Current Evidence about Nutrition Support in Cardiac Surgery Patients-What Do We Know?

PubMed

Hill, Aileen; Nesterova, Ekaterina; Lomivorotov, Vladimir; Efremov, Sergey; Goetzenich, Andreas; Benstoem, Carina; Zamyatin, Mikhail; Chourdakis, Michael; Heyland, Daren; Stoppe, Christian

2018-05-11

Nutrition support is increasingly recognized as a clinically relevant aspect of the intensive care treatment of cardiac surgery patients. However, evidence from adequate large-scale studies evaluating its clinical significance for patients’ mid- to long-term outcome remains sparse. Considering nutrition support as a key component in the perioperative treatment of these critically ill patients led us to review and discuss our understanding of the metabolic response to the inflammatory burst induced by cardiac surgery. In addition, we discuss how to identify patients who may benefit from nutrition therapy, when to start nutritional interventions, present evidence about the use of enteral and parenteral nutrition and the potential role of pharmaconutrition in cardiac surgery patients. Although the clinical setting of cardiac surgery provides advantages due to its scheduled insult and predictable inflammatory response, researchers and clinicians face lack of evidence and several limitations in the clinical routine, which are critically considered and discussed in this paper.

Approaches to Dispute Resolution in Additional Support Needs in Scotland

ERIC Educational Resources Information Center

Riddell, Sheila; Weedon, Elisabet

2009-01-01

The Education (Additional Support for Learning) (Scotland) Act 2004 aimed, among other things, to increase parents' rights in relation to the education of their children. In addition to the creation of the Additional Supports Needs Tribunals for Scotland, parents were given new rights to challenge local authority decisions through mediation and…

A Systematic Review of the Economic Evidence for Home Support Interventions in Dementia.

PubMed

Clarkson, Paul; Davies, Linda; Jasper, Rowan; Loynes, Niklas; Challis, David

2017-09-01

Recent evidence signals the need for effective forms of home support to people with dementia and their carers. The cost-effectiveness evidence of different approaches to support is scant. To appraise economic evidence on the cost-effectiveness of home support interventions for dementia to inform future evaluation. A systematic literature review of full and partial economic evaluations was performed using the British National Health Service Economic Evaluation Database supplemented by additional references. Study characteristics and findings, including incremental cost-effectiveness ratios, when available, were summarized narratively. Study quality was appraised using the National Health Service Economic Evaluation Database critical appraisal criteria and independent ratings, agreed by two reviewers. Studies were located on a permutation matrix describing their mix of incremental costs/effects to aid decision making. Of the 151 articles retrieved, 14 studies met the inclusion criteria: 8 concerning support to people with dementia and 6 to carers. Five studies were incremental cost-utility analyses, seven were cost-effectiveness analyses, and two were cost consequences analyses. Five studies expressed incremental cost-effectiveness ratios as cost per quality-adjusted life-year (£6,696-£207,942 per quality-adjusted life-year). In four studies, interventions were dominant over usual care. Two interventions were more costly but more beneficial and were favorable against current acceptability thresholds. Occupational therapy, home-based exercise, and a carers' coping intervention emerged as cost-effective approaches for which there was better evidence. These interventions used environmental modifications, behavior management, physical activity, and emotional support as active components. More robust evidence is needed to judge the value of these and other interventions across the dementia care pathway. Copyright © 2017 International Society for Pharmacoeconomics and

20 CFR 404.750 - Evidence of a parent's support.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Evidence of a parent's support. 404.750 Section 404.750 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND... parent's support. If you apply for parent's benefits, we will ask you for evidence to show that you...

Additional Support Needs Policy in Scotland: Challenging or Reinforcing Social Inequality?

ERIC Educational Resources Information Center

Riddell, Sheila; Weedon, Elisabet

2016-01-01

This paper focuses on Scottish policy on additional support needs and its material outcomes. The central question addressed is the extent to which the Scottish additional support needs system undermines or reinforces existing social and economic inequalities. Administrative data highlight the inflation of the additional support needs category,…

Evidence to Support Tooth Brushing in Critically Ill Patients

PubMed Central

Ames, Nancy J.

2012-01-01

Tooth brushing in critically ill patients has been advocated by many as a standard of care despite the limited evidence to support this practice. Attention has been focused on oral care as the evidence accumulates to support an association between the bacteria in the oral microbiome and those respiratory pathogens that cause pneumonia. It is plausible to assume that respiratory pathogens originating in the oral cavity are aspirated into the lungs, causing infection. A recent study of the effects of a powered toothbrush on the incidence of ventilator-associated pneumonia was stopped early because of a lack of effect in the treatment group. This review summarizes the evidence that supports the effectiveness of tooth brushing in critically ill adults and children receiving mechanical ventilation. Possible reasons for the lack of benefit of tooth brushing demonstrated in clinical trials are discussed. Recommendations for future trials in critically ill patients are suggested. With increased emphasis being placed on oral care, the evidence that supports this intervention must be evaluated carefully. PMID:21532045

Evidence to support tooth brushing in critically ill patients.

PubMed

Ames, Nancy J

2011-05-01

Tooth brushing in critically ill patients has been advocated by many as a standard of care despite the limited evidence to support this practice. Attention has been focused on oral care as the evidence accumulates to support an association between the bacteria in the oral microbiome and those respiratory pathogens that cause pneumonia. It is plausible to assume that respiratory pathogens originating in the oral cavity are aspirated into the lungs, causing infection. A recent study of the effects of a powered toothbrush on the incidence of ventilator-associated pneumonia was stopped early because of a lack of effect in the treatment group. This review summarizes the evidence that supports the effectiveness of tooth brushing in critically ill adults and children receiving mechanical ventilation. Possible reasons for the lack of benefit of tooth brushing demonstrated in clinical trials are discussed. Recommendations for future trials in critically ill patients are suggested. With increased emphasis being placed on oral care, the evidence that supports this intervention must be evaluated carefully.

Evidence Supporting an Early as Well as Late Heavy Bombardment on the Moon

NASA Technical Reports Server (NTRS)

Frey, Herbert

2015-01-01

Evidence supporting an intense early bombardment on the Moon in addition to the traditional Late Heavy Bombardment at approx. 4 BY ago include the distribution of N(50) Crater Retention Ages (CRAs) for candidate basins, a variety of absolute age scenarios for both a "young" and an "old" Nectaris age, and the decreasing contrasts in both topographic relief and Bouguer gravity with increasing CRA.

Evidence supporting an intentional Neandertal burial at La Chapelle-aux-Saints.

PubMed

Rendu, William; Beauval, Cédric; Crevecoeur, Isabelle; Bayle, Priscilla; Balzeau, Antoine; Bismuth, Thierry; Bourguignon, Laurence; Delfour, Géraldine; Faivre, Jean-Philippe; Lacrampe-Cuyaubère, François; Tavormina, Carlotta; Todisco, Dominique; Turq, Alain; Maureille, Bruno

2014-01-07

The bouffia Bonneval at La Chapelle-aux-Saints is well known for the discovery of the first secure Neandertal burial in the early 20th century. However, the intentionality of the burial remains an issue of some debate. Here, we present the results of a 12-y fieldwork project, along with a taphonomic analysis of the human remains, designed to assess the funerary context of the La Chapelle-aux-Saints Neandertal. We have established the anthropogenic nature of the burial pit and underlined the taphonomic evidence of a rapid burial of the body. These multiple lines of evidence support the hypothesis of an intentional burial. Finally, the discovery of skeletal elements belonging to the original La Chapelle aux Saints 1 individual, two additional young individuals, and a second adult in the bouffia Bonneval highlights a more complex site-formation history than previously proposed.

A search for the evidence supporting community paediatric practice

PubMed Central

Rudolf, M; Lyth, N; Bundle, A; Rowland, G; Kelly, A; Bosson, S; Garner, M; Guest, P; Khan, M; Thazin, R; Bennett, T; Damman, D; Cove, V; Kaur, V

1999-01-01

AIM—Controversy exists regarding the evidence base of medicine. Estimates range from 20% to 80% in various specialties, but there have been no studies in paediatrics. The aim of this study was to ascertain the evidence base for community paediatrics.
METHODS—Twelve community paediatricians working in clinics and schools in Yorkshire, Manchester, Teesside, and Cheshire carried out a prospective review of consecutive clinical contacts. Evidence for diagnostic processes, prescribing, referrals, counselling/advice, and child health promotion was found by searching electronic databases. This information was critically appraised and a consensus was obtained regarding quality and whether it supported actions taken.
RESULTS—Two hundred and forty seven consultations and 1149 clinical actions were performed. Good evidence was found from a randomised controlled trial or other appropriate study for 39.9% of the 629actions studied; convincing non-experimental evidence for 7%; inconclusive evidence for 25.4%; evidence of ineffectiveness for 0.2%; and no evidence for 27.5%. Prescribing and child health promotion activities had the highest levels of quality evidence, and counselling/advice had the lowest.
CONCLUSIONS—An encouraging amount of evidence was found to support much of community paediatric practice. This study improved on previous research in other specialties because actions other than medications and surgery were included.

 PMID:10325707

Is there evidence to support a forefoot strike pattern in barefoot runners? A review.

PubMed

Lorenz, Daniel S; Pontillo, Marisa

2012-11-01

Barefoot running is a trend among running enthusiasts that is the subject of much controversy. At this time, benefits appear to be more speculative and anecdotal than evidence based. Additionally, the risk of injuries is not well established. A PubMed search was undertaken for articles published in English from 1980 to 2011. Additional references were accrued from reference lists of research articles. While minimal data exist that definitively support barefoot running, there are data lending support to the argument that runners should use a forefoot strike pattern in lieu of a heel strike pattern to reduce ground reaction forces, ground contact time, and step length. Whether there is a positive or negative effect on injury has yet to be determined. Unquestionably, more research is needed before definitive conclusions can be drawn.

Supporting decision-making processes for evidence-based mental health promotion.

PubMed

Jané-Llopis, Eva; Katschnig, Heinz; McDaid, David; Wahlbeck, Kristian

2011-12-01

The use of evidence is critical in guiding decision-making, but evidence from effect studies will be only one of a number of factors that will need to be taken into account in the decision-making processes. Equally important for policymakers will be the use of different types of evidence including implementation essentials and other decision-making principles such as social justice, political, ethical, equity issues, reflecting public attitudes and the level of resources available, rather than be based on health outcomes alone. This paper, aimed to support decision-makers, highlights the importance of commissioning high-quality evaluations, the key aspects to assess levels of evidence, the importance of supporting evidence-based implementation and what to look out for before, during and after implementation of mental health promotion and mental disorder prevention programmes.

The theories underpinning rational emotive behaviour therapy: where's the supportive evidence?

PubMed

MacInnes, Douglas

2004-08-01

This paper examines the underlying theoretical philosophy of one of the most widely used cognitive behaviour therapies, rational emotive behaviour therapy. It examines whether two central theoretical principles are supported by research evidence: firstly, that irrational beliefs lead to dysfunctional emotions and inferences and that rational beliefs lead to functional emotions and inferences and, secondly, that demand beliefs are the primary core irrational belief. The established criteria for evaluating the efficacy of the theories are detailed and used to evaluate the strength of evidence supporting these two assumptions. The findings indicate there is limited evidence to support these theories. Copyright 2004 Elsevier Ltd.

Evidence supporting the use of cone-beam computed tomography in orthodontics.

PubMed

van Vlijmen, Olivier J C; Kuijpers, Mette A R; Bergé, Stefaan J; Schols, Jan G J H; Maal, Thomas J J; Breuning, Hero; Kuijpers-Jagtman, Anne Marie

2012-03-01

The authors conducted a systematic review of cone-beam computed tomography (CBCT) applications in orthodontics and evaluated the level of evidence to determine whether the use of CBCT is justified in orthodontics. The authors identified articles by searching the Cochrane Library, PubMed, MEDLINE, Embase, Scopus and Cumulative Index to Nursing and Allied Health Literature databases. They searched the articles' reference lists manually for additional articles and had no language limitations. They did not search the gray literature. Inclusion criteria were CBCT use in orthodontics and that the participants be human. The lowest level of evidence accepted for inclusion was a case series with five or more participants. The authors evaluated the studies' methodological quality according to 13 criteria related to study design, measurements and statistical analysis. The authors identified 550 articles, and 50 met the inclusion criteria. Study topics included temporary anchorage devices, cephalometry, combined orthodontic and surgical treatment, airway measurements, root resorption and tooth impactions, and cleft lip and palate. The methodological quality averaged 53 percent (range, 15-77 percent) of the maximum score. The authors found no high-quality evidence regarding the benefits of CBCT use in orthodontics. Limited evidence shows that CBCT offers better diagnostic potential, leads to better treatment planning or results in better treatment outcome than do conventional imaging modalities. Only the results of studies on airway diagnostics provided sound scientific data suggesting that CBCT use has added value. The additional radiation exposure should be weighed against possible benefits of CBCT, which have not been supported in the literature. In future studies, investigators should evaluate the effects of CBCT on treatment procedures, progression and outcome quantitatively.

The Evidence. Supported Education: A Promising Practice. Evidence-Based Practices KIT (Knowledge Informing Transformation)

ERIC Educational Resources Information Center

Unger, Karen V.

2011-01-01

Supported Employment is an evidence-based practice that helps people with mental illness find and keep meaningful jobs in the community. Given these outcomes the challenge for Supported Employment programs is to rethink the emphasis on immediate work for everyone and help consumers utilize appropriate education and training opportunities available…

Staff views on supporting evidence based practice for children with ASD.

PubMed

Trembath, David; Sulek, Rhylee; Paynter, Jessica; Simpson, Kate; Keen, Deb

2017-11-22

A variety of empirically supported interventions are available for children with autism spectrum disorder (ASD), but previous research suggests that their selection and use within an evidence-based practice (EBP) framework in clinical settings is challenging. To date, research has primarily focused on identifying individual, organisational, and contextual barriers to EBP rather than identifying collaborative solutions to these barriers through consultation with staff. The aim of our study was to explore staff views on supporting EBP in their work with children with ASD. We conducted five focus groups involving 29 professional (e.g., speech pathologists, teachers), paraprofessional (e.g., childcare workers), and managerial staff to explore their views. Audio recordings were transcribed verbatim and analysed using thematic analysis. Two central themes, comprising six categories, emerged to account for the participants' views. Initiative and Effort accounted for the range of creative strategies staff had developed to support their engagement in EBP. They also expressed the need for A Better Way involving organisational-wide support such as this engagement, including peer-to-peer mentoring. The findings suggest that an organisational-wide model to support engagement in EBP, with peer-to-peer mentoring at its foundation, may provide a desirable, ecologically valid, and acceptable model. Implications for Rehabilitation Clinicians and educators recognise the importance of evidence-based practice. Efforts to support evidence-based practice have focused mostly on access to research evidence. Clinicians and educators in this study were developing their own strategies based on intuition. They identified a need for organisation-wide approaches to supporting evidence-based practice. Peer-to-peer mentoring appears to be an acceptable and viable strategy.

Twelve evidence-based principles for implementing self-management support in primary care.

PubMed

Battersby, Malcolm; Von Korff, Michael; Schaefer, Judith; Davis, Connie; Ludman, Evette; Greene, Sarah M; Parkerton, Melissa; Wagner, Edward H

2010-12-01

Recommendations to improve self-management support and health outcomes for people with chronic conditions in primary care settings are provided on the basis of expert opinion supported by evidence for practices and processes. Practices and processes that could improve self-management support in primary care were identified through a nominal group process. In a targeted search strategy, reviews and meta-analyses were then identifed using terms from a wide range of chronic conditions and behavioral risk factors in combination with Self-Care, Self-Management, and Primary Care. On the basis of these reviews, evidence-based principles for self-management support were developed. The evidence is organized within the framework of the Chronic Care Model. Evidence-based principles in 12 areas were associated with improved patient self-management and/or health outcomes: (1) brief targeted assessment, (2) evidence-based information to guide shared decision-making, (3) use of a nonjudgmental approach, (4) collaborative priority and goal setting, (5) collaborative problem solving, (6) self-management support by diverse providers, (7) self-management interventions delivered by diverse formats, (8) patient self-efficacy, (9) active followup, (10) guideline-based case management for selected patients, (11) linkages to evidence-based community programs, and (12) multifaceted interventions. A framework is provided for implementing these principles in three phases of the primary care visit: enhanced previsit assessment, a focused clinical encounter, and expanded postvisit options. There is a growing evidence base for how self-management support for chronic conditions can be integrated into routine health care.

20 CFR 219.56 - When evidence of a parent's support is required.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false When evidence of a parent's support is... a parent's support is required. If a person applies for a parent's annuity, the Board will require evidence to show that the parent received at least one-half of his or her support from the employee in the...

Additivity pretraining and cue competition effects: developmental evidence for a reasoning-based account of causal learning.

PubMed

Simms, Victoria; McCormack, Teresa; Beckers, Tom

2012-04-01

The effect of additivity pretraining on blocking has been taken as evidence for a reasoning account of human and animal causal learning. If inferential reasoning underpins this effect, then developmental differences in the magnitude of this effect in children would be expected. Experiment 1 examined cue competition effects in children's (4- to 5-year-olds and 6- to 7-year-olds) causal learning using a new paradigm analogous to the food allergy task used in studies of human adult causal learning. Blocking was stronger in the older than the younger children, and additivity pretraining only affected blocking in the older group. Unovershadowing was not affected by age or by pretraining. In experiment 2, levels of blocking were found to be correlated with the ability to answer questions that required children to reason about additivity. Our results support an inferential reasoning explanation of cue competition effects. (c) 2012 APA, all rights reserved.

A prototype system to support evidence-based practice.

PubMed

Demner-Fushman, Dina; Seckman, Charlotte; Fisher, Cheryl; Hauser, Susan E; Clayton, Jennifer; Thoma, George R

2008-11-06

Translating evidence into clinical practice is a complex process that depends on the availability of evidence, the environment into which the research evidence is translated, and the system that facilitates the translation. This paper presents InfoBot, a system designed for automatic delivery of patient-specific information from evidence-based resources. A prototype system has been implemented to support development of individualized patient care plans. The prototype explores possibilities to automatically extract patients problems from the interdisciplinary team notes and query evidence-based resources using the extracted terms. Using 4,335 de-identified interdisciplinary team notes for 525 patients, the system automatically extracted biomedical terminology from 4,219 notes and linked resources to 260 patient records. Sixty of those records (15 each for Pediatrics, Oncology & Hematology, Medical & Surgical, and Behavioral Health units) have been selected for an ongoing evaluation of the quality of automatically proactively delivered evidence and its usefulness in development of care plans.

A Prototype System to Support Evidence-based Practice

PubMed Central

Demner-Fushman, Dina; Seckman, Charlotte; Fisher, Cheryl; Hauser, Susan E.; Clayton, Jennifer; Thoma, George R.

2008-01-01

Translating evidence into clinical practice is a complex process that depends on the availability of evidence, the environment into which the research evidence is translated, and the system that facilitates the translation. This paper presents InfoBot, a system designed for automatic delivery of patient-specific information from evidence-based resources. A prototype system has been implemented to support development of individualized patient care plans. The prototype explores possibilities to automatically extract patients’ problems from the interdisciplinary team notes and query evidence-based resources using the extracted terms. Using 4,335 de-identified interdisciplinary team notes for 525 patients, the system automatically extracted biomedical terminology from 4,219 notes and linked resources to 260 patient records. Sixty of those records (15 each for Pediatrics, Oncology & Hematology, Medical & Surgical, and Behavioral Health units) have been selected for an ongoing evaluation of the quality of automatically proactively delivered evidence and its usefulness in development of care plans. PMID:18998835

Evidence for dose-additive effects of pyrethroids on motor activity in rats.

PubMed

Wolansky, Marcelo J; Gennings, Chris; DeVito, Michael J; Crofton, Kevin M

2009-10-01

Pyrethroids are neurotoxic insecticides used in a variety of indoor and outdoor applications. Previous research characterized the acute dose-effect functions for 11 pyrethroids administered orally in corn oil (1 mL/kg) based on assessment of motor activity. We used a mixture of these 11 pyrethroids and the same testing paradigm used in single-compound assays to test the hypothesis that cumulative neurotoxic effects of pyrethroid mixtures can be predicted using the default dose-addition theory. Mixing ratios of the 11 pyrethroids in the tested mixture were based on the ED30 (effective dose that produces a 30% decrease in response) of the individual chemical (i.e., the mixture comprised equipotent amounts of each pyrethroid). The highest concentration of each individual chemical in the mixture was less than the threshold for inducing behavioral effects. Adult male rats received acute oral exposure to corn oil (control) or dilutions of the stock mixture solution. The mixture of 11 pyrethroids was administered either simultaneously (2 hr before testing) or after a sequence based on times of peak effect for the individual chemicals (4, 2, and 1 hr before testing). A threshold additivity model was fit to the single-chemical data to predict the theoretical dose-effect relationship for the mixture under the assumption of dose additivity. When subthreshold doses of individual chemicals were combined in the mixtures, we found significant dose-related decreases in motor activity. Further, we found no departure from the predicted dose-additive curve regardless of the mixture dosing protocol used. In this article we present the first in vivo evidence on pyrethroid cumulative effects supporting the default assumption of dose addition.

A Knowledge-based System for Intelligent Support in Pharmacogenomics Evidence Assessment: Ontology-driven Evidence Representation and Retrieval.

PubMed

Lee, Chia-Ju; Devine, Beth; Tarczy-Hornoch, Peter

2017-01-01

Pharmacogenomics holds promise as a critical component of precision medicine. Yet, the use of pharmacogenomics in routine clinical care is minimal, partly due to the lack of efficient and effective use of existing evidence. This paper describes the design, development, implementation and evaluation of a knowledge-based system that fulfills three critical features: a) providing clinically relevant evidence, b) applying an evidence-based approach, and c) using semantically computable formalism, to facilitate efficient evidence assessment to support timely decisions on adoption of pharmacogenomics in clinical care. To illustrate functionality, the system was piloted in the context of clopidogrel and warfarin pharmacogenomics. In contrast to existing pharmacogenomics knowledge bases, the developed system is the first to exploit the expressivity and reasoning power of logic-based representation formalism to enable unambiguous expression and automatic retrieval of pharmacogenomics evidence to support systematic review with meta-analysis.

5 CFR 831.1206 - Evidence supporting entitlement to disability benefits.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Evidence supporting entitlement to disability benefits. 831.1206 Section 831.1206 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) RETIREMENT Disability Retirement § 831.1206 Evidence...

5 CFR 831.1206 - Evidence supporting entitlement to disability benefits.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Evidence supporting entitlement to disability benefits. 831.1206 Section 831.1206 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) RETIREMENT Disability Retirement § 831.1206 Evidence...

9. DETAIL OF FIXED SUPPORT (A RECENT ADDITION THE ...

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

9. DETAIL OF FIXED SUPPORT (A RECENT ADDITION -- THE BRIDGE IS NO LONGER MOVEABLE) AND LOWER CHORD OF THROUGH TRUSS, LOOKING SOUTH - Romeo Road, Sanitary & Ship Canal Bridge, Spanning Sanitary & Ship Canal, Romeoville, Will County, IL

Supporting Implementation of Evidence-Based Practices through Practice-Based Coaching

ERIC Educational Resources Information Center

Snyder, Patricia A; Hemmeter, Mary Louise; Fox, Lise

2015-01-01

In active implementation science frameworks, coaching has been described as an important competency "driver" to ensure evidence-based practices are implemented as intended. Empirical evidence also has identified coaching as a promising job-embedded professional development strategy to support implementation of quality teaching practices.…

Evidence supporting the biologic nature of gender identity.

PubMed

Saraswat, Aruna; Weinand, Jamie D; Safer, Joshua D

2015-02-01

To review current literature that supports a biologic basis of gender identity. A traditional literature review. Evidence that there is a biologic basis for gender identity primarily involves (1) data on gender identity in patients with disorders of sex development (DSDs, also known as differences of sex development) along with (2) neuroanatomical differences associated with gender identity. Although the mechanisms remain to be determined, there is strong support in the literature for a biologic basis of gender identity.

Tools to support evidence-informed public health decision making

PubMed Central

2014-01-01

Background Public health professionals are increasingly expected to engage in evidence-informed decision making to inform practice and policy decisions. Evidence-informed decision making involves the use of research evidence along with expertise, existing public health resources, knowledge about community health issues, the local context and community, and the political climate. The National Collaborating Centre for Methods and Tools has identified a seven step process for evidence-informed decision making. Tools have been developed to support public health professionals as they work through each of these steps. This paper provides an overview of tools used in three Canadian public health departments involved in a study to develop capacity for evidence-informed decision making. Methods As part of a knowledge translation and exchange intervention, a Knowledge Broker worked with public health professionals to identify and apply tools for use with each of the steps of evidence-informed decision making. The Knowledge Broker maintained a reflective journal and interviews were conducted with a purposive sample of decision makers and public health professionals. This paper presents qualitative analysis of the perceived usefulness and usability of the tools. Results Tools were used in the health departments to assist in: question identification and clarification; searching for the best available research evidence; assessing the research evidence for quality through critical appraisal; deciphering the ‘actionable message(s)’ from the research evidence; tailoring messages to the local context to ensure their relevance and suitability; deciding whether and planning how to implement research evidence in the local context; and evaluating the effectiveness of implementation efforts. Decision makers provided descriptions of how the tools were used within the health departments and made suggestions for improvement. Overall, the tools were perceived as valuable for advancing

Tools to support evidence-informed public health decision making.

PubMed

Yost, Jennifer; Dobbins, Maureen; Traynor, Robyn; DeCorby, Kara; Workentine, Stephanie; Greco, Lori

2014-07-18

Public health professionals are increasingly expected to engage in evidence-informed decision making to inform practice and policy decisions. Evidence-informed decision making involves the use of research evidence along with expertise, existing public health resources, knowledge about community health issues, the local context and community, and the political climate. The National Collaborating Centre for Methods and Tools has identified a seven step process for evidence-informed decision making. Tools have been developed to support public health professionals as they work through each of these steps. This paper provides an overview of tools used in three Canadian public health departments involved in a study to develop capacity for evidence-informed decision making. As part of a knowledge translation and exchange intervention, a Knowledge Broker worked with public health professionals to identify and apply tools for use with each of the steps of evidence-informed decision making. The Knowledge Broker maintained a reflective journal and interviews were conducted with a purposive sample of decision makers and public health professionals. This paper presents qualitative analysis of the perceived usefulness and usability of the tools. Tools were used in the health departments to assist in: question identification and clarification; searching for the best available research evidence; assessing the research evidence for quality through critical appraisal; deciphering the 'actionable message(s)' from the research evidence; tailoring messages to the local context to ensure their relevance and suitability; deciding whether and planning how to implement research evidence in the local context; and evaluating the effectiveness of implementation efforts. Decision makers provided descriptions of how the tools were used within the health departments and made suggestions for improvement. Overall, the tools were perceived as valuable for advancing and sustaining evidence

When Is Statistical Evidence Superior to Anecdotal Evidence in Supporting Probability Claims? The Role of Argument Type

ERIC Educational Resources Information Center

Hoeken, Hans; Hustinx, Lettica

2009-01-01

Under certain conditions, statistical evidence is more persuasive than anecdotal evidence in supporting a claim about the probability that a certain event will occur. In three experiments, it is shown that the type of argument is an important condition in this respect. If the evidence is part of an argument by generalization, statistical evidence…

SUPPORT Tools for evidence-informed health Policymaking (STP) 1: What is 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. In this article, we discuss the following three questions: What is evidence? What is the role of research evidence in informing health policy decisions? What is evidence-informed policymaking? Evidence-informed health policymaking is an approach to policy decisions that aims to ensure that decision making is well-informed by the best available research evidence. It is characterised by the systematic and transparent access to, and appraisal of, evidence as an input into the policymaking process. The overall process of policymaking is not assumed to be systematic and transparent. However, within the overall process of policymaking, systematic processes are used to ensure that relevant research is identified, appraised and used appropriately. These processes are transparent in order to ensure that others can examine what research evidence was used to inform policy decisions, as well as the judgements made about the evidence and its implications. Evidence-informed policymaking helps policymakers gain an understanding of these processes. PMID:20018099

Evidence for Dose-Additive Effects of Pyrethroids on Motor Activity in Rats

PubMed Central

Wolansky, Marcelo J.; Gennings, Chris; DeVito, Michael J.; Crofton, Kevin M.

2009-01-01

Background Pyrethroids are neurotoxic insecticides used in a variety of indoor and outdoor applications. Previous research characterized the acute dose–effect functions for 11 pyrethroids administered orally in corn oil (1 mL/kg) based on assessment of motor activity. Objectives We used a mixture of these 11 pyrethroids and the same testing paradigm used in single-compound assays to test the hypothesis that cumulative neurotoxic effects of pyrethroid mixtures can be predicted using the default dose–addition theory. Methods Mixing ratios of the 11 pyrethroids in the tested mixture were based on the ED30 (effective dose that produces a 30% decrease in response) of the individual chemical (i.e., the mixture comprised equipotent amounts of each pyrethroid). The highest concentration of each individual chemical in the mixture was less than the threshold for inducing behavioral effects. Adult male rats received acute oral exposure to corn oil (control) or dilutions of the stock mixture solution. The mixture of 11 pyrethroids was administered either simultaneously (2 hr before testing) or after a sequence based on times of peak effect for the individual chemicals (4, 2, and 1 hr before testing). A threshold additivity model was fit to the single-chemical data to predict the theoretical dose–effect relationship for the mixture under the assumption of dose additivity. Results When subthreshold doses of individual chemicals were combined in the mixtures, we found significant dose-related decreases in motor activity. Further, we found no departure from the predicted dose-additive curve regardless of the mixture dosing protocol used. Conclusion In this article we present the first in vivo evidence on pyrethroid cumulative effects supporting the default assumption of dose addition. PMID:20019907

46 CFR 355.5 - Additional material.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Additional material. 355.5 Section 355.5 Shipping... STATES CITIZENSHIP § 355.5 Additional material. If additional material is determined to be essential to clarify or support the evidence of U.S. citizenship, such material shall be furnished by the...

46 CFR 355.5 - Additional material.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Additional material. 355.5 Section 355.5 Shipping... STATES CITIZENSHIP § 355.5 Additional material. If additional material is determined to be essential to clarify or support the evidence of U.S. citizenship, such material shall be furnished by the...

46 CFR 355.5 - Additional material.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Additional material. 355.5 Section 355.5 Shipping... STATES CITIZENSHIP § 355.5 Additional material. If additional material is determined to be essential to clarify or support the evidence of U.S. citizenship, such material shall be furnished by the...

20 CFR 655.21 - Supporting evidence for temporary need.

Code of Federal Regulations, 2010 CFR

2010-04-01

... nature of the employer's job opportunity and number of foreign workers being requested for certification...) Retention of documentation. The documentation required in this section and any other supporting evidence...

Computer Maintenance Operations Center (CMOC), additional computer support equipment ...

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

Computer Maintenance Operations Center (CMOC), additional computer support equipment - Beale Air Force Base, Perimeter Acquisition Vehicle Entry Phased-Array Warning System, Techinical Equipment Building, End of Spencer Paul Road, north of Warren Shingle Road (14th Street), Marysville, Yuba County, CA

Support Mechanisms for Evidence-Based Policy-Making in Education. Eurydice Report

ERIC Educational Resources Information Center

Riiheläinen, Jari Matti; Böhm, Franziska

2017-01-01

The report describes the mechanisms and practices that support evidence-based policy-making in the education sector in Europe. It comparatively looks at institutions and practices in evidence-based policy-making, as well as the accessibility, and mediation, of evidence. The report presents more detailed information on each individual country, with…

Additional specimen of Microraptor provides unique evidence of dinosaurs preying on birds

PubMed Central

O'Connor, Jingmai; Zhou, Zhonghe; Xu, Xing

2011-01-01

Preserved indicators of diet are extremely rare in the fossil record; even more so is unequivocal direct evidence for predator–prey relationships. Here, we report on a unique specimen of the small nonavian theropod Microraptor gui from the Early Cretaceous Jehol biota, China, which has the remains of an adult enantiornithine bird preserved in its abdomen, most likely not scavenged, but captured and consumed by the dinosaur. We provide direct evidence for the dietary preferences of Microraptor and a nonavian dinosaur feeding on a bird. Further, because Jehol enantiornithines were distinctly arboreal, in contrast to their cursorial ornithurine counterparts, this fossil suggests that Microraptor hunted in trees thereby supporting inferences that this taxon was also an arborealist, and provides further support for the arboreality of basal dromaeosaurids. PMID:22106278

"Compacted" procedures for adults' simple addition: A review and critique of the evidence.

PubMed

Chen, Yalin; Campbell, Jamie I D

2018-04-01

We review recent empirical findings and arguments proffered as evidence that educated adults solve elementary addition problems (3 + 2, 4 + 1) using so-called compacted procedures (e.g., unconscious, automatic counting); a conclusion that could have significant pedagogical implications. We begin with the large-sample experiment reported by Uittenhove, Thevenot and Barrouillet (2016, Cognition, 146, 289-303), which tested 90 adults on the 81 single-digit addition problems from 1 + 1 to 9 + 9. They identified the 12 very-small addition problems with different operands both ≤ 4 (e.g., 4 + 3) as a distinct subgroup of problems solved by unconscious, automatic counting: These items yielded a near-perfectly linear increase in answer response time (RT) yoked to the sum of the operands. Using the data reported in the article, however, we show that there are clear violations of the sum-counting model's predictions among the very-small addition problems, and that there is no real RT boundary associated with addends ≤4. Furthermore, we show that a well-known associative retrieval model of addition facts-the network interference theory (Campbell, 1995)-predicts the results observed for these problems with high precision. We also review the other types of evidence adduced for the compacted procedure theory of simple addition and conclude that these findings are unconvincing in their own right and only distantly consistent with automatic counting. We conclude that the cumulative evidence for fast compacted procedures for adults' simple addition does not justify revision of the long-standing assumption that direct memory retrieval is ultimately the most efficient process of simple addition for nonzero problems, let alone sufficient to recommend significant changes to basic addition pedagogy.

Evidence-informed health policy 2 - survey of organizations that support the use of research evidence.

PubMed

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

2008-12-17

Previous surveys of organizations that support the development of evidence-informed health policies have focused on organizations that produce clinical practice guidelines (CPGs) or undertake health technology assessments (HTAs). Only rarely have surveys focused at least in part on units that directly support the use of research evidence in developing health policy on an international, national, and state or provincial level (i.e., government support units, or GSUs) that are in some way successful or innovative or that support the use of research evidence in low- and middle-income countries (LMICs). We drew on many people and organizations around the world, including our project reference group, to generate a list of organizations to survey. We modified a questionnaire that had been developed originally by the Appraisal of Guidelines, Research and Evaluation in Europe (AGREE) collaboration and adapted one version of the questionnaire for organizations producing CPGs and HTAs, and another for GSUs. We sent the questionnaire by email to 176 organizations and followed up periodically with non-responders by email and telephone. We received completed questionnaires from 152 (86%) organizations. More than one-half of the organizations (and particularly HTA agencies) reported that examples from other countries were helpful in establishing their organization. A higher proportion of GSUs than CPG- or HTA-producing organizations involved target users in the selection of topics or the services undertaken. Most organizations have few (five or fewer) full-time equivalent (FTE) staff. More than four-fifths of organizations reported providing panels with or using systematic reviews. GSUs tended to use a wide variety of explicit valuation processes for the research evidence, but none with the frequency that organizations producing CPGs, HTAs, or both prioritized evidence by its quality. Between one-half and two-thirds of organizations do not collect data systematically about

Levels of Evidence: Supportive and Palliative Care Studies (PDQ®)—Health Professional Version

Cancer.gov

Levels of Evidence for Supportive and Palliative Care Summaries includes cited references primarily from the peer-reviewed biomedical literature. Get detailed information about how to weigh the strength of the evidence obtained in supportive and palliative care studies in this clinician summary.

ProVac Global Initiative: a vision shaped by ten years of supporting evidence-based policy decisions.

PubMed

Jauregui, Barbara; Janusz, Cara Bess; Clark, Andrew D; Sinha, Anushua; Garcia, Ana Gabriela Felix; Resch, Stephen; Toscano, Cristiana M; Sanderson, Colin; Andrus, Jon Kim

2015-05-07

The Pan American Health Organization (PAHO) created the ProVac Initiative in 2004 with the goal of strengthening national technical capacity to make evidence-based decisions on new vaccine introduction, focusing on economic evaluations. In view of the 10th anniversary of the ProVac Initiative, this article describes its progress and reflects on lessons learned to guide the next phase. We quantified the output of the Initiative's capacity-building efforts and critically assess its progress toward achieving the milestones originally proposed in 2004. Additionally, we reviewed how country studies supported by ProVac have directly informed and strengthened the deliberations around new vaccine introduction. Since 2004, ProVac has conducted four regional workshops and supported 24 health economic analyses in 15 Latin American and Caribbean countries. Five Regional Centers of Excellence were funded, resulting in six operational research projects and nine publications. Twenty four decisions on new vaccine introductions were supported with ProVac studies. Enduring products include the TRIVAC and CERVIVAC cost-effectiveness models, the COSTVAC program costing model, methodological guides, workshop training materials and the OLIVES on-line data repository. Ten NITAGs were strengthened through ProVac activities. The evidence accumulated suggests that initiatives with emphasis on sustainable training and direct support for countries to generate evidence themselves, can help accelerate the introduction of the most valuable new vaccines. International and Regional Networks of Collaborators are necessary to provide technical support and tools to national teams conducting analyses. Timeliness, integration, quality and country ownership of the process are four necessary guiding principles for national economic evaluations to have an impact on policymaking. It would be an asset to have a model that offers different levels of complexity to choose from depending on the vaccine being

Knowledge into action - supporting the implementation of evidence into practice in Scotland.

PubMed

Davies, Sandra; Herbert, Paul; Wales, Ann; Ritchie, Karen; Wilson, Suzanne; Dobie, Laura; Thain, Annette

2017-03-01

The knowledge into action model for NHS Scotland provides a framework for librarians and health care staff to support getting evidence into practice. Central to this model is the development of a network of knowledge brokers to facilitate identification, use, creation and sharing of knowledge. To translate the concepts described in the model into tangible activities with the intention of supporting better use of evidence in health care and subsequently improving patient outcomes. Four areas of activity were addressed by small working groups comprising knowledge services staff in local and national boards. The areas of activity were as follows: defining existing and required capabilities and developing learning opportunities for the knowledge broker network; establishing national search and summarising services; developing actionable knowledge tools; and supporting person-to-person knowledge sharing. This work presents the development of practical tools and support to translate a conceptual model for getting knowledge into action into a series of activities and outputs to support better use of evidence in health care and subsequently improved patient outcomes. © 2017 Health Libraries Group.

Intelligence is as intelligence does: can additional support needs replace disability?

PubMed

Arnold, Samuel R C; Riches, Vivienne C; Stancliffe, Roger J

2011-12-01

Abstract In many developed cultures there is an assumption that IQ is intelligence. However, emerging theories of multiple intelligences, of emotional intelligence, as well as the application of IQ testing to other cultural groups, and to people with disability, raises many questions as to what IQ actually measures. Despite recent research that shows IQ testing produces a floor effect when applied to people with lower IQ, as well as research that shows the Flynn effect also applies to people with lower IQ, in practice IQ scores below a certain cut-off are still being used to determine and classify a person's intellectual disability. However, a new paradigm is emerging, almost returning to the original intent of Binet, where measurement is made of the supports the person needs. In this paper, we argue that if one extends the notions of this supports paradigm that diagnosis of intellectual or physical disability could potentially be replaced by diagnosis of additional intellectual support needs, or additional physical support needs.

Organizational Supports for Research Evidence Use in State Public Health Agencies: A Latent Class Analysis.

PubMed

Hu, Hengrui; Allen, Peg; Yan, Yan; Reis, Rodrigo S; Jacob, Rebekah R; Brownson, Ross C

2018-05-30

Use of research evidence in public health decision making can be affected by organizational supports. Study objectives are to identify patterns of organizational supports and explore associations with research evidence use for job tasks among public health practitioners. In this longitudinal study, we used latent class analysis to identify organizational support patterns, followed by mixed logistic regression analysis to quantify associations with research evidence use. The setting included 12 state public health department chronic disease prevention units and their external partnering organizations involved in chronic disease prevention. Chronic disease prevention staff from 12 US state public health departments and partnering organizations completed self-report surveys at 2 time points, in 2014 and 2016 (N = 872). Latent class analysis was employed to identify subgroups of survey participants with distinct patterns of perceived organizational supports. Two classify-analyze approaches (maximum probability assignment and multiple pseudo-class draws) were used in 2017 to investigate the association between latent class membership and research evidence use. The optimal model identified 4 latent classes, labeled as "unsupportive workplace," "low agency leadership support," "high agency leadership support," and "supportive workplace." With maximum probability assignment, participants in "high agency leadership support" (odds ratio = 2.08; 95% CI, 1.35-3.23) and "supportive workplace" (odds ratio = 1.74; 95% CI, 1.10-2.74) were more likely to use research evidence in job tasks than "unsupportive workplace." The multiple pseudo-class draws produced comparable results with odds ratio = 2.09 (95% CI, 1.31-3.30) for "high agency leadership support" and odds ratio = 1.74 (95% CI, 1.07-2.82) for "supportive workplace." Findings suggest that leadership support may be a crucial element of organizational supports to encourage research evidence use. Organizational supports such

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

Catalytic functionalities of supported sulfides. I. Effect of support and additives on the CoMo catalyst

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

Muralidhar, G.; Massoth, F.E.; Shabtai, J.

1984-01-01

C-S hydrogenolysis (HDS) of thiophene, hydrogenation (HYD) of 1-hexene, and hydrocracking (HCG) of 2,4,4-trimethyl-1-pentene, were used as separate model test reactions to differentiate and assess the catalytic functionalities of sulfided CoMo catalysts, and their dependence on the nature of the support and incorporation of additives. Rate constants and relative catalyst activities for these three reaction types were determined. HDS and HYD activities of CoMo supported on different types of Al/sub 2/O/sub 3/ were higher, while the HCG activity was lower compared with CoMo supported on SiO/sub 2/-Al/sub 2/O/sub 3/, SiO/sub 2/-MgO, or TiO/sub 2/. For SiO/sub 2/-Al/sub 2/O/sub 3/ supportsmore » both HDS and HYD activities decreased with increase in SiO/sub 2/ content from 10 to 75%, while HCG activity showed the opposite trend. Additives to a finished CoMo catalyst at 0.5% level caused variations in HDS and HCG activities, while HYD was essentially unaffected. HDS was promoted by NH/sub 4/HF/sub 2/ and NH/sub 4/Cl, but depressed by NaNO/sub 3/, Ca(NO/sub 3/)/sub 2/, and H/sub 3/BO/sub 3/. HCG was promoted by NH/sub 4/HF/sub 2/, NH/sub 4/Cl, and H/sub 3/BO/sub 3/. Additives at 5% level, prior to or after CoMo impregnation, showed a strong depressing effect on HDS and a lesser effect on HYD, while HCG was strongly promoted by NH/sub 4/HF/sub 2/, Ti isopropoxide, and H/sub 3/BO/sub 3/. The changes in catalytic functionalities are rationalized in terms of different interactions between CoMo phase, support, and additives. 3 tables, 1 figure.« less

Additional Support Needs Reforms and Social Justice in Scotland

ERIC Educational Resources Information Center

Riddell, Sheila; Stead, Joan; Weedon, Elisabet; Wright, Kevin

2010-01-01

New additional support-needs legislation in Scotland sought to recognise the way in which poverty, as well as individual impairment, contribute to the creation of children's difficulties in learning. As well as identifying a wider range of needs, the legislation sought to provide parents, irrespective of social background, with more powerful means…

What evidence and support do state-level public health practitioners need to address obesity prevention.

PubMed

Leeman, Jennifer; Teal, Randall; Jernigan, Jan; Reed, Jenica Huddleston; Farris, Rosanne; Ammerman, Alice

2014-01-01

Obesity has reached epidemic proportions. Public health practitioners are distinctly positioned to promote the environmental changes essential to addressing obesity. The Centers for Disease Control and Prevention (CDC) and other entities provide evidence and technical assistance to support this work, yet little is known about how practitioners use evidence and support as they intervene to prevent obesity. The study's purpose was to describe how practitioners and CDC project officers characterized the obesity prevention task, where practitioners accessed support and evidence, and what approaches to support and evidence they found most useful. APPROACH OR DESIGN: Mixed-methods, cross-sectional interviews, and survey. State-level public health obesity prevention programs. Public health practitioners and CDC project officers. We conducted 10 in-depth interviews with public health practitioners (n = 7) and project officers (n = 3) followed by an online survey completed by 62 practitioners (50% response rate). We applied content analysis to interview data and descriptive statistics to survey data. Practitioners characterized obesity prevention as uncertain and complex, involving interdependence among actors, multiple levels of activity, an excess of information, and a paucity of evidence. Survey findings provide further detail on the types of evidence and support practitioners used and valued. We recommend approaches to tailoring evidence and support to the needs of practitioners working on obesity prevention and other complex health problems.

Building a knowledge translation platform in Malawi to support evidence-informed health policy.

PubMed

Berman, Joshua; Mitambo, Collins; Matanje-Mwagomba, Beatrice; Khan, Shiraz; Kachimanga, Chiyembekezo; Wroe, Emily; Mwape, Lonia; van Oosterhout, Joep J; Chindebvu, Getrude; van Schoor, Vanessa; Puchalski Ritchie, Lisa M; Panisset, Ulysses; Kathyola, Damson

2015-12-08

With the support of the World Health Organization's Evidence-Informed Policy Network, knowledge translation platforms have been developed throughout Africa, the Americas, Eastern Europe, and Asia to further evidence-informed national health policy. In this commentary, we discuss the approaches, activities and early lessons learned from the development of a Knowledge Translation Platform in Malawi (KTPMalawi). Through ongoing leadership, as well as financial and administrative support, the Malawi Ministry of Health has strongly signalled its intention to utilize a knowledge translation platform methodology to support evidence-informed national health policy. A unique partnership between Dignitas International, a medical and research non-governmental organization, and the Malawi Ministry of Health, has established KTPMalawi to engage national-level policymakers, researchers and implementers in a coordinated approach to the generation and utilization of health-sector research. Utilizing a methodology developed and tested by knowledge translation platforms across Africa, a stakeholder mapping exercise and initial capacity building workshops were undertaken and a multidisciplinary Steering Committee was formed. This Steering Committee prioritized the development of two initial Communities of Practice to (1) improve data utilization in the pharmaceutical supply chain and (2) improve the screening and treatment of hypertension within HIV-infected populations. Each Community of Practice's mandate is to gather and synthesize the best available global and local evidence and produce evidence briefs for policy that have been used as the primary input into structured deliberative dialogues. While a lack of sustained initial funding slowed its early development, KTPMalawi has greatly benefited from extensive technical support and mentorship by an existing network of global knowledge translation platforms. With the continued support of the Malawi Ministry of Health and the

Caught on Video! Using Handheld Digital Video Cameras to Support Evidence-Based Reasoning

ERIC Educational Resources Information Center

Lottero-Perdue, Pamela S.; Nealy, Jennifer; Roland, Christine; Ryan, Amy

2011-01-01

Engaging elementary students in evidence-based reasoning is an essential aspect of science and engineering education. Evidence-based reasoning involves students making claims (i.e., answers to questions, or solutions to problems), providing evidence to support those claims, and articulating their reasoning to connect the evidence to the claim. In…

Evidence that Additions of Grignard Reagents to Aliphatic Aldehydes Do Not Involve Single-Electron-Transfer Processes.

PubMed

Otte, Douglas A L; Woerpel, K A

2015-08-07

Addition of allylmagnesium reagents to an aliphatic aldehyde bearing a radical clock gave only addition products and no evidence of ring-opened products that would suggest single-electron-transfer reactions. The analogous Barbier reaction also did not provide evidence for a single-electron-transfer mechanism in the addition step. Other Grignard reagents (methyl-, vinyl-, t-Bu-, and triphenylmethylmagnesium halides) also do not appear to add to an alkyl aldehyde by a single-electron-transfer mechanism.

14 CFR 1261.107 - Evidence in support of claim.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Evidence in support of claim. 1261.107 Section 1261.107 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION PROCESSING OF... statement from the claimant's supervisor or other person or persons having personal knowledge of the facts...

14 CFR 1261.107 - Evidence in support of claim.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Evidence in support of claim. 1261.107 Section 1261.107 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION PROCESSING OF... statement from the claimant's supervisor or other person or persons having personal knowledge of the facts...

Developing an Evidence-Informed Support Service for Schools--Reflections on a UK Model

ERIC Educational Resources Information Center

Sharples, Jonathan

2015-01-01

This paper reports on a "proof-of-concept" for evidence-informed practice, whereby schools are provided with tailored support in accessing research evidence and help in implementing evidence-based approaches. Two aspects of intermediary brokerage are explored: (a) creating tailored summary materials for schools, based on education…

Consensus Recommendations for Systematic Evaluation of Drug-Drug Interaction Evidence for Clinical Decision Support

PubMed Central

Scheife, Richard T.; Hines, Lisa E.; Boyce, Richard D.; Chung, Sophie P.; Momper, Jeremiah; Sommer, Christine D.; Abernethy, Darrell R.; Horn, John; Sklar, Stephen J.; Wong, Samantha K.; Jones, Gretchen; Brown, Mary; Grizzle, Amy J.; Comes, Susan; Wilkins, Tricia Lee; Borst, Clarissa; Wittie, Michael A.; Rich, Alissa; Malone, Daniel C.

2015-01-01

Background Healthcare organizations, compendia, and drug knowledgebase vendors use varying methods to evaluate and synthesize evidence on drug-drug interactions (DDIs). This situation has a negative effect on electronic prescribing and medication information systems that warn clinicians of potentially harmful medication combinations. Objective To provide recommendations for systematic evaluation of evidence from the scientific literature, drug product labeling, and regulatory documents with respect to DDIs for clinical decision support. Methods A conference series was conducted to develop a structured process to improve the quality of DDI alerting systems. Three expert workgroups were assembled to address the goals of the conference. The Evidence Workgroup consisted of 15 individuals with expertise in pharmacology, drug information, biomedical informatics, and clinical decision support. Workgroup members met via webinar from January 2013 to February 2014. Two in-person meetings were conducted in May and September 2013 to reach consensus on recommendations. Results We developed expert-consensus answers to three key questions: 1) What is the best approach to evaluate DDI evidence?; 2) What evidence is required for a DDI to be applicable to an entire class of drugs?; and 3) How should a structured evaluation process be vetted and validated? Conclusion Evidence-based decision support for DDIs requires consistent application of transparent and systematic methods to evaluate the evidence. Drug information systems that implement these recommendations should be able to provide higher quality information about DDIs in drug compendia and clinical decision support tools. PMID:25556085

Evaluation of Evidence of Statistical Support and Corroboration of Subgroup Claims in Randomized Clinical Trials.

PubMed

Wallach, Joshua D; Sullivan, Patrick G; Trepanowski, John F; Sainani, Kristin L; Steyerberg, Ewout W; Ioannidis, John P A

2017-04-01

Many published randomized clinical trials (RCTs) make claims for subgroup differences. To evaluate how often subgroup claims reported in the abstracts of RCTs are actually supported by statistical evidence (P < .05 from an interaction test) and corroborated by subsequent RCTs and meta-analyses. This meta-epidemiological survey examines data sets of trials with at least 1 subgroup claim, including Subgroup Analysis of Trials Is Rarely Easy (SATIRE) articles and Discontinuation of Randomized Trials (DISCO) articles. We used Scopus (updated July 2016) to search for English-language articles citing each of the eligible index articles with at least 1 subgroup finding in the abstract. Articles with a subgroup claim in the abstract with or without evidence of statistical heterogeneity (P < .05 from an interaction test) in the text and articles attempting to corroborate the subgroup findings. Study characteristics of trials with at least 1 subgroup claim in the abstract were recorded. Two reviewers extracted the data necessary to calculate subgroup-level effect sizes, standard errors, and the P values for interaction. For individual RCTs and meta-analyses that attempted to corroborate the subgroup findings from the index articles, trial characteristics were extracted. Cochran Q test was used to reevaluate heterogeneity with the data from all available trials. The number of subgroup claims in the abstracts of RCTs, the number of subgroup claims in the abstracts of RCTs with statistical support (subgroup findings), and the number of subgroup findings corroborated by subsequent RCTs and meta-analyses. Sixty-four eligible RCTs made a total of 117 subgroup claims in their abstracts. Of these 117 claims, only 46 (39.3%) in 33 articles had evidence of statistically significant heterogeneity from a test for interaction. In addition, out of these 46 subgroup findings, only 16 (34.8%) ensured balance between randomization groups within the subgroups (eg, through stratified

Getting Started: Preparation for the Teaching Programme. Additional Literacy Support. The National Literacy Strategy.

ERIC Educational Resources Information Center

Department for Education and Employment, London (England).

This Getting Started guide contains material presented at a two-day Additional Literacy Support (ALS) training course in the summer of 1999. ALS is designed to help pupils in Key Stage 2 who have already fallen behind in literacy, but who would not otherwise receive any additional support in this area. Each module includes a practical, high…

Contested evidence: Exposure to competing scientific claims and public support for banning bisphenol A.

PubMed

Brewer, Paul R; Ley, Barbara L

2014-05-01

The public controversy surrounding bisphenol A (BPA) revolves around competing claims about what scientific evidence shows regarding the effects of the chemical on human health. This study uses an experiment embedded within a public opinion survey to test the effects of exposure to such claims on public support for banning the use of BPA in products. Exposure to the claim that "there is not enough scientific evidence that BPA harms human health" reduced support, whereas exposure to the claim that there "is enough scientific evidence" failed to increase support. No effect emerged among those simultaneously exposed to both claims. The "not enough evidence" claim influenced less educated respondents and women but not college-educated respondents or men. Aspects of the underlying structure of opinion also differed depending on which claim(s) respondents received. The results illuminate how members of the public respond to competing scientific claims regarding controversial issues.

Job attitudes among workers with disabilities: The importance of family support in addition to organizational support.

PubMed

Pérez, Vanesa; Alcover, Carlos-María; Chambel, Maria José

2015-01-01

In the case of workers with disabilities, family support is often essential to gain access to the labor market and achieve personal autonomy and financial independence, in addition to fostering job satisfaction and permanence in the organization. Moreover, the support offered by organizations is particularly valued by workers with disabilities, as the organizations that hire such people generally go to considerable lengths to ensure their adaptation and integration in the workplace, contributing to job satisfaction and permanence in the organization. The aim of this study is to investigate the relationships between organizational support and family support with job satisfaction and intention to quit the organization among workers with disabilities employed in ordinary firms. Our study surveyed 204 workers using a questionnaire, and we used Structural Equation Modeling (SEM) analyses to test these relationships. Our results show that organizational support is a significant explanatory factor in the levels of job satisfaction. Moreover, our results indicate that the participants perceived high levels of support from their families, facilitating the conciliation of work and family life. Our results have practical implications in order to improve full integration and normalization of workers with disabilities in ordinary jobs.

Are claims made in orthodontic journal advertisements evidence-supported?

PubMed

Livas, Christos; Kouskoura, Thaleia; Ren, Yijin; Katsaros, Christos; Pandis, Nikolaos

2015-03-01

To examine the supporting evidence of advertisements published in six leading orthodontic journals. The 2012-2013 printed issues of American Journal of Orthodontics and Dentofacial Orthopedics, Australian Orthodontic Journal, Journal of Orthodontics, European Journal of Orthodontics, Journal of Clinical Orthodontics, and Journal of Orofacial Orthopedics were screened for advertisements implying superior performance compared with competitor products. Advertisements were classified according to type of product, availability, and currency of supporting references. A total of 99 unique advertisements claiming clinical benefit or superiority were identified. The overwhelming majority of the identified advertisements promoted appliance products (62.6%), orthodontic materials (14.1%), and dental operatory equipment, including imaging systems (12.1%). Advertisements were found to provide references or not regardless of the product type. Half of the advertisements referred to at least one peer-reviewed publication, whereas unpublished studies were cited by 25% of the advertisements. Most of the referenced articles were published within the past 5 years. The scientific background of advertisements in the orthodontic literature appears limited. While surveillance of journal advertising needs to be regulated, clinicians are urged to critically appraise the claims being made in orthodontic print advertisements by consulting the associated existing evidence.

Is the evidence supporting dental procedures strong? A survey of Cochrane systematic reviews in oral health.

PubMed

Faggion, Clovis Mariano

2012-09-01

Every day a large number and variety of dental procedures are performed in clinical dental practice. There is, however, no information on the overall quality of evidence supporting these procedures. The objective of this study was to assess whether several common dental procedures are based on sound evidence. All Cochrane systematic reviews (CSR) published in dentistry were surveyed. The authors' conclusions about the quality of evidence supporting a specific clinical treatment were used as the measure of outcome. The evidence was considered adequate if the authors did not clearly state the evidence was weak in the conclusions while also suggesting some evidence of the effectiveness of the therapy. Of 120 CSRs assessed, in only 26 (22.0% of the reviews) was the quality of evidence regarded as adequate for supporting clinical decisions, although some methodological limitations were identified in the full text of these reviews. Moreover, the authors of most reviews reported weak or unavailable evidence. On the basis of CSRs, the overall quality of evidence can be regarded as low or nonexistent for most of the dental procedures assessed. The information reported may guide future research. Copyright © 2012 Elsevier Inc. All rights reserved.

Educating the Educators: Developing Those Who Support Learning for Students with Additional Learning Needs

ERIC Educational Resources Information Center

McLachlan, Benita; Davis, Geraldine

2013-01-01

This article reports findings from a research project which developed and introduced the Enhanced Learning Support Assistant Programme (ELSAP) as a source of professional development for learning support assistants who were supporting students with additional learning needs in a college of further education in England. The purpose of this article…

Apology in the criminal justice setting: evidence for including apology as an additional component in the legal system.

PubMed

Petrucci, Carrie J

2002-01-01

The criminal justice system has reached unprecedented scope in the United States, with over 6.4 million people under some type of supervision. Remedies that have the potential to reduce this number are continually being sought. This article analyzes an innovative strategy currently being reconsidered in criminal justice: the apology. Despite a legal system that only sporadically acknowledges it, evidence for the use of apology is supported by social science research, current criminal justice theories, case law, and empirical studies. Social psychological, sociological and socio-legal studies pinpoint the elements and function of apology, what makes apologies effective, and concerns about apology if it were implemented in the criminal justice system. Theoretical evidence is examined (including restorative justice, therapeutic jurisprudence, crime, shame, and reintegration) to explore the process of apology in the criminal justice context. Attribution theory and social conduct theory are used to explain the apology process specifically for victims and offenders. A brief examination of case law reveals that though apology has no formal place in criminal law, it has surfaced recently under the federal sentencing guidelines. Finally, empirical evidence in criminal justice settings reveals that offenders want to apologize and victims desire an apology. Moreover, by directly addressing the harmful act, apology may be the link to reduced recidivism for offenders, as well as empowerment for victims. This evidence combined suggests that apology is worthy of further study as a potentially valuable addition to the criminal justice process. Copyright 2002 John Wiley & Sons, Ltd.

Evidence-Based Literacy Support: The "Literacy Octopus" Trial. Evaluation Report and Executive Summary

ERIC Educational Resources Information Center

Lord, Pippa; Rabiasz, Adam; Roy, Palak; Harland, Jennie; Styles, Ben; Fowler, Katherine

2017-01-01

The Evidence-based Literacy Support-"Literacy Octopus" Trial tested a range of dissemination interventions and resources, all of which aimed to engage schools in using evidence-based materials to improve teaching and learning in Key Stage 2 literacy. Four delivery partners provided interventions. These included light-touch,…

Exploring Nurse Manager Support of Evidence-Based Practice: Clinical Nurse Perceptions.

PubMed

Caramanica, Laura; Spiva, LeeAnna

2018-05-01

The study identifies what constitutes nurse manager (NM) support and other resources that enable clinical nurses (CNs) to engage in evidence-based practice (EBP). Clinical nurses report that NM support enables them to use EBP but what constitutes NM support is still unclear. Nurse managers, CNs, and EBP mentors received specialized education and use a team approach for EBP. Data were collected preintervention, mid-intervention, and postintervention from observations, interviews, journaling, and surveys. Results demonstrate how NMs can perform their role responsibilities and still engage CNs to develop a spirit of inquiry, seek answers to their clinical questions using EBP, and advance their clinical performance to improve patient outcomes. Four NM supportive behaviors emerged: cultivating a shared EBP vision, ensuring use of EBP, communicating the value of EBP, and providing resources for EBP. Through education and support, NMs describe supportive behaviors necessary for the successful conduction of EBP by CNs.

Pedagogical Scholarship in Public Health: A Call for Cultivating Learning Communities to Support Evidence-Based Education.

PubMed

Merzel, Cheryl; Halkitis, Perry; Healton, Cheryl

Public health education is experiencing record growth and transformation. The current emphasis on learning outcomes necessitates attention to creating and evaluating the best curricula and learning methods for helping public health students develop public health competencies. Schools and programs of public health would benefit from active engagement in pedagogical research and additional platforms to support dissemination and implementation of educational research findings. We reviewed current avenues for sharing public health educational research, curricula, and best teaching practices; we identified useful models from other health professions; and we offered suggestions for how the field of public health education can develop communities of learning devoted to supporting pedagogy. Our goal was to help advance an agenda of innovative evidence-based public health education, enabling schools and programs of public health to evaluate and measure success in meeting the current and future needs of the public health profession.

Continuous track paths reveal additive evidence integration in multistep decision making.

PubMed

Buc Calderon, Cristian; Dewulf, Myrtille; Gevers, Wim; Verguts, Tom

2017-10-03

Multistep decision making pervades daily life, but its underlying mechanisms remain obscure. We distinguish four prominent models of multistep decision making, namely serial stage, hierarchical evidence integration, hierarchical leaky competing accumulation (HLCA), and probabilistic evidence integration (PEI). To empirically disentangle these models, we design a two-step reward-based decision paradigm and implement it in a reaching task experiment. In a first step, participants choose between two potential upcoming choices, each associated with two rewards. In a second step, participants choose between the two rewards selected in the first step. Strikingly, as predicted by the HLCA and PEI models, the first-step decision dynamics were initially biased toward the choice representing the highest sum/mean before being redirected toward the choice representing the maximal reward (i.e., initial dip). Only HLCA and PEI predicted this initial dip, suggesting that first-step decision dynamics depend on additive integration of competing second-step choices. Our data suggest that potential future outcomes are progressively unraveled during multistep decision making.

Automatic indexing and retrieval of encounter-specific evidence for point-of-care support.

PubMed

O'Sullivan, Dympna M; Wilk, Szymon A; Michalowski, Wojtek J; Farion, Ken J

2010-08-01

Evidence-based medicine relies on repositories of empirical research evidence that can be used to support clinical decision making for improved patient care. However, retrieving evidence from such repositories at local sites presents many challenges. This paper describes a methodological framework for automatically indexing and retrieving empirical research evidence in the form of the systematic reviews and associated studies from The Cochrane Library, where retrieved documents are specific to a patient-physician encounter and thus can be used to support evidence-based decision making at the point of care. Such an encounter is defined by three pertinent groups of concepts - diagnosis, treatment, and patient, and the framework relies on these three groups to steer indexing and retrieval of reviews and associated studies. An evaluation of the indexing and retrieval components of the proposed framework was performed using documents relevant for the pediatric asthma domain. Precision and recall values for automatic indexing of systematic reviews and associated studies were 0.93 and 0.87, and 0.81 and 0.56, respectively. Moreover, precision and recall for the retrieval of relevant systematic reviews and associated studies were 0.89 and 0.81, and 0.92 and 0.89, respectively. With minor modifications, the proposed methodological framework can be customized for other evidence repositories. Copyright 2010 Elsevier Inc. All rights reserved.

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

Positive and negative social support and HPA-axis hyperactivity: Evidence from glucocorticoids in human hair.

PubMed

Iob, Eleonora; Kirschbaum, Clemens; Steptoe, Andrew

2018-06-12

While positive social support is associated with lower prevalence of disease and better treatment outcomes, negative social relationships can instead have unfavourable consequences for several physical and mental health conditions. However, the specific mechanisms by which this nexus might operate remain poorly understood. Hypothalamic-pituitary-adrenal (HPA) axis hyperactivity owing to psychosocial stress has been proposed as a potential pathway underlying the link between social support and health. Hair glucocorticoids such as cortisol and cortisone are emerging as promising biomarkers of long-term retrospective HPA activation. Therefore, the aim of this investigation was to examine the effects of positive and negative experiences of social support within key relationships (i.e. spouse/partner, children, other family members, and friends) on cortisol and cortisone. These associations were tested in a sample of 2520 older adults (mean age 68.1) from the English Longitudinal Study of Ageing. Hair samples were collected in wave 6 (2012/13). To understand the impact of cumulative exposure to poor social support, the analysis used self-reported data from waves 4 (2008/09) and 6. Covariates included demographic, socioeconomic, lifestyle, and hair characteristics. In cross sectional analyses, lower positive support from all sources and specifically from children were associated with higher cortisol. Additionally, lower positive support from children was positively associated with cortisone. Similarly, higher overall negative support was related to higher cortisol, and greater negative support from children was also positively associated with cortisone. In longitudinal analyses, there was evidence for positive associations between hair glucocorticoids and cumulative exposure to poorer social support. Experiences of low positive and high negative social support, particularly from children, were both related to higher hair glucocorticoids. Hence, social relationships of

New evidence: data documenting parental support for earlier sexuality education.

PubMed

Barr, Elissa M; Moore, Michele J; Johnson, Tammie; Forrest, Jamie; Jordan, Melissa

2014-01-01

Numerous studies document support for sexuality education to be taught in high school, and often, in middle school. However, little research has been conducted addressing support for sexuality education in elementary schools. As part of the state Behavioral Risk Factor Surveillance System (BRFSS) Survey administration, the Florida Department of Health conducted the Florida Child Health Survey (FCHS) by calling back parents who had children in their home and who agreed to participate (N = 1715). Most parents supported the following sexuality education topics being taught specifically in elementary school: communication skills (89%), human anatomy/reproductive information (65%), abstinence (61%), human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) (53%), and gender/sexual orientation issues (52%). Support was even greater in middle school (62-91%) and high school (72-91%) for these topics and for birth control and condom education. Most parents supported comprehensive sexuality education (40.4%), followed by abstinence-plus (36.4%) and abstinence-only (23.2%). Chi-square results showed significant differences in the type of sexuality education supported by almost all parent demographic variables analyzed including sex, race, marital status, and education. Results add substantial support for age-appropriate school-based sexuality education starting at the elementary school level, the new National Sexuality Education Standards, and funding to support evidence-based abstinence-plus or comprehensive sexuality education. © 2013, American School Health Association.

Organizational supports used by private child and family serving agencies to facilitate evidence use: a mixed methods study protocol.

PubMed

Chuang, Emmeline; Collins-Camargo, Crystal; McBeath, Bowen

2017-04-08

Challenges to evidence use are well documented. Less well understood are the formal supports-e.g., technical infrastructure, inter-organizational relationships-organizations may put in place to help overcome these challenges. This study will identify supports for evidence use currently used by private child and family serving agencies delivering publicly funded behavioral health and/or human services; examine contextual, organizational, and managerial factors associated with use of such supports; and determine how identified supports affect evidence use by staff at multiple levels of the organization. We will use a sequential explanatory mixed methods design, with study activities occurring in two sequential phases: In phase 1, quantitative survey data collected from managers of private child and family serving agencies in six states (CA, IN, KY, MO, PA, and WI) and analyzed using both regression and qualitative comparative analysis (QCA) will identify organizational supports currently being used to facilitate evidence use and examine the contextual, organizational, and managerial factors associated with the use of such supports. In phase 2, data from phase 1 will be used to select a purposive sample of 12 agencies for in-depth case studies. In those 12 agencies, semi-structured interviews with key informants and managers, focus groups with frontline staff, and document analysis will provide further insight into agencies' motivation for investing in organizational supports for evidence use and the facilitators and barriers encountered in doing so. Semi-structured interviews with managers and focus groups with frontline staff will also assess whether and how identified supports affect evidence use at different levels of the organization (senior executives, middle managers, frontline supervisors, and frontline staff). Within- and between-case analyses supplemented by QCA will identify combinations of factors associated with the highest and lowest levels of staff

Sustainability of evidence-based healthcare: research agenda, methodological advances, and infrastructure support.

PubMed

Proctor, Enola; Luke, Douglas; Calhoun, Annaliese; McMillen, Curtis; Brownson, Ross; McCrary, Stacey; Padek, Margaret

2015-06-11

Little is known about how well or under what conditions health innovations are sustained and their gains maintained once they are put into practice. Implementation science typically focuses on uptake by early adopters of one healthcare innovation at a time. The later-stage challenges of scaling up and sustaining evidence-supported interventions receive too little attention. This project identifies the challenges associated with sustainability research and generates recommendations for accelerating and strengthening this work. A multi-method, multi-stage approach, was used: (1) identifying and recruiting experts in sustainability as participants, (2) conducting research on sustainability using concept mapping, (3) action planning during an intensive working conference of sustainability experts to expand the concept mapping quantitative results, and (4) consolidating results into a set of recommendations for research, methodological advances, and infrastructure building to advance understanding of sustainability. Participants comprised researchers, funders, and leaders in health, mental health, and public health with shared interest in the sustainability of evidence-based health care. Prompted to identify important issues for sustainability research, participants generated 91 distinct statements, for which a concept mapping process produced 11 conceptually distinct clusters. During the conference, participants built upon the concept mapping clusters to generate recommendations for sustainability research. The recommendations fell into three domains: (1) pursue high priority research questions as a unified agenda on sustainability; (2) advance methods for sustainability research; (3) advance infrastructure to support sustainability research. Implementation science needs to pursue later-stage translation research questions required for population impact. Priorities include conceptual consistency and operational clarity for measuring sustainability, developing evidence

Characterization of Effect of Support Structures in Laser Additive Manufacturing of Stainless Steel

NASA Astrophysics Data System (ADS)

Järvinen, Jukka-Pekka; Matilainen, Ville; Li, Xiaoyun; Piili, Heidi; Salminen, Antti; Mäkelä, Ismo; Nyrhilä, Olli

Laser additive manufacturing (LAM) of stainless steel is a layer wisetechnology for fabricating 3D parts from metal powder via selectively melting powder with laser beam. Support structures play a significant role in LAM process as they help to remove heat away from the process and on the other hand hold the work piece in its place. A successful design of support structures can help to achievea building process fast and inexpensive with high quality. Aimof this study was to characterize the usability of two types of support structures: web and tube supports. Purpose of this studywas also to analyze how suitable they are in two industrial application cases: case for dental application and case for jewelry application. It was concluded that the removability of web supports was much better than tube supports. It was noticed that support structures are an important part of LAM process and they strongly affect the manufacturability and the end quality of the part.

A review of the evidence supporting the aesthetic orthodontic treatment need indices.

PubMed

Borzabadi-Farahani, Ali

2012-11-01

Aesthetic improvement and psychological enhancement have been cited as justifications for orthodontic treatment. This paper reviews the evidence that relates malocclusion to psychological health and quality of life and explores whether this evidence supports the most commonly used aesthetic Orthodontic Treatment Need Indices (OTNI). The relevant cited material from the MEDLINE, Web of Science, Scopus, Cochrane databases, and scientific textbooks were used. The citation rate was confirmed by using the Google Scholar. The subjective nature of aesthetic indices and the variable perception of attractiveness between clinicians and patients, and among various cultures or countries are a few limitations of aesthetic OTNI. The available evidence of mainly cross-sectional studies on the link between malocclusion and either psychosocial well-being or quality of life is not conclusive, and sometimes contradictory, to suggest these characteristics are affected by malocclusions. Further, the long-term longitudinal studies did not suggest that people with malocclusion are disadvantaged psychologically, or their quality of life would be worse off, which challenges using aesthetic OTNI to assess the social and psychological implications of malocclusion. The subjective nature of aesthetic OTNI and the minor contributory role of malocclusion in psychosocial health or quality of life undermine using aesthetic indices to assess the likely social and psychological implications of malocclusion. Consequently, using aesthetic OTNI, as a method to quantify malocclusion remains open to debate. Various soft and hard-tissue analyses are used before formulating a treatment plan (i.e., assessment of sagittal and vertical skeletal relationships). The addition of a shortened version of these analyses to the aesthetic OTNI can be a good substitute for the aesthetic components of OTNI, if an assessment of the aesthetic aspects of malocclusion is intended. This reduces subjectivity and improves the

Driving Innovation to Support the Warfighter: Additive Manufacturing Initiatives Within the Defense Logistics Agency

DTIC Science & Technology

2016-12-01

43 Defense AT&L: November-December 2016 Driving Innovation to Support the Warfighter Additive Manufacturing Initiatives Within the Defense...Degree in National Resource Strategy from the Industrial College of the Armed Forces in Washington, D.C. T he spotlight is on for additive manufacturing ...and meet the warfighter’s needs” (see Figure 2). In order to “deliver additively manufactured solutions you can trust” (see Figure 2) in the DoD

Different models to mobilize peer support to improve diabetes self-management and clinical outcomes: evidence, logistics, evaluation considerations and needs for future research.

PubMed

Heisler, Michele

2010-06-01

Much of diabetes care needs to be carried out by patients between office visits with their health care providers. Yet, many patients face difficulties carrying out these tasks. In addition, many adults with diabetes cannot count on effective support from their families and friends to help them with their self-management. Peer support programmes are a promising approach to enhance social and emotional support, assist patients in daily management and living with diabetes and promote linkages to clinical care. This background paper provides a brief overview of different approaches to mobilize peer support for diabetes self-management support, discusses evidence to date on the effectiveness of each of these models, highlights logistical and evaluation issues for each model and concludes with a discussion of directions for future research in this area.

Different models to mobilize peer support to improve diabetes self-management and clinical outcomes: evidence, logistics, evaluation considerations and needs for future research

PubMed Central

2010-01-01

Much of diabetes care needs to be carried out by patients between office visits with their health care providers. Yet, many patients face difficulties carrying out these tasks. In addition, many adults with diabetes cannot count on effective support from their families and friends to help them with their self-management. Peer support programmes are a promising approach to enhance social and emotional support, assist patients in daily management and living with diabetes and promote linkages to clinical care. This background paper provides a brief overview of different approaches to mobilize peer support for diabetes self-management support, discusses evidence to date on the effectiveness of each of these models, highlights logistical and evaluation issues for each model and concludes with a discussion of directions for future research in this area. PMID:19293400

Supporting Evidence-Informed Teaching in Biomedical and Health Professions Education Through Knowledge Translation: An Interdisciplinary Literature Review.

PubMed

Tractenberg, Rochelle E; Gordon, Morris

2017-01-01

Phenomenon: The purpose of "systematic" reviews/reviewers of medical and health professions educational research is to identify best practices. This qualitative article explores the question of whether systematic reviews can support "evidence informed" teaching and contrasts traditional systematic reviewing with a knowledge translation (KT) approach to this objective. Degrees of freedom analysis (DOFA) is used to examine the alignment of systematic review methods with educational research and the pedagogical strategies and approaches that might be considered with a decision-making framework developed to support valid assessment. This method is also used to explore how KT can be used to inform teaching and learning. The nature of educational research is not compatible with most (11/14) methods for systematic review. The inconsistency of systematic reviewing with the nature of educational research impedes both the identification and implementation of "best-evidence" pedagogy and teaching. This is primarily because research questions that do support the purposes of review do not support educational decision making. By contrast to systematic reviews of the literature, both a DOFA and KT are fully compatible with informing teaching using evidence. A DOFA supports the translation of theory to a specific teaching or learning case, so could be considered a type of KT. The DOFA results in a test of alignment of decision options with relevant educational theory, and KT leads to interventions in teaching or learning that can be evaluated. Examples of how to structure evaluable interventions are derived from a KT approach that are simply not available from a systematic review. Insights: Systematic reviewing of current empirical educational research is not suitable for deriving or supporting best practices in education. However, both "evidence-informed" and scholarly approaches to teaching can be supported as KT projects, which are inherently evaluable and can generate

Project management office in health care: a key strategy to support evidence-based practice change.

PubMed

Lavoie-Tremblay, Mélanie; Bonneville-Roussy, Arielle; Richer, Marie-Claire; Aubry, Monique; Vezina, Michel; Deme, Mariama

2012-01-01

This article describes the contribution of a Transition Support Office (TSO) in a health care center in Canada to supporting changes in practice based on evidence and organizational performance in the early phase of a major organizational change. Semistructured individual interviews were conducted with 11 members of the TSO and 13 managers and clinicians from an ambulatory sector in the organization who received support from the TSO. The main themes addressed in the interviews were the description of the TSO, the context of implementation, and the impact. Using the Competing Value Framework by Quinn and Rohrbaugh [Public Product Rev. 1981;5(2):122-140], results revealed that the TSO is a source of expertise that facilitates innovation and implementation of change. It provides material support and human expertise for evidence-based projects. As a single organizational entity responsible for managing change, it gives a sense of cohesiveness. It also facilitates communication among human resources of the entire organization. The TSO is seen as an expertise provider that promotes competency development, training, and evidence-based practices. The impact of a TSO on change in practices and organizational performance in a health care system is discussed.

Impact of Legislation on Post-School Transition Practice for Young People with Additional Support Needs in Scotland

ERIC Educational Resources Information Center

Richardson, Thomas D.; Jindal-Snape, Divya; Hannah, Elizabeth F. S.

2017-01-01

A longitudinal study was conducted to understand post-school transition practice for young people with additional support needs (ASN) before and after the implementation of key legislation, the Education (Additional Support for Learning) (Scotland) Act 2004, amended in 2009. Primary data were collected from one local authority in Scotland. Twelve…

Trichloroethylene: Mechanistic, epidemiologic and other supporting evidence of carcinogenic hazard.

PubMed

Rusyn, Ivan; Chiu, Weihsueh A; Lash, Lawrence H; Kromhout, Hans; Hansen, Johnni; Guyton, Kathryn Z

2014-01-01

The chlorinated solvent trichloroethylene (TCE) is a ubiquitous environmental pollutant. The carcinogenic hazard of TCE was the subject of a 2012 evaluation by a Working Group of the International Agency for Research on Cancer (IARC). Information on exposures, relevant data from epidemiologic studies, bioassays in experimental animals, and toxicity and mechanism of action studies was used to conclude that TCE is carcinogenic to humans (Group 1). This article summarizes the key evidence forming the scientific bases for the IARC classification. Exposure to TCE from environmental sources (including hazardous waste sites and contaminated water) is common throughout the world. While workplace use of TCE has been declining, occupational exposures remain of concern, especially in developing countries. The strongest human evidence is from studies of occupational TCE exposure and kidney cancer. Positive, although less consistent, associations were reported for liver cancer and non-Hodgkin lymphoma. TCE is carcinogenic at multiple sites in multiple species and strains of experimental animals. The mechanistic evidence includes extensive data on the toxicokinetics and genotoxicity of TCE and its metabolites. Together, available evidence provided a cohesive database supporting the human cancer hazard of TCE, particularly in the kidney. For other target sites of carcinogenicity, mechanistic and other data were found to be more limited. Important sources of susceptibility to TCE toxicity and carcinogenicity were also reviewed by the Working Group. In all, consideration of the multiple evidence streams presented herein informed the IARC conclusions regarding the carcinogenicity of TCE. © 2013.

Trichloroethylene: Mechanistic, Epidemiologic and Other Supporting Evidence of Carcinogenic Hazard

PubMed Central

Rusyn, Ivan; Chiu, Weihsueh A.; Lash, Lawrence H.; Kromhout, Hans; Hansen, Johnni; Guyton, Kathryn Z.

2013-01-01

The chlorinated solvent trichloroethylene (TCE) is a ubiquitous environmental pollutant. The carcinogenic hazard of TCE was the subject of a 2012 evaluation by a Working Group of the International Agency for Research on Cancer (IARC). Information on exposures, relevant data from epidemiologic studies, bioassays in experimental animals, and toxicity and mechanism of action studies was used to conclude that TCE is carcinogenic to humans (Group 1). This article summarizes the key evidence forming the scientific bases for the IARC classification. Exposure to TCE from environmental sources (including from hazardous waste sites and contaminated water) is common throughout the world. While workplace use of TCE has been declining, occupational exposures remain of concern, especially in developing countries. Strongest human evidence is from studies of occupational TCE exposure and kidney cancer. Positive, although less consistent, associations were reported for liver cancer and non-Hodgkin's lymphoma. TCE is carcinogenic at multiple sites in multiple species and strains of experimental animals. The mechanistic evidence includes extensive data on the toxicokinetics and genotoxicity of TCE and its metabolites. Together, available evidence provided a cohesive database supporting the human cancer hazard of TCE, particularly in the kidney. For other target sites of carcinogenicity, mechanistic and other data were found to be more limited. Important sources of susceptibility to TCE toxicity and carcinogenicity were also reviewed by the Working Group. In all, consideration of the multiple evidence streams presented herein informed the IARC conclusions regarding the carcinogenicity of TCE. PMID:23973663

Non-genetic data supporting genetic evidence for the eastern wolf

USGS Publications Warehouse

Mech, L. David

2011-01-01

Two schools of thought dominate the molecular-genetics literature on Canis spp. (wolves) in the western Great Lakes region of the US and Canada: (1) they are hybrids between Canis lupus (Gray Wolf) and Canis latrans (Coyote), or (2) they are hybrids between the Gray Wolf and Canis lycaon (Eastern Wolf). This article presents 3 types of non-genetic evidence that bears on the controversy and concludes that all 3 support the second interpretation.

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

Empirically Supported Treatments in Psychotherapy: Towards an Evidence-Based or Evidence-Biased Psychology in Clinical Settings?

PubMed Central

Castelnuovo, Gianluca

2010-01-01

The field of research and practice in psychotherapy has been deeply influenced by two different approaches: the empirically supported treatments (ESTs) movement, linked with the evidence-based medicine (EBM) perspective and the “Common Factors” approach, typically connected with the “Dodo Bird Verdict”. About the first perspective, since 1998 a list of ESTs has been established in mental health field. Criterions for “well-established” and “probably efficacious” treatments have arisen. The development of these kinds of paradigms was motivated by the emergence of a “managerial” approach and related systems for remuneration also for mental health providers and for insurance companies. In this article ESTs will be presented underlining also some possible criticisms. Finally complementary approaches, that could add different evidence in the psychotherapy research in comparison with traditional EBM approach, are presented. PMID:21833197

Engineering thermoplastics for additive manufacturing: a critical perspective with experimental evidence to support functional applications.

PubMed

Cicala, Gianluca; Latteri, Alberta; Del Curto, Barbara; Lo Russo, Alessio; Recca, Giuseppe; Farè, Silvia

2017-01-28

Among additive manufacturing techniques, the filament-based technique involves what is referred to as fused deposition modeling (FDM). FDM materials are currently limited to a selected number of polymers. The present study focused on investigating the potential of using high-end engineering polymers in FDM. In addition, a critical review of the materials available on the market compared with those studied here was completed. Different engineering thermoplastics, ranging from industrial grade polycarbonates to novel polyetheretherketones (PEEKs), were processed by FDM. Prior to this, for innovative filaments based on PEEK, extrusion processing was carried out. Mechanical properties (i.e., tensile and flexural) were investigated for each extruded material. An industrial-type FDM machine (Stratasys Fortus® 400 mc) was used to fully characterize the effect of printing parameters on the mechanical properties of polycarbonate. The obtained properties were compared with samples obtained by injection molding. Finally, FDM samples made of PEEK were also characterized and compared with those obtained by injection molding. The effect of raster to raster air gap and raster angle on tensile and flexural properties of printed PC was evidenced; the potential of PEEK filaments, as novel FDM material, was highlighted in comparison to state of the art materials. Comparison with injection molded parts allowed to better understand FDM potential for functional applications. The study discussed pros and cons of the different materials. Finally, the development of novel PEEK filaments achieved important results offering a novel solution to the market when high mechanical and thermal properties are required.

Measuring Clinical Decision Support Influence on Evidence-Based Nursing Practice.

PubMed

Cortez, Susan; Dietrich, Mary S; Wells, Nancy

2016-07-01

To measure the effect of clinical decision support (CDS) on oncology nurse evidence-based practice (EBP).
. Longitudinal cluster-randomized design.
. Four distinctly separate oncology clinics associated with an academic medical center.
. The study sample was comprised of randomly selected data elements from the nursing documentation software. The data elements were patient-reported symptoms and the associated nurse interventions. The total sample observations were 600, derived from a baseline, posteducation, and postintervention sample of 200 each (100 in the intervention group and 100 in the control group for each sample).
. The cluster design was used to support randomization of the study intervention at the clinic level rather than the individual participant level to reduce possible diffusion of the study intervention. An elongated data collection cycle (11 weeks) controlled for temporary increases in nurse EBP related to the education or CDS intervention.
. The dependent variable was the nurse evidence-based documentation rate, calculated from the nurse-documented interventions. The independent variable was the CDS added to the nursing documentation software.
. The average EBP rate at baseline for the control and intervention groups was 27%. After education, the average EBP rate increased to 37%, and then decreased to 26% in the postintervention sample. Mixed-model linear statistical analysis revealed no significant interaction of group by sample. The CDS intervention did not result in an increase in nurse EBP.
. EBP education increased nurse EBP documentation rates significantly but only temporarily. Nurses may have used evidence in practice but may not have documented their interventions.
. More research is needed to understand the complex relationship between CDS, nursing practice, and nursing EBP intervention documentation. CDS may have a different effect on nurse EBP, physician EBP, and other medical professional EBP.

31 CFR 10.63 - Service of complaint; service of other papers; service of evidence in support of complaint...

Code of Federal Regulations, 2010 CFR

2010-07-01

... section. (e) Filing of papers. Whenever the filing of a paper is required or permitted in connection with... other papers; service of evidence in support of complaint; filing of papers. 10.63 Section 10.63 Money...; service of evidence in support of complaint; filing of papers. (a) Service of complaint—(1) In general...

The evidence for the use of nutritional support in liver disease.

PubMed

Koretz, Ronald L

2014-03-01

Although there is a well established association between malnutrition and poorer clinical outcomes in patients with liver disease, that fact alone does not prove that improving the malnutrition will improve outcome. The best way to determine if nutritional interventions are effective is to compare them to untreated control groups in well designed and executed randomized clinical trials. A recent systematic review assessed 37 trials that compared parenteral nutrition, enteral nutrition, or nutritional supplements to no nutritional therapy in patients with a variety of liver diseases. Since the publication of that review, an additional three trials have become available. Whereas all but one of the trials did have methodologic shortcomings that may have allowed the introduction of bias (which usually results in an overestimation of benefit), the trials failed to show much, if any, benefit. In fact, the single trial at low risk of bias found that more deaths occurred in the recipients of the supplements. Although malnutrition may be associated with a poor outcome, the current best evidence indicates that the provision of adjunctive nutritional support (parenteral or enteral nutrition, or nutritional supplements) to patients with a variety of liver diseases (alcoholic hepatitis, cirrhosis, hepatocellular carcinoma, liver surgery, liver transplantation, obstructive jaundice, hepatitis C antiviral treatment) does not improve clinical outcomes.

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...

Geophysical, archaeological and historical evidence support a solar-output model for climate change

USGS Publications Warehouse

Perry, C.A.; Hsu, K.J.

2000-01-01

Although the processes of climate change are not completely understood, an important causal candidate is variation in total solar output. Reported cycles in various climate-proxy data show a tendency to emulate a fundamental harmonic sequence of a basic solar-cycle length (11 years) multiplied by 2(N) (where N equals a positive or negative integer). A simple additive model for total solar-output variations was developed by superimposing a progression of fundamental harmonic cycles with slightly increasing amplitudes. The timeline of the model was calibrated to the Pleistocene/Holocene boundary at 9,000 years before present. The calibrated model was compared with geophysical, archaeological, and historical evidence of warm or cold climates during the Holocene. The evidence of periods of several centuries of cooler climates worldwide called 'little ice ages,' similar to the period anno Domini (A.D.) 1280-1860 and reoccurring approximately every 1,300 years, corresponds well with fluctuations in modeled solar output. A more detailed examination of the climate sensitive history of the last 1,000 years further supports the model. Extrapolation of the model into the future suggests a gradual cooling during the next few centuries with intermittent minor warmups and a return to near little-ice-age conditions within the next 500 years. This cool period then may be followed approximately 1,500 years from now by a return to altithermal conditions similar to the previous Holocene Maximum.

Geophysical, archaeological, and historical evidence support a solar-output model for climate change

PubMed Central

Perry, Charles A.; Hsu, Kenneth J.

2000-01-01

Although the processes of climate change are not completely understood, an important causal candidate is variation in total solar output. Reported cycles in various climate-proxy data show a tendency to emulate a fundamental harmonic sequence of a basic solar-cycle length (11 years) multiplied by 2N (where N equals a positive or negative integer). A simple additive model for total solar-output variations was developed by superimposing a progression of fundamental harmonic cycles with slightly increasing amplitudes. The timeline of the model was calibrated to the Pleistocene/Holocene boundary at 9,000 years before present. The calibrated model was compared with geophysical, archaeological, and historical evidence of warm or cold climates during the Holocene. The evidence of periods of several centuries of cooler climates worldwide called “little ice ages,” similar to the period anno Domini (A.D.) 1280–1860 and reoccurring approximately every 1,300 years, corresponds well with fluctuations in modeled solar output. A more detailed examination of the climate sensitive history of the last 1,000 years further supports the model. Extrapolation of the model into the future suggests a gradual cooling during the next few centuries with intermittent minor warmups and a return to near little-ice-age conditions within the next 500 years. This cool period then may be followed approximately 1,500 years from now by a return to altithermal conditions similar to the previous Holocene Maximum. PMID:11050181

What supports do health system organizations have in place to facilitate evidence-informed decision-making? A qualitative study.

PubMed

Ellen, Moriah E; Léon, Gregory; Bouchard, Gisèle; Lavis, John N; Ouimet, Mathieu; Grimshaw, Jeremy M

2013-08-06

Decisions regarding health systems are sometimes made without the input of timely and reliable evidence, leading to less than optimal health outcomes. Healthcare organizations can implement tools and infrastructures to support the use of research evidence to inform decision-making. The purpose of this study was to profile the supports and instruments (i.e., programs, interventions, instruments or tools) that healthcare organizations currently have in place and which ones were perceived to facilitate evidence-informed decision-making. In-depth semi-structured telephone interviews were conducted with individuals in three different types of positions (i.e., a senior management team member, a library manager, and a 'knowledge broker') in three types of healthcare organizations (i.e., regional health authorities, hospitals and primary care practices) in two Canadian provinces (i.e., Ontario and Quebec). The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. A total of 57 interviews were conducted in 25 organizations in Ontario and Quebec. The main findings suggest that, for the healthcare organizations that participated in this study, the following supports facilitate evidence-informed decision-making: facilitating roles that actively promote research use within the organization; establishing ties to researchers and opinion leaders outside the organization; a technical infrastructure that provides access to research evidence, such as databases; and provision and participation in training programs to enhance staff's capacity building. This study identified the need for having a receptive climate, which laid the foundation for the implementation of other tangible initiatives and supported the use of research in decision-making. This study adds to the literature on organizational efforts that can increase the use of research evidence in decision-making. Some of the identified supports may increase the use of

Automatic evidence quality prediction to support evidence-based decision making.

PubMed

Sarker, Abeed; Mollá, Diego; Paris, Cécile

2015-06-01

Evidence-based medicine practice requires practitioners to obtain the best available medical evidence, and appraise the quality of the evidence when making clinical decisions. Primarily due to the plethora of electronically available data from the medical literature, the manual appraisal of the quality of evidence is a time-consuming process. We present a fully automatic approach for predicting the quality of medical evidence in order to aid practitioners at point-of-care. Our approach extracts relevant information from medical article abstracts and utilises data from a specialised corpus to apply supervised machine learning for the prediction of the quality grades. Following an in-depth analysis of the usefulness of features (e.g., publication types of articles), they are extracted from the text via rule-based approaches and from the meta-data associated with the articles, and then applied in the supervised classification model. We propose the use of a highly scalable and portable approach using a sequence of high precision classifiers, and introduce a simple evaluation metric called average error distance (AED) that simplifies the comparison of systems. We also perform elaborate human evaluations to compare the performance of our system against human judgments. We test and evaluate our approaches on a publicly available, specialised, annotated corpus containing 1132 evidence-based recommendations. Our rule-based approach performs exceptionally well at the automatic extraction of publication types of articles, with F-scores of up to 0.99 for high-quality publication types. For evidence quality classification, our approach obtains an accuracy of 63.84% and an AED of 0.271. The human evaluations show that the performance of our system, in terms of AED and accuracy, is comparable to the performance of humans on the same data. The experiments suggest that our structured text classification framework achieves evaluation results comparable to those of human performance

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...

Supporting Better Evidence Generation and Use within Social Innovation in Health in Low- and Middle-Income Countries: A Qualitative Study.

PubMed

Ballard, Madeleine; Tran, Jenny; Hersch, Fred; Lockwood, Amy; Hartigan, Pamela; Montgomery, Paul

2017-01-01

While several papers have highlighted a lack of evidence to scale social innovations in health, fewer have explored decision-maker understandings of the relative merit of different types of evidence, how such data are interpreted and applied, and what practical support is required to improve evidence generation. The objectives of this paper are to understand (1) beliefs and attitudes towards the value of and types of evidence in scaling social innovations for health, (2) approaches to evidence generation and evaluation used in systems and policy change, and (3) how better evidence-generation can be undertaken and supported within social innovation in health. Thirty-two one-on-one interviews were conducted between July and November 2015 with purposively selected practitioners, policymakers, and funders from low- and middle- income countries (LMICs). Data were analysed using a Framework Analysis Approach. While practitioners, funders, and policymakers said they held outcome evidence in high regard, their practices only bear out this assertion to varying degrees. Few have given systematic consideration to potential unintended consequences, in particular harm, of the programs they implement, fund, or adopt. Stakeholders suggest that better evidence-generation can be undertaken and supported within social innovation in health by supporting the research efforts of emerging community organizations; creating links between practitioners and academia; altering the funding landscape for evidence-generation; providing responsive technical education; and creating accountability for funders, practitioners, and policymakers. How better evidence-generation can be undertaken and supported within social innovation in health is a previously under-operationalised aspect of the policy-making process that remains essential in order to refrain from causing harm, enable the optimization of existing interventions, and ultimately, to scale and fund what works.

Clinical evidence supporting pharmacogenomic biomarker testing provided in US Food and Drug Administration drug labels.

PubMed

Wang, Bo; Canestaro, William J; Choudhry, Niteesh K

2014-12-01

Genetic biomarkers that predict a drug's efficacy or likelihood of toxicity are assuming increasingly important roles in the personalization of pharmacotherapy, but concern exists that evidence that links use of some biomarkers to clinical benefit is insufficient. Nevertheless, information about the use of biomarkers appears in the labels of many prescription drugs, which may add confusion to the clinical decision-making process. To evaluate the evidence that supports pharmacogenomic biomarker testing in drug labels and how frequently testing is recommended. Publicly available US Food and Drug Administration databases. We identified drug labels that described the use of a biomarker and evaluated whether the label contained or referenced convincing evidence of its clinical validity (ie, the ability to predict phenotype) and clinical utility (ie, the ability to improve clinical outcomes) using guidelines published by the Evaluation of Genomic Applications in Practice and Prevention Working Group. We graded the completeness of the citation of supporting studies and determined whether the label recommended incorporation of biomarker test results in therapeutic decision making. Of the 119 drug-biomarker combinations, only 43 (36.1%) had labels that provided convincing clinical validity evidence, whereas 18 (15.1%) provided convincing evidence of clinical utility. Sixty-one labels (51.3%) made recommendations about how clinical decisions should be based on the results of a biomarker test; 36 (30.3%) of these contained convincing clinical utility data. A full description of supporting studies was included in 13 labels (10.9%). Fewer than one-sixth of drug labels contained or referenced convincing evidence of clinical utility of biomarker testing, whereas more than half made recommendations based on biomarker test results. It may be premature to include biomarker testing recommendations in drug labels when convincing data that link testing to patient outcomes do not exist.

Teachers' Perceptions of Students' Additional Support Needs: In the Eye of the Beholder?

ERIC Educational Resources Information Center

Bruggink, Marjon; Goei, Sui L.; Koot, Hans M.

2016-01-01

Nowadays, teachers are regarded as key players in the process of identifying and catering to students' additional support needs within mainstream primary classrooms. However, teachers' professional judgements regarding students with special needs have been found to be contextually influenced (e.g. by school context, student population, level of…

Evidence in support of foster care during acute refugee crises.

PubMed

Duerr, Ann; Posner, Samuel F; Gilbert, Mark

2003-11-01

The United Nations High Commissioner on Refugees (UNHCR) and United Nations Children's Fund (UNICEF) policy encourages foster care during refugee emergencies. We examined evidence to support this policy using data from the 1994 Rwandan refugee crisis. The association of weight gain and acute illness with family status (foster children vs children living with their biological families) was examined using latent growth curve and repeated measures logistic regression analysis. Weight gain for all children averaged 0.40 kg/month and was associated with child's age but not with family status, child's or caregiver's sex, caregiver's marital status, possession of blankets or plastic sheeting, severe malnutrition, month of enrollment, or acute illness. Illness was not more common among foster children than among children living with their biological families. This analysis supports the UNHCR/UNICEF recommendation of fostering for unaccompanied children during an acute refugee crisis.

Supporting employees’ work-family needs improves health care quality: longitudinal evidence from long-term care

PubMed Central

Okechukwu, Cassandra A.; Kelly, Erin L.; Bacic, Janine; DePasquale, Nicole; Hurtado, David; Kossek, Ellen; Sembajwe, Grace

2016-01-01

We analyzed qualitative and quantitative data from U.S.-based employees in 30 long-term care facilities. Analysis of semi-structured interviews from 154 managers informed quantitative analyses. Quantitative data include 1,214 employees’ scoring of their supervisors and their organizations on family supportiveness (individual scores and aggregated to facility level), and three outcomes: (1), care quality indicators assessed at facility level (n=30) and collected monthly for six months after employees’ data collection; (2), employees’ dichotomous survey response on having additional off-site jobs; and (3), proportion of employees with additional jobs at each facility. Thematic analyses revealed that managers operate within the constraints of an industry that simultaneously: (a) employs low-wage employees with multiple work-family challenges, and (b) has firmly institutionalized goals of prioritizing quality of care and minimizing labor costs. Managers universally described providing work-family support and prioritizing care quality as antithetical to each other. Concerns surfaced that family-supportiveness encouraged employees to work additional jobs off-site, compromising care quality. Multivariable linear regression analysis of facility-level data revealed that higher family-supportive supervision was associated with significant decreases in residents’ incidence of all pressure ulcers (−2.62%) and other injuries (−9.79%). Higher family-supportive organizational climate was associated with significant decreases in all falls (−17.94%) and falls with injuries (−7.57%). Managers’ concerns about additional jobs were not entirely unwarranted: multivariable logistic regression of employee-level data revealed that among employees with children, having family-supportive supervision was associated with significantly higher likelihood of additional off-site jobs (RR 1.46, 95%CI 1.08-1.99), but family-supportive organizational climate was associated with

Supporting employees' work-family needs improves health care quality: Longitudinal evidence from long-term care.

PubMed

Okechukwu, Cassandra A; Kelly, Erin L; Bacic, Janine; DePasquale, Nicole; Hurtado, David; Kossek, Ellen; Sembajwe, Grace

2016-05-01

We analyzed qualitative and quantitative data from U.S.-based employees in 30 long-term care facilities. Analysis of semi-structured interviews from 154 managers informed quantitative analyses. Quantitative data include 1214 employees' scoring of their supervisors and their organizations on family supportiveness (individual scores and aggregated to facility level), and three outcomes: (1), care quality indicators assessed at facility level (n = 30) and collected monthly for six months after employees' data collection; (2), employees' dichotomous survey response on having additional off-site jobs; and (3), proportion of employees with additional jobs at each facility. Thematic analyses revealed that managers operate within the constraints of an industry that simultaneously: (a) employs low-wage employees with multiple work-family challenges, and (b) has firmly institutionalized goals of prioritizing quality of care and minimizing labor costs. Managers universally described providing work-family support and prioritizing care quality as antithetical to each other. Concerns surfaced that family-supportiveness encouraged employees to work additional jobs off-site, compromising care quality. Multivariable linear regression analysis of facility-level data revealed that higher family-supportive supervision was associated with significant decreases in residents' incidence of all pressure ulcers (-2.62%) and other injuries (-9.79%). Higher family-supportive organizational climate was associated with significant decreases in all falls (-17.94%) and falls with injuries (-7.57%). Managers' concerns about additional jobs were not entirely unwarranted: multivariable logistic regression of employee-level data revealed that among employees with children, having family-supportive supervision was associated with significantly higher likelihood of additional off-site jobs (RR 1.46, 95%CI 1.08-1.99), but family-supportive organizational climate was associated with lower likelihood

Mutations in RIT1 cause Noonan syndrome - additional functional evidence and expanding the clinical phenotype.

PubMed

Koenighofer, M; Hung, C Y; McCauley, J L; Dallman, J; Back, E J; Mihalek, I; Gripp, K W; Sol-Church, K; Rusconi, P; Zhang, Z; Shi, G-X; Andres, D A; Bodamer, O A

2016-03-01

RASopathies are a clinically heterogeneous group of conditions caused by mutations in 1 of 16 proteins in the RAS-mitogen activated protein kinase (RAS-MAPK) pathway. Recently, mutations in RIT1 were identified as a novel cause for Noonan syndrome. Here we provide additional functional evidence for a causal role of RIT1 mutations and expand the associated phenotypic spectrum. We identified two de novo missense variants p.Met90Ile and p.Ala57Gly. Both variants resulted in increased MEK-ERK signaling compared to wild-type, underscoring gain-of-function as the primary functional mechanism. Introduction of p.Met90Ile and p.Ala57Gly into zebrafish embryos reproduced not only aspects of the human phenotype but also revealed abnormalities of eye development, emphasizing the importance of RIT1 for spatial and temporal organization of the growing organism. In addition, we observed severe lymphedema of the lower extremity and genitalia in one patient. We provide additional evidence for a causal relationship between pathogenic mutations in RIT1, increased RAS-MAPK/MEK-ERK signaling and the clinical phenotype. The mutant RIT1 protein may possess reduced GTPase activity or a diminished ability to interact with cellular GTPase activating proteins; however the precise mechanism remains unknown. The phenotypic spectrum is likely to expand and includes lymphedema of the lower extremities in addition to nuchal hygroma. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Molecular phylogenetic evidence supports a new family of octocorals and a new genus of Alcyoniidae (Octocorallia, Alcyonacea)

PubMed Central

McFadden, Catherine S.; van Ofwegen, Leen P.

2013-01-01

Abstract Molecular phylogenetic evidence indicates that the octocoral family Alcyoniidae is highly polyphyletic, with genera distributed across Octocorallia in more than 10 separate clades. Most alcyoniid taxa belong to the large and poorly resolved Holaxonia–Alcyoniina clade of octocorals, but members of at least four genera of Alcyoniidae fall outside of that group. As a first step towards revision of the family, we describe a new genus, Parasphaerasclera gen. n., and family, Parasphaerascleridae fam. n., of Alcyonacea to accommodate species of Eleutherobia Pütter, 1900 and Alcyonium Linnaeus, 1758 that have digitiform to digitate or lobate growth forms, completely lack sclerites in the polyps, and have radiates or spheroidal sclerites in the colony surface and interior. Parasphaerascleridae fam. n. constitutes a well-supported clade that is phylogenetically distinct from all other octocoral taxa. We also describe a new genus of Alcyoniidae, Sphaerasclera gen. n., for a species of Eleutherobia with a unique capitate growth form. Sphaerasclera gen. n. is a member of the Anthomastus–Corallium clade of octocorals, but is morphologically and genetically distinct from Anthomastus Verrill, 1878 and Paraminabea Williams & Alderslade, 1999, two similar but dimorphic genera of Alcyoniidae that are its sister taxa. In addition, we have re-assigned two species of Eleutherobia that have clavate to capitate growth forms, polyp sclerites arranged to form a collaret and points, and spindles in the colony interior to Alcyonium, a move that is supported by both morphological and molecular phylogenetic evidence. PMID:24223488

Supporting Better Evidence Generation and Use within Social Innovation in Health in Low- and Middle-Income Countries: A Qualitative Study

PubMed Central

Tran, Jenny; Hersch, Fred; Lockwood, Amy; Montgomery, Paul

2017-01-01

Background While several papers have highlighted a lack of evidence to scale social innovations in health, fewer have explored decision-maker understandings of the relative merit of different types of evidence, how such data are interpreted and applied, and what practical support is required to improve evidence generation. The objectives of this paper are to understand (1) beliefs and attitudes towards the value of and types of evidence in scaling social innovations for health, (2) approaches to evidence generation and evaluation used in systems and policy change, and (3) how better evidence-generation can be undertaken and supported within social innovation in health. Methods Thirty-two one-on-one interviews were conducted between July and November 2015 with purposively selected practitioners, policymakers, and funders from low- and middle- income countries (LMICs). Data were analysed using a Framework Analysis Approach. Results While practitioners, funders, and policymakers said they held outcome evidence in high regard, their practices only bear out this assertion to varying degrees. Few have given systematic consideration to potential unintended consequences, in particular harm, of the programs they implement, fund, or adopt. Stakeholders suggest that better evidence-generation can be undertaken and supported within social innovation in health by supporting the research efforts of emerging community organizations; creating links between practitioners and academia; altering the funding landscape for evidence-generation; providing responsive technical education; and creating accountability for funders, practitioners, and policymakers. Conclusion How better evidence-generation can be undertaken and supported within social innovation in health is a previously under-operationalised aspect of the policy-making process that remains essential in order to refrain from causing harm, enable the optimization of existing interventions, and ultimately, to scale and fund what

A cross-sectional survey of supports for evidence-informed decision-making in healthcare organisations: a research protocol.

PubMed

Ouimet, Mathieu; Lavis, John N; Léon, Grégory; Ellen, Moriah E; Bédard, Pierre-Olivier; Grimshaw, Jeremy M; Gagnon, Marie-Pierre

2014-10-09

This protocol builds on the development of a) a framework that identified the various supports (i.e. positions, activities, interventions) that a healthcare organisation or health system can implement for evidence-informed decision-making (EIDM) and b) a qualitative study that showed the current mix of supports that some Canadian healthcare organisations have in place and the ones that are perceived to facilitate the use of research evidence in decision-making. Based on these findings, we developed a web survey to collect cross-sectional data about the specific supports that regional health authorities and hospitals in two Canadian provinces (Ontario and Quebec) have in place to facilitate EIDM. This paper describes the methods for a cross-sectional web survey among 32 regional health authorities and 253 hospitals in the provinces of Quebec and Ontario (Canada) to collect data on the current mix of organisational supports that these organisations have in place to facilitate evidence-informed decision-making. The data will be obtained through a two-step survey design: a 10-min survey among CEOs to identify key units and individuals in regard to our objectives (step 1) and a 20-min survey among managers of the key units identified in step 1 to collect information about the activities performed by their unit regarding the acquisition, assessment, adaptation and/or dissemination of research evidence in decision-making (step 2). The study will target three types of informants: CEOs, library/documentation centre managers and all other key managers whose unit is involved in the acquisition, assessment, adaptation/packaging and/or dissemination of research evidence in decision-making. We developed an innovative data collection system to increase the likelihood that only the best-informed respondent available answers each survey question. The reporting of the results will be done using descriptive statistics of supports by organisation type and by province. This study will

Why Some Students Refuse Additional Learning Support: Transition at a Further Education College

ERIC Educational Resources Information Center

Smith, Andrew

2006-01-01

In a specialist further education college, it was recognised that students aged 16/17 transferring to vocational study after their compulsory schooling were refusing to take up their entitlement to additional learning support. This created a shortfall in the college's predicted units of funding; also, course managers reported that several of these…

A framework for production of systematic review based briefings to support evidence-informed decision-making.

PubMed

Chambers, Duncan; Wilson, Paul

2012-07-09

We have developed a framework for translating existing sources of synthesized and quality-assessed evidence, primarily systematic reviews, into actionable messages in the form of short accessible briefings. The service aims to address real-life problems in response to requests from decision-makers.Development of the framework was based on a scoping review of existing resources and our initial experience with two briefing topics, including models of service provision for young people with eating disorders. We also drew on previous experience in dissemination research and practice. Where appropriate, we made use of the SUPporting POlicy relevant Reviews and Trials (SUPPORT) tools for evidence-informed policymaking. To produce a product that it is fit for this purpose it has been necessary to go beyond a traditional summary of the available evidence relating to effectiveness. Briefings have, therefore, included consideration of cost effectiveness, local applicability, implications relating to local service delivery, budgets, implementation and equity. Our first evidence briefings produced under this framework cover diagnostic endoscopy by specialist nurses and integrated care pathways in mental healthcare settings. The framework will enable researchers to present and contextualize evidence from systematic reviews and other sources of synthesized and quality-assessed evidence. The approach is designed to address the wide range of questions of interest to decision-makers, especially those commissioning services or managing service delivery and organization in primary or secondary care. Evaluation of the use and usefulness of the evidence briefings we produce is an integral part of the framework and will help to fill a gap in the literature.

What supports do health system organizations have in place to facilitate evidence-informed decision-making? a qualitative study

PubMed Central

2013-01-01

Background Decisions regarding health systems are sometimes made without the input of timely and reliable evidence, leading to less than optimal health outcomes. Healthcare organizations can implement tools and infrastructures to support the use of research evidence to inform decision-making. Objectives The purpose of this study was to profile the supports and instruments (i.e., programs, interventions, instruments or tools) that healthcare organizations currently have in place and which ones were perceived to facilitate evidence-informed decision-making. Methods In-depth semi-structured telephone interviews were conducted with individuals in three different types of positions (i.e., a senior management team member, a library manager, and a ‘knowledge broker’) in three types of healthcare organizations (i.e., regional health authorities, hospitals and primary care practices) in two Canadian provinces (i.e., Ontario and Quebec). The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. Results A total of 57 interviews were conducted in 25 organizations in Ontario and Quebec. The main findings suggest that, for the healthcare organizations that participated in this study, the following supports facilitate evidence-informed decision-making: facilitating roles that actively promote research use within the organization; establishing ties to researchers and opinion leaders outside the organization; a technical infrastructure that provides access to research evidence, such as databases; and provision and participation in training programs to enhance staff’s capacity building. Conclusions This study identified the need for having a receptive climate, which laid the foundation for the implementation of other tangible initiatives and supported the use of research in decision-making. This study adds to the literature on organizational efforts that can increase the use of research evidence in decision

The Experimental Evidence in Support of Glycosylation Mechanisms at the SN1-SN2 Interface.

PubMed

Adero, Philip Ouma; Amarasekara, Harsha; Wen, Peng; Bohé, Luis; Crich, David

2018-05-30

A critical review of the state-of-the-art evidence in support of the mechanisms of glycosylation reactions is provided. Factors affecting the stability of putative oxocarbenium ions as intermediates at the S N 1 end of the mechanistic continuum are first surveyed before the evidence, spectroscopic and indirect, for the existence of such species on the time scale of glycosylation reactions is presented. Current models for diastereoselectivity in nucleophilic attack on oxocarbenium ions are then described. Evidence in support of the intermediacy of activated covalent glycosyl donors is reviewed, before the influences of the structure of the nucleophile, of the solvent, of temperature, and of donor-acceptor hydrogen bonding on the mechanism of glycosylation reactions are surveyed. Studies on the kinetics of glycosylation reactions and the use of kinetic isotope effects for the determination of transition-state structure are presented, before computational models are finally surveyed. The review concludes with a critical appraisal of the state of the art.

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

Using Practice-Based Evidence to Improve Supportive Care Practices to Reduce Central Line-Associated Bloodstream Infections in a Pediatric Oncology Unit [Formula: see text].

PubMed

Linder, Lauri A; Gerdy, Cheryl; Abouzelof, Rouett; Wilson, Andrew

Children with cancer are a subset of patients with central lines with distinct risk factors for infection including periods of prolonged neutropenia and compromised mucous membrane integrity. This article relates the implementation of principles of practice-based evidence to identify interventions in addition to best practice maintenance care bundles to reduce central line-associated bloodstream infections involving viridans group streptococci and coagulase-negative staphylococci on an inpatient pediatric oncology unit. Review of individual events combined with review of current clinical practice guided the development of structured protocols emphasizing routine oral care and general supportive cares. Key principles of the protocols emphasized a 1-2-3 mnemonic and included daily bathing, twice daily oral care, and out-of-bed activity 3 times daily. Poisson regression identified a significant main effect for time period for central line-associated bloodstream infection rates involving both viridans group streptococci and coagulase-negative staphylococci. Significant differences were present between the preintervention baseline and implementation of the supportive care protocols. Project outcomes demonstrate the added value of using principles of practice-based evidence to guide the development of interventions to improve clinical care when evidence-based sources are limited.

Supporting Young Children's Vocabulary Growth: The Challenges, the Benefits, and Evidence-Based Strategies

ERIC Educational Resources Information Center

Jalongo, Mary Renck; Sobolak, Michelle J.

2011-01-01

The complexity of words makes vocabulary development a multi-faceted process that presents challenges to early childhood educators, offers benefits to young learners, and must be supported through evidence-based strategies. All students, regardless of socio-economic status or background, need to make significant gains in receptive and expressive…

BUNDLE OF MEASURES TO SUPPORT INTRAHOSPITAL EXCLUSIVE BREASTFEEDING: EVIDENCE OF SYSTEMATIC REVIEWS.

PubMed

Coca, Kelly Pereira; Pinto, Vânia Lopes; Westphal, Flavia; Mania, Pâmilla Nayara Alves; Abrão, Ana Cristina Freitas de Vilhena

2018-04-23

To identify the main recommendations found in systematic reviews regarding exclusive breastfeeding protective factors. Integrative review based on the guiding question: What evidence is found in literature regarding the protective factors of exclusive breastfeeding during the intrahospital period? A search was conducted in the Cochrane Library, PubMed/MEDLINE and LILACS database using the keyword "Breast Feeding" and the word "Breastfeeding". Systematic reviews published from 2007 to 2016 that answered the guiding question were included in the study, whereas systematic reviews that analyzed breastfeeding of preterm infants and breastfeeding of children with orofacial malformation were excluded. The sample included eight systematic reviews. The recommendations related to the protective factors for exclusive in-hospital breastfeeding found in the systematic reviews were: early skin-to-skin contact, rooming-in care, intervention for treating painful nipples during breastfeeding, restriction of infant supplementation, baby-led breastfeeding and educational interventions and support for mothers during hospital stay. The proposed measures included the six practices presented as protective factors. The review enabled the identification of evidence to support the recommended measures from delivery room to hospital discharge, with the aim of encouraging breastfeeding and preventing intrahospital weaning.

A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease.

PubMed

Mente, Andrew; de Koning, Lawrence; Shannon, Harry S; Anand, Sonia S

2009-04-13

Although a wealth of literature links dietary factors and coronary heart disease (CHD), the strength of the evidence supporting valid associations has not been evaluated systematically in a single investigation. We conducted a systematic search of MEDLINE for prospective cohort studies or randomized trials investigating dietary exposures in relation to CHD. We used the Bradford Hill guidelines to derive a causation score based on 4 criteria (strength, consistency, temporality, and coherence) for each dietary exposure in cohort studies and examined for consistency with the findings of randomized trials. Strong evidence supports valid associations (4 criteria satisfied) of protective factors, including intake of vegetables, nuts, and "Mediterranean" and high-quality dietary patterns with CHD, and associations of harmful factors, including intake of trans-fatty acids and foods with a high glycemic index or load. Among studies of higher methodologic quality, there was also strong evidence for monounsaturated fatty acids and "prudent" and "western" dietary patterns. Moderate evidence (3 criteria) of associations exists for intake of fish, marine omega-3 fatty acids, folate, whole grains, dietary vitamins E and C, beta carotene, alcohol, fruit, and fiber. Insufficient evidence (< or =2 criteria) of association is present for intake of supplementary vitamin E and ascorbic acid (vitamin C); saturated and polyunsaturated fatty acids; total fat; alpha-linolenic acid; meat; eggs; and milk. Among the dietary exposures with strong evidence of causation from cohort studies, only a Mediterranean dietary pattern is related to CHD in randomized trials. The evidence supports a valid association of a limited number of dietary factors and dietary patterns with CHD. Future evaluation of dietary patterns, including their nutrient and food components, in cohort studies and randomized trials is recommended.

Supporting Evidence-Based Practice in Schools with an Online Database of Best Practices

ERIC Educational Resources Information Center

Powers, Joelle D.; Bowen, Natasha K.; Bowen, Gary L.

2011-01-01

In spite of multidisciplinary recommendations to use evidence-based interventions in schools and a growing knowledge base of such practices, most schools are not using empirically supported interventions. On the basis of a careful analysis of barriers to the implementation of the best researched programs, an online, free, and publicly available…

Evaluating Evidence-Based Nutrition Support Practice Among Healthcare Professionals With and Without the Certified Nutrition Support Clinician Credential.

PubMed

Brody, Rebecca; Hise, Mary; Marcus, Andrea Fleisch; Harvey-Banchik, Lillian; Matarese, Laura E

2016-01-01

The National Board of Nutrition Support Certification credentials healthcare professionals and certifies that holders of the Certified Nutrition Support Clinician (CNSC) credential have specialized knowledge of safe and effective nutrition support therapy. The purpose of this pilot study was to survey healthcare professionals affiliated with the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) regarding their approaches to nutrition support practice using a complex patient case scenario in accordance with established clinical guidelines. An electronic survey was emailed to individuals affiliated with A.S.P.E.N. Eight multiple-choice knowledge questions addressed evidence-based nutrition support practice issues for a patient with progressing pancreatitis. Demographic and clinical characteristic data were collected. Of 48,093 email invitations sent, 4455 (9.1%) responded and met inclusion criteria. Most respondents were dietitians (70.8%) and in nutrition support practice for 10.3 years, and 29.3% held the CNSC credential. Respondents with the CNSC credential answered 6.18 questions correctly compared with 4.56 for non-CNSC respondents (P < .001). For all 8 questions, CNSC respondents were significantly more likely to choose the correct answer compared with non-CNSC respondents (P < .001). Professionals with the CNSC credential scored significantly higher on a complex case-based knowledge assessment of guideline recommendations for the nutrition support treatment of pancreatitis compared with those without a credential. © 2015 American Society for Parenteral and Enteral Nutrition.

Additives to local anesthetics for peripheral nerve blocks: Evidence, limitations, and recommendations.

PubMed

Bailard, Neil S; Ortiz, Jaime; Flores, Roland A

2014-03-01

The therapeutic rationale, clinical effectiveness, and potential adverse effects of medications used in combination with local anesthetics for peripheral nerve block therapy are reviewed. A wide range of agents have been tested as adjuncts to peripheral nerve blocks, which are commonly performed for regional anesthesia during or after hand or arm surgery, neck or spine surgery, and other procedures. Studies to determine the comparative merits of nerve block adjuncts are complicated by the wide variety of coadministered local anesthetics and sites of administration and by the heterogeneity of primary endpoints. Sodium bicarbonate has been shown to speed the onset of mepivacaine nerve blocks but delay the onset of others. Epinephrine has been shown to prolong sensory nerve blockade and delay systemic uptake of local anesthetics, thus reducing the risk of anesthetic toxicity. Tramadol, buprenorphine, dexamethasone, and clonidine appear to be effective additives in some situations. Midazolam, magnesium, dexmedetomidine, and ketamine cannot be routinely recommended as nerve block additives due to a dearth of supportive data, modest efficacy, and (in the case of ketamine) significant adverse effects. Recent studies suggest that administering additives intravenously or intramuscularly can provide many of the benefits of perineural administration while reducing the potential for neurotoxicity, contamination, and other hazards. Some additives to local anesthetics can hasten the onset of nerve block, prolong block duration, or reduce toxicity. On the other hand, poorly selected or unnecessary additives may not have the desired effect and may even expose patients to unnecessary risks.

Sensitivity to food additives, vaso-active amines and salicylates: a review of the evidence.

PubMed

Skypala, Isabel J; Williams, M; Reeves, L; Meyer, R; Venter, C

2015-01-01

Although there is considerable literature pertaining to IgE and non IgE-mediated food allergy, there is a paucity of information on non-immune mediated reactions to foods, other than metabolic disorders such as lactose intolerance. Food additives and naturally occurring 'food chemicals' have long been reported as having the potential to provoke symptoms in those who are more sensitive to their effects. Diets low in 'food chemicals' gained prominence in the 1970s and 1980s, and their popularity remains, although the evidence of their efficacy is very limited. This review focuses on the available evidence for the role and likely adverse effects of both added and natural 'food chemicals' including benzoate, sulphite, monosodium glutamate, vaso-active or biogenic amines and salicylate. Studies assessing the efficacy of the restriction of these substances in the diet have mainly been undertaken in adults, but the paper will also touch on the use of such diets in children. The difficulty of reviewing the available evidence is that few of the studies have been controlled and, for many, considerable time has elapsed since their publication. Meanwhile dietary patterns and habits have changed hugely in the interim, so the conclusions may not be relevant for our current dietary norms. The conclusion of the review is that there may be some benefit in the removal of an additive or a group of foods high in natural food chemicals from the diet for a limited period for certain individuals, providing the diagnostic pathway is followed and the foods are reintroduced back into the diet to assess for the efficacy of removal. However diets involving the removal of multiple additives and food chemicals have the very great potential to lead to nutritional deficiency especially in the paediatric population. Any dietary intervention, whether for the purposes of diagnosis or management of food allergy or food intolerance, should be adapted to the individual's dietary habits and a suitably

Occupational therapy-based and evidence-supported recommendations for assessment and exercises in hand osteoarthritis.

PubMed

Kjeken, Ingvild

2011-12-01

The aims of this study were to develop recommendations for occupational therapy assessment and design of hand exercise programmes in patients with hand osteoarthritis. An expert group followed a Delphi procedure to reach consensus for up to 10 recommendations for assessment and exercises, respectively. Thereafter, an evidence-based approach was used to identify and appraise research evidence supporting each recommendation, before the recommendations were validated by the expert group. The process resulted in 10 recommendations for assessment and eight for design of exercise programmes. The literature search revealed that there is a paucity of clinical trials to guide recommendations for hand osteoarthritis, and the evidence for the majority of the recommendations was based on expert opinions. Also, even if a systematic review demonstrates some evidence for the efficacy of strength training exercises in hand OA, the evidence for any specific exercise is limited to expert opinions. A first set of recommendations for assessment and exercise in hand osteoarthritis has been developed. For many of the recommendations there is a paucity of research evidence. High-quality studies are therefore needed to establish a high level of evidence concerning functional assessment and the effect of hand exercises in hand osteoarthritis.

Use of an evidence-based algorithm for patients with traumatic hemothorax reduces need for additional interventions.

PubMed

Dennis, Bradley M; Gondek, Stephen P; Guyer, Richard A; Hamblin, Susan E; Gunter, Oliver L; Guillamondegui, Oscar D

2017-04-01

Concerted management of the traumatic hemothorax is ill-defined. Surgical management of specific hemothoraces may be beneficial. A comprehensive strategy to delineate appropriate patients for additional procedures does not exist. We developed an evidence-based algorithm for hemothorax management. We hypothesize that the use of this algorithm will decrease additional interventions. A pre-/post-study was performed on all patients admitted to our trauma service with traumatic hemothorax from August 2010 to September 2013. An evidence-based management algorithm was initiated for the management of retained hemothoraces. Patients with length of stay (LOS) less than 24 hours or admitted during an implementation phase were excluded. Study data included age, Injury Severity Score, Abbreviated Injury Scale chest, mechanism of injury, ventilator days, intensive care unit (ICU) LOS, total hospital LOS, and interventions required. Our primary outcome was number of patients requiring more than 1 intervention. Secondary outcomes were empyema rate, number of patients requiring specific additional interventions, 28-day ventilator-free days, 28-day ICU-free days, hospital LOS, all-cause 6-month readmission rate. Standard statistical analysis was performed for all data. Six hundred forty-two patients (326 pre and 316 post) met the study criteria. There were no demographic differences in either group. The number of patients requiring more than 1 intervention was significantly reduced (49 pre vs. 28 post, p = 0.02). Number of patients requiring VATS decreased (27 pre vs. 10 post, p < 0.01). Number of catheters placed by interventional radiology increased (2 pre vs. 10 post, p = 0.02). Intrapleural thrombolytic use, open thoracotomy, empyema, and 6-month readmission rates were unchanged. The "post" group more ventilator-free days (median, 23.9 vs. 22.5, p = 0.04), but ICU and hospital LOS were unchanged. Using an evidence-based hemothorax algorithm reduced the number of patients

The Use of Prompting as an Evidence-Based Strategy to Support Children with ASD in School Settings in New Zealand

ERIC Educational Resources Information Center

Hayes, Dervla

2013-01-01

This article examines the use of prompting as an evidence-based strategy to support children with autism to develop their language, communication and social interactions skills. The literature is reviewed using a three-ringed, evidence-based practice model to support evaluation of the use of prompting. The article outlines considerations about the…

Arthroplasty knee registry of Catalonia: What scientific evidence supports the implantation of our prosthesis?

PubMed

Samaniego Alonso, R; Gaviria Parada, E; Pons Cabrafiga, M; Espallargues Carreras, M; Martinez Cruz, O

2018-02-28

In our environment, it is increasingly necessary to perform an activity based on scientific evidence and the field of prosthetic surgery should be governed by the same principles. The national arthroplasty registries allow us to obtain a large amount of data in order to evaluate this technique. The aim of our study is to analyse the scientific evidence that supports the primary total knee arthroplasties implanted in Catalonian public hospitals, based on the Arthoplasty Registry of Catalonia (RACat) MATERIAL AND METHODS: A review of the literature was carried out on knee prostheses (cruciate retaining, posterior stabilized, constricted and rotational) recorded in RACat between the period 2005-2013 in the following databases: Orthopedic Data Evaluation Panel, PubMed, TripDatabase and Google Scholar. The prostheses implanted in fewer than 10 units (1,358 prostheses corresponding to 62 models) were excluded. 41,947 prostheses (96.86%) were analysed out of 43,305 implanted, corresponding to 74 different models. In 13 models (n = 4,715) (11.24%) no clinical evidence to support their use was found. In the remaining 36 models (n = 13,609) (32.45%), level iv studies were the most predominant evidence. There was a significant number of implanted prostheses (11.24%) for which no clinical evidence was found. The number of models should be noted, 36 out of 110, with fewer than 10 units implanted. The use of arthroplasty registries has proved an extremely useful tool that allows us to analyse and draw conclusions in order to improve the efficiency of this surgical technique. Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Evidence for single metal two electron oxidative addition and reductive elimination at uranium.

PubMed

Gardner, Benedict M; Kefalidis, Christos E; Lu, Erli; Patel, Dipti; McInnes, Eric J L; Tuna, Floriana; Wooles, Ashley J; Maron, Laurent; Liddle, Stephen T

2017-12-01

Reversible single-metal two-electron oxidative addition and reductive elimination are common fundamental reactions for transition metals that underpin major catalytic transformations. However, these reactions have never been observed together in the f-block because these metals exhibit irreversible one- or multi-electron oxidation or reduction reactions. Here we report that azobenzene oxidises sterically and electronically unsaturated uranium(III) complexes to afford a uranium(V)-imido complex in a reaction that satisfies all criteria of a single-metal two-electron oxidative addition. Thermolysis of this complex promotes extrusion of azobenzene, where H-/D-isotopic labelling finds no isotopomer cross-over and the non-reactivity of a nitrene-trap suggests that nitrenes are not generated and thus a reductive elimination has occurred. Though not optimally balanced in this case, this work presents evidence that classical d-block redox chemistry can be performed reversibly by f-block metals, and that uranium can thus mimic elementary transition metal reactivity, which may lead to the discovery of new f-block catalysis.

The status of states' policies to support evidence-based practices in children's mental health.

PubMed

Cooper, Janice L; Aratani, Yumiko

2009-12-01

This study examined the efforts of states' mental health authorities to promote the use of evidence-based practices through policy. Data were drawn from three components of a national study, including a survey of state children's mental health directors (N=53), which was developed using a three-step process that involved stakeholders. Data from the directors' survey revealed that over 90% of states are implementing strategies to support the use of evidence-based practices. The scope of these efforts varies, with 36% reporting statewide reach. Further, states' strategies for implementing evidence-based practices are often not accompanied by comparable efforts to enhance information systems, even though enhancing such systems can bolster opportunities for successful implementation. Variability in the adoption of evidence-based practices, poor attention to information systems, and inconsistent fiscal policies threaten states' efforts to improve the quality of children's mental health services.

Additive benefits of autonomy support and enhanced expectancies for motor learning.

PubMed

Wulf, Gabriele; Chiviacowsky, Suzete; Cardozo, Priscila Lopes

2014-10-01

Two factors that have been shown to facilitate motor learning are autonomy support (AS) and enhanced expectancies (EE) for performance. We examined the individual and combined influences of these factors. In a 2 × 2 design, participants learning a novel motor skill (throwing with the non-dominant arm) were or were not provided a choice (AS) about the ball color on each of 6 10-trial blocks during practice, and were or were not given bogus positive social-comparative feedback (EE). This resulted in four groups: AS/EE, AS, EE, and C (control). One day after the practice phase, participants completed 10 retention and 10 transfer trials. The distance to the target--a bull's eye with a 1m radius and 10 concentric circles--was 7.5m during practice and retention, and 8.5m during transfer. Autonomy support and enhanced expectancies had additive advantages for learning, with both main effects being significant for retention and transfer. On both tests, the AS/EE group showed the greatest throwing accuracy. Also, the accuracy scores of the AS and EE groups were higher than those of the C group. Furthermore, self-efficacy measured after practice and before retention and transfer was increased by both AS and EE. Thus, supporting learners' need for autonomy by given them a small choice--even though it was not directly related to task performance--and enhancing their performance expectancies appeared to independently influence learning. Copyright © 2014 Elsevier B.V. All rights reserved.

20 CFR 404.780 - Evidence of “good cause” for exceeding time limits on accepting proof of support or application...

Code of Federal Regulations, 2010 CFR

2010-04-01

... accepting proof of support or application for a lump-sum death payment. (a) When evidence of good cause is... death payment. You may be asked for evidence of good cause for these delays if— (1) You are the insured... limits on accepting proof of support or application for a lump-sum death payment. 404.780 Section 404.780...

Primary total hip arthroplasty in Catalonia: What is the clinical evidence that supports our prosthesis?

PubMed

Chaverri-Fierro, D; Lobo-Escolar, L; Espallargues, M; Martínez-Cruz, O; Domingo, L; Pons-Cabrafiga, M

The implementation of National Prostheses Registries allows us to obtain a large amount of data and make conclusions in order to improve the use of them. Sweden was the first country to implement a National Prostheses Registry in 1979. Catalonia has been doing this since 2005. The aim of our study is to analyse the evidence that supports primary total hip replacement in Catalonia in the last 9 years, based on the Arthroplasty Registry of Catalonia (RACat). A review of the literature was carried out of the prosthesis (acetabular cups/stems) reported in the RACat between the period 2005 to 2013 in the following databases: ODEP (Orthopaedic Data Evaluation Panel), TRIP database, PubMed, and Google Scholar. Those prostheses implanted in less than 10 units (182 acetabular components corresponding to 49 models/228 stems corresponding to 63 models) were excluded. A total of 18,634 (99%) implanted acetabular cups were analysed out of a total number of 18,816, corresponding to 74 different models. In 18 models (2527 acetabular cups) no clinical evidence to support its use was found. An analysis was performed on 19,367 (98.84%) out of a total number of 19,595 implanted stems, corresponding to 75 different models. In 16 models (1845 stems) no clinical evidence was found to support their use. Variable evidence was found in the 56 models of acetabular cups (16,107) and 59 models of stems (17,522), most of it corresponding to level iv clinical evidence. There was a significant number implanted prostheses evaluated (13.56% acetabular cups/9.5% stems) for which no clinical evidence was found. The elevated number of models is highlighted (49 types for acetabular cups/63 types for stems) with less than 10 units implanted, which corresponds to only 1% of the total implants. The use of arthroplasty registers is shown to be an extremely helpful tool that allows analyses and conclusions to be made for the follow-up and post-marketing surveillance period. Copyright © 2016 SECOT

Evidence-based guidelines for supportive care of patients with Ebola virus disease.

PubMed

Lamontagne, François; Fowler, Robert A; Adhikari, Neill K; Murthy, Srinivas; Brett-Major, David M; Jacobs, Michael; Uyeki, Timothy M; Vallenas, Constanza; Norris, Susan L; Fischer, William A; Fletcher, Thomas E; Levine, Adam C; Reed, Paul; Bausch, Daniel G; Gove, Sandy; Hall, Andrew; Shepherd, Susan; Siemieniuk, Reed A; Lamah, Marie-Claude; Kamara, Rashida; Nakyeyune, Phiona; Soka, Moses J; Edwin, Ama; Hazzan, Afeez A; Jacob, Shevin T; Elkarsany, Mubarak Mustafa; Adachi, Takuya; Benhadj, Lynda; Clément, Christophe; Crozier, Ian; Garcia, Armando; Hoffman, Steven J; Guyatt, Gordon H

2018-02-17

The 2013-16 Ebola virus disease outbreak in west Africa was associated with unprecedented challenges in the provision of care to patients with Ebola virus disease, including absence of pre-existing isolation and treatment facilities, patients' reluctance to present for medical care, and limitations in the provision of supportive medical care. Case fatality rates in west Africa were initially greater than 70%, but decreased with improvements in supportive care. To inform optimal care in a future outbreak of Ebola virus disease, we employed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to develop evidence-based guidelines for the delivery of supportive care to patients admitted to Ebola treatment units. Key recommendations include administration of oral and, as necessary, intravenous hydration; systematic monitoring of vital signs and volume status; availability of key biochemical testing; adequate staffing ratios; and availability of analgesics, including opioids, for pain relief. Copyright © 2018 Elsevier Ltd. All rights reserved.

[Evidence and Evidence Gaps - an Introduction].

PubMed

Dreier, G; Löhler, J

2016-04-01

Treating patients requires the inclusion of existing evidence in any health care decision, to be able to choose the best diagnosis or treatment measure or to make valid prognosis statements for a particular patient in consideration of the physician's own expertise.The basis are clinical trials, the results of which are ideally gathered in systematic reviews, rated, summarized and published. In addition to the GCP (Good Clinical Practice)-compliant planning, conducting and analysis of clinical studies it is essential, that all study results are made publicly available, in order to avoid publication bias. This includes the public registration of planned and discontinued trials. In the last 25 years, the evidence-based medicine (EbM) has increasingly found its way into clinical practice and research. Here EbM is closely associated with the names Archibald Cochrane and David Sackett. In Germany, both the German Cochrane Centre (DCZ) and the network of evidence-based medicine (DNEbM) were established approximately 15 years ago. In the international Cochrane Collaboration clinicians and other scientists like statisticians interdisciplinary work side by side to develop the methods of evidence-based medicine and to address the topics of evidence generation and processing as well as the transfer of knowledge. Challenge: Existing evidence primarily serves doctors to support their decision-making, but is also the basis for providing scientific proof for a health care intervention's benefit to patients and ultimately payers/health insurances. The closure of existing evidence gaps requires substantial human and financial resources, a complex organizational structure and can only succeed with the involvement of clinical and methodological expertise and specific knowledge in the field of clinical research. In addition, the knowledge must be transferred into practice, using journals, guidelines, conferences, databases, information portals with processed evidence and not least the

Using knowledge brokering to promote evidence-based policy-making: The need for support structures.

PubMed Central

van Kammen, Jessika; de Savigny, Don; Sewankambo, Nelson

2006-01-01

Knowledge brokering is a promising strategy to close the "know-do gap" and foster greater use of research findings and evidence in policy-making. It focuses on organizing the interactive process between the producers and users of knowledge so that they can co-produce feasible and research-informed policy options. We describe a recent successful experience with this novel approach in the Netherlands and discuss the requirements for effective institutionalization of knowledge brokering. We also discuss the potential of this approach to assist health policy development in low-income countries based on the experience of developing the Regional East-African Health (REACH)-Policy Initiative. We believe that intermediary organizations, such as regional networks, dedicated institutional mechanisms and funding agencies, can play key roles in supporting knowledge brokering. We recommend the need to support and learn from the brokerage approach to strengthen the relationship between the research and policy communities and hence move towards a stronger culture of evidence-based policy and policy-relevant research. PMID:16917647

Additional Support for the Information Systems Analyst Exam as a Valid Program Assessment Tool

ERIC Educational Resources Information Center

Carpenter, Donald A.; Snyder, Johnny; Slauson, Gayla Jo; Bridge, Morgan K.

2011-01-01

This paper presents a statistical analysis to support the notion that the Information Systems Analyst (ISA) exam can be used as a program assessment tool in addition to measuring student performance. It compares ISA exam scores earned by students in one particular Computer Information Systems program with scores earned by the same students on the…

Community interventions providing care and support to orphans and vulnerable children: a review of evaluation evidence.

PubMed

Schenk, Katie D

2009-07-01

Children affected by HIV in their families and communities face multiple risks to their health, education and psychosocial wellbeing. Community interventions for children who have been orphaned or rendered vulnerable take many forms, including educational assistance, home-based care, legal protection and psychosocial support. Despite a recent influx of funding for programme implementation, there exists little evidence to inform policymakers about whether their investments are improving the lives of vulnerable children and meeting key benchmarks including the Millennium Development Goals. This paper reviews the current evidence base on evaluations of community interventions for orphans and vulnerable children (OVC) in high HIV-prevalence African settings, focusing on studies' methodologies. Sources reviewed include published research studies and evidence from the unpublished programmatic "grey literature" located through database and internet searches. A total of 21 studies, varying in scope and generalisability, were identified. Interventions reviewed address children's wellbeing through various strategies within their communities. Evaluation methodologies reflect quantitative and qualitative approaches, including surveys (with and without baseline or comparison data), costing studies, focus groups, interviews, case studies, and participatory review techniques. Varied study methodologies reflect diverse research questions, various intervention types, and the challenges associated with evaluating complex interventions; highlighting the need to broaden the research paradigm in order to build the evidence base by including quasi-experimental and process evaluation approaches, and seeking further insights through participatory qualitative methodologies and costing studies. Although findings overall indicate the value of community interventions in effecting measurable improvements in child and family wellbeing, the quality and rigour of evidence is varied. A strategic

The care unit in nursing home research: evidence in support of a definition.

PubMed

Estabrooks, Carole A; Morgan, Debra G; Squires, Janet E; Boström, Anne-Marie; Slaughter, Susan E; Cummings, Greta G; Norton, Peter G

2011-04-14

Defining what constitutes a resident care unit in nursing home research is both a conceptual and practical challenge. The aim of this paper is to provide evidence in support of a definition of care unit in nursing homes by demonstrating: (1) its feasibility for use in data collection, (2) the acceptability of aggregating individual responses to the unit level, and (3) the benefit of including unit level data in explanatory models. An observational study design was used. Research (project) managers, healthcare aides, care managers, nursing home administrators and directors of care from thirty-six nursing homes in the Canadian prairie provinces of Alberta, Saskatchewan and Manitoba provided data for the study. A definition of care unit was developed and applied in data collection and analyses. A debriefing session was held with research managers to investigate their experiences with using the care unit definition. In addition, survey responses from 1258 healthcare aides in 25 of the 36 nursing homes in the study, that had more than one care unit, were analyzed using a multi-level modeling approach. Trained field workers administered the Alberta Context Tool (ACT), a 58-item self-report survey reflecting 10 organizational context concepts, to healthcare aides using computer assisted personal interviews. To assess the appropriateness of obtaining unit level scores, we assessed aggregation statistics (ICC(1), ICC(2), η², and ω²), and to assess the value of using the definition of unit in explanatory models, we performed multi-level modeling. In 10 of the 36 nursing homes, the care unit definition developed was used to align the survey data (for analytic purposes) to specific care units as designated by our definition, from that reported by the facility administrator. The aggregation statistics supported aggregating the healthcare aide responses on the ACT to the realigned unit level. Findings from the multi-level modeling further supported unit level aggregation. A

The care unit in nursing home research: Evidence in support of a definition

PubMed Central

2011-01-01

Background Defining what constitutes a resident care unit in nursing home research is both a conceptual and practical challenge. The aim of this paper is to provide evidence in support of a definition of care unit in nursing homes by demonstrating: (1) its feasibility for use in data collection, (2) the acceptability of aggregating individual responses to the unit level, and (3) the benefit of including unit level data in explanatory models. Methods An observational study design was used. Research (project) managers, healthcare aides, care managers, nursing home administrators and directors of care from thirty-six nursing homes in the Canadian prairie provinces of Alberta, Saskatchewan and Manitoba provided data for the study. A definition of care unit was developed and applied in data collection and analyses. A debriefing session was held with research managers to investigate their experiences with using the care unit definition. In addition, survey responses from 1258 healthcare aides in 25 of the 36 nursing homes in the study, that had more than one care unit, were analyzed using a multi-level modeling approach. Trained field workers administered the Alberta Context Tool (ACT), a 58-item self-report survey reflecting 10 organizational context concepts, to healthcare aides using computer assisted personal interviews. To assess the appropriateness of obtaining unit level scores, we assessed aggregation statistics (ICC(1), ICC(2), η2, and ω2), and to assess the value of using the definition of unit in explanatory models, we performed multi-level modeling. Results In 10 of the 36 nursing homes, the care unit definition developed was used to align the survey data (for analytic purposes) to specific care units as designated by our definition, from that reported by the facility administrator. The aggregation statistics supported aggregating the healthcare aide responses on the ACT to the realigned unit level. Findings from the multi-level modeling further supported

Working group reports: Evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project

USDA-ARS?s Scientific Manuscript database

The "Evaluation of the Evidence to Support Practice Guidelines for the Nutritional Care of Preterm Infants: The Pre-B Project" is the first phase in a process to present the current state of knowledge and to support the development of evidence-informed guidance for the nutritional care of preterm an...

Equity and Blindness: Closing Evidence Gaps to Support Universal Eye Health.

PubMed

Ramke, Jacqueline; Zwi, Anthony B; Palagyi, Anna; Blignault, Ilse; Gilbert, Clare E

2015-01-01

The World Health Organization Program for the Prevention of Blindness adopted the principles of universal health coverage (UHC) in its latest plan, Universal Eye Health: A Global Action Plan, 2014-2019. This plan builds on the achievements of Vision 2020, which aimed to reduce the global prevalence of avoidable blindness, and its unequal distribution, by the year 2020. We reviewed the literature on health equity and the generation and use of evidence to promote equity, particularly in eye health. We describe the nature and extent of the equity-focused evidence to support and inform eye health programs on the path to universal eye health, and propose ways to improve the collection and reporting of this evidence. Blindness prevalence decreased in all regions of the world between 1990 and 2010, albeit not at the same rate or to the same extent. In 2010, the prevalence of blindness in West Africa (6.0%) remained 15 times higher than in high-income regions (0.4%); within all regions, women had a higher prevalence of blindness than men. Beyond inter-regional and sex differences, there is little comparable data on the distribution of blindness across social groups within regions and countries, or on whether this distribution has changed over time. Similarly, interventions known to address inequity in blindness are few, and equity-relevant goals, targets and indicators for eye health programs are scarce. Equity aims of eye health programs can benefit from the global momentum towards achieving UHC, and the progress being made on collecting, communicating and using equity-focused evidence.

The diagnosis of male infertility: an analysis of the evidence to support the development of global WHO guidance-challenges and future research opportunities.

PubMed

Barratt, Christopher L R; Björndahl, Lars; De Jonge, Christopher J; Lamb, Dolores J; Osorio Martini, Francisco; McLachlan, Robert; Oates, Robert D; van der Poel, Sheryl; St John, Bianca; Sigman, Mark; Sokol, Rebecca; Tournaye, Herman

2017-11-01

Herein, we describe the consensus guideline methodology, summarize the evidence-based recommendations we provided to the World Health Organization (WHO) for their consideration in the development of global guidance and present a narrative review of the diagnosis of male infertility as related to the eight prioritized (problem or population (P), intervention (I), comparison (C) and outcome(s) (O) (PICO)) questions. Additionally, we discuss the challenges and research gaps identified during the synthesis of this evidence. The aim of this paper is to present an evidence-based approach for the diagnosis of male infertility as related to the eight prioritized PICO questions. Collating the evidence to support providing recommendations involved a collaborative process as developed by WHO, namely: identification of priority questions and critical outcomes; retrieval of up-to-date evidence and existing guidelines; assessment and synthesis of the evidence; and the formulation of draft recommendations to be used for reaching consensus with a wide range of global stakeholders. For each draft recommendation the quality of the supporting evidence was then graded and assessed for consideration during a WHO consensus. Evidence was synthesized and recommendations were drafted to address the diagnosis of male infertility specifically encompassing the following: What is the prevalence of male infertility and what proportion of infertility is attributable to the male? Is it necessary for all infertile men to undergo a thorough evaluation? What is the clinical (ART/non ART) value of traditional semen parameters? What key male lifestyle factors impact on fertility (focusing on obesity, heat and tobacco smoking)? Do supplementary oral antioxidants or herbal therapies significantly influence fertility outcomes for infertile men? What are the evidence-based criteria for genetic screening of infertile men? How does a history of neoplasia and related treatments in the male impact on (his and

The diagnosis of male infertility: an analysis of the evidence to support the development of global WHO guidance—challenges and future research opportunities

PubMed Central

Barratt, Christopher L R; Björndahl, Lars; De Jonge, Christopher J; Lamb, Dolores J; Osorio Martini, Francisco; McLachlan, Robert; Oates, Robert D; van der Poel, Sheryl; St John, Bianca; Sigman, Mark; Sokol, Rebecca; Tournaye, Herman

2017-01-01

Abstract BACKGROUND Herein, we describe the consensus guideline methodology, summarize the evidence-based recommendations we provided to the World Health Organization (WHO) for their consideration in the development of global guidance and present a narrative review of the diagnosis of male infertility as related to the eight prioritized (problem or population (P), intervention (I), comparison (C) and outcome(s) (O) (PICO)) questions. Additionally, we discuss the challenges and research gaps identified during the synthesis of this evidence. OBJECTIVE AND RATIONALE The aim of this paper is to present an evidence-based approach for the diagnosis of male infertility as related to the eight prioritized PICO questions. SEARCH METHODS Collating the evidence to support providing recommendations involved a collaborative process as developed by WHO, namely: identification of priority questions and critical outcomes; retrieval of up-to-date evidence and existing guidelines; assessment and synthesis of the evidence; and the formulation of draft recommendations to be used for reaching consensus with a wide range of global stakeholders. For each draft recommendation the quality of the supporting evidence was then graded and assessed for consideration during a WHO consensus. OUTCOMES Evidence was synthesized and recommendations were drafted to address the diagnosis of male infertility specifically encompassing the following: What is the prevalence of male infertility and what proportion of infertility is attributable to the male? Is it necessary for all infertile men to undergo a thorough evaluation? What is the clinical (ART/non ART) value of traditional semen parameters? What key male lifestyle factors impact on fertility (focusing on obesity, heat and tobacco smoking)? Do supplementary oral antioxidants or herbal therapies significantly influence fertility outcomes for infertile men? What are the evidence-based criteria for genetic screening of infertile men? How does a

Evidence-based surgery: barriers, solutions, and the role of evidence synthesis.

PubMed

Garas, George; Ibrahim, Amel; Ashrafian, Hutan; Ahmed, Kamran; Patel, Vanash; Okabayashi, Koji; Skapinakis, Petros; Darzi, Ara; Athanasiou, Thanos

2012-08-01

Surgery is a rapidly evolving field, making the rigorous testing of emerging innovations vital. However, most surgical research fails to employ randomized controlled trials (RCTs) and has particularly been based on low-quality study designs. Subsequently, the analysis of data through meta-analysis and evidence synthesis is particularly difficult. Through a systematic review of the literature, this article explores the barriers to achieving a strong evidence base in surgery and offers potential solutions to overcome the barriers. Many barriers exist to evidence-based surgical research. They include enabling factors, such as funding, time, infrastructure, patient preference, ethical issues, and additionally barriers associated with specific attributes related to researchers, methodologies, or interventions. Novel evidence synthesis techniques in surgery are discussed, including graphics synthesis, treatment networks, and network meta-analyses that help overcome many of the limitations associated with existing techniques. They offer the opportunity to assess gaps and quantitatively present inconsistencies within the existing evidence of RCTs. Poorly or inadequately performed RCTs and meta-analyses can give rise to incorrect results and thus fail to inform clinical practice or revise policy. The above barriers can be overcome by providing academic leadership and good organizational support to ensure that adequate personnel, resources, and funding are allocated to the researcher. Training in research methodology and data interpretation can ensure that trials are conducted correctly and evidence is adequately synthesized and disseminated. The ultimate goal of overcoming the barriers to evidence-based surgery includes the improved quality of patient care in addition to enhanced patient outcomes.

Replacing and Additive Horizontal Gene Transfer in Streptococcus

PubMed Central

Choi, Sang Chul; Rasmussen, Matthew D.; Hubisz, Melissa J.; Gronau, Ilan; Stanhope, Michael J.; Siepel, Adam

2012-01-01

The prominent role of Horizontal Gene Transfer (HGT) in the evolution of bacteria is now well documented, but few studies have differentiated between evolutionary events that predominantly cause genes in one lineage to be replaced by homologs from another lineage (“replacing HGT”) and events that result in the addition of substantial new genomic material (“additive HGT”). Here in, we make use of the distinct phylogenetic signatures of replacing and additive HGTs in a genome-wide study of the important human pathogen Streptococcus pyogenes (SPY) and its close relatives S. dysgalactiae subspecies equisimilis (SDE) and S. dysgalactiae subspecies dysgalactiae (SDD). Using recently developed statistical models and computational methods, we find evidence for abundant gene flow of both kinds within each of the SPY and SDE clades and of reduced levels of exchange between SPY and SDD. In addition, our analysis strongly supports a pronounced asymmetry in SPY–SDE gene flow, favoring the SPY-to-SDE direction. This finding is of particular interest in light of the recent increase in virulence of pathogenic SDE. We find much stronger evidence for SPY–SDE gene flow among replacing than among additive transfers, suggesting a primary influence from homologous recombination between co-occurring SPY and SDE cells in human hosts. Putative virulence genes are correlated with transfer events, but this correlation is found to be driven by additive, not replacing, HGTs. The genes affected by additive HGTs are enriched for functions having to do with transposition, recombination, and DNA integration, consistent with previous findings, whereas replacing HGTs seen to influence a more diverse set of genes. Additive transfers are also found to be associated with evidence of positive selection. These findings shed new light on the manner in which HGT has shaped pathogenic bacterial genomes. PMID:22617954

GJ 581 update: Additional evidence for a Super-Earth in the habitable zone

NASA Astrophysics Data System (ADS)

Vogt, S. S.; Butler, R. P.; Haghighipour, N.

2012-08-01

We present an analysis of the significantly expanded HARPS 2011 radial velocity data set for GJ 581 that was presented by Forveille et al. (2011). Our analysis reaches substantially different conclusions regarding the evidence for a Super-Earth-mass planet in the star's Habitable Zone. We were able to reproduce their reported χν2 and RMS values only after removing some outliers from their models and refitting the trimmed down RV set. A suite of 4000 N-body simulations of their Keplerian model all resulted in unstable systems and revealed that their reported 3.6σ detection of e=0.32 for the eccentricity of GJ 581e is manifestly incompatible with the system's dynamical stability. Furthermore, their Keplerian model, when integrated only over the time baseline of the observations, significantly increases the χν2 and demonstrates the need for including non-Keplerian orbital precession when modeling this system. We find that a four-planet model with all of the planets on circular or nearly circular orbits provides both an excellent self-consistent fit to their RV data and also results in a very stable configuration. The periodogram of the residuals to a 4-planet all-circular-orbit model reveals significant peaks that suggest one or more additional planets in this system. We conclude that the present 240-point HARPS data set, when analyzed in its entirety, and modeled with fully self-consistent stable orbits, by and of itself does offer significant support for a fifth signal in the data with a period near 32 days. This signal has a false alarm probability of <4 % and is consistent with a planet of minimum mass 2.2 M_⊙, orbiting squarely in the star's habitable zone at 0.13 AU, where liquid water on planetary surfaces is a distinct possibility.

Applications of Metal Additive Manufacturing in Veterinary Orthopedic Surgery

NASA Astrophysics Data System (ADS)

Harrysson, Ola L. A.; Marcellin-Little, Denis J.; Horn, Timothy J.

2015-03-01

Veterinary medicine has undergone a rapid increase in specialization over the last three decades. Veterinarians now routinely perform joint replacement, neurosurgery, limb-sparing surgery, interventional radiology, radiation therapy, and other complex medical procedures. Many procedures involve advanced imaging and surgical planning. Evidence-based medicine has also become part of the modus operandi of veterinary clinicians. Modeling and additive manufacturing can provide individualized or customized therapeutic solutions to support the management of companion animals with complex medical problems. The use of metal additive manufacturing is increasing in veterinary orthopedic surgery. This review describes and discusses current and potential applications of metal additive manufacturing in veterinary orthopedic surgery.

An Examination of the Addition of Video Informed Reflective Practice to the Active Support Toolkit

ERIC Educational Resources Information Center

Baker, Peter; Appleton, Philippa; Williams, Rosie

2017-01-01

Background: This study evaluated a package of Active Support (AS), which included standard training with additional video informed reflective practice. Materials & Methods: The training package was implemented as part of a service improvement initiative in four residential intellectual disability homes, using a concurrent multiple baseline…

Additional evidence on the use of personal ornaments in the Middle Paleolithic of North Africa

PubMed Central

d'Errico, Francesco; Vanhaeren, Marian; Barton, Nick; Bouzouggar, Abdeljalil; Mienis, Henk; Richter, Daniel; Hublin, Jean-Jacques; McPherron, Shannon P.; Lozouet, Pierre

2009-01-01

Recent investigations into the origins of symbolism indicate that personal ornaments in the form of perforated marine shell beads were used in the Near East, North Africa, and SubSaharan Africa at least 35 ka earlier than any personal ornaments in Europe. Together with instances of pigment use, engravings, and formal bone tools, personal ornaments are used to support an early emergence of behavioral modernity in Africa, associated with the origin of our species and significantly predating the timing for its dispersal out of Africa. Criticisms have been leveled at the low numbers of recovered shells, the lack of secure dating evidence, and the fact that documented examples were not deliberately shaped. In this paper, we report on 25 additional shell beads from four Moroccan Middle Paleolithic sites. We review their stratigraphic and chronological contexts and address the issue of these shells having been deliberately modified and used. We detail the results of comparative analyses of modern, fossil, and archaeological assemblages and microscopic examinations of the Moroccan material. We conclude that Nassarius shells were consistently used for personal ornamentation in this region at the end of the last interglacial. Absence of ornaments at Middle Paleolithic sites postdating Marine Isotope Stage 5 raises the question of the possible role of climatic changes in the disappearance of this hallmark of symbolic behavior before its reinvention 40 ka ago. Our results suggest that further inquiry is necessary into the mechanisms of cultural transmission within early Homo sapiens populations. PMID:19717433

Integration of evidence-based practice in bedside teaching paediatrics supported by e-learning.

PubMed

Potomkova, Jarmila; Mihal, Vladimir; Zapletalova, Jirina; Subova, Dana

2010-03-01

Bedside teaching with evidence-based practice elements, supported by e-learning activities, can play an important role in modern medical education. Teachers have to incorporate evidence from the medical literature to increase student motivation and interactivity. An integral part of the medical curricula at Palacky University Olomouc (Czech Republic) are real paediatric scenarios supplemented with a review of current literature to enhance evidence-based bedside teaching & learning. Searching for evidence is taught through librarian-guided interactive hands-on sessions and/or web-based tutorials followed by clinical case presentations and feedback. Innovated EBM paediatric clerkship demonstrated students' preferences towards web-based interactive bedside teaching & learning. In two academic years (2007/2008, 2008/2009), learning-focused feedback from 106 and 131 students, resp. was obtained about their attitudes towards evidence-based bedside teaching. The assessment included among others the overall level of instruction, quality of practical evidence-based training, teacher willingness and impact of instruction on increased interest in the specialty. There was some criticism about excessive workload. A parallel survey was carried out on the perceived values of different forms of information skills training (i.e. demonstration, online tutorials, and librarian-guided interactive search sessions) and post-training self-reported level of search skills. The new teaching/learning paediatric portfolio is a challenge for further activities, including effective knowledge translation, continuing medical & professional development of teachers, and didactic, clinically integrated teaching approaches.

Promoting Evidence-Based Practices: The Adoption of a Prevention Support System in Community Settings

ERIC Educational Resources Information Center

Hunter, Sarah B.; Paddock, Susan M.; Ebener, Patricia; Burkhart, A. K.; Chinman, Matthew

2009-01-01

Prevention support systems (PSSs) are designed to help communities implement evidence-based practices (EBPs). Little is known about the factors that influence their adoption. In this article, we examined adoption of a PSS for substance abuse prevention called Getting To Outcomes (GTO)[R] among staff in two community coalitions with varying levels…

Evidence-based management of ambulatory electronic health record system implementation: an assessment of conceptual support and qualitative evidence.

PubMed

McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia; Rizer, Milisa; Huerta, Timothy R

2014-07-01

While electronic health record (EHR) systems have potential to drive improvements in healthcare, a majority of EHR implementations fall short of expectations. Shortcomings in implementations are often due to organizational issues around the implementation process rather than technological problems. Evidence from both the information technology and healthcare management literature can be applied to improve the likelihood of implementation success, but the translation of this evidence into practice has not been widespread. Our objective was to comprehensively study and synthesize best practices for managing ambulatory EHR system implementation in healthcare organizations, highlighting applicable management theories and successful strategies. We held 45 interviews with key informants in six U.S. healthcare organizations purposively selected based on reported success with ambulatory EHR implementation. We also conducted six focus groups comprised of 37 physicians. Interview and focus group transcripts were analyzed using both deductive and inductive methods to answer research questions and explore emergent themes. We suggest that successful management of ambulatory EHR implementation can be guided by the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. While participants did not acknowledge nor emphasize use of this model, we found evidence that successful implementation practices could be framed using the PDSA model. Additionally, successful sites had three strategies in common: 1) use of evidence from published health information technology (HIT) literature emphasizing implementation facilitators; 2) focusing on workflow; and 3) incorporating critical management factors that facilitate implementation. Organizations seeking to improve ambulatory EHR implementation processes can use frameworks such as the PDSA QI model to guide efforts and provide a means to formally accommodate new evidence over time. Implementing formal management strategies and incorporating

SUPPORT Tools for evidence-informed health Policymaking (STP) 12: Finding and using research evidence about resource use and costs

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. In this article, we address considerations about resource use and costs. The consequences of a policy or programme option for resource use differ from other impacts (both in terms of benefits and harms) in several ways. However, considerations of the consequences of options for resource use are similar to considerations related to other impacts in that policymakers and their staff need to identify important impacts on resource use, acquire and appraise the best available evidence regarding those impacts, and ensure that appropriate monetary values have been applied. We suggest four questions that can be considered when assessing resource use and the cost consequences of an option. These are: 1. What are the most important impacts on resource use? 2. What evidence is there for important impacts on resource use? 3. How confident is it possible to be in the evidence for impacts on resource use? 4. Have the impacts on resource use been valued appropriately in terms of their true costs? PMID:20018102

Applying evidence to support ethical decisions: is the placebo really powerless?.

PubMed

Porzsolt, Franz; Schlotz-Gorton, Nicole; Biller-Andorno, Nikola; Thim, Anke; Meissner, Karin; Roeckl-Wiedmann, Irmgard; Herzberger, Barbara; Ziegler, Renatus; Gaus, Wilhelm; Pöppe, Ernst

2004-01-01

Using placebos in day-to-day practice is an ethical problem. This paper summarises the available epidemiological evidence to support this difficult decision. Based on these data we propose to differentiate between placebo and "knowledge framing". While the use of placebo should be confined to experimental settings in clinical trials, knowledge framing--which is only conceptually different from placebo--is a desired, expected and necessary component of any doctor-patient encounter. Examples from daily practice demonstrate both, the need to investigate the effects of knowledge framing and its impact on ethical, medical, economical and legal decisions.

Hippocampal declarative memory supports gesture production: Evidence from amnesia

PubMed Central

Hilliard, Caitlin; Cook, Susan Wagner; Duff, Melissa C.

2016-01-01

Spontaneous co-speech hand gestures provide a visuospatial representation of what is being communicated in spoken language. Although it is clear that gestures emerge from representations in memory for what is being communicated (De Ruiter, 1998; Wesp, Hesse, Keutmann, & Wheaton, 2001), the mechanism supporting the relationship between gesture and memory is unknown. Current theories of gesture production posit that action – supported by motor areas of the brain – is key in determining whether gestures are produced. We propose that when and how gestures are produced is determined in part by hippocampally-mediated declarative memory. We examined the speech and gesture of healthy older adults and of memory-impaired patients with hippocampal amnesia during four discourse tasks that required accessing episodes and information from the remote past. Consistent with previous reports of impoverished spoken language in patients with hippocampal amnesia, we predicted that these patients, who have difficulty generating multifaceted declarative memory representations, may in turn have impoverished gesture production. We found that patients gestured less overall relative to healthy comparison participants, and that this was particularly evident in tasks that may rely more heavily on declarative memory. Thus, gestures do not just emerge from the motor representation activated for speaking, but are also sensitive to the representation available in hippocampal declarative memory, suggesting a direct link between memory and gesture production. PMID:27810497

20 CFR 418.2250 - What evidence will you need to support your request that we use a more recent tax year?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false What evidence will you need to support your request that we use a more recent tax year? 418.2250 Section 418.2250 Employees' Benefits SOCIAL SECURITY... evidence will you need to support your request that we use a more recent tax year? We will follow the rules...

METEOR: An Enterprise Health Informatics Environment to Support Evidence-Based Medicine.

PubMed

Puppala, Mamta; He, Tiancheng; Chen, Shenyi; Ogunti, Richard; Yu, Xiaohui; Li, Fuhai; Jackson, Robert; Wong, Stephen T C

2015-12-01

The aim of this paper is to propose the design and implementation of next-generation enterprise analytics platform developed at the Houston Methodist Hospital (HMH) system to meet the market and regulatory needs of the healthcare industry. For this goal, we developed an integrated clinical informatics environment, i.e., Methodist environment for translational enhancement and outcomes research (METEOR). The framework of METEOR consists of two components: the enterprise data warehouse (EDW) and a software intelligence and analytics (SIA) layer for enabling a wide range of clinical decision support systems that can be used directly by outcomes researchers and clinical investigators to facilitate data access for the purposes of hypothesis testing, cohort identification, data mining, risk prediction, and clinical research training. Data and usability analysis were performed on METEOR components as a preliminary evaluation, which successfully demonstrated that METEOR addresses significant niches in the clinical informatics area, and provides a powerful means for data integration and efficient access in supporting clinical and translational research. METEOR EDW and informatics applications improved outcomes, enabled coordinated care, and support health analytics and clinical research at HMH. The twin pressures of cost containment in the healthcare market and new federal regulations and policies have led to the prioritization of the meaningful use of electronic health records in the United States. EDW and SIA layers on top of EDW are becoming an essential strategic tool to healthcare institutions and integrated delivery networks in order to support evidence-based medicine at the enterprise level.

Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence.

PubMed

Sarris, Jerome; McIntyre, Erica; Camfield, David A

2013-04-01

Research in the area of herbal psychopharmacology has revealed a variety of promising medicines that may provide benefit in the treatment of general anxiety and specific anxiety disorders. However, a comprehensive review of plant-based anxiolytics has been absent to date. Thus, our aim was to provide a comprehensive narrative review of plant-based medicines that have clinical and/or preclinical evidence of anxiolytic activity. We present the article in two parts. In part one, we reviewed herbal medicines for which only preclinical investigations for anxiolytic activity have been performed. In this current article (part two), we review herbal medicines for which there have been both preclinical and clinical investigations of anxiolytic activity. A search of MEDLINE (PubMed), CINAHL, Scopus and the Cochrane Library databases was conducted (up to 28 October 2012) for English language papers using the search terms 'anxiety' OR 'anxiety disorder' OR 'generalized anxiety disorder' OR 'social phobia' OR 'post-traumatic stress disorder' OR 'panic disorder' OR 'agoraphobia' OR 'obsessive compulsive disorder' in combination with the search terms 'Herb*' OR 'Medicinal Plants' OR 'Botanical Medicine' OR 'Chinese herb*', in addition to individual herbal medicines. This search of the literature revealed 1,525 papers, of which 53 plants were included in the review (having at least one study using the whole plant extract). Of these plants, 21 had human clinical trial evidence (reviewed here in part two), with the other 32 having solely preclinical evidence (reviewed in part one). Support for efficacy was found for chronic use (i.e. greater than one day) of the following herbs in treating a range of anxiety disorders in human clinical trials: Piper methysticum, Matricaria recutita, Ginkgo biloba, Scutellaria lateriflora, Silybum marianum, Passiflora incarnata, Withania somniferum, Galphimia glauca, Centella asiatica, Rhodiola rosea, Echinacea spp., Melissa officinalis and Echium

A multi-site randomised controlled trial of evidence-based supported employment for adults with severe and persistent mental illness.

PubMed

Waghorn, Geoffrey; Dias, Shannon; Gladman, Beverley; Harris, Meredith; Saha, Sukanta

2014-12-01

The Individual Placement and Support (IPS) approach is an evidence-based form of supported employment for people with severe and persistent mental illness. This approach is not yet widely available in Australia even though there is mounting evidence of its generalisability outside the USA. One previous Australian randomised controlled trial found that IPS is effective for young people with first episode psychosis. The aim of the current trial was to assess the effectiveness of evidence-based supported employment when implemented for Australian adult consumers of public mental health services by utilising existing service systems. A four-site randomised control trial design (n = 208) was conducted in Brisbane (two sites), Townsville and Cairns. The intervention consisted of an IPS supported employment service hosted by a community mental health team. The control condition was delivered at each site by mental health teams referring consumers to other disability employment services in the local area. At 12 months, those in the IPS condition had 2.4 times greater odds of commencing employment than those in the control condition (42.5% vs. 23.5%). The conditions did not differ on secondary employment outcomes including job duration, hours worked, or job diversity. Attrition was higher than expected in both conditions with 28.4% completing the baseline interview but taking no further part in the study. The results support previous international findings that IPS-supported employment is more effective than non-integrated supported employment. IPS can be successfully implemented this way in Australia, but with a loss of effect strength compared to previous USA trials. © 2014 Occupational Therapy Australia.

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...

Neonatal non-invasive respiratory support: synchronised NIPPV, non-synchronised NIPPV or bi-level CPAP: what is the evidence in 2013?

PubMed

Roberts, C T; Davis, P G; Owen, L S

2013-01-01

Nasal continuous positive airway pressure (NCPAP) has proven to be an effective mode of non-invasive respiratory support in preterm infants; however, many infants still require endotracheal ventilation, placing them at an increased risk of morbidities such as bronchopulmonary dysplasia. Several other modes of non-invasive respiratory support beyond NCPAP, including synchronised and non-synchronised nasal intermittent positive pressure ventilation (SNIPPV and nsNIPPV) and bi-level positive airway pressure (BiPAP) are now also available. These techniques require different approaches, and the exact mechanisms by which they act remain unclear. SNIPPV has been shown to reduce the rate of reintubation in comparison to NCPAP when used as post-extubation support, but the evidence for nsNIPPV and BiPAP in this context is less convincing. There is some evidence that NIPPV (whether synchronised or non-synchronised) used as primary respiratory support is beneficial, but the variation in study methodology makes this hard to translate confidently into clinical practice. There is currently no evidence to suggest a reduction in mortality or important morbidities such as bronchopulmonary dysplasia, with NIPPV or BiPAP in comparison to NCPAP, and there is a lack of appropriately designed studies in this area. This review discusses the different approaches and proposed mechanisms of action of SNIPPV, nsNIPPV and BiPAP, the challenges of applying the available evidence for these distinct modalities of non-invasive respiratory support to clinical practice, and possible areas of future research. © 2013 S. Karger AG, Basel.

Analysis of evidence supporting the Federation of Bosnia and Herzegovina reimbursement medicines lists: role of the WHO Essential Medicines List, Cochrane systematic reviews and technology assessment reports.

PubMed

Mahmić-Kaknjo, Mersiha; Marušić, Ana

2015-07-01

We compared recently introduced Basic Medicines Lists of the Federation of Bosnia and Herzegovina (BH) (FBH Basic Lists (FBLs)) with the World Health Organization (WHO) Essential Medicines List (EML) and the evidence supporting the inclusion of additional medicines on FBLs. The sources of data included the 18th edition of the EML and the following FBLs: 2013 Hospital List, 2013 A List in Outpatient Setting, and 2012 List financed by the Federal Solidarity Fund. For medicines found on FBLs but not on EML, we searched the Cochrane Database of Systematic Reviews (CSR) and public health technology assessment (HTA) reports for evidence. FBLs had 134 medicines and 17 combinations that were not on EML, as well as 9 medicines deleted and 4 rejected from EML. EML had 82 medicines and 10 combinations of medicines not included in FBLs. Out of 125 medicines on FBLs but not on EML, 52 (42%) had good CSR evidence supporting their inclusion (n = 38) or exclusion (n = 14). For the rest (n = 74), we found 24 favourable HTA reports. For the total of 89 medicines (27%) listed on FBLs, we found no evidence (EML, CSR, HTA reports) good enough to justify their inclusion in FBLs. In circumstances of scarce financial resources, greater reliance on well-established, proven list is crucial. Independent, unbiased, high-quality evidence such as WHO EML, CSR and HTA reports (national or international with local adaptations) should be used when deciding on medicine reimbursement.

Social Support and Supervisory Quality Interventions in the Workplace: A Stakeholder-Centered Best-Evidence Synthesis of Systematic Reviews on Work Outcomes.

PubMed

Wagner, S L; White, M I; Schultz, I Z; Williams-Whitt, K; Koehn, C; Dionne, C E; Koehoorn, M; Harder, H G; Pasca, R; Wärje, O; Hsu, V; McGuire, L; Lama, I; Schulz, W; Kube, D; Wright, M D

2015-10-01

There is controversy surrounding the impact of workplace interventions aimed at improving social support and supervisory quality on absenteeism, productivity and financial outcomes. To determine the value of social support interventions for work outcomes. Databases were searched for systematic reviews between 2000 and 2012 to complete a synthesis of systematic reviews guided by the PRISMA statement and the IOM guidelines for systematic reviews. Assessment of articles for inclusion and methodological quality was conducted independently by at least two researchers, with differences resolved by consensus. The search resulted in 3363 titles of which 3248 were excluded following title/abstract review, leaving 115 articles that were retrieved and underwent full article review. 10 articles met the set inclusion criteria, with 7 focusing on social support, 2 on supervisory quality and 1 on both. We found moderate and limited evidence, respectively, that social support and supervisory quality interventions positively impact workplace outcomes. There is moderate evidence that social support and limited evidence that supervisory quality interventions have a positive effect on work outcomes.

Recent Evidence for Emerging Digital Technologies to Support Global HIV Engagement in Care

PubMed Central

Jongbloed, Kate; Parmar, Sunjit; van der Kop, Mia; Spittal, Patricia M.; Lester, Richard T.

2017-01-01

Antiretroviral therapy is a powerful tool to reduce morbidity and mortality for the 35 million people living with HIV globally. However, availability of treatment alone is insufficient to meet new UNAIDS 90-90-90 targets calling for rapid scale-up of engagement in HIV care to end the epidemic in 2030. Digital technology interventions (mHealth, eHealth, and telehealth) are emerging as one approach to support lifelong engagement in HIV care. This review synthesizes recent reviews and primary studies published since January 2014 on digital technology interventions for engagement in HIV care after diagnosis. Technologies for health provide emerging and proven solutions to support achievement of the United Nations targets for the generalized HIV-affected population. Much of the existing evidence addresses antiretroviral therapy (ART) adherence; however, studies have begun to investigate programs to support linkage and retention in care as well as interventions to engage key populations facing extensive barriers to care. PMID:26454756

Humanistic psychotherapy research 1990-2015: from methodological innovation to evidence-supported treatment outcomes and beyond.

PubMed

Angus, Lynne; Watson, Jeanne Cherry; Elliott, Robert; Schneider, Kirk; Timulak, Ladislav

2015-01-01

Over the past 25 years, humanistic psychotherapy (HP) researchers have actively contributed to the development and implementation of innovative practice-informed research measures and coding systems. Qualitative and quantitative research findings, including meta-analyses, support the identification of HP approaches as evidence-based treatments for a variety of psychological conditions. Implications for future psychotherapy research, training, and practice are discussed in terms of addressing the persistent disjunction between significant HP research productivity and relatively low support for HP approaches in university-based clinical training programs, funding agencies, and government-supported clinical guidelines. Finally, specific recommendations are provided to further enhance and expand the impact of HP research for clinical training programs and the development of treatment guidelines.

Investigation assessing the publicly available evidence supporting postmarketing withdrawals, revocations and suspensions of marketing authorisations in the EU since 2012

PubMed Central

Lynn, Elizabeth; Shakir, Saad

2018-01-01

Objectives To assess the sources of publicly available evidence supporting withdrawal, revocation or suspension of marketing authorisations (‘regulatory actions’) due to safety reasons in the EU since 2012 and to investigate the time taken since initial marketing authorisation to reach these regulatory decisions. Setting This investigation examined the sources of evidence supporting 18 identified prescription medicinal products which underwent regulatory action due to safety reasons within the EU in the period 1 July 2012 to 31 December 2016. Results Eighteen single or combined active substances (‘medicinal products’) withdrawn, revoked or suspended within the EU for safety reasons between 2012 and 2016 met the inclusion criteria. Case reports were most commonly cited, supporting 94.4% of regulatory actions (n=17), followed by randomised controlled trial, meta-analyses, animal and in vitro, ex vivo or in silico study designs, each cited in 72.2% of regulatory actions (n=13). Epidemiological study designs were least commonly cited (n=8, 44.4%). Multiple sources of evidence contributed to 94.4% of regulatory decisions (n=17). Death was the most common adverse drug reaction leading to regulatory action (n=5; 27.8%), with four of these related to medication error or overdose. Median (IQR) time taken to reach a decision from the start of regulatory review was found to be 204.5 days (143, 535 days) and decreased across the study period. Duration of marketing prior to regulatory action, from the medicinal product’s authorisation date, increased across the period 2012–2016. Conclusions The sources of evidence supporting pharmacovigilance regulatory activities appear to have changed since implementation of Directive 2010/84/EU and Regulation (EU) No. 1235/2010. This, together with a small improvement in regulatory efficiency, suggests progress towards more rapid regulatory decisions based on more robust evidence. Future research should continue to monitor

Evidence on global medical travel.

PubMed

Ruggeri, Kai; Záliš, Ladislav; Meurice, Christopher R; Hilton, Ian; Ly, Terry-Lisa; Zupan, Zorana; Hinrichs, Saba

2015-11-01

The potential benefits of travelling across national borders to obtain medical treatment include improved care, decreased costs and reduced waiting times. However, medical travel involves additional risks, compared to obtaining treatment domestically. We review the publicly-available evidence on medical travel. We suggest that medical travel needs to be understood in terms of its potential risks and benefits so that it can be evaluated against alternatives by patients who are seeking care. We propose three domains -quality standards, informed decision-making, economic and legal protection - in which better evidence could support the development of medical travel policies.

Evidence on global medical travel

PubMed Central

Záliš, Ladislav; Meurice, Christopher R; Hilton, Ian; Ly, Terry-Lisa; Zupan, Zorana; Hinrichs, Saba

2015-01-01

Abstract The potential benefits of travelling across national borders to obtain medical treatment include improved care, decreased costs and reduced waiting times. However, medical travel involves additional risks, compared to obtaining treatment domestically. We review the publicly-available evidence on medical travel. We suggest that medical travel needs to be understood in terms of its potential risks and benefits so that it can be evaluated against alternatives by patients who are seeking care. We propose three domains –quality standards, informed decision-making, economic and legal protection – in which better evidence could support the development of medical travel policies. PMID:26549906

Standardized description of scientific evidence using the Evidence Ontology (ECO)

PubMed Central

Chibucos, Marcus C.; Mungall, Christopher J.; Balakrishnan, Rama; Christie, Karen R.; Huntley, Rachael P.; White, Owen; Blake, Judith A.; Lewis, Suzanna E.; Giglio, Michelle

2014-01-01

The Evidence Ontology (ECO) is a structured, controlled vocabulary for capturing evidence in biological research. ECO includes diverse terms for categorizing evidence that supports annotation assertions including experimental types, computational methods, author statements and curator inferences. Using ECO, annotation assertions can be distinguished according to the evidence they are based on such as those made by curators versus those automatically computed or those made via high-throughput data review versus single test experiments. Originally created for capturing evidence associated with Gene Ontology annotations, ECO is now used in other capacities by many additional annotation resources including UniProt, Mouse Genome Informatics, Saccharomyces Genome Database, PomBase, the Protein Information Resource and others. Information on the development and use of ECO can be found at http://evidenceontology.org. The ontology is freely available under Creative Commons license (CC BY-SA 3.0), and can be downloaded in both Open Biological Ontologies and Web Ontology Language formats at http://code.google.com/p/evidenceontology. Also at this site is a tracker for user submission of term requests and questions. ECO remains under active development in response to user-requested terms and in collaborations with other ontologies and database resources. Database URL: Evidence Ontology Web site: http://evidenceontology.org PMID:25052702

Evidence does not support absorption of intact solid lipid nanoparticles via oral delivery

NASA Astrophysics Data System (ADS)

Hu, Xiongwei; Fan, Wufa; Yu, Zhou; Lu, Yi; Qi, Jianping; Zhang, Jian; Dong, Xiaochun; Zhao, Weili; Wu, Wei

2016-03-01

Whether and to what extent solid lipid nanoparticles (SLNs) can be absorbed integrally via oral delivery should be clarified because it is the basis for elucidation of absorption mechanisms. To address this topic, the in vivo fate of SLNs as well as their interaction with biomembranes is investigated using water-quenching fluorescent probes that can signal structural variations of lipid-based nanocarriers. Live imaging indicates prolonged retention of SLNs in the stomach, whereas in the intestine, SLNs can be digested quickly. No translocation of intact SLNs to other organs or tissues can be observed. The in situ perfusion study shows bioadhesion of both SLNs and simulated mixed micelles (SMMs) to intestinal mucus, but no evidence of penetration of integral nanocarriers. Both SLNs and SMMs exhibit significant cellular uptake, but fail to penetrate cell monolayers. Confocal laser scanning microscopy reveals that nanocarriers mainly concentrate on the surface of the monolayers, and no evidence of penetration of intact vehicles can be obtained. The mucous layer acts as a barrier to the penetration of both SLNs and SMMs. Both bile salt-decoration and SMM formulation help to strengthen the interaction with biomembranes. It is concluded that evidence does not support absorption of intact SLNs via oral delivery.Whether and to what extent solid lipid nanoparticles (SLNs) can be absorbed integrally via oral delivery should be clarified because it is the basis for elucidation of absorption mechanisms. To address this topic, the in vivo fate of SLNs as well as their interaction with biomembranes is investigated using water-quenching fluorescent probes that can signal structural variations of lipid-based nanocarriers. Live imaging indicates prolonged retention of SLNs in the stomach, whereas in the intestine, SLNs can be digested quickly. No translocation of intact SLNs to other organs or tissues can be observed. The in situ perfusion study shows bioadhesion of both SLNs and

Effects of School-Wide Positive Behavior Support on Internalizing Problems: Current Evidence and Future Directions

ERIC Educational Resources Information Center

McIntosh, Kent; Ty, Sophie V.; Miller, Lynn D.

2014-01-01

School-wide Positive Behavior Support (SWPBS) has a large evidence base for preventing and addressing externalizing problem behavior, but there is little research examining its effects on internalizing problems, such as anxiety and depression. Given the prevalence of internalizing problems in today's children and youth, it is worthwhile to examine…

A Scaffolding Framework to Support the Construction of Evidence-Based Arguments among Middle School Students

ERIC Educational Resources Information Center

Belland, Brian R.; Glazewski, Krista D.; Richardson, Jennifer C.

2008-01-01

Problem-based learning (PBL) is an instructional approach in which students in small groups engage in an authentic, ill-structured problem, and must (1) define, generate and pursue learning issues to understand the problem, (2) develop a possible solution, (3) provide evidence to support their solution, and (4) present their solution and the…

An evidence-based approach to perioperative nutrition support in the elective surgery patient.

PubMed

Miller, Keith R; Wischmeyer, Paul E; Taylor, Beth; McClave, Stephen A

2013-09-01

In surgical practice, great attention is given to the perioperative management of the elective surgical patient with regard to surgical planning, stratification of cardiopulmonary risk, and postoperative assessment for complication. However, growing evidence supports the beneficial role for implementation of a consistent and literature-based approach to perioperative nutrition therapy. Determining nutrition risk should be a routine component of the preoperative evaluation. As with the above issues, this concept begins with the clinician's first visit with the patient as risk is assessed and the severity of the surgical insult considered. If the patient is an appropriate candidate for benefit from preoperative support, a plan for initiation and reassessment should be implemented. Once appropriate nutrition end points have been achieved, special consideration should be given to beneficial practices the immediate day preceding surgery that may better prepare the patient for the intervention from a metabolic standpoint. In the operating room, consideration should be given to the potential placement of enteral access during the index operation as well as judicious and targeted intraoperative resuscitation. Immediately following the intervention, adequate resuscitation and glycemic control are key concepts, as is an evidence-based approach to the early advancement of an enteral/oral diet in the postoperative patient. Through the implementation of perioperative nutrition therapy plans in the elective surgery setting, outcomes can be improved.

Using computerised decision support to improve compliance of cancer multidisciplinary meetings with evidence-based guidance

PubMed Central

Patkar, Vivek; Acosta, Dionisio; Davidson, Tim; Jones, Alison; Fox, John

2012-01-01

Objectives The cancer multidisciplinary team (MDT) meeting (MDM) is regarded as the best platform to reduce unwarranted variation in cancer care through evidence-compliant management. However, MDMs are often overburdened with many different agendas and hence struggle to achieve their full potential. The authors developed an interactive clinical decision support system called MATE (Multidisciplinary meeting Assistant and Treatment sElector) to facilitate explicit evidence-based decision making in the breast MDMs. Design Audit study and a questionnaire survey. Setting Breast multidisciplinary unit in a large secondary care teaching hospital. Participants All members of the breast MDT at the Royal Free Hospital, London, were consulted during the process of MATE development and implementation. The emphasis was on acknowledging the clinical needs and practical constraints of the MDT and fitting the system around the team's workflow rather than the other way around. Delegates, who attended MATE workshop at the England Cancer Networks' Development Programme conference in March 2010, participated in the questionnaire survey. Outcome measures The measures included evidence-compliant care, measured by adherence to clinical practice guidelines, and promoting research, measured by the patient identification rate for ongoing clinical trials. Results MATE identified 61% more patients who were potentially eligible for recruitment into clinical trials than the MDT, and MATE recommendations demonstrated better concordance with clinical practice guideline than MDT recommendations (97% of MATE vs 93.2% of MDT; N=984). MATE is in routine use in breast MDMs at the Royal Free Hospital, London, and wider evaluations are being considered. Conclusions Sophisticated decision support systems can enhance the conduct of MDMs in a way that is acceptable to and valued by the clinical team. Further rigorous evaluations are required to examine cost-effectiveness and measure the impact on patient

Nurses in need of additional support: web sites offering information in eldercare nursing environments.

PubMed

Matusitz, Jonathan; Breen, Gerald-Mark; Marathe, Shriram S; Wan, Thomas T H

2010-01-01

Studies have shown the usefulness of telemedicine and telecare in multiple settings. One form of telemedicine is e-health. Residents of nursing homes are a unique population that may significantly benefit from the e-health resources available to their caregivers. E-health Web sites appear to be viable, feasible, and timely interventional methods to provide the additional knowledge and support practitioners in these settings may need to provide preventative, reactive, and remedial care for frail residents.

Shifting mindsets: a realist synthesis of evidence from self-management support training.

PubMed

Davies, Freya; Wood, Fiona; Bullock, Alison; Wallace, Carolyn; Edwards, Adrian

2018-03-01

Accompanying the growing expectation of patient self-management is the need to ensure health care professionals (HCPs) have the required attitudes and skills to provide effective self-management support (SMS). Results from existing training interventions for HCPs in SMS have been mixed and the evidence base is weaker for certain settings, including supporting people with progressive neurological conditions (PNCs). We set out to understand how training operates, and to identify barriers and facilitators to training designed to support shifts in attitudes amongst HCPs. We undertook a realist literature synthesis focused on: (i) the influence of how HCPs, teams and organisations view and adopt self-management; and (ii) how SMS needs to be tailored for people with PNCs. A traditional database search strategy was used alongside citation tracking, grey literature searching and stakeholder recommendations. We supplemented PNC-specific literature with data from other long-term conditions. Key informant interviews and stakeholder advisory group meetings informed the synthesis process. Realist context-mechanism-outcome configurations were generated and mapped onto the stages described in Mezirow's Transformative Learning Theory. Forty-four original articles were included (19 relating to PNCs), from which seven refined theories were developed. The theories identified important training elements (evidence provision, building skills and confidence, facilitating reflection and generating empathy). The significant influence of workplace factors as possible barriers or facilitators was highlighted. Embracing SMS often required challenging traditional professional role boundaries. The integration of SMS into routine care is not an automatic outcome from training. A transformative learning process is often required to trigger the necessary mindset shift. Training should focus on how individual HCPs define and value SMS and how their work context (patient group and organisational

Self-management support interventions for persons with chronic disease: an evidence-based analysis.

PubMed

Franek, J

2013-01-01

Self-management support interventions such as the Stanford Chronic Disease Self-Management Program (CDSMP) are becoming more widespread in attempt to help individuals better self-manage chronic disease. To systematically assess the clinical effectiveness of self-management support interventions for persons with chronic diseases. A literature search was performed on January 15, 2012, using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database for studies published between January 1, 2000, and January 15, 2012. A January 1, 2000, start date was used because the concept of non-disease-specific/general chronic disease self-management was first published only in 1999. Reference lists were examined for any additional relevant studies not identified through the search. Randomized controlled trials (RCTs) comparing self-management support interventions for general chronic disease against usual care were included for analysis. Results of RCTs were pooled using a random-effects model with standardized mean difference as the summary statistic. Ten primary RCTs met the inclusion criteria (n = 6,074). Nine of these evaluated the Stanford CDSMP across various populations; results, therefore, focus on the CDSMP. HEALTH STATUS OUTCOMES: There was a small, statistically significant improvement in favour of CDSMP across most health status measures, including pain, disability, fatigue, depression, health distress, and self-rated health (GRADE quality low). There was no significant difference between modalities for dyspnea (GRADE quality very low). There was significant improvement in health-related quality of life according to the EuroQol 5-D in favour of CDSMP, but inconsistent findings across other quality-of-life measures.HEALTHY BEHAVIOUR OUTCOMES: There was a small, statistically significant

Getting to uptake: do communities of practice support the implementation of evidence-based practice?

PubMed

Barwick, Melanie A; Peters, Julia; Boydell, Katherine

2009-02-01

Practitioners are increasingly encouraged to adopt evidence-based practices (EBP) leading to a need for new knowledge translation strategies to support implementation and practice change. This study examined the benefits of a community of practice in the context of Ontario's children's mental health sector where organizations are mandated to adopt a standardized outcome measure to monitor client response to treatment. Readiness for change, practice change, content knowledge, and satisfaction with and use of implementation supports were examined among practitioners newly trained on the measure who were randomly assigned to a community of practice (CoP) or a practice as usual (PaU) group. CoP practitioners attended 6 sessions over 12 months; PaU practitioners had access to usual implementation supports. Groups did not differ on readiness for change or reported practice change, although CoP participants demonstrated greater use of the tool in practice, better content knowledge and were more satisfied with implementation supports than PaU participants. CoPs present a promising model for translating EBP knowledge and promoting practice change in children's mental health that requires further study.

OMERACT Filter Evidence Supporting the Measurement of At-work Productivity Loss as an Outcome Measure in Rheumatology Research.

PubMed

Beaton, Dorcas E; Dyer, Sarah; Boonen, Annelies; Verstappen, Suzanne M M; Escorpizo, Reuben; Lacaille, Diane V; Bosworth, Ailsa; Gignac, Monique A M; Leong, Amye; Purcaru, Oana; Leggett, Sarah; Hofstetter, Cathy; Peterson, Ingemar F; Tang, Kenneth; Fautrel, Bruno; Bombardier, Claire; Tugwell, Peter S

2016-01-01

Indicators of work role functioning (being at work, and being productive while at work) are important outcomes for persons with arthritis. As the worker productivity working group at OMERACT (Outcome Measures in Rheumatology), we sought to provide an evidence base for consensus on standardized instruments to measure worker productivity [both absenteeism and at-work productivity (presenteeism) as well as critical contextual factors]. Literature reviews and primary studies were done and reported to the OMERACT 12 (2014) meeting to build the OMERACT Filter 2.0 evidence for worker productivity outcome measurement instruments. Contextual factor domains that could have an effect on scores on worker productivity instruments were identified by nominal group techniques, and strength of influence was further assessed by literature review. At OMERACT 9 (2008), we identified 6 candidate measures of absenteeism, which received 94% endorsement at the plenary vote. At OMERACT 11 (2012) we received over the required minimum vote of 70% for endorsement of 2 at-work productivity loss measures. During OMERACT 12 (2014), out of 4 measures of at-work productivity loss, 3 (1 global; 2 multiitem) received support as having passed the OMERACT Filter with over 70% of the plenary vote. In addition, 3 contextual factor domains received a 95% vote to explore their validity as core contextual factors: nature of work, work accommodation, and workplace support. Our current recommendations for at-work productivity loss measures are: WALS (Workplace Activity Limitations Scale), WLQ PDmod (Work Limitations Questionnaire with modified physical demands scale), WAI (Work Ability Index), WPS (Arthritis-specific Work Productivity Survey), and WPAI (Work Productivity and Activity Impairment Questionnaire). Our future research focus will shift to confirming core contextual factors to consider in the measurement of worker productivity.

Implicit attentional bias for facial emotion in dissociative seizures: Additional evidence.

PubMed

Pick, Susannah; Mellers, John D C; Goldstein, Laura H

2018-03-01

This study sought to extend knowledge about the previously reported preconscious attentional bias (AB) for facial emotion in patients with dissociative seizures (DS) by exploring whether the finding could be replicated, while controlling for concurrent anxiety, depression, and potentially relevant cognitive impairments. Patients diagnosed with DS (n=38) were compared with healthy controls (n=43) on a pictorial emotional Stroop test, in which backwardly masked emotional faces (angry, happy, neutral) were processed implicitly. The group with DS displayed a significantly greater AB to facial emotion relative to controls; however, the bias was not specific to negative or positive emotions. The group effect could not be explained by performance on standardized cognitive tests or self-reported depression/anxiety. The study provides additional evidence of a disproportionate and automatic allocation of attention to facial affect in patients with DS, including both positive and negative facial expressions. Such a tendency could act as a predisposing factor for developing DS initially, or may contribute to triggering individuals' seizures on an ongoing basis. Psychological interventions such as Cognitive Behavioral Therapy (CBT) or AB modification might be suitable approaches to target this bias in clinical practice. Copyright © 2018 Elsevier Inc. All rights reserved.

Traditional Lower Blepharoplasty: Is Additional Support Necessary? A 30-Year Review.

PubMed

Maffi, Terry R; Chang, Shiliang; Friedland, Jack A

2011-07-01

Several refinements have been made in lower eyelid rejuvenation, and there is now strong belief that the traditional approach places too little emphasis on lower eyelid support. The purpose of this study was to retrospectively review the 30-year experience of the senior author (J.A.F.) performing primary lower blepharoplasty by the traditional approach and to determine the complication rate when lower lid-tightening procedures were not performed concomitantly. A retrospective chart review of all traditional blepharoplasties performed by the senior author over the past 30 years was performed. The traditional approach was performed through an external, subciliary incision. Concomitant lower lid-tightening procedures were not performed. The authors determined the complication rate of the procedure, such as symptomatic lower eyelid malposition and chemosis. A total of 3014 patients underwent traditional lower blepharoplasties and, after applying the exclusion criteria, 2007 patients were studied. A postoperative complication was defined as the development of either chemosis or symptomatic lower eyelid malposition. Chemosis developed in only 1.2 percent of the patients (24 of 2007). Eight of the 2007 patients (0.4 percent) developed symptomatic lower eyelid malposition. This study proves that when performed meticulously and precisely, traditional lower blepharoplasty is safe and effective. Correction of preoperatively diagnosed lower lid laxity is essential; however, when lower eyelid tone is adequate, the authors believe that the routine addition of a tightening procedure for support or the routine use of combined internal and external approaches is unnecessary. Therapeutic, IV.

Reciprocity of agonistic support in ravens.

PubMed

Fraser, Orlaith N; Bugnyar, Thomas

2012-01-01

Cooperative behaviour through reciprocation or interchange of valuable services in primates has received considerable attention, especially regarding the timeframe of reciprocation and its ensuing cognitive implications. Much less, however, is known about reciprocity in other animals, particularly birds. We investigated patterns of agonistic support (defined as a third party intervening in an ongoing conflict to attack one of the conflict participants, thus supporting the other) in a group of 13 captive ravens, Corvus corax. We found support for long-term, but not short-term, reciprocation of agonistic support. Ravens were more likely to support individuals who preened them, kin and dominant group members. These results suggest that ravens do not reciprocate on a calculated tit-for-tat basis, but aid individuals from whom reciprocated support would be most useful and those with whom they share a good relationship. Additionally, dyadic levels of agonistic support and consolation (postconflict affiliation from a bystander to the victim) correlated strongly with each other, but we found no evidence to suggest that receiving agonistic support influences the victim's likelihood of receiving support (consolation) after the conflict ends. Our findings are consistent with an emotionally mediated form of reciprocity in ravens and provide additional support for convergent cognitive evolution in birds and mammals.

Reciprocity of agonistic support in ravens

PubMed Central

Fraser, Orlaith N.; Bugnyar, Thomas

2012-01-01

Cooperative behaviour through reciprocation or interchange of valuable services in primates has received considerable attention, especially regarding the timeframe of reciprocation and its ensuing cognitive implications. Much less, however, is known about reciprocity in other animals, particularly birds. We investigated patterns of agonistic support (defined as a third party intervening in an ongoing conflict to attack one of the conflict participants, thus supporting the other) in a group of 13 captive ravens, Corvus corax. We found support for long-term, but not short-term, reciprocation of agonistic support. Ravens were more likely to support individuals who preened them, kin and dominant group members. These results suggest that ravens do not reciprocate on a calculated tit-for-tat basis, but aid individuals from whom reciprocated support would be most useful and those with whom they share a good relationship. Additionally, dyadic levels of agonistic support and consolation (postconflict affiliation from a bystander to the victim) correlated strongly with each other, but we found no evidence to suggest that receiving agonistic support influences the victim’s likelihood of receiving support (consolation) after the conflict ends. Our findings are consistent with an emotionally mediated form of reciprocity in ravens and provide additional support for convergent cognitive evolution in birds and mammals. PMID:22298910

A Qualitative Assessment of the Evidence Utilization for Health Policy-Making on the Basis of SUPPORT Tools in a Developing Country

PubMed Central

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

2017-01-01

Background: SUPPORT tools consist of 18 articles addressing the health policy-makers so that they can learn how to make evidence-informed health policies. These tools have been particularly recommended for developing countries. The present study tries to explain the process of evidence utilization for developing policy documents in the Iranian Ministry of Health and Medical Education (MoHME) and to compare the findings with those of SUPPORT tools. Methods: A qualitative research was conducted, using the framework analysis approach. Participants consisted of senior managers and technicians in MoHME. Purposeful sampling was done, with a maximum variety, for the selection of research participants: individuals having at least 5 years of experience in preparing evidence-based policy documents. Face-to-face interviews were conducted for data collection. As a guideline for the interviews, ‘the Utilization of Evidence in Policy-Making Organizations’ procedure was used. The data were analyzed through the analysis of the framework method using MAXQDA 10 software. Results: The participants acquired the research evidence in a topic-based form, and they were less likely to search on the basis of the evidence pyramid. To assess the quality of evidence, they did not use standard critical tools; to adapt the evidence and interventions with the local setting, they did not use the ideas and experiences of all stakeholders, and in preparing the evidence-based policy documents, they did not take into consideration the window of opportunity, did not refrain from using highly technical terms, did not write user-friendly summaries, and did not present alternative policy options. In order to develop health policies, however, they used the following innovations: attention to the financial burden of policy issues on the agenda, sensitivity analysis of the preferred policy option on the basis of technical, sociopolitical, and economic feasibility, advocacy from other scholars, using the

The Evidence Base for How We Learn: Supporting Students' Social, Emotional, and Academic Development. Consensus Statements of Evidence from the Council of Distinguished Scientists

ERIC Educational Resources Information Center

Jones, Stephanie M.; Kahn, Jennifer

2017-01-01

"The Evidence Base for How We Learn: Supporting Students' Social, Emotional, and Academic Development" articulates the scientific consensus regarding how people learn. The research brief presents a set of consensus statements--developed and unanimously signed onto by the Commission's Council of Distinguished Scientists--that affirm the…

Evidence and evidence gaps - an introduction.

PubMed

Dreier, Gabriele; Löhler, Jan

2016-01-01

, databases, information portals with processed evidence as well as specific journals and finally teaching are appropriate vehicles. One problem is the multitude of information so that knowledge gaps may affect the clinical routine despite actually existing evidence. Generally, it still takes several years until new knowledge is implemented in daily routine. Tasks: The German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (Deutsche Gesellschaft für Hals-, Nasen- und Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V., DGHNOKHC) and the Professional Association of Otolaryngologists (Deutscher Berufsverband der HNO-Ärzte e.V., BVHNO) have fundamental interest in supporting their members in generating, processing, and providing evidence as well as accompanying knowledge transfer. It encompasses the fields of diagnostics, therapy, and prognosis in the same way as prevention and applies to medicinal products as well as to medical devices or surgical procedures. The base for this is the regular assessment of evidence gaps, also in the area of established procedures, that has to be followed by a prioritization of research questions and the subsequent initiation of clinical research. In addition, large trials verifying therapies and diagnostics, for example in the context of daily conditions after approval, can only be conducted combining all resources in the ENT community. Method, results, and outlook: Together, the executive committees of the DGHNOKHC and the BVHNO founded the German Study Center of Oto-Rhino-Laryngology, Head and Neck Surgery (Deutsches Studienzentrum für Hals-, Nasen- und Ohren-Heilkunde, Kopf- und Hals-Chirurgie, DSZ-HNO). First projects have been initiated, among those a clinical trial on the therapy of sudden hearing loss supported by the BMBF and a survey on evidence gaps in oto-rhino-laryngology. It seems to be both reasonable and feasible to make available methodological expertise via such an infrastructure of a study center for physicians in

A web-based platform to support an evidence-based mental health intervention: lessons from the CBITS web site.

PubMed

Vona, Pamela; Wilmoth, Pete; Jaycox, Lisa H; McMillen, Janey S; Kataoka, Sheryl H; Wong, Marleen; DeRosier, Melissa E; Langley, Audra K; Kaufman, Joshua; Tang, Lingqi; Stein, Bradley D

2014-11-01

To explore the role of Web-based platforms in behavioral health, the study examined usage of a Web site for supporting training and implementation of an evidence-based intervention. Using data from an online registration survey and Google Analytics, the investigators examined user characteristics and Web site utilization. Site engagement was substantial across user groups. Visit duration differed by registrants' characteristics. Less experienced clinicians spent more time on the Web site. The training section accounted for most page views across user groups. Individuals previously trained in the Cognitive-Behavioral Intervention for Trauma in Schools intervention viewed more implementation assistance and online community pages than did other user groups. Web-based platforms have the potential to support training and implementation of evidence-based interventions for clinicians of varying levels of experience and may facilitate more rapid dissemination. Web-based platforms may be promising for trauma-related interventions, because training and implementation support should be readily available after a traumatic event.

Evidence of Convergent and Discriminant Validity of Child, Teacher, and Peer Reports of Teacher-Student Support

PubMed Central

Li, Yan; Hughes, Jan N.; Kwok, Oi-man; Hsu, Hsien-Yuan

2012-01-01

This study investigated the construct validity of measures of teacher-student support in a sample of 709 ethnically diverse second and third grade academically at-risk students. Confirmatory factor analysis investigated the convergent and discriminant validities of teacher, child, and peer reports of teacher-student support and child conduct problems. Results supported the convergent and discriminant validity of scores on the measures. Peer reports accounted for the largest proportion of trait variance and non-significant method variance. Child reports accounted for the smallest proportion of trait variance and the largest method variance. A model with two latent factors provided a better fit to the data than a model with one factor, providing further evidence of the discriminant validity of measures of teacher-student support. Implications for research, policy, and practice are discussed. PMID:21767024

Connecting Education to Quality: Engaging Medical Students in the Development of Evidence-Based Clinical Decision Support Tools.

PubMed

Crabtree, Elizabeth A; Brennan, Emily; Davis, Amanda; Squires, Jerry E

2017-01-01

Evidence-based practice (EBP) skills are crucial for delivering high-quality patient care. It is essential that medical students learn EBP concepts through a practical, in-depth research project. To date, literature on preparing students in this manner is limited. In academic year 2014-2015, the Medical University of South Carolina's (MUSC's) Center for Evidence-Based Practice (now known as the Value Institute) partnered with College of Medicine faculty to revitalize the undergraduate medical student EBP curriculum. Without adding to the number of the lecture hours, the curriculum was restructured to be more process driven, project based, and clinically relevant. The resulting yearlong EBP course partnered small teams of medical students with interprofessional clinical teams to engage the students in developing evidence-based clinical decision support tools. The content developed during the EBP projects is currently being used to develop evidence-based clinical practice guidelines and accompanying order sets. It is likely that this model will serve as a new framework for guideline development and will greatly expand the breadth of evidence-based content currently produced and available for clinicians at the MUSC. It would be feasible to offer a similar course within the MUSC to other disciplines and colleges, or at other institutions, if there were support from administration, interest on the part of clinicians and medical faculty, and individuals with the required expertise available to develop the curriculum and facilitate the course. It is worth considering how to improve the course and evaluating opportunities to implement it within other settings.

Effects of the addition of functional electrical stimulation to ground level gait training with body weight support after chronic stroke.

PubMed

Prado-Medeiros, Christiane L; Sousa, Catarina O; Souza, Andréa S; Soares, Márcio R; Barela, Ana M F; Salvini, Tania F

2011-01-01

The addition of functional electrical stimulation (FES) to treadmill gait training with partial body weight support (BWS) has been proposed as a strategy to facilitate gait training in people with hemiparesis. However, there is a lack of studies that evaluate the effectiveness of FES addition on ground level gait training with BWS, which is the most common locomotion surface. To investigate the additional effects of commum peroneal nerve FES combined with gait training and BWS on ground level, on spatial-temporal gait parameters, segmental angles, and motor function. Twelve people with chronic hemiparesis participated in the study. An A1-B-A2 design was applied. A1 and A2 corresponded to ground level gait training using BWS, and B corresponded to the same training with the addition of FES. The assessments were performed using the Modified Ashworth Scale (MAS), Functional Ambulation Category (FAC), Rivermead Motor Assessment (RMA), and filming. The kinematics analyzed variables were mean walking speed of locomotion; step length; stride length, speed and duration; initial and final double support duration; single-limb support duration; swing period; range of motion (ROM), maximum and minimum angles of foot, leg, thigh, and trunk segments. There were not changes between phases for the functional assessment of RMA, for the spatial-temporal gait variables and segmental angles, no changes were observed after the addition of FES. The use of FES on ground level gait training with BWS did not provide additional benefits for all assessed parameters.

Sustainability in Health care by Allocating Resources Effectively (SHARE) 7: supporting staff in evidence-based decision-making, implementation and evaluation in a local healthcare setting.

PubMed

Harris, Claire; Allen, Kelly; Waller, Cara; Dyer, Tim; Brooke, Vanessa; Garrubba, Marie; Melder, Angela; Voutier, Catherine; Gust, Anthony; Farjou, Dina

2017-06-21

This is the seventh in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was a systematic, integrated, evidence-based program for resource allocation within a large Australian health service. It aimed to facilitate proactive use of evidence from research and local data; evidence-based decision-making for resource allocation including disinvestment; and development, implementation and evaluation of disinvestment projects. From the literature and responses of local stakeholders it was clear that provision of expertise and education, training and support of health service staff would be required to achieve these aims. Four support services were proposed. This paper is a detailed case report of the development, implementation and evaluation of a Data Service, Capacity Building Service and Project Support Service. An Evidence Service is reported separately. Literature reviews, surveys, interviews, consultation and workshops were used to capture and process the relevant information. Existing theoretical frameworks were adapted for evaluation and explication of processes and outcomes. Surveys and interviews identified current practice in use of evidence in decision-making, implementation and evaluation; staff needs for evidence-based practice; nature, type and availability of local health service data; and preferred formats for education and training. The Capacity Building and Project Support Services were successful in achieving short term objectives; but long term outcomes were not evaluated due to reduced funding. The Data Service was not implemented at all. Factors influencing the processes and outcomes are discussed. Health service staff need access to education, training, expertise and support to enable evidence-based decision-making and to implement and evaluate the changes arising from those decisions. Three support services were proposed based on research

Physiotherapy for ankylosing spondylitis: evidence and application.

PubMed

Passalent, Laura A

2011-03-01

Ankylosing spondylitis (AS) is a disease that tends to affect younger individuals, many of whom are in the prime of their lives; therefore, incorporating the most up-to-date evidence into physiotherapy practice is critical. The purpose of this review is to update the most recent evidence related to physiotherapy intervention for AS and highlight the application of the findings to current physiotherapy research and clinical practice. The results of this review add to the evidence supporting physiotherapy as an intervention for AS. The emphasis continues to be on exercise as the most studied physiotherapy modality, with very few studies examining other physiotherapy modalities. Results of the studies reviewed support the use of exercise, spa therapy, manual therapy and electrotherapeutic modalities. In addition, the results of this review help to understand who might benefit from certain interventions, as well as barriers to management. A review of recently published articles has resulted in a number of studies that support the body of literature describing physiotherapy as an effective form of intervention for AS. In order to continue to build on the existing research, further examination into physiotherapy modalities, beyond exercise-based intervention, needs to be explored.

Evidence-Based Communication Practices for Children with Visual Impairments and Additional Disabilities: An Examination of Single-Subject Design Studies

ERIC Educational Resources Information Center

Parker, Amy T.; Grimmett, Eric S.; Summers, Sharon

2008-01-01

This review examines practices for building effective communication strategies for children with visual impairments, including those with additional disabilities, that have been tested by single-subject design methodology. The authors found 30 studies that met the search criteria and grouped intervention strategies to align any evidence of the…

Supporting Adolescent Orphan Girls to Stay in School as HIV Risk Prevention: Evidence From a Randomized Controlled Trial in Zimbabwe

PubMed Central

Cho, Hyunsan; Rusakaniko, Simbarashe; Iritani, Bonita; Mapfumo, John; Halpern, Carolyn

2011-01-01

Objectives. Using a randomized controlled trial in rural eastern Zimbabwe, we tested whether comprehensive support to keep orphan adolescent girls in school could reduce HIV risk. Methods. All orphan girls in grade 6 in 25 primary schools were invited to participate in the study in fall 2007 (n = 329). Primary schools were randomized to condition. All primary schools received a universal daily feeding program; intervention participants received fees, uniforms, and a school-based helper to monitor attendance and resolve problems. We conducted annual surveys and collected additional information on school dropout, marriage, and pregnancy rates. We analyzed data using generalized estimating equations over 3 time points, controlling for school and age at baseline. Results. The intervention reduced school dropout by 82% and marriage by 63% after 2 years. Compared with control participants, the intervention group reported greater school bonding, better future expectations, more equitable gender attitudes, and more concerns about the consequences of sex. Conclusions. We found promising evidence that comprehensive school support may reduce HIV risk for orphan girls. Further study, including assessment of dose response, cost benefit, and HIV and herpes simplex virus 2 biomarker measurement, is warranted. PMID:21493943

Antidotes and treatments for chemical warfare/terrorism agents: an evidence-based review.

PubMed

Rodgers, G C; Condurache, C T

2010-09-01

This article reviews the evidence supporting the efficacy of antidotes used or recommended for the potential chemical warfare agents of most concern. Chemical warfare agents considered include cyanide, vesicants, pulmonary irritants such as chlorine and phosgene, and nerve agents. The strength of evidence for most antidotes is weak, highlighting the need for additional research in this area.

Barriers, facilitators and views about next steps to implementing supports for evidence-informed decision-making in health systems: a qualitative study.

PubMed

Ellen, Moriah E; Léon, Grégory; Bouchard, Gisèle; Ouimet, Mathieu; Grimshaw, Jeremy M; Lavis, John N

2014-12-05

Mobilizing research evidence for daily decision-making is challenging for health system decision-makers. In a previous qualitative paper, we showed the current mix of supports that Canadian health-care organizations have in place and the ones that are perceived to be helpful to facilitate the use of research evidence in health system decision-making. Factors influencing the implementation of such supports remain poorly described in the literature. Identifying the barriers to and facilitators of different interventions is essential for implementation of effective, context-specific, supports for evidence-informed decision-making (EIDM) in health systems. The purpose of this study was to identify (a) barriers and facilitators to implementing supports for EIDM in Canadian health-care organizations, (b) views about emerging development of supports for EIDM, and (c) views about the priorities to bridge the gaps in the current mix of supports that these organizations have in place. This qualitative study was conducted in three types of health-care organizations (regional health authorities, hospitals, and primary care practices) in two Canadian provinces (Ontario and Quebec). Fifty-seven in-depth semi-structured telephone interviews were conducted with senior managers, library managers, and knowledge brokers from health-care organizations that have already undertaken strategic initiatives in knowledge translation. The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. Limited resources (i.e., money or staff), time constraints, and negative attitudes (or resistance) toward change were the most frequently identified barriers to implementing supports for EIDM. Genuine interest from health system decision-makers, notably their willingness to invest money and resources and to create a knowledge translation culture over time in health-care organizations, was the most frequently identified facilitator to

Getting to Uptake: Do Communities of Practice Support the Implementation of Evidence-Based Practice?

PubMed Central

Barwick, Melanie A.; Peters, Julia; Boydell, Katherine

2009-01-01

Introduction Practitioners are increasingly encouraged to adopt evidence-based practices (EBP) leading to a need for new knowledge translation strategies to support implementation and practice change. This study examined the benefits of a community of practice in the context of Ontario’s children’s mental health sector where organizations are mandated to adopt a standardized outcome measure to monitor client response to treatment. Method Readiness for change, practice change, content knowledge, and satisfaction with and use of implementation supports were examined among practitioners newly trained on the measure who were randomly assigned to a community of practice (CoP) or a practice as usual (PaU) group. CoP practitioners attended 6 sessions over 12 months; PaU practitioners had access to usual implementation supports. Results Groups did not differ on readiness for change or reported practice change, although CoP participants demonstrated greater use of the tool in practice, better content knowledge and were more satisfied with implementation supports than PaU participants. Conclusion CoPs present a promising model for translating EBP knowledge and promoting practice change in children’s mental health that requires further study. PMID:19270845

Continuous support for women during childbirth.

PubMed

Bohren, Meghan A; Hofmeyr, G Justus; Sakala, Carol; Fukuzawa, Rieko K; Cuthbert, Anna

2017-07-06

additional information from the trial authors. The quality of the evidence was assessed using the GRADE approach. We included a total of 27 trials, and 26 trials involving 15,858 women provided usable outcome data for analysis. These trials were conducted in 17 different countries: 13 trials were conducted in high-income settings; 13 trials in middle-income settings; and no studies in low-income settings. Women allocated to continuous support were more likely to have a spontaneous vaginal birth (average RR 1.08, 95% confidence interval (CI) 1.04 to 1.12; 21 trials, 14,369 women; low-quality evidence) and less likely to report negative ratings of or feelings about their childbirth experience (average RR 0.69, 95% CI 0.59 to 0.79; 11 trials, 11,133 women; low-quality evidence) and to use any intrapartum analgesia (average RR 0.90, 95% CI 0.84 to 0.96; 15 trials, 12,433 women). In addition, their labours were shorter (MD -0.69 hours, 95% CI -1.04 to -0.34; 13 trials, 5429 women; low-quality evidence), they were less likely to have a caesarean birth (average RR 0.75, 95% CI 0.64 to 0.88; 24 trials, 15,347 women; low-quality evidence) or instrumental vaginal birth (RR 0.90, 95% CI 0.85 to 0.96; 19 trials, 14,118 women), regional analgesia (average RR 0.93, 95% CI 0.88 to 0.99; 9 trials, 11,444 women), or a baby with a low five-minute Apgar score (RR 0.62, 95% CI 0.46 to 0.85; 14 trials, 12,615 women). Data from two trials for postpartum depression were not combined due to differences in women, hospitals and care providers included; both trials found fewer women developed depressive symptomatology if they had been supported in birth, although this may have been a chance result in one of the studies (low-quality evidence). There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, such as admission to special care nursery (average RR 0.97, 95% CI 0.76 to 1.25; 7 trials, 8897 women; low-quality evidence), and exclusive or any breastfeeding

Impact of Evidence Type and Judicial Warning on Juror Perceptions of Global and Specific Witness Evidence.

PubMed

Wheatcroft, Jacqueline M; Keogan, Hannah

2017-04-03

The Court of Appeal in England and Wales held (R. v. Sardar, 2012) there had been no exceptional circumstances that justified a jury retiring with a transcript of the complainant's interview. This paper reports an investigation into the impact multiple evidence forms and use of a judicial warning has on juror evaluations of a witness. The warning focuses juror attention on placing disproportionate weight on the evidence as opposed to their general impression of it. Sixty jury-eligible participants were presented with witness evidence in transcript, video, or transcript plus video format. Half the participants in each condition received the warning. All mock jurors completed a questionnaire which assessed perceptions of witness and task. Outcomes showed that transcript plus video evidence, when accompanied by a warning, did impact on mock jurors' global assessments of the witness. The warning made the task less clear for jurors and, in the video condition, led to higher ratings of how satisfactory and reliable the witness was. Findings support the provision of a judicial warning to jurors and show some initial support for judiciary opposition to the provision of an additional transcript only when jurors are asked to make the more usual global witness assessments.

Emerging Evidence on Neutrophil Motility Supporting Its Usefulness to Define Vitamin C Intake Requirements.

PubMed

Elste, Volker; Troesch, Barbara; Eggersdorfer, Manfred; Weber, Peter

2017-05-16

Establishing intake recommendations for vitamin C remains a challenge, as no suitable functional parameter has yet been agreed upon. In this report, we review the emerging evidence on neutrophil motility as a possible marker of vitamin C requirements and put the results in perspective with other approaches. A recent in vitro study showed that adequate levels of vitamin C were needed for this function to work optimally when measured as chemotaxis and chemokinesis. In a human study, neutrophil motility was optimal at intakes ≥250 mg/day. Interestingly, a Cochrane review showed a significant reduction in the duration of episodes of common cold with regular vitamin C intakes in a similar range. Additionally, it was shown that at a plasma level of 75 µmol/L, which is reached with vitamin C intakes ≥200 mg/day, incidences of cardiovascular disease were lowest. This evidence would suggest that daily intakes of 200 mg vitamin C might be advisable for the general adult population, which can be achieved by means of a diverse diet. However, additional studies are warranted to investigate the usefulness of neutrophil motility as a marker of vitamin C requirements.

How task characteristics and social support relate to managerial learning: empirical evidence from Dutch home care.

PubMed

Ouweneel, A P Else; Taris, Toon W; Van Zolingen, Simone J; Schreurs, Paul J G

2009-01-01

Researchers have revealed that managers profit most from informal and on-the-job learning. Moreover, research has shown that task characteristics and social support affect informal learning. On the basis of these insights, the authors examined the effects of task characteristics (psychological job demands, job control) and social support from the supervisor and colleagues on informal on-the-job learning among 1588 managers in the Dutch home-care sector. A regression analysis revealed that high demands, high control, and high colleague and supervisor support were each associated with high levels of informal learning. The authors found no evidence for statistical interactions among the effects of these concepts. They concluded that to promote managers' informal workplace learning, employers should especially increase job control.

20 CFR 10.332 - What additional medical information will OWCP require to support continuing payment of benefits?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false What additional medical information will OWCP require to support continuing payment of benefits? 10.332 Section 10.332 Employees' Benefits OFFICE OF... COMPENSATION UNDER THE FEDERAL EMPLOYEES' COMPENSATION ACT, AS AMENDED Medical and Related Benefits Medical...

Derivation and validation of the Personal Support Algorithm: an evidence-based framework to inform allocation of personal support services in home and community care.

PubMed

Sinn, Chi-Ling Joanna; Jones, Aaron; McMullan, Janet Legge; Ackerman, Nancy; Curtin-Telegdi, Nancy; Eckel, Leslie; Hirdes, John P

2017-11-25

Personal support services enable many individuals to stay in their homes, but there are no standard ways to classify need for functional support in home and community care settings. The goal of this project was to develop an evidence-based clinical tool to inform service planning while allowing for flexibility in care coordinator judgment in response to patient and family circumstances. The sample included 128,169 Ontario home care patients assessed in 2013 and 25,800 Ontario community support clients assessed between 2014 and 2016. Independent variables were drawn from the Resident Assessment Instrument-Home Care and interRAI Community Health Assessment that are standardised, comprehensive, and fully compatible clinical assessments. Clinical expertise and regression analyses identified candidate variables that were entered into decision tree models. The primary dependent variable was the weekly hours of personal support calculated based on the record of billed services. The Personal Support Algorithm classified need for personal support into six groups with a 32-fold difference in average billed hours of personal support services between the highest and lowest group. The algorithm explained 30.8% of the variability in billed personal support services. Care coordinators and managers reported that the guidelines based on the algorithm classification were consistent with their clinical judgment and current practice. The Personal Support Algorithm provides a structured yet flexible decision-support framework that may facilitate a more transparent and equitable approach to the allocation of personal support services.

Brief Report: An Independent Replication and Extension of Psychometric Evidence Supporting the Theory of Mind Inventory

ERIC Educational Resources Information Center

Greenslade, Kathryn J.; Coggins, Truman E.

2016-01-01

This study presents an independent replication and extension of psychometric evidence supporting the "Theory of Mind Inventory" ("ToMI"). Parents of 20 children with ASD (4; 1-6; 7 years; months) and 20 with typical development (3; 1-6; 5), rated their child's theory of mind abilities in everyday situations. Other parent report…

Further evidence supporting the concurrent influence of aflatoxin and manganese

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

Katzen, J.S.; Llewellyn, G.C.

Trace elements, including manganese may afford protection from deleterious effects of aflatoxin. Young male Fischer rats received ip injections of aflatoxin B1 (AFB1) in dimethyl sulfoxide (DMSO), 1 mg/kg, 2 mg/kg or 4 mg/kg. Control groups received DMSO ip or no injection. All animals were intubated with 3 microCi of (/sup 54/Mn)-MnCl/sub 2/ 12 hr post-injection. Sacrifice occurred 72 hr after gavage of the radiolabel. All tested levels of AFB1 affected the loss of total body radioactivity. This response was observed within 12 hr when toxin-treated groups excreted almost 4 times more counts than controls. From 12-36 hr following radiolabelmore » administration, AFB1 appeared to enhance excretion; by 72 hr, toxin-treated animals (especially those receiving higher doses) appeared to conserve the metal. Aflatoxicosis manifested itself through reduced body weight gain. The data provide support evidence that Mn and AFB1 biointeract.« less

Factors Influencing Staff Perceptions of Administrator Support for Tier 2 and 3 Interventions: A Multilevel Perspective

ERIC Educational Resources Information Center

Debnam, Katrina J.; Pas, Elise T.; Bradshaw, Catherine P.

2013-01-01

Although the number of schools implementing School-Wide Positive Behavioral Interventions and Supports (SWPBIS) is increasing, and there is great demand for evidence-based Tier 2 and 3 interventions for students requiring additional support, little systematic research has examined administrator support for such programming. This article examines…

Cancer based pharmacogenomics network supported with scientific evidences: from the view of drug repurposing.

PubMed

Wang, Liwei; Liu, Hongfang; Chute, Christopher G; Zhu, Qian

2015-01-01

Pharmacogenomics (PGx) as an emerging field, is poised to change the way we practice medicine and deliver health care by customizing drug therapies on the basis of each patient's genetic makeup. A large volume of PGx data including information among drugs, genes, and single nucleotide polymorphisms (SNPs) has been accumulated. Normalized and integrated PGx information could facilitate revelation of hidden relationships among drug treatments, genomic variations, and phenotype traits to better support drug discovery and next generation of treatment. In this study, we generated a normalized and scientific evidence supported cancer based PGx network (CPN) by integrating cancer related PGx information from multiple well-known PGx resources including the Pharmacogenomics Knowledge Base (PharmGKB), the FDA PGx Biomarkers in Drug Labeling, and the Catalog of Published Genome-Wide Association Studies (GWAS). We successfully demonstrated the capability of the CPN for drug repurposing by conducting two case studies. The CPN established in this study offers comprehensive cancer based PGx information to support cancer orientated research, especially for drug repurposing.

Methodological exemplar of integrating quantitative and qualitative evidence - supportive care for men with prostate cancer: what are the most important components?

PubMed

Huntley, Alyson L; King, Anna J L; Moore, Theresa H M; Paterson, Charlotte; Persad, Raj; Sharp, Debbie; Evans, Maggie

2017-01-01

To present a methodological exemplar of integrating findings from a quantitative and qualitative review on the same topic to provide insight into components of care that contribute to supportive care that is acceptable to men with prostate cancer. Men with prostate cancer are likely to live a long time with the disease, experience side effects from treatment and therefore have ongoing supportive care needs. Quantitative and qualitative reviews have been published but the findings have yet to be integrated. Integration of quantitative and qualitative synthesized evidence. Two previously published systematic reviews. Synthesized evidence on supportive care for men with prostate cancer was integrated from two previously published systematic reviews: a narrative quantitative review and a qualitative review with thematic synthesis. These two streams of synthesized evidence were synthesized using concurrent narrative summary. Data from both reviews were used to develop a set of propositions from which a summary of components of care that likely to contribute to supportive care acceptable to men with prostate cancer were identified. Nine propositions were developed which covered men's supportive care focusing on the role of health professionals. These propositions were used to compose nine components of care likely to lead to supportive care that is acceptable to men with prostate cancer. Some of these components are no/low cost such as developing a more empathic personalized approach, but more specific approaches need further investigation in randomized controlled trials, for example, online support. This methodological exemplar demonstrates the integration of quantitative and qualitative synthesized data to determine components of care likely to lead to provision of supportive care acceptable to men with prostate cancer. © 2016 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

Life support decision making in critical care: Identifying and appraising the qualitative research evidence.

PubMed

Giacomini, Mita; Cook, Deborah; DeJean, Deirdre

2009-04-01

The objective of this study is to identify and appraise qualitative research evidence on the experience of making life-support decisions in critical care. In six databases and supplementary sources, we sought original research published from January 1990 through June 2008 reporting qualitative empirical studies of the experience of life-support decision making in critical care settings. Fifty-three journal articles and monographs were included. Of these, 25 reported prospective studies and 28 reported retrospective studies. We abstracted methodologic characteristics relevant to the basic critical appraisal of qualitative research (prospective data collection, ethics approval, purposive sampling, iterative data collection and analysis, and any method to corroborate findings). Qualitative research traditions represented include grounded theory (n = 15, 28%), ethnography or naturalistic methods (n = 15, 28%), phenomenology (n = 9, 17%), and other or unspecified approaches (n = 14, 26%). All 53 documents describe the research setting; 97% indicate purposive sampling of participants. Studies vary in their capture of multidisciplinary clinician and family perspectives. Thirty-one (58%) report research ethics board review. Only 49% report iterative data collection and analysis, and eight documents (15%) describe an analytically driven stopping point for data collection. Thirty-two documents (60%) indicated a method for corroborating findings. Qualitative evidence often appears outside of clinical journals, with most research from the United States. Prospective, observation-based studies follow life-support decision making directly. These involve a variety of participants and yield important insights into interactions, communication, and dynamics. Retrospective, interview-based studies lack this direct engagement, but focus on the recollections of fewer types of participants (particularly patients and physicians), and typically address specific issues (communication and

Effects of School-Wide Positive Behavioral Interventions and Supports on Internalizing Problems: Current Evidence and Future Directions

ERIC Educational Resources Information Center

McIntosh, Kent; Ty, Sophie V.; Miller, Lynn D.

2014-01-01

School-Wide Positive Behavioral Interventions and Supports (SWPBIS) has a large evidence base for preventing and addressing externalizing problem behavior, but there is little research examining its effects on internalizing problems, such as anxiety and depression. Given the prevalence of internalizing problems in today's children and youth, it is…

A Qualitative Assessment of the Evidence Utilization for Health Policy-Making on the Basis of SUPPORT Tools in a Developing Country.

PubMed

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

2017-01-08

SUPPORT tools consist of 18 articles addressing the health policy-makers so that they can learn how to make evidence-informed health policies. These tools have been particularly recommended for developing countries. The present study tries to explain the process of evidence utilization for developing policy documents in the Iranian Ministry of Health and Medical Education (MoHME) and to compare the findings with those of SUPPORT tools. A qualitative research was conducted, using the framework analysis approach. Participants consisted of senior managers and technicians in MoHME. Purposeful sampling was done, with a maximum variety, for the selection of research participants: individuals having at least 5 years of experience in preparing evidence-based policy documents. Face-to-face interviews were conducted for data collection. As a guideline for the interviews, 'the Utilization of Evidence in Policy-Making Organizations' procedure was used. The data were analyzed through the analysis of the framework method using MAXQDA 10 software. The participants acquired the research evidence in a topic-based form, and they were less likely to search on the basis of the evidence pyramid. To assess the quality of evidence, they did not use standard critical tools; to adapt the evidence and interventions with the local setting, they did not use the ideas and experiences of all stakeholders, and in preparing the evidence-based policy documents, they did not take into consideration the window of opportunity, did not refrain from using highly technical terms, did not write user-friendly summaries, and did not present alternative policy options. In order to develop health policies, however, they used the following innovations: attention to the financial burden of policy issues on the agenda, sensitivity analysis of the preferred policy option on the basis of technical, sociopolitical, and economic feasibility, advocacy from other scholars, using the multi-criteria decision

First long-term evidence supporting endovascular repair of abdominal aortic aneurysms.

PubMed

Indes, Jeffrey E; Muhs, Bart E; Dardik, Alan

2013-04-01

The traditional method of treating abdominal aortic aneurysms with open surgical repair has been steadily replaced by endovascular repair, thought to be a more minimally invasive approach. It is not known, however, whether the endovascular approach is truly less invasive for operative physiology; in addition, this approach has a different spectrum of complications. As such, it is uncertain whether elective endovascular repair of nonruptured aortic aneurysms reduces long-term morbidity and mortality compared with traditional open approaches. In this article, the authors evaluate a recent publication investigating long-term outcomes of a prospective randomized multicenter trial evaluating patients with asymptomatic abdominal aortic aneurysms treated with either endovascular or open repair, and discuss the results in the context of current evidence.

Clinical Evidence Supporting US Food and Drug Administration Approval of Otolaryngologic Prescription Drug Indications, 2005-2014.

PubMed

Rathi, Vinay K; Wang, Bo; Ross, Joseph S; Downing, Nicholas S; Kesselheim, Aaron S; Gray, Stacey T

2017-04-01

Objective The US Food and Drug Administration (FDA) approves indications for prescription drugs based on premarket pivotal clinical studies designed to demonstrate safety and efficacy. We characterized the pivotal studies supporting FDA approval of otolaryngologic prescription drug indications. Study Design Retrospective cross-sectional analysis. Setting Publicly available FDA documents. Subjects Recently approved (2005-2014) prescription drug indications for conditions treated by otolaryngologists or their multidisciplinary teams. Drugs could be authorized for treatment of otolaryngologic disease upon initial approval (original indications) or thereafter via supplemental applications (supplemental indications). Methods Pivotal studies were categorized by enrollment, randomization, blinding, comparator type, and primary endpoint. Results Between 2005 and 2014, the FDA approved 48 otolaryngologic prescription drug indications based on 64 pivotal studies, including 21 original indications (19 drugs, 31 studies) and 27 supplemental indications (18 drugs, 33 studies). Median enrollment was 299 patients (interquartile range, 198-613) for original indications and 197 patients (interquartile range, 64-442) for supplemental indications. Most indications were supported by ≥1 randomized study (original: 20/21 [95%], supplemental: 21/27 [78%]) and ≥1 double-blinded study (original: 14/21 [67%], supplemental: 17/27 [63%]). About half of original indications (9/21 [43%]) and one-quarter of supplemental indications (7/27 [26%]) were supported by ≥1 active-controlled study. Nearly half (original: 8/21 [38%], supplemental: 14/27 [52%]) of all indications were approved based exclusively on studies using surrogate markers as primary endpoints. Conclusion The quality of clinical evidence supporting FDA approval of otolaryngologic prescription drug indications varied widely. Otolaryngologists should consider limitations in premarket evidence when helping patients make informed

Supporting the Implementation of Evidence-Based Practices for Adults with Co-Occurring Mental and Substance Use Disorders

ERIC Educational Resources Information Center

Biegel, David E.; Kola, Lenore A.; Ronis, Robert R.

2007-01-01

Significant barriers exist to the implementation of evidence-based practices into routine mental health and substance abuse settings. This paper discusses the role and function of technical assistance centers to help support the implementation process using, as a guide, the experience of the Ohio Substance Abuse and Mental Illness Coordinating…

Use of Evidence in the Implementation of Social Programs: A Qualitative Study from Chile.

PubMed

Flores, Rodrigo; Naranjo, Carola; Hein, Andreas

2016-01-01

Through this qualitative, empirical study the authors aim to explore and describe the sources of knowledge that are used to guide intervention practice by social workers in Chile. Particular attention was paid to factors that may facilitate or hinder the use of research-based evidence to guide social interventions design, implementation, and outcome evaluation. In order to explore these issues, 25 semi-structured interviews with social workers from Chilean social service non-profit organizations were conducted. The main findings suggest that social workers do not use research-based evidence to support their social interventions due to various personal organizational constraints (e.g., lack of time, lack of access to resources for disseminating evidence, lack of English command). In addition, no evaluation processes of social programs which will support evidence-based effectiveness could be found. One key barrier to support use of evidence and evidence production may be related to the fact that most non-governmental organizations maintain a hierarchical and vertical relationship with state agencies (program design, oversight, and funding) for social program development.

Evidence-based practice implementation: the impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice.

PubMed

Aarons, Gregory A; Sommerfeld, David H; Walrath-Greene, Christine M

2009-12-31

The goal of this study is to extend research on evidence-based practice (EBP) implementation by examining the impact of organizational type (public versus private) and organizational support for EBP on provider attitudes toward EBP and EBP use. Both organization theory and theory of innovation uptake and individual adoption of EBP guide the approach and analyses in this study. We anticipated that private sector organizations would provide greater levels of organizational support for EBPs leading to more positive provider attitudes towards EBPs and EBP use. We also expected attitudes toward EBPs to mediate the association of organizational support and EBP use. Participants were mental health service providers from 17 communities in 16 states in the United States (n = 170). Path analyses were conducted to compare three theoretical models of the impact of organization type on organizational support for EBP and of organizational support on provider attitudes toward EBP and EBP use. Consistent with our predictions, private agencies provided greater support for EBP implementation, and staff working for private agencies reported more positive attitudes toward adopting EBPs. Organizational support for EBP partially mediated the association of organization type on provider attitudes toward EBP. Organizational support was significantly positively associated with attitudes toward EBP and EBP use in practice. This study offers further support for the importance of organizational context as an influence on organizational support for EBP and provider attitudes toward adopting EBP. The study demonstrates the role organizational support in provider use of EBP in practice. This study also suggests that organizational support for innovation is a malleable factor in supporting use of EBP. Greater attention should be paid to organizational influences that can facilitate the dissemination and implementation of EBPs in community settings.

The work of the European Union Reference Laboratory for Food Additives (EURL) and its support for the authorisation process of feed additives in the European Union: a review

PubMed Central

von Holst, Christoph; Robouch, Piotr; Bellorini, Stefano; de la Huebra, María José González; Ezerskis, Zigmas

2016-01-01

ABSTRACT This paper describes the operation of the European Union Reference Laboratory for Feed Additives (EURL) and its role in the authorisation procedure of feed additives in the European Union. Feed additives are authorised according to Regulation (EC) No. 1831/2003, which introduced a completely revised authorisation procedure and also established the EURL. The regulations authorising feed additives contain conditions of use such as legal limits of the feed additives, which require the availability of a suitable method of analysis for official control purposes under real world conditions. It is the task of the EURL to evaluate the suitability of analytical methods as proposed by the industry for this purpose. Moreover, the paper shows that one of the major challenges is the huge variety of the methodology applied in feed additive analysis, thus requiring expertise in quite different analytical areas. In order to cope with this challenge, the EURL is supported by a network of national reference laboratories (NRLs) and only the merged knowledge of all NRLs allows for a scientifically sound assessment of the analytical methods. PMID:26540604

Biodegradation of diesel by mixed bacteria immobilized onto a hybrid support of peat moss and additives: a batch experiment.

PubMed

Lee, Young-Chul; Shin, Hyun-Jae; Ahn, Yeonghee; Shin, Min-Chul; Lee, Myungjin; Yang, Ji-Won

2010-11-15

We report microbial cell immobilization onto a hybrid support of peat moss for diesel biodegradation. Three strains isolated from a site contaminated with diesel oil were used in this study: Acinetobacter sp., Gordonia sp., and Rhodococcus sp. To increase not only diesel adsorption but also diesel biodegradation, additives such as zeolite, bentonite, chitosan, and alginate were tested. In this study, a peat moss, bentonite, and alginate (2/2.9/0.1 g, w/w/w) hybrid support (PBA) was the best support matrix, considering both diesel physical adsorption capacity and mixed microbial immobilization. Copyright © 2010 Elsevier B.V. All rights reserved.

Working group reports: evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project.

PubMed

Raiten, Daniel J; Steiber, Alison L; Carlson, Susan E; Griffin, Ian; Anderson, Diane; Hay, William W; Robins, Sandra; Neu, Josef; Georgieff, Michael K; Groh-Wargo, Sharon; Fenton, Tanis R

2016-02-01

The "Evaluation of the Evidence to Support Practice Guidelines for the Nutritional Care of Preterm Infants: The Pre-B Project" is the first phase in a process to present the current state of knowledge and to support the development of evidence-informed guidance for the nutritional care of preterm and high-risk newborn infants. The future systematic reviews that will ultimately provide the underpinning for guideline development will be conducted by the Academy of Nutrition and Dietetics' Evidence Analysis Library (EAL). To accomplish the objectives of this first phase, the Pre-B Project organizers established 4 working groups (WGs) to address the following themes: 1) nutrient specifications for preterm infants, 2) clinical and practical issues in enteral feeding of preterm infants, 3) gastrointestinal and surgical issues, and 4) current standards of infant feeding. Each WG was asked to 1) develop a series of topics relevant to their respective themes, 2) identify questions for which there is sufficient evidence to support a systematic review process conducted by the EAL, and 3) develop a research agenda to address priority gaps in our understanding of the role of nutrition in health and development of preterm/neonatal intensive care unit infants. This article is a summary of the reports from the 4 Pre-B WGs. © 2016 American Society for Nutrition.

Legalising medical use of cannabis in South Africa: Is the empirical evidence sufficient to support policy shifts in this direction?

PubMed

Parry, Charles D H; Myers, Bronwyn J

2014-03-12

Inkatha Freedom Party MP Mario Oriani-Ambrosini's impassioned plea to legalise the medical use of cannabis must be understood in the context of his own condition as well as legislative changes in at least ten countries. This article argues that any decisions to shift policy must be based on a consideration of the evidence on the risks and benefits associated with the medical use of cannabis for the individual and broader society. It concludes that there are important gaps in the evidence base, particularly in human trials supporting the efficacy of cannabis use for treating and preventing medical conditions and alleviating negative symptoms associated with these conditions. South African researchers should be enabled actively to support development of the necessary evidence base actively by conducting preclinical and clinical research in this area. Human trials to establish the efficacy of the use of cannabis/cannabinoids in addressing AIDS wasting syndrome and other negative sequelae of HIV and AIDS are especially needed.

A conservative method of testing whether combination analgesics produce additive or synergistic effects using evidence from acute pain and migraine.

PubMed

Moore, R A; Derry, C J; Derry, S; Straube, S; McQuay, H J

2012-04-01

Fixed-dose combination analgesics are used widely, and available both on prescription and over-the-counter. Combination drugs should provide more analgesia than with any single drug in the combination, but there is no evidence in humans about whether oral combinations have just additive effects, or are synergistic or even subadditive. We suggest that the measured result for the combination would be the summation of the absolute benefit increase (effect of active drug minus effect of placebo) of each component of a combination if effects were (merely) additive, and greater than the sum of the absolute benefits if they were synergistic. We tested measured effects of combination analgesics against the sum of the absolute benefits in acute pain and migraine using meta-analysis where individual components and combinations were tested against placebo in the same trials, and verified the result with meta-analyses where individual components and combinations were tested against placebo in different trials. Results showed that expected numbers needed to treat (NNT) for additive effects were generally within the 95% confidence interval of measured NNTs. This was true for combinations of paracetamol plus ibuprofen and paracetamol plus opioids in acute pain, and naproxen plus sumatriptan in migraine, but not where efficacy was very low or very high, nor combinations of paracetamol plus dextropropoxyphene. There was no evidence of synergy, defined as supra-additive effects. © 2011 European Federation of International Association for the Study of Pain Chapters.

Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE): protocol and preliminary results.

PubMed

Treweek, Shaun; Oxman, Andrew D; Alderson, Philip; Bossuyt, Patrick M; Brandt, Linn; Brożek, Jan; Davoli, Marina; Flottorp, Signe; Harbour, Robin; Hill, Suzanne; Liberati, Alessandro; Liira, Helena; Schünemann, Holger J; Rosenbaum, Sarah; Thornton, Judith; Vandvik, Per Olav; Alonso-Coello, Pablo

2013-01-09

Healthcare decision makers face challenges when using guidelines, including understanding the quality of the evidence or the values and preferences upon which recommendations are made, which are often not clear. GRADE is a systematic approach towards assessing the quality of evidence and the strength of recommendations in healthcare. GRADE also gives advice on how to go from evidence to decisions. It has been developed to address the weaknesses of other grading systems and is now widely used internationally. The Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE) consortium (http://www.decide-collaboration.eu/), which includes members of the GRADE Working Group and other partners, will explore methods to ensure effective communication of evidence-based recommendations targeted at key stakeholders: healthcare professionals, policymakers, and managers, as well as patients and the general public. Surveys and interviews with guideline producers and other stakeholders will explore how presentation of the evidence could be improved to better meet their information needs. We will collect further stakeholder input from advisory groups, via consultations and user testing; this will be done across a wide range of healthcare systems in Europe, North America, and other countries. Targeted communication strategies will be developed, evaluated in randomized trials, refined, and assessed during the development of real guidelines. Results of the DECIDE project will improve the communication of evidence-based healthcare recommendations. Building on the work of the GRADE Working Group, DECIDE will develop and evaluate methods that address communication needs of guideline users. The project will produce strategies for communicating recommendations that have been rigorously evaluated in diverse settings, and it will support the transfer of research into practice in healthcare systems globally.

Social support, volunteering and health around the world: cross-national evidence from 139 countries.

PubMed

Kumar, Santosh; Calvo, Rocio; Avendano, Mauricio; Sivaramakrishnan, Kavita; Berkman, Lisa F

2012-03-01

High levels of social capital and social integration are associated with self-rated health in many developed countries. However, it is not known whether this association extends to non-western and less economically advanced countries. We examine associations between social support, volunteering, and self-rated health in 139 low-, middle- and high-income countries. Data come from the Gallup World Poll, an internationally comparable survey conducted yearly from 2005 to 2009 for those 15 and over. Volunteering was measured by self-reports of volunteering to an organization in the past month. Social support was based on self-reports of access to support from relatives and friends. We started by estimating random coefficient (multi-level) models and then used multivariate logistic regression to model health as a function of social support and volunteering, controlling for age, gender, education, marital status, and religiosity. We found statistically significant evidence of cross-national variation in the association between social capital variables and self-rated health. In the multivariate logistic model, self-rated health were significantly associated with having social support from friends and relatives and volunteering. Results from stratified analyses indicate that these associations are strikingly consistent across countries. Our results indicate that the link between social capital and health is not restricted to high-income countries but extends across many geographical regions regardless of their national-income level. Copyright © 2012 Elsevier Ltd. All rights reserved.

A pathway-based analysis provides additional support for an immune-related genetic susceptibility to Parkinson's disease

PubMed Central

Holmans, Peter; Moskvina, Valentina; Jones, Lesley; Sharma, Manu; Vedernikov, Alexey; Buchel, Finja; Sadd, Mohamad; Bras, Jose M.; Bettella, Francesco; Nicolaou, Nayia; Simón-Sánchez, Javier; Mittag, Florian; Gibbs, J. Raphael; Schulte, Claudia; Durr, Alexandra; Guerreiro, Rita; Hernandez, Dena; Brice, Alexis; Stefánsson, Hreinn; Majamaa, Kari; Gasser, Thomas; Heutink, Peter; Wood, Nicholas W.; Martinez, Maria; Singleton, Andrew B.; Nalls, Michael A.; Hardy, John; Morris, Huw R.; Williams, Nigel M.; Arepalli, Sampath; Barker, Roger; Barrett, Jeffrey; Ben-Shlomo, Yoav; Berendse, Henk W.; Berg, Daniela; Bhatia, Kailash; de Bie, Rob M.A.; Biffi, Alessandro; Bloem, Bas; Brice, Alexis; Bochdanovits, Zoltan; Bonin, Michael; Bras, Jose M.; Brockmann, Kathrin; Brooks, Janet; Burn, David J.; Charlesworth, Gavin; Chen, Honglei; Chinnery, Patrick F.; Chong, Sean; Clarke, Carl E.; Cookson, Mark R.; Cooper, Jonathan M.; Corvol, Jen-Christophe; Counsell, Carl; Damier, Philippe; Dartigues, Jean Francois; Deloukas, Panagiotis; Deuschl, Günther; Dexter, David T.; van Dijk, Karin D.; Dillman, Allissa; Durif, Frank; Durr, Alexandra; Edkins, Sarah; Evans, Jonathan R.; Foltynie, Thomas; Gao, Jianjun; Gardner, Michelle; Gasser, Thomas; Gibbs, J. Raphael; Goate, Alison; Gray, Emma; Guerreiro, Rita; Gústafsson, Ómar; Hardy, John; Harris, Clare; Hernandez, Dena G.; Heutink, Peter; van Hilten, Jacobus J.; Hofman, Albert; Hollenbeck, Albert; Holmans, Peter; Holton, Janice; Hu, Michele; Huber, Heiko; Hudson, Gavin; Hunt, Sarah E.; Huttenlocher, Johanna; Illig, Thomas; Langford, Cordelia; Lees, Andrew; Lesage, Suzanne; Lichtner, Peter; Limousin, Patricia; Lopez, Grisel; Lorenz, Delia; Martinez, Maria; McNeill, Alisdair; Moorby, Catriona; Moore, Matthew; Morris, Huw; Morrison, Karen E.; Moskvina, Valentina; Mudanohwo, Ese; Nalls, Michael A.; Pearson, Justin; Perlmutter, Joel S.; Pétursson, Hjörvar; Plagnol, Vincent; Pollak, Pierre; Post, Bart; Potter, Simon; Ravina, Bernard; Revesz, Tamas; Riess, Olaf; Rivadeneira, Fernando; Rizzu, Patrizia; Ryten, Mina; Saad, Mohamad; Sawcer, Stephen; Schapira, Anthony; Scheffer, Hans; Sharma, Manu; Shaw, Karen; Sheerin, Una-Marie; Shoulson, Ira; Schulte, Claudia; Sidransky, Ellen; Simón-Sánchez, Javier; Singleton, Andrew B.; Smith, Colin; Stefánsson, Hreinn; Stefánsson, Kári; Steinberg, Stacy; Stockton, Joanna D.; Sveinbjornsdottir, Sigurlaug; Talbot, Kevin; Tanner, Carlie M.; Tashakkori-Ghanbaria, Avazeh; Tison, François; Trabzuni, Daniah; Traynor, Bryan J.; Uitterlinden, André G.; Velseboer, Daan; Vidailhet, Marie; Walker, Robert; van de Warrenburg, Bart; Wickremaratchi, Mirdhu; Williams, Nigel; Williams-Gray, Caroline H.; Winder-Rhodes, Sophie; Wood, Nicholas

2013-01-01

Parkinson's disease (PD) is the second most common neurodegenerative disease affecting 1–2% in people >60 and 3–4% in people >80. Genome-wide association (GWA) studies have now implicated significant evidence for association in at least 18 genomic regions. We have studied a large PD-meta analysis and identified a significant excess of SNPs (P < 1 × 10−16) that are associated with PD but fall short of the genome-wide significance threshold. This result was independent of variants at the 18 previously implicated regions and implies the presence of additional polygenic risk alleles. To understand how these loci increase risk of PD, we applied a pathway-based analysis, testing for biological functions that were significantly enriched for genes containing variants associated with PD. Analysing two independent GWA studies, we identified that both had a significant excess in the number of functional categories enriched for PD-associated genes (minimum P = 0.014 and P = 0.006, respectively). Moreover, 58 categories were significantly enriched for associated genes in both GWA studies (P < 0.001), implicating genes involved in the ‘regulation of leucocyte/lymphocyte activity’ and also ‘cytokine-mediated signalling’ as conferring an increased susceptibility to PD. These results were unaltered by the exclusion of all 178 genes that were present at the 18 genomic regions previously reported to be strongly associated with PD (including the HLA locus). Our findings, therefore, provide independent support to the strong association signal at the HLA locus and imply that the immune-related genetic susceptibility to PD is likely to be more widespread in the genome than previously appreciated. PMID:23223016

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...

The evidence for clinically significant bias in plasma glucose between liquid and lyophilized citrate buffer additive.

PubMed

Juricic, Gordana; Saracevic, Andrea; Kopcinovic, Lara Milevoj; Bakliza, Ana; Simundic, Ana-Maria

2016-12-01

Citrate buffer additive has been suggested to be of supreme performance in inhibiting glycolysis. However, there is little evidence in the literature regarding the comparability of glucose concentrations in liquid and lyophilized citrate buffer containing tubes. The aim of this study was to compare glucose concentrations in tubes containing liquid (Glucomedics) and lyophilized citrate buffer (Terumo VENOSAFE™ Glycemia) additive, measured immediately after centrifugation. Blood was collected from forty volunteers into both Glucomedics and Venosafe Glycemia tubes. Blood was centrifuged within 15min from venipuncture and glucose concentration was measured immediately after centrifugation, on the Abbott Architect analyzer. Differences between glucose concentrations in Glucomedics and Terumo tubes were tested using the paired t-test. Mean bias was calculated and compared to recommended quality specification for glucose (i.e. 2.2%). Glucose concentration in Terumo tubes was 3.4% lower than in Glucomedics tubes (P<0.001). The mean bias was clinically significant. There is a clinically significant difference between glucose concentrations in liquid and lyophilized citrate buffer additive tubes (Glucomedics vs. Terumo tubes) measured immediately after centrifugation. This difference may affect the patient outcome due to the misclassification of diabetes. Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Efficacy of an evidence-based clinical decision support in primary care practices: a randomized clinical trial.

PubMed

McGinn, Thomas G; McCullagh, Lauren; Kannry, Joseph; Knaus, Megan; Sofianou, Anastasia; Wisnivesky, Juan P; Mann, Devin M

2013-09-23

There is consensus that incorporating clinical decision support into electronic health records will improve quality of care, contain costs, and reduce overtreatment, but this potential has yet to be demonstrated in clinical trials. To assess the influence of a customized evidence-based clinical decision support tool on the management of respiratory tract infections and on the effectiveness of integrating evidence at the point of care. In a randomized clinical trial, we implemented 2 well-validated integrated clinical prediction rules, namely, the Walsh rule for streptococcal pharyngitis and the Heckerling rule for pneumonia. INTERVENTIONS AND MAIN OUTCOMES AND MEASURES: The intervention group had access to the integrated clinical prediction rule tool and chose whether to complete risk score calculators, order medications, and generate progress notes to assist with complex decision making at the point of care. The intervention group completed the integrated clinical prediction rule tool in 57.5% of visits. Providers in the intervention group were significantly less likely to order antibiotics than the control group (age-adjusted relative risk, 0.74; 95% CI, 0.60-0.92). The absolute risk of the intervention was 9.2%, and the number needed to treat was 10.8. The intervention group was significantly less likely to order rapid streptococcal tests compared with the control group (relative risk, 0.75; 95% CI, 0.58-0.97; P= .03). The integrated clinical prediction rule process for integrating complex evidence-based clinical decision report tools is of relevant importance for national initiatives, such as Meaningful Use. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01386047.

Evidence for the use of dry needling and physiotherapy in the management of cervicogenic or tension-type headache: a systematic review.

PubMed

France, Stacey; Bown, Jenna; Nowosilskyj, Matthew; Mott, Megan; Rand, Stephanie; Walters, Julie

2014-10-01

There is good evidence in the literature supporting physiotherapy in the management of some forms of headache. Dry needling of myofascial trigger points is becoming an increasingly common approach despite a paucity of research evidence supporting its use. The purpose of this review was to determine the evidence supporting the use of dry needling in addition to conventional physiotherapy in the management of tension-type and cervicogenic headache. Ten databases were searched for evidence of the effect of dry needling on the severity and frequency of tension and cervicogenic headache based ICHD classifications. Three relevant studies were identified and all three showed statistically significant improvements following dry needling, but no significant differences between groups. Only one study reported on headache frequency or intensity, reporting a 45 mm improvement in VAS score following the addition of dry needling to conventional physiotherapy. Two studies showed significant improvements with dry needling over 4-5 weeks of treatment. No adverse events were reported. The literature suggests that while there is insufficient evidence to strongly advocate for the use of dry needling, it may be a useful addition to conventional physiotherapy in headache management. Further research with a stronger methodological design is required. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

49 CFR 40.303 - What happens if the SAP believes the employee needs additional treatment, aftercare, or support...

Code of Federal Regulations, 2010 CFR

2010-10-01

... recommended services. You may also make use of SAP and employee assistance program (EAP) services in assisting... 49 Transportation 1 2010-10-01 2010-10-01 false What happens if the SAP believes the employee needs additional treatment, aftercare, or support group services even after the employee returns to...

Identification of a common language describing paediatric physiotherapy practice for children with additional support needs, to support communication with those outside the physiotherapy profession.

PubMed

Hunter, Cathleen; Maciver, Donald; Howden, Stella; Forsyth, Kirsty; Adamson, Amanda; Bremner, Lynne

2013-03-01

Children with additional support needs (ASNs) often require physiotherapy intervention to help maximise their participation within the primary school setting. The aim of this research was to investigate paediatric physiotherapy practice in supporting primary school aged children with ASNs, in order to identify a language to describe this, which could be used to support communication with teachers, parents and others outside the profession. Using a qualitative research multiple methods design, 2 focus groups and 5 structured interviews were held to investigate physiotherapy practice for this group. Senior paediatric physiotherapists (n=13) from a range of specialities, with experience of supporting primary school aged children with ASNs. Focus groups and interviews were digitally recorded, transcribed verbatim and analysed to establish links and patterns: followed by a cyclical process of respondent validation, and expert review. Eight targets for physiotherapy intervention and twelve technique headings were synthesised from the data. The language used for labelling and description of these was aimed to be easily understood by colleagues outside the profession. The findings clearly identified the role of the paediatric physiotherapist as being to support primary school aged children with ASNs to acquire aspects of postural control, mobility and cardio-respiratory function. By grouping the data into eight areas of challenge as the focus of intervention, and twelve commonly used techniques, the researchers generated a language which can be used by paediatric physiotherapists to support communication with teachers, parents and others outside the profession, when describing their intent and interactions regarding these children. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Additivity of abrupt onset effects supports nonspatial distraction, not the capture of spatial attention.

PubMed

Folk, Charles L; Remington, Roger W; Wu, Shu-Chieh

2009-02-01

In a recent article, Schreij, Owens, and Theeuwes (2008) reported that abruptly onsetting distractors produce costs in performance even when spatial-cuing effects confirm the presence of a top-down set for color. The authors argued that these results show that abruptly onsetting new objects capture attention independent of a top-down set and, thus, provide conclusive evidence against the theory that attentional capture is contingent on top-down attentional control settings (Folk, Remington, & Johnston, 1992). In the following article, we argue that, contrary to the conclusion drawn by Schreij et al., their own data (1) disconfirm the claim that their abrupt onsets captured spatial attention and (2) are consistent with nonspatial interference accounts of singleton-distractor effects. In support of the nonspatial account, we show that in a paradigm similar to Schreij et al.'s, distractors that do not capture attention can nonetheless influence responses to a target. We conclude that the results of Schreij et al. do not represent a challenge to contingent capture theory.

Toward an evidence-based system for innovation support for implementing innovations with quality: tools, training, technical assistance, and quality assurance/quality improvement.

PubMed

Wandersman, Abraham; Chien, Victoria H; Katz, Jason

2012-12-01

An individual or organization that sets out to implement an innovation (e.g., a new technology, program, or policy) generally requires support. In the Interactive Systems Framework for Dissemination and Implementation, a Support System should work with Delivery Systems (national, state and/or local entities such as health and human service organizations, community-based organizations, schools) to enhance their capacity for quality implementation of innovations. The literature on the Support System [corrected] has been underresearched and under-developedThis article begins to conceptualize theory, research, and action for an evidence-based system for innovation support (EBSIS). EBSIS describes key priorities for strengthening the science and practice of support. The major goal of EBSIS is to enhance the research and practice of support in order to build capacity in the Delivery System for implementing innovations with quality, and thereby, help the Delivery System achieve outcomes. EBSIS is guided by a logic model that includes four key support components: tools, training, technical assistance, and quality assurance/quality improvement. EBSIS uses the Getting To Outcomes approach to accountability to aid the identification and synthesis of concepts, tools, and evidence for support. We conclude with some discussion of the current status of EBSIS and possible next steps, including the development of collaborative researcher-practitioner-funder-consumer partnerships to accelerate accumulation of knowledge on the Support System.

Pet ownership and cardiovascular risk reduction: supporting evidence, conflicting data and underlying mechanisms.

PubMed

Arhant-Sudhir, Kanish; Arhant-Sudhir, Rish; Sudhir, Krishnankutty

2011-11-01

1. It is widely believed that pet ownership is beneficial to humans and that some of this benefit is through favourable effects on cardiovascular risk. In the present review, we critically examine the evidence in support of this hypothesis and present the available data with respect to major cardiovascular risk factors. 2. There is evidence that dog owners are less sedentary and have lower blood pressure, plasma cholesterol and triglycerides, attenuated responses to laboratory-induced mental stress and improved survival following myocardial infarction compared with non-pet owners. However, conflicting data exist with regard to the association between pet ownership and each of these risk factors. 3. Numerous non-cardiovascular effects of pet ownership have been reported, largely in the psychosocial domain, but the relationship is complex and can vary with demographic and social factors. 4. A unifying hypothesis is presented, linking improved mood and emotional state to decreased central and regional autonomic activity, improved endothelial function and, thus, lower blood pressure and reduced cardiac arrhythmias. 5. Overall, ownership of domestic pets, particularly dogs, is associated with positive health benefits. © 2011 The Authors. Clinical and Experimental Pharmacology and Physiology © 2011 Blackwell Publishing Asia Pty Ltd.

Evaluation of Organizational Readiness in Clinical Settings for Social Supporting Evidence-Based Information Seeking Behavior after Introducing IT in a Developing Country.

PubMed

Kahouei, Mehdi; Alaei, Safollah; Panahi, Sohaila Sadat Ghazavi Shariat; Zadeh, Jamileh Mahdi

2015-01-01

The health sector of Iran has endeavored to encourage physicians and medical students to use research findings in their practice. Remarkable changes have occurred, including: holding computer skills courses, digital library workshops for physicians and students, and establishing websites in hospitals. The findings showed that a small number of the participants completely agreed that they were supported by supervisors and colleagues to use evidence-based information resources in their clinical decisions. Health care organizations in Iran need other organizational facilitators such as social influences, organizational support, leadership, strong organizational culture, and climate in order to implement evidence-based practice.

Sign-Supported English: Is It Effective at Teaching Vocabulary to Young Children with English as an Additional Language?

ERIC Educational Resources Information Center

Marshall, Chloë R.; Hobsbaum, Angela

2015-01-01

Background: Children who are learning English as an Additional Language (EAL) may start school with smaller vocabularies than their monolingual peers. Given the links between vocabulary and academic achievement, it is important to evaluate interventions that are designed to support vocabulary learning in this group of children. Aims: To evaluate…

Does evidence support the use of cat allergen immunotherapy?

PubMed

Dhami, Sangeeta; Agarwal, Arnav

2018-06-04

Cat allergy can manifest as allergic rhinitis, conjunctivitis and/or asthma. With widespread cat ownership and exposure, cat allergy has emerged as a major cause of morbidity. Cat allergen immunotherapy is a potential disease modifying treatment for patients with cat allergy. We examine evidence on the effectiveness, cost-effectiveness and safety of cat allergen immunotherapy and consider the clinical contexts in which it should be prescribed. The European Association of Allergy and Clinical Immunology systematic reviews on allergic rhinitis and asthma along with the accompanying guidelines on allergic rhinitis were used as primary sources of evidence. Subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are most common routes of administration for allergen immunotherapy (AIT). A limited number of high-quality studies related to cat dander have shown mixed results in improvements in ocular and nasal symptoms, asthma symptoms, peak expiratory flow rate and medication use scores with subcutaneous immunotherapy. Two studies examining cat dander and cat-related allergy response with sublingual immunotherapy have shown mixed results in terms of symptomatic response. One randomized trial examining intralymphatic immunotherapy has shown a positive symptom response and a favourable safety profile. Although studies have reported mixed results regarding safety of SCIT, adverse events have been reported more commonly with SCIT than SLIT. There is a limited body of high-quality evidence on the effectiveness and safety of cat AIT and no high-quality data on its cost-effectiveness. The available evidence on effectiveness is mixed based on studying a limited array of immunological, physiological and patient-reported outcome measures. Based on this evidence and extrapolating on the wider evidence base in AIT, it is likely that some patients may benefit from this modality of treatment, particularly those with moderate-to-severe disease who are inadequately

An Additional Baurusuchid from the Cretaceous of Brazil with Evidence of Interspecific Predation among Crocodyliformes

PubMed Central

Godoy, Pedro L.; Montefeltro, Felipe C.; Norell, Mark A.; Langer, Max C.

2014-01-01

A new Baurusuchidae (Crocodyliformes, Mesoeucrocodylia), Aplestosuchus sordidus, is described based on a nearly complete skeleton collected in deposits of the Adamantina Formation (Bauru Group, Late Cretaceous) of Brazil. The nesting of the new taxon within Baurusuchidae can be ensured based on several exclusive skull features of this clade, such as the quadrate depression, medial approximation of the prefrontals, rostral extension of palatines (not reaching the level of the rostral margin of suborbital fenestrae), cylindrical dorsal portion of palatine bar, ridge on the ectopterygoid-jugal articulation, and supraoccipital with restricted thin transversal exposure in the caudalmost part of the skull roof. A newly proposed phylogeny of Baurusuchidae encompasses A. sordidus and recently described forms, suggesting its sixter-taxon relationship to Baurusuchus albertoi, within Baurusuchinae. Additionally, the remains of a sphagesaurid crocodyliform were preserved in the abdominal cavity of the new baurusuchid. Direct fossil evidence of behavioral interaction among fossil crocodyliforms is rare and mostly restricted to bite marks resulting from predation, as well as possible conspecific male-to-male aggression. This is the first time that a direct and unmistaken evidence of predation between different taxa of this group is recorded as fossils. This discovery confirms that baurusuchids were top predators of their time, with sphagesaurids occupying a lower trophic position, possibly with a more generalist diet. PMID:24809508

Morphological and molecular evidence supporting an arbutoid mycorrhizal relationship in the Costa Rican páramo.

PubMed

Osmundson, Todd W; Halling, Roy E; den Bakker, Henk C

2007-05-01

This study examines evidence for a particular arbutoid mycorrhizal interaction in páramo, a high-altitude neotropical ecosystem important in hydrological regulation but poorly known in terms of its fungal communities. Comarostaphylis arbutoides Lindley (Ericaceae) often forms dense thickets in Central American páramo habitats. Based on phylogenetic classification, it has been suggested that C. arbutoides forms arbutoid mycorrhizae with diverse Basidiomycetes and Ascomycetes; however, this assumption has not previously been confirmed. Based on field data, we hypothesized an arbutoid mycorrhizal association between C. arbutoides and the recently described bolete Leccinum monticola Halling & G.M. Mueller; in this study, we applied a rigorous approach using anatomical and molecular data to examine evidence for such an association. We examined root samples collected beneath L. monticola basidiomes for mycorrhizal structures, and we also compared rDNA internal transcribed spacer (ITS) sequences between mycorrhizal root tips and leaf or basidiome material of the suspected symbionts. Root cross sections showed a thin hyphal sheath and intracellular hyphal coils typical of arbutoid mycorrhizae. DNA sequence comparisons confirmed the identity of C. arbutoides and L. monticola as the mycorrhizal symbionts. In addition, this paper provides additional evidence for the widespread presence of minisatellite-like inserts in the ITS1 spacer in Leccinum species (including a characterization of the insert in L. monticola) and reports the use of an angiosperm-specific ITS primer pair useful for amplifying plant DNA from mycorrhizal roots without co-amplifying fungal DNA.

20 CFR 418.1250 - What evidence will you need to support your request that we use a more recent tax year?

Code of Federal Regulations, 2010 CFR

2010-04-01

... request that we use a more recent tax year? 418.1250 Section 418.1250 Employees' Benefits SOCIAL SECURITY... determine your income-related monthly adjustment amount, we will ask for evidence of the major life-changing..., additional evidence documenting the major life-changing event(s) will not be needed. ...

20 CFR 418.1250 - What evidence will you need to support your request that we use a more recent tax year?

Code of Federal Regulations, 2011 CFR

2011-04-01

... request that we use a more recent tax year? 418.1250 Section 418.1250 Employees' Benefits SOCIAL SECURITY... determine your income-related monthly adjustment amount, we will ask for evidence of the major life-changing..., additional evidence documenting the major life-changing event(s) will not be needed. ...

Comparison of consumer derived evidence with an omaha system evidence-based practice guideline for community dwelling older adults.

PubMed

Pruinelli, Lisiane; Fu, Helen; Monsen, Karen A; Westra, Bonnie L

2014-01-01

Consumer involvement in healthcare is critical to support continuity of care for consumers to manage their health while transitioning from one care setting to another. Validation of evidence-based practice (EBP) guideline by consumers is essential to achieving consumer health goals over time that is consistent with their needs and preferences. The purpose of this study was to compare an Omaha System EBP guideline for community dwelling older adults with consumer-derived evidence of their ongoing needs, resources, and strategies after home care discharge. All identified problems were relevant for all patients except for Neglect and Substance use. Ten additional problems were identified from the interviews, five of which affected at least 10% of the participants. Consumer derived evidence both validated and expanded EBP guidelines; thus further emphasizing the importance of consumer involvement in the delivery of home healthcare.

8 CFR 213a.2 - Use of affidavit of support.

Code of Federal Regulations, 2014 CFR

2014-01-01

... the form designated by USCIS for this purpose. (ii) An affidavit of support is executed when a sponsor... days to submit the additional evidence. An immigration judge may direct the intending immigrant to... sponsor shall be deemed to have established a domicile in the United States for purposes of this paragraph...

8 CFR 213a.2 - Use of affidavit of support.

Code of Federal Regulations, 2012 CFR

2012-01-01

... the form designated by USCIS for this purpose. (ii) An affidavit of support is executed when a sponsor... days to submit the additional evidence. An immigration judge may direct the intending immigrant to... sponsor shall be deemed to have established a domicile in the United States for purposes of this paragraph...

8 CFR 213a.2 - Use of affidavit of support.

Code of Federal Regulations, 2013 CFR

2013-01-01

... the form designated by USCIS for this purpose. (ii) An affidavit of support is executed when a sponsor... days to submit the additional evidence. An immigration judge may direct the intending immigrant to... sponsor shall be deemed to have established a domicile in the United States for purposes of this paragraph...

Relationship between blood and urine alcohol concentrations in apprehended drivers who claimed consumption of alcohol after driving with and without supporting evidence.

PubMed

Jones, Alan Wayne; Kugelberg, Fredrik C

2010-01-30

For various reasons, many people suspected of driving under the influence of alcohol (DUIA) are not apprehended sitting behind the wheel, but some time after the driving. This gives them the opportunity to claim they drank alcohol after the time of driving or after they were involved in a road-traffic crash. Alleged post-offence drinking is not easy for the prosecution to disprove, which often means that the DUIA charge is dropped or the person is acquitted if the case goes to trial. The routine practice of sampling and measuring the concentration of alcohol in blood (BAC) and urine (UAC) and calculating urine/blood ratios (UAC/BAC) and the changes in UAC between two successive voids furnishes useful information to support or challenge alleged drinking after driving. We present here a retrospective case series of DUIA offenders (N=40) in half of which there was supporting evidence of an after-drink (eye witness or police reports) and in the other half no such evidence existed apart from the suspect's admission. When there was supporting evidence of an after-drink, the UAC/BAC ratio for the first void was close to or less than unity (mean 1.04, median 1.08, range 0.54-1.21) and the UAC increased by 0.21 g/L (range 0.02-0.57) between the two voids. Without any supporting evidence of post-offence drinking the mean UAC/BAC ratio was 1.46 (range 1.35-1.93) for the first void, verifying that absorption and distribution of alcohol in all body fluids and tissues was complete. In these cases, the UAC between successive voids decreased by 0.25 g/L on average (range 0.10-0.49), indicating the post-absorptive phase of the BAC curve. Long experience from investigating claims of post-offence drinking leads us to conclude that in the vast majority of cases this lacks any substance and is simply a last resort by DUIA offenders to evade justice. Unless supporting evidence exists (eye witness, police reports, etc.) of post-offence drinking the courts are encouraged to ignore this

An online community of practice to support evidence-based physiotherapy practice in manual therapy.

PubMed

Evans, Cathy; Yeung, Euson; Markoulakis, Roula; Guilcher, Sara

2014-01-01

The purpose of this study was to explore how a community of practice promoted the creation and sharing of new knowledge in evidence-based manual therapy using Wenger's constructs of mutual engagement, joint enterprise, and shared repertoire as a theoretical framework. We used a qualitative approach to analyze the discussion board contributions of the 19 physiotherapists who participated in the 10-week online continuing education course in evidence-based practice (EBP) in manual therapy. The course was founded on community of practice, constructivism, social, and situated learning principles. The 1436 postings on 9 active discussion boards revealed that the community of practice was a social learning environment that supported strong participation and mutual engagement. Design features such as consistent facilitation, weekly guiding questions, and collaborative assignments promoted the creation and sharing of knowledge. Participants applied research evidence to the contexts in which they worked through reflective comparison of what they were reading to its applicability in their everyday practice. Participants' shared goals contributed to the common ground established in developing collective knowledge about different study designs, how to answer research questions, and the difficulties of conducting sound research. An online longitudinal community of practice utilized as a continuing education approach to deliver an online course based on constructivist and social learning principles allowed geographically dispersed physiotherapists to be mutually engaged in a joint enterprise in evidence-based manual therapy. Advantages included opportunity for reflection, modeling, and collaboration. Future studies should examine the impact of participation on clinical practice. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital

DynaMed Plus®: An Evidence-Based Clinical Reference Resource.

PubMed

Charbonneau, Deborah H; James, LaTeesa N

2018-01-01

DynaMed Plus ® from EBSCO Health is an evidence-based tool that health professionals can use to inform clinical care. DynaMed Plus content undergoes a review process, and the evidence is synthesized in detailed topic overviews. A unique three-level rating scale is used to assess the quality of available evidence. Topic overviews summarize current evidence and provide recommendations to support health providers at the point-of-care. Additionally, DynaMed Plus content can be accessed via a desktop computer or mobile platforms. Given this, DynaMed Plus can be a time-saving resource for health providers. Overall, DynaMed Plus provides evidence summaries using an easy-to-read bullet format, and the resource incorporates images, clinical calculators, patient handouts, and practice guidelines in one place.

Electrochemical and Morphological Investigations of Ga Addition to Pt Electrocatalyst Supported on Carbon

PubMed Central

Paganoto, Giordano T.; Santos, Deise M.; Guimarães, Marco C. C.; Carneiro, Maria Tereza W. D.

2017-01-01

This paper is consisted in the synthesis of platinum-based electrocatalysts supported on carbon (Vulcan XC-72) and investigation of the addition of gallium in their physicochemical and electrochemical properties toward ethanol oxidation reaction (EOR). PtGa/C electrocatalysts were prepared through thermal decomposition of polymeric precursor method at a temperature of 350°C. Six different compositions were homemade: Pt50Ga50/C, Pt60Ga40/C, Pt70Ga30/C, Pt80Ga20/C, Pt90Ga10/C, and Pt100/C. These electrocatalysts were electrochemically characterized by cyclic voltammetry (CV), chronoamperometry (CA), chronopotentiometry (CP), and electrochemical impedance spectroscopy (EIS) in the presence and absence of ethanol 1.0 mol L−1. Thermogravimetric analysis (TGA), energy dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), and transmission electron microscopy (TEM) were also carried out for a physicochemical characterization of those materials. XRD results showed the main peaks of face-centered cubic Pt. The particle sizes obtained from XRD and TEM analysis range from 7.2 nm to 12.9 nm. The CV results indicate behavior typical of Pt-based electrocatalysts in acid medium. The CV, EIS, and CA data reveal that the addition of up to 31% of gallium to the Pt highly improves catalytic activity on EOR response when compared to Pt100/C. PMID:28466065

Altered γ-aminobutyric acid neurotransmission in major depressive disorder: a critical review of the supporting evidence and the influence of serotonergic antidepressants

PubMed Central

Pehrson, Alan L; Sanchez, Connie

2015-01-01

Evidence suggesting that central nervous system γ-aminobutyric acid (GABA) concentrations are reduced in patients with major depressive disorder (MDD) has been present since at least 1980, and this idea has recently gained support from more recent magnetic resonance spectroscopy data. These observations have led to the assumption that MDD’s underlying etiology is tied to an overall reduction in GABA-mediated inhibitory neurotransmission. In this paper, we review the mechanisms that govern GABA and glutamate concentrations in the brain, and provide a comprehensive and critical evaluation of the clinical data supporting reduced GABA neurotransmission in MDD. This review includes an evaluation of magnetic resonance spectroscopy data, as well as data on the expression and function of the GABA-synthesizing enzyme glutamic acid decarboxylase, GABA neuron-specific cell markers, such as parvalbumin, calretinin and calbindin, and the GABAA and GABAB receptors in clinical MDD populations. We explore a potential role for glial pathology in MDD-related reductions in GABA concentrations, and evidence of a connection between neurosteroids, GABA neurotransmission, and hormone-related mood disorders. Additionally, we investigate the effects of GABAergic pharmacological agents on mood, and demonstrate that these compounds have complex effects that do not universally support the idea that reduced GABA neurotransmission is at the root of MDD. Finally, we discuss the connections between serotonergic and GABAergic neurotransmission, and show that two serotonin-focused antidepressants – the selective serotonin-reuptake inhibitor fluoxetine and the multimodal antidepressant vortioxetine – modulate GABA neurotransmission in opposing ways, despite both being effective MDD treatments. Altogether, this review demonstrates that there are large gaps in our understanding of the relationship between GABA physiology and MDD, which must be remedied with more data from well

The Debate Continues: Further Evidence of Discontinuity in Dewey's Philosophy.

ERIC Educational Resources Information Center

Prawat, Richard S.

2003-01-01

Responds to a critique of a thesis that Dewey underwent a dramatic midcareer change in his philosophy and that this change drew heavily on Pierce's metaphysics, offering additional evidence to support the claim that comparison of the 1910 and 1933 versions of "How We Think" reveals a major change in Dewey's views about inductionism. New…

20 CFR 418.1255 - What kind of major life-changing event evidence will you need to support your request for us to...

Code of Federal Regulations, 2012 CFR

2012-04-01

... evidence will you need to support your request for us to use a more recent tax year? 418.1255 Section 418...-Related Monthly Adjustment Amount Determinations Using A More Recent Tax Year's Modified Adjusted Gross... for us to use a more recent tax year? (a) If your spouse died and we do not have evidence of the death...

20 CFR 418.1255 - What kind of major life-changing event evidence will you need to support your request for us to...

Code of Federal Regulations, 2014 CFR

2014-04-01

... evidence will you need to support your request for us to use a more recent tax year? 418.1255 Section 418...-Related Monthly Adjustment Amount Determinations Using A More Recent Tax Year's Modified Adjusted Gross... for us to use a more recent tax year? (a) If your spouse died and we do not have evidence of the death...

20 CFR 418.1255 - What kind of major life-changing event evidence will you need to support your request for us to...

Code of Federal Regulations, 2011 CFR

2011-04-01

... evidence will you need to support your request for us to use a more recent tax year? 418.1255 Section 418...-Related Monthly Adjustment Amount Determinations Using A More Recent Tax Year's Modified Adjusted Gross... for us to use a more recent tax year? (a) If your spouse died and we do not have evidence of the death...

20 CFR 418.1255 - What kind of major life-changing event evidence will you need to support your request for us to...

Code of Federal Regulations, 2013 CFR

2013-04-01

... evidence will you need to support your request for us to use a more recent tax year? 418.1255 Section 418...-Related Monthly Adjustment Amount Determinations Using A More Recent Tax Year's Modified Adjusted Gross... for us to use a more recent tax year? (a) If your spouse died and we do not have evidence of the death...

Social support and nocturnal blood pressure dipping: a systematic review.

PubMed

Fortmann, Addie L; Gallo, Linda C

2013-03-01

Attenuated nocturnal blood pressure (BP) dipping is a better predictor of cardiovascular disease (CVD) morbidity and mortality than resting BP measurements. Studies have reported associations between social support, variously defined, and BP dipping. A systematic review of the literature was conducted to investigate associations of functional and structural social support with nocturnal BP dipping assessed over a minimum of 24 hours. A total of 297 articles were identified. Of these, 11 met criteria for inclusion; all studies were cross-sectional in design and included adult participants only (mean age = 19 to 72 years). Evidence was most consistent for an association between functional support and BP dipping, such that 5 of 7 studies reported statistically (or marginally) significant positive associations with BP dipping. Statistically significant functional support-BP dipping associations were moderate (standardized effect size (d) = 0.41) to large (d = 2.01) in magnitude. Studies examining structural support were fewer and relatively less consistent; however, preliminary evidence was observed for associations of marital status and social contact frequency with BP dipping. Statistically significant structural support findings were medium (d = 0.53) to large (d = 1.13) in magnitude. Overall, findings suggest a link between higher levels of functional support and greater nocturnal BP dipping; preliminary evidence was also observed for the protective effects of marriage and social contact frequency. Nonetheless, the relatively small number of studies conducted to date and the heterogeneity of findings across meaningful subgroups suggest that additional research is needed to substantiate these conclusions.

Better Evidence, Better Choices, Better Schools: State Supports for Evidence-Based School Improvement and the Every Student Succeeds Act. Series on Implementation of the Every Student Succeeds Act

ERIC Educational Resources Information Center

Fleischman, Steve; Scott, Caitlin; Sargrad, Scott

2016-01-01

Signed into law in December 2015, the Every Student Suceeds Act (ESSA) offers state education agencies significant opportunities to use evidence to support the improvement of schools and ensure better outcomes for all students. ESSA replaces the law, regulations, and guidance established through the 2001 No Child Left Behind Act (NCLB), but two…

Evidence & Gap Maps: A tool for promoting evidence informed policy and strategic research agendas.

PubMed

Snilstveit, Birte; Vojtkova, Martina; Bhavsar, Ami; Stevenson, Jennifer; Gaarder, Marie

2016-11-01

A range of organizations are engaged in the production of evidence on the effects of health, social, and economic development programs on human welfare outcomes. However, evidence is often scattered around different databases, web sites, and the gray literature and is often presented in inaccessible formats. Lack of overview of the evidence in a specific field can be a barrier to the use of existing research and prevent efficient use of limited resources for new research. Evidence & Gap Maps (EGMs) aim to address these issues and complement existing synthesis and mapping approaches. EGMs are a new addition to the tools available to support evidence-informed policymaking. To provide an accessible resource for researchers, commissioners, and decision makers, EGMs provide thematic collections of evidence structured around a framework which schematically represents the types of interventions and outcomes of relevance to a particular sector. By mapping the existing evidence using this framework, EGMs provide a visual overview of what we know and do not know about the effects of different programs. They make existing evidence available, and by providing links to user-friendly summaries of relevant studies, EGMs can facilitate the use of existing evidence for decision making. They identify key "gaps" where little or no evidence from impact evaluations and systematic reviews is available and can be a valuable resource to inform a strategic approach to building the evidence base in a particular sector. The article will introduce readers to the concept and methods of EGMs and present a demonstration of the EGM tool using existing examples. Copyright © 2016 Elsevier Inc. All rights reserved.

Support Required for Primary and Secondary Students with Communication Disorders and/or Other Learning Needs

ERIC Educational Resources Information Center

McLeod, Sharynne; McKinnon, David H.

2010-01-01

Prioritization of school students with additional learning needs is a reality due to a finite resource base. Limited evidence exists regarding teachers' prioritization of primary and secondary school students with additional learning needs. The aim of the present article was to differentiate teachers' perceptions of the level of support required…

Assessment and Placement: Supporting Student Success in College Gateway Courses

ERIC Educational Resources Information Center

Vandal, Bruce

2014-01-01

Evidence is mounting that the vast majority of students who are currently placed into prerequisite remedial education could be successful in gateway college-­level courses if they receive additional academic support as a corequisite. Recent research on college placement exams reveals that the exams are unreliable at predicting college success, and…

Experimental Evidence for LENR in a Polarized Pd/D Lattice

NASA Astrophysics Data System (ADS)

Szpak, S.

2005-03-01

Experimental evidence in support of claims that excess enthalpy production in a polarized Pd/D lattice is of a nuclear origin is questioned on various grounds, eg marginal intensity and difficulty in reproducing. Here, evidence is presented that is 100% reproducible and of sufficient intensity to be well outside of experimental errors. In addition to the thermal behavior, the nuclear manifestations include: X-ray emission; tritium production; and, when an operating cell is placed in an external electric field, fusion to create heavier metals such as Ca, Al, Mg, and Zn.

Working memory training in older adults: Bayesian evidence supporting the absence of transfer.

PubMed

Guye, Sabrina; von Bastian, Claudia C

2017-12-01

The question of whether working memory training leads to generalized improvements in untrained cognitive abilities is a longstanding and heatedly debated one. Previous research provides mostly ambiguous evidence regarding the presence or absence of transfer effects in older adults. Thus, to draw decisive conclusions regarding the effectiveness of working memory training interventions, methodologically sound studies with larger sample sizes are needed. In this study, we investigated whether or not a computer-based working memory training intervention induced near and far transfer in a large sample of 142 healthy older adults (65 to 80 years). Therefore, we randomly assigned participants to either the experimental group, which completed 25 sessions of adaptive, process-based working memory training, or to the active, adaptive visual search control group. Bayesian linear mixed-effects models were used to estimate performance improvements on the level of abilities, using multiple indicator tasks for near (working memory) and far transfer (fluid intelligence, shifting, and inhibition). Our data provided consistent evidence supporting the absence of near transfer to untrained working memory tasks and the absence of far transfer effects to all of the assessed abilities. Our results suggest that working memory training is not an effective way to improve general cognitive functioning in old age. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

SUPPORT Tools for evidence-informed health Policymaking (STP) 16: Using research evidence in balancing the pros and cons of policies

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. In this article, we address the use of evidence to inform judgements about the balance between the pros and cons of policy and programme options. We suggest five questions that can be considered when making these judgements. These are: 1. What are the options that are being compared? 2. What are the most important potential outcomes of the options being compared? 3. What is the best estimate of the impact of the options being compared for each important outcome? 4. How confident can policymakers and others be in the estimated impacts? 5. Is a formal economic model likely to facilitate decision making? PMID:20018106

Evidence Supports the Use of Soy Protein to Promote Cardiometabolic Health and Muscle Development.

PubMed

Paul, Greg; Mendelson, Garry J

2015-01-01

Consumption of adequate amounts of dietary protein can help individuals maintain a healthy body composition, especially when combined with resistance exercise and during weight loss. It is well established that dietary protein intake supports muscle development and helps reduce loss of lean body mass during weight loss. Numerous studies have demonstrated the efficacy of soy protein intake for promoting fat loss while preserving muscle mass and supporting lean body mass gains. In fact, soy protein and animal-based proteins both support weight loss and weight maintenance equally as part of an energy-restricted diet; however, soy protein offers additional cardiometabolic advantages. Key teaching points: Soy protein is a high-quality, plant-based protein that can be consumed throughout the life span. More human clinical studies have been conducted to assess the cholesterol-lowering effects of soy protein than any other cholesterol-lowering food ingredient. Ingestion of proteins with unique and complementary characteristics like soy, whey, and casein helps resistance-trained individuals achieve significant muscle growth. Recent research supports the efficacy of consuming a combination of soy, whey, and casein after resistance exercise to extend the time period that muscle building occurs.

Facilitating the implementation of evidence- based practice through contextual support and nursing leadership.

PubMed

Kueny, Angela; Shever, Leah L; Lehan Mackin, Melissa; Titler, Marita G

2015-01-01

Nurse managers (NMs) play an important role promoting evidence-based practice (EBP) on clinical units within hospitals. However, there is a dearth of research focused on NM perspectives about institutional contextual factors to support the goal of EBP on the clinical unit. The purpose of this article is to identify contextual factors described by NMs to drive change and facilitate EBP at the unit level, comparing and contrasting these perspectives across nursing units. This study employed a qualitative descriptive design using interviews with nine NMs who were participating in a large effectiveness study. To stratify the sample, NMs were selected from nursing units designated as high or low performing based on implementation of EBP interventions, scores on the Meyer and Goes research use scale, and fall rates. Descriptive content analysis was used to identify themes that reflect the complex nature of infrastructure described by NMs and contextual influences that supported or hindered their promotion of EBP on the clinical unit. NMs perceived workplace culture, structure, and resources as facilitators or barriers to empowering nurses under their supervision to use EBP and drive change. A workplace culture that provides clear communication of EBP goals or regulatory changes, direct contact with CEOs, and clear expectations supported NMs in their promotion of EBP on their units. High-performing unit NMs described a structure that included nursing-specific committees, allowing nurses to drive change and EBP from within the unit. NMs from high-performing units were more likely to articulate internal resources, such as quality-monitoring departments, as critical to the implementation of EBP on their units. This study contributes to a deeper understanding of institutional contextual factors that can be used to support NMs in their efforts to drive EBP changes at the unit level.

Evidence-based hypnotherapy for depression.

PubMed

Alladin, Assen

2010-04-01

Cognitive hypnotherapy (CH) is a comprehensive evidence-based hypnotherapy for clinical depression. This article describes the major components of CH, which integrate hypnosis with cognitive-behavior therapy as the latter provides an effective host theory for the assimilation of empirically supported treatment techniques derived from various theoretical models of psychotherapy and psychopathology. CH meets criteria for an assimilative model of psychotherapy, which is considered to be an efficacious model of psychotherapy integration. The major components of CH for depression are described in sufficient detail to allow replication, verification, and validation of the techniques delineated. CH for depression provides a template that clinicians and investigators can utilize to study the additive effects of hypnosis in the management of other psychological or medical disorders. Evidence-based hypnotherapy and research are encouraged; such a movement is necessary if clinical hypnosis is to integrate into mainstream psychotherapy.

A Review of the Evidence Supporting the Vitamin D-Cancer Prevention Hypothesis in 2017.

PubMed

Grant, William B

2018-02-01

The vitamin D-cancer prevention hypothesis has been evaluated through several types of studies, including geographical ecological studies related to indices of solar ultraviolet-B (UVB) dose (the primary source of vitamin D for most people), observational studies related to UVB exposure or serum 25-hydroxyvitamin D [25(OH)D] concentrations, laboratory studies of mechanisms, and clinical trials. Each approach has strengths and limitations. Ecological studies indirectly measure vitamin D production and incorporate the assumption that vitamin D mediates the effect of UVB exposure. Findings from observational studies with long follow-up times are affected by changing 25(OH)D concentrations over time. Most clinical trials have been poorly designed and conducted, based largely on guidelines for pharmaceutical drugs rather than on nutrients. However, three clinical trials do support the hypothesis. In general, the totality of the evidence, as evaluated using Hill's criteria for causality in a biological system, supports the vitamin D-cancer prevention hypothesis. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

How experimental biology and ecology can support evidence-based decision-making in conservation: avoiding pitfalls and enabling application.

PubMed

Cooke, Steven J; Birnie-Gauvin, Kim; Lennox, Robert J; Taylor, Jessica J; Rytwinski, Trina; Rummer, Jodie L; Franklin, Craig E; Bennett, Joseph R; Haddaway, Neal R

2017-01-01

Policy development and management decisions should be based upon the best available evidence. In recent years, approaches to evidence synthesis, originating in the medical realm (such as systematic reviews), have been applied to conservation to promote evidence-based conservation and environmental management. Systematic reviews involve a critical appraisal of evidence, but studies that lack the necessary rigour (e.g. experimental, technical and analytical aspects) to justify their conclusions are typically excluded from systematic reviews or down-weighted in terms of their influence. One of the strengths of conservation physiology is the reliance on experimental approaches that help to more clearly establish cause-and-effect relationships. Indeed, experimental biology and ecology have much to offer in terms of building the evidence base that is needed to inform policy and management options related to pressing issues such as enacting endangered species recovery plans or evaluating the effectiveness of conservation interventions. Here, we identify a number of pitfalls that can prevent experimental findings from being relevant to conservation or would lead to their exclusion or down-weighting during critical appraisal in a systematic review. We conclude that conservation physiology is well positioned to support evidence-based conservation, provided that experimental designs are robust and that conservation physiologists understand the nuances associated with informing decision-making processes so that they can be more relevant.

How experimental biology and ecology can support evidence-based decision-making in conservation: avoiding pitfalls and enabling application

PubMed Central

Birnie-Gauvin, Kim; Lennox, Robert J.; Taylor, Jessica J.; Rytwinski, Trina; Rummer, Jodie L.; Franklin, Craig E.; Bennett, Joseph R.; Haddaway, Neal R.

2017-01-01

Abstract Policy development and management decisions should be based upon the best available evidence. In recent years, approaches to evidence synthesis, originating in the medical realm (such as systematic reviews), have been applied to conservation to promote evidence-based conservation and environmental management. Systematic reviews involve a critical appraisal of evidence, but studies that lack the necessary rigour (e.g. experimental, technical and analytical aspects) to justify their conclusions are typically excluded from systematic reviews or down-weighted in terms of their influence. One of the strengths of conservation physiology is the reliance on experimental approaches that help to more clearly establish cause-and-effect relationships. Indeed, experimental biology and ecology have much to offer in terms of building the evidence base that is needed to inform policy and management options related to pressing issues such as enacting endangered species recovery plans or evaluating the effectiveness of conservation interventions. Here, we identify a number of pitfalls that can prevent experimental findings from being relevant to conservation or would lead to their exclusion or down-weighting during critical appraisal in a systematic review. We conclude that conservation physiology is well positioned to support evidence-based conservation, provided that experimental designs are robust and that conservation physiologists understand the nuances associated with informing decision-making processes so that they can be more relevant. PMID:28835842

[Online information service: the library support for evidence-based practice].

PubMed

Markulin, Helena; Petrak, Jelka

2014-01-01

It frequently happens that physicians do not have adequate skills or enough time for searching and evaluating evidence needed in their everyday practice. Medical librarian can serve as a mediator in enabling physicians to utilize the potential offered by contemporary evidence-based medicine. The Central Medical Library (CML) at University of Zagreb, School of Medicine, designed a web-based information service aimed at the promotion of evidence-based practice in the Croatian medical community. The users can ask for a help in finding information on their clinical problems. A responsible librarian will analyse the problem, search information resources and evaluate the evidence. The answer is returned to the user by an e-mail. In the 2008-2012 period 166 questions from 12 clinical fields were received and most of them (36.1%) came from internal medicine doctors. The share of treatment-related questions was 70.5%. In the setting of underdeveloped ICT infrastructure and inadequate EBM resources availability, such information service can help in transfer of scientific evidence into the everyday clinical practice.

Systems and Methods for Designing and Fabricating Contact-Free Support Structures for Overhang Geometries of Parts in Powder-Bed Metal Additive Manufacturing

NASA Technical Reports Server (NTRS)

Cooper, Kenneth (Inventor); Chou, Yuag-Shan (Inventor)

2017-01-01

Systems and methods are provided for designing and fabricating contact-free support structures for overhang geometries of parts fabricated using electron beam additive manufacturing. One or more layers of un-melted metallic powder are disposed in an elongate gap between an upper horizontal surface of the support structure and a lower surface of the overhang geometry. The powder conducts heat from the overhang geometry to the support structure. The support structure acts as a heat sink to enhance heat transfer and reduce the temperature and severe thermal gradients due to poor thermal conductivity of metallic powders underneath the overhang. Because the support structure is not connected to the part, the support structure can be removed freely without any post-processing step.

Evidence from prospective cohort studies does not support current dietary fat guidelines: a systematic review and meta-analysis.

PubMed

Harcombe, Zoë; Baker, Julien S; Davies, Bruce

2017-12-01

National dietary guidelines were introduced in 1977 and 1983, by the US and UK governments to reduce coronary heart disease (CHD) mortality by reducing dietary fat intake. Our 2016 systematic review examined the epidemiological evidence available to the dietary committees at the time; we found no support for the recommendations to restrict dietary fat. The present investigation extends our work by re-examining the totality of epidemiological evidence currently available relating to dietary fat guidelines. A systematic review and meta-analysis of prospective cohort studies currently available, which examined the relationship between dietary fat, serum cholesterol and the development of CHD, were undertaken. Across 7 studies, involving 89 801 participants (94% male), there were 2024 deaths from CHD during the mean follow-up of 11.9±5.6 years. The death rate from CHD was 2.25%. Eight data sets were suitable for inclusion in meta-analysis; all excluded participants with previous heart disease. Risk ratios (RRs) from meta-analysis were not statistically significant for CHD deaths and total or saturated fat consumption. The RR from meta-analysis for total fat intake and CHD deaths was 1.04 (95% CI 0.98 to 1.10). The RR from meta-analysis for saturated fat intake and CHD deaths was 1.08 (95% CI 0.94 to 1.25). Epidemiological evidence to date found no significant difference in CHD mortality and total fat or saturated fat intake and thus does not support the present dietary fat guidelines. The evidence per se lacks generalisability for population-wide guidelines. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Dietary fat guidelines have no evidence base: where next for public health nutritional advice?

PubMed

Harcombe, Zoë

2017-05-01

National dietary guidelines were introduced in 1977 and 1983, by the US and UK governments, with the aim of reducing coronary heart disease (CHD) mortality. The 2 specific dietary fat recommendations were to reduce total fat and saturated fat consumption to 30% and 10% of total energy intake, respectively. 4 systematic reviews (3 with meta-analysis) were undertaken to examine the evidence for these dietary fat guidelines: (1) randomised controlled trial (RCT) and (2) prospective cohort (PC) evidence at the time the guidelines were introduced; and (3) RCT and (4) PC evidence currently available. This narrative review examines all evidence collated. The RCT and PC evidence available to the dietary committees did not support the introduction of the dietary fat guidelines. The RCT and PC evidence currently available does not support the extant recommendations. Furthermore, the quality of the evidence is so poor that it could not be relied on had it provided support. Dietary fat guidelines have prevailed for almost 40 years. The evidence base at the time of their introduction has been examined for the first time and found lacking. Evidence currently available provides no additional support. Public health opinion differed when the guidelines were introduced. Opposition to the guidelines is becoming more strident. Substantial increases in diet-related illness over the past four decades, particularly obesity and type 2 diabetes, indicate that a review of dietary advice is warranted. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Disparities and menthol marketing: additional evidence in support of point of sale policies.

PubMed

Moreland-Russell, Sarah; Harris, Jenine; Snider, Doneisha; Walsh, Heidi; Cyr, Julianne; Barnoya, Joaquin

2013-09-25

This study examined factors associated with point-of-sale tobacco marketing in St. Louis, an urban city in the United States. Using spatial analysis, descriptive statistics, and multilevel modeling, we examined point-of-sale data and the proportion of mentholated cigarette and total cigarette marketing from 342 individual tobacco retail stores within St. Louis census tracts characterized by the percent of black adults and children. Menthol and total tobacco product marketing was highest in areas with the highest percentages of black residents. When examining menthol marketing to children, we did not find as strong of a relationship, however results of multilevel modeling indicate that as the proportion of black children in a census tract increased, the proportion of menthol marketing near candy also increased. These results indicate the need for communities globally to counter this targeted marketing by taking policy action specifically through the enactment of marketing restrictions provided by the 2009 Family Smoking Prevention and Tobacco Control Act and the Framework Convention of Tobacco Control.

Disparities and Menthol Marketing: Additional Evidence in Support of Point of Sale Policies

PubMed Central

Moreland-Russell, Sarah; Harris, Jenine; Snider, Doneisha; Walsh, Heidi; Cyr, Julianne; Barnoya, Joaquin

2013-01-01

This study examined factors associated with point-of-sale tobacco marketing in St. Louis, an urban city in the United States. Using spatial analysis, descriptive statistics, and multilevel modeling, we examined point-of-sale data and the proportion of mentholated cigarette and total cigarette marketing from 342 individual tobacco retail stores within St. Louis census tracts characterized by the percent of black adults and children. Menthol and total tobacco product marketing was highest in areas with the highest percentages of black residents. When examining menthol marketing to children, we did not find as strong of a relationship, however results of multilevel modeling indicate that as the proportion of black children in a census tract increased, the proportion of menthol marketing near candy also increased. These results indicate the need for communities globally to counter this targeted marketing by taking policy action specifically through the enactment of marketing restrictions provided by the 2009 Family Smoking Prevention and Tobacco Control Act and the Framework Convention of Tobacco Control. PMID:24071922

The Juggling Act of Supervision in Community Mental Health: Implications for Supporting Evidence-Based Treatment.

PubMed

Dorsey, Shannon; Pullmann, Michael D; Kerns, Suzanne E U; Jungbluth, Nathaniel; Meza, Rosemary; Thompson, Kelly; Berliner, Lucy

2017-11-01

Supervisors are an underutilized resource for supporting evidence-based treatments (EBTs) in community mental health. Little is known about how EBT-trained supervisors use supervision time. Primary aims were to describe supervision (e.g., modality, frequency), examine functions of individual supervision, and examine factors associated with time allocation to supervision functions. Results from 56 supervisors and 207 clinicians from 25 organizations indicate high prevalence of individual supervision, often alongside group and informal supervision. Individual supervision serves a wide range of functions, with substantial variation at the supervisor-level. Implementation climate was the strongest predictor of time allocation to clinical and EBT-relevant functions.

Evidence-based librarianship: searching for the needed EBL evidence.

PubMed

Eldredge, J D

2000-01-01

This paper discusses the challenges of finding evidence needed to implement Evidence-Based Librarianship (EBL). Focusing first on database coverage for three health sciences librarianship journals, the article examines the information contents of different databases. Strategies are needed to search for relevant evidence in the library literature via these databases, and the problems associated with searching the grey literature of librarianship. Database coverage, plausible search strategies, and the grey literature of library science all pose challenges to finding the needed research evidence for practicing EBL. Health sciences librarians need to ensure that systems are designed that can track and provide access to needed research evidence to support Evidence-Based Librarianship (EBL).

Moderating effects of nurses' organizational justice between organizational support and organizational citizenship behaviors for evidence-based practice.

PubMed

Chang, Ching-Sheng

2014-10-01

Lack of existing literature on the correlation among organizational justice, organizational support, and organizational citizenship behaviors has created a research gap in previous evidence-based practice (EBP) studies on nursing personnel. To investigate whether organizational justice among nurses has a moderating effect between their organizational support and organizational citizenship behaviors in order to bridge such a gap of existing literature with the EBP study on nursing personnel. Nursing staff of one large and influential hospital in Taiwan was surveyed. Four hundred questionnaires were distributed, and 386 were collected with a valid response rate of 96.50%. SPSS 17.0 and Amos 17.0 statistical software packages were used for data analysis. Nurses' organizational support positively influences their organizational citizenship behaviors, and their organizational justice perception has a positive moderating effect between organizational support and organizational citizenship behaviors. Results call hospitals' attention to the type of individual behaviors that may improve organizational performance. When nursing staff perceive fair and impartial treatment by the organization and supportive emotional attachment, behaviors beneficial for the organization are expressed in return. Subjective perceptions of nursing staff play an important role in organizational exchange relationship; the higher the degree of nursing staff's perceived organizational justice, the higher the degree of their organizational support, perception, and exhibition of organizational citizenship behaviors such as altruistic behavior and dedication to the work. © 2014 Sigma Theta Tau International.

Inference evaluation in a finite evidence domain

NASA Astrophysics Data System (ADS)

Ratway, Michael J.; Bellomo, Carryn

2000-08-01

Modeling of a target starts with a subject matter expert (SME) analysis of the available sensor(s) data. The SME then forms relationships between the data and known target attributes, called evidence, to support modeling of different types of targets or target activity. Speeds in the interval 10 to 30 knots and ranges less than 30 nautical miles are two samples of target evidence derived from sensor data. Evidence is then organized into sets to define the activities of a target and/or to distinguish different types of targets. For example, near an airport, target activities of takeoff, landing, and holding need to be evaluated in addition to target classification of civilian or commercial aircraft. This paper discusses a method for evaluation of the inferred activities over the finite evidence domain formed from the collection of models under consideration. The methodology accounts for repeated use of evidence in different models. For example, 'near an airport' is a required piece of evidence used repeatedly in the takeoff, landing, and holding models of a wide area sensor. Properties of the activity model evaluator methodology are discussed in terms of model construction and informal results are presented in a Boolean evidence type of problem domain.

Scientific Evidence and Potential Barriers in the Management of Brazilian Protected Areas.

PubMed

Giehl, Eduardo L H; Moretti, Marcela; Walsh, Jessica C; Batalha, Marco A; Cook, Carly N

2017-01-01

Protected areas are a crucial tool for halting the loss of biodiversity. Yet, the management of protected areas is under resourced, impacting the ability to achieve effective conservation actions. Effective management depends on the application of the best available knowledge, which can include both scientific evidence and the local knowledge of onsite managers. Despite the clear value of evidence-based conservation, there is still little known about how much scientific evidence is used to guide the management of protected areas. This knowledge gap is especially evident in developing countries, where resource limitations and language barriers may create additional challenges for the use of scientific evidence in management. To assess the extent to which scientific evidence is used to inform management decisions in a developing country, we surveyed Brazilian protected area managers about the information they use to support their management decisions. We targeted on-ground managers who are responsible for management decisions made at the local protected area level. We asked managers about the sources of evidence they use, how frequently they assess the different sources of evidence and the scientific content of the different sources of evidence. We also considered a range of factors that might explain the use of scientific evidence to guide the management of protected areas, such as the language spoken by managers, the accessibility of evidence sources and the characteristics of the managers and the protected areas they manage. The managers who responded to our questionnaire reported that they most frequently made decisions based on their personal experience, with scientific evidence being used relatively infrequently. While managers in our study tended to value scientific evidence less highly than other sources, most managers still considered science important for management decisions. Managers reported that the accessibility of scientific evidence is low relative

Support for Special Education Administrators: A Framework for Building and Sustaining Capacity

ERIC Educational Resources Information Center

Adams, James S.

2013-01-01

Research supports evidence indicating a nationwide concern that administrative training programs are not meeting the needs of Special Education Administrators. Additionally, researchers suggest that the need to have well prepared special education administrators (SEAs) is greater now than ever before and the demand for SEAs exceeds the supply of…

Anaesthetic management of obese parturients: what is the evidence supporting practice guidelines?

PubMed

Eley, V A; van Zundert, A A J; Lipman, J; Callaway, L K

2016-09-01

Increasing rates of obesity in western populations present management difficulties for clinicians caring for obese pregnant women. Various governing bodies have published clinical guidelines for the care of obese parturients. These guidelines refer to two components of anaesthetic care: anaesthetic consultation in the antenatal period for women with a body mass index (BMI) ≥ 40 kg/m 2 and the provision of early epidural analgesia in labour. These recommendations are based on the increased incidence of obstetric complications and the predicted risks and difficulties in providing anaesthetic care. The concept behind early epidural analgesia is logical-site the epidural early, use it for surgical anaesthesia and avoid general anaesthesia if surgery is required. Experts support this recommendation, but there is weak supporting evidence. It is known that the management of labour epidurals in obese women is complicated and that women with extreme obesity require higher rates of general anaesthesia. Anecdotally, anaesthetists view and apply the early epidural recommendation inconsistently and the acceptability of early epidural analgesia to pregnant women is variable. In this topic review, we critically appraise these two practice recommendations. The elements required for effective implementation in multidisciplinary maternity care are considered. We identify gaps in the current literature and suggest areas for future research. While prospective cohort studies addressing epidural extension ('top-up') in obese parturients would help inform practice, audit of local practice may better answer the question "is early epidural analgesia beneficial to obese women in my practice?".

Evidence to Support a Contribution of Polyreactive Antibodies to HLA Serum Reactivity.

PubMed

Gao, Baoshan; Rong, Chunshu; Porcheray, Fabrice; Moore, Carolina; Girouard, Timothy C; Saidman, Susan L; Wong, Waichi; Fu, Yaowen; Zorn, Emmanuel

2016-01-01

Assessing the serum reactivity to HLA is essential for the evaluation of transplant candidates and the follow-up of allograft recipients. In this study, we look for evidence at the clonal level that polyreactive antibodies cross-reactive to apoptotic cells and multiple autoantigens can also react to HLA and contribute to the overall serum reactivity. We immortalized B cell clones from the blood of 2 kidney transplant recipients and characterized their reactivity to self-antigens, apoptotic cells as well as native, denatured, and cryptic HLA determinants using enzyme-linked immunosorbent assay (ELISA), immunofluorescence, flow cytometry and Luminex assays. We also assessed the reactivity of 300 pretransplant serum specimens to HLA and apoptotic cells. We report here 4 distinct B cell clones cross-reactive to self and HLA class I. All 4 clones reacted to numerous HLA class I alleles but did not appear to target canonical "shared" epitopes. In parallel experiments, we observed a strong correlation between IgG reactivity to HLA and apoptotic cells in pretransplant serum samples collected from 300 kidney transplant recipients. Further analysis revealed that samples with higher reactivity to apoptotic cells displayed significantly higher class I percent panel-reactive antibodies compared to samples with low reactivity to apoptotic cells. We provide here (1) proof of principle at the clonal level that human polyreactive antibodies can cross-react to HLA, multiple self-antigens and apoptotic cells and (2) supportive evidence that polyreactive antibodies contribute to overall HLA reactivity in the serum of patients awaiting kidney transplant.

Evidence to support a contribution of polyreactive antibodies to HLA serum reactivity

PubMed Central

Gao, Baoshan; Rong, Chunshu; Porcheray, Fabrice; Moore, Carolina; Girouard, Timothy C.; Saidman, Susan L.; Wong, Waichi; Fu, Yaowen; Zorn, Emmanuel

2015-01-01

Background Assessing the serum reactivity to HLA is essential for the evaluation of transplant candidates and the follow-up of allograft recipients. In this study, we look for evidence at the clonal level that polyreactive antibodies cross-reactive to apoptotic cells and multiple autoantigens can also react to HLA and contribute to the overall serum reactivity. Methods We immortalized B cell clones from the blood of two kidney transplant recipients and characterized their reactivity to self-antigens, apoptotic cells as well as native, denatured and cryptic HLA determinants using ELISA, immunofluorescence, flow cytometry and Luminex assays. We also assessed the reactivity of 300 pre-transplant serum specimens to HLA and apoptotic cells. Results We report here 4 distinct B cell clones cross-reactive to self and HLA class I. All 4 clones reacted to numerous HLA class I alleles but did not appear to target canonical “shared” epitopes. In parallel experiments, we observed a strong correlation between IgG reactivity to HLA and apoptotic cells in pre-transplant serum samples collected from 300 kidney transplant recipients. Further analysis revealed that samples with higher reactivity to apoptotic cells displayed significantly higher class I percent PRA compared to samples with low reactivity to apoptotic cells. Conclusions We provide here 1) proof of principle at the clonal level that human polyreactive antibodies can cross-react to HLA, multiple self-antigens and apoptotic cells and 2) supportive evidence that polyreactive antibodies contribute to overall HLA reactivity in the serum of patients awaiting kidney transplant. PMID:26285015

Line-depth-ratio temperatures for the close binary ν Octantis: new evidence supporting the conjectured circumstellar retrograde planet

NASA Astrophysics Data System (ADS)

Ramm, D. J.

2015-06-01

We explore the possibly that either star-spots or pulsations are the cause of a periodic radial velocity (RV) signal (P ˜ 400 d) from the K-giant binary ν Octantis (P ˜ 1050 d, e ˜ 0.25), alternatively conjectured to have a retrograde planet. Our study is based on temperatures derived from 22 line-depth ratios (LDRs) for ν Oct and 20 calibration stars. Empirical evidence and stability modelling provide unexpected support for the planet since other standard explanations (star-spots, pulsations and additional stellar masses) each have credibility problems. However, the proposed system presents formidable challenges to planet formation and stability theories: it has by far the smallest stellar separation of any claimed planet-harbouring binary (a_{_bin} ˜ 2.6 au) and an equally unbelievable separation ratio (a_{_pl}/a_{_bin} ˜ 0.5), hence the necessity that the circumstellar orbit be retrograde. The LDR analysis of 215 ν Oct spectra acquired between 2001 and 2007, from which the RV perturbation was first revealed, have no significant periodicity at any frequency. The LDRs recover the original 21 stellar temperatures with an average accuracy of 45 ± 25 K. The 215 ν Oct temperatures have a standard deviation of only 4.2 K. Assuming the host primary is not pulsating, the temperatures converted to magnitude differences strikingly mimic the very stable photometric Hipparcos observations 15 years previously, implying the long-term stability of the star and demonstrating a novel use of LDRs as a photometric gauge. Our results provide substantial new evidence that conventional star-spots and pulsations are unlikely causes of the RV perturbation. The controversial system deserves continued attention, including with higher resolving-power spectra for bisector and LDR analyses.

UK women's experiences of breastfeeding and additional breastfeeding support: a qualitative study of Baby Café services.

PubMed

Fox, Rebekah; McMullen, Sarah; Newburn, Mary

2015-07-07

Whilst 81 % of UK women initiate breastfeeding, there is a steep decline in breastfeeding rates during the early postnatal period, with just 55 % of women breastfeeding at six weeks. 80 % of these women stopped breastfeeding sooner than they intended, with women citing feeding difficulties and lack of adequate support. As part of efforts to increase breastfeeding continuation rates, many public and voluntary organisations offer additional breastfeeding support services, which provide practical support in the early postnatal period and beyond. This paper focuses on the qualitative experiences of UK users of Baby Café services to examine their experiences of breastfeeding and breastfeeding support. The study was based upon in-depth interviews and focus groups with users of eight Baby Café breastfeeding support groups across the UK. Thirty-six interviews and five focus groups were conducted with a total of fifty-one mothers using the service. Interviews and group discussions were analysed using N Vivo software to draw out key themes and discussions. Whilst each mother's infant feeding journey is unique, reflecting her own personal circumstances and experiences, several themes emerged strongly from the data. Many women felt that they had been given unrealistic expectations of breastfeeding by professionals keen to promote the benefits. This left them feeling unprepared when they encountered pain, problems and relentlessness of early infant feeding, leading to feelings of guilt and inadequacy over their feeding decisions. Mothers valued the combination of expert professional and peer support provided by Baby Café services and emphasised the importance of social support from other mothers in enabling them to continue feeding for as long as they wished. The research emphasises the need for realistic rather than idealistic antenatal preparation and the importance of timely and parent-centred breastfeeding support, particularly in the immediate postnatal weeks. The

Peer support and peer-led family support for persons living with schizophrenia.

PubMed

Duckworth, Kenneth; Halpern, Lisa

2014-05-01

Peer support and peer-led family psychoeducation represent two distinct and complementary recovery-oriented models to support individuals who live with schizophrenia and their families, respectively. The goals of these models focus on improving knowledge, coping, self-care, social support, and self-management strategies. These models represent important capacity-building strategies for people who live with the illness and the people who love them. This brief article is intended to provide the practicing clinician, person living with schizophrenia, and policy maker with a working knowledge of the current state of the literature in these two related fields. Practitioners should consider these resources and integrate them into their care. A person living with schizophrenia could use this review to advocate for appropriate resources and to identify career opportunities. Policy makers could benefit from an understanding of the literature to mitigate financial and cultural barriers to adopting these practices. The last 5 years have seen a dramatic expansion of the application of randomized controlled trials (RCTs) to give evidence to match the experience of people in these programs. The field has seen Wellness Recovery Action Plan (WRAP) named as evidence-based practice by the National Registry of Evidence-Based Practices. A RCT was also conducted for another peer-developed and led program called Building Recovery of Individual Dreams & Goals through Education & Support. Family to Family, the largest peer-led family psychoeducation course, was also found to have significant impact after the study and also 6 months later in RCT. Family to Family has also been named as an evidence-based practice. The field of people who are living well with schizophrenia working as resources and supports to others living with the illness is an idea that is growing momentum. This momentum has been matched by the RCT evidence. Peer support as a professional role has an emerging literature

The Significance of Ongoing Teacher Support in Earth Science Education Programs: Evidence from the GLOBE Program

NASA Astrophysics Data System (ADS)

Penuel, B.; Korbak, C.; Shear, L.

2003-12-01

study, SRI researchers used the data on student data reporting activity from different partners to identify candidate sites for case studies, where we might investigate the nature of follow-up activities provided by successful partners more closely. We worked to select 2 regional partners that had evidence of high percentages of teachers trained that reported data and that also offered follow-up to teachers. Case study researchers conducted observations within 2-3 active GLOBE schools supported by each regional partner organization and interviewed teachers, principals, and partner staff. On the basis of our observation data and transcripts from interviews, we compiled profiles of schools' implementation and analyzed the core activities of each regional partner. Researchers found that keys to promoting successful implementation in one partnership were: one partnership were: close alignment with state mathematics and science initiatives; mentors that helped teachers by modeling inquiry in GLOBE and by assisting with equipment set-up and curriculum planning; and allowing room for schools to adopt diverse goals for GLOBE. In the second partnership, keys to success included a strategic approach to developing funding for the program; a focus on integration of culturally-relevant knowledge into teacher preparation; follow-up support for teachers; and use of GLOBE as an opportunity to investigate local evidence of climate change. Both partner organizations were challenged by funding limitations that prevented them from providing as much follow-up support as they believe is necessary.

SUPPORT Tools for evidence-informed health Policymaking (STP) 15: Engaging the public in 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. In this article, we address strategies to inform and engage the public in policy development and implementation. The importance of engaging the public (both patients and citizens) at all levels of health systems is widely recognised. They are the ultimate recipients of the desirable and undesirable impacts of public policies, and many governments and organisations have acknowledged the value of engaging them in evidence-informed policy development. The potential benefits of doing this include the establishment of policies that include their ideas and address their concerns, the improved implementation of policies, improved health services, and better health. Public engagement can also be viewed as a goal in itself by encouraging participative democracy, public accountability and transparency. We suggest three questions that can be considered with regard to public participation strategies. These are: 1. What strategies can be used when working with the mass media to inform the public about policy development and implementation? 2. What strategies can be used when working with civil society groups to inform and engage them in policy development and implementation? 3. What methods can be used to involve consumers in policy development and implementation? PMID:20018105

Integration of Evidence Base into a Probabilistic Risk Assessment

NASA Technical Reports Server (NTRS)

Saile, Lyn; Lopez, Vilma; Bickham, Grandin; Kerstman, Eric; FreiredeCarvalho, Mary; Byrne, Vicky; Butler, Douglas; Myers, Jerry; Walton, Marlei

2011-01-01

INTRODUCTION: A probabilistic decision support model such as the Integrated Medical Model (IMM) utilizes an immense amount of input data that necessitates a systematic, integrated approach for data collection, and management. As a result of this approach, IMM is able to forecasts medical events, resource utilization and crew health during space flight. METHODS: Inflight data is the most desirable input for the Integrated Medical Model. Non-attributable inflight data is collected from the Lifetime Surveillance for Astronaut Health study as well as the engineers, flight surgeons, and astronauts themselves. When inflight data is unavailable cohort studies, other models and Bayesian analyses are used, in addition to subject matters experts input on occasion. To determine the quality of evidence of a medical condition, the data source is categorized and assigned a level of evidence from 1-5; the highest level is one. The collected data reside and are managed in a relational SQL database with a web-based interface for data entry and review. The database is also capable of interfacing with outside applications which expands capabilities within the database itself. Via the public interface, customers can access a formatted Clinical Findings Form (CLiFF) that outlines the model input and evidence base for each medical condition. Changes to the database are tracked using a documented Configuration Management process. DISSCUSSION: This strategic approach provides a comprehensive data management plan for IMM. The IMM Database s structure and architecture has proven to support additional usages. As seen by the resources utilization across medical conditions analysis. In addition, the IMM Database s web-based interface provides a user-friendly format for customers to browse and download the clinical information for medical conditions. It is this type of functionality that will provide Exploratory Medicine Capabilities the evidence base for their medical condition list

Novel Overhang Support Designs for Powder-Based Electron Beam Additive Manufacturing (EBAM)

NASA Technical Reports Server (NTRS)

Nabors, Sammy A.

2014-01-01

NASA Marshall Space Flight Center, in collaboration with the University of Alabama, has developed a contact-free support structure used to fabricate overhang-type geometries via EBAM. The support structure is used for 3-D metal-printed components for the aerospace, automotive, biomedical and other industries. Current techniques use support structures to address deformation challenges inherent in 3-D metal printing. However, these structures (overhangs) are bonded to the component and need to be removed in post-processing using a mechanical tool. This new technology improves the overhang support structure design for components by eliminating associated geometric defects and post-processing requirements.

Identifying Educational Practices Supported by Rigorous Evidence: A Guide to the Selection of Evidence-Based Practices

ERIC Educational Resources Information Center

Regional Resource Center Program, 2014

2014-01-01

One component of the recently required State Systemic Improvement Plan (SSIP) for State Departments of Education calls for the selection and implementation of evidence-based practices (EBPs). This report provides six steps to guide the process of selecting evidence based practices (EBP): (1) Begin with the End in Mind--Determine Targeted Outcomes;…

Rhizolith evidence in support of a late Holocene sea-level highstand at least 0.5 m higher than present at Key Biscayne, Florida

NASA Astrophysics Data System (ADS)

Froede, Carl R., Jr.

2002-03-01

R. Fairbridge and F. Shepard proposed different sea-level curves for the late Holocene. South Florida, as a tectonically stable platform, provides a key locale from which late Quaternary sea-level measurements have been attempted. Previous studies supporting Holocene sea-level curves have focused on mangrove peat deposits, barrier ridges, and archaeological sites. However, in situ biological indicators provide the best evidence in support of varying sea-level positions during the late Holocene. The northeastern side of Key Biscayne, Florida, has two areas of rock reef where rhizoliths (i.e., fossilized root casts) are exposed within the intertidal zone. They have previously been interpreted as the fossilized roots of a former black mangrove (Avicennia germinans) forest. However, the morphology, size, orientation, and areal extent of the rhizoliths is best understood if they are interpreted as the former root casts of turtle grass (Thalassia testudinum). This interpretation would constitute in situ biological evidence of a late Holocene sea-level position at least 0.5 m higher than at present. Previously published 14C dating of the calcareous paste inside the rhizoliths suggests that they formed 1 2 k.y. before present. This corresponds to a higher than present sea-level highstand supported by independent evidence from other areas in south Florida.

Genetic Evidence Supports the Multiethnic Character of Teopancazco, a Neighborhood Center of Teotihuacan, Mexico (AD 200-600)

PubMed Central

Álvarez-Sandoval, Brenda A.; Manzanilla, Linda R.; González-Ruiz, Mercedes; Malgosa, Assumpció; Montiel, Rafael

2015-01-01

Multiethnicity in Teopancazco, Teotihuacan, is supported by foreign individuals found in the neighborhood center as well as by the diversity observed in funerary rituals at the site. Studies of both stable and strontium isotopes as well as paleodietary analysis, suggest that the population of Teopancazco was composed by three population groups: people from Teotihuacan, people from nearby sites (Tlaxcala-Hidalgo-Puebla), and people from afar, including the coastal plains. In an attempt to understand the genetic dynamics in Teopancazco we conducted an ancient DNA (aDNA) analysis based on mtDNA. Our results show that the level of genetic diversity is consistent with the multiethnicity phenomenon at the neighborhood center. Levels of genetic diversity at different time periods of Teopancazco’s history show that multiethnicity was evident since the beginning and lasted until the collapse of the neighborhood center. However, a PCA and a Neighbor-Joining tree suggested the presence of a genetically differentiated group (buried at the Transitional phase) compared to the population from the initial phase (Tlamimilolpa) as well as the population from the final phase (Xolalpan) of the history of Teopancazco. Genetic studies showed no differences in genetic diversity between males and females in the adult population of Teopancazco, this data along with ample archaeological evidence, suggest a neolocal post-marital pattern of residence in Teopancazco. Nevertheless, genetic analyses on the infant population showed that the males are significantly more heterogeneous than the females suggesting a possible differential role in cultural practices by sex in the infant sector. Regarding interpopulation analysis, we found similar indices of genetic diversity between Teopancazco and heterogeneous native groups, which support the multiethnic character of Teopancazco. Finally, our data showed a close genetic relationship between Teopancazco and populations from the �

Genetic Evidence Supports the Multiethnic Character of Teopancazco, a Neighborhood Center of Teotihuacan, Mexico (AD 200-600).

PubMed

Álvarez-Sandoval, Brenda A; Manzanilla, Linda R; González-Ruiz, Mercedes; Malgosa, Assumpció; Montiel, Rafael

2015-01-01

Multiethnicity in Teopancazco, Teotihuacan, is supported by foreign individuals found in the neighborhood center as well as by the diversity observed in funerary rituals at the site. Studies of both stable and strontium isotopes as well as paleodietary analysis, suggest that the population of Teopancazco was composed by three population groups: people from Teotihuacan, people from nearby sites (Tlaxcala-Hidalgo-Puebla), and people from afar, including the coastal plains. In an attempt to understand the genetic dynamics in Teopancazco we conducted an ancient DNA (aDNA) analysis based on mtDNA. Our results show that the level of genetic diversity is consistent with the multiethnicity phenomenon at the neighborhood center. Levels of genetic diversity at different time periods of Teopancazco's history show that multiethnicity was evident since the beginning and lasted until the collapse of the neighborhood center. However, a PCA and a Neighbor-Joining tree suggested the presence of a genetically differentiated group (buried at the Transitional phase) compared to the population from the initial phase (Tlamimilolpa) as well as the population from the final phase (Xolalpan) of the history of Teopancazco. Genetic studies showed no differences in genetic diversity between males and females in the adult population of Teopancazco, this data along with ample archaeological evidence, suggest a neolocal post-marital pattern of residence in Teopancazco. Nevertheless, genetic analyses on the infant population showed that the males are significantly more heterogeneous than the females suggesting a possible differential role in cultural practices by sex in the infant sector. Regarding interpopulation analysis, we found similar indices of genetic diversity between Teopancazco and heterogeneous native groups, which support the multiethnic character of Teopancazco. Finally, our data showed a close genetic relationship between Teopancazco and populations from the "Teotihuacan corridor

Force That Increases at Larger Distance Has Some Psychological and Astronomical Evidence Supporting its Existence

NASA Astrophysics Data System (ADS)

Struck, James

2011-09-01

Force that Increases with distance is different than dark energy as I am arguing for existence of force based on psychological and astronomical bases. Hubble shift, doppler shift, comet return, quasar zoo and quasars and psychological evidence of interest in distant objects lends support to a force like gravity, nuclear, weak, strong, virtual, decay, biological, growth forces which increases its intensity with distance unlike gravity which decreases in intensity with distance. Jane Frances Back Struck contributed to this finding with her request that her grandparents have "perfect justice" even though her grandparents had died before she was born; interest increasing with distance from grandparents.

Newborn screening for proximal urea cycle disorders: Current evidence supporting recommendations for newborn screening.

PubMed

Merritt, J Lawrence; Brody, Linnea L; Pino, Gisele; Rinaldo, Piero

2018-04-20

Current newborn screening (NBS) for urea cycle disorders (UCD) is incomplete as only distal UCDs are included in most NBS programs by measuring elevated amino acid concentrations. NBS for the proximal UCDs involves the detection in NBS spots of low citrulline values, a finding which is often overlooked because it is considered to be inadequate. We retrospectively analyzed NBS blood spots from known UCD patients comparing the utility of the Region 4 Stork (R4S) interpretive tools to conventional cutoff based interpretation. This study shows the utility of R4S tools in detecting all UCDs, and provides evidence to support the nomination to add proximal UCDs to the recommended uniform screening panel. Copyright © 2018 Elsevier Inc. All rights reserved.

The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance.

PubMed

Balen, Adam H; Morley, Lara C; Misso, Marie; Franks, Stephen; Legro, Richard S; Wijeyaratne, Chandrika N; Stener-Victorin, Elisabet; Fauser, Bart C J M; Norman, Robert J; Teede, Helena

2016-11-01

Here we describe the consensus guideline methodology, summarise the evidence-based recommendations we provided to the World Health Organisation (WHO) for their consideration in the development of global guidance and present a narrative review on the management of anovulatory infertility in women with polycystic ovary syndrome (PCOS). The aim of this paper was to present an evidence base for the management of anovulatory PCOS. The evidence to support providing recommendations involved a collaborative process for: (i) identification of priority questions and critical outcomes, (ii) retrieval of up-to-date evidence and exiting guidelines, (iii) assessment and synthesis of the evidence and (iv) the formulation of draft recommendations to be used for reaching consensus with a wide range of global stakeholders. For each draft recommendation, the methodologist evaluated the quality of the supporting evidence that was then graded as very low, low, moderate or high for consideration during consensus. Evidence was synthesized and we made recommendations across the definition of PCOS including hyperandrogenism, menstrual cycle regulation and ovarian assessment. Metabolic features and the impact of ethnicity were covered. Management includes lifestyle changes, bariatric surgery, pharmacotherapy (including clomiphene citrate (CC), aromatase inhibitors, metformin and gonadotropins), as well as laparoscopic surgery. In-vitro fertilization (IVF) was considered as were the risks of ovulation induction and of pregnancy in PCOS. Approximately 80% of women who suffer from anovulatory infertility have PCOS. Lifestyle intervention is recommended first in women who are obese largely on the basis of general health benefits. Bariatric surgery can be considered where the body mass index (BMI) is ≥35 kg/m 2 and lifestyle therapy has failed. Carefully conducted and monitored pharmacological ovulation induction can achieve good cumulative pregnancy rates and multiple pregnancy rates can be

The Relationship Between College Zoology Students' Religious Beliefs and Their Ability to Objectively View the Scientific Evidence Supporting Evolutionary Theory.

ERIC Educational Resources Information Center

Sinclair, Anne; Baldwin, Beatrice

An anonymous 12-item, multiple-choice questionnaire was administered to 218 southern college, introductory zoology students prior to and following a study of evolutionary theory to assess their understanding and acceptance of the credibility of the evidence supporting the theory. Key topics addressed were the history of evolutionary thought, basic…

Supportive interventions for enhancing dietary intake in malnourished or nutritionally at-risk adults.

PubMed

Baldwin, Christine; Kimber, Katherine L; Gibbs, Michelle; Weekes, Christine Elizabeth

2016-12-20

Supportive interventions such as serving meals in a dining room environment or the use of assistants to feed patients are frequently recommended for the management of nutritionally vulnerable groups. Such interventions are included in many policy and guideline documents and have implications for staff time but may incur additional costs, yet there appears to be a lack of evidence for their efficacy. To assess the effects of supportive interventions for enhancing dietary intake in malnourished or nutritionally at-risk adults. We identified publications from comprehensive searches of the Cochrane Library, MEDLINE, Embase, AMED, British Nursing Index, CINAHL, SCOPUS, ISI Web of Science databases, scrutiny of the reference lists of included trials and related systematic reviews and handsearching the abstracts of relevant meetings. The date of the last search for all databases was 31 March 2013. Additional searches of CENTRAL, MEDLINE, ClinicalTrials.gov and WHO ICTRP were undertaken to September 2016. The date of the last search for these databases was 14 September 2016. Randomised controlled trials of supportive interventions given with the aim of enhancing dietary intake in nutritionally vulnerable adults compared with usual care. Three review authors and for the final search, the editor, selected trials from titles and abstracts and independently assessed eligibility of selected trials. Two review authors independently extracted data and assessed risk of bias, as well as evaluating overall quality of the evidence utilising the GRADE instrument, and then agreed as they entered data into the review. The likelihood of clinical heterogeneity amongst trials was judged to be high as trials were in populations with widely different clinical backgrounds, conducted in different healthcare settings and despite some grouping of similar interventions, involved interventions that varied considerably. We were only able, therefore, to conduct meta-analyses for the outcome measures

Introducing embedded indigenous psychological support teams: a suggested addition to psychological first aid in an international context.

PubMed

Edwards-Stewart, Amanda; Ahmad, Zeba S; Thoburn, John W; Furman, Rich; Lambert, Ashly J; Shelly, Lauren; Gunn, Ginger

2012-01-01

The current article introduces Embedded Indigenous Psychological Support Teams (IPST) as a possible addition to current disaster relief efforts. This article highlights psychological first aid in an international context by drawing on mainstream disaster relief models such as The American Red Cross, Critical Incident Stress Management, and Flexible Psychological First Aid. IPST are explained as teams utilizing techniques from both CISM and FPFA with a focus on resiliency. It is currently theorized that in utilizing IPST existing disaster relief models may be more effective in mitigating negative physical or mental health consequences post-disaster.

Evidence-based financial management.

PubMed

Finkler, Steven A; Henley, Richard J; Ward, David M

2003-10-01

Like the practice of evidence-based medicine, evidence-based financial management can be used by providers to improve results. The concept provides a framework that managers and researchers can use to help direct efforts in gathering and using evidence to support management decisions in health care.

How is research evidence used to support claims made in advertisements for wound care products?

PubMed

Dumville, Jo C; Petherick, Emily S; O'Meara, Susan; Raynor, Pauline; Cullum, Nicky

2009-05-01

To investigate the amount, type and accuracy of citations use in support of product related claims from advertisements of wound care products. Although articles submitted to most medical journals are subjected to peer review, such scrutiny is often not required for the content of advertisements. A contents survey of advertisements from two wound care journals (Journal of Wound Care and Ostomy Wound Management) from 2002-2003 and the British Medical Journal, 2002-2003. Data collected from advertisements included identification of product related claims made and any corresponding citations. Where journal articles were cited to support claims, the articles were obtained. Where data on file were cited, this material was requested. In each case the accuracy of claims in relation to the content of the supporting citation was assessed. The use of citations to support product related claims was infrequent in advertisements from wound care journals, where 35% of advertisements containing a product related claim also contained at least one citation, compared with 63% of advertisements from the British Medical Journal. Of citations that were supplied, journal articles were less common in the wound journals (40% vs. 73% in the British Medical Journal) and data on file more common (38% vs. 6% in the British Medical Journal). Where journal articles were obtained, 56% of claims in the wound care journals advertisements were not supported by the cited article, compared with 12% of claims in the British Medical Journal. The wound journals advertised predominantly medical devices. The use and accuracy of referencing in advertisements from wound care journals was poor. Nurses have increasing responsibilities for the prescribing of both drugs and devices, which must be accompanied by the ability to interpret marketing materials and research evidence critically. Nurse educators must ensure that nurse education generally and nurse prescriber training particularly, builds skills of

A Practical Protocol for Situating Evidence-Based Mental Health Programs and Practices within School-Wide Positive Behavioral Interventions and Supports

ERIC Educational Resources Information Center

Runge, Timothy J.; Knoster, Timothy P.; Moerer, Deanna; Breinich, Todd; Palmiero, James

2017-01-01

Schools have limited experience and little guidance to identify and install evidence-based and promising programs and practices/interventions (EBPs) within advanced tiers of School-Wide Positive Behavioral Intervention and Supports (SWPBIS). One form of guidance is the Hexagon Tool which can be used to ensure a match between the EBP and student…

Should luteal phase support be introduced in ovarian stimulation/IUI programmes? An evidence-based review.

PubMed

Cohlen, B J

2009-01-01

World-wide, intrauterine insemination (IUI) is still one of the most applied techniques to enhance the probability of conception in couples with longstanding subfertility. The outcome of this treatment option depends on many confounding factors. One of the confounding factors receiving little attention is the quality of the luteal phase. From IVF studies, it is known that ovarian stimulation causes luteal phase deficiency. Based on the best available evidence, this short review summarizes the indications for mild ovarian stimulation combined with IUI and the optimal stimulation programme. While it has been established that stimulated IVF/intracytoplasmic sperm injection cycles have deficient luteal phases, the question remains whether the quality of the luteal phase when only two or three corpora lutea are present (as is the case in stimulated IUI cycles) is impaired as well. There are too few large non-IVF trials studying luteal phase quality to answer this question. Recently a randomized trial has been published that investigated luteal phase support in an IUI programme. This study is discussed in detail. It is recommended to apply luteal phase support in stimulated IUI cycles only when proven costeffective. Further trials are mandatory to investigate both endometrial and hormonal profile changes in the luteal phase after mild ovarian stimulation, and the cost-effectiveness of luteal support in IUI programmes.

Development and preliminary evidence for the validity of an instrument assessing implementation of human-factors principles in medication-related decision-support systems—I-MeDeSA

PubMed Central

Zachariah, Marianne; Seidling, Hanna M; Neri, Pamela M; Cresswell, Kathrin M; Duke, Jon; Bloomrosen, Meryl; Volk, Lynn A; Bates, David W

2011-01-01

Background Medication-related decision support can reduce the frequency of preventable adverse drug events. However, the design of current medication alerts often results in alert fatigue and high over-ride rates, thus reducing any potential benefits. Methods The authors previously reviewed human-factors principles for relevance to medication-related decision support alerts. In this study, instrument items were developed for assessing the appropriate implementation of these human-factors principles in drug–drug interaction (DDI) alerts. User feedback regarding nine electronic medical records was considered during the development process. Content validity, construct validity through correlation analysis, and inter-rater reliability were assessed. Results The final version of the instrument included 26 items associated with nine human-factors principles. Content validation on three systems resulted in the addition of one principle (Corrective Actions) to the instrument and the elimination of eight items. Additionally, the wording of eight items was altered. Correlation analysis suggests a direct relationship between system age and performance of DDI alerts (p=0.0016). Inter-rater reliability indicated substantial agreement between raters (κ=0.764). Conclusion The authors developed and gathered preliminary evidence for the validity of an instrument that measures the appropriate use of human-factors principles in the design and display of DDI alerts. Designers of DDI alerts may use the instrument to improve usability and increase user acceptance of medication alerts, and organizations selecting an electronic medical record may find the instrument helpful in meeting their clinicians' usability needs. PMID:21946241

[Insufficient evidence supporting iron supplementation in anaemia during pregnancy].

PubMed

Wiegerinck, Melanie M; Mol, Ben Willem J

2012-01-01

The Royal Dutch Organization of Midwives (KNOV) recently presented their practice guideline 'Anaemia in midwifery practice'. The guideline identified available evidence on diagnosis, prognosis and treatment of anaemia in pregnancy. Anaemia based on iron deficiency and subsequent treatment with iron supplementation are probably the most frequent aspects of care for pregnant women. However, there is surprisingly enough no evidence of the efficacy of iron supplementation treatment on relevant clinical outcomes in pregnant women with anaemia. We plead to make the next guideline a multidisciplinary one. Such a guideline may lead to a large pragmatic trial evaluating the efficacy of iron supplementation treatment for patients with anaemia.

An Analysis of School Wide Supports and Barriers to Collaborative Problem Solving Teams

ERIC Educational Resources Information Center

Ciampaglia, Brie I.

2010-01-01

While there is preliminary evidence supporting the use of collaborative problem solving teams in schools (e.g., Telzrow, McNamara, & Hollinger, 2000) only a few outcome measures have been explored in relation to these procedures, and the results have been inconsistently demonstrated across projects (Burns & Symington, 2002). Additionally, it has…

What is the effect of additional physiotherapy on sitting balance following stroke compared to standard physiotherapy treatment: a systematic review.

PubMed

Bank, Jessica; Charles, Katherine; Morgan, Prue

2016-02-01

Sitting balance dysfunction is commonly experienced following stroke. Physiotherapists utilize interventions to address this problem but it is unclear whether treatment type, target or practice intensity may affect outcomes. To compare the effects of standard physiotherapy to standard physiotherapy plus an additional physiotherapy treatment after stroke. The databases of Cochrane Library, CINAHL, Embase, Ovid Medline, AMED, and the Physiotherapy Evidence Database (PEDro) up to December 2014 were searched. Randomized controlled trials in English reported in peer-reviewed journals regarding the effect of additional physiotherapy on sitting balance were retrieved. The PEDro scale was used to assess study quality. Eleven studies met inclusion criteria. Nine targeted the ICF (International Classification of Function, Disability and Health) domain of Activity. The Trunk control test (TCT) was used as a primary outcome measure in five studies, and the Trunk Impairment Scale (TIS) was used in four. There was a significant effect (mean difference = 1.67, 95% CI = 0.54-2.80) favoring intervention, as measured by the TIS. There was no evidence to support the effect of additional treatment on sitting balance as measured by the TCT (mean difference = - 1.53, 95% CI = - 9.37 to 6.32). The current evidence supports strategies that target deficits at the activity level and increase total treatment time. The TIS is most responsive as a measure of treatment efficacy. Further research is required using recommended outcome measures to facilitate generation of a minimum data set and data pooling.

Psychosocially Supportive Design: The Case for Greater Attention to Social Space Within the Pediatric Hospital.

PubMed

McLaughlan, Rebecca

2018-04-01

Models of patient and family-centered care advocate catering to psychosocial needs when designing healthcare facilities yet there is little evidence available to determine how the built environment can cater to psychosocial needs. This article highlights the obstacles to overcoming this knowledge deficit in the pursuit of evidence-based guidelines to inform social provisions within the pediatric hospital setting. It will propose a working definition for psychosocial space and identify new research directions to enhance understandings of the relationship between social space and well-being. While traditional multibed ward configurations afforded opportunities for peer support relationships to develop, both for patients and caregivers, the contemporary preference for single-occupancy rooms intensifies the need to critically examine social spaces within the pediatric hospital. Research suggests a correlation between social support and well-being. This article reviews the research underpinning contemporary understandings of this relationship; it positions literature from sociology, environmental psychology, and evidence-based design to highlight the limitations of this knowledge and identify where additional research is required to inform evidence-based design guidelines for psychosocially supportive spaces within pediatric healthcare settings. Evidence regarding the therapeutic value of social support within the pediatric hospital is not sufficiently sophisticated or conclusive to inform guidelines for the provision of social space with pediatric hospitals. There is an urgent need for targeted research to inform evidence-based design guidelines; this will demand a broad disciplinary approach.

On-the-Job Evidence-Based Medicine Training for Clinician-Scientists of the Next Generation.

PubMed

Leung, Elaine Yl; Malick, Sadia M; Khan, Khalid S

2013-08-01

Clinical scientists are at the unique interface between laboratory science and frontline clinical practice for supporting clinical partnerships for evidence-based practice. In an era of molecular diagnostics and personalised medicine, evidence-based laboratory practice (EBLP) is also crucial in aiding clinical scientists to keep up-to-date with this expanding knowledge base. However, there are recognised barriers to the implementation of EBLP and its training. The aim of this review is to provide a practical summary of potential strategies for training clinician-scientists of the next generation. Current evidence suggests that clinically integrated evidence-based medicine (EBM) training is effective. Tailored e-learning EBM packages and evidence-based journal clubs have been shown to improve knowledge and skills of EBM. Moreover, e-learning is no longer restricted to computer-assisted learning packages. For example, social media platforms such as Twitter have been used to complement existing journal clubs and provide additional post-publication appraisal information for journals. In addition, the delivery of an EBLP curriculum has influence on its success. Although e-learning of EBM skills is effective, having EBM trained teachers available locally promotes the implementation of EBM training. Training courses, such as Training the Trainers, are now available to help trainers identify and make use of EBM training opportunities in clinical practice. On the other hand, peer-assisted learning and trainee-led support networks can strengthen self-directed learning of EBM and research participation among clinical scientists in training. Finally, we emphasise the need to evaluate any EBLP training programme using validated assessment tools to help identify the most crucial ingredients of effective EBLP training. In summary, we recommend on-the-job training of EBM with additional focus on overcoming barriers to its implementation. In addition, future studies evaluating the

On-the-Job Evidence-Based Medicine Training for Clinician-Scientists of the Next Generation

PubMed Central

Leung, Elaine YL; Malick, Sadia M; Khan, Khalid S

2013-01-01

Clinical scientists are at the unique interface between laboratory science and frontline clinical practice for supporting clinical partnerships for evidence-based practice. In an era of molecular diagnostics and personalised medicine, evidence-based laboratory practice (EBLP) is also crucial in aiding clinical scientists to keep up-to-date with this expanding knowledge base. However, there are recognised barriers to the implementation of EBLP and its training. The aim of this review is to provide a practical summary of potential strategies for training clinician-scientists of the next generation. Current evidence suggests that clinically integrated evidence-based medicine (EBM) training is effective. Tailored e-learning EBM packages and evidence-based journal clubs have been shown to improve knowledge and skills of EBM. Moreover, e-learning is no longer restricted to computer-assisted learning packages. For example, social media platforms such as Twitter have been used to complement existing journal clubs and provide additional post-publication appraisal information for journals. In addition, the delivery of an EBLP curriculum has influence on its success. Although e-learning of EBM skills is effective, having EBM trained teachers available locally promotes the implementation of EBM training. Training courses, such as Training the Trainers, are now available to help trainers identify and make use of EBM training opportunities in clinical practice. On the other hand, peer-assisted learning and trainee-led support networks can strengthen self-directed learning of EBM and research participation among clinical scientists in training. Finally, we emphasise the need to evaluate any EBLP training programme using validated assessment tools to help identify the most crucial ingredients of effective EBLP training. In summary, we recommend on-the-job training of EBM with additional focus on overcoming barriers to its implementation. In addition, future studies evaluating the

Supporting Universal Prevention Programs: A Two-Phased Coaching Model

PubMed Central

Becker, Kimberly D.; Darney, Dana; Domitrovich, Celene; Keperling, Jennifer Pitchford; Ialongo, Nicholas S.

2013-01-01

Schools are adopting evidence-based programs designed to enhance students’ emotional and behavioral competencies at increasing rates (Hemmeter, Snyder, & Artman, 2011). At the same time, teachers express the need for increased support surrounding implementation of these evidence-based programs (Carter & Van Norman, 2010). Ongoing professional development in the form of coaching may enhance teacher skills and implementation (Noell et al., 2005; Stormont, Reinke, Newcomer, Darney, & Lewis, 2012). There exists a need for a coaching model that can be applied to a variety of teacher skill levels and one that guides coach decision-making about how best to support teachers. This article provides a detailed account of a two-phased coaching model with empirical support developed and tested with coaches and teachers in urban schools (Becker, Bradshaw, Domitrovich, & Ialongo, 2013). In the initial universal coaching phase, all teachers receive the same coaching elements regardless of their skill level. Then, in the tailored coaching phase, coaching varies according to the strengths and needs of each teacher. Specifically, more intensive coaching strategies are used only with teachers who need additional coaching supports whereas other teachers receive just enough support to consolidate and maintain their strong implementation. Examples of how coaches used the two-phased coaching model when working with teachers who were implementing two universal prevention programs (i.e., the PATHS® curriculum and PAX Good Behavior Game [PAX GBG]) provide illustrations of the application of this model. The potential reach of this coaching model extends to other school-based programs as well as other settings in which coaches partner with interventionists to implement evidence-based programs. PMID:23660973

Evidence of linkage and association on chromosome 20 for late-onset Alzheimer disease.

PubMed

Goddard, Katrina A B; Olson, Jane M; Payami, Haydeh; van der Voet, Monique; Kuivaniemi, Helena; Tromp, Gerard

2004-06-01

Recently, we reported evidence of linkage on chromosome 20 for Alzheimer disease (AD) using a novel statistical approach to incorporate covariates (e.g., age, ApoE genotype) into the analysis. These results suggest that very elderly subjects (>85 years), and individuals who carry an epsilon2 allele at the ApoE locus are more likely to be linked to this candidate region. The region on chromosome 20 includes a strong candidate gene, cystatin C (CST3), which has previously been associated with AD in case-control studies. We investigated these findings further by genotyping additional markers to narrow the candidate region, and to identify evidence of linkage disequilibrium as additional support for a susceptibility locus on chromosome 20. We selected 43 elderly sibships (89 subjects) from the NIMH AD Genetics Initiative based on current age older than 84 years, and identified 129 unrelated control subjects who were older than 84 years from the Oregon Brain Aging Study to conduct linkage and association studies in this region. Fourteen additional markers were evaluated, including 4 markers located within or near CST3. We narrowed the candidate region on chromosome 20 to an 11.8-cM region between markers D20S174 and D20S471, which includes the CST3 candidate gene. In addition, we observed evidence of association for markers located near the CST3 candidate gene, with P values between 0.002 and 0.08 for two-locus haplotypes. These results support the presence of a susceptibility locus for AD in the vicinity of CST3 for very elderly subjects with AD.

Evidence- and practice-informed approach to implementing peer grief support after suicide systematically in the USA.

PubMed

Cook, Franklin James; Langford, Linda; Ruocco, Kim

2017-01-01

The landmark report, Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines, identifies the suicide bereaved as an underserved population and recommends systematic development of peer grief support to help meet the needs of survivors of suicide loss. A widespread array of peer grief support after suicide (PGSS) services exists nationally, but only as a decentralized network of autonomous programs. Some research indicates that peer support is generally helpful to the suicide bereaved, a finding that is reinforced by a large body of emerging research showing that peer support is effective in mental illness and substance abuse recovery. The practice, study, growth, and refinement of peer support in those fields have generated viable ideas about the elements and principles of effective peer support-for individual practitioners and for programs and organizations-that could be used to guide the systematic implementation of PGSS. In addition, a comprehensive PGSS program (Tragedy Assistance Program for Survivors) that currently serves a large population-survivors of suicide in the military-could be a model for national PGSS systems development. Finally, there are several frameworks for systems development-zero suicide, consumer-operated services, recovery-oriented systems of care, and the consumer action research model-that could guide the expansion and increased effectiveness of PGSS in keeping with the Guidelines' recommendation.

Students' abilities to critique scientific evidence when reading and writing scientific arguments

NASA Astrophysics Data System (ADS)

Knight, Amanda M.

Scientific arguments are used to persuade others for explanations that make sense of the natural world. Over time, through the accumulation of evidence, one explanation for a scientific phenomenon tends to take precedence. In science education, arguments make students' thinking and reasoning visible while also supporting the development of their conceptual, procedural, and epistemic knowledge. As such, argumentation has become a goal within recent policy documents, including the Next Generation Science Standards, which, in turn, presents a need for comprehensive, effective, and scalable assessments. This dissertation used assessments that measure students' abilities to critique scientific evidence, which is measured in terms of the form of justification and the support of empirical evidence, when reading and writing scientific arguments. Cognitive interviews were then conducted with a subset of the students to explore the criteria they used to critique scientific evidence. Specifically, the research investigated what characteristics of scientific evidence the students preferred, how they critiqued both forms of justification and empirical evidence, and whether the four constructs represented four separate abilities. Findings suggest that students' prioritized the type of empirical evidence to the form of justification, and most often selected relevant-supporting justifications. When writing scientific arguments, most students constructed a justified claim, but struggled to justify their claims with empirical evidence. In comparison, when reading scientific arguments, students had trouble locating a justification when it was not empirical data. Additionally, it was more difficult for students to critique than identify or locate empirical evidence, and it was more difficult for students to identify than locate empirical evidence. Findings from the cognitive interviews suggest that students with more specific criteria tended to have more knowledge of the construct

Prayer in Clinical Practice: what does evidence support?

PubMed

Kim-Godwin, YeounSoo

2013-01-01

A Korean-born U.S. nurse educator shares a perspective on prayer in clinical settings in South Korea and asks what appropriate, ethical prayer practice should be in the United States. A review of research on prayer for health and in nursing practice is offered, concluding with evidence-based suggestions for prayer with and for patients in clinical settings.

Danish evidence-based clinical guideline for use of nutritional support in pulmonary rehabilitation of undernourished patients with stable COPD.

PubMed

Beck, Anne Marie; Iepsen, Ulrik Winning; Tobberup, Randi; Jørgensen, Karsten Juhl

2015-02-01

Disease-related under-nutrition is a common problem in individuals with COPD. The rationale for nutritional support in pulmonary rehabilitation therefore seems obvious. However there is limited evidence regarding the patient-relevant outcomes i.e. activities of daily living (ADL) or quality of life. Therefore the topic was included in The Danish Health and Medicines Authority's development of an evidence-based clinical guideline for rehabilitation of patients with stable COPD. The methods were specified by The Danish Health and Medicines Authority as part of a standardized approach to evidence-based national clinical practice guidelines. They included formulation of a PICO with pre-defined criteria for the Population, Intervention, Control and Outcomes. Existing guidelines or systematic reviews were used after assessment using the AGREE II tool or AMSTAR, if possible. We identified primary studies by means of a systematic literature search (July to December 2013), and any identified studies were then quality assessed using the Cochrane risk of bias tool and the GRADE approach. The extracted data on our pre-defined outcomes were summarized in meta-analyses when possible, or meta-analyses from existing guidelines or systematic reviews were adapted. The results were used for labeling and wording of the recommendations. Data from 12 randomized controlled trials were included in a systematic review, which formed the basis for our recommendations as no new primary studies had been published. There were evidence of moderate quality that nutritional support for undernourished patients with COPD lead to a weight gain of 1.7kg (95% confidence interval: 1.3 to 2.2kg), but the effect was quantified as a mean change from baseline, which is less reliable. There were evidence of moderate quality that nutritional therapy does not increase in the 6 minute walking distance of 13 m (95% confidence interval: -27 to 54 m) when results in the intervention and control groups were

Evidence supporting radiation hormesis in atomic bomb survivor cancer mortality data.

PubMed

Doss, Mohan

2012-12-01

A recent update on the atomic bomb survivor cancer mortality data has concluded that excess relative risk (ERR) for solid cancers increases linearly with dose and that zero dose is the best estimate for the threshold, apparently validating the present use of the linear no threshold (LNT) model for estimating the cancer risk from low dose radiation. A major flaw in the standard ERR formalism for estimating cancer risk from radiation (and other carcinogens) is that it ignores the potential for a large systematic bias in the measured baseline cancer mortality rate, which can have a major effect on the ERR values. Cancer rates are highly variable from year to year and between adjacent regions and so the likelihood of such a bias is high. Calculations show that a correction for such a bias can lower the ERRs in the atomic bomb survivor data to negative values for intermediate doses. This is consistent with the phenomenon of radiation hormesis, providing a rational explanation for the decreased risk of cancer observed at intermediate doses for which there is no explanation based on the LNT model. The recent atomic bomb survivor data provides additional evidence for radiation hormesis in humans.

Authentication of digital video evidence

NASA Astrophysics Data System (ADS)

Beser, Nicholas D.; Duerr, Thomas E.; Staisiunas, Gregory P.

2003-11-01

In response to a requirement from the United States Postal Inspection Service, the Technical Support Working Group tasked The Johns Hopkins University Applied Physics Laboratory (JHU/APL) to develop a technique tha will ensure the authenticity, or integrity, of digital video (DV). Verifiable integrity is needed if DV evidence is to withstand a challenge to its admissibility in court on the grounds that it can be easily edited. Specifically, the verification technique must detect additions, deletions, or modifications to DV and satisfy the two-part criteria pertaining to scientific evidence as articulated in Daubert et al. v. Merrell Dow Pharmaceuticals Inc., 43 F3d (9th Circuit, 1995). JHU/APL has developed a prototype digital video authenticator (DVA) that generates digital signatures based on public key cryptography at the frame level of the DV. Signature generation and recording is accomplished at the same time as DV is recorded by the camcorder. Throughput supports the consumer-grade camcorder data rate of 25 Mbps. The DVA software is implemented on a commercial laptop computer, which is connected to a commercial digital camcorder via the IEEE-1394 serial interface. A security token provides agent identification and the interface to the public key infrastructure (PKI) that is needed for management of the public keys central to DV integrity verification.

Tafamidis delays disease progression in patients with early stage transthyretin familial amyloid polyneuropathy: additional supportive analyses from the pivotal trial.

PubMed

Keohane, Denis; Schwartz, Jeffrey; Gundapaneni, Balarama; Stewart, Michelle; Amass, Leslie

2017-03-01

Tafamidis, a non-NSAID highly specific transthyretin stabilizer, delayed neurologic disease progression as measured by Neuropathy Impairment Score-Lower Limbs (NIS-LL) in an 18-month, double-blind, placebo-controlled randomized trial in 128 patients with early-stage transthyretin V30M familial amyloid polyneuropathy (ATTRV30M-FAP). The current post hoc analyses aimed to further evaluate the effects of tafamidis in delaying ATTRV30M-FAP progression in this trial. Pre-specified, repeated-measures analysis of change from baseline in NIS-LL in this trial (ClinicalTrials.gov NCT00409175) was repeated with addition of baseline as covariate and multiple imputation analysis for missing data by treatment group. Change in NIS-LL plus three small-fiber nerve tests (NIS-LL + Σ3) and NIS-LL plus seven nerve tests (NIS-LL + Σ7) were assessed without baseline as covariate. Treatment outcomes over the NIS-LL, Σ3, Σ7, modified body mass index and Norfolk Quality of Life-Diabetic Neuropathy Total Quality of Life Score were also examined using multivariate analysis techniques. Neuropathy progression based on NIS-LL change from baseline to Month 18 remained significantly reduced for tafamidis versus placebo in the baseline-adjusted and multiple imputation analyses. NIS-LL + Σ3 and NIS-LL + Σ7 captured significant treatment group differences. Multivariate analyses provided strong statistical evidence for a superior tafamidis treatment effect. These supportive analyses confirm that tafamidis delays neurologic progression in early-stage ATTRV30M-FAP. NCT00409175.

Supporting Evidence Use in Networked Professional Learning: The Role of the Middle Leader

ERIC Educational Resources Information Center

LaPointe-McEwan, Danielle; DeLuca, Christopher; Klinger, Don A.

2017-01-01

Background: In Canada, contemporary collaborative professional learning models for educators utilise multiple forms of evidence to inform practice. Commonly, two forms of evidence are prioritised: (a) research-based evidence and (b) classroom-based evidence of student learning. In Ontario, the integration of these two forms of evidence within…

Supporting evidence-based practice for nurses through information technologies.

PubMed

Doran, Diane M; Haynes, R Brian; Kushniruk, André; Straus, Sharon; Grimshaw, Jeremy; Hall, Linda McGillis; Dubrowski, Adam; Di Pietro, Tammie; Newman, Kristine; Almost, Joan; Nguyen, Ha; Carryer, Jennifer; Jedras, Dawn

2010-03-01

To evaluate the usability of mobile information terminals, such as personal digital assistants (PDAs) or Tablet personal computers, to improve access to information resources for nurses and to explore the relationship between PDA or Tablet-supported information resources and outcomes. The authors evaluated an initiative of the Nursing Secretariat, Ontario Ministry of Health and Long-Term Care, which provided nurses with PDAs and Tablet PCs, to enable Internet access to information resources. Nurses had access to drug and medical reference information, best practice guidelines (BPGs), and to abstracts of recent research studies. The authors took place over a 12-month period. Diffusion of Innovation theory and the Promoting Action on Research Implementation in Health Services (PARIHS) model guided the selection of variables for study. A longitudinal design involving questionnaires was used to evaluate the impact of the mobile technologies on barriers to research utilization, perceived quality of care, and on nurses' job satisfaction. The setting was 29 acute care, long-term care, home care, and correctional organizations in Ontario, Canada. The sample consisted of 488 frontline-nurses. Nurses most frequently consulted drug and medical reference information, Google, and Nursing PLUS. Overall, nurses were most satisfied with the Registered Nurses Association of Ontario (RNAO) BPGs and rated the RNAO BPGs as the easiest resource to use. Among the PDA and Tablet users, there was a significant improvement in research awareness/values, and in communication of research. There was also, for the PDA users only, a significant improvement over time in perceived quality of care and job satisfaction, but primarily in long-term care settings. It is feasible to provide nurses with access to evidence-based practice resources via mobile information technologies to reduce the barriers to research utilization.

Supporting middle school students' construction of evidence-based arguments: Impact of and student interactions with computer-based argumentation scaffolds

NASA Astrophysics Data System (ADS)

Belland, Brian Robert

Middle school students have difficulty creating evidence-based arguments (EBAs) during problem-based learning (PBL) units due to challenges (a) adequately representing the unit's central problem (Ge & Land, 2004; Liu & Bera, 2005), (b) determining and obtaining the most relevant evidence (Pedersen & Liu, 2002-2003), and (c) synthesizing gathered information to construct a sound argument (Cho & Jonassen, 2002). I designed and developed the Connection Log to support middle school students in this process. This study addressed (1) the Connection Log's impact on (a) argument evaluation ability, and (b) group argument quality and (2) how and why middle school science students used the Connection Log. Four sections of a 7th-grade science class participated. Student groups selected a stakeholder position related to the Human Genome Project (HGP) and needed to decide on and promote a plan to use $3 million to further their position as pertains to the HGP. I randomly assigned one higher-achieving and one lower-achieving class to Connection Log or no Connection Log conditions. Students completed an argument evaluation test, and impact on argument evaluation ability was determined using nested ANOVA. Two graduate students, blind to treatment conditions, rated group arguments, and impact on group argument quality was determined using nested MANOVA. To determine how and why students used the Connection Log, I videotaped and interviewed one small group from each class in the experimental condition. I coded transcripts and generated themes, triangulating the two data sources with informal observations during all class sessions and what students wrote in the Connection Log. I detected no significant differences on claim, evidence, or connection of claim to evidence ratings of debate performances. However, students used the Connection Log to counter different difficulties, and I found a significant main effect of the Connection Log on argument evaluation ability, as well as a

Evidence-based medicine: medical librarians providing evidence at the point of care.

PubMed

Yaeger, Lauren H; Kelly, Betsy

2014-01-01

Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. .. by best available external clinical evidence we mean clinically relevant research.' Health care reform authorized by the Affordable Care Act is based on the belief that evidence-based practice (EBP) generates cost savings due to the delivery of more effective care.2 Medical librarians, skilled in identifying appropriate resources and working with multiple complex interfaces, can support clinicians' efforts to practice evidence based medicine by providing time and expertise in articulating the clinical question and identifying the best evidence.

Social Support, Network Structure, and the Inventory of Socially Supportive Behaviors.

ERIC Educational Resources Information Center

Stokes, Joseph P.; Wilson, Diane Grimard

The Inventory of Socially Supportive Behaviors (ISSB) appears to be a satisfactory measure of social support with good reliability and some evidence of validity. To investigate the dimensionality of the ISSB through factor analytic procedures and to predict social support from social network variables, 179 college students (97 male, 82 female)…

Support of the supporters.

PubMed

Stiefel, F

2008-02-01

A growing body of evidence indicates that health care professionals working with severely ill patients are in need of support. Beside "external" factors, such as heavy clinical patient volume or administrative duties, "intra-psychic stressors," related to the inner significance of contextual factors, are an important source of clinician's distress. Identification of and working through intrapsychic stressors can considerably reduce psychological distress and thus provide effective and long-lasting support of the oncology clinician. This article discusses key elements of intra-psychic stressors, namely (1) emotions towards the patient, (2) awareness of own limits, (3) confusion about empathy, identification, counter-transference and collusion, (4) the influence of early development and life trajectory on career choices and professional identity and (5) the conflicting roles a health care professional being in need of support has to face.

Communicating statin evidence to support shared decision-making.

PubMed

Barrett, Bruce; Ricco, Jason; Wallace, Margaret; Kiefer, David; Rakel, Dave

2016-04-06

The practice of clinical medicine rests on a foundation of ethical principles as well as scientific knowledge. Clinicians must artfully balance the principle of beneficence, doing what is best for patients, with autonomy, allowing patients to make their own well-informed health care decisions. The clinical communication process is complicated by varying degrees of confidence in scientific evidence regarding patient-oriented benefits, and by the fact that most medical options are associated with possible harms as well as potential benefits. Evidence-based clinical guidelines often neglect patient-oriented issues involved with the thoughtful practice of shared decision-making, where individual values, goals, and preferences should be prioritized. Guidelines on the use of statin medications for preventing cardiovascular events are a case in point. Current guidelines endorse the use of statins for people whose 10-year risk of cardiovascular events is as low as 7.5%. Previous guidelines set the 10-year risk benchmark at 20%. Meta-analysis of randomized trials suggests that statins can reduce cardiovascular event rates by about 25%, bringing 10-year risk from 7.5 to 5.6%, for example, or from 20 to 15%. Whether or not these benefits should justify the use of statins for individual patients depends on how those advantages are valued in comparison with disadvantages, such as side effect risks, and with inconveniences associated with taking a pill each day and visiting clinicians and laboratories regularly. Whether or not the overall benefit-harm balance justifies the use of a medication for an individual patient cannot be determined by a guidelines committee, a health care system, or even the attending physician. Instead, it is the individual patient who has a fundamental right to decide whether or not taking a drug is worthwhile. Researchers and professional organizations should endeavor to develop shared decision-making tools that provide up-to-date best evidence in

Where Is the Evidence for "Evidence-Based" Therapy?

PubMed

Shedler, Jonathan

2018-06-01

The term evidence-based therapy is a de facto code word for manualized therapy, most often brief cognitive behavior therapy and its variants. It is widely asserted that "evidence-based" therapy is scientifically proven, superior to other forms of psychotherapy, and the gold standard of care. Research findings do not support such assertions. Research on evidence-based therapies demonstrates that they are weak treatments. They have not shown superiority to other forms of psychotherapy, few patients get well, and treatment benefits do not last. Questionable research practices create a distorted picture of the actual benefits of these therapies. Copyright © 2018 Jonathan Shedler. Published by Elsevier Inc. All rights reserved.

Scoping review of resources for integrating evidence-based supported employment into spinal cord injury rehabilitation.

PubMed

Cotner, Bridget A; Ottomanelli, Lisa; Keleher, Virginia; Dirk, Lynn

2018-02-27

Individual placement and support (IPS), an evidence-based supported employment (SE) program, has helped Veterans with spinal cord injury (SCI) receiving care in the Veterans Health Administration to obtain work. To facilitate integration of IPS into SCI rehabilitation, resources are needed. A scoping review was conducted to identify tools and resources suitable for providers of SCI care. Applying a modified version of Arksey and O'Malley's framework, a scoping review of literature on SE tools or resources was conducted. The original review focused on resources published between 2002 and 2015 and available in English. Prior to publication an updated review through 2017 was conducted. From 1822 tools and resources identified in the initial review, 24 met criteria for inclusion and were evaluated by an advisory panel of experts, who selected 16 tools that addressed five topics: IPS in SCI (n = 2) orientation to SCI (n = 3); IPS SE (n = 7), job accommodations (n = 2), and benefits planning (n = 2). The updated review yielded no tools or resources that met inclusion criteria. Despite few resources to guide implementation of IPS in SCI, 16 essential resources were identified that, combined into a toolkit, may facilitate translation of IPS in SCI from research to clinical care. Implications for rehabilitation The toolkit consists of 16 essential resources and is currently available online to all persons involved in spinal cord injury rehabilitation to educate them about this effective means of assisting persons with spinal cord injury to find employment and to facilitate translation of individual placement and support in spinal cord injury from research to clinical care. While expert-informed, the toolkit is being field tested with both clinical and vocational providers to facilitate the adoption of individual placement and support by spinal cord injury rehabilitation programs. The revised version will be made available online.

Glacial geomorphic evidence for a late climatic change on Mars

NASA Technical Reports Server (NTRS)

Kargel, J. S.; Strom, R. G.

1992-01-01

In a series of preliminary reports, we documented evidence of former glacial epochs on Mars. Apparent glacial landforms seemed to be concentrated primarily at middle to high southern latitudes. We now have additional evidence supporting the view that Martian glaciation appears to have been more extensive than previously recognized. The growth and collapse of ice sheets on Mars seems closely analogous to the growth and decline of Earth's great Pleistocene ice sheets. This implies that climate change was probably somewhat comparable on the two planets, although in the case of Mars the entire planet seems to have changed rapidly to a cold, dry present-day environment after the collapse of the ice sheets.

47 CFR 36.605 - Calculation of safety net additive.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 2 2010-10-01 2010-10-01 false Calculation of safety net additive. 36.605... § 36.605 Calculation of safety net additive. (a) “Safety net additive support.” A rural incumbent local exchange carrier shall receive safety net additive support if it satisfies the conditions set forth in...

47 CFR 36.605 - Calculation of safety net additive.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 2 2011-10-01 2011-10-01 false Calculation of safety net additive. 36.605... § 36.605 Calculation of safety net additive. (a) “Safety net additive support.” A rural incumbent local exchange carrier shall receive safety net additive support if it satisfies the conditions set forth in...

The busy social brain: evidence for automaticity and control in the neural systems supporting social cognition and action understanding.

PubMed

Spunt, Robert P; Lieberman, Matthew D

2013-01-01

Much social-cognitive processing is believed to occur automatically; however, the relative automaticity of the brain systems underlying social cognition remains largely undetermined. We used functional MRI to test for automaticity in the functioning of two brain systems that research has indicated are important for understanding other people's behavior: the mirror neuron system and the mentalizing system. Participants remembered either easy phone numbers (low cognitive load) or difficult phone numbers (high cognitive load) while observing actions after adopting one of four comprehension goals. For all four goals, mirror neuron system activation showed relatively little evidence of modulation by load; in contrast, the association of mentalizing system activation with the goal of inferring the actor's mental state was extinguished by increased cognitive load. These results support a dual-process model of the brain systems underlying action understanding and social cognition; the mirror neuron system supports automatic behavior identification, and the mentalizing system supports controlled social causal attribution.

20 CFR 418.2250 - What evidence will you need to support your request that we use a more recent tax year?

Code of Federal Regulations, 2012 CFR

2012-04-01

... request that we use a more recent tax year? 418.2250 Section 418.2250 Employees' Benefits SOCIAL SECURITY... Premiums Determinations Using A More Recent Tax Year's Modified Adjusted Gross Income § 418.2250 What evidence will you need to support your request that we use a more recent tax year? We will follow the rules...

20 CFR 418.2250 - What evidence will you need to support your request that we use a more recent tax year?

Code of Federal Regulations, 2014 CFR

2014-04-01

... request that we use a more recent tax year? 418.2250 Section 418.2250 Employees' Benefits SOCIAL SECURITY... Premiums Determinations Using A More Recent Tax Year's Modified Adjusted Gross Income § 418.2250 What evidence will you need to support your request that we use a more recent tax year? We will follow the rules...

20 CFR 418.2250 - What evidence will you need to support your request that we use a more recent tax year?

Code of Federal Regulations, 2013 CFR

2013-04-01

... request that we use a more recent tax year? 418.2250 Section 418.2250 Employees' Benefits SOCIAL SECURITY... Premiums Determinations Using A More Recent Tax Year's Modified Adjusted Gross Income § 418.2250 What evidence will you need to support your request that we use a more recent tax year? We will follow the rules...

Supporting universal prevention programs: a two-phased coaching model.

PubMed

Becker, Kimberly D; Darney, Dana; Domitrovich, Celene; Keperling, Jennifer Pitchford; Ialongo, Nicholas S

2013-06-01

Schools are adopting evidence-based programs designed to enhance students' emotional and behavioral competencies at increasing rates (Hemmeter et al. in Early Child Res Q 26:96-109, 2011). At the same time, teachers express the need for increased support surrounding implementation of these evidence-based programs (Carter and Van Norman in Early Child Educ 38:279-288, 2010). Ongoing professional development in the form of coaching may enhance teacher skills and implementation (Noell et al. in School Psychol Rev 34:87-106, 2005; Stormont et al. 2012). There exists a need for a coaching model that can be applied to a variety of teacher skill levels and one that guides coach decision-making about how best to support teachers. This article provides a detailed account of a two-phased coaching model with empirical support developed and tested with coaches and teachers in urban schools (Becker et al. 2013). In the initial universal coaching phase, all teachers receive the same coaching elements regardless of their skill level. Then, in the tailored coaching phase, coaching varies according to the strengths and needs of each teacher. Specifically, more intensive coaching strategies are used only with teachers who need additional coaching supports, whereas other teachers receive just enough support to consolidate and maintain their strong implementation. Examples of how coaches used the two-phased coaching model when working with teachers who were implementing two universal prevention programs (i.e., the PATHS curriculum and PAX Good Behavior Game [PAX GBG]) provide illustrations of the application of this model. The potential reach of this coaching model extends to other school-based programs as well as other settings in which coaches partner with interventionists to implement evidence-based programs.

A new Permian gnetalean cone as fossil evidence for supporting current molecular phylogeny.

PubMed

Wang, Zi-Qiang

2004-08-01

The order Gnetales has been the central focus of controversy in seed plant phylogeny. Traditional treatment of morphology supports the anthophyte hypothesis with Gnetales sister to angiosperms but current molecular data reject this hypothesis. A new fossil gnetalean cone, Palaeognetaleana auspicia gen. et sp. nov., is reported from the Upper Permian in North China, and its phylogenic implications are considered. Samples of cones from the upper part of the Upper Permian redbeds of Baode section, northwestern Shanxi Province, China, were examined. The cone is characterized by its unusual nature of reproduction that combines features of post-Triassic gnetaleans and some of the Palaeozoic conifers. It is made up of a number of imbricate axillary units, each simply formed by an ovule and a subtending bract, which may be comparable with the axillary seed-scale complex of some of the Palaeozoic conifer cones. The cone exhibits at least a partially bisexual character that appears to have pollen sacs with monosulcate ribbed pollen grains and sessile, asymmetric, and radiospermic ovules. The ovule has an integument of three envelopes: an outer one of pointed scales; a middle sclerified one; and an inner cuticle that extends upward into a micropyle with an oblique tip. The new Permian cone has unequivocal affinity with the Gnetales. The fossil has considerably extended the divergence time of the Gnetales from 140 (210?) back to 270 myr ago and, therefore, provides the first significant fossil evidence to support the current conclusion based on molecular data of seed plants, i.e. monophyletic gymnosperms, comprising the Gnetales are closely related to conifers.

The Adult Livers of Immunodeficient Mice Support Human Hematopoiesis: Evidence for a Hepatic Mast Cell Population that Develops Early in Human Ontogeny

PubMed Central

Muench, Marcus O.; Beyer, Ashley I.; Fomin, Marina E.; Thakker, Rahul; Mulvaney, Usha S.; Nakamura, Masato; Suemizu, Hiroshi; Bárcena, Alicia

2014-01-01

The liver plays a vital role in hematopoiesis during mammalian prenatal development but its hematopoietic output declines during the perinatal period. Nonetheless, hepatic hematopoiesis is believed to persist into adulthood. We sought to model human adult-liver hematopoiesis by transplantation of fetal and neonatal hematopoietic stem cells (HSCs) into adult immunodeficient mice. Livers were found to be engrafted with human cells consisting primarily of monocytes and B-cells with lesser contributions by erythrocytes, T-cells, NK-cells and mast-cells. A resident population of CD117++CD203c+ mast cells was also documented in human midgestation liver, indicating that these cells comprise part of the liver's resident immune cell repertoire throughout human ontogeny. The murine liver was shown to support human multilineage hematopoiesis up to 321 days after transplant. Evidence of murine hepatic hematopoiesis was also found in common mouse strains as old as 2 years. Human HSC engraftment of the murine liver was demonstrated by detection of high proliferative-potential colony-forming cells in clonal cultures, observation of CD38−CD34++ and CD133+CD34++ cells by flow cytometry, and hematopoietic reconstitution of secondary transplant recipients of chimeric liver cells. Additionally, chimeric mice with both hematopoietic and endothelial reconstitution were generated by intrasplenic injection of immunodeficient mice with liver specific expression of the urokinase-type plasminogen activator (uPA) transgene. In conclusion, the murine liver is shown to be a hematopoietic organ throughout adult life that can also support human hematopoiesis in severely immunodeficient strains. Further humanization of the murine liver can be achieved in mice harboring an uPA transgene, which support engraftment of non-hematopoietic cells types. Thus, offering a model system to study the interaction of diverse human liver cell types that regulate hematopoiesis and immune function in the liver

Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis.

PubMed

Jordan, Rachel E; Majothi, Saimma; Heneghan, Nicola R; Blissett, Deirdre B; Riley, Richard D; Sitch, Alice J; Price, Malcolm J; Bates, Elizabeth J; Turner, Alice M; Bayliss, Susan; Moore, David; Singh, Sally; Adab, Peymane; Fitzmaurice, David A; Jowett, Susan; Jolly, Kate

2015-05-01

Self-management (SM) support for patients with chronic obstructive pulmonary disease (COPD) is variable in its coverage, content, method and timing of delivery. There is insufficient evidence for which SM interventions are the most effective and cost-effective. To undertake (1) a systematic review of the evidence for the effectiveness of SM interventions commencing within 6 weeks of hospital discharge for an exacerbation for COPD (review 1); (2) a systematic review of the qualitative evidence about patient satisfaction, acceptance and barriers to SM interventions (review 2); (3) a systematic review of the cost-effectiveness of SM support interventions within 6 weeks of hospital discharge for an exacerbation of COPD (review 3); (4) a cost-effectiveness analysis and economic model of post-exacerbation SM support compared with usual care (UC) (economic model); and (5) a wider systematic review of the evidence of the effectiveness of SM support, including interventions (such as pulmonary rehabilitation) in which there are significant components of SM, to identify which components are the most important in reducing exacerbations, hospital admissions/readmissions and improving quality of life (review 4). The following electronic databases were searched from inception to May 2012: MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Science Citation Index [Institute of Scientific Information (ISI)]. Subject-specific databases were also searched: PEDro physiotherapy evidence database, PsycINFO and the Cochrane Airways Group Register of Trials. Ongoing studies were sourced through the metaRegister of Current Controlled Trials, International Standard Randomised Controlled Trial Number database, World Health Organization International Clinical Trials Registry Platform Portal and ClinicalTrials.gov. Specialist abstract and conference proceedings were sourced through ISI's Conference Proceedings

Evidence-Based Special Education in the Context of Scarce Evidence-Based Practices

ERIC Educational Resources Information Center

TEACHING Exceptional Children, 2014

2014-01-01

Evidence-based practices (EBPs) are supported as generally effective for populations of learners by bodies of high-quality and experimental research and, when aligned with stakeholder values and practical needs, should be prioritized for implementation. However, evidence-based practices are not currently available for all learner types in all…

Creating infrastructure supportive of evidence-based nursing practice: leadership strategies.

PubMed

Newhouse, Robin P

2007-01-01

Nursing leadership is the cornerstone of successful evidence-based practice (EBP) programs within health care organizations. The key to success is a strategic approach to building an EBP infrastructure, with allocation of appropriate human and material resources. This article indicates the organizational infrastructure that enables evidence-based nursing practice and strategies for leaders to enhance evidence-based practice using "the conceptual model for considering the determinants of diffusion, dissemination, and implementation of innovations in health service delivery and organization." Enabling EBP within organizations is important for promoting positive outcomes for nurses and patients. Fostering EBP is not a static or immediate outcome, but a long-term developmental process within organizations. Implementation requires multiple strategies to cultivate a culture of inquiry where nurses generate and answer important questions to guide practice. Organizations that can enable the culture and build infrastructure to help nurses develop EBP competencies will produce a professional environment that will result in both personal growth for their staff and improvements in quality that would not otherwise be possible.

Prosecutors' Perspectives on Biological Evidence and Injury Evidence in Sexual Assault Cases.

PubMed

Alderden, Megan; Cross, Theodore P; Vlajnic, Maja; Siller, Laura

2018-06-01

Little prior research has explored how prosecutors perceive and utilize biological and injury evidences in sexual assault cases. In this qualitative study, semistructured interviews were conducted with assistant district attorneys (ADAs) working in an urban district attorney's office in the northeastern United States. ADAs were asked to describe how biological and injury evidences could be probative and their strategies for using this evidence. The interviews suggest that prosecutors perceive the probative value of biological and injury evidences on a continuum, varying based on case characteristics. Prosecutors felt that undergoing a forensic medical examination in itself supported victims' credibility. Biological evidence bolstered victims' credibility if it matched the victim's account better than the defendant's. They perceived DNA evidence as helpful when it identified unknown suspects, confirmed identification of suspects by other means, or rebutted defendants' denial of sexual contact. DNA evidence was also helpful when victims were incapacitated, too traumatized to recall or talk about the assault, or too young to identify assailants, and when police used the information in interrogating suspects. The biggest limitation to biological evidence prosecutors cited was overcoming the consent defense. The ADAs reported they used DNA evidence even when it was not particularly probative, because it confirms the correct person is being prosecuted, it communicates the victim's and prosecution's seriousness, and it meets jury expectations in trials. Prosecutors found injury evidence useful because it corroborated victims' accounts and helped refute defendant claims of consensual sex. The findings may assist in educating others about biological and injury evidences in these cases, and could inspire professionals and advocates to work to develop and support a broad range of investigative methods.

20 CFR 418.1250 - What evidence will you need to support your request that we use a more recent tax year?

Code of Federal Regulations, 2014 CFR

2014-04-01

... request that we use a more recent tax year? 418.1250 Section 418.1250 Employees' Benefits SOCIAL SECURITY... More Recent Tax Year's Modified Adjusted Gross Income § 418.1250 What evidence will you need to support your request that we use a more recent tax year? When you request that we use a more recent tax year to...

20 CFR 418.1250 - What evidence will you need to support your request that we use a more recent tax year?

Code of Federal Regulations, 2013 CFR

2013-04-01

... request that we use a more recent tax year? 418.1250 Section 418.1250 Employees' Benefits SOCIAL SECURITY... More Recent Tax Year's Modified Adjusted Gross Income § 418.1250 What evidence will you need to support your request that we use a more recent tax year? When you request that we use a more recent tax year to...

20 CFR 418.1250 - What evidence will you need to support your request that we use a more recent tax year?

Code of Federal Regulations, 2012 CFR

2012-04-01

... request that we use a more recent tax year? 418.1250 Section 418.1250 Employees' Benefits SOCIAL SECURITY... More Recent Tax Year's Modified Adjusted Gross Income § 418.1250 What evidence will you need to support your request that we use a more recent tax year? When you request that we use a more recent tax year to...

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

Micropublications: a semantic model for claims, evidence, arguments and annotations in biomedical communications

PubMed Central

2014-01-01

Background Scientific publications are documentary representations of defeasible arguments, supported by data and repeatable methods. They are the essential mediating artifacts in the ecosystem of scientific communications. The institutional “goal” of science is publishing results. The linear document publication format, dating from 1665, has survived transition to the Web. Intractable publication volumes; the difficulty of verifying evidence; and observed problems in evidence and citation chains suggest a need for a web-friendly and machine-tractable model of scientific publications. This model should support: digital summarization, evidence examination, challenge, verification and remix, and incremental adoption. Such a model must be capable of expressing a broad spectrum of representational complexity, ranging from minimal to maximal forms. Results The micropublications semantic model of scientific argument and evidence provides these features. Micropublications support natural language statements; data; methods and materials specifications; discussion and commentary; challenge and disagreement; as well as allowing many kinds of statement formalization. The minimal form of a micropublication is a statement with its attribution. The maximal form is a statement with its complete supporting argument, consisting of all relevant evidence, interpretations, discussion and challenges brought forward in support of or opposition to it. Micropublications may be formalized and serialized in multiple ways, including in RDF. They may be added to publications as stand-off metadata. An OWL 2 vocabulary for micropublications is available at http://purl.org/mp. A discussion of this vocabulary along with RDF examples from the case studies, appears as OWL Vocabulary and RDF Examples in Additional file 1. Conclusion Micropublications, because they model evidence and allow qualified, nuanced assertions, can play essential roles in the scientific communications ecosystem in places

Little Evidence Exists To Support The Expectation That Providers Would Consolidate To Enter New Payment Models.

PubMed

Neprash, Hannah T; Chernew, Michael E; McWilliams, J Michael

2017-02-01

Provider consolidation has been associated with higher health care prices and spending. The prevailing wisdom is that payment reform will accelerate consolidation, especially between physicians and hospitals and among physician groups, as providers position themselves to bear financial risk for the full continuum of patient care. Drawing on data from a number of sources from 2008 onward, we examined the relationship between Medicare's accountable care organization (ACO) programs and provider consolidation. We found that consolidation was under way in the period 2008-10, before the Affordable Care Act (ACA) established the ACO programs. While the number of hospital mergers and the size of specialty-oriented physician groups increased after the ACA was passed, we found minimal evidence that consolidation was associated with ACO penetration at the market level or with physicians' participation in ACOs within markets. We conclude that payment reform has been associated with little acceleration in consolidation in addition to trends already under way, but there is evidence of potential defensive consolidation in response to new payment models. Project HOPE—The People-to-People Health Foundation, Inc.

Respiratory Support in Bronchiolitis: Trial Evidence.

PubMed

Cunningham, Steve

2018-05-01

Acute viral lower respiratory tract infection is frequently associated with hypoxemia and respiratory distress, sometimes progressing to hypercarbia and respiratory failure. In recent years, trials have assessed the effects of oxygen supplementation and respiratory support with high-flow oxygen therapy. An oxygen saturation target of 90% is as safe and clinically effective as 94% in infants with bronchiolitis. Trials of high-flow humidified oxygen have demonstrated safety, but as yet poorly demarcated an appropriate place for use within the clinical course of the disease. Effective trials of continuous positive airway pressure are lacking and urgently required. The trials reported to date have highlighted the need for common outcomes in relation to treatment failure. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Does the scientific evidence support the advertising claims made for products containing Lactobacillus casei and Bifidobacterium lactis? A systematic review.

PubMed

Meléndez-Illanes, Lorena; González-Díaz, Cristina; Chilet-Rosell, Elisa; Álvarez-Dardet, Carlos

2016-09-01

To analyse the scientific evidence that exists for the advertising claims made for two products containing Lactobacillus casei and Bifidobacterium lactis and to conduct a comparison between the published literature and what is presented in the corporate website. Systematic review, using Medline through Pubmed and Embase. We included human clinical trials that exclusively measured the effect of Lactobacillus casei or Bifidobacterium lactis on a healthy population, and where the objective was related to the health claims made for certain products in advertising. We assessed the levels of evidence and the strength of the recommendation according to the classification criteria established by the Oxford Centre for Evidence Based Medicine (CEBM). We also assessed the outcomes of the studies published on the website that did not appear in the search. Of the 440 articles identified, 16 met the inclusion criteria. Only four (25%) of these presented a level of evidence of 1b and a recommendation grade of A, all corresponding to studies on product containing Bifidobacterium lactis, and only 12 of the 16 studies were published on the corporate website (47). There is insufficient scientific evidence to support the health claims made for these products, especially in the case of product containing Lactobacillus casei. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Evidence Information Service as a New Platform for Supporting Evidence-Based Policy: A Consultation of UK Parliamentarians

ERIC Educational Resources Information Center

Lawrence, Natalia S.; Chambers, Jemma C.; Morrison, Sinead M.; Bestmann, Sven; O'Grady, Gerard; Chambers, Christopher D.; Kythreotis, Andrew

2017-01-01

The value of evidence-based policy is well established, yet major hurdles remain in connecting policymakers with the wider research community. Here we assess whether a UK Evidence Information Service (EIS) could facilitate interaction between parliamentarians and research professionals. Fifty-six UK parliamentarians were interviewed to gauge the…

Archaeal phylogenomics provides evidence in support of a methanogenic origin of the Archaea and a thaumarchaeal origin for the eukaryotes.

PubMed

Kelly, S; Wickstead, B; Gull, K

2011-04-07

We have developed a machine-learning approach to identify 3537 discrete orthologue protein sequence groups distributed across all available archaeal genomes. We show that treating these orthologue groups as binary detection/non-detection data is sufficient to capture the majority of archaeal phylogeny. We subsequently use the sequence data from these groups to infer a method and substitution-model-independent phylogeny. By holding this phylogeny constrained and interrogating the intersection of this large dataset with both the Eukarya and the Bacteria using Bayesian and maximum-likelihood approaches, we propose and provide evidence for a methanogenic origin of the Archaea. By the same criteria, we also provide evidence in support of an origin for Eukarya either within or as sisters to the Thaumarchaea.

Archaeal phylogenomics provides evidence in support of a methanogenic origin of the Archaea and a thaumarchaeal origin for the eukaryotes

PubMed Central

Kelly, S.; Wickstead, B.; Gull, K.

2011-01-01

We have developed a machine-learning approach to identify 3537 discrete orthologue protein sequence groups distributed across all available archaeal genomes. We show that treating these orthologue groups as binary detection/non-detection data is sufficient to capture the majority of archaeal phylogeny. We subsequently use the sequence data from these groups to infer a method and substitution-model-independent phylogeny. By holding this phylogeny constrained and interrogating the intersection of this large dataset with both the Eukarya and the Bacteria using Bayesian and maximum-likelihood approaches, we propose and provide evidence for a methanogenic origin of the Archaea. By the same criteria, we also provide evidence in support of an origin for Eukarya either within or as sisters to the Thaumarchaea. PMID:20880885

Database-supported teleconferencing: an additional clinical mentoring tool to assist a multinational company HIV/AIDS treatment program in Africa.

PubMed

Clevenbergh, P; Van der Borght, S F M; van Cranenburgh, K; Janssens, V; Kitenge Lubangi, C; Gahimbaza, L; Lange, J M A; Rinke de Wit, T F; Rijckborst, H

2006-01-01

The lack of human resources for health is presently recognized as a major factor limiting scale-up of antiretroviral treatment (ART) programs in resourcelimited settings. The mobilization of public and private partners, the decentralization of care, and the training of non-HIV specialist nurses and general practitioners could help increase the number of HIV-infected patients receiving ART. In addition to other forms of training, scheduled teleconferences (TCs) have been organized to support a comprehensive HIV treatment program delivered by a private company's health team. To describe the role of the TC as an additional tool in mentoring a company's health care workers (HCWs). For this study, all TC reports were retrospectively reviewed and the questions classified by topic. Participating Heineken physicians evaluated the technical quality and scientific relevance of the TCs through an anonymous survey. From October 2001 to December 2003, 10 HCWs working in 14 operating companies in 5 African countries raised 268 problems during 45 TCs. A total of 79 questions (29%) were asked about antiretroviral (ARV) therapy, 53 (20%) about the diagnosis and treatment of opportunistic infection, 43 (16%) about ARV toxicity, 40 (15%) about care organization and policy, 32 (12%) about laboratory or drug supply, and 21 (8%) about biological parameters. The mean TC attendance rate was 70%. The level of satisfaction among local company physicians was 65% for logistics, 89% for scientific relevance, 84% for applicability of advice, and 85% overall. The most common complaints concerned the poor quality of the telephone connection and language problems for francophone participants. Database-supported teleconferencing could be an additional tool to mentor company HCWs in their routine care of HIV-infected workers and family members. The role and costeffectiveness of telemedicine in improving health outcomes should be further studied.

Comparing a Mobile Decision Support System Versus the Use of Printed Materials for the Implementation of an Evidence-Based Recommendation: Protocol for a Qualitative Evaluation.

PubMed

Camacho, Jhon; Medina Ch, Ana María; Landis-Lewis, Zach; Douglas, Gerald; Boyce, Richard

2018-04-13

The distribution of printed materials is the most frequently used strategy to disseminate and implement clinical practice guidelines, although several studies have shown that the effectiveness of this approach is modest at best. Nevertheless, there is insufficient evidence to support the use of other strategies. Recent research has shown that the use of computerized decision support presents a promising approach to address some aspects of this problem. The aim of this study is to provide qualitative evidence on the potential effect of mobile decision support systems to facilitate the implementation of evidence-based recommendations included in clinical practice guidelines. We will conduct a qualitative study with two arms to compare the experience of primary care physicians while they try to implement an evidence-based recommendation in their clinical practice. In the first arm, we will provide participants with a printout of the guideline article containing the recommendation, while in the second arm, we will provide participants with a mobile app developed after formalizing the recommendation text into a clinical algorithm. Data will be collected using semistructured and open interviews to explore aspects of behavioral change and technology acceptance involved in the implementation process. The analysis will be comprised of two phases. During the first phase, we will conduct a template analysis to identify barriers and facilitators in each scenario. Then, during the second phase, we will contrast the findings from each arm to propose hypotheses about the potential impact of the system. We have formalized the narrative in the recommendation into a clinical algorithm and have developed a mobile app. Data collection is expected to occur during 2018, with the first phase of analysis running in parallel. The second phase is scheduled to conclude in July 2019. Our study will further the understanding of the role of mobile decision support systems in the implementation

Supporting evidence-based health care in crises: what information do humanitarian organizations need?

PubMed

Turner, Tari; Green, Sally; Harris, Claire

2011-03-01

In crisis situations, there is an enormous burden of disease and very limited resources. To achieve the best possible health outcomes in these situations and ensure that scarce resources are not wasted, knowledge from health research needs to be translated into practice. We investigated what information from health research was needed by humanitarian aid workers in crisis settings and how it could be best provided. Semistructured interviews were conducted by telephone with 19 humanitarian aid workers from a range of organizations around the world and the results analyzed thematically. Participants identified a clear and currently unmet need for access to high-quality health research to support evidence-based practice in crisis situations. They emphasized that research into delivery of health care was potentially more valuable than research into the effectiveness of particular clinical interventions and highlighted the importance of including contextual information to enable the relevance of the research to be assessed. They suggested that providers of health research information and humanitarian aid organizations work together to develop these resources. ©2011 American Medical Association. All rights reserved.

Multi-criteria clinical decision support: A primer on the use of multiple criteria decision making methods to promote evidence-based, patient-centered healthcare.

PubMed

Dolan, James G

2010-01-01

Current models of healthcare quality recommend that patient management decisions be evidence-based and patient-centered. Evidence-based decisions require a thorough understanding of current information regarding the natural history of disease and the anticipated outcomes of different management options. Patient-centered decisions incorporate patient preferences, values, and unique personal circumstances into the decision making process and actively involve both patients along with health care providers as much as possible. Fundamentally, therefore, evidence-based, patient-centered decisions are multi-dimensional and typically involve multiple decision makers.Advances in the decision sciences have led to the development of a number of multiple criteria decision making methods. These multi-criteria methods are designed to help people make better choices when faced with complex decisions involving several dimensions. They are especially helpful when there is a need to combine "hard data" with subjective preferences, to make trade-offs between desired outcomes, and to involve multiple decision makers. Evidence-based, patient-centered clinical decision making has all of these characteristics. This close match suggests that clinical decision support systems based on multi-criteria decision making techniques have the potential to enable patients and providers to carry out the tasks required to implement evidence-based, patient-centered care effectively and efficiently in clinical settings.The goal of this paper is to give readers a general introduction to the range of multi-criteria methods available and show how they could be used to support clinical decision-making. Methods discussed include the balance sheet, the even swap method, ordinal ranking methods, direct weighting methods, multi-attribute decision analysis, and the analytic hierarchy process (AHP).

Multi-criteria clinical decision support: A primer on the use of multiple criteria decision making methods to promote evidence-based, patient-centered healthcare

PubMed Central

Dolan, James G.

2010-01-01

Current models of healthcare quality recommend that patient management decisions be evidence-based and patient-centered. Evidence-based decisions require a thorough understanding of current information regarding the natural history of disease and the anticipated outcomes of different management options. Patient-centered decisions incorporate patient preferences, values, and unique personal circumstances into the decision making process and actively involve both patients along with health care providers as much as possible. Fundamentally, therefore, evidence-based, patient-centered decisions are multi-dimensional and typically involve multiple decision makers. Advances in the decision sciences have led to the development of a number of multiple criteria decision making methods. These multi-criteria methods are designed to help people make better choices when faced with complex decisions involving several dimensions. They are especially helpful when there is a need to combine “hard data” with subjective preferences, to make trade-offs between desired outcomes, and to involve multiple decision makers. Evidence-based, patient-centered clinical decision making has all of these characteristics. This close match suggests that clinical decision support systems based on multi-criteria decision making techniques have the potential to enable patients and providers to carry out the tasks required to implement evidence-based, patient-centered care effectively and efficiently in clinical settings. The goal of this paper is to give readers a general introduction to the range of multi-criteria methods available and show how they could be used to support clinical decision-making. Methods discussed include the balance sheet, the even swap method, ordinal ranking methods, direct weighting methods, multi-attribute decision analysis, and the analytic hierarchy process (AHP) PMID:21394218

Evidence-Based Reform in Education

ERIC Educational Resources Information Center

Slavin, Robert E.

2017-01-01

Education policies should support the use of programs and practices with strong evidence of effectiveness. The Every Student Succeeds Act (ESSA) contains evidence standards and incentives to use programs that meet them. This provides a great opportunity for evidence to play a stronger role in decisions about education programs and practices.…

Recovery Support for Adolescents with Substance use Disorders: The Impact of Recovery Support Telephone Calls Provided by Pre-Professional Volunteers

PubMed Central

Garner, Bryan R; Godley, Mark D; Passetti, Lora L; Funk, Rodney R; White, William L

2014-01-01

The present quasi-experiment examined the direct and indirect effects of recovery support telephone calls following adolescent substance use disorder treatment. Six-month outcome data from 202 adolescents who had received recovery support calls from primarily pre-professional (i.e., college-level social service students) volunteers was compared to 6-month outcome data from a matched comparison sample of adolescents (n = 404). Results suggested adolescents in the recovery support sample had significantly greater reductions in their recovery environment risk relative to the comparison sample (β = -.17). Path analysis also suggested that the reduction in recovery environment risk produced by recovery support calls had indirect impacts (via recovery environment risk) on reductions in social risk (β = .22), substance use (β = .23), and substance-related problems (β = .16). Finally, moderation analyses suggested the effects of recovery support calls did not differ by gender, but were significantly greater for adolescents with lower levels of treatment readiness. In addition to providing rare empirical support for the effectiveness of recovery support services, an important contribution of this study is that it provides evidence that recovery support services do not necessarily have to be “peer-based,” at least in terms of the recovery support service provider having the experiential credentials of being “in recovery.” If replicated, this latter finding may have particularly important implications for helping increase the recovery support workforce. PMID:25574502

Taphonomic evidence for high-speed adapted fins in thunniform ichthyosaurs.

PubMed

Lingham-Soliar, Theagarten; Plodowski, Gerhard

2007-01-01

Ichthyosaurs have been compared with the fast-swimming thunniform groups of marine vertebrates, tuna, lamnid sharks, and dolphins, based on similarity of shape of the body and locomotory organs. In addition to shape, high-tensile stiffness of the control surfaces has been shown to be essential in maximizing hydrodynamic efficiency in extant thunniform swimmers. To date, there has been no evidence of a stiffening support system for the dorsal fin and dorsal lobe of the caudal fin in ichthyosaurs, the sole stiffening structure of the ventral lobe being an extension of the vertebral column along its leading edge. Stenopterygius SMF 457 is arguably the best soft-tissue preserved ichthyosaur specimen known. Here, we examine soft-tissue preservation in this specimen in the control surfaces and provide the first evidence of a complex architecture of stiff fibers in the dorsal and caudal fins. We find by comparisons and by analogy that these fibers provided a remarkable mechanism for high tensile stiffness and efficiency of the locomotory organs virtually identical to that of the great white shark, Carcharodon carcharias. It is the first mechanostructural study of the control surfaces of a Jurassic ichthyosaur that adds essential evidence in support of the view that these forms were high-speed thunniform swimmers.

Taphonomic evidence for high-speed adapted fins in thunniform ichthyosaurs

NASA Astrophysics Data System (ADS)

Lingham-Soliar, Theagarten; Plodowski, Gerhard

2007-01-01

Ichthyosaurs have been compared with the fast-swimming thunniform groups of marine vertebrates, tuna, lamnid sharks, and dolphins, based on similarity of shape of the body and locomotory organs. In addition to shape, high-tensile stiffness of the control surfaces has been shown to be essential in maximizing hydrodynamic efficiency in extant thunniform swimmers. To date, there has been no evidence of a stiffening support system for the dorsal fin and dorsal lobe of the caudal fin in ichthyosaurs, the sole stiffening structure of the ventral lobe being an extension of the vertebral column along its leading edge. Stenopterygius SMF 457 is arguably the best soft-tissue preserved ichthyosaur specimen known. Here, we examine soft-tissue preservation in this specimen in the control surfaces and provide the first evidence of a complex architecture of stiff fibers in the dorsal and caudal fins. We find by comparisons and by analogy that these fibers provided a remarkable mechanism for high tensile stiffness and efficiency of the locomotory organs virtually identical to that of the great white shark, Carcharodon carcharias. It is the first mechanostructural study of the control surfaces of a Jurassic ichthyosaur that adds essential evidence in support of the view that these forms were high-speed thunniform swimmers.

Adjusting Claims as New Evidence Emerges: Do Students Incorporate New Evidence into Their Scientific Explanations?

ERIC Educational Resources Information Center

Novak, Ann M.; Treagust, David F.

2018-01-01

Constructing explanations of complex phenomena is an important part of doing science and it is also an important component of learning science. Students need opportunities to make claims based on available evidence and then use science concepts to justify why evidence supports the claim. But what happens when "new" evidence emerges for…

Role of Additives in Composite PEI/Oxide CO 2 Adsorbents: Enhancement in the Amine Efficiency of Supported PEI by PEG in CO 2 Capture from Simulated Ambient Air

DOE PAGES

Sakwa-Novak, Miles A.; Tan, Shuai; Jones, Christopher W.

2015-10-20

Supported amines are promising candidate adsorbents for the removal of CO 2 from flue gases and directly from ambient air. The incorporation of additives into polymeric amines such as poly(ethylenimine) (PEI) supported on mesoporous oxides is an effective strategy to improve the performance of the materials. Here, several practical aspects of this strategy are addressed with regards to direct air capture. The influence of three additives (CTAB, PEG200, PEG1000) was systematically explored under dry simulated air capture conditions (400 ppm of CO 2, 30 °C). With SBA-15 as a model support for poly(ethylenimine) (PEI), the nature of the additive inducedmore » heterogeneities in the deposition of organic on the interior and exterior of the particles, an important consideration for future scale up to practical systems. The PEG200 additive increased the observed thermodynamic performance (~60% increase in amine efficiency) of the adsorbents regardless of the PEI content, while the other molecules had less positive effects. A threshold PEG200/PEI value was identified at which the diffusional limitations of CO 2 within the materials were nearly eliminated. The threshold PEG/PEI ratio may have physical origin in the interactions between PEI and PEG, as the optimal ratio corresponded to nearly equimolar OH/reactive (1°, 2°) amine ratios. As a result, the strategy is shown to be robust to the characteristics of the host support, as PEG200 improved the amine efficiency of PEI when supported on two varieties of mesoporous γ-alumina with PEI.« less

Role of Additives in Composite PEI/Oxide CO 2 Adsorbents: Enhancement in the Amine Efficiency of Supported PEI by PEG in CO 2 Capture from Simulated Ambient Air

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

Sakwa-Novak, Miles A.; Tan, Shuai; Jones, Christopher W.

Supported amines are promising candidate adsorbents for the removal of CO 2 from flue gases and directly from ambient air. The incorporation of additives into polymeric amines such as poly(ethylenimine) (PEI) supported on mesoporous oxides is an effective strategy to improve the performance of the materials. Here, several practical aspects of this strategy are addressed with regards to direct air capture. The influence of three additives (CTAB, PEG200, PEG1000) was systematically explored under dry simulated air capture conditions (400 ppm of CO 2, 30 °C). With SBA-15 as a model support for poly(ethylenimine) (PEI), the nature of the additive inducedmore » heterogeneities in the deposition of organic on the interior and exterior of the particles, an important consideration for future scale up to practical systems. The PEG200 additive increased the observed thermodynamic performance (~60% increase in amine efficiency) of the adsorbents regardless of the PEI content, while the other molecules had less positive effects. A threshold PEG200/PEI value was identified at which the diffusional limitations of CO 2 within the materials were nearly eliminated. The threshold PEG/PEI ratio may have physical origin in the interactions between PEI and PEG, as the optimal ratio corresponded to nearly equimolar OH/reactive (1°, 2°) amine ratios. As a result, the strategy is shown to be robust to the characteristics of the host support, as PEG200 improved the amine efficiency of PEI when supported on two varieties of mesoporous γ-alumina with PEI.« less

Social support and leisure-time physical activity: longitudinal evidence from the Brazilian Pró-Saúde cohort study.

PubMed

Oliveira, Aldair J; Lopes, Claudia S; de Leon, Antônio C Ponce; Rostila, Mikael; Griep, Rosane H; Werneck, Guilherme L; Faerstein, Eduardo

2011-07-26

Although social support has been observed to exert a beneficial influence on leisure-time physical activity (LTPA), multidimensional approaches examining social support and prospective evidence of its importance are scarce. The purpose of this study was to investigate how four dimensions of social support affect LTPA engagement, maintenance, type, and time spent by adults during a two-year follow-up. This paper reports on a longitudinal study of 3,253 non-faculty public employees at a university in Rio de Janeiro (the Pró-Saúde study). LTPA was evaluated using a dichotomous question with a two-week reference period, and further questions concerning LTPA type (individual or group) and time spent on the activity. Social support was measured by the Medical Outcomes Study Social Support Scale (MOS-SSS). To assess the association between social support and LTPA, two different statistical models were used: binary and multinomial logistic regression models for dichotomous and polytomous outcomes, respectively. Models were adjusted separately for those who began LTPA in the middle of the follow up (engagement group) and for those who had maintained LTPA since the beginning of the follow up (maintenance group). After adjusting for confounders, statistically significant associations (p < 0.05) between dimensions of social support and group LTPA were found in the engagement group. Also, the emotional/information dimension was associated with time spent on LTPA (OR = 2.01; 95% CI 1.2-3.9). In the maintenance group, material support was associated with group LTPA (OR = 1.80; 95% CI; 1.1-3.1) and the positive social interaction dimension was associated with time spent on LTPA (OR = 1.65; 95% CI; 1.1-2.7). All dimensions of social support influenced LTPA type or the time spent on the activity. However, our findings suggest that social support is more important in engagement than in maintenance. This finding is important, because it suggests that maintenance of LTPA must be

Social support and leisure-time physical activity: longitudinal evidence from the Brazilian Pró-Saúde cohort study

PubMed Central

2011-01-01

Background Although social support has been observed to exert a beneficial influence on leisure-time physical activity (LTPA), multidimensional approaches examining social support and prospective evidence of its importance are scarce. The purpose of this study was to investigate how four dimensions of social support affect LTPA engagement, maintenance, type, and time spent by adults during a two-year follow-up. Methods This paper reports on a longitudinal study of 3,253 non-faculty public employees at a university in Rio de Janeiro (the Pró-Saúde study). LTPA was evaluated using a dichotomous question with a two-week reference period, and further questions concerning LTPA type (individual or group) and time spent on the activity. Social support was measured by the Medical Outcomes Study Social Support Scale (MOS-SSS). To assess the association between social support and LTPA, two different statistical models were used: binary and multinomial logistic regression models for dichotomous and polytomous outcomes, respectively. Models were adjusted separately for those who began LTPA in the middle of the follow up (engagement group) and for those who had maintained LTPA since the beginning of the follow up (maintenance group). Results After adjusting for confounders, statistically significant associations (p < 0.05) between dimensions of social support and group LTPA were found in the engagement group. Also, the emotional/information dimension was associated with time spent on LTPA (OR = 2.01; 95% CI 1.2-3.9). In the maintenance group, material support was associated with group LTPA (OR = 1.80; 95% CI; 1.1-3.1) and the positive social interaction dimension was associated with time spent on LTPA (OR = 1.65; 95% CI; 1.1-2.7). Conclusions All dimensions of social support influenced LTPA type or the time spent on the activity. However, our findings suggest that social support is more important in engagement than in maintenance. This finding is important, because it

Motivations for Botanical Use by Socioeconomically Diverse, Urban Adults: Does Evidence Support Motivation?

PubMed

Duffy, Grace F; Shupe, Emily Stave; Kuczmarski, Marie Fanelli; Zonderman, Alan B; Evans, Michele K

2017-10-01

The study objectives were to characterize botanical dietary supplement (BDS) use and to compare the motivations for botanical supplement (BS) use to the efficacy of the botanical in a socioeconomically and racially diverse urban adult population. Subjects were from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, a 20-year prospective health disparities study with African American and white adults from Baltimore, Maryland. All study participants completed two dietary recalls and a dietary supplement (DS) questionnaire in Wave 3 (n = 2140). Diet quality was evaluated by the Healthy Eating Index-2010 and the Mean Adequacy Ratio for 17 micronutrients. A comparison of reported motivations to efficacy reported in the literature of single BS was conducted. Approximately 50% (1062/2140) of participants took DS. Of these, 8% (n = 178) reported taking either BS or BDS. It was found that BDS users had better diet quality than DS users as well as nonusers of DS. The top three motivations for BDS users were to improve overall health, to maintain health, and to supplement the diet. There is limited evidence for the efficacy of most BS. Review of the efficacy of the 15 BS reported by ≥5% of the study population revealed beneficial health roles for only fiber, gingko biloba extract EGb 761, and hawthorn berry. To the authors' knowledge, this study is the first to report a better quality diet with BDS use for a racially diverse urban population. Yet, improvement in diet is needed because overall quality did not achieve current recommendations. To improve overall health, it may be beneficial for this population to focus on dietary modifications to reduce the risks associated with chronic diseases. In general, the reported motivations for BS use were not supported by clinical evidence.

"On the other hand ...": the evidence does not support the use of hand-carried ultrasound by hospitalists.

PubMed

Feldman, Mitchell D; Petersen, Amy Jean; Tice, Jeffrey A

2010-03-01

In the right hands, ultrasound is a safe and helpful diagnostic imaging tool. However, evidence supporting the use of hand-carried ultrasound (HCU) by hospitalist physicians has not kept pace with expanding application of these devices. In spite of its strategic point-of-care benefit, use of this technology by hospitalists may not ultimately translate into improved efficiency and better clinical outcomes. Optimal levels of training in image acquisition and interpretation remain to be established. Novelty, availability, and the results of a few small studies lacking patient-centered outcomes remain insufficient grounds to justify the expanded clinical utilization of these medical imaging devices by nonspecialists.

Clonazepam responsive opsoclonus myoclonus syndrome: additional evidence in favour of fastigial nucleus disinhibition hypothesis?

PubMed

Paliwal, Vimal Kumar; Chandra, Satish; Verma, Ritu; Kalita, Jayantee; Misra, Usha K

2010-05-01

Opsoclonus myoclonus syndrome is a rare paraneoplastic syndrome seen in 50% of children with neuroblastoma. Neural generator of opsoclonus and myoclonus is not known but evidences suggest the role of fastigial nucleus disinhibition from the loss of function of inhibitory (GABAergic) Purkinje cells in the cerebellum. We present a child with paraneoplastic opsoclonus myoclonus syndrome who responded well to clonazepam. Response to clonazepam is an evidence for the involvement of GABAergic neural circuits in the genesis of opsoclonus myoclonus syndrome and is in agreement with fastigial nucleus disinhibition hypothesis.

SEAS (Surveillance Environmental Acoustic Support Program) Support

DTIC Science & Technology

1984-02-29

ASEPS software - Provide support for AMES - Support for OUTPOST CREOLE, BIG DIPPER and MFA , First, a summary of the tasks as delineated in the contract...addition, the contractor will provide an engineer/scientist to support the BIG DIPPER data processing activities at NOSC. Task 3: SEAS Inventory - The...SI to provide support to SEAS for the OUTPOST -’ CREOLE III exercise which followed immediately after the BIG DIPPER .. exercise. OUTPOST CREOLE III

7 CFR 3017.900 - Adequate evidence.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Adequate evidence. 3017.900 Section 3017.900 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER... Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

Evidence-Based Support for the Characteristics of Tsunami Warning Messages for Local, Regional and Distant Sources

NASA Astrophysics Data System (ADS)

Gregg, C. E.; Johnston, D. M.; Sorensen, J. H.; Vogt Sorensen, B.; Whitmore, P.

2014-12-01

Many studies since 2004 have documented the dissemination and receipt of risk information for local to distant tsunamis and factors influencing people's responses. A few earlier tsunami studies and numerous studies of other hazards provide additional support for developing effective tsunami messages. This study explores evidence-based approaches to developing such messages for the Pacific and National Tsunami Warning Centers in the US. It extends a message metric developed for the NWS Tsunami Program. People at risk to tsunamis receive information from multiple sources through multiple channels. Sources are official and informal and environmental and social cues. Traditionally, official tsunami messages followed a linear dissemination path through relatively few channels from warning center to emergency management to public and media. However, the digital age has brought about a fundamental change in the dissemination and receipt of official and informal communications. Information is now disseminated in very non-linear paths and all end-user groups may receive the same message simultaneously. Research has demonstrated a range of factors that influence rapid respond to an initial real or perceived threat. Immediate response is less common than one involving delayed protective actions where people first engage in "milling behavior" to exchange information and confirm the warning before taking protective action. The most important message factors to achieve rapid response focus on the content and style of the message and the frequency of dissemination. Previously we developed a tsunami message metric consisting of 21 factors divided into message content and style and receiver characteristics. Initially, each factor was equally weighted to identify gaps, but here we extend the work by weighting specific factors. This utilizes recent research that identifies the most important determinants of protective action. We then discuss the prioritization of message information

Consequences of non-random species loss for decomposition dynamics: Experimental evidence for additive and non-additive effects

Treesearch

Becky A. Ball; Mark D. Hunter; John S. Kominoski; Christopher M. Swan; Mark A. Bradford

2008-01-01

Although litter decomposition is a fundamental ecological process, most of our understanding comes from studies of single-species decay. Recently, litter-mixing studies have tested whether monoculture data can be applied to mixed-litter systems. These studies have mainly attempted to detect non-additive effects of litter mixing, which address potential consequences of...

Clinical Impact and Evidence Base for Physiotherapy in Treating Childhood Chronic Pain

PubMed Central

Amaria, Khush; Campbell, Fiona; McGrath, Patricia A.

2011-01-01

ABSTRACT Purpose: As part of the special series on pain, our objectives are to describe the key features of chronic pain in children, present the rationale for interdisciplinary treatment, report a case study based on our biopsychosocial approach, and highlight the integral role of physiotherapy in reducing children's pain and improving function. We also evaluate the evidence base supporting physiotherapy for treating chronic neuropathic pain in children. Summary of Key Points: Chronic pain affects many children and adolescents. Certain challenging pain conditions begin primarily during adolescence and disproportionately affect girls and women. Children with these conditions require an interdisciplinary treatment programme that includes physiotherapy as well as medication and/or psychological intervention. Converging lines of evidence from cohort follow-up studies, retrospective chart reviews, and one randomized controlled trial support the effectiveness of physiotherapy within an interdisciplinary programme for treating children with chronic pain. Conclusions: Evidence-based practice dictates that health care providers adopt clear guidelines for determining when treatments are effective and for identifying children for whom such treatments are most effective. Thus, additional well-designed trials are required to better identify the specific physiotherapy modalities that are most important in improving children's pain and function. PMID:22210976

29 CFR 98.900 - Adequate evidence.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 1 2012-07-01 2012-07-01 false Adequate evidence. 98.900 Section 98.900 Labor Office of the Secretary of Labor GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 98.900 Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

29 CFR 98.900 - Adequate evidence.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 1 2011-07-01 2011-07-01 false Adequate evidence. 98.900 Section 98.900 Labor Office of the Secretary of Labor GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 98.900 Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

29 CFR 98.900 - Adequate evidence.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 1 2013-07-01 2013-07-01 false Adequate evidence. 98.900 Section 98.900 Labor Office of the Secretary of Labor GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 98.900 Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

Delivering patient decision aids on the Internet: definitions, theories, current evidence, and emerging research areas

PubMed Central

2013-01-01

Background In 2005, the International Patient Decision Aids Standards Collaboration identified twelve quality dimensions to guide assessment of patient decision aids. One dimension—the delivery of patient decision aids on the Internet—is relevant when the Internet is used to provide some or all components of a patient decision aid. Building on the original background chapter, this paper provides an updated definition for this dimension, outlines a theoretical rationale, describes current evidence, and discusses emerging research areas. Methods An international, multidisciplinary panel of authors examined the relevant theoretical literature and empirical evidence through 2012. Results The updated definition distinguishes Internet-delivery of patient decision aids from online health information and clinical practice guidelines. Theories in cognitive psychology, decision psychology, communication, and education support the value of Internet features for providing interactive information and deliberative support. Dissemination and implementation theories support Internet-delivery for providing the right information (rapidly updated), to the right person (tailored), at the right time (the appropriate point in the decision making process). Additional efforts are needed to integrate the theoretical rationale and empirical evidence from health technology perspectives, such as consumer health informatics, user experience design, and human-computer interaction. Despite Internet usage ranging from 74% to 85% in developed countries and 80% of users searching for health information, it is unknown how many individuals specifically seek patient decision aids on the Internet. Among the 86 randomized controlled trials in the 2011 Cochrane Collaboration’s review of patient decision aids, only four studies focused on Internet-delivery. Given the limited number of published studies, this paper particularly focused on identifying gaps in the empirical evidence base and

How do living arrangements and intergenerational support matter for psychological health of elderly parents? Evidence from Myanmar, Vietnam, and Thailand.

PubMed

Teerawichitchainan, Bussarawan; Pothisiri, Wiraporn; Long, Giang Thanh

2015-07-01

Living arrangements and family support for older persons have become an increasingly important policy concern in developing and rapidly aging Asia. Formulating a sound elderly care policy for the region will benefit from empirically examining how living arrangements, particularly coresidence, and intergenerational exchanges of financial, instrumental, and emotional support are associated with old-age psychological health. This study analyzes data from nationally representative aging surveys in Myanmar, Vietnam, and Thailand for 2011-2012 to offer a comparative perspective from Southeast Asia where various kinship systems coexist. Results suggest that coresidence with a child of culturally preferred gender significantly improves the emotional health of Vietnamese and Thai elders but with different implications. In Vietnam, living with a married son is more beneficial to parents' psychological wellbeing than living with other children. In Thailand, coresidence regardless of the child's gender improves old-age psychological wellbeing but living with a daughter brings greater benefits than living only with son. Evidence points to the importance of understanding the dominant kinship system that may shape normative filial expectations and gender role expectations within the family. In Vietnam and Thailand, the positive association holds even after intergenerational support is controlled, suggesting that the value of culturally preferred coresidence goes beyond practical functions. In Myanmar, there are almost no significant differences in psychological wellbeing among elderly across various living arrangements, except between coresidence and network living arrangements. For all settings, we do not find evidence in support of network family arrangements as a complete substitute for coresidence in terms of promoting old-age psychological wellbeing after filial support is controlled. Our study highlights important cultural nuances for theorizing the nature of the

Evidence-based development and evaluation of mobile cognitive support apps for people on the autism spectrum: methodological conclusions from two R+D projects.

PubMed

Gyori, Miklos; Stefanik, Krisztina; Kanizsai-Nagy, Ildikó

2015-01-01

A growing body of evidence confirms that mobile digital devices have key potentials as assistive/educational tools for people with autism spectrum disorders. The aim of this paper is to outline key aspects of development and evaluation methodologies that build on, and provide systematic evidence on effects of using such apps. We rely on the results of two R+D projects, both using quantitative and qualitative methods to support development and to evaluate developed apps (n=54 and n=22). Analyzing methodological conclusions from these studies we outline some guidelines for an 'ideal' R+D methodology but we also point to important trade-offs between the need for best systematic evidence and the limitations on development time and costs. We see these trade-offs as a key issue to be resolved in this field.

Navy Additive Manufacturing: Policy Analysis for Future DLA Material Support

DTIC Science & Technology

2014-12-01

printing (3DP) for it is a direct offshoot of inkjet paper printing. There are two subtypes to his modality that both involve depositing droplets of...liquid material in layers. The first is material jetting, which uses an inkjet head to move across a print area and deposit a polymer or wax in layers... inkjet printer, this means that the product can be made in multiple colors. Supports have to be built, but they can be made of a different material that

Use of Evidence-Based Practice Resources and Empirically Supported Treatments for Posttraumatic Stress Disorder among University Counseling Center Psychologists

ERIC Educational Resources Information Center

Juel, Morgen Joray

2012-01-01

In the present study, an attempt was made to determine the degree to which psychologists at college and university counseling centers (UCCs) utilized empirically supported treatments with their posttraumatic stress disorder (PTSD) clients. In addition, an attempt was made to determine how frequently UCC psychologists utilized a number of…

Supported employment for persons with mental illness: systematic review of the effectiveness of individual placement and support in the UK.

PubMed

Heffernan, John; Pilkington, Paul

2011-08-01

High levels of unemployment among persons with mental illness are a significant social disability. The individual placement and support (IPS) model of vocational support has been shown to be effective in establishing persons with mental health problems back into competitive employment in North America. Evidence outside North America is more limited. To examine the evidence for the effectiveness of the IPS model of supported employment within the United Kingdom. Systematic review of studies of the effectiveness of IPS conducted principally in the United Kingdom. The evidence base was small. Overall quality of evidence was fair. There is evidence that interventions with high fidelity to the IPS model increase the proportion of patients engaged in work or education/training over the short- to medium-term (6-18 months follow-up). More research is needed to improve the evidence base in relation to IPS within a UK context. Evaluation should focus on both the nature and quality of the employment gained, patient and service factors.

2 CFR 180.900 - Adequate evidence.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 2 Grants and Agreements 1 2013-01-01 2013-01-01 false Adequate evidence. 180.900 Section 180.900 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF... Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

2 CFR 180.900 - Adequate evidence.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 2 Grants and Agreements 1 2012-01-01 2012-01-01 false Adequate evidence. 180.900 Section 180.900 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF... Adequate evidence. Adequate evidence means information sufficient to support the reasonable belief that a...

New Evidence: Data Documenting Parental Support for Earlier Sexuality Education

ERIC Educational Resources Information Center

Barr, Elissa M.; Moore, Michele J.; Johnson, Tammie; Forrest, Jamie; Jordan, Melissa

2014-01-01

Background: Numerous studies document support for sexuality education to be taught in high school, and often, in middle school. However, little research has been conducted addressing support for sexuality education in elementary schools. Methods: As part of the state Behavioral Risk Factor Surveillance System (BRFSS) Survey administration, the…

Outcomes of online support and resources for cancer survivors: a systematic literature review.

PubMed

Hong, Yan; Peña-Purcell, Ninfa C; Ory, Marcia G

2012-03-01

This study aims to review systematically the available literature on health outcomes of online cancer support and resources. We searched major databases with the following selection criteria: (1) empirical study on use of online support or resources by cancer survivors, (2) reporting effects or outcomes of online support or resources, (3) focusing on adult cancer survivors, and (4) peer-reviewed articles published by 2010. A total of 24 studies (37 articles) were included in the review. Most studies were focused on breast cancer survivors and had small sample sizes. Fifteen studies employed a cross-sectional design including eight qualitative studies. Only five studies used pre-post design, and four employed RCT design. The outcome measures have focused on psychosocial effects; most studies reported positive effects, although none of the RCT studies reported significant outcomes. Existing studies of online cancer support and resources have demonstrated preliminary but inconclusive evidence for positive outcomes. We call for additional studies with rigorous study designs and the inclusion of more diverse participants and cancer conditions. Connecting diverse cancer survivors to culturally appropriate, evidence-based online support and resources is a strategy to enhance health outcomes. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

The Evidence-base for Using Ontologies and Semantic Integration Methodologies to Support Integrated Chronic Disease Management in Primary and Ambulatory Care: Realist Review. Contribution of the IMIA Primary Health Care Informatics WG.

PubMed

Liyanage, H; Liaw, S-T; Kuziemsky, C; Terry, A L; Jones, S; Soler, J K; de Lusignan, S

2013-01-01

Most chronic diseases are managed in primary and ambulatory care. The chronic care model (CCM) suggests a wide range of community, technological, team and patient factors contribute to effective chronic disease management. Ontologies have the capability to enable formalised linkage of heterogeneous data sources as might be found across the elements of the CCM. To describe the evidence base for using ontologies and other semantic integration methods to support chronic disease management. We reviewed the evidence-base for the use of ontologies and other semantic integration methods within and across the elements of the CCM. We report them using a realist review describing the context in which the mechanism was applied, and any outcome measures. Most evidence was descriptive with an almost complete absence of empirical research and important gaps in the evidence-base. We found some use of ontologies and semantic integration methods for community support of the medical home and for care in the community. Ubiquitous information technology (IT) and other IT tools were deployed to support self-management support, use of shared registries, health behavioural models and knowledge discovery tools to improve delivery system design. Data quality issues restricted the use of clinical data; however there was an increased use of interoperable data and health system integration. Ontologies and semantic integration methods are emergent with limited evidence-base for their implementation. However, they have the potential to integrate the disparate community wide data sources to provide the information necessary for effective chronic disease management.

Evidence supporting laparoscopic hernia repair in children.

PubMed

Jessula, Samuel; Davies, Dafydd A

2018-06-01

Pediatric inguinal hernias are a commonly performed surgical procedure. Currently, they can be approached via open or laparoscopic surgery. We summarize the current evidence for laparoscopic inguinal hernia repairs in children. Laparoscopic and open inguinal hernia repair in children are associated with similar operative times for unilateral hernia, as well as similar cosmesis, complication rates and recurrence rates. Bilateral hernia repair has been shown to be faster through a laparoscopic approach. The laparoscopic approach is associated with decreased pain scores and earlier recovery, although only in the initial postoperative period. Laparoscopy allows for easy evaluation of the patency of contralateral processus vaginalis, although the clinical significance of and need for repair of an identified defect is unclear. Laparoscopic surgery for pediatric inguinal hernias offers some advantages over open repair with most outcomes being equal. It should be considered a safe alternative to open repair to children and their caregivers.

Being baby friendly: evidence-based breastfeeding support.

PubMed

Cleminson, J; Oddie, S; Renfrew, M J; McGuire, W

2015-03-01

Breast feeding improves important outcomes for mothers and infants. In the UK, breastfeeding rates have historically been low, particularly among socially disadvantaged young women. Although there have been gradual increases in breastfeeding initiation rates since 2000, rates of exclusive breast feeding and continuation until 6 months remain lower than those in similar countries. This review summarises the evidence for effective and cost-effective strategies to help women, particularly those in low income groups, make informed choices, overcome barriers and establish and maintain breast feeding. We describe the development and impact of the Unicef Baby Friendly Initiative, and the roles and responsibilities, and challenges and opportunities that clinicians have in promoting breast feeding and maintaining a baby-friendly culture and environment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Geochemical evidence for airborne dust additions to soils in Channel Islands National Park, California

USGS Publications Warehouse

Muhs, D.R.; Budahn, J.R.; Johnson, D.L.; Reheis, M.; Beann, J.; Skipp, G.; Fisher, E.; Jones, J.A.

2008-01-01

There is an increasing awareness that dust plays important roles in climate change, biogeochemical cycles, nutrient supply to ecosystems, and soil formation. In Channel Islands National Park, California, soils are clay-rich Vertisols or Alfisols and Mollisols with vertic properties. The soils are overlain by silt-rich mantles that contrast sharply with the underlying clay-rich horizons. Silt mantles contain minerals that are rare or absent in the volcanic rocks that dominate these islands. Immobile trace elements (Sc-Th-La and Ta-Nd-Cr) and rare-earth elements show that the basalt and andesite on the islands have a composition intermediate between upper-continental crust and oceanic crust. In contrast, the silt fractions and, to a lesser extent, clay fractions of the silt mantle have compositions closer to average upper-continental crust and very similar to Mojave Desert dust. Island shelves, exposed during the last glacial period, could have provided a source of eolian sediment for the silt mantles, but this is not supported by mineralogical data. We hypothesize that a more likely source for the silt-rich mantles is airborne dust from mainland California and Baja California, either from the Mojave Desert or from the continental shelf during glacial low stands of sea. Although average winds are from the northwest in coastal California, easterly winds occur numerous times of the year when "Santa Ana" conditions prevail, caused by a high-pressure cell centered over the Great Basin. The eolian silt mantles constitute an important medium of plant growth and provide evidence that abundant eolian silt and clay may be delivered to the eastern Pacific Ocean from inland desert sources. ?? 2007 Geological Society of America.

Applying Evidence-Based Medicine in Telehealth: An Interactive Pattern Recognition Approximation

PubMed Central

Fernández-Llatas, Carlos; Meneu, Teresa; Traver, Vicente; Benedi, José-Miguel

2013-01-01

Born in the early nineteen nineties, evidence-based medicine (EBM) is a paradigm intended to promote the integration of biomedical evidence into the physicians daily practice. This paradigm requires the continuous study of diseases to provide the best scientific knowledge for supporting physicians in their diagnosis and treatments in a close way. Within this paradigm, usually, health experts create and publish clinical guidelines, which provide holistic guidance for the care for a certain disease. The creation of these clinical guidelines requires hard iterative processes in which each iteration supposes scientific progress in the knowledge of the disease. To perform this guidance through telehealth, the use of formal clinical guidelines will allow the building of care processes that can be interpreted and executed directly by computers. In addition, the formalization of clinical guidelines allows for the possibility to build automatic methods, using pattern recognition techniques, to estimate the proper models, as well as the mathematical models for optimizing the iterative cycle for the continuous improvement of the guidelines. However, to ensure the efficiency of the system, it is necessary to build a probabilistic model of the problem. In this paper, an interactive pattern recognition approach to support professionals in evidence-based medicine is formalized. PMID:24185841

Large-scale Assessment Yields Evidence of Minimal Use of Reasoning Skills in Traditionally Taught Classes

NASA Astrophysics Data System (ADS)

Thacker, Beth

2017-01-01

Large-scale assessment data from Texas Tech University yielded evidence that most students taught traditionally in large lecture classes with online homework and predominantly multiple choice question exams, when asked to answer free-response (FR) questions, did not support their answers with logical arguments grounded in physics concepts. In addition to a lack of conceptual understanding, incorrect and partially correct answers lacked evidence of the ability to apply even lower level reasoning skills in order to solve a problem. Correct answers, however, did show evidence of at least lower level thinking skills as coded using a rubric based on Bloom's taxonomy. With the introduction of evidence-based instruction into the labs and recitations of the large courses and in a small, completely laboratory-based, hands-on course, the percentage of correct answers with correct explanations increased. The FR format, unlike other assessment formats, allowed assessment of both conceptual understanding and the application of thinking skills, clearly pointing out weaknesses not revealed by other assessment instruments, and providing data on skills beyond conceptual understanding for course and program assessment. Supported by National Institutes of Health (NIH) Challenge grant #1RC1GM090897-01.

Preparation of an amphiphilic resin-supported BINAP ligand and its use for rhodium-catalyzed asymmetric 1,4-addition of phenylboronic acid in water.

PubMed

Otomaru, Yusuke; Senda, Taichi; Hayashi, Tamio

2004-09-16

[reaction: see text] The axially chiral bisphosphine ligand, 2,2'-bis(diphenylphosphino)-1,1'-binaphthyl (binap), was supported on a polystyrene-poly(ethylene glycol) copolymer (PS-PEG) resin and was used successfully for the rhodium-catalyzed asymmetric 1,4-addition of phenylboronic acid to alpha,beta-unsaturated ketones in water.

20 CFR 418.2255 - What kind of evidence of a major life-changing event will you need to support your request for us...

Code of Federal Regulations, 2011 CFR

2011-04-01

...-changing event will you need to support your request for us to use a more recent tax year? 418.2255 Section 418.2255 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE SUBSIDIES Income-Related Monthly... Modified Adjusted Gross Income § 418.2255 What kind of evidence of a major life-changing event will you...

The effectiveness of the bone bridge transtibial amputation technique: A systematic review of high-quality evidence.

PubMed

Kahle, Jason T; Highsmith, M Jason; Kenney, John; Ruth, Tim; Lunseth, Paul A; Ertl, Janos

2017-06-01

This literature review was undertaken to determine if commonly held views about the benefits of a bone bridge technique are supported by the literature. Four databases were searched for articles pertaining to surgical strategies specific to a bone bridge technique of the transtibial amputee. A total of 35 articles were identified as potential articles. Authors included methodology that was applied to separate topics. Following identification, articles were excluded if they were determined to be low quality evidence or not pertinent. Nine articles were identified to be pertinent to one of the topics: Perioperative Care, Acute Care, Subjective Analysis and Function. Two articles sorted into multiple topics. Two articles were sorted into the Perioperative Care topic, 4 articles sorted into the Acute Care topic, 2 articles into the Subjective Analysis topic and 5 articles into the Function topic. There are no high quality (level one or two) clinical trials reporting comparisons of the bone bridge technique to traditional methods. There is limited evidence supporting the clinical outcomes of the bone bridge technique. There is no agreement supporting or discouraging the perioperative and acute care aspects of the bone bridge technique. There is no evidence defining an interventional comparison of the bone bridge technique. Current level III evidence supports a bone bridge technique as an equivalent option to the non-bone bridge transtibial amputation technique. Formal level I and II clinical trials will need to be considered in the future to guide clinical practice. Clinical relevance Clinical Practice Guidelines are evidence based. This systematic literature review identifies the highest quality evidence to date which reports a consensus of outcomes agreeing bone bridge is as safe and effective as alternatives. The clinical relevance is understanding bone bridge could additionally provide a mechanistic advantage for the transtibial amputee.

Perceptual support promotes strategy generation: Evidence from equation solving.

PubMed

Alibali, Martha W; Crooks, Noelle M; McNeil, Nicole M

2017-08-30

Over time, children shift from using less optimal strategies for solving mathematics problems to using better ones. But why do children generate new strategies? We argue that they do so when they begin to encode problems more accurately; therefore, we hypothesized that perceptual support for correct encoding would foster strategy generation. Fourth-grade students solved mathematical equivalence problems (e.g., 3 + 4 + 5 = 3 + __) in a pre-test. They were then randomly assigned to one of three perceptual support conditions or to a Control condition. Participants in all conditions completed three mathematical equivalence problems with feedback about correctness. Participants in the experimental conditions received perceptual support (i.e., highlighting in red ink) for accurately encoding the equal sign, the right side of the equation, or the numbers that could be added to obtain the correct solution. Following this intervention, participants completed a problem-solving post-test. Among participants who solved the problems incorrectly at pre-test, those who received perceptual support for correctly encoding the equal sign were more likely to generate new, correct strategies for solving the problems than were those who received feedback only. Thus, perceptual support for accurate encoding of a key problem feature promoted generation of new, correct strategies. Statement of Contribution What is already known on this subject? With age and experience, children shift to using more effective strategies for solving math problems. Problem encoding also improves with age and experience. What the present study adds? Support for encoding the equal sign led children to generate correct strategies for solving equations. Improvements in problem encoding are one source of new strategies. © 2017 The British Psychological Society.

Experimental evidence supports the abscess theory of development of radicular cysts.

PubMed

Nair, P N R; Sundqvist, Göran; Sjögren, Ulf

2008-08-01

The objective of this study was to experimentally induce inflammatory cysts in an animal model so as to test the hypothesis that radicular cysts develop via the "abscess pathway." Twenty-eight perforated custom-made Teflon cages were surgically implanted into defined locations in the back of 7 Sprague Dawley rats. A week after the implantation of the cages, a known quantity of freshly grown, close allogeneic oral keratinocytes in phosphate buffer solution (PBS) was injected into each cage. One cage per animal was treated as the control that received only epithelial cells. The remaining 3 cages of each animal were trials. Seven days post epithelial cell inoculation; a suspension of 0.2 mL of Fusobacterium nucleatum (10(8) bacteria per mL) was injected into each of the 3 trial cages. Two, 12, and 24 weeks after the inoculation of the bacteria, the cages were taken out, and the tissue contents were fixed and processed by correlative light and transmission electron microscopy. Sixteen of the 21 trial cages could be processed and yielded results. Inoculations of epithelial cells followed 1 week later by F. nucleatum into tissue cages resulted in the development inflammatory cysts in 2 of the 16 cages. The 2 cages contained a total of 4 cystic sites. None of the control cages showed the presence of any cyst-like pathology. Inflammatory cysts were induced by initiating acute inflammatory foci (abscess/necrotic area) by bacterial injection that got enclosed by a proliferating epithelium. This finding provides strong experimental evidence in support of the "abscess theory" of development of radicular cysts.

Enhancement of cognitive and neural functions through complex reasoning training: evidence from normal and clinical populations

PubMed Central

Chapman, Sandra B.; Mudar, Raksha A.

2014-01-01

Public awareness of cognitive health is fairly recent compared to physical health. Growing evidence suggests that cognitive training offers promise in augmenting cognitive brain performance in normal and clinical populations. Targeting higher-order cognitive functions, such as reasoning in particular, may promote generalized cognitive changes necessary for supporting the complexities of daily life. This data-driven perspective highlights cognitive and brain changes measured in randomized clinical trials that trained gist reasoning strategies in populations ranging from teenagers to healthy older adults, individuals with brain injury to those at-risk for Alzheimer's disease. The evidence presented across studies support the potential for Gist reasoning training to strengthen cognitive performance in trained and untrained domains and to engage more efficient communication across widespread neural networks that support higher-order cognition. The meaningful benefits of Gist training provide compelling motivation to examine optimal dose for sustained benefits as well as to explore additive benefits of meditation, physical exercise, and/or improved sleep in future studies. PMID:24808834

Out of sight, out of mind: the presence of forensic evidence counts more than its absence.

PubMed

Eerland, Anita; Post, Lysanne S; Rassin, Eric; Bouwmeester, Samantha; Zwaan, Rolf A

2012-05-01

Recent evidence suggests that decision makers in criminal procedures are susceptible to biases. We previously found support for the presence of a feature positive effect (FPE, i.e., people attach more meaning to present than to absent information) in legal-decision making. In this study, we tried to uncover the mechanisms behind the FPE. Taking a cue from the literature on situation models in language comprehension, we investigated whether a FPE manifests itself in the memorization and use of forensic evidence. Students read a case file about a fistfight as well as additional evidence. The forensic evidence was manipulated such that a FPE on guilt estimation and conviction rate could be assessed. While subjects read additional forensic evidence, their eye movements were recorded to explore the presence of FPE in online processing. Afterwards, subjects were asked to decide on the suspect's guilt. They had to recall all information they remembered from the case file and indicate which parts of information they considered relevant to this decision. The results provided evidence for the occurrence of FPE in memorization and use of information and can be explained by the theoretical construct of situation models. Copyright © 2012 Elsevier B.V. All rights reserved.

Brief Report: An Independent Replication and Extension of Psychometric Evidence Supporting the Theory of Mind Inventory.

PubMed

Greenslade, Kathryn J; Coggins, Truman E

2016-08-01

This study presents an independent replication and extension of psychometric evidence supporting the Theory of Mind Inventory (ToMI). Parents of 20 children with ASD (4; 1-6; 7 years; months) and 20 with typical development (3; 1-6; 5), rated their child's theory of mind abilities in everyday situations. Other parent report and child behavioral assessments included the Social Responsiveness Scale-2, Vineland Adaptive Behavior Scales-2, Peabody Picture Vocabulary Test-4, and Clinical Evaluation of Language Fundamentals-Preschool, 2. Results revealed high internal consistency, expected developmental changes in children with typical development, expected group differences between children with and without ASD, and strong correlations with other measures of social and communication abilities. The ToMI demonstrates strong psychometrics, suggesting considerable utility in identifying theory of mind deficits in children with ASD.

Observational evidence and strength of evidence domains: case examples

PubMed Central

2014-01-01

Background Systematic reviews of healthcare interventions most often focus on randomized controlled trials (RCTs). However, certain circumstances warrant consideration of observational evidence, and such studies are increasingly being included as evidence in systematic reviews. Methods To illustrate the use of observational evidence, we present case examples of systematic reviews in which observational evidence was considered as well as case examples of individual observational studies, and how they demonstrate various strength of evidence domains in accordance with current Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) methods guidance. Results In the presented examples, observational evidence is used when RCTs are infeasible or raise ethical concerns, lack generalizability, or provide insufficient data. Individual study case examples highlight how observational evidence may fulfill required strength of evidence domains, such as study limitations (reduced risk of selection, detection, performance, and attrition); directness; consistency; precision; and reporting bias (publication, selective outcome reporting, and selective analysis reporting), as well as additional domains of dose-response association, plausible confounding that would decrease the observed effect, and strength of association (magnitude of effect). Conclusions The cases highlighted in this paper demonstrate how observational studies may provide moderate to (rarely) high strength evidence in systematic reviews. PMID:24758494

The effect of education with workplace supports on practitioners' evidence-based practice knowledge and implementation behaviours.

PubMed

Novak, Iona; McIntyre, Sarah

2010-12-01

Individual and workplace barriers affect uptake of evidence-based practice (EBP). This study evaluated the effects of a 1-day workshop with workplace supports on allied health professionals' EBP knowledge and behaviour. A prospective longitudinal pre-post design was used. A total of 88 allied health professionals participated. Knowledge was measured using the Adapted Fresno Test (AFT), behaviour was measured using frequency counts of presentations using EBP methodologies and critically appraised topics (CATs) were produced. Mean differences were analysed using paired t-tests. EBP knowledge significantly improved immediately after education on the AFT (from 36.67 to 46.84/156) a mean change of 10.17 points (95% confidence interval (CI): 7.19-13.50) (P <0.001). Behaviour also changed over 18 months. EBP content in presentations increased from 3 to 100% (t = 24.39, P <0.001, 95%CI: 0.86-1.03). CATs produced significantly increased by 0.26 per head (t =5.55, P <0.001, 95% CI: 0.17-0.35). Education with workplace supports (supervision, incentives, resource allocation and working groups) may lead to improvements in EBP knowledge and implementation. © 2010 The Authors. Australian Occupational Therapy Journal © 2010 Australian Association of Occupational Therapists.

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

Evidence-Based Supplements for the Enhancement of Athletic Performance.

PubMed

Peeling, Peter; Binnie, Martyn J; Goods, Paul S R; Sim, Marc; Burke, Louise M

2018-03-01

A strong foundation in physical conditioning and sport-specific experience, in addition to a bespoke and periodized training and nutrition program, are essential for athlete development. Once these underpinning factors are accounted for, and the athlete reaches a training maturity and competition level where marginal gains determine success, a role may exist for the use of evidence-based performance supplements. However, it is important that any decisions surrounding performance supplements are made in consideration of robust information that suggests the use of a product is safe, legal, and effective. The following review focuses on the current evidence-base for a number of common (and emerging) performance supplements used in sport. The supplements discussed here are separated into three categories based on the level of evidence supporting their use for enhancing sports performance: (1) established (caffeine, creatine, nitrate, beta-alanine, bicarbonate); (2) equivocal (citrate, phosphate, carnitine); and (3) developing. Within each section, the relevant performance type, the potential mechanisms of action, and the most common protocols used in the supplement dosing schedule are summarized.