Impact of Report Recommendation on Follow-Up Ultrasound Studies in the Work-Up of Incidental Thyroid Nodules

The primary objective of this study was to determine the impact of report recommendation on follow-up ultrasound studies in the work-up of incidental thyroid nodules. Secondary objective was to determine the rate of cost savings, number of missed thyroid cancers avoided, and number of negative fine needle aspirations/biopsies avoided. This study utilized de-identified data of RadPartners (RP) from 102 hospitals and 180 outpatient centers, 1936 CT scans pre-intervention and 2121 CT scans post-intervention were analyzed. Secondary analysis was performed utilizing Medicare cost data from a 5 percent sample data set from the Comparative Effectiveness and Data Analysis Resource (CEDAR). Results demonstrate a cost savings of $23,057,207 in the Medicare population with 7,592 negative fine needle aspirations/biopsies and 750 additional thyroid cancers detected. Using a clinical decision tree model and economic modeling, best practice development for the reporting of incidental thyroid nodules will lead to improvement in value of care. This model can be applied in future studies of other common incidentaloma management and associated Medicare cost analysis

Decision superiority: putting the emphasis back on the warfighter

Military operations have all the trademarks of agile decision making due to the complexity, uncertainty, time constraints, high risk and ill-defined goals of the mission environment. Any discussion of the naval command and control environment must address the relationship between the decision maker and the technological systems with which he operates. The U.S. Navy tends to address issues of decision supeiority with improved technology, sometmes disregarding what the human operator brings to the picture. We argue that this approach provides limited short-term gains in terms of human performance. Addressing the root cause of decision making problems by realigning professional training, selection and experience with the prerequisite analytical, intuitive, creative and affective skills is a superior approach. A decision maker's skill of striking a balance among these abilities, finding the right synthesis for the right situation, adapting to the situation, and moving along the continnum of performance, is what is needed to improve decision making in the maritime environment - not more C2 displays. Through the synthesis and application of the fields of expertise developoment and decision making, a framework of command tactical performance or "artful competence" is presented that has direct impllications for improving decision superiority

Applying an Effective Practice Framework to Create a Lesson Syllabus for Undergraduate Jazz Trombone Students

This essay provides a review of concepts and findings from recent research in the psychology of expertise that are relevant to the unique difficulties of jazz trombone practice. An adapted framework is developed based on deliberate practice and motivation psychology concepts to help jazz trombonists and teachers design an effective, organized, and personalized system for skill development. This framework is applied in the creation of a syllabus for an undergraduate jazz trombone studio