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The challenges of developing and delivering a computer-based simulation of the patient management environment were signi cant, but this was only part of the effort required to produce a useful assessment tool In order for the system to be useful for licensure evaluation, it had o be possible to quantify examinee responses as an indication of pro ciency: it was not only necessary to collect meaningful examinee responses; it was necessary to score them During much of the period in which Primum was being developed, effort was also underway to create scoring procedures The evolution of these procedures was associated with dramatic changes; four conceptually different systems were developed Each of these scoring procedures required that the simulation system be able to capture examinee responses and compare them to a key The procedures differed in which information was used to calculate the scores and how that information was aggregated The simplest and earliest procedures were based on the scoring approaches that had been applied to PMPs administered on paper Although there were many variations on this theme, the basic approach is that examinees are given points for selecting keyed actions that were identi ed as bene cial for management and points are lost for ordered actions that are non-indicated and may be dangerous to the patient The main problem with this approach was that test-wise examinees could sometimes achieve adequate scores by ordering non-intrusive procedures and avoiding potentially risky procedures Adequate scores did not necessarily re ect adequate management A second scoring procedure that was examined applied the Rasch model to the response patterns based on the key (Julian and Wright, 1988) More than any of the others, this approach is purely data driven It provided an implicit weighting for items based on the likelihood that examinees of a given pro ciency level would order those actions Both of these approaches were limited by the fact that the resulting scores may not show a strong correspondence to the judgments that expert clinicians would make if they reviewed the associated examinee performances The nal two scoring approaches that were studied share in common the fact that they are both explicit efforts to model that expert judgment Again, both approaches begin with items that could be quanti ed based on a kind of key Content experts reviewed case material and identi ed actions that would be bene cial for the given case presentation This de nition of bene cial was process rather than outcomes based in that bene cial items were those that would be appropriate for patients with a given presentation For example, diagnostic tests that would rule out reasonable differential diagnoses may be considered as bene cial as those that would identify the speci c problem that would ultimately prove to be the correct answer In addition to identifying those actions that would be considered bene cial, content experts categorized the non-indicated actions based on their level of potential risk to the patient (or level of invasiveness) These latter two procedures differed in terms of how the scored actions were combined to create an aggregate score The rst of these procedures used linear regression For this.

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GTIN - 13 In C#.NET Using Barcode generator for .NET framework Control to generate, create EAN13 .14 Gudinchet F, Fournier D, Jichlinski P, Meyrat B Traumatic priapism in a child: evaluation with color- ow oppler sonography J Urol 1992;148:380 15 Feldstein VA Post-traumatic high- ow priapism evaluation with color ow Doppler sonography J Ultrasound Med 1993;12:589 16 Walker TG, Grant PW, Goldstein I, Krane RJ, Green eld A High- ow priapism: treatment with super-selective transcatheter embolization Radiology 1990;174:1053 17 Steers WD, Selby JBJ Use of methylene blue and selective embolization of the pudendal artery for high- ow priapism refractory to medical and surgical treatments J Urol 1991;146:1361 18 Puppo P, Belgrano E, Germinale F, Bottino P, Giuliani L Angiographic treatment of high- ow priapism Eur Urol 1985;11:397 19 Levine FJ, Tejada IS, Payton TR, Goldstein I Recurrent prolonged erections and priapism as a sequela of priapism: pathophysiology and management J Urol 1991;145:764 20 Crummy JB, Ishizuka J, Madsen PO Post-traumatic priapism: successful treatment with autologous clot embolization AJR 1979;133:329 21 Berger R, Billups K, Brock G, Broderick GA, Dhabuwala CB, Goldstein I, Hakim LS, Hellstrom W, Honig S, Levine LA, Lue T, Munarriz R, Montague DK, Mulcahy JJ, Nehra A, Rogers ZR, Rosen R, Seftel AD, Shabsigh R, Steers W AFUD Thought Leader Panel for evaluation and treatment of priapism Int J Impot Res 2001;13 (Suppl5):S39 43 22 Guideline on the Management of Priapism American Urologic Association, 2003 23 Hakim LS, Kulaksizoglu H, Mulligan R, Green eld A, Goldstein I Evolving concepts in the diagnosis and treatment of arterial high ow priapism J Urol 1996 Feb;155(2):541 8.Related: QR Code Printing .NET Data, Make Data Matrix .NET , Creating PDF417 .NET

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Changes in the industry, particularly those of a technological or marketing nature, must be analyzed in terms of the company s outlook The analyst should obtain a feel for the industry Background information can usually be obtained from trade sources The analyst should understand the growth and cyclical characteristics of the industry He should review the performance of the company relative to its industry, and he should understand the reasons for any pronounced differences in trends between the company and its industry (b) COMPILE FINANCIAL INFORMATION REGARDING THE COMPANY The appraiser should obtain audit reports for the past ve years Some situations may require a complete audit of the books or even the services of a forensic accountant The appraiser should disclose the source of the nancial information upon which he has relied The appraiser should review the historical income accounts, including such areas as of cers compensation, the company s relationship with af liated entities, and travel and entertainment It is helpful to restate the income account in ratios, as this may disclose trends in cost-price relationships that should be discussed with management Margins by product lines should be reviewed for a multiline company The appraiser should obtain the latest interim statement and interview management with regard to the company s outlook It is useful to get the interim statement for the same period of the previous year It is helpful to review a ve-year comparison of the balance sheets, to analyze changes that may be occurring in nancial position, and to evaluate its capacity to nance future growth The balance sheet may indicate the existence of nonoperating assets, which, if material, should be segregated and valued separately The potential existence of hidden assets or hidden liabilities should be discussed in interviews with management The capital structure must be carefully reviewed, as well as the terms of any stock purchase agreements or stock options The appraiser should get sales, income, and dividend data to review both the growth and cyclical characteristics of the company, as well as its long-term dividend policy It is important to review the long-term outlook with management and to obtain nancial projections if available (c) SELECT GUIDELINE COMPANIES Having reviewed the quantitative and qualitative factors discussed above, the appraiser must translate this complex array of facts into value This requires an analysis of the most relevant facts from the actual marketplace This is ordinarily done through the selection and analysis of guideline companies that can be used to formulate objective guidelines for the evaluation of the ubject company Guideline companies are publicly held companies that come as close as possible to the investment characteristics of the company being valued Ideally, they are in the same industry Frequently, however, there are no public companies in the same industry, so it is necessary to select companies with an underlying similarity of investment characteristics based on markets, products, growth, cyclical variability, and other factors Such companies were traditionally called comparative companies, a term that seems to connote companies just like the company being valued It is seldom, if ever, possible to nd publicly held companies just like the company under consideration Appraisers have come to generally use the term guideline companies as a more appropriate term than comparative companies The importance of a thorough, objective selection of guideline companies cannot be overestimated The credibility of any valuation analysis is dependent on the demonstrated objectivity of the selection of guideline companies There are numerous sources for identifying public companies by industry In recent years, many appraisers have switched from printed sources of information on possible guideline companies to computerized databases It must be recognized that the breadth and depth of coverage and the accuracy of the information contained in such services will affect the results Although they are far more ef cient than the traditional printed sources, if such databases are not comprehensive in the number of companies they cover or in the way they classify businesses, some actively traded companies that meet the criteria established for the selection of guideline companies may be missed The appraiser must clearly state the criteria used in selecting guideline companies A description of each guideline company nally selected should be part of the report.

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