Radar Shows Evidence of Seas

NASA Image and Video Library

2007-03-13

This movie, comprised of several detailed images taken by Cassini radar instrument, shows bodies of liquid near Titan north pole. These images show that many of the features commonly associated with lakes on Earth

The growth of a culture of evidence-based obstetrics in South Africa: a qualitative case study

PubMed Central

2011-01-01

Background While the past two decades have seen a shift towards evidence-based obstetrics and midwifery, the process through which a culture of evidence-based practice develops and is sustained within particular fields of clinical practice has not been well documented, particularly in LMICs (low- and middle-income countries). Forming part of a broader qualitative study of evidence-based policy making, this paper describes the development of a culture of evidence-based practice amongst maternal health policy makers and senior academic obstetricians in South Africa Methods A qualitative case-study approach was used. This included a literature review, a policy document review, a timeline of key events and the collection and analysis of 15 interviews with policy makers and academic clinicians involved in these policy processes and sampled using a purposive approach. The data was analysed thematically. Results The concept of evidence-based medicine became embedded in South African academic obstetrics at a very early stage in relation to the development of the concept internationally. The diffusion of this concept into local academic obstetrics was facilitated by contact and exchange between local academic obstetricians, opinion leaders in international research and structures promoting evidence-based practice. Furthermore the growing acceptance of the concept was stimulated locally through the use of existing professional networks and meetings to share ideas and the contribution of local researchers to building the evidence base for obstetrics both locally and internationally. As a testimony to the extent of the diffusion of evidence-based medicine, South Africa has strongly evidence-based policies for maternal health. Conclusion This case study shows that the combined efforts of local and international researchers can create a culture of evidence-based medicine within one country. It also shows that doing so required time and perseverance from international researchers

Large scale genomic analysis shows no evidence for pathogen adaptation between the blood and cerebrospinal fluid niches during bacterial meningitis

PubMed Central

Lees, John A.; Kremer, Philip H. C.; Manso, Ana S.; Croucher, Nicholas J.; Ferwerda, Bart; Serón, Mercedes Valls; Oggioni, Marco R.; Parkhill, Julian; Brouwer, Matthijs C.; van der Ende, Arie; van de Beek, Diederik

2017-01-01

Recent studies have provided evidence for rapid pathogen genome diversification, some of which could potentially affect the course of disease. We have previously described such variation seen between isolates infecting the blood and cerebrospinal fluid (CSF) of a single patient during a case of bacterial meningitis. Here, we performed whole-genome sequencing of paired isolates from the blood and CSF of 869 meningitis patients to determine whether such variation frequently occurs between these two niches in cases of bacterial meningitis. Using a combination of reference-free variant calling approaches, we show that no genetic adaptation occurs in either invaded niche during bacterial meningitis for two major pathogen species, Streptococcus pneumoniae and Neisseria meningitidis. This study therefore shows that the bacteria capable of causing meningitis are already able to do this upon entering the blood, and no further sequence change is necessary to cross the blood–brain barrier. Our findings place the focus back on bacterial evolution between nasopharyngeal carriage and invasion, or diversity of the host, as likely mechanisms for determining invasiveness. PMID:28348877

Biological Evidence Management for DNA Analysis in Cases of Sexual Assault

PubMed Central

Magalhães, Teresa; Dinis-Oliveira, Ricardo Jorge; Silva, Benedita; Corte-Real, Francisco; Nuno Vieira, Duarte

2015-01-01

Biological evidence with forensic interest may be found in several cases of assault, being particularly relevant if sexually related. Sexual assault cases are characterized by low rates of disclosure, reporting, prosecution, and conviction. Biological evidence is sometimes the only way to prove the occurrence of sexual contact and to identify the perpetrator. The major focus of this review is to propose practical approaches and guidelines to help health, forensic, and law enforcement professionals to deal with biological evidence for DNA analysis. Attention should be devoted to avoiding contamination, degradation, and loss of biological evidence, as well as respecting specific measures to properly handle evidence (i.e., selection, collection, packing, sealing, labeling, storage, preservation, transport, and guarantee of the chain custody). Biological evidence must be carefully managed since the relevance of any finding in Forensic Genetics is determined, in the first instance, by the integrity and quantity of the samples submitted for analysis. PMID:26587562

Evicase: an evidence-based case structuring approach for personalized healthcare.

PubMed

Carmeli, Boaz; Casali, Paolo; Goldbraich, Anna; Goldsteen, Abigail; Kent, Carmel; Licitra, Lisa; Locatelli, Paolo; Restifo, Nicola; Rinott, Ruty; Sini, Elena; Torresani, Michele; Waks, Zeev

2012-01-01

The personalized medicine era stresses a growing need to combine evidence-based medicine with case based reasoning in order to improve the care process. To address this need we suggest a framework to generate multi-tiered statistical structures we call Evicases. Evicase integrates established medical evidence together with patient cases from the bedside. It then uses machine learning algorithms to produce statistical results and aggregators, weighted predictions, and appropriate recommendations. Designed as a stand-alone structure, Evicase can be used for a range of decision support applications including guideline adherence monitoring and personalized prognostic predictions.

Making the Case for Evidence-Based Practice

ERIC Educational Resources Information Center

Bates, Joanne; McClure, Janelle; Spinks, Andy

2010-01-01

Evidence-based practice is the collection, interpretation, and use of data, such as collection statistics or assessment results, that measure the effectiveness of a library media program. In this article, the authors will present various forms of evidence and show that any library media specialist can use data to make informed decisions that…

Detail of exciter turbine showing shaft, scroll case, servomotor and ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Detail of exciter turbine showing shaft, scroll case, servo-motor and operating ring (left foreground) and hand wheel for butterfly valve (right background) - Morony Hydroelectric Facility, Dam and Powerhouse, Morony Dam Road, Great Falls, Cascade County, MT

FOXP2 Targets Show Evidence of Positive Selection in European Populations

PubMed Central

Ayub, Qasim; Yngvadottir, Bryndis; Chen, Yuan; Xue, Yali; Hu, Min; Vernes, Sonja C.; Fisher, Simon E.; Tyler-Smith, Chris

2013-01-01

Forkhead box P2 (FOXP2) is a highly conserved transcription factor that has been implicated in human speech and language disorders and plays important roles in the plasticity of the developing brain. The pattern of nucleotide polymorphisms in FOXP2 in modern populations suggests that it has been the target of positive (Darwinian) selection during recent human evolution. In our study, we searched for evidence of selection that might have followed FOXP2 adaptations in modern humans. We examined whether or not putative FOXP2 targets identified by chromatin-immunoprecipitation genomic screening show evidence of positive selection. We developed an algorithm that, for any given gene list, systematically generates matched lists of control genes from the Ensembl database, collates summary statistics for three frequency-spectrum-based neutrality tests from the low-coverage resequencing data of the 1000 Genomes Project, and determines whether these statistics are significantly different between the given gene targets and the set of controls. Overall, there was strong evidence of selection of FOXP2 targets in Europeans, but not in the Han Chinese, Japanese, or Yoruba populations. Significant outliers included several genes linked to cellular movement, reproduction, development, and immune cell trafficking, and 13 of these constituted a significant network associated with cardiac arteriopathy. Strong signals of selection were observed for CNTNAP2 and RBFOX1, key neurally expressed genes that have been consistently identified as direct FOXP2 targets in multiple studies and that have themselves been associated with neurodevelopmental disorders involving language dysfunction. PMID:23602712

Evidence, discovery and justification: the case of evidence-based medicine.

PubMed

Gaeta, Rodolfo; Gentile, Nelida

2016-08-01

The purpose of this paper is to develop some thoughts on philosophical issues surrounding evidence-based medicine (EBM), especially related to its epistemological dimensions. After considering the scope of several philosophical concepts that are relevant to the discussion, and drawing some distinctions among different aspects of EBM, we evaluate the status of EBM and suggest that EBM is mainly a meta-methodology. Then, we outline an evaluation of the thesis that EBM is a 'new paradigm' in the practice of medicine. We argue that EBM does not seem to have arisen in the way Kuhn imagined paradigms to arise but as a conscious, deliberate proposal, more as programme than as a reality. Furthermore, there is something paradoxical about appealing to evidence or to the best evidence as a way of promoting a new paradigm. For the proposal seems to assume that there is something that by its own virtue is the best evidence for a given time. But this idea would have been rejected by Kuhn. If EBM involves a genuine new alternative in the field of medicine and shows a way in which the discipline will endure henceforth, this indicates that it is not what Kuhn once called a 'paradigm' and even, paradoxically, it is good evidence that scientific paradigms do not exist, at least in medicine. © 2015 John Wiley & Sons, Ltd.

FOXP2 targets show evidence of positive selection in European populations.

PubMed

Ayub, Qasim; Yngvadottir, Bryndis; Chen, Yuan; Xue, Yali; Hu, Min; Vernes, Sonja C; Fisher, Simon E; Tyler-Smith, Chris

2013-05-02

Forkhead box P2 (FOXP2) is a highly conserved transcription factor that has been implicated in human speech and language disorders and plays important roles in the plasticity of the developing brain. The pattern of nucleotide polymorphisms in FOXP2 in modern populations suggests that it has been the target of positive (Darwinian) selection during recent human evolution. In our study, we searched for evidence of selection that might have followed FOXP2 adaptations in modern humans. We examined whether or not putative FOXP2 targets identified by chromatin-immunoprecipitation genomic screening show evidence of positive selection. We developed an algorithm that, for any given gene list, systematically generates matched lists of control genes from the Ensembl database, collates summary statistics for three frequency-spectrum-based neutrality tests from the low-coverage resequencing data of the 1000 Genomes Project, and determines whether these statistics are significantly different between the given gene targets and the set of controls. Overall, there was strong evidence of selection of FOXP2 targets in Europeans, but not in the Han Chinese, Japanese, or Yoruba populations. Significant outliers included several genes linked to cellular movement, reproduction, development, and immune cell trafficking, and 13 of these constituted a significant network associated with cardiac arteriopathy. Strong signals of selection were observed for CNTNAP2 and RBFOX1, key neurally expressed genes that have been consistently identified as direct FOXP2 targets in multiple studies and that have themselves been associated with neurodevelopmental disorders involving language dysfunction. Copyright © 2013 The American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.

Four cases of type 1 diabetes mellitus showing sharp serum transaminase increases and hepatomegaly due to glycogenic hepatopathy.

PubMed

Ikarashi, Yuichi; Kogiso, Tomomi; Hashimoto, Etsuko; Yamamoto, Kuniko; Kodama, Kazuhisa; Taniai, Makiko; Torii, Nobuyuki; Takaike, Hiroko; Uchigata, Yasuko; Tokushige, Katsutoshi

2017-03-01

Poorly controlled diabetes mellitus (DM) patients sometimes show serum transaminase elevations due to steatohepatitis. However, we experienced four cases with type 1 DM with sharp elevations in serum transaminases that could not be explained by steatohepatitis alone and showed bright liver. They were diagnosed with glycogenic hepatopathy (GH) clinicopathologically. The four patients had a median age of 22.5 years (range, 19-29 years) and 12.5 (4-15)-year histories of type 1 DM and showed marked increases in serum transaminases (aspartate aminotransferase, 698 U/L [469-2763 U/L]; alanine transaminase, 255 U/L [216-956 U/L]). Diabetes mellitus control was poor and hemoglobin A1c was 12.7% (11-16.5%). Three cases had a past history of diabetic ketoacidosis. Hepatomegaly and hyperdense liver were seen on computed tomography scans. Magnetic resonance imaging showed low intensity in T2-weighted images. The pathological findings revealed pale and swollen hepatocytes and glycogenated nuclei. The architecture of the liver was preserved, and steatosis and fibrosis were mild. The cytoplasm of hepatocytes stained densely positive with periodic acid-Schiff, and the positive staining disappeared after diastase digestion, suggesting glycogen deposition. No other cause of hepatitis was evident, and the diagnosis was GH. Elevated transaminases improved within 1 month with good glycemic control. Transaminase elevations were observed several times in three cases with poor glycemic control. Glycogenic hepatopathy is rare, but extremely high serum elevations of transaminases are important to identify clinically. Despite showing a good clinical course in general, GH sometimes recurs and requires strict glycemic control. Clinicians should be aware of and recognize GH when dealing with uncontrolled DM patients. © 2016 The Japan Society of Hepatology.

The medical and scientific evidence in alleged tubocurarine poisonings. A review of the so-called Dr. X case.

PubMed

Siegel, H; Rieders, F; Holmstedt, B

1985-01-01

The problem of proving the presence or absence of a poison in a buried cadaver is the central theme of this presentation. Certain general questions are posed which may serve to guide those seeking to determine the cause of death in buried cadavers and allegedly due to a poison. Medicolegal and scientific evidence is presented from the court records of five deaths which were alleged homicides due to intravenous tubocurarine. As to the medical evidence: The prosecution claimed absence of adequate medical causes but full congruence with intravenous tubocurarine as the cause of death. The defense claimed and presented its evidence, including history, clinical picture, gross and microscopic pathological findings--for the deaths having occurred from competent natural causes in all but one case. In that one case the cause was undetermined. In two of the four cases evidence was presented for the mechanism of death and why they died at the time that they did. As to the forensic toxicological evidence: The prosecution claimed qualitative identification but with no particular quantitative detection or identification limits of tubocurarine in the remains based on results of combinations of HPLC followed by RIA and of some selected ion direct inlet mass spectrometry. The defense corroborated--along with a quantitative estimate--the presence of a substantial concentration of tubocurarine in the liver specimen of one case. However the chain of custody of this particular specimen was compromised for a period of several days between post-exhumation autopsy and submission to the prosecution toxicologists. With respect to all the other specimens examined by the defense, direct inlet mass spectrometry failed to show ions which are critical for establishing the identity of tubocurarine. The defense also presented results of experiments which showed that the tissues of the cases in question destroyed tubocurarine at such a rate that no reasonably conceivable administered amount could

Plausibility and evidence: the case of homeopathy.

PubMed

Rutten, Lex; Mathie, Robert T; Fisher, Peter; Goossens, Maria; van Wassenhoven, Michel

2013-08-01

Homeopathy is controversial and hotly debated. The conclusions of systematic reviews of randomised controlled trials of homeopathy vary from 'comparable to conventional medicine' to 'no evidence of effects beyond placebo'. It is claimed that homeopathy conflicts with scientific laws and that homoeopaths reject the naturalistic outlook, but no evidence has been cited. We are homeopathic physicians and researchers who do not reject the scientific outlook; we believe that examination of the prior beliefs underlying this enduring stand-off can advance the debate. We show that interpretations of the same set of evidence--for homeopathy and for conventional medicine--can diverge. Prior disbelief in homeopathy is rooted in the perceived implausibility of any conceivable mechanism of action. Using the 'crossword analogy', we demonstrate that plausibility bias impedes assessment of the clinical evidence. Sweeping statements about the scientific impossibility of homeopathy are themselves unscientific: scientific statements must be precise and testable. There is growing evidence that homeopathic preparations can exert biological effects; due consideration of such research would reduce the influence of prior beliefs on the assessment of systematic review evidence.

Single-Case Research Design: An Alternative Strategy for Evidence-Based Practice

ERIC Educational Resources Information Center

Stapleton, Drue; Hawkins, Andrew

2015-01-01

Objective: The trend of utilizing evidence-based practice (EBP) in athletic training is now requiring clinicians, researchers, educators, and students to be equipped to both engage in and make judgments about research evidence. Single-case design (SCD) research may provide an alternative approach to develop such skills and inform clinical and…

Evidence-based medicine - an appropriate tool for evidence-based health policy? A case study from Norway.

PubMed

Malterud, Kirsti; Bjelland, Anne Karen; Elvbakken, Kari Tove

2016-03-05

Evidence-based policy (EBP), a concept modelled on the principles of evidence-based medicine (EBM), is widely used in different areas of policymaking. Systematic reviews (SRs) with meta-analyses gradually became the methods of choice for synthesizing research evidence about interventions and judgements about quality of evidence and strength of recommendations. Critics have argued that the relation between research evidence and service policies is weak, and that the notion of EBP rests on a misunderstanding of policy processes. Having explored EBM standards and knowledge requirements for health policy decision-making, we present an empirical point of departure for discussing the relationship between EBM and EBP. In a case study exploring the Norwegian Knowledge Centre for the Health Services (NOKC), an independent government unit, we first searched for information about the background and development of the NOKC to establish a research context. We then identified, selected and organized official NOKC publications as an empirical sample of typical top-of-the-line knowledge delivery adhering to EBM standards. Finally, we explored conclusions in this type of publication, specifically addressing their potential as policy decision tools. From a total sample of 151 SRs published by the NOKC in the period 2004-2013, a purposive subsample from 2012 (14 publications) advised major caution about their conclusions because of the quality or relevance of the underlying documentation. Although the case study did not include a systematic investigation of uptake and policy consequences, SRs were found to be inappropriate as universal tools for health policy decision-making. The case study demonstrates that EBM is not necessarily suited to knowledge provision for every kind of policy decision-making. Our analysis raises the question of whether the evidence-based movement, represented here by an independent government organization, undertakes too broad a range of commissions using

Inhibition of IL-17A by secukinumab shows no evidence of increased Mycobacterium tuberculosis infections

PubMed Central

Kammüller, Michael; Tsai, Tsen-Fang; Griffiths, Christopher EM; Kapoor, Nidhi; Kolattukudy, Pappachan E; Brees, Dominique; Chibout, Salah-Dine; Safi Jr, Jorge; Fox, Todd

2017-01-01

Secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin-17A (IL-17A), has been shown to have significant efficacy in the treatment of moderate to severe psoriasis, psoriatic arthritis and ankylosing spondylitis. Blocking critical mediators of immunity may carry a risk of increased opportunistic infections. Here we present clinical and in vitro findings examining the effect of secukinumab on Mycobacterium tuberculosis infection. We re-assessed the effect of secukinumab on the incidence of acute tuberculosis (TB) and reactivation of latent TB infection (LTBI) in pooled safety data from five randomized, double-blind, placebo-controlled, phase 3 clinical trials in subjects with moderate to severe plaque psoriasis. No cases of TB were observed after 1 year. Importantly, in subjects with a history of pulmonary TB (but negative for interferon-γ release and receiving no anti-TB medication) or positive for latent TB (screened by interferon-γ release assay and receiving anti-TB medication), no cases of active TB were reported. Moreover, an in vitro study examined the effect of the anti-tumor necrosis factor-α (TNFα) antibody adalimumab and secukinumab on dormant M. tuberculosis H37Rv in a novel human three-dimensional microgranuloma model. Auramine-O, Nile red staining and rifampicin resistance of M. tuberculosis were measured. In vitro, anti-TNFα treatment showed increased staining for Auramine-O, decreased Nile red staining and decreased rifampicin resistance, indicative of mycobacterial reactivation. In contrast, secukinumab treatment was comparable to control indicating a lack of effect on M. tuberculosis dormancy. To date, clinical and preclinical investigations with secukinumab found no evidence of increased M. tuberculosis infections. PMID:28868144

Crime event 3D reconstruction based on incomplete or fragmentary evidence material--case report.

PubMed

Maksymowicz, Krzysztof; Tunikowski, Wojciech; Kościuk, Jacek

2014-09-01

Using our own experience in 3D analysis, the authors will demonstrate the possibilities of 3D crime scene and event reconstruction in cases where originally collected material evidence is largely insufficient. The necessity to repeat forensic evaluation is often down to the emergence of new facts in the course of case proceedings. Even in cases when a crime scene and its surroundings have undergone partial or complete transformation, with regard to elements significant to the course of the case, or when the scene was not satisfactorily secured, it is still possible to reconstruct it in a 3D environment based on the originally-collected, even incomplete, material evidence. In particular cases when no image of the crime scene is available, its partial or even full reconstruction is still potentially feasible. Credibility of evidence for such reconstruction can still satisfy the evidence requirements in court. Reconstruction of the missing elements of the crime scene is still possible with the use of information obtained from current publicly available databases. In the study, we demonstrate that these can include Google Maps(®*), Google Street View(®*) and available construction and architecture archives. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Evidence-informed health policy 4 – Case descriptions of organizations that support the use of research evidence

PubMed Central

Lavis, John N; Moynihan, Ray; Oxman, Andrew D; Paulsen, Elizabeth J

2008-01-01

Background Previous efforts to produce case descriptions have typically not focused on the organizations that produce research evidence and support its use. External evaluations of such organizations have typically not been analyzed as a group to identify the lessons that have emerged across multiple evaluations. Case descriptions offer the potential for capturing the views and experiences of many individuals who are familiar with an organization, including staff, advocates, and critics. Methods We purposively sampled a subgroup of organizations from among those that participated in the second (interview) phase of the study and (once) from among other organizations with which we were familiar. We developed and pilot-tested a case description data collection protocol, and conducted site visits that included both interviews and documentary analyses. Themes were identified from among responses to semi-structured questions using a constant comparative method of analysis. We produced both a brief (one to two pages) written description and a video documentary for each case. Results We conducted 51 interviews as part of the eight site visits. Two organizational strengths were repeatedly cited by individuals participating in the site visits: use of an evidence-based approach (which was identified as being very time-consuming) and existence of a strong relationship between researchers and policymakers (which can be challenged by conflicts of interest). Two organizational weaknesses – a lack of resources and the presence of conflicts of interest – were repeatedly cited by individuals participating in the site visits. Participants offered two main suggestions for the World Health Organization (and other international organizations and networks): 1) mobilize one or more of government support, financial resources, and the participation of both policymakers and researchers; and 2) create knowledge-related global public goods. Conclusion The findings from our case

Challenging evidence-based decision-making: a hypothetical case study about return to work.

PubMed

Aas, Randi W; Alexanderson, Kristina

2012-03-01

A hypothetical case study about return to work was used to explore the process of translating research into practice. The method involved constructing a case study derived from the characteristics of a typical, sick-listed employee with non-specific low back pain in Norway. Next, the five-step evidence-based process, including the Patient, Intervention, Co-Interventions and Outcome framework (PICO), was applied to the case study. An inductive analysis produced 10 technical and more fundamental challenges to incorporate research into intervention decisions for an individual with comorbidity. A more dynamic, interactive approach to the evidence-based practice process is proposed. It is recommended that this plus the 10 challenges are validated with real life cases, as the hypothetical case study may not be replicable. Copyright © 2011 John Wiley & Sons, Ltd.

The Impact of Acceptance of Electronic Evidence before and after the 2006 Federal Rules of Evidence on Criminal Cases

ERIC Educational Resources Information Center

Borrego, Jesus

2010-01-01

Legal scholars have established that the U.S. Department of Justice's 2004 Federal Rules of Evidence (FRE) has created confusion in legal rulings on criminal cases involving digital evidence, resulting in conflicting verdicts. With the 2006 FRE update, the Department of Justice attempted to correct the problem. The conceptual framework for this…

A clinicopathological review of 34 cases of inflammatory breast disease showing an association between corynebacteria infection and granulomatous mastitis.

PubMed

Taylor, Graeme B; Paviour, Sue D; Musaad, Sahar; Jones, Wayne O; Holland, David J

2003-04-01

Granulomatous mastitis is a rare condition of unknown aetiology. The great majority of cases has not been associated with bacterial pathogens if women with mammary tuberculosis are excluded. We noted that some women in Auckland with a histological diagnosis of granulomatous mastitis had both microbiological and histological evidence of corynebacteria infection and aimed to study this further. Thirty-four women were reviewed who presented with inflammatory breast disease and had microbiological specimens from which corynebacteria were isolated and/or histological specimens containing coryneform bacteria. These 34 cases were compared with 28 controls with similar histology but no evidence of corynebacteria infection. Twenty-seven (79%) of the cases and 21 (75%) of the controls had histological and/or cytological evidence of suppurative granulomas. Fourteen of the 34 cases also had Gram-positive bacilli (GPB), recognisable as coryneform bacteria, in histological sections. In all cases the bacilli were confined to empty spaces, consistent with dissolved lipid, and were surrounded by neutrophils and, frequently, suppurative granulomas. Corynebacterium species were isolated from 52 of 116 microbiological specimens taken from the 34 cases. Forty of these 52 cultures were pure. Twenty-four of the cultures were further classified biochemically and using 16S rRNA gene sequencing. Twenty of the 24 were lipophilic Corynebacterium species and 14 were identified as Corynebacterium kroppenstedtii. The cases were more likely to present with fever or neutrophilia and more often formed sinuses than the controls but other clinical features were similar. Maori and Pacific Islanders accounted for 77% of the women across both groups. We suggest granulomatous mastitis can be associated with corynebacteria infection, particularly infection by C. kroppenstedtii. The significance of this finding, which has previously been described in only a single case report, is discussed.

Infectious mononucleosis lymphoadenitis showing histologic findings indistinguishable from toxoplasma lymphadenitis. A report of three cases.

PubMed

Kojima, Masaru; Kashimura, Makoto; Itoh, Hideaki; Noro, Masahiro; Matsuda, Hazuki; Tsukamoto, Norihumi; Akikusa, Bunshiro; Masawa, Nobuhide; Morita, Yukio

2010-06-15

Lymph node lesions in infectious mononucleosis (IM) show a marked histologic diversity. We report here three cases of IM lymphadenitis with histologic findings indistinguishable from those of toxoplasmic lymphadenitis. The histologic findings of the three cases presented here showed a histologic triad of toxoplasmic lymphadenitis, including (i) numerous lymphoid follicles with hyperplastic germinal centers; (ii) small clusters or single epithelioid histiocytes; and (iii) multiple foci of monocytoid B-cells. Moreover, all three lesions contained isolated or small clusters of epithelioid histiocytes within the hyperplastic germinal centers and the periphery of lymphoid follicles, which are the most specific histologic findings of toxoplasmic lymphadenitis. However, serologic findings confirmed EBV infection in all three cases. On in situ hybridization, numerous Epstein-Barr virus (EBV)-encoded small RNA (EBER)-positive cells were demonstrated in the germinal center, as well as in interfollicular areas in all three cases. Toxoplasmosis gondii infection was excluded in at least one case, based on serologic findings. Polymerase chain reaction analysis also demonstrated that there was no T. gondii DNA in the remaining two cases. Two of our three cases showed atypical clinical presentations, including an absence of atypical lymphocytosis in peripheral blood in two cases, age more than 30 years, and an absence of systemic symptoms in one case. It appears that previous descriptions emphasize the differential diagnostic problems between IM lymphadenitis and malignant lymphomas. However, from a therapeutic perspective, it is important to discriminate IM lymphadenitis from toxoplasmic lymphadenitis particularly in patients showing atypical clinical features. 2010 Elsevier GmbH. All rights reserved.

Does iodine excess lead to hypothyroidism? Evidence from a case-control study in India.

PubMed

Kotwal, Atul; Kotwal, Jyoti; Prakash, Rajat; Kotwal, Narendra

2015-08-01

Iodine deficiency disorders have been known to mankind since antiquity and various researchers elucidated the role of iodine in its causation. However, recent evidence shows that the entire control program ignored multi-causality and association of increased iodine intake with hypothyroidism. This study was conducted to assess differences of iodine intake as measured by urinary iodine excretion (UIE) between cases of hypothyroidism and healthy controls. A case-control study was conducted with three groups (cases, hospital controls and community controls) in two cities of India. Patients with overt hypothyroidism were cases (n = 150) and were compared with age, sex and socioeconomic status-matched hospital (n = 154) and community (n = 488) controls. Thyroid function tests (T3, T4, TSH) were used as diagnostic and inclusion criteria. TPOAb and UIE estimation were carried out for all study participants. Mean values of TPOAb and UIE were higher in cases as compared to hospital controls as well as community controls (p <0.05). With a cut off of 34 IU/mL for TPOAb, more cases had an anti-TPO level >34 as compared to hospital controls (p <0.001) as well as community controls (p <0.001); OR, 0.06 (95% CI, 0.03, 0.12) and 0.08 (0.05, 0.12), respectively. For UIE cut-off of 300 μg/L, more cases than hospital controls (p = 0.090) and community controls (p = 0.001) had higher levels; OR, 0.671, (0.422, 1.066) and 0.509, (0.348, 0.744), respectively. The study has clearly shown that cases of hypothyroidism are associated with excess iodine intake. Cohort studies to generate further evidence and an eco-social epidemiological approach have been suggested as the way forward. Copyright © 2015 IMSS. Published by Elsevier Inc. All rights reserved.

Perceptions on the Role of Evidence: An English Alcohol Policy Case Study

ERIC Educational Resources Information Center

Toner, Paul; Lloyd, Charlie; Thom, Betsy; MacGregor, Susanne; Godfrey, Christine; Herring, Rachel; Tchilingirian, Jordan

2014-01-01

This paper explores the competing influences which inform public health policy and describes the role that research evidence plays within the policy-making process. In particular it draws on a recent English alcohol policy case study to assess the role of evidence in informing policy and practice. Semi-structured interviews with key national,…

Synthesizing Single-Case Research to Identify Evidence-Based Practices: Some Brief Reflections

ERIC Educational Resources Information Center

Horner, Robert H.; Kratochwill, Thomas R.

2012-01-01

The purposes of this paper are to (a) propose an operational standard for defining a "practice," (b) encourage development of professional standards for visual and statistical analysis of single-case research, and (c) propose a standard for using single-case research results to identify practices that are "evidence-based." These topics are not new…

[Burden of proof in medical cases--presumption of fact and prima facie evidence. II. Presumption of fact and prima facie evidence].

PubMed

Sliwka, Marcin

2004-01-01

The aim of this paper was to present the main rules concerning the burden of proof in polish civil trials, including medical cases. The standard rules were presented with all the important exclusions such as presumption of law and fact or prima facie evidence. The author analyses the effect of these institutions on burden of proof in medical cases. The difference between presumptions of fact and prima facie evidence was analysed and explained. This paper also describes the importance of the res ipsa loquitur rule in United Kingdom and USA. This paper includes numerous High Court sentences on evidential and medical issues.

Evidence-Based Assessment in Case Management to Improve Abnormal Cancer Screen Follow-Up

ERIC Educational Resources Information Center

Vourlekis, Betsy; Ell, Kathleen; Padgett, Deborah

2005-01-01

The authors describe an evidence-based assessment protocol for intensive case management to improve screening diagnostic follow-up developed through a research project in breast and cervical cancer early detection funded by the Centers for Disease Control and Prevention. Three components of an evidence-based approach to assessment are presented…

Primary Subcutaneous Synovial Sarcoma: First Reported Subcutaneous Case Showing TLE1 Immunoreactivity.

PubMed

Alegría-Landa, Victoria; Nájera, Laura; Massa, Dolores Suárez; Roustan, Gastón; Río, María Del; Kutzner, Heinz; Requena, Luis

2018-05-08

Synovial sarcoma (SS) accounts for 5%-10% of all soft tissue sarcomas. It is a well-defined soft tissue neoplasm with biphasic and monophasic histologic subtypes and unknown histogenesis. It usually occurs in the extremities, especially the thigh-knee region of young adults. Recurrences are frequent and distant metastasis developed in approximately half of the patients. SSs are characterized by a recurrent nonrandom chromosomal translocation, t(X; 18) (p11; q11), which is considered the primary genetic event in more than 90% of cases. Only 4 cases of cutaneous and subcutaneous SSs have been published in the literature so far. We report a case of primary subcutaneous SS in the forearm of a young woman and discuss the histopathologic differential diagnosis with other similar neoplasms. This is the first reported case of primary cutaneous SS showing immunoreactivity for TLE1 in the nuclei of neoplastic cells, supporting the use of this marker for diagnosis of this rare cutaneous neoplasm.

Wong-Type Dermatomyositis Showing Porokeratosis-Like Changes (Columnar Dyskeratosis): A Case Report and Review of the Literature

PubMed Central

Umanoff, Nicole; Fisher, Ari; Carlson, J. Andrew

2015-01-01

Background Wong-type dermatomyositis (DM) exhibits simultaneous pityriasis rubra pilaris (PRP) features. Case Report A 50-year-old woman presented with a heliotrope rash, Gottron's papules, and a poikilodermic, erythematous rash in shawl distribution without evidence of muscle weakness. Despite topical corticosteroids, the eruption progressed 9 months later to include generalized hyperkeratotic follicular papules, islands of sparing, and atrophic macules with a collarette of scale suggestive of porokeratosis. Mild dysphonia was the only sign of muscle weakness. Serology showed positive ANA. Histopathology revealed interface dermatitis with dermal mucin and melanophages, irregular psoriasiform hyperplasia, alternating mounds of para- and orthokeratosis, and tiers of dyskeratotic cells (columnar dyskeratosis). Systemic corticosteroid therapy was not tolerated; acitretin diminished the hyperkeratosis. While hyperpigmentation persisted, no progression of cutaneous or muscular symptoms has occurred after 22 months of follow-up and cessation of the therapy. Overall, her course did not differ from the natural history documented in the literature review of Wong-type DM. The most similar case also exhibited pseudocornoid lamella changes. Conclusion Wong-type DM is a clinicopathologic DM-PRP hybrid that can also exhibit porokeratosis-like features best described as columnar dyskeratosis. Recognizing these types of lesions in DM is warranted in order to make an accurate assessment of their prognostic significance. PMID:27047930

Phylogenetic evidence for a case of misleading rather than mislabeling in caviar in the United Kingdom.

PubMed

Johnson, Tania Aspasia; Iyengar, Arati

2015-01-01

Sturgeons and paddlefish are freshwater fish which are highly valued for their caviar. Despite the fact that every single species of sturgeon and paddlefish is listed under CITES, there are reports of illegal trade in caviar where products are deliberately mislabeled. Three samples of caviar purchased in the United Kingdom were investigated for accurate CITES labeling using COI and cyt b sequencing. Initial species identification was carried out using BLAST followed by phylogenetic analyses using both maximum parsimony and maximum likelihood methods. Results showed no evidence for mislabeling with respect to CITES labels in any of the three samples, but we observed clear evidence for a case of misleading the customer in one sample. © 2014 American Academy of Forensic Sciences.

Voices of decision makers on evidence-based policy: A case of evolving TB/HIV co-infection policy in India.

PubMed

Reddy, K Srikanth; Sahay, Seema

2016-01-01

This study explores decision makers' perspectives on evidence-based policy (EBP) development using the case of TB/HIV co-infection in India. Twelve in-depth interviews were conducted with purposively selected key national and international policy decision makers in India. Verbatim transcripts were processed and analysed thematically using QSR (NUD*IST 6). The decision makers were unequivocal in recognizing the TB/HIV co-infection as an important public health issue in India and stated the problem to be different than Africa. The need of having a "third programme" for co-infection was not felt. According to them, the public health management of this co-infection must be within the realm of these two programmes. The study also emphasized on decision makers' perspectives on evidence and the process of utilization of evidence for decision-making for co-infection. Study findings showed global evidence was not always accepted by the decision makers and study shows several examples of decision makers demanding local evidence for policy decisions. Decision makers did make interim policies based on global evidence but most of the time their mandate was to get local evidence. Thus, operations research/implementation science especially multi-centric studies emerge as important strategy for EBP development. Researcher-policy maker interface was a gap where role of researcher as aggressive communicator of research findings was expected.

Case of gastric neuroendocrine carcinoma showing an interesting tumorigenic pathway.

PubMed

Uesugi, Noriyuki; Sugimoto, Ryo; Eizuka, Makoto; Fujita, Yasuko; Osakabe, Mitsumasa; Koeda, Keisuke; Kosaka, Takashi; Yanai, Shunichi; Ishida, Kazuyuki; Sasaki, Akira; Matsumoto, Takayuki; Sugai, Tamotsu

2017-11-16

Here, we report a case of gastric neuroendocrine carcinoma showing an interesting tumorigenic pathway. A 57-year-old Japanese woman presented with epigastric tenderness, and distal gastrectomy was performed. In the surgical specimen, histologically, the tumor tissue was composed of three subtypes of tumor components showing different histological architecture and cellular atypia, diagnosed as neuroendocrine tumor (NET) G2, NET G3, and neuroendocrine carcinoma (NEC) components. Immunohistochemically, the Ki-67-positive rates of NET G2, NET G3, and NEC components were 6.5%, 99.5% and 88.1%, respectively. Although allelic imbalance (AI) on chromosomes 1p, 3p, 8q, TP53, 18q and 22q was commonly found in all components, AI of 4p was found in NET G3 and NEC components (but not in the NET G2 component). In contrast, AIs of 5q and 9p were found in only the NEC component. Thus, we showed the progression from NET G2 to NEC, via NET G3, within the same tumor.

Skeletal Indicators of Shark Feeding on Human Remains: Evidence from Florida Forensic Anthropology Cases.

PubMed

Stock, Michala K; Winburn, Allysha P; Burgess, George H

2017-11-01

This research examines a series of six Florida forensic anthropology cases that exhibit taphonomic evidence of marine deposition and shark-feeding activities. In each case, we analyzed patterns of trauma/damage on the skeletal remains (e.g., sharp-force bone gouges and punctures) and possible mechanisms by which they were inflicted during shark predation/scavenging. In some cases, shark teeth were embedded in the remains; in the absence of this evidence, we measured interdental distance from defects in the bone to estimate shark body length, as well as to draw inferences about the potential species responsible. We discuss similarities and differences among the cases and make comparisons to literature documenting diagnostic shark-inflicted damage to human remains from nearby regions. We find that the majority of cases potentially involve bull or tiger sharks scavenging the remains of previously deceased, adult male individuals. This scavenging results in a distinctive taphonomic signature including incised gouges in cortical bone. © 2017 American Academy of Forensic Sciences.

Procedures and Claims among US Evidence-Producing Organisations: The Case of the Incredible Years Programme

ERIC Educational Resources Information Center

Karlsson, Patrik; Bergmark, Anders; Lundström, Tommy

2014-01-01

We explore how four evidence-producing organisations in the US go ahead when they rate the evidence base for psychosocial interventions, using the Incredible Years programme as our case study. The findings demonstrate variation in the procedures and resulting evidence claims across the organisations, with some organisations being strict and some…

Factors associated with trace evidence analyses and DNA findings among police reported cases of rape.

PubMed

Forr, Camilla; Schei, Berit; Stene, Lise Eilin; Ormstad, Kari; Hagemann, Cecilie Therese

2018-02-01

The aim of this study was to examine the association between victim, suspect and assault characteristics and (1) forensic analysis of trace evidence, (2) detection of spermatozoa and (3) DNA match in police-reported cases of rape/attempted rape. In addition, we explored whether DNA findings were associated with legal outcome. We conducted a retrospective, descriptive study based on police-reported rapes and attempted rapes of women  ≥16 years of age in Sør-Trøndelag Police District throughout 1997-2010. Police data were merged with information from the Sexual Assault Centre (SAC) at St. Olavs University Hospital, Trondheim, Norway. We used binary and multivariable logistic regression for the comparisons. We identified 324 victims (mean age 24 years). The police requested analysis in 135 (45%) of the 299 collected victim samples. The police decision to analyze was after adjustment associated with the victim being employed or under education, and a public venue, but not with interval from assault to sampling. Spermatozoa were detected in 79 (61%) of the analyzed cases, of which 71 were collected from victims within 24h. Interval from assault being <24h and reporting a penetrative assault remained associated with the findings of spermatozoa after adjustments. Forensic analyses of trace evidence collected from victim, suspect and/or venue disclosed matching DNA profiles in 57 (40%) of a total of 143 analyzed cases. Matching DNA profiles were associated with suspect being known to the victim and with the venue being private. A higher proportion of cases with a DNA match were prosecuted in court: 20 of the 29 cases prosecuted. However, despite a DNA match 35 cases were anyway dismissed because of insufficient evidence. Although many of the associations in our study were expected, it is still important to report the actual numbers to gain insight into the importance of a DNA match in legal proceedings. A substantial proportion of cases with DNA match was dismissed

Evidence in clinical reasoning: a computational linguistics analysis of 789,712 medical case summaries 1983-2012.

PubMed

Seidel, Bastian M; Campbell, Steven; Bell, Erica

2015-03-21

Better understanding of clinical reasoning could reduce diagnostic error linked to 8% of adverse medical events and 30% of malpractice cases. To a greater extent than the evidence-based movement, the clinical reasoning literature asserts the importance of practitioner intuition—unconscious elements of diagnostic reasoning. The study aimed to analyse the content of case report summaries in ways that explored the importance of an evidence concept, not only in relation to research literature but also intuition. The study sample comprised all 789,712 abstracts in English for case reports contained in the database PUBMED for the period 1 January 1983 to 31 December 2012. It was hypothesised that, if evidence and intuition concepts were viewed by these clinical authors as essential to understanding their case reports, they would be more likely to be found in the abstracts. Computational linguistics software was used in 1) concept mapping of 21,631,481 instances of 201 concepts, and 2) specific concept analyses examining 200 paired co-occurrences for 'evidence' and research 'literature' concepts. 'Evidence' is a fundamentally patient-centred, intuitive concept linked to less common concepts about underlying processes, suspected disease mechanisms and diagnostic hunches. In contrast, the use of research literature in clinical reasoning is linked to more common reasoning concepts about specific knowledge and descriptions or presenting features of cases. 'Literature' is by far the most dominant concept, increasing in relevance since 2003, with an overall relevance of 13% versus 5% for 'evidence' which has remained static. The fact that the least present types of reasoning concepts relate to diagnostic hunches to do with underlying processes, such as what is suspected, raises questions about whether intuitive practitioner evidence-making, found in a constellation of dynamic, process concepts, has become less important. The study adds support to the existing corpus of

Use of existing systematic reviews for evidence assessments in infectious disease prevention: a comparative case study.

PubMed

Harder, Thomas; Remschmidt, Cornelius; Haller, Sebastian; Eckmanns, Tim; Wichmann, Ole

2016-10-11

Given limited resources and time constraints, the use of existing systematic reviews (SR) for the development of evidence-based public health recommendations has become increasingly important. Recently, a five-step approach for identifying, analyzing, appraising and using existing SRs based on recent guidance by the US Agency for Healthcare Research and Quality (AHRQ) was proposed within the Project on a Framework for Rating Evidence in Public Health (PRECEPT). However, case studies are needed to test whether this approach is useful, what challenges arise and how problems can be solved. In two case studies, the five-step approach was applied to integrate existing SRs in the development of evidence-based public health recommendations. Case study A focused on the role of neonatal sepsis as a risk factor for adverse neurodevelopmental outcome. Case study B examined the efficacy, effectiveness and safety of influenza vaccination during pregnancy. For each step, we report the approach of the review team, discuss challenges and describe solutions. For case study A, one existing SR was identified, while in case study B four SRs were eligible for analysis. We found that comparison of inclusion criteria alone was sufficient to judge on relevance of SRs in case study A, but not B. Although methodological quality of all identified SRs was acceptable, risk of bias assessments of individual studies included in the SRs had to be repeated in both case studies. Particular challenges appeared in case study B where multiple SRs addressed the same research question. With the help of spreadsheets comparing the characteristics of the existing SR we decided to use the most comprehensive one for our evidence synthesis and supplemented the results with those from the other SRs. In both case studies using the complete SR was not possible. The five-step approach provided useful and structured guidance and should be routinely applied when using existing SRs as a basis for evidence

The business case for building better hospitals through evidence-based design.

PubMed

Sadler, Blair L; DuBose, Jennifer; Zimring, Craig

2008-01-01

After establishing the connection between building well-designed evidence-based facilities and improved safety and quality for patients, families, and staff, this article presents the compelling business case for doing so. It demonstrates why ongoing operating savings and initial capital costs must be analyzed and describes specific steps to ensure that design innovations are implemented effectively. Hospital leaders and boards are now beginning to face a new reality: They can no longer tolerate preventable hospital-acquired conditions such as infections, falls, and injuries to staff or unnecessary intra-hospital patient transfers that can increase errors. Nor can they subject patients and families to noisy, confusing environments that increase anxiety and stress. They must effectively deploy all reasonable quality improvement techniques available. To be optimally effective, a variety of tactics must be combined and implemented in an integrated way. Hospital leadership must understand the clear connection between building well-designed healing environments and improved healthcare safety and quality for patients, families, and staff, as well as the compelling business case for doing so. Emerging pay-for-performance (P4P) methodologies that reward hospitals for quality and refuse to pay hospitals for the harm they cause (e.g., infections and falls) further strengthen this business case. When planning to build a new hospital or to renovate an existing facility, healthcare leaders should address a key question: Will the proposed project incorporate all relevant and proven evidence-based design innovations to optimize patient safety, quality, and satisfaction as well as workforce safety, satisfaction, productivity, and energy efficiency? When conducting a business case analysis for a new project, hospital leaders should consider ongoing operating savings and the market share impact of evidence-based design interventions as well as initial capital costs. They should

Gun Shows and Gun Violence: Fatally Flawed Study Yields Misleading Results

PubMed Central

Hemenway, David; Webster, Daniel; Pierce, Glenn; Braga, Anthony A.

2010-01-01

A widely publicized but unpublished study of the relationship between gun shows and gun violence is being cited in debates about the regulation of gun shows and gun commerce. We believe the study is fatally flawed. A working paper entitled “The Effect of Gun Shows on Gun-Related Deaths: Evidence from California and Texas” outlined this study, which found no association between gun shows and gun-related deaths. We believe the study reflects a limited understanding of gun shows and gun markets and is not statistically powered to detect even an implausibly large effect of gun shows on gun violence. In addition, the research contains serious ascertainment and classification errors, produces results that are sensitive to minor specification changes in key variables and in some cases have no face validity, and is contradicted by 1 of its own authors’ prior research. The study should not be used as evidence in formulating gun policy. PMID:20724672

Gun shows and gun violence: fatally flawed study yields misleading results.

PubMed

Wintemute, Garen J; Hemenway, David; Webster, Daniel; Pierce, Glenn; Braga, Anthony A

2010-10-01

A widely publicized but unpublished study of the relationship between gun shows and gun violence is being cited in debates about the regulation of gun shows and gun commerce. We believe the study is fatally flawed. A working paper entitled "The Effect of Gun Shows on Gun-Related Deaths: Evidence from California and Texas" outlined this study, which found no association between gun shows and gun-related deaths. We believe the study reflects a limited understanding of gun shows and gun markets and is not statistically powered to detect even an implausibly large effect of gun shows on gun violence. In addition, the research contains serious ascertainment and classification errors, produces results that are sensitive to minor specification changes in key variables and in some cases have no face validity, and is contradicted by 1 of its own authors' prior research. The study should not be used as evidence in formulating gun policy.

Evidence-based clinical policy: case report of a reproducible process to encourage understanding and evaluation of evidence.

PubMed

Rikard-Bell, G; Waters, E; Ward, J

2006-07-01

We report within a case study a reproducible process to facilitate the explicit incorporation of evidence by a multidisciplinary group into clinical policy development. To support the decision-making of a multidisciplinary Intersectoral Advisory Group (IAG) convened by the Royal Australasian College of Physicians Health Policy Unit, a systematic review of randomized controlled trials about environmental tobacco smoke and smoking cessation interventions in paediatric settings was first undertaken. As reported in detail here, IAG members were then formally engaged in a transparent and replicable process to understand and interpret the synthesized evidence and to proffer their independent reactions regarding policy, practice and research. Our intention was to ensure that all IAG members were democratically engaged and made aware of the available evidence. As clinical policy must engage stakeholder representatives from diverse backgrounds, a process to equalize understanding of the evidence and 'democratize' judgment about its implications is needed. Future research must then examine the benefits of such explicit steps when guidelines, in turn, are implemented. We hypothesize that changes to future practice will be more likely if processes undertaken to develop guidelines are transparent to clinicians and other target groups.

Evidence-based policy versus morality policy: the case of syringe access programs.

PubMed

de Saxe Zerden, Lisa; O'Quinn, Erin; Davis, Corey

2015-01-01

Evidence-based practice (EBP) combines proven interventions with clinical experience, ethics, and client preferences to inform treatment and services. Although EBP is integrated into most aspects of social work and public health, at times EBP is at odds with social policy. In this article the authors explore the paradox of evidence-based policy using syringe access programs (SAP) as a case example, and review methods of bridging the gap between the emphasis on EBP and lack of evidence informing SAP policy. Analysis includes the overuse of morality policy and examines historical and current theories why this paradox exists. Action steps are highlighted for creating effective policy and opportunities for public health change. Strategies on reframing the problem and shifting target population focus to garner support for evidence-based policy change are included. This interdisciplinary understanding of the way in which these factors converge is a critical first step in moving beyond morality-based policy toward evidence-based policy.

Case Reports, Case Series - From Clinical Practice to Evidence-Based Medicine in Graduate Medical Education.

PubMed

Sayre, Jerry W; Toklu, Hale Z; Ye, Fan; Mazza, Joseph; Yale, Steven

2017-08-07

Case reports and case series or case study research are descriptive studies that are prepared for illustrating novel, unusual, or atypical features identified in patients in medical practice, and they potentially generate new research questions. They are empirical inquiries or investigations of a patient or a group of patients in a natural, real-world clinical setting. Case study research is a method that focuses on the contextual analysis of a number of events or conditions and their relationships. There is disagreement among physicians on the value of case studies in the medical literature, particularly for educators focused on teaching evidence-based medicine (EBM) for student learners in graduate medical education. Despite their limitations, case study research is a beneficial tool and learning experience in graduate medical education and among novice researchers. The preparation and presentation of case studies can help students and graduate medical education programs evaluate and apply the six American College of Graduate Medical Education (ACGME) competencies in the areas of medical knowledge, patient care, practice-based learning, professionalism, systems-based practice, and communication. A goal in graduate medical education should be to assist residents to expand their critical thinking, problem-solving, and decision-making skills. These attributes are required in the teaching and practice of EBM. In this aspect, case studies provide a platform for developing clinical skills and problem-based learning methods. Hence, graduate medical education programs should encourage, assist, and support residents in the publication of clinical case studies; and clinical teachers should encourage graduate students to publish case reports during their graduate medical education.

Subject Case in Children with SLI and Unaffected Controls: Evidence for the Agr/Tns Omission Model.

ERIC Educational Resources Information Center

Wexler, Kenneth; Rice, Mabel; Schutze, Carson T.

1998-01-01

Presents new evidence for the view that specific language impairment (SLI) involves a syntactic-feature deficit within non-evident grammar. The data involve morphological case and its interaction with verbal inflection. (Author/VWL)

Policy Claims and Problem Frames: A Cross-Case Comparison of Evidence-Based Policy in an Australian Context

ERIC Educational Resources Information Center

van Toorn, Georgia; Dowse, Leanne

2016-01-01

This paper explores the signification of evidence-based policy as a new policy-making paradigm in Australia through a cross-case comparison of the role of evidence in two key areas: child protection and illicit drug policy. Although evidence makes certain courses of action appear valid and credible, quality evidence is not necessarily the critical…

Neglect of Medical Evidence of Torture in Guantánamo Bay: A Case Series

PubMed Central

Iacopino, Vincent; Xenakis, Stephen N.

2011-01-01

Background In the wake of the September 11, 2001 attacks on the US, the government authorized the use of “enhanced interrogation” techniques that were previously recognized as torture. While the complicity of US health professionals in the design and implementation of US torture practices has been documented, little is known about the role of health providers, assigned to the US Department of Defense (DoD) at the US Naval Station Guantánamo Bay, Cuba (GTMO), who should have been in a position to observe and document physical and psychological evidence of torture and ill treatment. Methods and Findings We reviewed GTMO medical records and relevant case files (client affidavits, attorney–client notes and summaries, and legal affidavits of medical experts) of nine individuals for evidence of torture and ill treatment and documentation by medical personnel. In each of the nine cases, GTMO detainees alleged abusive interrogation methods that are consistent with torture as defined by the UN Convention Against Torture as well as the more restrictive US definition of torture that was operational at the time. The medical affidavits in each of the nine cases indicate that the specific allegations of torture and ill treatment are highly consistent with physical and psychological evidence documented in the medical records and evaluations by non-governmental medical experts. However, the medical personnel who treated the detainees at GTMO failed to inquire and/or document causes of the physical injuries and psychological symptoms they observed. Psychological symptoms were commonly attributed to “personality disorders” and “routine stressors of confinement.” Temporary psychotic symptoms and hallucinations did not prompt consideration of abusive treatment. Psychological assessments conducted by non-governmental medical experts revealed diagnostic criteria for current major depression and/or PTSD in all nine cases. Conclusion The findings in these nine cases from

Sex offender polygraph examination: an evidence-based case management tool for social workers.

PubMed

Levenson, Jill S

2009-10-01

This article will review the use of polygraphy in the assessment and treatment of sexual perpetrators. Such information can be utilized by social workers who are involved in the treatment and case management of child sexual abuse cases. First, the controversial literature regarding the validity and reliability of polygraph examination in general will be reviewed. Next, an emerging body of evidence supporting the utility of polygraph testing with sex offenders will be discussed. Finally, ways that social workers can incorporate this knowledge into their case management and clinical roles will be offered.

An evidence-based approach to case management model selection for an acute care facility: is there really a preferred model?

PubMed

Terra, Sandra M

2007-01-01

This research seeks to determine whether there is adequate evidence-based justification for selection of one acute care case management model over another. Acute Inpatient Hospital. This article presents a systematic review of published case management literature, resulting in classification specific to terms of level of evidence. This review examines the best available evidence in an effort to select an acute care case management model. Although no single case management model can be identified as preferred, it is clear that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and to form a foundation for the efficacy of hospital case management practice. Although no single case management model can be identified as preferred, this systematic review demonstrates that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and forming a foundation for the efficacy of hospital case management practice. Distinctive aspects of case management frameworks can be used to guide the development of an acute care case management model. The study illustrates: * The effectiveness of case management when there is direct patient contact by the case manager regardless of disease condition: not only does the quality of care increase but also length of stay (LOS) decreases, care is defragmented, and both patient and physician satisfaction can increase. * The preferred case management models result in measurable outcomes that can directly relate to, and demonstrate alignment with, organizational strategy. * Acute care management programs reduce cost and LOS, and improve outcomes. * An integrated case management program that includes social workers, as well as nursing, is the most effective acute care management model. * The successful case management model will recognize physicians, as well as patients, as valued customers with whom partnership can positively affect financial outcomes in terms of

Evidence-Informed, Individual Treatment of a Child with Sexual Behavior Problems: A Case Study.

PubMed

Allen, Brian; Berliner, Lucy

2015-11-01

Children with sexual behavior problems pose a significant challenge for community-based mental health clinicians. Very few clinical trials are available to guide intervention and those interventions that are available are based in a group format. The current case study demonstrates the application of evidence-informed treatment techniques during the individual treatment of a 10-year-old boy displaying interpersonal sexual behavior problems. Specifically, the clinician adapts and implements a group-based model developed and tested by Bonner et al. (1999) for use with an individual child and his caregivers. Key points of the case study are discussed within the context of implementing evidence-informed treatments for children with sexual behavior problems.

Transrectal Ultra Sonography based evidence of Ksharasutra therapy for Fistula-in-ano - A case series.

PubMed

Nema, Aditya; Gupta, Sanjay Kumar; Dudhamal, Tukaram S; Mahanta, Vyasadeva

Ksharasutra (parasurgical procedure using a thread treated by alkalies) is being practiced in Indian system of medicine since ancient time for management of ano-rectal disorders; particularly for Bhagandara, (fistula in ano), and generally difficult to treat. In this case series, standard Ksharasutra was prepared as per the Ayurvedic Pharmacopeia of India and used to treat the different cases of Bhagandara. In this case series total 6 patients of Bhagandara were treated with Ksharasutra and partial fistulectomy. The average Unit Cutting Time and healing (UCTH) was observed 7.86 days/cm. During treatment Panchawalkala Kwatha (decoction of five medicinal plant's bark), Shatdhautaghrita, Jatyaditaila and Erandabhrishtaharitaki Churna were used as adjuvant drugs. To generate quality evidence Transrectal Ultra Sonography (TRUS) was used in pre as well as post-treatment and showed remarkable tool to assess effect of treatment. Substantial clinical result was observed at the end of treatment and all the patients were free of fistula. No recurrence was observed in any case during the 12 follow up of 12 months. The treatment was reported safe and well tolerated in all the patients. Copyright © 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Published by Elsevier B.V. All rights reserved.

A case of unresectable combined hepatocellular cholangiocarcinoma showing favorable response to LFP therapy.

PubMed

Kato, Sayuri; Takeuchi, Yasuto; Wada, Nozomu; Morimoto, Yuuki; Kuwaki, Kenji; Ohnishi, Hideki; Nakamura, Shinichiro; Shiraha, Hidenori; Takaki, Akinobu; Okada, Hiroyuki

2016-01-01

A woman in her 50s was admitted to our hospital because of multiple tumors detected in her liver. She was diagnosed with combined hepatocellular cholangiocarcinoma using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and biopsy of the liver tumors. We judged the tumors to be unresectable because they were found in both lobes of the liver, with a tumor thrombus being found in the main left portal vein. The pathological findings showed that the tumors exhibited characteristics of hepatocellular carcinoma. Therefore, sorafenib was administered;however, 6 months later, the disease progressed. Consequently, she received second-line chemotherapy with a one-shot intra-arterial injection of cisplatin, but this too was ineffective, and her general condition worsened. As hence, we changed the regimen to 5-fluorouracil continuous infusion and consecutive low dose cisplatin (LFP) therapy. After one cycle of chemotherapy with LFP, Gd-EOB-DTPA-enhanced MRI showed markedly decreased sizes and numbers of tumors. To date, she has completed six cycles of LFP therapy, and almost all her tumors are no longer visible on MRI. She has recovered to a good state and has achieved long-term survival. Thus, this case indicates that although LFP therapy is generally selected for cases of advanced hepatocellular carcinoma, it also appears to be effective for long-term disease control in cases of hepatocellular cholangiocarcinoma.

Day case hernia repair: weak evidence or practice gap?

PubMed

Scarfe, Anje; Duncan, Joanna; Ma, Ning; Cameron, Alun; Rankin, David; Karatassas, Alex; Fletcher, David; Watters, David; Maddern, Guy

2018-06-01

Analysis of a private insurer's administrative data set revealed significant variation in the length of hospital stay following hernia surgery. This review examined factors influencing the performance of day surgery for inguinal, femoral and umbilical hernia repair in adults. A systematic literature search was conducted in the PubMed, Embase and Cochrane Library databases to identify studies and clinical practice guidelines (CPGs) comparing same day hernia surgery to surgery followed by an overnight stay. Screening of studies by abstract and full text was completed by a single researcher and checked by a second. Studies were selected for inclusion based on a step-wise approach across three phases. Limited evidence from one systematic review, and three case series studies including 3213 patients found that same day hernia surgery was as safe and effective as an overnight stay. All identified CPGs recommended a same day procedure for most patients. Two case series studies reported that 3-8% of patients were ineligible for day procedures due to medical reasons; however, the characteristics of patients, in general, which are not suitable, have not been adequately investigated. Day surgery for groin hernia repair is safe and effective for most patients. However, evidence-based support is only one of many factors that may contribute to the uptake of day surgery in Australia. There is an opportunity for key stakeholders across the private healthcare system to deliver an equally effective but more sustainable and affordable hernia care by increasing the day surgery rates. © 2018 Royal Australasian College of Surgeons.

A Case Study Showing How One Young Child Represented Issues Concerned with Attachment and Separation in Her Spontaneous Explorations

ERIC Educational Resources Information Center

Arnold, Cath

2009-01-01

This paper presents a case study of a young child, demonstrating evidence of a connection between "enveloping" objects and understanding presence and absence of a temporary and permanent nature. The starting point for the researcher was: an interest in identifying schemas or repeated patterns in order to understand cognitive development and; a…

An Evaluation of Multiple Single-Case Outcome Indicators Using Convergent Evidence Scaling

ERIC Educational Resources Information Center

McGill, Ryan J.; Busse, R. T.

2014-01-01

The purpose of this article is to evaluate the consistency of five single-case outcome indicators, used to assess response-to-intervention data from a pilot Tier 2 reading intervention that was implemented at an elementary school. Using convergent evidence scaling, the indicators were converted onto a common interpretive scale for each case…

20 CFR 408.320 - What evidence shows that a person has authority to sign an application for you?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false What evidence shows that a person has authority to sign an application for you? 408.320 Section 408.320 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Filing Applications Filing Your Application...

20 CFR 408.320 - What evidence shows that a person has authority to sign an application for you?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What evidence shows that a person has authority to sign an application for you? 408.320 Section 408.320 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Filing Applications Filing Your Application...

Evidence of Time-Of-Day Pricing In the United States. Volume 2, Appendices and Case Studies

DOT National Transportation Integrated Search

1984-05-01

This is the companion volume to the research report, Evidence on Time of Transit Pricing in the United States. This volume serves as an expanded appendix to the Volume 1 report, principally providing detailed case-by-case summaries on experiences wit...

Two cases of matrix-producing carcinoma showing chondromyxoid matrix in cytological specimens.

PubMed

Tajima, Shogo; Koda, Kenji

2015-01-01

Matrix-producing carcinoma (MPC) is extremely rare. Limited reports have described the cytological aspects of MPC. Herein, we present 2 cases of MPC, both of which showed ring-enhancement on magnetic resonance imaging (MRI) and chondromyxoid matrix on cytological specimens. In these cases, the diagnosis of MPC was preoperatively suspected. Recognizing extracellular matrix as chondromyxoid matrix on the cytological specimen is important in making a distinction between MPC and mucinous carcinoma. They share some features on cytology and MRI (ring-enhancement) but have different prognoses and involve different approaches for obtaining histological specimens for neoadjuvant therapy. The reason for the different approaches for obtaining the histological specimens is that tumor cells usually distribute peripherally in MPC in contrast to the relatively uniform distribution of mucinous carcinoma. Therefore, it would be helpful if the diagnosis of MPC can be suspected by examination of the cytological specimen.

Risk, statistical inference, and the law of evidence: the use of epidemiological data in toxic tort cases.

PubMed

Brannigan, V M; Bier, V M; Berg, C

1992-09-01

Toxic torts are product liability cases dealing with alleged injuries due to chemical or biological hazards such as radiation, thalidomide, or Agent Orange. Toxic tort cases typically rely more heavily than other product liability cases on indirect or statistical proof of injury. There have been numerous theoretical analyses of statistical proof of injury in toxic tort cases. However, there have been only a handful of actual legal decisions regarding the use of such statistical evidence, and most of those decisions have been inconclusive. Recently, a major case from the Fifth Circuit, involving allegations that Benedectin (a morning sickness drug) caused birth defects, was decided entirely on the basis of statistical inference. This paper examines both the conceptual basis of that decision, and also the relationships among statistical inference, scientific evidence, and the rules of product liability in general.

A 10-Day Developmental Voyage: Converging Evidence from Three Studies Showing that Self-Esteem May Be Elevated and Maintained without Negative Outcomes

ERIC Educational Resources Information Center

Kafka, S.; Hunter, J. A.; Hayhurst, J.; Boyes, M.; Thomson, R. L.; Clarke, H.; Grocott, A. M.; Stringer, M.; O'Brien, K. S.

2012-01-01

Empirical evidence shows that educational experiences in the context of the outdoors lead to elevated self-esteem. Although elevated self-esteem is widely assumed to promote beneficial outcomes, recent evidence suggests that elevated self-esteem may also facilitate a variety of negative outcomes (i.e., increased prejudice, aggression, drug and…

[Case with probable dementia with Lewy bodies, who shows reduplicative paramnesia and Capgras syndrome].

PubMed

Ohara, Kazuyuki; Morita, Yoshio

2006-01-01

We report a case of probable dementia with Lewy bodies (DLB), showing reduplicative paramnesia (RP) and Capgras syndrome (CS). The patient, a right-handed 60 year-old male, began to show progressive dementia. At the age of 65, he showed fluctuating cognitive impairment and recurrent visual hallucinations. His SPECT demonstrated hypoperfusion not in the medial temporal cortices, but in the parieto-occipital lobes, where the right hemisphere was dominantly hypoperfused. He was diagnosed with probable DLB. In addition to recurrent visual hallucinations, he showed a sense of self- (or others) transfiguration, consciousness of something non-existent (Leibhaftige Bewusstheit; Jaspers, K.), and fluctuating visuo-spacial impairment. At the age of 67, he gradually complained of his duplicative wives "sosie". Finally he went so far as to talk about a nameless phantom boarder. We considered that RP and CS of this case comprised a sense of self-(or others) transfiguration, misidentification of important persons and places, and productive symptoms such as consciousness of something non-existent (Leibhaftige Bewusstheit) and visual hallucinations. The above mentioned symptoms might be originated not only from the disturbance of visuospacial recognition, which involves the limbic system (especially amygdala), medial frontal cortex, and right hemisphere of the brain, but also from the disturbance of recursive consciousness, due to diffusely damaged brain regions with Lewy body pathology. (Authors' abstract)

42 CFR 405.1028 - Prehearing case review of evidence submitted to the ALJ.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Prehearing case review of evidence submitted to the ALJ. 405.1028 Section 405.1028 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Determinations, Redeterminations, Reconsiderations,...

LGB-Affirmative Cognitive Behavioral Treatment for Social Anxiety: A Case Study Applying Evidence-Based Practice Principles

ERIC Educational Resources Information Center

Walsh, Kate; Hope, Debra A.

2010-01-01

Guided by the American Psychological Association's principles of evidence-based practice, this article reviews a single-case treatment outcome study whereby a client characteristic, sexual identity, was integrated into the assessment and treatment of social anxiety symptoms. The case involved a young adult European-American male who presented to a…

The Politics of Evidence Use in Health Policy Making in Germany-the Case of Regulating Hospital Minimum Volumes.

PubMed

Ettelt, Stefanie

2017-06-01

This article examines the role of scientific evidence in informing health policy decisions in Germany, using minimum volumes policy as a case study. It argues that scientific evidence was used strategically at various stages of the policy process both by individual corporatist actors and by the Federal Joint Committee as the regulator. Minimum volumes regulation was inspired by scientific evidence suggesting a positive relationship between service volume and patient outcomes for complex surgical interventions. Federal legislation was introduced in 2002 to delegate the selection of services and the setting of volumes to corporatist decision makers. Yet, despite being represented in the Federal Joint Committee, hospitals affected by its decisions took the Committee to court to seek legal redress and prevent policy implementation. Evidence has been key to support, and challenge, decisions about minimum volumes, including in court. The analysis of the role of scientific evidence in minimum volumes regulation in Germany highlights the dynamic relationship between evidence use and the political and institutional context of health policy making, which in this case is characterized by the legislative nature of policy making, corporatism, and the role of the judiciary in reviewing policy decisions. Copyright © 2017 by Stefanie Ettelt.

Ten cases of severe oral lichen planus showing granular C3 deposition in oral mucosal basement membrane zone.

PubMed

Hashimoto, Takashi; Fukuda, Aoi; Himejima, Akio; Morita, Shosuke; Tsuruta, Daisuke; Koga, Hiroshi; Krol, Rafal P; Ishii, Norito

2015-01-01

Oral lichen planus (OLP) may show depositions of immunoglobulins and complement components in oral mucosal basement membrane zone (BMZ) in direct immunofluorescence, although these finding are not frequently seen. We collected and examined ten cases of severe OLP showing granular C3 deposition in BMZ. In addition to clinical, histopathological and direct immunofluorescence assessments, we performed various immune-serological tests, including indirect immunofluorescence of normal human skin and 1M NaCl-split skin, immunoblotting of normal human epidermal and dermal extracts, recombinant proteins of BP180 NC16a and C-terminal domains, concentrated culture supernatant of HaCaT cells and purified human laminin-332, and enzyme-linked immunosorbent assays for BP230 and BP180. Direct immunofluorescence showed C3 deposition in BMZ exclusively of granular pattern in 7 cases and of both granular and linear patterns in 3 cases. The 10 cases showed no positive reactivity for either IgG or IgA antibodies in any immuno-serological tests. Detailed analyses of clinical, histopathological and immunological findings revealed striking female prevalence, although other parameters were in general characteristic of OLP. Granular C3 deposition in oral BMZ may be one of the characteristic features of severe OLP, although mechanisms for C3 deposition and its pathogenic role in OLP are currently unknown.

In the teeth of the evidence: the curious case of evidence-based medicine.

PubMed

Davidoff, F

1999-03-01

For a very long time, evidence from research has contributed to clinical decision making. Over the past 50 years, however, the nature of clinical research evidence has drastically changed compared with previous eras: its standards are higher, the tools for assembling and analyzing it are more powerful, and the context in which it is used is less authoritarian. The consequence has been a shift in both the concept and the practice of clinical decision making known as evidence-based medicine. Evidence-based decisions, by definition, use the strongest available evidence, are often more quantitatively informed than decisions made in the traditional fashion; and sometimes run counter to expert opinion. The techniques of evidence-based medicine are also helpful in resolving conflicting opinions. Evidence-based medicine did not simply appear in vacuo; its roots extend back at least as far as the great French Encyclopedia of the 18th century, and the subsequent work of Pierre Louis in Paris in the early 19th century. The power of the evidence-based approach has been enhanced in recent years by the development of the techniques of systematic review and meta-analysis. While this approach has its critics, we would all want the best available evidence used in making decisions about our care if we got sick. It is only fair that the patients under our care receive nothing less.

The Challenges of Institutional Research in Building a Culture of Evidence: A Case Study

ERIC Educational Resources Information Center

Goomas, David T.; Isbell, Teresa

2015-01-01

The process of building a culture of evidence involves using data to understand where students are experiencing problems, designing strategies for remedying those problems, implementing them, and then evaluating the effectiveness of those implemented strategies. This case study is about two programs that were implemented within the last two years…

Brain SPECT Imaging in Complex Psychiatric Cases: An Evidence-Based, Underutilized Tool

PubMed Central

Amen, Daniel G; Trujillo, Manuel; Newberg, Andrew; Willeumier, Kristen; Tarzwell, Robert; Wu, Joseph C; Chaitin, Barry

2011-01-01

Over the past 20 years brain Single Photon Emission Computed Tomography (SPECT) imaging has developed a substantial, evidence-based foundation and is now recommended by professional societies for numerous indications relevant to psychiatric practice. Unfortunately, SPECT in clinical practice is utilized by only a handful of clinicians. This article presents a rationale for a more widespread use of SPECT in clinical practice for complex cases, and includes seven clinical applications where it may help optimize patient care. PMID:21863144

The neurophysiology of language processing shapes the evolution of grammar: evidence from case marking.

PubMed

Bickel, Balthasar; Witzlack-Makarevich, Alena; Choudhary, Kamal K; Schlesewsky, Matthias; Bornkessel-Schlesewsky, Ina

2015-01-01

Do principles of language processing in the brain affect the way grammar evolves over time or is language change just a matter of socio-historical contingency? While the balance of evidence has been ambiguous and controversial, we identify here a neurophysiological constraint on the processing of language that has a systematic effect on the evolution of how noun phrases are marked by case (i.e. by such contrasts as between the English base form she and the object form her). In neurophysiological experiments across diverse languages we found that during processing, participants initially interpret the first base-form noun phrase they hear (e.g. she…) as an agent (which would fit a continuation like … greeted him), even when the sentence later requires the interpretation of a patient role (as in … was greeted). We show that this processing principle is also operative in Hindi, a language where initial base-form noun phrases most commonly denote patients because many agents receive a special case marker ("ergative") and are often left out in discourse. This finding suggests that the principle is species-wide and independent of the structural affordances of specific languages. As such, the principle favors the development and maintenance of case-marking systems that equate base-form cases with agents rather than with patients. We confirm this evolutionary bias by statistical analyses of phylogenetic signals in over 600 languages worldwide, controlling for confounding effects from language contact. Our findings suggest that at least one core property of grammar systematically adapts in its evolution to the neurophysiological conditions of the brain, independently of socio-historical factors. This opens up new avenues for understanding how specific properties of grammar have developed in tight interaction with the biological evolution of our species.

Effect of evidence-based approach on the customer orientation (Case study: Physicians Health Centers in Isfahan province in 2014)

PubMed Central

Esfahani, NG; Maharati, Y

2015-01-01

Introduction: The purpose of this research was to examine the approach, based on evidence to customer-orientation attending physicians in the region, them being the subject collection. Research method: This is a definitive-analytic and cross-sectional configuration, which was completed in 2014. The statistical community in this research consists of 212 doctors in the healthcare hubs. The working physicians chose 200 patients by means of a simple accidental sampling. The analysis means was the researcher built survey whose efficacy and reliability were verified. In this research, the fundamental equation design and partial least square technique were applied to examine the presumptions and fitness pattern and the structural design was agreed as adequate. Findings: The outcomes showed four cases linked to the character, a behavior which was meant to treat; traditional origins of evidence were employed to retrieve data based on the reliable evidence and the shortage of limitations to the performance of client orientation strategy of evidence-based influences were meaningful. Two ranges of the doctor's information, the absence of restrictions, and the finding of the sign of dimensions about the client orientation approach were according to the evidence that had no meaningful influence. Conclusion: The utilization of evidence-based training not only increased awareness, character, and abilities of the doctors but also allowed them to answer to the requirements of clients in choosing excellent decisions and presenting a better quality of healthcare, by decreasing treatment prices for patients, bringing satisfaction of patients, and finally having a better effectiveness for patients and institutions. PMID:28316691

Effect of evidence-based approach on the customer orientation (Case study: Physicians Health Centers in Isfahan province in 2014).

PubMed

Esfahani, N G; Maharati, Y

2015-01-01

Introduction: The purpose of this research was to examine the approach, based on evidence to customer-orientation attending physicians in the region, them being the subject collection. Research method: This is a definitive-analytic and cross-sectional configuration, which was completed in 2014. The statistical community in this research consists of 212 doctors in the healthcare hubs. The working physicians chose 200 patients by means of a simple accidental sampling. The analysis means was the researcher built survey whose efficacy and reliability were verified. In this research, the fundamental equation design and partial least square technique were applied to examine the presumptions and fitness pattern and the structural design was agreed as adequate. Findings: The outcomes showed four cases linked to the character, a behavior which was meant to treat; traditional origins of evidence were employed to retrieve data based on the reliable evidence and the shortage of limitations to the performance of client orientation strategy of evidence-based influences were meaningful. Two ranges of the doctor's information, the absence of restrictions, and the finding of the sign of dimensions about the client orientation approach were according to the evidence that had no meaningful influence. Conclusion: The utilization of evidence-based training not only increased awareness, character, and abilities of the doctors but also allowed them to answer to the requirements of clients in choosing excellent decisions and presenting a better quality of healthcare, by decreasing treatment prices for patients, bringing satisfaction of patients, and finally having a better effectiveness for patients and institutions.

Use of Murine Bioassay to Resolve Ovine Transmissible Spongiform Encephalopathy Cases Showing a Bovine Spongiform Encephalopathy Molecular Profile

PubMed Central

Beck, Katy E; Sallis, Rosemary E; Lockey, Richard; Vickery, Christopher M; Béringue, Vincent; Laude, Hubert; Holder, Thomas M; Thorne, Leigh; Terry, Linda A; Tout, Anna C; Jayasena, Dhanushka; Griffiths, Peter C; Cawthraw, Saira; Ellis, Richard; Balkema-Buschmann, Anne; Groschup, Martin H; Simmons, Marion M; Spiropoulos, John

2012-01-01

Two cases of unusual transmissible spongiform encephalopathy (TSE) were diagnosed on the same farm in ARQ/ARQ PrP sheep showing attributes of both bovine spongiform encephalopathy (BSE) and scrapie. These cases, UK-1 and UK-2, were investigated further by transmissions to wild-type and ovine transgenic mice. Lesion profiles (LP) on primary isolation and subpassage, incubation period (IP) of disease, PrPSc immunohistochemical (IHC) deposition pattern and Western blot profiles were used to characterize the prions causing disease in these sheep. Results showed that both cases were compatible with scrapie. The presence of BSE was contraindicated by the following: LP on primary isolation in RIII and/or MR (modified RIII) mice; IP and LP after serial passage in wild-type mice; PrPSc deposition pattern in wild-type mice; and IP and Western blot data in transgenic mice. Furthermore, immunohistochemistry (IHC) revealed that each case generated two distinct PrPSc deposition patterns in both wild-type and transgenic mice, suggesting that two scrapie strains coexisted in the ovine hosts. Critically, these data confirmed the original differential IHC categorization that these UK-1 and UK-2 cases were not compatible with BSE. PMID:21919992

Examining the prevalence, role and impact of evidence regarding Antisocial Personality, sociopathy and psychopathy in capital cases: a survey of defense team members.

PubMed

Edens, John F; Cox, Jennifer

2012-01-01

Although anecdotal case accounts suggest that evidence concerning Antisocial Personality Disorder (APD), sociopathy and psychopathy is frequently introduced by the prosecution in capital murder trials, to date there has been no systematic research to determine the actual prevalence, role, or perceived impact of such evidence in these cases. Survey data collected from attendees at a national capital mitigation conference (n=41) indicated that prosecution evidence concerning APD was quite prevalent, with "sociopath" and "psychopath" labels being introduced less frequently. Evidence concerning these disorders, which were assessed primarily via DSM criteria and self-report personality inventories, was most often introduced by the prosecution in the sentencing phase to address a defendant's ostensible risk of future dangerousness and/or to rebut mitigating evidence-although it was also introduced frequently in the guilt/innocence phase of these trials to rebut mental health evidence offered by the defense. Survey respondents believed that evidence concerning APD, sociopathy, and psychopathy had a considerable impact on trial outcomes. Also, although defense objections were common, such evidence was rarely ruled to be inadmissible in these cases. Copyright © 2012 John Wiley & Sons, Ltd.

Evidence-based treatment of attention deficit/hyperactivity disorder in a preschool-age child: a case study.

PubMed

Verduin, Timothy L; Abikoff, Howard; Kurtz, Steven M S

2008-04-01

This case study illustrates a behavioral treatment of "Peter," a 4-year-old male with attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder. Multiple evidence-based treatment procedures were implemented, affording the opportunity to explore issues common to the clinical application of empirically supported interventions. Among the strategies utilized were behavioral parent training, school consultation and behavioral training of educators, school-based contingency management, and a behavioral daily report card. Numerous issues are discussed, including the limited evidence regarding interventions for preschool-age children with ADHD, factors influencing treatment planning and sequencing, collaboration with schools and parents, and evidence-based assessment of treatment gains.

20 CFR 10.116 - What additional evidence is needed in cases based on occupational disease?

Code of Federal Regulations, 2012 CFR

2012-04-01

... based on occupational disease? 10.116 Section 10.116 Employees' Benefits OFFICE OF WORKERS' COMPENSATION... of Proof § 10.116 What additional evidence is needed in cases based on occupational disease? (a) The... particular occupational diseases. The medical report should also include the information specified on the...

20 CFR 10.116 - What additional evidence is needed in cases based on occupational disease?

Code of Federal Regulations, 2013 CFR

2013-04-01

... based on occupational disease? 10.116 Section 10.116 Employees' Benefits OFFICE OF WORKERS' COMPENSATION... of Proof § 10.116 What additional evidence is needed in cases based on occupational disease? (a) The... particular occupational diseases. The medical report should also include the information specified on the...

20 CFR 10.116 - What additional evidence is needed in cases based on occupational disease?

Code of Federal Regulations, 2014 CFR

2014-04-01

... based on occupational disease? 10.116 Section 10.116 Employees' Benefits OFFICE OF WORKERS' COMPENSATION... of Proof § 10.116 What additional evidence is needed in cases based on occupational disease? (a) The... particular occupational diseases. The medical report should also include the information specified on the...

Indocyanine green angiographic evidence of choroiditis in scleroderma.

PubMed

Abdellatief, Amro; Balasubramaniam, Saranya C; Grube, Thomas J; Gonzalez Santiago, Tania M; Osborn, Thomas G; Pulido, Jose S

2015-01-01

The purpose of this case report was to demonstrate evidence of indocyanine green angiography leakage consistent with choroiditis in a patient with scleroderma. In this case report, the patient underwent a variety of tests and examinations, including systemic evaluation, full ocular examination, skin biopsy, indocyanine green, and fluorescein angiography testing. A 52-year-old man had blurred vision centrally in both eyes. Vision was 20/25 and 20/20. Posterior examination showed cotton-wool spots in both eyes. The patient met European League against Rheumatism (EULAR) criteria for scleroderma. Fluorescein angiography confirmed the presence of leakage from the retinal vessels. More importantly, indocyanine green angiography revealed choroidal vessel leakage in both eyes. This provided evidence of choroiditis before vessel obliteration. Previous studies have shown evidence of choriocapillaris obliteration. Choroidal vessel leakage, however, has not been reported in patients with scleroderma. The results of this case demonstrate the usefulness of indocyanine green angiography in detecting the presence of choroiditis in scleroderma.

Diagnosis of a 64-year-old patient presenting with suspected lumbar spinal stenosis: an evidence-based case report

PubMed Central

Emary, Peter C.

2015-01-01

Objective: To present an evidence-based case report on the diagnosis of a patient with suspected lumbar spinal stenosis (LSS). Case: A 64-year-old man presented with signs and symptoms suggestive of LSS, but physical examination and diagnostic imaging findings were inconclusive. Other co-morbidities included diabetes, congestive heart failure, and left hip joint osteoarthritis. Outcome: PubMed was searched for systematic reviews of diagnostic studies on LSS. Two recent articles were found and appraised with respect to their validity, importance, and applicability in diagnosing the current patient. Copies of his magnetic resonance imaging were also obtained and used in combination with the appraised literature, including diagnostic test specificities and likelihood ratios, to confirm an LSS diagnosis. Summary: This case illustrates how research evidence can be used in clinical practice, particularly in the diagnosis of an individual patient. PMID:25729085

20 CFR 10.116 - What additional evidence is needed in cases based on occupational disease?

Code of Federal Regulations, 2011 CFR

2011-04-01

... based on occupational disease? 10.116 Section 10.116 Employees' Benefits OFFICE OF WORKERS' COMPENSATION... of Proof § 10.116 What additional evidence is needed in cases based on occupational disease? (a) The... occupational diseases. The medical report should also include the information specified on the checklist for...

20 CFR 10.116 - What additional evidence is needed in cases based on occupational disease?

Code of Federal Regulations, 2010 CFR

2010-04-01

... based on occupational disease? 10.116 Section 10.116 Employees' Benefits OFFICE OF WORKERS' COMPENSATION... of Proof § 10.116 What additional evidence is needed in cases based on occupational disease? (a) The... occupational diseases. The medical report should also include the information specified on the checklist for...

Organizational impact of evidence-informed decision making training initiatives: a case study comparison of two approaches.

PubMed

Champagne, François; Lemieux-Charles, Louise; Duranceau, Marie-France; MacKean, Gail; Reay, Trish

2014-05-02

The impact of efforts by healthcare organizations to enhance the use of evidence to improve organizational processes through training programs has seldom been assessed. We therefore endeavored to assess whether and how the training of mid- and senior-level healthcare managers could lead to organizational change. We conducted a theory-driven evaluation of the organizational impact of healthcare leaders' participation in two training programs using a logic model based on Nonaka's theory of knowledge conversion. We analyzed six case studies nested within the two programs using three embedded units of analysis (individual, group and organization). Interviews were conducted during intensive one-week data collection site visits. A total of 84 people were interviewed. We found that the impact of training could primarily be felt in trainees' immediate work environments. The conversion of attitudes was found to be easier to achieve than the conversion of skills. Our results show that, although socialization and externalization were common in all cases, a lack of combination impeded the conversion of skills. We also identified several individual, organizational and program design factors that facilitated and/or impeded the dissemination of the attitudes and skills gained by trainees to other organizational members. Our theory-driven evaluation showed that factors before, during and after training can influence the extent of skills and knowledge transfer. Our evaluation went further than previous research by revealing the influence--both positive and negative--of specific organizational factors on extending the impact of training programs.

A Case of Uveal Colobomas Showing Marked Left-Right Difference in Diabetic Retinopathy.

PubMed

Moriya, Takeshi; Ochi, Ryosuke; Imagawa, Yukihiro; Sato, Bumpei; Morishita, Seita; Tonari, Masahiro; Fukumoto, Masanori; Suzuki, Hiroyuki; Kobayashi, Takatoshi; Kida, Teruyo; Ikeda, Tsunehiko

2016-01-01

Congenital uveal colobomas, including inferior iris and choroidal colobomas, are associated with microcornea and microphthalmia and often show left-right differences (laterality). The purpose of this study was to report a case of choroidal coloboma associated with left-right differences in diabetic retinopathy (DR). This study reports a 59-year-old male with bilateral iris and choroidal colobomas. The colobomatous area in the patient's right eye extended to the macula, and his right eye had been amblyopic since birth. The colobomatous area in his left eye was less extensive and did not involve the macula. Examination of the patient's left eye revealed multiple hemorrhages and hard exudates in the macula due to DR, but examination of his right eye showed almost no changes in DR, thus revealing a marked left-right difference. Optical coherence tomography showed more extensive retinal thinning in the patient's right eye than in his left eye. Fluorescein fundus angiography revealed a retinal nonperfusion area only in the left eye, and panretinal photocoagulation was subsequently performed. Our findings show that the reason for the left-right difference in DR was attributed to the more severe choroidal coloboma and retinal thinning in the patient's right eye compared to his left eye, thus reducing oxygen demand, as is also seen in eyes with severe myopia.

Experimental evidence showing that no mitotically active female germline progenitors exist in postnatal mouse ovaries.

PubMed

Zhang, Hua; Zheng, Wenjing; Shen, Yan; Adhikari, Deepak; Ueno, Hiroo; Liu, Kui

2012-07-31

It has been generally accepted for more than half a century that, in most mammalian species, oocytes cannot renew themselves in postnatal or adult life, and that the number of oocytes is already fixed in fetal or neonatal ovaries. This assumption, however, has been challenged over the past decade. In this study, we have taken an endogenous genetic approach to this question and generated a multiple fluorescent Rosa26(rbw/+);Ddx4-Cre germline reporter mouse model for in vivo and in vitro tracing of the development of female germline cell lineage. Through live cell imaging and de novo folliculogenesis experiments, we show that the Ddx4-expressing cells from postnatal mouse ovaries did not enter mitosis, nor did they contribute to oocytes during de novo folliculogenesis. Our results provide evidence that supports the traditional view that no postnatal follicular renewal occurs in mammals, and no mitotically active Ddx4-expressing female germline progenitors exist in postnatal mouse ovaries.

[Burden of proof in medical cases--presumption of fact and prima facie evidence. 1. Burden of proof].

PubMed

Sliwka, Marcin

2004-01-01

The aim of this paper was to present the main rules concerning the burden of proof in polish civil trials, including medical cases. This paper also describes the subject of evidence were presented and explained. The court influence on evidence procedure was also analysed. The effect of the institution of informed consent on burden of proof in polish civil law is also described. This paper includes numerous High Court sentences on evidential and medical issues.

Synchronous Endometrial and Ovarian Carcinomas: Evidence of Clonality.

PubMed

Anglesio, Michael S; Wang, Yi Kan; Maassen, Madlen; Horlings, Hugo M; Bashashati, Ali; Senz, Janine; Mackenzie, Robertson; Grewal, Diljot S; Li-Chang, Hector; Karnezis, Anthony N; Sheffield, Brandon S; McConechy, Melissa K; Kommoss, Friedrich; Taran, Florin A; Staebler, Annette; Shah, Sohrab P; Wallwiener, Diethelm; Brucker, Sara; Gilks, C Blake; Kommoss, Stefan; Huntsman, David G

2016-06-01

Many women with ovarian endometrioid carcinoma present with concurrent endometrial carcinoma. Organ-confined and low-grade synchronous endometrial and ovarian tumors (SEOs) clinically behave as independent primary tumors rather than a single advanced-stage carcinoma. We used 18 SEOs to investigate the ancestral relationship between the endometrial and ovarian components. Based on both targeted and exome sequencing, 17 of 18 patient cases of simultaneous cancer of the endometrium and ovary from our series showed evidence of a clonal relationship, ie, primary tumor and metastasis. Eleven patient cases fulfilled clinicopathological criteria that would lead to classification as independent endometrial and ovarian primary carcinomas, including being of FIGO stage T1a/1A, with organ-restricted growth and without surface involvement; 10 of 11 of these cases showed evidence of clonality. Our observations suggest that the disseminating cells amongst SEOs are restricted to physically accessible and microenvironment-compatible sites yet remain indolent, without the capacity for further dissemination. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Bayesian framework for the evaluation of fiber evidence in a double murder--a case report.

PubMed

Causin, Valerio; Schiavone, Sergio; Marigo, Antonio; Carresi, Pietro

2004-05-10

Fiber evidence found on a suspect vehicle was the only useful trace to reconstruct the dynamics of the transportation of two corpses. Optical microscopy, UV-Vis microspectrophotometry and infrared analysis were employed to compare fibers recovered in the trunk of a car to those of the blankets composing the wrapping in which the victims had been hidden. A "pseudo-1:1" taping permitted to reconstruct the spatial distribution of the traces and to further strengthen the support to one of the hypotheses. The Likelihood Ratio (LR) was calculated, in order to quantify the support given by forensic evidence to the explanations proposed. A generalization of the Likelihood Ratio equation to cases analogous to this has been derived. Fibers were the only traces that helped in the corroboration of the crime scenario, being absent any DNA, fingerprints and ballistic evidence.

[Analysis of the knowledge and practices of health care workers in Emergency Departments regarding the protection and preservation of evidence in forensic cases].

PubMed

Ilçe, Arzu; Yıldız, Dilek; Baysal, Gonca; Ozdoğan, Fatma; Taş, Fatma

2010-11-01

The frequency of violent incidents is increasing. This increase has made the role of Emergency Department (ED) staff more important in the collection, recording, protection, and storage of the evidence until the arrival of the responsible people concerned with the issue. Therefore, this study was designed to analyze the knowledge and practices of the nursing staff working in the EDs with respect to the protection and preservation of the evidence in forensic cases. This research, which was designed to be descriptive, was conducted with 44 health care workers in the hospitals with Emergency Departments in the center of Bolu province between October 2008 and January 2009. It was observed that 90.9% of the health care workers encountered forensic cases, 65.9% of them had not attended any training on forensic cases, and 22.7% of them did not use care when removing and storing the clothes of the patient. It was considered that 90.9% of the health care workers duly carry out their duties and responsibilities in forensic cases; however, 18.2% of them do not have sufficient knowledge or practical experience in the preservation and protection of evidence in forensic cases. It was observed that most health care workers do not have sufficient knowledge or practical experience in the preservation and protection of evidence in forensic cases.

Evidence-Based Treatment of Attention Deficit/Hyperactivity Disorder in a Preschool-Age Child: A Case Study

ERIC Educational Resources Information Center

Verduin, Timothy L.; Abikoff, Howard; Kurtz, Steven M. S.

2008-01-01

This case study illustrates a behavioral treatment of "Peter," a 4-year-old male with attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder. Multiple evidence-based treatment procedures were implemented, affording the opportunity to explore issues common to the clinical application of empirically supported…

Production and comprehension show divergent constituent order preferences: Evidence from elicited pantomime

PubMed Central

Hall, Matthew L.; Ahn, Y. Danbi; Mayberry, Rachel I.; Ferreira, Victor S.

2015-01-01

All natural languages develop devices to communicate who did what to whom. Elicited pantomime provides one model for studying this process, by providing a window into how humans (hearing non-signers) behave in a natural communicative modality (silent gesture) without established conventions from a grammar. Most studies in this paradigm focus on production, although they sometimes make assumptions about how comprehenders would likely behave. Here, we directly assess how naïve speakers of English (Experiments 1 & 2), Korean (Experiment 1), and Turkish (Experiment 2) comprehend pantomimed descriptions of transitive events, which are either semantically reversible (Experiments 1 & 2) or not (Experiment 2). Contrary to previous assumptions, we find no evidence that Person-Person-Action sequences are ambiguous to comprehenders, who simply adopt an agent-first parsing heuristic for all constituent orders. We do find that Person-Action-Person sequences yield the most consistent interpretations, even in native speakers of SOV languages. The full range of behavior in both production and comprehension provides counter-evidence to the notion that producers’ utterances are motivated by the needs of comprehenders. Instead, we argue that production and comprehension are subject to different sets of cognitive pressures, and that the dynamic interaction between these competing pressures can help explain synchronic and diachronic constituent order phenomena in natural human languages, both signed and spoken. PMID:25642018

Egg Case Silk Gene Sequences from Argiope Spiders: Evidence for Multiple Loci and a Loss of Function Between Paralogs

PubMed Central

Chaw, R. Crystal; Collin, Matthew; Wimmer, Marjorie; Helmrick, Kara-Leigh; Hayashi, Cheryl Y.

2017-01-01

Spiders swath their eggs with silk to protect developing embryos and hatchlings. Egg case silks, like other fibrous spider silks, are primarily composed of proteins called spidroins (spidroin = spider-fibroin). Silks, and thus spidroins, are important throughout the lives of spiders, yet the evolution of spidroin genes has been relatively understudied. Spidroin genes are notoriously difficult to sequence because they are typically very long (≥ 10 kb of coding sequence) and highly repetitive. Here, we investigate the evolution of spider silk genes through long-read sequencing of Bacterial Artificial Chromosome (BAC) clones. We demonstrate that the silver garden spider Argiope argentata has multiple egg case spidroin loci with a loss of function at one locus. We also use degenerate PCR primers to search the genomic DNA of congeneric species and find evidence for multiple egg case spidroin loci in other Argiope spiders. Comparative analyses show that these multiple loci are more similar at the nucleotide level within a species than between species. This pattern is consistent with concerted evolution homogenizing gene copies within a genome. More complicated explanations include convergent evolution or recent independent gene duplications within each species. PMID:29127108

The Economic Case for Education

ERIC Educational Resources Information Center

Woessmann, Ludger

2016-01-01

The case for education can be made from many perspectives. This paper makes the case for education based on economic outcomes. Surveying the most recent empirical evidence, it shows the crucial role of education for individual and societal prosperity. Education is a leading determinant of economic growth, employment, and earnings in modern…

Neural dissociation of phonological and visual attention span disorders in developmental dyslexia: FMRI evidence from two case reports.

PubMed

Peyrin, C; Lallier, M; Démonet, J F; Pernet, C; Baciu, M; Le Bas, J F; Valdois, S

2012-03-01

A dissociation between phonological and visual attention (VA) span disorders has been reported in dyslexic children. This study investigates whether this cognitively-based dissociation has a neurobiological counterpart through the investigation of two cases of developmental dyslexia. LL showed a phonological disorder but preserved VA span whereas FG exhibited the reverse pattern. During a phonological rhyme judgement task, LL showed decreased activation of the left inferior frontal gyrus whereas this region was activated at the level of the controls in FG. Conversely, during a visual categorization task, FG demonstrated decreased activation of the parietal lobules whereas these regions were activated in LL as in the controls. These contrasted patterns of brain activation thus mirror the cognitive disorders' dissociation. These findings provide the first evidence for an association between distinct brain mechanisms and distinct cognitive deficits in developmental dyslexia, emphasizing the importance of taking into account the heterogeneity of the reading disorder. Copyright © 2012 Elsevier Inc. All rights reserved.

The Role of Forensic Botany in Solving a Case: Scientific Evidence on the Falsification of a Crime Scene.

PubMed

Aquila, Isabella; Gratteri, Santo; Sacco, Matteo A; Ricci, Pietrantonio

2018-05-01

Forensic botany can provide useful information for pathologists, particularly on crime scene investigation. We report the case of a man who arrived at the hospital and died shortly afterward. The body showed widespread electrical lesions. The statements of his brother and wife about the incident aroused a large amount of suspicion in the investigators. A crime scene investigation was carried out, along with a botanical morphological survey on small vegetations found on the corpse. An autopsy was also performed. Botanical analysis showed some samples of Xanthium spinosum, thus leading to the discovery of the falsification of the crime scene although the location of the true crime scene remained a mystery. The botanical analysis, along with circumstantial data and autopsy findings, led to the discovery of the real crime scene and became crucial as part of the legal evidence regarding the falsity of the statements made to investigators. © 2017 American Academy of Forensic Sciences.

Belief beyond the evidence: using the proposed effect of breakfast on obesity to show 2 practices that distort scientific evidence1234

PubMed Central

Brown, Andrew W; Bohan Brown, Michelle M

2013-01-01

Background: Various intentional and unintentional factors influence beliefs beyond what scientific evidence justifies. Two such factors are research lacking probative value (RLPV) and biased research reporting (BRR). Objective: We investigated the prevalence of RLPV and BRR in research about the proposition that skipping breakfast causes weight gain, which is called the proposed effect of breakfast on obesity (PEBO) in this article. Design: Studies related to the PEBO were synthesized by using a cumulative meta-analysis. Abstracts from these studies were also rated for the improper use of causal language and biased interpretations. In separate analyses, articles that cited an observational study about the PEBO were rated for the inappropriate use of causal language, and articles that cited a randomized controlled trial (RCT) about the PEBO were rated for misleadingly citing the RCT. Results: The current body of scientific knowledge indicates that the PEBO is only presumed true. The observational literature on the PEBO has gratuitously established the association, but not the causal relation, between skipping breakfast and obesity (final cumulative meta-analysis P value <10−42), which is evidence of RLPV. Four examples of BRR are evident in the PEBO literature as follows: 1) biased interpretation of one's own results, 2) improper use of causal language in describing one's own results, 3) misleadingly citing others’ results, and 4) improper use of causal language in citing others’ work. Conclusions: The belief in the PEBO exceeds the strength of scientific evidence. The scientific record is distorted by RLPV and BRR. RLPV is a suboptimal use of collective scientific resources. PMID:24004890

Evidence-Based Health Care Policy in Reimbursement Decisions: Lessons from a Series of Six Equivocal Case-Studies

PubMed Central

Van Herck, Pieter; Annemans, Lieven; Sermeus, Walter; Ramaekers, Dirk

2013-01-01

Context Health care technological evolution through new drugs, implants and other interventions is a key driver of healthcare spending. Policy makers are currently challenged to strengthen the evidence for and cost-effectiveness of reimbursement decisions, while not reducing the capacity for real innovations. This article examines six cases of reimbursement decision making at the national health insurance authority in Belgium, with outcomes that were contested from an evidence-based perspective in scientific or public media. Methods In depth interviews with key stakeholders based on the adapted framework of Davies allowed us to identify the relative impact of clinical and health economic evidence; experience, expertise & judgment; financial impact & resources; values, ideology & political beliefs; habit & tradition; lobbyists & pressure groups; pragmatics & contingencies; media attention; and adoption from other payers & countries. Findings Evidence was not the sole criterion on which reimbursement decisions were based. Across six equivocal cases numerous other criteria were perceived to influence reimbursement policy. These included other considerations that stakeholders deemed crucial in this area, such as taking into account the cost to the patient, and managing crisis scenarios. However, negative impacts were also reported, in the form of bypassing regular procedures unnecessarily, dominance of an opinion leader, using information selectively, and influential conflicts of interest. Conclusions ‘Evidence’ and ‘negotiation’ are both essential inputs of reimbursement policy. Yet, purposely selected equivocal cases in Belgium provide a rich source to learn from and to improve the interaction between both. We formulated policy recommendations to reconcile the impact of all factors identified. A more systematic approach to reimburse new care may be one of many instruments to resolve the budgetary crisis in health care in other countries as well, by separating

Organizational impact of evidence-informed decision making training initiatives: a case study comparison of two approaches

PubMed Central

2014-01-01

Background The impact of efforts by healthcare organizations to enhance the use of evidence to improve organizational processes through training programs has seldom been assessed. We therefore endeavored to assess whether and how the training of mid- and senior-level healthcare managers could lead to organizational change. Methods We conducted a theory-driven evaluation of the organizational impact of healthcare leaders’ participation in two training programs using a logic model based on Nonaka’s theory of knowledge conversion. We analyzed six case studies nested within the two programs using three embedded units of analysis (individual, group and organization). Interviews were conducted during intensive one-week data collection site visits. A total of 84 people were interviewed. Results We found that the impact of training could primarily be felt in trainees’ immediate work environments. The conversion of attitudes was found to be easier to achieve than the conversion of skills. Our results show that, although socialization and externalization were common in all cases, a lack of combination impeded the conversion of skills. We also identified several individual, organizational and program design factors that facilitated and/or impeded the dissemination of the attitudes and skills gained by trainees to other organizational members. Conclusions Our theory-driven evaluation showed that factors before, during and after training can influence the extent of skills and knowledge transfer. Our evaluation went further than previous research by revealing the influence—both positive and negative—of specific organizational factors on extending the impact of training programs. PMID:24885800

Principled Principals: New Evidence from Chicago Shows They Fire the Least Effective Teachers

ERIC Educational Resources Information Center

Jacob, Brian A.

2011-01-01

If principals have the authority to dismiss teachers, will they dismiss the less effective ones, or will they instead make perverse decisions by letting the good teachers go? Evidence from low-stakes surveys suggests that principals are able to identify the most and least effective teachers in their schools, as measured by their impact on student…

Designing a rapid response program to support evidence-informed decision-making in the Americas region: using the best available evidence and case studies.

PubMed

Haby, Michelle M; Chapman, Evelina; Clark, Rachel; Barreto, Jorge; Reveiz, Ludovic; Lavis, John N

2016-08-18

The objective of this work was to inform the design of a rapid response program to support evidence-informed decision-making in health policy and practice for the Americas region. Specifically, we focus on the following: (1) What are the best methodological approaches for rapid reviews of the research evidence? (2) What other strategies are needed to facilitate evidence-informed decision-making in health policy and practice? and (3) How best to operationalize a rapid response program? The evidence used to inform the design of a rapid response program included (i) two rapid reviews of methodological approaches for rapid reviews of the research evidence and strategies to facilitate evidence-informed decision-making, (ii) supplementary literature in relation to the "shortcuts" that could be considered to reduce the time needed to complete rapid reviews, (iii) four case studies, and (iv) supplementary literature to identify additional operational issues for the design of the program. There is no agreed definition of rapid reviews in the literature and no agreed methodology for conducting them. Better reporting of rapid review methods is needed. The literature found in relation to shortcuts will be helpful in choosing shortcuts that maximize timeliness while minimizing the impact on quality. Evidence for other strategies that can be used concurrently to facilitate the uptake of research evidence, including evidence drawn from rapid reviews, is presented. Operational issues that need to be considered in designing a rapid response program include the implications of a "user-pays" model, the importance of recruiting staff with the right mix of skills and qualifications, and ensuring that the impact of the model on research use in decision-making is formally evaluated. When designing a new rapid response program, greater attention needs to be given to specifying the rapid review methods and reporting these in sufficient detail to allow a quality assessment. It will also be

Creating the Future of Evidence-Based Nutrition Recommendations: Case Studies from Lipid Research123

PubMed Central

Dwyer, Johanna T; Rubin, Kristin H; Psota, Tricia L; Liska, DeAnn J; Montain, Scott J

2016-01-01

Strategic translational research is designed to address research gaps that answer specific guidance questions. It provides translational value with respect to nutrition guidance and regulatory and public policy. The relevance and the quality of evidence both matter in translational research. For example, design decisions regarding population, intervention, comparator, and outcome criteria affect whether or not high-quality studies are considered relevant to specific guidance questions and are therefore included as evidence within the context of systematic review frameworks used by authoritative food and health organizations. The process used in systematic reviews, developed by the USDA for its Nutrition Evidence Library, is described. An eating pattern and cardiovascular disease (CVD) evidence review is provided as an example, and factors that differentiated the studies considered relevant and included in that evidence base from those that were excluded are noted. Case studies on ω-3 (n–3) fatty acids (FAs) and industrial trans-FAs illustrate key factors vital to relevance and translational impact, including choice of a relevant population (e.g., healthy, at risk, or diseased subjects; general population or high-performance soldiers); dose and form of the intervention (e.g., food or supplement); use of relevant comparators (e.g., technically feasible and realistic); and measures for both exposure and outcomes (e.g., inflammatory markers or CVD endpoints). Specific recommendations are provided to help increase the impact of nutrition research on future dietary guidance, policy, and regulatory issues, particularly in the area of lipids. PMID:27422509

Using Evidence in L2 Argumentative Writing: A Longitudinal Case Study across High School and University

ERIC Educational Resources Information Center

Kibler, Amanda K.; Hardigree, Christine

2017-01-01

This 8-year longitudinal case study of Fabiola, a Spanish-English bilingual, investigated her argumentative writing development, focusing on her use of evidence to support and develop arguments over time from high school through university. Data sources included 36 writing samples. Texts across grade levels and course types were analyzed to…

Electrophysiological evidence showing muscarinic agonist-antagonist activities of N-desmethylclozapine using hippocampal excitatory and inhibitory neurons.

PubMed

Sugawara, Yuto; Kikuchi, Yui; Yoneda, Mitsugu; Ohno-Shosaku, Takako

2016-07-01

The atypical antipsychotic clozapine is widely used for treatment-resistant schizophrenic patients. Clozapine and its major active metabolite, N-desmethylclozapine (NDMC), have complex pharmacological properties, and interact with various neurotransmitter receptors. There are several biochemical studies reporting that NDMC exhibits a partial agonist profile at the human recombinant M1 muscarinic receptors. However, direct electrophysiological evidence showing the ability of NDMC to activate native M1 receptors in intact neurons is poor. Using rat hippocampal neurons, we previously demonstrated that activation of muscarinic receptors by a muscarinic agonist, oxotremorine M (oxo-M), induces a decrease in outward K(+)current at -40mV. In the present study, using this muscarinic current response we assessed agonist and antagonist activities of clozapine and NDMC at native muscarinic receptors in intact hippocampal excitatory and inhibitory neurons. Suppression of the oxo-M-induced current response by the M1 antagonist pirenzepine was evident only in excitatory neurons, while the M3 antagonist darifenacin was effective in both types of neurons. Muscarinic agonist activity of NDMC was higher than that of clozapine, higher in excitatory neurons than in inhibitory neurons, sensitive to pirenzepine, and partially masked when co-applied with clozapine. Muscarinic antagonist activity of clozapine as well as NDMC was not different between excitatory and inhibitory neurons, but clozapine was more effective than NDMC. These results demonstrate that NDMC has the ability to activate native M1 receptors expressed in hippocampal excitatory neurons, but its agonist activity might be limited in clozapine-treated patients because of the presence of excessive clozapine with muscarinic antagonist activity. Copyright © 2016 Elsevier B.V. All rights reserved.

Abdominal Wall Endometriosis: Myofibroblasts as a Possible Evidence of Metaplasia: A Case Report.

PubMed

Ibrahim, Mohamed Gamal; Delarue, Eleonore; Abesadze, Elene; Haas, Matthias; Sehouli, Jalid; Chiantera, Vito; Mechsner, Sylvia

2017-01-01

In this study, we report about a patient with extra-uterine endometriosis (EM) in the abdominal wall muscle with evident metaplasia based on the abundant alpha smooth muscle actin (ASMA)-expressing myofibroblasts. Laparotomy excision of the abdominal wall EM was done following ultrasonographic evidence of a hypodense swelling in the right rectus abdominis, which was confirmed by MRI. Immunohistochemistry staining for ASMA and collagen I was done, with the results confirming that endometriotic stromal cells expressed both. Anterior abdominal wall endometriosis was suspected because of the patient's history of recurrent EM combined with the cyclic nature of symptoms. MRI is useful in determining the extent of the disease. In case of persisting symptoms even under hormonal treatment, surgical excision is mandatory. The expression of both ASMA and collagen I in and around EM lesions supports the notion of the metaplastic process in the course of disease development. © 2016 S. Karger AG, Basel.

When evidence is not enough: a case study on alcohol marketing legislation in Brazil.

PubMed

Vendrame, Alan

2017-01-01

This case study identifies the influence and mechanisms that the alcohol industry in Brazil has been able to bring to bear to maintain self-regulation in the marketing of beer and many wines set against a trend of increasing alcohol consumption in Brazil, particularly among young people and women. It identifies the forms of power and strategies used by the alcohol industry in Brazil that may be useful for other countries to consider in seeking to move from self-regulation to state regulation of alcohol marketing. A review was conducted of recent legal documents and court cases, as well as the activities of alcoholic beverage industries. Because of an exemption, Brazilian law had established that both beer and many wines are not alcoholic beverages for marketing purposes. These beverages are subjected to industry self-regulation codes. Research shows that beer and wine marketing often violates industry codes, with little or no enforcement of penalties for non-compliance. Attempts to include beer and wine in the legal definition of alcohol have been opposed by the alcohol industry, and the courts have delegated responsibility to the legislature. The recent legal activities surrounding alcohol sales during the 2014 World Cup games in Brazil provide evidence of the alcohol industry's influence on the legislative process. The alcohol industry in Brazil plays a significant role in the formulation of public policies on alcohol, especially regarding the regulation of marketing. This power is exercised by strong lobbying of government officials responsible for public policies. © 2016 Society for the Study of Addiction.

Improving GRADE evidence tables part 1: a randomized trial shows improved understanding of content in summary of findings tables with a new format.

PubMed

Carrasco-Labra, Alonso; Brignardello-Petersen, Romina; Santesso, Nancy; Neumann, Ignacio; Mustafa, Reem A; Mbuagbaw, Lawrence; Etxeandia Ikobaltzeta, Itziar; De Stio, Catherine; McCullagh, Lauren J; Alonso-Coello, Pablo; Meerpohl, Joerg J; Vandvik, Per Olav; Brozek, Jan L; Akl, Elie A; Bossuyt, Patrick; Churchill, Rachel; Glenton, Claire; Rosenbaum, Sarah; Tugwell, Peter; Welch, Vivian; Garner, Paul; Guyatt, Gordon; Schünemann, Holger J

2016-06-01

The current format of summary of findings (SoFs) tables for presenting effect estimates and associated quality of evidence improve understanding and assist users finding key information in systematic reviews. Users of SoF tables have demanded alternative formats to express findings from systematic reviews. We conducted a randomized controlled trial among systematic review users to compare the relative merits of a new format with the current formats of SoF tables regarding understanding, accessibility of information, satisfaction, and preference. Our primary goal was to show that the new format is not inferior to the current format. Of 390 potentially eligible subjects, 290 were randomized. Of seven items testing understanding, three showed similar results, two showed small differences favoring the new format, and two (understanding risk difference and quality of the evidence associated with a treatment effect) showed large differences favoring the new format [63% (95% confidence interval {CI}: 55, 71) and 62% (95% CI: 52, 71) more correct answers, respectively]. Respondents rated information in the alternative format as more accessible overall and preferred the new format over the current format. While providing at least similar levels of understanding for some items and increased understanding for others, users prefer the new format of SoF tables. Copyright © 2016 Elsevier Inc. All rights reserved.

Consistency between direct and indirect trial evidence: is direct evidence always more reliable?

PubMed

Madan, Jason; Stevenson, Matt D; Cooper, Katy L; Ades, A E; Whyte, Sophie; Akehurst, Ron

2011-01-01

To present a case study involving the reduction in incidence of febrile neutropenia (FN) after chemotherapy with granulocyte colony-stimulating factors (G-CSFs), illustrating difficulties that may arise when following the common preference for direct evidence over indirect evidence. Evidence of the efficacy of treatments was identified from two previous systematic reviews. We used Bayesian evidence synthesis to estimate relative treatment effects based on direct evidence, indirect evidence, and both pooled together. We checked for inconsistency between direct and indirect evidence and explored the role of one specific trial using cross-validation. A subsequent review identified further studies not available at the time of the original analysis. We repeated the analyses on the enlarged evidence base. We found substantial inconsistency in the original evidence base. The median odds ratio of FN for primary pegfilgrastim versus no primary G-CSF was 0.06 (95% credible interval: 0.02-0.19) based on direct evidence, but 0.27 (95% credible interval: 0.13-0.53) based on indirect evidence (P value for consistency hypothesis 0.027). The additional trials were consistent with the earlier indirect, rather than the direct, evidence, and there was no inconsistency between direct and indirect estimates in the updated evidence. The earlier inconsistency was due to one trial comparing primary pegfilgrastim with no primary G-CSF. Predictive cross-validation showed that this study was inconsistent with the evidence as a whole and with other trials making this comparison. Both the Cochrane Handbook and the NICE Methods Guide express a preference for direct evidence. A more robust strategy, which is in line with the accepted principles of evidence synthesis, would be to combine all relevant and appropriate information, whether direct or indirect. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

How are evidence and knowledge used in orthopaedic decision-making? Three comparative case studies of different approaches to implementation of clinical guidance in practice.

PubMed

Grove, Amy; Clarke, Aileen; Currie, Graeme

2018-05-31

The uptake and use of clinical guidelines is often insufficient to change clinical behaviour and reduce variation in practice. As a consequence of diverse organisational contexts, the simple provision of guidelines cannot ensure fidelity or guarantee their use when making decisions. Implementation research in surgery has focused on understanding what evidence exists for clinical practice decisions but limits understanding to the technical, educational and accessibility issues. This research aims to identify where, when and how evidence and knowledge are used in orthopaedic decision-making and how variation in these factors contributes to different approaches to implementation of clinical guidance in practice. We used in-depth case studies to examine guideline implementation in real-life surgical practice. We conducted comparative case studies in three English National Health Service hospitals over a 12-month period. Each in-depth case study consisted of a mix of qualitative methods including interviews, observations and document analysis. Data included field notes from observations of day-to-day practice, 64 interviews with NHS surgeons and staff and the collection of 121 supplementary documents. Case studies identified 17 sources of knowledge and evidence which influenced clinical decisions in elective orthopaedic surgery. A comparative analysis across cases revealed that each hospital had distinct approaches to decision-making. Decision-making is described as occurring as a result of how 17 types of knowledge and evidence were privileged and of how they interacted and changed in context. Guideline implementation was contingent and mediated through four distinct contextual levels. Implementation could be assessed for individual surgeons, groups of surgeons or the organisation as a whole, but it could also differ between these levels. Differences in how evidence and knowledge were used contributed to variations in practice from guidelines. A range of complex and

Uptake of evidence in policy development: the case of user fees for health care in public health facilities in Uganda.

PubMed

Nabyonga-Orem, Juliet; Ssengooba, Freddie; Mijumbi, Rhona; Tashobya, Christine Kirunga; Marchal, Bruno; Criel, Bart

2014-12-18

Several countries in Sub Saharan Africa have abolished user fees for health care but the extent to which such a policy decision is guided by evidence needs further exploration. We explored the barriers and facilitating factors to uptake of evidence in the process of user fee abolition in Uganda and how the context and stakeholders involved shaped the uptake of evidence. This study builds on previous work in Uganda that led to the development of a middle range theory (MRT) outlining the main facilitating factors for knowledge translation (KT). Application of the MRT to the case of abolition of user fees contributes to its refining. Employing a theory-driven inquiry and case study approach given the need for in-depth investigation, we reviewed documents and conducted interviews with 32 purposefully selected key informants. We assessed whether evidence was available, had or had not been considered in policy development and the reasons why and; assessed how the actors and the context shaped the uptake of evidence. Symbolic, conceptual and instrumental uses of evidence were manifest. Different actors were influenced by different types of evidence. While technocrats in the ministry of health (MoH) relied on formal research, politicians relied on community complaints. The capacity of the MoH to lead the KT process was weak and the partnerships for KT were informal. The political window and alignment of the evidence with overall government discourse enhanced uptake of evidence. Stakeholders were divided, seemed to be polarized for various reasons and had varying levels of support and influence impacting the uptake of evidence. Evidence will be taken up in policy development in instances where the MoH leads the KT process, there are partnerships for KT in place, and the overall government policy and the political situation can be expected to play a role. Different actors will be influenced by different types of evidence and their level of support and influence will impact

14 CFR 16.223 - Evidence.

Code of Federal Regulations, 2010 CFR

2010-01-01

... shall be submitted in written form in advance of the oral hearing pursuant to the schedule established in the hearing officer's prehearing conference report. Written direct and rebuttal fact testimony... written testimony and evidence. Except in the case of evidence obtained by subpoena, or in the case of a...

Performance-based Incentives to Improve Health Status of Mothers and Newborns: What Does the Evidence Show?

PubMed Central

Agarwal, Koki; Askew, Ian; Iriarte, Emma; Morgan, Lindsay; Watson, Julia

2013-01-01

Performance-based incentives (PBIs) aim to counteract weak providers’ performance in health systems of many developing countries by providing rewards that are directly linked to better health outcomes for mothers and their newborns. Translating funding into better health requires many actions by a large number of people. The actions span from community to the national level. While different forms of PBIs are being implemented in a number of countries to improve health outcomes, there has not been a systematic review of the evidence of their impact on the health of mothers and newborns. This paper analyzes and synthesizes the available evidence from published studies on the impact of supply-side PBIs on the quantity and quality of health services for mothers and newborns. This paper reviews evidence from published and grey literature that spans PBI for public-sector facilities, PBI in social insurance reforms, and PBI in NGO contracting. Some initiatives focus on safe deliveries, and others reward a broader package of results that include deliveries. The Evidence Review Team that focused on supply-side incentives for the US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives, reviewed published research reports and papers and added studies from additional grey literature that were deemed relevant. After collecting and reviewing 17 documents, nine studies were included in this review, three of which used before-after designs; four included comparison or control groups; one applied econometric methods to a five-year time series; and one reported results from a large-scale impact evaluation with randomly-assigned intervention and control facilities. The available evidence suggests that incentives that reward providers for institutional deliveries result in an increase in the number of institutional deliveries. There is some evidence that the content of antenatal care can improve with PBI. We found no

Performance-based incentives to improve health status of mothers and newborns: what does the evidence show?

PubMed

Eichler, Rena; Agarwal, Koki; Askew, Ian; Iriarte, Emma; Morgan, Lindsay; Watson, Julia

2013-12-01

Performance-based incentives (PBIs) aim to counteract weak providers' performance in health systems of many developing countries by providing rewards that are directly linked to better health outcomes for mothers and their newborns. Translating funding into better health requires many actions by a large number of people. The actions span from community to the national level. While different forms of PBIs are being implemented in a number of countries to improve health outcomes, there has not been a systematic review of the evidence of their impact on the health of mothers and newborns. This paper analyzes and synthesizes the available evidence from published studies on the impact of supply-side PBIs on the quantity and quality of health services for mothers and newborns. This paper reviews evidence from published and grey literature that spans PBI for public-sector facilities, PBI in social insurance reforms, and PBI in NGO contracting. Some initiatives focus on safe deliveries, and others reward a broader package of results that include deliveries. The Evidence Review Team that focused on supply-side incentives for the US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives, reviewed published research reports and papers and added studies from additional grey literature that were deemed relevant. After collecting and reviewing 17 documents, nine studies were included in this review, three of which used before-after designs; four included comparison or control groups; one applied econometric methods to a five-year time series; and one reported results from a large-scale impact evaluation with randomly-assigned intervention and control facilities. The available evidence suggests that incentives that reward providers for institutional deliveries result in an increase in the number of institutional deliveries. There is some evidence that the content of antenatal care can improve with PBI. We found no direct

Ketamine for cancer pain: what is the evidence?

PubMed

Jonkman, Kelly; van de Donk, Tine; Dahan, Albert

2017-06-01

In this review, we assess the benefit of ketamine in the treatment of terminal cancer pain that is refractory to opioid treatment and/or complicated by neuropathy. While randomized controlled trials consistently show lack of clinical efficacy of ketamine in treating cancer pain, a large number of open-label studies and case series show benefit. Ketamine is an N-methyl-D-aspartate receptor antagonist that at low-dose has effective analgesic properties. In cancer pain, ketamine is usually prescribed as adjuvant to opioid therapy when pain becomes opioid resistant or when neuropathic pain symptoms dominate the clinical picture. A literature search revealed four randomized controlled trials that examined the benefit of oral, subcutaneous or intravenous ketamine in opioid refractory cancer pain. None showed clinically relevant benefit in relieving pain or reducing opioid consumption. This suggests absence of evidence of benefit for ketamine as adjuvant analgesic in cancer pain. These findings contrast the benefit from ketamine observed in a large number of open-label studies and (retrospective) case series. We relate the opposite outcomes to methodological issues. The complete picture is such that there is still insufficient evidence to state with certainty that ketamine is not effective in cancer pain.

Long-term (5 years), high daily dosage of dietary agmatine--evidence of safety: a case report.

PubMed

Gilad, Gad M; Gilad, Varda H

2014-11-01

There is presently a great interest in the therapeutic potential of agmatine, decarboxylated arginine, for various diseases. Recent clinical studies have already shown that oral agmatine sulfate given for up to 3 weeks provides a safe and, as compared with current therapeutics, more effective treatment for neuropathic pain. These studies have ushered in the use of dietary agmatine as a nutraceutical. However, in view of information paucity, assessment of long-term safety of oral agmatine treatment is now clearly required. The authors of this report undertook to assess their own health status during ongoing consumption of a high daily dosage of oral agmatine over a period of 4-5 years. A daily dose of 2.67 g agmatine sulfate was encapsulated in gelatin capsules; the regimen consists of six capsules daily, each containing 445 mg, three in the morning and three in the evening after meals. Clinical follow-up consists of periodic physical examinations and laboratory blood and urine analyses. All measurements thus far remain within normal values and good general health status is sustained throughout the study period, up to 5 years. This case study shows for the first time that the recommended high dosage of agmatine may be consumed for at least 5 years without evidence of any adverse effects. These initial findings are highly important as they provide significant evidence for the extended long-term safety of a high daily dosage of dietary agmatine--a cardinal advantage for its utility as a nutraceutical.

Evidence-based dentistry: a model for clinical practice.

PubMed

Faggion, Clóvis M; Tu, Yu-Kang

2007-06-01

Making decisions in dentistry should be based on the best evidence available. The objective of this study was to demonstrate a practical procedure and model that clinicians can use to apply the results of well-conducted studies to patient care by critically appraising the evidence with checklists and letter grade scales. To demonstrate application of this model for critically appraising the quality of research evidence, a hypothetical case involving an adult male with chronic periodontitis is used as an example. To determine the best clinical approach for this patient, a four-step, evidence-based model is demonstrated, consisting of the following: definition of a research question using the PICO format, search and selection of relevant literature, critical appraisal of identified research reports using checklists, and the application of evidence. In this model, the quality of research evidence was assessed quantitatively based on different levels of quality that are assigned letter grades of A, B, and C by evaluating the studies against the QUOROM (Quality of Reporting Meta-Analyses) and CONSORT (Consolidated Standards of Reporting Trials) checklists in a tabular format. For this hypothetical periodontics case, application of the model identified the best available evidence for clinical decision making, i.e., one randomized controlled trial and one systematic review of randomized controlled trials. Both studies showed similar answers for the research question. The use of a letter grade scale allowed an objective analysis of the quality of evidence. A checklist-driven model that assesses and applies evidence to dental practice may substantially improve dentists' decision making skill.

Eight-step method to build the clinical content of an evidence-based care pathway: the case for COPD exacerbation

PubMed Central

2012-01-01

Background Optimization of the clinical care process by integration of evidence-based knowledge is one of the active components in care pathways. When studying the impact of a care pathway by using a cluster-randomized design, standardization of the care pathway intervention is crucial. This methodology paper describes the development of the clinical content of an evidence-based care pathway for in-hospital management of chronic obstructive pulmonary disease (COPD) exacerbation in the context of a cluster-randomized controlled trial (cRCT) on care pathway effectiveness. Methods The clinical content of a care pathway for COPD exacerbation was developed based on recognized process design and guideline development methods. Subsequently, based on the COPD case study, a generalized eight-step method was designed to support the development of the clinical content of an evidence-based care pathway. Results A set of 38 evidence-based key interventions and a set of 24 process and 15 outcome indicators were developed in eight different steps. Nine Belgian multidisciplinary teams piloted both the set of key interventions and indicators. The key intervention set was judged by the teams as being valid and clinically applicable. In addition, the pilot study showed that the indicators were feasible for the involved clinicians and patients. Conclusions The set of 38 key interventions and the set of process and outcome indicators were found to be appropriate for the development and standardization of the clinical content of the COPD care pathway in the context of a cRCT on pathway effectiveness. The developed eight-step method may facilitate multidisciplinary teams caring for other patient populations in designing the clinical content of their future care pathways. PMID:23190552

Epidermis and Enamel: Insights Into Gnawing Criticisms of Human Bitemark Evidence.

PubMed

Barsley, Robert E; Bernstein, Mark L; Brumit, Paula C; Dorion, Robert B J; Golden, Gregory S; Lewis, James M; McDowell, John D; Metcalf, Roger D; Senn, David R; Sweet, David; Weems, Richard A

2018-06-01

Critics describe forensic dentists' management of bitemark evidence as junk science with poor sensitivity and specificity and state that linkages to a biter are unfounded. Those vocal critics, supported by certain media, characterize odontologists' previous errors as egregious and petition government agencies to render bitemark evidence inadmissible. Odontologists acknowledge that some practitioners have made past mistakes. However, it does not logically follow that the errors of a few identify a systemic failure of bitemark analysis. Scrutiny of the contentious cases shows that most occurred 20 to 40 years ago. Since then, research has been ongoing and more conservative guidelines, standards, and terminology have been adopted so that past errors are no longer reflective of current safeguards. The authors recommend a comprehensive root analysis of problem cases to be used to determine all the factors that contributed to those previous problems. The legal community also shares responsibility for some of the past erroneous convictions. Currently, most proffered bitemark cases referred to odontologists do not reach courts because those forensic dentists dismiss them as unacceptable or insufficient for analysis. Most bitemark evidence cases have been properly managed by odontologists. Bitemark evidence and testimony remain relevant and have made significant contributions in the justice system.

Twenty Years of Evidence on the Outcomes of Malpractice Claims

PubMed Central

2008-01-01

Two decades of social science research on the outcomes of medical malpractice claims show malpractice outcomes bear a surprisingly good correlation with the quality of care provided to the patient as judged by other physicians. Physicians win 80% to 90% of the jury trials with weak evidence of medical negligence, approximately 70% of the borderline cases, and even 50% of the trials in cases with strong evidence of medical negligence. With only one exception, all of the studies of malpractice settlements also find a correlation between the odds of a settlement payment and the quality of care provided to the plaintiff. Between 80% and 90% of the claims rated as defensible are dropped or dismissed without payment. In addition, the amount paid in settlement drops as the strength of the patient’s evidence weakens. PMID:19048355

27 CFR 53.182 - Supporting evidence required in case of tax-paid articles used for further manufacture.

Code of Federal Regulations, 2010 CFR

2010-04-01

... required in case of tax-paid articles used for further manufacture. 53.182 Section 53.182 Alcohol, Tobacco... articles used for further manufacture. (a) Evidence to be submitted by claimant. No claim for credit or... material in the manufacture or production of, or as a component part of, a second article manufactured or...

Evidence for declining numbers of Ebola cases--Montserrado County, Liberia, June-October 2014.

PubMed

Nyenswah, Tolbert G; Westercamp, Matthew; Kamali, Amanda Ashraf; Qin, Jin; Zielinski-Gutierrez, Emily; Amegashie, Fred; Fallah, Mosaka; Gergonne, Bernadette; Nugba-Ballah, Roselyn; Singh, Gurudev; Aberle-Grasse, John M; Havers, Fiona; Montgomery, Joel M; Bawo, Luke; Wang, Susan A; Rosenberg, Ronald

2014-11-21

The epidemic of Ebola virus disease (Ebola) in West Africa that began in March 2014 has caused approximately 13,200 suspected, probable, and confirmed cases, including approximately 6,500 in Liberia. About 50% of Liberia's reported cases have been in Montserrado County (population 1.5 million), the most populous county, which contains the capital city, Monrovia. To examine the course of the Ebola epidemic in Montserrado County, data on Ebola treatment unit (ETU) admissions, laboratory testing of patient blood samples, and collection of dead bodies were analyzed. Each of the three data sources indicated consistent declines of 53%-73% following a peak incidence in mid-September. The declines in ETU admissions, percentage of patients with reverse transcription-polymerase chain reaction (RT-PCR) test results positive for Ebola, and dead bodies are the first evidence of reduction in disease after implementation of multiple prevention and response measures. The possible contributions of these interventions to the decline is not yet fully understood or corroborated. A reduction in cases suggests some progress; however, eliminating Ebola transmission is the critical goal and will require greatly intensified efforts for complete, high-quality surveillance to direct and drive the rapid intervention, tracking, and response efforts that remain essential.

Field Evidence of Social Influence in the Expression of Political Preferences: The Case of Secessionists Flags in Barcelona

PubMed Central

Parravano, Antonio; Noguera, José A.; Hermida, Paula; Tena-Sánchez, Jordi

2015-01-01

Models of social influence have explored the dynamics of social contagion, imitation, and diffusion of different types of traits, opinions, and conducts. However, few behavioral data indicating social influence dynamics have been obtained from direct observation in “natural” social contexts. The present research provides that kind of evidence in the case of the public expression of political preferences in the city of Barcelona, where thousands of citizens supporting the secession of Catalonia from Spain have placed a Catalan flag in their balconies and windows. Here we present two different studies. 1) During July 2013 we registered the number of flags in 26% of the electoral districts in the city of Barcelona. We find that there is a large dispersion in the density of flags in districts with similar density of pro-independence voters. However, by comparing the moving average to the global mean we find that the density of flags tends to be fostered in electoral districts where there is a clear majority of pro-independence vote, while it is inhibited in the opposite cases. We also show that the distribution of flags in the observed districts deviates significantly from that of an equivalent random distribution. 2) During 17 days around Catalonia’s 2013 national holiday we observed the position at balcony resolution of the flags displayed in the facades of a sub-sample of 82 blocks. We compare the ‘clustering index’ of flags on the facades observed each day to thousands of equivalent random distributions. Again we provide evidence that successive hangings of flags are not independent events but that a local influence mechanism is favoring their clustering. We also find that except for the national holiday day the density of flags tends to be fostered in facades located in electoral districts where there is a clear majority of pro-independence vote. PMID:25961562

Protecting Digital Evidence Integrity by Using Smart Cards

NASA Astrophysics Data System (ADS)

Saleem, Shahzad; Popov, Oliver

RFC 3227 provides general guidelines for digital evidence collection and archiving, while the International Organization on Computer Evidence offers guidelines for best practice in the digital forensic examination. In the light of these guidelines we will analyze integrity protection mechanism provided by EnCase and FTK which is mainly based on Message Digest Codes (MDCs). MDCs for integrity protection are not tamper proof, hence they can be forged. With the proposed model for protecting digital evidence integrity by using smart cards (PIDESC) that establishes a secure platform for digitally signing the MDC (in general for a whole range of cryptographic services) in combination with Public Key Cryptography (PKC), one can show that this weakness might be overcome.

Evidence of metachronous development of ovarian teratomas: a case report of bilateral mature cystic teratomas of the ovaries and systematic literature review.

PubMed

Wang, Wen-Chung; Lai, Yen-Chein

2017-03-14

Mature cystic teratomas are usually found in the ovaries. They are bilateral in 10 to 15% of cases and multiple cystic teratomas may be present in one ovary. The aim of this study is to clarify if development of mature cystic teratomas of the ovaries in a single host is metachronous or due to autoimplant or recurrence. We report a woman with bilateral mature cystic teratomas of the ovaries. DNA profiles of these teratomas were investigated via short tandem repeat (STR) analysis and methylation statuses were determined via methylation sensitive multiplex ligation-dependent probe amplification methods. The results showed that the cystic teratomas originated from different stages of oogonia or primary oocyte before germinal vesicle stage failure of meiosis I in female gametogenesis. Potentially relevant literature was searched in PubMed database. Cases of bilateral or multiple mature cystic teratomas of the ovaries were analyzed. To date, there has been no reported case of multiple mature cystic teratomas in which clarification of the origin was achieved using molecular genetic methods. The results of this case study provide evidence of metachronous development of mature cystic teratomas of the ovaries and may serve as a reference in the management of patients following laparoscopic cystectomy.

Modularity of music: evidence from a case of pure amusia.

PubMed

Piccirilli, M; Sciarma, T; Luzzi, S

2000-10-01

A case of pure amusia in a 20 year old left handed non-professional musician is reported. The patient showed an impairment of music abilities in the presence of normal processing of speech and environmental sounds. Furthermore, whereas recognition and production of melodic sequences were grossly disturbed, both the recognition and production of rhythm patterns were preserved. This selective breakdown pattern was produced by a focal lesion in the left superior temporal gyrus. This case thus suggests that not only linguistic and musical skills, but also melodic and rhythmic processing are independent of each other. This functional dissociation in the musical domain supports the hypothesis that music components have a modular organisation. Furthermore, there is the suggestion that amusia may be produced by a lesion located strictly in one hemisphere and that the superior temporal gyrus plays a crucial part in melodic processing.

Use of Evidence-Based Decision-Making in Comprehensive Dental Treatment of a Patient with Meth Mouth-A Case Report.

PubMed

Al Hazzani, Saad A

2017-06-01

This case report illustrates the use of evidence-based practice in formulating a comprehensive dental treatment plan for a patient who presented himself with signs of oral health debilitation accompanying methamphetamine (MA) abuse called "meth mouth" with the goal of providing dental care practitioners in Saudi Arabia with an insight into the global problem of MA abuse and its impact on oral health. This report documents the case of a 22-year-old male patient who reported to the clinic with rampant caries caused due to MA abuse exacerbated by poor oral hygiene and smoking habit. The treatment plan of this present case was formulated on the lines of the evidence-based dentistry approach. A clinical question was composed based on the Problem, Intervention, Comparison, and Outcome format to identify past studies and case reports on meth mouth. A standard search was conducted on PubMed Central. Standard guidelines on the treatment of meth mouth were extracted from the Web site of the American Dental Association. A total of 2 systematic reviews, 7 review articles, 4 epidemiologic studies, 5 case reports, and 1 American Dental Association guideline were found. Accelerated dental decay leading to rampant caries in young and middle-aged adults is a characteristic oral finding in MA abusers. The most important factor that affects the prognosis of dental care is complete cessation of MA use by the patient. Copyright © 2017 Elsevier Inc. All rights reserved.

Medicaid case-mix nursing home reimbursement in three states.

PubMed

Swan, James H; Pickard, Ruth B

2003-01-01

Case-mix nursing facility payment raises issues of access, quality, equity, and cost. Case-mix should better match payment to costs, improve access, and provide incentives to increased staffing and quality of care; but it may also increase costs. This paper reports analysis of Medicaid cost-report data from three case-mix states. Case-mix did not discourage capacity building and was more equitable for providers. Medicaid access declined in one state but increased in another. There were shifts toward greater skilled care in two states, with evidence of greater focus of resources on patient care. Case-mix showed no evidence of cost-constraint and some signs of increased costs. Whether such mixed outcomes are viable in the current era remains to be seen.

Interpersonal Psychotherapy for Adolescents With Mood and Behavior Dysregulation: Evidence-Based Case Study

PubMed Central

Miller, Leslie; Hlastala, Stefanie A.; Mufson, Laura; Leibenluft, Ellen; Riddle, Mark

2018-01-01

Interpersonal psychotherapy for depressed adolescents, an evidence-based psychotherapy, has been adapted for youth with chronic irritability and excessive reactivity (i.e., temper outbursts), to create Interpersonal Psychotherapy for Mood and Behavior Dysregulation (IPT-MBD). Youth with chronic irritability and excessive reactivity were originally conceptualized as severe mood dysregulation (SMD) and in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) as disruptive mood dysregulation disorder. Because outbursts are the most prominent symptom, behavioral management strategies are typically a common focus of treatment. These outbursts, along with other mood symptoms, result in significant impairment in multiple domains, with a particularly adverse impact on interpersonal functioning. For this reason improving relationships is an important target for treatment. We present an evidence-based case study of an adolescent who met research criteria for SMD and who received the IPT-MBD intervention as part of a research study. Monthly ratings assessing severity and improvement of SMD symptoms were conducted by an independent evaluator. This adolescent had an overall improvement in SMD symptoms, attended all scheduled therapy sessions, and parent and teen reported satisfaction with the treatment. We discuss factors that may influence the effectiveness of this treatment. PMID:29707641

Essential Resources for Implementation and Sustainability of Evidence-Based Health Promotion Programs: A Mixed Methods Multi-Site Case Study.

PubMed

Dattalo, M; Wise, M; Ford Ii, J H; Abramson, B; Mahoney, J

2017-04-01

As of October 2016, use of federal Older Americans Act funds for health promotion and disease prevention will be restricted to the Administration on Aging's criteria for high-level evidence-based health promotion programs. Dissemination of these programs to rural communities remains limited. Therefore a strong need exists to identify strategies that facilitate program implementation and sustainability. The objective of this study was to compare organizational readiness and implementation strategies used by rural communities that achieved varying levels of success in sustaining evidence-based health promotion programs for older adults. We utilized a qualitative multi-site case study design to analyze the longitudinal experiences of eight rural sites working to implement evidence-based health promotion program over 3 years (8/2012-7/2015). Multiple sources of data (interviews, documents, reports, surveys) from each site informed the analysis. We used conventional content analysis to conduct a cross-case comparison to identify common features of rural counties that successfully implemented and sustained their target evidence-based health promotion program. Readiness to implement evidence-based programs as low at baseline as all site leaders described needing to secure additional resources for program implementation. Sites that successfully utilized six essential resources implemented and sustained greater numbers of workshops: (1) External Partnerships, (2) Agency Leadership Commitment, (3) Ongoing Source of Workshop Leaders, (4) Health Promotion Coordination Tasks Assigned to Specific Staff, (5) Organizational Stability, and (6) Change Team Engagement. The six essential resources described in this study can help rural communities assess their readiness to implement health promotion programs and work secure the resources necessary for successful implementation.

U.S. Broadcast Deregulation: A Case of Dubious Evidence.

ERIC Educational Resources Information Center

Levin, Harry J.

1986-01-01

Reviews the empirical evidence cited by the FCC in favor of increasing the allowable number of radio and TV stations owned by one group. Argues FCC was biased in favor of deregulation despite weighty evidence indicating continued need for regulation. (MS)

Systems Thinking Tools for Improving Evidence-Based Practice: A Cross-Case Analysis of Two High School Leadership Teams

ERIC Educational Resources Information Center

Kensler, Lisa A. W.; Reames, Ellen; Murray, John; Patrick, Lynne

2012-01-01

Teachers and administrators have access to large volumes of data but research suggests that they lack the skills to use data effectively for continuous school improvement. This study involved a cross-case analysis of two high school leadership teams' early stages of evidence-based practice development; differing forms of external support were…

Numerous eosinophilic globules (skeinoid fibers) in a duodenal stromal tumor: an exceptional case showing smooth muscle differentiation.

PubMed

Matsukuma, S; Doi, M; Suzuki, M; Ikegawa, K; Sato, K; Kuwabara, N

1997-11-01

A unique case of duodenal stromal tumor in a 51-year-old man is reported. The tumor histologically showed spindle cell proliferation and numerous eosinophilic globules. Most globules were composed of tangled 45 nm thick fibrils, which were ultrastructurally identical to 'skeinoid fibers'. The presence of glycogen granules in the tumor cells and the immunoreactivity for alpha-smooth muscle actin suggested smooth muscle differentiation. Focal ultrastructural findings also supported the smooth muscle nature of this tumor. There were no immunohistochemical and ultrastructural features indicating neural differentiation. In previous studies, the presence of such 'skeinoid fibers' was suggested to be a histological marker for neural differentiation in gastrointestinal stromal tumor. However, the findings in the present case suggest that numerous 'skeinoid fibers' can be identified in duodenal stromal tumor with smooth muscle differentiation, although this condition may be rare.

Role and use of evidence in policymaking: an analysis of case studies from the health sector in Nigeria.

PubMed

Onwujekwe, Obinna; Uguru, Nkoli; Russo, Giuliano; Etiaba, Enyi; Mbachu, Chinyere; Mirzoev, Tolib; Uzochukwu, Benjamin

2015-10-24

Health policymaking is a complex process and analysing the role of evidence is still an evolving area in many low- and middle-income countries. Where evidence is used, it is greatly affected by cognitive and institutional features of the policy process. This paper examines the role of different types of evidence in health policy development in Nigeria. The role of evidence was compared between three case studies representing different health policies, namely the (1) integrated maternal neonatal and child health strategy (IMNCH); (2) oral health (OH) policy; and (3) human resource for health (HRH) policy. The data was collected using document reviews and 31 in-depth interviews with key policy actors. Framework Approach was used to analyse the data, aided by NVivo 10 software. Most respondents perceived evidence to be factual and concrete to support a decision. Evidence was used more if it was perceived to be context-specific, accessible and timely. Low-cost high-impact evidence, such as the Lancet series, was reported to have been used in drafting the IMNCH policy. In the OH and HRH policies, informal evidence such as experts' experiences and opinions, were reported to have been useful in the policy drafting stage. Both formal and informal evidence were mentioned in the HRH and OH policies, while the development of the IMNCH was revealed to have been informed mainly by more formal evidence. Overall, respondents suggested that formal evidence, such as survey reports and research publications, were most useful in the agenda-setting stage to identify the need for the policy and thus initiating the policy development process. International and local evidence were used to establish the need for a policy and develop policy, and less to develop policy implementation options. Recognition of the value of different evidence types, combined with structures for generating and using evidence, are likely to enhance evidence-informed health policy development in Nigeria and other

Study types and reliability of Real World Evidence compared with experimental evidence used in Polish reimbursement decision-making processes.

PubMed

Wilk, N; Wierzbicka, N; Skrzekowska-Baran, I; Moćko, P; Tomassy, J; Kloc, K

2017-04-01

The aim of this study was to identify the relationship and impact between Real World Evidence (RWE) and experimental evidence (EE) in Polish decision-making processes for the drugs from selected Anatomical Therapeutic Chemical (ATC) groups. Descriptive study. A detailed analysis was performed for 58 processes from five ATC code groups in which RWE for effectiveness, or effectiveness and safety were cited in Agency for Health Technology Assessment and Tariff System's (AOTMiT) documents published between January 2012 and September 2015: Verification Analysis of AOTMiT, Statement of the Transparency Council of AOTMiT, and Recommendation of the President of AOTMiT. In 62% of the cases, RWE supported the EE and confirmed its main conclusions. The majority of studies in the EE group showed to be RCTs (97%), and the RWE group included mainly cohort studies (89%). There were more studies without a control group within RWE compared with the EE group (10% vs 1%). Our results showed that EE are more often assessed using Jadad, NICE or NOS scale by AOTMiT compared with RWE (93% vs 48%). When the best evidence within a given decision-making process is analysed, half of RWE and two-thirds of EE are considered high quality evidence. RWE plays an important role in the decision-making processes on public funding of drugs in Poland, contributing to nearly half (45%) of all the evidence considered. There exist such processes in which the proportion of RWE is dominant, with one process showing RWE as the only evidence presented. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Improved method of laser photovaporization for endometrium cases

NASA Astrophysics Data System (ADS)

Xia, En-ju; Lu, Hua; Chen, En-ling; Wan, Hong-yue

1995-03-01

Endometrium was destroyed by Nd-YAG laser under B ultrasonic monitoring through direct application of a fibrous catheter specially designed by Dong-lin Lee (an optical engineer). Of the 12 patients 11 cases had dysfunctional uterine bleeding and one case had postmenopausal uterine bleeding. The mean time of laser treatment was 5' 45', the mean volume of irrigating solution was 850 ml, and the mean estimated blood loss was less than 9 ml. All patients showed neither evidence of infection nor uterine perforation. Follow-up examination for 3 - 16 months showed amenorrhea in 4 cases, spotting in 4 cases, and obviously reduced menstrual flow in 3 cases. One patient, partly treated, had normal menstruation.

The IAT shows no evidence for Kandinsky's color-shape associations.

PubMed

Makin, Alexis D J; Wuerger, Sophie M

2013-01-01

In the early twentieth century, the Bauhaus revolutionized art and design by using simple colors and forms. Wassily Kandinsky was especially interested in the relationship of these two visual attributes and postulated a fundamental correspondence between color and form: yellow triangle, red square and blue circle. Subsequent empirical studies used preference judgments to test Kandinsky's original color-form combinations, usually yielding inconsistent results. We have set out to test the validity of these postulated associations by using the Implicit Association Test. Participants pressed one of two buttons on each trial. On some trials they classified shapes (e.g., circle or triangle). On interleaved trials they classified colors (e.g., blue or yellow). Response times should theoretically be faster when the button mapping follows Kandinsky's associations: For example, when the left key is used to report blue or circle and the right is used for yellow and triangle, than when the response mapping is the opposite of this (blue or triangle, yellow or circle). Our findings suggest that there is no implicit association between the original color-form combinations. Of the three combinations we tested, there was only a marginal effect in one case. It can be concluded that the IAT does not support Kandinsky's postulated color-form associations, and that these are probably not a universal property of the visual system.

The IAT shows no evidence for Kandinsky's color-shape associations

PubMed Central

Makin, Alexis D. J.; Wuerger, Sophie M.

2013-01-01

In the early twentieth century, the Bauhaus revolutionized art and design by using simple colors and forms. Wassily Kandinsky was especially interested in the relationship of these two visual attributes and postulated a fundamental correspondence between color and form: yellow triangle, red square and blue circle. Subsequent empirical studies used preference judgments to test Kandinsky's original color-form combinations, usually yielding inconsistent results. We have set out to test the validity of these postulated associations by using the Implicit Association Test. Participants pressed one of two buttons on each trial. On some trials they classified shapes (e.g., circle or triangle). On interleaved trials they classified colors (e.g., blue or yellow). Response times should theoretically be faster when the button mapping follows Kandinsky's associations: For example, when the left key is used to report blue or circle and the right is used for yellow and triangle, than when the response mapping is the opposite of this (blue or triangle, yellow or circle). Our findings suggest that there is no implicit association between the original color-form combinations. Of the three combinations we tested, there was only a marginal effect in one case. It can be concluded that the IAT does not support Kandinsky's postulated color-form associations, and that these are probably not a universal property of the visual system. PMID:24062709

Alimemazine poisoning as evidence of Munchausen syndrome by proxy: A pediatric case report.

PubMed

Gomila, Isabel; López-Corominas, Victoria; Pellegrini, Manuela; Quesada, Loreto; Miravet, Elena; Pichini, Simona; Barceló, Bernardino

2016-09-01

Munchausen syndrome by proxy (MSBP), also known as fabricated or induced illness in a child by a caretaker, is a form of abuse where a caregiver deliberately produces or feigns illness in a person under his or her care, so that the proxy will receive medical care that gratifies the caregiver. The affected children are often hospitalized for long periods and endure repetitive, painful and expensive diagnostic attempts. We present an analytically confirmed case of MSBP by alimemazine. A 3-year-old boy was brought repetitively to a Pediatric Emergency Department by his mother because he presented limb tremors, dysarthria, obnubilation, and ataxia and generalized tonic-clonic seizures coinciding with intermittent fever. Neither the rest of the physical examination nor the complementary tests showed any significant alterations. MSBP was suspected and a routine systematic toxicological analysis in urine and blood was requested. Alimemazine was detected in all biological samples. The administration of this drug was never mentioned by the mother and the subsequent interview with her corroborated the suspicion of MSBP. Clinically, after separation from the mother, the child's neurological symptoms gradually improved until the complete disappearance of the cerebellar symptoms. Alimemazine was quantified in serum, urine, gastric content and cerebrospinal fluid samples by gas chromatography-mass spectrometry (maximum serum level was 0.42μg/ml). Hair quantification of alimemazine was performed by ultra-performance liquid chromatography-tandem mass spectrometry in different segments of hair. The results confirmed regular substance use during the at least eight last months (8.8, 14.7, 19.7 and 4.6ng/mg hair starting from most proximal segment). This patient represents the first case published with analytical data of alimemazine in blood, urine, gastric content, cerebrospinal fluid and hair, which allowed us to prove an acute and repetitive poisoning with alimemazine as evidence

A bias-adjusted evidence synthesis of RCT and observational data: the case of total hip replacement.

PubMed

Schnell-Inderst, Petra; Iglesias, Cynthia P; Arvandi, Marjan; Ciani, Oriana; Matteucci Gothe, Raffaella; Peters, Jaime; Blom, Ashley W; Taylor, Rod S; Siebert, Uwe

2017-02-01

Evaluation of clinical effectiveness of medical devices differs in some aspects from the evaluation of pharmaceuticals. One of the main challenges identified is lack of robust evidence and a will to make use of experimental and observational studies (OSs) in quantitative evidence synthesis accounting for internal and external biases. Using a case study of total hip replacement to compare the risk of revision of cemented and uncemented implant fixation modalities, we pooled treatment effect estimates from OS and RCTs, and simplified existing methods for bias-adjusted evidence synthesis to enhance practical application. We performed an elicitation exercise using methodological and clinical experts to determine the strength of beliefs about the magnitude of internal and external bias affecting estimates of treatment effect. We incorporated the bias-adjusted treatment effects into a generalized evidence synthesis, calculating both frequentist and Bayesian statistical models. We estimated relative risks as summary effect estimates with 95% confidence/credibility intervals to capture uncertainty. When we compared alternative approaches to synthesizing evidence, we found that the pooled effect size strongly depended on the inclusion of observational data as well as on the use bias-adjusted estimates. We demonstrated the feasibility of using observational studies in meta-analyses to complement RCTs and incorporate evidence from a wider spectrum of clinically relevant studies and healthcare settings. To ensure internal validity, OS data require sufficient correction for confounding and selection bias, either through study design and primary analysis, or by applying post-hoc bias adjustments to the results. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.

Evidence-informed policy formulation and implementation: a comparative case study of two national policies for improving health and social care in Sweden.

PubMed

Strehlenert, H; Richter-Sundberg, L; Nyström, M E; Hasson, H

2015-12-08

Evidence has come to play a central role in health policymaking. However, policymakers tend to use other types of information besides research evidence. Most prior studies on evidence-informed policy have focused on the policy formulation phase without a systematic analysis of its implementation. It has been suggested that in order to fully understand the policy process, the analysis should include both policy formulation and implementation. The purpose of the study was to explore and compare two policies aiming to improve health and social care in Sweden and to empirically test a new conceptual model for evidence-informed policy formulation and implementation. Two concurrent national policies were studied during the entire policy process using a longitudinal, comparative case study approach. Data was collected through interviews, observations, and documents. A Conceptual Model for Evidence-Informed Policy Formulation and Implementation was developed based on prior frameworks for evidence-informed policymaking and policy dissemination and implementation. The conceptual model was used to organize and analyze the data. The policies differed regarding the use of evidence in the policy formulation and the extent to which the policy formulation and implementation phases overlapped. Similarities between the cases were an emphasis on capacity assessment, modified activities based on the assessment, and a highly active implementation approach relying on networks of stakeholders. The Conceptual Model for Evidence-Informed Policy Formulation and Implementation was empirically useful to organize the data. The policy actors' roles and functions were found to have a great influence on the choices of strategies and collaborators in all policy phases. The Conceptual Model for Evidence-Informed Policy Formulation and Implementation was found to be useful. However, it provided insufficient guidance for analyzing actors involved in the policy process, capacity-building strategies

Polymorphism of CRISPR shows separated natural groupings of Shigella subtypes and evidence of horizontal transfer of CRISPR

PubMed Central

Yang, Chaojie; Li, Peng; Su, Wenli; Li, Hao; Liu, Hongbo; Yang, Guang; Xie, Jing; Yi, Shengjie; Wang, Jian; Cui, Xianyan; Wu, Zhihao; Wang, Ligui; Hao, Rongzhang; Jia, Leili; Qiu, Shaofu; Song, Hongbin

2015-01-01

Clustered, regularly interspaced, short palindromic repeats (CRISPR) act as an adaptive RNA-mediated immune mechanism in bacteria. They can also be used for identification and evolutionary studies based on polymorphisms within the CRISPR locus. We amplified and analyzed 6 CRISPR loci from 237 Shigella strains belonging to the 4 species groups, as well as 13 Escherichia coli strains. The CRISPR-associated (cas) gene sequence arrays of these strains were screened and compared. The CRISPR sequences from Shigella were conserved among subtypes, suggesting that CRISPR may represent a new identification tool for the detection and discrimination of Shigella species. Secondary structure analysis showed a different stem-loop structure at the terminal repeat, suggesting a distinct recognition mechanism in the formation of crRNA. In addition, the presence of “self-target” spacers and polymorphisms within CRISPR in Shigella indicated a selective pressure for inhibition of this system, which has the potential to damage “self DNA.” Homology analysis of spacers showed that CRISPR might be involved in the regulation of virulence transmission. Phylogenetic analysis based on CRISPR sequences from Shigella and E. coli indicated that although phenotypic properties maintain convergent evolution, the 4 Shigella species do not represent natural groupings. Surprisingly, comparative analysis of Shigella repeats with other species provided new evidence for CRISPR horizontal transfer. Our results suggested that CRISPR analysis is applicable for the detection of Shigella species and for investigation of evolutionary relationships. PMID:26327282

Polymorphism of CRISPR shows separated natural groupings of Shigella subtypes and evidence of horizontal transfer of CRISPR.

PubMed

Yang, Chaojie; Li, Peng; Su, Wenli; Li, Hao; Liu, Hongbo; Yang, Guang; Xie, Jing; Yi, Shengjie; Wang, Jian; Cui, Xianyan; Wu, Zhihao; Wang, Ligui; Hao, Rongzhang; Jia, Leili; Qiu, Shaofu; Song, Hongbin

2015-01-01

Clustered, regularly interspaced, short palindromic repeats (CRISPR) act as an adaptive RNA-mediated immune mechanism in bacteria. They can also be used for identification and evolutionary studies based on polymorphisms within the CRISPR locus. We amplified and analyzed 6 CRISPR loci from 237 Shigella strains belonging to the 4 species groups, as well as 13 Escherichia coli strains. The CRISPR-associated (cas) gene sequence arrays of these strains were screened and compared. The CRISPR sequences from Shigella were conserved among subtypes, suggesting that CRISPR may represent a new identification tool for the detection and discrimination of Shigella species. Secondary structure analysis showed a different stem-loop structure at the terminal repeat, suggesting a distinct recognition mechanism in the formation of crRNA. In addition, the presence of "self-target" spacers and polymorphisms within CRISPR in Shigella indicated a selective pressure for inhibition of this system, which has the potential to damage "self DNA." Homology analysis of spacers showed that CRISPR might be involved in the regulation of virulence transmission. Phylogenetic analysis based on CRISPR sequences from Shigella and E. coli indicated that although phenotypic properties maintain convergent evolution, the 4 Shigella species do not represent natural groupings. Surprisingly, comparative analysis of Shigella repeats with other species provided new evidence for CRISPR horizontal transfer. Our results suggested that CRISPR analysis is applicable for the detection of Shigella species and for investigation of evolutionary relationships.

Initiatives supporting evidence informed health system policymaking in Cameroon and Uganda: a comparative historical case study.

PubMed

Ongolo-Zogo, Pierre; Lavis, John N; Tomson, Goran; Sewankambo, Nelson K

2014-11-29

There is a scarcity of empirical data on institutions devoted to knowledge brokerage and their influence in Africa. Our objective was to describe two pioneering Knowledge Translation Platforms (KTPs) supporting evidence informed health system policymaking (EIHSP) in Cameroon and Uganda since 2006. This comparative historical case study of Evidence Informed Policy Network (EVIPNet) Cameroon and Regional East African Community Health Policy Initiative (REACH-PI) Uganda using multiple methods comprised (i) a descriptive documentary analysis for a narrative historical account, (ii) an interpretive documentary analysis of the context, profiles, activities and outputs inventories and (iii) an evaluative survey of stakeholders exposed to evidence briefs produced and policy dialogues organized by the KTPs. Both initiatives benefited from the technical and scientific support from the global EVIPNet resource group. EVIPNet Cameroon secretariat operates with a multidisciplinary group of part-time researchers in a teaching hospital closely linked to the ministry of health. REACH-PI Uganda secretariat operates with a smaller team of full time staff in a public university. Financial resources were mobilized from external donors to scale up capacity building, knowledge management, and linkage and exchange activities. Between 2008 and 2012, twelve evidence briefs were produced in Cameroon and three in Uganda. In 2012, six rapid evidence syntheses in response to stakeholders' urgent needs were produced in Cameroon against 73 in Uganda between 2010 and 2012. Ten policy dialogues (seven in Cameroon and three in Uganda) informed by pre-circulated evidence briefs were well received. Both KTPs contributed to developing and testing new resources and tools for EIHSP. A network of local and global experts has created new spaces for evidence informed deliberations on priority health policy issues related to MDGs. This descriptive historical account of two KTPs housed in government

The integration and evaluation of a social-media facilitated journal club to enhance the student learning experience of evidence-based practice: A case study.

PubMed

Ferguson, Caleb; DiGiacomo, Michelle; Gholizadeh, Leila; Ferguson, Leila E; Hickman, Louise D

2017-01-01

Nurses are required to interpret and apply knowledge so communities will receive care based on best available evidence, as opposed to care that is simply based on tradition or authority. Fostering nursing students' critical appraisal skills will assist in their capacity to engage with, interpret and use best evidence. Journal clubs are frequently used approach to engage learners with research and develop critical appraisal skills. Given new flipped and blended approaches to teaching and learning there is need to rejuvenate how research is utilised and integrated within journal clubs to maximise engagement and translation of evidence. This paper provides a case study of a single site Australian university experience of transitioning a traditional physical journal club, to a social media-facilitated club within a postgraduate health subject to stimulate and facilitate engagement with the chosen manuscripts. This case study is based on our own experiences, supported by literature and includes qualitative comments obtained via student feedback surveys during November 2015. Case study. Social media-facilitated journal clubs offer an efficient way to continue developing critical appraisal skills in nursing students. The integration of a social media-facilitated journal clubs increased student attention, engagement with presented activities and overall student satisfaction within this evidence-based practice subject. Future rigorously-designed, large-scale studies are required to evaluate the impact of online journal clubs on the uptake of evidence-based practice, including those resulting in improved patient outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

Resective surgical approach shows a high performance in the management of advanced cases of bisphosphonate-related osteonecrosis of the jaws: a retrospective survey of 347 cases.

PubMed

Graziani, Filippo; Vescovi, Paolo; Campisi, Giuseppina; Favia, Gianfranco; Gabriele, Mario; Gaeta, Giovanni Maria; Gennai, Stefano; Goia, Franco; Miccoli, Mario; Peluso, Franco; Scoletta, Matteo; Solazzo, Luigi; Colella, Giuseppe

2012-11-01

The aim of this study was to evaluate the results of the surgical treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in a large cohort. A retrospective cohort multicenter study was designed. Patients were enrolled if they were diagnosed with BRONJ and received operative treatment. Data on demographic, health status, perioperative, and surgical factors were collected retrospectively. The primary outcome variable was a change in BRONJ staging (improvement, worsening, or no change). Interventions were grouped by local debridement and resective surgery. Data were collected for other variables as cofactors. Univariate analysis and logistic regressions were then performed. Of the 347 BRONJ-affected subjects, 59% showed improvement, 30% showed no change, and 11% showed worsening. Improvement was observed in 49% of cases treated with local debridement and 68% of cases treated with resective surgery. Multivariate analysis indicated that maxillary location, resective surgery, and no additional corticosteroid treatment were associated with a positive outcome. Surgical treatment of BRONJ appeared to be more effective when resective procedures were performed. Nonetheless, other factors, such as the absence of symptoms and the types of drug administration, should be taken into account before clinical decisions are made. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Reading Speed, Comprehension and Eye Movements While Reading Japanese Novels: Evidence from Untrained Readers and Cases of Speed-Reading Trainees

PubMed Central

Miyata, Hiromitsu; Minagawa-Kawai, Yasuyo; Watanabe, Shigeru; Sasaki, Toyofumi; Ueda, Kazuhiro

2012-01-01

Background A growing body of evidence suggests that meditative training enhances perception and cognition. In Japan, the Park-Sasaki method of speed-reading involves organized visual training while forming both a relaxed and concentrated state of mind, as in meditation. The present study examined relationships between reading speed, sentence comprehension, and eye movements while reading short Japanese novels. In addition to normal untrained readers, three middle-level trainees and one high-level expert on this method were included for the two case studies. Methodology/Principal Findings In Study 1, three of 17 participants were middle-level trainees on the speed-reading method. Immediately after reading each story once on a computer monitor, participants answered true or false questions regarding the content of the novel. Eye movements while reading were recorded using an eye-tracking system. Results revealed higher reading speed and lower comprehension scores in the trainees than in the untrained participants. Furthermore, eye-tracking data by untrained participants revealed multiple correlations between reading speed, accuracy and eye-movement measures, with faster readers showing shorter fixation durations and larger saccades in X than slower readers. In Study 2, participants included a high-level expert and 14 untrained students. The expert showed higher reading speed and statistically comparable, although numerically lower, comprehension scores compared with the untrained participants. During test sessions this expert moved her eyes along a nearly straight horizontal line as a first pass, without moving her eyes over the whole sentence display as did the untrained students. Conclusions/Significance In addition to revealing correlations between speed, comprehension and eye movements in reading Japanese contemporary novels by untrained readers, we describe cases of speed-reading trainees regarding relationships between these variables. The trainees overall

Male genital leiomyomas showing androgen receptor expression.

PubMed

Suárez-Peñaranda, José Manuel; Vieites, Begoña; Evgenyeva, Elena; Vázquez-Veiga, Hugo; Forteza, Jeronimo

2007-12-01

Genital leiomyoma in men include those superficial leiomyomas arising in the scrotum and the areola. They are unusual neoplasms: few cases have been reported in the literature and they usually escape clinical diagnosis. Three cases of male genital leiomyomas are reported: two in the scrotum and one in the areola. They were all conservatively excised and the behaviour was completely benign in all cases. Histopathological examination showed the typical findings of superficial leiomyomas, with some minor differences between cases arising in the scrotum and those from the areola. Immunohistochemical findings not only confirmed the smooth muscle nature of all cases but also showed unequivocal immunostaining for androgen receptors in the leiomyomas from the scrotum. Immunostaining for androgen receptors in scrotal leiomyomas is, as far as we are aware, a previously unknown characteristic of male genital leiomyomas. This finding supports the role of steroid hormones in the growth of genital leiomyomas, similar to leiomyomas found in other locations.

Single-Case Design Research: Building the Evidence-Base in the Field of Education of Deaf and Hard of Hearing Students.

PubMed

Cannon, Joanna E; Guardino, Caroline; Antia, Shirin D; Luckner, John L

2016-01-01

The field of education of deaf and hard of hearing (DHH) students has a paucity of evidence-based practices (EBPs) to guide instruction. The authors discussed how the research methodology of single-case design (SCD) can be used to build EBPs through direct and systematic replication of studies. An overview of SCD research methods is presented, including an explanation of how internal and external validity issues are addressed, and why SCD is appropriate for intervention research with DHH children. The authors then examine the SCD research in the field according to quality indicators (QIs; at the individual level and as a body of evidence) to determine the existing evidence base. Finally, future replication areas are recommended to fill the gaps in SCD research with students who are DHH in order to add to the evidence base in the field.

Case mix adjusted nursing-home reimbursement: a critical review of the evidence.

PubMed

Weissert, W G; Musliner, M C

1992-01-01

Nursing-home case mix adjusted payment systems typically base payments on estimates of patients' care needs, but to date the data on their effectiveness are ambiguous. Studies mainly show that access for patients most in need of care appears to improve under these systems. Case mix based payment systems have both positive and negative effects on quality of care and require compensating mechanisms for the potentially harmful incentives they can generate. On the positive side, nursing homes are paid more equitably; the negative aspect is reflected in higher costs, particularly for administration. A Health Care Financing Administration (HCFA) demonstration project may provide insights, but its limited number of predominantly small, rural, participating states, its tandem quality assurance system, and potentially confounding market variables may restrict the value of this project. We do not yet have the data to assess the impact of instituting case mix adjustment systems.

Study design and hierarchy of evidence for surgical decision making.

PubMed

Sprague, Sheila; McKay, Paula; Thoma, Achilleas

2008-04-01

This article provides a historical overview of the hierarchy of evidence for surgical decision making and discusses key study designs in the hierarchy of evidence. This encompasses meta-analyses, randomized controlled trials, and observational studies, including cohort and case-controlled studies, case series and case reports, and basic science studies. This article also reviews the principles and importance of evidence-based plastic surgery and describes several systems to rate the strength of the scientific evidence.

Occupational exposure to diesel engine emissions and risk of lung cancer: evidence from two case-control studies in Montreal, Canada.

PubMed

Pintos, Javier; Parent, Marie-Elise; Richardson, Lesley; Siemiatycki, Jack

2012-11-01

To examine the risk of lung cancer among men associated with exposure to diesel engine emissions incurred in a wide range of occupations and industries. 2 population-based lung cancer case-control studies were conducted in Montreal. Study I (1979-1986) comprised 857 cases and 533 population controls; study II (1996-2001) comprised 736 cases and 894 population controls. A detailed job history was obtained, from which we inferred lifetime occupational exposure to 294 agents, including diesel engine emissions. ORs were estimated for each study and in the pooled data set, adjusting for socio-demographic factors, smoking history and selected occupational carcinogens. While it proved impossible to retrospectively estimate absolute exposure concentrations, there were estimates and analyses by relative measures of cumulative exposure. Increased risks of lung cancer were found in both studies. The pooled analysis showed an OR of lung cancer associated with substantial exposure to diesel exhaust of 1.80 (95% CI 1.3 to 2.6). The risk associated with substantial exposure was higher for squamous cell carcinomas (OR 2.09; 95% CI 1.3 to 3.2) than other histological types. Joint effects between diesel exhaust exposure and tobacco smoking are compatible with a multiplicative synergistic effect. Our findings provide further evidence supporting a causal link between diesel engine emissions and risk of lung cancer. The risk is stronger for the development of squamous cell carcinomas than for small cell tumours or adenocarcinomas.

Showing Enantiomorphous Crystals of Tartaric Acid

ERIC Educational Resources Information Center

Andrade-Gamboa, Julio

2007-01-01

Most of the articles and textbooks that show drawings of enantiomorphous crystals use an inadequate view to appreciate the fact that they are non-superimposable mirror images of one another. If a graphical presentation of crystal chirality is not evident, the main attribute of crystal enantiomorphism can not be recognized by students. The classic…

Criminal Evidence Act, 1992 [Excerpts. 7 July 1992].

PubMed

1993-04-30

This Act amends Ireland's law on evidence to do the following among other things: a) in cases involving sexual or violent acts, allow a person under the age of 17 to give evidence by means of a live television link, unless the court sees good reason to the contrary; b) allow, upon a court's authorization, questions to be put to such a person in such a case by means of an intermediary; c) allow video recordings of interviews with children conducted by police officers or other competent persons to be admitted as evidence in such cases; and d) abolish the requirement that the unsworn evidence of a child must be corroborated and leave to the court's discretion whether to warn a jury about convicting a person on the basis of the uncorroborated evidence of a child. Additional provisions of the Act relate to the competence and compellability of spouses and former spouses to give evidence.

The 5-HTTLPR confers susceptibility to anorexia nervosa in Han Chinese: evidence from a case-control and family-based study.

PubMed

Chen, Jue; Kang, Qing; Jiang, Wenhui; Fan, Juan; Zhang, Mingdao; Yu, Shunying; Zhang, Chen

2015-01-01

Accumulating evidence has implied that serotonin system dysfunction may be involved in the etiology of anorexia nervosa (AN). Serotonin-transporter-linked promoter region (5-HTTLPR) polymorphism is the genetic variant coding for the serotonin transporter and has a modulatory effect on its expression. This study aimed to investigate the possible association between the 5-HTTLPR and the susceptibility and severity of AN in Han Chinese using a case-control (255 patients and 351 controls) and family based study (198 trios). Eating disorder examination was used to measure the severity of AN behavioral symptoms. For the case-control study, the 5-HTTLPR showed significant association with AN in our sample (genotypic P = 0.03). The frequency of S allele was significantly higher in patients than that in controls (OR = 1.38, 95%CI: 1.06-1.79, P = 0.017). For the family-based study, the S allele of 5-HTTLPR was preferentially transmitted rather than non-transmitted from the parents to affected offspring (P = 0.013). The results of ANCOVA test revealed no significant association between the 5-HTTLPR polymorphism and severity of AN. Our findings suggested that 5-HTTLPR is able to confer susceptibility to AN in Han Chinese.

Evidence Combination From an Evolutionary Game Theory Perspective

PubMed Central

Deng, Xinyang; Han, Deqiang; Dezert, Jean; Deng, Yong; Shyr, Yu

2017-01-01

Dempster-Shafer evidence theory is a primary methodology for multi-source information fusion because it is good at dealing with uncertain information. This theory provides a Dempster’s rule of combination to synthesize multiple evidences from various information sources. However, in some cases, counter-intuitive results may be obtained based on that combination rule. Numerous new or improved methods have been proposed to suppress these counter-intuitive results based on perspectives, such as minimizing the information loss or deviation. Inspired by evolutionary game theory, this paper considers a biological and evolutionary perspective to study the combination of evidences. An evolutionary combination rule (ECR) is proposed to help find the most biologically supported proposition in a multi-evidence system. Within the proposed ECR, we develop a Jaccard matrix game (JMG) to formalize the interaction between propositions in evidences, and utilize the replicator dynamics to mimick the evolution of propositions. Experimental results show that the proposed ECR can effectively suppress the counter-intuitive behaviors appeared in typical paradoxes of evidence theory, compared with many existing methods. Properties of the ECR, such as solution’s stability and convergence, have been mathematically proved as well. PMID:26285231

Hemangioma of the rib showing a relatively high 18F-FDG uptake: a case report with a literature review

PubMed Central

Emori, Makoto; Terashima, Yoshinori; Hasegawa, Tadashi; Shimizu, Junya; Nagoya, Satoshi; Yamashita, Toshihiko

2017-01-01

Hemangioma of the rib is a rare benign tumor that is often difficult to distinguish from malignant bone tumors. Rib hemangioma often shows bony disruption with a slight cortical disruption, extraosseous lesion, and expanded bone on computed tomography (CT). We report the case of a 68-year-old man with atypical rib hemangioma with a slight cortical disruption and no expanded bone. The tumor showed relatively high 18FDG-uptake on positron emission tomography (PET)/CT. Rib hemangioma often shows higher 18FDG-uptake. PET/CT may not provide useful information for distinguishing rib hemangioma from a malignant tumor. Close observation without surgical resection may be feasible if the tumor is diagnosed as a rib hemangioma by biopsy. PMID:28959457

The importance of scientific evaluation of biological evidence--data from eight years of case review.

PubMed

Coyle, Heather Miller

2012-12-01

In 2009, the National Research Council published a report stating that the addition of more science and technology into the field of forensic science in the United States would be of great benefit to the judicial system. As a starting point to address this NRC report, one needs to make an assessment of the system. One factor that is continuously requested is an estimate of an error rate. In any given scientific area of forensics that is difficult to quantitate except by external review and audits. After eight years of requested defense review of cases with biological and DNA evidence, most cases appear to be scientifically sound in test methods and procedures. However, there were some cases where errors in the forensic science process did occur. This article takes information compiled from those eight years of defense review and summarizes the cases where errors have been discovered and discusses the scientific implications of these errors. The scope of this article is limited to crime scene collection and forensic science laboratory testing of biological materials for body fluid identification and DNA individualization to a source. The greatest value of defense review comes from (a) providing effective balance and independent oversight to the judicial process and (b) collecting data into a format that can be useful as a guide in training programs. Copyright © 2012 Forensic Science Society. Published by Elsevier Ireland Ltd. All rights reserved.

Splenic trauma as an adverse effect of torso-protecting side airbags: biomechanical and case evidence.

PubMed

Hallman, Jason J; Brasel, Karen J; Yoganandan, Narayan; Pintar, Frank A

2009-10-01

Injury mechanisms from frontal airbags, first identified in anecdotal reports, are now well documented for pediatric, small female, and out-of-position occupants. In contrast, torso side airbags have not yet been consistently associated with specific injury risks in field assessments. To determine possible torso side airbag-related injuries, the present study identified crashes involving side airbags from reports within the CIREN, NASS, and SCI databases. Injury patterns were compared to patterns from lateral crashes in absence of side airbag. Splenic trauma (AIS 3+) was found present in five cases of torso side airbag deployment at lower impact severity (as measured by velocity change and compartment intrusion) than cases of splenic trauma without side airbag. Five additional cases were found to contain similar injury patterns but occurred with greater crash severity. To supplement case analyses, full scale sled tests were conducted with a THOR-NT dummy and cadaveric specimen. Four THOR tests with door- and seat-mounted torso side airbags confirmed that out-of-position (early inflation stage) airbag contact elevated thoracic injury metrics compared to optimal (fully inflated) contact. Out-of-position seat-mounted airbag deployment also produced AIS 3 splenic trauma in the cadaveric specimen. Due to potentially sudden or delayed onset of intraperitoneal hemorrhage and hypovolemic shock following splenic trauma, further biomechanical investigation of this anecdotal evidence is essential to identify injury mechanisms, prevention techniques, and methods for early diagnosis.

Splenic Trauma as an Adverse Effect of Torso-Protecting Side Airbags: Biomechanical and Case Evidence

PubMed Central

Hallman, Jason J.; Brasel, Karen J.; Yoganandan, Narayan; Pintar, Frank A.

2009-01-01

Injury mechanisms from frontal airbags, first identified in anecdotal reports, are now well documented for pediatric, small female, and out-of-position occupants. In contrast, torso side airbags have not yet been consistently associated with specific injury risks in field assessments. To determine possible torso side airbag-related injuries, the present study identified crashes involving side airbags from reports within the CIREN, NASS, and SCI databases. Injury patterns were compared to patterns from lateral crashes in absence of side airbag. Splenic trauma (AIS 3+) was found present in five cases of torso side airbag deployment at lower impact severity (as measured by velocity change and compartment intrusion) than cases of splenic trauma without side airbag. Five additional cases were found to contain similar injury patterns but occurred with greater crash severity. To supplement case analyses, full scale sled tests were conducted with a THOR-NT dummy and cadaveric specimen. Four THOR tests with door- and seat-mounted torso side airbags confirmed that out-of-position (early inflation stage) airbag contact elevated thoracic injury metrics compared to optimal (fully inflated) contact. Out-of-position seat-mounted airbag deployment also produced AIS 3 splenic trauma in the cadaveric specimen. Due to potentially sudden or delayed onset of intraperitoneal hemorrhage and hypovolemic shock following splenic trauma, further biomechanical investigation of this anecdotal evidence is essential to identify injury mechanisms, prevention techniques, and methods for early diagnosis. PMID:20184829

Prosecuting Child Sexual Abuse: The Importance of Evidence Type

ERIC Educational Resources Information Center

Walsh, Wendy A.; Jones, Lisa M.; Cross, Theodore P.; Lippert, Tonya

2010-01-01

Corroborating evidence has been associated with a decrease in children's distress during the court process, yet few studies have empirically examined the impact of evidence type on prosecution rates. This study examined the types of evidence and whether charges were filed in a sample of child sexual abuse cases (n = 329). Cases with a child…

Rendering clinical psychology an evidence-based scientific discipline: a case study.

PubMed

St Stoyanov, Drozdstoj; Machamer, Peter K; Schaffner, Kenneth F

2012-02-01

Both modern neuroscience and clinical psychology taken as separate fields have failed to reveal the explanatory mechanisms underlying mental disorders. The evidence acquired inside the mono-disciplinary matrices of neurobiology, clinical psychology and psychopathology are deeply insufficient in terms of their validity, reliability and utility. Further, no effective trans-disciplinary connections have been developed between them. In this context, our case study aims at illustrating some specific facets of clinical psychology as a crucial discipline for explaining and understanding mental disorder. The methods employed in clinical psychology are scrutinized using the exemplar case of the Minnesota Multiphasic Personality Inventory (MMPI). We demonstrate that a clinical interview and a clinical psychological rating scale consist of the same kind of cognitive content. The provisional difference can be described in terms of its having two comparable complementary cognitive structures. The test is composed of self-evaluation reports (items) formulated as questions or statements. The psychopathological structured interview is formulated in terms of subjective experience indicated as symptoms (these are self-reports recorded by the physician), complemented with the so-called 'signs' or the presumably 'objective' observations of the overt behaviours of the patient. However, the cognitive content of clinical judgment is beyond any doubt as subjective as the narrative of the patient. None of the components of the structured psychopathological interview is independent of the inter-subjective system created in the situation of clinical assessment. Therefore, the protocols from various clinicians that serve to sustain the reliability claim of the 'scientific' Diagnostic Statistical Manual of Mental Disorders cannot be regarded as independent measurements of the cognitive content and value of the psychological rating scales or vice versa. © 2011 Blackwell Publishing Ltd.

A business case for quality improvement in addiction treatment: evidence from the NIATx collaborative.

PubMed

Quanbeck, Andrew R; Madden, Lynn; Edmundson, Eldon; Ford, James H; McConnell, K John; McCarty, Dennis; Gustafson, David H

2012-01-01

The Network for the Improvement of Addiction Treatment (NIATx) promotes treatment access and retention through a customer-focused quality improvement model. This paper explores the issue of the "business case" for quality improvement in addiction treatment from the provider's perspective. The business case model developed in this paper is based on case examples of early NIATx participants coupled with a review of the literature. Process inefficiencies indicated by long waiting times, high no-show rates, and low continuation rates cause underutilization of capacity and prevent optimal financial performance. By adopting customer-focused practices aimed at removing barriers to treatment access and retention, providers may be able to improve financial performance, increase staff retention, and gain long-term strategic advantage.

From Opinion-Based to Evidence-Based Social Work: The Swedish Case

ERIC Educational Resources Information Center

Sundell, Knut; Soydan, Haluk; Tengvald, Karin; Anttila, Sten

2010-01-01

This article presents an account of Sweden's Institute for Evidence-Based Social Work Practice (IMS), located in Stockholm, Sweden. The article places IMS in the context of making Swedish social care services less opinion-based and more evidence-based. The institute is an example of how policy-driven processes promote the use of evidence-based…

Contracting and Procurement for Evidence-Based Interventions in Public-Sector Human Services: A Case Study.

PubMed

Willging, Cathleen E; Aarons, Gregory A; Trott, Elise M; Green, Amy E; Finn, Natalie; Ehrhart, Mark G; Hecht, Debra B

2016-09-01

Sustainment of evidence-based interventions (EBIs) in human services depends on the inner context of community-based organizations (CBOs) that provide services and the outer context of their broader environment. Increasingly, public officials are experimenting with contracting models from for-profit industries to procure human services. In this case study, we conducted qualitative interviews with key government and CBO stakeholders to examine implementation of the Best Value-Performance Information Procurement System to contract for EBIs in a child welfare system. Findings suggest that stakeholder relationships may be compromised when procurement disregards local knowledge, communication, collaboration, and other factors supporting EBIs and public health initiatives.

Contracting and Procurement for Evidence-Based Interventions in Public-Sector Human Services: A Case Study

PubMed Central

Willging, Cathleen E.; Aarons, Gregory A.; Trott, Elise M.; Green, Amy E.; Finn, Natalie; Ehrhart, Mark G.; Hecht, Debra B.

2016-01-01

Sustainment of evidence-based interventions (EBIs) in human services depends on the inner context of community-based organizations (CBOs) that provide services and the outer context of their broader environment. Increasingly, public officials are experimenting with contracting models from for-profit industries to procure human services. In this case study, we conducted qualitative interviews with key government and CBO stakeholders to examine implementation of the Best Value-Performance Information Procurement System to contract for EBIs in a child welfare system. Findings suggest that stakeholder relationships may be compromised when procurement disregards local knowledge, communication, collaboration, and other factors supporting EBIs and public health initiatives. PMID:26386977

Affiliation, joint venture or PSO? Case studies show why provider strategies differ.

PubMed

1998-03-01

Joint venture, affiliation or PSO? Here are three case studies of providers who chose different paths under Medicare risk, plus some key questions you'll want to ask of your own provider organization. Learn from these examples so you'll make the best contracting decisions.

Mesenchymal stromal cells of osteosarcoma patients do not show evidence of neoplastic changes during long-term culture.

PubMed

Buddingh, Emilie P; Ruslan, S Eriaty N; Reijnders, Christianne M A; Szuhai, Karoly; Kuijjer, Marieke L; Roelofs, Helene; Hogendoorn, Pancras C W; Maarten Egeler, R; Cleton-Jansen, Anne-Marie; Lankester, Arjan C

2015-01-01

In vitro expanded mesenchymal stromal cells (MSCs) are increasingly used as experimental cellular therapy. However, there have been concerns regarding the safety of their use, particularly with regard to possible oncogenic transformation. MSCs are the hypothesized precursor cells of high-grade osteosarcoma, a tumor with often complex karyotypes occurring mainly in adolescents and young adults. To determine if MSCs from osteosarcoma patients could be predisposed to malignant transformation we cultured MSCs of nine osteosarcoma patients and five healthy donors for an average of 649 days (range 601-679 days). Also, we compared MSCs derived from osteosarcoma patients at diagnosis and from healthy donors using genome wide gene expression profiling. Upon increasing passage, increasing frequencies of binucleate cells were detected, but no increase in proliferation suggestive of malignant transformation occurred in MSCs from either patients or donors. Hematopoietic cell specific Lyn substrate 1 (HLCS1) was differentially expressed (fold change 0.25, P value 0.0005) between MSCs of osteosarcoma patients (n = 14) and healthy donors (n = 9). This study shows that although HCLS1 expression was downregulated in MSCs of osteosarcoma patients and binucleate cells were present in both patient and donor derived MSCs, there was no evidence of neoplastic changes to occur during long-term culture.

Using evidence-integrated e-learning to enhance case management continuing education for psychiatric nurses: a randomised controlled trial with follow-up.

PubMed

Liu, Wen-I; Rong, Jiin-Ru; Liu, Chieh-Yu

2014-11-01

E-learning is a flexible strategy to improve nurses' knowledge of case management, but there are methodological limitations in previous research into the effectiveness of such programs. To describe the development and effectiveness of an evidence-integrated e-learning program in case management continuing education for Taiwanese psychiatric nurses. Multiple methods were adopted to develop the program and a randomised controlled trial with repeated measures was employed to evaluate it. The e-learning program was developed in four stages: (1) systematic review of literature; (2) needs assessment through a national survey and focus group; (3) development of learning materials; and (4) pilot test. Following program development, psychiatric nurses were recruited and randomly allocated into an experimental or comparison group. The experimental group participated in an e-learning continuing education program. The case management knowledge index with sufficient reliability and validity and a satisfaction survey were used to determine the outcomes. A generalised estimating equation was used to assess the difference between the 2 groups before, after, and at 3 months follow-up. The learning material comprised 5 simulated learning modules, self-assessment questions, learning cases, sharing experiences, and learning resources. A total of 200 participants completed the 3 measurements. Knowledge scores in the experimental group significantly exceeded those in the comparison group after the program and at the 3-month follow-up. Participants reported positive learning perceptions. The program provides an evidence-based educational resource for nursing continuing education in case management. Copyright © 2014 Elsevier Ltd. All rights reserved.

Developing integrated clinical reasoning competencies in dental students using scaffolded case-based learning - empirical evidence.

PubMed

Postma, T C; White, J G

2016-08-01

This study provides empirical evidence of the development of integrated clinical reasoning in the discipline-based School of Dentistry, University of Pretoria, South Africa. Students were exposed to case-based learning in comprehensive patient care (CPC) in the preclinical year of study, scaffolded by means of the four-component instructional design model for complex learning. Progress test scores of third- to fifth-year dental students, who received case-based teaching and learning in the third year (2009-2011), were compared to the scores of preceding fourth- and fifth-year cohorts. These fourth- and fifth-year cohorts received content-based teaching concurrently with their clinical training in CPC. The progress test consisted of a complex case study and 32 MCQs on tracer conditions. Students had to gather the necessary information and had to make diagnostic and treatment-planning decisions. Preclinical students who participated in the case-based teaching and learning achieved similar scores compared to final-year students who received lecture-based teaching and learning. Final-year students who participated in the case-based learning made three more correct clinical decisions per student, compared to those who received content-based teaching. Students struggled more with treatment-planning than with diagnostic decisions. The scaffolded case-based learning appears to contribute to accurate clinical decisions when compared to lecture-based teaching. It is suggested that the development of integrated reasoning competencies starts as early as possible in a dental curriculum, perhaps even in the preclinical year of study. Treatment-planning should receive particular attention. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Pathways of Adaptation: Two Case Studies with One Evidence-Based Substance Use Prevention Program Tailored for Indigenous Youth.

PubMed

Ivanich, Jerreed D; Mousseau, Alicia C; Walls, Melissa; Whitbeck, Les; Whitesell, Nancy Rumbaugh

2018-06-06

Indigenous communities often face disproportionate challenges across a variety of health domains, and effective prevention strategies are sorely needed. Unfortunately, evidence is scant regarding what approaches are effective for these communities. A common approach is to take an evidence-based practice or program with documented effectiveness in other populations and implement it with Indigenous populations. While a science of intervention adaptation is emerging, there remains little guidance on processes for adaptation that strategically leverage both existing scientific evidence and Indigenous prevention strategies. In this paper, two case studies illustrate promising practices for adaptation, documenting the approaches of two research teams funded under the National Institutes of Health's initiative to support Intervention Research to Improve Native American Health (IRINAH). These teams worked with distinct Indigenous populations in the USA and Canada to culturally adapt the same prevention program, the Iowa Strengthening Families Program for Parents and Youth 10-14. The approaches of these two teams and the programs that resulted are compared and contrasted, and critical elements of adaptation in partnership with Indigenous communities are discussed.

Localized malignant pleural mesothelioma: report of two cases.

PubMed

Tanzi, Silvia; Tiseo, Marcello; Internullo, Eveline; Cacciani, Giancarlo; Capra, Roberto; Carbognani, Paolo; Rusca, Michele; Rindi, Guido; Ardizzoni, Andrea

2009-08-01

Localized malignant pleural mesothelioma is very rare tumor disease. There are sporadic reports in the literature showing that this entity has a different biologic behavior compared with diffuse pleural mesothelioma. We report two cases of radically resected localized pleural malignant mesothelioma, with a previous history of asbestos exposure. Both cases showed a microscopic and immunohistochemical findings of malignant mesothelioma, biphasic and sarcomatoid lympho-histiocitoid variant type, respectively, without evidence of diffuse pleural spread. The first is very peculiar case of bilateral localized malignant pleural mesothelioma with complete response to chemotherapy and localized late recurrence, radically resected and treated with adjuvant radiotherapy. The second case revealed as a solitary localized mass, underwent a complete en bloc resection and adjuvant radiotherapy. Both cases demonstrate that the localized malignant mesothelioma should be distinguished from diffuse form and that complete resection is associated with good prognosis.

Evidence Arguments for Using Formal Methods in Software Certification

NASA Technical Reports Server (NTRS)

Denney, Ewen W.; Pai, Ganesh

2013-01-01

We describe a generic approach for automatically integrating the output generated from a formal method/tool into a software safety assurance case, as an evidence argument, by (a) encoding the underlying reasoning as a safety case pattern, and (b) instantiating it using the data produced from the method/tool. We believe this approach not only improves the trustworthiness of the evidence generated from a formal method/tool, by explicitly presenting the reasoning and mechanisms underlying its genesis, but also provides a way to gauge the suitability of the evidence in the context of the wider assurance case. We illustrate our work by application to a real example-an unmanned aircraft system- where we invoke a formal code analysis tool from its autopilot software safety case, automatically transform the verification output into an evidence argument, and then integrate it into the former.

A Judicial Presentation of Evidence of a Student Culture of "Dealing"

ERIC Educational Resources Information Center

Wood, Nathan B.; Lawrenz, Frances; Haroldson, Rachelle

2009-01-01

This study uses a new-to-educational-research methodology, based on the legal process, to build a case that U.S. students have been largely ignored in discussion and planning for their own, presumed futures. A variety of evidence, from two large and distinct data bases, is drawn together to show: (1) students perceive their classrooms in ways…

Estimating error rates for firearm evidence identifications in forensic science.

PubMed

Song, John; Vorburger, Theodore V; Chu, Wei; Yen, James; Soons, Johannes A; Ott, Daniel B; Zhang, Nien Fan

2018-03-01

Estimating error rates for firearm evidence identification is a fundamental challenge in forensic science. This paper describes the recently developed congruent matching cells (CMC) method for image comparisons, its application to firearm evidence identification, and its usage and initial tests for error rate estimation. The CMC method divides compared topography images into correlation cells. Four identification parameters are defined for quantifying both the topography similarity of the correlated cell pairs and the pattern congruency of the registered cell locations. A declared match requires a significant number of CMCs, i.e., cell pairs that meet all similarity and congruency requirements. Initial testing on breech face impressions of a set of 40 cartridge cases fired with consecutively manufactured pistol slides showed wide separation between the distributions of CMC numbers observed for known matching and known non-matching image pairs. Another test on 95 cartridge cases from a different set of slides manufactured by the same process also yielded widely separated distributions. The test results were used to develop two statistical models for the probability mass function of CMC correlation scores. The models were applied to develop a framework for estimating cumulative false positive and false negative error rates and individual error rates of declared matches and non-matches for this population of breech face impressions. The prospect for applying the models to large populations and realistic case work is also discussed. The CMC method can provide a statistical foundation for estimating error rates in firearm evidence identifications, thus emulating methods used for forensic identification of DNA evidence. Published by Elsevier B.V.

Estimating error rates for firearm evidence identifications in forensic science

PubMed Central

Song, John; Vorburger, Theodore V.; Chu, Wei; Yen, James; Soons, Johannes A.; Ott, Daniel B.; Zhang, Nien Fan

2018-01-01

Estimating error rates for firearm evidence identification is a fundamental challenge in forensic science. This paper describes the recently developed congruent matching cells (CMC) method for image comparisons, its application to firearm evidence identification, and its usage and initial tests for error rate estimation. The CMC method divides compared topography images into correlation cells. Four identification parameters are defined for quantifying both the topography similarity of the correlated cell pairs and the pattern congruency of the registered cell locations. A declared match requires a significant number of CMCs, i.e., cell pairs that meet all similarity and congruency requirements. Initial testing on breech face impressions of a set of 40 cartridge cases fired with consecutively manufactured pistol slides showed wide separation between the distributions of CMC numbers observed for known matching and known non-matching image pairs. Another test on 95 cartridge cases from a different set of slides manufactured by the same process also yielded widely separated distributions. The test results were used to develop two statistical models for the probability mass function of CMC correlation scores. The models were applied to develop a framework for estimating cumulative false positive and false negative error rates and individual error rates of declared matches and non-matches for this population of breech face impressions. The prospect for applying the models to large populations and realistic case work is also discussed. The CMC method can provide a statistical foundation for estimating error rates in firearm evidence identifications, thus emulating methods used for forensic identification of DNA evidence. PMID:29331680

Perinatal findings of Seckel syndrome: a case report of a fetus showing primordial dwarfism and severe microcephaly.

PubMed

Takikawa, Keiko Miyachi; Kikuchi, Akihiko; Yokoyama, Akiko; Ono, Kyoko; Iwasawa, Yuki; Sunagawa, Sorahiro; Takagi, Kimiyo; Kawame, Hiroshi; Nakamura, Tomohiko

2008-01-01

Seckel syndrome is a rare form of primordial dwarfism and most of the previous reports have been limited to postnatal findings. We report on a fetus showing severe microcephaly, intrauterine growth restriction and a few gyri with shallow sulci on the fetal brain suggesting cortical dysplasia, followed by ultrasound and magnetic resonance imaging in the prenatal period. Cardiotocograph revealed a reassuring fetal status throughout the whole pregnancy period. A male infant weighing 1,556 g was delivered at 39 weeks' gestation, and a diagnosis of Seckel syndrome was made based on postnatal typical findings. Although previous reports on prenatal findings of Seckel syndrome are quite limited, we think that our case presents typical features of a fetus affected by this syndrome. When prenatal ultrasound shows severe microcephaly and intrauterine growth restriction, this rare syndrome should be included in the differential diagnosis. Moreover, magnetic resonance imaging of the affected fetal brain provides further diagnostic clues. Copyright 2008 S. Karger AG, Basel.

Hair and fiber transfer in an abduction case--evidence from different levels of trace evidence transfer.

PubMed

Taupin, J M

1996-07-01

Levels of trace evidence transfer were examined in a casework context. A girl was allegedly abducted in a car and rape attempted by the accused, who denied any contact with the victim. Clothing worn by the victim and the accused, and the covers from the front seats of the car, were analyzed for trace evidence. Three types of corresponding fibers and four possible pathways of transfer were identified. Synthetic fibers similar to those composing the car seat covers were located on the victim's clothing, consistent with direct transfer. Secondary transfer was indicated by dyed brown human head-type hairs (possibly originating from the accused's wife) located on the seat covers and on the victim's clothing. Secondary and possibly tertiary transfer was indicated by pink synthetic material and associated fibers (possibly originating from the victim's mother) located on the victim's clothing, a car seat cover and the accused's clothing. Light microscopy, comparison microscopy, and cross-sectioning techniques were used. The multiple fiber matches and the differing pathways and levels of transfer increased the strength of the association between the accused and the victim. After the fiber evidence was led at the trial, the accused pleaded guilty, thereby affirming the value of secondary transfer evidence.

Evidence Combination From an Evolutionary Game Theory Perspective.

PubMed

Deng, Xinyang; Han, Deqiang; Dezert, Jean; Deng, Yong; Shyr, Yu

2016-09-01

Dempster-Shafer evidence theory is a primary methodology for multisource information fusion because it is good at dealing with uncertain information. This theory provides a Dempster's rule of combination to synthesize multiple evidences from various information sources. However, in some cases, counter-intuitive results may be obtained based on that combination rule. Numerous new or improved methods have been proposed to suppress these counter-intuitive results based on perspectives, such as minimizing the information loss or deviation. Inspired by evolutionary game theory, this paper considers a biological and evolutionary perspective to study the combination of evidences. An evolutionary combination rule (ECR) is proposed to help find the most biologically supported proposition in a multievidence system. Within the proposed ECR, we develop a Jaccard matrix game to formalize the interaction between propositions in evidences, and utilize the replicator dynamics to mimick the evolution of propositions. Experimental results show that the proposed ECR can effectively suppress the counter-intuitive behaviors appeared in typical paradoxes of evidence theory, compared with many existing methods. Properties of the ECR, such as solution's stability and convergence, have been mathematically proved as well.

Short- and long-term memory contributions to immediate serial recognition: evidence from serial position effects.

PubMed

Purser, Harry; Jarrold, Christopher

2010-04-01

A long-standing body of research supports the existence of separable short- and long-term memory systems, relying on phonological and semantic codes, respectively. The aim of the current study was to measure the contribution of long-term knowledge to short-term memory performance by looking for evidence of phonologically and semantically coded storage within a short-term recognition task, among developmental samples. Each experimental trial presented 4-item lists. In Experiment 1 typically developing children aged 5 to 6 years old showed evidence of phonologically coded storage across all 4 serial positions, but evidence of semantically coded storage at Serial Positions 1 and 2. In a further experiment, a group of individuals with Down syndrome was investigated as a test case that might be expected to use semantic coding to support short-term storage, but these participants showed no evidence of semantically coded storage and evidenced phonologically coded storage only at Serial Position 4, suggesting that individuals with Down syndrome have a verbal short-term memory capacity of 1 item. Our results suggest that previous evidence of semantic effects on "short-term memory performance" does not reflect semantic coding in short-term memory itself, and provide an experimental method for researchers wishing to take a relatively pure measure of verbal short-term memory capacity, in cases where rehearsal is unlikely.

Evidence-Based Advances in Reptile Medicine.

PubMed

Mitchell, Mark A; Perry, Sean M

2017-09-01

Evidence-based medicine allows veterinarians to practice high-quality medicine, because the basis for all decision making is quantitative, objective, and reproducible. Case reports and case series are limited in their scope and application. Cross-sectional studies, likewise, cannot provide answers to specific variable testing with a temporal application. It is essential for the reptile specialty to expand into case-control studies, cohort studies, and experimental/intervention studies. Unfortunately, much of the reptile literature remains limited to descriptive studies. This article reviews current evidence-based topics in reptile medicine and shares how everyone practicing in the field can contribute to improving this specialty. Copyright © 2017 Elsevier Inc. All rights reserved.

Effects of Behavioral Genetic Evidence on Perceptions of Criminal Responsibility and Appropriate Punishment.

PubMed

Appelbaum, Paul S; Scurich, Nicholas; Raad, Raymond

2015-05-01

Demonstrations of a link between genetic variants and criminal behavior have stimulated increasing use of genetic evidence to reduce perceptions of defendants' responsibility for criminal behavior and to mitigate punishment. However, because only limited data exist regarding the impact of such evidence on decision makers and the public at large, we recruited a representative sample of the U.S. adult population (n=960) for a web-based survey. Participants were presented with descriptions of three legal cases and were asked to: determine the length of incarceration for a convicted murderer; adjudicate an insanity defense; and decide whether a defendant should receive the death penalty. A fully crossed, between-participants, factorial design was used, varying the type of evidence (none, genetic, neuroimaging, both), heinousness of the crime, and past criminal record, with sentence or verdict as the primary outcome. Also assessed were participants' apprehension of the defendant, belief in free will, political ideology, and genetic knowledge. Across all three cases, genetic evidence had no significant effects on outcomes. Neuroimaging data showed an inconsistent effect in one of the two cases in which it was introduced. In contrast, heinousness of the offense and past criminal record were strongly related to participants' decisions. Moreover, participants' beliefs about the controllability of criminal behavior and political orientations were significantly associated with their choices. Our findings suggest that neither hopes that genetic evidence will modify judgments of culpability and punishment nor fears about the impact of genetic evidence on decision makers are likely to come to fruition.

Effects of Behavioral Genetic Evidence on Perceptions of Criminal Responsibility and Appropriate Punishment

PubMed Central

Appelbaum, Paul S.; Scurich, Nicholas; Raad, Raymond

2015-01-01

Demonstrations of a link between genetic variants and criminal behavior have stimulated increasing use of genetic evidence to reduce perceptions of defendants’ responsibility for criminal behavior and to mitigate punishment. However, because only limited data exist regarding the impact of such evidence on decision makers and the public at large, we recruited a representative sample of the U.S. adult population (n=960) for a web-based survey. Participants were presented with descriptions of three legal cases and were asked to: determine the length of incarceration for a convicted murderer; adjudicate an insanity defense; and decide whether a defendant should receive the death penalty. A fully crossed, between-participants, factorial design was used, varying the type of evidence (none, genetic, neuroimaging, both), heinousness of the crime, and past criminal record, with sentence or verdict as the primary outcome. Also assessed were participants’ apprehension of the defendant, belief in free will, political ideology, and genetic knowledge. Across all three cases, genetic evidence had no significant effects on outcomes. Neuroimaging data showed an inconsistent effect in one of the two cases in which it was introduced. In contrast, heinousness of the offense and past criminal record were strongly related to participants’ decisions. Moreover, participants’ beliefs about the controllability of criminal behavior and political orientations were significantly associated with their choices. Our findings suggest that neither hopes that genetic evidence will modify judgments of culpability and punishment nor fears about the impact of genetic evidence on decision makers are likely to come to fruition. PMID:26240516

Ancestral state reconstructions require biological evidence to test evolutionary hypotheses: A case study examining the evolution of reproductive mode in squamate reptiles.

PubMed

Griffith, Oliver W; Blackburn, Daniel G; Brandley, Matthew C; Van Dyke, James U; Whittington, Camilla M; Thompson, Michael B

2015-09-01

To understand evolutionary transformations it is necessary to identify the character states of extinct ancestors. Ancestral character state reconstruction is inherently difficult because it requires an accurate phylogeny, character state data, and a statistical model of transition rates and is fundamentally constrained by missing data such as extinct taxa. We argue that model based ancestral character state reconstruction should be used to generate hypotheses but should not be considered an analytical endpoint. Using the evolution of viviparity and reversals to oviparity in squamates as a case study, we show how anatomical, physiological, and ecological data can be used to evaluate hypotheses about evolutionary transitions. The evolution of squamate viviparity requires changes to the timing of reproductive events and the successive loss of features responsible for building an eggshell. A reversal to oviparity requires that those lost traits re-evolve. We argue that the re-evolution of oviparity is inherently more difficult than the reverse. We outline how the inviability of intermediate phenotypes might present physiological barriers to reversals from viviparity to oviparity. Finally, we show that ecological data supports an oviparous ancestral state for squamates and multiple transitions to viviparity. In summary, we conclude that the first squamates were oviparous, that frequent transitions to viviparity have occurred, and that reversals to oviparity in viviparous lineages either have not occurred or are exceedingly rare. As this evidence supports conclusions that differ from previous ancestral state reconstructions, our paper highlights the importance of incorporating biological evidence to evaluate model-generated hypotheses. © 2015 Wiley Periodicals, Inc.

Single-Case Design Research: Building the Evidence-Base in the Field of Education of Deaf and Hard of Hearing Students

ERIC Educational Resources Information Center

Cannon, Joanna E.; Guardino, Caroline; Antia, Shirin D.; Luckner, John L.

2015-01-01

The field of education of deaf and hard of hearing (DHH) students has a paucity of evidence-based practices (EBPs) to guide instruction. The authors discussed how the research methodology of single-case design (SCD) can be used to build EBPs through direct and systematic replication of studies. An overview of SCD research methods is presented,…

Agreement between the results of meta-analyses from case reports and from clinical studies regarding the efficacy of laronidase therapy in patients with mucopolysaccharidosis type I who initiated enzyme replacement therapy in adult age: An example of case reports meta-analyses as an useful tool for evidence-based medicine in rare diseases.

PubMed

Sampayo-Cordero, Miguel; Miguel-Huguet, Bernat; Pardo-Mateos, Almudena; Moltó-Abad, Marc; Muñoz-Delgado, Cecilia; Pérez-López, Jordi

2018-02-01

Case reports might have a prominent role in the rare diseases field, due to the small number of patients affected by one such disease. A previous systematic review regarding the efficacy of laronidase therapy in patients with mucopolysaccharidosis type I (MPS-I) who initiated enzyme replacement therapy (ERT) in adult age has been published. The review included a meta-analysis of 19 clinical studies and the description of eleven case reports. It was of interest to perform a meta-analysis of those case reports to explore the role of such meta-analyses as a tool for evidence-based medicine in rare diseases. The study included all case reports with standard treatment regimen. Primary analysis was the percentage of case reports showing an improvement in a specific outcome. Only when that percentage was statistically higher than 5%, the improvement was confirmed as such. The outcomes that accomplished this criterion were ranked and compared to the GRADE criteria obtained by those same outcomes in the previous meta-analysis of clinical studies. There were three outcomes that had a significant improvement: Urine glycosaminoglycans, liver volume and 6-minute walking test. Positive and negative predictive values, sensitivity and specificity for the results of the meta-analysis of case reports as compared to that of clinical studies were 100%, 88.9%, 75% and 100%, respectively. Accordingly, absolute (Rho=0.82, 95%CI: 0.47 to 0.95) and relative agreement (Kappa=0.79, 95%CI: 0.593 to 0.99) between the number of case reports with improvement in a specific outcome and the GRADE evidence score for that outcome were good. Sensitivity analysis showed that agreement between the meta-analysis of case reports and that of the clinical studies were good only when using a strong confirmatory strategy for outcome improvement in case reports. We found an agreement between the results of meta-analyses from case reports and from clinical studies in the efficacy of laronidase therapy in

29 CFR 511.13 - Evidence.

Code of Federal Regulations, 2012 CFR

2012-07-01

... AMERICAN SAMOA § 511.13 Evidence. In accordance with the notice of hearing, the committee and any... scheduled to testify. Oral or documentary evidence may be received, but the committee shall exclude... for participation as a party shall have the right to present his or her case by oral or documentary...

29 CFR 511.13 - Evidence.

Code of Federal Regulations, 2010 CFR

2010-07-01

... AMERICAN SAMOA § 511.13 Evidence. In accordance with the notice of hearing, the committee and any... scheduled to testify. Oral or documentary evidence may be received, but the committee shall exclude... for participation as a party shall have the right to present his or her case by oral or documentary...

29 CFR 511.13 - Evidence.

Code of Federal Regulations, 2013 CFR

2013-07-01

... AMERICAN SAMOA § 511.13 Evidence. In accordance with the notice of hearing, the committee and any... scheduled to testify. Oral or documentary evidence may be received, but the committee shall exclude... for participation as a party shall have the right to present his or her case by oral or documentary...

29 CFR 511.13 - Evidence.

Code of Federal Regulations, 2011 CFR

2011-07-01

... AMERICAN SAMOA § 511.13 Evidence. In accordance with the notice of hearing, the committee and any... scheduled to testify. Oral or documentary evidence may be received, but the committee shall exclude... for participation as a party shall have the right to present his or her case by oral or documentary...

29 CFR 511.13 - Evidence.

Code of Federal Regulations, 2014 CFR

2014-07-01

... AMERICAN SAMOA § 511.13 Evidence. In accordance with the notice of hearing, the committee and any... scheduled to testify. Oral or documentary evidence may be received, but the committee shall exclude... for participation as a party shall have the right to present his or her case by oral or documentary...

Death of the (traveling) salesman: primates do not show clear evidence of multi-step route planning.

PubMed

Janson, Charles

2014-05-01

Several comparative studies have linked larger brain size to a fruit-eating diet in primates and other animals. The general explanation for this correlation is that fruit is a complex resource base, consisting of many discrete patches of many species, each with distinct nutritional traits, the production of which changes predictably both within and between seasons. Using this information to devise optimal spatial foraging strategies is among the most difficult problems to solve in all of mathematics, a version of the famous Traveling Salesman Problem. Several authors have suggested that primates might use their large brains and complex cognition to plan foraging strategies that approximate optimal solutions to this problem. Three empirical studies have examined how captive primates move when confronted with the simplest version of the problem: a spatial array of equally valuable goals. These studies have all concluded that the subjects remember many food source locations and show very efficient travel paths; some authors also inferred that the subjects may plan their movements based on considering combinations of three or more future goals at a time. This analysis re-examines critically the claims of planned movement sequences from the evidence presented. The efficiency of observed travel paths is largely consistent with use of the simplest of foraging rules, such as visiting the nearest unused "known" resource. Detailed movement sequences by test subjects are most consistent with a rule that mentally sums spatial information from all unused resources in a given trial into a single "gravity" measure that guides movements to one destination at a time. © 2013 Wiley Periodicals, Inc.

Man's underground best friend: domestic ferrets, unlike the wild forms, show evidence of dog-like social-cognitive skills.

PubMed

Hernádi, Anna; Kis, Anna; Turcsán, Borbála; Topál, József

2012-01-01

Recent research has shown that dogs' possess surprisingly sophisticated human-like social communication skills compared to wolves or chimpanzees. The effects of domestication on the emergence of socio-cognitive skills, however, are still highly debated. One way to investigate this is to compare socialized individuals from closely related domestic and wild species. In the present study we tested domestic ferrets (Mustela furo) and compared their performance to a group of wild Mustela hybrids and to domestic dogs (Canis familiaris). We found that, in contrast to wild Mustela hybrids, both domestic ferrets and dogs tolerated eye-contact for a longer time when facing their owners versus the experimenter and they showed a preference in a two-way choice task towards their owners. Furthermore, domestic ferrets, unlike the wild hybrids, were able to follow human directional gestures (sustained touching; momentary pointing) and could reach the success rate of dogs. Our study provides the first evidence that domestic ferrets, in a certain sense, are more dog-like than their wild counterparts. These findings support the hypothesis that domestic species may share basic socio-cognitive skills that enable them to engage in effectively orchestrated social interactions with humans.

Open access of evidence-based publications: the case of the orthopedic and musculoskeletal literature.

PubMed

Yammine, Kaissar

2015-11-01

The open access model, where researchers can publish their work and make it freely available to the whole medical community, is gaining ground over the traditional type of publication. However, fees are to be paid by either the authors or their institutions. The purpose of this paper is to assess the proportion and type of open access evidence-based articles in the form of systematic reviews and meta-analyses in the field of musculoskeletal disorders and orthopedic surgery. PubMed database was searched and the results showed a maximal number of hits for low back pain and total hip arthroplasty. We demonstrated that despite a 10-fold increase in the number of evidence-based publications in the past 10 years, the rate of free systematic reviews in the general biomedical literature did not change for the last two decades. In addition, the average percentage of free open access systematic reviews and meta-analyses for the commonest painful musculoskeletal conditions and orthopedic procedures was 20% and 18%, respectively. Those results were significantly lower than those of the systematic reviews and meta-analyses in the remaining biomedical research. Such findings could indicate a divergence between the efforts engaged at promoting evidence-based principles and those at disseminating evidence-based findings in the field of musculoskeletal disease and trauma. The high processing fee is thought to be a major limitation when considering open access model for publication. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

A Technique for Showing Causal Arguments in Accident Reports

NASA Technical Reports Server (NTRS)

Holloway, C. M.; Johnson, C. W.

2005-01-01

In the prototypical accident report, specific findings, particularly those related to causes and contributing factors, are usually written out explicitly and clearly. Also, the evidence upon which these findings are based is typically explained in detail. Often lacking, however, is any explicit discussion, description, or depiction of the arguments that connect the findings and the evidence. That is, the reports do not make clear why the investigators believe that the specific evidence they found necessarily leads to the particular findings they enumerated. This paper shows how graphical techniques can be used to depict relevant arguments supporting alternate positions on the causes of a complex road-traffic accident.

Effectiveness and implementation of enhanced recovery after surgery programmes: a rapid evidence synthesis.

PubMed

Paton, Fiona; Chambers, Duncan; Wilson, Paul; Eastwood, Alison; Craig, Dawn; Fox, Dave; Jayne, David; McGinnes, Erika

2014-07-22

To assess the evidence on the impact of enhanced recovery programmes for patients undergoing elective surgery in acute hospital settings in the UK. Rapid evidence synthesis. Eight databases were searched from 1990 to March 2013 without language restrictions. Relevant reports and guidelines, websites and reference lists of retrieved articles were scanned to identify additional studies. Systematic reviews, RCTs not included in the systematic reviews, economic evaluations and UK NHS cost analysis, implementation case studies and surveys of patient experience in a UK setting were eligible for inclusion. We assessed the impact of enhanced recovery programmes on health or cost-related outcomes, and assessed implementation case studies and patient experience in UK settings. Studies were quality assessed where appropriate using the Centre for Reviews and Dissemination Database of Abstracts of Reviews of Effects critical appraisal process. 17 systematic reviews and 12 additional RCTs were included. Ten relevant economic evaluations were included. No cost analysis studies were identified. Most of the evidence focused on colorectal surgery. 14 innovation case studies and 15 implementation case studies undertaken in National Health Service settings described factors critical to the success of an enhanced recovery programme. Evidence for colorectal surgery suggests that enhanced recovery programmes may reduce hospital stays by 0.5-3.5 days compared with conventional care. There were no significant differences in reported readmission rates. Other surgical specialties showed greater variation in reductions in length of stay reflecting the limited evidence identified. Findings relating to other outcomes were hampered by a lack of robust evidence and poor reporting. There is consistent, albeit limited, evidence that enhanced recovery programmes can reduce length of patient hospital stay without increasing readmission rates. The extent to which managers and clinicians considering

20 CFR 416.927 - Evaluating opinion evidence.

Code of Federal Regulations, 2010 CFR

2010-04-01

... are responsible for making the determination or decision about whether you meet the statutory... rest of the relevant evidence we receive. (c) Making disability determinations. After we review all of... or decision based on that evidence. (2) If any of the evidence in your case record, including any...

Military Rule of Evidence 404(b): Toothless Giant of the Evidence World

DTIC Science & Technology

1996-04-01

Evidence Practice ........... 49 B. Applying the Military Rules of Evidence ........... 52 C. Refining the Standard of Proof .................... 56 D. What...committed such an offence at another time and with another person, and that he had a tendency to such practices , ought not to be admitted."" This report...a practice not forbidden by 45 Stone, England, supra note 12, at 959. Prior cases had held uncharged misconduct inadmissible, apparently on the theory

The Use of Evidence in Public Debates in the Media: The Case of Swiss Direct-Democratic Campaigns in the Health Policy Sector

ERIC Educational Resources Information Center

Stucki, Iris

2016-01-01

This article analyses the reporting of evidence in Swiss direct-democratic campaigns in the health policy sector, assuming that an informed public helps democracy function successfully. A content analysis of the media's news reporting shows that of 5030 media items retrieved, a reference to evidence is found in 6.8%. The voter receives evidence in…

Extraordinary Claims Require Extraordinary Evidence: The Case of Non-Local Perception, a Classical and Bayesian Review of Evidences

PubMed Central

Tressoldi, Patrizio E.

2011-01-01

Starting from the famous phrase “extraordinary claims require extraordinary evidence,” we will present the evidence supporting the concept that human visual perception may have non-local properties, in other words, that it may operate beyond the space and time constraints of sensory organs, in order to discuss which criteria can be used to define evidence as extraordinary. This evidence has been obtained from seven databases which are related to six different protocols used to test the reality and the functioning of non-local perception, analyzed using both a frequentist and a new Bayesian meta-analysis statistical procedure. According to a frequentist meta-analysis, the null hypothesis can be rejected for all six protocols even if the effect sizes range from 0.007 to 0.28. According to Bayesian meta-analysis, the Bayes factors provides strong evidence to support the alternative hypothesis (H1) over the null hypothesis (H0), but only for three out of the six protocols. We will discuss whether quantitative psychology can contribute to defining the criteria for the acceptance of new scientific ideas in order to avoid the inconclusive controversies between supporters and opponents. PMID:21713069

Meta-analysis of screening and case finding tools for depression in cancer: evidence based recommendations for clinical practice on behalf of the Depression in Cancer Care consensus group.

PubMed

Mitchell, Alex J; Meader, Nick; Davies, Evan; Clover, Kerrie; Carter, Gregory L; Loscalzo, Matthew J; Linden, Wolfgang; Grassi, Luigi; Johansen, Christoffer; Carlson, Linda E; Zabora, James

2012-10-01

To examine the validity of screening and case-finding tools used in the identification of depression as defined by an ICD10/DSM-IV criterion standard. We identified 63 studies involving 19 tools (in 33 publications) designed to help clinicians identify depression in cancer settings. We used a standardized rating system. We excluded 11 tools without at least two independent studies, leaving 8 tools for comparison. Across all cancer stages there were 56 diagnostic validity studies (n=10,009). For case-finding, one stem question, two stem questions and the BDI-II all had level 2 evidence (2a, 2b and 2c respectively) and given their better acceptability we gave the stem questions a grade B recommendation. For screening, two stem questions had level 1b evidence (with high acceptability) and the BDI-II had level 2c evidence. For every 100 people screened in advanced cancer, the two questions would accurately detect 18 cases, while missing only 1 and correctly reassure 74 with 7 falsely identified. For every 100 people screened in non-palliative settings the BDI-II would accurately detect 17 cases, missing 2 and correctly re-assure 70, with 11 falsely identified as cases. The main cautions are the reliance on DSM-IV definitions of major depression, the large number of small studies and the paucity of data for many tools in specific settings. Although no single tool could be offered unqualified support, several tools are likely to improve upon unassisted clinical recognition. In clinical practice, all tools should form part of an integrated approach involving further follow-up, clinical assessment and evidence based therapy. Copyright © 2012 Elsevier B.V. All rights reserved.

Nitrosamine and related food intake and gastric and oesophageal cancer risk: A systematic review of the epidemiological evidence

PubMed Central

Jakszyn, Paula; González, Carlos Alberto

2006-01-01

AIM: To study the association between nitrite and nitrosamine intake and gastric cancer (GC), between meat and processed meat intake, GC and oesophageal cancer (OC), and between preserved fish, vegetable and smoked food intake and GC. METHODS: In this article we reviewed all the published cohort and case-control studies from 1985-2005, and analyzed the relationship between nitrosamine and nitrite intake and the most important related food intake (meat and processed meat, preserved vegetables and fish, smoked foods and beer drinking) and GC or OC risk. Sixty-one studies, 11 cohorts and 50 case-control studies were included. RESULTS: Evidence from case-control studies supported an association between nitrite and nitrosamine intake with GC but evidence was insufficient in relation to OC. A high proportion of case-control studies found a positive association with meat intake for both tumours (11 of 16 studies on GC and 11 of 18 studies on OC). A relatively large number of case-control studies showed quite consistent results supporting a positive association between processed meat intake and GC and OC risk (10 of 14 studies on GC and 8 of 9 studies on OC). Almost all the case-control studies found a positive and significant association between preserved fish, vegetable and smoked food intake and GC. The evidence regarding OC was more limited. Overall the evidence from cohort studies was insufficient or more inconsistent than that from case-control studies. CONCLUSION: The available evidence supports a positive association between nitrite and nitrosamine intake and GC, between meat and processed meat intake and GC and OC, and between preserved fish, vegetable and smoked food intake and GC, but is not conclusive. PMID:16865769

Making the case for evidence-based design in healthcare: a descriptive case study of organizational decision making.

PubMed

Shoemaker, Lorie K; Kazley, Abby Swanson; White, Andrea

2010-01-01

The aim of this study was to describe the organizational decision-making process used in the selection of evidence-based design (EBD) concepts, the criteria used to make these decisions, and the extent to which leadership style may have influenced the decision-making process. Five research questions were formulated to frame the direction of this study, including: (1) How did healthcare leaders learn of innovations in design? (2) How did healthcare leaders make decisions in the selection of healthcare design concepts? (3) What criteria did healthcare leaders use in the decision-making process? (4) How did healthcare leaders consider input from the staff in design decisions? and (5) To what extent did the leadership style of administrators affect the outcomes of the decision-making process? Current issues affecting healthcare in the community led the principal investigator's organization to undertake an ambitious facilities expansion project. As part of its planning process, the organization learned of EBD principles that seemingly had a positive impact on patient care and safety and staff working conditions. Although promising, a paucity of empirical research addressed the cost/benefit of incorporating many EBD concepts into one hospital setting, and there was no research that articulated the organizational decision-making process used by healthcare administrators when considering the use of EBD in expansion projects. A mixed-method, descriptive, qualitative, single-case study and quantitative design were used to address the five research questions. The Systems Research Organizing Model provided the theoretical framework. A variety of data collection methods was used, including interviews of key respondents, the review of documentary evidence, and the Multifactor Leadership Questionnaire. A participatory process was used throughout the design decision phases, involving staff at all levels of the organization. The Internet and architects facilitated learning about

Evidence of singularities for a family of contour dynamics equations

PubMed Central

Córdoba, Diego; Fontelos, Marco A.; Mancho, Ana M.; Rodrigo, Jose L.

2005-01-01

In this work, we show evidence of the existence of singularities developing in finite time for a class of contour dynamics equations depending on a parameter 0 < α ≤ 1. The limiting case α → 0 corresponds to 2D Euler equations, and α = 1 corresponds to the surface quasi-geostrophic equation. The singularity is point-like, and it is approached in a self-similar manner. PMID:15837929

Further evidence for the case against neuropsychoanalysis: How Yovell, Solms, and Fotopoulou's response to our critique confirms the irrelevance and harmfulness to psychoanalysis of the contemporary neuroscientific trend.

PubMed

Blass, Rachel B; Carmeli, Zvi

2015-12-01

In their paper "The case for neuropsychoanalysis" Yovell, Solms, and Fotopoulou (2015) respond to our critique of neuropsychoanalysis (Blass & Carmeli, 2007), setting forth evidence and arguments which, they claim, demonstrate why neuroscience is relevant and important for psychoanalysis and hence why dialogue between the fields is necessary. In the present paper we carefully examine their evidence and arguments and demonstrate how and why their claim is completely mistaken. In fact, Yovell, Solms, and Fotopoulou's paper only confirms our position on the irrelevance and harmfulness to psychoanalysis of the contemporary neuroscientific trend. We show how this trend perverts the essential nature of psychoanalysis and of how it is practiced. The clinical impact and its detrimental nature is highlighted by discussion of clinical material presented by Yovell et al (2015). In the light of this we argue that the debate over neuropsychoanalysis should be of interest to all psychoanalysts, not only those concerned with biology or interdisciplinary dialogue. Copyright © 2016 Institute of Psychoanalysis.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY SHOWS INNER CHOROIDAL ISCHEMIA IN ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY.

PubMed

Dolz-Marco, Rosa; Sarraf, David; Giovinazzo, Vincent; Freund, K Bailey

2017-01-01

To describe multimodal imaging findings of an evolving case of acute posterior multifocal placoid pigment epitheliopathy occurring in a young healthy male. Case report of a patient with acute posterior multifocal placoid pigment epitheliopathy including comprehensive systemic and ocular examinations. Ultra-widefield autofluorescence, fluorescein angiography, indocyanine green angiography, and serial optical coherence tomography angiography were performed. A 34-year-old male presented with acute vision loss in his left eye for 2 weeks. His best-corrected visual acuity was 20/20 in his right eye and 20/200 in his left eye. Dilated funduscopic examination revealed multiple creamy white deep retinal lesions showing macular involvement of the left eye with a diffuse area of pigmentary changes. The presence of multiple areas of hypoperfusion of the inner choroid were demonstrated with fluorescein and indocyanine green angiography. Serial optical coherence tomography angiography showed multiple evolving areas of decreased flow at the level of the inner choroid. Although the pathogenesis of acute posterior multifocal placoid pigment epitheliopathy remains unknown, there is growing evidence of a primary choroidal involvement with secondary damage to the overlying retinal pigment epithelium and the outer retinal layers. Optical coherence tomography angiography may provide valuable information for the diagnosis and follow-up of this condition avoiding invasive angiographic procedures.

Further evidence for a locus for cutaneous malignant melanoma-dysplastic nevus (CMM/DN) on chromosome Ip, and evidence for genetic heterogeneity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goldstein, A.M.; Fraser, M.C.; McBride, O.W.

Assignment of a susceptibility locus for cutaneous malignant melanoma-dysplastic nevus (CMM/DN) to chromosome 1p remains controversial. The authors examined the relationship between CMM/DN and markers D1S47, PND, and D1S160 on seven new families (set B) plus updated versions of six previously reported families (set A). Three linkage analyses were performed: (1) CMM alone - all individuals without confirmed melanoma or borderline lesions were considered unaffected (model I); (2) CMM/DN with variable age at onset and sporadics (model II); and (3) CMM/DN using the model of Bale et al. (model III). For CMM alone and D1S47, Z[sub max] = 3.12 atmore » [theta] = .10. For D1S160 and CMM alone, Z[sub max] = 1.76 at [theta] = .10. PND showed no evidence for linkage to CMM alone. Models II and III showed strong evidence for linkage to D1S47, D1S160, and PND in the set A pedigrees but not in the set B families. The authors tested for homogeneity of CMM/DN (model II) by splitting families into two groups on the basis of (1) the proportion of CMM/DN cases and (2) the occurrence of immune-related tumors. In group 1 there was significant evidence of heterogeneity with both D1S47 and D1S160, and in group 2 there was significant evidence of heterogeneity with D1S160. Thus, diagnostic, clinical, and genetic heterogeneity are the likely reasons that previous studies have failed to confirm linkage of CMM/DN to chromosome 1p. The results showed significant evidence for a CMM locus linked to D1S47, as well as significant evidence for heterogeneity with only a subset of the families appearing linked to chromosome 1p. 38 refs., 1 fig., 5 tabs.« less

Research on image evidence in land supervision and GIS management

NASA Astrophysics Data System (ADS)

Li, Qiu; Wu, Lixin

2006-10-01

Land resource development and utilization brings many problems. The numbers, the scale and volume of illegal land use cases are on the increasing. Since the territory is vast, and the land violations are concealment, it is difficulty for an effective land supervision and management. In this paper, the concepts of evidence, and preservation of evidence were described first. The concepts of image evidence (IE), natural evidence (NE), natural preservation of evidence (NPE), general preservation of evidence (GPE) were proposed based on the characteristics of remote sensing image (RSI) which has a characteristic of objectiveness, truthfulness, high spatial resolution, more information included. Using MapObjects and Visual Basic 6.0, under the Access management to implement the conjunction of spatial vector database and attribute data table; taking RSI as the data sources and background layer; combining the powerful management of geographic information system (GIS) for spatial data, and visual analysis, a land supervision and GIS management system was design and implemented based on NPE. The practical use in Beijing shows that the system is running well, and solved some problems in land supervision and management.

Formalizing Evidence Type Definitions for Drug-Drug Interaction Studies to Improve Evidence Base Curation.

PubMed

Utecht, Joseph; Brochhausen, Mathias; Judkins, John; Schneider, Jodi; Boyce, Richard D

2017-01-01

In this research we aim to demonstrate that an ontology-based system can categorize potential drug-drug interaction (PDDI) evidence items into complex types based on a small set of simple questions. Such a method could increase the transparency and reliability of PDDI evidence evaluation, while also reducing the variations in content and seriousness ratings present in PDDI knowledge bases. We extended the DIDEO ontology with 44 formal evidence type definitions. We then manually annotated the evidence types of 30 evidence items. We tested an RDF/OWL representation of answers to a small number of simple questions about each of these 30 evidence items and showed that automatic inference can determine the detailed evidence types based on this small number of simpler questions. These results show proof-of-concept for a decision support infrastructure that frees the evidence evaluator from mastering relatively complex written evidence type definitions.

Mortality risk factors show similar trends in modern and historic populations exposed to plague.

PubMed

Rubini, Mauro; Gualdi-Russo, Emanuela; Manzon, Vanessa S; Rinaldo, Natascia; Bianucci, Raffaella

2016-05-31

Plague has been responsible for two major historic pandemics (6th-8th century CE; 14th-19th century CE) and a modern one. The recent Malagasy plague outbreaks raised new concerns on the deadly potential of the plague-causing bacteria Yersinia pestis. Between September 2014 and April 2015, outbreaks of bubonic and pneumonic plague hit the Malagasy population. Two hundred and sixty-three cases, including 71 deaths, have been reported in 16 different districts with a case fatality rate of 27%. The scope of our study was to ascertain whether the risk factors for health in modern-day populations exposed to plague and in ancient populations that faced the two historic pandemics varied or remained substantially unaltered. The risk of mortality of the Malagasy population with those obtained from the reconstruction of three samples of European populations exposed to the historic pandemics was contrasted. The evidence shows that the risks of death are not uniform across age neither in modern nor in historic populations exposed to plague and shows precise concentrations in specific age groups (children between five and nine years of age and young adults). Although in the post-antibiotic era, the fatality rates have drastically reduced, both modern and historic populations were exposed to the same risk factors that are essentially represented by a low standard of environmental hygiene, poor nutrition, and weak health systems.

Alcohol drinking and esophageal cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population.

PubMed

Oze, Isao; Matsuo, Keitaro; Wakai, Kenji; Nagata, Chisato; Mizoue, Tetsuya; Tanaka, Keitaro; Tsuji, Ichiro; Sasazuki, Shizuka; Inoue, Manami; Tsugane, Shoichiro

2011-05-01

Although alcohol drinking is considered as an important risk factor for esophageal cancer, the magnitude of the association might be varied among geographic areas. Therefore, we reviewed epidemiologic studies on the association between alcohol drinking and esophageal cancer among the Japanese population. Original data were obtained from MEDLINE, searched using PubMed or from searches of the Ichushi database, complemented with manual searches. Evaluation of associations was based on the strength of evidence ('convincing', 'probable', 'possible' or 'insufficient') and the magnitude of association ('strong', 'moderate', 'weak' or 'no association'), together with biological plausibility as previously evaluated by the International Agency of Research on Cancer. We identified four cohort studies and nine case-control studies. All cohort studies and case-control studies showed strong positive associations between esophageal cancer and alcohol drinking. All cohort studies and six case-control studies showed that alcohol drinking had the dose- or frequency-response relationships with esophageal cancer. In addition, four case-control studies showed that acetaldehyde dehydrogenase Glu504Lys polymorphism had strong effect modification with alcohol drinking. We conclude that there is convincing evidence that alcohol drinking increases the risk of esophageal cancer in the Japanese population.

Secondary school physics teachers' conceptions of scientific evidence: A collective case study

NASA Astrophysics Data System (ADS)

Taylor, Joseph A.

Engaging secondary school students in inquiry-oriented tasks that more closely simulate the scholarly activities of scientists has been recommended as a way to improve scientific literacy. Two tasks that are frequently recommended include students' design of original experiments, and students' evaluation of scientific evidence and conclusions. Yet, little is known about teachers' conceptions of experimentation. The principal aim of this study, therefore, was to describe the nature of prospective and practicing physics teachers' conceptions of scientific evidence. More specifically, the following research questions guided this study: (1) What types of issues related to the measurement reliability and experimental validity of scientific evidence do practicing and prospective physics teachers think about when designing experiments? (2) When presented with hypothetical scenarios that describe unsound experimental procedures or poorly supported conclusions (or both), what concerns will prospective and practicing physics teachers raise? And (3) When the participants' responses to parallel research prompts are compared across protocols, what similarities and differences exist? The nature of the teacher-participants' conceptions was described from an analysis of data collected from research prompts such as interviews and hand written artifacts. In these research prompts, the teachers "thought aloud" while designing experiments and critically evaluated student-collected evidence presented in hypothetical classroom scenarios. The data from this study suggested that the three teachers, while contemplating the reliability and validity of scientific evidence, frequently used their conceptions of evidence in conjunction with specific subject matter conceptions. The data also indicated that the relationship between subject matter knowledge and conceptions of evidence was more pronounced for some conceptions of evidence than for others. Suggestions for future research included

Evidence suggests water once flowed vigorously on Mars

NASA Astrophysics Data System (ADS)

Showstack, Randy

2012-10-01

"In some cases, when you do geology, a picture is worth 1000 words," Mars Science Laboratory project scientist John Grotzinger said at a 27 September news briefing to announce that imagery taken by a camera onboard NASA's Mars Curiosity rover shows evidence that water once flowed vigorously in a region on the surface of Mars. One of the pictured rock outcrops, about 10-15 centimeters thick and named Hottah after Canada's Hottah lake, "looked like somebody came along the surface of Mars with a jackhammer and lifted up a sidewalk that you might see in downtown LA in sort of a construction site," said Grotzinger, who is with the California Institute of Technology in Pasadena. "This is a rock that was formed in the presence of water, and we can characterize that water as being a vigorous flow on the surface of Mars," he said. "We were really excited about this because this is one of the reasons we were interested in coming to this landing site, because it presented from orbit quite a strong case that we would find evidence for water on the ground."

Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies.

PubMed

Taylor, Luke E; Swerdfeger, Amy L; Eslick, Guy D

2014-06-17

There has been enormous debate regarding the possibility of a link between childhood vaccinations and the subsequent development of autism. This has in recent times become a major public health issue with vaccine preventable diseases increasing in the community due to the fear of a 'link' between vaccinations and autism. We performed a meta-analysis to summarise available evidence from case-control and cohort studies on this topic (MEDLINE, PubMed, EMBASE, Google Scholar up to April, 2014). Eligible studies assessed the relationship between vaccine administration and the subsequent development of autism or autism spectrum disorders (ASD). Two reviewers extracted data on study characteristics, methods, and outcomes. Disagreement was resolved by consensus with another author. Five cohort studies involving 1,256,407 children, and five case-control studies involving 9,920 children were included in this analysis. The cohort data revealed no relationship between vaccination and autism (OR: 0.99; 95% CI: 0.92 to 1.06) or ASD (OR: 0.91; 95% CI: 0.68 to 1.20), nor was there a relationship between autism and MMR (OR: 0.84; 95% CI: 0.70 to 1.01), or thimerosal (OR: 1.00; 95% CI: 0.77 to 1.31), or mercury (Hg) (OR: 1.00; 95% CI: 0.93 to 1.07). Similarly the case-control data found no evidence for increased risk of developing autism or ASD following MMR, Hg, or thimerosal exposure when grouped by condition (OR: 0.90, 95% CI: 0.83 to 0.98; p=0.02) or grouped by exposure type (OR: 0.85, 95% CI: 0.76 to 0.95; p=0.01). Findings of this meta-analysis suggest that vaccinations are not associated with the development of autism or autism spectrum disorder. Furthermore, the components of the vaccines (thimerosal or mercury) or multiple vaccines (MMR) are not associated with the development of autism or autism spectrum disorder. Copyright © 2014 Elsevier Ltd. All rights reserved.

Pure word deafness following left temporal damage: Behavioral and neuroanatomical evidence from a new case.

PubMed

Maffei, Chiara; Capasso, Rita; Cazzolli, Giulia; Colosimo, Cesare; Dell'Acqua, Flavio; Piludu, Francesca; Catani, Marco; Miceli, Gabriele

2017-12-01

Pure Word Deafness (PWD) is a rare disorder, characterized by selective loss of speech input processing. Its most common cause is temporal damage to the primary auditory cortex of both hemispheres, but it has been reported also following unilateral lesions. In unilateral cases, PWD has been attributed to the disconnection of Wernicke's area from both right and left primary auditory cortex. Here we report behavioral and neuroimaging evidence from a new case of left unilateral PWD with both cortical and white matter damage due to a relatively small stroke lesion in the left temporal gyrus. Selective impairment in auditory language processing was accompanied by intact processing of nonspeech sounds and normal speech, reading and writing. Performance on dichotic listening was characterized by a reversal of the right-ear advantage typically observed in healthy subjects. Cortical thickness and gyral volume were severely reduced in the left superior temporal gyrus (STG), although abnormalities were not uniformly distributed and residual intact cortical areas were detected, for example in the medial portion of the Heschl's gyrus. Diffusion tractography documented partial damage to the acoustic radiations (AR), callosal temporal connections and intralobar tracts dedicated to single words comprehension. Behavioral and neuroimaging results in this case are difficult to integrate in a pure cortical or disconnection framework, as damage to primary auditory cortex in the left STG was only partial and Wernicke's area was not completely isolated from left or right-hemisphere input. On the basis of our findings we suggest that in this case of PWD, concurrent partial topological (cortical) and disconnection mechanisms have contributed to a selective impairment of speech sounds. The discrepancy between speech and non-speech sounds suggests selective damage to a language-specific left lateralized network involved in phoneme processing. Copyright © 2017 Elsevier Ltd. All rights

Selection of examples in case-based computer-aided decision systems

PubMed Central

Mazurowski, Maciej A.; Zurada, Jacek M.; Tourassi, Georgia D.

2013-01-01

Case-based computer-aided decision (CB-CAD) systems rely on a database of previously stored, known examples when classifying new, incoming queries. Such systems can be particularly useful since they do not need retraining every time a new example is deposited in the case base. The adaptive nature of case-based systems is well suited to the current trend of continuously expanding digital databases in the medical domain. To maintain efficiency, however, such systems need sophisticated strategies to effectively manage the available evidence database. In this paper, we discuss the general problem of building an evidence database by selecting the most useful examples to store while satisfying existing storage requirements. We evaluate three intelligent techniques for this purpose: genetic algorithm-based selection, greedy selection and random mutation hill climbing. These techniques are compared to a random selection strategy used as the baseline. The study is performed with a previously presented CB-CAD system applied for false positive reduction in screening mammograms. The experimental evaluation shows that when the development goal is to maximize the system’s diagnostic performance, the intelligent techniques are able to reduce the size of the evidence database to 37% of the original database by eliminating superfluous and/or detrimental examples while at the same time significantly improving the CAD system’s performance. Furthermore, if the case-base size is a main concern, the total number of examples stored in the system can be reduced to only 2–4% of the original database without a decrease in the diagnostic performance. Comparison of the techniques shows that random mutation hill climbing provides the best balance between the diagnostic performance and computational efficiency when building the evidence database of the CB-CAD system. PMID:18854606

Alpha-Particle-Induced Complex Chromosome Exchanges Transmitted through Extra-Thymic Lymphopoiesis In Vitro Show Evidence of Emerging Genomic Instability

PubMed Central

Sumption, Natalia; Goodhead, Dudley T.; Anderson, Rhona M.

2015-01-01

Human exposure to high-linear energy transfer α-particles includes environmental (e.g. radon gas and its decay progeny), medical (e.g. radiopharmaceuticals) and occupational (nuclear industry) sources. The associated health risks of α-particle exposure for lung cancer are well documented however the risk estimates for leukaemia remain uncertain. To further our understanding of α-particle effects in target cells for leukaemogenesis and also to seek general markers of individual exposure to α-particles, this study assessed the transmission of chromosomal damage initially-induced in human haemopoietic stem and progenitor cells after exposure to high-LET α-particles. Cells surviving exposure were differentiated into mature T-cells by extra-thymic T-cell differentiation in vitro. Multiplex fluorescence in situ hybridisation (M-FISH) analysis of naïve T-cell populations showed the occurrence of stable (clonal) complex chromosome aberrations consistent with those that are characteristically induced in spherical cells by the traversal of a single α-particle track. Additionally, complex chromosome exchanges were observed in the progeny of irradiated mature T-cell populations. In addition to this, newly arising de novo chromosome aberrations were detected in cells which possessed clonal markers of α-particle exposure and also in cells which did not show any evidence of previous exposure, suggesting ongoing genomic instability in these populations. Our findings support the usefulness and reliability of employing complex chromosome exchanges as indicators of past or ongoing exposure to high-LET radiation and demonstrate the potential applicability to evaluate health risks associated with α-particle exposure. PMID:26252014

Real-World Evidence In Support Of Precision Medicine: Clinico-Genomic Cancer Data As A Case Study.

PubMed

Agarwala, Vineeta; Khozin, Sean; Singal, Gaurav; O'Connell, Claire; Kuk, Deborah; Li, Gerald; Gossai, Anala; Miller, Vincent; Abernethy, Amy P

2018-05-01

The majority of US adult cancer patients today are diagnosed and treated outside the context of any clinical trial (that is, in the real world). Although these patients are not part of a research study, their clinical data are still recorded. Indeed, data captured in electronic health records form an ever-growing, rich digital repository of longitudinal patient experiences, treatments, and outcomes. Likewise, genomic data from tumor molecular profiling are increasingly guiding oncology care. Linking real-world clinical and genomic data, as well as information from other co-occurring data sets, could create study populations that provide generalizable evidence for precision medicine interventions. However, the infrastructure required to link, ensure quality, and rapidly learn from such composite data is complex. We outline the challenges and describe a novel approach to building a real-world clinico-genomic database of patients with cancer. This work represents a case study in how data collected during routine patient care can inform precision medicine efforts for the population at large. We suggest that health policies can promote innovation by defining appropriate uses of real-world evidence, establishing data standards, and incentivizing data sharing.

Evidence for Reflected Light from the Most Eccentric Known Exoplanet

NASA Astrophysics Data System (ADS)

Kane, Stephen

2015-12-01

Planets in highly eccentric orbits form a class of objects not seen within our Solar System. The most extreme case known amongst these objects is the planet orbiting HD 20782, with an orbital period of 597 days and an eccentricity of 0.96. Here we present new data and analysis for this system as part of the Transit Ephemeris Refinement and Monitoring Survey (TERMS). New radial velocities acquired during periastron provide incredible accuracy for the planetary orbit and astrometric results that show the companion is indeed planetary in nature. We obtained MOST photometry during a predicted periastron passage that shows evidence of phase variations due to reflected light from the planet. The extreme nature of this planet presents an ideal case from which to test theories regarding the formation of eccentric orbits and the response of atmospheres to extreme changes in flux.

Evidence-based Draft Guideline for Prevention of Midwifery Malpractices based on Referred Cases to the Forensic Medicine Commission and the Medical Council from 2006-2011.

PubMed

Asadi, Leila; Beigi, Marjan; Valiani, Mahbube; Mardani, Fardin

2017-01-01

Medical errors are the main concerns in health systems, which considering their ascending rate in the recent years, especially in the field of midwifery, have caused a medical crisis. Considering the importance of evidence-based health services as a way to improve health systems, the aim of this study was to suggest a guideline for preventing malpractice in midwifery services. In this cross-sectional study that was conducted in 2013, we investigated 206 cases that were referred to the Isfahan Legal Medicine Organization and Medical Council of Forensic Medicine from 2006-2011. Data were collected by a checklist and were analyzed using SPSS-16 software. Descriptive statistical tests (mean, maximum, minimum, standard deviation, frequency, and percentage agreement) were used to describe the data. Then, we used the Delphi technique with the participation from 17 experts in midwifery, gynecology, and legal medicine to provide an evidence-based draft guideline for prevention of midwifery errors. A total of 206 cases were reviewed. In 66 cases (32%) the verdict for malpractice in midwifery services was approved. A practical draft guideline for preventing clinical errors for midwifery in the fields of pregnancy, delivery, and postpartum period was developed. This evidence-based draft guideline can improve the attention of all the healthcare providers, especially midwives and physicians to prevent urgent problems and offer effective health services for mothers and infants.

Medico-Legal Findings, Legal Case Progression, and Outcomes in South African Rape Cases: Retrospective Review

PubMed Central

Jewkes, Rachel; Christofides, Nicola; Vetten, Lisa; Jina, Ruxana; Sigsworth, Romi; Loots, Lizle

2009-01-01

.036), ano-genital injuries alone (AOR 7.00, 95% CI 1.44–33.9, p = 0.017), or both nongenital and ano-genital injuries (AOR 12.34, 95% CI 2.87–53.0, p = 0.001). DNA was not associated with case outcome. Conclusions This is the first study, to our knowledge, to show an association between documentation of ano-genital injuries, trials commencing, and convictions in rape cases in a developing country. Its findings are of particular importance because they show the value of good basic medical practices in documentation of injuries, rather than more expensive DNA evidence, in assisting courts in rape cases. Health care providers need training to provide high quality health care responses after rape, but we have shown that the core elements of the medico-legal response require very little technology. As such they should be replicable in low- and middle-income country settings. Our findings raise important questions about the value of evidence that requires the use of forensic laboratories at a population level in countries like South Africa that have substantial inefficiencies in their police services. Please see later in the article for the Editors' Summary PMID:19823567

Adenoid cystic carcinoma of the right main bronchus showing squamous differentiation and mimicking mucoepidermoid carcinoma: a case report.

PubMed

Tajima, Shogo; Koda, Kenji

2015-01-01

Complete dissection of tracheobronchial adenoid cystic carcinoma (TACC) by surgery alone is sometimes difficult and has a greater propensity than tracheobronchial mucoepidermoid carcinoma (TMEC) for its surgical margin to become positive. In addition, TACC is more likely to present distant metastases than TMEC. Considering these facts, TACC and TMEC should be differentiated based on histopathological examination of biopsy specimens. Herein, we present a case of 54-year-old woman with a tumor in the right main bronchus, whose biopsy specimen was difficult to diagnose as TACC or TMEC. The specimen from the rounded protrusion of the tumor showed squamous differentiation, along with the presence of glandular and basaloid cells, making morphological examination alone ineffective in rendering a definite diagnosis. Thus, the addition of immunohistochemical analysis, αSMA and CD43 expression in basaloid cells and c-kit expression in glandular cells, was useful for accurately diagnosing TACC in this case. The squamous component was considered to be neoplastic because of its increased expression of cyclin D1 and overexpression of p16. The surgically resected specimen contained typical morphology of ACC, and the diagnosis of TACC was definitely confirmed.

Primary Spinal Intramedullary Neurocysticercosis: A Report of 3 Cases.

PubMed

Datta, Subramanya G S; Mehta, Ritu; Macha, Shrikant; Tripathi, Sanjog

2017-09-01

We describe a series of 3 cases of the rare intramedullary form of primary spinal neurocysticercosis. The cases were seen in varied age groups and showed different profiles at presentation. All the cases were thoroughly evaluated clinically and radiologically. Serologic tests were not conducted. In all cases, magnetic resonance imaging showed a large intramedullary lesion in the thoracic spinal cord consisting of a cystic lesion with a well-defined intramural nodule. One case was managed with steroids and cysticidal therapy, a second case was managed with steroids and surgery (2 emergency procedures), while the third case was managed without any medical or surgical intervention, as the patient was unwilling for either. All cases showed good neurologic recovery. In the second case where surgery was done, histologic examination of the resected specimen demonstrated the cysticercal parasite surrounded by mixed inflammatory infiltrate. As there were no intracranial lesions in all 3 cases, the final diagnosis was primary isolated intramedullary neurocysticercosis. Primary isolated intramedullary-neurocysticercosis remains a rare condition afflicting the spinal cord. It forms a small subset of cysticercal infestation of the neuraxis. Such evidence is rare, and only anecdotal reports are available. Our case series captures the wide spectrum of presentations, as well as the management options, and highlights the varied ways in which these cases were managed. Copyright © 2017 Elsevier Inc. All rights reserved.

Computed tomography findings of gaseous necrosis in epithelial ovarian cancer: a report of three cases.

PubMed

Cronin, Paul; Crosse, Barbara; Lane, Geoff; Spencer, John A

2002-01-01

Necrosis in pathologic specimens of ovarian cancer is well documented; however, computed tomography (CT) evidence of gaseous necrosis in the absence of fistulation with bowel has not yet been described. We report three cases of ovarian adenocarcinoma that on CT showed evidence of gross gaseous necrosis, mimicking a pelvic abscess.

Creating and synthesizing evidence with decision makers in mind: integrating evidence from clinical trials and other study designs.

PubMed

Atkins, David

2007-10-01

Randomized controlled trials (RCTs) remain the accepted "gold standard" for determining the efficacy of new drugs or medical procedures. Randomized trials alone, however, cannot provide all the relevant information decision makers need to determine the relative risks and benefits when choosing the best treatment of individual patients or weighing the implications of particular policies affecting medical therapies. To demonstrate the limitations of RCTs in providing the information needed by medical decision makers, and to show how information from observational studies can supplement evidence from RCTs. Qualitative description of the limitations of RCTs in providing the information needed by medical decision makers, and demonstration of how evidence from additional sources can aid in decision making, using the examples of deciding whether a 60-year-old woman with mildly elevated blood pressure should take daily low-dose aspirin, and whether a hospital network should implement carotid artery surgery for asymptomatic patients. Even the most rigorously designed RCTs leave many questions central to medical decision making unanswered. Research using cohort and case-control designs, disease and intervention registries, and outcomes studies based on administrative data can all shed light on who is most likely to benefit from the treatment, and what the important tradeoffs are. This suggests the need to revise the traditional evidence hierarchy, whereby evidence progresses linearly from basic research to rigorous RCTs. This revised hierarchy recognizes that other research designs can provide important evidence to strengthen our understanding of how to apply research findings in practice.

Institutionalizing evidence-based practice: an organizational case study using a model of strategic change

PubMed Central

2009-01-01

Background There is a general expectation within healthcare that organizations should use evidence-based practice (EBP) as an approach to improving the quality of care. However, challenges exist regarding how to make EBP a reality, particularly at an organizational level and as a routine, sustained aspect of professional practice. Methods A mixed method explanatory case study was conducted to study context; i.e., in terms of the presence or absence of multiple, inter-related contextual elements and associated strategic approaches required for integrated, routine use of EBP ('institutionalization'). The Pettigrew et al. Content, Context, and Process model was used as the theoretical framework. Two sites in the US were purposively sampled to provide contrasting cases: i.e., a 'role model' site, widely recognized as demonstrating capacity to successfully implement and sustain EBP to a greater degree than others; and a 'beginner' site, self-perceived as early in the journey towards institutionalization. Results The two sites were clearly different in terms of their organizational context, level of EBP activity, and degree of institutionalization. For example, the role model site had a pervasive, integrated presence of EBP versus a sporadic, isolated presence in the beginner site. Within the inner context of the role model site, there was also a combination of the Pettigrew and colleagues' receptive elements that, together, appeared to enhance its ability to effectively implement EBP-related change at multiple levels. In contrast, the beginner site, which had been involved for a few years in EBP-related efforts, had primarily non-receptive conditions in several contextual elements and a fairly low overall level of EBP receptivity. The beginner site thus appeared, at the time of data collection, to lack an integrated context to either support or facilitate the institutionalization of EBP. Conclusion Our findings provide evidence of some of the key contextual elements

Weakening forensic science in Spain: from expert evidence to documentary evidence.

PubMed

Lucena-Molina, Jose-Juan; Pardo-Iranzo, Virginia; Gonzalez-Rodriguez, Joaquin

2012-07-01

An amendment in 2002 to the Spanish Code of Criminal Procedure converted into documentary evidence the expert reports prepared by official laboratories aimed at determining the nature, weight, and purity of seized drugs. In most cases, experts are spared from appearance before the courts. This is likely to be extended to other forensic fields. After an overview of criminalistic identification in current forensic science, the objectivity and reliability concepts used by jurists and scientists are considered by comparing the paradigm of individualization with that of likelihood. Subsequently, a detailed critical study is made on the above-mentioned Spanish legal reform, and a comparison is made with the decision on the Melendez-Diaz v. Massachusetts case as ruled by the Supreme Court of the United States. Although the reform is in compliance with the Spanish Constitution, it is at odds with science, in particular regarding the logic underpinning the scientific evaluation of evidence. © 2012 American Academy of Forensic Sciences.

A Nigerian Case-Study of Perceptions of Science.

ERIC Educational Resources Information Center

Bajah, Samuel Tunde

1985-01-01

Case study and survey evidence is presented which shows that many Nigerians view science mainly as a body of knowledge imported by the white man. The concept of "African science" is explained and related to an emerging consciousness which, it is hoped, will influence the nature and quality of science instruction in Nigeria. (JDH)

Towards Trustable Digital Evidence with PKIDEV: PKI Based Digital Evidence Verification Model

NASA Astrophysics Data System (ADS)

Uzunay, Yusuf; Incebacak, Davut; Bicakci, Kemal

How to Capture and Preserve Digital Evidence Securely? For the investigation and prosecution of criminal activities that involve computers, digital evidence collected in the crime scene has a vital importance. On one side, it is a very challenging task for forensics professionals to collect them without any loss or damage. On the other, there is the second problem of providing the integrity and authenticity in order to achieve legal acceptance in a court of law. By conceiving digital evidence simply as one instance of digital data, it is evident that modern cryptography offers elegant solutions for this second problem. However, to our knowledge, there is not any previous work proposing a systematic model having a holistic view to address all the related security problems in this particular case of digital evidence verification. In this paper, we present PKIDEV (Public Key Infrastructure based Digital Evidence Verification model) as an integrated solution to provide security for the process of capturing and preserving digital evidence. PKIDEV employs, inter alia, cryptographic techniques like digital signatures and secure time-stamping as well as latest technologies such as GPS and EDGE. In our study, we also identify the problems public-key cryptography brings when it is applied to the verification of digital evidence.

Btu accounting: Showing results

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nelson, K.E.

1994-10-01

In the preceding article in this series last month, the author showed how to calculate the energy consumed to make a pound of product. To realize a payoff, however, the results must be presented in graphs or tables that clearly display what has happened. They must call attention to plant performance and ultimately lead to more efficient use of energy. Energy-consumption reporting is particularly valuable when viewed over a period of time. The author recommend compiling data annually and maintaining a ten-year performance history. Four cases are considered: individual plant performance; site performance for sites having more than one plant;more » company performance, for companies having more than one site; and performance based on product, for identical or similar products made at different plants or sites. Of these, individual plant performance is inherently the most useful. It also serves as the best basis for site, company and product performance reports. A key element in energy accounting is the relating of all energy consumption to a common basis. As developed last month in Part 1 in this series, the author chose Btu[sub meth] (i.e., Btu of methane equivalent, expressed as its higher heating value) for this purpose. It represents the amount of methane that would be needed to replace (in the case of fuels) or generate (in the case of steam and power) the energy being used.« less

Analgesics use and ESRD in younger age: a case-control study

PubMed Central

van der Woude, Fokke J; Heinemann, Lothar AJ; Graf, Helmut; Lewis, Michael; Moehner, Sabine; Assmann, Anita; Kühl-Habich, Doerthe

2007-01-01

Background An ad hoc peer-review committee was jointly appointed by Drug Authorities and Industry in Germany, Austria and Switzerland in 1999/2000 to review the evidence for a causal relation between phenacetin-free analgesics and nephropathy. The committee found the evidence as inconclusive and requested a new case-control study of adequate design. Methods We performed a population-based case-control study with incident cases of end-stage renal disease (ESRD) under the age of 50 years and four age and sex-matched neighborhood controls in 170 dialysis centers (153 in Germany, and 17 in Austria) from January 1, 2001 to December 31, 2004. Data on lifetime medical history, risk factors, treatment, job exposure and intake of analgesics were obtained in a standardized face-to-face interview using memory aids to enhance accuracy. Study design, study performance, analysis plan, and study report were approved by an independent international advisory committee and by the Drug Authorities involved. Unconditional logistic regression analyses were performed. Results The analysis included 907 cases and 3,622 controls who had never used phenacetin-containing analgesics in their lifetime. The use of high cumulative lifetime dose (3rd tertile) of analgesics in the period up to five years before dialysis was not associated with later ESRD. Adjusted odds ratios with 95% confidence intervals were 0.8 (0.7 – 1.0) and 1.0 (0.8 – 1.3) for ever- compared with no or low use and high use compared with low use, respectively. The same results were found for all analgesics and for mono-, and combination preparations with and without caffeine. No increased risk was shown in analyses stratifying for dose and duration. Dose-response analyses showed that analgesic use was not associated with an increased risk for ESRD up to 3.5 kg cumulative lifetime dose (98 % of the cases with ESRD). While the large subgroup of users with a lifetime dose up to 0.5 kg (278 cases and 1365 controls) showed a

Vitamin A serostatus and heterosexual transmission of HIV: case-control study in Tanzania and review of the evidence.

PubMed

Villamor, Eduardo; Kapiga, Saidi H; Fawzi, Wafaie W

2006-03-01

Results from a randomized clinical trial suggested that vitamin A/beta-carotene supplementation to HIV-1-infected women during pregnancy and lactation may increase the risk of vertical transmission. Limited information is available on the potential role of vitamin A on heterosexual HIV transmission. This is a relevant question in many resource-limited settings where both vitamin A deficiency and HIV infection are highly prevalent. We conducted a case-control study (34 cases and 38 controls) nested within a cohort of HIV-negative women attending family planning clinics in Tanzania, to examine whether low serum concentrations at baseline were associated with the risk of seroconversion. There was not a significant association (OR = 2.14, 95% C I = 0.54, 8.45). In light of these and previous results, we conclude that there is not enough evidence yet to suggest a causal association between vitamin A and heterosexual transmission.

Development of a meta-algorithm for guiding primary care encounters for patients with multimorbidity using evidence-based and case-based guideline development methodology.

PubMed

Muche-Borowski, Cathleen; Lühmann, Dagmar; Schäfer, Ingmar; Mundt, Rebekka; Wagner, Hans-Otto; Scherer, Martin

2017-06-22

The study aimed to develop a comprehensive algorithm (meta-algorithm) for primary care encounters of patients with multimorbidity. We used a novel, case-based and evidence-based procedure to overcome methodological difficulties in guideline development for patients with complex care needs. Systematic guideline development methodology including systematic evidence retrieval (guideline synopses), expert opinions and informal and formal consensus procedures. Primary care. The meta-algorithm was developed in six steps:1. Designing 10 case vignettes of patients with multimorbidity (common, epidemiologically confirmed disease patterns and/or particularly challenging health care needs) in a multidisciplinary workshop.2. Based on the main diagnoses, a systematic guideline synopsis of evidence-based and consensus-based clinical practice guidelines was prepared. The recommendations were prioritised according to the clinical and psychosocial characteristics of the case vignettes.3. Case vignettes along with the respective guideline recommendations were validated and specifically commented on by an external panel of practicing general practitioners (GPs).4. Guideline recommendations and experts' opinions were summarised as case specific management recommendations (N-of-one guidelines).5. Healthcare preferences of patients with multimorbidity were elicited from a systematic literature review and supplemented with information from qualitative interviews.6. All N-of-one guidelines were analysed using pattern recognition to identify common decision nodes and care elements. These elements were put together to form a generic meta-algorithm. The resulting meta-algorithm reflects the logic of a GP's encounter of a patient with multimorbidity regarding decision-making situations, communication needs and priorities. It can be filled with the complex problems of individual patients and hereby offer guidance to the practitioner. Contrary to simple, symptom-oriented algorithms, the meta

The availability of health information system for decision-making with evidence-based medicine approach-a case study: Kermanshah, Iran.

PubMed

Safari, Ameneh; Safari, Yahya

2018-08-01

Evidence-based medicine (EBM) is defining proper and wise use of the best evidence in clinical decision for patient׳s care. This study have done with the aim of evaluating health information system for decision-making with EBM approach in educational hospital of Kermanshah city. The statistical population include all the specialist and specialty, and also head nurses of educational hospitals in Kermanshah city. The data collected by researcher made questionnaire. The content validities of the questionnaire were confirmed by experts to complete the questions of the questionnaire. Then, the reliability of the questionnaire was evaluated using the Cronbach׳s alpha coefficient. The results have showed that the accessibility rate to the internet sources is in desirable level. The results have showed that there was a significant difference at least in one group between the availability of hospital information system EBM establishment in terms of accessing to the internet based data, according to the academic major ( P = 0.021 ). The sufficiency of hospital information system in evidence-based medicine establishment in terms of necessary knowledge for implementing it according to the educational major have showed a significant statistical difference at least in one group ( P = 0.001 ). Kermanshah׳s hospital have a desirable condition in terms of accessibility to the internet sources, knowledge of EBM and its implementation which this have showed the availability of desirable platform for decision-making with the EBM approach. However, it is better to implement regulate educational periods for educating the doctors and nurses in order to reach practical implementation of the EBM approach.

Multiple orthokeratinized odontogenic cysts: a case report.

PubMed

Cheng, Yi-Shing Lisa; Liang, Hui; Wright, John; Teenier, Tom

2015-03-01

The purpose of this report is to document the clinical, radiographic, pathological and molecular findings of the first case of multiple orthokeratinized odontogenic cysts (OOCs). Multiple odontogenic keratocysts are one of the major features of nevoid basal cell carcinoma syndrome (NBCCS), and loss of heterozygosity in the PTCH gene, the culprit gene for NBCCS, has recently been found in sporadic OOC cases. Therefore, in this presenting case, we also investigated the possibility that this patient might also have NBCCS, by comparing the available clinical information and the molecular findings of this case to the diagnostic criteria for NBCCS (as proposed by the First International Colloquium on NBCCS in 2011). However, this patient with multiple OOCs showed no evidence of having NBCCS. This conclusion supports the findings from previous case series based on sporadic cases that OOC does not appear to be associated with NBCCS.

What can we learn from the existing evidence of the business case for investments in nursing care: importance of content, context, and policy environment.

PubMed

Yakusheva, Olga; Wholey, Douglas; Frick, Kevin D

2013-04-01

Decisions of health care institutions to invest in nursing care are often guided by mixed and conflicting evidence of effects of the investments on organizational function and sustainability. This paper uses new evidence generated through Interdisciplinary Nursing Quality Research Initiative (INQRI)-funded research and published in peer-reviewed journals, to illustrate where the business case for nursing investments stands and to discuss factors that may limit the existing evidence and its transferability into clinical practice. We conclude that there are 3 limiting factors: (1) the existing business case for nursing investments is likely understated due to the inability of most studies to capture spillover and long-run dynamic effects, thus causing organizations to forfeit potentially viable nursing investments that may improve long-term financial stability; (2) studies rarely devote sufficient attention to describing the content and the organization-specific contextual factors, thus limiting generalizability; and (3) fragmentation of the current health care delivery and payment systems often leads to the financial benefits of investments in nursing care accruing outside of the organization incurring the costs, thus making potentially quality-improving and cost-saving interventions financially unattractive from the organization's perspective. The payment reform, with its emphasis on high-quality affordable patient-centered care, is likely to strengthen the business case for investments in nursing care. Methodologically rigorous approaches that focus on broader societal implications of investments in nursing care, combined with a thorough understanding of potential barriers and facilitators of nursing change, should be an integral part of future research and policy efforts.

Mutant p53 expression in kidney tubules adjacent to renal cell carcinoma: evidence of a precursor lesion.

PubMed

Lai, R; el Dabbagh, L; Mourad, W A

1996-06-01

Neoplastic transformation can be associated with mutations of the p53 gene. This leads to stabilization of its protein product and to its accumulation, which allows immunohistochemical detection. Mutant p53 expression has been seen in many neoplasms, including renal cell carcinoma (RCC). We recently described putative precursor lesions of RCC. The lesions were defined as intratubular epithelial dysplasia (IED) of kidney tubules adjacent to RCC. They were seen in one-third of the cases studied. The findings were based only on light microscopic analysis. We hypothesized that neoplastic transformation would be manifested by mutant p53 expression in the kidney tubules adjacent to RCC and not in nonneoplastic kidneys. Immunohistochemical staining for p53 in 24 cases of RCC with adjacent kidneys was performed. We used the DO-7 monoclonal antibody reactive for the N-terminal of the p53 protein on formalin-fixed paraffin-embedded tissue. Sections from 14 kidneys resected for nonneoplastic conditions were used as controls. Twenty-one (87%) of the 24 cases of RCC had nuclear p53 expression in the tumor cells. This included 14 cases (58%) with intense reactivity and 7 cases (29%) with weaker p53 immunoreactivity. Of the 24 cases of RCC, IED was identified in 13 cases (54%). Immunoreactivity for p53 was focally seen in tubules of all the lesions, as well as in the nonlesional areas. Six of the lesions exhibited intense nuclear staining. The kidneys adjacent to the RCC, with no evidence of IED, showed focally intense positive p53 nuclear staining in four cases. None of the control specimens showed p53 expression. Our findings provide supportive evidence that previously described IED in kidneys adjacent to RCC are most likely precursor lesions of the neoplasm. Aberrant expression of p53 in areas without evidence of IED may suggest that neoplastic transformation manifested by p53 mutation in kidney tubules may be seen before the development of the morphologic features of

A Case of Tuberous Sclerosis Without Multiorgan Involvement.

PubMed

Falsafi, Parisa; Taghavi-Zenouz, Ali; Khorshidi-Khiyavi, Reza; Nezami, Nariman; Estiar, Mehrdad Asghari

2015-02-24

Tuberous sclerosis or Tuberous sclerosis complex (TSC) is a relatively rare autosomal dominant and progressive neurocutaneous disorder involves multiple organs mainly brain, heart, kidney, lung, liver, skin and eye. The diagnosis is typically made clinically. Here, we are reporting a case of TSC presented mainly with dermatologic findings and only neurologic manifestations on MRI. A 15-year-old female with intellectual disability is followed up at neurology clinic for history of seizure. Intelligence evaluation showed that she has intellectual disability. She had wart like lesions distributed in form of butterfly over the face especially involving nose. She did not have any sign and symptom of heart, kidney, lung, bone and eye involvement. Also, her laboratory tests were normal. Despite the physical examination showed absolutely intact neurologic examination, but brain MRI and CT scan revealed several cortical and subcortical tubers, and subependymal glial nodules; no evidence of giant cell astrocytomas and aneurysm. Hypesignal foci are seen at subcortical white matter on long TR images. Fibers are involved. In this case, there is no evidence of giant cell astrocytomas and aneurysm. It seems that TSC could be the prevalent disorder and referring intellectual disability patients in birth with normal organs could be diagnosed as TSC. Therefore, there is necessary need to design genetic natal and post natal tests for diagnosis of TSC cases. Also, there is pivotal that similar cases must be reported; perhaps TSC is more prevalent than to be considered.

Truth and Evidence in Validity Theory

ERIC Educational Resources Information Center

Borsboom, Denny; Markus, Keith A.

2013-01-01

According to Kane (this issue), "the validity of a proposed interpretation or use depends on how well the evidence supports" the claims being made. Because truth and evidence are distinct, this means that the validity of a test score interpretation could be high even though the interpretation is false. As an illustration, we discuss the case of…

Characteristics, circumstances and pathology of sudden or unnatural deaths of cases with evidence of pathological hoarding.

PubMed

Darke, Shane; Duflou, Johan

2017-01-01

The study aimed to determine the characteristics and circumstances of cases sudden or unnatural death (n = 61) with evidence of pathological hoarding, their major organ pathology and toxicology. The mean age was 65·8 yrs (a mean of 16.1 years of potential life lost), 62·3% were male, and 28·2% were obese. 95·1% lived alone, and 96·7% died in their residence, with no medical intervention. In all cases severe squalor and extensive hoarding were noted. The direct cause of death was attributed to disease in 75·4%, heart disease being a significant factor in 52·5%. Accidents causing death directly related to hoarding occurred in two cases. Autopsy revealed extensive pathology: severe coronary artery narrowing (42·4%), myocardial replacement fibrosis (44·1%), emphysema (39·0%), nephrosclerosis (46·6%). Signs of hypothermia were present in 14·8%, and diabetes was diagnosed in 21·3%. The most commonly detected substance was alcohol (32·1%). Medications for heart disease (5·4%) or diabetes (7·1%) were rare. The overall clinical picture was of an isolated group, with a heavy burden of physical disease and, in all probability, a high level of psychiatric disorders, who died alone in their homes. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Migrating foreign body in the tracheobronchial tree of childen: report of two cases.

PubMed

Oviawe, O; Abhulimhen-Iyoha, B I; Obaseki, D E

2011-06-01

Tracheobronchial foreign bodies (FBs) especially in infants and children can cause respiratory obstruction and can lead to death if intervention is delayed. Two cases of migrating FBs in the tracheobronchial (T-b) tree with fatal outcome are reported: Case 1 was an 11-year-old girl with a ten-week history of episodes of fever, cough, breathlessness and progressive weight loss. No positive history of FB aspiration. She was cachetic and febrile with short attention span, dyspnoeic, a flattened left upper hemithorax, mediastinal shift and evidence of atelectasis. Case 2, a 5-year-old girl with a three-month history of aspiration of a tiny toy. She developed fever, cough and marked weight loss, developed severe respiratory distress three days prior to presentation. She was febrile, had grade II finger clubbing, markedly dyspnoeic, left mediastinal shift, and evidence of left sided atelectasis. X-ray films in Case 1 showed evidence of FB at various locations in the T-b tree, and complete opacification and atelectasis of left hemithorax in Case 2. Planned bronchoscopy could not be done as both patients were adjudged to be too severely ill for the procedure. Both patients died after 9 days and 8 hours of hospital stay, respectively. Postmortem revealed FB in right main bronchus in both patients (tooth and toy, respectively) and evidence of tuberculosis in Case 2. Fatal outcome is attributed to inappropriate healthcare seeking behaviour, lack of medical expertise and material resources in our health facilities.

Giving women their own case notes to carry during pregnancy.

PubMed

Brown, Heather C; Smith, Helen J; Mori, Rintaro; Noma, Hisashi

2015-10-14

(moderate quality evidence). More women in the case notes group had operative deliveries (one trial, RR 1.83, 95% CI 1.08 to 3.12; 212 women), and caesarean sections (one trial, average RR 1.51, 95% CI 1.10 to 2.08; 501 women; moderate quality evidence). The four trials are small, and not all of them reported on all outcomes. The results suggest that there are both potential benefits (increased maternal control and increased availability of antenatal records during hospital attendance) and harms (more operative deliveries). Importantly, all of the trials report that more women in the case notes group would prefer to carry their antenatal records in another pregnancy. There is insufficient evidence on health-related behaviours (smoking and breastfeeding), women's satisfaction, and clinical outcomes. It is important to emphasise that this review shows a lack of evidence of benefit rather than evidence of no benefit.

Evidence-based dentistry.

PubMed

Chambers, David W

2010-01-01

choose to wait for collective professional standards to reveal acceptable practice or follow a strategy of punctuated equilibrium, only switching out established practice habits when very conspicuous advantages are identified. Integration in medicine appears to follow the statistically sophisticated practice of updating estimates of clinical parameters (probabilities) for diagnoses, treatments, prognoses, and side-effects. This approach is likely beyond the skill or interest of clinical dentists and it fails to incorporate values in the integration. The use of decision trees to integrate both research and experiential parameters and values is illustrated and it is shown that such a technique identifies why there are very few cases in dentistry where evidence needs to be consulted and indicates what such cases are.

Paratesticular fibrous pseudotumor: a report of five cases and literature review.

PubMed

Zhang, Zhicheng; Yang, Jun; Li, Mingchao; Cai, Wei; Liu, Qingquan; Wang, Tao; Guo, Xiaolin; Wang, Shaogang; Liu, Jihong; Ye, Zhangqun

2014-12-01

Paratesticular fibrous pseudotumor is a rare benign tumor that originates from intrascrotal tissue, such as tunica vaginalis, epididymis, or spermatic cord. Five cases of fibrous pseudotumor in our hospital were reviewed retrospectively, and the clinical manifestations were analyzed. Three cases of unilateral nodules, comprising one case located in the tunica vaginalis and two cases located in the epididymis, underwent local excision of the unilateral nodule. Two cases of diffuse incrassation in the tunica vaginalis underwent right radical orchiectomy. Postoperative pathological examination showed that all were fibrous pseudotumors. An average follow-up of 26 months showed uneventful results without recurrence for all patients. Fibrous pseudotumor is not a neoplasm but a reactive fibrous inflammatory hyperplasia. Definitive diagnosis requires pathological examination. Radical orchiectomy should be avoided when possible, and local excision should be performed because of the lack of obvious evidence of potential malignancy.

Drug-induced gynecomastia: an evidence-based review.

PubMed

Deepinder, Fnu; Braunstein, Glenn D

2012-09-01

Drugs are estimated to cause about 10 - 25% of all cases of gynecomastia. Over the course of several decades, multiple medications have been implicated in the development of gynecomastia mostly in the form of case reports and case series. However, these reports suffer from a multitude of deficiencies, including poor quality of evidence. Studies were selected for this review by performing an extensive electronic and hand-search using BIOSIS, EMBASE and Medline, from 1940 to present, for all reported drug associations of gynecomastia and their possible pathophysiology. Quality of evidence was assessed on a three-point scale: good, fair and poor, and each of the drugs reported to cause gynecomastia was assigned a level of strength. The pathophysiology of gynecomastia is also discussed in detail for each of the drugs found to have a good or fair evidence of association with gynecomastia. Most of the reported drug-gynecomastia associations were based on poor quality evidence. The drugs definitely associated with the onset of gynecomastia are spironolactone, cimetidine, ketoconazole, hGH, estrogens, hCG, anti-androgens, GnRH analogs and 5-α reductase inhibitors. Medications probably associated with gynecomastia include risperidone, verapamil, nifedipine, omeprazole, alkylating agents, HIV medications (efavirenz), anabolic steroids, alcohol and opioids.

Spontaneous posterior rectus sheath hernia: a case report.

PubMed

Ng, Chu Woon; Sandstrom, Anna; Lim, Grace

2018-04-15

Hernias of the posterior rectus sheath are very rare abdominal wall hernias with only a handful of cases reported in the literature to date. As an uncommon disease, it is important to recognize and report this case in order to enhance scientific knowledge of this disease. This case report presents a spontaneous posterior rectus sheath herniation in a 79-year-old white man with previous abdominal surgery for appendicitis. His herniation was discovered incidentally during an examination for his chief complaints of lower abdominal pain and diarrhea which were later diagnosed as Salmonella-related gastroenteritis. A computed tomography scan of his abdomen and pelvis showed abdominal wall hernia with loops of small bowel extending into his rectus abdominis muscle. In this case, it was decided to leave the situation alone for now due to no evidence of bowel obstruction and the low risk of this hernia getting strangulated, which otherwise would have warranted urgent surgery. This report adds to the limited stock of available literature on this unusual issue and strengthens the evidence base on the best approach to support informed clinical decision making. The significant clinical implication of such case reports is increased identification rate of rare clinical conditions which otherwise often go unnoticed.

Case of remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome) showing dermatomyositis-like eruption.

PubMed

Takeda, Kiminobu; Fujita, Jun; Fujii, Toshiki; Tanabe, Hiroshi; Mochizuki, Takashi; Yanagihara, Makoto

2010-01-01

A 73-year-old woman developed linear erythema at the sites of scratching-induced scars on the bilateral thighs 2 weeks before the initial consultation. Subsequently, edematous erythema developed in the upper eyelids, dorsum of the nose and the face, and pitting edema in the dorsum of the bilateral hands and feet. The C-reactive protein (CRP) level was 8.2 mg/dL and erythrocyte sedimentation rate (ESR) 121 mm/h. The antinuclear antibody titer was 1:160, and rheumatoid factor (RF) and anti-Jo-1 antibody were negative. X-ray examination of the bilateral hands showed neither narrowing of the joint spaces nor bone erosion. Ga scintigraphy showed synovitis of the bilateral wrists. A diagnosis of remitting seronegative symmetrical synovitis with pitting edema syndrome (RS3PE) was made. The erythema disappeared after diclofenac sodium administration. However, because the joint swelling and pitting edema did not improve, p.o. administration of prednisolone (20 mg/day) was initiated. The CRP and ESR levels normalized 2 months after the initiation of administration, and pitting edema disappeared after 3 months. We report this case because linear erythema like that observed in dermatomyositis has not been described as eruptions associated with RS3PE.

Evidence-informed policymaking in practice: country-level examples of use of evidence for iCCM policy

PubMed Central

Rodríguez, Daniela C; Shearer, Jessica; Mariano, Alda RE; Juma, Pamela A; Dalglish, Sarah L; Bennett, Sara

2015-01-01

Integrated Community Case Management of Childhood Illness (iCCM) is a policy for providing treatment for malaria, diarrhoea and pneumonia for children below 5 years at the community level, which is generating increasing evidence and support at the global level. As countries move to adopt iCCM, it becomes important to understand how this growing evidence base is viewed and used by national stakeholders. This article explores whether, how and why evidence influenced policy formulation for iCCM in Niger, Kenya and Mozambique, and uses Carol Weiss’ models of research utilization to further explain the use of evidence in these contexts. A documentary review and in-depth stakeholder interviews were conducted as part of retrospective case studies in each study country. Findings indicate that all three countries used national monitoring data to identify the issue of children dying in the community prior to reaching health facilities, whereas international research evidence was used to identify policy options. Nevertheless, policymakers greatly valued local evidence and pilot projects proved critical in advancing iCCM. World Health Organization and United Nations Children's Fund (UNICEF) functioned as knowledge brokers, bringing research evidence and experiences from other countries to the attention of local policymakers as well as sponsoring site visits and meetings. In terms of country-specific findings, Niger demonstrated both Interactive and Political models of research utilization by using iCCM to capitalize on the existing health infrastructure. Both Mozambique and Kenya exhibit Problem-Solving research utilization with different outcomes. Furthermore, the persistent quest for additional evidence suggests a Tactical use of research in Kenya. Results presented here indicate that while evidence from research studies and other contexts can be critical to policy development, local evidence is often needed to answer key policymaker questions. In the end, evidence may not

A Case of Teriparatide on Pregnancy-Induced Osteoporosis

PubMed Central

Lee, Seok Hong; Hong, Moon-Ki; Park, Seung Won; Park, Hyoung-Moo; Kim, Jaetaek

2013-01-01

Pregnancy-induced osteoporosis is a rare disorder characterized by fragility fracture and low bone mineral density (BMD) during or shortly after pregnancy, and its etiology is still unclear. We experienced a case of a 39-year-old woman who suffered from lumbago 3 months after delivery. Biochemical evidence of increased bone resorption is observed without secondary causes of osteoporosis. Radiologic examination showed multiple compression fractures on her lumbar vertebrae. We report a case of patient with pregnancy-induced osteoporosis improved her clinical symptom, BMD and bone turnover marker after teriparatide therapy. PMID:24524067

Synthesizing Econometric Evidence: The Case of Demand Elasticity Estimates.

PubMed

DeCicca, Philip; Kenkel, Don

2015-06-01

Econometric estimates of the responsiveness of health-related consumer demand to higher prices are often key ingredients for risk policy analysis. We review the potential advantages and challenges of synthesizing econometric evidence on the price-responsiveness of consumer demand. We draw on examples of research on consumer demand for health-related goods, especially cigarettes. We argue that the overarching goal of research synthesis in this context is to provide policy-relevant evidence for broad-brush conclusions. We propose three main criteria to select among research synthesis methods. We discuss how in principle and in current practice synthesis of research on the price-elasticity of smoking meets our proposed criteria. Our analysis of current practice also contributes to academic research on the specific policy question of the effectiveness of higher cigarette prices to reduce smoking. Although we point out challenges and limitations, we believe more work on research synthesis in this area will be productive and important. © 2015 Society for Risk Analysis.

Unusual hand postures but not familiar tools show motor equivalence with precision grasping.

PubMed

Tang, Rixin; Whitwell, Robert L; Goodale, Melvyn A

2016-06-01

A central question in sensorimotor control is whether or not actions performed with the hands and corresponding actions performed with tools share a common underlying motor plan, even though different muscles and effectors are engaged. There is certainly evidence that tools used to extend the reach of the limb can be incorporated into the body schema after training. But even so, it is not clear whether or not actions such as grasping with tools and grasping with the fingers share the same programming network, i.e. show 'motor equivalence'. Here we first show that feedback-appropriate motor programming for grasps with atypical hand postures readily transfers to stereotypical precision grasps. In stark contrast, however, we find no evidence for an analogous transfer of the programming for grasps using tools to the same stereotypical precision grasps. These findings have important implications for our understanding of body schema. Although the extension of the limb that is afforded by tool use may be incorporated into the body schema, the programming of a grasping movement made with tools appears to resist such incorporation. It could be the case that the proprioceptive signals from the limb can be easily updated to reflect the end of a tool held in the hand, but the motor programs and sensory signals associated with grasping with the thumb and finger cannot be easily adapted to control the opening and closing of a tool. Instead, new but well-practiced motor programs are put in place for tool use that do not exhibit motor equivalence with manual grasping. Copyright © 2016 Elsevier B.V. All rights reserved.

32 CFR 724.209 - Evidence supporting applications.

Code of Federal Regulations, 2011 CFR

2011-07-01

... applications. In the absence of law, evidence or policy to the contrary, naval discharges shall be considered just, equitable and proper as issued. When hearings are scheduled, applicants must be prepared to present their case at the scheduled time. In the absence of any other evidence, naval discharge review...

Evidence Value of Textile Fiber - Transfer and Persistence of Fibers.

PubMed

Siegel, J A

1997-12-01

Fibers comprise probably the most common form of trace evidence in forensic science today. They occur in perhaps one-quarter of all cases that involve trace evidence and a large majority of crime laboratories routinely characterize textile fibers. Although a great deal of research has been done on how to best characterize and compare fibers, relatively little time has been spent on determining the significance of fiber evidence. This article presents a summary of the studies of fiber transfer and persistence and determination of the significance of fiber evidence. This accumulated research and analysis will enable fiber examiners to better interpret evidence in cases where foreign fibers have been transferred during contact between victims and perpetrators of crimes. Copyright © 1997 Central Police University.

The Evidence Value Matrix for Diagnostic Imaging.

PubMed

Seidel, David; Frank, Richard A; Schmidt, Sebastian

2016-10-01

Evidence and value are independent factors that together affect the adoption of diagnostic imaging. For example, noncoverage decisions by reimbursement authorities can be justified by a lack of evidence and/or value. To create transparency and a common understanding among various stakeholders, we have proposed a two-dimensional matrix that allows classification of imaging devices into three distinct categories based on the available evidence and value: "question marks" (low value demonstrated in studies of any evidence level), "candidates" (high value demonstrated in retrospective case-control studies and smaller case series), and "stars" (high value demonstrated in large prospective cohort studies or, preferably, randomized controlled trials). We use several examples to illustrate the application of our matrix. A major benefit of the matrix includes the development of specific strategies for evidence and value generation. High-evidence/low-value studies are expensive and unlikely to convince decision makers, given the uncertainty of the impact on patient management and outcomes. Developing question marks into candidates first and then into stars will often be quicker and less expensive ("success sequence"). Only this more sophisticated and objective approach can justify the additional funding necessary to generate the evidence base to inform reimbursement by payers and adoption by providers. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Severe malaria - a case of fatal Plasmodium knowlesi infection with post-mortem findings: a case report

PubMed Central

2010-01-01

Background Zoonotic malaria caused by Plasmodium knowlesi is an important, but newly recognized, human pathogen. For the first time, post-mortem findings from a fatal case of knowlesi malaria are reported here. Case presentation A formerly healthy 40 year-old male became symptomatic 10 days after spending time in the jungle of North Borneo. Four days later, he presented to hospital in a state of collapse and died within two hours. He was hyponatraemic and had elevated blood urea, potassium, lactate dehydrogenase and amino transferase values; he was also thrombocytopenic and eosinophilic. Dengue haemorrhagic shock was suspected and a post-mortem examination performed. Investigations for dengue virus were negative. Blood for malaria parasites indicated hyperparasitaemia and single species P. knowlesi infection was confirmed by nested-PCR. Macroscopic pathology of the brain and endocardium showed multiple petechial haemorrhages, the liver and spleen were enlarged and lungs had features consistent with ARDS. Microscopic pathology showed sequestration of pigmented parasitized red blood cells in the vessels of the cerebrum, cerebellum, heart and kidney without evidence of chronic inflammatory reaction in the brain or any other organ examined. Brain sections were negative for intracellular adhesion molecule-1. The spleen and liver had abundant pigment containing macrophages and parasitized red blood cells. The kidney had evidence of acute tubular necrosis and endothelial cells in heart sections were prominent. Conclusions The overall picture in this case was one of systemic malaria infection that fit the WHO classification for severe malaria. Post-mortem findings in this case were unexpectedly similar to those that define fatal falciparum malaria, including cerebral pathology. There were important differences including the absence of coma despite petechial haemorrhages and parasite sequestration in the brain. These results suggest that further study of knowlesi malaria

Use of Evidence from Systematic Reviews to Inform Commissioning Decisions: A Case Study

ERIC Educational Resources Information Center

Chambers, Duncan; Grant, Rod; Warren, Erica; Pearson, Sally-Anne; Wilson, Paul

2012-01-01

Systematic reviews provide high-level evidence but there are barriers to their use by policy makers. This paper reports the preparation and evaluation of an evidence briefing, using systematic reviews and other existing sources of synthesised evidence, to support a possible reorganisation of services for young people with eating disorders in an…

Comparing the Persuasiveness of Narrative and Statistical Evidence Using Meta-Analysis.

ERIC Educational Resources Information Center

Allen, Mike; Preiss, Raymond W.

1997-01-01

Compares the persuasiveness of using statistical versus narrative evidence (case studies or examples) across 15 investigations. Indicates that when comparing messages, statistical evidence is more persuasive than narrative evidence. (PA)

Astronomers Discover Most Distant Galaxy Showing Key Evidence For Furious Star Formation

NASA Astrophysics Data System (ADS)

2003-12-01

Astronomers have discovered a key signpost of rapid star formation in a galaxy 11 billion light-years from Earth, seen as it was when the Universe was only 20 percent of its current age. Using the National Science Foundation's Very Large Array (VLA) radio telescope, the scientists found a huge quantity of dense interstellar gas -- the environment required for active star formation -- at the greatest distance yet detected. A furious spawning of the equivalent of 1,000 Suns per year in a distant galaxy dubbed the Cloverleaf may be typical of galaxies in the early Universe, the scientists say. Cloverleaf galaxy VLA image (green) of radio emission from HCN gas, superimposed on Hubble Space Telescope image of the Cloverleaf galaxy. The four images of the Cloverleaf are the result of gravitational lensing. CREDIT: NRAO/AUI/NSF, STScI (Click on Image for Larger Version) "This is a rate of star formation more than 300 times greater than that in our own Milky Way and similar spiral galaxies, and our discovery may provide important information about the formation and evolution of galaxies throughout the Universe," said Philip Solomon, of Stony Brook University in New York. While the raw material for star formation has been found in galaxies at even greater distances, the Cloverleaf is by far the most distant galaxy showing this essential signature of star formation. That essential signature comes in the form of a specific frequency of radio waves emitted by molecules of the gas hydrogen cyanide (HCN). "If you see HCN, you are seeing gas with the high density required to form stars," said Paul Vanden Bout of the National Radio Astronomy Observatory (NRAO). Solomon and Vanden Bout worked with Chris Carilli of NRAO and Michel Guelin of the Institute for Millimeter Astronomy in France. They reported their results in the December 11 issue of the scientific journal Nature. In galaxies like the Milky Way, dense gas traced by HCN but composed mainly of hydrogen molecules is always

A Case of Cardiac Cephalalgia Showing Reversible Coronary Vasospasm on Coronary Angiogram

PubMed Central

Yang, YoungSoon; Jin, Dong Gyu; Jang, Il Mi; Jang, YoungHee; Na, Hae Ri; Kim, SanYun

2010-01-01

Background Under certain conditions, exertional headaches may reflect coronary ischemia. Case Report A 44-year-old woman developed intermittent exercise-induced headaches with chest tightness over a period of 10 months. Cardiac catheterization followed by acetylcholine provocation demonstrated a right coronary artery spasm with chest tightness, headache, and ischemic effect of continuous electrocardiography changes. The patient's headache disappeared following intra-arterial nitroglycerine injection. Conclusions A coronary angiogram with provocation study revealed variant angina and cardiac cephalalgia, as per the International Classification of Headache Disorders (code 10.6). We report herein a patient with cardiac cephalalgia that manifested as reversible coronary vasospasm following an acetylcholine provocation test. PMID:20607049

Face and body recognition show similar improvement during childhood.

PubMed

Bank, Samantha; Rhodes, Gillian; Read, Ainsley; Jeffery, Linda

2015-09-01

Adults are proficient in extracting identity cues from faces. This proficiency develops slowly during childhood, with performance not reaching adult levels until adolescence. Bodies are similar to faces in that they convey identity cues and rely on specialized perceptual mechanisms. However, it is currently unclear whether body recognition mirrors the slow development of face recognition during childhood. Recent evidence suggests that body recognition develops faster than face recognition. Here we measured body and face recognition in 6- and 10-year-old children and adults to determine whether these two skills show different amounts of improvement during childhood. We found no evidence that they do. Face and body recognition showed similar improvement with age, and children, like adults, were better at recognizing faces than bodies. These results suggest that the mechanisms of face and body memory mature at a similar rate or that improvement of more general cognitive and perceptual skills underlies improvement of both face and body recognition. Copyright © 2015 Elsevier Inc. All rights reserved.

Renal medullary carcinoma: molecular, pathological and clinical evidence for treatment with topoisomerase-inhibiting therapy.

PubMed

Schaeffer, Edward M; Guzzo, Thomas J; Furge, Kyle A; Netto, George; Westphal, Michael; Dykema, Karl; Yang, Ximing; Zhou, Ming; Teh, Bin Tean; Pavlovich, Christian P

2010-07-01

Aetiology (case series) Level of Evidence 4. To present the molecular rationale and potential clinical benefit of topoisomerase II (TopoII)-inhibiting therapy for renal medullary carcinoma (RMC), a rare but extremely lethal form of kidney cancer that classically afflicts young men with sickle-cell trait. The current therapeutic approach with these aggressive tumours is radical nephrectomy followed by systemic chemotherapy, but the prognosis remains dismal. The whole-genome expression was analysed in four RMC tumours. We also report a case of metastatic RMC in which a complete response was achieved for 9 months using a TopoII-inhibiting therapy. Expanded whole-genome expression analysis showed increases of TopoII in all cases. There was also overall deregulation of DNA remodelling and repair, and an ontological association between RMC and urothelial carcinoma. Using a TopoII-inhibiting agent, there was a complete response for 9 months in a patient with metastatic RMC. This report provides molecular evidence for the rational use of TopoII inhibitors in the treatment of RMC.

The use of neuroscientific evidence in Canadian criminal proceedings

PubMed Central

Chandler, Jennifer A.

2015-01-01

This article addresses the question of how neuroscientific evidence is currently used in the Canadian criminal justice system, with a view to identifying the main contexts in which this evidence is raised, as well as to discern the impact of this evidence on judgements of responsibility, dangerousness, and treatability. The most general Canadian legal database was searched for cases in the five-year period between 2008 and 2012 in which neuroscientific evidence related to the responsibility and recidivism risk of criminal offenders was considered. Canadian courts consider neuroscientific evidence of many types, particularly evidence of prenatal alcohol exposure, traumatic brain injury, and neuropsychological testing. The majority of the cases are sentencing decisions, which is useful given that it offers an opportunity to observe how judges wrestle with the tension that evidence of diminished capacity due to brain damage tends to reduce moral blameworthiness, while it also tends to increase perceptions of risk and dangerousness. This so-called double-edged sword of the biological explanation of criminal behavior was reflected in this study, and raises questions about whether and when the pursuit of such evidence is advisable from the defense perspective. PMID:27774212

Treatment of Medial Tibial Stress Syndrome With Radial Soundwave Therapy in Elite Athletes: Current Evidence, Report on Two Cases, and Proposed Treatment Regimen.

PubMed

Saxena, Amol; Fullem, Brian; Gerdesmeyer, Ludger

Two case reports of high-level athletes with medial tibial stress syndrome (MTSS), 1 an Olympian with an actual stress fracture, are presented. Successful treatment included radial soundwave therapy, pneumatic leg braces, relative rest using an antigravity treadmill, and temporary foot orthoses. Radial soundwave therapy has a high level of evidence for treatment of MTSS. We also present recent evidence of the value of vitamin D assessment. Both patients had a successful outcome with minimal downtime. Finally, a suggested treatment regimen for MTSS is presented. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

49 CFR 1503.635 - Evidence.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Other Regulations Relating to Transportation (Continued) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY ADMINISTRATIVE AND PROCEDURAL RULES INVESTIGATIVE AND ENFORCEMENT PROCEDURES... present the party's case or defense by oral, documentary, or demonstrative evidence, to submit rebuttal...

Evidence-based Draft Guideline for Prevention of Midwifery Malpractices based on Referred Cases to the Forensic Medicine Commission and the Medical Council from 2006–2011

PubMed Central

Asadi, Leila; Beigi, Marjan; Valiani, Mahbube; Mardani, Fardin

2017-01-01

Background: Medical errors are the main concerns in health systems, which considering their ascending rate in the recent years, especially in the field of midwifery, have caused a medical crisis. Considering the importance of evidence-based health services as a way to improve health systems, the aim of this study was to suggest a guideline for preventing malpractice in midwifery services. Materials and Methods: In this cross-sectional study that was conducted in 2013, we investigated 206 cases that were referred to the Isfahan Legal Medicine Organization and Medical Council of Forensic Medicine from 2006–2011. Data were collected by a checklist and were analyzed using SPSS-16 software. Descriptive statistical tests (mean, maximum, minimum, standard deviation, frequency, and percentage agreement) were used to describe the data. Then, we used the Delphi technique with the participation from 17 experts in midwifery, gynecology, and legal medicine to provide an evidence-based draft guideline for prevention of midwifery errors. Results: A total of 206 cases were reviewed. In 66 cases (32%) the verdict for malpractice in midwifery services was approved. A practical draft guideline for preventing clinical errors for midwifery in the fields of pregnancy, delivery, and postpartum period was developed. Conclusions: This evidence-based draft guideline can improve the attention of all the healthcare providers, especially midwives and physicians to prevent urgent problems and offer effective health services for mothers and infants. PMID:28904546

29 CFR 458.78 - Rules of evidence.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 2 2010-07-01 2010-07-01 false Rules of evidence. 458.78 Section 458.78 Labor Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR STANDARDS OF CONDUCT STANDARDS.... Every party shall have a right to present his case by oral and documentary evidence and to submit...

Lonely Individuals Do Not Show Interpersonal Self-Positivity Bias: Evidence From N400

PubMed Central

Zhu, Min; Zhu, Changzheng; Gao, Xiangping; Luo, Junlong

2018-01-01

Self-positivity bias is one of the well-studied psychological phenomena, however, little is known about the bias in the specific dimension on social interaction, which we called herein interpersonal self-positivity bias—people tend to evaluate themselves more positively on social interactions, prefer to be included rather than to be excluded by others. In the present study, we used a modified self-reference task associated with N400 to verify such bias and explore whether impoverished social interaction (loneliness) could modulate it. Findings showed that exclusion verbs elicited larger N400 amplitudes than inclusion verbs, suggesting that most people have interpersonal self-positivity bias. However, loneliness was significantly correlated with N400 effect, showing those with high scores of loneliness had smaller differences in the N400 than those with lower scores. These findings indicated impoverished social interaction weakens interpersonal self-positivity bias; however, the underlying mechanisms need to be explored in future research. PMID:29681875

Evidence for rare and common genetic risk variants for schizophrenia at protein kinase C, alpha.

PubMed

Carroll, L S; Williams, N M; Moskvina, V; Russell, E; Norton, N; Williams, H J; Peirce, T; Georgieva, L; Dwyer, S; Grozeva, D; Greene, E; Farmer, A; McGuffin, P; Morris, D W; Corvin, A; Gill, M; Rujescu, D; Sham, P; Holmans, P; Jones, I; Kirov, G; Craddock, N; O'Donovan, M C; Owen, M J

2010-11-01

We earlier reported a genome-wide significant linkage to schizophrenia at chromosome 17 that was identified in a single pedigree (C702) consisting of six affected, male siblings with DSM-IV schizophrenia and prominent mood symptoms. In this study, we adopted several approaches in an attempt to map the putative disease locus. First, mapping the source of linkage to chromosome 17 in pedigree C702. We refined the linkage region in family C702 to a 21-marker segment spanning 11.7 Mb at 17q23-q24 by genotyping a total of 50 microsatellites across chromosome 17 in the pedigree. Analysis of data from 1028 single nucleotide polymorphisms (SNPs) across the refined linkage region identified a single region of homozygosity present in pedigree C702 but not in 2938 UK controls. This spanned ~432 kb of the gene encoding protein kinase C, alpha (PRKCA), the encoded protein of which has been implicated in the pathogenesis of psychiatric disorders. Analysis of pedigree C702 by oligonucleotide-array comparative genome hybridization excluded the possibility that this region of homozygosity was because of a deletion. Mutation screening of PRKCA identified a rare, four-marker haplotype (C-HAP) in the 3' untranslated region of the gene, which was present in the homozygous state in all six affected members of pedigree C702. No other homozygotes were observed in genotype data for a total of 6597 unrelated Europeans (case N=1755, control N=3580 and parents of probands N=1262). Second, association analysis of C702 alleles at PRKCA. The low-frequency haplotype (C-HAP) showed a trend for association in a study of unrelated schizophrenia cases and controls from the UK (661 cases, 2824 controls, P=0.078 and odd ratio (OR)=1.9) and significant evidence for association when the sample was expanded to include cases with bipolar (N=710) and schizoaffective disorder (N=50) (psychosis sample: 1421 cases, 2824 controls, P=0.037 and OR=1.9). Given that all the affected members of C702 are male, we

Dental movement acceleration: Literature review by an alternative scientific evidence method

PubMed Central

Camacho, Angela Domínguez; Cujar, Sergio Andres Velásquez

2014-01-01

The aim of this study was to analyze the majority of publications using effective methods to speed up orthodontic treatment and determine which publications carry high evidence-based value. The literature published in Pubmed from 1984 to 2013 was reviewed, in addition to well-known reports that were not classified under this database. To facilitate evidence-based decision making, guidelines such as the Consolidation Standards of Reporting Trials, Preferred Reporting items for systematic Reviews and Meta-analyses, and Transparent Reporting of Evaluations with Non-randomized Designs check list were used. The studies were initially divided into three groups: local application of cell mediators, physical stimuli, and techniques that took advantage of the regional acceleration phenomena. The articles were classified according to their level of evidence using an alternative method for orthodontic scientific article classification. 1a: Systematic Reviews (SR) of randomized clinical trials (RCTs), 1b: Individual RCT, 2a: SR of cohort studies, 2b: Individual cohort study, controlled clinical trials and low quality RCT, 3a: SR of case-control studies, 3b: Individual case-control study, low quality cohort study and short time following split mouth designs. 4: Case-series, low quality case-control study and non-systematic review, and 5: Expert opinion. The highest level of evidence for each group was: (1) local application of cell mediators: the highest level of evidence corresponds to a 3B level in Prostaglandins and Vitamin D; (2) physical stimuli: vibratory forces and low level laser irradiation have evidence level 2b, Electrical current is classified as 3b evidence-based level, Pulsed Electromagnetic Field is placed on the 4th level on the evidence scale; and (3) regional acceleration phenomena related techniques: for corticotomy the majority of the reports belong to level 4. Piezocision, dentoalveolar distraction, alveocentesis, monocortical tooth dislocation and ligament

Medicine Based Evidence for Individualized Decision Making: Case Study of Systemic Lupus Erythematosus.

PubMed

Wivel, Ashley E; Lapane, Kate; Kleoudis, Christi; Singer, Burton H; Horwitz, Ralph I

2017-11-01

To guide management decisions for an index patient, evidence is required from comparisons between approximate matches to the profile of the index case, where some matches contain responses to treatment and others act as controls. We describe a method for constructing clinically relevant histories/profiles using data collected but unreported from 2 recent phase 3 randomized controlled trials assessing belimumab in subjects with clinically active and serologically positive systemic lupus erythematosus. Outcome was the Systemic lupus erythematosus Responder Index (SRI) measured at 52 weeks. Among 1175 subjects, we constructed an algorithm utilizing 11 trajectory variables including 4 biological, 2 clinical, and 5 social/behavioral. Across all biological and social/behavioral variables, the proportion of responders based on the SRI whose value indicated clinical worsening or no improvement ranged from 27.5% to 42.3%. Kappa values suggested poor agreement, indicating that each biological and patient-reported outcome provides different information than gleaned from the SRI. The richly detailed patient profiles needed to guide decision-making in clinical practice are sharply at odds with the limited information utilized in conventional randomized controlled trial analyses. Copyright © 2017 Elsevier Inc. All rights reserved.

Evidence for the treatment of co-occurring stuttering and speech sound disorder: A clinical case series.

PubMed

Unicomb, Rachael; Hewat, Sally; Spencer, Elizabeth; Harrison, Elisabeth

2017-06-01

There is a paucity of evidence to guide treatment for children with co-occurring stuttering and speech sound disorder. Some guidelines suggest treating the two disorders simultaneously using indirect treatment approaches; however, the research supporting these recommendations is over 20 years old. In this clinical case series, we investigate whether these co-occurring disorders could be treated concurrently using direct treatment approaches supported by up-to-date, high-level evidence, and whether this could be done in an efficacious, safe and efficient manner. Five pre-school-aged participants received individual concurrent, direct intervention for both stuttering and speech sound disorder. All participants used the Lidcombe Program, as manualised. Direct treatment for speech sound disorder was individualised based on analysis of each child's sound system. At 12 months post commencement of treatment, all except one participant had completed the Lidcombe Program, and were less than 1.0% syllables stuttered on samples gathered within and beyond the clinic. These four participants completed Stage 1 of the Lidcombe Program in between 14 and 22 clinic visits, consistent with current benchmark data for this programme. At the same assessment point, all five participants exhibited significant increases in percentage of consonants correct and were in alignment with age-expected estimates of this measure. Further, they were treated in an average number of clinic visits that compares favourably with other research on treatment for speech sound disorder. These preliminary results indicate that young children with co-occurring stuttering and speech sound disorder may be treated concurrently using direct treatment approaches. This method of service delivery may have implications for cost and time efficiency and may also address the crucial need for early intervention in both disorders. These positive findings highlight the need for further research in the area and contribute to

Inflammatory myofibroblastic tumor of maxilla showing sarcomatous change in an edentulous site with a history of tooth extraction following periodontitis: A case report with discussion.

PubMed

Biniraj, K R; Janardhanan, Mahija

2014-05-01

Inflammatory myofibroblastic tumor (IMT) is a rare tumor of uncertain origin with variable biological behavior ranging from reactive lesions to highly aggressive malignancy. Oral IMTs are extremely rare and only 25 cases had been reported so far. A case of IMT with sarcomatous transformation in an extraction site with a history of tooth extraction following tooth mobility of an upper left molar tooth is presented here. The tooth was extracted following a complaint of gingival swelling and mobility of tooth. Though malignant transformation in IMTs had been documented in the extra oral sites, wide search of associated literature suggests, this is the first case of oral IMT showing malignant change associated with gingiva. The case report attempts to highlight the variant possibilities of tooth mobility other than periodontitis and the importance of assessing the primary cause of such conditions.

Inflammatory myofibroblastic tumor of maxilla showing sarcomatous change in an edentulous site with a history of tooth extraction following periodontitis: A case report with discussion

PubMed Central

Biniraj, K. R.; Janardhanan, Mahija

2014-01-01

Inflammatory myofibroblastic tumor (IMT) is a rare tumor of uncertain origin with variable biological behavior ranging from reactive lesions to highly aggressive malignancy. Oral IMTs are extremely rare and only 25 cases had been reported so far. A case of IMT with sarcomatous transformation in an extraction site with a history of tooth extraction following tooth mobility of an upper left molar tooth is presented here. The tooth was extracted following a complaint of gingival swelling and mobility of tooth. Though malignant transformation in IMTs had been documented in the extra oral sites, wide search of associated literature suggests, this is the first case of oral IMT showing malignant change associated with gingiva. The case report attempts to highlight the variant possibilities of tooth mobility other than periodontitis and the importance of assessing the primary cause of such conditions. PMID:25024554

The Courage to Collaborate: The Case for Labor-Management Partnerships in Education

ERIC Educational Resources Information Center

Futernick, Ken

2016-01-01

In "The Courage to Collaborate," school turnaround expert Ken Futernick makes the case that collaboration between school management and teacher unions is a necessary condition for educational improvement. The author cites evidence showing that collaboration often leads to increased trust, stronger professional relationships, better…

Building capacity for evidence informed decision making in public health: a case study of organizational change.

PubMed

Peirson, Leslea; Ciliska, Donna; Dobbins, Maureen; Mowat, David

2012-02-20

Core competencies for public health in Canada require proficiency in evidence informed decision making (EIDM). However, decision makers often lack access to information, many workers lack knowledge and skills to conduct systematic literature reviews, and public health settings typically lack infrastructure to support EIDM activities. This research was conducted to explore and describe critical factors and dynamics in the early implementation of one public health unit's strategic initiative to develop capacity to make EIDM standard practice. This qualitative case study was conducted in one public health unit in Ontario, Canada between 2008 and 2010. In-depth information was gathered from two sets of semi-structured interviews and focus groups (n = 27) with 70 members of the health unit, and through a review of 137 documents. Thematic analysis was used to code the key informant and document data. The critical factors and dynamics for building EIDM capacity at an organizational level included: clear vision and strong leadership, workforce and skills development, ability to access research (library services), fiscal investments, acquisition and development of technological resources, a knowledge management strategy, effective communication, a receptive organizational culture, and a focus on change management. With leadership, planning, commitment and substantial investments, a public health department has made significant progress, within the first two years of a 10-year initiative, towards achieving its goal of becoming an evidence informed decision making organization.

Cotton fiber tips have diverse morphologies and show evidence of apical cell wall synthesis

PubMed Central

Stiff , Michael R.; Haigler, Candace H.

2016-01-01

Cotton fibers arise through highly anisotropic expansion of a single seed epidermal cell. We obtained evidence that apical cell wall synthesis occurs through examining the tips of young elongating Gossypium hirsutum (Gh) and G. barbadense (Gb) fibers. We characterized two tip types in Gh fiber (hemisphere and tapered), each with distinct apical diameter, central vacuole location, and distribution of cell wall components. The apex of Gh hemisphere tips was enriched in homogalacturonan epitopes, including a relatively high methyl-esterified form associated with cell wall pliability. Other wall components increased behind the apex including cellulose and the α-Fuc-(1,2)-β-Gal epitope predominantly found in xyloglucan. Gb fibers had only one narrow tip type featuring characters found in each Gh tip type. Pulse-labeling of cell wall glucans indicated wall synthesis at the apex of both Gh tip types and in distal zones. Living Gh hemisphere and Gb tips ruptured preferentially at the apex upon treatment with wall degrading enzymes, consistent with newly synthesized wall at the apex. Gh tapered tips ruptured either at the apex or distantly. Overall, the results reveal diverse cotton fiber tip morphologies and support primary wall synthesis occurring at the apex and discrete distal regions of the tip. PMID:27301434

Applying a Health Network approach to translate evidence-informed policy into practice: A review and case study on musculoskeletal health

PubMed Central

2012-01-01

Background While translation of evidence into health policy and practice is recognised as critical to optimising health system performance and health-related outcomes for consumers, mechanisms to effectively achieve these goals are neither well understood, nor widely communicated. Health Networks represent a framework which offers a possible solution to this dilemma, particularly in light of emerging evidence regarding the importance of establishing relationships between stakeholders and identifying clinical leaders to drive evidence integration and translation into policy. This is particularly important for service delivery related to chronic diseases. In Western Australia (WA), disease and population-specific Health Networks are comprised of cross-discipline stakeholders who work collaboratively to develop evidence-informed policies and drive their implementation. Since establishment of the Health Networks in WA, over 50 evidence-informed Models of Care (MoCs) have been produced across 18 condition or population-focused Networks. The aim of this paper is to provide an overview of the Health Network framework in facilitating the translation of evidence into policy and practice with a particular focus on musculoskeletal health. Case presentation A review of activities of the WA Musculoskeletal Health Network was undertaken, focussing on outcomes and the processes used to achieve them in the context of: development of policy, procurement of funding, stakeholder engagement, publications, and projects undertaken by the Network which aligned to implementation of MoCs. The Musculoskeletal Health Network has developed four MoCs which reflect Australian National Health Priority Areas. Establishment of community-based services for consumers with musculoskeletal health conditions is a key recommendation from these MoCs. Through mapping barriers and enablers to policy implementation, working groups, led by local clinical leaders and supported by the broader Network and

X inactivation in Rett syndrome: A preliminary study showing partial preferential inactivation of paternal X with the M27{beta} probe

DOE Office of Scientific and Technical Information (OSTI.GOV)

Camus, P.; Abbadi, N.; Gilgenkrantz, S.

1994-04-15

Rett syndrome (RS) is a severe progressive neurological disorder occurring exclusively in females. Most cases are sporadic. The few familial cases (less than 1%) cannot be explained by a simple mode of inheritance. Several hypotheses have been proposed: X-linked male lethal mutation, maternal uniparental disomy, fresh mutation on the X chromosome, involvement of mitochondrial DNA and differential inactivation with metabolic interference of X-borne alleles. The authors have examined the pattern of X inactivation in 10 affected girls who were selected according to the clinical criteria previously described and accepted by the French Rett Scientific Committee. The X inactivation pattern wasmore » studied by analysis of methylation at the hypervariable locus DXS255 with the M27{beta} probe. The results show a more-or-less skewed inactivation of paternal X in 8 Rett females, and 2 cases of symmetrical inactivation. In control girls, inactivation was symmetrical cases and the maternal X has been preferentially inactivated in the other 2 cases. In no case was a total skewed inactivation observed. Though there was clear evidence for a preferential paternal X inactivation that was statistically significant further studies are necessary to establish a relationship between X inactivation pattern and Rett syndrome.« less

When "Happy" Means "Sad": Neuropsychological Evidence for the Right Prefrontal Cortex Contribution to Executive Semantic Processing

ERIC Educational Resources Information Center

Samson, Dana; Connolly, Catherine; Humphreys, Glyn W.

2007-01-01

The contribution of the left inferior prefrontal cortex in semantic processing has been widely investigated in the last decade. Converging evidence from functional imaging studies shows that this region is involved in the "executive" or "controlled" aspects of semantic processing. In this study, we report a single case study of a patient, PW, with…

[Approaching the "evidence-practice gap" in pharmaceutical risk management: analysis of healthcare claim data].

PubMed

Nakayama, Takeo

2012-01-01

The concept of evidence-based medicine (EBM) has promulgated among healthcare professionals in recent years, on the other hand, the problem of underuse of useful clinical evidence is coming to be important. This is called as evidence-practice gap. The major concern about evidence-practice gap is insufficient implementation of evidence-based effective treatment, however, the perspective can be extended to measures to improve drug safety and prevention of drug related adverse events. First, this article reviews the characteristics of the database of receipt (healthcare claims) and the usefulness for research purpose of pharmacoepidemiology. Second, as the real example of the study on evidence-practice gap by using the receipt database, the case of ergot-derived anti-Parkinson drugs, of which risk of valvulopathy has been identified, is introduced. The receipt analysis showed that more than 70% of Parkinson's disease patients prescribed with cabergoline or pergolide did not undergo echocardiography despite the revision of the product label recommendation. Afterwards, the issues of pharmaceutical risk management and risk communication will be discussed.

Careers in Forensics: Analysis, Evidence, and Law

ERIC Educational Resources Information Center

Torpey, Elka Maria

2009-01-01

In legal proceedings, a case is only as strong as its evidence. And whether that evidence is strong depends, in large part, on the work of forensic specialists. The field of forensics is broad and involves many kinds of workers. Some of them are involved in crimesolving. Others, such as forensic social workers or forensic economists, help to…

Osteological, Biomolecular and Geochemical Examination of an Early Anglo-Saxon Case of Lepromatous Leprosy

PubMed Central

Inskip, Sarah A.; Taylor, G. Michael; Zakrzewski, Sonia R.; Mays, Simon A.; Pike, Alistair W. G.; Llewellyn, Gareth; Williams, Christopher M.; Lee, Oona Y-C; Wu, Houdini H. T.; Minnikin, David E.; Besra, Gurdyal S.; Stewart, Graham R.

2015-01-01

We have examined a 5th to 6th century inhumation from Great Chesterford, Essex, UK. The incomplete remains are those of a young male, aged around 21–35 years at death. The remains show osteological evidence of lepromatous leprosy (LL) and this was confirmed by lipid biomarker analysis and ancient DNA (aDNA) analysis, which provided evidence for both multi-copy and single copy loci from the Mycobacterium leprae genome. Genotyping showed the strain belonged to the 3I lineage, but the Great Chesterford isolate appeared to be ancestral to 3I strains found in later medieval cases in southern Britain and also continental Europe. While a number of contemporaneous cases exist, at present, this case of leprosy is the earliest radiocarbon dated case in Britain confirmed by both aDNA and lipid biomarkers. Importantly, Strontium and Oxygen isotope analysis suggest that the individual is likely to have originated from outside Britain. This potentially sheds light on the origins of the strain in Britain and its subsequent spread to other parts of the world, including the Americas where the 3I lineage of M. leprae is still found in some southern states of America. PMID:25970602

Osteological, biomolecular and geochemical examination of an early anglo-saxon case of lepromatous leprosy.

PubMed

Inskip, Sarah A; Taylor, G Michael; Zakrzewski, Sonia R; Mays, Simon A; Pike, Alistair W G; Llewellyn, Gareth; Williams, Christopher M; Lee, Oona Y-C; Wu, Houdini H T; Minnikin, David E; Besra, Gurdyal S; Stewart, Graham R

2015-01-01

We have examined a 5th to 6th century inhumation from Great Chesterford, Essex, UK. The incomplete remains are those of a young male, aged around 21-35 years at death. The remains show osteological evidence of lepromatous leprosy (LL) and this was confirmed by lipid biomarker analysis and ancient DNA (aDNA) analysis, which provided evidence for both multi-copy and single copy loci from the Mycobacterium leprae genome. Genotyping showed the strain belonged to the 3I lineage, but the Great Chesterford isolate appeared to be ancestral to 3I strains found in later medieval cases in southern Britain and also continental Europe. While a number of contemporaneous cases exist, at present, this case of leprosy is the earliest radiocarbon dated case in Britain confirmed by both aDNA and lipid biomarkers. Importantly, Strontium and Oxygen isotope analysis suggest that the individual is likely to have originated from outside Britain. This potentially sheds light on the origins of the strain in Britain and its subsequent spread to other parts of the world, including the Americas where the 3I lineage of M. leprae is still found in some southern states of America.

Challenges to evidence-based health promotion: a case study of a Food Security Coalition in Ontario, Canada.

PubMed

Meyer, Samantha B; Edge, Sara S; Beatty, Jocelyn; Leatherdale, Scott; Perlman, Chris; Dean, Jennifer; Ward, Paul R; Kirkpatrick, Sharon I

2017-03-30

Developing the evidence base for health promotion can be challenging because interventions often have to target competing determinants of health, including social, structural, environmental and political determinants; all of which are difficult to measure and thus evaluate. Drawing on a case study of food insecurity, which refers to inadequate access to food due to financial constraints, we illustrate the challenges faced by community-based organizations in collecting data to form an evidence base for the development and evaluation of collective programmes aimed at addressing food insecurity. Interviews were conducted with members of a multi-stakeholder coalition (n = 22 interviewees; n = 10 organizations) who collectively work to address food insecurity in their community through a range of community-based programmes and services. Member organizations also provided a list of measures currently used to inform programme and service development and evaluation. Data were collected in a city in Southern Ontario, Canada between May and September 2015. Participants identified four barriers to collecting data: Organizational needs and philosophies; concerns surrounding clientele wellbeing and dignity; issues of feasibility; and restrictive requirements imposed by funding bodies. Participants also discussed their previous successes in collecting meaningful data for identifying impact. Our results point to the challenge of generating data suitable for developing and evaluating programmes aimed at broader determinants of health, while maintaining the primary goal of meeting clients' needs. Documenting change at intermediate- and macro-levels would provide evidence for the collective effectiveness of current programmes and services offered. However, appropriate resources need to be invested to allow for scientific evaluation. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Declarative memory and skill-related knowledge: Evidence from a case study of amnesia and implications for theories of memory.

PubMed

Gregory, Emma; McCloskey, Michael; Ovans, Zoe; Landau, Barbara

2016-01-01

Theoretical and empirical studies of memory have long been framed by a distinction between declarative and non-declarative memory. We question the sharpness of the distinction by reporting evidence from amnesic L.S.J., who despite retrograde memory losses in declarative knowledge domains, shows sparing of declarative knowledge related to premorbid skill (e.g., playing an instrument). We previously showed that L.S.J. had severe losses of retrograde declarative knowledge across areas of premorbid expertise (e.g., artists of famous works) and everyday knowledge (e.g., company names for logos). Here we present evidence that L.S.J. has sparing of what we call skill-related declarative knowledge, in four domains in which she had premorbid skill (art, music, aviation, driving). L.S.J.'s pattern of loss and sparing raises questions about the strict separation between classically-defined memory types and aligns with a recent proposal by Stanley and Krakauer [2013. Motor skill depends on knowledge of facts. Frontiers in Human Neuroscience, 7,1-11].

Environmental exposure to BDE47 is associated with increased diabetes prevalence: Evidence from community-based case-control studies and an animal experiment

NASA Astrophysics Data System (ADS)

Zhang, Zhan; Li, Shushu; Liu, Lu; Wang, Li; Xiao, Xue; Sun, Zhenzhen; Wang, Xichen; Wang, Chao; Wang, Meilin; Li, Lei; Xu, Qiujin; Gao, Weimin; Wang, Shou-Lin

2016-06-01

Brominated flame retardants exposure has been associated with increasing trends of diabetes and metabolic disease. Thus, the purpose of this study was to provide evidence of polybrominated diphenyl ethers (PBDEs) exposure in relation to diabetes prevalence and to reveal the potential underlying mechanism in epidemiological and animal studies. All the participants received a questionnaire, health examination, and the detection of 7 PBDE congeners in serum in two independent community-based studies from 2011 to 2012 in China. Male rats were exposed to 2,2’4,4’-tetrabromodiphenyl ether (BDE47) for 8 weeks to explore its effects on glucose homeostasis and potential mechanisms using high-throughput genomic analysis. Among the 7 congeners, BDE47 showed significant high detection rate and concentration in cases in Study I and Study II. Every tertile of BDE47 exposure significantly increased the risk of diabetes prevalence in Study I (Ptrend = 0.001) and Study II (Ptrend < 0.001). Additionally, BDE47 treatments induced hyperglycemia in rats. Furthermore, gene microarray analysis showed that diabetes pathway and three gene ontology terms involved in glucose transport were enriched. The results indicated that environmental exposure to BDE47 was associated with increased diabetes prevalence. However, further prospective and mechanistic studies are needed to the causation of diabetes in relation to BDE47.

EPR: Evidence and fallacy.

PubMed

Nichols, Joseph W; Bae, You Han

2014-09-28

The enhanced permeability and retention (EPR) of nanoparticles in tumors has long stood as one of the fundamental principles of cancer drug delivery, holding the promise of safe, simple and effective therapy. By allowing particles preferential access to tumors by virtue of size and longevity in circulation, EPR provided a neat rationale for the trend toward nano-sized drug carriers. Following the discovery of the phenomenon by Maeda in the mid-1980s, this rationale appeared to be well justified by the flood of evidence from preclinical studies and by the clinical success of Doxil. Clinical outcomes from nano-sized drug delivery systems, however, have indicated that EPR is not as reliable as previously thought. Drug carriers generally fail to provide superior efficacy to free drug systems when tested in clinical trials. A closer look reveals that EPR-dependent drug delivery is complicated by high tumor interstitial fluid pressure (IFP), irregular vascular distribution, and poor blood flow inside tumors. Furthermore, the animal tumor models used to study EPR differ from clinical tumors in several key aspects that seem to make EPR more pronounced than in human patients. On the basis of this evidence, we believe that EPR should only be invoked on a case-by-case basis, when clinical evidence suggests the tumor type is susceptible. Copyright © 2014 Elsevier B.V. All rights reserved.

Constructing a New Theory from Old Ideas and New Evidence

ERIC Educational Resources Information Center

Rhodes, Marjorie; Wellman, Henry

2013-01-01

A central tenet of constructivist models of conceptual development is that children's initial conceptual level constrains how they make sense of new evidence and thus whether exposure to evidence will prompt conceptual change. Yet little experimental evidence directly examines this claim for the case of sustained, fundamental conceptual…

Evidence-based librarianship: an overview.

PubMed

Eldredge, J D

2000-10-01

To demonstrate how the core characteristics of both evidence-based medicine (EBM) and evidence-based health care (EBHC) can be adapted to health sciences librarianship. Narrative review essay involving development of a conceptual framework. The author describes the central features of EBM and EBHC. Following each description of a central feature, the author then suggests ways that this feature applies to health sciences librarianship. First, the decision-making processes of EBM and EBHC are compatible with health sciences librarianship. Second, the EBM and EBHC values of favoring rigorously produced scientific evidence in decision making are congruent with the core values of librarianship. Third, the hierarchical levels of evidence can be applied to librarianship with some modifications. Library researchers currently favor descriptive-survey and case-study methods over systematic reviews, randomized controlled trials, or other higher levels of evidence. The library literature nevertheless contains diverse examples of randomized controlled trials, controlled-comparison studies, and cohort studies conducted by health sciences librarians. Health sciences librarians are confronted with making many practical decisions. Evidence-based librarianship offers a decision-making framework, which integrates the best available research evidence. By employing this framework and the higher levels of research evidence it promotes, health sciences librarians can lay the foundation for more collaborative and scientific endeavors.

Hepatic perivascular epithelioid cell tumor: five case reports and literature review.

PubMed

Liu, Zhen; Qi, Yafei; Wang, Chuanzhuo; Zhang, Xiaobo; Wang, Baosheng

2015-01-01

Perivascular epithelioid cell tumor (PEComa) is a rare tumor. Here, we present data regarding clinical presentations, diagnoses, management, and prognosis of five cases of hepatic PEComa between January 2002 and December 2008. Ultrasonography showed hyperechoic masses in all patients. Precontrast computed tomography (CT) showed that all lesions scanned were heterogeneous in density and were heterogeneously enhanced in arterial phase images. In two cases, magnetic resonance imaging showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images. In enhanced scanning, lesions showed asymmetrical enhancement during arterial phase imaging. All tumors were composed of varying proportions of smooth muscle, adipose tissue, and thick-walled blood vessels, and showed positive immunohistochemical staining for Human Melanoma Black-45. All patients underwent hepatectomy, and there was no evidence of recurrence or metastasis during the follow-up period. Copyright © 2012. Published by Elsevier Taiwan.

To Show Is to Know? The Conceptualization of Evidence and Discourses of Vision in Social Science and Education Research

ERIC Educational Resources Information Center

Baker, Bernadette

2017-01-01

The demand for evidence in particular forms shapes contemporary educational policy, curriculum studies' debates over the politics of knowledge "versus" wisdom, and research into classroom practice. This paper provides a genealogical trace that examines the arbitrary and historical linkage of discourses of vision (especially when vision…

From science to evidence: the testimony on causation in the Bendectin cases.

PubMed

Sanders, J

1993-11-01

Critics of American tort law often question the ability of lay jurors to make factual determinations in trials involving complex scientific evidence. In this article, Professor Sanders attempts to refocus tort reform debate by studying how trial procedures themselves contribute to jurors' inability to properly assess scientific evidence. Professor Sanders' analysis centers on trials involving Bendectin, a drug which plaintiffs have claimed caused birth defects in the children of mothers who took it during pregnancy. After noting that the weight of scientific and federal judicial opinion concludes that plaintiffs cannot establish a causal link between Bendectin use and birth defects by a preponderance of the evidence, Professor Sanders analyzes the transcripts of six Bendectin trials to determine why jury verdicts do not comport with the weight of scientific and judicial opinion. Based on his conclusion that trials are incapable of adequately conveying the weight of scientific opinion to a lay jury, he evaluates the ability of various trial reform proposals to ameliorate this problem. Finally he recommends adopting proposals that would facilitate jurors' understanding of scientific evidence and lead to verdicts consistent with the weight of scientific opinion.

A Domain-Specific System for Representing Knowledge of Both Man-Made Objects and Human Actions. Evidence from a Case with an Association of Deficits

ERIC Educational Resources Information Center

Vannuscorps, Gilles; Pillon, Agnesa

2011-01-01

We report the single-case study of a brain-damaged individual, JJG, presenting with a conceptual deficit and whose knowledge of living things, man-made objects, and actions was assessed. The aim was to seek for empirical evidence pertaining to the issue of how conceptual knowledge of objects, both living things and man-made objects, is related to…

An unusual case showing fatal rupture of a gastric ulcer or gastromalacia? The importance/role of histology for differential diagnosis.

PubMed

De-Giorgio, Fabio; Lodise, Maria; Pascali, Vincenzo L; Spagnolo, Antonio G; d'Aloja, Ernesto; Arena, Vincenzo

2015-01-01

Gastromalacia is the acute autolytic erosion of the gastric wall. It generally occurs postmortem, and it appears as a slimy brownish black region of the wall which occurs principally in the gastric fundus. A 59-year-old woman died in the Emergency Department following a 2-day period of mild abdominal pain, vomiting, and diarrhea. A forensic autopsy was performed which revealed a rupture of the gastric fundus that had caused leakage of gastric content into the abdominal cavity. There was no macroscopic evidence of peritonitis, and the stomach wall adjacent to the rupture site showed marked thinning. The gross appearance was typical of gastromalacia. In contrast, histological observations revealed the presence of an ulcer at the site of perforation and a severe acute inflammatory reaction indicating a robust reaction with an antemortem rupture. © 2014 American Academy of Forensic Sciences.

An Atypical Acidophil Cell Line Tumor Showing Focal Differentiation Toward Both Growth Hormone and Prolactin Cells.

PubMed

Naritaka, Heiji; Kameya, Toru; Sato, Yuichi; Furuhata, Shigeru; Okui, Junichi; Kamiguchi, Yuji; Otani, Mitsuhiro; Toya, Shigeo

1995-01-01

We report a case of giant pituitary adenoma in a child. Computerized tomography (CT) scan revealed a suprasellar extension tumor mass with hydrocephalus. There was no clinical evidence of acromegaly, gigantism, and other hormonal symptoms. Endocrinologic studies showed within normal value of serum growth hormone (GH: 4.2 ng/mL) and slightly increased levels of prolactin (PRL: 78 ng/mL) and other pituitary hormone values were within normal range. On suppression test by bromocryptin, both GH and PRL levels were reduced. Histopathological findings revealed that the tumor consisted of predominantly chromophobic and partly eosinophilic adenoma cells. Immunohistochemical staining detected GH and PRL in a small number of distinctly different adenoma cells, respectively. Nonradioactive in situ hybridization (ISH) also showed GH and PRL mRNA expression in identical immunopositive cells. Electron microscopy (EM) demonstrated adenoma cells with moderate or small numbers of two types of dense granules and without fibrous body which are characteristic of sparsely granulated GH-cell adenomas. The adenoma does not fit into any classification but may be an atypical acidophil cell line tumor showing focal differentiation toward both GH and PRL cells.

[Conservative treatment of nonspecific, chronic low back pain : Evidence of the efficacy - a systematic literature review].

PubMed

Bredow, J; Bloess, K; Oppermann, J; Boese, C K; Löhrer, L; Eysel, P

2016-07-01

Non-specific chronic low back pain (NSCLBP): Which conservative therapy shows an evident effectiveness - A review of the current literature. Our results are based on literature reviews of current randomised control studies, reviews and meta-analysis drawn from the Cochrane Library and Medline-Database between the years 2004 until 2015. German and English Studies were included. We focused on different conservative Treatments of NSCLBP, which are listed at, the NVL-Guidelines. Based on the given evidence we evaluated their effectiveness. As part of the review we identified 4657 Publications, 85 were included in this study. Therapeutic options such as bed rest, TENS, Massage, Spine Supports, Back Schools and Antidepressants showed no evident effectiveness. Injections, NSAR analgesic therapy, Thermotherapy and Opioid analgesic therapy indicated a short-time effectiveness. A long term success (> 6 weeks) however, can not be shown. Only the Movement therapy can, in the summation of the included studies, postulate an evident (Evidence Level I) long-term effect treating NSCLBP. Only a few therapy options indicate a significant evident effectiveness for treating NSCLBP conservatively. At short notice methods such as injection therapy, thermo-therapy and analgesic therapies with NSAR and/or opioids help coping the acute phase. In the long term only movement therapy seems to provide an evident effectiveness. In the case of therapy-refractory NSCLBP a multimodal therapy should be considered.

Extensive cerebral Sinovenous Thrombosis in a 5 Year Old Girl, Following Mild Dehydration. (Case Report and Review of Literature).

PubMed

Ashrafzadeh, Farah; Akhondian, Javad; Beiraghi Toosi, Mehran; Hashemi, Nargess

2013-12-01

Cerebral sinovenous thrombosis (CSVT) in children has rarely been reported in the literature, especially without underlying disorder. It has increasingly been diagnosed due to clinical awareness and sensitive neuroimaging techniques. The aim of this article was to report a case of cerebral sinovenous thrombosis without underlying disorder. We reported a 5 year old girl, presented with severe headache and seizure. She had a history of fever and diarrhea before the onset of headache. Neuroimaging showed evidence of CSVT on MRI and magnetic resonance venography. Investigations showed no inherited thrombophilia. The patient was treated with low molecular weight heparin (LMWH) which continued by warfarin. This case illustrated severe complications of dehydration in pediatrics without any evidence of underlying disorders.

Status of Single-Case Research Designs for Evidence-Based Practice

ERIC Educational Resources Information Center

Matson, Johnny L.; Turygin, Nicole C.; Beighley, Jennifer; Matson, Michael L.

2012-01-01

The single-case research design has become a paradoxical methodology in the applied sciences. While various experimental designs have been in place for over 50 years, there has not been wide acceptance of single-case methodology outside clinical and school psychology, or the field of special education. These methods were developed in the U.S.A.,…

Contrasting Medical and Legal Standards of Evidence: A Precision Medicine Case Study

PubMed Central

Marchant, Gary E.; Scheckel, Kathryn; Campos-Outcalt, Doug

2016-01-01

Precis As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system’s expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed. PMID:27256135

Contrasting Medical and Legal Standards of Evidence: A Precision Medicine Case Study.

PubMed

Marchant, Gary E; Scheckel, Kathryn; Campos-Outcalt, Doug

2016-03-01

As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system's expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed. © 2016 American Society of Law, Medicine & Ethics.

In Idiopathic Calcium Oxalate Stone Formers, Unattached Stones Show Evidence of Having Originated as Attached Stones on Randall’s Plaque

PubMed Central

Miller, Nicole L.; Williams, James C.; Evan, Andrew P.; Bledsoe, Sharon B.; Coe, Fredric L.; Worcester, Elaine M.; Munch, Larry C.; Handa, Shelly E.; Lingeman, James E.

2009-01-01

Objective To analyze the structure and composition of unattached stones in idiopathic calcium oxalate stone formers (ICSF) and compare them to attached stones from the same cohort in order to investigate whether more than one pathogenic mechanism exists for stone formation in ICSF. Patients and methods ICSF undergoing percutaneous nephrolithotomy or ureteroscopy for treatment of nephrolithiasis were consented for this study. All accessible renal papillae were endoscopically imaged using a digital endoscope. All stones were removed and determined by the operating surgeon to be attached or unattached to the underlying papilla. Micro-computed tomography (micro-CT), which provides three-dimensional analysis of entire stones, was used to compare the structure and composition of attached versus unattached stones. Results Of 115 stones collected from 9 patients (12 renal units), only 25 stones were found not to be attached to renal papillae. Of these 25 stones, 4 were lost and 12 showed definite morphological evidence of having been attached to tissue, probably having been knocked off of papillae during access. For the remaining 9 stones, micro-CT analysis revealed at least one internal region of calcium phosphate within each of these unattached calcium oxalate (CaOx) stones. That is, the internal structure of the unattached stones is consistent with their having originated attached to RP, and then having become detached but retained in the kidney, with new layers of CaOx eventually covering the original attachment site. Conclusions Micro CT analysis supports the hypothesis that in ICSF, both attached and unattached stones occur as a result of a common pathogenic mechanism. That is, in this type of stone former, CaOx stones—even those not showing morphology that betrays attachment—all originate attached to interstitial plaque on the renal papilla. PMID:19549258

Laryngospasm during emergency department ketamine sedation: a case-control study.

PubMed

Green, Steven M; Roback, Mark G; Krauss, Baruch

2010-11-01

The objective of this study was to assess predictors of emergency department (ED) ketamine-associated laryngospasm using case-control techniques. We performed a matched case-control analysis of a sample of 8282 ED ketamine sedations (including 22 occurrences of laryngospasm) assembled from 32 prior published series. We sequentially studied the association of each of 7 clinical variables with laryngospasm by assigning 4 controls to each case while matching for the remaining 6 variables. We then used univariate statistics and conditional logistic regression to analyze the matched sets. We found no statistical association of age, dose, oropharyngeal procedure, underlying physical illness, route, or coadministered anticholinergics with laryngospasm. Coadministered benzodiazepines showed a borderline association in the multivariate but not univariate analysis that was considered anomalous. This case-control analysis of the largest available sample of ED ketamine-associated laryngospasm did not demonstrate evidence of association with age, dose, or other clinical factors. Such laryngospasm seems to be idiosyncratic, and accordingly, clinicians administering ketamine must be prepared for its rapid identification and management. Given no evidence that they decrease the risk of laryngospasm, coadministered anticholinergics seem unnecessary.

Studies Using an in Vitro Model Show Evidence of Involvement of Epithelial-Mesenchymal Transition of Human Endometrial Epithelial Cells in Human Embryo Implantation*

PubMed Central

Uchida, Hiroshi; Maruyama, Tetsuo; Nishikawa-Uchida, Sayaka; Oda, Hideyuki; Miyazaki, Kaoru; Yamasaki, Akiko; Yoshimura, Yasunori

2012-01-01

Human embryo implantation is a critical multistep process consisting of embryo apposition/adhesion, followed by penetration and invasion. Through embryo penetration, the endometrial epithelial cell barrier is disrupted and remodeled by an unknown mechanism. We have previously developed an in vitro model for human embryo implantation employing the human choriocarcinoma cell line JAR and the human endometrial adenocarcinoma cell line Ishikawa. Using this model we have shown that stimulation with ovarian steroid hormones (17β-estradiol and progesterone, E2P4) and suberoylanilide hydroxamic acid (SAHA), a histone deacetylase inhibitor, enhances the attachment and adhesion of JAR spheroids to Ishikawa. In the present study we showed that the attachment and adhesion of JAR spheroids and treatment with E2P4 or SAHA individually induce the epithelial-mesenchymal transition (EMT) in Ishikawa cells. This was evident by up-regulation of N-cadherin and vimentin, a mesenchymal cell marker, and concomitant down-regulation of E-cadherin in Ishikawa cells. Stimulation with E2P4 or SAHA accelerated Ishikawa cell motility, increased JAR spheroid outgrowth, and enhanced the unique redistribution of N-cadherin, which was most prominent in proximity to the adhered spheroids. Moreover, an N-cadherin functional blocking antibody attenuated all events but not JAR spheroid adhesion. These results collectively provide evidence suggesting that E2P4- and implanting embryo-induced EMT of endometrial epithelial cells may play a pivotal role in the subsequent processes of human embryo implantation with functional control of N-cadherin. PMID:22174415

Demonstration Show That Promotes and Assesses Conceptual Understanding Using the Structure of Drama

ERIC Educational Resources Information Center

Walter Kerby, Holly; DeKorver, Brittland K.; Cantor, Joanne; Weiland, Marcia J.; Babiarz, Christopher L.

2016-01-01

Demonstration shows are a widely used form of Informal Science Education. While there is evidence that the shows are highly enjoyable, little work has been done to investigate the cognitive impacts of these shows. This article describes the development and production of "The Boiling Point," a show that uses the structure of a play to…

[A Case of Left Vertebral Artery Aneurysm Showing Evoked Potentials on Bilateral Electrode by the Left Vagus Nerve Stimulation to Electromyographic Tracheal Tube].

PubMed

Kadoya, Tatsuo; Uehara, Hirofumi; Yamamoto, Toshinori; Shiraishi, Munehiro; Kinoshita, Yuki; Joyashiki, Takeshi; Enokida, Kengo

2016-02-01

Previously, we reported a case of brainstem cavernous hemangioma showing false positive responses to electromyographic tracheal tube (EMG tube). We concluded that the cause was spontaneous respiration accompanied by vocal cord movement. We report a case of left vertebral artery aneurysm showing evoked potentials on bilateral electrodes by the left vagus nerve stimulation to EMG tube. An 82-year-old woman underwent clipping of a left unruptured vertebral artery-posterior inferior cerebellar artery aneurysm. General anesthesia was induced with remifentanil, propofol and suxamethonium, and was maintained with oxygen, air, remifentanil and propofol. We monitored somatosensory evoked potentials, motor evoked potentials, and electromyogram of the vocal cord. When the manipulation reached brainstem and the instrument touched the left vagus nerve, evoked potentials appeared on bilateral electrodes. EMG tube is equipped with two electrodes on both sides. We concluded that the left vagus nerve stimulation generated evoked potentials of the left laryngeal muscles, and they were simultaneously detected as potential difference between two electrodes on both sides. EMG tube is used to identify the vagus nerve. However, it is necessary to bear in mind that each vagus nerve stimulation inevitably generates evoked potentials on bilateral electrodes.

Forensic botany: using plant evidence to aid in forensic death investigation.

PubMed

Miller Coyle, Heather; Lee, Cheng-Lung; Lin, Wen-Yu; Lee, Henry C; Palmbach, Timothy M

2005-08-01

Forensic botany is still an under-utilized resource in forensic casework, although it has been used on occasion. It is an area of specialty science that could include traditional botanical classification of species, DNA, or materials evidence (trace and transfer evidence), crime mapping or geo-sourcing, all dependent on the specific case application under consideration. Critical to the evaluation of plant evidence is careful collection, documentation, and preservation for later scientific analysis. This article reviews proper procedures and recent cases where botanical evidence played a role in establishing either manner or time of death. Plant evidence can be useful for determining if a death was due to an accident, suicide, or homicide, or what time of year burial may have taken place. In addition, plant evidence can be used to determine if a crime scene is a primary or secondary scene and to locate missing bodies.

Genotypic analysis of the earliest known prehistoric case of tuberculosis in Britain.

PubMed

Taylor, G Michael; Young, Douglas B; Mays, Simon A

2005-05-01

The earliest known case of human tuberculosis in Britain dates to the middle period of the Iron Age, approximately 2,200 years before present. Bone lesions on the spine of a male skeleton excavated at Tarrant Hinton in Dorset, United Kingdom, show evidence of Pott's disease and are supported by molecular evidence of Mycobacterium tuberculosis complex DNA amplified by IS6110 PCR (19). In the present study, we used a further series of sensitive PCR methods to confirm the diagnosis of tuberculosis and to determine the genotype of the infecting strain. These tests demonstrated that this individual was infected with a strain of M. tuberculosis rather than Mycobacterium bovis. The strain had undergone the tuberculosis D1 deletion affecting the mmpS6 and mmpL6 genes and can therefore be identified as a member of the family of "modern" M. tuberculosis isolates. All evidence obtained was consistent with surviving mycobacterial DNA being highly fragmented in this case.

Evidence flowers: An innovative, visual method of presenting "best evidence" summaries to health professional and lay audiences.

PubMed

Babatunde, O O; Tan, V; Jordan, J L; Dziedzic, K; Chew-Graham, C A; Jinks, C; Protheroe, J; van der Windt, D A

2018-06-01

Barriers to dissemination and engagement with evidence pose a threat to implementing evidence-based medicine. Understanding, retention, and recall can be enhanced by visual presentation of information. The aim of this exploratory research was to develop and evaluate the accessibility and acceptability of visual summaries for presenting evidence syntheses with multiple exposures or outcomes to professional and lay audiences. "Evidence flowers" were developed as a visual method of presenting data from 4 case scenarios: 2 complex evidence syntheses with multiple outcomes, Cochrane reviews, and clinical guidelines. Petals of evidence flowers were coloured according to the GRADE evidence rating system to display key findings and recommendations from the evidence summaries. Application of evidence flowers was observed during stakeholder workshops. Evaluation and feedback were conducted via questionnaires and informal interviews. Feedback from stakeholders on the evidence flowers collected from workshops, questionnaires, and interviews was encouraging and helpful for refining the design of the flowers. Comments were made on the content and design of the flowers, as well as the usability and potential for displaying different types of evidence. Evidence flowers are a novel and visually stimulating method for presenting research evidence from evidence syntheses with multiple exposures or outcomes, Cochrane reviews, and clinical guidelines. To promote access and engagement with research evidence, evidence flowers may be used in conjunction with other evidence synthesis products, such as (lay) summaries, evidence inventories, rapid reviews, and clinical guidelines. Additional research on potential adaptations and applications of the evidence flowers may further bridge the gap between research evidence and clinical practice. Copyright © 2018 John Wiley & Sons, Ltd.

Millennial-scale isotope records from a wide-ranging predator show evidence of recent human impact to oceanic food webs

PubMed Central

Wiley, Anne E.; Ostrom, Peggy H.; Welch, Andreanna J.; Fleischer, Robert C.; Gandhi, Hasand; Southon, John R.; Stafford, Thomas W.; Penniman, Jay F.; Hu, Darcy; Duvall, Fern P.; James, Helen F.

2013-01-01

Human exploitation of marine ecosystems is more recent in oceanic than near shore regions, yet our understanding of human impacts on oceanic food webs is comparatively poor. Few records of species that live beyond the continental shelves date back more than 60 y, and the sheer size of oceanic regions makes their food webs difficult to study, even in modern times. Here, we use stable carbon and nitrogen isotopes to study the foraging history of a generalist, oceanic predator, the Hawaiian petrel (Pterodroma sandwichensis), which ranges broadly in the Pacific from the equator to near the Aleutian Islands. Our isotope records from modern and ancient, radiocarbon-dated bones provide evidence of over 3,000 y of dietary stasis followed by a decline of ca. 1.8‰ in δ15N over the past 100 y. Fishery-induced trophic decline is the most likely explanation for this sudden shift, which occurs in genetically distinct populations with disparate foraging locations. Our isotope records also show that coincident with the apparent decline in trophic level, foraging segregation among petrel populations decreased markedly. Because variation in the diet of generalist predators can reflect changing availability of their prey, a foraging shift in wide-ranging Hawaiian petrel populations suggests a relatively rapid change in the composition of oceanic food webs in the Northeast Pacific. Understanding and mitigating widespread shifts in prey availability may be a critical step in the conservation of endangered marine predators such as the Hawaiian petrel. PMID:23671094

Millennial-scale isotope records from a wide-ranging predator show evidence of recent human impact to oceanic food webs.

PubMed

Wiley, Anne E; Ostrom, Peggy H; Welch, Andreanna J; Fleischer, Robert C; Gandhi, Hasand; Southon, John R; Stafford, Thomas W; Penniman, Jay F; Hu, Darcy; Duvall, Fern P; James, Helen F

2013-05-28

Human exploitation of marine ecosystems is more recent in oceanic than near shore regions, yet our understanding of human impacts on oceanic food webs is comparatively poor. Few records of species that live beyond the continental shelves date back more than 60 y, and the sheer size of oceanic regions makes their food webs difficult to study, even in modern times. Here, we use stable carbon and nitrogen isotopes to study the foraging history of a generalist, oceanic predator, the Hawaiian petrel (Pterodroma sandwichensis), which ranges broadly in the Pacific from the equator to near the Aleutian Islands. Our isotope records from modern and ancient, radiocarbon-dated bones provide evidence of over 3,000 y of dietary stasis followed by a decline of ca. 1.8‰ in δ(15)N over the past 100 y. Fishery-induced trophic decline is the most likely explanation for this sudden shift, which occurs in genetically distinct populations with disparate foraging locations. Our isotope records also show that coincident with the apparent decline in trophic level, foraging segregation among petrel populations decreased markedly. Because variation in the diet of generalist predators can reflect changing availability of their prey, a foraging shift in wide-ranging Hawaiian petrel populations suggests a relatively rapid change in the composition of oceanic food webs in the Northeast Pacific. Understanding and mitigating widespread shifts in prey availability may be a critical step in the conservation of endangered marine predators such as the Hawaiian petrel.

Building capacity for evidence informed decision making in public health: a case study of organizational change

PubMed Central

2012-01-01

Background Core competencies for public health in Canada require proficiency in evidence informed decision making (EIDM). However, decision makers often lack access to information, many workers lack knowledge and skills to conduct systematic literature reviews, and public health settings typically lack infrastructure to support EIDM activities. This research was conducted to explore and describe critical factors and dynamics in the early implementation of one public health unit's strategic initiative to develop capacity to make EIDM standard practice. Methods This qualitative case study was conducted in one public health unit in Ontario, Canada between 2008 and 2010. In-depth information was gathered from two sets of semi-structured interviews and focus groups (n = 27) with 70 members of the health unit, and through a review of 137 documents. Thematic analysis was used to code the key informant and document data. Results The critical factors and dynamics for building EIDM capacity at an organizational level included: clear vision and strong leadership, workforce and skills development, ability to access research (library services), fiscal investments, acquisition and development of technological resources, a knowledge management strategy, effective communication, a receptive organizational culture, and a focus on change management. Conclusion With leadership, planning, commitment and substantial investments, a public health department has made significant progress, within the first two years of a 10-year initiative, towards achieving its goal of becoming an evidence informed decision making organization. PMID:22348688

Identification case of evidence in timber tracing of Pinus radiate, using high-resolution melting (HRM) analysis.

PubMed

Solano, Jaime; Anabalón, Leonardo; Encina, Francisco

2016-03-01

Fast, accurate detection of plant species and their hybrids using molecular tools will facilitate assessment and monitoring of timber tracing evidence. In this study the origin of unknown pine samples is determined for a case of timber theft in the region of Araucania southern Chile. We evaluate the utility of the trnL marker region for species identification applied to pine wood based on High Resolution Melting. This efficient tracing methods can be incorporated into forestry applications such as certification of origin. The object of this work was genotype identification using high-resolution melting (HRM) and trnL approaches for Pinus radiata (Don) in timber tracing evidence. Our results indicate that trnL is a very sensitive marker for delimiting species and HRM analysis was used successfully for genotyping Pinus samples for timber tracing purposes. Genotyping samples by HRM analysis with the trnL1 approach allowed us to differentiate two wood samples from the Pinaceae family: Pinus radiata (Don) and Pseudotsuga menziesii (Mirb.) Franco. The same approach with Pinus trnL wood was not able to discriminate between samples of Pinus radiata, indicating that the samples were genetically indistinguishable, possibly because they have the same genotype at this locus. Timber tracing with HRM analysis is expected to contribute to future forest certification schemes, control of illegal trading, and molecular traceability of Pinus spp. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Four Cases of Pediatric Photokeratitis Present to the Emergency Department After Watching the Same Theater Show.

PubMed

Mangan, Mehmet Serhat; Arıcı, Ceyhun; Atalay, Eray; Tanyıldız, Burak; Oruçoğlu, Faik

2015-10-01

We report four consecutive cases of photokeratitis that presented to the emergency department, interestingly after having watched the same theatre performance in the same school. The patients' ages (3 male, 1 female) ranged from 9 to 13 years. All patients presented with similar complaints consisting of pain, tearing, foreign body sensation, photophobia and blurred vision in both eyes. Patients reported watching a theatre performance in the same school approximately 4 hours before symptom onset. On slit-lamp examination, conjunctival injection and corneal punctate epithelial erosions were observed in the interpalpebral zone in both eyes. On fundus examination, no pathology was observed in the vitreous, posterior pole or peripheral retina. All cases were treated with topical antibiotics and lubricant eye drops. Corneas were clear two days later in the control visit. In this case report, exposure to ultraviolet light from high-power lamps used in the theatre was proposed as a possible cause of corneal epithelial cell damage and subsequent photokeratitis.

Epidemiological evidence in forensic pharmacovigilance.

PubMed

Persaud, Nav; Healy, David

2012-01-01

Until recently epidemiological evidence was not regarded as helpful in determining cause and effect. It generated associations that then had to be explained in terms of bio-mechanisms and applied to individual patients. A series of legal cases surrounding possible birth defects triggered by doxylamine (Bendectin) and connective tissue disorders linked to breast implants made it clear that in some instances epidemiological evidence might have a more important role, but the pendulum swung too far so that epidemiological evidence has in recent decades been given an unwarranted primacy, partly perhaps because it suits the interests of certain stakeholders. Older and more recent epidemiological studies on doxylamine and other antihistamines are reviewed to bring out the ambiguities and pitfalls of an undue reliance on epidemiological studies.

Development of Evidence-Based Health Policy Documents in Developing Countries: A Case of Iran

PubMed Central

Imani-Nasab, Mohammad Hasan; Seyedin, Hesam; Majdzadeh, Reza; Yazdizadeh, Bahareh; Salehi, Masoud

2014-01-01

Background: Evidence-based policy documents that are well developed by senior civil servants and are timely available can reduce the barriers to evidence utilization by health policy makers. This study examined the barriers and facilitators in developing evidence-based health policy documents from the perspective of their producers in a developing country. Methods: In a qualitative study with a framework analysis approach, we conducted semi-structured interviews using purposive and snowball sampling. A qualitative analysis software (MAXQDA-10) was used to apply the codes and manage the data. This study was theory-based and the results were compared to exploratory studies about the factors influencing evidence-based health policymaking. Results: 18 codes and three main themes of behavioral, normative, and control beliefs were identified. Factors that influence the development of evidence-based policy documents were identified by the participants: behavioral beliefs included quality of policy documents, use of resources, knowledge and innovation, being time-consuming and contextualization; normative beliefs included policy authorities, policymakers, policy administrators, and co-workers; and control beliefs included recruitment policy, performance management, empowerment, management stability, physical environment, access to evidence, policy making process, and effect of other factors. Conclusion: Most of the cited barriers to the development of evidence-based policy were related to control beliefs, i.e. barriers at the organizational and health system levels. This study identified the factors that influence the development of evidence-based policy documents based on the components of the theory of planned behavior. But in exploratory studies on evidence utilization by health policymakers, the identified factors were only related to control behaviors. This suggests that the theoretical approach may be preferable to the exploratory approach in identifying the barriers

Development of evidence-based health policy documents in developing countries: a case of Iran.

PubMed

Imani-Nasab, Mohammad Hasan; Seyedin, Hesam; Majdzadeh, Reza; Yazdizadeh, Bahareh; Salehi, Masoud

2014-02-07

Evidence-based policy documents that are well developed by senior civil servants and are timely available can reduce the barriers to evidence utilization by health policy makers. This study examined the barriers and facilitators in developing evidence-based health policy documents from the perspective of their producers in a developing country. In a qualitative study with a framework analysis approach, we conducted semi-structured interviews using purposive and snowball sampling. A qualitative analysis software (MAXQDA-10) was used to apply the codes and manage the data. This study was theory-based and the results were compared to exploratory studies about the factors influencing evidence-based health policy-making. 18 codes and three main themes of behavioral, normative, and control beliefs were identified. Factors that influence the development of evidence-based policy documents were identified by the participants: behavioral beliefs included quality of policy documents, use of resources, knowledge and innovation, being time-consuming and contextualization; normative beliefs included policy authorities, policymakers, policy administrators, and co-workers; and control beliefs included recruitment policy, performance management, empowerment, management stability, physical environment, access to evidence, policy making process, and effect of other factors. Most of the cited barriers to the development of evidence-based policy were related to control beliefs, i.e. barriers at the organizational and health system levels. This study identified the factors that influence the development of evidence-based policy documents based on the components of the theory of planned behavior. But in exploratory studies on evidence utilization by health policymakers, the identified factors were only related to control behaviors. This suggests that the theoretical approach may be preferable to the exploratory approach in identifying the barriers and facilitators of a behavior.

36 CFR 14.24 - Showing as to citizenship required.

Code of Federal Regulations, 2011 CFR

2011-07-01

... INTERIOR RIGHTS-OF-WAY Procedures § 14.24 Showing as to citizenship required. (a) Individuals. An individual applicant applying for a right-of-way under any right-of-way act, except the Act of March 3, 1891... marital status is not required. In other cases, a married woman or widow must show the date of her...

36 CFR 14.24 - Showing as to citizenship required.

Code of Federal Regulations, 2014 CFR

2014-07-01

... INTERIOR RIGHTS-OF-WAY Procedures § 14.24 Showing as to citizenship required. (a) Individuals. An individual applicant applying for a right-of-way under any right-of-way act, except the Act of March 3, 1891... marital status is not required. In other cases, a married woman or widow must show the date of her...

36 CFR 14.24 - Showing as to citizenship required.

Code of Federal Regulations, 2013 CFR

2013-07-01

... INTERIOR RIGHTS-OF-WAY Procedures § 14.24 Showing as to citizenship required. (a) Individuals. An individual applicant applying for a right-of-way under any right-of-way act, except the Act of March 3, 1891... marital status is not required. In other cases, a married woman or widow must show the date of her...

36 CFR 14.24 - Showing as to citizenship required.

Code of Federal Regulations, 2012 CFR

2012-07-01

... INTERIOR RIGHTS-OF-WAY Procedures § 14.24 Showing as to citizenship required. (a) Individuals. An individual applicant applying for a right-of-way under any right-of-way act, except the Act of March 3, 1891... marital status is not required. In other cases, a married woman or widow must show the date of her...

Effectiveness of case management for homeless persons: a systematic review.

PubMed

de Vet, Renée; van Luijtelaar, Maurice J A; Brilleslijper-Kater, Sonja N; Vanderplasschen, Wouter; Beijersbergen, Mariëlle D; Wolf, Judith R L M

2013-10-01

We reviewed the literature on standard case management (SCM), intensive case management (ICM), assertive community treatment (ACT), and critical time intervention (CTI) for homeless adults. We searched databases for peer-reviewed English articles published from 1985 to 2011 and found 21 randomized controlled trials or quasi-experimental studies comparing case management to other services. We found little evidence for the effectiveness of ICM. SCM improved housing stability, reduced substance use, and removed employment barriers for substance users. ACT improved housing stability and was cost-effective for mentally ill and dually diagnosed persons. CTI showed promise for housing, psychopathology, and substance use and was cost-effective for mentally ill persons. More research is needed on how case management can most effectively support rapid-rehousing approaches to homelessness.

A prospective multiple case study of the impact of emerging scientific evidence on established colorectal cancer screening programs: a study protocol.

PubMed

Geddie, Hannah; Dobrow, Mark J; Hoch, Jeffrey S; Rabeneck, Linda

2012-06-01

Health-policy decision making is a complex and dynamic process, for which strong evidentiary support is required. This includes scientifically produced research, as well as information that relates to the context in which the decision takes place. Unlike scientific evidence, this "contextual evidence" is highly variable and often includes information that is not scientifically produced, drawn from sources such as political judgement, program management experience and knowledge, or public values. As the policy decision-making process is variable and difficult to evaluate, it is often unclear how this heterogeneous evidence is identified and incorporated into "evidence-based policy" decisions. Population-based colorectal cancer screening poses an ideal context in which to examine these issues. In Canada, colorectal cancer screening programs have been established in several provinces over the past five years, based on the fecal occult blood test (FOBT) or the fecal immunochemical test. However, as these programs develop, new scientific evidence for screening continues to emerge. Recently published randomized controlled trials suggest that the use of flexible sigmoidoscopy for population-based screening may pose a greater reduction in mortality than the FOBT. This raises the important question of how policy makers will address this evidence, given that screening programs are being established or are already in place. This study will examine these issues prospectively and will focus on how policy makers monitor emerging scientific evidence and how both scientific and contextual evidence are identified and applied for decisions about health system improvement. This study will employ a prospective multiple case study design, involving participants from Ontario, Alberta, Manitoba, Nova Scotia, and Quebec. In each province, data will be collected via document analysis and key informant interviews. Documents will include policy briefs, reports, meeting minutes, media

How Do Dentists Understand Evidence and Adopt It in Practice?

ERIC Educational Resources Information Center

Sbaraini, Alexandra; Carter, Stacy M.; Evans, R. Wendell

2012-01-01

Although there is now a large evidence-based dentistry literature, previous investigators have shown that dentists often consider research evidence irrelevant to their practice. To understand why this is the case, we conducted a qualitative study. Objective: Our aim was to identify how dentists define evidence and how they adopt it in practice.…

Permanent global amnesia: case report.

PubMed

Bertolucci, Paulo H F; Siviero, Marilena O; Bueno, Orlando F A; Okamoto, Ivan H; Camargo, Candida H P; Santos, Ruth F

2004-04-01

To present a case of permanent global amnesia related to hippocampal damage. Permanent global amnesia is a very rare condition of unknown etiology; lesions restricted to the hippocampus are uncommon, which hinders investigations of this pattern of memory loss. This case is unusually well documented, as the patient underwent extensive neuropsychological evaluations. A cheerful right-handed, 83-year-old retired electrician was first evaluated in 1990 for progressive difficulty in learning new information and in recalling events over the preceding 3-4 years. Tests over the next 5 years showed that the impairment was confined to episodic declarative memory. New verbal information could be stored only in episodic memory in a restricted manner, limited by short-term memory capacity. A relatively mild retrograde amnesia was detected. Semantic and implicit memory was spared, as were other functions evaluated. The patient's language and executive function were strikingly efficient. Magnetic resonance imaging of the brain showed bilateral atrophy of the hippocampi and amygdalae, ruling out conditions such as tumour growth. A diagnosis of permanent global amnesia was made. In the ensuing years, the retrograde amnesia worsened, but no new deficits were identified. This case, the first with a detailed cognitive examination, is evidence of a relatively pure hippocampal pattern for memory loss in permanent global amnesia.

Using the case study teaching method to promote college students' critical thinking skills

NASA Astrophysics Data System (ADS)

Terry, David Richard

2007-12-01

The purpose of this study was to examine general and domain-specific critical thinking skills in college students, particularly ways in which these skills might be increased through the use of the case study method of teaching. General critical thinking skills were measured using the Watson-Glaser Critical Thinking Appraisal (WGCTA) Short Form, a forty-item paper-and-pencil test designed to measure important abilities involved in critical thinking, including inference, recognition of assumptions, deduction, interpretation, and evaluation of arguments. The ability to identify claims and support those claims with evidence is also an important aspect of critical thinking. I developed a new instrument, the Claim and Evidence Assessment Tool (CEAT), to measure these skills in a domain-specific manner. Forty undergraduate students in a general science course for non-science majors at a small two-year college in the northeastern United States experienced positive changes in general critical thinking according to results obtained using the Watson-Glaser Critical Thinking Appraisal (WGCTA). In addition, the students showed cumulative improvement in their ability to identify claims and evidence, as measured by the Claim and Evidence Assessment Tool (CEAT). Mean score on the WGCTA improved from 22.15 +/- 4.59 to 23.48 +/- 4.24 (out of 40), and the mean CEAT score increased from 14.98 +/- 3.28 to 16.20 +/- 3.08 (out of 24). These increases were modest but statistically and educationally significant. No differences in claim and evidence identification were found between students who learned about specific biology topics using the case study method of instruction and those who were engaged in more traditional instruction, and the students' ability to identify claims and evidence and their factual knowledge showed little if any correlation. The results of this research were inconclusive regarding whether or not the case study teaching method promotes college students' general or

Effectiveness of Different Models of Case Management for Substance-Abusing Populations

PubMed Central

Vanderplasschen, Wouter; Wolf, Judith; Rapp, Richard C.; Broekaert, Eric

2007-01-01

Case management has been implemented in substance abuse treatment to improve (cost-) effectiveness, but controversy exists about its potential to realize this objective. A systematic and comprehensive review of peer-reviewed articles (n = 48) published between 1993 and 2003 is presented, focusing on the effects of different models of case management among various substance-abusing populations. Results show that several studies have reported positive effects, but only some randomized and controlled trials have demonstrated the effectiveness of case management compared with other interventions. Longitudinal effects of this intervention remain unclear. Although no compelling evidence was found for the effectiveness of case management, some evidence is available about the (differential) effectiveness of intensive case management and assertive community treatment for homeless and dually-diagnosed substance abusers. Strengths-based and generalist case management have proven to be relatively effective for substance abusers in general. Most positive effects concern reduced use of inpatient services and increased utilization of community-based services, prolonged treatment retention, improved quality of life, and high client satisfaction. Outcomes concerning drug use and psychosocial functioning are less consistent, but seem to be mediated by retention in treatment and case management. Further research is required to learn more about the extent of the effects of this intervention, how long these are sustained and what specific elements cause particular outcomes. PMID:17523588

25-hydroxyvitamin D and breast cancer, colorectal cancer, and colorectal adenomas: case-control versus nested case-control studies.

PubMed

Grant, William B

2015-02-01

Existing literature includes concerns regarding reliability of case-control studies of breast cancer incidence with respect to 25-hydroxyvitamin D (25(OH)D) concentrations. For breast cancer, only case-control studies consistently find inverse correlations between 25(OH)D and breast cancer. However, for colorectal cancer, nested case-control studies find significant inverse correlations with respect to 25(OH)D concentrations at baseline for mean follow-up times of 7 years. This is a review of results currently existing in literature. I provide evidence that 25(OH)D concentration values are only useful for short follow-up times for breast cancer since it develops rapidly. To support the robust nature of breast cancer case-control studies, I show that results from 11 studies from seven countries align in a robust power-law fit to the odds ratio versus mean 25(OH)D concentrations. Case-control studies of breast cancer incidence rates provide reliable results. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

From Usability Engineering to Evidence-based Usability in Health IT.

PubMed

Marcilly, Romaric; Peute, Linda; Beuscart-Zephir, Marie-Catherine

2016-01-01

Usability is a critical factor in the acceptance, safe use, and success of health IT. The User-Centred Design process is widely promoted to improve usability. However, this traditional case by case approach that is rooted in the sound understanding of users' needs is not sufficient to improve technologies' usability and prevent usability-induced use-errors that may harm patients. It should be enriched with empirical evidence. This evidence is on design elements (what are the most valuable design principles, and the worst usability mistakes), and on the usability evaluation methods (which combination of methods is most suitable in which context). To achieve this evidence, several steps must be fulfilled and challenges must be overcome. Some attempts to search evidence for designing elements of health IT and for usability evaluation methods exist and are summarized. A concrete instance of evidence-based usability design principles for medication-related alerting systems is briefly described.

Evidence-based librarianship: an overview

PubMed Central

Eldredge, Jonathan D.

2000-01-01

Objective: To demonstrate how the core characteristics of both evidence-based medicine (EBM) and evidence-based health care (EBHC) can be adapted to health sciences librarianship. Method: Narrative review essay involving development of a conceptual framework. The author describes the central features of EBM and EBHC. Following each description of a central feature, the author then suggests ways that this feature applies to health sciences librarianship. Results: First, the decision-making processes of EBM and EBHC are compatible with health sciences librarianship. Second, the EBM and EBHC values of favoring rigorously produced scientific evidence in decision making are congruent with the core values of librarianship. Third, the hierarchical levels of evidence can be applied to librarianship with some modifications. Library researchers currently favor descriptive-survey and case-study methods over systematic reviews, randomized controlled trials, or other higher levels of evidence. The library literature nevertheless contains diverse examples of randomized controlled trials, controlled-comparison studies, and cohort studies conducted by health sciences librarians. Conclusions: Health sciences librarians are confronted with making many practical decisions. Evidence-based librarianship offers a decision-making framework, which integrates the best available research evidence. By employing this framework and the higher levels of research evidence it promotes, health sciences librarians can lay the foundation for more collaborative and scientific endeavors. PMID:11055296

Observational Evidence for Atoms.

ERIC Educational Resources Information Center

Jones, Edwin R., Jr.; Childers, Richard L.

1984-01-01

Discusses the development of the concept of atomicity and some of the many which can be used to establish its validity. Chemical evidence, evidence from crystals, Faraday's law of electrolysis, and Avogadro's number are among the areas which show how the concept originally developed from a purely philosophical idea. (JN)

The Impact of Osseous Malalignment and Realignment Procedures in Knee Ligament Surgery: A Systematic Review of the Clinical Evidence.

PubMed

Tischer, Thomas; Paul, Jochen; Pape, Dietrich; Hirschmann, Michael T; Imhoff, Andreas B; Hinterwimmer, Stefan; Feucht, Matthias J

2017-03-01

Failure rates of knee ligament surgery may be high, and the impact of osseous alignment on surgical outcome remains controversial. Basic science studies have demonstrated that osseous malalignment can negatively affect ligament strain and that realignment procedures may improve knee joint stability. The purpose of this review was to summarize the clinical evidence concerning the impact of osseous malalignment and realignment procedures in knee ligament surgery. The hypotheses were that lower extremity malalignment would be an important contributor to knee ligament surgery failure and that realignment surgery would contribute to increased knee stability and improved outcome in select cases. Systematic review; Level of evidence, 4. According to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic electronic search of the PubMed database was performed in November 2015 to identify clinical studies investigating (A) the influence of osseous alignment on postoperative stability and/or failure rates after knee ligament surgery and (B) the impact of osseous realignment procedures in unstable knees with or without additional knee ligament surgery on postoperative knee function and stability. Methodological quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and the Coleman Methodological Score (CMS). Of the 1466 potentially relevant articles, 28 studies fulfilled the inclusion and exclusion criteria. Average study quality was poor (CMS, 40). For part A, studies showed increased rerupture rate after anterior cruciate ligament (ACL) replacement in patients with increased tibial slope. Concerning the posterior cruciate ligament (PCL)/posterolateral corner (PLC)/lateral collateral ligament (LCL), varus malalignment was considered a significant risk factor for failure. For part B, studies showed decreased anterior tibial translation after slope-decreasing high tibial

The Impact of Osseous Malalignment and Realignment Procedures in Knee Ligament Surgery: A Systematic Review of the Clinical Evidence

PubMed Central

Tischer, Thomas; Paul, Jochen; Pape, Dietrich; Hirschmann, Michael T.; Imhoff, Andreas B.; Hinterwimmer, Stefan; Feucht, Matthias J.

2017-01-01

Background: Failure rates of knee ligament surgery may be high, and the impact of osseous alignment on surgical outcome remains controversial. Basic science studies have demonstrated that osseous malalignment can negatively affect ligament strain and that realignment procedures may improve knee joint stability. Hypothesis/Purpose: The purpose of this review was to summarize the clinical evidence concerning the impact of osseous malalignment and realignment procedures in knee ligament surgery. The hypotheses were that lower extremity malalignment would be an important contributor to knee ligament surgery failure and that realignment surgery would contribute to increased knee stability and improved outcome in select cases. Study Design: Systematic review; Level of evidence, 4. Methods: According to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic electronic search of the PubMed database was performed in November 2015 to identify clinical studies investigating (A) the influence of osseous alignment on postoperative stability and/or failure rates after knee ligament surgery and (B) the impact of osseous realignment procedures in unstable knees with or without additional knee ligament surgery on postoperative knee function and stability. Methodological quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and the Coleman Methodological Score (CMS). Results: Of the 1466 potentially relevant articles, 28 studies fulfilled the inclusion and exclusion criteria. Average study quality was poor (CMS, 40). For part A, studies showed increased rerupture rate after anterior cruciate ligament (ACL) replacement in patients with increased tibial slope. Concerning the posterior cruciate ligament (PCL)/posterolateral corner (PLC)/lateral collateral ligament (LCL), varus malalignment was considered a significant risk factor for failure. For part B, studies showed decreased

Evidence-based medicine and patient choice: the case of heart failure care.

PubMed

Sanders, Tom; Harrison, Stephen; Checkland, Kath

2008-04-01

The implementation of evidence-based medicine and policies aimed at increasing user involvement in health care decisions are central planks of contemporary English health policy. Yet they are potentially in conflict. Our aim was to explore how clinicians working in the field of heart failure resolve this conflict. Qualitative semi-structured interviews were carried out with health professionals who were currently caring for patients with heart failure, and observations were conducted at one dedicated heart failure clinic in northern England. While clinicians acknowledged that patients' ideas and preferences should be an important part of treatment decisions, the widespread acceptance of an evidence-based clinical protocol for heart failure among the clinic doctors significantly influenced the content and style of the consultation. Evidence-based medicine was used to buttress professional authority and seemed to provide an additional barrier to the adoption of patient-centred clinical practice.

Using Bayes factors to evaluate evidence for no effect: examples from the SIPS project.

PubMed

Dienes, Zoltan; Coulton, Simon; Heather, Nick

2018-02-01

To illustrate how Bayes factors are important for determining the effectiveness of interventions. We consider a case where inappropriate conclusions were drawn publicly based on significance testing, namely the SIPS project (Screening and Intervention Programme for Sensible drinking), a pragmatic, cluster-randomized controlled trial in each of two health-care settings and in the criminal justice system. We show how Bayes factors can disambiguate the non-significant findings from the SIPS project and thus determine whether the findings represent evidence of absence or absence of evidence. We show how to model the sort of effects that could be expected, and how to check the robustness of the Bayes factors. The findings from the three SIPS trials taken individually are largely uninformative but, when data from these trials are combined, there is moderate evidence for a null hypothesis (H0) and thus for a lack of effect of brief intervention compared with simple clinical feedback and an alcohol information leaflet (B = 0.24, P = 0.43). Scientists who find non-significant results should suspend judgement-unless they calculate a Bayes factor to indicate either that there is evidence for a null hypothesis (H0) over a (well-justified) alternative hypothesis (H1), or that more data are needed. © 2017 Society for the Study of Addiction.

Using animal performance data to evidence the under-reporting of case herds during an epizootic: application to an outbreak of bluetongue in cattle.

PubMed

Nusinovici, Simon; Monestiez, Pascal; Seegers, Henri; Beaudeau, François; Fourichon, Christine

2014-01-01

Following the emergence of the Bluetongue virus serotype 8 (BTV-8) in France in 2006, a surveillance system (both passive and active) was implemented to detect and follow precociously the progression of the epizootic wave. This system did not allow a precise estimation of the extent of the epizootic. Infection by BTV-8 is associated with a decrease of fertility. The objective of this study was to evaluate whether a decrease in fertility can be used to evidence the under-reporting of cases during an epizootic and to quantify to what extent non-reported cases contribute to the total burden of the epizootic. The cow fertility in herds in the outbreak area (reported or not) was monitored around the date of clinical signs. A geostatistical interpolation method was used to estimate a date of clinical signs for non-reported herds. This interpolation was based on the spatiotemporal dynamic of confirmed case herds reported in 2007. Decreases in fertility were evidenced for both types of herds around the date of clinical signs. In non-reported herds, the decrease fertility was large (60% of the effect in reported herds), suggesting that some of these herds have been infected by the virus during 2007. Production losses in non-reported infected herds could thus contribute to an important part of the total burden of the epizootic. Overall, results indicate that performance data can be used to evidence the under-reporting during an epizootic. This approach could be generalized to pathogens that affect cattle's performance, including zoonotic agents such as Coxiella burnetii or Rift Valley fever virus.

Canine eosinophilic folliculitis and furunculosis in three cases.

PubMed

Curtis, C F; Bond, R; Blunden, A S; Thomson, D G; McNeil, P E; Whitbread, T W

1995-03-01

The historical, clinical and histopathological features of three dogs with eosinophilic folliculitis and furunculosis are described. The disease was characterised by the rapid development of pruritic, papular, pustular and ulcerative lesions on the dorsum of the muzzle. Skin lesions were confined to the face in two cases. The third dog had more generalised pustular lesions. Skin biopsy specimens showed marked eosinophil infiltration particularly centred on pilosebaceous units. Dermal collagen necrosis was evident in two cases. Similar facial lesions have previously been described as 'nasal pyoderma'. The three dogs failed to respond to initial antibacterial therapy but showed a rapid clinical response when prednisolone was given orally at doses ranging from 1 to 2.2 mg/kg, in addition to the antibacterial therapy, suggesting that glucocorticoids are indicated for the treatment of eosinophilic folliculitis and furunculosis. The aetiology of the disease was not determined.

Evidence of the big fix

NASA Astrophysics Data System (ADS)

Hamada, Yuta; Kawai, Hikaru; Kawana, Kiyoharu

2014-06-01

We give an evidence of the Big Fix. The theory of wormholes and multiverse suggests that the parameters of the Standard Model are fixed in such a way that the total entropy at the late stage of the universe is maximized, which we call the maximum entropy principle. In this paper, we discuss how it can be confirmed by the experimental data, and we show that it is indeed true for the Higgs vacuum expectation value vh. We assume that the baryon number is produced by the sphaleron process, and that the current quark masses, the gauge couplings and the Higgs self-coupling are fixed when we vary vh. It turns out that the existence of the atomic nuclei plays a crucial role to maximize the entropy. This is reminiscent of the anthropic principle, however it is required by the fundamental law in our case.

Associations and propositions: the case for a dual-process account of learning in humans.

PubMed

McLaren, I P L; Forrest, C L D; McLaren, R P; Jones, F W; Aitken, M R F; Mackintosh, N J

2014-02-01

We review evidence that supports the conclusion that people can and do learn in two distinct ways - one associative, the other propositional. No one disputes that we solve problems by testing hypotheses and inducing underlying rules, so the issue amounts to deciding whether there is evidence that we (and other animals) also rely on a simpler, associative system, that detects the frequency of occurrence of different events in our environment and the contingencies between them. There is neuroscientific evidence that associative learning occurs in at least some animals (e.g., Aplysia californica), so it must be the case that associative learning has evolved. Since both associative and propositional theories can in principle account for many instances of successful learning, the problem is then to show that there are at least some cases where the two classes of theory predict different outcomes. We offer a demonstration of cue competition effects in humans under incidental conditions as evidence against the argument that all such effects are based on cognitive inference. The latter supposition would imply that if the necessary information is unavailable to inference then no cue competition should occur. We then discuss the case of unblocking by reinforcer omission, where associative theory predicts an irrational solution to the problem, and consider the phenomenon of the Perruchet effect, in which conscious expectancy and conditioned response dissociate. Further discussion makes use of evidence that people will sometimes provide one solution to a problem when it is presented to them in summary form, and another when they are presented in rapid succession with trial-by trial information. We also demonstrate that people trained on a discrimination may show a peak shift (predicted by associative theory), but given the time and opportunity to detect the relationships between S+ and S-, show rule-based behavior instead. Finally, we conclude by presenting evidence that

The Leadville Mine Drainage Tunnel Catastrophe: A Case Study of How Isotope Geochemistry Provided Forensic Evidence to Inform Policy Decisions

NASA Astrophysics Data System (ADS)

Williams, M. W.; Wireman, M.; Liu, F.; Gertson, J.

2008-12-01

A state of emergency was declared in February 2008 because of fears that a blocked drainage tunnel in the Leadville mining district of Colorado could cause a catastrophic flood. An estimated 1 billion gallons of metals-laden water poses an eminent threat to the city of Leadville and the headwaters of the Arkansas river. Within days of the declaration of a state of emergency, Governor Ritter and Senator Salazer of Colorado, along with a host of other local and statewide politicians, visited the site and emphasized the need to develop a fast yet safe mitigation plan. Here we provide information from a case study that illustrates how a suite of isotopic and hydrologic tools enables identification of critical, site-specific variables essential in developing a science plan to guide targeted remediation of the Leadville drainage tunnel. The isotopic tools, including both stable and radiogenic isotopes, provided clear and compelling evidence of water sources and flowpaths in an area that has undergone extensive perturbations, including the drilling of more than 2,000 mine shafts. This forensic evidence was the key information in developing a plan to plug the drainage tunnel several hundred feet underground, divert a major source of polluted water from reaching the collapsed tunnel and piping it to an existing treatment plant, and guidance on where to place pumps in additional mine shafts, and the drilling of new wells to pump water in case the plugging of the tunnel caused water to pool up and raise the water table to dangerous heights. This particular case of forensic hydrology using isotopic tools not only provides the scientific basis for an operational plan to defuse a life- and property-threatening situation, it also provides the basis for decommissioning an existing water treatment plant, which will result in savings of over 1 million annually in operational costs. Decommissioning the existing water treatment plant will pay for the tunnel mitigation within several

Evidence for increased Chlamydia case finding after the introduction of rectal screening among women attending 2 Canadian sexually transmitted infection clinics.

PubMed

Gratrix, Jennifer; Singh, Ameeta E; Bergman, Joshua; Egan, Caroline; Plitt, Sabrina S; McGinnis, Justin; Bell, Christopher A; Drews, Steven J; Read, Ron

2015-02-01

Chlamydia trachomatis is the most common notifiable disease in Canada, and extragenital sites are believed to serve as hidden reservoirs for ongoing transmission of infection. There are no specific Canadian screening guidelines for asymptomatic individuals from extragenital sites. We sought to determine the prevalence and factors associated with rectal C. trachomatis among female sexually transmitted infection (STI) clinic attendees in Alberta, Canada. Between 20 July and 31 December 2012, all female attendees at 2 Provincial STI clinics receiving a pelvic examination, regardless of a history of anal intercourse, were screened for rectal C. trachomatis using the Gen-Probe Aptima COMBO 2 Assay. Demographic and behavior variables were compared between rectal-only chlamydia cases and genitourinary cases using χ(2) or Fisher exact test, Mann-Whitney test, and logistic regression. A total of 3055 women were screened for rectal chlamydia. The prevalence of rectal chlamydia ranged from 11.7% to 13.5%. There were 133 rectal-only cases, increasing case detection by 44.3% from 300 genitourinary cases to 433 total cases, ranging from 21.7% to 88.2% by clinic. Women who were a contact to an STI were less likely to have rectal-only chlamydia for both clinics (P ≤ .001). Our findings add to the growing body of evidence supporting universal rectal screening in high-risk women such as those undergoing pelvic exams at STI clinics. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

FIA: An Open Forensic Integration Architecture for Composing Digital Evidence

NASA Astrophysics Data System (ADS)

Raghavan, Sriram; Clark, Andrew; Mohay, George

The analysis and value of digital evidence in an investigation has been the domain of discourse in the digital forensic community for several years. While many works have considered different approaches to model digital evidence, a comprehensive understanding of the process of merging different evidence items recovered during a forensic analysis is still a distant dream. With the advent of modern technologies, pro-active measures are integral to keeping abreast of all forms of cyber crimes and attacks. This paper motivates the need to formalize the process of analyzing digital evidence from multiple sources simultaneously. In this paper, we present the forensic integration architecture (FIA) which provides a framework for abstracting the evidence source and storage format information from digital evidence and explores the concept of integrating evidence information from multiple sources. The FIA architecture identifies evidence information from multiple sources that enables an investigator to build theories to reconstruct the past. FIA is hierarchically composed of multiple layers and adopts a technology independent approach. FIA is also open and extensible making it simple to adapt to technological changes. We present a case study using a hypothetical car theft case to demonstrate the concepts and illustrate the value it brings into the field.

Perforating folliculitis in a patient treated with nilotinib: a further evidence of C-kit involvement.

PubMed

Llamas-Velasco, Mar; Steegmann, Juan Luis; Carrascosa, Raquel; Fraga, Javier; García Diez, Amaro; Requena, Luis

2014-07-01

We present a case of perforating folliculitis in a patient treated with nilotinib, a kinase inhibitor. A 48-year-old man presented with a severely pruritic follicular rash for several months that started after reaching a complete molecular response of his myeloid chronic while treated with nilotinib. Clinical examination showed predominantly follicular pinpoint papules on trunk and proximal extremities and a biopsy showed a slightly dilated hair follicle with a focal disruption of the infundibular follicular epithelium. Other diseases related with perforating folliculitis were ruled out. The temporary relationship between the treatment and the appearance of the lesions suggests some pathogenic role of nilotinib. Relationship with nilotinib is also supported by previous similar cases related with sorafenib therapy. Both drugs inhibit c-kit and PDGF-R. PDGF-R has been previously involved in murine and human in vitro models of hair follicle cycle. So, our case supports in vivo the previous evidence of the importance of PDGF-R, a kinase, in the normal hair follicle development.

Formal Foundations for Hierarchical Safety Cases

NASA Technical Reports Server (NTRS)

Denney, Ewen; Pai, Ganesh; Whiteside, Iain

2015-01-01

Safety cases are increasingly being required in many safety-critical domains to assure, using structured argumentation and evidence, that a system is acceptably safe. However, comprehensive system-wide safety arguments present appreciable challenges to develop, understand, evaluate, and manage, partly due to the volume of information that they aggregate, such as the results of hazard analysis, requirements analysis, testing, formal verification, and other engineering activities. Previously, we have proposed hierarchical safety cases, hicases, to aid the comprehension of safety case argument structures. In this paper, we build on a formal notion of safety case to formalise the use of hierarchy as a structuring technique, and show that hicases satisfy several desirable properties. Our aim is to provide a formal, theoretical foundation for safety cases. In particular, we believe that tools for high assurance systems should be granted similar assurance to the systems to which they are applied. To this end, we formally specify and prove the correctness of key operations for constructing and managing hicases, which gives the specification for implementing hicases in AdvoCATE, our toolset for safety case automation. We motivate and explain the theory with the help of a simple running example, extracted from a real safety case and developed using AdvoCATE.

Evidence-based healthcare in developing countries.

PubMed

Pearson, Alan; Jordan, Zoe

2010-06-01

Developing countries have limited resources, so it is particularly important to invest in healthcare that works. The case for evidence-based practice has long been made in the West. However, poor access to information makes this endeavour near impossible for health professionals working with vulnerable communities in low-income economies. This paper provides a call to action to create an evidence base for health professionals in developing countries and identify appropriate strategies for the dissemination of this information in realistic and meaningful ways.

Hierarchy of evidence relating to hand surgery in Brazilian orthopedic journals.

PubMed

Moraes, Vinícius Ynoe de; Belloti, João Carlos; Moraes, Fábio Ynoe de; Galbiatti, José Antonio; Palácio, Evandro Pereira; Santos, João Baptista Gomes Dos; Faloppa, Flávio

2011-03-01

There is no systematic assessment of the quality of scientific production in the specialty of hand surgery in our setting. This study aimed to systematically assess the status of evidence generation relating to hand surgery and to evaluate the reproducibility of the classification method based on an evidence pyramid. Secondary study conducted at Universidade Federal de São Paulo (Unifesp) and Faculdade Estadual de Medicina de Marília (Famema). Two researchers independently conducted an electronic database search for hand surgery studies published between 2000 and 2009 in the two main Brazilian orthopedic journals (Acta Ortopédica Brasileira and Revista Brasileira de Ortopedia). The studies identified were subsequently classified according to methodological design (systematic review of the literature, randomized clinical trial, cohort study, case-control study, case series and other studies) and evidence level (I to V). A total of 1,150 articles were evaluated, and 83 (7.2%) were included in the final analysis. Studies with evidence level IV (case series) accounted for 41 (49%) of the published papers. Studies with evidence level V (other studies) accounted for 12 (14.5%) of the papers. Only two studies (2.4%) were ranked as level I or II. The inter-rater reproducibility was excellent (k = 0.94). Hand surgery articles corresponded to less than one tenth of Brazilian orthopedic production. Studies with evidence level IV were the commonest type. The reproducibility of the classification stratified by evidence level was almost perfect.

Exploring the uptake and framing of research evidence on universal screening for intimate partner violence against women: a knowledge translation case study.

PubMed

Wathen, C Nadine; Macgregor, Jennifer Cd; Sibbald, Shannon L; Macmillan, Harriet L

2013-04-12

Significant emphasis is currently placed on the need to enhance health care decision-making with research-derived evidence. While much has been written on specific strategies to enable these "knowledge-to-action" processes, there is less empirical evidence regarding what happens when knowledge translation (KT) processes do not proceed as planned. The present paper provides a KT case study using the area of health care screening for intimate partner violence (IPV). A modified citation analysis method was used, beginning with a comprehensive search (August 2009 to October 2012) to capture scholarly and grey literature, and news reports citing a specific randomized controlled trial published in a major medical journal on the effectiveness of screening women, in health care settings, for exposure to IPV. Results of the searches were extracted, coded and analysed using a multi-step mixed qualitative and quantitative content analysis process. The trial was cited in 147 citations from 112 different sources in journal articles, commentaries, books, and government and news reports. The trial also formed part of the evidence base for several national-level practice guidelines and policy statements. The most common interpretations of the trial were "no benefit of screening", "no harms of screening", or both. Variation existed in how these findings were represented, ranging from summaries of the findings, to privileging one outcome over others, and to critical qualifications, especially with regard to methodological rigour of the trial. Of note, interpretations were not always internally consistent, with the same evidence used in sometimes contradictory ways within the same source. Our findings provide empirical data on the malleability of "evidence" in knowledge translation processes, and its potential for multiple, often unanticipated, uses. They have implications for understanding how research evidence is used and interpreted in policy and practice, particularly in

Nonsyndromic cleft lip and palate: No evidence of linkage to HLA or factor 13A

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hecht, J.T.; Yaping Wang; Connor, B.

1993-06-01

Nonsyndromic cleft lip with or without cleft palate (CLP) is a common craniofacial anomaly, the etiology of which is not known. Population studies have shown that a large proportion of cases occur sporadically. Recently, segregation analyses applied to CLP families have demonstrated that an autosomal dominant/codominant gene(s) may cause clefting in cases. Associations of autosomal dominant CLP and nonsyndromic cleft palate (CP) with HLA and F13A genes on chromosome 6p have been suggested previously. Linkage to these two areas on chromosome 6p were tested in 12 autosomal dominant families with CLP. With a LOD score of [minus]2 or less formore » exclusion, no evidence of linkage was found to four chromosome 6p markers. Multipoint analysis showed no evidence of a clefting locus in this region spanning 54 cM on chromosome 6p in these CLP families. 30 refs., 2 figs., 1 tab.« less

The impact of multiple show-ups on eyewitness decision-making and innocence risk.

PubMed

Smith, Andrew M; Bertrand, Michelle; Lindsay, R C L; Kalmet, Natalie; Grossman, Deborah; Provenzano, Daniel

2014-09-01

If an eyewitness rejects a show-up, police may respond by finding a new suspect and conducting a second show-up with the same eyewitness. Police may continue finding suspects and conducting show-ups until the eyewitness makes an identification (Study 1). Relatively low criterion-setting eyewitnesses filter themselves out of the multiple show-ups procedure by choosing the first suspect with whom they are presented (Studies 2 and 3). Accordingly, response bias was more stringent on the second show-up when compared with the first, but became no more stringent with additional show-ups. Despite this stringent shift in response bias, innocence risk increased with additional show-ups, as false alarms cumulate (Studies 2 and 3). Although unbiased show-up instructions decreased innocent suspect identifications, the numbers were still discouraging (Study 4). Given the high number of innocent suspects who would be mistakenly identified through the use of multiple show-up procedures, using such identifications as evidence of guilt is questionable. Although evidence of guilt is limited to identifications from a single show-up, practical constraints might sometimes require police to use additional show-ups. Accordingly, we propose a stronger partition between evidentiary and investigative procedures. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Need to Address Evidence-Based Practice in Educational Administration

ERIC Educational Resources Information Center

Kowalski, Theodore

2009-01-01

Purpose: This article presents a case for addressing evidence-based practice (EBP) in educational administration. Content is arranged around four objectives: (a) summarizing the status of educational administration as a profession, (b) defining evidence and the model, (c) explaining EBP's social and professional merit, and (d) identifying barriers…

Documentary evidence of past floods in Europe and their utility in flood frequency estimation

NASA Astrophysics Data System (ADS)

Kjeldsen, T. R.; Macdonald, N.; Lang, M.; Mediero, L.; Albuquerque, T.; Bogdanowicz, E.; Brázdil, R.; Castellarin, A.; David, V.; Fleig, A.; Gül, G. O.; Kriauciuniene, J.; Kohnová, S.; Merz, B.; Nicholson, O.; Roald, L. A.; Salinas, J. L.; Sarauskiene, D.; Šraj, M.; Strupczewski, W.; Szolgay, J.; Toumazis, A.; Vanneuville, W.; Veijalainen, N.; Wilson, D.

2014-09-01

This review outlines the use of documentary evidence of historical flood events in contemporary flood frequency estimation in European countries. The study shows that despite widespread consensus in the scientific literature on the utility of documentary evidence, the actual migration from academic to practical application has been limited. A detailed review of flood frequency estimation guidelines from different countries showed that the value of historical data is generally recognised, but practical methods for systematic and routine inclusion of this type of data into risk analysis are in most cases not available. Studies of historical events were identified in most countries, and good examples of national databases attempting to collate the available information were identified. The conclusion is that there is considerable potential for improving the reliability of the current flood risk assessments by harvesting the valuable information on past extreme events contained in the historical data sets.

A rare case of recurrent ovarian cancer presenting as a round ligament metastasis.

PubMed

Togami, Shinichi; Kato, Tomoyasu; Oi, Takateru; Ishikawa, Mitsuya; Onda, Takashi; Ikeda, Shun-ichi; Kasamatsu, Takahiro

2011-11-07

We report a rare case of recurrent ovarian cancer presenting as a round ligament metastasis. A 44-year-old woman presented with a lower abdominal mass. Computed tomography showed a pelvic mass. Primary surgery was performed. A histopathological examination showed an ovarian serous adenocarcinoma of Stage IIIb. The patient received 6 cycles of paclitaxel and carboplatin. Almost 2 years after the initial operation, the patient noticed a left inguinal mass. Computed tomography showed a left inguinal mass, 18 mm in size. An excisional biopsy was performed and the tumor was found to originate in the left round ligament. A histopathological examination showed serous adenocarcinoma and there was no evidence of lymph node tissue. Recurrence of ovarian cancer in the round ligament is extremely rare. This unique case suggests, however, that the round ligament in rare cases may be a recurrence site for ovarian cancer, and that accurate differentiation including confirmation by diagnostic imaging and excisional biopsy, is necessary for a definitive pathological diagnosis.

Definition of drug-resistant epilepsy: is it evidence based?

PubMed

Wiebe, Samuel

2013-05-01

Clinical case definitions are the cornerstone of clinical communication and of clinical and epidemiologic research. The ramifications of establishing a case definition are extensive, including potentially large changes in epidemiologic estimates of frequency, and decisions for clinical management. Yet, defining a condition entails numerous challenges such as defining the scope and purpose, incorporating the strongest evidence base with clinical expertise, accounting for patients' values, and considering impact on care. The clinical case definition of drug-resistant epilepsy, in addition, must address what constitutes an adequate intervention for an individual drug, what are the outcomes of relevance, what period of observation is sufficient to determine success or failure, how many medications should be tried, whether seizure frequency should play a role, and what is the role of side effects and tolerability. On the other hand, the principles of evidence-based medicine (EBM) aim at providing a systematic approach to incorporating the best available evidence into the process of clinical decision for individual patients. The case definition of drug-resistant epilepsy proposed by the the International League Against Epilepsy (ILAE) in 2009 is evaluated in terms of the principles of EBM as well as the stated goals of the authors of the definition. Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

Single case design studies in music therapy: resurrecting experimental evidence in small group and individual music therapy clinical settings.

PubMed

Geist, Kamile; Hitchcock, John H

2014-01-01

The profession would benefit from greater and routine generation of causal evidence pertaining to the impact of music therapy interventions on client outcomes. One way to meet this goal is to revisit the use of Single Case Designs (SCDs) in clinical practice and research endeavors in music therapy. Given the appropriate setting and goals, this design can be accomplished with small sample sizes and it is often appropriate for studying music therapy interventions. In this article, we promote and discuss implementation of SCD studies in music therapy settings, review the meaning of internal study validity and by extension the notion of causality, and describe two of the most commonly used SCDs to demonstrate how they can help generate causal evidence to inform the field. In closing, we describe the need for replication and future meta-analysis of SCD studies completed in music therapy settings. SCD studies are both feasible and appropriate for use in music therapy clinical practice settings, particularly for testing effectiveness of interventions for individuals or small groups. © the American Music Therapy Association 2014. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Presentation of Science in Everyday Life: The Science Show

ERIC Educational Resources Information Center

Watermeyer, Richard

2013-01-01

This paper constitutes a case-study of the "science show" model of public engagement employed by a company of science communicators focused on the popularization of science, technology, engineering and mathematics (STEM) subject disciplines with learner constituencies. It examines the potential of the science show to foster the interest…

Distribution Characteristics of Air-Bone Gaps – Evidence of Bias in Manual Audiometry

PubMed Central

Margolis, Robert H.; Wilson, Richard H.; Popelka, Gerald R.; Eikelboom, Robert H.; Swanepoel, De Wet; Saly, George L.

2015-01-01

Objective Five databases were mined to examine distributions of air-bone gaps obtained by automated and manual audiometry. Differences in distribution characteristics were examined for evidence of influences unrelated to the audibility of test signals. Design The databases provided air- and bone-conduction thresholds that permitted examination of air-bone gap distributions that were free of ceiling and floor effects. Cases with conductive hearing loss were eliminated based on air-bone gaps, tympanometry, and otoscopy, when available. The analysis is based on 2,378,921 threshold determinations from 721,831 subjects from five databases. Results Automated audiometry produced air-bone gaps that were normally distributed suggesting that air- and bone-conduction thresholds are normally distributed. Manual audiometry produced air-bone gaps that were not normally distributed and show evidence of biasing effects of assumptions of expected results. In one database, the form of the distributions showed evidence of inclusion of conductive hearing losses. Conclusions Thresholds obtained by manual audiometry show tester bias effects from assumptions of the patient’s hearing loss characteristics. Tester bias artificially reduces the variance of bone-conduction thresholds and the resulting air-bone gaps. Because the automated method is free of bias from assumptions of expected results, these distributions are hypothesized to reflect the true variability of air- and bone-conduction thresholds and the resulting air-bone gaps. PMID:26627469

Theory and Practice of Community Development: A Case Study from the United Kingdom.

ERIC Educational Resources Information Center

Popple, Keith; Quinney, Anne

2002-01-01

A top-down approach to British community development is rooted in Victorian paternalism, a bottom-up approach in radical action. The case of ACHIEVE (Academic Centre for Health Improvement and Evidence of Effectiveness) shows how the current government's top-down approach is inadequate and potentially exploitive. It emphasizes development and…

A philosophical argument against evidence-based policy.

PubMed

Anjum, Rani Lill; Mumford, Stephen D

2017-10-01

Evidence-based medicine has two components. The methodological or ontological component consists of randomized controlled trials and their systematic review. This makes use of a difference-making conception of cause. But there is also a policy component that makes a recommendation for uniform intervention, based on the evidence from randomized controlled trials. The policy side of evidence-based medicine is basically a form of rule utilitarianism. But it is then subject to an objection from Smart that rule utilitarianism inevitably collapses. If one assumes (1) you should recommend the intervention that has brought most benefit (the core of evidence-based policy making), (2) individual variation (acknowledged by use of randomization) and (3) no intervention benefits all (contingent but true), then the objection can be brought to bear. A utility maximizer should always ignore the rule in an individual case where greater benefit can be secured through doing so. In the medical case, this would mean that a clinician who knows that a patient would not benefit from the recommended intervention has good reason to ignore the recommendation. This is indeed the feeling of many clinicians who would like to offer other interventions but for an aversion to breaking clinical guidelines. © 2016 John Wiley & Sons, Ltd.

32 CFR 724.209 - Evidence supporting applications.

Code of Federal Regulations, 2010 CFR

2010-07-01

... just, equitable and proper as issued. When hearings are scheduled, applicants must be prepared to present their case at the scheduled time. In the absence of any other evidence, naval discharge review...

Building a Culture of Evidence: A Case Study of a California Community College

ERIC Educational Resources Information Center

Baker, Jill H.; Sax, Caren L.

2012-01-01

The purpose of this study was to better understand the practices associated with building a culture of evidence and to identify the factors influencing the success of such an endeavor. By definition, a culture of evidence is based upon practices employing data and research to inform decision making at all levels of the institution, with the…

Effectiveness of Case Management for Homeless Persons: A Systematic Review

PubMed Central

de Vet, Renée; van Luijtelaar, Maurice J. A.; Brilleslijper-Kater, Sonja N.; Vanderplasschen, Wouter; Beijersbergen, Mariëlle D.

2013-01-01

We reviewed the literature on standard case management (SCM), intensive case management (ICM), assertive community treatment (ACT), and critical time intervention (CTI) for homeless adults. We searched databases for peer-reviewed English articles published from 1985 to 2011 and found 21 randomized controlled trials or quasi-experimental studies comparing case management to other services. We found little evidence for the effectiveness of ICM. SCM improved housing stability, reduced substance use, and removed employment barriers for substance users. ACT improved housing stability and was cost-effective for mentally ill and dually diagnosed persons. CTI showed promise for housing, psychopathology, and substance use and was cost-effective for mentally ill persons. More research is needed on how case management can most effectively support rapid-rehousing approaches to homelessness. PMID:23947309

Fibrinolytic agents in the management of posthemorrhagic hydrocephalus in preterm infants: the evidence.

PubMed

Haines, S J; Lapointe, M

1999-05-01

The objective of this study was to review current literature on the management of posthemorrhagic hydrocephalus in preterm infants with intraventricular administration of fibrinolytic agents; to this end a literature search was carried out electronically. The keywords used were "intraventricular hemorrhage" or "posthemorrhagic hydrocephalus" in combination with "fibrinolytic agent," "urokinase," "streptokinase," or "recombinant tissue plasminogen activator" and "intraventricular administration"; the search covered the years 1966-1998 and was restricted to English language papers and human subjects. It was supplemented by a search through the reference lists of the articles identified. Articles dealing with intracerebral hemorrhage or hematoma, intraventricular hemorrhage in adults, nontherapeutic issues and laboratory research were excluded. The articles included are summarized in evidence and evaluation tables. Five scientific publications evaluating the use of a fibrinolytic agent to manage posthemorrhagic hydrocephalus were retrieved. In the studies described in these reports, a total of 62 neonates received streptokinase, urokinase or r-tPA intraventricularly. No two of the regimens were identical in the drug used, method of administration and duration of therapy. The time before therapy was started ranged from 2 to 35 days after the ictus. Among the case series reported, three were small series with a total of 38 neonates. One other case series of 18 neonates compared the treatment group with an historical control group. All case series showed that endoventricular fibrinolytic therapy was practical. The proportion of cases in which shunt placement was performed ranged from 11% to 100%. Only one small prospective, randomized, controlled study was identified. That study was too small to allow useful conclusions. Overall, 3 cases of secondary intraventricular hemorrhage were reported. However, it was not possible to determine with certainty whether these episodes

Integrating evidence-based practices for increasing cancer screenings in safety net health systems: a multiple case study using the Consolidated Framework for Implementation Research.

PubMed

Liang, Shuting; Kegler, Michelle C; Cotter, Megan; Emily, Phillips; Beasley, Derrick; Hermstad, April; Morton, Rentonia; Martinez, Jeremy; Riehman, Kara

2016-08-02

Implementing evidence-based practices (EBPs) to increase cancer screenings in safety net primary care systems has great potential for reducing cancer disparities. Yet there is a gap in understanding the factors and mechanisms that influence EBP implementation within these high-priority systems. Guided by the Consolidated Framework for Implementation Research (CFIR), our study aims to fill this gap with a multiple case study of health care safety net systems that were funded by an American Cancer Society (ACS) grants program to increase breast and colorectal cancer screening rates. The initiative funded 68 safety net systems to increase cancer screening through implementation of evidence-based provider and client-oriented strategies. Data are from a mixed-methods evaluation with nine purposively selected safety net systems. Fifty-two interviews were conducted with project leaders, implementers, and ACS staff. Funded safety net systems were categorized into high-, medium-, and low-performing cases based on the level of EBP implementation. Within- and cross-case analyses were performed to identify CFIR constructs that influenced level of EBP implementation. Of 39 CFIR constructs examined, six distinguished levels of implementation. Two constructs were from the intervention characteristics domain: adaptability and trialability. Three were from the inner setting domain: leadership engagement, tension for change, and access to information and knowledge. Engaging formally appointed internal implementation leaders, from the process domain, also distinguished level of implementation. No constructs from the outer setting or individual characteristics domain differentiated systems by level of implementation. Our study identified a number of influential CFIR constructs and illustrated how they impacted EBP implementation across a variety of safety net systems. Findings may inform future dissemination efforts of EBPs for increasing cancer screening in similar settings. Moreover

Benchmarking: measuring the outcomes of evidence-based practice.

PubMed

DeLise, D C; Leasure, A R

2001-01-01

Measurement of the outcomes associated with implementation of evidence-based practice changes is becoming increasingly emphasized by multiple health care disciplines. A final step to the process of implementing and sustaining evidence-supported practice changes is that of outcomes evaluation and monitoring. The comparison of outcomes to internal and external measures is known as benchmarking. This article discusses evidence-based practice, provides an overview of outcomes evaluation, and describes the process of benchmarking to improve practice. A case study is used to illustrate this concept.

Teaching Prospect Theory with the "Deal or No Deal" Game Show

ERIC Educational Resources Information Center

Baker, Ardith; Bittner, Teresa; Makrigeorgis, Christos; Johnson, Gloria; Haefner, Joseph

2010-01-01

Recent evidence indicates that decision makers are more sensitive to potential losses than gains. Loss aversion psychology has led behavioural economists to look beyond expected utility by developing "prospect theory." We demonstrate this theory using the "Deal or No Deal" game show.

The Development of Experimentation and Evidence Evaluation Skills at Preschool Age

NASA Astrophysics Data System (ADS)

Piekny, Jeanette; Grube, Dietmar; Maehler, Claudia

2014-01-01

Researchers taking a domain-general approach to the development of scientific reasoning long thought that the ability to engage in scientific reasoning did not develop until adolescence. However, more recent studies have shown that preschool children already have a basic ability to evaluate evidence and a basic understanding of experimentation. Data providing insights into when exactly in the preschool years significant gains in these abilities occur are scarce. Drawing on a sample of 138 preschool children, this longitudinal study therefore examined how children's ability to evaluate evidence and their understanding of experimentation develop between the ages of four and six. Findings showed that the ability to evaluate evidence was already well developed at age four and increased steadily and significantly over time as long as the pattern of covariation was perfect. In the case of imperfect covariation, the proportion of correct answers was low over the period of observation, but showed a significant increase between the ages of four and five. If the data did not allow relationship between variables to be inferred, the proportion of correct answers was low, with a significant increase between the ages of five and six. The children's understanding of experimentation increased significantly between the ages of five and six. The implications of these findings for age-appropriate science programs in preschool are discussed.

Integrating the Principles of Effective Intervention into Batterer Intervention Programming: The Case for Moving Toward More Evidence-Based Programming.

PubMed

Radatz, Dana L; Wright, Emily M

2016-01-01

The majority of batterer intervention program (BIP) evaluations have indicated they are marginally effective in reducing domestic violence recidivism. Meanwhile, correctional programs used to treat a variety of offenders (e.g., substance users, violent offenders, and so forth) that adhere to the "principles of effective intervention" (PEI) have reported significant reductions in recidivism. This article introduces the PEI-the principles on which evidence-based practices in correctional rehabilitation are based-and identifies the degree to which they are currently integrated into BIPs. The case is made that batterer programs could be more effective if they incorporate the PEI. Recommendations for further integration of the principles into BIPs are also provided. © The Author(s) 2015.

A Review of Three Commonly Used Herbs Which Enhance Memory and New Evidences Which Show Their Combination Could Improve Memory in Young Animals.

PubMed

Hong, Fei; Wang, Liju; Wu, Sharon L; Tang, H C; Sha, Ou; Wai, Maria S M; Yew, David T

2017-01-01

This review looks into the herbs Gingko biloba, Polygala tenuifolia, and Lycii fructus for their widely studied neuroprotective properties. In particular, we investigated memory enhancing effect of these herbs, and their potential synergetic effect on memory with new data. Sixmonth treated mice demonstrated shorter escape latency in water maze and shorter arrival time in a consolidated memory task. Immunochemistry showed evident increase in superoxide dismutase activities in the prefrontal cortex, implying protection against free radicals during aging. Discrete increase of catecholaminergic neurons was found in the prefrontal cortex, hippocampus, corpus striatum, and midbrain, suggesting better memory and better control on mood and behavior. Necrotic cells in the brain decreased as indicated by immunocytochemistry of lactic dehydrogenase. Terminal deoxynucleotidyl transferase dUTP nick end labeling showed no apoptotic cells in most brain areas in high dose group. Biochemistry revealed increase of dopaminergic cells in treatment groups at prefrontal cortex, and in the hippocampus and cerebellum of the high dose group. Most 6-month groups showed increase of serotonin in all three areas. For the high dose group, GABA increased in the hippocampus but not prefrontal cortex, which would help induce sleep at night. Protein kinase C increased in most groups at prefrontal cortex, hippocampus and cerebellum, signifying increase of possible signal transduction pathways for memory or other nervous activations. Our results intimate that the interaction of the three herbs exerts beneficial effects on memory, associated cognitive function, and necrosis. Future investigations based on the present data shall aid development of clinically relevant medication. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

[An Unusual Case of Acute Epidural Hematoma Showing Rapid Spontaneous Resolution with Delayed Recurrence].

PubMed

Yokoyama, Takahiro; Sugimoto, Tetsuaki; Yoneyama, Takumi; Futami, Munetomo; Takeshima, Hideo

2018-05-01

A 16-year-old boy collided with a passenger car while riding a motorcycle. He was thrown to a distance and experienced a head injury on impact. When brought to our medical facility, he was alert, had no neurological abnormalities, and did not complain of headache. A head computed tomography(CT)scan indicated a left cranial fracture and an acute epidural hematoma(15mm thick)directly under the fracture. Follow-up head CT performed 3 hours after the injury indicated no change in the size of the hematoma. The head CT performed on the following day indicated that most of the hematoma had disappeared. As the patient had neither headache nor neurological symptoms, he was placed under observation. However, a head CT performed 7 days after the injury indicated the formation of an epidural hematoma approximately the same size as the initial hematoma and located at the same site. We performed craniotomy to evacuate the hematoma, identify the source of the bleeding, and restore hemostasis. Although cases in which an acute epidural hematoma rapidly and spontaneously resolves have been reported, these are extremely rare. Recurrence of an epidural hematoma despite normal blood coagulation function after its initial rapid resolution has not been reported yet. We report on this rare case of acute epidural hematoma with reference to relevant literatures.

27 CFR 44.229 - Collateral evidence as to landing.

Code of Federal Regulations, 2011 CFR

2011-04-01

... landing. 44.229 Section 44.229 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE... evidence as to landing. In case of inability to furnish the prescribed evidence of landing, application for... provisions of this subpart, respecting the proofs of landing, have not been complied with, and the cause of...

Illicit Drugs, Policing and the Evidence-Based Policy Paradigm

ERIC Educational Resources Information Center

Ritter, Alison; Lancaster, Kari

2013-01-01

The mantra of evidence-based policy (EBP) suggests that endeavours to implement evidence-based policing will produce better outcomes. However there is dissonance between the rhetoric of EBP and the actuality of policing policy. This disjuncture is critically analysed using the case study of illicit drugs policing. The dissonance may be ameliorated…

Chickenpox encephalitis and encephalopathy: evidence for differing pathogenesis.

PubMed Central

Shope, T. C.

1982-01-01

Retrospective assessment of hepatic and central nervous system involvement associated with chickenpox cases at a large metropolitan medical center reveals that 28 of 58 patients had biochemical, but not inflammatory, evidence of liver involvement. An additional 18 patients had biochemical liver abnormalities along with non-inflammatory encephalopathy (Reye syndrome) and 12 had clear evidence of central nervous system inflammatory involvement (encephalitis). There were no cases of solitary inflammatory liver involvement. Reviewed evidence suggests that the pathogenesis of hepatopathy and hepatoencephalopathy (Reye syndrome) is not caused by replication of virus in the involved organs, but instead is mediated through a cytotoxic mechanism and that the inflammatory brain disease is also not caused by viral replication in brain tissue, but appears to be tissue damage associated with immune cell responses (post-infectious encephalitis). The concept put forth in this essay is that a virus replicating in one organ (skin) could affect the macromolecular function of cells in another organ (liver, brain) bringing about both hepatopathy and hepatoencephalopathy. PMID:6295009

The many meanings of evidence: a comparative analysis of the forms and roles of evidence within three health policy processes in Cambodia.

PubMed

Walls, Helen; Liverani, Marco; Chheng, Kannarath; Parkhurst, Justin

2017-11-10

Discussions within the health community routinely emphasise the importance of evidence in informing policy formulation and implementation. Much of the support for the evidence-based policy movement draws from concern that policy decisions are often based on inadequate engagement with high-quality evidence. In many such discussions, evidence is treated as differing only in quality, and assumed to improve decisions if it can only be used more. In contrast, political science scholars have described this as an overly simplistic view of the policy-making process, noting that research 'use' can mean a variety of things and relies on nuanced aspects of political systems. An approach more in recognition of how policy-making systems operate in practice can be to consider how institutions and ideas influence which pieces of evidence appear to be relevant for, and are used within, different policy processes. Drawing on in-depth interviews undertaken in 2015-2016 with key health sector stakeholders in Cambodia, we investigate the evidence perceived to be relevant to policy decisions for three contrasting health policy examples, namely tobacco control, HIV/AIDS and performance-based salary incentives. These cases allow us to examine the ways that policy-relevant evidence may differ given the framing of the issue and the broader institutional context in which evidence is considered. The three health issues show few similarities in how pieces of evidence were used in various aspects of policy-making, despite all being discussed within a broad policy environment in which evidence-based policy-making is rhetorically championed. Instead, we find that evidence use can be better understood by mapping how these health policy issues differ in terms of the issue characteristics, and also in terms of the stakeholders structurally established as having a dominant influence for each issue. Both of these have important implications for evidence use. Contrasting concerns of key stakeholders

Evidence from Social Service Enhancement Projects: Selected Cases from Norway's HUSK Project.

PubMed

Johannessen, Asbjorn; Eide, Solveig Botnen

2015-01-01

Through this article the authors describe the social service context of the HUSK (The University Research Program to Support Selected Municipal Social Service Offices) projects and briefly describe 10 of the 50 projects funded throughout the country. The welfare state context for the cases and the criteria for case selection are also provided. The 10 cases are organized into three categories that feature the role of dialogue, educational innovation, and service innovation. These cases provide the foundation for the analysis and implications located in the subsequent articles of the special issue.

Empirical evidences of owners’ managerial behaviour - the case of small companies

NASA Astrophysics Data System (ADS)

Lobontiu, G.; Banica, M.; Ravai-Nagy, S.

2017-05-01

In a small firm, the founder or the owner-manager often leaves his or her own personal “stamp” on the way things are done, finding solutions for the multitude of problems the firm faces, and maintaining control over the firm’s operations. The paper aims to investigate the degree to which the owner-managers are controlling the operations of their firm on a day-to-day basis or even getting involved into the management of the functional areas. Our empirical research, conducted on a sample of 200 small and medium-sized enterprises (SME) from the North-Western Romania, Maramures (NUTS3 level - RO114), shows that owner-managers tend to be all-powerful, making decisions based on their experience. Furthermore, the survey highlights the focus of owner-managers on two functional areas, namely the production, and sales and marketing. Finally, the correlation analysis states that in the case of small firms, the owner-manager is more involved in managing the functional areas of the firm, as compared to the medium-ones.

Petrographic evidence shows that pottery exchange between the Olmec and their neighbors was two-way

PubMed Central

Stoltman, James B.; Marcus, Joyce; Flannery, Kent V.; Burton, James H.; Moyle, Robert G.

2005-01-01

Petrographic thin sections of pottery from five Formative Mexican archaeological sites show that exchanges of vessels between highland and lowland chiefly centers were reciprocal, or two-way. These analyses contradict recent claims that the Gulf Coast was the sole source of pottery carved with iconographic motifs. Those claims were based on neutron activation, which, by relying on chemical elements rather than actual minerals, has important limitations in its ability to identify nonlocal pottery from within large data sets. Petrography shows that the ceramics in question (and hence their carved motifs) have multiple origins and were widely traded. PMID:16061796

Contactless experiments on individual DNA molecules show no evidence for molecular wire behavior.

PubMed

Gómez-Navarro, C; Moreno-Herrero, F; de Pablo, P J; Colchero, J; Gómez-Herrero, J; Baró, A M

2002-06-25

A fundamental requirement for a molecule to be considered a molecular wire (MW) is the ability to transport electrical charge with a reasonably low resistance. We have carried out two experiments that measure first, the charge transfer from an electrode to the molecule, and second, the dielectric response of the MW. The latter experiment requires no contacts to either end of the molecule. From our experiments we conclude that adsorbed individual DNA molecules have a resistivity similar to mica, glass, and silicon oxide substrates. Therefore adsorbed DNA is not a conductor, and it should not be considered as a viable candidate for MW applications. Parallel studies on other nanowires, including single-walled carbon nanotubes, showed conductivity as expected.

Research Trends in Evidence-Based Medicine: A Joinpoint Regression Analysis of More than 50 Years of Publication Data

PubMed Central

Hung, Bui The; Long, Nguyen Phuoc; Hung, Le Phi; Luan, Nguyen Thien; Anh, Nguyen Hoang; Nghi, Tran Diem; Van Hieu, Mai; Trang, Nguyen Thi Huyen; Rafidinarivo, Herizo Fabien; Anh, Nguyen Ky; Hawkes, David; Huy, Nguyen Tien; Hirayama, Kenji

2015-01-01

Background Evidence-based medicine (EBM) has developed as the dominant paradigm of assessment of evidence that is used in clinical practice. Since its development, EBM has been applied to integrate the best available research into diagnosis and treatment with the purpose of improving patient care. In the EBM era, a hierarchy of evidence has been proposed, including various types of research methods, such as meta-analysis (MA), systematic review (SRV), randomized controlled trial (RCT), case report (CR), practice guideline (PGL), and so on. Although there are numerous studies examining the impact and importance of specific cases of EBM in clinical practice, there is a lack of research quantitatively measuring publication trends in the growth and development of EBM. Therefore, a bibliometric analysis was constructed to determine the scientific productivity of EBM research over decades. Methods NCBI PubMed database was used to search, retrieve and classify publications according to research method and year of publication. Joinpoint regression analysis was undertaken to analyze trends in research productivity and the prevalence of individual research methods. Findings Analysis indicates that MA and SRV, which are classified as the highest ranking of evidence in the EBM, accounted for a relatively small but auspicious number of publications. For most research methods, the annual percent change (APC) indicates a consistent increase in publication frequency. MA, SRV and RCT show the highest rate of publication growth in the past twenty years. Only controlled clinical trials (CCT) shows a non-significant reduction in publications over the past ten years. Conclusions Higher quality research methods, such as MA, SRV and RCT, are showing continuous publication growth, which suggests an acknowledgement of the value of these methods. This study provides the first quantitative assessment of research method publication trends in EBM. PMID:25849641

R&D Project on Algebra Software Seen to Show Promise

ERIC Educational Resources Information Center

Trotter, Andrew

2007-01-01

Computer software that shows students visual models of mathematical concepts--and lets them manipulate those models by doing math--has a certain intuitive appeal. Now, recent research on SimCalc Mathworlds, one of the pioneering examples of such software, is providing some of the best evidence so far that the approach can lead to gains in student…

The use of neuroscientific evidence in the courtroom by those accused of criminal offenses in England and Wales

PubMed Central

Catley, Paul; Claydon, Lisa

2015-01-01

This examination of the extent of the use of neuroscientific evidence in England and Wales identifies 204 reported cases in which such evidence has been used by those accused of criminal offenses during the eight-year period from 2005–12. Based on the number of reported cases found, the use of such evidence appears well established with those accused of criminal offenses utilizing such evidence in approximately 1 per cent of cases in the Court of Appeal (Criminal Division). Neuroscientific evidence is used to quash convictions, to lead to convictions for lesser offenses and to lead to reduced sentences. In addition, cases are identified where neuroscientific evidence is used to avoid extradition, to challenge bail conditions and to resist prosecution appeals against unduly lenient sentences. The range of uses identified is wide: including challenging prosecution evidence as to the cause of death or injury, challenging the credibility of witnesses and arguing that those convicted were unfit to plead, lacked mens rea or were entitled to mental condition defenses. The acceptance of such evidence reflects the willingness of the courts in England and Wales to hear novel scientific argument, where it is valid and directly relevant to the issue(s) to be decided. Indeed, in some of the cases the courts expressed an expectation that structural brain scan evidence should have been presented to support the argument being made. PMID:27774211

Evidence of direct cardiac damage following high-intensity exercise in chronic energy restriction: A case report and literature review.

PubMed

Baird, Marianne F; Grace, Fergal; Sculthorpe, Nicholas; Graham, Scott M; Fleming, Audrey; Baker, Julien S

2017-07-01

Following prolonged endurance events such as marathons, elevated levels of cardiospecific biomarkers are commonly reported. Although transiently raised levels are generally not considered to indicate clinical myocardial damage, comprehension of this phenomenon remains incomplete. The popularity of high-intensity interval training highlights a paucity of research measuring cardiac biomarker response to this type of exercise. This a posteriori case report discusses the elevation of cardiac troponins (cTn) associated with short interval, high-intensity exercise. In this case report, an apparently healthy 29-year-old recreationally active female presented clinically raised cardiac troponin I (cTnI) levels (>0.04 ng/mL), after performing high-intensity cycle ergometer sprints. As creatine kinase (CK) is expressed by multiple organs (e.g., skeletal muscle, brain, and myocardium), cTnI assays were performed to determine any changes in total serum CK levels not originating from skeletal muscle damage. A posteriori the individual's daily energy expenditure indicated chronically low-energy availability. Psychometric testing suggested that the individual scored positive for disordered eating, highly for fatigue levels, and low in mental health components. The current case report provides novel evidence of elevated cTnI occurring as a result of performing short duration, high intensity, cycle ergometer exercise in an individual with self-reported chronically depleted energy balance. A schematic to identify potentially "at risk" individuals is presented. Considering this as a case report, results cannot be generalized; however, the main findings suggest that individuals who habitually restrict their calorie intake below their bodies' daily energy requirements, may have elevated biomarkers of exercise induced myocardial stress from performing high-intensity exercise.

SUPPORT Tools for evidence-informed health Policymaking (STP) 3: Setting priorities for supporting evidence-informed policymaking

PubMed Central

2009-01-01

This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. Policymakers have limited resources for developing – or supporting the development of – evidence-informed policies and programmes. These required resources include staff time, staff infrastructural needs (such as access to a librarian or journal article purchasing), and ongoing professional development. They may therefore prefer instead to contract out such work to independent units with more suitably skilled staff and appropriate infrastructure. However, policymakers may only have limited financial resources to do so. Regardless of whether the support for evidence-informed policymaking is provided in-house or contracted out, or whether it is centralised or decentralised, resources always need to be used wisely in order to maximise their impact. Examples of undesirable practices in a priority-setting approach include timelines to support evidence-informed policymaking being negotiated on a case-by-case basis (instead of having clear norms about the level of support that can be provided for each timeline), implicit (rather than explicit) criteria for setting priorities, ad hoc (rather than systematic and explicit) priority-setting process, and the absence of both a communications plan and a monitoring and evaluation plan. In this article, we suggest questions that can guide those setting priorities for finding and using research evidence to support evidence-informed policymaking. These are: 1. Does the approach to prioritisation make clear the timelines that have been set for addressing high-priority issues in different ways? 2. Does the approach incorporate explicit criteria for determining priorities? 3. Does the approach incorporate an explicit process for determining priorities? 4. Does the approach incorporate a communications strategy and a monitoring and evaluation plan? PMID:20018110

SUPPORT Tools for evidence-informed health Policymaking (STP) 3: Setting priorities for supporting evidence-informed policymaking.

PubMed

Lavis, John N; Oxman, Andrew D; Lewin, Simon; Fretheim, Atle

2009-12-16

This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. Policymakers have limited resources for developing--or supporting the development of--evidence-informed policies and programmes. These required resources include staff time, staff infrastructural needs (such as access to a librarian or journal article purchasing), and ongoing professional development. They may therefore prefer instead to contract out such work to independent units with more suitably skilled staff and appropriate infrastructure. However, policymakers may only have limited financial resources to do so. Regardless of whether the support for evidence-informed policymaking is provided in-house or contracted out, or whether it is centralised or decentralised, resources always need to be used wisely in order to maximise their impact. Examples of undesirable practices in a priority-setting approach include timelines to support evidence-informed policymaking being negotiated on a case-by-case basis (instead of having clear norms about the level of support that can be provided for each timeline), implicit (rather than explicit) criteria for setting priorities, ad hoc (rather than systematic and explicit) priority-setting process, and the absence of both a communications plan and a monitoring and evaluation plan. In this article, we suggest questions that can guide those setting priorities for finding and using research evidence to support evidence-informed policymaking. These are: 1. Does the approach to prioritisation make clear the timelines that have been set for addressing high-priority issues in different ways? 2. Does the approach incorporate explicit criteria for determining priorities? 3. Does the approach incorporate an explicit process for determining priorities? 4. Does the approach incorporate a communications strategy and a monitoring and evaluation plan?

Ideas and Evidence in Science.

ERIC Educational Resources Information Center

Talbot, Chris

2000-01-01

Describes how some of the Theory of Knowledge (ToK) requirements, which is a central part of the International Baccalaurate (IB) Diploma program, for the natural sciences component can be addressed through case studies from the history of chemistry and related subjects. Provides examples for the 'Ideas and evidence in science' which can be useful…

Monkeys show recognition without priming in a classification task.

PubMed

Basile, Benjamin M; Hampton, Robert R

2013-02-01

Humans show visual perceptual priming by identifying degraded images faster and more accurately if they have seen the original images, while simultaneously failing to recognize the same images. Such priming is commonly thought, with little evidence, to be widely distributed phylogenetically. Following Brodbeck (1997), we trained rhesus monkeys (Macaca mulatta) to categorize photographs according to content (e.g., birds, fish, flowers, people). In probe trials, we tested whether monkeys were faster or more accurate at categorizing degraded versions of previously seen images (primed) than degraded versions of novel images (unprimed). Monkeys categorized reliably, but showed no benefit from having previously seen the images. This finding was robust across manipulations of image quality (color, grayscale, line drawings), type of image degradation (occlusion, blurring), levels of processing, and number of repetitions of the prime. By contrast, in probe matching-to-sample trials, monkeys recognized the primes, demonstrating that they remembered the primes and could discriminate them from other images in the same category under the conditions used to test for priming. Two experiments that replicated Brodbeck's (1997) procedures also produced no evidence of priming. This inability to find priming in monkeys under perceptual conditions sufficient for recognition presents a puzzle. Copyright © 2012 Elsevier B.V. All rights reserved.

Monkeys show recognition without priming in a classification task

PubMed Central

Basile, Benjamin M.; Hampton, Robert R.

2012-01-01

Humans show visual perceptual priming by identifying degraded images faster and more accurately if they have seen the original images, while simultaneously failing to recognize the same images. Such priming is commonly thought, with little evidence, to be widely distributed phylogenetically. Following Brodbeck (1997), we trained rhesus monkeys (Macaca mulatta) to categorize photographs according to content (e.g., birds, fish, flowers, people). In probe trials, we tested whether monkeys were faster or more accurate at categorizing degraded versions of previously seen images (primed) than degraded versions of novel images (unprimed). Monkeys categorized reliably, but showed no benefit from having previously seen the images. This finding was robust across manipulations of image quality (color, grayscale, line drawings), type of image degradation (occlusion, blurring), levels of processing, and number of repetitions of the prime. By contrast, in probe matching-to-sample trials, monkeys recognized the primes, demonstrating that they remembered the primes and could discriminate them from other images in the same category under the conditions used to test for priming. Two experiments that replicated Brodbeck’s (1997) procedures also produced no evidence of priming. This inability to find priming in monkeys under perceptual conditions sufficient for recognition presents a puzzle. PMID:22975587

From evidence to action

PubMed Central

Verheyen, Cees CPM; Kerkhoffs, Gino M; Bhandari, Mohit; Schünemann, Holger J

2009-01-01

ABSTRACT Good guidelines will help us to take evidence into practice. In a survey among Dutch orthopedic surgeons, development and use of evidence-based guidelines was perceived as one of the best ways of moving from opinion-based to evidence-based orthopedic practice. The increasing number of guidelines means that knowing how to make a critical appraisal of guidelines is now a key part of every surgeon’s life. This is particularly true because guidelines use varying systems to judge the quality of evidence and the strength of recommendations. In this manuscript we discuss what a guideline is, where we can find guidelines, how to evaluate the quality of guidelines, and finally provide an example on the different steps of guideline development. Thus, we show that good guidelines are a summary of the best available evidence and that they provide a graded recommendation to help surgeons in evidence-based practice. PMID:19234892

Connecting Evidence and Policy: Bringing Researchers and Policy Makers Together for Effective Evidence-Based Health Policy in the Netherlands: A Case Study

ERIC Educational Resources Information Center

Van Egmond, Stans; Bekker, Marleen; Bal, Roland; van der Grinten, Tom

2011-01-01

The use of evidence in health promotion has become the gold standard, and obliges rethinking how to increase the (often limited) use of evidence in public health policy. Recently calls have been made to reconceptualise science policy relations as dynamic, interactive and co-constructive practices. Building on a qualitative investigation of an…

[Case and studies].

PubMed

Schubert, András

2015-11-15

Case studies and case reports form an important and ever growing part of scientific and scholarly literature. The paper deals with the share and citation rate of these publication types on different fields of research. In general, evidence seems to support the opinion that an excessive number of such publications may negatively influence the impact factor of the journal. In the literature of scientometrics, case studies (at least the presence of the term "case study" in the titles of the papers) have a moderate share, but their citation rate is practically equal to that of other publication types.

The Second Stroke Audit of Catalonia shows improvements in many, but not all quality indicators.

PubMed

Abilleira, Sònia; Ribera, Aida; Sánchez, Emília; Tresserras, Ricard; Gallofré, Miquel

2012-01-01

Periodic audits allow monitoring of healthcare quality by comparing performances at different time points. Aims To assess quality of in-hospital stroke care in Catalonia in 2007 and compare it with 2005 (post-/preguidelines delivery, respectively). Data on 13 evidence-based performance measures were collected by a retrospective review of medical records of consecutive stroke admissions (January-December 2007) to 47 acute hospitals in Catalonia. Adherence was calculated according to the ratio (patients with documented performance measures' compliance) (valid cases for that measure). Sampling weights were applied to produce estimates of compliance. The proportions of compliance with performance measures in both audits were compared using random-effects logistic regressions, with each performance measure as the dependent variable and audit edition as the explanatory variable to determine whether changes in stroke care quality occurred along time. We analyzed 1767 events distributed among 47 hospitals. In 2007, there was an increase in tissue plasminogen activator administrations (2·8% vs. 5·9%) and stroke unit admissions (16·6% vs. 22·6%) and a reduction in seven-day mortality (9·5% vs. 6·8%). Logistic regression models provided evidence of improved adherences to seven performance measures (screening of dysphagia, management of hyperthermia, baseline computed tomography scan, baseline glycemia, rehabilitation needs, early mobilization, and anticoagulants for atrial fibrillation), but worsening of management of hypertension, dyslipidemia, and antithrombotics at discharge. The remaining three performance measures showed no changes. The Second Stroke Audit showed improvements in most dimensions of care, although unexpectedly a few but relevant performance measures became worse. Therefore, periodic stroke audits are needed to check changes in quality of care over time. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.

An Ensemble Deep Convolutional Neural Network Model with Improved D-S Evidence Fusion for Bearing Fault Diagnosis.

PubMed

Li, Shaobo; Liu, Guokai; Tang, Xianghong; Lu, Jianguang; Hu, Jianjun

2017-07-28

Intelligent machine health monitoring and fault diagnosis are becoming increasingly important for modern manufacturing industries. Current fault diagnosis approaches mostly depend on expert-designed features for building prediction models. In this paper, we proposed IDSCNN, a novel bearing fault diagnosis algorithm based on ensemble deep convolutional neural networks and an improved Dempster-Shafer theory based evidence fusion. The convolutional neural networks take the root mean square (RMS) maps from the FFT (Fast Fourier Transformation) features of the vibration signals from two sensors as inputs. The improved D-S evidence theory is implemented via distance matrix from evidences and modified Gini Index. Extensive evaluations of the IDSCNN on the Case Western Reserve Dataset showed that our IDSCNN algorithm can achieve better fault diagnosis performance than existing machine learning methods by fusing complementary or conflicting evidences from different models and sensors and adapting to different load conditions.

An Ensemble Deep Convolutional Neural Network Model with Improved D-S Evidence Fusion for Bearing Fault Diagnosis

PubMed Central

Li, Shaobo; Liu, Guokai; Tang, Xianghong; Lu, Jianguang

2017-01-01

Intelligent machine health monitoring and fault diagnosis are becoming increasingly important for modern manufacturing industries. Current fault diagnosis approaches mostly depend on expert-designed features for building prediction models. In this paper, we proposed IDSCNN, a novel bearing fault diagnosis algorithm based on ensemble deep convolutional neural networks and an improved Dempster–Shafer theory based evidence fusion. The convolutional neural networks take the root mean square (RMS) maps from the FFT (Fast Fourier Transformation) features of the vibration signals from two sensors as inputs. The improved D-S evidence theory is implemented via distance matrix from evidences and modified Gini Index. Extensive evaluations of the IDSCNN on the Case Western Reserve Dataset showed that our IDSCNN algorithm can achieve better fault diagnosis performance than existing machine learning methods by fusing complementary or conflicting evidences from different models and sensors and adapting to different load conditions. PMID:28788099

The Influence of Weight-of-Evidence Messages on (Vaccine) Attitudes: A Sequential Mediation Model.

PubMed

Clarke, Christopher E; Weberling McKeever, Brooke; Holton, Avery; Dixon, Graham N

2015-01-01

Media coverage of contentious risk issues often features competing claims about whether a risk exists and what scientific evidence shows, and journalists often cover these issues by presenting both sides. However, for topics defined by scientific agreement, balanced coverage erroneously heightens uncertainty about scientific information and the issue itself. In this article, we extend research on combating so-called information and issue uncertainty using weight of evidence, drawing on the discredited autism-vaccine link as a case study. We examine whether people's perceptions of issue uncertainty (about whether a link exists) change before and after they encounter a news message with weight-of-evidence information. We also explore whether message exposure is associated with broader issue judgments, specifically vaccine attitudes. Participants (n = 181) read news articles that included or omitted weight-of-evidence content stating that scientific studies have found no link and that scientists agree that none exists. Postexposure issue uncertainty decreased-in other words, issue certainty increased-from preexposure levels across all conditions. Moreover, weight-of-evidence messages were associated with positive vaccine attitudes indirectly via reduced information uncertainty (i.e., one's belief that scientific opinion and evidence concerning a potential link is unclear) as well as issue uncertainty. We discuss implications for risk communication.

Toward Creating Synergy Among Policy, Procedures, and Implementation of Evidence-Based Models in Child Welfare Systems: Two Case Examples.

PubMed

Chamberlain, Patricia

2017-03-01

Over the past four to five decades, multiple randomized controlled trials have verified that preventive interventions targeting key parenting skills can have far-reaching effects on improving a diverse array of child outcomes. Further, these studies have shown that parenting skills can be taught, and they are malleable. Given these advances, prevention scientists are in a position to make solid empirically based recommendations to public child service systems on using parent-mediated interventions to optimize positive outcomes for the children and families that they serve. Child welfare systems serve some of this country's most vulnerable children and families, yet they have been slow (compared to juvenile justice and mental health systems) to adopt empirically based interventions. This paper describes two child-welfare-initiated, policy-based case studies that have sought to scale-up research-based parenting skills into the routine services that caseworkers deliver to the families that they serve. In both case studies, the child welfare system leaders worked with evaluators and model developers to tailor policy, administrative, and fiscal system practices to institutionalize and sustain evidence-based practices into usual foster care services. Descriptions of the implementations, intervention models, and preliminary results are described.

Query-oriented evidence extraction to support evidence-based medicine practice.

PubMed

Sarker, Abeed; Mollá, Diego; Paris, Cecile

2016-02-01

Evidence-based medicine practice requires medical practitioners to rely on the best available evidence, in addition to their expertise, when making clinical decisions. The medical domain boasts a large amount of published medical research data, indexed in various medical databases such as MEDLINE. As the size of this data grows, practitioners increasingly face the problem of information overload, and past research has established the time-associated obstacles faced by evidence-based medicine practitioners. In this paper, we focus on the problem of automatic text summarisation to help practitioners quickly find query-focused information from relevant documents. We utilise an annotated corpus that is specialised for the task of evidence-based summarisation of text. In contrast to past summarisation approaches, which mostly rely on surface level features to identify salient pieces of texts that form the summaries, our approach focuses on the use of corpus-based statistics, and domain-specific lexical knowledge for the identification of summary contents. We also apply a target-sentence-specific summarisation technique that reduces the problem of underfitting that persists in generic summarisation models. In automatic evaluations run over a large number of annotated summaries, our extractive summarisation technique statistically outperforms various baseline and benchmark summarisation models with a percentile rank of 96.8%. A manual evaluation shows that our extractive summarisation approach is capable of selecting content with high recall and precision, and may thus be used to generate bottom-line answers to practitioners' queries. Our research shows that the incorporation of specialised data and domain-specific knowledge can significantly improve text summarisation performance in the medical domain. Due to the vast amounts of medical text available, and the high growth of this form of data, we suspect that such summarisation techniques will address the time

Fibers under fire: suggestions for improving their use to provide forensic evidence.

PubMed

Grieve, M C; Wiggins, K G

2001-07-01

The current emphasis on DNA technology in forensic science has led many to believe that trace evidence examinations, including fibers, may be of little value. Reasons are given here to show that this is an erroneous assumption. In the face of this situation, fibers examiners have been challenged to consider ways in which they can improve the services they offer to the Criminal Justice System not only by increasing the efficiency of the examinations, but also by expressing the evidential value of the findings in a clearer way. The separate stages within fibers casework from evidence collection to report writing are critically examined. Suggestions are made on how improvements may be achieved. Areas where particular progress can be made include improving communication and exchange of information between the investigator and the scientist and streamlining analysis by using the latest equipment in conjunction with effective case management. In addition, ways of making better use of existing data pertaining to fiber frequencies, accumulating new data by using the resources of working groups, and improving training procedures with respect to evidence interpretation are discussed.

Enabling Spaces in Education Research: An Agenda for Impactful, Collective Evidence to Support All to Be First among Un-Equals

ERIC Educational Resources Information Center

Ebersohn, Liesel

2016-01-01

Single case studies are prolific in South African education research. I equate the abundance of case studies to the urgency for evidence to transform the highly unequal landscape of education opportunities. In contrast however, stand-alone case study evidence does not offer much impact in building an evidence-based body of knowledge for education…

20 CFR 220.27 - What is needed to show an impairment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... is needed to show an impairment. A physical or mental impairment must result from anatomical... diagnostic techniques. A physical or mental impairment must be established by medical evidence consisting of... also § 220.112 for the effect of a medical opinion about whether or not a claimant is disabled.) ...

[Clinical features of four atypical pediatric cases of endemic typhus with pneumonia].

PubMed

Liu, Jin-rong; Xu, Bao-ping; Li, Shao-gang; Liu, Jun; Tian, Bao-lin; Zhao, Shun-ying

2013-10-01

To analyze clinical manifestations, treatment and prognosis of 4 cases with endemic typhus. The clinical data of four endemic typhus patients in prognosis were retrospectively analyzed. These four atypical cases of endemic typhus with pneumonia were treated in our department from October 2011 to March 2012. They were all male, with an age range of 15 months to 7 years. The four patients had long history, mild respiratory symptom and no improvement was found after treatment with cephalosporins. There were no evidences of bacterial, viral, or fungal infections and we thought they might have infection with other pathogen. Three were from rural areas. Routine blood tests, Weil-Felix reaction, blood smear (Giemsa staining) , and indirect immunofluorescence assay were performed. Blood smear and IFA tests showed evidences for endemic typhus. The clinical presentations were atypical, the patients had no headache, but all had fever, rash, and pneumonia of varying severity. None of the patients had a severe cough, but bronchial casts were observed in one case. Recurrent fever was reported in three cases. Physical examinations showed no eschars, but one patient had a subconjunctival hemorrhage, and one had skin scratches, cervical lymphadenopathy, pleural effusion, pericardial effusion, and cardiac dilatation. Two patients had remarkably increased peripheral blood leukocyte counts; both these patients also had high alanine aminotransferase (ALT) levels and one had a high C-reactive protein (CRP) level. Weil-Felix testing was negative or the OX19 titer was low. The peripheral blood smear (Giemsa stain) showed intracellular pathogens in all four cases. After combined therapy with doxycycline and macrolide antibiotics, all four patients recovered well. The endemic typhus children often come from rural areas. The clinical presentations were atypical, they usually have no headache, but have fever (often Periodic fever) , rash, and pneumonia of varying severity in these four cases

The case of Ohio v. Robinson. An 1870 bite mark case.

PubMed

Pierce, L J; Strickland, D J; Smith, E S

1990-06-01

In 1870, Ansil L. Robinson was charged with the murder of his mistress, Mary Lunsford, in Mansfield, Ohio, U.S.A. Evidence against Robinson included an attempt to match his teeth to bite marks on the victim's arm. Robinson was acquitted after a 3-week trial despite the evidence linking his teeth to the wounds. This trial represents an early and perhaps the first attempt to admit bite-mark evidence in a court of law in the United States. The acquittal resulted in the obscurity that prevented this case from coming to the awareness of the forensic dental and legal communities sooner.

Non-Malignant Respiratory Disease Among Workers in Industries Using Styrene—A Review of the Evidence

PubMed Central

Nett, Randall J.; Cox-Ganser, Jean M.; Hubbs, Ann F.; Ruder, Avima M.; Cummings, Kristin J.; Huang, Yuh-Chin T.; Kreiss, Kathleen

2017-01-01

Background Asthma and obliterative bronchiolitis (OB) cases have occurred among styrene-exposed workers. We aimed to investigate styrene as a risk factor for non-malignant respiratory disease (NMRD). Methods From a literature review, we identified case reports and assessed cross-sectional and mortality studies for strength of evidence of positive association (i.e., strong, intermediate, suggestive, none) between styrene exposure and NMRD-related morbidity and mortality. Results We analyzed 55 articles and two unpublished case reports. Ten OB cases and eight asthma cases were identified. Six (75%) asthma cases had abnormal styrene inhalation challenges. Thirteen (87%) of 15 cross-sectional studies and 12 (50%) of 24 mortality studies provided at least suggestive evidence that styrene was associated with NMRD-related morbidity or mortality. Six (66%) of nine mortality studies assessing chronic obstructive pulmonary disease-related mortality indicated excess mortality. Conclusions Available evidence suggests styrene exposure is a potential risk factor for NMRD. Additional studies of styrene-exposed workers are warranted. PMID:28079275

A phase I trial of NK-92 cells for refractory hematological malignancies relapsing after autologous hematopoietic cell transplantation shows safety and evidence of efficacy

PubMed Central

Williams, Brent A.; Law, Arjun Datt; Routy, Bertrand; denHollander, Neal; Gupta, Vikas; Wang, Xing-Hua; Chaboureau, Amélie; Viswanathan, Sowmya; Keating, Armand

2017-01-01

Background Autologous NK cell therapy can treat a variety of malignancies, but is limited by patient-specific variations in potency and cell number expansion. In contrast, allogeneic NK cell lines can overcome many of these limitations. Cells from the permanent NK-92 line are constitutively activated, lack inhibitory receptors and appear to be safe based on two prior phase I trials. Materials and Methods We conducted a single-center, non-randomized, non-blinded, open-label, Phase I dose-escalation trial of irradiated NK-92 cells in adults with refractory hematological malignancies who relapsed after autologous hematopoietic cell transplantation (AHCT). The objectives were to determine safety, feasibility and evidence of activity. Patients were treated at one of three dose levels (1 × 109 cells/m2, 3 × 109 cells/m2 and 5 × 109 cells/m2), given on day 1, 3 and 5 for a planned total of six monthly cycles. Results Twelve patients with lymphoma or multiple myeloma who relapsed after AHCT for relapsed/refractory disease were enrolled in this trial. The treatment was well tolerated, with minor toxicities restricted to acute infusional events, including fever, chills, nausea and fatigue. Two patients achieved a complete response (Hodgkin lymphoma and multiple myeloma), two patients had minor responses and one had clinical improvement on the trial. Conclusions Irradiated NK-92 cells can be administered at very high doses with minimal toxicity in patients with refractory blood cancers, who had relapsed after AHCT. We conclude that high dose NK-92 therapy is safe, shows some evidence of efficacy in patients with refractory blood cancers and warrants further clinical investigation. PMID:29179517

Using Getting To Outcomes to facilitate the use of an evidence-based practice in VA homeless programs: a cluster-randomized trial of an implementation support strategy.

PubMed

Chinman, Matthew; McCarthy, Sharon; Hannah, Gordon; Byrne, Thomas Hugh; Smelson, David A

2017-03-09

Incorporating evidence-based integrated treatment for dual disorders into typical care settings has been challenging, especially among those serving Veterans who are homeless. This paper presents an evaluation of an effort to incorporate an evidence-based, dual disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) into case management teams serving Veterans who are homeless, using an implementation strategy called Getting To Outcomes (GTO). This Hybrid Type III, cluster-randomized controlled trial assessed the impact of GTO over and above MISSION-Vet Implementation as Usual (IU). Both conditions received standard MISSION-Vet training and manuals. The GTO group received an implementation manual, training, technical assistance, and data feedback. The study occurred in teams at three large VA Medical Centers over 2 years. Within each team, existing sub-teams (case managers and Veterans they serve) were the clusters randomly assigned. The trial assessed MISSION-Vet services delivered and collected via administrative data and implementation barriers and facilitators, via semi-structured interview. No case managers in the IU group initiated MISSION-Vet while 68% in the GTO group did. Seven percent of Veterans with case managers in the GTO group received at least one MISSION-Vet session. Most case managers appreciated the MISSION-Vet materials and felt the GTO planning meetings supported using MISSION-Vet. Case manager interviews also showed that MISSION-Vet could be confusing; there was little involvement from leadership after their initial agreement to participate; the data feedback system had a number of difficulties; and case managers did not have the resources to implement all aspects of MISSION-Vet. This project shows that GTO-like support can help launch new practices but that multiple implementation facilitators are needed for successful execution of a complex evidence

Translating evidence-based guidelines to improve feedback practices: the interACT case study.

PubMed

Barton, Karen L; Schofield, Susie J; McAleer, Sean; Ajjawi, Rola

2016-02-09

There has been a substantial body of research examining feedback practices, yet the assessment and feedback landscape in higher education is described as 'stubbornly resistant to change'. The aim of this paper is to present a case study demonstrating how an entire programme's assessment and feedback practices were re-engineered and evaluated in line with evidence from the literature in the interACT (Interaction and Collaboration via Technology) project. Informed by action research the project conducted two cycles of planning, action, evaluation and reflection. Four key pedagogical principles informed the re-design of the assessment and feedback practices. Evaluation activities included document analysis, interviews with staff (n = 10) and students (n = 7), and student questionnaires (n = 54). Descriptive statistics were used to analyse the questionnaire data. Framework thematic analysis was used to develop themes across the interview data. InterACT was reported by students and staff to promote self-evaluation, engagement with feedback and feedback dialogue. Streamlining the process after the first cycle of action research was crucial for improving engagement of students and staff. The interACT process of promoting self-evaluation, reflection on feedback, feedback dialogue and longitudinal perspectives of feedback has clear benefits and should be transferable to other contexts. InterACT has involved comprehensive re-engineering of the assessment and feedback processes using educational principles to guide the design taking into account stakeholder perspectives. These principles and the strategies to enact them should be transferable to other contexts.

Dual pathology—An unreported case

PubMed Central

Yap, Darren; Rasheed, Ashraf; Rashid, Majid

2015-01-01

Introduction Symptomatic biliary disease in children and young adults requiring surgical intervention are uncommon. However even rarer is the occurrence of a spontaneous gallbladder necrosis in a child. We report a case of spontaneous necrosis in a child with no apparent causative factors. Case Fit and well 16 year-old boy presented with acute generalized lower abdominal pain. Examination revealed mild epigastric pain with rebound tenderness and guarding of the right iliac fossa. Diagnostic laparoscopy showed a necrotic gallbladder and incidental finding of a Meckel’s diverticulum. He had a cholecystectomy and Meckel’s diverticulum resection. Patient recovered uneventfully and was discharged home. He was reviewed 2 months later and recovered well with no evidence of any post-operative complication. He was discharged without any further follow up. Discussion Gall bladder necrosis is a rare cause of an acute abdomen. We present the first reported case of a spontaneous gallbladder necrosis with no apparent cause. Literature review showed various causes of gall bladder necrosis including trauma, acalculous cholecystitis, gallbladder torsion, gangrenous cholecystitis and etc. Conclusion We report a case of spontaneous gallbladder necrosis in a young healthy male with no family history of thrombotic disorders or any history of sepsis, intervention, trauma and no obvious underlying anatomical or histological abnormalities. This is an exceedingly rare pathology and one would be forgiven for not including it on the list of a differential diagnosis in such circumstance. However it is important to send tissue sample to exclude any underlying histological aetiological factors. PMID:26657530

Exploring the uptake and framing of research evidence on universal screening for intimate partner violence against women: a knowledge translation case study

PubMed Central

2013-01-01

Background Significant emphasis is currently placed on the need to enhance health care decision-making with research-derived evidence. While much has been written on specific strategies to enable these “knowledge-to-action” processes, there is less empirical evidence regarding what happens when knowledge translation (KT) processes do not proceed as planned. The present paper provides a KT case study using the area of health care screening for intimate partner violence (IPV). Methods A modified citation analysis method was used, beginning with a comprehensive search (August 2009 to October 2012) to capture scholarly and grey literature, and news reports citing a specific randomized controlled trial published in a major medical journal on the effectiveness of screening women, in health care settings, for exposure to IPV. Results of the searches were extracted, coded and analysed using a multi-step mixed qualitative and quantitative content analysis process. Results The trial was cited in 147 citations from 112 different sources in journal articles, commentaries, books, and government and news reports. The trial also formed part of the evidence base for several national-level practice guidelines and policy statements. The most common interpretations of the trial were “no benefit of screening”, “no harms of screening”, or both. Variation existed in how these findings were represented, ranging from summaries of the findings, to privileging one outcome over others, and to critical qualifications, especially with regard to methodological rigour of the trial. Of note, interpretations were not always internally consistent, with the same evidence used in sometimes contradictory ways within the same source. Conclusions Our findings provide empirical data on the malleability of “evidence” in knowledge translation processes, and its potential for multiple, often unanticipated, uses. They have implications for understanding how research evidence is used and

Laparoscopy shows superiority over endoscopy for early detection of malignant atrophic papulosis gastrointestinal complications: a case report and review of literature.

PubMed

Toledo, A E; Shapiro, L S; Farrell, J F; Magro, C M; Polito, J

2015-11-02

The malignant form of atrophic papulosis (Köhlmeier-Degos disease) is a rare thrombo-occlusive vasculopathy that can affect multiple organ systems. Patients typically present with distinctive skin lesions reflective of vascular drop out. The small bowel is the most common internal organ involved, resulting in considerable morbidity and mortality attributable to ischemic microperforations. Determination of the presence of gastrointestinal lesions is critical in distinguishing systemic from the benign, cutaneous only disease and in identifying candidates for treatment. We describe an 18 year old male who first presented with cutaneous atrophic papulosis but became critically ill from small bowel microperforations. He had an almost immediate and dramatic response to treatment. Prior to his presentation with acute abdomen he had upper and lower endoscopy showing areas of nonspecific patchy erythema. At laparotomy, innumerable characteristic lesions with central pearly hue and erythematous border were seen. PubMed was used for a literature search using the keywords malignant atrophic papulosis, Degos disease, endoscopy, laparoscopy and laparotomy. This search yielded 200 articles which were further analyzed for diagnostic procedures and findings. Among the 200 articles we identified only 11 cases in which endoscopy was performed. Results of endoscopy and laparotomy in our patient with malignant atrophic papulosis were compared to those in the literature. Endoscopy of the gastrointestinal tract has shown gastritis and non-specific inflammation whereas laparoscopy shows white plaques with red borders on the serosal surface of the small bowel and the peritoneum. From personal communications with other physicians worldwide, we identified three additional unpublished cases in which endoscopy revealed only minimal changes while laparoscopy showed dramatic lesions. From our experience the endoscopic findings are often subtle and nonspecific, whereas laparascopy or laparotomy

A pilot project using evidence-based clinical pathways and payment reform in China's rural hospitals shows early success.

PubMed

Cheng, Tsung-Mei

2013-05-01

Reforming China's public hospitals to curb widespread overtreatment and improve the quality and affordability of care has been the most challenging aspect of that nation's ambitious health reform, which began in 2009. This article describes a pilot project under way in several of China's provinces that combines payment reform with the implementation of evidence-based clinical pathways at a few hospitals serving rural areas. Results to date include reduced length-of-stay and prescription drug use and higher patient and provider satisfaction. These early results suggest that the pilot may be achieving its goals, which may have far-reaching and positive implications for China's ongoing reform.

Advanced lung adenocarcinomas with ROS1-rearrangement frequently show hepatoid cell

PubMed Central

Kong, Mei; Zhou, Jianya; Ding, Wei; Zhou, Jianying

2016-01-01

Defining distinctive histologic characteristics of ROS1-rearranged non-small-cell lung carcinomas (NSCLCs) may help identify cases that merit molecular testing. However, the majority of previous reports have focused on surgical specimens but only limited studies assessed histomorphology of advanced NSCLCs. In order to identify the clinical and histological characteristics of ROS1-rearranged advanced NSCLCs, we examined five hundred sixteen Chinese patients with advanced NSCLCs using ROS1 fluorescence in situ hybridization and real-time polymerase chain reaction and then analyzed for clinical and pathological features. We performed univariate and multivariate analyses to identify predictive factors associated with ROS1 rearrangement. 19 tumors were identified with ROS1 rearrangement (3.7% of adenocarcinomas). 16 ROS1+ and 122 ROS1- samples with available medical records and enough tumor cells were included for histological analysis. Compared with ROS1-negative advanced NSCLCs, ROS1-rearranged advanced NSCLCs were associated with a younger age at presentation. ROS1 rearrangements were not significantly associated with sex, smoking history, drinking history and metastatic sites. The most common histological pattern was solid growth (12/16), followed by acinar (4/16) growth. 66.7% cases with solid growth pattern showed hepatoid cytology (8/12) and 75% cases with acinar growth pattern showed a cribriform structure (3/4). 18.8% cases were found to have abundant extracellular mucus or signet-ring cells (3/16). Only one case with solid growth pattern showed psammomatous calcifications. In conclusion, age, hepatoid cytology and cribriform structure are the independent predictors for ROS1-rearranged advanced NSCLCs, recognizing these may be helpful in finding candidates for genomic alterations, especially when available tissue samples are limited. PMID:27708233

Slowing of the HIV Epidemic in Ukraine: Evidence from Case Reporting and Key Population Surveys, 2005–2012

PubMed Central

Vitek, Charles R.; Čakalo, Jurja-Ivana; Kruglov, Yuri V.; Dumchev, Konstantin V.; Salyuk, Tetyana O.; Božičević, Ivana; Baughman, Andrew L.; Spindler, Hilary H.; Martsynovska, Violetta A.; Kobyshcha, Yuri V.; Abdul-Quader, Abu S.; Rutherford, George W.

2014-01-01

Background Ukraine developed Europe's most severe HIV epidemic due to widespread transmission among persons who inject drugs (PWID). Since 2004, prevention has focused on key populations; antiretroviral therapy (ART) coverage has increased. Recent data show increases in reported HIV cases through 2011, especially attributed to sexual transmission, but also signs of potential epidemic slowing. We conducted a data triangulation exercise to better analyze available data and inform program implementation. Methods and Findings We reviewed data for 2005 to 2012 from multiple sources, primarily national HIV case reporting and integrated biobehavioral surveillance (IBBS) studies among key populations. Annually reported HIV cases increased at a progressively slower rate through 2011 with recent increases only among older, more immunosuppressed individuals; cases decreased 2.7% in 2012. Among women <25 years of age, cases attributed to heterosexual transmission and HIV prevalence in antenatal screening declined after 2008. Reported cases among young PWID declined by three-fourths. In 2011, integrated biobehavioral surveillance demonstrated decreased HIV prevalence among young members of key populations compared with 2009. HIV infection among female sex workers (FSW) remains strongly associated with a personal history of injecting drug use (IDU). Conclusions This analysis suggests that Ukraine's HIV epidemic has slowed, with decreasing reported cases and older cases predominating among those diagnosed. Recent decreases in cases and in prevalence support decreased incidence among young PWID and women. Trends among heterosexual men and men who have sex with men (MSM) are less clear; further study and enhanced MSM prevention are needed. FSW appear to have stable prevalence with risk strongly associated with IDU. Current trends suggest the Ukrainian epidemic can be contained with enhanced prevention among key populations and increased treatment access. PMID:25251080

Are paediatric operations evidence based? A prospective analysis of general surgery practice in a teaching paediatric hospital.

PubMed

Zani-Ruttenstock, Elke; Zani, Augusto; Bullman, Emma; Lapidus-Krol, Eveline; Pierro, Agostino

2015-01-01

Paediatric surgical practice should be based upon solid scientific evidence. A study in 1998 (Baraldini et al., Pediatr Surg Int) indicated that only a quarter of paediatric operations were supported by the then gold standard of evidence based medicine (EBM) which was defined by randomized controlled trials (RCTs). The aim of the current study was to re-evaluate paediatric surgical practice 16 years after the previous study in a larger cohort of patients. A prospective observational study was performed in a tertiary level teaching hospital for children. The study was approved by the local research ethics board. All diagnostic and therapeutic procedures requiring a general anaesthetic carried out over a 4-week period (24 Feb 2014-22 Mar 2014) under the general surgery service or involving a general paediatric surgeon were included in the study. Pubmed and EMBASE were used to search in the literature for the highest level of evidence supporting the recorded procedures. Evidence was classified according to the Oxford Centre for Evidence Based Medicine (OCEBM) 2009 system as well as according to the classification used by Baraldini et al. Results was compared using Χ (2) test. P < 0.05 was considered statistically significant. During the study period, 126 operations (36 different types) were performed on 118 patients. According to the OCEBM classification, 62 procedures (49 %) were supported by systematic reviews of multiple homogeneous RCTs (level 1a), 13 (10 %) by individual RCTs (level 1b), 5 (4 %) by systematic reviews of cohort studies (level 2a), 11 (9 %) by individual cohort studies, 1 (1 %) by systematic review of case-control studies (level 3a), 14 (11 %) by case-control studies (level 3b), 9 (7 %) by case series (type 4) and 11 procedures (9 %) were based on expert opinion or deemed self-evident interventions (type 5). High level of evidence (OCEBM level 1a or 1b or level I according to Baraldini et al. PSI 1998) supported 75 (60 %) operations in the current

LTDNA Evidence on Trial

PubMed Central

Roberts, Paul

2016-01-01

Adopting the interpretative/hermeneutical method typical of much legal scholarship, this article considers two sets of issues pertaining to LTDNA profiles as evidence in criminal proceedings. The section titled Expert Evidence as Forensic Epistemic Warrant addresses some rather large questions about the epistemic status and probative value of expert testimony in general. It sketches a theoretical model of expert evidence, highlighting five essential criteria: (1) expert competence; (2) disciplinary domain; (3) methodological validity; (4) materiality; and (5) legal admissibility. This generic model of expert authority, highlighting law's fundamentally normative character, applies to all modern forms of criminal adjudication, across Europe and farther afield. The section titled LTDNA Evidence in UK Criminal Trials then examines English and Northern Irish courts' attempts to get to grips with LTDNA evidence in recent cases. Better appreciating the ways in which UK courts have addressed the challenges of LTDNA evidence may offer some insights into parallel developments in other legal systems. Appellate court rulings follow a predictable judicial logic, which might usefully be studied and reflected upon by any forensic scientist or statistician seeking to operate effectively in criminal proceedings. Whilst each legal jurisdiction has its own unique blend of jurisprudence, institutions, cultures and historical traditions, there is considerable scope for comparative analysis and cross-jurisdictional borrowing and instruction. In the spirit of promoting more nuanced and sophisticated international interdisciplinary dialogue, this article examines UK judicial approaches to LTDNA evidence and begins to elucidate their underlying institutional logic. Legal argument and broader policy debates are not confined to considerations of scientific validity, contamination risks and evidential integrity, or associated judgments of legal admissibility or exclusion. They also crucially

LTDNA Evidence on Trial.

PubMed

Roberts, Paul

2016-01-01

Adopting the interpretative/hermeneutical method typical of much legal scholarship, this article considers two sets of issues pertaining to LTDNA profiles as evidence in criminal proceedings. The section titled Expert Evidence as Forensic Epistemic Warrant addresses some rather large questions about the epistemic status and probative value of expert testimony in general. It sketches a theoretical model of expert evidence, highlighting five essential criteria: (1) expert competence; (2) disciplinary domain; (3) methodological validity; (4) materiality; and (5) legal admissibility. This generic model of expert authority, highlighting law's fundamentally normative character, applies to all modern forms of criminal adjudication, across Europe and farther afield. The section titled LTDNA Evidence in UK Criminal Trials then examines English and Northern Irish courts' attempts to get to grips with LTDNA evidence in recent cases. Better appreciating the ways in which UK courts have addressed the challenges of LTDNA evidence may offer some insights into parallel developments in other legal systems. Appellate court rulings follow a predictable judicial logic, which might usefully be studied and reflected upon by any forensic scientist or statistician seeking to operate effectively in criminal proceedings. Whilst each legal jurisdiction has its own unique blend of jurisprudence, institutions, cultures and historical traditions, there is considerable scope for comparative analysis and cross-jurisdictional borrowing and instruction. In the spirit of promoting more nuanced and sophisticated international interdisciplinary dialogue, this article examines UK judicial approaches to LTDNA evidence and begins to elucidate their underlying institutional logic. Legal argument and broader policy debates are not confined to considerations of scientific validity, contamination risks and evidential integrity, or associated judgments of legal admissibility or exclusion. They also crucially

New journals for publishing medical case reports.

PubMed

Akers, Katherine G

2016-04-01

Because they do not rank highly in the hierarchy of evidence and are not frequently cited, case reports describing the clinical circumstances of single patients are seldom published by medical journals. However, many clinicians argue that case reports have significant educational value, advance medical knowledge, and complement evidence-based medicine. Over the last several years, a vast number (∼160) of new peer-reviewed journals have emerged that focus on publishing case reports. These journals are typically open access and have relatively high acceptance rates. However, approximately half of the publishers of case reports journals engage in questionable or "predatory" publishing practices. Authors of case reports may benefit from greater awareness of these new publication venues as well as an ability to discriminate between reputable and non-reputable journal publishers.

Motor knowledge is one dimension for concept organization: further evidence from a Chinese semantic dementia case.

PubMed

Lin, Nan; Guo, Qihao; Han, Zaizhu; Bi, Yanchao

2011-11-01

Neuropsychological and neuroimaging studies have indicated that motor knowledge is one potential dimension along which concepts are organized. Here we present further direct evidence for the effects of motor knowledge in accounting for categorical patterns across object domains (living vs. nonliving) and grammatical domains (nouns vs. verbs), as well as the integrity of other modality-specific knowledge (e.g., visual). We present a Chinese case, XRK, who suffered from semantic dementia with left temporal lobe atrophy. In naming and comprehension tasks, he performed better at nonliving items than at living items, and better at verbs than at nouns. Critically, multiple regression method revealed that these two categorical effects could be both accounted for by the charade rating, a continuous measurement of the significance of motor knowledge for a concept or a semantic feature. Furthermore, charade rating also predicted his performances on the generation frequency of semantic features of various modalities. These findings consolidate the significance of motor knowledge in conceptual organization and further highlights the interactions between different types of semantic knowledge. Copyright © 2010 Elsevier Inc. All rights reserved.

Early Incorporation of an Evidence-Based Aquatic-Assisted Approach to Arthroscopic Rotator Cuff Repair Rehabilitation: Prospective Case Study.

PubMed

Burmaster, Chris; Eckenrode, Brian J; Stiebel, Matthew

2016-01-01

Both traditional and progressive rotator cuff repair rehabilitation protocols often delay active motion of the shoulder for 6 weeks or more. The early inclusion of a comprehensive aquatic-assisted exercise program presents a unique approach to postoperative management. The purpose of this case study is to describe a comprehensive evidence-based, aquatic-assisted rehabilitation program following arthroscopic rotator cuff repair. A 73-year-old woman with a nonretracted, medium-size, full-thickness tear (2.5 cm) of the supraspinatus tendon underwent arthroscopic rotator cuff repair and was referred for postoperative physical therapy. The rehabilitation program was initiated at 2 weeks postoperatively and consisted of concurrent land- and aquatic-based interventions over 6 weeks for a total of 18 physical therapy visits. Improvements were made in all 5 patient-reported outcome measures that were recorded weekly over the course of care. Improvements reached or exceeded minimal detectable change levels for the Shoulder Pain and Disability Index and the Penn Shoulder Score. Her numeric pain rating scale score at rest decreased from 4/10 at the initial evaluation to 2/10 at 8 weeks postoperatively and with activity decreased from 9/10 to 6/10. Shoulder strength and range of motion values also exhibited improvement over the course of care. No adverse events occurred during the case study. This case study illustrates the safe inclusion of low-stress aquatic exercises as an early adjunct to traditional land-based rotator cuff repair rehabilitation programs in small- to medium-size repairs. Further studies are needed to determine the long-term effectiveness of adding aquatic therapy to traditional postoperative programs. © 2016 American Physical Therapy Association.

Observational Evidence for the Causes and Consequences of Chromospheric Reconnection

NASA Astrophysics Data System (ADS)

Yan, Limei; He, Jiansen; Xia, Lidong; Jiao, Fangran

2015-05-01

The chromospheric anemone jets with an inverse “Y” shape are ubiquitous, as revealed by the Solar Optical Telescope observations. These jets are considered to be consequences of chromospheric magnetic reconnections. Although these jets have been studied intensively, the dynamics and their driving causes remain unclear observationally. In this work, we report a case of a chromospheric jet showing complete observational evidence for the cause and consequence of chromospheric intermittent reconnection. The intermittent eruption of this jet shows two distinct quasi-periods, 50-60 s and 600-700 s. The short-period eruptions may be related to the plasmoid-induced reconnection, and the long-period ones may be interpreted as sequences of cycles of energy storage and release during magnetic reconnections. The observations also reveal Alfvénic waves with a mean period around 88 s and a maximum transverse displacement around 0.″26. The jet is hosted by a loop moving smoothly with a horizontal speed of ˜0.4 km s-1. Our results provide observational evidence supporting the magnetic reconnection model of the formation of the chromospheric jets with related products, in which the loop advection drives intermittent magnetic reconnections, and the reconnection outflows carrying plasmoids collide further with the ambient field lines and finally excite waves and jets.

5. Detail showing north set of doors of Bunker 104. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

5. Detail showing north set of doors of Bunker 104. Padlock is hidden behind cylindrical casing. - Puget Sound Naval Shipyard, Munitions Storage Bunker, Naval Ammunitions Depot, South of Campbell Trail, Bremerton, Kitsap County, WA

Non-front-fanged colubroid snakes: a current evidence-based analysis of medical significance.

PubMed

Weinstein, Scott A; White, Julian; Keyler, Daniel E; Warrell, David A

2013-07-01

acetylcholinesterase inhibitors (e.g. neostigmine) and wound care on a case-by-case basis. Hazard level 3 species comprised a larger group capable of producing significant local effects only, often associated with a protracted bite (eg Heterodon nasicus, Borikenophis (Alsophis) portoricensis, Platyceps (Coluber) rhodorachis). Management is restricted to wound care. Bites by Hazard level 4 species comprised the majority of surveyed taxa and these showed only minor effects of no clinical importance. This study has produced a comprehensive evidence-based listing of NFFC snakes tabulated against medical significance of bites, together with best-practice management recommendations. This analysis assumes increasing importance, as there is growing exposure to lesser-known NFFC snakes, particularly in captive collections that may uncover further species of significance in the future. Careful and accurate documentation of bites by verified species of NFFC snakes is required to increase the evidence base and establish the best medical management approach for each species. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy?

PubMed