays (ELISAs targeting NS1 antigen (Ag are now commercially available. Here we evaluated these tests using a well-characterized panel of clinical samples to determine their effectiveness for early diagnosis.Retrospective samples from South America were used to evaluate the following tests: (i "Dengue NS1 Ag STRIP" and (ii "Platelia Dengue NS1 Ag ELISA" (Bio-Rad, France, (iii "Dengue NS1 Detect Rapid Test (1st Generation" and (iv "DENV Detect NS1 ELISA" (InBios International, United States, (v "Panbio Dengue Early Rapid (1st generation" (vi "Panbio Dengue Early ELISA (2nd generation" and (vii "SD Bioline Dengue NS1 Ag Rapid Test" (Alere, United States. Overall, the sensitivity of the RDTs ranged from 71.9%-79.1% while the sensitivity of the ELISAs varied between 85.6-95.9%, using virus isolation as the reference method. Most tests had lower sensitivity for DENV-4 relative to the other three serotypes, were less sensitive in detecting secondary infections, and appeared to be most sensitive on Day 3-4 post symptom onset. The specificity of all evaluated tests ranged from 95%-100%.ELISAs had greater overall sensitivity than RDTs. In conjunction with other parameters, the performance data can help determine which dengue diagnostics should be used during the first few days of illness, when the patients are most likely to present to a clinic seeking care.

Evaluating quality management systems for HIV rapid testing services in primary healthcare clinics in rural KwaZulu-Natal, South Africa.

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Ziningi Jaya

Full Text Available Rapid HIV tests have improved access to HIV diagnosis and treatment by providing quick and convenient testing in rural clinics and resource-limited settings. In this study, we evaluated the quality management system for voluntary and provider-initiated point-of-care HIV testing in primary healthcare (PHC clinics in rural KwaZulu-Natal (KZN, South Africa.We conducted a quality assessment audit in eleven PHC clinics that offer voluntary HIV testing and counselling in rural KZN, South Africa from August 2015 to October 2016. All the participating clinics were purposively selected from the province-wide survey of diagnostic services. We completed an on-site monitoring checklist, adopted from the WHO guidelines for assuring accuracy and reliability of HIV rapid tests, to assess the quality management system for HIV rapid testing at each clinic. To determine clinic's compliance to WHO quality standards for HIV rapid testing the following quality measure was used, a 3-point scale (high, moderate and poor. A high score was defined as a percentage rating of 90 to 100%, moderate was defined as a percentage rating of 70 to 90%, and poor was defined as a percentage rating of less than 70%. Clinic audit scores were summarized and compared. We employed Pearson pair wise correlation coefficient to determine correlations between clinics audit scores and clinic and clinics characteristics. Linear regression model was computed to estimate statistical significance of the correlates. Correlations were reported as significant at p ≤0.05.Nine out of 11 audited rural PHC clinics are located outside 20Km of the nearest town and hospital. Majority (18.2% of the audited rural PHC clinics reported that HIV rapid test was performed by HIV lay counsellors. Overall, ten clinics were rated moderate, in terms of their compliance to the stipulated WHO guidelines. Audit results showed that rural PHC clinics' average rating score for compliance to the WHO guidelines ranged

Evaluating quality management systems for HIV rapid testing services in primary healthcare clinics in rural KwaZulu-Natal, South Africa.

Science.gov (United States)

Jaya, Ziningi; Drain, Paul K; Mashamba-Thompson, Tivani P

2017-01-01

Rapid HIV tests have improved access to HIV diagnosis and treatment by providing quick and convenient testing in rural clinics and resource-limited settings. In this study, we evaluated the quality management system for voluntary and provider-initiated point-of-care HIV testing in primary healthcare (PHC) clinics in rural KwaZulu-Natal (KZN), South Africa. We conducted a quality assessment audit in eleven PHC clinics that offer voluntary HIV testing and counselling in rural KZN, South Africa from August 2015 to October 2016. All the participating clinics were purposively selected from the province-wide survey of diagnostic services. We completed an on-site monitoring checklist, adopted from the WHO guidelines for assuring accuracy and reliability of HIV rapid tests, to assess the quality management system for HIV rapid testing at each clinic. To determine clinic's compliance to WHO quality standards for HIV rapid testing the following quality measure was used, a 3-point scale (high, moderate and poor). A high score was defined as a percentage rating of 90 to 100%, moderate was defined as a percentage rating of 70 to 90%, and poor was defined as a percentage rating of less than 70%. Clinic audit scores were summarized and compared. We employed Pearson pair wise correlation coefficient to determine correlations between clinics audit scores and clinic and clinics characteristics. Linear regression model was computed to estimate statistical significance of the correlates. Correlations were reported as significant at p ≤0.05. Nine out of 11 audited rural PHC clinics are located outside 20Km of the nearest town and hospital. Majority (18.2%) of the audited rural PHC clinics reported that HIV rapid test was performed by HIV lay counsellors. Overall, ten clinics were rated moderate, in terms of their compliance to the stipulated WHO guidelines. Audit results showed that rural PHC clinics' average rating score for compliance to the WHO guidelines ranged between 64.4% (CI

Quality assurance in radiology: peer review and peer feedback.

Science.gov (United States)

Strickland, N H

2015-11-01

Peer review in radiology means an assessment of the accuracy of a report issued by another radiologist. Inevitably, this involves a judgement opinion from the reviewing radiologist. Peer feedback is the means by which any form of peer review is communicated back to the original author of the report. This article defines terms, discusses the current status, identifies problems, and provides some recommendations as to the way forward, concentrating upon the software requirements for efficient peer review and peer feedback of reported imaging studies. Radiologists undertake routine peer review in their everyday clinical practice, particularly when reporting and preparing for multidisciplinary team meetings. More formal peer review of reported imaging studies has been advocated as a quality assurance measure to promote good clinical practice. It is also a way of assessing the competency of reporting radiologists referred for investigation to bodies such as the General Medical Council (GMC). The literature shows, firstly, that there is a very wide reported range of discrepancy rates in many studies, which have used a variety of non-comparable methodologies; and secondly, that applying scoring systems in formal peer review is often meaningless, unhelpful, and can even be detrimental. There is currently a lack of electronic peer feedback system software on the market to inform radiologists of any review of their work that has occurred or to provide them with clinical outcome information on cases they have previously reported. Learning opportunities are therefore missed. Radiologists should actively engage with the medical informatics industry to design optimal peer review and feedback software with features to meet their needs. Such a system should be easy to use, be fully integrated with the radiological information and picture archiving systems used clinically, and contain a free-text comment box, without a numerical scoring system. It should form a temporary record

Modelling Feedback in Virtual Patients: An Iterative Approach.

Science.gov (United States)

Stathakarou, Natalia; Kononowicz, Andrzej A; Henningsohn, Lars; McGrath, Cormac

2018-01-01

Virtual Patients (VPs) offer learners the opportunity to practice clinical reasoning skills and have recently been integrated in Massive Open Online Courses (MOOCs). Feedback is a central part of a branched VP, allowing the learner to reflect on the consequences of their decisions and actions. However, there is insufficient guidance on how to design feedback models within VPs and especially in the context of their application in MOOCs. In this paper, we share our experiences from building a feedback model for a bladder cancer VP in a Urology MOOC, following an iterative process in three steps. Our results demonstrate how we can systematize the process of improving the quality of VP components by the application of known literature frameworks and extend them with a feedback module. We illustrate the design and re-design process and exemplify with content from our VP. Our results can act as starting point for discussions on modelling feedback in VPs and invite future research on the topic.

Audio Feedback -- Better Feedback?

Science.gov (United States)

Voelkel, Susanne; Mello, Luciane V.

2014-01-01

National Student Survey (NSS) results show that many students are dissatisfied with the amount and quality of feedback they get for their work. This study reports on two case studies in which we tried to address these issues by introducing audio feedback to one undergraduate (UG) and one postgraduate (PG) class, respectively. In case study one…

Computational aspects of feedback in neural circuits.

Directory of Open Access Journals (Sweden)

Wolfgang Maass

2007-01-01

Full Text Available It has previously been shown that generic cortical microcircuit models can perform complex real-time computations on continuous input streams, provided that these computations can be carried out with a rapidly fading memory. We investigate the computational capability of such circuits in the more realistic case where not only readout neurons, but in addition a few neurons within the circuit, have been trained for specific tasks. This is essentially equivalent to the case where the output of trained readout neurons is fed back into the circuit. We show that this new model overcomes the limitation of a rapidly fading memory. In fact, we prove that in the idealized case without noise it can carry out any conceivable digital or analog computation on time-varying inputs. But even with noise, the resulting computational model can perform a large class of biologically relevant real-time computations that require a nonfading memory. We demonstrate these computational implications of feedback both theoretically, and through computer simulations of detailed cortical microcircuit models that are subject to noise and have complex inherent dynamics. We show that the application of simple learning procedures (such as linear regression or perceptron learning to a few neurons enables such circuits to represent time over behaviorally relevant long time spans, to integrate evidence from incoming spike trains over longer periods of time, and to process new information contained in such spike trains in diverse ways according to the current internal state of the circuit. In particular we show that such generic cortical microcircuits with feedback provide a new model for working memory that is consistent with a large set of biological constraints. Although this article examines primarily the computational role of feedback in circuits of neurons, the mathematical principles on which its analysis is based apply to a variety of dynamical systems. Hence they may also

Feedback Conversations: Creating Feedback Dialogues with a New Textual Tool for Industrial Design Student Feedback

Science.gov (United States)

Funk, Mathias; van Diggelen, Migchiel

2017-01-01

In this paper, the authors describe how a study of a large database of written university teacher feedback in the department of Industrial Design led to the development of a new conceptual framework for feedback and the design of a new feedback tool. This paper focuses on the translation of related work in the area of feedback mechanisms for…

Effectiveness of a training program in supervisors' ability to provide feedback on residents' communication skills

NARCIS (Netherlands)

Junod Perron, N.; Nendaz, M.; Louis-Simonet, M.; Sommer, J.; Gut, A.; Baroffio, A.; Dolmans, D.; Vleuten, C.P.M. van der

2013-01-01

Teaching communication skills (CS) to residents during clinical practice remains problematic. Direct observation followed by feedback is a powerful way to teach CS in clinical practice. However, little is known about the effect of training on feedback skills in this field. Controlled studies are

Feedback on Feedback: Eliciting Learners' Responses to Written Feedback through Student-Generated Screencasts

Science.gov (United States)

Fernández-Toro, María; Furnborough, Concha

2014-01-01

Despite the potential benefits of assignment feedback, learners often fail to use it effectively. This study examines the ways in which adult distance learners engage with written feedback on one of their assignments. Participants were 10 undergraduates studying Spanish at the Open University, UK. Their responses to feedback were elicited by means…

Testing Quick Response (QR) Codes as an Innovation to Improve Feedback Among Geographically-Separated Clerkship Sites.

Science.gov (United States)

Snyder, Matthew J; Nguyen, Dana R; Womack, Jasmyne J; Bunt, Christopher W; Westerfield, Katie L; Bell, Adriane E; Ledford, Christy J W

2018-03-01

Collection of feedback regarding medical student clinical experiences for formative or summative purposes remains a challenge across clinical settings. The purpose of this study was to determine whether the use of a quick response (QR) code-linked online feedback form improves the frequency and efficiency of rater feedback. In 2016, we compared paper-based feedback forms, an online feedback form, and a QR code-linked online feedback form at 15 family medicine clerkship sites across the United States. Outcome measures included usability, number of feedback submissions per student, number of unique raters providing feedback, and timeliness of feedback provided to the clerkship director. The feedback method was significantly associated with usability, with QR code scoring the highest, and paper second. Accessing feedback via QR code was associated with the shortest time to prepare feedback. Across four rotations, separate repeated measures analyses of variance showed no effect of feedback system on the number of submissions per student or the number of unique raters. The results of this study demonstrate that preceptors in the family medicine clerkship rate QR code-linked feedback as a high usability platform. Additionally, this platform resulted in faster form completion than paper or online forms. An overarching finding of this study is that feedback forms must be portable and easily accessible. Potential implementation barriers and the social norm for providing feedback in this manner need to be considered.

Comprehensive Joint Feedback Control for Standing by Functional Neuromuscular Stimulation – a Simulation Study

Science.gov (United States)

Nataraj, Raviraj; Audu, Musa L.; Kirsch, Robert F.; Triolo, Ronald J.

2013-01-01

Previous investigations of feedback control of standing after spinal cord injury (SCI) using functional neuromuscular stimulation (FNS) have primarily targeted individual joints. This study assesses the potential efficacy of comprehensive (trunk, hips, knees, and ankles) joint-feedback control against postural disturbances using a bipedal, three-dimensional computer model of SCI stance. Proportional-derivative feedback drove an artificial neural network trained to produce muscle excitation patterns consistent with maximal joint stiffness values achievable about neutral stance given typical SCI muscle properties. Feedback gains were optimized to minimize upper extremity (UE) loading required to stabilize against disturbances. Compared to the baseline case of maximum constant muscle excitations used clinically, the controller reduced UE loading by 55% in resisting external force perturbations and by 84% during simulated one-arm functional tasks. Performance was most sensitive to inaccurate measurements of ankle plantar/dorsiflexion position and hip ab/adduction velocity feedback. In conclusion, comprehensive joint-feedback demonstrates potential to markedly improve FNS standing function. However, alternative control structures capable of effective performance with fewer sensor-based feedback parameters may better facilitate clinical usage. PMID:20923741

Local Dynamics of a Laser with Rapidly Oscillating Parameters

Directory of Open Access Journals (Sweden)

E. V. Grigorieva

2013-01-01

Full Text Available The dynamics of class B lasers with the incoherent optical feedback formed by quickly vibrating external mirrors is viewed. The problem of the stability of equilibrium in a model system with rapidly oscillating coefficients is studied. The averaged system with the distributed delay is received. It is determined that in the presence of fast delay oscillation the limit of instability of a balance state moves towards significantly greater values of the feedback coefficient. The dependence of the shift with increasing the amplitude modulation has a band structure, so the rapid oscillations of delay can stabilize or destabilize the equilibrium. Normal forms which show changes of the sign of Lyapunov quantityalong border are constructed. They describe characteristics of periodic and quasiperiodic modes close to the balance state.

About Politeness, Face, and Feedback: Exploring Resident and Faculty Perceptions of How Institutional Feedback Culture Influences Feedback Practices.

Science.gov (United States)

Ramani, Subha; Könings, Karen D; Mann, Karen V; Pisarski, Emily E; van der Vleuten, Cees P M

2018-03-06

To explore resident and faculty perspectives on what constitutes feedback culture, their perceptions of how institutional feedback culture (including politeness concepts) might influence the quality and impact of feedback, feedback seeking, receptivity, and readiness to engage in bidirectional feedback. Using a constructivist grounded theory approach, five focus group discussions with internal medicine residents, three focus group discussions with general medicine faculty, and eight individual interviews with subspecialist faculty were conducted at Brigham and Women's Hospital between April and December 2016. Discussions and interviews were audiotaped and transcribed verbatim; concurrent data collection and analysis were performed using the constant comparative approach. Analysis was considered through the lens of politeness theory and organizational culture. Twenty-nine residents and twenty-two general medicine faculty participated in focus group discussions, and eight subspecialty faculty participated in interviews. The institutional feedback culture was described by participants as: (1) a culture of politeness, in which language potentially damaging to residents' self-esteem was discouraged, and (2) a culture of excellence, in which the institution's outstanding reputation and pedigree of trainees inhibited constructive feedback. Three key themes situated within this broader cultural context were discovered: normalizing constructive feedback to promote a culture of growth, overcoming the mental block to feedback seeking, and hierarchical culture impeding bidirectional feedback. An institutional feedback culture of excellence and politeness may impede honest, meaningful feedback and may impact feedback seeking, receptivity, and bidirectional feedback exchanges. It is essential to understand the institutional feedback culture before it can be successfully changed.

The hardware implementation of the CERN SPS ultrafast feedback processor demonstrator

CERN Document Server

Dusakto, J E; Fox, J D; Olsen, J; Rivetta, C H; Höfle, W

2013-01-01

An ultrafast 4GSa/s transverse feedback processor has been developed for proof-of-concept studies of feedback control of e-cloud driven and transverse mode coupled intra-bunch instabilities in the CERN SPS. This system consists of a high-speed ADC on the front end and equally fast DAC on the back end. All control and signal processing is implemented in FPGA logic. This system is capable of taking up to 16 sample slices across a single SPS bunch and processing each slice individually within a reconfigurable signal processor. This demonstrator system is a rapidly developed prototype, consisting of both commercial and custom-design components. It can stabilize the motion of a single particle bunch using closed loop feedback. The system can also run open loop as a high-speed arbitrary waveform generator and contains diagnostic features including a special ADC snapshot capture memory. This paper describes the overall system, the feedback processor and focuses on the hardware architecture, design ...

BLACK HOLE FORAGING: FEEDBACK DRIVES FEEDING

International Nuclear Information System (INIS)

Dehnen, Walter; King, Andrew

2013-01-01

We suggest a new picture of supermassive black hole (SMBH) growth in galaxy centers. Momentum-driven feedback from an accreting hole gives significant orbital energy, but little angular momentum to the surrounding gas. Once central accretion drops, the feedback weakens and swept-up gas falls back toward the SMBH on near-parabolic orbits. These intersect near the black hole with partially opposed specific angular momenta, causing further infall and ultimately the formation of a small-scale accretion disk. The feeding rates into the disk typically exceed Eddington by factors of a few, growing the hole on the Salpeter timescale and stimulating further feedback. Natural consequences of this picture include (1) the formation and maintenance of a roughly toroidal distribution of obscuring matter near the hole; (2) random orientations of successive accretion disk episodes; (3) the possibility of rapid SMBH growth; (4) tidal disruption of stars and close binaries formed from infalling gas, resulting in visible flares and ejection of hypervelocity stars; (5) super-solar abundances of the matter accreting on to the SMBH; and (6) a lower central dark-matter density, and hence annihilation signal, than adiabatic SMBH growth implies. We also suggest a simple subgrid recipe for implementing this process in numerical simulations

Biotic and Biogeochemical Feedbacks to Climate Change

Science.gov (United States)

Torn, M. S.; Harte, J.

2002-12-01

, observational, or modeling, can adequately capture the complex factors that govern species distributions over relevant spatial and temporal scales, careful integration of these methods can yield needed insights. The potential for large, rapid, or unexpected feedbacks of biogeochemistry and energy balance to climate change make this a worthwhile challenge.

How Attributes of the Feedback Message affect Subsequent Feedback Seeking: The interactive effects of feedback sign and type

OpenAIRE

Medvedeff, Megan; Gregory, Jane Brodie; Levy, Paul E

2008-01-01

In the current study, we examined the interactive effects of feedback type and sign on feedback-seeking behaviour, as well as the moderating role of regulatory focus. Using a behavioural measure of feedback seeking, we demonstrated a strong interaction between feedback type and sign, such that individuals subsequently sought the most feedback after they were provided with negative process feedback. Additionally, results suggested that an individual's chronic regulatory focus has implications ...

STAR CLUSTER FORMATION WITH STELLAR FEEDBACK AND LARGE-SCALE INFLOW

International Nuclear Information System (INIS)

Matzner, Christopher D.; Jumper, Peter H.

2015-01-01

During star cluster formation, ongoing mass accretion is resisted by stellar feedback in the form of protostellar outflows from the low-mass stars and photo-ionization and radiation pressure feedback from the massive stars. We model the evolution of cluster-forming regions during a phase in which both accretion and feedback are present and use these models to investigate how star cluster formation might terminate. Protostellar outflows are the strongest form of feedback in low-mass regions, but these cannot stop cluster formation if matter continues to flow in. In more massive clusters, radiation pressure and photo-ionization rapidly clear the cluster-forming gas when its column density is too small. We assess the rates of dynamical mass ejection and of evaporation, while accounting for the important effect of dust opacity on photo-ionization. Our models are consistent with the census of protostellar outflows in NGC 1333 and Serpens South and with the dust temperatures observed in regions of massive star formation. Comparing observations of massive cluster-forming regions against our model parameter space, and against our expectations for accretion-driven evolution, we infer that massive-star feedback is a likely cause of gas disruption in regions with velocity dispersions less than a few kilometers per second, but that more massive and more turbulent regions are too strongly bound for stellar feedback to be disruptive

Cortical electrophysiological network dynamics of feedback learning

NARCIS (Netherlands)

Cohen, M.X.; Wilmes, K.A.; van de Vijver, I.

2011-01-01

Understanding the neurophysiological mechanisms of learning is important for both fundamental and clinical neuroscience. We present a neurophysiologically inspired framework for understanding cortical mechanisms of feedback-guided learning. This framework is based on dynamic changes in systems-level

The Group Objective Structured Clinical Experience: building communication skills in the clinical reasoning context.

Science.gov (United States)

Konopasek, Lyuba; Kelly, Kevin V; Bylund, Carma L; Wenderoth, Suzanne; Storey-Johnson, Carol

2014-07-01

Students are rarely taught communication skills in the context of clinical reasoning training. The purpose of this project was to combine the teaching of communication skills using SPs with clinical reasoning exercises in a Group Objective Structured Clinical Experience (GOSCE) to study feasibility of the approach, the effect on learners' self-efficacy and attitude toward learning communication skills, and the effect of providing multiple sources of immediate, collaborative feedback. GOSCE sessions were piloted in Pediatrics and Medicine clerkships with students assessing their own performance and receiving formative feedback on communication skills from peers, standardized patients (SPs), and faculty. The sessions were evaluated using a retrospective pre/post-training questionnaire rating changes in self-efficacy and attitudes, and the value of the feedback. Results indicate a positive impact on attitudes toward learning communication skills and self-efficacy regarding communication in the clinical setting. Also, learners considered feedback by peers, SPs, and faculty valuable in each GOSCE. The GOSCE is an efficient and learner-centered method to attend to multiple goals of teaching communication skills, clinical reasoning, self-assessment, and giving feedback in a formative setting. The GOSCE is a low-resource, feasible strategy for experiential learning in communication skills and clinical reasoning. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

CO2 forcing induces semi-direct effects with consequences for climate feedback interpretations

Science.gov (United States)

Andrews, Timothy; Forster, Piers M.

2008-02-01

Climate forcing and feedbacks are diagnosed from seven slab-ocean GCMs for 2 × CO2 using a regression method. Results are compared to those using conventional methodologies to derive a semi-direct forcing due to tropospheric adjustment, analogous to the semi-direct effect of absorbing aerosols. All models show a cloud semi-direct effect, indicating a rapid cloud response to CO2; cloud typically decreases, enhancing the warming. Similarly there is evidence of semi-direct effects from water-vapour, lapse-rate, ice and snow. Previous estimates of climate feedbacks are unlikely to have taken these semi-direct effects into account and so misinterpret processes as feedbacks that depend only on the forcing, but not the global surface temperature. We show that the actual cloud feedback is smaller than what previous methods suggest and that a significant part of the cloud response and the large spread between previous model estimates of cloud feedback is due to the semi-direct forcing.

Rapid detection of Corynebacterium pseudotuberculosis in clinical samples from sheep.

Science.gov (United States)

Kumar, Jyoti; Tripathi, Bhupendra Nath; Kumar, Rajiv; Sonawane, Ganesh Gangaram; Dixit, Shivendra Kumar

2013-08-01

Corynebacterium pseudotuberculosis, a Gram-positive bacterium is the causative agent of caseous lymphadenitis (CLA), a chronic disease of sheep, goats and other warm blooded animals. In the present study, a total of 1,080 sheep reared under semi-intensive system on organized farms situated in the semi arid tropical region of Rajasthan, India, was clinically examined. Pus samples from superficial lymph nodes of 25 (2.31%) adult sheep showing clinical lesions similar to CLA were collected for laboratory analyses. On the basis of morphological, cultural and biochemical characteristics 12 (48%) bacterial isolates from pus identified it as C. pseudotuberculosis. A polymerase chain reaction (PCR) assay targeting Putative oligopeptide/dipeptide ABC transporter, nicotinamide adenine dinucleotide phosphate (NADP) oxidoreductase coenzyme F420-dependent and proline iminopeptidase (PIP) genes of C. pseudotuberculosis was developed that showed 14 pus samples as positive. All C. pseudotuberculosis isolates were also found positive for these genes in the PCR. The specificity of the PCR products was confirmed by sequencing of the amplified products that showed 98-100% homology with published sequences available in the NCBI database. The present study shows the incidence of CLA as 2.31%, 1.1% and 1.29% based on clinical, bacterial culture and direct pus PCR assay, respectively. The PCR assay was rapid, specific and as significant as bacterial culture in detecting bacteria directly in the clinical pus samples. The PCR assay developed in the study can be applied for the diagnosis and control of CLA. Furthermore, the assay can also be applied to detect C. pseudotuberculosis in various clinical samples.

Impact of a novel teaching method based on feedback, activity, individuality and relevance on students' learning.

Science.gov (United States)

Edafe, Ovie; Brooks, William S; Laskar, Simone N; Benjamin, Miles W; Chan, Philip

2016-03-20

This study examines the perceived impact of a novel clinical teaching method based on FAIR principles (feedback, activity, individuality and relevance) on students' learning on clinical placement. This was a qualitative research study. Participants were third year and final year medical students attached to one UK vascular firm over a four-year period (N=108). Students were asked to write a reflective essay on how FAIRness approach differs from previous clinical placement, and its advantages and disadvantages. Essays were thematically analysed and globally rated (positive, negative or neutral) by two independent researchers. Over 90% of essays reported positive experiences of feedback, activity, individuality and relevance model. The model provided multifaceted feedback; active participation; longitudinal improvement; relevance to stage of learning and future goals; structured teaching; professional development; safe learning environment; consultant involvement in teaching. Students perceived preparation for tutorials to be time intensive for tutors/students; a lack of teaching on medical sciences and direct observation of performance; more than once weekly sessions would be beneficial; some issues with peer and public feedback, relevance to upcoming exam and large group sizes. Students described negative experiences of "standard" clinical teaching. Progressive teaching programmes based on the FAIRness principles, feedback, activity, individuality and relevance, could be used as a model to improve current undergraduate clinical teaching.

Feedback GAP: study protocol for a cluster-randomized trial of goal setting and action plans to increase the effectiveness of audit and feedback interventions in primary care.

Science.gov (United States)

Ivers, Noah M; Tu, Karen; Francis, Jill; Barnsley, Jan; Shah, Baiju; Upshur, Ross; Kiss, Alex; Grimshaw, Jeremy M; Zwarenstein, Merrick

2010-12-17

feedback design. Intention-to-treat approach will be used to analyze the trial. Analysis will be performed on patient-level variables using generalized estimating equation models to adjust for covariates and account for the clustered nature of the data. The trial is powered to show small, but clinically important differences of 7 mmHG in systolic BP and 0.32 mmol/L in LDL. ClinicalTrials.gov NCT00996645.

Barriers and Facilitators to Effective Feedback: A Qualitative Analysis of Data From Multispecialty Resident Focus Groups.

Science.gov (United States)

Reddy, Shalini T; Zegarek, Matthew H; Fromme, H Barrett; Ryan, Michael S; Schumann, Sarah-Anne; Harris, Ilene B

2015-06-01

Despite the importance of feedback, the literature suggests that there is inadequate feedback in graduate medical education. We explored barriers and facilitators that residents in anesthesiology, emergency medicine, obstetrics and gynecology, and surgery experience with giving and receiving feedback during their clinical training. Residents from 3 geographically diverse teaching institutions were recruited to participate in focus groups in 2012. Open-ended questions prompted residents to describe their experiences with giving and receiving feedback, and discuss facilitators and barriers. Data were transcribed and analyzed using the constant comparative method associated with a grounded theory approach. A total of 19 residents participated in 1 of 3 focus groups. Five major themes related to feedback were identified: teacher factors, learner factors, feedback process, feedback content, and educational context. Unapproachable attendings, time pressures due to clinical work, and discomfort with giving negative feedback were cited as major barriers in the feedback process. Learner engagement in the process was a major facilitator in the feedback process. Residents provided insights for improving the feedback process based on their dual roles as teachers and learners. Time pressures in the learning environment may be mitigated by efforts to improve the quality of teacher-learner relationships. Forms for collecting written feedback should be augmented by faculty development to ensure meaningful use. Efforts to improve residents' comfort with giving feedback and encouraging learners to engage in the feedback process may foster an environment conducive to increasing feedback.

Feedback and Incentives

DEFF Research Database (Denmark)

Eriksson, Tor Viking; Poulsen, Anders; Villeval, Marie Claire

2009-01-01

This paper experimentally investigates the impact of different pay schemes and relative performance feedback policies on employee effort. We explore three feedback rules: no feedback on relative performance, feedback given halfway through the production period, and continuously updated feedback. ...... behind, and front runners do not slack off. But in both pay schemes relative performance feedback reduces the quality of the low performers' work; we refer to this as a "negative quality peer effect"....

Climate-society feedbacks and the avoidance of dangerous climate change

Science.gov (United States)

Jarvis, A. J.; Leedal, D. T.; Hewitt, C. N.

2012-09-01

The growth in anthropogenic CO2 emissions experienced since the onset of the Industrial Revolution is the most important disturbance operating on the Earth's climate system. To avoid dangerous climate change, future greenhouse-gas emissions will have to deviate from business-as-usual trajectories. This implies that feedback links need to exist between climate change and societal actions. Here, we show that, consciously or otherwise, these feedbacks can be represented by linking global mean temperature change to the growth dynamics of CO2 emissions. We show that the global growth of new renewable sources of energy post-1990 represents a climate-society feedback of ~0.25%yr-1 per degree increase in global mean temperature. We also show that to fulfil the outcomes negotiated in Durban in 2011, society will have to become ~ 50 times more responsive to global mean temperature change than it has been since 1990. If global energy use continues to grow as it has done historically then this would result in amplification of the long-term endogenous rate of decarbonization from -0.6%yr-1 to ~-13%yr-1. It is apparent that modest levels of feedback sensitivity pay large dividends in avoiding climate change but that the marginal return on this effort diminishes rapidly as the required feedback strength increases.

The effect of electronic monitoring feedback on medication adherence and clinical outcomes: A systematic review.

Science.gov (United States)

van Heuckelum, Milou; van den Ende, Cornelia H M; Houterman, Anne E J; Heemskerk, Charlotte P M; van Dulmen, Sandra; van den Bemt, Bart J F

2017-01-01

This study aims to assess the efficacy of Electronic Monitoring Feedback (EMF) as an intervention to improve medication adherence (i.e. dose- or full adherence) and clinical outcomes in adult patients. A systematic search was performed in Medline, EMBASE, PsycINFO and Web of Science and reported according to the PRISMA guidelines. Randomised controlled trials (RCTs) comparing EMF with usual care were identified to systematically summarise the evidence for use of EMF in improving medication adherence and clinical outcomes. The GRADE approach was used to assess the quality of the body of evidence. Of 9,993 initially-identified studies, ten studies (four of high-quality and six of low-quality) were included. The sample size of the studies included varied from 18 to 205 patients. Four of the six studies (66.7%) reported a significant positive effect of EMF on mean dose adherence levels, whereas a significant positive effect of EMF on mean full adherence levels was found in all of the included studies (100%, five out of five of the studies included). A significant positive effect of EMF on clinical outcomes was reported in one of the seven studies included. The overall effect of EMF on mean dose- and full adherence was positive and the overall effect of EMF on clinical outcomes was inconclusive. Considering the positive effect of EMF on medication adherence, EMF might be a promising intervention to enhance medication adherence. However, the effect of EMF on clinical outcomes was inconclusive. Prior to implementing EMF in clinical practice, future research with high-quality studies (e.g. adequate sample sizes, follow-up periods and no interfering co-interventions) is required to examine the (long-term) efficacy of EMF.

A rapid two-step algorithm detects and identifies clinical macrolide and beta-lactam antibiotic resistance in clinical bacterial isolates.

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Lu, Xuedong; Nie, Shuping; Xia, Chengjing; Huang, Lie; He, Ying; Wu, Runxiang; Zhang, Li

2014-07-01

Aiming to identify macrolide and beta-lactam resistance in clinical bacterial isolates rapidly and accurately, a two-step algorithm was developed based on detection of eight antibiotic resistance genes. Targeting at genes linked to bacterial macrolide (msrA, ermA, ermB, and ermC) and beta-lactam (blaTEM, blaSHV, blaCTX-M-1, blaCTX-M-9) antibiotic resistances, this method includes a multiplex real-time PCR, a melting temperature profile analysis as well as a liquid bead microarray assay. Liquid bead microarray assay is applied only when indistinguishable Tm profile is observed. The clinical validity of this method was assessed on clinical bacterial isolates. Among the total 580 isolates that were determined by our diagnostic method, 75% of them were identified by the multiplex real-time PCR with melting temperature analysis alone, while the remaining 25% required both multiplex real-time PCR with melting temperature analysis and liquid bead microarray assay for identification. Compared with the traditional phenotypic antibiotic susceptibility test, an overall agreement of 81.2% (kappa=0.614, 95% CI=0.550-0.679) was observed, with a sensitivity and specificity of 87.7% and 73% respectively. Besides, the average test turnaround time is 3.9h, which is much shorter in comparison with more than 24h for the traditional phenotypic tests. Having the advantages of the shorter operating time and comparable high sensitivity and specificity with the traditional phenotypic test, our two-step algorithm provides an efficient tool for rapid determination of macrolide and beta-lactam antibiotic resistances in clinical bacterial isolates. Copyright © 2014 Elsevier B.V. All rights reserved.

Robust wide-range control of nuclear reactors by using the feedforward-feedback concept

International Nuclear Information System (INIS)

Weng, C.K.; Edwards, R.M.; Ray, A.

1994-01-01

A robust feedforward-feedback controller is proposed for wide-range operations of nuclear reactors. This control structure provides (a) optimized performance over a wide operating range resulting form the feedforward element and (b) guaranteed robust stability and performance resulting from the feedback element. The feedforward control law is synthesized via nonlinear programming, which generates an optimal control sequence over a finite-time horizon under specified constraints. The feedback control is synthesized via the structured singular value μ approach to guarantee robustness in the presence of disturbances and modeling uncertainties. The results of simulation experiments are presented to demonstrate efficacy of the proposed control structure for a large rapid power reduction to avoid unnecessary plant trips

Negative feedback and adaptive resistance to the targeted therapy of cancer.

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Chandarlapaty, Sarat

2012-04-01

Mutational activation of growth factor signaling pathways is commonly observed and often necessary for oncogenic transformation. Under physiologic conditions, these pathways are subject to tight regulation through negative feedback, which limits the extent and duration of signaling events after physiologic stimulation. Until recently, the role of these negative feedback pathways in oncogene-driven cancers has been poorly understood. In this review, I discuss the evidence for the existence and relevance of negative feedback pathways within oncogenic signaling networks, the selective advantages such feedback pathways may confer, and the effects such feedback might have on therapies aimed at inhibiting oncogenic signaling. Negative feedback pathways are ubiquitous features of growth factor signaling networks. Because growth factor signaling networks play essential roles in the majority of cancers, their therapeutic targeting has become a major emphasis of clinical oncology. Drugs targeting these networks are predicted to inhibit the pathway but also to relieve the negative feedback. This loss of negative feedback can itself promote oncogenic signals and cancer cell survival. Drug-induced relief of feedback may be viewed as one of the major consequences of targeted therapy and a key contributor to therapeutic resistance.

Perceived Insider Status and Feedback Reactions: A Dual Path of Feedback Motivation Attribution

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Weijiong Wu

2017-05-01

Full Text Available Many studies have evaluated how the characteristics of feedback receiver, feedback deliverer and feedback information influence psychological feedback reactions of the feedback receiver while largely neglecting that feedback intervention is a kind of social interaction process. To address this issue, this study proposes that employees’ perceived insider status (PIS, as a kind of employee-organization relationship, could also influence employees’ reactions to supervisory feedback. In particular, this study investigates the influence of PIS focusing on affective and cognitive feedback reactions, namely feedback satisfaction and feedback utility. Surveys were conducted in a machinery manufacturing company in the Guangdong province of China. Samples were collected from 192 employees. Data analysis demonstrated that PIS and feedback utility possessed a U-shaped relationship, whereas PIS and feedback satisfaction exhibited positively linear relationships. The analysis identified two kinds of mediating mechanisms related to feedback satisfaction and feedback utility. Internal feedback motivation attribution partially mediated the relationship between PIS and feedback satisfaction but failed to do the same with respect to the relationship between PIS and feedback utility. In contrast, external feedback motivation attribution partially mediated the relationship between PIS and feedback utility while failing to mediate the relationship between PIS and feedback satisfaction. Theoretical contributions and practical implications of the findings are discussed at the end of the paper.

Younger but not older adults benefit from salient feedback during learning

Directory of Open Access Journals (Sweden)

Michael eHerbert

2011-08-01

Full Text Available Older adults are impaired in reinforcement learning (RL when feedback is partially ambiguous (e.g., Eppinger and Kray, 2011. In this study we examined whether older adults benefit from salient feedback information during learning. We used an electrophysiological approach and investigated 15 younger and 15 older adults with a RL task in which they had to learn stimulus-response associations under two learning conditions. In the positive learning conditions, participants could gain 50 Cents for a correct response but did not gain or lose money (*00 Cent for an incorrect response. In negative learning conditions, they could lose 50 Cents for an incorrect response but did not gain or lose money (*00 Cent for a correct response. As the identical outcome 00 Cent is either better or worse than the alternative outcome depending on the learning condition, this feedback type is ambiguous. To examine the influence of feedback salience we compared this condition with a condition in which positive and negative outcomes were color-coded and thereby clearly separable. The behavioral results indicated that younger adults reached higher accuracy levels under salient feedback conditions. Moreover, the error-related negativity (ERN and the feedback-related negativity (FRN for losses were larger if the good-bad dimension of feedback was salient. Hence, in younger adults salient feedback facilitates the rapid evaluation of outcomes on a good-bad dimension and by this supports learning. In contrast, for older adults we obtained neither behavioral nor electrophysiological effects of feedback salience. The older adults’ performance monitoring system therefore appears less flexible in integrating additional information in this evaluation process.

An Evaluation of Instructive Feedback to Teach Play Behavior to a Child with Autism Spectrum Disorder.

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Grow, Laura L; Kodak, Tiffany; Clements, Andrea

2017-09-01

Instructive feedback is used to expose learners to secondary targets during skill acquisition programs (Reichow & Wolery, in Journal of Applied Behavior Analysis, 44 , 327-340, 2011; Werts, Wolery, Gast, & Holcombe, in Journal of Behavioral Education, 5 , 55-75, 1995). Although unrelated feedback may have clinical utility in practice, very little research has evaluated unrelated instructive feedback, particularly for promoting play behavior (Colozzi, Ward, & Crotty, in Education and Training in Developmental Disabilities, 43 , 226-248, 2008). The purpose of the study was to determine if play emerged after embedding instructive feedback during the consequence portion of discrete trial training to teach tacts. An adapted alternating treatments design was used to compare tact training with and without instructive feedback for play behaviors. Instructive feedback resulted in the emergence of play behaviors during tabletop instruction and a play area of a classroom. We discuss the results in terms of clinical practice and future research.

Provider-related barriers to rapid HIV testing in U.S. urban non-profit community clinics, community-based organizations (CBOs) and hospitals.

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Bogart, Laura M; Howerton, Devery; Lange, James; Setodji, Claude Messan; Becker, Kirsten; Klein, David J; Asch, Steven M

2010-06-01

We examined provider-reported barriers to rapid HIV testing in U.S. urban non-profit community clinics, community-based organizations (CBOs), and hospitals. 12 primary metropolitan statistical areas (PMSAs; three per region) were sampled randomly, with sampling weights proportional to AIDS case reports. Across PMSAs, all 671 hospitals and a random sample of 738 clinics/CBOs were telephoned for a survey on rapid HIV test availability. Of the 671 hospitals, 172 hospitals were randomly selected for barriers questions, for which 158 laboratory and 136 department staff were eligible and interviewed in 2005. Of the 738 clinics/CBOs, 276 were randomly selected for barriers questions, 206 were reached, and 118 were eligible and interviewed in 2005-2006. In multivariate models, barriers regarding translation of administrative/quality assurance policies into practice were significantly associated with rapid HIV testing availability. For greater rapid testing diffusion, policies are needed to reduce administrative barriers and provide quality assurance training to non-laboratory staff.

Positive Change in Feedback Perceptions and Behavior: A 10-Year Follow-up Study.

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Balmer, Dorene F; Tenney-Soeiro, Rebecca; Mejia, Erika; Rezet, Beth

2018-01-01

Providing and learning from feedback are essential components of medical education, and typically described as resistant to change. But given a decade of change in the clinical context in which feedback occurs, the authors asked if, and how, perceptions of feedback and feedback behaviors might have changed in response to contextual affordances. In 2017, the authors conducted a follow-up, ethnographic study on 2 general pediatric floors at the same children's hospital where another ethnographic study on a general pediatric floor was conducted in 2007. Data sources included (1) 21 and 34 hours of observation in 2007 and 2017, respectively, (2) 35 and 25 interviews with general pediatric attending physicians and residents in 2007 and 2017, respectively, and (3) a review of 120 program documents spanning 2007 to 2017. Data were coded and organized around 3 recommendations for feedback that were derived from 2007 data and served as standards for assessing change in 2017. Data revealed progress in achieving each recommendation. Compared with 2007, participants in 2017 more clearly distinguished between feedback and evaluation; residents were more aware of in-the-moment feedback, and they had shifted their orientation from evaluation and grades to feedback and learning. Explanations for progress in achieving recommendations, which were derived from the data, pointed to institutional and national influences, namely, the pediatric milestones. On the basis of follow-up, ethnographic data, changes in the clinical context of pediatric education may afford positive change in perceptions of feedback and feedback behavior and point to influences within and beyond the institution. Copyright © 2018 by the American Academy of Pediatrics.

Spectral Characteristic Based on Fabry—Pérot Laser Diode with Two-Stage Optical Feedback

International Nuclear Information System (INIS)

Wu Jian-Wei; Nakarmi Bikash

2013-01-01

An optical device, consisting of a multi-mode Fabry—Pérot laser diode (MMFP-LD) with two-stage optical feedback, is proposed and experimentally demonstrated. The results show that the single-mode output with side-mode suppression ratio (SMSR) of ∼21.7 dB is attained by using the first-stage feedback. By using the second-stage feedback, the SMSR of single-mode operation could be increased to ∼28.5 dB while injection feedback power of −29 dBm is introduced into the laser diode. In the case of up to −29 dBm feedback power, the outcome SMSR is rapidly decayed to a very low level so that an obvious multi-mode operation in the output spectrum could be achieved at the feedback power level of −15.5 dBm. Thus, a transition between single- and multi-mode operations could be flexibly controlled by adjusting the injected power in the second-stage feedback system. Additionally, in the case of injection locking, the outcome SMSR and output power at the locked wavelength are as high as ∼50 dB and ∼5.8 dBm, respectively

Clinical features of Parkinson’s disease with and without rapid eye movement sleep behavior disorder

OpenAIRE

Liu, Ye; Zhu, Xiao-Ying; Zhang, Xiao-Jin; Kuo, Sheng-Han; Ondo, William G.; Wu, Yun-Cheng

2017-01-01

Background Rapid eye movement sleep behavior disorder (RBD) and Parkinson’s disease (PD) are two distinct clinical diseases but they share some common pathological and anatomical characteristics. This study aims to confirm the clinical features of RBD in Chinese PD patients. Methods One hundred fifty PD patients were enrolled from the Parkinson`s disease and Movement Disorders Center in  Department of Neurology, Shanghai General Hospital from January 2013 to August 2014. This study examined P...

Feedback on Feedback--Does It Work?

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Speicher, Oranna; Stollhans, Sascha

2015-01-01

It is well documented that providing assessment feedback through the medium of screencasts is favourably received by students and encourages deeper engagement with the feedback given by the language teacher (inter alia Abdous & Yoshimura, 2010; Brick & Holmes, 2008; Cann, 2007; Stannard, 2007). In this short paper we will report the…

Relational interaction in occupational therapy: Conversation analysis of positive feedback.

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Weiste, Elina

2018-01-01

The therapeutic relationship is an important factor for good therapy outcomes. The primary mediator of a beneficial therapy relationship is clinician-client interaction. However, few studies identify the observable interactional attributes of good quality relational interactions, e.g. offering the client positive feedback. The present paper aims to expand current understanding of relational interaction by analyzing the real-time interactional practices therapists use for offering positive feedback, an important value in occupational therapy. The analysis is based on the conversation analysis of 15 video-recorded occupational therapy encounters in psychiatric outpatient clinics. Two types of positive feedback were identified. In aligning feedback, therapists encouraged and complimented clients' positive perspectives on their own achievements in adopting certain behaviour, encouraging and supporting their progress. In redirecting feedback, therapists shifted the perspective from clients' negative experiences to their positive experiences. This shift was interactionally successful if they laid the foundation for the shift in perspective and attuned their expressions to the clients' emotional states. Occupational therapists routinely provide their clients with positive feedback. Awareness of the interactional attributes related to positive feedback is critically important for successful relational interaction.

Impact of a novel teaching method based on feedback, activity, individuality and relevance on students’ learning

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Brooks, William S.; Laskar, Simone N.; Benjamin, Miles W.; Chan, Philip

2016-01-01

Objectives This study examines the perceived impact of a novel clinical teaching method based on FAIR principles (feedback, activity, individuality and relevance) on students’ learning on clinical placement. Methods This was a qualitative research study. Participants were third year and final year medical students attached to one UK vascular firm over a four-year period (N=108). Students were asked to write a reflective essay on how FAIRness approach differs from previous clinical placement, and its advantages and disadvantages. Essays were thematically analysed and globally rated (positive, negative or neutral) by two independent researchers. Results Over 90% of essays reported positive experiences of feedback, activity, individuality and relevance model.  The model provided multifaceted feedback; active participation; longitudinal improvement; relevance to stage of learning and future goals; structured teaching; professional development; safe learning environment; consultant involvement in teaching. Students perceived preparation for tutorials to be time intensive for tutors/students; a lack of teaching on medical sciences and direct observation of performance; more than once weekly sessions would be beneficial; some issues with peer and public feedback, relevance to upcoming exam and large group sizes. Students described negative experiences of “standard” clinical teaching. Conclusions Progressive teaching programmes based on the FAIRness principles, feedback, activity, individuality and relevance, could be used as a model to improve current undergraduate clinical teaching. PMID:26995588

Radiography student perceptions of clinical stressors.

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Mason, Starla L

2006-01-01

Technological change and the increasingly rapid pace of life in the United States and globally have contributed to increased levels of stress and burnout experienced by workers and their families. Although studies are available on the levels of workplace stress and burnout affecting radiographers, little to no research has been conducted to assess the stressors encountered by radiography students in the clinical environment. This study was designed to pinpoint the primary sources of stress for radiography students and to determine the most effective measures to alleviate the stress that students experience in the clinical environment. It also sought to identify the clinical activities and practices that enhance learning. A convenience sample of radiography students attending an Association of Collegiate Educators in Radiologic Technology meeting was surveyed. Students were asked to rank their greatest stressors in the clinical environment, the most desired qualities in a clinical instructor and clinical environment, and the clinical practices and activities that best enhance their learning. Descriptive statistics were used to report the results. Data were collected for 82 first-year and second-year students. Students identified 7 primary clinical stressors: fear of making a mistake/repeat, feeling unprepared/inexperienced, intimidation by staff and by instructors, difficult/critical patients, hurtful criticism, too much supervision and negative responses to questions/requests for help. Students indicated that more frequent feedback, availability of the clinical instructor and other staff, assurance that mistakes happen and the opportunity to make mistakes were clinical practices that eased stress. The majority of students cited hands-on learning and repetition as the clinical activities that most reinforced their learning. Summary Radiography students in this survey experience some of the same clinical stressors as radiographers and other allied health workers

Motivation and emotion predict medical students' attention to computer-based feedback.

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Naismith, Laura M; Lajoie, Susanne P

2017-12-14

Students cannot learn from feedback unless they pay attention to it. This study investigated relationships between the personal factors of achievement goal orientations, achievement emotions, and attention to feedback in BioWorld, a computer environment for learning clinical reasoning. Novice medical students (N = 28) completed questionnaires to measure their achievement goal orientations and then thought aloud while solving three endocrinology patient cases and reviewing corresponding expert solutions. Questionnaires administered after each case measured participants' experiences of five feedback emotions: pride, relief, joy, shame, and anger. Attention to individual text segments of the expert solutions was modelled using logistic regression and the method of generalized estimating equations. Participants did not attend to all of the feedback that was available to them. Performance-avoidance goals and shame positively predicted attention to feedback, and performance-approach goals and relief negatively predicted attention to feedback. Aspects of how the feedback was displayed also influenced participants' attention. Findings are discussed in terms of their implications for educational theory as well as the design and use of computer learning environments in medical education.

Development and clinical evaluation of a rapid diagnostic kit for feline leukemia virus infection.

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Kim, Won-Shik; Chong, Chom-Kyu; Kim, Hak-Yong; Lee, Gyu-Cheol; Jeong, Wooseog; An, Dong-Jun; Jeoung, Hye-Young; Lee, Jae-In; Lee, Young-Ki

2014-01-01

Feline leukemia virus (FeLV) causes a range of neoplastic and degenerative diseases in cats. To obtain a more sensitive and convenient diagnosis of the disease, we prepared monoclonal antibodies specific for the FeLV p27 to develop a rapid diagnostic test with enhanced sensitivity and specificity. Among these antibodies, we identified two clones (hybridomas 8F8B5 and 8G7D1) that specifically bound to FeLV and were very suitable for a diagnostic kit. The affinity constants for 8F8B5 and 8G7D1 were 0.35 × 10⁸ and 0.86 × 10⁸, respectively. To investigate the diagnostic abilities of the rapid kit using these antibodies, we performed several clinical studies. Assessment of analytical sensitivity revealed that the detection threshold of the rapid diagnostic test was 2 ng/mL for recombinant p27 and 12.5 × 10⁴ IU/mL for FeLV. When evaluating 252 cat sera samples, the kit was found to have a kappa value of 0.88 compared to polymerase chain reaction (PCR), indicating a significant correlation between data from the rapid diagnostic test and PCR. Sensitivity and specificity of the kit were 95.2% (20/21) and 98.5% (257/261), respectively. Our results demonstrated that the rapid diagnostic test would be a suitable diagnostic tool for the rapid detection of FeLV infection in cats.

Feedback intervention to doctors improves patient satisfaction among outpatients in Inner Mongolia Autonomous Region, China.

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Qiao, T; Geater, A F; Chongsuvivatwong, V; Fan, Y; Guo, Z

2017-11-01

The doctor-patient relationship (DPR) in China is known to be tense. We tested whether an intervention program providing individualized feedback to doctors by patients could improve patients' satisfaction in an outpatient setting. A non-randomized controlled prepost intervention study in a tertiary hospital. Six surgery clinics were chosen as the intervention group and eight internal medicine clinics as the control group. Before the program started, patients attending each group of clinics were asked to fill in the Short-Form Patient Satisfaction Questionnaire (PSQ-18). In the experimental period, patients attending the intervention clinics were requested to rate their perception of the doctor's quality of care in various domains on an 8-question feedback card immediately after exiting from the examination room and to drop the completed card into the feedback box for the particular doctor. The cards were then collected by the doctor confidentially at the end of each day. There was no feedback in the control clinics. After the experimental period ended, the doctors in both groups of clinics were reassessed by a new series of patients using PSQ-18. The PSQ-18 scores were compared within the same group of clinics over time, and the changes in satisfaction score compared between intervention and control clinics. There were 189 and 190 responders in the intervention group and 190 and 200 in the control group, before and after the intervention period, respectively. Scores in all domains increased significantly (P patient satisfaction scores in the intervention clinics compared with the control clinics was confirmed by mixed-effects linear regression controlling for the effects of gender, age, marital status, education, and household income in the domains of general satisfaction, technical quality, communication, and accessibility and convenience. Timely feedback to doctors of patients' perception of quality of care received can improve outpatient satisfaction in a

A Randomized Controlled Trial to Compare e-Feedback Versus "Standard" Face-to-Face Verbal Feedback to Improve the Acquisition of Procedural Skill.

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Al-Jundi, Wissam; Elsharif, Mohamed; Anderson, Melanie; Chan, Phillip; Beard, Jonathan; Nawaz, Shah

Constructive feedback plays an important role in learning during surgical training. Standard feedback is usually given verbally following direct observation of the procedure by a trained assessor. However, such feedback requires the physical presence of expert faculty members who are usually busy and time-constrained by clinical commitments. We aim to evaluate electronic feedback (e-feedback) after video observation of surgical suturing in comparison with standard face-to-face verbal feedback. A prospective, blinded, randomized controlled trial comparing e-feedback with standard verbal feedback was carried out in February 2015 using a validated pro formas for assessment. The study participants were 38 undergraduate medical students from the University of Sheffield, UK. They were recorded on video performing the procedural skill, completed a self-evaluation form, and received e-feedback on the same day (group 1); observed directly by an assessor, invited to provide verbal self-reflection, and then received standard verbal feedback (group 2). In both groups, the feedback was provided after performing the procedure. The participants returned 2 days later and performed the same skill again. Poststudy questionnaire was used to assess the acceptability of each feedback among the participants. Overall, 19 students in group 1 and 18 students in group 2 completed the study. Although there was a significant improvement in the overall mean score on the second performance of the task for all participants (first performance mean 11.59, second performance mean 15.95; p ≤ 0.0001), there was no difference in the overall mean improvement score between group 1 and group 2 (4.74 and 3.94, respectively; p = 0.49). The mean overall scores for the e-feedback group at baseline recorded by 2 independent investigators showed good agreement (mean overall scores of 12.84 and 11.89; Cronbach α = 0.86). Poststudy questionnaire demonstrated that both e-feedback and standard verbal feedback

Clinical and Taxonomic Status of Pathogenic Nonpigmented or Late-Pigmenting Rapidly Growing Mycobacteria

OpenAIRE

Brown-Elliott, Barbara A.; Wallace, Richard J.

2002-01-01

The history, taxonomy, geographic distribution, clinical disease, and therapy of the pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria (RGM) are reviewed. Community-acquired disease and health care-associated disease are highlighted for each species. The latter grouping includes health care-associated outbreaks and pseudo-outbreaks as well as sporadic disease cases. Treatment recommendations for each species and type of disease are also described. Special emphasis is on ...

Ice/Bedrock Feedbacks as a Principle Contributor to Glacial-Interglacial Oscillations

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Kimmel, J.; Lee, K.; Jackson, C. H.

2014-12-01

Since the mid-Pleistocene, the oscillation between glacial and interglacial climate states occurs with a period of approximately 100 kyr. Each cycle is comprised of a slow glaciation with a subsequent rapid deglaciation. While the solar forcing is clearly an important driver for these transitions, the power spectrum of the solar forcing is quite different from the subsequent climate response and, in general, does not have a noticeable correlation with global ice volume. Instead, previous studies have shown that internal climate processes and their interactions (e.g., CO2, water vapor, isostatic bed response) play a significant role in producing these global climate cycles. The rapid retreat of large ice sheets at the start of an interglacial is often attributed to the interaction between surface and atmospheric processes. While calving is thought to amplify this retreat, it is not typically considered a principle driver of the ice sheet response. Our study investigates the potential for ice/bedrock feedbacks to be a principle contributor in shaping the glacial-interglacial climate oscillation -- particularly the rapid deglaciation that precedes an interglacial. The ice sheet model we develop includes a piecewise linear ice/bedrock feedback while atmospheric and surface processes are taken to be as simple as possible. Due to the long timescale of the bedrock response and the rapid mass loss due to calving, the model ice sheet exhibits rapid deglaciation from a stable maximum when it retreats through an overdeepening. However, ice sheet advance is also shown to be as rapid unless a more complex bedrock response is considered. In particular, we show that a forebulge created by the displacement of the mantle adds a new stable branch to the volume/equilibrium line bifurcation diagram that results in slower growth of the ice sheet during glaciation.

Medical students' perception of objective structured clinical examination: a feedback for process improvement.

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Nasir, Abdulrasheed A; Yusuf, Ayodeji S; Abdur-Rahman, Lukman O; Babalola, Olasunkanmi M; Adeyeye, Ademola A; Popoola, Ademola A; Adeniran, James O

2014-01-01

Medical educators have always been desirous of the best methods for formative and summative evaluation of trainees. The Objective Structured Clinical Examination (OSCE) is an approach for student assessment in which aspects of clinical competence are evaluated in a comprehensive, consistent, and structured manner with close attention to the objectivity of the process. Though popular in most medical schools globally, its use in Nigeria medical schools appears limited. This study was conceived to explore students' perception about the acceptability of OSCE process and to provide feedback to be used to improve the assessment technique. A cross-sectional survey was conducted on final-year medical students, who participated in the final MBBS surgery examination in June 2011. A 19-item self-administered structured questionnaire was employed to obtain relevant data on demographics of respondents and questions evaluating the OSCE stations in terms of the quality of instructions and organization, learning opportunities, authenticity and transparency of the process, and usefulness of the OSCE as an assessment instrument compared with other formats. Students' responses were based on a 5-point Likert scales ranging from strongly disagree to strongly agree. The data were analyzed using SPSS, version 15 (SPSS, Inc, Chicago, IL). The study took place at the University of Ilorin, College of Health Science. A total of 187 final-year medical students were enrolled in to the survey. Of 187 eligible students, 151 completed the self-administered questionnaire representing 80.7% response rate. A total of 61 (40.4%) students felt that it was easy to understand written instructions at the OSCE stations. In total, 106 (70.2%) students felt that the time allocated to each station was adequate. A total of 89 (58.9%) students agreed that the OSCE accurately measured their knowledge and skill, and 85 (56.3%) reported that OSCE enhanced their communication skill. Of the respondents, 80 (53

Bayesian feedback versus Markovian feedback in a two-level atom

International Nuclear Information System (INIS)

Wiseman, H.M.; Mancini, Stefano; Wang Jin

2002-01-01

We compare two different approaches to the control of the dynamics of a continuously monitored open quantum system. The first is Markovian feedback, as introduced in quantum optics by Wiseman and Milburn [Phys. Rev. Lett. 70, 548 (1993)]. The second is feedback based on an estimate of the system state, developed recently by Doherty and Jacobs [Phys. Rev. A 60, 2700 (1999)]. Here we choose to call it, for brevity, Bayesian feedback. For systems with nonlinear dynamics, we expect these two methods of feedback control to give markedly different results. The simplest possible nonlinear system is a driven and damped two-level atom, so we choose this as our model system. The monitoring is taken to be homodyne detection of the atomic fluorescence, and the control is by modulating the driving. The aim of the feedback in both cases is to stabilize the internal state of the atom as close as possible to an arbitrarily chosen pure state, in the presence of inefficient detection and other forms of decoherence. Our results (obtained without recourse to stochastic simulations) prove that Bayesian feedback is never inferior, and is usually superior, to Markovian feedback. However, it would be far more difficult to implement than Markovian feedback and it loses its superiority when obvious simplifying approximations are made. It is thus not clear which form of feedback would be better in the face of inevitable experimental imperfections

Interpreting Feedback: A Discourse Analysis of Teacher Feedback and Student Identity

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Torres, J. T.; Anguiano, Carlos J.

2016-01-01

Feedback has typically been studied as a means of improving academic performance. Few studies inquire into the processes by which feedback shapes student identity. The authors carry out a discourse analysis of written comments to explore how feedback is discursively constructed by both teachers and students. Analysis of written feedback,…

Forcings and feedbacks in the GeoMIP ensemble for a reduction in solar irradiance and increase in CO2

Science.gov (United States)

Huneeus, Nicolas; Boucher, Olivier; Alterskjær, Kari; Cole, Jason N. S.; Curry, Charles L.; Ji, Duoying; Jones, Andy; Kravitz, Ben; Kristjánsson, Jón Egill; Moore, John C.; Muri, Helene; Niemeier, Ulrike; Rasch, Phil; Robock, Alan; Singh, Balwinder; Schmidt, Hauke; Schulz, Michael; Tilmes, Simone; Watanabe, Shingo; Yoon, Jin-Ho

2014-05-01

The effective radiative forcings (including rapid adjustments) and feedbacks associated with an instantaneous quadrupling of the preindustrial CO2 concentration and a counterbalancing reduction of the solar constant are investigated in the context of the Geoengineering Model Intercomparison Project (GeoMIP). The forcing and feedback parameters of the net energy flux, as well as its different components at the top-of-atmosphere (TOA) and surface, were examined in 10 Earth System Models to better understand the impact of solar radiation management on the energy budget. In spite of their very different nature, the feedback parameter and its components at the TOA and surface are almost identical for the two forcing mechanisms, not only in the global mean but also in their geographical distributions. This conclusion holds for each of the individual models despite intermodel differences in how feedbacks affect the energy budget. This indicates that the climate sensitivity parameter is independent of the forcing (when measured as an effective radiative forcing). We also show the existence of a large contribution of the cloudy-sky component to the shortwave effective radiative forcing at the TOA suggesting rapid cloud adjustments to a change in solar irradiance. In addition, the models present significant diversity in the spatial distribution of the shortwave feedback parameter in cloudy regions, indicating persistent uncertainties in cloud feedback mechanisms.

Utility of an app-based system to improve feedback following workplace-based assessment.

Science.gov (United States)

Lefroy, Janet; Roberts, Nicola; Molyneux, Adrian; Bartlett, Maggie; Gay, Simon; McKinley, Robert

2017-05-31

To determine whether an app-based software system to support production and storage of assessment feedback summaries makes workplace-based assessment easier for clinical tutors and enhances the educational impact on medical students. We monitored our workplace assessor app's usage by Year 3 to 5 medical students in 2014-15 and conducted focus groups with Year 4 medical students and interviews with clinical tutors who had used the apps. Analysis was by constant comparison using a framework based on elements of van der Vleuten's utility index. The app may enhance the content of feedback for students. Using a screen may be distracting if the app is used during feedback discussions.    Educational impact was reduced by students' perceptions that an easy-to-produce feedback summary is less valuable than one requiring more tutor time and effort. Tutors' typing, dictation skills and their familiarity with mobile devices varied. This influenced their willingness to use the assessment and feedback mobile app rather than the equivalent web app. Electronic feedback summaries had more real and perceived uses than anticipated both for tutors and students including perceptions that they were for the school rather than the student. Electronic workplace-based assessment systems can be acceptable to tutors and can make giving detailed written feedback more practical but can interrupt the social interaction required for the feedback conversation. Tutor training and flexible systems will be required to minimise unwanted consequences. The educational impact on both tutors and students of providing pre-formulated advice within the app is worth further study.

Rapid gated Thallium-201 perfusion SPECT - clinically feasible?

International Nuclear Information System (INIS)

Wadhwa, S.S.; Mansberg, R.; Fernandes, V.B.; Wilkinson, D.; Abatti, D.

1998-01-01

Full text: Standard dose energy window optimised Thallium-201 (Tl-201) SPECT has about half the counts of a standard dose from Technetium-99m Sestamibi (Tc99m-Mibi) gated perfusion SPECT. This study investigates the clinical feasibility of rapid energy window optimised Tl-201 gated perfusion SPECT (gated-TI) and compares quantitative left ventricular ejection fraction (LVEF) and visually assessed image quality for wall motion and thickening to analogous values obtained from Tc99m-Mibi gated perfusion SPECT (gated - mibi). Methods: We studied 60 patients with a rest gated Tl-201 SPECT (100 MBq, 77KeV peak, 34% window, 20 sec/projection) followed by a post stress gated Sestamibi SPECT (1GBq, 140KeV, 20% window, 20 sec/projection) separate dual isotope protocol. LVEF quantitation was performed using commercially available software (SPECTEF, General Electric). Visual grading of image quality for wall thickening and motion was performed using a three-point scale (excellent, good and poor). Results: LVEF for gated Tl-201 SPECT was 59.6 ± 12.0% (Mean ± SD). LVEF for gated Sestamibi SPECT was 60.4 ±11.4% (Mean ± SD). These were not significantly different (P=0.27, T-Test). There was good correlation (r=0.9) between gated-TI and gated-mibi LVEF values. The quality of gated-Tl images was ranked as excellent, good and poor in 12, 50 and 38% of the patients respectively. Image quality was better in gated-mibi SPECT, with ratings of 12, 62 and 26% respectively. Conclusion: Rapid gated Thallium-201 acquisition with energy window optimisation can be effectively performed on majority of patients and offers the opportunity to assess not only myocardial perfusion and function, as with Technetium based agents, but also viability using a single day one isotope protocol

A dual visual-local feedback model of the vergence eye movement system

NARCIS (Netherlands)

Erkelens, C.J.

2011-01-01

Pure vergence movements are the eye movements that we make when we change our binocular fixation between targets differing in distance but not in direction relative to the head. Pure vergence is slow and controlled by visual feedback. Saccades are the rapid eye movements that we make between targets

Providing Feedback on Computer-Based Algebra Homework in Middle-School Classrooms

Science.gov (United States)

Fyfe, Emily R.

2016-01-01

Homework is transforming at a rapid rate with continuous advances in educational technology. Computer-based homework, in particular, is gaining popularity across a range of schools, with little empirical evidence on how to optimize student learning. The current aim was to test the effects of different types of feedback on computer-based homework.…

Understanding Surgical Resident and Fellow Perspectives on Their Operative Performance Feedback Needs: A Qualitative Study.

Science.gov (United States)

Bello, Ricardo J; Sarmiento, Samuel; Meyer, Meredith L; Rosson, Gedge D; Cooney, Damon S; Lifchez, Scott D; Cooney, Carisa M

2018-04-20

Operative performance feedback is essential for surgical training. We aimed to understand surgical trainees' views on their operative performance feedback needs and to characterize feedback to elucidate factors affecting its value from the resident perspective. Using a qualitative research approach, 2 research fellows conducted semistructured, one-on-one interviews with surgical trainees. We analyzed recurring themes generated during interviews related to feedback characteristics, as well as the extent to which performance rating tools can help meet trainees' operative feedback needs. Departments or divisions of general or plastic surgery at 9 US academic institutions. Surgical residents and clinical fellows in general or plastic surgery. We conducted 30 interviews with 9 junior residents, 14 senior residents, and 7 clinical fellows. Eighteen (60%) participants were in plastic and 12 (40%) were in general surgery. Twenty-four participants (80%) reported feedback as very or extremely important during surgical training. All trainees stated that verbal, face-to-face feedback is the most valuable, especially if occurring during (92%) or immediately after (65%) cases. Of those trainees using performance rating tools (74%), most (57%) expressed positive views about them but wanted the tools to complement and not replace verbal feedback in surgical education. Trainees value feedback more if received within 1 week or the case. Verbal, face-to-face feedback is very or extremely important to surgical trainees. Residents and fellows prefer to receive feedback during or immediately after a case and continue to value feedback if received within 1 week of the event. Performance rating tools can be useful for providing formative feedback and documentation but should not replace verbal, face-to-face feedback. Considering trainee views on feedback may help reduce perceived gaps in feedback demand-versus-supply in surgical training, which may be essential to overcoming current

Feedback på arbejdspladser

DEFF Research Database (Denmark)

Holdt Christensen, Peter

Feedback på arbejdspladser er vigtig. Men feedback er også et populært begreb mange taler med om uden dog at vide sig helt sikker på hvad det er. Formålet med denne bog er at bidrage til en bedre forståelse af hvad feedback er, hvordan det fungerer og dermed hvordan arbejdspladser bedst muligt bør...... understøtte feedback. Med udgangspunkt i forskningen identificeres centrale udfordringer ved feedback, bl.a. hvorfor det kan være svært at give præcis feedback, hvordan forholdet mellem lederen og den ansatte påvirker den feedback der gives, og hvad der kendetegner en feedback kultur. Bogen er skrevet til...... undervisere og studerende på videregående uddannelser samt praktikere der ønsker en systematisk og forskningsbaseret forståelse af feedback på arbejdspladser. Bogen er således ikke en kogebog til bedre feedback, men en analyse og diskussion af hvad forskningen ved om feedback, og bidrager med inspiration og...

Effectiveness of a Training Program in Supervisors' Ability to Provide Feedback on Residents' Communication Skills

Science.gov (United States)

Junod Perron, Noelle; Nendaz, Mathieu; Louis-Simonet, Martine; Sommer, Johanna; Gut, Anne; Baroffio, Anne; Dolmans, Diana; van der Vleuten, Cees

2013-01-01

Teaching communication skills (CS) to residents during clinical practice remains problematic. Direct observation followed by feedback is a powerful way to teach CS in clinical practice. However, little is known about the effect of training on feedback skills in this field. Controlled studies are scarce as well as studies that go beyond…

Rapid diagnostic testing for community-acquired pneumonia: can innovative technology for clinical microbiology be exploited?

Science.gov (United States)

Yu, Victor L; Stout, Janet E

2009-12-01

Two nonsynchronous events have affected the management of community-acquired pneumonia (CAP): spiraling empiricism for CAP and the "golden era" of clinical microbiology. The development of broad-spectrum antibiotics has led to widespread empiric use without ascertaining the etiology of the infecting microbe. Unfortunately, this approach clashes with the second event, which is the advent of molecular-based microbiology that can identify the causative pathogen rapidly at the point of care. The urinary antigen is a most effective rapid test that has allowed targeted therapy for Legionnaire disease at the point of care. The high specificity (> 90%) allows the clinician to administer appropriate anti-Legionella therapy based on a single rapid test; however, its low sensitivity (76%) means that a notable number of cases of Legionnaire disease will go undiagnosed if other tests, especially culture, are not performed. Further, culture for Legionella is not readily available. If a culture is not performed, epidemiologic identification of the source of the bacterium cannot be ascertained by molecular fingerprinting of the patient and the putative source strain. We recommend resurrection of the basic principles of infectious disease, which are to identify the microbial etiology of the infection and to use narrow, targeted antimicrobial therapy. To reduce antimicrobial overuse with subsequent antimicrobial resistance, these basic principles must be applied in concert with traditional and newer tests in the clinical microbiology laboratory.

Using Feedback to Promote Physical Activity: The Role of the Feedback Sign.

Science.gov (United States)

Kramer, Jan-Niklas; Kowatsch, Tobias

2017-06-02

Providing feedback is a technique to promote health behavior that is emphasized by behavior change theories. However, these theories make contradicting predictions regarding the effect of the feedback sign-that is, whether the feedback signals success or failure. Thus, it is unclear whether positive or negative feedback leads to more favorable behavior change in a health behavior intervention. The aim of this study was to examine the effect of the feedback sign in a health behavior change intervention. Data from participants (N=1623) of a 6-month physical activity intervention was used. Participants received a feedback email at the beginning of each month. Feedback was either positive or negative depending on the participants' physical activity in the previous month. In an exploratory analysis, change in monthly step count averages was used to evaluate the feedback effect. The feedback sign did not predict the change in monthly step count averages over the course of the intervention (b=-84.28, P=.28). Descriptive differences between positive and negative feedback can be explained by regression to the mean. The feedback sign might not influence the effect of monthly feedback emails sent out to participants of a large-scale physical activity intervention. However, randomized studies are needed to further support this conclusion. Limitations as well as opportunities for future research are discussed. ©Jan-Niklas Kramer, Tobias Kowatsch. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.06.2017.

Rapid quality assurance with requirements smells

OpenAIRE

Femmer, Henning; Méndez Fernández, Daniel; Wagner, Stefan; Eder, Sebastian

2016-01-01

Context: Bad requirements quality can cause expensive consequences during the software development lifecycle, especially if iterations are long and feedback comes late. Objectives: We aim at a light-weight static requirements analysis approach that allows for rapid checks immediately when requirements are written down. Method: We transfer the concept of code smells to Requirements Engineering as Requirements Smells. To evaluate the benefits and limitations, we define Requirements Smells, real...

Feedback versus no feedback to improve patient outcome in group psychotherapy for eating disorders (F-EAT): A randomized clinical trial

DEFF Research Database (Denmark)

Davidsen, Annika Helgadóttir; Waaddegaard, Mette; Poulsen, Stig Bernt

of continuous feedback on adherence and outcome in group psychotherapy. Methods/design: The trial is set up in a randomized design for outpatients diagnosed with bulimia nervosa, binge eating disorder, or eating disorder not otherwise specified (DSM-IV). They are allocated 1:1 to the experimental group...

Patients' experiences with routine outcome monitoring and clinical feedback systems: A systematic review and synthesis of qualitative empirical literature.

Science.gov (United States)

Solstad, Stig Magne; Castonguay, Louis Georges; Moltu, Christian

2017-05-19

Routine outcome monitoring (ROM) and clinical feedback (CF) systems have become important tools for psychological therapies, but there are challenges for their successful implementation. To overcome these challenges, a greater understanding is needed about how patients experience the use of ROM/CF. We conducted a systematic literature search of qualitative studies on patient experiences with the use of ROM/CF in mental health services. The findings from 16 studies were synthesized, resulting in four meta-themes: (1) Suspicion towards service providers, (2) Flexibility and support to capture complexity, (3) Empowering patients, and (4) Developing collaborative practice. We discuss the implications of these meta-themes for further development and implementation of ROM/CF into clinical practice, acknowledging the limitations of our review and suggesting avenues for further research. Clinical or methodological significance of this article: This article provides useful and actionable knowledge about the patient perspective on ROM/CF, an important discussion on the current state of research in this area, and useful and concrete suggestions for further avenues of research.

Self-Perceived Competence as a Mediator between Maternal Feedback and Depressive Symptoms in Adolescents

Science.gov (United States)

Jacquez, Farrah; Cole, David A.; Searle, Barbara

2004-01-01

Self-report, other-report, clinical interview, and behavioral observations of evaluative maternal feedback (e.g., positive feedback, criticism), adolescent depressive symptoms, and self-perceived competence were obtained from 72 adolescents and their mothers. Most path analyses supported the hypothesis that adolescent self-perceived competence…

Effects of Informative and Confirmatory Feedback on Brain Activation During Negative Feedback Processing

Directory of Open Access Journals (Sweden)

Yeon-Kyoung eWoo

2015-06-01

Full Text Available The current study compared the effects of informative and confirmatory feedback on brain activation during negative feedback processing. For confirmatory feedback trials, participants were informed that they had failed the task, whereas informative feedback trials presented task relevant information along with the notification of their failure. Fourteen male undergraduates performed a series of spatial-perceptual tasks and received feedback while their brain activity was recorded. During confirmatory feedback trials, greater activations in the amygdala, dorsal anterior cingulate cortex, and the thalamus (including the habenular were observed in response to incorrect responses. These results suggest that confirmatory feedback induces negative emotional reactions to failure. In contrast, informative feedback trials elicited greater activity in the dorsolateral prefrontal cortex (DLPFC when participants experienced failure. Further psychophysiological interaction (PPI analysis revealed a negative coupling between the DLPFC and the amygdala during informative feedback relative to confirmatory feedback trials. These findings suggest that providing task-relevant information could facilitate implicit down-regulation of negative emotions following failure.

Surgical assessment clinic - One stop emergency out-patient clinic for rapid assessment, reduced admissions and improved acute surgical service: A quality improvement study

Directory of Open Access Journals (Sweden)

Christina A.W. Macano

2017-11-01

Conclusion: By providing suitable guidance for referring practitioners we have optimised our clinic use significantly and improved our acute ambulatory surgical care. We have reduced admissions, provided rapid treatment and have established a service that helps address the ever increasing demand on acute services within the NHS.

Using rapid prototyping to design a smoking cessation website with end-users

OpenAIRE

Ronquillo, C. E.; Currie, L.; Rowsell, D.; Phillips, J. C.

2016-01-01

Rapid prototyping is an iterative approach to design involving cycles of prototype building, review by end-users, and refinement, and can be a valuable tool in user-centered website design. Informed by various user-centered approaches, we used rapid prototyping as a tool to collaborate with users in building a peer-support focused smoking-cessation website for gay men living with HIV. Rapid prototyping was effective in eliciting feedback on the needs of this group of potential end-users\\ud fr...

Rateless feedback codes

DEFF Research Database (Denmark)

Sørensen, Jesper Hemming; Koike-Akino, Toshiaki; Orlik, Philip

2012-01-01

This paper proposes a concept called rateless feedback coding. We redesign the existing LT and Raptor codes, by introducing new degree distributions for the case when a few feedback opportunities are available. We show that incorporating feedback to LT codes can significantly decrease both...... the coding overhead and the encoding/decoding complexity. Moreover, we show that, at the price of a slight increase in the coding overhead, linear complexity is achieved with Raptor feedback coding....

The double-loop feedback for active learning with understanding

DEFF Research Database (Denmark)

Christensen, Hans Peter

2004-01-01

Learning is an active process, and in engineering education authentic projects is often used to activate the students and promote learning. However, it is not all activity that leads to deep learning; and in a rapid changing society deep understanding is necessary for life-long learning. Empirical...... findings at DTU question the direct link between high activity and a deep approach to learning. Active learning is important to obtain engineering competencies, but active learning requires more than activity. Feedback and reflection is crucial to the learning process, since new knowledge is built...... on the student’s existing understanding. A model for an active learning process with a double-loop feedback is suggested - the first loop gives the student experience through experimentation, the second conceptual understanding through reflection. Students often miss the second loop, so it is important...

General practitioners uses and perceptions of voluntary electronic feedback on treatment outcomes - a qualitative study.

Science.gov (United States)

Lippert, Maria Laura; Kousgaard, Marius Brostrøm; Bjerrum, Lars

2014-11-30

Currently, there is a strong focus on the diffusion and implementation of indicator-based technologies for assessing and improving the quality of care in general practice. The aim of this study was to explore how and for what purposes indicator-based feedback is used by the general practitioners (GPs) and how they perceive it to contribute to their work. Qualitative interviews with nine GPs in two regions in Denmark. The main selection criterion was that the informants had experience with retrieving electronic feedback. The data generation was explorative and open-ended and the analysis took an iterative approach with continuous refinement of themes that emerged from the data. The study identified two main uses of feedback: i) Administration of a regular disease control schedule for patients with chronic disease and ii) Routine monitoring of outcomes for purposes of resource prioritisation and medication management. Both uses were deemed valuable by the GPs, but also as an additional extra to the clinical core task. All the GPs experienced the feedback to be of limited relevance to the most central and challenging aspects of clinical work understood as the care for individuals. This led to different reactions: Some GPs would use the feedback as a point of departure for broader deliberations about individual patient needs and treatment approaches. For others, the perceived limitations decreased their overall motivation to seek feedback. The study points to the importance of clarifying limitations as well as possibilities with respect to different aspects of clinical quality when introducing indicator-based technologies to practitioners. The results also emphasize that an indicator-based approach to quality improvement should not stand alone in general practice since some of the most central and challenging aspects of clinical work are not covered by this approach.

Rapidly Progressive Osteoarthritis: a Review of the Clinical and Radiologic Presentation.

Science.gov (United States)

Flemming, Donald J; Gustas-French, Cristy N

2017-07-01

The purpose of this paper is to review the distinct clinical and radiographic features that may lead to prompt diagnosis of rapidly progressive osteoarthritis (RPOA) and thus obviate unnecessary and costly diagnostic workup. RPOA is uncommon but is more frequently seen in practice because of the aging population. RPOA is a destructive arthropathy that occurs most commonly in elderly women but can also be seen in patients that have sustained trauma. The dramatic radiologic manifestations of RPOA can lead to diagnostic confusion with other arthropathies, infection, and osteonecrosis. RPOA was originally described in the hip but may also involve the shoulder. The etiology of RPOA is not well understood, but subchondral fracture probably plays a role in the development of dramatic destruction of the joint that is seen in affected patients. Early diagnosis may reduce the complexity of surgical management. RPOA is an uncommon condition that occurs most frequently in elderly woman or in patients who have sustained trauma. Prompt recognition of the clinical and radiologic features of this arthropathy can reduce unnecessary diagnostic workup and complexity of surgical intervention.

Rapid quality assurance with Requirements Smells

OpenAIRE

Femmer, H.; Fernández, D. Méndez; Wagner, S.; Eder, S.

2016-01-01

Bad requirements quality can cause expensive consequences during the software development lifecycle, especially if iterations are long and feedback comes late. %-- the faster a problem is found, the cheaper it is to fix. This makes explicit the need of a lightweight detection mechanism of requirements quality violations. We aim at a light-weight static requirements analysis approach that allows for rapid checks immediately when requirements are written down. We transfer the concept of code sm...

Velocity Feedback Experiments

Directory of Open Access Journals (Sweden)

Chiu Choi

2017-02-01

Full Text Available Transient response such as ringing in a control system can be reduced or removed by velocity feedback. It is a useful control technique that should be covered in the relevant engineering laboratory courses. We developed velocity feedback experiments using two different low cost technologies, viz., operational amplifiers and microcontrollers. These experiments can be easily integrated into laboratory courses on feedback control systems or microcontroller applications. The intent of developing these experiments was to illustrate the ringing problem and to offer effective, low cost solutions for removing such problem. In this paper the pedagogical approach for these velocity feedback experiments was described. The advantages and disadvantages of the two different implementation of velocity feedback were discussed also.

The long-term fate of permafrost peatlands under rapid climate warming

Science.gov (United States)

Swindles, Graeme T.; Morris, Paul J.; Mullan, Donal; Watson, Elizabeth J.; Turner, T. Edward; Roland, Thomas P.; Amesbury, Matthew J.; Kokfelt, Ulla; Schoning, Kristian; Pratte, Steve; Gallego-Sala, Angela; Charman, Dan J.; Sanderson, Nicole; Garneau, Michelle; Carrivick, Jonathan L.; Woulds, Clare; Holden, Joseph; Parry, Lauren; Galloway, Jennifer M.

2015-01-01

Permafrost peatlands contain globally important amounts of soil organic carbon, owing to cold conditions which suppress anaerobic decomposition. However, climate warming and permafrost thaw threaten the stability of this carbon store. The ultimate fate of permafrost peatlands and their carbon stores is unclear because of complex feedbacks between peat accumulation, hydrology and vegetation. Field monitoring campaigns only span the last few decades and therefore provide an incomplete picture of permafrost peatland response to recent rapid warming. Here we use a high-resolution palaeoecological approach to understand the longer-term response of peatlands in contrasting states of permafrost degradation to recent rapid warming. At all sites we identify a drying trend until the late-twentieth century; however, two sites subsequently experienced a rapid shift to wetter conditions as permafrost thawed in response to climatic warming, culminating in collapse of the peat domes. Commonalities between study sites lead us to propose a five-phase model for permafrost peatland response to climatic warming. This model suggests a shared ecohydrological trajectory towards a common end point: inundated Arctic fen. Although carbon accumulation is rapid in such sites, saturated soil conditions are likely to cause elevated methane emissions that have implications for climate-feedback mechanisms. PMID:26647837

Fostering Dental Students' Academic Achievements and Reflection Skills Through Clinical Peer Assessment and Feedback.

Science.gov (United States)

Tricio, Jorge A; Woolford, Mark J; Escudier, Michael P

2016-08-01

Peer assessment is increasingly being encouraged to enhance dental students' learning. The aim of this study was to evaluate the educational impact in terms of academic achievements and reflective thinking of a formative prospective peer assessment and feedback protocol. Volunteer final-year dental students at King's College London Dental Institute, UK, received training on peer assessment, peer feedback, and self-reflection. At the beginning (baseline) and end (resultant) of the 2012-13 academic year, 86 students (55% of the year group) completed a reflection questionnaire (RQ). Sixty-eight of those students used a modified Direct Observation of Procedural Skills (DOPS) as a framework for peer assessment and peer feedback during a complete academic year. End-of-year, high-stakes examination grades and RQ scores from the participants and nonparticipants were statistically compared. The participants completed 576 peer DOPS. Those 22 students who peer assessed each other ≥10 times exhibited highly statistically significant differences and powerful positive effect sizes in their high-stakes exam grades (p=0.0001, d=0.74) and critical reflection skills (p=0.005, d=1.41) when compared to those who did not assess one another. Furthermore, only the same 22 students showed a statistically significant increase and positive effect size in their critical reflection skills from baseline to resultant (p=0.003, d=1.04). The results of this study suggest that the protocol used has the potential to impact dental students' academic and reflection skills, provided it is practiced in ten or more peer encounters and ensuring peer feedback is provided followed by self-reflection.

Rapid targeted somatic mutation analysis of solid tumors in routine clinical diagnostics.

Science.gov (United States)

Magliacane, Gilda; Grassini, Greta; Bartocci, Paola; Francaviglia, Ilaria; Dal Cin, Elena; Barbieri, Gianluca; Arrigoni, Gianluigi; Pecciarini, Lorenza; Doglioni, Claudio; Cangi, Maria Giulia

2015-10-13

Tumor genotyping is an essential step in routine clinical practice and pathology laboratories face a major challenge in being able to provide rapid, sensitive and updated molecular tests. We developed a novel mass spectrometry multiplexed genotyping platform named PentaPanel to concurrently assess single nucleotide polymorphisms in 56 hotspots of the 5 most clinically relevant cancer genes, KRAS, NRAS, BRAF, EGFR and PIK3CA for a total of 221 detectable mutations. To both evaluate and validate the PentaPanel performance, we investigated 1025 tumor specimens of 6 different cancer types (carcinomas of colon, lung, breast, pancreas, and biliary tract, and melanomas), systematically addressing sensitivity, specificity, and reproducibility of our platform. Sanger sequencing was also performed for all the study samples. Our data showed that PentaPanel is a high throughput and robust tool, allowing genotyping for targeted therapy selection of 10 patients in the same run, with a practical turnaround time of 2 working days. Importantly, it was successfully used to interrogate different DNAs isolated from routinely processed specimens (formalin-fixed paraffin embedded, frozen, and cytological samples), covering all the requirements of clinical tests. In conclusion, the PentaPanel platform can provide an immediate, accurate and cost effective multiplex approach for clinically relevant gene mutation analysis in many solid tumors and its utility across many diseases can be particularly relevant in multiple clinical trials, including the new basket trial approach, aiming to identify appropriate targeted drug combination strategies.

Implementing RapidArc into clinical routine

DEFF Research Database (Denmark)

Van Esch, Ann; Huyskens, Dominique P; Behrens, Claus F

2011-01-01

With the increased commercial availability of intensity modulated arc therapy (IMAT) comes the need for comprehensive QA programs, covering the different aspects of this newly available technology. This manuscript proposes such a program for the RapidArc (RA) (Varian Medical Systems, Palo Alto...

Economic impact of rapid diagnostic methods in Clinical Microbiology: Price of the test or overall clinical impact.

Science.gov (United States)

Cantón, Rafael; Gómez G de la Pedrosa, Elia

2017-12-01

The need to reduce the time it takes to establish a microbiological diagnosis and the emergence of new molecular microbiology and proteomic technologies has fuelled the development of rapid and point-of-care techniques, as well as the so-called point-of-care laboratories. These laboratories are responsible for conducting both techniques partially to response to the outsourcing of the conventional hospital laboratories. Their introduction has not always been accompanied with economic studies that address their cost-effectiveness, cost-benefit and cost-utility, but rather tend to be limited to the unit price of the test. The latter, influenced by the purchase procedure, does not usually have a regulated reference value in the same way that medicines do. The cost-effectiveness studies that have recently been conducted on mass spectrometry in the diagnosis of bacteraemia and the use of antimicrobials have had the greatest clinical impact and may act as a model for future economic studies on rapid and point-of-care tests. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Using Rapid Prototyping to Design a Smoking Cessation Website with End-Users.

Science.gov (United States)

Ronquillo, Charlene; Currie, Leanne; Rowsell, Derek; Phillips, J Craig

2016-01-01

Rapid prototyping is an iterative approach to design involving cycles of prototype building, review by end-users and refinement, and can be a valuable tool in user-centered website design. Informed by various user-centered approaches, we used rapid prototyping as a tool to collaborate with users in building a peer-support focused smoking-cessation website for gay men living with HIV. Rapid prototyping was effective in eliciting feedback on the needs of this group of potential end-users from a smoking cessation website.

Development and implementation of an objective structured clinical examination to provide formative feedback on communication and interpersonal skills in geriatric training.

Science.gov (United States)

O'Sullivan, Patricia; Chao, Serena; Russell, Matthew; Levine, Sharon; Fabiny, Anne

2008-09-01

Teaching and assessment of communication and interpersonal skills, one of the American Council for Graduate Medical Education-designated core competencies, is an important but difficult task in the training of physicians. Assessment of trainees offers an opportunity to provide explicit feedback on their skills and encourages learning. This article describes a pilot study in which clinician-educators affiliated with the geriatrics training programs at Beth Israel Deaconess Medical Center and Boston University Medical Center designed and piloted a novel Objective Structured Clinical Examination (OSCE) to assess the communication and interpersonal skills of medical, dental, and geriatric psychiatry fellows. The OSCE consisted of three stations where geriatricians and standardized patients evaluated candidates using specifically designed checklists and an abbreviated version of the Master Interview Rating Scale. Communication skills were assessed through performance of specific "real life" clinical tasks, such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills were assessed through the effect of the communication between doctor and standardized patient on fostering trust, relieving anxiety, and establishing a therapeutic relationship. This pilot study demonstrated that the OSCE format of assessment provides a valid means of evaluating the communication and interpersonal skills of interdisciplinary geriatric trainees and provides a valuable forum for formative assessment and feedback. Given that geriatricians and non geriatricians involved in elder care both need communication and interpersonal skills, this novel OSCE can be used for assessment of these skills in trainees in diverse healthcare subspecialties.

Fault Tolerant Feedback Control

DEFF Research Database (Denmark)

Stoustrup, Jakob; Niemann, H.

2001-01-01

An architecture for fault tolerant feedback controllers based on the Youla parameterization is suggested. It is shown that the Youla parameterization will give a residual vector directly in connection with the fault diagnosis part of the fault tolerant feedback controller. It turns out...... that there is a separation be-tween the feedback controller and the fault tolerant part. The closed loop feedback properties are handled by the nominal feedback controller and the fault tolerant part is handled by the design of the Youla parameter. The design of the fault tolerant part will not affect the design...... of the nominal feedback con-troller....

Can vibratory feedback be used to improve postural stability in persons with transtibial limb loss?

Science.gov (United States)

Rusaw, David; Hagberg, Kerstin; Nolan, Lee; Ramstrand, Nerrolyn

2012-01-01

The use of vibration as a feedback modality to convey motion of the body has been shown to improve measures of postural stability in some groups of patients. Because individuals using transtibial prostheses lack sensation distal to the amputation, vibratory feedback could possibly be used to improve their postural stability. The current investigation provided transtibial prosthesis users (n = 24, mean age 48 yr) with vibratory feedback proportional to the signal received from force transducers located under the prosthetic foot. Postural stability was evaluated by measuring center of pressure (CoP) movement, limits of stability, and rhythmic weight shift while participants stood on a force platform capable of rotations in the pitch plane (toes up/toes down). The results showed that the vibratory feedback increased the mediolateral displacement amplitude of CoP in standing balance and reduced the response time to rapid voluntary movements of the center of gravity. The results suggest that the use of vibratory feedback in an experimental setting leads to improvements in fast open-loop mechanisms of postural control in transtibial prosthesis users.

Feedback promotes learning success! Which kind of feedback for the faculty is given by an interdisciplinary OSCE with focus on decision-making?

Directory of Open Access Journals (Sweden)

Stibane, Tina

2016-08-01

Full Text Available Clinical skills such as history taking, diagnostic reasoning, therapy planning, and giving advice are even more complex than practical skills like lung auscultation and have to be applied in complex clinical situations. We judged this competence in an interdisciplinary formative OSCE conducted with students of Marburg University. Results of 218 students passing 643 OSCE stations composed of 37 different scenarios were analyzed. As a competence based examination that reflects the practical skills gained during clinical training, the here presented analysis serves also as a feedback instrument for clinical teachers, their respective disciplines and the medical faculty as a whole.

Holistic feedback approach with video and peer discussion under teacher supervision.

Science.gov (United States)

Hunukumbure, Agra Dilshani; Smith, Susan F; Das, Saroj

2017-09-29

High quality feedback is vital to learning in medical education but many students and teachers have expressed dissatisfaction on current feedback practices. Lack of teachers' insight into students' feedback requirements may be a key, which might be addressed by giving control to the students with student led feedback practices. The conceptual framework was built on three dimensions of learning theory by Illeris and Vygotsky's zone of proximal development and scaffolding. We introduced a feedback session with self-reflection and peer feedback in the form of open discussion on video-recorded student performances under teacher's guidance. The aims of this qualitative study were to explore students' perception on this holistic feedback approach and to investigate ways of maximising effective feedback and learning. Semi-structured interviews were used to gather data which were evaluated using a thematic analytical approach. The participants were third year medical students of Imperial College London on clinical placements at Hillingdon Hospital. Video based self-reflection helped some students to identify mistakes in communication and technical skills of which they were unaware prior to the session. Those who were new to video feedback found their expected self-image different to that of their actual image on video, leading to some distress. However many also identified that mistakes were not unique to themselves through peer videos and learnt from both model performances and from each other's mistakes. Balancing honest feedback with empathy was a challenge for many during peer discussion. The teacher played a vital role in making the session a success by providing guidance and a supportive environment. This study has demonstrated many potential benefits of this holistic feedback approach with video based self-reflection and peer discussion with students engaging at a deeper cognitive level than the standard descriptive feedback.

El feedback como herramienta docente en la formación clínica. 1.ª parte

Directory of Open Access Journals (Sweden)

Juan José Rodríguez Salvador

2018-03-01

Full Text Available Resumen: Las 2 preocupaciones más importantes de los tutores y los docentes clínicos son cómo hacer que los residentes y los alumnos se motiven, y cómo ofrecerles feedback de manera constructiva. Además, los docentes clínicos sienten que no tienen conocimientos ni entrenamiento suficiente sobre cómo dar feedback. En este artículo describimos cómo utilizar el feedback de forma que la supervisión resulte una experiencia productiva y estimulante tanto para el aprendiz como para el docente. Revisamos las características básicas que debe poseer un feedback a la vez constructivo y centrado tanto en el que aprende, como en su programa docente; proponemos una sistemática para dar feedback informal en 4 pasos y ofrecemos unos ejemplos para su puesta en escena. Abstract: The 2 most important concerns of tutors and clinical teachers are how to get residents and students motivated and how to offer feedback constructively. In addition, clinical teachers feel that they do not have enough knowledge or training on how to give feedback. In this article, we describe how to use feedback so that supervision is a productive and stimulating experience for both the learner and the teacher. We review the basic characteristics that a feedback should have to be constructive and focused on the learner and their teaching program at the same time. We propose a systematic structure for giving informal feedback in 4 steps and we offer some examples for its staging. Palabras clave: Formación de tutores, Educación médica, Feedback, Residencia y rotaciones médicas, Keywords: Preceptor development, Medical education, Feedback, Internship and residency

Feedback-related brain activity predicts learning from feedback in multiple-choice testing.

Science.gov (United States)

Ernst, Benjamin; Steinhauser, Marco

2012-06-01

Different event-related potentials (ERPs) have been shown to correlate with learning from feedback in decision-making tasks and with learning in explicit memory tasks. In the present study, we investigated which ERPs predict learning from corrective feedback in a multiple-choice test, which combines elements from both paradigms. Participants worked through sets of multiple-choice items of a Swahili-German vocabulary task. Whereas the initial presentation of an item required the participants to guess the answer, corrective feedback could be used to learn the correct response. Initial analyses revealed that corrective feedback elicited components related to reinforcement learning (FRN), as well as to explicit memory processing (P300) and attention (early frontal positivity). However, only the P300 and early frontal positivity were positively correlated with successful learning from corrective feedback, whereas the FRN was even larger when learning failed. These results suggest that learning from corrective feedback crucially relies on explicit memory processing and attentional orienting to corrective feedback, rather than on reinforcement learning.

Impact of tailored feedback in assessment of communication skills for medical students.

Science.gov (United States)

Uhm, Seilin; Lee, Gui H; Jin, Jeong K; Bak, Yong I; Jeoung, Yeon O; Kim, Chan W

2015-01-01

Finding out the effective ways of teaching and assessing communication skills remain a challenging part of medication education. This study aims at exploring the usefulness and effectiveness of having additional feedback using qualitative analysis in assessment of communication skills in undergraduate medical training. We also determined the possibilities of using qualitative analysis in developing tailored strategies for improvement in communication skills training. This study was carried out on medical students (n=87) undergoing their final year clinical performance examination on communication skills using standardized patient by video-recording and transcribing their performances. Video-recordings of 26 students were randomly selected for qualitative analysis, and additional feedback was provided. We assessed the level of acceptance of communication skills scores between the study and nonstudy group and within the study group, before and after receiving feedback based on qualitative analysis. There was a statistically significant increase in the level of acceptance of feedback after delivering additional feedback using qualitative analysis, where the percentage of agreement with feedback increased from 15.4 to 80.8% (pskills assessment gives essential information for medical students to learn and self-reflect, which could potentially lead to improved communication skills. As evident from our study, feedback becomes more meaningful and effective with additional feedback using qualitative analysis.

Influence of facial feedback during a cooperative human-robot task in schizophrenia.

Science.gov (United States)

Cohen, Laura; Khoramshahi, Mahdi; Salesse, Robin N; Bortolon, Catherine; Słowiński, Piotr; Zhai, Chao; Tsaneva-Atanasova, Krasimira; Di Bernardo, Mario; Capdevielle, Delphine; Marin, Ludovic; Schmidt, Richard C; Bardy, Benoit G; Billard, Aude; Raffard, Stéphane

2017-11-03

Rapid progress in the area of humanoid robots offers tremendous possibilities for investigating and improving social competences in people with social deficits, but remains yet unexplored in schizophrenia. In this study, we examined the influence of social feedbacks elicited by a humanoid robot on motor coordination during a human-robot interaction. Twenty-two schizophrenia patients and twenty-two matched healthy controls underwent a collaborative motor synchrony task with the iCub humanoid robot. Results revealed that positive social feedback had a facilitatory effect on motor coordination in the control participants compared to non-social positive feedback. This facilitatory effect was not present in schizophrenia patients, whose social-motor coordination was similarly impaired in social and non-social feedback conditions. Furthermore, patients' cognitive flexibility impairment and antipsychotic dosing were negatively correlated with patients' ability to synchronize hand movements with iCub. Overall, our findings reveal that patients have marked difficulties to exploit facial social cues elicited by a humanoid robot to modulate their motor coordination during human-robot interaction, partly accounted for by cognitive deficits and medication. This study opens new perspectives for comprehension of social deficits in this mental disorder.

Student Engagement with Feedback

Science.gov (United States)

Scott, Jon; Shields, Cathy; Gardner, James; Hancock, Alysoun; Nutt, Alex

2011-01-01

This report considers Biological Sciences students' perceptions of feedback, compared with those of the University as a whole, this includes what forms of feedback were considered most useful and how feedback used. Compared with data from previous studies, Biological Sciences students gave much greater recognition to oral feedback, placing it on a…

How emotion shapes behavior: feedback, anticipation, and reflection, rather than direct causation.

Science.gov (United States)

Baumeister, Roy F; Vohs, Kathleen D; DeWall, C Nathan; Zhang, Liqing

2007-05-01

Fear causes fleeing and thereby saves lives: this exemplifies a popular and common sense but increasingly untenable view that the direct causation of behavior is the primary function of emotion. Instead, the authors develop a theory of emotion as a feedback system whose influence on behavior is typically indirect. By providing feedback and stimulating retrospective appraisal of actions, conscious emotional states can promote learning and alter guidelines for future behavior. Behavior may also be chosen to pursue (or avoid) anticipated emotional outcomes. Rapid, automatic affective responses, in contrast to the full-blown conscious emotions, may inform cognition and behavioral choice and thereby help guide current behavior. The automatic affective responses may also remind the person of past emotional outcomes and provide useful guides as to what emotional outcomes may be anticipated in the present. To justify replacing the direct causation model with the feedback model, the authors review a large body of empirical findings.

Combining Electrochemical Sensors with Miniaturized Sample Preparation for Rapid Detection in Clinical Samples

Science.gov (United States)

Bunyakul, Natinan; Baeumner, Antje J.

2015-01-01

Clinical analyses benefit world-wide from rapid and reliable diagnostics tests. New tests are sought with greatest demand not only for new analytes, but also to reduce costs, complexity and lengthy analysis times of current techniques. Among the myriad of possibilities available today to develop new test systems, amperometric biosensors are prominent players—best represented by the ubiquitous amperometric-based glucose sensors. Electrochemical approaches in general require little and often enough only simple hardware components, are rugged and yet provide low limits of detection. They thus offer many of the desirable attributes for point-of-care/point-of-need tests. This review focuses on investigating the important integration of sample preparation with (primarily electrochemical) biosensors. Sample clean up requirements, miniaturized sample preparation strategies, and their potential integration with sensors will be discussed, focusing on clinical sample analyses. PMID:25558994

Feedback i matematik

DEFF Research Database (Denmark)

Sortkær, Bent

2017-01-01

Feedback bliver i litteraturen igen og igen fremhævet som et af de mest effektive midler til at fremme elevers præstationer i skolen (Hartberg, Dobson, & Gran, 2012; Hattie & Timperley, 2007; Wiliam, 2015). Dette på trods af, at flere forskere påpeger, at feedback ikke altid er læringsfremmende...... (Hattie & Gan, 2011), og nogle endda viser, at feedback kan have en negativ virkning i forhold til præstationer (Kluger & DeNisi, 1996). Artiklen vil undersøge disse tilsyneladende modstridende resultater ved at stille spørgsmålet: Under hvilke forudsætninger virker feedback i matematik læringsfremmende......? Dette gøres ved at dykke ned i forskningslitteraturen omhandlende feedback ud fra en række temaer for på den måde at besvare ovenstående spørgsmål....

Trainees' Perceptions of Feedback: Validity Evidence for Two FEEDME (Feedback in Medical Education) Instruments.

Science.gov (United States)

Bing-You, Robert; Ramesh, Saradha; Hayes, Victoria; Varaklis, Kalli; Ward, Denham; Blanco, Maria

2018-01-01

Construct: Medical educators consider feedback a core component of the educational process. Effective feedback allows learners to acquire new skills, knowledge, and attitudes. Learners' perceptions of feedback are an important aspect to assess with valid methods in order to improve the feedback skills of educators and the feedback culture. Although guidelines for delivering effective feedback have existed for several decades, medical students and residents often indicate that they receive little feedback. A recent scoping review on feedback in medical education did not reveal any validity evidence on instruments to assess learner's perceptions of feedback. The purpose of our study was to gather validity evidence on two novel FEEDME (Feedback in Medical Education) instruments to assess medical students' and residents' perceptions of the feedback that they receive. After the authors developed an initial instrument with 54 items, cognitive interviews with medical students and residents suggested that 2 separate instruments were needed, one focused on the feedback culture (FEEDME-Culture) and the other on the provider of feedback (FEEDME-Provider). A Delphi study with 17 medical education experts and faculty members assessed content validity. The response process was explored involving 31 medical students and residents at 2 academic institutions. Exploratory factor analysis and reliability analyses were performed on completed instruments. Two Delphi consultation rounds refined the wording of items and eliminated several items. Learners found both instruments easy and quick to answer; it took them less than 5 minutes to complete. Learners preferred an electronic format of the instruments over paper. Factor analysis revealed a two- and three-factor solution for the FEEDME-Culture and FEEDME-Provider instruments, respectively. Cronbach's alpha was greater than 0.80 for all factors. Items on both instruments were moderately to highly correlated (range, r = .3-.7). Our

Rapid detection of methicillin-resistant Staphylococcus aureus directly from clinical samples: methods, effectiveness and cost considerations

Directory of Open Access Journals (Sweden)

Stürenburg, Enno

2009-07-01

Full Text Available Methicillin-resistant Staphylococcus aureus (MRSA isolates is a serious public health problem whose ever-increasing rate is commensurate with the pressure it is exerting on the healthcare system. At present, more than 20% of clinical S. aureus isolates in German hospitals are methicillin resistant. Strategies from low-prevalence countries show that this development is not necessarily inevitable. In the Scandinavian countries and the Netherlands, thanks to a rigorous prevention programme, MRSA prevalence has been kept at an acceptably low level (<1–3%. Central to these ‘search and destroy’ control strategies is an admission screening using several MRSA swabs taken from mucocutaneous colonisation sites of high-risk patients (‘MRSA surveillance’. It has also been reported that the speed with which MRSA carriage is detected has an important role to play, as it is a key component of any effective strategy to prevent the pathogen from spreading. Since MRSA culturing involves a 2–3 day delay before the final results are available, rapid detection techniques (commonly referred to as ‘MRSA rapid tests’ using PCR methods and, most recently, rapid culturing methods have been developed. The implementation of rapid tests reduces the time of detection of MRSA carriers from 48–72 to 2–5 h. Clinical evaluation data have shown that MRSA can thus be detected with very high sensitivity. Specificity however is sometimes impaired due to false-positive PCR signals occurring in mixed flora specimens. In order to rule out any false-positive PCR results, a culture screen must always be carried out simultaneously.The data provide preliminary evidence that a PCR assay can reduce nosocomial MRSA transmission in high-risk patients or high-risk areas, whereas an approach that screens all patients admitted to the hospital is probably not effective. Information concerning the cost-effectiveness of rapid MRSA tests is still sparse and thus the issue remains

The Data-to-Action Framework: A Rapid Program Improvement Process

Science.gov (United States)

Zakocs, Ronda; Hill, Jessica A.; Brown, Pamela; Wheaton, Jocelyn; Freire, Kimberley E.

2015-01-01

Although health education programs may benefit from quality improvement methods, scant resources exist to help practitioners apply these methods for program improvement. The purpose of this article is to describe the Data-to-Action framework, a process that guides practitioners through rapid-feedback cycles in order to generate actionable data to…

A randomized controlled trial of a personalized feedback intervention for problem gamblers.

Directory of Open Access Journals (Sweden)

John A Cunningham

Full Text Available Personalized feedback is a promising self-help for problem gamblers. Such interventions have shown consistently positive results with other addictive behaviours, and our own pilot test of personalized normative feedback materials for gamblers yielded positive findings. The current randomized controlled trial evaluated the effectiveness, and the sustained efficacy, of the personalized feedback intervention materials for problem gamblers.Respondents recruited by a general population telephone screener of Ontario adults included gamblers with moderate and severe gambling problems. Those who agreed to participate were randomly assigned to receive: 1 the full personalized normative feedback intervention; 2 a partial feedback that contained all the feedback information provided to those in condition 1 but without the normative feedback content (i.e., no comparisons provided to general population gambling norms; or 3 a waiting list control condition. The primary hypothesis was that problem gamblers who received the personalized normative feedback intervention would reduce their gambling more than problem gamblers who did not receive any intervention (waiting list control condition by the six-month follow-up.The study found no evidence for the impact of normative personalized feedback. However, participants who received, the partial feedback (without norms reduced the number of days they gambled compared to participants who did not receive the intervention. We concluded that personalized feedback interventions were well received and the materials may be helpful at reducing gambling. Realistically, it can be expected that the personalized feedback intervention may have a limited, short term impact on the severity of participants' problem gambling because the intervention is just a brief screener. An Internet-based version of the personalized feedback intervention tool, however, may offer an easy to access and non-threatening portal that can be used to

Skriftlig feedback i engelskundervisningen

DEFF Research Database (Denmark)

Kjærgaard, Hanne Wacher

2017-01-01

The article describes useful feedback strategies in language teaching and describes the feedback practices of lower-seconday teachers in Denmark. The article is aimed at language teahcers in secondary schools.......The article describes useful feedback strategies in language teaching and describes the feedback practices of lower-seconday teachers in Denmark. The article is aimed at language teahcers in secondary schools....

Feedback and efficient behavior.

Directory of Open Access Journals (Sweden)

Sandro Casal

Full Text Available Feedback is an effective tool for promoting efficient behavior: it enhances individuals' awareness of choice consequences in complex settings. Our study aims to isolate the mechanisms underlying the effects of feedback on achieving efficient behavior in a controlled environment. We design a laboratory experiment in which individuals are not aware of the consequences of different alternatives and, thus, cannot easily identify the efficient ones. We introduce feedback as a mechanism to enhance the awareness of consequences and to stimulate exploration and search for efficient alternatives. We assess the efficacy of three different types of intervention: provision of social information, manipulation of the frequency, and framing of feedback. We find that feedback is most effective when it is framed in terms of losses, that it reduces efficiency when it includes information about inefficient peers' behavior, and that a lower frequency of feedback does not disrupt efficiency. By quantifying the effect of different types of feedback, our study suggests useful insights for policymakers.

Feedback - fra et elevperspektiv

DEFF Research Database (Denmark)

Petersen, Benedikte Vilslev; Pedersen, Bent Sortkær

Feedback bliver i litteraturen igen og igen fremhævet som et af de mest effektive midler til at fremme elevers præstationer i skolen (Hattie og Timperley, 2007). Andre studier er dog inde på at feedback ikke altid er læringsfremmende og nogle viser endda at feedback kan have en negativ virkning i...... forhold til præstationer (Kluger & DeNisi, 1996). I forsøget på at forklare hvordan og hvorfor feedback virker (forskelligt), er der undersøgt flere dimensioner og forhold omkring feedback (se bl.a. Black og Wiliam, 1998; Hattie og Timperley, 2007; Shute, 2008). Dog er der få studier der undersøger...... hvordan feedback opleves fra et elevperspektiv (Ruiz-Primo og Li, 2013). Samtidig er der i feedbacklitteraturen en mangel på kvalitative studier, der kommer tæt på fænomenet feedback, som det viser sig i klasserummet (Ruiz-Primo og Li, 2013) i naturlige omgivelser (Black og Wiliam, 1998), og hvordan...

Feedback reliability calculation for an iterative block decision feedback equalizer

OpenAIRE

Huang, G; Nix, AR; Armour, SMD

2009-01-01

A new class of iterative block decision feedback equalizer (IB-DFE) was pioneered by Chan and Benvenuto. Unlike the conventional DFE, the IB-DFE is optimized according to the reliability of the feedback (FB) symbols. Since the use of the training sequence (TS) for feedback reliability (FBR) estimation lowers the bandwidth efficiency, FBR estimation without the need for additional TS is of considerable interest. However, prior FBR estimation is limited in the literature to uncoded M-ary phases...

A clinical measure of maximal and rapid stepping in older women.

Science.gov (United States)

Medell, J L; Alexander, N B

2000-08-01

In older adults, clinical measures have been used to assess fall risk based on the ability to maintain stance or to complete a functional task. However, in an impending fall situation, a stepping response is often used when strategies to maintain stance are inadequate. We examined how maximal and rapid stepping performance might differ among healthy young, healthy older, and balance-impaired older adults, and how this stepping performance related to other measures of balance and fall risk. Young (Y; n = 12; mean age, 21 years), unimpaired older (UO; n = 12; mean age, 69 years), and balance-impaired older women IO; n = 10; mean age, 77 years) were tested in their ability to take a maximal step (Maximum Step Length or MSL) and in their ability to take rapid steps in three directions (front, side, and back), termed the Rapid Step Test (RST). Time to complete the RST and stepping errors occurring during the RST were noted. The IO group, compared with the Y and UO groups, demonstrated significantly poorer balance and higher fall risk, based on performance on tasks such as unipedal stance. Mean MSL was significantly higher (by 16%) in the Y than in the UO group and in the UO (by 30%) than in the IO group. Mean RST time was significantly faster in the Y group versus the UO group (by 24%) and in the UO group versus the IO group (by 15%). Mean RST errors tended to be higher in the UO than in the Y group, but were significantly higher only in the UO versus the IO group. Both MSL and RST time correlated strongly (0.5 to 0.8) with other measures of balance and fall risk including unipedal stance, tandem walk, leg strength, and the Activities-Specific Balance Confidence (ABC) scale. We found substantial declines in the ability of both unimpaired and balance-impaired older adults to step maximally and to step rapidly. Stepping performance is closely related to other measures of balance and fall risk and might be considered in future studies as a predictor of falls and fall

Feedback stabilization initiative

International Nuclear Information System (INIS)

1997-06-01

Much progress has been made in attaining high confinement regimes in magnetic confinement devices. These operating modes tend to be transient, however, due to the onset of MHD instabilities, and their stabilization is critical for improved performance at steady state. This report describes the Feedback Stabilization Initiative (FSI), a broad-based, multi-institutional effort to develop and implement methods for raising the achievable plasma betas through active MHD feedback stabilization. A key element in this proposed effort is the Feedback Stabilization Experiment (FSX), a medium-sized, national facility that would be specifically dedicated to demonstrating beta improvement in reactor relevant plasmas by using a variety of MHD feedback stabilization schemes

Feedback stabilization initiative

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-06-01

Much progress has been made in attaining high confinement regimes in magnetic confinement devices. These operating modes tend to be transient, however, due to the onset of MHD instabilities, and their stabilization is critical for improved performance at steady state. This report describes the Feedback Stabilization Initiative (FSI), a broad-based, multi-institutional effort to develop and implement methods for raising the achievable plasma betas through active MHD feedback stabilization. A key element in this proposed effort is the Feedback Stabilization Experiment (FSX), a medium-sized, national facility that would be specifically dedicated to demonstrating beta improvement in reactor relevant plasmas by using a variety of MHD feedback stabilization schemes.

Feedback matters current feedback practices in the EFL classroom

CERN Document Server

Reitbauer, Margit; Mercer, Sarah; Schumm-Fauster, Jennifer

2013-01-01

This varied collection of papers is concerned with feedback in the language learning context. With its blend of theoretical overviews, action research-based empirical studies and practical implications, this will be a valuable resource for all academics and practitioners concerned with generating feedback that matters.

Evaluation of stiffness feedback for hard nodule identification on a phantom silicone model

OpenAIRE

Li, M.; Konstantinova, J.; Xu, G.; He, B.; Aminzadeh, V.; Xie, J.; Wurdemann, H.; Althoefer, K.

2017-01-01

Haptic information in robotic surgery can significantly improve clinical outcomes and help detect hard soft-tissue inclusions that indicate potential abnormalities. Visual representation of tissue stiffness information is a cost-effective technique. Meanwhile, direct force feedback, although considerably more expensive than visual representation, is an intuitive method of conveying information regarding tissue stiffness to surgeons. In this study, real-time visual stiffness feedback by slidin...

Feedback using an ePortfolio for medicine long cases: quality not quantity.

Science.gov (United States)

Bleasel, Jane; Burgess, Annette; Weeks, Ruth; Haq, Inam

2016-10-21

The evidence for the positive impact of an electronic Portfolio (ePortfolio) on feedback in medicine is mixed. An ePortfolio for medical long cases in a Graduate Medical Program was developed. The purpose of this study was to explore the perceptions of medical students and faculty of the impact of the ePortfolio on the feedback process. In total, 130 Year 3 medical students, and six faculty participated in the study. This is a mixed methods study, using a combination of both quantitative and qualitative approaches. Quantitative methods were used to quantify the number of long cases performed. Qualitative methods were used to explore the relationship between quantity and quality of feedback, and provide a rich understanding of both students' and faculty's experience and perceptions of the ePortfolio. Students received a variable quantity of feedback at each of the three studied clinical schools, with an average of between 4 - 5.4 feedback episodes per student. Feedback that was constructive, specific and timely and delivered by a senior academic was important. Quantity was not an essential factor, with two episodes of detailed feedback reported to be adequate. The barriers to the use of the ePortfolio were technical aspects of the platform that interfered with student engagement. Feedback using the ePortfolio for medical long cases is a valuable tool providing a senior clinician delivers detailed, constructive and personalized feedback in a timely fashion. The ePortfolio system needs to be user-friendly to engage students.

The importance and acceptability of general and maladaptive personality trait computerized assessment feedback.

Science.gov (United States)

Lengel, Gregory J; Mullins-Sweatt, Stephanie N

2017-01-01

Personality traits are a useful component of clinical assessment, and have been associated with positive and negative life outcomes. Assessment of both general and maladaptive personality traits may be beneficial practice, as they may complement each other to comprehensively and accurately describe one's personality. Notably, personal preferences regarding assessment feedback have not been studied. The current study examined the acceptability of personality assessment feedback from the perspective of the examinee. Treatment-seeking participants from a university (n = 72) and Amazon.com MTurk (n = 101) completed measures of the 5-factor model and the DSM-5 alternative model of personality disorder, and were then provided feedback on their general and maladaptive personality traits. Individuals then provided feedback on which aspects they found most useful. Results demonstrated strong participant agreement that the personality trait feedback was accurate and relevant. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Credibility and (disuse of feedback to inform teaching : a qualitative case study of physician-faculty perspectives

Directory of Open Access Journals (Sweden)

Carr TF

2015-06-01

Full Text Available Evaluation plays a central role in teaching in that physician-faculty theoretically use evaluations from clinical learners to inform their teaching. Knowledge about how physician-faculty access and internalize feedback from learners is sparse and concerning given its importance in medical training. This study aims to broaden our understanding. Using multiple data sources, this cross-sectional qualitative case study conducted in Spring of 2014 explored the internalization of learner feedback among physician-faculty teaching medical students, residents and fellows at a southwest academic medical center. Twelve one-on-one interviews were triangulated with observation notes and a national survey. Thematic and document analysis was conducted. Results revealed that the majority accessed and reviewed evaluations about their teaching. Most admitted not using learner feedback to inform teaching while a quarter did use them. Factors influencing participants use or disuse of learner feedback were the a reporting metrics and mechanisms, and b physician-faculty perception of learner credibility. Physician-faculty did not regard learners’ ability to assess and recognize effective teaching skills highly. To refine feedback for one-on-one teaching in the clinical setting, recommendations by study participants include: a redesigning of evaluation reporting metrics and narrative sections, and b feedback rubric training for learners.

[Real-time feedback systems for improvement of resuscitation quality].

Science.gov (United States)

Lukas, R P; Van Aken, H; Engel, P; Bohn, A

2011-07-01

The quality of chest compression is a determinant of survival after cardiac arrest. Therefore, the European Resuscitation Council (ERC) 2010 guidelines on resuscitation strongly focus on compression quality. Despite its impact on survival, observational studies have shown that chest compression quality is not reached by professional rescue teams. Real-time feedback devices for resuscitation are able to measure chest compression during an ongoing resuscitation attempt through a sternal sensor equipped with a motion and pressure detection system. In addition to the electrocardiograph (ECG) ventilation can be detected by transthoracic impedance monitoring. In cases of quality deviation, such as shallow chest compression depth or hyperventilation, feedback systems produce visual or acoustic alarms. Rescuers can thereby be supported and guided to the requested quality in chest compression and ventilation. Feedback technology is currently available both as a so-called stand-alone device and as an integrated feature in a monitor/defibrillator unit. Multiple studies have demonstrated sustainable enhancement in the education of resuscitation due to the use of real-time feedback technology. There is evidence that real-time feedback for resuscitation combined with training and debriefing strategies can improve both resuscitation quality and patient survival. Chest compression quality is an independent predictor for survival in resuscitation and should therefore be measured and documented in further clinical multicenter trials.

Formativ Feedback

DEFF Research Database (Denmark)

Hyldahl, Kirsten Kofod

Denne bog undersøger, hvordan lærere kan anvende feedback til at forbedre undervisningen i klasselokalet. I denne sammenhæng har John Hattie, professor ved Melbourne Universitet, udviklet en model for feedback, hvilken er baseret på synteser af meta-analyser. I 2009 udgav han bogen "Visible...

Response to written feedback of clinical data within a longitudinal study: a qualitative study exploring the ethical implications

Directory of Open Access Journals (Sweden)

Wyke Sally

2011-01-01

Full Text Available Abstract Background There is a growing ethical imperative to feedback research results to participants but there remains a striking lack of empirical research on how people respond to individualised feedback. We sought to explore longitudinal study participants' response to receiving individual written feedback of weight-related and blood results, and to consider the balance of harms against benefits. Methods A qualitative study with face-to-face and telephone interviews conducted with 50 men and women who had participated in the fifth and most recent wave of the cohort study 'West of Scotland Twenty-07' and received a feedback letter containing body mass index (BMI, body fat percentage, cholesterol and glycated haemoglobin A1c (HbA1c results. Results Expectations of, and response to, the feedback of their individual results varied. Whilst half of the participants were on the whole 'pleased' with their results or held neutral views, half reported negative responses such as 'shock' or 'concern', particularly in relation to the weight-related results. Participants who were overweight and obese used the most negative language about their results, with some being quite distressed and reporting feelings of powerlessness, low self-image and anxiety over future health. Nevertheless, some people reported having implemented lifestyle changes in direct response to the feedback, resulting in significant weight-loss and/or dietary improvements. Others reported being motivated to change their behaviour. Age and gender differences were apparent in these narratives of behaviour change. Conclusions The potential harm caused to some participants may be balanced against the benefit to others. More evaluation of the impact of the format, content and means of individualised feedback of research findings in non-trial studies is required given the growing ethical imperative to offer participants a choice of receiving their results, and the likelihood that a high

Technical feasibility study of 60 MWe fast reactor concept: RAPID

International Nuclear Information System (INIS)

Kambe, Mitsuru; Ueda, Nobuyuki; Uotani, Masaki

1993-01-01

A study has been performed on the passive safety features and technical feasibility of an inherently safe 60 MWe fast reactor concept RAPID to meet various power requirements in Japan. The system dynamic analyses on the UTOP and ULOF transients revealed that the enhanced reactivity feedback derived from an annular core configuration and the integrated fuel assembly provides a high margin of self-protection. Structural integrity of the integrated fuel assembly has also been confirmed. The following innovative key technologies have been demonstrated; Lithium Injection Modules (LIM) for ultimate shutdown, Lithium Expansion Modulus (LEM) for inherent reactivity feedback and Void Leading Channel (VLC) for the sodium void worth reduction. (author)

Room for improvement: Palliating the ego in feedback-resistant medical students.

Science.gov (United States)

Perrella, Andrew

2017-05-01

Feedback in medical education provides the impetus for growth in a field pressured to demonstrate continuous progress. Unfortunately, as it always incorporates some level of judgment, certain students appear more resistant than receptive to receiving feedback. Coupled with the ubiquitous stressors of medicine-examinations, perpetual knowledge acquisition, competition for employment-there subtly emerges a learning environment in which the mindset of medical trainees morphs from collegiality to outperformance of one's peers. As the unconscious mind is ultimately focused on self-protection, the cognitive response of reflecting upon received feedback is overcome by an emotional response to safeguard one's self-image against criticism in a culture of comparison. Although self-confidence plays a critical role in mitigating burnout, the relationship between resiliency and ego-armoring is rarely discussed in the literature. Consequently, despite the best intentions of educators in fostering clinical maturity among their trainees, the fact remains that insecurity, inadequacy and invulnerability continue to drive feedback-resistance among medical students.

Technologies for learner-centered feedback

Directory of Open Access Journals (Sweden)

Jane Costello

2013-09-01

Full Text Available As the number, type, and use of technologies to support learning increases, so do the opportunities for using these technologies for feedback. Learner-centered feedback is a core to the teaching-learning process. It is related to assessment in describing how learners perform in their learning, their gain in knowledge, skills, and attitudes. Feedback, types of feedback, guidelines for effective learner-centered feedback, and feedback’s relationship to assessment are presented. Methods of providing feedback, for example, automated, audio scribe pens, digital audio, etc., and the related technologies are described. Technologies that allow instructors to make informed decisions about the use of various methods for feedback are discussed.

Corrective feedback, learner uptake, and feedback perception in a Chinese as a foreign language classroom

Directory of Open Access Journals (Sweden)

Tingfeng Fu

2016-03-01

Full Text Available The role of corrective feedback in second language classrooms has received considerable research attention in the past few decades. However, most of this research has been conducted in English-teaching settings, either ESL or EFL. This study examined teacher feedback, learner uptake as well as learner and teacher perception of feedback in an adult Chinese as a foreign language classroom. Ten hours of classroom interactions were videotaped, transcribed and coded for analysis. Lyster and Ranta’s (1997 coding system involving six types of feedback was initially used to identify feedback frequency and learner uptake. However, the teacher was found to use a number of additional feedback types. Altogether, 12 types of feedback were identified: recasts, delayed recasts, clarification requests, translation, metalinguistic feedback, elicitation, explicit correction, asking a direct question, repetition, directing question to other students, re-asks, and using L1-English. Differences were noted in the frequency of some of the feedback types as well as learner uptake compared to what had been reported in some previous ESL and EFL studies. With respect to the new feedback types, some led to noticeable uptake. As for the students’ and teacher’s perceptions, they did not match and both the teacher and the students were generally not accurate in perceiving the frequency of each feedback type. The findings are discussed in terms of the role of context in affecting the provision and effectiveness of feedback and its relationship to student and teacher perception of feedback.

Evaluating the veterinary clinical teacher

NARCIS (Netherlands)

Boerboom, T.B.B.|info:eu-repo/dai/nl/322942489

2011-01-01

Introduction Providing clinical teachers with student feedback is an important part of faculty development. The current literature provides a range of instruments developed to generate student rating feedback. However, these instruments often lack a theoretical framework and evidence concerning

Multi-bunch Feedback Systems

International Nuclear Information System (INIS)

Lonza, M; Schmickler, H

2014-01-01

Coupled-bunch instabilities excited by the interaction of the particle beam with its surroundings can seriously limit the performance of circular particle accelerators. These instabilities can be cured by the use of active feedback systems based on sensors capable of detecting the unwanted beam motion and actuators that apply the feedback correction to the beam. Advances in electronic technology now allow the implementation of feedback loops using programmable digital systems. Besides important advantages in terms of flexibility and reproducibility, digital systems open the way to the use of novel diagnostic tools and additional features. We first introduce coupled-bunch instabilities, analysing the equation of motion of charged particles and the different modes of oscillation of a multi-bunch beam, showing how they can be observed and measured. Different types of feedback systems will then be presented as examples of real implementations that belong to the history of multi-bunch feedback systems. The main components of a feedback system and the related issues will also be analysed. Finally, we shall focus on digital feedback systems, their characteristics, and features, as well as on how they can be concretely exploited for both the optimization of feedback performance and for beam dynamics studies

Active Learning of Classification Models with Likert-Scale Feedback.

Science.gov (United States)

Xue, Yanbing; Hauskrecht, Milos

2017-01-01

Annotation of classification data by humans can be a time-consuming and tedious process. Finding ways of reducing the annotation effort is critical for building the classification models in practice and for applying them to a variety of classification tasks. In this paper, we develop a new active learning framework that combines two strategies to reduce the annotation effort. First, it relies on label uncertainty information obtained from the human in terms of the Likert-scale feedback. Second, it uses active learning to annotate examples with the greatest expected change. We propose a Bayesian approach to calculate the expectation and an incremental SVM solver to reduce the time complexity of the solvers. We show the combination of our active learning strategy and the Likert-scale feedback can learn classification models more rapidly and with a smaller number of labeled instances than methods that rely on either Likert-scale labels or active learning alone.

Dynamic feedback circuits function as a switch for shaping a maturation-inducing steroid pulse in Drosophila

DEFF Research Database (Denmark)

Møller, Morten Erik; Danielsen, Erik Thomas; Herder, Rachel

2013-01-01

. Remarkably, our study shows that the same well-defined genetic program that stimulates a systemic downstream response to ecdysone is also utilized upstream to set the duration and amplitude of the ecdysone pulse. Activation of this switch-like mechanism ensures a rapid, self-limiting PG response......Steroid hormones trigger the onset of sexual maturation in animals by initiating genetic response programs that are determined by steroid pulse frequency, amplitude and duration. Although steroid pulses coordinate growth and timing of maturation during development, the mechanisms generating...... of hormone synthesis, the two key parameters determining pulse shape (amplitude and duration). We show that ecdysone has a positive-feedback effect on the PG, rapidly amplifying its own synthesis to trigger pupariation as the onset of maturation. During the prepupal stage, a negative-feedback signal ensures...

Giving Feedback: Development of Scales for the Mum Effect, Discomfort Giving Feedback, and Feedback Medium Preference

Science.gov (United States)

Cox, Susie S.; Marler, Laura E.; Simmering, Marcia J.; Totten, Jeff W.

2011-01-01

Research in organizational behavior and human resources promotes the view that it is critical for managers to provide accurate feedback to employees, yet little research addresses rater tendencies (i.e., the "mum effect") and attitudes that influence how performance feedback is given. Because technology has changed the nature of…

Evaluation of stiffness feedback for hard nodule identification on a phantom silicone model.

Science.gov (United States)

Li, Min; Konstantinova, Jelizaveta; Xu, Guanghua; He, Bo; Aminzadeh, Vahid; Xie, Jun; Wurdemann, Helge; Althoefer, Kaspar

2017-01-01

Haptic information in robotic surgery can significantly improve clinical outcomes and help detect hard soft-tissue inclusions that indicate potential abnormalities. Visual representation of tissue stiffness information is a cost-effective technique. Meanwhile, direct force feedback, although considerably more expensive than visual representation, is an intuitive method of conveying information regarding tissue stiffness to surgeons. In this study, real-time visual stiffness feedback by sliding indentation palpation is proposed, validated, and compared with force feedback involving human subjects. In an experimental tele-manipulation environment, a dynamically updated color map depicting the stiffness of probed soft tissue is presented via a graphical interface. The force feedback is provided, aided by a master haptic device. The haptic device uses data acquired from an F/T sensor attached to the end-effector of a tele-manipulated robot. Hard nodule detection performance is evaluated for 2 modes (force feedback and visual stiffness feedback) of stiffness feedback on an artificial organ containing buried stiff nodules. From this artificial organ, a virtual-environment tissue model is generated based on sliding indentation measurements. Employing this virtual-environment tissue model, we compare the performance of human participants in distinguishing differently sized hard nodules by force feedback and visual stiffness feedback. Results indicate that the proposed distributed visual representation of tissue stiffness can be used effectively for hard nodule identification. The representation can also be used as a sufficient substitute for force feedback in tissue palpation.

Evaluation of stiffness feedback for hard nodule identification on a phantom silicone model.

Directory of Open Access Journals (Sweden)

Min Li

Full Text Available Haptic information in robotic surgery can significantly improve clinical outcomes and help detect hard soft-tissue inclusions that indicate potential abnormalities. Visual representation of tissue stiffness information is a cost-effective technique. Meanwhile, direct force feedback, although considerably more expensive than visual representation, is an intuitive method of conveying information regarding tissue stiffness to surgeons. In this study, real-time visual stiffness feedback by sliding indentation palpation is proposed, validated, and compared with force feedback involving human subjects. In an experimental tele-manipulation environment, a dynamically updated color map depicting the stiffness of probed soft tissue is presented via a graphical interface. The force feedback is provided, aided by a master haptic device. The haptic device uses data acquired from an F/T sensor attached to the end-effector of a tele-manipulated robot. Hard nodule detection performance is evaluated for 2 modes (force feedback and visual stiffness feedback of stiffness feedback on an artificial organ containing buried stiff nodules. From this artificial organ, a virtual-environment tissue model is generated based on sliding indentation measurements. Employing this virtual-environment tissue model, we compare the performance of human participants in distinguishing differently sized hard nodules by force feedback and visual stiffness feedback. Results indicate that the proposed distributed visual representation of tissue stiffness can be used effectively for hard nodule identification. The representation can also be used as a sufficient substitute for force feedback in tissue palpation.

What higher education students do with teacher feedback: Feedback ...

African Journals Online (AJOL)

Writing pedagogy research has constantly maintained that feedback is 'an essential component of virtually every model of the writing process' (Hall, 1990: 43) as it motivates writers to improve their next draft. Feedback during the writing process improves not only student attitude to writing but writing performance if students ...

Virtual sensory feedback for gait improvement in neurological patients

Directory of Open Access Journals (Sweden)

Yoram eBaram

2013-10-01

Full Text Available We review a treatment modality for movement disorders by sensory feedback. The natural closed-loop sensory-motor feedback system is imitated by a wearable virtual reality apparatus, employing body-mounted inertial sensors and responding dynamically to the patient’s own motion. Clinical trials have shown a significant gait improvement in patients with Parkinson's disease using the apparatus. In contrast to open-loop devices, which impose constant-velocity visual cues in a treadmill fashion, or rhythmic auditory cues in a metronome fashion, requiring constant vigilance and attention strategies, and in some cases, instigating freezing in Parkinson’s patients, the closed-loop device improved gait parameters and eliminated freezing in most patients, without side effects. Patients with multiple sclerosis, previous stroke, senile gait and cerebral palsy using the device also improved their balance and gait substantially. Training with the device has produced a residual improvement, suggesting virtual sensory feedback for the treatment of neurological movement disorders.

Age differences in feedback reactions: The roles of employee feedback orientation on social awareness and utility.

Science.gov (United States)

Wang, Mo; Burlacu, Gabriela; Truxillo, Donald; James, Keith; Yao, Xiang

2015-07-01

Organizations worldwide are currently experiencing shifts in the age composition of their workforces. The workforce is aging and becoming increasingly age-diverse, suggesting that organizational researchers and practitioners need to better understand how age differences may manifest in the workplace and the implications for human resource practice. Integrating socioemotional selectivity theory with the performance feedback literature and using a time-lagged design, the current study examined age differences in moderating the relationships between the characteristics of performance feedback and employee reactions to the feedback event. The results suggest that older workers had higher levels of feedback orientation on social awareness, but lower levels of feedback orientation on utility than younger workers. Furthermore, the positive associations between favorability of feedback and feedback delivery and feedback reactions were stronger for older workers than for younger workers, whereas the positive association between feedback quality and feedback reactions was stronger for younger workers than for older workers. Finally, the current study revealed that age-related differences in employee feedback orientation could explain the different patterns of relationships between feedback characteristics and feedback reactions across older and younger workers. These findings have both theoretical and practical implications for building theory about workplace aging and improving ways that performance feedback is managed across employees from diverse age groups. (c) 2015 APA, all rights reserved).

Peer feedback for examiner quality assurance on MRCGP International South Asia: a mixed methods study.

Science.gov (United States)

Perera, D P; Andrades, Marie; Wass, Val

2017-12-08

The International Membership Examination (MRCGP[INT]) of the Royal College of General Practitioners UK is a unique collaboration between four South Asian countries with diverse cultures, epidemiology, clinical facilities and resources. In this setting good quality assurance is imperative to achieve acceptable standards of inter rater reliability. This study aims to explore the process of peer feedback for examiner quality assurance with regard to factors affecting the implementation and acceptance of the method. A sequential mixed methods approach was used based on focus group discussions with examiners (n = 12) and clinical examination convenors who acted as peer reviewers (n = 4). A questionnaire based on emerging themes and literature review was then completed by 20 examiners at the subsequent OSCE exam. Qualitative data were analysed using an iterative reflexive process. Quantitative data were integrated by interpretive analysis looking for convergence, complementarity or dissonance. The qualitative data helped understand the issues and informed the process of developing the questionnaire. The quantitative data allowed for further refining of issues, wider sampling of examiners and giving voice to different perspectives. Examiners stated specifically that peer feedback gave an opportunity for discussion, standardisation of judgments and improved discriminatory abilities. Interpersonal dynamics, hierarchy and perception of validity of feedback were major factors influencing acceptance of feedback. Examiners desired increased transparency, accountability and the opportunity for equal partnership within the process. The process was stressful for examiners and reviewers; however acceptance increased with increasing exposure to receiving feedback. The process could be refined to improve acceptability through scrupulous attention to training and selection of those giving feedback to improve the perceived validity of feedback and improved reviewer feedback

Sonification and haptic feedback in addition to visual feedback enhances complex motor task learning.

Science.gov (United States)

Sigrist, Roland; Rauter, Georg; Marchal-Crespo, Laura; Riener, Robert; Wolf, Peter

2015-03-01

Concurrent augmented feedback has been shown to be less effective for learning simple motor tasks than for complex tasks. However, as mostly artificial tasks have been investigated, transfer of results to tasks in sports and rehabilitation remains unknown. Therefore, in this study, the effect of different concurrent feedback was evaluated in trunk-arm rowing. It was then investigated whether multimodal audiovisual and visuohaptic feedback are more effective for learning than visual feedback only. Naïve subjects (N = 24) trained in three groups on a highly realistic virtual reality-based rowing simulator. In the visual feedback group, the subject's oar was superimposed to the target oar, which continuously became more transparent when the deviation between the oars decreased. Moreover, a trace of the subject's trajectory emerged if deviations exceeded a threshold. The audiovisual feedback group trained with oar movement sonification in addition to visual feedback to facilitate learning of the velocity profile. In the visuohaptic group, the oar movement was inhibited by path deviation-dependent braking forces to enhance learning of spatial aspects. All groups significantly decreased the spatial error (tendency in visual group) and velocity error from baseline to the retention tests. Audiovisual feedback fostered learning of the velocity profile significantly more than visuohaptic feedback. The study revealed that well-designed concurrent feedback fosters complex task learning, especially if the advantages of different modalities are exploited. Further studies should analyze the impact of within-feedback design parameters and the transferability of the results to other tasks in sports and rehabilitation.

MR-guided HIFU treatment of symptomatic uterine fibroids using novel feedback-regulated volumetric ablation: effectiveness and clinical practice.

Science.gov (United States)

Ruhnke, H; Eckey, T; Bohlmann, M K; Beldoch, M P; Neumann, A; Agic, A; Hägele, J; Diedrich, K; Barkhausen, J; Hunold, P

2013-09-01

To evaluate a novel feedback-regulated volumetric sonication method in MR-guided HIFU treatment of symptomatic uterine fibroids. 27 fibroids with an average volume of 124.9 ± 139.8 cc in 18 women with symptomatic uterine fibroids were ablated using the new HIFU system Sonalleve (1.5 T MR system Achieva, Philips). 21 myomas in 13 women were reevaluated 6 months later. Standard (treatment) cells (TC) and feedback-regulated (feedback) cells (FC) with a diameter of 4, 8, 12, and 16 mm were used and compared concerning sonication success, diameter of induced necrosis, and maximum achieved temperature. The non-perfused volume ratio (NPV related to myoma volume) was quantified. The fibroid volume was measured before, 1 month, and 6 months after therapy. Symptoms were quantified using a specific questionnaire (UFS-QoL). In total, 205 TC and 227 FC were applied. The NPV ratio was 23 ± 15 % (2 - 55). The TC were slightly smaller than intended (-3.9 ± 52 %; range, -100 - 81), while the FC were 20.1 ± 25.3 % bigger (p = 0.02). Feedback mechanism is less diversifying in diameter (p feedback cells leads to more contiguous necrosis in diameter and a less diversifying temperature. ▶ MR-guided HIFU ablation of symptomatic uterine fibroids is a valuable treatment option. ▶ By non-invasive HIFU fibroid volumes can be reduced and symptoms improved. ▶ The novel feedback-regulated treatment cells offer advantages over standard treatment cells. © Georg Thieme Verlag KG Stuttgart · New York.

Interns reflect: the effect of formative assessment with feedback during pre-internship

Directory of Open Access Journals (Sweden)

McKenzie S

2017-01-01

Full Text Available Susan McKenzie,1 Annette Burgess,2 Craig Mellis1 1Central Clinical School, 2Education Office, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Background: It is widely known that the opportunity for medical students to be observed and to receive feedback on their procedural skills performance is variable in the senior years. To address this problem, we provided our Pre-Intern (PrInt students with “one-to-one” formative feedback on their ability to perform urethral catheterization (U/C and hypothesized that their future practice of U/C as interns would benefit. This study sought to evaluate the performance and practice of interns in U/C 4–5 months after having received feedback on their performance of U/C as PrInt students.Methods: Between 2013 and 2014, two cohorts of interns, (total n=66 who had received recent formative feedback on their U/C performance as PrInt students at Central Clinical School, were invited to complete an anonymous survey. The survey contained nine closed unvalidated questions and one open-ended question, designed to allow interns to report on their current practice of U/C.Results: Forty-one out of 66 interns (62% completed the survey. Thirty-five out of 41 respondents (85% reported that the assessment with feedback during their PrInt term was beneficial to their practice. Thirty of 41 (73% reported being confident to perform U/C independently. Eleven out of 41 respondents (27% reported that they had received additional training at intern orientation. Nine of the 11 interns (82% reported that they had a small, but a significant, increase in confidence to perform U/C when compared with the 30 of the 41 respondents (73% who had not (p=0.03.Conclusion: Our results substantiate our hypothesis that further education by assessment with feedback in U/C during PrInt was of benefit to interns’ performance. Additional educational reinforcement in U/C during intern orientation further improved intern

Evaluation of a multi-methods approach to the collection and dissemination of feedback on OSCE performance in dental education.

Science.gov (United States)

Wardman, M J; Yorke, V C; Hallam, J L

2018-05-01

Feedback is an essential part of the learning process, and students expect their feedback to be personalised, meaningful and timely. Objective Structured Clinical Examination (OSCE) assessments allow examiners to observe students carefully over the course of a number of varied station types, across a number of clinical knowledge and skill domains. They therefore present an ideal opportunity to record detailed feedback which allows students to reflect on and improve their performance. This article outlines two methods by which OSCE feedback was collected and then disseminated to undergraduate dental students across 2-year groups in a UK dental school: (i) Individual written feedback comments made by examiners during the examination, (ii) General audio feedback recorded by groups of examiners immediately following the examination. Evaluation of the feedback was sought from students and staff examiners. A multi-methods approach utilising Likert questionnaire items (quantitative) and open-ended feedback questions (qualitative) was used. Data analysis explored student and staff perceptions of the audio and written feedback. A total of 131 students (response rate 68%) and 52 staff examiners (response rate 83%) completed questionnaires. Quantitative data analysis showed that the written and audio formats were reported as a meaningful source of feedback for learning by both students (93% written, 89% audio) and staff (96% written, 92% audio). Qualitative data revealed the complementary nature of both types of feedback. Written feedback gives specific, individual information whilst audio shares general observations and allows students to learn from others. The advantages, limitations and challenges of the feedback methods are discussed, leading to the development of an informed set of implementation guidelines. Written and audio feedback methods are valued by students and staff. It is proposed that these may be very easily applied to OSCEs running in other dental schools. �

Feedback and Incentives:

DEFF Research Database (Denmark)

Eriksson, Tor Viking; Poulsen, Anders; Villeval, Marie-Claire

This paper experimentally investigates the impact of different pay and relative performance information policies on employee effort. We explore three information policies: No feedback about relative performance, feedback given halfway through the production period, and continuously updated feedba...... of positive peer effects since the underdogs almost never quit the competition even when lagging significantly behind, and frontrunners do not slack off. Moreover, in both pay schemes information feedback reduces the quality of the low performers' work....

Brugbar peer feedback

DEFF Research Database (Denmark)

Hvass, Helle; Heger, Stine

Studerende kan være medskabere af undervisning i akademisk skrivning, når de modtager og giver feedback til hinandens ufærdige akademiske tekster. Det ser vi i et udviklingsprojekt, hvor vi afprøver kollektive vejledningsformater. Vi har dog erfaret: 1. at studerende mangler træning i at give og ...... modtage feedback 2. at den manglende træning kan stå i vejen for realiseringen af læringspotentialet ved peer feedback....

Feedback using an ePortfolio for medicine long cases: quality not quantity

Directory of Open Access Journals (Sweden)

Jane Bleasel

2016-10-01

Full Text Available Abstract Background The evidence for the positive impact of an electronic Portfolio (ePortfolio on feedback in medicine is mixed. An ePortfolio for medical long cases in a Graduate Medical Program was developed. The purpose of this study was to explore the perceptions of medical students and faculty of the impact of the ePortfolio on the feedback process. Methods In total, 130 Year 3 medical students, and six faculty participated in the study. This is a mixed methods study, using a combination of both quantitative and qualitative approaches. Quantitative methods were used to quantify the number of long cases performed. Qualitative methods were used to explore the relationship between quantity and quality of feedback, and provide a rich understanding of both students’ and faculty’s experience and perceptions of the ePortfolio. Results Students received a variable quantity of feedback at each of the three studied clinical schools, with an average of between 4 – 5.4 feedback episodes per student. Feedback that was constructive, specific and timely and delivered by a senior academic was important. Quantity was not an essential factor, with two episodes of detailed feedback reported to be adequate. The barriers to the use of the ePortfolio were technical aspects of the platform that interfered with student engagement. Conclusions Feedback using the ePortfolio for medical long cases is a valuable tool providing a senior clinician delivers detailed, constructive and personalized feedback in a timely fashion. The ePortfolio system needs to be user-friendly to engage students.

Global climate feedbacks

Energy Technology Data Exchange (ETDEWEB)

Manowitz, B.

1990-10-01

The important physical, chemical, and biological events that affect global climate change occur on a mesoscale -- requiring high spatial resolution for their analysis. The Department of Energy has formulated two major initiatives under the US Global Change Program: ARM (Atmospheric Radiation Measurements), and CHAMMP (Computer Hardware Advanced Mathematics and Model Physics). ARM is designed to use ground and air-craft based observations to document profiles of atmospheric composition, clouds, and radiative fluxes. With research and models of important physical processes, ARM will delineate the relationships between trace gases, aerosol and cloud structure, and radiative transfer in the atmosphere, and will improve the parameterization of global circulation models. The present GCMs do not model important feedbacks, including those from clouds, oceans, and land processes. The purpose of this workshop is to identify such potential feedbacks, to evaluate the uncertainties in the feedback processes (and, if possible, to parameterize the feedback processes so that they can be treated in a GCM), and to recommend research programs that will reduce the uncertainties in important feedback processes. Individual reports are processed separately for the data bases.

Learning how to learn using simulation: Unpacking disguised feedback using a qualitative analysis of doctors' telephone talk.

Science.gov (United States)

Eppich, Walter J; Rethans, Jan-Joost; Dornan, Timothy; Teunissen, Pim W

2018-05-04

Telephone talk between clinicians represents a substantial workplace activity in postgraduate clinical education, yet junior doctors receive little training in goal-directed, professional telephone communication. To assess educational needs for telephone talk and develop a simulation-based educational intervention. Thematic analysis of 17 semi-structured interviews with doctors-in-training from various training levels and specialties. We identified essential elements to incorporate into simulation-based telephone talk, including common challenging situations for junior doctors as well as explicit and informal aspects that promote learning. These elements have implications for both junior doctors and clinical supervisors, including: (a) explicit teaching and feedback practices and (b) informal conversational interruptions and questions. The latter serve as "disguised" feedback, which aligns with recent conceptualizations of feedback as "performance relevant information". In addition to preparing clinical supervisors to support learning through telephone talk, we propose several potential educational strategies: (a) embedding telephone communication skills throughout simulation activities and (b) developing stand-alone curricular elements to sensitize junior doctors to "disguised" feedback during telephone talk as a mechanism to augment future workplace learning, i.e. 'learning how to learn' through simulation.

Clinical Evaluation of Rapid Diagnostic Test Kit for Scrub Typhus with Improved Performance.

Science.gov (United States)

Kim, Young-Jin; Park, Sungman; Premaratna, Ranjan; Selvaraj, Stephen; Park, Sang-Jin; Kim, Sora; Kim, Donghwan; Kim, Min Soo; Shin, Dong Hoon; Choi, Kyung-Chan; Kwon, Soon-Hwan; Seo, Wonjun; Lee, Nam Taek; Kim, Seung-Han; Kang, Heui Keun; Kim, Yoon-Won

2016-08-01

Diagnosis of scrub typhus is challenging due to its more than twenty serotypes and the similar clinical symptoms with other acute febrile illnesses including leptospirosis, murine typhus and hemorrhagic fever with renal syndrome. Accuracy and rapidity of a diagnostic test to Orientia tsutsugamushi is an important step to diagnose this disease. To discriminate scrub typhus from other diseases, the improved ImmuneMed Scrub Typhus Rapid Diagnostic Test (RDT) was evaluated in Korea and Sri Lanka. The sensitivity at the base of each IgM and IgG indirect immunofluorescent assay (IFA) in Korean patients was 98.6% and 97.1%, and the specificity was 98.2% and 97.7% respectively. The sensitivity and specificity for retrospective diagnosis at the base of IFA in Sri Lanka was 92.1% and 96.1%. ImmuneMed RDT was not reactive to any serum from seventeen diseases including hemorrhagic fever with renal syndrome (n = 48), leptospirosis (n = 23), and murine typhus (n = 48). ImmuneMed RDT shows superior sensitivity (98.6% and 97.1%) compared with SD Bioline RDT (84.4% at IgM and 83.3% at IgG) in Korea. The retrospective diagnosis of ImmuneMed RDT exhibits 94.0% identity with enzyme-linked Immunosorbent assay (ELISA) using South India patient serum samples. These results suggest that this RDT can replace other diagnostic tests and is applicable for global diagnosis of scrub typhus. This rapid and accurate diagnosis will be beneficial for diagnosing and managing scrub typhus.

Hvad siger forskningen om feedback?

DEFF Research Database (Denmark)

Holdt Christensen, Peter

2016-01-01

”Feedback skal serveres ligesom en gammeldags sandwich. Først lidt brød, så det lidt sejere kød og til sidst igen til lidt brød”. Sådan nogenlunde lyder en pragmatisk løsning på udfordringerne ved at give feedback. Når medarbejdere skal have negativ feedback, skal denne altså pakkes ind, så...... feedbacken indledes med let fordøjeligt positiv feedback, derefter kommer den negative – og noget sværere fordøjelige – feedback, og til sidst afrundes feedbacken med en god udgangsreplik, nemlig den positive feedback....

Influence of feedback characteristics on perceived learning value of feedback in clerkships: does culture matter?

Science.gov (United States)

Suhoyo, Yoyo; Van Hell, Elisabeth A; Kerdijk, Wouter; Emilia, Ova; Schönrock-Adema, Johanna; Kuks, Jan B M; Cohen-Schotanus, Janke

2017-04-05

Various feedback characteristics have been suggested to positively influence student learning. It is not clear how these feedback characteristics contribute to students' perceived learning value of feedback in cultures classified low on the cultural dimension of individualism and high on power distance. This study was conducted to validate the influence of five feedback characteristics on students' perceived learning value of feedback in an Indonesian clerkship context. We asked clerks in Neurology (n = 169) and Internal Medicine (n = 132) to assess on a 5-point Likert scale the learning value of the feedback they received. We asked them to record whether the feedback provider (1) informed the student what went well, (2) mentioned which aspects of performance needed improvement, (3) compared the student's performance to a standard, (4) further explained or demonstrated the correct performance, and (5) prepared an action plan with the student to improve performance. Data were analyzed using multilevel regression. A total of 250 students participated in this study, 131 from Internal Medicine (response rate 99%) and 119 from Neurology (response rate 70%). Of these participants, 225 respondents (44% males, 56% females) completed the form and reported 889 feedback moments. Students perceived feedback as more valuable when the feedback provider mentioned their weaknesses (β = 0.153, p learning value of feedback. No gender differences were found for perceived learning value. In Indonesia, we could validate four out of the five characteristics for effective feedback. We argue that our findings relate to culture, in particular to the levels of individualism and power distance. The recognized characteristics of what constitutes effective feedback should be validated across cultures.

Results from an audit feedback strategy for chronic obstructive pulmonary disease in-hospital care: a joint analysis from the AUDIPOC and European COPD audit studies.

Science.gov (United States)

Lopez-Campos, Jose Luis; Asensio-Cruz, M Isabel; Castro-Acosta, Ady; Calero, Carmen; Pozo-Rodriguez, Francisco

2014-01-01

Clinical audits have emerged as a potential tool to summarize the clinical performance of healthcare over a specified period of time. However, the effectiveness of audit and feedback has shown inconsistent results and the impact of audit and feedback on clinical performance has not been evaluated for COPD exacerbations. In the present study, we analyzed the results of two consecutive nationwide clinical audits performed in Spain to evaluate both the in-hospital clinical care provided and the feedback strategy. The present study is an analysis of two clinical audits performed in Spain that evaluated the clinical care provided to COPD patients who were admitted to the hospital for a COPD exacerbation. The first audit was performed from November-December 2008. The feedback strategy consisted of personalized reports for each participant center, the presentation and discussion of the results at regional, national and international meetings and the creation of health-care quality standards for COPD. The second audit was part of a European study during January and February 2011. The impact of the feedback strategy was evaluated in term of clinical care provided and in-hospital survival. A total of 94 centers participated in the two audits, recruiting 8,143 admissions (audit 1∶3,493 and audit 2∶4,650). The initially provided clinical care was reasonably acceptable even though there was considerable variability. Several diagnostic and therapeutic procedures improved in the second audit. Although the differences were significant, the degree of improvement was small to moderate. We found no impact on in-hospital mortality. The present study describes COPD hospital care in Spanish hospitals and evaluates the impact of peer-benchmarked, individually written and group-oral feedback strategy on the clinical outcomes for treating COPD exacerbations. It describes small to moderate improvements in the clinical care provided to COPD patients with no impact on in

Development of the Teacher Feedback Observation Scheme: evaluating the quality of feedback in peer groups

NARCIS (Netherlands)

Thurlings, Marieke; Vermeulen, Marjan; Kreijns, Karel; Bastiaens, Theo; Stijnen, Sjef

2018-01-01

Research suggests that feedback is an essential element in learning. This study focuses on feedback that teachers provide in reciprocal peer groups to improve their performance in the classroom. The Teacher Feedback Observation Scheme (TFOS) was developed to identify feedback patterns, which

Feedback System Theory

Science.gov (United States)

1978-11-01

R 2. GOVT A $ SION NO. 3 RIEqLPýIVT’S.;TALOG NUMBER r/ 4. TITLE (and wbiFflT, -L M4 1 , FEEDBACK SYSTEM THEORY ~r Inter in- 6. PERFORMING ORG. REPORT...ANNUAL REPORT FEEDBACK SYSTEM THEORY AFOSR GRANT NO. 76-2946B Air Force Office of Scientific Research for year ending October 31, 1978 79 02 08 L|I...re less stringent than in other synthesis techniques which cannot handle significant parameter uncertainty. _I FEEDBACK SYSTEM THEORY 1. Introduction

Degeneration of rapid eye movement sleep circuitry underlies rapid eye movement sleep behavior disorder.

Science.gov (United States)

McKenna, Dillon; Peever, John

2017-05-01

During healthy rapid eye movement sleep, skeletal muscles are actively forced into a state of motor paralysis. However, in rapid eye movement sleep behavior disorder-a relatively common neurological disorder-this natural process is lost. A lack of motor paralysis (atonia) in rapid eye movement sleep behavior disorder allows individuals to actively move, which at times can be excessive and violent. At first glance this may sound harmless, but it is not because rapid eye movement sleep behavior disorder patients frequently injure themselves or the person they sleep with. It is hypothesized that the degeneration or dysfunction of the brain stem circuits that control rapid eye movement sleep paralysis is an underlying cause of rapid eye movement sleep behavior disorder. The link between brain stem degeneration and rapid eye movement sleep behavior disorder stems from the fact that rapid eye movement sleep behavior disorder precedes, in the majority (∼80%) of cases, the development of synucleinopathies such as Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy, which are known to initially cause degeneration in the caudal brain stem structures where rapid eye movement sleep circuits are located. Furthermore, basic science and clinical evidence demonstrate that lesions within the rapid eye movement sleep circuits can induce rapid eye movement sleep-specific motor deficits that are virtually identical to those observed in rapid eye movement sleep behavior disorder. This review examines the evidence that rapid eye movement sleep behavior disorder is caused by synucleinopathic neurodegeneration of the core brain stem circuits that control healthy rapid eye movement sleep and concludes that rapid eye movement sleep behavior disorder is not a separate clinical entity from synucleinopathies but, rather, it is the earliest symptom of these disorders. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and

Interns reflect: the effect of formative assessment with feedback during pre-internship

OpenAIRE

McKenzie, Susan; Burgess, Annette; Mellis, Craig

2017-01-01

Susan McKenzie,1 Annette Burgess,2 Craig Mellis1 1Central Clinical School, 2Education Office, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Background: It is widely known that the opportunity for medical students to be observed and to receive feedback on their procedural skills performance is variable in the senior years. To address this problem, we provided our Pre-Intern (PrInt) students with “one-to-one” formative feedback on their ability to p...

Evaluating quality management systems for HIV rapid testing services in primary healthcare clinics in rural KwaZulu-Natal, South Africa

OpenAIRE

Jaya, Ziningi; Drain, Paul K.; Mashamba-Thompson, Tivani P.

2017-01-01

Introduction Rapid HIV tests have improved access to HIV diagnosis and treatment by providing quick and convenient testing in rural clinics and resource-limited settings. In this study, we evaluated the quality management system for voluntary and provider-initiated point-of-care HIV testing in primary healthcare (PHC) clinics in rural KwaZulu-Natal (KZN), South Africa. Material and methods We conducted a quality assessment audit in eleven PHC clinics that offer voluntary HIV testing and couns...

Visual Acuity Testing: Feedback Affects Neither Outcome nor Reproducibility, but Leaves Participants Happier.

Science.gov (United States)

Bach, Michael; Schäfer, Kerstin

2016-01-01

Assessment of visual acuity is a well standardized procedure at least for expert opinions and clinical trials. It is often recommended not giving patients feedback on the correctness of their responses. As this viewpoint has not been quantitatively examined so far, we quantitatively assessed possible effects of feedback on visual acuity testing. In 40 normal participants we presented Landolt Cs in 8 orientations using the automated Freiburg Acuity Test (FrACT, feedback was provided in 2 x 4 conditions: (A) no feedback, (B) acoustic signals indicating correctness, (C)visual indication of correct orientation, and (D) a combination of (B) and (C). After each run the participants judged comfort. Main outcome measures were absolute visual acuity (logMAR), its test-retest agreement (limits of agreement) and participants' comfort estimates on a 5-step symmetric Likert scale. Feedback influenced acuity outcome significantly (p = 0.02), but with a tiny effect size: 0.02 logMAR poorer acuity for (D) compared to (A), even weaker effects for (B) and (C). Test-retest agreement was high (limits of agreement: ± 1.0 lines) and did not depend on feedback (p>0.5). The comfort ranking clearly differed, by 2 steps on the Likert scale: the condition (A)-no feedback-was on average "slightly uncomfortable", the other three conditions were "slightly comfortable" (pFeedback affected neither reproducibility nor the acuity outcome to any relevant extent. The participants, however, reported markedly greater comfort with any kind of feedback. We conclude that systematic feedback (as implemented in FrACT) offers nothing but advantages for routine use.

A review of invasive and non-invasive sensory feedback in upper limb prostheses.

Science.gov (United States)

Svensson, Pamela; Wijk, Ulrika; Björkman, Anders; Antfolk, Christian

2017-06-01

The constant challenge to restore sensory feedback in prosthetic hands has provided several research solutions, but virtually none has reached clinical fruition. A prosthetic hand with sensory feedback that closely imitates an intact hand and provides a natural feeling may induce the prosthetic hand to be included in the body image and also reinforces the control of the prosthesis. Areas covered: This review presents non-invasive sensory feedback systems such as mechanotactile, vibrotactile, electrotactile and combinational systems which combine the modalities; multi-haptic feedback. Invasive sensory feedback has been tried less, because of the inherent risk, but it has successfully shown to restore some afferent channels. In this review, invasive methods are also discussed, both extraneural and intraneural electrodes, such as cuff electrodes and transverse intrafascicular multichannel electrodes. The focus of the review is on non-invasive methods of providing sensory feedback to upper-limb amputees. Expert commentary: Invoking embodiment has shown to be of importance for the control of prosthesis and acceptance by the prosthetic wearers. It is a challenge to provide conscious feedback to cover the lost sensibility of a hand, not be overwhelming and confusing for the user, and to integrate technology within the constraint of a wearable prosthesis.

Using wireless technology in clinical practice: does feedback of daily walking activity improve walking outcomes of individuals receiving rehabilitation post-stroke? Study protocol for a randomized controlled trial

Science.gov (United States)

2013-01-01

Background Regaining independent ambulation is the top priority for individuals recovering from stroke. Thus, physical rehabilitation post-stroke should focus on improving walking function and endurance. However, the amount of walking completed by individuals with stroke attending rehabilitation is far below that required for independent community ambulation. There has been increased interest in accelerometer-based monitoring of walking post-stroke. Walking monitoring could be integrated within the goal-setting process for those with ambulation goals in rehabilitation. The feedback from these devices can be downloaded to a computer to produce reports. The purpose of this study is to determine the effect of accelerometer-based feedback of daily walking activity during rehabilitation on the frequency and duration of walking post-stroke. Methods Participants will be randomly assigned to one of two groups: feedback or no feedback. Participants will wear accelerometers daily during in- and out-patient rehabilitation and, for participants in the feedback group, the participants’ treating physiotherapist will receive regular reports of walking activity. The primary outcome measures are the amount of daily walking completed, as measured using the accelerometers, and spatio-temporal characteristics of walking (e.g. walking speed). We will also examine goal attainment, satisfaction with progress towards goals, stroke self-efficacy, and community-integration. Discussion Increased walking activity during rehabilitation is expected to improve walking function and community re-integration following discharge. In addition, a focus on altering walking behaviour within the rehabilitation setting may lead to altered behaviour and increased activity patterns after discharge. Trial registration ClinicalTrials.gov NCT01521234 PMID:23865593

Enhancing creative cognition with a rapid right-parietal neurofeedback procedure.

Science.gov (United States)

Agnoli, Sergio; Zanon, Marco; Mastria, Serena; Avenanti, Alessio; Corazza, Giovanni Emanuele

2018-02-14

The present article describes an innovative neurofeedback training (NFT) procedure aimed at increasing creative cognition through the enhancement of specific brain activities previously associated with divergent thinking. We designed and tested two NFT protocols based on training alpha and beta EEG oscillations selectively measured over the right parietal region. A total of 80 participants were involved, 40 in the alpha NFT protocol and 40 in the beta NFT protocol. The NFT loop was closed on a video stream that would advance only when oscillation power exceeded a normalized threshold. The total duration of the protocol was two hours in a single day, hence its classification as rapid. Changes in ideational fluency and originality, measured with a divergent thinking task, were compared between participants receiving real video feedback and participants receiving sham feedback. We controlled for individual differences in creative achievement level. Results showed that the protocols were effective at enhancing alpha and beta activities in the targeted area. Differences between the two protocols emerged in their effectiveness at promoting divergent thinking. While no significant changes in originality resulted from the rapid alpha NFT, increases in both originality and fluency emerged as a consequence of the rapid beta NFT. These results were particularly evident in participants starting with a low creative achievement level. Possible interpretations and future directions are proposed and discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Mythology of Feedback

Science.gov (United States)

Adcroft, Andy

2011-01-01

Much of the general education and discipline-specific literature on feedback suggests that it is a central and important element of student learning. This paper examines feedback from a social process perspective and suggests that feedback is best understood through an analysis of the interactions between academics and students. The paper argues…

Evaluation of Ion Torrent sequencing technology for rapid clinical human leucocyte antigen typing.

Science.gov (United States)

Guerra, Sandra G; Chong, Winnie; Brown, Colin J; Navarrete, Cristina V

2018-06-05

The development of techniques to define the human leucocyte antigen (HLA) region has proven to be challenging due to its high level of polymorphism. Within a clinical laboratory, a technique for high-resolution HLA typing, which is rapid and cost effective is essential. NGS has provided a rapid, high-resolution HLA typing solution, which has reduced the number of HLA ambiguities seen with other typing methods. In this study, the One Lambda NXType NGS kit was tested on the Ion Torrent PGM platform. A total of 362 registry donors from four ethnic populations (Europeans, South Asians, Africans and Chinese) were NGS HLA typed across 9-loci (HLA-A, -B, -C, -DRB1,-DRB345 -DQB1 and -DPB1). Concordance rates of 91%-98% were obtained (for HLA-A, -B, -C, -DRB1, -DQB1 and -DPB1) when compared to historical PCR-SSO HLA types, and the identification of uncommon alleles such as A*24:07:01 and C*04:82 were observed. A turnaround time of four days was achieved for typing 44 samples. However, some limitations were observed; primer locations did not allow all ambiguities to be resolved for HLA Class II where Exon I and IV amplification are needed (HLA-DRB1*04:07:01/04:92, HLA-DRB1*09:01:02/*09:21 and HLA-DRB1*12:01:01/*12:10). This study has demonstrated high-resolution typing by NGS can be achieved in an acceptable turnaround time for a clinical laboratory; however, the Ion Torrent workflow has some technical limitations that should be addressed. © 2018 John Wiley & Sons Ltd.

From Static Output Feedback to Structured Robust Static Output Feedback: A Survey

OpenAIRE

Sadabadi , Mahdieh ,; Peaucelle , Dimitri

2016-01-01

This paper reviews the vast literature on static output feedback design for linear time-invariant systems including classical results and recent developments. In particular, we focus on static output feedback synthesis with performance specifications, structured static output feedback, and robustness. The paper provides a comprehensive review on existing design approaches including iterative linear matrix inequalities heuristics, linear matrix inequalities with rank constraints, methods with ...

myTIPreport and Training for Independent Practice: A Tool for Real-Time Workplace Feedback for Milestones and Procedural Skills.

Science.gov (United States)

Connolly, AnnaMarie; Goepfert, Alice; Blanchard, Anita; Buys, Elizabeth; Donnellan, Nicole; Amundsen, Cindy L; Galvin, Shelley L; Kenton, Kimberly

2018-02-01

Few tools currently exist for effective, accessible delivery of real-time, workplace feedback in the clinical setting. We developed and implemented a real-time, web-based tool for performance-based feedback in the clinical environment. The tool (myTIPreport) was designed for performance-based feedback to learners on the Accreditation Council for Graduate Medical Education (ACGME) Milestones and procedural skills. "TIP" stands for "Training for Independent Practice." We implemented myTIPreport in obstetrics and gynecology (Ob-Gyn) and female pelvic medicine and reconstructive surgery (FPMRS) programs between November 2014 and May 2015. Residents, fellows, teachers, and program directors completed preimplementation and postimplementation surveys on their perceptions of feedback. Preimplementation surveys were completed by 656 participants of a total of 980 learners and teachers in 19 programs (12 Ob-Gyn and 7 FPMRS). This represented 72% (273 of 378) of learners and 64% (383 of 602) of teachers. Seventy percent of participants (381 of 546) reported having their own individual processes for real-time feedback; the majority (79%, 340 of 430) described these processes as informal discussions . Over 6 months, one-third of teachers and two-thirds of learners used the myTIPreport tool a total of 4311 times. Milestone feedback was recorded 944 times, and procedural feedback was recorded 3367 times. Feedback addressed all ACGME Milestones and procedures programmed into myTIPreport. Most program directors reported that tool implementation was successful. The majority of learners successfully received workplace feedback using myTIPreport. This web-based tool, incorporating procedures and ACGME Milestones, may be an important transition from other feedback formats.

Feedback as Real-Time Constructions

Science.gov (United States)

Keiding, Tina Bering; Qvortrup, Ane

2014-01-01

This article offers a re-description of feedback and the significance of time in feedback constructions based on systems theory. It describes feedback as internal, real-time constructions in a learning system. From this perspective, feedback is neither immediate nor delayed, but occurs in the very moment it takes place. This article argues for a…

Ambulatory Feedback System

Science.gov (United States)

Finger, Herbert; Weeks, Bill

1985-01-01

This presentation discusses instrumentation that will be used for a specific event, which we hope will carry on to future events within the Space Shuttle program. The experiment is the Autogenic Feedback Training Experiment (AFTE) scheduled for Spacelab 3, currently scheduled to be launched in November, 1984. The objectives of the AFTE are to determine the effectiveness of autogenic feedback in preventing or reducing space adaptation syndrome (SAS), to monitor and record in-flight data from the crew, to determine if prediction criteria for SAS can be established, and, finally, to develop an ambulatory instrument package to mount the crew throughout the mission. The purpose of the Ambulatory Feedback System (AFS) is to record the responses of the subject during a provocative event in space and provide a real-time feedback display to reinforce the training.

Feedback på tekst i grupper

DEFF Research Database (Denmark)

Hvass, Helle; Heger, Stine

2017-01-01

med temaet Feedback på tekst i grupper er via aktiviteter at gøre de studerende bevidste om, at feedback er noget, de skal lære, og noget, de skal øve sig på. De forskellige aktiviteter sætter de studerende i gang med at skabe rammer for feedback, at træne feedback og at give og modtage feedback på...... hinandens tekster. Temaet er bygget op omkring 2 forskellige elementer: 1) forberedelse af feedback og 2) udførelse af feedback....

Understanding feedback: A learning theory perspective

NARCIS (Netherlands)

Thurlings, Marieke; Vermeulen, Marjan; Bastiaens, Theo; Stijnen, Sjef

2018-01-01

This article aims to review literature on feedback to teachers. Because research has hardly focused on feedback among teachers, the review’s scope also includes feedback in class- rooms. The review proposes that the effectiveness of feedback and feedback processes depend on the learning theory

The Correlation between Clinical Variables and Sleep Onset Rapid Eye Movement Period Frequencies in Narcoleptic Patients

Directory of Open Access Journals (Sweden)

Jin Hwa Jeong

2010-11-01

Full Text Available Background and Objective A diagnosis of narcolepsy is defined by less than 8 minutes of mean sleep latency, and two or more sleep onset rapid eye movement periods on the Multiple Sleep Latency Test. This study examined the relationship between the sleep onset rapid eye movement period frequencies during Multiple Sleep Latency Test and narcoleptic symptom severity. Methods From March 2004 to August 2009, 126 patients suffering from excessive daytime sleepiness who visited the Sleep Disorders Clinic of St. Vincent’s Hospital at the Catholic University of Korea were tested by polysomnography and Multiple Sleep Latency Test. Subjects were divided into three groups according to the number of sleep onset rapid eye movement periods that appeared on the Multiple Sleep Latency Test. Symptom severity instruments included the Epworth Sleepiness Scale and the Stanford Center for Narcolepsy Sleep Inventory, and various sleep parameters. In addition, we performed human leukocyte antigen genotyping for human leukocyte antigen-DQB1*0602 on all patients. Results Among the three groups classified by the number of sleep onset rapid eye movement periods during Multiple Sleep Latency Test, we found no significant differences in demographic features, Epworth Sleepiness Scale, and most polysomnographic findings. However, we observed cataplexy, hypnagogic hallucination, sleep paralysis, and human leukocyte antigen-DQB1*0602 positivity more frequently in groups with higher sleep onset rapid eye movement period frequencies. In addition, the proportions of stage II sleep, REM sleep latency from polysomnography, and mean sleep latency and mean REM sleep latency from the Multiple Sleep Latency Test significantly decreased with increasing sleep onset rapid eye movement period frequency. Conclusions In this study, we demonstrated that sleep onset rapid eye movement period frequency during Multiple Sleep Latency Test correlated with sleep architecture, daytime symptom

Electrocortical reactivity to social feedback in youth: A pilot study of the Island Getaway task

Directory of Open Access Journals (Sweden)

Autumn Kujawa

2014-10-01

Full Text Available Peer relationships become a major concern in adolescence, yet event-related potential (ERP measures of reactivity to social feedback in adolescence are limited. In this pilot study, we tested a novel task to elicit reactivity to social feedback in youth. Participants (10–15 years old; 57.9% male; N = 19 played a game that involved exchanging personal information with peers, voting to remove players from the game, and receiving rejection and acceptance feedback from peers. Results indicated that participants modified their voting behavior in response to peer feedback, and rejection feedback was associated with a negativity in the ERP wave compared to acceptance (i.e., the feedback negativity, FN. The FN predicted behavioral patterns, such that participants who showed greater neural reactivity to social feedback were less likely to reject co-players. Preliminary analyses suggest that the task may be a useful measure of individual differences: adolescents higher in social anxiety symptoms were less likely to reject peers and showed an enhanced FN to rejection vs. acceptance feedback, and higher depressive symptoms predicted an increased FN to rejection specifically. Results suggest that the FN elicited by social feedback may be a useful, economical neural measure of social processing across development and in clinical research.

Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS): multicentre, three arm, cluster randomised controlled trial.

Science.gov (United States)

Guthrie, Bruce; Kavanagh, Kimberley; Robertson, Chris; Barnett, Karen; Treweek, Shaun; Petrie, Dennis; Ritchie, Lewis; Bennie, Marion

2016-08-18

 To evaluate the effectiveness of feedback on safety of prescribing compared with moderately enhanced usual care.  Three arm, highly pragmatic cluster randomised trial.  262/278 (94%) primary care practices in three Scottish health boards.  Practices were randomised to: "usual care," consisting of emailed educational material with support for searching to identify patients (88 practices at baseline, 86 analysed); usual care plus feedback on practice's high risk prescribing sent quarterly on five occasions (87 practices, 86 analysed); or usual care plus the same feedback incorporating a behavioural change component (87 practices, 86 analysed).  The primary outcome was a patient level composite of six prescribing measures relating to high risk use of antipsychotics, non-steroidal anti-inflammatories, and antiplatelets. Secondary outcomes were the six individual measures. The primary analysis compared high risk prescribing in the two feedback arms against usual care at 15 months. Secondary analyses examined immediate change and change in trend of high risk prescribing associated with implementation of the intervention within each arm.  In the primary analysis, high risk prescribing as measured by the primary outcome fell from 6.0% (3332/55 896) to 5.1% (2845/55 872) in the usual care arm, compared with 5.9% (3341/56 194) to 4.6% (2587/56 478) in the feedback only arm (odds ratio 0.88 (95% confidence interval 0.80 to 0.96) compared with usual care; P=0.007) and 6.2% (3634/58 569) to 4.6% (2686/58 582) in the feedback plus behavioural change component arm (0.86 (0.78 to 0.95); P=0.002). In the pre-specified secondary analysis of change in trend within each arm, the usual care educational intervention had no effect on the existing declining trend in high risk prescribing. Both types of feedback were associated with significantly more rapid decline in high risk prescribing after the intervention compared with before.  Feedback of prescribing safety data

Real-time feedback can improve infant manikin cardiopulmonary resuscitation by up to 79%--a randomised controlled trial.

Science.gov (United States)

Martin, Philip; Theobald, Peter; Kemp, Alison; Maguire, Sabine; Maconochie, Ian; Jones, Michael

2013-08-01

European and Advanced Paediatric Life Support training courses. Sixty-nine certified CPR providers. CPR providers were randomly allocated to a 'no-feedback' or 'feedback' group, performing two-thumb and two-finger chest compressions on a "physiological", instrumented resuscitation manikin. Baseline data was recorded without feedback, before chest compressions were repeated with one group receiving feedback. Indices were calculated that defined chest compression quality, based upon comparison of the chest wall displacement to the targets of four, internationally recommended parameters: chest compression depth, release force, chest compression rate and compression duty cycle. Baseline data were consistent with other studies, with <1% of chest compressions performed by providers simultaneously achieving the target of the four internationally recommended parameters. During the 'experimental' phase, 34 CPR providers benefitted from the provision of 'real-time' feedback which, on analysis, coincided with a statistical improvement in compression rate, depth and duty cycle quality across both compression techniques (all measures: p<0.001). Feedback enabled providers to simultaneously achieve the four targets in 75% (two-finger) and 80% (two-thumb) of chest compressions. Real-time feedback produced a dramatic increase in the quality of chest compression (i.e. from <1% to 75-80%). If these results transfer to a clinical scenario this technology could, for the first time, support providers in consistently performing accurate chest compressions during infant CPR and thus potentially improving clinical outcomes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Styrket feedback gennem studerendes selvevaluering

DEFF Research Database (Denmark)

Andersen, Lars Bo

2016-01-01

Studerende er ofte utilfredse med såvel kvaliteten som kvantiteten af feedback på skriftligt arbejde. Ligeledes kan det som underviser være svært at afgive feedback, der tager udgangspunkt i de studerendes respektive læringssituationer, hvis man ikke har andet afsæt end opgavetekster. Denne artikel...... beskriver derfor to eksperimenter med brug af selvevaluering som kvalificerende mellemled i ekstern feedback på skriveøvelser. Eksperimenternes formål er at styrke den formative læring ved skriftligt arbejde. I det første eksperiment bestod feedbacken af underviser-feedback, mens det andet eksperiment...... indebar peer-feedback og fælles feedback. I begge tilfælde blev selvevalueringen foretaget med udgangspunkt i en kriteriebaseret retteguide. Eksperimenterne medførte, at den eksterne feedback blev målrettet og kvalificeret i forhold til den enkelte studerende, mens selve skriveprocessen mod forventning...

Rapid determination of natural steroidal hormones in saliva for the clinical diagnoses

Directory of Open Access Journals (Sweden)

Oh Jin-Aa

2012-03-01

Full Text Available Abstract Background Saliva samples are easily collectable and non-invasive, and the monitoring of natural steroidal hormones, such as estrone (E1, 17β-estradiol (E2, estriol (E3, progesterone (P, and testosterone (T, in saliva has attracted much attention due to its numerous potential clinical and health-related applications. Because E1, E2, E3, P and T are useful indicators in numerous clinical and health-related diagnoses, there is a need for simultaneous determination. Results A gas chromatography-mass spectrometric assay was developed for rapid simultaneous determination of E1, E2, E3, P and T in saliva for clinical diagnoses. Extraction was achieved with a liquid extraction using 3.0 mL of pentane. The extract was dried and silylated with N-methyl-N-(trimethylsilyl trifluoroacetamide/NH4I (100:2 under a catalysis of 1.5% dithioerythritol for 10 min at 90°C. The accuracy of the analytes was in the range of 96% to 112% at concentrations of 0.05 and 0.10 μg/L (5.0 and 10.0 μg/L for E3, respectively, with relative standard deviations of less than 11%. The lowest quantification limits were from 0.002 to 0.6 μg/L for 1.0 mL of saliva. Conclusion Natural steroidal hormones were detected in the concentration ranges of nd to 0.2 μg/L in human saliva. The salivary testosterone values in the patients with prostatic carcinoma were significantly lower than in normal males. The method may useful in numerous clinical and health-related diagnoses.

Am I ready for it? Students’ perceptions of meaningful feedback on entrustable professional activities

NARCIS (Netherlands)

Duijn, Chantal C. M. A.; Welink, Lisanne S; Mandoki, Mira; Ten Cate, Olle Th J; Kremer, Wim D. J.; Bok, Harold G. J.

2017-01-01

Background Receiving feedback while in the clinical workplace is probably the most frequently voiced desire of students. In clinical learning environments, providing and seeking performance-relevant information is often difficult for both supervisors and students. The use of entrustable professional

SU-E-T-23: A Developing Australian Network for Datamining and Modelling Routine Radiotherapy Clinical Data and Radiomics Information for Rapid Learning and Clinical Decision Support

Energy Technology Data Exchange (ETDEWEB)

Thwaites, D [University of Sydney, Camperdown, Sydney (Australia); Holloway, L [Ingham Institute, Sydney, NSW (Australia); Bailey, M; Carolan, M; Miller, A [Illawarra Cancer Care Centre, Wollongong, NSW (Australia); Barakat, S; Field, M [University of Sydney, Sydney, NSW (Australia); Delaney, G; Vinod, S [Liverpool Hospital, Liverpool, NSW (Australia); Dekker, A [Maastro Clinic, Maastricht (Netherlands); Lustberg, T; Soest, J van; Walsh, S [MAASTRO Clinic, Maastricht (Netherlands)

2015-06-15

Purpose: Large amounts of routine radiotherapy (RT) data are available, which can potentially add clinical evidence to support better decisions. A developing collaborative Australian network, with a leading European partner, aims to validate, implement and extend European predictive models (PMs) for Australian practice and assess their impact on future patient decisions. Wider objectives include: developing multi-institutional rapid learning, using distributed learning approaches; and assessing and incorporating radiomics information into PMs. Methods: Two initial standalone pilots were conducted; one on NSCLC, the other on larynx, patient datasets in two different centres. Open-source rapid learning systems were installed, for data extraction and mining to collect relevant clinical parameters from the centres’ databases. The European DSSs were learned (“training cohort”) and validated against local data sets (“clinical cohort”). Further NSCLC studies are underway in three more centres to pilot a wider distributed learning network. Initial radiomics work is underway. Results: For the NSCLC pilot, 159/419 patient datasets were identified meeting the PM criteria, and hence eligible for inclusion in the curative clinical cohort (for the larynx pilot, 109/125). Some missing data were imputed using Bayesian methods. For both, the European PMs successfully predicted prognosis groups, but with some differences in practice reflected. For example, the PM-predicted good prognosis NSCLC group was differentiated from a combined medium/poor prognosis group (2YOS 69% vs. 27%, p<0.001). Stage was less discriminatory in identifying prognostic groups. In the good prognosis group two-year overall survival was 65% in curatively and 18% in palliatively treated patients. Conclusion: The technical infrastructure and basic European PMs support prognosis prediction for these Australian patient groups, showing promise for supporting future personalized treatment decisions

SU-E-T-23: A Developing Australian Network for Datamining and Modelling Routine Radiotherapy Clinical Data and Radiomics Information for Rapid Learning and Clinical Decision Support

International Nuclear Information System (INIS)

Thwaites, D; Holloway, L; Bailey, M; Carolan, M; Miller, A; Barakat, S; Field, M; Delaney, G; Vinod, S; Dekker, A; Lustberg, T; Soest, J van; Walsh, S

2015-01-01

Purpose: Large amounts of routine radiotherapy (RT) data are available, which can potentially add clinical evidence to support better decisions. A developing collaborative Australian network, with a leading European partner, aims to validate, implement and extend European predictive models (PMs) for Australian practice and assess their impact on future patient decisions. Wider objectives include: developing multi-institutional rapid learning, using distributed learning approaches; and assessing and incorporating radiomics information into PMs. Methods: Two initial standalone pilots were conducted; one on NSCLC, the other on larynx, patient datasets in two different centres. Open-source rapid learning systems were installed, for data extraction and mining to collect relevant clinical parameters from the centres’ databases. The European DSSs were learned (“training cohort”) and validated against local data sets (“clinical cohort”). Further NSCLC studies are underway in three more centres to pilot a wider distributed learning network. Initial radiomics work is underway. Results: For the NSCLC pilot, 159/419 patient datasets were identified meeting the PM criteria, and hence eligible for inclusion in the curative clinical cohort (for the larynx pilot, 109/125). Some missing data were imputed using Bayesian methods. For both, the European PMs successfully predicted prognosis groups, but with some differences in practice reflected. For example, the PM-predicted good prognosis NSCLC group was differentiated from a combined medium/poor prognosis group (2YOS 69% vs. 27%, p<0.001). Stage was less discriminatory in identifying prognostic groups. In the good prognosis group two-year overall survival was 65% in curatively and 18% in palliatively treated patients. Conclusion: The technical infrastructure and basic European PMs support prognosis prediction for these Australian patient groups, showing promise for supporting future personalized treatment decisions

Feedforward and feedback motor control abnormalities implicate cerebellar dysfunctions in autism spectrum disorder.

Science.gov (United States)

Mosconi, Matthew W; Mohanty, Suman; Greene, Rachel K; Cook, Edwin H; Vaillancourt, David E; Sweeney, John A

2015-02-04

Sensorimotor abnormalities are common in autism spectrum disorder (ASD) and among the earliest manifestations of the disorder. They have been studied far less than the social-communication and cognitive deficits that define ASD, but a mechanistic understanding of sensorimotor abnormalities in ASD may provide key insights into the neural underpinnings of the disorder. In this human study, we examined rapid, precision grip force contractions to determine whether feedforward mechanisms supporting initial motor output before sensory feedback can be processed are disrupted in ASD. Sustained force contractions also were examined to determine whether reactive adjustments to ongoing motor behavior based on visual feedback are altered. Sustained force was studied across multiple force levels and visual gains to assess motor and visuomotor mechanisms, respectively. Primary force contractions of individuals with ASD showed greater peak rate of force increases and large transient overshoots. Individuals with ASD also showed increased sustained force variability that scaled with force level and was more severe when visual gain was highly amplified or highly degraded. When sustaining a constant force level, their reactive adjustments were more periodic than controls, and they showed increased reliance on slower feedback mechanisms. Feedforward and feedback mechanism alterations each were associated with more severe social-communication impairments in ASD. These findings implicate anterior cerebellar circuits involved in feedforward motor control and posterior cerebellar circuits involved in transforming visual feedback into precise motor adjustments in ASD. Copyright © 2015 the authors 0270-6474/15/352015-11$15.00/0.

Quantity and quality of written feedback, action plans, and student ...

African Journals Online (AJOL)

Background. Mini-clinical-evaluation exercise (mini-CEX) assessment forms that have been modified with the addition of specific spaces on separate sheets are expected to improve the quantity and quality of written feedback and the action plan for further learning which is agreed upon, and to encourage written reflection.

Synthesis of human-nature feedbacks

Directory of Open Access Journals (Sweden)

Vanessa Hull

2015-09-01

Full Text Available In today's globalized world, humans and nature are inextricably linked. The coupled human and natural systems (CHANS framework provides a lens with which to understand such complex interactions. One of the central components of the CHANS framework involves examining feedbacks among human and natural systems, which form when effects from one system on another system feed back to affect the first system. Despite developments in understanding feedbacks in single disciplines, interdisciplinary research on CHANS feedbacks to date is scant and often site-specific, a shortcoming that prevents complex coupled systems from being fully understood. The special feature "Exploring Feedbacks in Coupled Human and Natural Systems (CHANS" makes strides to fill this critical gap. Here, as an introduction to the special feature, we provide an overview of CHANS feedbacks. In addition, we synthesize key CHANS feedbacks that emerged in the papers of this special feature across agricultural, forest, and urban landscapes. We also examine emerging themes explored across the papers, including multilevel feedbacks, time lags, and surprises as a result of feedbacks. We conclude with recommendations for future research that can build upon the foundation provided in the special feature.

Feedback For Helpers

Science.gov (United States)

Stromer, Walter F.

1975-01-01

The author offers some feedback to those in the helping professions in three areas: (1) forms and letters; (2) jumping to conclusions; and (3) blaming and belittling, in hopes of stimulating more feedback as well as more positive ways of performing their services. (HMV)

Training effectiveness feedback

International Nuclear Information System (INIS)

Wiggin, N.A.

1987-01-01

A formal method of getting feedback about the job performance of employees is a necessary part of all the authors training programs. The formal process may prove to be inadequate if it is the only process in use. There are many ways and many opportunities to get good feedback about employee performance. It is important to document these methods and specific instances to supplement the more formalized process. The key is to identify them, encourage them, use them, and document the training actions that result from them. This paper describes one plant's method of getting feedback about performance of technicians in the field

Teacher feedback in the classroom. Analyzing and developing teachers' feedback behavior in secondary education

NARCIS (Netherlands)

Voerman, A.

2014-01-01

Providing feedback is one of the most influential means of teachers to enhance student learning. In this dissertation, we first focused on what is known from research about effective (i.e. learning-enhancing) feedback. Effective feedback, mostly studied from a cognitive psychologist point of view,

Feedback Networks

OpenAIRE

Zamir, Amir R.; Wu, Te-Lin; Sun, Lin; Shen, William; Malik, Jitendra; Savarese, Silvio

2016-01-01

Currently, the most successful learning models in computer vision are based on learning successive representations followed by a decision layer. This is usually actualized through feedforward multilayer neural networks, e.g. ConvNets, where each layer forms one of such successive representations. However, an alternative that can achieve the same goal is a feedback based approach in which the representation is formed in an iterative manner based on a feedback received from previous iteration's...

Malaysian Tertiary Level ESL Students’ Perceptions toward Teacher Feedback, Peer Feedback and Self-assessment in their Writing

Directory of Open Access Journals (Sweden)

Kayatri Vasu

2016-09-01

Full Text Available In Malaysia, teacher feedback is highly preferred by students, who often believe that teachers know best. Teacher feedback shows them their teacher’s idea of an ideal writing. However, excessive dependence on teachers adds to their workload. Therefore, teachers are increasingly promoting two other alternative methods that are gradually gaining importance. These methods are peer feedback and self-assessment. This study investigates ESL students’ perceptions toward teacher feedback, peer feedback and self-assessment in students’ writing process. Questionnaires, adapted from the instruments in the literature, were administered to 107 randomly selected students in a private local university in Malaysia. Students found feedback given to the content and organization of their writing more useful than feedback provided for their vocabulary and grammar. It was also found that students perceived feedback from teacher, peers and self-assessment all as highly useful. Additionally the results indicated while there was no significant difference (p > .05 between the students’ perceptions toward teacher feedback and self-assessment, they were both perceived as significantly more useful (p < .001 than peer feedback. The students also perceived explicit feedback as significantly more useful (p < .001 than implicit feedback. The results of this study have implications for English language learning-teaching practitioners and researchers. They shed light on the options preferred by students in revising their writing in ESL writing classrooms. Future research on the effects of teacher feedback, peer feedback and self-assessment on students’ writing performance will provide better insight on the preferred methods in ESL writing classrooms in similar settings.

GIVING AND RECEIVING CONSTRUCTIVE FEEDBACK

Directory of Open Access Journals (Sweden)

Ірина Олійник

2015-05-01

Full Text Available The article scrutinizes the notion of feedback applicable in classrooms where team teaching is provided. The experience of giving and receiving feedback has been a good practice in cooperation between a U.S. Peace Corps volunteer and a Ukrainian counterpart. Giving and receiving feedback is an effective means of classroom observation that provides better insight into the process of teaching a foreign language. The article discusses the stages of feedback and explicates the notion of sharing experience between two teachers working simultaneously in the same classroom. The guidelines for giving and receiving feedback have been provided as well as the most commonly used vocabulary items have been listed. It has been proved that mutual feedback leads to improving teaching methods and using various teaching styles and techniques.

Moving Feedback Forward: Theory to Practice

Science.gov (United States)

Orsmond, Paul; Maw, Stephen J.; Park, Julian R.; Gomez, Stephen; Crook, Anne C.

2013-01-01

There is substantial research interest in tutor feedback and students' perception and use of such feedback. This paper considers some of the major issues raised in relation to tutor feedback and student learning. We explore some of the current feedback drivers, most notably the need for feedback to move away from simply a monologue from a tutor to…

RF feedback for KEKB

Energy Technology Data Exchange (ETDEWEB)

Ezura, Eizi; Yoshimoto, Shin-ichi; Akai, Kazunori [National Lab. for High Energy Physics, Tsukuba, Ibaraki (Japan)

1996-08-01

This paper describes the present status of the RF feedback development for the KEK B-Factory (KEKB). A preliminary experiment concerning the RF feedback using a parallel comb-filter was performed through a choke-mode cavity and a klystron. The RF feedback has been tested using the beam of the TRISTAN Main Ring, and has proved to be effective in damping the beam instability. (author)

Addressing unwarranted clinical variation: A rapid review of current evidence.

Science.gov (United States)

Harrison, Reema; Manias, Elizabeth; Mears, Stephen; Heslop, David; Hinchcliff, Reece; Hay, Liz

2018-05-15

Unwarranted clinical variation (UCV) can be described as variation that can only be explained by differences in health system performance. There is a lack of clarity regarding how to define and identify UCV and, once identified, to determine whether it is sufficiently problematic to warrant action. As such, the implementation of systemic approaches to reducing UCV is challenging. A review of approaches to understand, identify, and address UCV was undertaken to determine how conceptual and theoretical frameworks currently attempt to define UCV, the approaches used to identify UCV, and the evidence of their effectiveness. Rapid evidence assessment (REA) methodology was used. A range of text words, synonyms, and subject headings were developed for the major concepts of unwarranted clinical variation, standards (and deviation from these standards), and health care environment. Two electronic databases (Medline and Pubmed) were searched from January 2006 to April 2017, in addition to hand searching of relevant journals, reference lists, and grey literature. Results were merged using reference-management software (Endnote) and duplicates removed. Inclusion criteria were independently applied to potentially relevant articles by 3 reviewers. Findings were presented in a narrative synthesis to highlight key concepts addressed in the published literature. A total of 48 relevant publications were included in the review; 21 articles were identified as eligible from the database search, 4 from hand searching published work and 23 from the grey literature. The search process highlighted the voluminous literature reporting clinical variation internationally; yet, there is a dearth of evidence regarding systematic approaches to identifying or addressing UCV. Wennberg's classification framework is commonly cited in relation to classifying variation, but no single approach is agreed upon to systematically explore and address UCV. The instances of UCV that warrant investigation and

Remission of classic rapid cycling bipolar disorder with levothyroxine augmentation therapy in a male patient having clinical hypothyroidism

Directory of Open Access Journals (Sweden)

Chen PH

2015-02-01

Full Text Available Pao-Huan Chen, Yu-Jui Huang Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan Abstract: The literature suggests that patients with bipolar disorder, particularly females, have greater vulnerability to rapid cycling features. Levothyroxine therapy might be potentially useful to attenuate mood instability in this patient group. In contrast, reports on male patients remain limited and controversial. Herein, we report a 32-year-old male patient who had bipolar 1 disorder for 12 years who developed a breakthrough rapid cycling course and first-onset clinical hypothyroidism at the age of 31 years during lithium therapy. After levothyroxine augmentation therapy was introduced, the patient had remission from the rapid cycling illness course along with normalization of serum levels of free T4 and thyroid stimulating hormone in the subsequent year. This observation suggested that investigation of both levothyroxine pharmacology and thyroid pathology in male patients with rapid cycling bipolar disorder might be of much value. Keywords: mood disorder, therapy, thyroid hormone

Next-generation audit and feedback for inpatient quality improvement using electronic health record data: a cluster randomised controlled trial.

Science.gov (United States)

Patel, Sajan; Rajkomar, Alvin; Harrison, James D; Prasad, Priya A; Valencia, Victoria; Ranji, Sumant R; Mourad, Michelle

2018-03-05

Audit and feedback improves clinical care by highlighting the gap between current and ideal practice. We combined best practices of audit and feedback with continuously generated electronic health record data to improve performance on quality metrics in an inpatient setting. We conducted a cluster randomised control trial comparing intensive audit and feedback with usual audit and feedback from February 2016 to June 2016. The study subjects were internal medicine teams on the teaching service at an urban tertiary care hospital. Teams in the intensive feedback arm received access to a daily-updated team-based data dashboard as well as weekly inperson review of performance data ('STAT rounds'). The usual feedback arm received ongoing twice-monthly emails with graphical depictions of team performance on selected quality metrics. The primary outcome was performance on a composite discharge metric (Discharge Mix Index, 'DMI'). A washout period occurred at the end of the trial (from May through June 2016) during which STAT rounds were removed from the intensive feedback arm. A total of 40 medicine teams participated in the trial. During the intervention period, the primary outcome of completion of the DMI was achieved on 79.3% (426/537) of patients in the intervention group compared with 63.2% (326/516) in the control group (Paudit and feedback using timely data and STAT rounds significantly increased performance on a composite discharge metric compared with usual feedback. With the cessation of STAT rounds, performance between the intensive and usual feedback groups did not differ significantly, highlighting the importance of feedback delivery on effecting change. The trial was registered with ClinicalTrials.gov (NCT02593253). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Acute gouty arthritis and rapidly progressive renal failure as manifestation of multiple myeloma: clinical case description

Directory of Open Access Journals (Sweden)

O.V. Gudym

2017-08-01

Full Text Available The article describes a clinical case of multiple myeloma in 78-year-old man, its clinical onset was as an acute attack of gout. The patient was admitted to hospital due to the development of the first acute attack of gout. The attack was characterized by polyarthricular joint lesion of the upper and lower extremities, pronounced inflammatory reaction, insufficient response to the use of non-steroidal anti-inflammatory drugs, and a high level of hyperuricemia. The serum uric acid concentration ranged from 636 to 712 μmol/l. The study of the synovial fluid of the inflamed knee joint made it possible to reveal uric acid crystals and to confirm the diagnosis of acute gouty arthritis. Simultaneously, the patient had significant renal impairment: creatinine was 574 μmol/l, urea — 39.9 mmol/l, glomerular filtration rate according to CKD-EPI — 8 ml/min. The daily proteinuria was 1.8 g. A retrospective assessment of laboratory parameters allowed to reveal completely normal indicators of renal function 6 months ago. Considering the development of acute gouty arthritis, its polyarticular nature, persistent course, rapid involvement of new joints, high uric acid levels during an acute attack exceeding 600 μmol/l (10 mg/dL, rapid development of renal failure within 6 months until the terminal stage, it was suggested the secondary nature of gout on the background of kidney damage by another pathological process. Further clinical, laboratory and instrumental studies allowed verifying multiple myeloma with renal damage. Bence Jones protein in the urine was not detected, there was also no evidence of hyperproteinemia. However, pain in the spine, ribs and chest was the basis for carrying out an X-ray study of the bones of the skeleton. Changes in the skeleton typical for multiple myeloma have been identified. Myelogram showed a high content of plasma cells (21.1 %, electrophoresis of blood proteins showed a high M-gradient (30.42 %, and a cytochemical

Altered Sensory Feedbacks in Pianist's Dystonia: the altered auditory feedback paradigm and the glove effect

Directory of Open Access Journals (Sweden)

Felicia Pei-Hsin Cheng

2013-12-01

Full Text Available Background: This study investigates the effect of altered auditory feedback (AAF in musician's dystonia (MD and discusses whether altered auditory feedback can be considered as a sensory trick in MD. Furthermore, the effect of AAF is compared with altered tactile feedback, which can serve as a sensory trick in several other forms of focal dystonia. Methods: The method is based on scale analysis (Jabusch et al. 2004. Experiment 1 employs synchronization paradigm: 12 MD patients and 25 healthy pianists had to repeatedly play C-major scales in synchrony with a metronome on a MIDI-piano with 3 auditory feedback conditions: 1. normal feedback; 2. no feedback; 3. constant delayed feedback. Experiment 2 employs synchronization-continuation paradigm: 12 MD patients and 12 healthy pianists had to repeatedly play C-major scales in two phases: first in synchrony with a metronome, secondly continue the established tempo without the metronome. There are 4 experimental conditions, among them 3 are the same altered auditory feedback as in Experiment 1 and 1 is related to altered tactile sensory input. The coefficient of variation of inter-onset intervals of the key depressions was calculated to evaluate fine motor control. Results: In both experiments, the healthy controls and the patients behaved very similarly. There is no difference in the regularity of playing between the two groups under any condition, and neither did AAF nor did altered tactile feedback have a beneficial effect on patients’ fine motor control. Conclusions: The results of the two experiments suggest that in the context of our experimental designs, AAF and altered tactile feedback play a minor role in motor coordination in patients with musicians' dystonia. We propose that altered auditory and tactile feedback do not serve as effective sensory tricks and may not temporarily reduce the symptoms of patients suffering from MD in this experimental context.

3D Rapid Prototyping for Otolaryngology-Head and Neck Surgery: Applications in Image-Guidance, Surgical Simulation and Patient-Specific Modeling.

Science.gov (United States)

Chan, Harley H L; Siewerdsen, Jeffrey H; Vescan, Allan; Daly, Michael J; Prisman, Eitan; Irish, Jonathan C

2015-01-01

The aim of this study was to demonstrate the role of advanced fabrication technology across a broad spectrum of head and neck surgical procedures, including applications in endoscopic sinus surgery, skull base surgery, and maxillofacial reconstruction. The initial case studies demonstrated three applications of rapid prototyping technology are in head and neck surgery: i) a mono-material paranasal sinus phantom for endoscopy training ii) a multi-material skull base simulator and iii) 3D patient-specific mandible templates. Digital processing of these phantoms is based on real patient or cadaveric 3D images such as CT or MRI data. Three endoscopic sinus surgeons examined the realism of the endoscopist training phantom. One experienced endoscopic skull base surgeon conducted advanced sinus procedures on the high-fidelity multi-material skull base simulator. Ten patients participated in a prospective clinical study examining patient-specific modeling for mandibular reconstructive surgery. Qualitative feedback to assess the realism of the endoscopy training phantom and high-fidelity multi-material phantom was acquired. Conformance comparisons using assessments from the blinded reconstructive surgeons measured the geometric performance between intra-operative and pre-operative reconstruction mandible plates. Both the endoscopy training phantom and the high-fidelity multi-material phantom received positive feedback on the realistic structure of the phantom models. Results suggested further improvement on the soft tissue structure of the phantom models is necessary. In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases. No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room. The applicability of common model design and fabrication techniques

Development of a longitudinal feedback cavity for the beam feedback system

International Nuclear Information System (INIS)

Huang Gang; Chen Huaibi; Huang Wenhui; Tong Dechun; Lin Yuzheng; Zhao Zhentang

2003-01-01

Longitudinal beam feedback system is widely used to damp coupling bunch instability. Kicker is one of the key components of the longitudinal feedback system. A prototype cavity of longitudinal feedback kicker is developed according to the parameter of BEPC II. The usage of nose cone in the kicker design increased the shunt impedance. In order to avoid the extra tapper in the storage ring, the racetrack shape beam pipe is applied in the kicker. The impedance and the bandwidth of the kicker is measured by the coaxial line impedance measurement platform and the result achieved the design goals

Optimal allocation of reviewers for peer feedback

DEFF Research Database (Denmark)

Wind, David Kofoed; Jensen, Ulf Aslak; Jørgensen, Rasmus Malthe

2017-01-01

feedback to be effective students should give and receive useful feedback. A key challenge in peer feedback is allocating the feedback givers in a good way. It is important that reviewers are allocated to submissions such that the feedback distribution is fair - meaning that all students receive good......Peer feedback is the act of letting students give feedback to each other on submitted work. There are multiple reasons to use peer feedback, including students getting more feedback, time saving for teachers and increased learning by letting students reflect on work by others. In order for peer...... indicated the quality of the feedback. Using this model together with historical data we calculate the feedback-giving skill of each student and uses that as input to an allocation algorithm that assigns submissions to reviewers, in order to optimize the feedback quality for all students. We test...

Feedback Systems for Linear Colliders

International Nuclear Information System (INIS)

1999-01-01

Feedback systems are essential for stable operation of a linear collider, providing a cost-effective method for relaxing tight tolerances. In the Stanford Linear Collider (SLC), feedback controls beam parameters such as trajectory, energy, and intensity throughout the accelerator. A novel dithering optimization system which adjusts final focus parameters to maximize luminosity contributed to achieving record performance in the 1997-98 run. Performance limitations of the steering feedback have been investigated, and improvements have been made. For the Next Linear Collider (NLC), extensive feedback systems are planned as an integral part of the design. Feedback requirements for JLC (the Japanese Linear Collider) are essentially identical to NLC; some of the TESLA requirements are similar but there are significant differences. For NLC, algorithms which incorporate improvements upon the SLC implementation are being prototyped. Specialized systems for the damping rings, rf and interaction point will operate at high bandwidth and fast response. To correct for the motion of individual bunches within a train, both feedforward and feedback systems are planned. SLC experience has shown that feedback systems are an invaluable operational tool for decoupling systems, allowing precision tuning, and providing pulse-to-pulse diagnostics. Feedback systems for the NLC will incorporate the key SLC features and the benefits of advancing technologies

Feedback systems in the SLC

International Nuclear Information System (INIS)

Thompson, K.A.; Jobe, R.K.; Johnson, R.; Phinney, N.

1987-02-01

Two classes of computer-controlled feedback have been implemented to stabilize parameters in subsystems of the SLC: (1) ''slow'' (time scales ∼ minutes) feedback, and (2) ''fast'', i.e., pulse-to-pulse, feedback. The slow loops run in a single FEEDBACK process in the SLC host VAX, which acquires signals and sets control parameters via communication with the database and the network of normal SLC microprocessors. Slow loops exist to stabilize beam energy and energy spread, beam position and angle, and timing of kicker magnets, and to compensate for changes in the phase length of the rf drive line. The fast loops run in dedicated microprocessors, and may sample and/or feedback on particular parameters as often as every pulse of the SLC beam. The first implementations of fast feedback are to control transverse beam blow-up and to stabilize the energy and energy spread of bunches going into the SLC arcs. The overall architecture of the feedback software and the operator interface for controlling loops are discussed

Emotional feedback for mobile devices

CERN Document Server

Seebode, Julia

2015-01-01

This book investigates the functional adequacy as well as the affective impression made by feedback messages on mobile devices. It presents an easily adoptable experimental setup to examine context effects on various feedback messages, and applies it to auditory, tactile and auditory-tactile feedback messages. This approach provides insights into the relationship between the affective impression and functional applicability of these messages as well as an understanding of the influence of unimodal components on the perception of multimodal feedback messages. The developed paradigm can also be extended to investigate other aspects of context and used to investigate feedback messages in modalities other than those presented. The book uses questionnaires implemented on a Smartphone, which can easily be adopted for field studies to broaden the scope even wider. Finally, the book offers guidelines for the design of system feedback.

Multi-bunch feedback systems

CERN Document Server

Lonza, M

2008-01-01

Coupled-bunch instabilities excited by the interaction of the particle beam with its surroundings can seriously limit the performance of circular particle accelerators. These instabilities can be cured by the use of active feedback systems based on sensors capable of detecting the unwanted beam motion and actuators that apply the feedback correction to the beam. The advances in electronic technology now allow the implementation of feedback loops using programmable digital systems. Besides important advantages in terms of flexibility and reproducibility, digital systems open the way to the use of novel diagnostic tools and additional features. The lecture will first introduce coupled-bunch instabilities analysing the equation of motion of charged particles and the different modes of oscillation of a multi-bunch beam, showing how they can be observed and measured. Different types of feedbacks systems will then be presented as examples of real implementations that belong to the history of multi-bunch feedback sy...

Multi-bunch Feedback Systems

CERN Document Server

Lonza, M.

2014-12-19

Coupled-bunch instabilities excited by the interaction of the particle beam with its surroundings can seriously limit the performance of circular particle accelerators. These instabilities can be cured by the use of active feedback systems based on sensors capable of detecting the unwanted beam motion and actuators that apply the feedback correction to the beam. Advances in electronic technology now allow the implementation of feedback loops using programmable digital systems. Besides important advantages in terms of flexibility and reproducibility, digital systems open the way to the use of novel diagnostic tools and additional features. We first introduce coupled-bunch instabilities, analysing the equation of motion of charged particles and the different modes of oscillation of a multi-bunch beam, showing how they can be observed and measured. Different types of feedback systems will then be presented as examples of real implementations that belong to the history of multi-bunch feedback systems. The main co...

Providing Feedback: Practical Skills and Strategies.

Science.gov (United States)

Sarkany, David; Deitte, Lori

2017-06-01

Feedback is an essential component of education. It is designed to influence, reinforce, and change behaviors, concepts, and attitudes in learners. Although providing constructive feedback can be challenging, it is a learnable skill. The negative consequences of destructive feedback or lack of feedback all together are far-reaching. This article summarizes the components of constructive feedback and provides readers with tangible skills to enhance their ability to give effective feedback to learners and peers. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Training Peer-Feedback Skills on Geometric Construction Tasks: Role of Domain Knowledge and Peer-Feedback Levels

Science.gov (United States)

Alqassab, Maryam; Strijbos, Jan-Willem; Ufer, Stefan

2018-01-01

Peer feedback is widely used to train assessment skills and to support collaborative learning of various learning tasks, but research on peer feedback in the domain of mathematics is limited. Although domain knowledge seems to be a prerequisite for peer-feedback provision, it only recently received attention in the peer-feedback literature. In…

Standardized Patients Provide a Reliable Assessment of Athletic Training Students' Clinical Skills

Science.gov (United States)

Armstrong, Kirk J.; Jarriel, Amanda J.

2016-01-01

Context: Providing students reliable objective feedback regarding their clinical performance is of great value for ongoing clinical skill assessment. Since a standardized patient (SP) is trained to consistently portray the case, students can be assessed and receive immediate feedback within the same clinical encounter; however, no research, to our…

Sustainable feedback: students’ and tutors’ perceptions

NARCIS (Netherlands)

Geitz, Gerry; Joosten-ten Brinke, Desirée; Kirschner, Paul A.

2018-01-01

Feedback has been shown to substantially influence students’ learning. However, not everything characterized as feedback is effective. Sustainable feedback places students in an active role in which they generate and use feedback from peers, self or others and aims at developing lifelong learning

Multi-bunch Feedback Systems

OpenAIRE

Lonza, M.; Schmickler, H.

2016-01-01

Coupled-bunch instabilities excited by the interaction of the particle beam with its surroundings can seriously limit the performance of circular particle accelerators. These instabilities can be cured by the use of active feedback systems based on sensors capable of detecting the unwanted beam motion and actuators that apply the feedback correction to the beam. Advances in electronic technology now allow the implementation of feedback loops using programmable digital systems. Besides importa...

Influence of feedback characteristics on perceived learning value of feedback in clerkships : does culture matter?

NARCIS (Netherlands)

Suhoyo, Yoyo; Van Hell, Elisabeth A.; Kerdijk, Wouter; Emilia, Ova; Schonrock-Adema, Johanna; Kuks, Jan B. M.; Cohen-Schotanus, Janke

2017-01-01

Background: Various feedback characteristics have been suggested to positively influence student learning. It is not clear how these feedback characteristics contribute to students' perceived learning value of feedback in cultures classified low on the cultural dimension of individualism and high on

Influence of feedback characteristics on perceived learning value of feedback in clerkships : does culture matter?

NARCIS (Netherlands)

Suhoyo, Yoyo; Van Hell, Elisabeth A; Kerdijk, Wouter; Emilia, Ova; Schönrock-Adema, Johanna; Kuks, Jan B M; Cohen-Schotanus, Janke

2017-01-01

BACKGROUND: Various feedback characteristics have been suggested to positively influence student learning. It is not clear how these feedback characteristics contribute to students' perceived learning value of feedback in cultures classified low on the cultural dimension of individualism and high on

"Are You Listening Please?" The Advantages of Electronic Audio Feedback Compared to Written Feedback

Science.gov (United States)

Lunt, Tom; Curran, John

2010-01-01

Feedback on students' work is, probably, one of the most important aspects of learning, yet students' report, according to the National Union of Students (NUS) Survey of 2008, unhappiness with the feedback process. Students were unhappy with the quality, detail and timing of feedback. This paper examines the benefits of using audio, as opposed to…

The Impact of Middle-School Students' Feedback Choices and Performance on Their Feedback Memory

Science.gov (United States)

Cutumisu, Maria; Schwartz, Daniel L.

2016-01-01

This paper presents a novel examination of the impact of students' feedback choices and performance on their feedback memory. An empirical study was designed to collect the choices to seek critical feedback from a hundred and six Grade 8 middle-school students via Posterlet, a digital assessment game in which students design posters. Upon…

Clinical and taxonomic status of pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria.

Science.gov (United States)

Brown-Elliott, Barbara A; Wallace, Richard J

2002-10-01

The history, taxonomy, geographic distribution, clinical disease, and therapy of the pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria (RGM) are reviewed. Community-acquired disease and health care-associated disease are highlighted for each species. The latter grouping includes health care-associated outbreaks and pseudo-outbreaks as well as sporadic disease cases. Treatment recommendations for each species and type of disease are also described. Special emphasis is on the Mycobacterium fortuitum group, including M. fortuitum, M. peregrinum, and the unnamed third biovariant complex with its recent taxonomic changes and newly recognized species (including M. septicum, M. mageritense, and proposed species M. houstonense and M. bonickei). The clinical and taxonomic status of M. chelonae, M. abscessus, and M. mucogenicum is also detailed, along with that of the closely related new species, M. immunogenum. Additionally, newly recognized species, M. wolinskyi and M. goodii, as well as M. smegmatis sensu stricto, are included in a discussion of the M. smegmatis group. Laboratory diagnosis of RGM using phenotypic methods such as biochemical testing and high-performance liquid chromatography and molecular methods of diagnosis are also discussed. The latter includes PCR-restriction fragment length polymorphism analysis, hybridization, ribotyping, and sequence analysis. Susceptibility testing and antibiotic susceptibility patterns of the RGM are also annotated, along with the current recommendations from the National Committee for Clinical Laboratory Standards (NCCLS) for mycobacterial susceptibility testing.

Feedback, Incentives and Peer Effects

DEFF Research Database (Denmark)

Eriksson, Tor Viking; Poulsen, Anders; Villeval, Marie Claire

This paper experimentally investigates the impact of different pay and relative performance information policies on employee effort. We explore three information policies: No feedback, feedback given halfway through the production period, and continuously updated feedback about relative performan...... behind, and frontrunners do not slack off....

Cutaneous Feedback of Fingertip Deformation and Vibration for Palpation in Robotic Surgery.

Science.gov (United States)

Pacchierotti, Claudio; Prattichizzo, Domenico; Kuchenbecker, Katherine J

2016-02-01

Despite its expected clinical benefits, current teleoperated surgical robots do not provide the surgeon with haptic feedback largely because grounded forces can destabilize the system's closed-loop controller. This paper presents an alternative approach that enables the surgeon to feel fingertip contact deformations and vibrations while guaranteeing the teleoperator's stability. We implemented our cutaneous feedback solution on an Intuitive Surgical da Vinci Standard robot by mounting a SynTouch BioTac tactile sensor to the distal end of a surgical instrument and a custom cutaneous display to the corresponding master controller. As the user probes the remote environment, the contact deformations, dc pressure, and ac pressure (vibrations) sensed by the BioTac are directly mapped to input commands for the cutaneous device's motors using a model-free algorithm based on look-up tables. The cutaneous display continually moves, tilts, and vibrates a flat plate at the operator's fingertip to optimally reproduce the tactile sensations experienced by the BioTac. We tested the proposed approach by having eighteen subjects use the augmented da Vinci robot to palpate a heart model with no haptic feedback, only deformation feedback, and deformation plus vibration feedback. Fingertip deformation feedback significantly improved palpation performance by reducing the task completion time, the pressure exerted on the heart model, and the subject's absolute error in detecting the orientation of the embedded plastic stick. Vibration feedback significantly improved palpation performance only for the seven subjects who dragged the BioTac across the model, rather than pressing straight into it.

The effect of physician feedback and an action checklist on diabetes care measures.

Science.gov (United States)

Schectman, Joel M; Schorling, John B; Nadkarni, Mohan M; Lyman, Jason A; Siadaty, Mir S; Voss, John D

2004-01-01

The objective was to evaluate whether physician feedback accompanied by an action checklist improved diabetes care process measures. Eighty-three physicians in an academic general medicine clinic were provided a single feedback report on the most recent date and result of diabetes care measures (glycosylated hemoglobin [A1c], urine microalbumin, serum creatinine, lipid levels, retinal examination) as well as recent diabetes medication refills with calculated dosing and adherence on 789 patients. An educational session regarding the feedback and adherence information was provided. The physicians were asked to complete a checklist accompanying the feedback on each of their patients, indicating requested actions with respect to follow-up, testing, and counseling. The physicians completed 82% of patient checklists, requesting actions consistent with patient needs on the basis of the feedback. Of the physicians, 93% felt the patient information and intervention format to be useful. The odds of urine microalbumin testing, serum creatinine, lipid profile, A1c, and retinal examination increased in the 6 months after the feedback. The increase was sustained at 1 year only for microalbumin and retinal exams. There was no significant change in refill adherence for the group overall after the feedback, although adherence did improve among patients of physicians attending the educational session. No significant change was noted in lipid or A1c levels during the study period. In conclusion, a simple physician feedback tool with action checklist can be both helpful and popular for improving rates of diabetes care guideline adherence. More complex interventions are likely required to improve diabetes outcomes.

Common-Message Broadcast Channels with Feedback in the Nonasymptotic Regime: Full Feedback

DEFF Research Database (Denmark)

Trillingsgaard, Kasper Fløe; Yang, Wei; Durisi, Giuseppe

2018-01-01

We investigate the maximum coding rate achievable on a two-user broadcast channel for the case where a common message is transmitted with feedback using either fixed-blocklength codes or variable-length codes. For the fixed-blocklength-code setup, we establish nonasymptotic converse and achievabi......We investigate the maximum coding rate achievable on a two-user broadcast channel for the case where a common message is transmitted with feedback using either fixed-blocklength codes or variable-length codes. For the fixed-blocklength-code setup, we establish nonasymptotic converse...... and achievability bounds. An asymptotic analysis of these bounds reveals that feedback improves the second-order term compared to the no-feedback case. In particular, for a certain class of anti-symmetric broadcast channels, we show that the dispersion is halved. For the variable-length-code setup, we demonstrate...

Personality assessment and feedback (PAF): strategies and preliminary findings

DEFF Research Database (Denmark)

Hesse, Morten; Fridell, Mats; Pedersen, Mads Kjær

2008-01-01

Background: Co-morbid personality disorders are common in substance dependent patients, and personality disorders are associated with worse clinical outcomes, worse retention and compliance, and alliance problems. The whole range of personality disorders is present in substance dependent patients......, and antisocial personality disorder is particularly common. However, clinical strategies must vary strongly across disorders. Objectives: To test the clinical effectiveness of a full personality disorder assessment and individual feedback to patient and caseworker, against screening for axis I disorders alone...... anxiety or depression, drug and alcohol dependence, attention deficit hyperactivity disorder, and current level of functioning. The axis II disorder includes a semi-structured interview for personality disorders. Outcomes include global functioning (Work and Social Adjustment Scale), substance use...

The Effects of Post-observational Feedback Modes on Teaching Beliefs : Peer vs. Teacher-Mediated Feedback

Directory of Open Access Journals (Sweden)

İlknur Yuksel

2011-01-01

Full Text Available The aim of this study was to investigate whether the pre-service teachers' language teaching beliefs changed as a result of two different post-observational reşective feedback modes; teacher mediated and peer feedback, during their teaching practice. For each post-observational feedback mode, two groups of eight Turkish pre-service language teachers attending to the final year at English Language Teaching Department at Anadolu University, totally 16 pre-service teachers participated in the study. The qualitative and quantitative data was collected at the beginning and end of the different feedback treatments from each group. The results indicated that the feedback modes on pre-service teachers’ teaching practice could influence their beliefs about teaching. Peer feedback had a potential to change the teachers’ beliefs through critical reşection skills that were fostered as a result of collaboration within the peer group

A rapid MALDI-TOF MS identification database at genospecies level for clinical and environmental Aeromonas strains.

Directory of Open Access Journals (Sweden)

Cinzia Benagli

Full Text Available The genus Aeromonas has undergone a number of taxonomic and nomenclature revisions over the past 20 years, and new (subspecies and biogroups are continuously described. Standard identification methods such as biochemical characterization have deficiencies and do not allow clarification of the taxonomic position. This report describes the development of a matrix-assisted laser desorption/ionisation-time of flight mass spectrometry (MALDI-TOF MS identification database for a rapid identification of clinical and environmental Aeromonas isolates.

Feedback as real-time constructions

DEFF Research Database (Denmark)

Keiding, Tina Bering; Qvortrup, Ane

2014-01-01

instant it takes place. This article argues for a clear distinction between the timing of communicative events, such as responses that are provided as help for feedback constructions, and the feedback construction itself as an event in a psychic system. Although feedback is described as an internal...

Bunch by bunch feedback systems

International Nuclear Information System (INIS)

Tobiyama, Makoto

2006-01-01

Outlines of bunch-by-bunch feedback systems for suppressing multibunch instabilities in electron/positron storage rings are presented. The design principles and functions of the feedback components are reviewed. Recent topics of applying very fast and dense FPGA as feedback signal processor are also shown. (author)

Feedback Providing Improvement Strategies and Reflection on Feedback Use: Effects on Students' Writing Motivation, Process, and Performance

Science.gov (United States)

Duijnhouwer, Hendrien; Prins, Frans J.; Stokking, Karel M.

2012-01-01

This study investigated the effects of feedback providing improvement strategies and a reflection assignment on students' writing motivation, process, and performance. Students in the experimental feedback condition (n = 41) received feedback including improvement strategies, whereas students in the control feedback condition (n = 41) received…

Lack of transfer of skills after virtual reality simulator training with haptic feedback.

Science.gov (United States)

Våpenstad, Cecilie; Hofstad, Erlend Fagertun; Bø, Lars Eirik; Kuhry, Esther; Johnsen, Gjermund; Mårvik, Ronald; Langø, Thomas; Hernes, Toril Nagelhus

2017-12-01

Virtual reality (VR) simulators enrich surgical training and offer training possibilities outside of the operating room (OR). In this study, we created a criterion-based training program on a VR simulator with haptic feedback and tested it by comparing the performances of a simulator group against a control group. Medical students with no experience in laparoscopy were randomly assigned to a simulator group or a control group. In the simulator group, the candidates trained until they reached predefined criteria on the LapSim ® VR simulator (Surgical Science AB, Göteborg, Sweden) with haptic feedback (Xitact TM IHP, Mentice AB, Göteborg, Sweden). All candidates performed a cholecystectomy on a porcine organ model in a box trainer (the clinical setting). The performances were video rated by two surgeons blinded to subject training status. In total, 30 students performed the cholecystectomy and had their videos rated (N = 16 simulator group, N = 14 control group). The control group achieved better video rating scores than the simulator group (p training program did not transfer skills to the clinical setting. Poor mechanical performance of the simulated haptic feedback is believed to have resulted in a negative training effect.

Can corrective feedback improve recognition memory?

Science.gov (United States)

Kantner, Justin; Lindsay, D Stephen

2010-06-01

An understanding of the effects of corrective feedback on recognition memory can inform both recognition theory and memory training programs, but few published studies have investigated the issue. Although the evidence to date suggests that feedback does not improve recognition accuracy, few studies have directly examined its effect on sensitivity, and fewer have created conditions that facilitate a feedback advantage by encouraging controlled processing at test. In Experiment 1, null effects of feedback were observed following both deep and shallow encoding of categorized study lists. In Experiment 2, feedback robustly influenced response bias by allowing participants to discern highly uneven base rates of old and new items, but sensitivity remained unaffected. In Experiment 3, a false-memory procedure, feedback failed to attenuate false recognition of critical lures. In Experiment 4, participants were unable to use feedback to learn a simple category rule separating old items from new items, despite the fact that feedback was of substantial benefit in a nearly identical categorization task. The recognition system, despite a documented ability to utilize controlled strategic or inferential decision-making processes, appears largely impenetrable to a benefit of corrective feedback.

Engaging Students with Audio Feedback

Science.gov (United States)

Cann, Alan

2014-01-01

Students express widespread dissatisfaction with academic feedback. Teaching staff perceive a frequent lack of student engagement with written feedback, much of which goes uncollected or unread. Published evidence shows that audio feedback is highly acceptable to students but is underused. This paper explores methods to produce and deliver audio…

Eco-feedback for non-consumption

NARCIS (Netherlands)

Lim, V.; Jense, A.; Janmaat, J.; Funk, M.

2014-01-01

Eco-feedback is a strategy to increase awareness of resource use and to encourage conservation. We applied eco-feedback on household food waste with the prospective to increase awareness and explore its impact on food related decision-making. In this paper we present a prototype of an eco-feedback

A Journey towards Sustainable Feedback

Science.gov (United States)

Mutch, Allyson; Young, Charlotte; Davey, Tamzyn; Fitzgerald, Lisa

2018-01-01

Meeting students' expectations associated with the provision of feedback is a perennial challenge for tertiary education. Efforts to provide comprehensive, timely feedback within our own first year undergraduate public health courses have not always met students' expectations. In response, we sought to develop peer feedback activities to support…

Factors influencing responsiveness to feedback: on the interplay between fear, confidence, and reasoning processes.

Science.gov (United States)

Eva, Kevin W; Armson, Heather; Holmboe, Eric; Lockyer, Jocelyn; Loney, Elaine; Mann, Karen; Sargeant, Joan

2012-03-01

Self-appraisal has repeatedly been shown to be inadequate as a mechanism for performance improvement. This has placed greater emphasis on understanding the processes through which self-perception and external feedback interact to influence professional development. As feedback is inevitably interpreted through the lens of one's self-perceptions it is important to understand how learners interpret, accept, and use feedback (or not) and the factors that influence those interpretations. 134 participants from 8 health professional training/continuing competence programs were recruited to participate in focus groups. Analyses were designed to (a) elicit understandings of the processes used by learners and physicians to interpret, accept and use (or not) data to inform their perceptions of their clinical performance, and (b) further understand the factors (internal and external) believed to influence interpretation of feedback. Multiple influences appear to impact upon the interpretation and uptake of feedback. These include confidence, experience, and fear of not appearing knowledgeable. Importantly, however, each could have a paradoxical effect of both increasing and decreasing receptivity. Less prevalent but nonetheless important themes suggested mechanisms through which cognitive reasoning processes might impede growth from formative feedback. Many studies have examined the effectiveness of feedback through variable interventions focused on feedback delivery. This study suggests that it is equally important to consider feedback from the perspective of how it is received. The interplay observed between fear, confidence, and reasoning processes reinforces the notion that there is no simple recipe for the delivery of effective feedback. These factors should be taken into account when trying to understand (a) why self-appraisal can be flawed, (b) why appropriate external feedback is vital (yet can be ineffective), and (c) why we may need to disentangle the goals of

Feedback-Assisted Extension of the Tokamak Operating Space to Low Safety Factor

Science.gov (United States)

Hanson, J. M.

2013-10-01

Recent DIII-D experiments have demonstrated stable operation at very low edge safety factor, q95 instability. The performance of tokamak fusion devices may benefit from increased plasma current, and thus, decreased q. However, disruptive stability limits are commonly encountered in experiments at qedge ~ 2 (limited plasmas) and q95 ~ 2 (diverted plasmas), limiting exploration of low q regimes. In the recent DIII-D experiments, the impact and control of key disruptive instabilities was studied. Locked n = 1 modes with exponential growth times on the order of the wall eddy current decay timescale τw preceded disruptions at q95 = 2 . The instabilities have a poloidal structure that is consistent with VALEN simulations of the RWM mode structure at q95 = 2 . Applying proportional gain magnetic feedback control of the n = 1 mode resulted in stabilized operation with q95 reaching 1.9, and an extension of the discharge lifetime for > 100τw . Loss of feedback control was accompanied by power supply saturation, followed by a rapidly growing n = 1 mode and disruption. Comparisons of the feedback dynamics with VALEN simulations will be presented. The DIII-D results complement and will be discussed alongside recent RFX-MOD demonstrations of RWM control using magnetic feedback in limited tokamak discharges with qedge economical fusion power production. Supported by the US Department of Energy under DE-FG02-04ER54761 and DE-FC02-04ER54698.

Control of conducting polymer actuators without physical feedback: simulated feedback control approach with particle swarm optimization

International Nuclear Information System (INIS)

Xiang, Xingcan; Mutlu, Rahim; Alici, Gursel; Li, Weihua

2014-01-01

Conducting polymer actuators have shown significant potential in articulating micro instruments, manipulation devices, and robotics. However, implementing a feedback control strategy to enhance their positioning ability and accuracy in any application requires a feedback sensor, which is extremely large in size compared to the size of the actuators. Therefore, this paper proposes a new sensorless control scheme without the use of a position feedback sensor. With the help of the system identification technique and particle swarm optimization, the control scheme, which we call the simulated feedback control system, showed a satisfactory command tracking performance for the conducting polymer actuator’s step and dynamic displacement responses, especially under a disturbance, without needing a physical feedback loop, but using a simulated feedback loop. The primary contribution of this study is to propose and experimentally evaluate the simulated feedback control scheme for a class of the conducting polymer actuators known as tri-layer polymer actuators, which can operate both in dry and wet media. This control approach can also be extended to other smart actuators or systems, for which the feedback control based on external sensing is impractical. (paper)

The effects of feedback self-consistency, therapist status, and attitude toward therapy on reaction to personality feedback.

Science.gov (United States)

Collins, David R; Stukas, Arthur A

2006-08-01

Individuals' reactions to interpersonal feedback may depend on characteristics of the feedback and the feedback source. The present authors examined the effects of experimentally manipulated personality feedback that they--in the guise of therapists--e-mailed to participants on the degree of their acceptance of the feedback. Consistent with Self-Verification Theory (W. B. Swann Jr., 1987), participants accepted feedback that was consistent with their self-views more readily than they did feedback that was inconsistent with their self-views. Furthermore, the authors found main effects for therapist's status and participant's attitude toward therapy. Significant interactions showed effects in which high-status therapists and positive client attitudes increased acceptance of self-inconsistent feedback, effects that were only partially mediated by clients' perceptions of therapist competence. The present results indicate the possibility that participants may be susceptible to self-concept change or to self-fulfilling prophecy effects in therapy when they have a positive attitude toward therapy or are working with a high-status therapist.

The Effects of Source, Revision Possibility, and Amount of Feedback on Marketing Students' Impressions of Feedback on an Assignment

Science.gov (United States)

Ackerman, David S.; Dommeyer, Curt J.; Gross, Barbara L.

2017-01-01

This study examines how three factors affect students' reactions to critical feedback on an assignment--amount of feedback (none vs. low amount vs. high amount), source of feedback (instructor-provided feedback vs. peer-provided feedback), and the situational context of the feedback (revision of paper is or is not possible). An incomplete 3 × 2 ×…

Feedback en educación médica Feedback in medical education

Directory of Open Access Journals (Sweden)

J.M. Fornells

2008-03-01

Full Text Available La propuesta de un modelo centrado en la persona que aprende y el desarrollo de estrategias de aprender a aprender persigue que los estudiantes sean más reflexivos y más autónomos en su propio proceso de aprendizaje y que se conviertan en los protagonistas de dicho proceso. Se trata, en definitiva, de dar los elementos necesarios a los estudiantes para que puedan autogestionar un proceso de aprendizaje permanente a lo largo de toda su vida profesional, una cuestión crucial en un contexto de evolución constante de los conocimientos. El feedback sería el retorno de información sobre su proceso de aprendizaje de acuerdo con unos objetivos preestablecidos. El feedback presenta información y no juicio, a diferencia de la evaluación, en consecuencia siempre es formativo. El feedback no es un fin en sí mismo sino un instrumento que informa al estudiante sobre su proceso de aprendizaje y facilita los cambios necesarios. El feedback estructurado y centrado en quien aprende se caracteriza por: autorreflexión del estudiante, centrado en quien aprende, preparación previa y relación de confianza tutor-residente.The proposal of a learner-centered model and the development of strategies for learning to learn, intends that students are more reflective and more independent in their own learning process and that they become the protagonists of this process. It really tries to give the students the necessary elements so that they can selfmanage a process of permanent learning throughout their professional life, a crucial question in a context of constant evolution of the knowledge. The return of information on the process of learning, in agreement with preestablished objectives. Feedback presents/displays information and is nonjudgemental, unlike the evaluation. Feedback always is formative. Feedback is not an aim in itself, but an instrument that informs the student on its process of learning and facilitates the necessary changes. Structured and

Neural cryptography with feedback.

Science.gov (United States)

Ruttor, Andreas; Kinzel, Wolfgang; Shacham, Lanir; Kanter, Ido

2004-04-01

Neural cryptography is based on a competition between attractive and repulsive stochastic forces. A feedback mechanism is added to neural cryptography which increases the repulsive forces. Using numerical simulations and an analytic approach, the probability of a successful attack is calculated for different model parameters. Scaling laws are derived which show that feedback improves the security of the system. In addition, a network with feedback generates a pseudorandom bit sequence which can be used to encrypt and decrypt a secret message.

Det ved vi om Feedback

DEFF Research Database (Denmark)

Christensen, Vibeke; Bærenholdt, Jørgen

Præsentation af forskningsviden om feedback i forskellige personkonstellationer i undervisningen: Feedback fra lærer til elev, fra elever til lærer, fra elev til elev og elevens eget arbejde med feedback til sig selv. De præsenterede forskningsresultater er udvalgt dels inden for en kognitivistisk...

Does outcome feedback make you a better emergency physician? A systematic review and research framework proposal.

Science.gov (United States)

Lavoie, Curtis F; Schachter, Howard; Stewart, Aviva T; McGowan, Jessie

2009-11-01

The organization of emergency medical care limits the ability of emergency physicians to know the outcomes of most of their patients after the patients leave the emergency department. This lack of outcome feedback may hinder the practice of emergency medicine (EM) by preventing "calibration" of the decision tools of practitioners. We sought to determine what is currently known about outcome feedback in EM, including its incidence, impact and modifiers. We searched the following databases: PreMEDLINE, MEDLINE, EMBASE, CINAHL, CENTRAL, PsycINFO, DARE, Health Technology Assessment Database and AMED. We performed manual searches on abstract databases, reference lists, various health information and research websites, and nonindexed journals. Selection entailed a 2-step screening pro cess to exclude articles not pertaining to outcome feedback in EM. Our search yielded 1128 bibliographic records, from which screening identified 7 relevant reports: 5 surveys, 1 system level evaluation and 1 intervention trial. All studies were found to have "inadequate" or "unable to assess" reporting and study quality. Systems for outcome feedback to EM residents have been increasingly available since 1984, though they are perceived to be inadequate. Commonly used mechanisms for outcome feedback include automatic routing of discharge summaries, case conferences for admitted patients and telephone calls to patients or families for discharged patients. With respect to attending emergency physicians, no conclusions or clinical recommendations can be made given the level of available evidence. The potential importance of outcome feedback remains, at this time, underevaluated. We propose a research framework, and hypothesize that increasing outcome feedback would increase emergency physician diagnostic accuracy, therapeutic outcomes, clinical efficiency and job satisfaction. Future research in this area should include surveys and focus groups, as well as simulated or real-world intervention

Tactile feedback improves auditory spatial localization

Directory of Open Access Journals (Sweden)

Monica eGori

2014-10-01

Full Text Available Our recent studies suggest that congenitally blind adults have severely impaired thresholds in an auditory spatial-bisection task, pointing to the importance of vision in constructing complex auditory spatial maps (Gori et al., 2014. To explore strategies that may improve the auditory spatial sense in visually impaired people, we investigated the impact of tactile feedback on spatial auditory localization in 48 blindfolded sighted subjects. We measured auditory spatial bisection thresholds before and after training, either with tactile feedback, verbal feedback or no feedback. Audio thresholds were first measured with a spatial bisection task: subjects judged whether the second sound of a three sound sequence was spatially closer to the first or the third sound. The tactile-feedback group underwent two audio-tactile feedback sessions of 100 trials, where each auditory trial was followed by the same spatial sequence played on the subject’s forearm; auditory spatial bisection thresholds were evaluated after each session. In the verbal-feedback condition, the positions of the sounds were verbally reported to the subject after each feedback trial. The no-feedback group did the same sequence of trials, with no feedback. Performance improved significantly only after audio-tactile feedback. The results suggest that direct tactile feedback interacts with the auditory spatial localization system, possibly by a process of cross-sensory recalibration. Control tests with the subject rotated suggested that this effect occurs only when the tactile and acoustic sequences are spatially coherent. Our results suggest that the tactile system can be used to recalibrate the auditory sense of space. These results encourage the possibility of designing rehabilitation programs to help blind persons establish a robust auditory sense of space, through training with the tactile modality.

Feedback to Managers, Volume II: A Review and Comparison of Sixteen Multi-Rater Feedback Instruments.

Science.gov (United States)

Van Velsor, Ellen; Leslie, Jean Brittain

"Feedback to Managers" is a two-volume report. Volume 2 compares 16 of the better feedback instruments available. The following are the instruments: (1) ACUMEN Group Feedback; (2) BENCHMARKS; (3) the Campbell Leadership Index; (4) COMPASS: the Managerial Practices Survey; (5) the Executive Success Profile; (6) Leader Behavior Analysis…

ABCDEFG IS - the principle of constructive feedback.

Science.gov (United States)

Bhattarai, M

2007-01-01

Feedback is an integral part of any learning experience. Constructive feedback is a powerful instrument and facilitates the learner's professional and personal development. "ABCDEFG IS", a mnemonic for the principles of constructive feedback, stands for Amount of the information, Benefit of the trainees, Change behaviour, Descriptive language, Environment, Focused, Group check, Interpretation check, and Sharing information. The eight important steps of feedback are: Ensure prior information, Collect data, Make appropriate meeting arrangement, Begin by encouraging self assessment by the trainee, Highlight areas where the trainee is doing well, Give feedback, Handle reaction maintaining the dignity and Plan actions. Communication and reflection also share many of the principles and steps of constructive feedback and giving regular feedback, thus, helps to improve communication and reflection. The feedback provider would be able to provide genuine feedback by following the appropriate steps and principles of constructive feedback and realize how important and rewarding its role is in teaching learning activities.

Leadership in Libraries--Feedback as Communication.

Science.gov (United States)

Wright, Dianne H.

This paper focuses on the role of feedback in effective communication and ways in which feedback can assist library managers at all levels in performing their role as leaders. The various kinds and sources of feedback are discussed, and the relationship between feedback and goal setting are considered, as well as the effects of goal setting and…

Opportunistic Relay Selection With Limited Feedback

KAUST Repository

Eltayeb, Mohammed E.

2015-08-01

Relay selection is a simple technique that achieves spatial diversity in cooperative relay networks. Generally, relay selection algorithms require channel state information (CSI) feedback from all cooperating relays to make a selection decision. This requirement poses two important challenges, which are often neglected in the literature. Firstly, the fed back channel information is usually corrupted by additive noise. Secondly, CSI feedback generates a great deal of feedback overhead (air-time) that could result in significant performance hits. In this paper, we propose a compressive sensing (CS) based relay selection algorithm that reduces the feedback overhead of relay networks under the assumption of noisy feedback channels. The proposed algorithm exploits CS to first obtain the identity of a set of relays with favorable channel conditions. Following that, the CSI of the identified relays is estimated using least squares estimation without any additional feedback. Both single and multiple relay selection cases are considered. After deriving closed-form expressions for the asymptotic end-to-end SNR at the destination and the feedback load for different relaying protocols, we show that CS-based selection drastically reduces the feedback load and achieves a rate close to that obtained by selection algorithms with dedicated error-free feedback. © 1972-2012 IEEE.

Sustained impact of a short small group course with systematic feedback in addition to regular clinical clerkship activities on musculoskeletal examination skills--a controlled study.

Science.gov (United States)

Perrig, Martin; Berendonk, Christoph; Rogausch, Anja; Beyeler, Christine

2016-01-28

The discrepancy between the extensive impact of musculoskeletal complaints and the common deficiencies in musculoskeletal examination skills lead to increased emphasis on structured teaching and assessment. However, studies of single interventions are scarce and little is known about the time-dependent effect of assisted learning in addition to a standard curriculum. We therefore evaluated the immediate and long-term impact of a small group course on musculoskeletal examination skills. All 48 Year 4 medical students of a 6 year curriculum, attending their 8 week clerkship of internal medicine at one University department in Berne, participated in this controlled study. Twenty-seven students were assigned to the intervention of a 6×1 h practical course (4-7 students, interactive hands-on examination of real patients; systematic, detailed feedback to each student by teacher, peers and patients). Twenty-one students took part in the regular clerkship activities only and served as controls. In all students clinical skills (CS, 9 items) were assessed in an Objective Structured Clinical Examination (OSCE) station, including specific musculoskeletal examination skills (MSES, 7 items) and interpersonal skills (IPS, 2 items). Two raters assessed the skills on a 4-point Likert scale at the beginning (T0), the end (T1) and 4-12 months after (T2) the clerkship. Statistical analyses included Friedman test, Wilcoxon rank sum test and Mann-Whitney U test. At T0 there were no significant differences between the intervention and control group. At T1 and T2 the control group showed no significant changes of CS, MSES and IPS compared to T0. In contrast, the intervention group significantly improved CS, MSES and IPS at T1 (p skills during regular clinical clerkship activities. However, an additional small group, interactive clinical skills course with feedback from various sources, improved these essential examination skills immediately after the teaching and several months later

Can performance feedback during instruction boost knowledge acquisition? Contrasting criterion-based and social comparison feedback

NARCIS (Netherlands)

Kolloffel, Bas Jan; de Jong, Anthonius J.M.

2016-01-01

Feedback indicating how well students are performing during a learning task can be very stimulating. In this study with a pre- and post-test design, the effects of two types of performance feedback on learning results were compared: feedback during a learning task was either stated in terms of how

Coaching and feedback: enhancing communication teaching and learning in veterinary practice settings.

Science.gov (United States)

Adams, Cindy L; Kurtz, Suzanne

2012-01-01

Communication is a critical clinical skill closely linked to clinical reasoning, medical problem solving, and significant outcomes of care such as accuracy, efficiency, supportiveness, adherence to treatment plans, and client and veterinarian satisfaction. More than 40 years of research on communication and communication education in human medicine and, more recently, in veterinary medicine provide a substantive rationale for formal communication teaching in veterinary education. As a result, veterinary schools are beginning to invest in communication training. However, if communication training is to result in development of veterinary communication skills to a professional level of competence, there must be follow-through with effective communication modeling and coaching in practice settings. The purpose of this article is to move the communication modeling and coaching done in the "real world" of clinical practice to the next level. The development of skills for communication coaching and feedback is demanding. We begin by comparing communication coaching with what is required for teaching other clinical skills in practice settings. Examining both, what it takes to teach others (whether DVM students or veterinarians in practice for several years) and what it takes to enhance one's own communication skills and capacities, we consider the why, what, and how of communication coaching. We describe the use of teaching instruments to structure this work and give particular attention to how to engage in feedback sessions, since these elements are so critical in communication teaching and learning. We consider the preconditions necessary to initiate and sustain communication skills training in practice, including the need for a safe and supportive environment within which to implement communication coaching and feedback. Finally we discuss the challenges and opportunities unique to coaching and to building and delivering communication skills training in practice

Feedbacks in human-landscape systems

Science.gov (United States)

Chin, Anne

2015-04-01

As human interactions with Earth systems intensify in the "Anthropocene", understanding the complex relationships among human activity, landscape change, and societal responses to those changes is increasingly important. Interdisciplinary research centered on the theme of "feedbacks" in human-landscape systems serves as a promising focus for unraveling these interactions. Deciphering interacting human-landscape feedbacks extends our traditional approach of considering humans as unidirectional drivers of change. Enormous challenges exist, however, in quantifying impact-feedback loops in landscapes with significant human alterations. This paper illustrates an example of human-landscape interactions following a wildfire in Colorado (USA) that elicited feedback responses. After the 2012 Waldo Canyon Fire, concerns for heightened flood potential and debris flows associated with post-fire hydrologic changes prompted local landowners to construct tall fences at the base of a burned watershed. These actions changed the sediment transport regime and promoted further landscape change and human responses in a positive feedback cycle. The interactions ultimately increase flood and sediment hazards, rather than dampening the effects of fire. A simple agent-based model, capable of integrating social and hydro-geomorphological data, demonstrates how such interacting impacts and feedbacks could be simulated. Challenges for fully capturing human-landscape feedback interactions include the identification of diffuse and subtle feedbacks at a range of scales, the availability of data linking impact with response, the identification of multiple thresholds that trigger feedback mechanisms, and the varied metrics and data needed to represent both the physical and human systems. By collaborating with social scientists with expertise in the human causes of landscape change, as well as the human responses to those changes, geoscientists could more fully recognize and anticipate the coupled

Visual feedback of tongue movement for novel speech sound learning

Directory of Open Access Journals (Sweden)

William F Katz

2015-11-01

Full Text Available Pronunciation training studies have yielded important information concerning the processing of audiovisual (AV information. Second language (L2 learners show increased reliance on bottom-up, multimodal input for speech perception (compared to monolingual individuals. However, little is known about the role of viewing one’s own speech articulation processes during speech training. The current study investigated whether real-time, visual feedback for tongue movement can improve a speaker’s learning of non-native speech sounds. An interactive 3D tongue visualization system based on electromagnetic articulography (EMA was used in a speech training experiment. Native speakers of American English produced a novel speech sound (/ɖ̠/; a voiced, coronal, palatal stop before, during, and after trials in which they viewed their own speech movements using the 3D model. Talkers’ productions were evaluated using kinematic (tongue-tip spatial positioning and acoustic (burst spectra measures. The results indicated a rapid gain in accuracy associated with visual feedback training. The findings are discussed with respect to neural models for multimodal speech processing.

Guideline implementation in clinical practice: Use of statistical process control charts as visual feedback devices

Directory of Open Access Journals (Sweden)

Fahad A Al-Hussein

2009-01-01

Conclusions: A process of audits in the context of statistical process control is necessary for any improvement in the implementation of guidelines in primary care. Statistical process control charts are an effective means of visual feedback to the care providers.

Rapid Detection of Herpes Viruses for Clinical Applications

Science.gov (United States)

Pierson, Duane; Mehta, Satish

2013-01-01

There are eight herpes viruses that infect humans, causing a wide range of diseases resulting in considerable morbidity and associated costs. Varicella zoster virus (VZV) is a human herpes virus that causes chickenpox in children and shingles in adults. Approximately 1,000,000 new cases of shingles occur each year; post-herpetic neuralgia (PHN) follows shingles in 100,000 to 200,000 people annually. PHN is characterized by debilitating, nearly unbearable pain for weeks, months, and even years. The onset of shingles is characterized by pain, followed by the zoster rash, leading to blisters and severe pain. The problem is that in the early stages, shingles can be difficult to diagnose; chickenpox in adults can be equally difficult to diagnose. As a result, both diseases can be misdiagnosed (false positive/negative). A molecular assay has been adapted for use in diagnosing VZV diseases. The polymerase chain reaction (PCR) assay is a non-invasive, rapid, sensitive, and highly specific method for VZV DNA detection. It provides unequivocal results and can effectively end misdiagnoses. This is an approximately two-hour assay that allows unequivocal diagnosis and rapid antiviral drug intervention. It has been demonstrated that rapid intervention can prevent full development of the disease, resulting in reduced likelihood of PHN. The technology was extended to shingles patients and demonstrated that VZV is shed in saliva and blood of all shingles patients. The amount of VZV in saliva parallels the medical outcome.

A Proposed Conceptual Framework and Investigation of Upward Feedback Receptivity in Medical Education.

Science.gov (United States)

Kost, Amanda; Combs, Heidi; Smith, Sherilyn; Klein, Eileen; Kritek, Patricia; Robins, Lynne; Cianciolo, Anna T; Butani, Lavjay; Gigante, Joseph; Ramani, Subha

2015-01-01

whether this process was feasible. Actual responses to receiving student feedback were mixed. Some reported having received feedback that motivated change, and others rejected the feedback they received on the grounds that it lacked validity or was inappropriate. Others expressed uncertainty about how they would react to student feedback. Faculty expressed a preference for receiving feedback about behaviors and items that were within their control. INSIGHTS: These findings suggest there is opportunity to pilot implementation of a structured student feedback mechanism, separate from teacher evaluations, in selected 3rd-year clerkships. Materials should developed to help faculty solicit, understand, and respond to student feedback and to help students frame and provide the kinds of feedback to teachers that will lead to suggested improvements. Both these endeavors have the potential to improve the clinical learning environment during 3rd-year clerkships through the cultivation of respectful communication and the encouragement of improvement in teaching efforts.

The long-term fate of permafrost peatlands under rapid climate warming

DEFF Research Database (Denmark)

Swindles, Graeme T.; Morris, Paul J.; Mullan, Donal

2015-01-01

Permafrost peatlands contain globally important amounts of soil organic carbon, owing to cold conditions which suppress anaerobic decomposition. However, climate warming and permafrost thaw threaten the stability of this carbon store. The ultimate fate of permafrost peatlands and their carbon...... stores is unclear because of complex feedbacks between peat accumulation, hydrology and vegetation. Field monitoring campaigns only span the last few decades and therefore provide an incomplete picture of permafrost peatland response to recent rapid warming. Here we use a high-resolution palaeoecological...... approach to understand the longer-term response of peatlands in contrasting states of permafrost degradation to recent rapid warming. At all sites we identify a drying trend until the late-twentieth century; however, two sites subsequently experienced a rapid shift to wetter conditions as permafrost thawed...

Controlling the unstable emission of a semiconductor laser subject to conventional optical feedback with a filtered feedback branch.

Science.gov (United States)

Ermakov, I V; Tronciu, V Z; Colet, Pere; Mirasso, Claudio R

2009-05-25

We show the advantages of controlling the unstable dynamics of a semiconductor laser subject to conventional optical feedback by means of a second filtered feedback branch. We give an overview of the analytical solutions of the double cavity feedback and show numerically that the region of stabilization is much larger when using a second branch with filtered feedback than when using a conventional feedback one.

Controlling the unstable emission of a semiconductor laser subject to conventional optical feedback with a filtered feedback branch

OpenAIRE

Ermakov, Ilya; Tronciu, Vasile; Colet, Pere; Mirasso, Claudio R.

2009-01-01

We show the advantages of controlling the unstable dynamics of a semiconductor laser subject to conventional optical feedback by means of a second filtered feedback branch. We give an overview of the analytical solutions of the double cavity feedback and show numerically that the region of stabilization is much larger when using a second branch with filtered feedback than when using a conventional feedback one.

Investigating Feedback on Practice Among Teachers: Coherence of Observed and Perceived Feedback

NARCIS (Netherlands)

Thurlings, Marieke; Vermeulen, Marjan; Bastiaens, Theo; Stijnen, Sjef

2018-01-01

Despite that benefits of feedback in student learning are reported in much research, little has been reported regarding the use of feedback from teach- ers to other teachers—a key tool in professional development. In this study, we triangulated data from videotaped peer coaching sessions, ques-

Rapid Antiretroviral Therapy Initiation for Women in an HIV-1 Prevention Clinical Trial Experiencing Primary HIV-1 Infection during Pregnancy or Breastfeeding.

Science.gov (United States)

Morrison, Susan; John-Stewart, Grace; Egessa, John J; Mubezi, Sezi; Kusemererwa, Sylvia; Bii, Dennis K; Bulya, Nulu; Mugume, Francis; Campbell, James D; Wangisi, Jonathan; Bukusi, Elizabeth A; Celum, Connie; Baeten, Jared M

2015-01-01

During an HIV-1 prevention clinical trial in East Africa, we observed 16 cases of primary HIV-1 infection in women coincident with pregnancy or breastfeeding. Nine of eleven pregnant women initiated rapid combination antiretroviral therapy (ART), despite having CD4 counts exceeding national criteria for ART initiation; breastfeeding women initiated ART or replacement feeding. Rapid ART initiation during primary HIV-1 infection during pregnancy and breastfeeding is feasible in this setting.

Rapid Antiretroviral Therapy Initiation for Women in an HIV-1 Prevention Clinical Trial Experiencing Primary HIV-1 Infection during Pregnancy or Breastfeeding.

Directory of Open Access Journals (Sweden)

Susan Morrison

Full Text Available During an HIV-1 prevention clinical trial in East Africa, we observed 16 cases of primary HIV-1 infection in women coincident with pregnancy or breastfeeding. Nine of eleven pregnant women initiated rapid combination antiretroviral therapy (ART, despite having CD4 counts exceeding national criteria for ART initiation; breastfeeding women initiated ART or replacement feeding. Rapid ART initiation during primary HIV-1 infection during pregnancy and breastfeeding is feasible in this setting.

Feedback Simulation for Acupressure Training and Skill Assessment.

Science.gov (United States)

Noll, Eric; Romeiser, Jamie; Shodhan, Shivam; Madariaga, Maria Cecilia; Guo, Xiaojun; Rizwan, Sabeen; Al-Bizri, Ehab; Bennett-Guerrero, Elliott

2017-08-01

Previous acupressure studies have yielded varying results. This could be due to differences in the amount of pressure applied to the acupressure point (acupoint) by study personnel within a study as well as between studies. Standardizing the level of pressure applied at an acupoint could improve clinical care and future research. As part of an ongoing randomized clinical trial of postoperative acupressure, five trainees were asked to perform 2 minutes of acupressure and light touch sessions on a simulator. The applied weight was recorded every minute. Individual skill assessment was performed using cumulative sum analysis. Six pretraining and 20 posttraining measurements in each acupressure and light touch group were compared with an expert's simulation values. Before training (baseline), there was significant difference in applied weight (grams) between the expert [5705 (636)] and five trainees [2998 (798), P = 0.004]. Four of the five trainees crossed the lower decision limit assessing proficiency in the acupressure group, and all five trainees were successful in the light touch group. The trainees' average number of measurements needed to cross the lower decision limit (H0), that is, defining that an individual failure rate does not statistically differ from the acceptable failure rate, was 21.3 measurements for acupressure. After this feedback simulation, trainees' scores showed no significant difference (P > 0.05) when assessed against the expert. Feedback simulation for acupressure training and skill assessment, evaluated by cumulative sum analysis, may help in improving the standardization of acupressure therapy performed during clinical practice or research.

Fast feedback for linear colliders

International Nuclear Information System (INIS)

Hendrickson, L.; Adolphsen, C.; Allison, S.; Gromme, T.; Grossberg, P.; Himel, T.; Krauter, K.; MacKenzie, R.; Minty, M.; Sass, R.

1995-01-01

A fast feedback system provides beam stabilization for the SLC. As the SLC is in some sense a prototype for future linear colliders, this system may be a prototype for future feedbacks. The SLC provides a good base of experience for feedback requirements and capabilities as well as a testing ground for performance characteristics. The feedback system controls a wide variety of machine parameters throughout the SLC and associated experiments, including regulation of beam position, angle, energy, intensity and timing parameters. The design and applications of the system are described, in addition to results of recent performance studies

Pre-Feedback Risk Expectancies and Reception of Low-Risk Health Feedback: Absolute and Comparative Lack of Reassurance.

Science.gov (United States)

Gamp, Martina; Renner, Britta

2016-11-01

Personalised health-risk assessment is one of the most common components of health promotion programs. Previous research on responses to health risk feedback has commonly focused on the reception of bad news (high-risk feedback). The reception of low-risk feedback has been comparably neglected since it is assumed that good news is reassuring and readily received. However, field studies suggest mixed responses to low-risk health feedback. Accordingly, we examine whether pre-feedback risk expectancies can mitigate the reassuring effects of good news. In two studies (N = 187, N = 565), after assessing pre-feedback risk expectancies, participants received low-risk personalised feedback about their own risk of developing (the fictitious) Tucson Chronic Fatigue Syndrome (TCFS). Study 2 also included peer TCFS risk status feedback. Afterwards, self- and peer-related risk perception for TCFS was assessed. In both studies, participants who expected to be at high risk but received good news (unexpected low-risk feedback) showed absolute lack of reassurance. Specifically, they felt at significantly greater TCFS risk than participants who received expected good news. Moreover, the unexpected low-risk group even believed that their risk was as high as (Study 1) or higher (Study 2) than that of their peers (comparative lack of reassurance). Results support the notion that high pre-feedback risk expectancies can mitigate absolute and comparative reassuring effects of good news. © 2016 The International Association of Applied Psychology.

Corrective Feedback, Learner Uptake, and Feedback Perception in a Chinese as a Foreign Language Classroom

Science.gov (United States)

Fu, Tingfeng; Nassaji, Hossein

2016-01-01

The role of corrective feedback in second language classrooms has received considerable research attention in the past few decades. However, most of this research has been conducted in English-teaching settings, either ESL or EFL. This study examined teacher feedback, learner uptake as well as learner and teacher perception of feedback in an adult…

Pseudo-Haptic Feedback in Teleoperation.

Science.gov (United States)

Neupert, Carsten; Matich, Sebastian; Scherping, Nick; Kupnik, Mario; Werthschutzky, Roland; Hatzfeld, Christian

2016-01-01

In this paper, we develop possible realizations of pseudo-haptic feedback in teleoperation systems based on existing works for pseudo-haptic feedback in virtual reality and the intended applications. We derive four potential factors affecting the performance of haptic feedback (calculation operator, maximum displacement, offset force, and scaling factor), which are analyzed in three compliance identification experiments. First, we analyze the principle usability of pseudo-haptic feedback by comparing information transfer measures for teleoperation and direct interaction. Pseudo-haptic interaction yields well above-chance performance, while direct interaction performs almost perfectly. In order to optimize pseudo-haptic feedback, in the second study we perform a full-factorial experimental design with 36 subjects performing 6,480 trials with 36 different treatments. Information transfer ranges from 0.68 bit to 1.72 bit in a task with a theoretical maximum of 2.6 bit, with a predominant effect of the calculation operator and a minor effect of the maximum displacement. In a third study, short- and long-term learning effects are analyzed. Learning effects regarding the performance of pseudo-haptic feedback cannot be observed for single-day experiments. Tests over 10 days show a maximum increase in information transfer of 0.8 bit. The results show the feasibility of pseudo-haptic feedback for teleoperation and can be used as design basis for task-specific systems.

Survey on multisensory feedback virtual reality dental training systems.

Science.gov (United States)

Wang, D; Li, T; Zhang, Y; Hou, J

2016-11-01

Compared with traditional dental training methods, virtual reality training systems integrated with multisensory feedback possess potentials advantages. However, there exist many technical challenges in developing a satisfactory simulator. In this manuscript, we systematically survey several current dental training systems to identify the gaps between the capabilities of these systems and the clinical training requirements. After briefly summarising the components, functions and unique features of each system, we discuss the technical challenges behind these systems including the software, hardware and user evaluation methods. Finally, the clinical requirements of an ideal dental training system are proposed. Future research/development areas are identified based on an analysis of the gaps between current systems and clinical training requirements. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Artificial proprioceptive feedback for myoelectric control.

Science.gov (United States)

Pistohl, Tobias; Joshi, Deepak; Ganesh, Gowrishankar; Jackson, Andrew; Nazarpour, Kianoush

2015-05-01

The typical control of myoelectric interfaces, whether in laboratory settings or real-life prosthetic applications, largely relies on visual feedback because proprioceptive signals from the controlling muscles are either not available or very noisy. We conducted a set of experiments to test whether artificial proprioceptive feedback, delivered noninvasively to another limb, can improve control of a two-dimensional myoelectrically-controlled computer interface. In these experiments, participants were required to reach a target with a visual cursor that was controlled by electromyogram signals recorded from muscles of the left hand, while they were provided with an additional proprioceptive feedback on their right arm by moving it with a robotic manipulandum. Provision of additional artificial proprioceptive feedback improved the angular accuracy of their movements when compared to using visual feedback alone but did not increase the overall accuracy quantified with the average distance between the cursor and the target. The advantages conferred by proprioception were present only when the proprioceptive feedback had similar orientation to the visual feedback in the task space and not when it was mirrored, demonstrating the importance of congruency in feedback modalities for multi-sensory integration. Our results reveal the ability of the human motor system to learn new inter-limb sensory-motor associations; the motor system can utilize task-related sensory feedback, even when it is available on a limb distinct from the one being actuated. In addition, the proposed task structure provides a flexible test paradigm by which the effectiveness of various sensory feedback and multi-sensory integration for myoelectric prosthesis control can be evaluated.

Can Performance Feedback during Instruction Boost Knowledge Acquisition? Contrasting Criterion-Based and Social Comparison Feedback

Science.gov (United States)

Kollöffel, Bas; de Jong, Ton

2016-01-01

Feedback indicating how well students are performing during a learning task can be very stimulating. In this study with a pre- and post-test design, the effects of two types of performance feedback on learning results were compared: feedback during a learning task was either stated in terms of how well the students were performing relative to…

Control and diagnostic uses of feedback

International Nuclear Information System (INIS)

Sen, A. K.

2000-01-01

Recent results on multimode feedback control of magnetohydrodynamic (MHD) modes and a variety of diagnostic uses of feedback are summarized. First, is the report on reduction and scaling of transport under feedback. By controlling the fluctuation amplitudes and consequently the transport via feedback, it is found that the scaling of the diffusion coefficient is linear with root-mean-square rms fluctuation level. The scaling appears not to agree with any generic theory. A variety of other diagnostic uses of feedback have been developed. The primary goal is an experimental methodology for the determination of dynamic models of plasma turbulence, both for better transport understanding and more credible feedback controller designs. A specific motivation is to search for a low-order dynamic model, suitable for the convenient study of both transport and feedback. First, the time series analysis method is used for the determination of chaotic attractor dimension of plasma fluctuations. For ExB rotational flute modes it is found to be close to three, indicating that a low-order dynamic model may be adequate for transport prediction and feedback controller design. Second, a new method for direct experimental determination of nonlinear dynamical models of plasma turbulence using feedback has been developed. Specifically, the process begins with a standard three-wave coupling model and introduces a variable feedback gain. The power spectrum, delayed power spectrum, and bispectrum of fluctuations are then experimentally obtained. By varying the feedback gain continuously, an arbitrary number of numerical equations for a fixed number of unknowns can be generated. Their numerical solution yields the linear dispersion, as well as nonlinear coupling coefficients. This method has been successfully applied for ExB rotationally driven flute modes. (c) 2000 American Institute of Physics

All about the money – External performance monitoring is affected by monetary, but not by socially conveyed feedback cues in more antisocial individuals

Directory of Open Access Journals (Sweden)

Daniela Melitta Pfabigan

2011-09-01

Full Text Available This study investigated the relationship between feedback processing and antisocial personality traits measured by the PSSI questionnaire (Kuhl & Kazén, 1997 in a healthy undergraduate sample. While event-related potentials (Feedback Related Negativity [FRN], P300 were recorded, participants encountered expected and unexpected feedback during a gambling task. As recent findings suggest learning problems and deficiencies during feedback processing in clinical populations of antisocial individuals, we performed two experiments with different healthy participants in which feedback about monetary gains or losses consisted either of social-emotional (facial emotion displays or non-social cues (numerical stimuli. Since the FRN and P300 are both sensitive to different aspects of feedback processing we hypothesized that they might help to differentiate between individuals scoring high and low on an antisocial trait measure.In line with previous evidence FRN amplitudes were enhanced after negative and after unexpected feedback stimuli. Crucially, participants scoring high on antisocial traits displayed larger FRN amplitudes than those scoring low only in response to expected and unexpected negative numerical feedback, but not in response to social-emotional feedback - irrespective of expectancy. P300 amplitudes were not modulated by antisocial traits at all, but by subjective reward probabilities. The present findings indicate that individuals scoring high on antisociality attribute higher motivational salience to monetary compared to emotional-social feedback which is reflected in FRN amplitude enhancement. Contrary to recent findings, however, no processing deficiencies concerning social-emotional feedback stimuli were apparent in those individuals. This indicates that stimulus salience is an important aspect in learning and feedback processes in individuals with antisocial traits which has potential implications for therapeutic interventions in

Feedback-linearization and feedback-feedforward decentralized control for multimachine power system

Energy Technology Data Exchange (ETDEWEB)

De Tuglie, Enrico [Dipartimento di Ingegneria dell' Ambiente, e per lo Sviluppo Sostenibile - DIASS, Politecnico di Bari, Viale del Turismo 8, 74100 Taranto (Italy); Iannone, Silvio Marcello; Torelli, Francesco [Dipartimento di Elettrotecnica, ed Elettronica - DEE, Politecnico di Bari, Via Re David 200, 70125 Bari (Italy)

2008-03-15

In this paper a decentralized nonlinear controller for large-scale power systems is investigated. The proposed controller design is based on the input-output feedback linearization methodology. In order to overcome computational difficulties in adopting such methodology, the overall interconnected nonlinear system, given as n-order, is analyzed as a cascade connection of an n{sub 1}-order nonlinear subsystem and an n{sub 2}-order linear subsystem. The controller design is obtained by applying input-output feedback linearization to the nonlinear subsystem and adopting a tracking control scheme, based on feedback-feedforward technique, for the linear subsystem. In the assumed system model, which is characterised by an interconnected structure between generating units, a decentralised adaptive controller is implemented by decentralizing these constraints. The use of a totally decentralised controller implies a system performance decay with respect to performance when the system is equipped with a centralised controller. Fortunately, the robustness of the proposed controller, based on input-output feedback procedure, guarantees good performance in terms of disturbance even when disturbances are caused by decentralization of interconnection constraints. Test results, provided on the IEEE 30 bus test system, demonstrate the effectiveness and practical applicability of proposed methodology. (author)

A rapid evidence-based service by librarians provided information to answer primary care clinical questions.

Science.gov (United States)

McGowan, Jessie; Hogg, William; Rader, Tamara; Salzwedel, Doug; Worster, Danielle; Cogo, Elise; Rowan, Margo

2010-03-01

A librarian consultation service was offered to 88 primary care clinicians during office hours. This included a streamlined evidence-based process to answer questions in fewer than 20 min. This included a contact centre accessed through a Web-based platform and using hand-held devices and computers with Web access. Librarians were given technical training in evidence-based medicine, including how to summarise evidence. To describe the process and lessons learned from developing and operating a rapid response librarian consultation service for primary care clinicians. Evaluation included librarian interviews and a clinician exit satisfaction survey. Clinicians were positive about its impact on their clinical practice and decision making. The project revealed some important 'lessons learned' in the clinical use of hand-held devices, knowledge translation and training for clinicians and librarians. The Just-in-Time Librarian Consultation Service showed that it was possible to provide evidence-based answers to clinical questions in 15 min or less. The project overcame a number of barriers using innovative solutions. There are many opportunities to build on this experience for future joint projects of librarians and healthcare providers.

Vibrotactile Feedback for Brain-Computer Interface Operation

Directory of Open Access Journals (Sweden)

Febo Cincotti

2007-01-01

Full Text Available To be correctly mastered, brain-computer interfaces (BCIs need an uninterrupted flow of feedback to the user. This feedback is usually delivered through the visual channel. Our aim was to explore the benefits of vibrotactile feedback during users' training and control of EEG-based BCI applications. A protocol for delivering vibrotactile feedback, including specific hardware and software arrangements, was specified. In three studies with 33 subjects (including 3 with spinal cord injury, we compared vibrotactile and visual feedback, addressing: (I the feasibility of subjects' training to master their EEG rhythms using tactile feedback; (II the compatibility of this form of feedback in presence of a visual distracter; (III the performance in presence of a complex visual task on the same (visual or different (tactile sensory channel. The stimulation protocol we developed supports a general usage of the tactors; preliminary experimentations. All studies indicated that the vibrotactile channel can function as a valuable feedback modality with reliability comparable to the classical visual feedback. Advantages of using a vibrotactile feedback emerged when the visual channel was highly loaded by a complex task. In all experiments, vibrotactile feedback felt, after some training, more natural for both controls and SCI users.