In order for the collaborations to be fruitful and sustainable between organisations and open source software (OSS) ecosystems, maintainers need to understand if, and how it is possible to evaluate OSS ecosystem health in an effective manner. Understanding how OSS maintainers characterise ecosystem health and how they evaluate these health characteristics using digital evaluation tools is interesting to analyse since it could give insight in how ecosystem health in practice is evaluated, which health aspects can be evaluated with the help of digital tools, and what barriers exists in the evaluation processes. This qualitative study is based on semi-structured interviews and was conducted in order to answer two research questions regarding this topic. The answers which were produced by the semi-structured interviews were transcribed and coded to later be analysed where conclusions could be drawn. The research attempts to broaden the academic perspective on how ecosystem maintainers view health and how health evaluation digital tools can help maintainers understand the state of their ecosystem health, and what barriers exist. It became clear during the research that answering how ecosystem health is to be characterized is incredibly difficult since the answer might differ in many ways depending on the nature of the project, where the project is in its life cycle, and who is asking the questions. Two views surrounding the definition of ecosystem health are presented, one revolving around longevity and the other revolving around an ecosystem life cycle perspective. Furthermore, Diversity, Governance, Activity and Licensing seem to be the health characteristics maintainers find to be the most important for ecosystem health evaluation. Out of these, tools such as the ones offered by CHAOSS, seem somewhat geared towards assessing Activity, Licensing and Diversity. Saving time and finding trends when evaluating health are examples of how tools help maintainers however, barriers exist for maintainers in smaller or younger projects who have not practiced health evaluation for a very long time. Finally, another barrier is the amount of additional context and human judgment which is needed when using tools for the health evaluation. / För att samarbetet mellan organisationer och öppen källkod (OSS) ekosystem ska vara gynnsamma och hållbara, måste ekosystemsunderhållare förstå om och hur det är möjligt att utvärdera OSS-ekosystemhälsa på ett effektivt sätt. Att förstå hur OSS-underhållare karaktäriserar ekosystemhälsa och hur de utvärderar dessa hälsoegenskaper med hjälp av digitala utvärderingsverktyg är intressant att analysera eftersom det skulle kunna ge insikt i hur ekosystemhälsa i praktiken utvärderas, vilka hälsoaspekter som kan utvärderas med hjälp av digitala verktyg, och vilka hinder som finns i utvärderingsprocesserna. Denna kvalitativa studie är baserad på semistrukturerade intervjuer och genomfördes för att besvara två forskningsfrågor inom detta ämne. Svaren som producerades av de semistrukturerade intervjuerna transkriberades och kodades för att senare analyseras där slutsatser kunde dras. Forskningen försöker vidga det akademiska perspektivet på hur ekosystemsunderhållare ser på hälsa och hur hälsoutvärderingsverktyg kan hjälpa underhållare att förstå hälsotillståndet för deras ekosystem, men också vilka hinder som finns i processerna. Det blev tydligt under forskningen att det är otroligt svårt att svara på hur ekosystemhälsa ska karakteriseras eftersom svaret kan skilja sig åt på många sätt beroende på projektets karaktär, var projektet befinner sig i sin livscykel och vem som ställer frågorna. Två synpunkter kring definitionen av ekosystemhälsa tas upp, en som kretsar kring livslängd, och den andra som kretsar kring ett ekosystemlivscykelperspektiv. Dessutom verkar Mångfald, Styrning, Aktivitet och Licensiering vara de hälsoegenskaper som underhållare anser vara de viktigaste för hälsoutvärdering av ekosystem. Av dessa verkar verktyg som de som erbjuds av CHAOSS något inriktade på att bedöma Aktivitet, licensiering och mångfald. Att spara tid och hitta trender när man utvärderar hälsa är exempel på hur verktyg hjälper underhållare, men hinder finns för underhållare i mindre eller yngre projekt som inte har praktiserat hälsoutvärdering under en längre period. Slutligen är en annan barriär den mängden ytterligare kontext och mänskligt omdöme som behövs när man använder verktyg för hälsoutvärderingen.

Background: A maioria dos métodos de rastreamento do câncer de colo de útero depende da colposcopia para a confirmação do diagnóstico. A colposcopia sofre com a falta de disponibilidade, a necessidade de longos deslocamentos por parte das pacientes e longas filas de espera. Objetivo: Avaliar o desempenho da Fotografia Cervical Digital como um método alternativo à colposcopia. Método: Foram realizadas colposcopies e Fotografias Digitais Cervicais em 228 pacientes. As Fotografias Digitais Cervicais foram avaliadas através da internet por três colposcopistas experientes. A concordância entre os métodos foi calculada através de Kappa e as porcentagens de concordância. Sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acuracia diagnóstica foram calculados para a colposcopia e a Fotografia Cervical Digital. A histologia foi utilizada como padrão-ouro. Resultados: A Fotografia Cervical Digital e a colposcopia concordaram em 89,9% dos casos (K=0,588). A Fotografia Cervical Digital e a colposcopia apresentaram desempenhos comparáveis, a sensibilidade foi de 52,5% e 35,0%, a especificidade de 91,86% e 91,28%, o valor preditivo positivo de 60,0% e 48,3%, valor preditivo negativo de 89,3% e 85,8%, e a acurácia diagnóstica de 84,4% e 80,7%, respectivamente. Conclusão: A Fotografia Cervical Digital é um método alternativo promissor à colposcopia. / Background: Most cervical cancer screening methods relies on colposcopy to confirm the diagnosis. Colposcopy suffers from the lack of availability, long patients’ displacement and waiting times. Objective: Evaluate the performance of the Cervical Digital Photography as an alternative method to colposcopy. Methods: Colposcopy and Cervical Digital Photography were performed in 228 women. The Cervical Digital Photographs were evaluated through internet by 3 colposcopy experts. The agreement between methods was calculated with kappa and percentages of agreement. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated for colposcopy and Cervical Digital Photography. Histology was the gold standard. Results: Cervical Digital Photography and colposcopy agreed in 89.9% of the cases (K=0.588). Cervical Digital Photography and colposcopy had comparable performances, sensitivity was 52.5% and 35.0%, specificity was 91.86% and 91.28%, positive predictive value was 60.0% and 48.3%, negative predictive value was 89.3% and 85.8%, and diagnostic accuracy was 84.4% and 80.7%, respectively. Conclusion: Cervical Digital Photography is a promising alternative method to colposcopy.

Background: A maioria dos métodos de rastreamento do câncer de colo de útero depende da colposcopia para a confirmação do diagnóstico. A colposcopia sofre com a falta de disponibilidade, a necessidade de longos deslocamentos por parte das pacientes e longas filas de espera. Objetivo: Avaliar o desempenho da Fotografia Cervical Digital como um método alternativo à colposcopia. Método: Foram realizadas colposcopies e Fotografias Digitais Cervicais em 228 pacientes. As Fotografias Digitais Cervicais foram avaliadas através da internet por três colposcopistas experientes. A concordância entre os métodos foi calculada através de Kappa e as porcentagens de concordância. Sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acuracia diagnóstica foram calculados para a colposcopia e a Fotografia Cervical Digital. A histologia foi utilizada como padrão-ouro. Resultados: A Fotografia Cervical Digital e a colposcopia concordaram em 89,9% dos casos (K=0,588). A Fotografia Cervical Digital e a colposcopia apresentaram desempenhos comparáveis, a sensibilidade foi de 52,5% e 35,0%, a especificidade de 91,86% e 91,28%, o valor preditivo positivo de 60,0% e 48,3%, valor preditivo negativo de 89,3% e 85,8%, e a acurácia diagnóstica de 84,4% e 80,7%, respectivamente. Conclusão: A Fotografia Cervical Digital é um método alternativo promissor à colposcopia. / Background: Most cervical cancer screening methods relies on colposcopy to confirm the diagnosis. Colposcopy suffers from the lack of availability, long patients’ displacement and waiting times. Objective: Evaluate the performance of the Cervical Digital Photography as an alternative method to colposcopy. Methods: Colposcopy and Cervical Digital Photography were performed in 228 women. The Cervical Digital Photographs were evaluated through internet by 3 colposcopy experts. The agreement between methods was calculated with kappa and percentages of agreement. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated for colposcopy and Cervical Digital Photography. Histology was the gold standard. Results: Cervical Digital Photography and colposcopy agreed in 89.9% of the cases (K=0.588). Cervical Digital Photography and colposcopy had comparable performances, sensitivity was 52.5% and 35.0%, specificity was 91.86% and 91.28%, positive predictive value was 60.0% and 48.3%, negative predictive value was 89.3% and 85.8%, and diagnostic accuracy was 84.4% and 80.7%, respectively. Conclusion: Cervical Digital Photography is a promising alternative method to colposcopy.

Background: A maioria dos métodos de rastreamento do câncer de colo de útero depende da colposcopia para a confirmação do diagnóstico. A colposcopia sofre com a falta de disponibilidade, a necessidade de longos deslocamentos por parte das pacientes e longas filas de espera. Objetivo: Avaliar o desempenho da Fotografia Cervical Digital como um método alternativo à colposcopia. Método: Foram realizadas colposcopies e Fotografias Digitais Cervicais em 228 pacientes. As Fotografias Digitais Cervicais foram avaliadas através da internet por três colposcopistas experientes. A concordância entre os métodos foi calculada através de Kappa e as porcentagens de concordância. Sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acuracia diagnóstica foram calculados para a colposcopia e a Fotografia Cervical Digital. A histologia foi utilizada como padrão-ouro. Resultados: A Fotografia Cervical Digital e a colposcopia concordaram em 89,9% dos casos (K=0,588). A Fotografia Cervical Digital e a colposcopia apresentaram desempenhos comparáveis, a sensibilidade foi de 52,5% e 35,0%, a especificidade de 91,86% e 91,28%, o valor preditivo positivo de 60,0% e 48,3%, valor preditivo negativo de 89,3% e 85,8%, e a acurácia diagnóstica de 84,4% e 80,7%, respectivamente. Conclusão: A Fotografia Cervical Digital é um método alternativo promissor à colposcopia. / Background: Most cervical cancer screening methods relies on colposcopy to confirm the diagnosis. Colposcopy suffers from the lack of availability, long patients’ displacement and waiting times. Objective: Evaluate the performance of the Cervical Digital Photography as an alternative method to colposcopy. Methods: Colposcopy and Cervical Digital Photography were performed in 228 women. The Cervical Digital Photographs were evaluated through internet by 3 colposcopy experts. The agreement between methods was calculated with kappa and percentages of agreement. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated for colposcopy and Cervical Digital Photography. Histology was the gold standard. Results: Cervical Digital Photography and colposcopy agreed in 89.9% of the cases (K=0.588). Cervical Digital Photography and colposcopy had comparable performances, sensitivity was 52.5% and 35.0%, specificity was 91.86% and 91.28%, positive predictive value was 60.0% and 48.3%, negative predictive value was 89.3% and 85.8%, and diagnostic accuracy was 84.4% and 80.7%, respectively. Conclusion: Cervical Digital Photography is a promising alternative method to colposcopy.