Astrophysical data on 5 eV to 1 keV radiation from the radiative decay of fundamental particles - Current limits and prospects for improvement

NASA Technical Reports Server (NTRS)

Bowyer, Stuart; Malina, Roger F.

1986-01-01

Line emission from the decay of fundamental particles, integrated over cosmological distances, can give rise to detectable spectral features in the diffuse astronomical background between 5 eV and 1 keV. Spectroscopic observations may allow these features to be separated from line emission from the numerous local sources of radiation. The current observational status and existing evidence for such features are reviewed. No definitive detections of nongalactic line features have been made. Several local sources of background mask the features at many wavelengths and confuse the interpretation of the data. No systematic spectral observations have been carried out to date. Upcoming experiments which can be expected to provide significantly better constraints on the presence of spectral features in the diffuse background from 5 eV to 1 keV are reviewed.

Household portfolio choices, health status and health care systems: A cross-country analysis based on SHARE.

PubMed

Atella, Vincenzo; Brunetti, Marianna; Maestas, Nicole

2012-05-01

Health risk is increasingly viewed as an important form of background risk that affects household portfolio decisions. However, its role might be mediated by the presence of a protective full-coverage national health service that could reduce households' probability of incurring current and future out-of-pocket medical expenditures. We use SHARE data to study the influence of current health status and future health risk on the decision to hold risky assets, across ten European countries with different health systems, each offering a different degree of protection against out-of-pocket medical expenditures. We find robust empirical evidence that perceived health status matters more than objective health status and, consistent with the theory of background risk, health risk affects portfolio choices only in countries with less protective health care systems. Furthermore, portfolio decisions consistent with background risk models are observed only with respect to middle-aged and highly-educated investors.

Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence

PubMed Central

Hill, Jonathan C.; Foster, Nadine E.; Protheroe, Joanne

2017-01-01

Background & aims Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care. Methods A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach. Results Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options. Conclusion This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most promising treatments is needed. PMID:28640822

Easy-Access Services in Low-Threshold Opiate Agonist Maintenance

ERIC Educational Resources Information Center

Hesse, Morten; Pedersen, Mads U.

2008-01-01

Background: There is currently evidence that methadone and buprenorphine maintenance is effective in reducing substance abuse. However, it is not known whether psychosocial support improves the outcome of methadone maintenance in the absence of control measures, such as regular urine testing. Materials and Methods: In a prospective observational…

Emanuel Miller Lecture: Confusions and Controversies about Asperger Syndrome

ERIC Educational Resources Information Center

Frith, Uta

2004-01-01

Background: Hans Asperger drew attention to individuals who show the core symptoms of autism in the presence of high verbal intelligence. Methods: A review of the literature explores current issues concerning the diagnosis and nature of Asperger syndrome. Results: The behavioural and neurophysiological evidence to date suggests that Asperger…

Development and Evaluation of a Computerized Engagement Intervention for IPS Supported Employment

ERIC Educational Resources Information Center

Haslett, William R.

2013-01-01

Background: Current information technology offers the promise of innovative approaches to engagement for mental health. Specific psychosocial services may also benefit from technology-based engagement interventions. Individual Placement and Support (IPS) is an evidence-based service that helps people who have a severe mental illness to gain…

Effect of personalized nutrition on health-related behavior change: evidence from the Food4Me randomized controlled trial

USDA-ARS?s Scientific Manuscript database

Background - Optimal nutritional choices are linked with better health but most current interventions to improve diet have limited effect. We tested the hypothesis that providing personalized nutrition (PN) advice based on collected information on individual diet and lifestyle, phenotype or genotype...

COMPARISON OF MYCOBACTERIUM AVIUM ISOLATES FROM DRINKING WATER AND FROM THE POPULATION SERVED BY THE SYSTEM

EPA Science Inventory

Background: Current evidence suggests that drinking water, soil, and produce are potential sources of Mycobacterium avium infections, a pathogen not known to be transmitted person-to-person.

Methods: We sampled water during 2000 - 2002 from a large municipal drinking wate...

Tensions and Challenges in China's Education Policy Borrowing

ERIC Educational Resources Information Center

Tan, Charlene

2016-01-01

Background: This article critically discusses the key tensions and challenges arising from the educational policy borrowing in China, through its current education reform. Focussing on the new curriculum reform (NCR), the paper highlights the interactions and conflicts between foreign and local ideologies and practices. Sources of evidence: The…

The omega-3 index is inversely associated with depressive symptoms among individuals with elevated oxidative stress biomarkers

USDA-ARS?s Scientific Manuscript database

Background: Omega-3 (n-3) fatty acid (FA) consumption is thought to improve depressive symptoms. However, current evidence is limited, and whether this association exists among Puerto Ricans, a population burdened by depression, remains uncertain. Objectives: We examined the association between ...

Exploring Hypotheses and Rationale for Causes of Infantile Colic

PubMed Central

Camilleri, Michael; Park, Seon-Young; Scarpato, Elena; Staiano, Annamaria

2016-01-01

Background Infantile colic is a frequent problem in neonates and infants. This review addresses current management including the results for nutrient modifications, soy-based formulas, and prebiotics, probiotics and synbiotics. Purpose Given the evidence that there is still an unmet clinical need, as current treatments are incompletely efficacious, we have examined the evidence around three hypothetical mechanisms that could potentially be involved in etiopathogenesis of infantile colic: immaturity of bile acid mechanisms that alter intraluminal and absorptive mechanisms, immaturity in motility and alterations in the microbiome. Understanding these potential mechanisms may lead to the introduction of diagnostic procedures that should enhance the selection or individualization of therapy for infantile colic. PMID:27647578

Does Mood Influence Text Processing and Comprehension? Evidence from an Eye-Movement Study

ERIC Educational Resources Information Center

Scrimin, Sara; Mason, Lucia

2015-01-01

Background: Previous research has indicated that mood influences cognitive processes. However, there is scarce data regarding the link between everyday emotional states and readers' text processing and comprehension. Aim: We aim to extend current research on the effects of mood induction on science text processing and comprehension, using…

Eating Disorder Symptomatology, Body Image, and Mindfulness: Findings in a Non-Clinical Sample

ERIC Educational Resources Information Center

Prowse, Emma; Bore, Miles; Dyer, Stella

2013-01-01

Background: There has been increasing interest in the use of mindfulness-based interventions in treating various disorders and conditions; however, evidence to support the application of mindfulness-based treatments for eating disorders is limited. The current study was designed as a preliminary investigation of the relationship between…

COMPARISON OF MYCOBACTERIUM AVIUM ISOLATES FROM A DRINKING WATER DISTRIBUTION SYSTEM AND FROM THE POPULATION SERVED BY THE SYSTEM

EPA Science Inventory

Background: Current evidence suggests that drinking water, soil, and produce are potential sources of Mycobacterium avium infections, a pathogen not known to be transmitted person-to-person.

Methods: We sampled water during 2000-2002 from a large municipal drinking water ...

Looking at Movies and Cartoons: Eye-Tracking Evidence from Williams Syndrome and Autism

ERIC Educational Resources Information Center

Riby, D.; Hancock, P. J. B.

2009-01-01

Background: Autism and Williams syndrome (WS) are neuro-developmental disorders associated with distinct social phenotypes. While individuals with autism show a lack of interest in socially important cues, individuals with WS often show increased interest in socially relevant information. Methods: The current eye-tracking study explores how…

A Randomised Controlled Trial of PEGASUS, a Psychoeducational Programme for Young People with High-Functioning Autism Spectrum Disorder

ERIC Educational Resources Information Center

Gordon, Kate; Murin, Marianna; Baykaner, Ozlem; Roughan, Laura; Livermore-Hardy, Vaan; Skuse, David; Mandy, Will

2015-01-01

Background: Psychoeducation is an essential component of postdiagnostic care for people with ASD (autism spectrum disorder), but there is currently no evidence base for clinical practice. We designed, manualised and evaluated PEGASUS (psychoeducation group for autism spectrum understanding and support), a group psychoeducational programme aiming…

Social Networks and Parent Motivational Beliefs: Evidence from an Urban School District

ERIC Educational Resources Information Center

Curry, Katherine A.; Jean-Marie, Gaëtane; Adams, Curt M.

2016-01-01

Background: Despite devotion of substantial resources and effort to increase parent/school partnerships, gaps remain between policy rhetoric and practice, especially in high-poverty communities. Current research focuses on parent involvement or effects of parent motivational beliefs on parent choice for behavior; however, it does not address the…

An Exploratory Study Of Lead Recovery In Lead-Acid Battery Lifecycle In US Market: An Evidence-Based Approach

EPA Science Inventory

Background: This research examines lead recovery and recycling in lead-acid batteries (LAB) which account for 88% of US lead consumption. We explore strategies to maximize lead recovery and recycling in the LAB lifecycle. Currently, there is limited information on recycling ra...

The Role of Peer Rejection in the Link between Reactive Aggression and Academic Performance

ERIC Educational Resources Information Center

Fite, Paula J.; Hendrickson, Michelle; Rubens, Sonia L.; Gabrielli, Joy; Evans, Spencer

2013-01-01

Background: There is substantial evidence to suggest that aggressive behavior is associated with poor academic performance in school-aged children. However, less is known about how different subtypes of aggression are related to academic performance and what variables may account for this association. Objective: The current study examined unique…

Integrating Telemedicine for Disaster Response: Testing the Emergency Telemedicine Technology Acceptance Model

ERIC Educational Resources Information Center

Davis, Theresa M.

2013-01-01

Background: There is little evidence that technology acceptance is well understood in healthcare. The hospital environment is complex and dynamic creating a challenge when new technology is introduced because it impacts current processes and workflows which can significantly affect patient care delivery and outcomes. This study tested the effect…

Health Inequity in People with Intellectual Disabilities: From Evidence to Action Applying an Appreciative Inquiry Approach

ERIC Educational Resources Information Center

Naaldenberg, Jenneken; Banks, Roger; Lennox, Nick; Ouellette-Kunz, Hélène; Meijer, Marijke; Lantman-de Valk, Henny van Schrojenstein

2015-01-01

Background: The current understanding of health inequities in people with intellectual disabilities does not readily translate into improvements in health status or health care. To identify opportunities for action, the 2013 IASSIDD health SIRG conference organized ten intensive workshops. Materials and methods: The workshops each addressed…

Development of a Comprehensive Heart Disease Knowledge Questionnaire

ERIC Educational Resources Information Center

Bergman, Hannah E.; Reeve, Bryce B.; Moser, Richard P.; Scholl, Sarah; Klein, William M. P.

2011-01-01

Background: Heart disease is the number one killer of both men and women in the United States, yet a comprehensive and evidence-based heart disease knowledge assessment is currently not available. Purpose: This paper describes the two-phase development of a novel heart disease knowledge questionnaire. Methods: After review and critique of the…

Adapting Compassion Focused Therapy for an Adult with a Learning Disability--A Case Study

ERIC Educational Resources Information Center

Cooper, Rosalind; Frearson, Julia

2017-01-01

Background: Joe was referred to the Community Learning Disabilities Team (CLDT) for support around low mood and overeating. Initial formulation suggested compassion focused therapy (CFT) as an intervention. The evidence base for using CFT with people with learning disabilities is currently limited. Materials and Methods: Adaptations were made to…

8 CFR 214.11 - Alien victims of severe forms of trafficking in persons.

Code of Federal Regulations, 2012 CFR

2012-01-01

... completed fingerprint and background checks, and presents prima facie evidence to show eligibility for T... waiver as provided in § 103.7(c) of this chapter; (ii) Three current photographs; (iii) The fingerprint... the allotted time. (5) Fingerprint procedure. All applicants for T nonimmigrant status must be...

8 CFR 214.11 - Alien victims of severe forms of trafficking in persons.

Code of Federal Regulations, 2013 CFR

2013-01-01

... completed fingerprint and background checks, and presents prima facie evidence to show eligibility for T... waiver as provided in § 103.7(c) of this chapter; (ii) Three current photographs; (iii) The fingerprint... the allotted time. (5) Fingerprint procedure. All applicants for T nonimmigrant status must be...

8 CFR 214.11 - Alien victims of severe forms of trafficking in persons.

Code of Federal Regulations, 2014 CFR

2014-01-01

... completed fingerprint and background checks, and presents prima facie evidence to show eligibility for T... waiver as provided in § 103.7(c) of this chapter; (ii) Three current photographs; (iii) The fingerprint... the allotted time. (5) Fingerprint procedure. All applicants for T nonimmigrant status must be...

"MetaTaal": Enhancing Complex Syntax in Children with Specific Language Impairment--A Metalinguistic and Multimodal Approach

ERIC Educational Resources Information Center

Zwitserlood, Rob; Wijnen, Frank; Weerdenburg, Marjolijn; Verhoeven, Ludo

2015-01-01

Background: Currently, most research on the effective treatment of morphosyntax in children with specific language impairment (SLI) pertains to younger children. In the last two decades, several studies have provided evidence that intervention for older school-age children with SLI can be effective. These metalinguistic intervention approaches…

Dark energy and the cosmic microwave background radiation

NASA Technical Reports Server (NTRS)

Dodelson, S.; Knox, L.

2000-01-01

We find that current cosmic microwave background anisotropy data strongly constrain the mean spatial curvature of the Universe to be near zero, or, equivalently, the total energy density to be near critical-as predicted by inflation. This result is robust to editing of data sets, and variation of other cosmological parameters (totaling seven, including a cosmological constant). Other lines of argument indicate that the energy density of nonrelativistic matter is much less than critical. Together, these results are evidence, independent of supernovae data, for dark energy in the Universe.

Dark energy and the cosmic microwave background radiation.

PubMed

Dodelson, S; Knox, L

2000-04-17

We find that current cosmic microwave background anisotropy data strongly constrain the mean spatial curvature of the Universe to be near zero, or, equivalently, the total energy density to be near critical-as predicted by inflation. This result is robust to editing of data sets, and variation of other cosmological parameters (totaling seven, including a cosmological constant). Other lines of argument indicate that the energy density of nonrelativistic matter is much less than critical. Together, these results are evidence, independent of supernovae data, for dark energy in the Universe.

Household portfolio choices, health status and health care systems: A cross-country analysis based on SHARE

PubMed Central

Atella, Vincenzo; Brunetti, Marianna; Maestas, Nicole

2013-01-01

Health risk is increasingly viewed as an important form of background risk that affects household portfolio decisions. However, its role might be mediated by the presence of a protective full-coverage national health service that could reduce households’ probability of incurring current and future out-of-pocket medical expenditures. We use SHARE data to study the influence of current health status and future health risk on the decision to hold risky assets, across ten European countries with different health systems, each offering a different degree of protection against out-of-pocket medical expenditures. We find robust empirical evidence that perceived health status matters more than objective health status and, consistent with the theory of background risk, health risk affects portfolio choices only in countries with less protective health care systems. Furthermore, portfolio decisions consistent with background risk models are observed only with respect to middle-aged and highly-educated investors. PMID:23885134

The Role of Parents in Young People's Education--A Critical Review of the Causal Evidence

ERIC Educational Resources Information Center

See, Beng Huat; Gorard, Stephen

2015-01-01

There is currently a considerable body of research suggesting that parental involvement is linked to young people's attainment at school. It is also generally agreed that a number of factors such as parental background, attention, warmth and parenting style are associated with children's later life outcomes. However, although widely assumed on the…

Paternal B vitamin intake is a determinant of growth, hepatic lipid metabolism and intestinal tumor volume in female Apc1638N mouse offspring

USDA-ARS?s Scientific Manuscript database

Background: The importance of maternal nutrition to offspring health and risk of disease is well established. Emerging evidence suggests paternal diet may affect offspring health as well. Objective: In the current study we sought to determine whether modulating pre-conception paternal B vitamin inta...

What Do Teachers Need? An Exploration of Evidence-Informed Practice for Classroom Assessment in Ontario

ERIC Educational Resources Information Center

Cooper, Amanda; Klinger, Don A.; McAdie, Patricia

2017-01-01

Background: Within the realm of public education, there is a well-known "knowledge to practice gap" on current conceptions of classroom assessment. A collaborative research project undertaken by the Elementary Teachers' Federation of Ontario (ETFO) and a research team at Queen's University explored the roots of this gap from the…

The Nature of Trauma Memories in Acute Stress Disorder in Children and Adolescents

ERIC Educational Resources Information Center

Salmond, C. H.; Meiser-Stedman, R.; Glucksman, E.; Thompson, P.; Dalgleish, T.; Smith, P.

2011-01-01

Background: There is increasing theoretical, clinical and research evidence for the role of trauma memory in the aetiology of acute pathological stress responses in adults. However, research into the phenomenology of trauma memories in young people is currently scarce. Methods: This study compared the nature of trauma narratives to narratives of…

Experiences of Two Multidisciplinary Team Members of Systemic Consultations in a Community Learning Disability Service

ERIC Educational Resources Information Center

Johnson, Clair; Viljoen, Nina

2017-01-01

Background: Systemic approaches can be useful in working with people with learning disabilities and their network. The evidence base for these approaches within the field of learning disabilities, however, is currently limited. Materials and Methods: This article presents part of a service evaluation of systemic consultations in a Community…

The Effectiveness of Antidepressant Medication in the Management of Behaviour Problems in Adults with Intellectual Disabilities: A Systematic Review

ERIC Educational Resources Information Center

Sohanpal, S. K.; Deb, S.; Thomas, C.; Soni, R.; Lenotre, L.; Unwin, G.

2007-01-01

Background: A comprehensive systematic review was performed to establish the current evidence base regarding the effectiveness of antidepressant medication for the management of behaviour problems in adults with intellectual disabilities. Method: An electronic search of PsycInfo, Embase, Medline and Cinahl databases was conducted spanning the time…

Preserved figure-ground segregation and symmetry perception in visual neglect.

PubMed

Driver, J; Baylis, G C; Rafal, R D

1992-11-05

A central controversy in current research on visual attention is whether figures are segregated from their background preattentively, or whether attention is first directed to unstructured regions of the image. Here we present neurological evidence for the former view from studies of a brain-injured patient with visual neglect. His attentional impairment arises after normal segmentation of the image into figures and background has taken place. Our results indicate that information which is neglected and unavailable to higher levels of visual processing can nevertheless be processed by earlier stages in the visual system concerned with segmentation.

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

Audren, Benjamin; Bellini, Emilio; Cuesta, Antonio J.

The existence of a cosmic neutrino background can be probed indirectly by CMB experiments, not only by measuring the background density of radiation in the universe, but also by searching for the typical signatures of the fluctuations of free-streaming species in the temperature and polarisation power spectrum. Previous studies have already proposed a rather generic parametrisation of these fluctuations, that could help to discriminate between the signature of ordinary free-streaming neutrinos, or of more exotic dark radiation models. Current data are compatible with standard values of these parameters, which seems to bring further evidence for the existence of a cosmicmore » neutrino background. In this work, we investigate the robustness of this conclusion under various assumptions. We generalise the definition of an effective sound speed and viscosity speed to the case of massive neutrinos or other dark radiation components experiencing a non-relativistic transition. We show that current bounds on these effective parameters do not vary significantly when considering an arbitrary value of the particle mass, or extended cosmological models with a free effective neutrino number, dynamical dark energy or a running of the primordial spectrum tilt. We conclude that it is possible to make a robust statement about the detection of the cosmic neutrino background by CMB experiments.« less

Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges

PubMed Central

Salem, Haitham; Nagpal, Caesa; Pigott, Teresa; Teixeira, Antonio Lucio

2017-01-01

Background: Akathisia continues to be a significant challenge in current neurological and psychiatric practice. Prompt and accurate detection is often difficult and there is a lack of consensus concerning the neurobiological basis of akathisia. No definitive treatment has been established for akathisia despite numerous preclinical and clinical studies. Method: We reviewed antipsychotic-induced akathisia including its clinical presentation, proposed underlying pathophysiology, current and under investigation therapeutic strategies. Conclusion: Despite the initial promise that second generation antipsychotics would be devoid of akathisia effects, this has not been confirmed. Currently, there are limited therapeutic options for the clinical practice and the evidence supporting the most widely used treatments (beta blockers, anticholinergic drugs) is still absent or inconsistent. PMID:27928948

Catechol-O-Methyltransferase "Val[superscript 158]Met" Genotype, Parenting Practices and Adolescent Alcohol Use: Testing the Differential Susceptibility Hypothesis

ERIC Educational Resources Information Center

Laucht, Manfred; Blomeyer, Dorothea; Buchmann, Arlette F.; Treutlein, Jens; Schmidt, Martin H.; Esser, Gunter; Jennen-Steinmetz, Christine; Rietschel, Marcella; Zimmermann, Ulrich S.; Banaschewski, Tobias

2012-01-01

Background: Recently, first evidence has been reported for a gene-parenting interaction (G x E) with regard to adolescent alcohol use. The present investigation set out to extend this research using the catechol-O-methyltransferase ("COMT") "Val[superscript 158]Met" polymorphism as a genetic susceptibility factor. Moreover, the current study…

Influence of Current Input-Output and Age of First Exposure on Phonological Acquisition in Early Bilingual Spanish-English-Speaking Kindergarteners

ERIC Educational Resources Information Center

Ruiz-Felter, Roxanna; Cooperson, Solaman J.; Bedore, Lisa M.; Peña, Elizabeth D.

2016-01-01

Background: Although some investigations of phonological development have found that segmental accuracy is comparable in monolingual children and their bilingual peers, there is evidence that language use affects segmental accuracy in both languages. Aims: To investigate the influence of age of first exposure to English and the amount of current…

Anti-Oxidative and Anti-Inflammatory Effects of Ginger in Health and Physical Activity: Review of Current Evidence

PubMed Central

Mashhadi, Nafiseh Shokri; Ghiasvand, Reza; Askari, Gholamreza; Hariri, Mitra; Darvishi, Leila; Mofid, Mohammad Reza

2013-01-01

Background: Ginger (Zingiber officinale Rosc.) belongs to the family Zingiberaceae. The health-promoting perspective of ginger is attributed to its rich phytochemistry. This study aimed to review the current evidence on ginger effects as an anti-inflammatory and anti-oxidative. Methods: We searched MEDLINE for related publications using “ginger” and “anti-oxidative” and “ginger” and “anti-inflammatory” as keywords. This search had considered Papers that had been published between 2000 and 2010 without any filter. Conclusions: The anticancer potential of ginger is well documented and its functional ingredients like gingerols, shogaol, and paradols are the valuable ingredients which can prevent various cancers. This review concludes to favor ginger but some ambiguities necessitate further research before claiming its efficacy. PMID:23717767

The relation between finger gnosis and mathematical ability: why redeployment of neural circuits best explains the finding

PubMed Central

Penner-Wilger, Marcie; Anderson, Michael L.

2013-01-01

This paper elaborates a novel hypothesis regarding the observed predictive relation between finger gnosis and mathematical ability. In brief, we suggest that these two cognitive phenomena have overlapping neural substrates, as the result of the re-use (“redeployment”) of part of the finger gnosis circuit for the purpose of representing numbers. We offer some background on the relation and current explanations for it; an outline of our alternate hypothesis; some evidence supporting redeployment over current views; and a plan for further research. PMID:24367341

The relation between finger gnosis and mathematical ability: why redeployment of neural circuits best explains the finding.

PubMed

Penner-Wilger, Marcie; Anderson, Michael L

2013-01-01

This paper elaborates a novel hypothesis regarding the observed predictive relation between finger gnosis and mathematical ability. In brief, we suggest that these two cognitive phenomena have overlapping neural substrates, as the result of the re-use ("redeployment") of part of the finger gnosis circuit for the purpose of representing numbers. We offer some background on the relation and current explanations for it; an outline of our alternate hypothesis; some evidence supporting redeployment over current views; and a plan for further research.

Clinical Applications of Procalcitonin in Pediatrics: An Advanced Biomarker for Inflammation and Infection-Can It Also Be Used in Trauma?

PubMed

Koutroulis, Ioannis; Loscalzo, Steven M; Kratimenos, Panagiotis; Singh, Sabina; Weiner, Evan; Syriopoulou, Vassiliki; Theocharis, Stamatios; Chrousos, Georgios

2014-01-01

Background. Procalcitonin is a small molecular peptide that has gained increased support as an adjunct diagnostic marker of infection in the adult population; the concordant body of evidence for the use of procalcitonin in pediatric populations is far less complete. Objectives. Our objective is to review the current evidence supporting the utilization of procalcitonin in children in a variety of clinical scenarios including SIRS, sepsis, burns, and trauma and to identify existing knowledge gaps. Methods. A thorough review of the literature was performed utilizing PubMed. We focused on using meta-analysis from adult populations to review current practices in interpretation and methodology and find concordant pediatric studies to determine if the same applications are validated in pediatric populations. Results. Current evidence supports the usage of procalcitonin as both a sensitive and a specific marker for the differentiation of systemic inflammatory response syndrome from sepsis in pediatrics with increased diagnostic accuracy compared to commonly used biomarkers including complete blood counts and C-reactive protein. Conclusions. Although the body of evidence is limited, initial observations suggest that procalcitonin can be used in pediatric trauma and burn patients as both a prognostic and a diagnostic marker, aiding in the identification of infection in patients with extensive underlying inflammation.

Clinical Applications of Procalcitonin in Pediatrics: An Advanced Biomarker for Inflammation and Infection—Can It Also Be Used in Trauma?

PubMed Central

Loscalzo, Steven M.; Singh, Sabina; Weiner, Evan; Syriopoulou, Vassiliki; Theocharis, Stamatios; Chrousos, Georgios

2014-01-01

Background. Procalcitonin is a small molecular peptide that has gained increased support as an adjunct diagnostic marker of infection in the adult population; the concordant body of evidence for the use of procalcitonin in pediatric populations is far less complete. Objectives. Our objective is to review the current evidence supporting the utilization of procalcitonin in children in a variety of clinical scenarios including SIRS, sepsis, burns, and trauma and to identify existing knowledge gaps. Methods. A thorough review of the literature was performed utilizing PubMed. We focused on using meta-analysis from adult populations to review current practices in interpretation and methodology and find concordant pediatric studies to determine if the same applications are validated in pediatric populations. Results. Current evidence supports the usage of procalcitonin as both a sensitive and a specific marker for the differentiation of systemic inflammatory response syndrome from sepsis in pediatrics with increased diagnostic accuracy compared to commonly used biomarkers including complete blood counts and C-reactive protein. Conclusions. Although the body of evidence is limited, initial observations suggest that procalcitonin can be used in pediatric trauma and burn patients as both a prognostic and a diagnostic marker, aiding in the identification of infection in patients with extensive underlying inflammation. PMID:27355024

A Systematic Review Protocol on the Use of Online Learning versus Blended Learning for Teaching Clinical Skills to Undergraduate Health Professional Students

ERIC Educational Resources Information Center

McCutcheon, Karen; Lohan, Maria; Traynor, Marian

2016-01-01

Aim: This paper is a review protocol that will be used to identify, critically appraise and synthesise the best current evidence relating to the use of online learning and blended learning approaches in teaching clinical skills in undergraduate health professionals. Background: Although previous systematic reviews on online learning vs. face to…

The Development of Early Literacy in Steiner- and Standard-Educated Children

ERIC Educational Resources Information Center

Cunningham, Anna J.; Carroll, Julia M.

2011-01-01

Background: There is evidence that children who are taught to read later in childhood (age 6-7) make faster progress in early literacy than those who are taught at a younger age (4-5 years), as is current practice in the UK. Aims: Steiner-educated children begin learning how to read at age 7, and have better reading-related skills at the onset of…

A DRD4 Gene by Maternal Sensitivity Interaction Predicts Risk for Overweight or Obesity in Two Independent Cohorts of Preschool Children

ERIC Educational Resources Information Center

Levitan, Robert D.; Jansen, Pauline; Wendland, Barbara; Tiemeier, Henning; Jaddoe, Vincent W.; Silveira, Patricia P.; Kennedy, James L.; Atkinson, Leslie; Fleming, Alison; Sokolowski, Marla; Gaudreau, Helene; Steiner, Meir; Dubé, Laurette; Hamilton, Jill; Moss, Ellen; Wazana, Ashley; Meaney, Michael

2017-01-01

Background: Recent evidence suggests that early exposure to low maternal sensitivity is a risk factor for obesity in children and adolescents. A separate line of study shows that the seven-repeat (7R) allele of the dopamine-4 receptor gene (DRD4) increases susceptibility to environmental factors including maternal sensitivity. The current study…

If Only "A Rose by Any Other Name Would Smell as Sweet": A Systematic Review on the Impact of Youth Work for Young People

ERIC Educational Resources Information Center

Mundy-McPherson, Stuart; Fouche, Christa; Elliot, Kim

2012-01-01

Background: Internationally there is an increasing commitment and investment to support the provision of youth work services and ongoing debate on youth worker effectiveness. However, the evidence of the impact of youth work is currently limited and disjointed. Objective: This article reports on and critically considers the results of a systematic…

Tobacco and Alcohol Use in People with Mild/Moderate Intellectual Disabilities: Giving Voice to Their Health Promotion Needs

ERIC Educational Resources Information Center

Kerr, Susan; Lawrence, Maggie; Middleton, Alan R.; Fitzsimmons, Lorna; Darbyshire, Christopher

2017-01-01

Background: Concerns have been raised about the use/misuse of tobacco and alcohol by people with mild/moderate intellectual disabilities. Aiming to address an identified gap in the current evidence base, this study sought to gain an understanding of the tobacco- and alcohol-related health promotion needs of this client group. Methods: Informed by…

Biological pathways, candidate genes and molecular markers associated with quality-of-life domains: an update

PubMed Central

Sprangers, Mirjam A.G.; Thong, Melissa S.Y.; Bartels, Meike; Barsevick, Andrea; Ordoñana, Juan; Shi, Qiuling; Wang, Xin Shelley; Klepstad, Pål; Wierenga, Eddy A.; Singh, Jasvinder A.; Sloan, Jeff A.

2014-01-01

Background There is compelling evidence of a genetic foundation of patient-reported QOL. Given the rapid development of substantial scientific advances in this area of research, the current paper updates and extends reviews published in 2010. Objectives The objective is to provide an updated overview of the biological pathways, candidate genes and molecular markers involved in fatigue, pain, negative (depressed mood) and positive (well-being/happiness) emotional functioning, social functioning, and overall QOL. Methods We followed a purposeful search algorithm of existing literature to capture empirical papers investigating the relationship between biological pathways and molecular markers and the identified QOL domains. Results Multiple major pathways are involved in each QOL domain. The inflammatory pathway has the strongest evidence as a controlling mechanism underlying fatigue. Inflammation and neurotransmission are key processes involved in pain perception and the COMT gene is associated with multiple sorts of pain. The neurotransmitter and neuroplasticity theories have the strongest evidence for their relationship with depression. Oxytocin-related genes and genes involved in the serotonergic and dopaminergic pathways play a role in social functioning. Inflammatory pathways, via cytokines, also play an important role in overall QOL. Conclusions Whereas the current findings need future experiments and replication efforts, they will provide researchers supportive background information when embarking on studies relating candidate genes and/or molecular markers to QOL domains. The ultimate goal of this area of research is to enhance patients’ QOL. PMID:24604075

A comparison of traditional anti-inflammation and anti-infection medicinal plants with current evidence from biomedical research: Results from a regional study

PubMed Central

Vieira, A.

2010-01-01

Background: In relation to pharmacognosy, an objective of many ethnobotanical studies is to identify plant species to be further investigated, for example, tested in disease models related to the ethnomedicinal application. To further warrant such testing, research evidence for medicinal applications of these plants (or of their major phytochemical constituents and metabolic derivatives) is typically analyzed in biomedical databases. Methods: As a model of this process, the current report presents novel information regarding traditional anti-inflammation and anti-infection medicinal plant use. This information was obtained from an interview-based ethnobotanical study; and was compared with current biomedical evidence using the Medline® database. Results: Of the 8 anti-infection plant species identified in the ethnobotanical study, 7 have related activities reported in the database; and of the 6 anti-inflammation plants, 4 have related activities in the database. Conclusion: Based on novel and complimentary results from the ethnobotanical and biomedical database analyses, it is suggested that some of these plants warrant additional investigation of potential anti-inflammatory or anti-infection activities in related disease models, and also additional studies in other population groups. PMID:21589754

SEE: structured representation of scientific evidence in the biomedical domain using Semantic Web techniques

PubMed Central

2014-01-01

Background Accounts of evidence are vital to evaluate and reproduce scientific findings and integrate data on an informed basis. Currently, such accounts are often inadequate, unstandardized and inaccessible for computational knowledge engineering even though computational technologies, among them those of the semantic web, are ever more employed to represent, disseminate and integrate biomedical data and knowledge. Results We present SEE (Semantic EvidencE), an RDF/OWL based approach for detailed representation of evidence in terms of the argumentative structure of the supporting background for claims even in complex settings. We derive design principles and identify minimal components for the representation of evidence. We specify the Reasoning and Discourse Ontology (RDO), an OWL representation of the model of scientific claims, their subjects, their provenance and their argumentative relations underlying the SEE approach. We demonstrate the application of SEE and illustrate its design patterns in a case study by providing an expressive account of the evidence for certain claims regarding the isolation of the enzyme glutamine synthetase. Conclusions SEE is suited to provide coherent and computationally accessible representations of evidence-related information such as the materials, methods, assumptions, reasoning and information sources used to establish a scientific finding by adopting a consistently claim-based perspective on scientific results and their evidence. SEE allows for extensible evidence representations, in which the level of detail can be adjusted and which can be extended as needed. It supports representation of arbitrary many consecutive layers of interpretation and attribution and different evaluations of the same data. SEE and its underlying model could be a valuable component in a variety of use cases that require careful representation or examination of evidence for data presented on the semantic web or in other formats. PMID:25093070

Evidence of Cross-correlation between the CMB Lensing and the γ-Ray Sky

NASA Astrophysics Data System (ADS)

Fornengo, Nicolao; Perotto, Laurence; Regis, Marco; Camera, Stefano

2015-03-01

We report the measurement of the angular power spectrum of cross-correlation between the unresolved component of the Fermi-LAT γ-ray sky maps and the cosmic microwave background lensing potential map reconstructed by the Planck satellite. The matter distribution in the universe determines the bending of light coming from the last scattering surface. At the same time, the matter density drives the growth history of astrophysical objects, including their capability at generating non-thermal phenomena, which in turn give rise to γ-ray emissions. The Planck lensing map provides information on the integrated distribution of matter, while the integrated history of γ-ray emitters is imprinted in the Fermi-LAT sky maps. We report here the first evidence of their correlation. We find that the multipole dependence of the cross-correlation measurement is in agreement with current models of the γ-ray luminosity function for active galactic nuclei and star-forming galaxies, with a statistical evidence of 3.0σ. Moreover, its amplitude can in general be matched only assuming that these extragalactic emitters are also the bulk contribution of the measured isotopic γ-ray background (IGRB) intensity. This leaves little room for a big contribution from galactic sources to the IGRB measured by Fermi-LAT, pointing toward direct evidence of the extragalactic origin of the IGRB.

Effects of a Computerized Working Memory Training Program on Working Memory, Attention, and Academics in Adolescents with Severe LD and Comorbid ADHD: A Randomized Controlled Trial

ERIC Educational Resources Information Center

Gray, S. A.; Chaban, P.; Martinussen, R.; Goldberg, R.; Gotlieb, H.; Kronitz, R.; Hockenberry, M.; Tannock, R.

2012-01-01

Background: Youths with coexisting learning disabilities (LD) and attention deficit hyperactivity disorder (ADHD) are at risk for poor academic and social outcomes. The underlying cognitive deficits, such as poor working memory (WM), are not well targeted by current treatments for either LD or ADHD. Emerging evidence suggests that WM might be…

Practitioner Review: The Effectiveness of Solution Focused Brief Therapy with Children and Families: A Systematic and Critical Evaluation of the Literature from 1990-2010

ERIC Educational Resources Information Center

Bond, Caroline; Woods, Kevin; Humphrey, Neil; Symes, Wendy; Green, Lorraine

2013-01-01

Background and scope: Solution focused brief therapy (SFBT) is a strengths-based therapeutic approach, emphasizing the resources that people possess and how these can be applied to a positive change process. The current study provides a systematic review of the SFBT evidence base and a critical evaluation of the use and application of SFBT in…

The background puzzle: how identical mutations in the same gene lead to different disease symptoms.

PubMed

Kammenga, Jan E

2017-10-01

Identical disease-causing mutations can lead to different symptoms in different people. The reason for this has been a puzzling problem for geneticists. Differential penetrance and expressivity of mutations has been observed within individuals with different and similar genetic backgrounds. Attempts have been made to uncover the underlying mechanisms that determine differential phenotypic effects of identical mutations through studies of model organisms. From these studies evidence is accumulating that to understand disease mechanism or predict disease prevalence, an understanding of the influence of genetic background is as important as the putative disease-causing mutations of relatively large effect. This review highlights current insights into phenotypic variation due to gene interactions, epigenetics and stochasticity in model organisms, and discusses their importance for understanding the mutational effect on disease symptoms. © 2017 Federation of European Biochemical Societies.

Evidence-based guidelines for use of probiotics in preterm neonates

PubMed Central

2011-01-01

Background Current evidence indicates that probiotic supplementation significantly reduces all-cause mortality and definite necrotising enterocolitis without significant adverse effects in preterm neonates. As the debate about the pros and cons of routine probiotic supplementation continues, many institutions are satisfied with the current evidence and wish to use probiotics routinely. Because of the lack of detail on many practical aspects of probiotic supplementation, clinician-friendly guidelines are urgently needed to optimise use of probiotics in preterm neonates. Aim To develop evidence-based guidelines for probiotic supplementation in preterm neonates. Methods To develop core guidelines on use of probiotics, including strain selection, dose and duration of supplementation, we primarily used the data from our recent updated systematic review of randomised controlled trials. For equally important issues including strain identification, monitoring for adverse effects, product format, storage and transport, and regulatory hurdles, a comprehensive literature search, covering the period 1966-2010 without restriction on the study design, was conducted, using the databases PubMed and EMBASE, and the proceedings of scientific conferences; these data were used in our updated systematic review. Results In this review, we present guidelines, including level of evidence, for the practical aspects (for example, strain selection, dose, duration, clinical and laboratory surveillance) of probiotic supplementation, and for dealing with non-clinical but important issues (for example, regulatory requirements, product format). Evidence was inadequate in some areas, and these should be a target for further research. Conclusion We hope that these evidence-based guidelines will help to optimise the use of probiotics in preterm neonates. Continued research is essential to provide answers to the current gaps in knowledge about probiotics. PMID:21806843

Six ways of experiencing information literacy in nursing: the findings of a phenomenographic study.

PubMed

Forster, Marc

2015-01-01

Information literacy plays a vital role in evidence-based practice in nursing. However there is currently little evidence to show how being information literate is actually experienced by nurses and therefore information literacy educational interventions are not genuinely evidence-based. Are they promoting the appropriate knowledge and skills to help nurses find and use the research evidence they need? To investigate how being information literate is experienced by nurses. To use the insights obtained to develop a description of the parameters of information literacy in nursing, including those of its role and value in evidence-based practice. Phenomenography. 41 UK nurses of varying experience, specialism and background. Open-ended interviews. 7 contexts in which information literacy is experienced, were mapped out and 6 representative ways of being an information literate nurse, in increasing levels of depth and sophistication, were described. These findings may form the basis of future evidence-based information literacy education programmes. Copyright © 2014 Elsevier Ltd. All rights reserved.

Examining the evidence for dynamical dark energy.

PubMed

Zhao, Gong-Bo; Crittenden, Robert G; Pogosian, Levon; Zhang, Xinmin

2012-10-26

We apply a new nonparametric Bayesian method for reconstructing the evolution history of the equation of state w of dark energy, based on applying a correlated prior for w(z), to a collection of cosmological data. We combine the latest supernova (SNLS 3 year or Union 2.1), cosmic microwave background, redshift space distortion, and the baryonic acoustic oscillation measurements (including BOSS, WiggleZ, and 6dF) and find that the cosmological constant appears consistent with current data, but that a dynamical dark energy model which evolves from w<-1 at z~0.25 to w>-1 at higher redshift is mildly favored. Estimates of the Bayesian evidence show little preference between the cosmological constant model and the dynamical model for a range of correlated prior choices. Looking towards future data, we find that the best fit models for current data could be well distinguished from the ΛCDM model by observations such as Planck and Euclid-like surveys.

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

Concussions: What a neurosurgeon should know about current scientific evidence and management strategies.

PubMed

Neal, Matthew T; Wilson, Jonathan L; Hsu, Wesley; Powers, Alexander K

2012-01-01

There has been a tremendous amount of interest focused on the topic of concussions over the past few decades. Neurosurgeons are frequently consulted to manage patients with mild traumatic brain injuries (mTBI) that have radiographic evidence of cerebral injury. These injuries share significant overlap with concussions, injuries that typically do not reveal radiographic evidence of structural injury, in the realms of epidemiology, pathophysiology, outcomes, and management. Further, neurosurgeons often manage patients with extracranial injuries that have concomitant concussions. In these cases, neurosurgeons are often the only "concussion experts" that patients encounter. The literature has been reviewed and data have been synthesized on the topic including sections on historical background, epidemiology, pathophysiology, diagnostic advances, clinical sequelae, and treatment suggestions, with neurosurgeons as the intended target audience. Neurosurgeons should have a fundamental knowledge of the scientific evidence that has developed regarding concussions and be prepared to guide patients with treatment plans.

Schema therapy for borderline personality disorder: a comprehensive review of its empirical foundations, effectiveness and implementation possibilities.

PubMed

Sempértegui, Gabriela A; Karreman, Annemiek; Arntz, Arnoud; Bekker, Marrie H J

2013-04-01

Borderline personality disorder is a serious psychiatric disorder for which the effectiveness of the current pharmacotherapeutical and psychotherapeutic approaches has shown to be limited. In the last decades, schema therapy has increased in popularity as a treatment of borderline personality disorder; however, systematic evaluation of both effectiveness and empirical evidence for the theoretical background of the therapy is limited. This literature review comprehensively evaluates the current empirical status of schema therapy for borderline personality disorder. We first described the theoretical framework and reviewed its empirical foundations. Next, we examined the evidence regarding effectiveness and implementability. We found evidence for a considerable number of elements of Young's schema model; however, the strength of the results varies and there are also mixed results and some empirical blanks in the theory. The number of studies on effectiveness is small, but reviewed findings suggest that schema therapy is a promising treatment. In Western-European societies, the therapy could be readily implemented as a cost-effective strategy with positive economic consequences. Copyright © 2012 Elsevier Ltd. All rights reserved.

Sicily statement on evidence-based practice

PubMed Central

Dawes, Martin; Summerskill, William; Glasziou, Paul; Cartabellotta, Antonino; Martin, Janet; Hopayian, Kevork; Porzsolt, Franz; Burls, Amanda; Osborne, James

2005-01-01

Background A variety of definitions of evidence-based practice (EBP) exist. However, definitions are in themselves insufficient to explain the underlying processes of EBP and to differentiate between an evidence-based process and evidence-based outcome. There is a need for a clear statement of what Evidence-Based Practice (EBP) means, a description of the skills required to practise in an evidence-based manner and a curriculum that outlines the minimum requirements for training health professionals in EBP. This consensus statement is based on current literature and incorporating the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers ("Signposting the future of EBHC"). Discussion Evidence-Based Practice has evolved in both scope and definition. Evidence-Based Practice (EBP) requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources. Health care professionals must be able to gain, assess, apply and integrate new knowledge and have the ability to adapt to changing circumstances throughout their professional life. Curricula to deliver these aptitudes need to be grounded in the five-step model of EBP, and informed by ongoing research. Core assessment tools for each of the steps should continue to be developed, validated, and made freely available. Summary All health care professionals need to understand the principles of EBP, recognise EBP in action, implement evidence-based policies, and have a critical attitude to their own practice and to evidence. Without these skills, professionals and organisations will find it difficult to provide 'best practice'. PMID:15634359

The biophysics of neuronal growth

NASA Astrophysics Data System (ADS)

Franze, Kristian; Guck, Jochen

2010-09-01

For a long time, neuroscience has focused on biochemical, molecular biological and electrophysiological aspects of neuronal physiology and pathology. However, there is a growing body of evidence indicating the importance of physical stimuli for neuronal growth and development. In this review we briefly summarize the historical background of neurobiophysics and give an overview over the current understanding of neuronal growth from a physics perspective. We show how biophysics has so far contributed to a better understanding of neuronal growth and discuss current inconsistencies. Finally, we speculate how biophysics may contribute to the successful treatment of lesions to the central nervous system, which have been considered incurable until very recently.

A systematic review of psychosocial interventions for adult refugees and asylum seekers.

PubMed

Tribe, Rachel H; Sendt, Kyra-Verena; Tracy, Derek K

2017-05-09

Europe is in the midst of the largest refugee migration since the Second World War; there is an urgent need to provide an updated systematic review of the current best evidence for managing mental distress in refugee populations. The aim of this review is to provide an exhaustive summary of the current literature on psychosocial interventions, both trauma- and non-trauma-focused, for refugee populations experiencing post-traumatic stress disorder (PTSD), depressive or anxiety symptoms. To produce recommendations for future research and current clinical practice. Searches were conducted in PubMed, PsychINFO (Hosted by Ovid), PILOTS and Social Services Abstracts; 5305 articles were screened and 40 were included. This review found medium to high quality evidence supporting the use of narrative exposure therapy (NET). A lack of culturally adapted treatments was apparent and there was less evidence to support standard cognitive behavioural therapy (CBT), Eye Movement Desensitisation and Reprocessing (EMDR) and multidisciplinary treatments. NET produced positive outcomes in refugees from a diverse range of backgrounds and trauma types. There is a general dearth of research in all intervention types: further research should include more "real-world" multidisciplinary interventions that better model clinical practice. Recommendations for evaluating local need, and creating a culturally sensitive workforce are discussed.

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 identifying emerging areas of research. Conclusions As of 2012, the updated theoretical rationale and emerging evidence suggest potential benefits to delivering patient decision aids on the Internet. However, additional research is needed to identify best practices and quality metrics for Internet-based development, evaluation, and dissemination, particularly in the areas of interactivity, multimedia components, socially-generated information, and implementation strategies. PMID:24625064

Clinimetric properties of lower limb neurological impairment tests for children and young people with a neurological condition: A systematic review

PubMed Central

Locke, Melissa; Hill, Bridget; Wells, Cherie; Bialocerkowski, Andrea

2017-01-01

Background Clinicians and researchers require sound neurological tests to measure changes in neurological impairments necessary for clinical decision-making. Little evidence-based guidance exists for selecting and interpreting an appropriate, paediatric-specific lower limb neurological test aimed at the impairment level. Objective To determine the clinimetric evidence underpinning neurological impairment tests currently used in paediatric rehabilitation to evaluate muscle strength, tactile sensitivity, and deep tendon reflexes of the lower limb in children and young people with a neurological condition. Methods Thirteen databases were systematically searched in two phases, from the date of database inception to 16 February 2017. Lower limb neurological impairment tests were first identified which evaluated muscle strength, tactile sensitivity or deep tendon reflexes in children or young people under 18 years of age with a neurological condition. Papers containing clinimetric evidence of these tests were then identified. The methodological quality of each paper was critically appraised using standardised tools and clinimetric evidence synthesised for each test. Results Thirteen papers were identified, which provided clinimetric evidence on six neurological tests. Muscle strength tests had the greatest volume of clinimetric evidence, however this evidence focused on reliability. Studies were variable in quality with inconsistent results. Clinimetric evidence for tactile sensitivity impairment tests was conflicting and difficult to extrapolate. No clinimetric evidence was found for impairment tests of deep tendon reflexes. Conclusions Limited high-quality clinimetric evidence exists for lower limb neurological impairment tests in children and young people with a neurological condition. Results of currently used neurological tests, therefore, should be interpreted with caution. Robust clinimetric evidence on these tests is required for clinicians and researchers to effectively select and evaluate rehabilitation interventions. PMID:28671957

Effectiveness of a Short, Intense Bridging Course for Scaffolding Students Commencing University-level Study of Chemistry

NASA Astrophysics Data System (ADS)

Schmid, Siegbert; Youl, David J.; George, Adrian V.; Read, Justin R.

2012-05-01

Bridging courses designed to support students commencing tertiary education are widespread, and some evidence for the value of semester-length courses has been reported; however, little attention has been paid to short-but-intense bridging courses, and empirical evidence of their effectiveness is particularly sparse. The current study followed the academic performance of a cohort of students enrolled in a first-year chemistry unit of study designed for those with little or no background knowledge of chemistry. The aims of this study are two-fold: first to determine the strength of the linkage between prior knowledge in chemistry and performance on the end of semester exam, and secondly, to explore the reasons for any differences observed. In particular, the value of the week-long intensive-mode bridging course offered by the University of Sydney was analysed. Quantitative and qualitative data were collected. The research has shown that participation in the chemistry bridging course is associated with 'bridging the gap' in academic performance between students with No Prior Chemistry background and those with a Strong Background. While the content of the bridging course is a significant contributor to academic success, so too is the confidence in their own learning that the course engenders among participants.

Music-supported therapy for stroke motor recovery: theoretical and practical considerations.

PubMed

Chen, Joyce L

2018-05-08

Music may confer benefits for well-being and health. What is the state of knowledge and evidence for a role of music in supporting the rehabilitation of movements after stroke? In this brief perspective, I provide background context and information about stroke recovery in general, in order to spark reflection and discussion for how we think music may impact motor recovery, given the current clinical milieu. © 2018 New York Academy of Sciences.

Detection prospects of the cosmic neutrino background

NASA Astrophysics Data System (ADS)

Li, Yu-Feng

2015-04-01

The existence of the cosmic neutrino background (CνB) is a fundamental prediction of the standard Big Bang cosmology. Although current cosmological probes provide indirect observational evidence, the direct detection of the CνB in a laboratory experiment is a great challenge to the present experimental techniques. We discuss the future prospects for the direct detection of the CνB, with the emphasis on the method of captures on beta-decaying nuclei and the PTOLEMY project. Other possibilities using the electron-capture (EC) decaying nuclei, the annihilation of extremely high-energy cosmic neutrinos (EHECνs) at the Z-resonance, and the atomic de-excitation method are also discussed in this review (talk given at the International Conference on Massive Neutrinos, Singapore, 9-13 February 2015).

Sleep and Children with Cerebral Palsy: A Review of Current Evidence and Environmental Non-Pharmacological Interventions

PubMed Central

Dutt, Risha; Roduta-Roberts, Mary; Brown, Cary A.

2015-01-01

Between 23%–46% of children with cerebral palsy experience sleep problems. Many of the sensory-motor and cognitive features of cerebral palsy (such as immobility, pain, and seizures) act as predisposing factors for sleep problems in this population. This paper presents the background related to the etiology and consequences of sleep problems in children with cerebral palsy. The relationship between pain and sleep is emphasized, as the risk of pain is highly prevalent in children with cerebral palsy. The review concludes with a discussion of the evidence-base for environmental non-pharmacological interventions based on light, temperature, sound and bedding to promote sleep for children with cerebral palsy. PMID:27417351

Lost in Translation: Piloting a Novel Framework to Assess the Challenges in Translating Scientific Uncertainty From Empirical Findings to WHO Policy Statements

PubMed Central

Benmarhnia, Tarik; Huang, Jonathan Y.; Jones, Catherine M.

2017-01-01

Background: Calls for evidence-informed public health policy, with implicit promises of greater program effectiveness, have intensified recently. The methods to produce such policies are not self-evident, requiring a conciliation of values and norms between policy-makers and evidence producers. In particular, the translation of uncertainty from empirical research findings, particularly issues of statistical variability and generalizability, is a persistent challenge because of the incremental nature of research and the iterative cycle of advancing knowledge and implementation. This paper aims to assess how the concept of uncertainty is considered and acknowledged in World Health Organization (WHO) policy recommendations and guidelines. Methods: We selected four WHO policy statements published between 2008-2013 regarding maternal and child nutrient supplementation, infant feeding, heat action plans, and malaria control to represent topics with a spectrum of available evidence bases. Each of these four statements was analyzed using a novel framework to assess the treatment of statistical variability and generalizability. Results: WHO currently provides substantial guidance on addressing statistical variability through GRADE (Grading of Recommendations Assessment, Development, and Evaluation) ratings for precision and consistency in their guideline documents. Accordingly, our analysis showed that policy-informing questions were addressed by systematic reviews and representations of statistical variability (eg, with numeric confidence intervals). In contrast, the presentation of contextual or "background" evidence regarding etiology or disease burden showed little consideration for this variability. Moreover, generalizability or "indirectness" was uniformly neglected, with little explicit consideration of study settings or subgroups. Conclusion: In this paper, we found that non-uniform treatment of statistical variability and generalizability factors that may contribute to uncertainty regarding recommendations were neglected, including the state of evidence informing background questions (prevalence, mechanisms, or burden or distributions of health problems) and little assessment of generalizability, alternate interventions, and additional outcomes not captured by systematic review. These other factors often form a basis for providing policy recommendations, particularly in the absence of a strong evidence base for intervention effects. Consequently, they should also be subject to stringent and systematic evaluation criteria. We suggest that more effort is needed to systematically acknowledge (1) when evidence is missing, conflicting, or equivocal, (2) what normative considerations were also employed, and (3) how additional evidence may be accrued. PMID:29179291

Running of featureful primordial power spectra

NASA Astrophysics Data System (ADS)

Gariazzo, Stefano; Mena, Olga; Miralles, Victor; Ramírez, Héctor; Boubekeur, Lotfi

2017-06-01

Current measurements of the temperature and polarization anisotropy power spectra of the cosmic microwave background (CMB) seem to indicate that the naive expectation for the slow-roll hierarchy within the most simple inflationary paradigm may not be respected in nature. We show that a primordial power spectrum with localized features could in principle give rise to the observed slow-roll anarchy when fitted to a featureless power spectrum. From a model comparison perspective, and assuming that nature has chosen a featureless primordial power spectrum, we find that, while with mock Planck data there is only weak evidence against a model with localized features, upcoming CMB missions may provide compelling evidence against such a nonstandard primordial power spectrum. This evidence could be reinforced if a featureless primordial power spectrum is independently confirmed from bispectrum and/or galaxy clustering measurements.

Treatment of lithium intoxication: facing the need for evidence.

PubMed

Haussmann, R; Bauer, M; von Bonin, S; Grof, P; Lewitzka, U

2015-12-01

Lithium has been used as the gold standard in the treatment of major depressive and bipolar disorders for decades. Due to its narrow therapeutic index, lithium toxicity is a common clinical problem. Although risk factors for lithium intoxication seem to be well-described, lacking patient education and inexperience of treatment are assumed to contribute to the probability of lithium intoxication. A review of literature shows that the treatment of lithium intoxication has not been adequately studied or standardized. The aim of this literature review is to compile and present current evidence on the treatment of lithium intoxication and contribute to a standardization regarding general treatment recommendations as well as evidence on indication for extracorporeal methods. Against the background of this common and potentially life-threatening condition, the standardization of the treatment of lithium intoxication is definitely a task for the future.

The current evidence base for the feasibility of 48-hour continuous subcutaneous infusions (CSCIs): A systematically-structured review

PubMed Central

Dickman, Andrew; Mason, Stephen; Ellershaw, John

2018-01-01

Background A continuous subcutaneous infusion (CSCI) is an effective method of multiple drug administration commonly encountered in end of life care when the oral route is compromised. At present, current practice is to limit syringe driver infusion time to a maximum of 24 hours as dictated by available chemical stability data. However, the ability to deliver prescribed medication by a CSCI over 48 hours may have numerous benefits in both patient care and health service resource utilisation. Aim To examine and present the current evidence base for the stability of 48-hour multiple-drug CSCIs in current clinical practice. Design A systematically-structured review following PRISMA guidelines. Data sources Three electronic databases and the grey literature were searched with no time limits. Empirical studies reporting data on the chemical stability of continuous subcutaneous infusions or solutions stored in polypropylene syringes were included. Results Twenty-one empirical studies were included in this review reporting chemical compatibility and stability of 32 discrete combinations of twenty-four drugs tested at a variety of different drug concentrations. The majority of combinations reported were assessed as being chemically compatible. The greatest risk of clinically significant chemical degradation was observed with midazolam. Only one study reported the microbiological stability of the solution examined. Conclusions There is currently limited evidence for the physical, chemical and microbiological stability of solutions for continuous subcutaneous infusion over a period of 48 hours. More stability data is required before the use of 48-hour CSCIs can be evaluated for use within clinical practice. PMID:29538455

Searching for differences in race: is there evidence for preferential detection of other-race faces?

PubMed

Lipp, Ottmar V; Terry, Deborah J; Smith, Joanne R; Tellegen, Cassandra L; Kuebbeler, Jennifer; Newey, Mareka

2009-06-01

Previous research has suggested that like animal and social fear-relevant stimuli, other-race faces (African American) are detected preferentially in visual search. Three experiments using Chinese or Indonesian faces as other-race faces yielded the opposite pattern of results: faster detection of same-race faces among other-race faces. This apparently inconsistent pattern of results was resolved by showing that Asian and African American faces are detected preferentially in tasks that have small stimulus sets and employ fixed target searches. Asian and African American other-race faces are found slower among Caucasian face backgrounds if larger stimulus sets are used in tasks with a variable mapping of stimulus to background or target. Thus, preferential detection of other-race faces was not found under task conditions in which preferential detection of animal and social fear-relevant stimuli is evident. Although consistent with the view that same-race faces are processed in more detail than other-race faces, the current findings suggest that other-race faces do not draw attention preferentially.

Development of buoyant currents in yield stress fluids

NASA Astrophysics Data System (ADS)

Rossi, P.; Karimfazli, I.

2017-11-01

Infinitesimal perturbations are known to decay in a motionless yield stress fluid. We present experimental evidence to reveal other mechanisms promoting free advection from a motionless background state. Development of natural convection in a cavity with differentially heated side-walls is investigated as a benchmark. Velocity and temperature fields are measured using particle image velocimetry/thermometry. We examine time evolution of the flow, compare experimental findings with theoretical predictions and comment on the striking features brought about by the yield stress.

The Primordial Inflation Polarization Explorer (PIPER)

NASA Technical Reports Server (NTRS)

Chuss, David

2010-01-01

The Primordial Inflation Polarization Explorer (PIPER) is a balloon-borne polarimeter that will measure the polarization of the cosmic microwave background to search for evidence for inflation. PIPER will observe more than half of the sky in four frequency bands from 200 to 600 GHz with a beam size of 21 arcminutes at the lowest frequency. PIPER simultaneously measures all four Stokes parameters using four co-aligned 32 by 40 element planar bolometer arrays. We give an instrument overview and report on the current status of the instrument.

Evidence for Neutral-Current Diffractive π 0 Production from Hydrogen in Neutrino Interactions on Hydrocarbon

DOE PAGES

Wolcott, J.; Aliaga, L.; Altinok, O.; ...

2016-09-01

Here, the MINERvA experiment observes an excess of events containing electromagnetic showers relative to the expectation from Monte Carlo simulations in neutral-current neutrino interactions with mean beam energy of 4.5 GeV on a hydrocarbon target. The excess is characterized and found to be consistent with neutral-current π 0 production with a broad energy distribution peaking at 7 GeV and a total cross section of 0.26more » $$\\pm$$ 0.02 (stat) $$\\pm$$ 0.08 (sys) x $$10^{-39} cm^{2}$$. The angular distribution, electromagnetic shower energy, and spatial distribution of the energy depositions of the excess are consistent with expectations from neutrino neutral-current diffractive neutral pion production from hydrogen in the hydrocarbon target. These data comprise the first direct experimental observation and constraint for a reaction that poses an important background process in neutrino oscillation experiments searching for $$\

Observing Inflationary Reheating

NASA Astrophysics Data System (ADS)

Martin, Jérôme; Ringeval, Christophe; Vennin, Vincent

2015-02-01

Reheating is the epoch which connects inflation to the subsequent hot big-bang phase. Conceptually very important, this era is, however, observationally poorly known. We show that the current Planck satellite measurements of the cosmic microwave background (CMB) anisotropies constrain the kinematic properties of the reheating era for most of the inflationary models. This result is obtained by deriving the marginalized posterior distributions of the reheating parameter for about 200 models of slow-roll inflation. Weighted by the statistical evidence of each model to explain the data, we show that the Planck 2013 measurements induce an average reduction of the posterior-to-prior volume by 40%. Making some additional assumptions on reheating, such as specifying a mean equation of state parameter, or focusing the analysis on peculiar scenarios, can enhance or reduce this constraint. Our study also indicates that the Bayesian evidence of a model can substantially be affected by the reheating properties. The precision of the current CMB data is therefore such that estimating the observational performance of a model now requires incorporating information about its reheating history.

The Role of Massage in Sports Performance and Rehabilitation: Current Evidence and Future Direction

PubMed Central

2008-01-01

Background Massage is a popular treatment choice of athletes, coaches, and sports physical therapists. Despite its purported benefits and frequent use, evidence demonstrating its efficacy is scarce. Purpose To identify current literature relating to sports massage and its role in effecting an athlete's psychological readiness, in enhancing sports performance, in recovery from exercise and competition, and in the treatment of sports related musculoskeletal injuries. Methods Electronic databases were used to identify papers relevant to this review. The following keywords were searched: massage, sports injuries, athletic injuries, physical therapy, rehabilitation, delayed onset muscle soreness, sports psychology, sports performance, sports massage, sports recovery, soft tissue mobilization, deep transverse friction massage, pre-event, and post exercise. Results Research studies pertaining to the following general categories were identified and reviewed: pre-event (physiological and psychological variables), sports performance, recovery, and rehabilitation. Discussion Despite the fact clinical research has been performed, a poor appreciation exists for the appropriate clinical use of sports massage. Conclusion Additional studies examining the physiological and psychological effects of sports massage are necessary in order to assist the sports physical therapist in developing and implementing clinically significant evidence based programs or treatments. PMID:21509135

Chinese herbal medicine and depression: the research evidence.

PubMed

Butler, Lee; Pilkington, Karen

2013-01-01

Background. Alternative approaches for managing depression are often sought and herbal mixtures are widely used in China. The aim of this paper was to provide an overall picture of the current evidence by analysing published systematic reviews and presenting a supplementary systematic review of trials in Western databases. Methods. Searches were conducted using AMED, Cochrane Library, EMBASE, MEDLINE/PubMed, PsycINFO, and trial registers. Results were screened and selected trials were evaluated by two reviewers working independently. Systematic reviews were identified and assessed using key criteria. Results. Five systematic reviews were located addressing the Chinese literature, adjunctive use of Chinese herbs, and the formulae Chaihu-Shugan-San, Xiao Yao San, and Free and Easy Wanderer Plus. The supplementary review located 8 trials, 3 of which were not included in previous reviews. Positive results were reported: no significant differences from medication, greater effect than medication or placebo, reduced adverse event rates when combined or compared with antidepressants. However, limitations in methodology and reporting were revealed. Conclusions. Despite promising results, particularly for Xiao Yao San and its modifications, the effectiveness of Chinese herbal medicine in depression could not be fully substantiated based on current evidence. Further well-designed, well-reported trials that reflect practice may be worth pursuing.

The use of adjustable gastric bands for management of severe and complex obesity

PubMed Central

Hopkins, James C. A.; Blazeby, Jane M.; Rogers, Chris A.; Welbourn, Richard

2016-01-01

Background Obesity levels in the UK have reached a sustained high and ∼4% of the population would be candidates for bariatric surgery based upon current UK NICE guidelines, which has important implications for Clinical Commissioning Groups. Sources of data Summary data from Cochrane systematic reviews, randomized controlled trials (RCTs) and cohort studies. Areas of agreement Currently, the only treatment that offers significant and durable weight loss for those with severe and complex obesity is surgery. Three operations account for 95% of all bariatric surgery in the UK, but the NHS offers surgery to only a small fraction of those who could benefit. Laparoscopic adjustable gastric banding (gastric banding) has potentially the lowest risk and up-front costs of the three procedures. Areas of controversy Reliable Level 1 evidence of the relative effectiveness of the operations is lacking. Growing points As a point intervention, weight loss surgery together with the chronic disease management strategy for obesity can prevent significant future disease and mortality, and the NHS should embrace both. Areas timely for developing research Better RCT evidence is needed including clinical effectiveness and economic analysis to answer the important question ‘which is the best of the three operations most frequently performed?’ This review considers the current evidence for gastric banding for the treatment of severe and complex obesity. PMID:27034443

Cystic fibrosis chronic rhinosinusitis: A comprehensive review

PubMed Central

Chaaban, Mohamad R.; Kejner, Alexandra; Rowe, Steven M.

2013-01-01

Background: Advances in the care of patients with cystic fibrosis (CF) have improved pulmonary outcomes and survival. In addition, rapid developments regarding the underlying genetic and molecular basis of the disease have led to numerous novel targets for treatment. However, clinical and basic scientific research focusing on therapeutic strategies for CF-associated chronic rhinosinusitis (CRS) lags behind the evidence-based approaches currently used for pulmonary disease. Methods: This review evaluates the available literature and provides an update concerning the pathophysiology, current treatment approaches, and future pharmaceutical tactics in the management of CRS in patients with CF. Results: Optimal medical and surgical strategies for CF CRS are lacking because of a dearth of well-performed clinical trials. Medical and surgical interventions are supported primarily by level 2 or 3 evidence and are aimed at improving clearance of mucus, infection, and inflammation. A number of novel therapeutics that target the basic defect in the cystic fibrosis transmembrane conductance regulator channel are currently under investigation. Ivacaftor, a corrector of the G551D mutation, was recently approved by the Food and Drug Administration. However, sinonasal outcomes using this and other novel drugs are pending. Conclusion: CRS is a lifelong disease in CF patients that can lead to substantial morbidity and decreased quality of life. A multidisciplinary approach will be necessary to develop consistent and evidence-based treatment paradigms. PMID:24119602

An epidemiological examination of the subluxation construct using Hill's criteria of causation

PubMed Central

2009-01-01

Background Chiropractors claim to locate, analyze and diagnose a putative spinal lesion known as subluxation and apply the mode of spinal manipulation (adjustment) for the correction of this lesion. Aim The purpose of this examination is to review the current evidence on the epidemiology of the subluxation construct and to evaluate the subluxation by applying epidemiologic criteria for it's significance as a causal factor. Methods The databases of PubMed, Cinahl, and Mantis were searched for studies using the keywords subluxation, epidemiology, manipulation, dose-response, temporality, odds ratio, relative risk, biological plausibility, coherence, and analogy. Results The criteria for causation in epidemiology are strength (strength of association), consistency, specificity, temporality (temporal sequence), dose response, experimental evidence, biological plausibility, coherence, and analogy. Applied to the subluxation all of these criteria remain for the most part unfulfilled. Conclusion There is a significant lack of evidence to fulfill the basic criteria of causation. This lack of crucial supportive epidemiologic evidence prohibits the accurate promulgation of the chiropractic subluxation. PMID:19954544

Personality disorder and alcohol treatment outcome: systematic review and meta-analysis.

PubMed

Newton-Howes, Giles M; Foulds, James A; Guy, Nicola H; Boden, Joseph M; Mulder, Roger T

2017-07-01

Background Personality disorders commonly coexist with alcohol use disorders (AUDs), but there is conflicting evidence on their association with treatment outcomes. Aims To determine the size and direction of the association between personality disorder and the outcome of treatment for AUD. Method We conducted a systematic review and meta-analysis of randomised trials and longitudinal studies. Results Personality disorders were associated with more alcohol-related impairment at baseline and less retention in treatment. However, during follow-up people with a personality disorder showed a similar amount of improvement in alcohol outcomes to that of people without such disorder. Synthesis of evidence was hampered by variable outcome reporting and a low quality of evidence overall. Conclusions Current evidence suggests the pessimism about treatment outcomes for this group of patients may be unfounded. However, there is an urgent need for more consistent and better quality reporting of outcomes in future studies in this area. © The Royal College of Psychiatrists 2017.

AAC services for multilingual populations: South African service provider perspectives.

PubMed

Tönsing, Kerstin M; van Niekerk, Karin; Schlünz, Georg I; Wilken, Ilana

In South Africa, many persons in need of augmentative and alternative communication (AAC) come from multilingual backgrounds. There is as yet a limited evidence base (locally and internationally) for the provision of AAC services to multilingual populations. The perspectives of service providers can assist in gaining an understanding of current practices and the factors that influence these. The study aimed to obtain the perspectives of AAC service providers about practices in providing AAC systems and AAC intervention to clients from multilingual backgrounds. Fifteen AAC service providers were purposefully chosen to participate in one of three focus groups - two face-to-face and one online focus group. Data from the face-to-face focus groups was transcribed verbatim. Thematic analysis was used to identify themes and subthemes in the data. Four overarching themes were identified, namely (a) current practices, (b) factors influencing current practices, (c) service provides' orientation towards different language options in AAC intervention, and (d) needs and desired developments regarding AAC technology. This paper reports on the first three themes. Service providers reported their practices to range from a focus on L1 exclusively, L2 exclusively, to a multilingual (sequential or simultaneous) approach. The South African language context, family language preferences and choices, service provider skill and knowledge, as well as AAC technology were identified as factors influencing their practices. Although many viewed access to multiple languages through AAC as positive, they also expressed concerns and reservations about providing multilingual AAC services. Although service providers in general saw the need to give clients from multilingual backgrounds access to multiple languages using AAC, this did not always translate into multilingual AAC practices. Both extrinsic factors (e.g. the lack of appropriate AAC devices, software and apps giving access to non-English languages) and intrinsic factors (service providers' language competency and their beliefs about the cognitive demands of multilingual AAC systems) influenced their practices and choices. Appropriate AAC service delivery to multilingual populations in South Africa would require not only appropriate AAC technology developments, but also research evidence to establish the efficacy of multilingual AAC interventions for clients with a variety of characteristics. Copyright © 2018 Elsevier Inc. All rights reserved.

Cognitive penetrability and emotion recognition in human facial expressions

PubMed Central

Marchi, Francesco

2015-01-01

Do our background beliefs, desires, and mental images influence our perceptual experience of the emotions of others? In this paper, we will address the possibility of cognitive penetration (CP) of perceptual experience in the domain of social cognition. In particular, we focus on emotion recognition based on the visual experience of facial expressions. After introducing the current debate on CP, we review examples of perceptual adaptation for facial expressions of emotion. This evidence supports the idea that facial expressions are perceptually processed as wholes. That is, the perceptual system integrates lower-level facial features, such as eyebrow orientation, mouth angle etc., into facial compounds. We then present additional experimental evidence showing that in some cases, emotion recognition on the basis of facial expression is sensitive to and modified by the background knowledge of the subject. We argue that such sensitivity is best explained as a difference in the visual experience of the facial expression, not just as a modification of the judgment based on this experience. The difference in experience is characterized as the result of the interference of background knowledge with the perceptual integration process for faces. Thus, according to the best explanation, we have to accept CP in some cases of emotion recognition. Finally, we discuss a recently proposed mechanism for CP in the face-based recognition of emotion. PMID:26150796

Testing Cosmic Inflation

NASA Technical Reports Server (NTRS)

Chuss, David

2010-01-01

The Cosmic Microwave Background (CMB) has provided a wealth of information about the history and physics of the early Universe. Much progress has been made on uncovering the emerging Standard Model of Cosmology by such experiments as COBE and WMAP, and ESA's Planck Surveyor will likely increase our knowledge even more. Despite the success of this model, mysteries remain. Currently understood physics does not offer a compelling explanation for the homogeneity, flatness, and the origin of structure in the Universe. Cosmic Inflation, a brief epoch of exponential expansion, has been posted to explain these observations. If inflation is a reality, it is expected to produce a background spectrum of gravitational waves that will leave a small polarized imprint on the CMB. Discovery of this signal would give the first direct evidence for inflation and provide a window into physics at scales beyond those accessible to terrestrial particle accelerators. I will briefly review aspects of the Standard Model of Cosmology and discuss our current efforts to design and deploy experiments to measure the polarization of the CMB with the precision required to test inflation.

Acute effect of ozone exposure on daily mortality in seven cities of Jiangsu Province, China: No clear evidence for threshold

PubMed Central

Chen, Kai; Zhou, Lian; Chen, Xiaodong; Bi, Jun; Kinney, Patrick L.

2017-01-01

Background Few multicity studies have addressed the health effects of ozone in China due to the scarcity of ozone monitoring data. A critical scientific and policy-relevant question is whether a threshold exists in the ozone-mortality relationship. Methods Using a generalized additive model and a univariate random-effects meta-analysis, this research evaluated the relationship between short-term ozone exposure and daily total mortality in seven cities of Jiangsu Province, China during 2013–2014. Spline, subset, and threshold models were applied to further evaluate whether a safe threshold level exists. Results This study found strong evidence that short-term ozone exposure is significantly associated with premature total mortality. A 10 μg/m3 increase in the average of the current and previous days’ maximum 8-h average ozone concentration was associated with a 0.55% (95% posterior interval: 0.34%, 0.76%) increase of total mortality. This finding is robust when considering the confounding effect of PM2.5, PM10, NO2, and SO2. No consistent evidence was found for a threshold in the ozone-mortality concentration-response relationship down to concentrations well below the current Chinese Ambient Air Quality Standard (CAAQS) level 2 standard (160 μg/m3). Conclusions Our findings suggest that ozone concentrations below the current CAAQS level 2 standard could still induce increased mortality risks in Jiangsu Province, China. Continuous air pollution control measures could yield important health benefits in Jiangsu Province, China, even in cities that meet the current CAAQS level 2 standard. PMID:28231551

The origin of the diffuse background gamma radiation

NASA Technical Reports Server (NTRS)

Stecker, F. W.; Puget, J. L.

1974-01-01

Recent observations provided evidence for diffuse background gamma radiation extending to energies beyond 100 MeV, and evidence of isotropy and implied cosmological origin. Significant features in the spectrum of this background radiation were observed which provide evidence for its origin in nuclear processes in the early stages of big-bang cosmology, and connect these processes with the galaxy formation theory. A test of the theory is in future observations of the background radiation in the 100 MeK to 100 GeV energy range which are made with large orbiting spark-chamber satellite detectors. The theoretical interpretations of present data, their connection with baryon-symmetric cosmology and galaxy formation theory, and the need for future observations are discussed.

Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations

PubMed Central

Balsells, Evelyn; Filipescu, Teodora; Kyaw, Moe H.; Wiuff, Camilla; Campbell, Harry; Nair, Harish

2016-01-01

Background Clostridium difficile is the leading cause of health care–associated infections. Given the high incidence of C. difficile infection (CDI) and the lack of primary prevention through immunization, health care professionals should be aware of the most current guidance, as well as strengths and limitations of the evidence base underpinning this guidance. Methods We identified publicly available national or organizational guidelines related to CDI infection and prevention control (IPC) published between 2000 and 2015 and for any health care setting through an internet search using the Google search engine. We reviewed CDI–targeted IPC recommendations and describe the assessment of evidence in available guidelines. Results We identified documents from 28 countries/territories, mainly from acute care hospitals in North America, the Western Pacific, and Europe (18 countries). We identified only a few specific recommendations for long–term care facilities (LTCFs) and from countries in South America (Uruguay and Chile), South East Asia (Thailand), and none for Africa or Eastern Mediterranean. Of 10 IPC areas, antimicrobial stewardship was universally recognized as essential and supported by high quality evidence. Five other widely reported “strong” recommendations were: effective environment cleaning (including medical equipment), case isolation, use of personal protective equipment, surveillance, and education. Several unresolved and emerging issues were documented and currently available evidence was classified mainly as of mixed quality. Conclusion Our review underlines the need for targeted CDI IPC guidelines in several countries and for LTCFs. International harmonisation on the assessment of the evidence for best practices is needed as well as more robust evidence to support targeted recommendations. PMID:28028434

Continuous Glucose Monitoring in Subjects with Type 1 Diabetes: Improvement in Accuracy by Correcting for Background Current

PubMed Central

Youssef, Joseph El; Engle, Julia M.; Massoud, Ryan G.; Ward, W. Kenneth

2010-01-01

Abstract Background A cause of suboptimal accuracy in amperometric glucose sensors is the presence of a background current (current produced in the absence of glucose) that is not accounted for. We hypothesized that a mathematical correction for the estimated background current of a commercially available sensor would lead to greater accuracy compared to a situation in which we assumed the background current to be zero. We also tested whether increasing the frequency of sensor calibration would improve sensor accuracy. Methods This report includes analysis of 20 sensor datasets from seven human subjects with type 1 diabetes. Data were divided into a training set for algorithm development and a validation set on which the algorithm was tested. A range of potential background currents was tested. Results Use of the background current correction of 4 nA led to a substantial improvement in accuracy (improvement of absolute relative difference or absolute difference of 3.5–5.5 units). An increase in calibration frequency led to a modest accuracy improvement, with an optimum at every 4 h. Conclusions Compared to no correction, a correction for the estimated background current of a commercially available glucose sensor led to greater accuracy and better detection of hypoglycemia and hyperglycemia. The accuracy-optimizing scheme presented here can be implemented in real time. PMID:20879968

Nutrition and neurodevelopment in children: focus on NUTRIMENTHE project.

PubMed

Anjos, Tania; Altmäe, Signe; Emmett, Pauline; Tiemeier, Henning; Closa-Monasterolo, Ricardo; Luque, Verónica; Wiseman, Sheila; Pérez-García, Miguel; Lattka, Eva; Demmelmair, Hans; Egan, Bernadette; Straub, Niels; Szajewska, Hania; Evans, Jayne; Horton, Claire; Paus, Tomas; Isaacs, Elizabeth; van Klinken, Jan Willem; Koletzko, Berthold; Campoy, Cristina

2013-12-01

There is growing evidence that early nutrition affects later cognitive performance. The idea that the diet of mothers, infants, and children could affect later mental performance has major implications for public health practice and policy development and for our understanding of human biology as well as for food product development, economic progress, and future wealth creation. To date, however, much of the evidence is from animal, retrospective studies and short-term nutritional intervention studies in humans. The positive effect of micronutrients on health, especially of pregnant women eating well to maximise their child's cognitive and behavioural outcomes, is commonly acknowledged. The current evidence of an association between gestational nutrition and brain development in healthy children is more credible for folate, n-3 fatty acids, and iron. Recent findings highlight the fact that single-nutrient supplementation is less adequate than supplementation with more complex formulae. However, the optimal content of micronutrient supplementation and whether there is a long-term impact on child's neurodevelopment needs to be investigated further. Moreover, it is also evident that future studies should take into account genetic heterogeneity when evaluating nutritional effects and also nutritional recommendations. The objective of the present review is to provide a background and update on the current knowledge linking nutrition to cognition and behaviour in children, and to show how the large collaborative European Project NUTRIMENTHE is working towards this aim.

Influence of background noise on the performance in the odor sensitivity task: effects of noise type and extraversion.

PubMed

Seo, Han-Seok; Hähner, Antje; Gudziol, Volker; Scheibe, Mandy; Hummel, Thomas

2012-10-01

Recent research demonstrated that background noise relative to silence impaired subjects' performance in a cognitively driven odor discrimination test. The current study aimed to investigate whether the background noise can also modulate performance in an odor sensitivity task that is less cognitively loaded. Previous studies have shown that the effect of background noise on task performance can be different in relation to degree of extraversion and/or type of noise. Accordingly, we wanted to examine whether the influence of background noise on the odor sensitivity task can be altered as a function of the type of background noise (i.e., nonverbal vs. verbal noise) and the degree of extraversion (i.e., introvert vs. extrovert group). Subjects were asked to conduct an odor sensitivity task in the presence of either nonverbal noise (e.g., party sound) or verbal noise (e.g., audio book), or silence. Overall, the subjects' mean performance in the odor sensitivity task was not significantly different across three auditory conditions. However, with regard to the odor sensitivity task, a significant interaction emerged between the type of background noise and the degree of extraversion. Specifically, verbal noise relative to silence significantly impaired or improved the performance of the odor sensitivity task in the introvert or extrovert group, respectively; the differential effect of introversion/extraversion was not observed in the nonverbal noise-induced task performance. In conclusion, our findings provide new empirical evidence that type of background noise and degree of extraversion play an important role in modulating the effect of background noise on subjects' performance in an odor sensitivity task.

Eliminate background interference from latent fingerprints using ultraviolet multispectral imaging

NASA Astrophysics Data System (ADS)

Huang, Wei; Xu, Xiaojing; Wang, Guiqiang

2014-02-01

Fingerprints are the most important evidence in crime scene. The technology of developing latent fingerprints is one of the hottest research areas in forensic science. Recently, multispectral imaging which has shown great capability in fingerprints development, questioned document detection and trace evidence examination is used in detecting material evidence. This paper studied how to eliminate background interference from non-porous and porous surface latent fingerprints by rotating filter wheel ultraviolet multispectral imaging. The results approved that background interference could be removed clearly from latent fingerprints by using multispectral imaging in ultraviolet bandwidth.

Cardiovascular disease risk scores in the current practice: which to use in rheumatoid arthritis?

PubMed

Purcarea, A; Sovaila, S; Gheorghe, A; Udrea, G; Stoica, V

2014-01-01

Cardiovascular disease (CVD) is the highest prevalence disease in the general population (GP) and it accounts for 20 million deaths worldwide each year. Its prevalence is even higher in rheumatoid arthritis. Early detection of subclinical disease is critical and the use of cardiovascular risk prediction models and calculators is widely spread. The impact of such techniques in the GP was previously studied. Despite their common background and similarities, some disagreement exists between most scores and their importance in special high-risk populations like rheumatoid arthritis (RA), having a low level of evidence. The current article aims to single out those predictive models (models) that could be most useful in the care of rheumatoid arthritis patients.

Cardiovascular disease risk scores in the current practice: which to use in rheumatoid arthritis?

PubMed Central

Purcarea, A; Sovaila, S; Gheorghe, A; Udrea, G; Stoica, V

2014-01-01

Cardiovascular disease (CVD) is the highest prevalence disease in the general population (GP) and it accounts for 20 million deaths worldwide each year. Its prevalence is even higher in rheumatoid arthritis. Early detection of subclinical disease is critical and the use of cardiovascular risk prediction models and calculators is widely spread. The impact of such techniques in the GP was previously studied. Despite their common background and similarities, some disagreement exists between most scores and their importance in special high-risk populations like rheumatoid arthritis (RA), having a low level of evidence. The current article aims to single out those predictive models (models) that could be most useful in the care of rheumatoid arthritis patients. PMID:25713603

Consumer perceptions of specific design characteristics for front-of-package nutrition labels.

PubMed

Acton, R B; Vanderlee, L; Roberto, C A; Hammond, D

2018-04-01

An increasing number of countries are developing front-of-package (FOP) labels; however, there is limited evidence examining the impact of specific design characteristics for these labels. The current study investigated consumer perceptions of several FOP label design characteristics, including potential differences among sociodemographic sub-groups. Two hundred and thirty-four participants aged 16 years or older completed nine label rating tasks on a laptop at a local shopping mall in Canada. The rating tasks asked participants to rate five primary design characteristics (border, background presence, background colour, 'caution' symbol and government attribution) on their noticeability, readability, believability and likelihood of changing their beverage choice. FOP labels with a border, solid background and contrasting colours increased noticeability. A solid background increased readability, while a contrasting background colour reduced it. Both a 'caution' symbol and a government attribution increased the believability of the labels and the perceived likelihood of influencing beverage choice. The effect of the design characteristics was generally similar across sociodemographic groups, with modest differences in five of the nine outcomes. Label design characteristics, such as the use of a border, colour and symbols can enhance the salience of FOP nutrition labels and may increase the likelihood that FOP labels are used by consumers.

Concerns with low-level ionizing radiation.

PubMed

Yalow, R S

1994-05-01

To clarify the effects of ionizing radiation and to dispel fear associated with the use of radioactivity in medical diagnosis and therapy. Studies of populations in geographic areas of increased cosmic radiation and high natural background radiation, radiation-exposed workers, patients with medical exposure to radioactivity, and accidental exposure are reviewed. No reproducible evidence shows harmful effects associated with increases in background radiation of 3 to 10 times the usual levels. American military personnel who participated in nuclear testing had no increase in leukemia or other cancers. Among 22,000 patients with hyperthyroidism treated with 131I (mean dose, 10 rem), no increased incidence of leukemia was found in comparison with 14,000 similar patients who received other treatment. A 20-year follow-up of 35,000 patients who underwent 131I uptake tests for evaluation of thyroid function revealed that those studied for other than a suspected tumor had only 60% of the thyroid cancers expected in a control group. Although early studies showed that high exposures to miners to radon and its daughters resulted in a substantial increase in lung cancer, no evidence exists for an increase in lung cancer among nonsmokers exposed to increased radon levels in the home. Perhaps the association of radiation with the atomic bomb has created a climate of fear about the possible dangers of radiation at any level; however, no evidence indicates that current radiation exposures associated with medical usage are harmful.

FUNCTIONAL PERFORMANCE TESTING OF THE HIP IN ATHLETES: A SYSTEMATIC REVIEW FOR RELIABILITY AND VALIDITY

PubMed Central

Martin, RobRoy L.

2012-01-01

Purpose/Background: The purpose of this study was to systematically review the literature for functional performance tests with evidence of reliability and validity that could be used for a young, athletic population with hip dysfunction. Methods: A search of PubMed and SPORTDiscus databases were performed to identify movement, balance, hop/jump, or agility functional performance tests from the current peer-reviewed literature used to assess function of the hip in young, athletic subjects. Results: The single-leg stance, deep squat, single-leg squat, and star excursion balance tests (SEBT) demonstrated evidence of validity and normative data for score interpretation. The single-leg stance test and SEBT have evidence of validity with association to hip abductor function. The deep squat test demonstrated evidence as a functional performance test for evaluating femoroacetabular impingement. Hop/Jump tests and agility tests have no reported evidence of reliability or validity in a population of subjects with hip pathology. Conclusions: Use of functional performance tests in the assessment of hip dysfunction has not been well established in the current literature. Diminished squat depth and provocation of pain during the single-leg balance test have been associated with patients diagnosed with FAI and gluteal tendinopathy, respectively. The SEBT and single-leg squat tests provided evidence of convergent validity through an analysis of kinematics and muscle function in normal subjects. Reliability of functional performance tests have not been established on patients with hip dysfunction. Further study is needed to establish reliability and validity of functional performance tests that can be used in a young, athletic population with hip dysfunction. Level of Evidence: 2b (Systematic Review of Literature) PMID:22893860

Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study

PubMed Central

Iravani, Mina; Janghorbani, Mohsen; Zarean, Ellahe; Bahrami, Masod

2016-01-01

Background: Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women. Objectives: The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran. Materials and Methods: This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis. Results: Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system. Conclusions: The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality. PMID:27175303

Effects of background color and symbol arrangement cues on construction of multi-symbol messages by young children without disabilities: implications for aided AAC design.

PubMed

Thistle, Jennifer J; Wilkinson, Krista

2017-09-01

Children whose speech does not meet their communication needs often benefit from augmentative and alternative communication (AAC). The design of an AAC display may influence the child's ability to communicate effectively. The current study examined how symbol background color cues and symbol arrangement affected construction of multi-symbol messages using line-drawing symbols, by young children with typical development. Participants (N = 52) heard a spoken phrase matching a photograph and selected line drawings within a 4 × 4 array. Friedman two-way ANOVAs evaluated speed and accuracy of multi-symbol message construction under four conditions in which the background color and arrangement of symbols was manipulated. Participants demonstrated significantly faster response times when symbols were arranged by word-class category compared to no symbol arrangement. The majority of children responded faster when symbols had white backgrounds, but this effect failed to reach statistical significance. This study provides preliminary evidence suggesting the importance of symbol arrangement for young children. The findings highlight the need for caution when incorporating background color on displays for young children. Future research is needed to examine the effect of visual cues on children who use AAC and consider additional factors that could influence efficacy of symbol arrangement and background color use.

Accessory breasts: a historical and current perspective.

PubMed

Loukas, Marios; Clarke, Pamela; Tubbs, R Shane

2007-05-01

The presence of accessory breast tissue such as extra nipples (polythelia) and extra breast (polymastia) is relatively common, with a high incidence of being misdiagnosed in clinical medicine. Although polythelia is congenital in origin and is identifiable at childhood, polymastia may not be evident until the influence of sex hormones during puberty. In this article, we present a review of the literature concerning the historical background of accessory breasts, their incidence, their misdiagnoses, and their association with other syndromes and diseases. Finally, we present the common treatment options available today for such conditions.

'Hot Topics' in Astrophysics

NASA Technical Reports Server (NTRS)

Maran, Stephen P.

2000-01-01

Three current topics in astrophysics are described here on the occasion of the joint meeting of the American Association of Physics Teachers and the American Astronomical Society (Jan. 7-11, 2001, San Diego, Calif.). Many equally exciting topics--ranging from the dozens of newly discovered planets of sunlike stars to evidence suggesting that the expansion of the universe is accelerating--could have been chosen. The topics discussed are: (1) the habitability of Mars, (2) black holes, galaxy bulges, and the X-ray background, and (3) the greatest explosions since the Big Bang.

Controversies about sugars consumption: state of the science.

PubMed

Rippe, James M; Marcos, Ascensión

2016-11-01

Few topics in nutrition generate more controversy and debate than the putative associations between added sugars and health. With this as background, a group of researchers in the area of sugars and health gathered at the European Nutrition Conference (FENS) in 2015 to discuss these controversies and provide evidence-based science. The purpose of the current article was to provide a brief summary of some of the highlights from each of the presenters and serve as an Introduction to the supplement which contains full articles based on their presentations.

Exploring patient values in medical decision making: a qualitative study.

PubMed

Lee, Yew Kong; Low, Wah Yun; Ng, Chirk Jenn

2013-01-01

Patient decisions are influenced by their personal values. However, there is a lack of clarity and attention on the concept of patient values in the clinical context despite clear emphasis on patient values in evidence-based medicine and shared decision making. The aim of the study was to explore the concept of patient values in the context of making decisions about insulin initiation among people with type 2 diabetes. We conducted individual in-depth interviews with people with type 2 diabetes who were making decisions about insulin treatment. Participants were selected purposively to achieve maximum variation. A semi-structured topic guide was used to guide the interviews which were audio-recorded and analysed using a thematic approach. We interviewed 21 participants between January 2011 and March 2012. The age range of participants was 28-67 years old. Our sample comprised 9 women and 12 men. Three main themes, 'treatment-specific values', 'life goals and philosophies', and 'personal and social background', emerged from the analysis. The patients reported a variety of insulin-specific values, which were negative and/or positive beliefs about insulin. They framed insulin according to their priorities and philosophies in life. Patients' decisions were influenced by sociocultural (e.g. religious background) and personal backgrounds (e.g. family situations). This study highlighted the need for expanding the current concept of patient values in medical decision making. Clinicians should address more than just values related to treatment options. Patient values should include patients' priorities, life philosophy and their background. Current decision support tools, such as patient decision aids, should consider these new dimensions when clarifying patient values.

Accelerated modern human-induced species losses: Entering the sixth mass extinction.

PubMed

Ceballos, Gerardo; Ehrlich, Paul R; Barnosky, Anthony D; García, Andrés; Pringle, Robert M; Palmer, Todd M

2015-06-01

The oft-repeated claim that Earth's biota is entering a sixth "mass extinction" depends on clearly demonstrating that current extinction rates are far above the "background" rates prevailing between the five previous mass extinctions. Earlier estimates of extinction rates have been criticized for using assumptions that might overestimate the severity of the extinction crisis. We assess, using extremely conservative assumptions, whether human activities are causing a mass extinction. First, we use a recent estimate of a background rate of 2 mammal extinctions per 10,000 species per 100 years (that is, 2 E/MSY), which is twice as high as widely used previous estimates. We then compare this rate with the current rate of mammal and vertebrate extinctions. The latter is conservatively low because listing a species as extinct requires meeting stringent criteria. Even under our assumptions, which would tend to minimize evidence of an incipient mass extinction, the average rate of vertebrate species loss over the last century is up to 100 times higher than the background rate. Under the 2 E/MSY background rate, the number of species that have gone extinct in the last century would have taken, depending on the vertebrate taxon, between 800 and 10,000 years to disappear. These estimates reveal an exceptionally rapid loss of biodiversity over the last few centuries, indicating that a sixth mass extinction is already under way. Averting a dramatic decay of biodiversity and the subsequent loss of ecosystem services is still possible through intensified conservation efforts, but that window of opportunity is rapidly closing.

An Evidence-Based Public Health Approach to Climate Change Adaptation

PubMed Central

Eidson, Millicent; Tlumak, Jennifer E.; Raab, Kristin K.; Luber, George

2014-01-01

Background: Public health is committed to evidence-based practice, yet there has been minimal discussion of how to apply an evidence-based practice framework to climate change adaptation. Objectives: Our goal was to review the literature on evidence-based public health (EBPH), to determine whether it can be applied to climate change adaptation, and to consider how emphasizing evidence-based practice may influence research and practice decisions related to public health adaptation to climate change. Methods: We conducted a substantive review of EBPH, identified a consensus EBPH framework, and modified it to support an EBPH approach to climate change adaptation. We applied the framework to an example and considered implications for stakeholders. Discussion: A modified EBPH framework can accommodate the wide range of exposures, outcomes, and modes of inquiry associated with climate change adaptation and the variety of settings in which adaptation activities will be pursued. Several factors currently limit application of the framework, including a lack of higher-level evidence of intervention efficacy and a lack of guidelines for reporting climate change health impact projections. To enhance the evidence base, there must be increased attention to designing, evaluating, and reporting adaptation interventions; standardized health impact projection reporting; and increased attention to knowledge translation. This approach has implications for funders, researchers, journal editors, practitioners, and policy makers. Conclusions: The current approach to EBPH can, with modifications, support climate change adaptation activities, but there is little evidence regarding interventions and knowledge translation, and guidelines for projecting health impacts are lacking. Realizing the goal of an evidence-based approach will require systematic, coordinated efforts among various stakeholders. Citation: Hess JJ, Eidson M, Tlumak JE, Raab KK, Luber G. 2014. An evidence-based public health approach to climate change adaptation. Environ Health Perspect 122:1177–1186; http://dx.doi.org/10.1289/ehp.1307396 PMID:25003495

The Early Universe: Searching for Evidence of Cosmic Inflation

NASA Technical Reports Server (NTRS)

Chuss, David T.

2012-01-01

In the past two decades, our understanding of the evolution and fate of the universe has increased dramatically. This "Age of Precision Cosmology" has been ushered in by measurements that have both elucidated the details of the Big Bang cosmology and set the direction for future lines of inquiry. Our universe appears to consist of 5% baryonic matter; 23% of the universe's energy content is dark matter which is responsible for the observed structure in the universe; and 72% of the energy density is so-called "dark energy" that is currently accelerating the expansion of the universe. In addition, our universe has been measured to be geometrically flat to 1 %. These observations and related details of the Big Bang paradigm have hinted that the universe underwent an epoch of accelerated expansion known as "inflation" early in its history. In this talk, I will review the highlights of modern cosmology, focusing on the contributions made by measurements of the cosmic microwave background, the faint afterglow of the Big Bang. I will also describe new instruments designed to measure the polarization of the cosmic microwave background in order to search for evidence of cosmic inflation.

Chinese Herbal Medicine and Depression: The Research Evidence

PubMed Central

Butler, Lee; Pilkington, Karen

2013-01-01

Background. Alternative approaches for managing depression are often sought and herbal mixtures are widely used in China. The aim of this paper was to provide an overall picture of the current evidence by analysing published systematic reviews and presenting a supplementary systematic review of trials in Western databases. Methods. Searches were conducted using AMED, Cochrane Library, EMBASE, MEDLINE/PubMed, PsycINFO, and trial registers. Results were screened and selected trials were evaluated by two reviewers working independently. Systematic reviews were identified and assessed using key criteria. Results. Five systematic reviews were located addressing the Chinese literature, adjunctive use of Chinese herbs, and the formulae Chaihu-Shugan-San, Xiao Yao San, and Free and Easy Wanderer Plus. The supplementary review located 8 trials, 3 of which were not included in previous reviews. Positive results were reported: no significant differences from medication, greater effect than medication or placebo, reduced adverse event rates when combined or compared with antidepressants. However, limitations in methodology and reporting were revealed. Conclusions. Despite promising results, particularly for Xiao Yao San and its modifications, the effectiveness of Chinese herbal medicine in depression could not be fully substantiated based on current evidence. Further well-designed, well-reported trials that reflect practice may be worth pursuing. PMID:23476701

Infection risk and intrauterine devices.

PubMed

Martínez, Francisca; López-Arregui, Eduardo

2009-01-01

For most women, intrauterine contraceptive devices (IUCD) are a safe option. Upper genital tract infections (pelvic inflammatory disease, PID) occur when pathogenic microorganisms ascend from the cervix and invade the endometrium and the fallopian tubes, causing an inflammatory reaction. Evidence-based recommendations regarding intrauterine contraception and risk of infection were presented at the Congress of the European Society of Contraception, in Prague, 2008: A clinical history (including sexual history) should be taken as part of the routine assessment for intrauterine contraception to identify women at high risk of sexually transmitted infections (STI); if appropriate a test should be offered; if symptoms or signs are present, appropriate diagnostic tests should be done, results awaited, necessary treatment completed, and IUCD insertion postponed until resolution. Prophylactic antibiotics are not recommended (evidence level II-3). STI screening is not routinely recommended. PID among IUCD users is most strongly related to the insertion process and to the background risk of STI (evidence level II-2). Conditions which represent an unacceptable health risk if an IUCD is inserted (WHO Medical Eligibility Criteria, MEC, Categories 3-4) are current PID, current purulent cervicitis, chlamydial or gonorrheal infection. For continuation as well as initiation, WHO MEC categories 3-4 are allotted to women with known pelvic tuberculosis, puerperal sepsis and septic abortion.

Behavioural and Autonomic Regulation of Response to Sensory Stimuli among Children: A Systematic Review of Relationship and Methodology

PubMed Central

Morato-Espino, Paulin Grace; Chan, Chetwyn C. H.; Tsang, Hector W. H.

2017-01-01

Background Previous studies have explored the correlates of behavioural and autonomic regulation of response to sensory stimuli in children; however, a comprehensive review of such relationship is lacking. This systematic review was performed to critically appraise the current evidence on such relationship and describe the methods used in these studies. Methods Online databases were systematically searched for peer-reviewed, full-text articles in the English language between 1999 and 2016, initially screened by title and abstract, and appraised and synthesized by two independent review authors. Results Fourteen Level III-3 cross-sectional studies were included for systematic review, among which six studies explored the relationship between behaviour and physiological regulation of responses to sensory stimuli. Three studies reported significant positive weak correlations among ASD children; however, no correlations were found in typically developing children. Methodological differences related to individual differences among participants, measures used, and varied laboratory experimental setting were noted. Conclusion This review suggests inconclusive evidence supporting the relationship between behavioural and physiological regulation of responses to sensory stimuli among children. Methodological differences may likely have confounded the results of the current evidence. We present methodological recommendations to address this matter for future researches. This trial is registered with PROSPERO registration number CRD42016043887. PMID:29333436

Acupuncture for Functional Dyspepsia: What Strength Does It Have? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

PubMed Central

Li, Jing; Li, Bo; Hu, Ya-Cai; Cai, Qiu-Han

2016-01-01

Background. Although the effectiveness of acupuncture therapy on functional dyspepsia (FD) has been systematically reviewed, the available reports are still contradictive and no robust evidence has been provided to date. Objective. To assess the current evidence of high quality on the effects of acupuncture for patients with FD. Methods. A comprehensive literature database search was conducted to identify randomized controlled trials (RCTs) comparing acupuncture therapies (including manual acupuncture and electroacupuncture) to sham acupuncture and medication use. A meta-analysis was performed following a strict methodology. Results. 16 RCTs involving 1436 participants were included. The majority of the trials were determined to be of low quality. Positive results were found for acupuncture in improving the Nepean Dyspepsia Index (NDI) and scores of the MOS 36-Item Short-Form Health Survey (SF-36), as well as in alleviating relevant symptoms (especially postprandial fullness and early satiation) of FD patients. Conclusion. Based on current available evidence, acupuncture therapy achieves statistically significant effect for FD in comparison with sham acupuncture and is superior to medication (prokinetic agents) in improving the symptoms and quality of life of FD patients. Nonetheless, despite stringent methodological analyses, the conclusion of our review still needs to be strengthened by additional RCTs of higher quality. PMID:28119758

The health effects of economic insecurity.

PubMed Central

Catalano, R

1991-01-01

BACKGROUND. Interest in the health and behavioral effects of economic insecurity appears to vary with the performance of the economy. The current recession in the United States and Western Europe and growing unemployment in Eastern Europe make it timely to analytically review the recent research concerned with the health effects of economic contraction. METHODS. The research concerned with the health and behavioral effects of economic insecurity is organized by dependent variable and method. Rules for determining which effects are supported by strong and which by weak evidence are developed and applied to the literature. RESULTS. Evidence for effects on symptoms of psychological distress, seeking help for psychological distress, and nonspecific physiological illness is strong. Evidence for effects on suicide, child abuse, adverse birth outcomes, and heart disease is characterized as weak or sufficiently controversial to warrant skepticism. CONCLUSIONS. The health effects of economic security are undoubtedly mediated by economic policies. Estimating the effect of policy alternatives on the incidence of various outcomes is, however, very difficult given the current state of the research. The effect of rising unemployment on health in Eastern Europe cannot, moreover, be estimated from existing research. Effects estimated from Western economies probably do not generalize to situations in which the meaning of economic insecurity is conditioned by profound social and political reforms. PMID:1951825

The interaction of family background and personal education on depressive symptoms in later life.

PubMed

Schaan, Barbara

2014-02-01

This study assesses the interaction between personal education and family background during childhood on depressive symptoms in later life by applying Ross & Mirowsky's resource substitution and structural amplification theory of health and education. OLS regression models are estimated using data from the "Survey of Health, Ageing and Retirement in Europe" (SHARE), which covers information on current social and health status as well as retrospective life histories from 20,716 respondents aged 50 or older from thirteen European countries. Higher education helps to overcome the negative consequences of a poor family background. Since people from poor families are less likely to attain higher educational levels, they lack exactly the resource they need in order to overcome the negative consequences their non-prosperous background has on depressive symptoms. Thus, low family background and low personal education amplify each other. Examining the processes described by theory of resource substitution and structural amplification over different age groups from midlife to old-age suggests that the moderating effect of education remains constant over age among people coming from a poor family background. However, there is some evidence for a decrease with age in the buffering effect of a well-off family background on depressive symptoms among the low educated group. Furthermore, the educational gap in depression diverges with age among individuals originating from a well-off family background. Taken together the results cautiously allude to the conclusion that three processes - cumulative (dis-)advantage, age-as-leveler, and persistent inequalities - might take place. Copyright © 2013 Elsevier Ltd. All rights reserved.

Adult men's beliefs, values, attitudes and experiences regarding contraceptives: a systematic review of qualitative studies.

PubMed

Hoga, Luiza A K; Rodolpho, Juliana R C; Sato, Priscila M; Nunes, Michelly C M; Borges, Ana L V

2014-04-01

To explore the men's beliefs, values, attitudes and experiences towards contraceptives. The promotion of male participation in contraceptive practices requires the knowledge and consideration of the beliefs, values, attitudes and experiences involved. The systematic review of the literature focusing on these themes can be useful for the evidence-based health care. A systematic review of qualitative studies. Studies published between 1994 until 2011 (inclusive) were included. The participants included men from all cultures, ethnic backgrounds and religions who have expressed their beliefs, values, attitudes and experiences regarding male contraceptives. The databases CINAHL, PubMed, PsycINFO, SciELO, LILACS and MedCarib were explored. The appraisal of primary studies, carried out through the JBI-QARI (Qualitative Assessment and Review Instrument) resulted in the inclusion of 16 studies in this systematic review. The set of statements of beliefs, values, attitudes and experiences regarding contraceptives resulted in five synthesis: (1) contraceptive behaviour is influenced by religious, family and social backgrounds; (2) gendered, male-centred values predominate in contraceptive behaviours; (3) the sense of invulnerability influences contraceptive behaviours; (4) strong obstacles should be overcome to use contraceptives; (5) behaviours, decision-making and experiences regarding male contraceptives. The male beliefs and values regarding contraceptives are strongly influenced by religious, family and social backgrounds, and their attitudes in this scope are male centred. A deeper male consciousness regarding contraceptive responsibility should be promoted. It requires the knowledge of the men's personal backgrounds regarding contraceptives because they can be diverse according to family, social and cultural contexts. The consideration of the men's personal perspective is essential in the planning and implementation of reproductive health care. These aspects are essential for the concretisation of the evidence-based health care, a current challenge worldwide. © 2013 John Wiley & Sons Ltd.

Standard Guidelines of Care: Performing Procedures in Patients on or Recently Administered with Isotretinoin

PubMed Central

Mysore, Venkataram; Mahadevappa, Omprakash H.; Barua, Shyamanta; Majid, Imran; Viswanath, Vishalakshi; Bhat, Ramesh M.; Talwar, Suresh; Thurakkal, Salim; Aurangabadkar, Sanjeev J.; Chatterjee, Manas; Ganjoo, Anil

2017-01-01

Background: Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13-cis-retinoic acid) states that the procedures should not be performed. The recommendations in standard books and drug insert require discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. These recommendations have been followed for over two decades despite little evidence for the stated increased risk of scarring. Objective: The Association of Cutaneous Surgeons (I) constituted a task force to review the evidence and to recommend consensus guidelines regarding the safety of skin procedures, including resurfacing, energy-device treatments, and dermatosurgical procedures in patients with concurrent or recent isotretinoin administration. Materials and Methods: Data were extracted from the literature through a PubMed search using the keywords “isotretinoin,” “safety,” “scarring,” “keloids,” “hypertrophic scarring,” and “pigmentation.” The evidence was then labeled and circulated to all members of task force for review. Results: The task force is of the opinion that there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued. The task force concludes that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration. PMID:29491653

Antibiotics versus appendectomy in the management of acute appendicitis: a review of the current evidence

PubMed Central

Fitzmaurice, Gerard J.; McWilliams, Billy; Hurreiz, Hisham; Epanomeritakis, Emanuel

2011-01-01

Background Acute appendicitis remains the most common cause of the acute abdomen in young adults, and the mainstay of treatment in most centres is an appendectomy. However, treatment for other intra-abdominal inflammatory processes, such as diverticulitis, consists initially of conservative management with antibiotics. The aim of this study was to determine the role of antibiotics in the management of acute appendicitis and to assess if appendectomy remains the gold standard of care. Methods A literature search using MEDLINE and the Cochrane Library identified studies published between 1999 and 2009, and we reviewed all relevant articles. The articles were critiqued using the Public Health Resource Unit (2006) appraisal tools. Results Our search yielded 41 papers, and we identified a total of 13 papers within the criteria specified. All of these papers, while posing pertinent questions and demonstrating the role of antibiotics as a bridge to surgery, failed to adequately justify their findings that antibiotics could be used as a definitive treatment of acute appendicitis. Conclusion Appendectomy remains the gold standard of treatment for acute appendicitis based on the current evidence. PMID:21651835

Dietary sodium, potassium, and alcohol: key players in the pathophysiology, prevention, and treatment of human hypertension.

PubMed

Koliaki, Chrysi; Katsilambros, Nicholas

2013-06-01

Western industrialized societies are currently experiencing an epidemic expansion of hypertension (HTN), which extends alarmingly even to children and adolescents. HTN constitutes an independent risk factor for cardiorenal disease and represents an extremely common comorbidity of diabetes and obesity. Numerous randomized clinical trials and meta-analyses have provided robust scientific evidence that reduced dietary salt intake, increased dietary potassium intake, moderation of alcohol consumption, optimal weight maintenance, and the adoption of "heart-friendly" dietary patterns such as the Dietary Approaches to Stop Hypertension or the Mediterranean diet can effectively lower blood pressure. Interestingly, the susceptibility of blood pressure to nutritional interventions is greatly variable among individuals, depending on age, race, genetic background, and comorbidities. The purpose of this review is to provide a comprehensive overview of currently available scientific evidence in the constantly evolving field of diet and HTN, placing particular emphasis on the key role of dietary sodium, dietary potassium, and alcohol intake in the pathophysiology, prevention, and treatment of human hypertension. © 2013 International Life Sciences Institute.

IceVeto: Extended PeV neutrino astronomy in the Southern Hemisphere with IceCube

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

Auffenberg, Jan; Collaboration: IceCube Collaboration

IceCube, the world's largest high-energy neutrino observatory, built at the South Pole, recently reported evidence of an astrophysical neutrino flux extending to PeV energies in the Southern Hemisphere. This observation raises the question of how the sensitivity in this energy range could be further increased. In the down-going sector, in IceCube's case the Southern Hemisphere, backgrounds from atmospheric muons and neutrinos pose a challenge to the identification of an astrophysical neutrino flux. The IceCube analysis, that led to the evidence for astrophysical neutrinos, is based on an in-ice veto strategy for background rejection. One possibility available to IceCube is themore » concept of an extended surface detector, IceVeto, which could allow the rejection of a large fraction of atmospheric backgrounds, primarily for muons from cosmic ray (CR) air showers as well as from neutrinos in the same air showers. Building on the experience of IceTop/IceCube, possibly the most cost-effective and sensitive way to build IceVeto is as an extension of the IceTop detector, with simple photomultiplier based detector modules for CR air shower detection. Initial simulations and estimates indicate that such a veto detector will significantly increase the sensitivity to an astrophysical flux of ν{sub μ} induced muon tracks in the Southern Hemisphere compared to current analyses. Here we present the motivation and capabilities based on initial simulations. Conceptual ideas for a simplified surface array will be discussed briefly.« less

Pacing: A concept analysis of a chronic pain intervention

PubMed Central

Jamieson-Lega, Kathryn; Berry, Robyn; Brown, Cary A

2013-01-01

BACKGROUND: The intervention of pacing is regularly recommended for chronic pain patients. However, pacing is poorly defined and appears to be interpreted in varying, potentially contradictory manners within the field of chronic pain. This conceptual lack of clarity has implications for effective service delivery and for researchers’ ability to conduct rigorous study. An examination of the background literature demonstrates that while pacing is often one part of a multidisciplinary pain management program, outcome research is hindered by a lack of a clear and shared definition of this currently ill-defined construct. OBJECTIVES: To conduct a formal concept analysis of the term ‘pacing’. METHODS: A standardized concept analysis process (including literature scoping to identify all uses of the concept, analysis to determine defining attributes of the concept and identification of model, borderline and contrary cases) was used to determine what the concept of pacing does and does not represent within the current evidence base. RESULTS: A conceptual model including the core attributes of action, time, balance, learning and self-management emerged. From these attributes, an evidence-based definition for pacing was composed and distributed to stakeholders for review. After consideration of stakeholder feedback, the emergent definition of pacing was finalized as follows: “Pacing is an active self-management strategy whereby individuals learn to balance time spent on activity and rest for the purpose of achieving increased function and participation in meaningful activities”. CONCLUSION: The findings of the present concept analysis will help to standardize the use and definition of the term pacing across disciplines for the purposes of both pain management and research. PMID:23717825

Current Guidelines Have Limited Applicability to Patients with Comorbid Conditions: A Systematic Analysis of Evidence-Based Guidelines

PubMed Central

Lugtenberg, Marjolein; Burgers, Jako S.; Clancy, Carolyn; Westert, Gert P.; Schneider, Eric C.

2011-01-01

Background Guidelines traditionally focus on the diagnosis and treatment of single diseases. As almost half of the patients with a chronic disease have more than one disease, the applicability of guidelines may be limited. The aim of this study was to assess the extent that guidelines address comorbidity and to assess the supporting evidence of recommendations related to comorbidity. Methodology/Principal Findings We conducted a systematic analysis of evidence-based guidelines focusing on four highly prevalent chronic conditions with a high impact on quality of life: chronic obstructive pulmonary disease, depressive disorder, diabetes mellitus type 2, and osteoarthritis. Data were abstracted from each guideline on the extent that comorbidity was addressed (general comments, specific recommendations), the type of comorbidity discussed (concordant, discordant), and the supporting evidence of the comorbidity-related recommendations (level of evidence, translation of evidence). Of the 20 guidelines, 17 (85%) addressed the issue of comorbidity and 14 (70%) provided specific recommendations on comorbidity. In general, the guidelines included few recommendations on patients with comorbidity (mean 3 recommendations per guideline, range 0 to 26). Of the 59 comorbidity-related recommendations provided, 46 (78%) addressed concordant comorbidities, 8 (14%) discordant comorbidities, and for 5 (8%) the type of comorbidity was not specified. The strength of the supporting evidence was moderate for 25% (15/59) and low for 37% (22/59) of the recommendations. In addition, for 73% (43/59) of the recommendations the evidence was not adequately translated into the guidelines. Conclusions/Significance Our study showed that the applicability of current evidence-based guidelines to patients with comorbid conditions is limited. Most guidelines do not provide explicit guidance on treatment of patients with comorbidity, particularly for discordant combinations. Guidelines should be more explicit about the applicability of their recommendations to patients with comorbidity. Future clinical trials should also include patients with the most prevalent combinations of chronic conditions. PMID:22028802

Economic Impact of Hospital Inpatient Palliative Care Consultation: Review of Current Evidence and Directions for Future Research

PubMed Central

Normand, Charles; Morrison, R. Sean

2014-01-01

Abstract Background: Maintaining the recent expansion of palliative care access in the United States is a recognized public health concern. Economic evaluation is essential to validate current provision and assess the case for new programs. Previous economic reviews in palliative care reported on programs across settings and systems; none has examined specifically the hospital consultative model, the dominant model of provision in the United States. Objectives: To review systematically the economic evidence on specialist palliative care consultation teams in the hospital setting, to appraise this evidence critically, and to identify areas for future research in this field. Data Sources: A meta-review (“a review of existing reviews”) was conducted of eight published systematic reviews and one relevant nonsystematic review. To identify articles published outside of the timeframe of these reviews, systematic searches were performed on the PubMed, CINAHL, and EconLit databases. Study Selection: Articles were included if they compared the costs and/or cost effectiveness of a specialist hospital inpatient palliative care consultation for adult patients with those of a comparator. Results: Ten studies were included and these demonstrate a clear pattern of cost-saving impact from inpatient consultation programs. Nevertheless, knowledge gaps still exist regarding the economic effects of these programs. Current evidence has been generated from the hospital perspective; health system costs, patient and caregiver costs, and health outcomes are typically not included. Conclusions: Inpatient palliative care consultation programs have been shown to save hospitals money and to provide improved care to patients with serious illness. With a clear pattern of cost-saving using current methodology, it is timely to begin expanding the scope of economic evaluation in this field. Future research must address the measurement of both costs and outcomes to understand more fully the role that palliative care plays in enhancing value in health care. Relevant domains for such research are identified. PMID:24984168

The origin of the diffuse background gamma-radiation

NASA Technical Reports Server (NTRS)

Stecker, F. W.; Puget, J. L.

1974-01-01

Recent observations have now provided evidence for diffuse background gamma radiation extending to energies beyond 100 MeV. There is some evidence of isotropy and implied cosmological origin. Significant features in the spectrum of this background radiation have been observed which provide evidence for its origin in nuclear processes in the early stages of the big-band cosmology and tie in these processes with galaxy fromation theory. A crucial test of the theory may lie in future observations of the background radiation in the 100 MeV to 100 GeV energy range which may be made with large orbiting spark-chamber satellite detectors. A discussion of the theoretical interpretations of present data, their connection with baryon symmetric cosmology and galaxy formation theory, and the need for future observations are given.

Patient-centred care in general dental practice - a systematic review of the literature

PubMed Central

2014-01-01

Background Delivering improvements in quality is a key objective within most healthcare systems, and a view which has been widely embraced within the NHS in the United Kingdom. Within the NHS, quality is evaluated across three key dimensions: clinical effectiveness, safety and patient experience, with the latter modelled on the Picker Principles of Patient-Centred Care (PCC). Quality improvement is an important feature of the current dental contract reforms in England, with “patient experience” likely to have a central role in the evaluation of quality. An understanding and appreciation of the evidence underpinning PCC within dentistry is highly relevant if we are to use this as a measure of quality in general dental practice. Methods A systematic review of the literature was undertaken to identify the features of PCC relevant to dentistry and ascertain the current research evidence base underpinning its use as a measure of quality within general dental practice. Results Three papers were identified which met the inclusion criteria and demonstrated the use of primary research to provide an understanding of the key features of PCC within dentistry. None of the papers identified were based in general dental practice and none of the three studies sought the views of patients. Some distinct differences were noted between the key features of PCC reported within the dental literature and those developed within the NHS Patient Experience Framework. Conclusions This systematic review reveals a lack of understanding of PCC within dentistry, and in particular general dental practice. There is currently a poor evidence base to support the use of the current patient reported outcome measures as indicators of patient-centredness. Further research is necessary to understand the important features of PCC in dentistry and patients’ views should be central to this research. PMID:24902842

Neurobiological Correlates in Forensic Assessment: A Systematic Review

PubMed Central

van der Gronde, Toon; Kempes, Maaike; van El, Carla; Rinne, Thomas; Pieters, Toine

2014-01-01

Background With the increased knowledge of biological risk factors, interest in including this information in forensic assessments is growing. Currently, forensic assessments are predominantly focused on psychosocial factors. A better understanding of the neurobiology of violent criminal behaviour and biological risk factors could improve forensic assessments. Objective To provide an overview of the current evidence about biological risk factors that predispose people to antisocial and violent behaviour, and determine its usefulness in forensic assessment. Methods A systematic literature search was conducted using articles from PsycINFO, Embase and Pubmed published between 2000 and 2013. Results This review shows that much research on the relationship between genetic predisposition and neurobiological alterations with aggression is performed on psychiatric patients or normal populations. However, the number of studies comparing offenders is limited. There is still a great need to understand how genetic and neurobiological alterations and/or deficits are related to violent behaviour, specifically criminality. Most studies focus on only one of the genetic or neurobiological fields related to antisocial and/or violent behaviour. To reliably correlate the findings of these fields, a standardization of methodology is urgently needed. Conclusion Findings from the current review suggest that violent aggression, like all forms of human behaviour, both develops under specific genetic and environmental conditions, and requires interplay between these conditions. Violence should be considered as the end product of a chain of life events, during which risks accumulate and potentially reinforce each other, displaying or triggering a specific situation. This systematic review did not find evidence of predispositions or neurobiological alterations that solely explain antisocial or violent behaviour. With better designed studies, more correlation between diverse fields, and more standardisation, it might be possible to elucidate underlying mechanisms. Thus, we advocate maintaining the current case-by-case differentiated approach to evidence-based forensic assessment. PMID:25330208

[Significance of Matrix-augmented Bone Marrow Stimulation for Treatment of Cartilage Defects of the Knee: A Consensus Statement of the DGOU Working Group on Tissue Regeneration].

PubMed

Niemeyer, Philipp; Becher, Christoph; Buhs, Matthias; Fickert, Stefan; Gelse, Kolja; Günther, Daniel; Kaelin, Raphael; Kreuz, Peter; Lützner, Jörg; Nehrer, Stefan; Madry, Henning; Marlovits, Stefan; Mehl, Julian; Ott, Henning; Pietschmann, Matthias; Spahn, Gunther; Tischer, Thomas; Volz, Martin; Walther, Markus; Welsch, Götz; Zellner, Johannes; Zinser, Wolfgang; Angele, Peter

2018-06-18

Surgical principles for treatment of full-thickness cartilage defects of the knee include bone marrow stimulation techniques (i.e. arthroscopic microfracturing) and transplantation techniques (i.e. autologous chondrocyte implantation and osteochondral transplantation). On the basis of increasing scientific evidence, indications for these established therapeutical concepts have been specified and clear recommendations for practical use have been given. Within recent years, matrix-augmented bone marrow stimulation has been established as a new treatment concept for chondral lesions. To date, scientific evidence is limited and specific indications are still unclear. The present paper gives an overview of available products as well as preclinical and clinical scientific evidence. On the basis of the present evidence and an expert consensus from the "Working Group on Tissue Regeneration" of the German Orthopaedic and Trauma Society (DGOU), indications are specified and recommendations for the use of matrix-augmented bone marrow stimulation are given. In principle, it can be stated that the various products offered in this field differ considerably in terms of the number and quality of related studies (evidence level). Against the background of the current data situation, their application is currently seen in the border area between cell transplantation and bone marrow stimulation techniques, but also as an improvement on traditional bone marrow stimulation within the indication range of microfracturing. The recommendations of the Working Group have preliminary character and require re-evaluation after improvement of the study situation. Georg Thieme Verlag KG Stuttgart · New York.

Hip Strength Deficits in People With Symptomatic Knee Osteoarthritis: A Systematic Review With Meta-analysis.

PubMed

Deasy, Margaret; Leahy, Edmund; Semciw, Adam Ivan

2016-08-01

Study Design Systematic review with meta-analysis. Background A complete understanding of impairments associated with knee osteoarthritis would optimize exercise interventions for people with knee osteoarthritis. Our current understanding of hip strength deficits in this population is based on studies with conflicting findings and small samples. There is a need to systematically review and pool current evidence. Objectives To determine whether hip strength deficits exist in people with symptomatic knee osteoarthritis. Methods Electronic databases (MEDLINE, CINAHL, Embase, the Cochrane Library, and PsycINFO) were searched through February 2016. Studies comparing hip strength in people diagnosed with symptomatic knee osteoarthritis to healthy control participants were included in the review. A meta-analysis with random effects was applied to relevant data from included studies and a modified Grading of Recommendations Assessment, Development and Evaluation approach was used to evaluate the quality of evidence for each pooled analysis. Results Five studies were included in the review. Meta-analysis revealed moderate-quality evidence of weaker isometric and isokinetic hip abduction strength in people with knee osteoarthritis (moderate difference: 7% to 24% weaker) and very low-quality evidence of no difference in isometric hip adduction strength. There was very low- to moderate-quality evidence of weaker isokinetic hip strength in the remaining planes of motion (moderate to large differences: 14% to 55% weaker). Conclusion Significant hip strength deficits exist in people with knee osteoarthritis. Hip strength assessment should be considered in clinical practice and may assist with directing targeted management strategies. Level of Evidence Symptom prevalence, level 1a-. J Orthop Sports PhysTher 2016;46(8):629-639. Epub3 Jul 2016. doi:10.2519/jospt.2016.6618.

A Systematic Review of Attention Biases in Opioid, Cannabis, Stimulant Use Disorders.

PubMed

Zhang, Melvyn; Ying, Jiangbo; Wing, Tracey; Song, Guo; Fung, Daniel S S; Smith, Helen

2018-06-01

Background : Opiates, cannabis, and amphetamines are highly abused, and use of these substances are prevalent disorders. Psychological interventions are crucial given that they help individuals maintain abstinence following a lapse or relapse into substance use. Advances in experimental psychology have suggested that automatic attention biases might be responsible for relapse. Prior reviews have provided evidence for the presence of these biases in addictive disorders and the effectiveness of bias modification. However, the prior studies are limited, as they failed to include trials involving participants with these prevalent addictive disorders or have failed to adopt a systematic approach in evidence synthesis. Objectives : The primary aim of this current systematic review is to synthesise the current evidence for attention biases amongst opioid use, cannabis use, and stimulant use disorders. The secondary aim is to determine the efficacy of attention bias modification interventions and other addictions related outcomes. Methods : A search was conducted from November 2017 to January 2018 on PubMed, MEDLINE, Embase, PsycINFO, Science Direct, Cochrane Central, and Scopus. The selection process of the articles was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A qualitative synthesis was undertaken. Risk of bias was assessed using the Cochrane Risk of Bias tool. Results : Six randomised trials were identified. The evidence synthesized from these trials have provided strong evidence that attentional biases are present in opioid and stimulant use disorders. Evidence synthesis for other secondary outcome measures could not be performed given the heterogeneity in the measures reported and the limited number of trials. The risk of bias assessment for the included trials revealed a high risk of selection and attrition bias. Conclusions : This review demonstrates the potential need for interventions targeting attention biases in opiate and cocaine use disorders.

WHO position on the use of fractional doses - June 2017, addendum to vaccines and vaccination against yellow fever WHO: Position paper - June 2013.

PubMed

World Health Organization

2017-10-13

This article presents the World Health Organization's (WHO) recommendations on the use of fractional doses of yellow fever vaccines excerpted from the "Yellow fever vaccine: WHO position on the use of fractional doses - June 2017, Addendum to Vaccines and vaccination against yellow fever WHO: Position Paper - June 2013″, published in the Weekly Epidemiological Record [1,2]. This addendum to the 2013 position paper pertains specifically to use of fractional dose YF (fYF) vaccination (fractional dose yellow fever vaccination refers to administration of a reduced volume of vaccine dose, which has been reconstituted as usual per manufacturer recommendations) in the context of YF vaccine supply shortages beyond the capacity of the global stockpile. The current WHO position on the use of yellow fever (YF) vaccine is set out in the 2013 WHO position paper on vaccines and vaccination against YF and those recommendations are unchanged. Footnotes to this paper provide a number of core references including references to grading tables that assess the quality of the scientific evidence, and to the evidence-to-recommendation table. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. Recommendations on the use of Yellow Fever vaccines were discussed by SAGE in October 2016; evidence presented at these meetings can be accessed at: www.who.int/immunization/sage/meetings/2016/October/presentations_background_docs/en/. Copyright © 2017. Published by Elsevier Ltd.

The adversarial court system and the expert medical witness: 'The truth the whole truth and nothing but the truth?'.

PubMed

Ryan, Matthew

2003-06-01

This discussion aims to provide the occasional medical expert witness with background knowledge of the adversarial court system and the role of the medical expert witness within it. The parallel evolution of the adversarial and inquisitorial legal systems has been more out of tradition rather than any systematic review of the effectiveness of one system or the other. Both legal systems have their merits and limitations. Witnesses within the adversarial system are required to present evidence in a structured and highly stylized format consisting of 'evidence in chief' followed by 'cross-examination'. This format is an attempt to exclude unreliable evidence. The medical witness is an 'expert' by means of specialized knowledge not possessed by the general public. This distinction allows the expert medical witness to offer his or her opinion as evidence. There remain several limitations to the expert's evidence and these relate to common knowledge, field of expertise and the 'ultimate issue'. The current practice of selection of expert medical witnesses is seriously flawed with several pressures operating to maximise bias and inaccurate testimony. Doctors should not only anticipate change in this area they should lead reform in this area.

Heating and background plasma modification associated with large amplitude kinetic Alfv'en wave launch in LAPD

NASA Astrophysics Data System (ADS)

Carter, T. A.; Auerbach, D. W.; Brugman, B. T.

2007-11-01

Large amplitude kinetic Alfv'en waves (δB/B ˜1% > k/k) are generated in the Large Plasma Device (LAPD) at UCLA using loop antennas. Substantial electron heating is observed, localized to the wave current channels. The Poynting flux associated with the Alfv'en waves is substantial and the observed heating may be at least in part due to collisional and Landau damping of these waves. However, heating by antenna near inductive electric fields may also be responsible for the observations. A discussion of both possibilities will be presented, including measurements of near fields of the antenna. The heating structures the background plasma and results in the excitation of drift-Alfv'en waves. These drift waves then interact with the incident Alfv'en wave, causing sideband generation which results in a nearly broadband state at high wave power. This process may represent an alternate mechanism by which unidirectional kinetic Alfv'en waves can nonlinearly generate a turbulent spectrum. In addition to electron heating, evidence for background density modification and electron acceleration is observed and will be presented.

Cannabis Smoking and Diabetes Mellitus: Results from Meta-Analysis with Eight Independent Replication Samples

PubMed Central

Alshaarawy, Omayma; Anthony, James C.

2016-01-01

Background In preclinical animal studies, evidence links cannabis smoking (CS) with hyperphagia, obesity, and insulin resistance. Nonetheless, in humans, CS might protect against type 2 diabetes mellitus (DM). Here, we offer epidemiological estimates from eight independent replications from (1) the National Health and Nutrition Examination Surveys, and (2) the National Surveys on Drug Use and Health (2005-12). Methods For each national survey participant, computer-assisted self-interviews assess CS and physician-diagnosed DM; NHANES provides additional biomarker values and a composite DM diagnosis. Regression analyses produce estimates of CS-DM associations. Meta-analyses summarize the replication estimates. Results Recently active CS and DM are inversely associated. The meta-analytic summary odds ratio is 0.7 (95% CI = 0.6, 0.8). Conclusions Current evidence is too weak for causal inference, but there now is a more stable evidence base for new lines of clinical translational research on a possibly protective (or spurious) CS-DM association suggested in prior research. PMID:25978795

When Average Is Not Good Enough: Students With Learning Disabilities at Selective, Private Colleges.

PubMed

Weis, Robert; Erickson, Celeste P; Till, Christina H

Adolescents with learning disabilities disproportionately come from lower socioeconomic status backgrounds, show normative deficits in academic skills, and attend 2-year, public colleges instead of 4-year institutions. However, students with learning disabilities are well represented at the United States' most expensive and selective postsecondary institutions. We examined the psychoeducational functioning of students receiving accommodations for learning disabilities at a private, selective, liberal arts college. We also determined whether students had objective evidence supporting their disability diagnoses and academic accommodations. Most students showed above-average cognitive abilities, average academic skills, and no evidence of impairment. Although nearly all students reported academic problems, most lacked objective evidence of academic difficulties prior to college as well as relative or normative deficits in broad academic skills or fluency. Results indicate a need for greater reliance on objective, multimethod/multi-informant data in the diagnostic process. Results also highlight limitations in the current professional guidelines for documentation decision making in higher education.

Gender differences amongst adult arsonists at psychiatric assessment.

PubMed

Dickens, Geoff; Sugarman, Philip; Ahmad, Farooq; Edgar, Simon; Hofberg, Kristina; Tewari, Sidharta

2007-07-01

Reports of gender differences amongst arsonists at psychiatric assessment are not uncommon, however some are based on relatively small samples. A new retrospective study highlighting gender differences could help to confirm or refute the current state of knowledge. The aim of the current study was to examine gender differences amongst a sample of 167 adult arsonists (129 males and 38 females). Information was collected from clinical records on sociodemographic, family background and childhood factors; adult adjustment; fire setting history; motives; features of pyromania and other offending, from the case notes of a group of arsonists referred to the West Midlands Psychiatry Service over a 24-year period. Female arsonists were older than males and more likely to have a psychiatric diagnosis. Women more frequently had a history of sexual abuse, while men had a more varied criminal background and more substance abuse problems. Our findings largely support previous research, and are discussed in this context, whilst also bringing attention to a more recently developed theory (Action System Model). Significant gender differences amongst arsonists indicates that different emphases in the treatment of male and female arsonists may be advisable, though a reliable evidence base for treatment has yet to be established.

Evidence for Coincident Fusion Products Using Silicon Surface-barrier Detectors

NASA Astrophysics Data System (ADS)

Jones, Steven; Scott, Mark; Keeney, Frank

2002-10-01

We report experimental results showing coincident proton and triton production from the reaction: d + d --> t (1.01 MeV) + p (3.02 MeV). Partially-deuterided thin titanium foils were positioned between two silicon surface-barrier detectors which were mounted in a small cylindrical vacuum chamber which also served as a Faraday cage. We performed Monte Carlo studies using the SRIM code to determine the expected energies of arriving particles after they exit the host foil. The dual-coincidence requirement reduces background to very low levels so that low yields from very thin TiD foils can be readily detected. In one sequence of experiments, we observed 74 foreground coincidences in the regions of interest compared with 24 background counts; the statistical significance is approximately ten standard deviations. A striking advance is that the repeatability from the dual-coincidence experiments is currently greater than 70%.

Association between dietary fiber and endometrial cancer: a dose-response meta-analysis123

PubMed Central

Bandera, Elisa V; Kushi, Lawrence H; Moore, Dirk F; Gifkins, Dina M; McCullough, Marjorie L

2008-01-01

Background Endometrial cancer is the most common female gynecologic cancer in the United States. Excessive and prolonged exposure of the endometrium to estrogens unopposed by progesterone and a high body mass are well-established risk factors for endometrial cancer. Although dietary fiber has been shown to beneficially reduce estrogen concentrations and prevent obesity, its role in endometrial cancer has received relatively little attention. Objective The objective was to summarize and quantify the current evidence of a role of dietary fiber consumption in endometrial cancer risk and to identify research gaps in this field. Design We conducted a systematic literature review of articles published through February 2007 to summarize the current evidence of a relation between dietary fiber consumption and endometrial cancer risk and to quantify the magnitude of the association by conducting a dose-response meta-analysis. Results Ten articles representing 1 case-cohort study and 9 case-control studies that evaluated several aspects of fiber consumption and endometrial cancer risk were identified through searches in various databases. On the basis of 7 case-control studies, the random-effects summary risk estimate was 0.82 (95% CI: 0.75, 0.90) per 5 g/1000 kcal dietary fiber, with no evidence of heterogeneity (I2: 0%, P for heterogeneity: 0.55). The random-effects summary estimate was 0.71 (95% CI: 0.59, 0.85) for the comparison of the highest with the lowest dietary fiber intake in 8 case-control studies, with little evidence of heterogeneity (I2: 20.8%, P for heterogeneity: 0.26). In contrast, the only prospective study that evaluated this association did not find an association. Conclusions Although the current evidence, based on data from case-control studies, supports an inverse association between dietary fiber and endometrial cancer, additional population-based studies, particularly cohort studies, are needed before definitive conclusions can be drawn. PMID:18065593

Intravenous rehydration of malnourished children with acute gastroenteritis and severe dehydration: A systematic review

PubMed Central

Houston, Kirsty A.; Gibb, Jack G.; Maitland, Kathryn

2017-01-01

Background: Rehydration strategies in children with severe acute malnutrition (SAM) and severe dehydration are extremely cautious. The World Health Organization (WHO) SAM guidelines advise strongly against intravenous fluids unless the child is shocked or severely dehydrated and unable to tolerate oral fluids. Otherwise, guidelines recommend oral or nasogastric rehydration using low sodium oral rehydration solutions. There is limited evidence to support these recommendations. Methods: We conducted a systematic review of randomised controlled trials (RCTs) and observational studies on 15 th June 2017 comparing different strategies of rehydration therapy in children with acute gastroenteritis and severe dehydration, specifically relating to intravenous rehydration, using standard search terms. Two authors assessed papers for inclusion. The primary endpoint was evidence of fluid overload. Results: Four studies were identified, all published in English, including 883 children, all of which were conducted in low resource settings. Two were randomised controlled trials and two observational cohort studies, one incorporated assessment of myocardial and haemodynamic function. There was no evidence of fluid overload or other fluid-related adverse events, including children managed on more liberal rehydration protocols. Mortality was high overall, and particularly in children with shock managed on WHO recommendations (day-28 mortality 82%). There was no difference in safety outcomes when different rates of intravenous rehydration were compared. Conclusions: The current ‘strong recommendations’ for conservative rehydration of children with SAM are not based on emerging evidence. We found no clinical trials providing a direct assessment of the current WHO guidelines, and those that were available suggested that these children have a high mortality and remain fluid depleted on current therapy. Recent studies have reported no evidence of fluid overload or heart failure with more liberal rehydration regimens. Clinical trials are urgently required to inform guidelines on routes and rates of intravenous rehydration therapy for dehydration in children with SAM. PMID:28944301

Intravenous rehydration of malnourished children with acute gastroenteritis and severe dehydration: A systematic review.

PubMed

Houston, Kirsty A; Gibb, Jack G; Maitland, Kathryn

2017-01-01

Background: Rehydration strategies in children with severe acute malnutrition (SAM) and severe dehydration are extremely cautious. The World Health Organization (WHO) SAM guidelines advise strongly against intravenous fluids unless the child is shocked or severely dehydrated and unable to tolerate oral fluids. Otherwise, guidelines recommend oral or nasogastric rehydration using low sodium oral rehydration solutions. There is limited evidence to support these recommendations. Methods: We conducted a systematic review of randomised controlled trials (RCTs) and observational studies on 15 th June 2017 comparing different strategies of rehydration therapy in children with acute gastroenteritis and severe dehydration, specifically relating to intravenous rehydration, using standard search terms. Two authors assessed papers for inclusion. The primary endpoint was evidence of fluid overload. Results: Four studies were identified, all published in English, including 883 children, all of which were conducted in low resource settings. Two were randomised controlled trials and two observational cohort studies, one incorporated assessment of myocardial and haemodynamic function. There was no evidence of fluid overload or other fluid-related adverse events, including children managed on more liberal rehydration protocols. Mortality was high overall, and particularly in children with shock managed on WHO recommendations (day-28 mortality 82%). There was no difference in safety outcomes when different rates of intravenous rehydration were compared. Conclusions: The current 'strong recommendations' for conservative rehydration of children with SAM are not based on emerging evidence. We found no clinical trials providing a direct assessment of the current WHO guidelines, and those that were available suggested that these children have a high mortality and remain fluid depleted on current therapy. Recent studies have reported no evidence of fluid overload or heart failure with more liberal rehydration regimens. Clinical trials are urgently required to inform guidelines on routes and rates of intravenous rehydration therapy for dehydration in children with SAM.

Serum cotinine levels and diabetes mellitus in never smokers.

PubMed

Alshaarawy, Omayma; Elbaz, Hosam A

2015-01-01

The aim of the current study is to examine the association of environmental tobacco smoke (ETS) exposure evident by serum cotinine level, and diabetes mellitus in never smokers. Previous studies suggest that active tobacco cigarette smoking is associated with diabetes mellitus risk. However it is not clear if the low-level "background" ETS exposure is associated with diabetes among never smokers. We present evidence from five independent replications based on the US nationally representative National Health and Nutrition Examination Surveys (NHANES) conducted 2003-12. Our exposure of interest is ETS exposure among never smokers, measured by serum cotinine levels (ng/mL), and our main outcome is diabetes mellitus assessed via self-reported physician-diagnosis, current use of insulin and/or oral hypoglycemic medications, plasma fasting glucose levels ≥126mg/dL or glycohemoglobin levels ≥6.5%. The conceptual model encompassed age, sex, ethnic self-identification, education, poverty-income ratio, alcohol drinking, total cholesterol and body mass index. In never smokers, higher serum cotinine levels were positively associated with diabetes mellitus (the meta-analytic summary estimate is 1.2, 95% CI=1.1, 1.2). This association was not evident among never smokers with cotinine levels below 3ng/mL. These replications help sustain evidence of ETS-diabetes mellitus association, which might be explained by shared psychosocial characteristics. Prospective studies with appropriate biomarkers are needed to further investigate this association. Copyright © 2015 Elsevier Inc. All rights reserved.

Treatments for compulsive buying: A systematic review of the quality, effectiveness and progression of the outcome evidence.

PubMed

Hague, Ben; Hall, Jo; Kellett, Stephen

2016-09-01

Background and aims This review appraises the progression and status of the evidence base for the treatment of compulsive buying disorder (CBD), in order to highlight what currently works and to prompt useful future research. Methods Online databases ISI Web of Knowledge, PsycINFO, and PubMed via Ovid were searched at two time points. Two quality checklists and an established model of therapy evaluation (hourglass model) evaluated the quality and progression of both psychotherapy and pharmacotherapy treatments for CBD. Uncontrolled effect sizes were calculated and meta-regression analyses were performed regarding treatment duration. Results A total of 29 articles met the inclusion criteria, which were divided into psychotherapy (n = 17) and pharmacotherapy treatments (n = 12). Of the 29 studies, only 5 studies have been tested under conditions of high methodological quality. Both forms of treatment had been evaluated in a haphazard manner across the stages of the hourglass model. Although large effects were demonstrated for group psychotherapy and pharmacotherapy, such evidence of effectiveness was undermined by poor study quality and risk of publication bias. Long-term CBD treatment was associated with improved outcome with pharmacotherapy, but not when delivering psychotherapy. Discussion Group psychotherapy currently appears the most promising treatment option for CBD. Poor methodological control and sporadic evaluation of specific treatments have slowed the generation of a convincing evidence base for CBD treatment. Defining the active ingredients of effective CBD treatment is a key research goal.

Treatments for compulsive buying: A systematic review of the quality, effectiveness and progression of the outcome evidence

PubMed Central

Hague, Ben; Hall, Jo; Kellett, Stephen

2016-01-01

Background and aims This review appraises the progression and status of the evidence base for the treatment of compulsive buying disorder (CBD), in order to highlight what currently works and to prompt useful future research. Methods Online databases ISI Web of Knowledge, PsycINFO, and PubMed via Ovid were searched at two time points. Two quality checklists and an established model of therapy evaluation (hourglass model) evaluated the quality and progression of both psychotherapy and pharmacotherapy treatments for CBD. Uncontrolled effect sizes were calculated and meta-regression analyses were performed regarding treatment duration. Results A total of 29 articles met the inclusion criteria, which were divided into psychotherapy (n = 17) and pharmacotherapy treatments (n = 12). Of the 29 studies, only 5 studies have been tested under conditions of high methodological quality. Both forms of treatment had been evaluated in a haphazard manner across the stages of the hourglass model. Although large effects were demonstrated for group psychotherapy and pharmacotherapy, such evidence of effectiveness was undermined by poor study quality and risk of publication bias. Long-term CBD treatment was associated with improved outcome with pharmacotherapy, but not when delivering psychotherapy. Discussion Group psychotherapy currently appears the most promising treatment option for CBD. Poor methodological control and sporadic evaluation of specific treatments have slowed the generation of a convincing evidence base for CBD treatment. Defining the active ingredients of effective CBD treatment is a key research goal. PMID:27640529

Incorporating external evidence in trial-based cost-effectiveness analyses: the use of resampling methods

PubMed Central

2014-01-01

Background Cost-effectiveness analyses (CEAs) that use patient-specific data from a randomized controlled trial (RCT) are popular, yet such CEAs are criticized because they neglect to incorporate evidence external to the trial. A popular method for quantifying uncertainty in a RCT-based CEA is the bootstrap. The objective of the present study was to further expand the bootstrap method of RCT-based CEA for the incorporation of external evidence. Methods We utilize the Bayesian interpretation of the bootstrap and derive the distribution for the cost and effectiveness outcomes after observing the current RCT data and the external evidence. We propose simple modifications of the bootstrap for sampling from such posterior distributions. Results In a proof-of-concept case study, we use data from a clinical trial and incorporate external evidence on the effect size of treatments to illustrate the method in action. Compared to the parametric models of evidence synthesis, the proposed approach requires fewer distributional assumptions, does not require explicit modeling of the relation between external evidence and outcomes of interest, and is generally easier to implement. A drawback of this approach is potential computational inefficiency compared to the parametric Bayesian methods. Conclusions The bootstrap method of RCT-based CEA can be extended to incorporate external evidence, while preserving its appealing features such as no requirement for parametric modeling of cost and effectiveness outcomes. PMID:24888356

Exploring Patient Values in Medical Decision Making: A Qualitative Study

PubMed Central

Lee, Yew Kong; Low, Wah Yun; Ng, Chirk Jenn

2013-01-01

Background Patient decisions are influenced by their personal values. However, there is a lack of clarity and attention on the concept of patient values in the clinical context despite clear emphasis on patient values in evidence-based medicine and shared decision making. The aim of the study was to explore the concept of patient values in the context of making decisions about insulin initiation among people with type 2 diabetes. Methods and Findings We conducted individual in-depth interviews with people with type 2 diabetes who were making decisions about insulin treatment. Participants were selected purposively to achieve maximum variation. A semi-structured topic guide was used to guide the interviews which were audio-recorded and analysed using a thematic approach. We interviewed 21 participants between January 2011 and March 2012. The age range of participants was 28–67 years old. Our sample comprised 9 women and 12 men. Three main themes, ‘treatment-specific values’, ‘life goals and philosophies’, and ‘personal and social background’, emerged from the analysis. The patients reported a variety of insulin-specific values, which were negative and/or positive beliefs about insulin. They framed insulin according to their priorities and philosophies in life. Patients’ decisions were influenced by sociocultural (e.g. religious background) and personal backgrounds (e.g. family situations). Conclusions This study highlighted the need for expanding the current concept of patient values in medical decision making. Clinicians should address more than just values related to treatment options. Patient values should include patients’ priorities, life philosophy and their background. Current decision support tools, such as patient decision aids, should consider these new dimensions when clarifying patient values. PMID:24282518

The Global Environment

NASA Astrophysics Data System (ADS)

Moore, John W.

2003-10-01

What can we teachers do? For students we can provide a strong background in the process of science and in scientific ethics. We can encourage students to apply such knowledge wisely throughout their lives. For the public at large, we can speak out in favor of real science at every opportunity. It is possible that the current scientific consensus on global warming is based on incomplete evidence, but global warming ought not be dismissed as unscientific or a hoax, and scientists ought not allow that to happen. As we celebrate National Chemistry Week, we should resolve to support chemistry and science as strongly as we can.

[History of acupuncture in Iran].

PubMed

Bai, Xinghua

2015-10-01

Iran is the neighbor of western China, and is a key transport junction on ancient Silk Road. The medical communication between China and Iran dates back to the 10th century, however, according to current evidences, it is indicated that acupuncture has not been introduced to Iran until the early 1970s. Unfortunately over the last 40 years, the acupuncture in Iran has not presented great development. The history of acupuncture development in Iran implies that geographical advantage and personnel exchanges are not essential to the international exchange of acupuncture, while language and cultural background may hinder the spread of acupuncture in foreign countries.

[The old man and the I sea U : Essay on faith, fate and evidence - after the manner of Hemingway].

PubMed

Lewandowski, K; Bartlett, R H

2017-01-01

Robert Bartlett, emeritus Professor of surgery at the University of Michigan in Ann Arbor, USA, transformed classical works of world literature (Charles Dickens: A Christmas Carol, Lewis Carroll: Alice in Wonderland) into teaching aids for advanced training in intensive care medicine. He recently turned his hand to the well-known work of Ernest Hemingway: the Nobel Prize winning novel The Old Man and the Sea. Subsequent to Robert Bartlett's essay this article provides background information and comments on the current problems in modern intensive care medicine addressed in his essay.

Current-limited electron beam injection

NASA Technical Reports Server (NTRS)

Stenzel, R. L.

1977-01-01

The injection of an electron beam into a weakly collisional, magnetized background plasma was investigated experimentally. The injected beam was energetic and cold, the background plasma was initially isothermal. Beam and plasma dimensions were so large that the system was considered unbounded. The temporal and spatial evolution of the beam-plasma system was dominated by collective effects. High-frequency electrostatic instabilities rapidly thermalized the beam and heated the background electrons. The injected beam current was balanced by a return current consisting of background electrons drifting toward the beam source. The drift between electrons and ions gave rise to an ion acoustic instability which developed into strong three-dimensional turbulence. It was shown that the injected beam current was limited by the return current which is approximately given by the electron saturation current. Non-Maxwellian electron distribution functions were observed.

OLFACTORY DYSFUNCTION IN PARKINSON’S DISEASE: POSITIVE EFFECT OF CIGARETTE SMOKING

PubMed Central

Sharer, James D.; Leon-Sarmiento, Fidias E.; Morley, James F.; Weintraub, Daniel; Doty, Richard L.

2014-01-01

Background There is compelling evidence from over 60 epidemiological studies that smoking significantly reduces the risk of Parkinson’s disease (PD). In general, those who currently smoke cigarettes, as well as those with a past history of such smoking, have a reduced risk of PD compared to those who have never smoked. Recently it has been suggested that a cardinal non-motor sensory symptom of PD, olfactory dysfunction, may be less severe in PD patients who smoke than in PD patients who do not, in contrast to the negative effect of smoking on olfaction described in the general population. Methods We evaluated University of Pennsylvania Smell Identification Test (UPSIT) scores from 323 Parkinson’s patients and 323 controls closely matched individually on age, sex, and smoking history (never, past, current). Results The patients exhibited much lower UPSIT scores than did the controls (P<0.0001). The relative decline in dysfunction of the current PD smokers was less than that of the never- and past-PD smokers (respective Ps=0.0005 & 0.0019). The female PD patients outperformed their male counterparts by a larger margin than did the female controls (3.66 vs. 1.07 UPSIT points; respective Ps < 0.0001 & 0.06). Age-related declines in UPSIT scores were generally present (P < 0.0001). No association between the olfactory measure and smoking dose, as indexed by pack years, was evident. Conclusions PD patients who currently smoke do not exhibit the smoking-related decline in olfaction observed in non-PD control subjects who currently smoke. The physiologic basis of this phenomenon is yet to be defined. PMID:25545729

The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 1: Background and Methods of the Development of Guidelines

PubMed Central

Young, Allan; Yatham, Lakshmi; Grunze, Heinz; Vieta, Eduard; Blier, Pierre; Moeller, Hans Jurgen; Kasper, Siegfried

2017-01-01

Abstract Background: This paper includes a short description of the important clinical aspects of Bipolar Disorder with emphasis on issues that are important for the therapeutic considerations, including mixed and psychotic features, predominant polarity, and rapid cycling as well as comorbidity. Methods: The workgroup performed a review and critical analysis of the literature concerning grading methods and methods for the development of guidelines. Results: The workgroup arrived at a consensus to base the development of the guideline on randomized controlled trials and related meta-analyses alone in order to follow a strict evidence-based approach. A critical analysis of the existing methods for the grading of treatment options was followed by the development of a new grading method to arrive at efficacy and recommendation levels after the analysis of 32 distinct scenarios of available data for a given treatment option. Conclusion: The current paper reports details on the design, method, and process for the development of CINP guidelines for the treatment of Bipolar Disorder. The rationale and the method with which all data and opinions are combined in order to produce an evidence-based operationalized but also user-friendly guideline and a specific algorithm are described in detail in this paper. PMID:27815414

Psychologists as Witnesses: Background and Good Practice in the Delivery of Evidence

ERIC Educational Resources Information Center

Ireland, Jane L.

2008-01-01

An outline of the background to the provision of psychological evidence within legal settings will be provided, with attention to formal and quasi-court settings (e.g., tribunals). Key points of relevance to psychologists and to educational psychologists in particular will be illustrated, including guidelines for defendable written and oral…

Menstrual hygiene management among adolescent schoolgirls in low- and middle-income countries: research priorities

PubMed Central

Phillips-Howard, Penelope A.; Caruso, Bethany; Torondel, Belen; Zulaika, Garazi; Sahin, Murat; Sommer, Marni

2016-01-01

Background A lack of adequate guidance on menstrual management; water, disposal, and private changing facilities; and sanitary hygiene materials in low- and middle-income countries leaves schoolgirls with limited options for healthy personal hygiene during monthly menses. While a plethora of observational studies have described how menstrual hygiene management (MHM) barriers in school impact girls’ dignity, well-being, and engagement in school activities, studies have yet to confirm if inadequate information and facilities for MHM significantly affects quantifiable school and health outcomes influencing girls’ life chances. Evidence on these hard outcomes will take time to accrue; however, a current lack of standardized methods, tools, and research funding is hampering progress and must be addressed. Objectives Compile research priorities for MHM and types of research methods that can be used. Results In this article, we highlight the current knowledge gaps in school-aged girls’ MHM research, and identify opportunities for addressing the dearth of hard evidence limiting the ability of governments, donors, and other agencies to appropriately target resources. We outline a series of research priorities and methodologies that were drawn from an expert panel to address global priorities for MHM in schools for the next 10 years. Conclusions A strong evidence base for different settings, standardized definitions regarding MHM outcomes, improved study designs and methodologies, and the creation of an MHM research consortia to focus attention on this neglected global issue. PMID:27938648

Heavier smoking increases coffee consumption: findings from a Mendelian randomization analysis

PubMed Central

Bjørngaard, Johan H; Nordestgaard, Ask Tybjærg; Taylor, Amy E; Treur, Jorien L; Gabrielsen, Maiken E; Munafò, Marcus R; Nordestgaard, Børge Grønne; Åsvold, Bjørn Olav; Romundstad, Pål; Davey Smith, George

2017-01-01

Abstract Background There is evidence for a positive relationship between cigarette and coffee consumption in smokers. Cigarette smoke increases metabolism of caffeine, so this may represent a causal effect of smoking on caffeine intake. Methods We performed Mendelian randomization analyses in the UK Biobank (N = 114 029), the Norwegian HUNT study (N = 56 664) and the Copenhagen General Population Study (CGPS) (N = 78 650). We used the rs16969968 genetic variant as a proxy for smoking heaviness in all studies and rs4410790 and rs2472297 as proxies for coffee consumption in UK Biobank and CGPS. Analyses were conducted using linear regression and meta-analysed across studies. Results Each additional cigarette per day consumed by current smokers was associated with higher coffee consumption (0.10 cups per day, 95% CI: 0.03, 0.17). There was weak evidence for an increase in tea consumption per additional cigarette smoked per day (0.04 cups per day, 95% CI: −0.002, 0.07). There was strong evidence that each additional copy of the minor allele of rs16969968 (which increases daily cigarette consumption) in current smokers was associated with higher coffee consumption (0.16 cups per day, 95% CI: 0.11, 0.20), but only weak evidence for an association with tea consumption (0.04 cups per day, 95% CI: -0.01, 0.09). There was no clear evidence that rs16969968 was associated with coffee or tea consumption in never or former smokers or that the coffee-related variants were associated with cigarette consumption. Conclusions Higher cigarette consumption causally increases coffee intake. This is consistent with faster metabolism of caffeine by smokers, but could also reflect a behavioural effect of smoking on coffee drinking. PMID:29025033

AHA Scientific Statement Population Approaches to Improve Diet, Physical Activity, and Smoking Habits A Scientific Statement From the American Heart Association

PubMed Central

Mozaffarian, Dariush; Afshin, Ashkan; Benowitz, Neal L.; Bittner, Vera; Daniels, Stephen R.; Franch, Harold A.; Jacobs, David R.; Kraus, William E.; Kris-Etherton, Penny M.; Krummel, Debra A.; Popkin, Barry M.; Whitsel, Laurie P.; Zakai, Neil A.

2013-01-01

Background Poor lifestyle, including suboptimal diet, physical inactivity, and tobacco use are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established. Methods and Results For this American Heart Association Scientific Statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) media and education campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts. Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified, providing a set of specific evidence-based strategies that deserve close attention and prioritization for wider implementation. Effective interventions included specific approaches in all 6 domains evaluated for improving diet, increasing activity, and reducing tobacco use. The writing group also identified several specific interventions in each of these domains for which current evidence was less robust, as well as other inconsistencies and evidence gaps, informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies. Conclusions This systematic review identified and graded the evidence for a range of population-based strategies to promote lifestyle change. The findings provide a framework for policy makers, advocacy groups, researchers, clinicians, communities, and other stakeholders to understand and implement the most effective approaches. New strategic initiatives and partnerships are needed to translate this evidence into action. PMID:22907934

Effects of Socio-Economic Background Factors on Typewriting Speed and Accuracy.

ERIC Educational Resources Information Center

Erickson, Lawrence W.

The socioeconomic backgrounds of typewriting students as such backgrounds affect typewriting performance is evaluated in this research. There is convincing evidence that socioeconomic factors play a significant role in affecting typewriting performance. Students from low socioeconomic backgrounds are almost always associated with the poorest…

What physicians need to know about dreams and dreaming.

PubMed

Pagel, James F

2012-11-01

An overview of the current status of dream science is given, designed to provide a basic background of this field for the sleep-interested physician. No cognitive state has been more extensively studied and is yet more misunderstood than dreaming. Much older work is methodologically limited by lack of definitions, small sample size, and constraints of theoretical perspective, with evidence equivocal as to whether any special relationship exists between rapid eye movement (REM) sleep and dreaming. As the relationship between dreams and REM sleep is so poorly defined, evidence-based studies of dreaming require a dream report. The different aspects of dreaming that can be studied include dream and nightmare recall frequency, dream content, dreaming effect on waking behaviors, dream/nightmare associated medications, and pathophysiology affecting dreaming. Whether studied from behavioral, neuroanatomical, neurochemical, pathophysiological or electrophysiological perspectives, dreaming reveals itself to be a complex cognitive state affected by a wide variety of medical, psychological, sleep and social variables.

Posttraumatic Stress Disorder, Cardiovascular and Metabolic Disease: A Review of the Evidence

PubMed Central

Dedert, Eric A.; Calhoun, Patrick S.; Watkins, Lana L.; Sherwood, Andrew; Beckham, Jean C.

2011-01-01

Background Posttraumatic stress disorder (PTSD) is a significant risk factor for cardiovascular and metabolic disease. Purpose The purpose of the current review is to evaluate the evidence suggesting that PTSD increases cardiovascular and metabolic risk factors, and to identify possible biomarkers and psychosocial characteristics and behavioral variables that are associated with these outcomes. Methods A systematic literature search in the period of 2002–2009 for PTSD, cardiovascular disease, and metabolic disease was conducted. Results The literature search yielded 78 studies on PTSD and cardiovascular/metabolic disease and biomarkers. Conclusions Although the available literature suggests an association of PTSD with cardiovascular disease and biomarkers, further research must consider potential confounds, incorporate longitudinal designs, and conduct careful PTSD assessments in diverse samples to address gaps in the research literature. Research on metabolic disease and biomarkers suggests an association with PTSD, but has not progressed as far as the cardiovascular research. PMID:20174903

Gravity-mediated dark matter annihilation in the Randall-Sundrum model

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

Rueter, T. D.; Rizzo, T. G.; Hewett, J. L.

Observational evidence for dark matter stems from its gravitational interactions, and as of yet there has been no evidence for dark matter interacting via other means. We examine models where dark matter interactions are purely gravitational in a Randall-Sundrum background. In particular, the Kaluza-Klein tower of gravitons which result from the warped fifth dimension can provide viable annihilation channels into Standard Model final states, and we find that we can achieve values of the annihilation cross section, < σv >, which are consistent with the observed relic abundance in the case of spin-1 dark matter. As a result, we examinemore » constraints on these models employing both the current photon line and continuum indirect dark matter searches, and assess the prospects of hunting for the signals of such models in future direct and indirect detection experiments.« less

Gravity-mediated dark matter annihilation in the Randall-Sundrum model

DOE PAGES

Rueter, T. D.; Rizzo, T. G.; Hewett, J. L.

2017-10-13

Observational evidence for dark matter stems from its gravitational interactions, and as of yet there has been no evidence for dark matter interacting via other means. We examine models where dark matter interactions are purely gravitational in a Randall-Sundrum background. In particular, the Kaluza-Klein tower of gravitons which result from the warped fifth dimension can provide viable annihilation channels into Standard Model final states, and we find that we can achieve values of the annihilation cross section, < σv >, which are consistent with the observed relic abundance in the case of spin-1 dark matter. As a result, we examinemore » constraints on these models employing both the current photon line and continuum indirect dark matter searches, and assess the prospects of hunting for the signals of such models in future direct and indirect detection experiments.« less

Anophelism in a Former Malaria Area of Northeastern Spain

PubMed Central

Bueno-Marí, Rubén; Jiménez-Peydró, Ricardo

2013-01-01

Background: A field study on diversity and distribution of anophelines currently present in a past endemic malaria area of Spain was carried out in order to identify possible risk areas of local disease transmission. Methods: Multiple larval sites were sampled from June to October of 2011 in the Region of Somontano de Barbastro (Northeastern Spain). The sampling effort was fixed at 10 minutes which included the active search for larvae in each biotope visited. Results: A total of 237 larval specimens belonging to four Anopheles species (Anopheles atroparvus, An. claviger, An. maculipennis and An. petragnani) were collected and identified. Conclusions: Malaria receptivity in the study area is high, especially in the area of Cinca river valley, due to the abundance of breeding sites of An. atroparvus very close to human settlements. Although current socio-economic conditions in Spain reduce possibilities of re-emergence of malaria transmission, it is evident that certain entomological and epidemiological vigilance must be maintained and even increased in the context of current processes of climate change and globalization. PMID:24409440

Legal physician‐assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in “vulnerable” groups

PubMed Central

Battin, Margaret P; van der Heide, Agnes; Ganzini, Linda; van der Wal, Gerrit

2007-01-01

Background Debates over legalisation of physician‐assisted suicide (PAS) or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician‐assisted dying is legal and data have been collected over a substantial period. Methods The data from Oregon (where PAS, now called death under the Oregon Death with Dignity Act, is legal) comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands (where both PAS and euthanasia are now legal) comprised all four government‐commissioned nationwide studies of end‐of‐life decision making (1990, 1995, 2001 and 2005) and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought. Results Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups. Conclusions Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician‐assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. PMID:17906058

Rehabilitation after Articular Cartilage Repair of the Knee in the Football (Soccer) Player

PubMed Central

Silvers, Holly Jacinda; Steinwachs, Matthias

2012-01-01

Background: Participation in football can put both male and female players at an increased risk for knee osteoarthritis. There is a higher prevalence of focal chondral defects in the knee of athletes compared to nonathletes. The management of chondral defects in the football player is complex and multifactorial. Objective: The aim of this study is to provide an overview of the current strategies for rehabilitation after articular cartilage repair of the knee in the football player. Design: A review of current literature and the scientific evidence for rehabilitation after articular cartilage repair of the knee. Conclusions: Articular cartilage repair has been shown to allow return to sport but rehabilitation timescales are lengthy. Successful rehabilitation for a return to football after articular cartilage repair of the knee requires the player to be able to accept the load of the sport. This necessitates a multidisciplinary approach to rehabilitation, especially in the transition from therapy to performance care. It should be recognized that not all players will return to football after articular cartilage repair. The evidence base for rehabilitative practice after articular cartilage repair is increasing but remains sparse in areas. PMID:26069608

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

Goodman, Julie, E-mail: jgoodman@gradientcorp.com

Background: The International Agency for Research on Cancer (IARC) recently developed a framework for evaluating mechanistic evidence that includes a list of 10 key characteristics of carcinogens. This framework is useful for identifying and organizing large bodies of literature on carcinogenic mechanisms, but it lacks sufficient guidance for conducting evaluations that fully integrate mechanistic evidence into hazard assessments. Objectives: We summarize the framework, and suggest approaches to strengthen the evaluation of mechanistic evidence using this framework. Discussion: While the framework is useful for organizing mechanistic evidence, its lack of guidance for implementation limits its utility for understanding human carcinogenic potential.more » Specifically, it does not include explicit guidance for evaluating the biological significance of mechanistic endpoints, inter- and intra-individual variability, or study quality and relevance. It also does not explicitly address how mechanistic evidence should be integrated with other realms of evidence. Because mechanistic evidence is critical to understanding human cancer hazards, we recommend that IARC develop transparent and systematic guidelines for the use of this framework so that mechanistic evidence will be evaluated and integrated in a robust manner, and concurrently with other realms of evidence, to reach a final human cancer hazard conclusion. Conclusions: IARC does not currently provide a standardized approach to evaluating mechanistic evidence. Incorporating the recommendations discussed here will make IARC analyses of mechanistic evidence more transparent, and lead to assessments of cancer hazards that reflect the weight of the scientific evidence and allow for scientifically defensible decision-making. - Highlights: • IARC has a revised framework for evaluating literature on carcinogenic mechanisms. • The framework is based on 10 key characteristics of carcinogens. • IARC should develop transparent and systematic guidelines for using the framework. • It should better address biological significance, study quality, and relevance. • It should better address integrating mechanistic evidence with other evidence.« less

Cost effectiveness analysis for nursing research.

PubMed

Bensink, Mark E; Eaton, Linda H; Morrison, Megan L; Cook, Wendy A; Curtis, R Randall; Gordon, Deborah B; Kundu, Anjana; Doorenbos, Ardith Z

2013-01-01

With ever-increasing pressure to reduce costs and increase quality, nurses are faced with the challenge of producing evidence that their interventions and care provide value. Cost effectiveness analysis (CEA) is a tool that can be used to provide this evidence by comparative evaluation of the costs and consequences of two or more alternatives. The aim of this article is to introduce the essential components of CEA to nurses and nurse researchers with the protocol of a recently funded cluster randomized controlled trial as an example. This article provides (a) a description of the main concepts and key steps in CEA and (b) a summary of the background and objectives of a CEA designed to evaluate a nursing-led pain and symptom management intervention in rural communities compared with the current usual care. As the example highlights, incorporating CEA into nursing research studies is feasible. The burden of the additional data collection required is offset by quantitative evidence of the given intervention's cost and impact using humanistic and economic outcomes. At a time when U.S. healthcare is moving toward accountable care, the information provided by CEA will be an important additional component of the evidence produced by nursing research.

Update on well-baby and well-child care from 0 to 5 years

PubMed Central

Rourke, Leslie; Leduc, Denis; Constantin, Evelyn; Carsley, Sarah; Rourke, James

2010-01-01

Abstract OBJECTIVE To provide an overview of the 2009 edition of the Rourke Baby Record (RBR), which incorporates recent research in the literature relating to preventive health care for children aged 0 to 5 years. QUALITY OF EVIDENCE Recommendations are identified as supported by good, fair, or consensus evidence, according to the classification of the Canadian Task Force on Preventive Health Care. MAIN MESSAGE New information and recommendations are given for growth monitoring, nutrition, developmental surveillance, physical examination maneuvers, immunization schedules, and advice for parents. Anticipatory guidance updates relate to injury prevention, infant swaddling, literacy facilitation, nonparental child care, parenting skills programs, serum lead levels, over-the-counter cough and cold medications, pacifiers, antipyretics, insect repellents, and dental care and oral health. The 2009 RBR is available in English and French in both National and Ontario versions and is endorsed by the College of Family Physicians of Canada and the Canadian Paediatric Society. CONCLUSION The RBR website (www.rourkebabyrecord.ca) provides a practical tool for well-baby and well-child care, including background information, current evidence and literature review appraisal, an interactive walk-through of the guides with links to further information and evidence, and additional practical resources. PMID:21156890

Routine systemic antibiotic prophylaxis for burn injuries in developing countries: A best evidence topic (BET)

PubMed Central

Stewart, Barclay T; Gyedu, Adam; Agbenorku, Pius; Amankwa, Richcane; Kushner, Adam L; Gibran, Nicole

2015-01-01

Background Burns are common in low- and middle-income countries (LMICs) and complicated by unhygienic conditions, malnutrition, use of high-risk homemade dressings and delayed presentation. Resultantly, use of routine systemic antibiotic prophylaxis (SAP) to prevent wound infection is common practice despite this intervention being abandoned in high-income countries due to increased antimicrobial resistance and non-bacterial suprainfection, Methods A best evidence topic (BET) was constructed using a structured protocol. The question addressed was: In LMICs, does routine use of SAP reduce burn wound infection, morbidity or mortality? Results From 704 retrieved records, 48 reports met criteria to be examined. Of those, 3 studies represented the best available evidence. Together, two randomized clinical trials (RCTs) and a retrospective cohort study reported no difference in the proportion of wound infection, any infection or length of hospital stay between SAP groups and controls. One RCT described a greater proportion of wounds infected with P. aeruginosa among SAP arms compared to controls. The studies had few participants and significant methodological weaknesses. Conclusion On the basis of limited, currently available evidence, the use of SAP cannot be recommended for patients in LMICs that present soon after burn injury. PMID:26260622

Relationship Between Exclusive Breastfeeding and Lower Risk of Childhood Obesity: A Narrative Review of Published Evidence

PubMed Central

Uwaezuoke, Samuel N; Eneh, Chizoma I; Ndu, Ikenna K

2017-01-01

Background: The pattern of infant feeding during the first 1000-day period—from conception to the second birthday—has a significant influence on the child’s growth trajectory. The relationship between exclusive breastfeeding and lower risk of childhood obesity has elicited much scientific interest, given the fact that this form of malnutrition is becoming a global epidemic. Aim: This narrative review aims to examine the evidence in the literature linking exclusive breastfeeding with reduction in obesity in children. Literature search: Using appropriate search terms, PubMed database was searched for relevant articles that met the review objective. Results: Evidence for the protective effect of exclusive breastfeeding against childhood obesity have been provided by studies which explored 5 physiologic mechanisms and those that established the causality between breastfeeding and lower risk of obesity. The few studies that disputed this relationship highlighted the influence of confounding factors. A new insight on molecular mechanisms, however, points to a direct and indirect effect of human milk oligosaccharides on the prevention of overweight and obesity. Conclusions: The preponderance of current evidence strongly suggests that exclusivity in breastfeeding can prevent the development of obesity in children. PMID:28469518

Masticatory Muscle Sleep Background EMG Activity is Elevated in Myofascial TMD Patients

PubMed Central

Raphael, Karen G.; Janal, Malvin N.; Sirois, David A.; Dubrovsky, Boris; Wigren, Pia E.; Klausner, Jack J.; Krieger, Ana C.; Lavigne, Gilles J.

2013-01-01

Despite theoretical speculation and strong clinical belief, recent research using laboratory polysomnographic (PSG) recording has provided new evidence that frequency of sleep bruxism (SB) masseter muscle events, including grinding or clenching of the teeth during sleep, is not increased for women with chronic myofascial temporomandibular disorder (TMD). The current case-control study compares a large sample of women suffering from chronic myofascial TMD (n=124) with a demographically matched control group without TMD (n=46) on sleep background electromyography (EMG) during a laboratory PSG study. Background EMG activity was measured as EMG root mean square (RMS) from the right masseter muscle after lights out. Sleep background EMG activity was defined as EMG RMS remaining after activity attributable to SB, other orofacial activity, other oromotor activity and movement artifacts were removed. Results indicated that median background EMG during these non SB-event periods was significantly higher (p<.01) for women with myofascial TMD (median=3.31 μV and mean=4.98 μV) than for control women (median=2.83 μV and mean=3.88 μV) with median activity in 72% of cases exceeding control activity. Moreover, for TMD cases, background EMG was positively associated and SB event-related EMG was negatively associated with pain intensity ratings (0–10 numerical scale) on post sleep waking. These data provide the foundation for a new focus on small, but persistent, elevations in sleep EMG activity over the course of the night as a mechanism of pain induction or maintenance. PMID:24237356

Dengue vaccine: WHO position paper, July 2016 - recommendations.

PubMed

World Health Organization

2017-03-01

This article presents the World Health Organization's (WHO) recommendations on the use of dengue vaccine excerpted from the WHO position paper on dengue vaccine published in the Weekly epidemiological Record in July 2016 (Dengue vaccine: WHO position paper, 2016) [1]. The current document is the first WHO position paper on dengue vaccination and focuses primarily on the available evidence concerning the only dengue vaccine to have been registered by National Regulatory Authorities. The position paper gives consideration to the epidemiological features of the disease and assesses the potential use of the vaccine for public health benefits. Footnotes to this paper provide a number of core references including references to grading tables that assess the quality of the scientific evidence, and to the evidence-to-recommendation table. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. This paper reflects the recommendations of the WHO's Strategic Advisory Group of Experts (SAGE) on immunization. Recommendations on the use of this dengue vaccine were discussed by SAGE in April 2016; evidence presented at that SAGE meeting can be accessed at: http://www.who.int/immunization/sage/previous/en/index.html. Copyright © 2016 Elsevier Ltd. All rights reserved.

Malaria vaccine: WHO position paper, January 2016 - Recommendations.

PubMed

2018-06-14

This article presents the World Health Organization's (WHO) recommendations on the use of malaria vaccine excerpted from the WHO position paper on malaria vaccine published in the Weekly epidemiological Record in January 2016 [1]. The current document is the first WHO position paper on malaria vaccination and focuses primarily on the available evidence concerning the only malaria vaccine having received a positive regulation assessment from the European Medicines Agency (EMA) [2]. The position paper gives consideration to the epidemiological features of the disease and assesses the potential use of the vaccine for public health benefits. Footnotes to this paper provide a number of core references including references to grading tables that assess the quality of the scientific evidence, and to the evidence to recommendation table. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. This paper reflects the joint recommendation of the WHO's Strategic Advisory Group of Experts (SAGE) on immunization and the Malaria Policy Advisory Committee (MPAC). These recommendations were discussed by SAGE and MPAC at the October 2015 SAGE meeting. Evidence presented at the meeting can be accessed at http://www.who.int/immunization/sage/previous/en/index.html. Copyright © 2016 Elsevier Ltd. All rights reserved.

The evidence basis for coenzyme Q therapy in oxidative phosphorylation disease.

PubMed

Haas, Richard H

2007-06-01

The evidence supporting a treatment benefit for coenzyme Q10 (CoQ10) in primary mitochondrial disease (mitochondrial disease) whilst positive is limited. Mitochondrial disease in this context is defined as genetic disease causing an impairment in mitochondrial oxidative phosphorylation (OXPHOS). There are no treatment trials achieving the highest Level I evidence designation. Reasons for this include the relative rarity of mitochondrial disease, the heterogeneity of mitochondrial disease, the natural cofactor status and easy 'over the counter availability' of CoQ10 all of which make funding for the necessary large blinded clinical trials unlikely. At this time the best evidence for efficacy comes from controlled trials in common cardiovascular and neurodegenerative diseases with mitochondrial and OXPHOS dysfunction the etiology of which is most likely multifactorial with environmental factors playing on a background of genetic predisposition. There remain questions about dosing, bioavailability, tissue penetration and intracellular distribution of orally administered CoQ10, a compound which is endogenously produced within the mitochondria of all cells. In some mitochondrial diseases and other commoner disorders such as cardiac disease and Parkinson's disease low mitochondrial or tissue levels of CoQ10 have been demonstrated providing an obvious rationale for supplementation. This paper discusses the current state of the evidence supporting the use of CoQ10 in mitochondrial disease.

A web-based library consult service for evidence-based medicine: Technical development

PubMed Central

Schwartz, Alan; Millam, Gregory

2006-01-01

Background Incorporating evidence based medicine (EBM) into clinical practice requires clinicians to learn to efficiently gain access to clinical evidence and effectively appraise its validity. Even using current electronic systems, selecting literature-based data to solve a single patient-related problem can require more time than practicing physicians or residents can spare. Clinical librarians, as informationists, are uniquely suited to assist physicians in this endeavor. Results To improve support for evidence-based practice, we have developed a web-based EBM library consult service application (LCS). Librarians use the LCS system to provide full text evidence-based literature with critical appraisal in response to a clinical question asked by a remote physician. LCS uses an entirely Free/Open Source Software platform and will be released under a Free Software license. In the first year of the LCS project, the software was successfully developed and a reference implementation put into active use. Two years of evaluation of the clinical, educational, and attitudinal impact on physician-users and librarian staff are underway, and expected to lead to refinement and wide dissemination of the system. Conclusion A web-based EBM library consult model may provide a useful way for informationists to assist clinicians, and is feasible to implement. PMID:16542453

Abandoning Presumptive Antimalarial Treatment for Febrile Children Aged Less Than Five Years—A Case of Running Before We Can Walk?

PubMed Central

English, Mike; Reyburn, Hugh; Goodman, Catherine; Snow, Robert W

2009-01-01

Background to the debate: Current guidelines recommend that all fever episodes in African children be treated presumptively with antimalarial drugs. But declining malarial transmission in parts of sub-Saharan Africa, declining proportions of fevers due to malaria, and the availability of rapid diagnostic tests mean it may be time for this policy to change. This debate examines whether enough evidence exists to support abandoning presumptive treatment and whether African health systems have the capacity to support a shift toward laboratory-confirmed rather than presumptive diagnosis and treatment of malaria in children under five. PMID:19127977

Time To Move from Presumptive Malaria Treatment to Laboratory-Confirmed Diagnosis and Treatment in African Children with Fever

PubMed Central

D'Acremont, Valérie; Lengeler, Christian; Mshinda, Hassan; Mtasiwa, Deo; Tanner, Marcel; Genton, Blaise

2009-01-01

Background to the debate: Current guidelines recommend that all fever episodes in African children be treated presumptively with antimalarial drugs. But declining malarial transmission in parts of sub-Saharan Africa, declining proportions of fevers due to malaria, and the availability of rapid diagnostic tests mean it may be time for this policy to change. This debate examines whether enough evidence exists to support abandoning presumptive treatment and whether African health systems have the capacity to support a shift toward laboratory-confirmed rather than presumptive diagnosis and treatment of malaria in children under five. PMID:19127974

Rectification of the background potassium current: a determinant of rotor dynamics in ventricular fibrillation.

PubMed

Samie, F H; Berenfeld, O; Anumonwo, J; Mironov, S F; Udassi, S; Beaumont, J; Taffet, S; Pertsov, A M; Jalife, J

2001-12-07

Ventricular fibrillation (VF) is the leading cause of sudden cardiac death. Yet, the mechanisms of VF remain elusive. Pixel-by-pixel spectral analysis of optical signals was carried out in video imaging experiments using a potentiometric dye in the Langendorff-perfused guinea pig heart. Dominant frequencies (peak with maximal power) were distributed throughout the ventricles in clearly demarcated domains. The fastest domain (25 to 32 Hz) was always on the anterior left ventricular (LV) wall and was shown to result from persistent rotor activity. Intermittent block and breakage of wavefronts at specific locations in the periphery of such rotors were responsible for the domain organization. Patch-clamping of ventricular myocytes from the LV and the right ventricle (RV) demonstrated an LV-to-RV drop in the amplitude of the outward component of the background rectifier current (I(B)). Computer simulations suggested that rotor stability in LV resulted from relatively small rectification of I(B) (presumably I(K1)), whereas instability, termination, and wavebreaks in RV were a consequence of strong rectification. This study provides new evidence in the isolated guinea pig heart that a persistent high-frequency rotor in the LV maintains VF, and that spatially distributed gradients in I(K1) density represent a robust ionic mechanism for rotor stabilization and wavefront fragmentation.

Transient current interruption mechanism in a magnetically delayed vacuum switch

NASA Technical Reports Server (NTRS)

Morris, Gibson, Jr.; Dougal, Roger A.

1993-01-01

The capacity of a magnetically delayed vacuum switch to conduct current depends on the density of plasma injected into the switch. Exceeding the current capacity results in the switch entering a lossy mode of operation characterized by a transient interruption of the main current (opening behavior) and a rapid increase of voltage across the vacuum gap. Streak and framing photographs of the discharge indicate that a decrease of luminosity near the middle of the gap preceeds the transition to the opening phase. The zone of low luminosity propagates toward the cathode. This evidence suggests that the mechanism causing the opening phase is erosion of the background plasma in a manner similar to that in a plasma-opening switch. The resulting ion depletion forces a space-charge-limited conduction mode. The switch inductance maintains a high discharge current even during the space-charge-limited conduction phase, thus producing high internal fields. The high accelerating voltage, in turn, produces electron and ion beams that heat the electrode surfaces. As a result of the heating, jets of electrode vapor issue from the electrodes, either cathode or anode, depending on the selection of electrode materials.

Conservative management of tendinopathies around hip

PubMed Central

Frizziero, Antonio; Vittadini, Filippo; Pignataro, Andrea; Gasparre, Giuseppe; Biz, Carlo; Ruggieri, Pietro; Masiero, Stefano

2016-01-01

Summary Background The anatomy of hip is widely complex and several anatomical structures interact and contribute to its functioning. For position and role, hip and the surrounding tendons, which have their insertion around, are overstressed and often overloaded, especially in athletes. This could lead to the developing of several tendinopathies, among which the differential diagnosis is often complicated. Many conservative treatments are used in clinical practice, while actually, no defined conservative protocol is recommended. Methods This is a review article. The aim of this manuscript is to evaluate the current evidences about the effectiveness of conservative management in hip tendinopathies. Conclusion Conservative treatment is effective in the management of hip tendinopathies and may be considered the first-line approach for patients affected. However, there is lack of evidences about which is the most effective treatment. Exercise therapy seems to provide long-term pain relief, but the literature is still lacking about the correct type, dose, posology, intensity of exercise prescribed. Further studies about different local approaches, as PRP or hyaluronic acid injections, may be encouraged. Level of evidence I. PMID:28066732

Aripiprazole for treating irritability in children & adolescents with autism: a systematic review

PubMed Central

Ghanizadeh, Ahmad; Tordjman, Sylvie; Jaafari, Nematollah

2015-01-01

Background & objectives: No clear therapeutic benefits of antipsychotics have been reported for the treatment of behavioural symptoms in autism. This systematic review provides an assessment of evidence for treating irritability in autism by aripiprazole. Methods: The databases of MEDLINE/PubMed and Google Scholar were searched for relevant articles about the effect of aripiprazole in children with autism. The articles were searched according to the inclusion and exclusion criteria specifed for this review. All the double-blind, controlled, randomized, clinical trials examining the efficacy of aripiprazole for treating children and adolescents with autism were included. Results: From the 93 titles identified, 26 were irrelevant and 58 were evaluated for more details. Only five articles met the inclusive criteria. The evidence from precise randomized double blind clinical trials of aripiprazole for the treatment of autism in children and adolescents was convincing enough to recommend aripiprazole. Adverse effects were not very common and were usually mild. Interpretation & conclusions: Current evidence suggests that aripiprazole is as effective and safe as risperidone for treating irritability in autism. However, further studies with larger sample size and longer duration are required. PMID:26458342

Intrathecal Drug Delivery Systems for Cancer Pain: A Health Technology Assessment

PubMed Central

2016-01-01

Background Intrathecal drug delivery systems can be used to manage refractory or persistent cancer pain. We investigated the benefits, harms, cost-effectiveness, and budget impact of these systems compared with current standards of care for adult patients with chronic pain due owing to cancer. Methods We searched Ovid MEDLINE, Ovid Embase, the Cochrane Library databases, National Health Service's Economic Evaluation Database, and Tufts Cost-Effectiveness Analysis Registry from January 1994 to April 2014 for evidence of effectiveness, harms, and cost-effectiveness. We used existing systematic reviews that had employed reliable search and screen methods and searched for studies published after the search date reported in the latest systematic review to identify studies. Two reviewers screened records and assessed study validity. The cost burden of publicly funding intrathecal drug delivery systems for cancer pain was estimated for a 5-year timeframe using a combination of published literature, information from the device manufacturer, administrative data, and expert opinion for the inputs. Results We included one randomized trial that examined effectiveness and harms, and one case series that reported an eligible economic evaluation. We found very low quality evidence that intrathecal drug delivery systems added to comprehensive pain management reduce overall drug toxicity; no significant reduction in pain scores was observed. Weak conclusions from economic evidence suggested that intrathecal drug delivery systems had the potential to be more cost-effective than high-cost oral therapy if administered for 7 months or longer. The cost burden of publicly funding this therapy is estimated to be $100,000 in the first year, increasing to $500,000 by the fifth year. Conclusions Current evidence could not establish the benefit, harm, or cost-effectiveness of intrathecal drug delivery systems compared with current standards of care for managing refractory cancer pain in adults. Publicly funding intrathecal drug delivery systems for cancer pain would result in a budget impact of several hundred thousand dollars per year. PMID:27026796

Accelerated modern human–induced species losses: Entering the sixth mass extinction

PubMed Central

Ceballos, Gerardo; Ehrlich, Paul R.; Barnosky, Anthony D.; García, Andrés; Pringle, Robert M.; Palmer, Todd M.

2015-01-01

The oft-repeated claim that Earth’s biota is entering a sixth “mass extinction” depends on clearly demonstrating that current extinction rates are far above the “background” rates prevailing between the five previous mass extinctions. Earlier estimates of extinction rates have been criticized for using assumptions that might overestimate the severity of the extinction crisis. We assess, using extremely conservative assumptions, whether human activities are causing a mass extinction. First, we use a recent estimate of a background rate of 2 mammal extinctions per 10,000 species per 100 years (that is, 2 E/MSY), which is twice as high as widely used previous estimates. We then compare this rate with the current rate of mammal and vertebrate extinctions. The latter is conservatively low because listing a species as extinct requires meeting stringent criteria. Even under our assumptions, which would tend to minimize evidence of an incipient mass extinction, the average rate of vertebrate species loss over the last century is up to 100 times higher than the background rate. Under the 2 E/MSY background rate, the number of species that have gone extinct in the last century would have taken, depending on the vertebrate taxon, between 800 and 10,000 years to disappear. These estimates reveal an exceptionally rapid loss of biodiversity over the last few centuries, indicating that a sixth mass extinction is already under way. Averting a dramatic decay of biodiversity and the subsequent loss of ecosystem services is still possible through intensified conservation efforts, but that window of opportunity is rapidly closing. PMID:26601195

Investigation of the Effects of Facility Background Pressure on the Performance and Voltage-Current Characteristics of the High Voltage Hall Accelerator

NASA Technical Reports Server (NTRS)

Kamhawi, Hani; Huang, Wensheng; Haag, Thomas; Spektor, Rostislav

2014-01-01

The National Aeronautics and Space Administration (NASA) Science Mission Directorate In-Space Propulsion Technology office is sponsoring NASA Glenn Research Center to develop a 4 kW-class Hall thruster propulsion system for implementation in NASA science missions. A study was conducted to assess the impact of varying the facility background pressure on the High Voltage Hall Accelerator (HiVHAc) thruster performance and voltage-current characteristics. This present study evaluated the HiVHAc thruster performance in the lowest attainable background pressure condition at NASA GRC Vacuum Facility 5 to best simulate space-like conditions. Additional tests were performed at selected thruster operating conditions to investigate and elucidate the underlying physics that change during thruster operation at elevated facility background pressure. Tests were performed at background pressure conditions that are three and ten times higher than the lowest realized background pressure. Results indicated that the thruster discharge specific impulse and efficiency increased with elevated facility background pressure. The voltage-current profiles indicated a narrower stable operating region with increased background pressure. Experimental observations of the thruster operation indicated that increasing the facility background pressure shifted the ionization and acceleration zones upstream towards the thrusters anode. Future tests of the HiVHAc thruster are planned at background pressure conditions that are expected to be two to three times lower than what was achieved during this test campaign. These tests will not only assess the impact of reduced facility background pressure on thruster performance, voltage-current characteristics, and plume properties; but will also attempt to quantify the magnitude of the ionization.

[Evidence-based medicine: a critical analysis of the concept of evidence in medicine].

PubMed

Federspil, G; Vettor, R

2001-06-01

There is currently a lively debate involving scholars from diverse cultural background on the subject of evidence-based medicine. In order to set out the grounds of discussion this paper deals with the problem of "evidence", both the concept and meaning of this term. After a brief history of the idea of "evidence" from antiquity to the present day, it will be underlined how modern day thinking recognizes the existence of two types of "evidence": rational evidence supported first by René Descartes, and perceptible evidence, defended by Francis Bacon. In contemporary epistemology the idea of "evidence" has been conceived above all as perceptible and is closely linked to the idea of fact. The concept of "scientific fact" will therefore be analyzed and will reveal how in science, contrary to prevailing opinion, "pure facts" practically do not exist and how the "facts" which scientists talk about in their research are always "facts depending on theory". Subsequently the capacity of "facts" to prove scientific hypothesis will be examined. In the light of more recent epistemological reflection the thesis will be maintained according to which facts are not capable of definitively proving the truth of a theory. Such reflection leads to the conclusion that in medicine "evidence" is always dependent on the theoretical and practical context in which researchers work. In the final part of the paper the epistemological presumptions and ambitions of evidence-based medicine will be examined. This analysis concludes that the epistemology on which evidence-based medicine relies upon does not grasp the true complexity of the scientific methodology and can weaken in doctors the beneficial stimulus that is doubt.

Investigation of the Effects of Facility Background Pressure on the Performance and Voltage-Current Characteristics of the High Voltage Hall Accelerator

NASA Technical Reports Server (NTRS)

Kamhawi, Hani; Huang, Wensheng; Haag, Thomas; Spektor, Rostislav

2014-01-01

The National Aeronautics and Space Administration (NASA) Science Mission Directorate In-Space Propulsion Technology office is sponsoring NASA Glenn Research Center to develop a 4 kW-class Hall thruster propulsion system for implementation in NASA science missions. A study was conducted to assess the impact of varying the facility background pressure on the High Voltage Hall Accelerator (HiVHAc) thruster performance and voltage-current characteristics. This present study evaluated the HiVHAc thruster performance in the lowest attainable background pressure condition at NASA GRC Vacuum Facility 5 to best simulate space-like conditions. Additional tests were performed at selected thruster operating conditions to investigate and elucidate the underlying physics that change during thruster operation at elevated facility background pressure. Tests were performed at background pressure conditions that are three and ten times higher than the lowest realized background pressure. Results indicated that the thruster discharge specific impulse and efficiency increased with elevated facility background pressure. The voltage-current profiles indicated a narrower stable operating region with increased background pressure. Experimental observations of the thruster operation indicated that increasing the facility background pressure shifted the ionization and acceleration zones upstream towards the thruster's anode. Future tests of the HiVHAc thruster are planned at background pressure conditions that are expected to be two to three times lower than what was achieved during this test campaign. These tests will not only assess the impact of reduced facility background pressure on thruster performance, voltage-current characteristics, and plume properties; but will also attempt to quantify the magnitude of the ionization and acceleration zones upstream shifting as a function of increased background pressure.

A Readout Integrated Circuit (ROIC) employing self-adaptive background current compensation technique for Infrared Focal Plane Array (IRFPA)

NASA Astrophysics Data System (ADS)

Zhou, Tong; Zhao, Jian; He, Yong; Jiang, Bo; Su, Yan

2018-05-01

A novel self-adaptive background current compensation circuit applied to infrared focal plane array is proposed in this paper, which can compensate the background current generated in different conditions. Designed double-threshold detection strategy is to estimate and eliminate the background currents, which could significantly reduce the hardware overhead and improve the uniformity among different pixels. In addition, the circuit is well compatible to various categories of infrared thermo-sensitive materials. The testing results of a 4 × 4 experimental chip showed that the proposed circuit achieves high precision, wide application and high intelligence. Tape-out of the 320 × 240 readout circuit, as well as the bonding, encapsulation and imaging verification of uncooled infrared focal plane array, have also been completed.

CUORE and Background Reduction Case Studies for CUPID

NASA Astrophysics Data System (ADS)

Sakai, Michinari; Gozlukluoglu, Nihal; Huang, Huan; Cuore Collaboration

2017-09-01

CUORE (Cryogenic Underground Observatory for Rare Events) is a bolometric experiment at cryogenic temperatures currently in operation to search for neutrinoless double beta decay. Successful detection of this extremely rare process requires stringent control of radioactive backgrounds of the experiment as well as the detector itself. Great care was taken in CUORE to select the materials and various parts that comprise the current detector. However next-generation neutrinoless double beta decay experiments face a challenge to further reduce backgrounds in order to probe more deeply into the effective Majorana neutrino mass phase space. In this presentation we will review the sensitivity and background budget for the currently running experiment CUORE, as well as the target sensitivity and background goals for the next generation experiment CUPID that will cover the inverted neutrino mass hierarchy. We will explore simulation based R&D case studies for background reduction and lay out achievable background reduction levels using possible materials and feasible geometries in the context of CUPID. National Science Foundation.

Cross-cultural differences in item and background memory: examining the influence of emotional intensity and scene congruency.

PubMed

Mickley Steinmetz, Katherine R; Sturkie, Charlee M; Rochester, Nina M; Liu, Xiaodong; Gutchess, Angela H

2018-07-01

After viewing a scene, individuals differ in what they prioritise and remember. Culture may be one factor that influences scene memory, as Westerners have been shown to be more item-focused than Easterners (see Masuda, T., & Nisbett, R. E. (2001). Attending holistically versus analytically: Comparing the context sensitivity of Japanese and Americans. Journal of Personality and Social Psychology, 81, 922-934). However, cultures may differ in their sensitivity to scene incongruences and emotion processing, which may account for cross-cultural differences in scene memory. The current study uses hierarchical linear modeling (HLM) to examine scene memory while controlling for scene congruency and the perceived emotional intensity of the images. American and East Asian participants encoded pictures that included a positive, negative, or neutral item placed on a neutral background. After a 20-min delay, participants were shown the item and background separately along with similar and new items and backgrounds to assess memory specificity. Results indicated that even when congruency and emotional intensity were controlled, there was evidence that Americans had better item memory than East Asians. Incongruent scenes were better remembered than congruent scenes. However, this effect did not differ by culture. This suggests that Americans' item focus may result in memory changes that are robust despite variations in scene congruency and perceived emotion.

Equilibrium thermodynamics and neutrino decoupling in quasi-metric cosmology

NASA Astrophysics Data System (ADS)

Østvang, Dag

2018-05-01

The laws of thermodynamics in the expanding universe are formulated within the quasi-metric framework. The quasi-metric cosmic expansion does not directly influence momenta of material particles, so the expansion directly cools null particles only (e.g., photons). Therefore, said laws differ substantially from their counterparts in standard cosmology. Consequently, all non-null neutrino mass eigenstates are predicted to have the same energy today as they had just after neutrino decoupling in the early universe. This indicates that the predicted relic neutrino background is strongly inconsistent with detection rates measured in solar neutrino detectors (Borexino in particular). Thus quasi-metric cosmology is in violent conflict with experiment unless some exotic property of neutrinos makes the relic neutrino background essentially undetectable (e.g., if all massive mass eigenstates decay into "invisible" particles over cosmic time scales). But in absence of hard evidence in favour of the necessary exotic neutrino physics needed to resolve said conflict, the current status of quasi-metric relativity has been changed to non-viable.

The Potential Role of the cABR in Assessment and Management of Hearing Impairment

PubMed Central

Anderson, Samira; Kraus, Nina

2013-01-01

Hearing aid technology has improved dramatically in the last decade, especially in the ability to adaptively respond to dynamic aspects of background noise. Despite these advancements, however, hearing aid users continue to report difficulty hearing in background noise and having trouble adjusting to amplified sound quality. These difficulties may arise in part from current approaches to hearing aid fittings, which largely focus on increased audibility and management of environmental noise. These approaches do not take into account the fact that sound is processed all along the auditory system from the cochlea to the auditory cortex. Older adults represent the largest group of hearing aid wearers; yet older adults are known to have deficits in temporal resolution in the central auditory system. Here we review evidence that supports the use of the auditory brainstem response to complex sounds (cABR) in the assessment of hearing-in-noise difficulties and auditory training efficacy in older adults. PMID:23431313

Life-course determinants of bone mass in young adults from a transitional rural community in India: the Andhra Pradesh Children and Parents Study (APCAPS)123

PubMed Central

Matsuzaki, Mika; Kuper, Hannah; Kulkarni, Bharati; Radhakrishna, KV; Viljakainen, Heli; Taylor, Amy E; Sullivan, Ruth; Bowen, Liza; Tobias, Jon H; Ploubidis, George B; Wells, Jonathan C; Prabhakaran, Dorairaj; Davey Smith, George; Ebrahim, Shah; Ben-Shlomo, Yoav; Kinra, Sanjay

2014-01-01

Background: Undernutrition and physical inactivity are both associated with lower bone mass. Objective: This study aimed to investigate the combined effects of early-life undernutrition and urbanized lifestyles in later life on bone mass accrual in young adults from a rural community in India that is undergoing rapid socioeconomic development. Design: This was a prospective cohort study of participants of the Hyderabad Nutrition Trial (1987–1990), which offered balanced protein-calorie supplementation to pregnant women and preschool children younger than 6 y in the intervention villages. The 2009–2010 follow-up study collected data on current anthropometric measures, bone mineral density (BMD) measured by dual-energy X-ray absorptiometry, blood samples, diet, physical activity, and living standards of the trial participants (n = 1446, aged 18–23 y). Results: Participants were generally lean and had low BMD [mean hip BMD: 0.83 (women), 0.95 (men) g/cm2; lumbar spine: 0.86 (women), 0.93 (men) g/cm2]. In models adjusted for current risk factors, no strong evidence of a positive association was found between BMD and early-life supplementation. On the other hand, current lean mass and weight-bearing physical activity were positively associated with BMD. No strong evidence of an association was found between BMD and current serum 25-hydroxyvitamin D or dietary intake of calcium, protein, or calories. Conclusions: Current lean mass and weight-bearing physical activity were more important determinants of bone mass than was early-life undernutrition in this population. In transitional rural communities from low-income countries, promotion of physical activity may help to mitigate any potential adverse effects of early nutritional disadvantage. PMID:24695898

Evidence on the Effectiveness of Water, Sanitation, and Hygiene (WASH) Interventions on Health Outcomes in Humanitarian Crises: A Systematic Review

PubMed Central

Ramesh, Anita; Blanchet, Karl; Ensink, Jeroen H. J.; Roberts, Bayard

2015-01-01

Background Water, sanitation, and hygiene (WASH) interventions are amongst the most crucial in humanitarian crises, although the impact of the different WASH interventions on health outcomes remains unclear. Aim To examine the quantity and quality of evidence on WASH interventions on health outcomes in humanitarian crises, as well as evaluate current evidence on their effectiveness against health outcomes in these contexts. Methods A systematic literature review was conducted of primary and grey quantitative literature on WASH interventions measured against health outcomes in humanitarian crises occurring from 1980–2014. Populations of interest were those in resident in humanitarian settings, with a focus on acute crisis and early recovery stages of humanitarian crises in low and middle-income countries. Interventions of interest were WASH-related, while outcomes of interest were health-related. Study quality was assessed via STROBE/CONSORT criteria. Results were analyzed descriptively, and PRISMA reporting was followed. Results Of 3963 studies initially retrieved, only 6 published studies measured a statistically significant change in health outcome as a result of a WASH intervention. All 6 studies employed point-of-use (POU) water quality interventions, with 50% using safe water storage (SWS) and 35% using household water treatment (HWT). All 6 studies used self-reported diarrhea outcomes, 2 studies also reported laboratory confirmed outcomes, and 2 studies reported health treatment outcomes (e.g. clinical admissions). 1 study measured WASH intervention success in relation to both health and water quality outcomes; 1 study recorded uptake (use of soap) as well as health outcomes. 2 studies were unblinded randomized-controlled trials, while 4 were uncontrolled longitudinal studies. 2 studies were graded as providing high quality evidence; 3 studies provided moderate and 1 study low quality evidence. Conclusion The current evidence base on the impact of WASH interventions on health outcomes in humanitarian crises is extremely limited, and numerous methodological limitations limit the ability to determine associative, let alone causal, relationships. PMID:26398228

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…

Dyslipidemias and Cardiovascular Prevention: Tailoring Treatment According to Lipid Phenotype.

PubMed

Sanin, Veronika; Pfetsch, Vanessa; Koenig, Wolfgang

2017-07-01

This study aimed to present the current information on the genetic background of dyslipidemias and provide insights into the complex pathophysiological role of several plasma lipids/lipoproteins in the pathogenesis of atherosclerotic cardiovascular disease. Furthermore, we aim to summarize established therapies and describe the scientific rationale for the development of novel therapeutic strategies. Evidence from genetic studies suggests that besides lowering low-density lipoprotein cholesterol, pharmacological reduction of triglyceride-rich lipoproteins, or lipoprotein(a) will reduce risk for coronary heart disease. Dyslipidemia, in particular hypercholesterolemia, is a common clinical condition and represents an important determinant of atherosclerotic vascular disease. Treatment decisions are currently guided by the causative lipid phenotype and the presence of other risk factors suggesting a very high cardiovascular risk. Therefore, the identification of lipid disorders and the optimal combination of therapeutic strategies provide an outstanding opportunity for reducing the onset and burden of cardiovascular disease.

Gravitational wave hotspots: Ranking potential locations of single-source gravitational wave emission

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

Simon, Joseph; Polin, Abigail; Lommen, Andrea

2014-03-20

The steadily improving sensitivity of pulsar timing arrays (PTAs) suggests that gravitational waves (GWs) from supermassive black hole binary (SMBHB) systems in the nearby universe will be detectable sometime during the next decade. Currently, PTAs assume an equal probability of detection from every sky position, but as evidence grows for a non-isotropic distribution of sources, is there a most likely sky position for a detectable single source of GWs? In this paper, a collection of Galactic catalogs is used to calculate various metrics related to the detectability of a single GW source resolvable above a GW background, assuming that everymore » galaxy has the same probability of containing an SMBHB. Our analyses of these data reveal small probabilities that one of these sources is currently in the PTA band, but as sensitivity is improved regions of consistent probability density are found in predictable locations, specifically around local galaxy clusters.« less

Endpoints and cutpoints in head and neck oncology trials: methodical background, challenges, current practice and perspectives.

PubMed

Hezel, Marcus; von Usslar, Kathrin; Kurzweg, Thiemo; Lörincz, Balazs B; Knecht, Rainald

2016-04-01

This article reviews the methodical and statistical basics of designing a trial, with a special focus on the process of defining and choosing endpoints and cutpoints as the foundations of clinical research, and ultimately that of evidence-based medicine. There has been a significant progress in the treatment of head and neck cancer in the past few decades. Currently available treatment options can have a variety of different goals, depending e.g. on tumor stage, among other factors. The outcome of a specific treatment in clinical trials is measured using endpoints. Besides classical endpoints, such as overall survival or organ preservation, other endpoints like quality of life are becoming increasingly important in designing and conducting a trial. The present work is based on electronic research and focuses on the solid methodical and statistical basics of a clinical trial, on the structure of study designs and on the presentation of various endpoints.

Association between breastfeeding and eczema during childhood and adolescence: A cohort study

PubMed Central

Ramette, Alban; Jurca, Maja; Goutaki, Myrofora; Beardsmore, Caroline S.; Kuehni, Claudia E.

2017-01-01

Background Breastfeeding is said to protect children from eczema (atopic dermatitis), but the available evidence is conflicting and subject to the influences of parental atopy and reverse causation (when mothers extended duration of breastfeeding because their children had eczema). Methods In the prospective, population-based Leicester Respiratory Cohort study, we assessed duration of breastfeeding in children aged 1–4 years. Prevalence of eczema was determined by questionnaire surveys that were repeated until the children were 17 years old. We investigated the association between having been breastfed and current eczema using generalized estimating equations, adjusting for potential confounders, and tested for effect modification by parental atopy. We also assessed the association between having been breastfed and incident eczema at ages 2, 4, and 6 years using multivariable logistic regression. Results Among the 5,676 children in the study, 2,284 (40%) had never been breastfed, while 1,610 (28%), 705 (12%), and 1,077 (19%) had been breastfed for 0–3, 4–6, and >6 months, respectively. Prevalence of current eczema decreased from 36% in 1-year-olds to 18% in children aged 10–17 years. Breastfeeding was not associated with current eczema. Compared with children who had never been breastfed, the adjusted odds ratios for current eczema at any age were 1.02 (95% confidence interval 0.90–1.15) for children who had been breastfed for 0–3 months, 0.97 (0.82–1.13) for children breastfed for 4–6 months, and 0.98 (0.85–1.14) for children breastfed for >6 months. There was no strong evidence for an effect modification by parental atopy (p-value for interaction term was 0.061) and no association between having been breastfed and incident eczema later in childhood. Conclusions This population-based cohort study found no evidence for protection of breastfeeding against childhood eczema at any age, from infancy through adolescence. PMID:28945812

The Association of Birth Weight and Infant Growth with Energy Balance-Related Behavior – A Systematic Review and Best-Evidence Synthesis of Human Studies

PubMed Central

Chinapaw, Mai J. M.; Jansma, Elise P.; Vrijkotte, Tanja G. M.; Gemke, Reinoud J. B. J.

2017-01-01

Background Suboptimal prenatal and early postnatal growths are associated with obesity in later life, but the underlying mechanisms are unknown. The aim of this study was to systematically review the literature that reports on the longitudinal association of (i) birth size or (ii) infant growth with later (i) energy intake, (ii) eating behaviors, (iii) physical activity or (iv) sedentary behavior in humans. Methods A comprehensive search of MEDLINE, EMBASE, PsycINFO and The Cochrane Library was conducted to identify relevant publications. We appraised the methodological quality of the studies and synthesized the extracted data through a best-evidence synthesis. Results Data from 41 publications were included. The quality of the studies was high in three papers, moderate in 11 and low in the large majority (n = 27) of papers appraised. Our best-evidence synthesis indicates that there is no evidence for an association of birth weight with later energy intake, eating behavior, physical activity or sedentary behavior. We found moderate evidence for an association of extreme birth weights (at both ends of the spectrum) with lower physical activity levels at a later age. Evidence for the association of infant growth with energy balance-related behavior was generally insufficient. Conclusions We conclude that current evidence does not support an association of early-life growth with energy balance-related behaviors in later life, except for an association of extreme birth weights with later physical activity. PMID:28081150

Current treatment of dyslipidaemia: PCSK9 inhibitors and statin intolerance.

PubMed

Koskinas, Konstantinos; Wilhelm, Matthias; Windecker, Stephan

2016-01-01

Statins are the cornerstone of the management of dyslipidaemias and prevention of cardiovascular disease. Although statins are, overall, safe and well tolerated, adverse events can occur and constitute an important barrier to maintaining long-term adherence to statin treatment. In patients who cannot tolerate statins, alternative treatments include switch to another statin, intermittent-dosage regimens and non-statin lipid-lowering medications. Nonetheless, a high proportion of statin-intolerant patients are unable to achieve recommended low-density lipoprotein (LDL) cholesterol goals, thereby resulting in substantial residual cardiovascular risk. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a protease implicated in LDL receptor degradation and plays a central role in cholesterol metabolism. In recent studies, PCSK9 inhibition by means of monoclonal antibodies achieved LDL cholesterol reductions of 50% to 70% across various patient populations and background lipid-lowering therapies, while maintaining a favourable safety profile. The efficacy and safety of the monoclonal antibodies alirocumab and evolocumab were confirmed in statin-intolerant patients, indicating that PCSK9 inhibitors represent an attractive treatment option in this challenging clinical setting. PCSK9 inhibitors recently received regulatory approval for clinical use and may be considered in properly selected patients according to current consensus documents, including patients with statin intolerance. In this review we summarise current evidence regarding diagnostic evaluation of statin-related adverse events, particularly statin-associated muscle symptoms, and we discuss current recommendations on the management of statin-intolerant patients. In view of emerging evidence of the efficacy and safety of PCSK9 inhibitors, we further discuss the role of monoclonal PCSK9 antibodies in the management of statin-intolerant hypercholesterolaemic patients.

Numerical simulation of large-scale field-aligned current generation from finite-amplitude magnetosonic waves

NASA Technical Reports Server (NTRS)

Yamauchi, M.

1994-01-01

A two-dimensional numerical simulation of finite-amplitude magnetohydrodynamic (MHD) magnetosonic waves is performed under a finite-velocity background convection condition. Isothermal cases are considered for simplicity. External dissipation is introduced by assuming that the field-aligned currents are generated in proportion to the accumulated charges. The simulation results are as follows: Paired field-aligned currents are found from the simulated waves. The flow directions of these field-aligned currents depend on the angle between the background convection and the wave normal, and hence two pairs of field-aligned currents are found from a bowed wave if we look at the overall structure. The majority of these field-aligned currents are closed within each pair rather than between two wings. These features are not observed under slow background convection. The result could be applied to the cusp current system and the substorm current system.

Evidence of lensing of the cosmic microwave background by dark matter halos.

PubMed

Madhavacheril, Mathew; Sehgal, Neelima; Allison, Rupert; Battaglia, Nick; Bond, J Richard; Calabrese, Erminia; Caligiuri, Jerod; Coughlin, Kevin; Crichton, Devin; Datta, Rahul; Devlin, Mark J; Dunkley, Joanna; Dünner, Rolando; Fogarty, Kevin; Grace, Emily; Hajian, Amir; Hasselfield, Matthew; Hill, J Colin; Hilton, Matt; Hincks, Adam D; Hlozek, Renée; Hughes, John P; Kosowsky, Arthur; Louis, Thibaut; Lungu, Marius; McMahon, Jeff; Moodley, Kavilan; Munson, Charles; Naess, Sigurd; Nati, Federico; Newburgh, Laura; Niemack, Michael D; Page, Lyman A; Partridge, Bruce; Schmitt, Benjamin; Sherwin, Blake D; Sievers, Jon; Spergel, David N; Staggs, Suzanne T; Thornton, Robert; Van Engelen, Alexander; Ward, Jonathan T; Wollack, Edward J

2015-04-17

We present evidence of the gravitational lensing of the cosmic microwave background by 10(13) solar mass dark matter halos. Lensing convergence maps from the Atacama Cosmology Telescope Polarimeter (ACTPol) are stacked at the positions of around 12 000 optically selected CMASS galaxies from the SDSS-III/BOSS survey. The mean lensing signal is consistent with simulated dark matter halo profiles and is favored over a null signal at 3.2σ significance. This result demonstrates the potential of microwave background lensing to probe the dark matter distribution in galaxy group and galaxy cluster halos.

Cognitive Mechanisms of Change in Delusions: An Experimental Investigation Targeting Reasoning to Effect Change in Paranoia

PubMed Central

Garety, Philippa; Waller, Helen; Emsley, Richard; Jolley, Suzanne; Kuipers, Elizabeth; Bebbington, Paul; Dunn, Graham; Fowler, David; Hardy, Amy; Freeman, Daniel

2015-01-01

Background: Given the evidence that reasoning biases contribute to delusional persistence and change, several research groups have made systematic efforts to modify them. The current experiment tested the hypothesis that targeting reasoning biases would result in change in delusions. Methods: One hundred and one participants with current delusions and schizophrenia spectrum psychosis were randomly allocated to a brief computerized reasoning training intervention or to a control condition involving computer-based activities of similar duration. The primary hypotheses tested were that the reasoning training intervention, would improve (1) data gathering and belief flexibility and (2) delusional thinking, specifically paranoia. We then tested whether the changes in paranoia were mediated by changes in data gathering and flexibility, and whether working memory and negative symptoms moderated any intervention effects. Results: On an intention-to-treat analysis, there were significant improvements in state paranoia and reasoning in the experimental compared with the control condition. There was evidence that changes in reasoning mediated changes in paranoia, although this effect fell just outside the conventional level of significance after adjustment for baseline confounders. Working memory and negative symptoms significantly moderated the effects of the intervention on reasoning. Conclusion: The study demonstrated the effectiveness of a brief reasoning intervention in improving both reasoning processes and paranoia. It thereby provides proof-of-concept evidence that reasoning is a promising intermediary target in interventions to ameliorate delusions, and thus supports the value of developing this approach as a longer therapeutic intervention. PMID:25053650

Vitamin A in Stargardt disease-an evidence-based update.

PubMed

Federspiel, Cecilie Aalund; Bertelsen, Mette; Kessel, Line

2018-06-25

High intake of vitamin A is suspected to be a risk factor for the progression of Stargardt disease (STGD1) and many health authorities recommend Stargardt patients not to use oral vitamin A supplements outside that provided naturally in the food. The present study provides the first systematic review of the current level of evidence regarding the role of supplementary vitamin A in STGD1. We conducted a systematic scientific literature search in the Pubmed database on studies reporting on the effect of oral vitamin A or serum retinol on visual function. In animal studies neither high nor low serum retinol in an Abca4 knockout mouse model of Stargardt showed any effect on electroretinography (ERG). In humans, significantly better visual function was reported in a cross-sectional study of patients with a low dietary intake of vitamin A, whereas a prospective study did not find any correlation between vitamin A supplementation and visual acuity. A newly introduced vitamin A substitute (C20-D(3)-vitamin A) has shown promising effects on ERG in a Stargardt mouse model. There are few studies on the effect of vitamin A in STGD1. The scarcity and inconclusiveness of evidence available impel further research efforts to reach a more confident conclusion. Currently, recommendations to avoid vitamin A dietary supplementation rely mainly on a theoretical background. Animal studies on vitamin A substitute as a possible therapeutic approach in preventing or slowing vision loss in STGD1 seems promising but further clinical trials are needed to verify the results.

Biological pathways, candidate genes, and molecular markers associated with quality-of-life domains: an update.

PubMed

Sprangers, Mirjam A G; Thong, Melissa S Y; Bartels, Meike; Barsevick, Andrea; Ordoñana, Juan; Shi, Qiuling; Wang, Xin Shelley; Klepstad, Pål; Wierenga, Eddy A; Singh, Jasvinder A; Sloan, Jeff A

2014-09-01

There is compelling evidence of a genetic foundation of patient-reported quality of life (QOL). Given the rapid development of substantial scientific advances in this area of research, the current paper updates and extends reviews published in 2010. The objective was to provide an updated overview of the biological pathways, candidate genes, and molecular markers involved in fatigue, pain, negative (depressed mood) and positive (well-being/happiness) emotional functioning, social functioning, and overall QOL. We followed a purposeful search algorithm of existing literature to capture empirical papers investigating the relationship between biological pathways and molecular markers and the identified QOL domains. Multiple major pathways are involved in each QOL domain. The inflammatory pathway has the strongest evidence as a controlling mechanism underlying fatigue. Inflammation and neurotransmission are key processes involved in pain perception, and the catechol-O-methyltransferase (COMT) gene is associated with multiple sorts of pain. The neurotransmitter and neuroplasticity theories have the strongest evidence for their relationship with depression. Oxytocin-related genes and genes involved in the serotonergic and dopaminergic pathways play a role in social functioning. Inflammatory pathways, via cytokines, also play an important role in overall QOL. Whereas the current findings need future experiments and replication efforts, they will provide researchers supportive background information when embarking on studies relating candidate genes and/or molecular markers to QOL domains. The ultimate goal of this area of research is to enhance patients' QOL.

Global Evidence on the Association between POS Advertising Bans and Youth Smoking Participation

PubMed Central

Shang, Ce; Huang, Jidong; Cheng, Kai-Wen; Li, Qing; Chaloupka, Frank J.

2016-01-01

Background: Point-of-sale (POS) tobacco advertising has been linked to youth smoking susceptibility and experimental smoking. However, there is limited evidence of the association between POS advertising bans and youth smoking participation. This study aims to examine how such bans are associated with current smoking, daily smoking, and regular smoking (≥1 cigarettes per day) participation among youth. Methods: one to two waves (primarily one wave) of the Global Youth Tobacco Survey were conducted in 130 countries between 2007 and 2011. These surveys were linked to the WHO “MPOWER” data using country and year identifiers to analyze the association between POS advertising bans (a dichotomous measure of the existence of such bans) and smoking participation in the past month. Weighted logistic regressions were employed to analyze this association while controlling for age, gender, parents’ smoking status, 6 MPOWER policy scores, and GDP per capita. Results and Conclusions: We find that in countries with POS advertising bans, current smoking (OR = 0.73, p ≤ 0.1), daily smoking (OR = 0.70, p ≤ 0.1), and regular smoking (OR = 0.75, p ≤ 0.05) participation in the past month is significantly lower, suggesting that POS promotion bans can potentially reduce youth smoking. This study provides evidence to support the implementation of POS promotion regulations by the US FDA and implementation of the WHO FCTC guidelines regarding restrictions on tobacco POS promotion. PMID:27005651

Characteristics and molecular basis of celecoxib modulation on Kv7 potassium channels

PubMed Central

Du, XN; Zhang, X; Qi, JL; An, HL; Li, JW; Wan, YM; Fu, Y; Gao, HX; Gao, ZB; Zhan, Y; Zhang, HL

2011-01-01

BACKGROUND AND PURPOSE Celecoxib is a selective cyclooxygenase-2 (COX-2) inhibitor used for the treatment of pain and inflammation. Emerging and accumulating evidence suggests that celecoxib can affect cellular targets other than COX, such as ion channels. In this study, we characterized the effects of celecoxib on Kv7 K+ channels and compared its effects with the well-established Kv7 channel opener retigabine. EXPERIMENTAL APPROACH A perforated whole-cell patch technique was used to record Kv7currents expressed in HEK 293 cells and M-type currents from rat superior cervical ganglion neurons. KEY RESULTS Celecoxib enhanced Kv7.2–7.4, Kv7.2/7.3 and Kv7.3/7.5 currents but inhibited Kv7.1 and Kv7.1/KCNE1 currents and these effects were concentration dependent. The IC50 value for inhibition of Kv7.1 channels was approximately 4 µM and the EC50 values for activation of Kv7.2–7.4, Kv7.2/Kv7.3 and Kv7.3/Kv7.5 channels were approximately 2–5 µM. The effects of celecoxib were manifested by increasing current amplitudes, shifting the voltage-dependent activation curve in a more negative direction and slowing the deactivation of Kv7 currents. 2,5-Dimethyl-celecoxib, a celecoxib analogue devoid of COX inhibition activity, has similar but greater effects on Kv7currents. Kv7.2(A235T) and Kv7.2(W236L) mutant channels, which have greatly attenuated responses to retigabine, showed a reversed response to celecoxib, from activation to inhibition. CONCLUSIONS AND IMPLICATIONS These results suggest that Kv7 channels are targets of celecoxib action and provide new mechanistic evidence for understanding the effects of celecoxib. They also provide a new approach to developing Kv7 modulators and for studying the structure–function relationship of Kv7 channels. PMID:21564087

Current Sheet Formation in a Conical Theta Pinch Faraday Accelerator with Radio-frequency Assisted Discharge

NASA Technical Reports Server (NTRS)

Polzin, Kurt A.; Hallock, Ashley K.; Choueiri, Edgar Y.

2008-01-01

Data from an inductive conical theta pinch accelerator are presented to gain insight into the process of inductive current sheet formation in the presence of a preionized background gas produced by a steady-state RF-discharge. The presence of a preionized plasma has been previously shown to allow for current sheet formation at lower discharge voltages and energies than those found in other pulsed inductive accelerator concepts, leading to greater accelerator efficiencies at lower power levels. Time-resolved magnetic probe measurements are obtained for different background pressures and pulse energies to characterize the effects of these parameters on current sheet formation. Indices are defined that describe time-resolved current sheet characteristics, such as the total current owing in the current sheet, the time-integrated total current ('strength'), and current sheet velocity. It is found that for a given electric field strength, maximums in total current, strength, and velocity occur for one particular background pressure. At other pressures, these current sheet indices are considerably smaller. The trends observed in these indices are explained in terms of the principles behind Townsend breakdown that lead to a dependence on the ratio of the electric field to the background pressure. Time-integrated photographic data are also obtained at the same experimental conditions, and qualitatively they compare quite favorably with the time-resolved magnetic field data.

Neutral details associated with emotional events are encoded: evidence from a cued recall paradigm.

PubMed

Mickley Steinmetz, Katherine R; Knight, Aubrey G; Kensinger, Elizabeth A

2016-11-01

Enhanced emotional memory often comes at the cost of memory for surrounding background information. Narrowed-encoding theories suggest that this is due to narrowed attention for emotional information at encoding, leading to impaired encoding of background information. Recent work has suggested that an encoding-based theory may be insufficient. Here, we examined whether cued recall-instead of previously used recognition memory tasks-would reveal evidence that non-emotional information associated with emotional information was effectively encoded. Participants encoded positive, negative, or neutral objects on neutral backgrounds. At retrieval, they were given either the item or the background as a memory cue and were asked to recall the associated scene element. Counter to narrowed-encoding theories, emotional items were more likely than neutral items to trigger recall of the associated background. This finding suggests that there is a memory trace of this contextual information and that emotional cues may facilitate retrieval of this information.

What Can Evidence-Use in Practice Learn from Evidence-Use in Policy?

ERIC Educational Resources Information Center

Rickinson, Mark; de Bruin, Kate; Walsh, Lucas; Hall, Matthew

2017-01-01

Background: This paper approaches evidence-informed practice from the perspective of evidence-informed policy-making. Using the findings of a recent study of evidence-use by educational policy-makers to raise questions about evidence-use by educational practitioners, it seeks to explore what such a study might tell us about how to understand and…

Masticatory muscle sleep background electromyographic activity is elevated in myofascial temporomandibular disorder patients.

PubMed

Raphael, K G; Janal, M N; Sirois, D A; Dubrovsky, B; Wigren, P E; Klausner, J J; Krieger, A C; Lavigne, G J

2013-12-01

Despite theoretical speculation and strong clinical belief, recent research using laboratory polysomnographic (PSG) recording has provided new evidence that frequency of sleep bruxism (SB) masseter muscle events, including grinding or clenching of the teeth during sleep, is not increased for women with chronic myofascial temporomandibular disorder (TMD). The current case-control study compares a large sample of women suffering from chronic myofascial TMD (n = 124) with a demographically matched control group without TMD (n = 46) on sleep background electromyography (EMG) during a laboratory PSG study. Background EMG activity was measured as EMG root mean square (RMS) from the right masseter muscle after lights out. Sleep background EMG activity was defined as EMG RMS remaining after activity attributable to SB, other orofacial activity, other oromotor activity and movement artefacts were removed. Results indicated that median background EMG during these non-SB event periods was significantly higher (P < 0·01) for women with myofascial TMD (median = 3·31 μV and mean = 4·98 μV) than for control women (median = 2·83 μV and mean = 3·88 μV) with median activity in 72% of cases exceeding control activity. Moreover, for TMD cases, background EMG was positively associated and SB event-related EMG was negatively associated with pain intensity ratings (0-10 numerical scale) on post-sleep waking. These data provide the foundation for a new focus on small, but persistent, elevations in sleep EMG activity over the course of the night as a mechanism of pain induction or maintenance. © 2013 John Wiley & Sons Ltd.

SEE: structured representation of scientific evidence in the biomedical domain using Semantic Web techniques.

PubMed

Bölling, Christian; Weidlich, Michael; Holzhütter, Hermann-Georg

2014-01-01

Accounts of evidence are vital to evaluate and reproduce scientific findings and integrate data on an informed basis. Currently, such accounts are often inadequate, unstandardized and inaccessible for computational knowledge engineering even though computational technologies, among them those of the semantic web, are ever more employed to represent, disseminate and integrate biomedical data and knowledge. We present SEE (Semantic EvidencE), an RDF/OWL based approach for detailed representation of evidence in terms of the argumentative structure of the supporting background for claims even in complex settings. We derive design principles and identify minimal components for the representation of evidence. We specify the Reasoning and Discourse Ontology (RDO), an OWL representation of the model of scientific claims, their subjects, their provenance and their argumentative relations underlying the SEE approach. We demonstrate the application of SEE and illustrate its design patterns in a case study by providing an expressive account of the evidence for certain claims regarding the isolation of the enzyme glutamine synthetase. SEE is suited to provide coherent and computationally accessible representations of evidence-related information such as the materials, methods, assumptions, reasoning and information sources used to establish a scientific finding by adopting a consistently claim-based perspective on scientific results and their evidence. SEE allows for extensible evidence representations, in which the level of detail can be adjusted and which can be extended as needed. It supports representation of arbitrary many consecutive layers of interpretation and attribution and different evaluations of the same data. SEE and its underlying model could be a valuable component in a variety of use cases that require careful representation or examination of evidence for data presented on the semantic web or in other formats.

A Review of Cochrane Systematic Reviews of Interventions Relevant to Orthoptic Practice.

PubMed

Rowe, Fiona J; Elliott, Sue; Gordon, Iris; Shah, Anupa

2017-09-01

To present an overview of the range of systematic reviews on intervention trials pertinent to orthoptic practice, produced by the Cochrane Eyes and Vision group (CEV). We searched the 2016 Cochrane Library database (31.03.2016) to identify completed reviews and protocols of direct relevance to orthoptic practice. These reviews are currently completed and published, available on www.thecochranelibrary.com (free to UK health employees) or via the CEV website (http://eyes.cochrane.org/) . We found 27 completed CEV reviews across the topics of strabismus, amblyopia, refractive errors, and low vision. Seven completed CEV protocols addressed topics of strabismus, amblyopia, refractive errors, low vision, and screening. We found 3 completed Cochrane Stroke reviews addressing visual field loss, eye movement impairment, and age-related vision loss. The systematic review process presents an important opportunity for any clinician to contribute to the establishment of reliable, evidence-based orthoptic practice. Each review has an abstract and plain language summary that many non-clinicians find useful, followed by a full copy of the review (background, objectives, methods, results, discussion) with a conclusion section that is divided into implications for practice and implications for research. The current reviews provide patients/parents/carers with information about various different conditions and treatment options, but also provide clinicians with a summary of the available evidence on interventions, to use as a guide for both clinical practice and future research planning. The reviews identified in this overview highlight the evidence available for effective interventions for strabismus, amblyopia, refractive errors, and low vision or stroke rehabilitation as well as the gaps in the evidence base. Thus, a demand exists for future robust, randomized, controlled trials of such interventions of importance in orthoptic practice.

Does intravenous contrast-enhanced computed tomography cause acute kidney injury? Protocol of a systematic review of the evidence

PubMed Central

2014-01-01

Background Contrast-induced acute kidney injury is a common cause of iatrogenic acute kidney injury (AKI). Most of the published estimates of AKI after contrast use originate from the cardiac catheterization literature despite contrast-enhanced computed tomography (CT) scans being the more common setting for contrast use. This systematic review aims to summarize the current evidence about (1)the risk of AKI following intravenous (IV) contrast-enhanced CT scans and(2) the risk of clinical outcomes (i.e. death, hospitalization and need for renal replacement therapy) due to IV contrast-enhanced CT scans. Methods/Design A systematic literature search for published studies will be performed using MEDLINE, EMBASE and The COCHRANE Library databases. Unpublished studies will be identified by searching through grey literature. No language restriction will be applied. The review will consider all studies that have examined the association between IV contrast media and AKI. To be selected, the study should include two arms: one group of exposed patients who received IV contrast material before CT scans and one group of unexposed group who did not receive contrast material before CT scans. Two authors will independently screen titles and abstracts obtained from electronic databases, extract data and will assess the quality of the studies selected using the Cochrane's ‘Risk of Bias’ assessment tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. A random-effects meta-analysis will be performed if there is no remarkable heterogeneity between studies. Discussion This systematic review will provide synthesis of current evidence around the effect of IV contrast material on AKI and other clinical outcomes. Results will be helpful for making evidence-based recommendations and guidelines for clinical and radiologic settings. Systematic review registration PROSPERO CRD42013003799. PMID:25148933

Promoting oral health during pregnancy: current evidence and implications for Australian midwives.

PubMed

George, Ajesh; Johnson, Maree; Blinkhorn, Anthony; Ellis, Sharon; Bhole, Sameer; Ajwani, Shilpi

2010-12-01

The aim of this paper is to examine current evidence supporting the promotion of oral health during pregnancy and proffer aspects of a potential role for Australian midwives. Research continues to show that poor oral health during pregnancy can have an impact on the health outcomes of the mother and baby. Poor maternal oral health increases the chances of infants developing early caries and is strongly associated with adverse pregnancy outcomes such as preterm and low birth-weight babies. Unfortunately in Australia, no preventive strategies exist to maintain the oral health of pregnant women. Systematic review. This review examines all literature on oral health during pregnancy published to date in the English language and focuses on whether preventive oral health strategies during the prenatal period are warranted in Australia and if so, how they could be provided. Maintaining oral health is important during pregnancy and many developed countries have implemented preventive strategies to address this issue using non-dental professionals such as prenatal care providers. However, despite the positive international evidence, limited importance is being given to the oral health of pregnant women in Australia. It is also evident that the unique potential of prenatal care providers such as midwives to assess and improve maternal oral heath is not being thoroughly utilised. Compounding the issue in Australia, especially for pregnant women from socioeconomically disadvantaged backgrounds, is the limited access to public dental services and the high cost of private dental treatment. Promoting and maintaining oral health during pregnancy is crucial, and preventive prenatal oral health services are needed in Australia to achieve this. Midwives have an excellent opportunity to offer preventive oral health services by providing oral health assessments, education and referrals for pregnant women attending antenatal clinics. © 2010 Blackwell Publishing Ltd.

Research as a standard of care in PICU

PubMed Central

Zimmerman, Jerry J.; Anand, Kanwaljeet J. S.; Meert, Kathleen L.; Willson, Douglas F.; Newth, Christopher J. L.; Harrison, Rick; Carcillo, Joseph A.; Berger, John; Jenkins, Tammara L.; Nicholson, Carol; Dean, J. Michael

2016-01-01

Background Excellence in clinical care coupled with basic and applied research reflects the maturation of a medical subspecialty, advances that field, and provides objective data for identifying best practices. Pediatric intensive care units (PICU) are uniquely suited for conducting translational and clinical research. Moreover, multiple investigations have reported that a majority of parents are interested in their children’s participation in clinical research, even when the research offers no direct benefit to their child. However, such activity may generate ethical conflict with bedside care providers trying to acutely identify the best approach for an individual critically ill child. Ultimately, this conflict may diminish enthusiasm for the generation of scientific evidence that supports application of evidence-based medicine into PICU clinical standard work. Objective Provide an overview of current state PICU clinical research strengths, liabilities, opportunities, and barriers, and contrast this with an established pediatric hematology-oncology iterative research model that constitutes a learning healthcare system. Design Narrative review of medical literature published in English. Conclusions Currently most PICU therapy is not evidence-based. Developing a learning healthcare system in the PICU integrates clinical research into usual practice and fosters a culture of evidence-based learning and continual care improvement. As PICU mortality has significantly decreased, identification and validation of patient-centered, clinically relevant research outcome measures other than mortality is essential for future clinical trial design. Because most pediatric critical illness may be classified as rare diseases, participation in research networks will facilitate iterative, collaborative, multi-institutional investigations that over time identify best practices to improve PICU outcomes. Despite real ethical challenges, critically ill children and their families should have the opportunity to participate in translational/clinical research whenever feasible. PMID:26513203

Reverse Current Shock Induced by Plasma-Neutral Collision

NASA Astrophysics Data System (ADS)

Wongwaitayakornkul, Pakorn; Haw, Magnus; Li, Hui; Li, Shengtai; Bellan, Paul

2017-10-01

The Caltech solar experiment creates an arched plasma-filled flux rope expanding into low density background plasma. A layer of electrical current flowing in the opposite direction with respect to the flux rope current is induced in the background plasma just ahead of the flux rope. Two dimensional spatial and temporal measurements by a 3-dimensional magnetic vector probe demonstrate the existence of this induced current layer forming ahead of the flux rope. The induced current magnitude is 20% of the magnitude of the current in the flux rope. The reverse current in the low density background plasma is thought to be a diamagnetic response that shields out the magnetic field ahead of the propagation. The spatial and magnetic characteristics of the reverse current layer are consistent with similar shock structures seen in 3-dimensional ideal MHD numerical simulations performed on the Turquoise supercomputer cluster using the Los Alamos COMPutational Astrophysics Simulation Suite. This discovery of the induced diamagnetic current provides useful insights for space and solar plasma.

The importance of associations with saprotrophic non-Rhizoctonia fungi among fully mycoheterotrophic orchids is currently under-estimated: novel evidence from sub-tropical Asia

PubMed Central

Lee, Yung-I; Yang, Chih-Kai; Gebauer, Gerhard

2015-01-01

Background and Aims Most fully mycoheterotrophic (MH) orchids investigated to date are mycorrhizal with fungi that simultaneously form ectomycorrhizas with forest trees. Only a few MH orchids are currently known to be mycorrhizal with saprotrophic, mostly wood-decomposing, fungi instead of ectomycorrhizal fungi. This study provides evidence that the importance of associations between MH orchids and saprotrophic non-Rhizoctonia fungi is currently under-estimated. Methods Using microscopic techniques and molecular approaches, mycorrhizal fungi were localized and identified for seven MH orchid species from four genera and two subfamilies, Vanilloideae and Epidendroideae, growing in four humid and warm sub-tropical forests in Taiwan. Carbon and nitrogen stable isotope natural abundances of MH orchids and autotrophic reference plants were used in order to elucidate the nutritional resources utilized by the orchids. Key Results Six out of the seven MH orchid species were mycorrhizal with either wood- or litter-decaying saprotrophic fungi. Only one orchid species was associated with ectomycorrhizal fungi. Stable isotope abundance patterns showed significant distinctions between orchids mycorrhizal with the three groups of fungal hosts. Conclusions Mycoheterotrophic orchids utilizing saprotrophic non-Rhizoctonia fungi as a carbon and nutrient source are clearly more frequent than hitherto assumed. On the basis of this kind of nutrition, orchids can thrive in deeply shaded, light-limiting forest understoreys even without support from ectomycorrhizal fungi. Sub-tropical East Asia appears to be a hotspot for orchids mycorrhizal with saprotrophic non-Rhizoctonia fungi. PMID:26113634

A hierarchy of effective teaching and learning to acquire competence in evidenced-based medicine

PubMed Central

Khan, Khalid S; Coomarasamy, Arri

2006-01-01

Background A variety of methods exists for teaching and learning evidence-based medicine (EBM). However, there is much debate about the effectiveness of various EBM teaching and learning activities, resulting in a lack of consensus as to what methods constitute the best educational practice. There is a need for a clear hierarchy of educational activities to effectively impart and acquire competence in EBM skills. This paper develops such a hierarchy based on current empirical and theoretical evidence. Discussion EBM requires that health care decisions be based on the best available valid and relevant evidence. To achieve this, teachers delivering EBM curricula need to inculcate amongst learners the skills to gain, assess, apply, integrate and communicate new knowledge in clinical decision-making. Empirical and theoretical evidence suggests that there is a hierarchy of teaching and learning activities in terms of their educational effectiveness: Level 1, interactive and clinically integrated activities; Level 2(a), interactive but classroom based activities; Level 2(b), didactic but clinically integrated activities; and Level 3, didactic, classroom or standalone teaching. Summary All health care professionals need to understand and implement the principles of EBM to improve care of their patients. Interactive and clinically integrated teaching and learning activities provide the basis for the best educational practice in this field. PMID:17173690

Focal plane infrared readout circuit with automatic background suppression

NASA Technical Reports Server (NTRS)

Pain, Bedabrata (Inventor); Yang, Guang (Inventor); Sun, Chao (Inventor); Shaw, Timothy J. (Inventor); Wrigley, Chris J. (Inventor)

2002-01-01

A circuit for reading out a signal from an infrared detector includes a current-mode background-signal subtracting circuit having a current memory which can be enabled to sample and store a dark level signal from the infrared detector during a calibration phase. The signal stored by the current memory is subtracted from a signal received from the infrared detector during an imaging phase. The circuit also includes a buffered direct injection input circuit and a differential voltage readout section. By performing most of the background signal estimation and subtraction in a current mode, a low gain can be provided by the buffered direct injection input circuit to keep the gain of the background signal relatively small, while a higher gain is provided by the differential voltage readout circuit. An array of such readout circuits can be used in an imager having an array of infrared detectors. The readout circuits can provide a high effective handling capacity.

Impact of Alternative Medical Device Approval Processes on Costs and Health

PubMed Central

George, Benjamin P.; Venkataraman, Vinayak; Dorsey, E. Ray

2014-01-01

Background Medical devices are often introduced prior to randomized‐trial evidence of efficacy and this slows completion of trials. Alternative regulatory approaches include restricting device use outside of trials prior to trial evidence of efficacy (like the drug approval process) or restricting out‐of‐trial use but permitting coverage within trials such as Medicare's Coverage with Study Participation (CSP). Methods We compared the financial impact to manufacturers and insurers of three regulatory alternatives: (1) limited regulation (current approach), (2) CSP, and (3) restrictive regulation (like the current drug approval process). Using data for patent foramen ovale closure devices, we modeled key parameters including recruitment time, probability of device efficacy, market adoption, and device cost/price to calculate profits to manufacturers, costs to insurers, and overall societal impact on health. Results For manufacturers, profits were greatest under CSP—driven by faster market adoption of effective devices—followed by restrictive regulation. Societal health benefit in total quality‐adjusted life years was greatest under CSP. Insurers’ expenditures for ineffective devices were greatest with limited regulation. Findings were robust over a reasonable range of probabilities of trial success. Conclusions Regulation restricting out‐of‐trial device use and extending limited insurance coverage to clinical trial participants may balance manufacturer and societal interests. PMID:25185975

A single-blind trial of reflexology for irritable bowel syndrome.

PubMed Central

Tovey, Philip

2002-01-01

BACKGROUND: Irritable bowel syndrome (IBS) is a significant problem for primary care, as treatment options are limited and it can frequently develop into a chronic condition. Complementary and alternative medicine, including reflexology, is being turned to increasingly in an attempt to manage symptoms. There are currently no studies which address the effectiveness of reflexology for IBS. Despite this, it continues to be advocated and used. AIM: To provide the first evidence on the effectiveness of reflexology in the management of the core defining symptoms of IBS. DESIGN OF STUDY: A single-blind trial carried out in primary care settings. SETTING: Thirty-four participants diagnosed with IBS on the basis of the Rome Criteria. METHOD: Participants were allocated to receive either a reflexology foot massage or a non-reflexology foot massage control group. RESULTS: On none of the three symptoms monitored--abdominal pain, constipation/diarrhoea, and abdominal distention--was there a statistically or clinically significant difference between reflexology and control groups. CONCLUSION: On the basis of these results there is nothing to suggest that reflexology produces any specific benefit for patients with IBS. There is currently no evidence to support its use. However this was one (relatively) small scale study; further research that, for example, assesses the impact of therapist (professional and lay) versus therapy, is still needed. PMID:11791811

Evaluating the professional libraries of practicing physical therapists

PubMed Central

Brown, Suzanne R.; Roush, James R.; Lamkin, Alyson R.; Perrakis, Rena; Kronenfeld, Michael R.

2007-01-01

Background and Purpose: The primary objective of this study was to explore the use of information resources by a sample of physical therapists. Methods: A qualitatively designed study using structured individual interviews, examination of professional libraries, and identification of information resources was initiated in three sites (Southern California, Arizona, and Georgia). Participants included forty physical therapists with between five and twenty years of experience. Results: The Internet and continuing education activities appeared to be the primary information sources for the physical therapists surveyed. The personal professional libraries of participants were limited in scope and contained titles copyrighted more than ten years ago. Access to peer-reviewed journals in the sample was limited primarily to those received as a benefit of professional association membership. Discussion and Conclusions: Participants did not maintain current print professional information resources. The majority of books in the personal and workplace professional libraries held copyrights dating from the time of the participants' enrollment in an entry-level physical therapy program. Medical librarians may play an important role in shifting physical therapy towards evidence-based practice by collaborating in professional development for this group. Physical therapy educators and professional leaders should support current public collections of physical therapy-related information resources to encourage the movement towards an evidence-based practice model in physical therapy. PMID:17252068

Added Sugars and Cardiovascular Disease Risk in Children

PubMed Central

Vos, Miriam B.; Kaar, Jill L.; Welsh, Jean A.; Van Horn, Linda V.; Feig, Daniel I.; Anderson, Cheryl A.M.; Patel, Mahesh J.; Munos, Jessica Cruz; Krebs, Nancy F.; Xanthakos, Stavra A.; Johnson, Rachel K.

2017-01-01

BACKGROUND Poor lifestyle behaviors are leading causes of preventable diseases globally. Added sugars contribute to a diet that is energy dense but nutrient poor and increase risk of developing obesity, cardiovascular disease, hypertension, obesity-related cancers, and dental caries. METHODS AND RESULTS For this American Heart Association scientific statement, the writing group reviewed and graded the current scientific evidence for studies examining the cardiovascular health effects of added sugars on children. The available literature was subdivided into 5 broad subareas: effects on blood pressure, lipids, insulin resistance and diabetes mellitus, nonalcoholic fatty liver disease, and obesity. CONCLUSIONS Associations between added sugars and increased cardiovascular disease risk factors among US children are present at levels far below current consumption levels. Strong evidence supports the association of added sugars with increased cardiovascular disease risk in children through increased energy intake, increased adiposity, and dyslipidemia. The committee found that it is reasonable to recommend that children consume ≤25 g (100 cal or ≈6 teaspoons) of added sugars per day and to avoid added sugars for children <2 years of age. Although added sugars most likely can be safely consumed in low amounts as part of a healthy diet, few children achieve such levels, making this an important public health target. PMID:27550974

Preventing Advanced Carious Lesions with Caries Atraumatic Restorative Technique.

PubMed

Byrd, Tammi O

2016-06-01

An alternative approach to controlling dental caries and preventing the associated pain, called atraumatic restorative technique (ART), is described for populations in need, where dental hygienists restore decayed teeth with glass ionomer restorations without prior removal of all decayed tooth structure. There are populations whose decay needs are not adequately being met within the current oral health care delivery system. These include those in poverty conditions, vulnerable children, and the elderly who are often in long-term care facilities without adequate resources or opportunities for traditional dentistry. ART provides a viable option for controlling caries and relieving the pain of untreated decay. The purpose of this article is to suggest that the evidence surrounding ART be viewed objectively and that dental hygienists, with additional education in this approach, can contribute to relieving the pain of untreated dental decay. Evidence suggests that teeth can be effectively restored with ART. Dental hygienists represent an appropriate workforce to provide ART with their current background and education combined plus a brief training program; it is suggested that dental hygiene educational programs include ART within the curriculum. Along with dental sealants and fluoride varnish application, ART can be an important component of a comprehensive preventive program to address the unmet needs of vulnerable populations. Copyright © 2016 Elsevier Inc. All rights reserved.

The American College of Preventive Medicine Policy Recommendations on Reducing and Preventing Firearm-Related Injuries and Deaths.

PubMed

Strong, Bethany L; Ballard, Sarah-Blythe; Braund, Wendy

2016-12-01

The American College of Preventive Medicine Policy Committee makes policy guidelines and recommendations on preventive medicine and public health topics for public health decision makers. After a review of the current evidence available in 2016, the College is providing a consensus-based set of policy recommendations designed to reduce firearm-related morbidity and mortality in the U.S. These guidelines address seven general areas pertaining to the public health threat posed by firearms: gun sales and background checks, assault weapons and high-capacity weapons, mental health, research funding, gun storage laws, and physician counseling. Copyright © 2016 American Journal of Preventive Medicine. All rights reserved.

Planck Cosmology, Planck Clusters, and What is to Come

NASA Astrophysics Data System (ADS)

Rozo, Eduardo

2015-08-01

Planck's view of the Cosmic Microwave Background (CMB) has ushered in a new era of precision cosmology. In the process, hints of tension with local universe cosmological probes have appeared, including not only tension between the CMB and local Hubble constant measurements, but between the CMB and Planck's own analysis of the SZ galaxy clusters discovered by Planck. We will discuss the state of cluster cosmology in light of these results, and comment on what is to come. Should these tensions continue to exist with ever future measurements of ever increasing precision, the current Planck results will stand as some of the first lines of evidence towards finally breaking the standard LCDM cosmological model!

Cognitive tutor: applied research in mathematics education.

PubMed

Ritter, Steven; Anderson, John R; Koedinger, Kenneth R; Corbett, Albert

2007-04-01

For 25 years, we have been working to build cognitive models of mathematics, which have become a basis for middle- and high-school curricula. We discuss the theoretical background of this approach and evidence that the resulting curricula are more effective than other approaches to instruction. We also discuss how embedding a well specified theory in our instructional software allows us to dynamically evaluate the effectiveness of our instruction at a more detailed level than was previously possible. The current widespread use of the software is allowing us to test hypotheses across large numbers of students. We believe that this will lead to new approaches both to understanding mathematical cognition and to improving instruction.

Power dissipation in the mixed metal-insulator state of self-heated VO2 single crystals and the effect of sliding domains

NASA Astrophysics Data System (ADS)

Fisher, B.; Patlagan, L.

2018-06-01

The mixed metal-insulator state in VO2 sets on within the current-controlled negative differential resistivity regime of I-V loops traced at ambient temperature. In this state, the stability of I(V) and/or spontaneous switching between initial and final steady states are governed by the load resistance RL in series with the sample. With increasing current (decreasing voltage), the power P = IV reaches a maximum (Pmax) and drops to a minimum (Pmin) along a path that depends on RL. For low enough RL, the ratio Pmax/Pmin may exceed by far the contrast in thermal emissivity from films of VO2 over the metal-insulator transition as reported in Kats et al. [Phys. Rev. X 3, 041004 (2013)]. The minimum is followed by a range of currents where the power increases with current. The return path overlaps the original path and continues towards backward switching. For a few samples, there is evidence from optical microscopy that the portion of the P(I) loop between Pmin and backward switching coincides with the range of currents where semiconducting domains slide within a metallic background. Damage induced in crystals by repeated I-V cycling suppresses domain sliding and flattens P(I) in the respective range of currents. This is consistent with the current dependent excess power dissipation being induced by the sliding domains.

The quality case for information technology in healthcare

PubMed Central

Bates, David W

2002-01-01

Background As described in the Institute of Medicine's Crossing the Quality Chasm report, the quality of health care in the U.S. today leaves much to be desired. Discussion One major opportunity for improving quality relates to increasing the use of information technology, or IT. Health care organizations currently invest less in IT than in any other information-intensive industry, and not surprisingly current systems are relatively primitive, compared with industries such as banking or aviation. Nonetheless, a number of organizations have demonstrated that quality can be substantially improved in a variety of ways if IT use is increased in ways that improve care. Specifically, computerization of processes that are error-prone and computerized decision support may substantially improve both efficiency and quality, as well as dramatically facilitate quality measurement. This report discusses the current levels of IT and quality in health care, how quality improvement and management are currently done, the evidence that more IT might be helpful, a vision of the future, and the barriers to getting there. Summary This report suggests that there are five key policy domains that need to be addressed: standards, incentives, security and confidentiality, professional involvement, and research, with financial incentives representing the single most important lever. PMID:12396233

Big bang nucleosynthesis, the CMB, and the origin of matter and space-time

NASA Astrophysics Data System (ADS)

Mathews, Grant J.; Gangopadhyay, Mayukh; Sasankan, Nishanth; Ichiki, Kiyotomo; Kajino, Toshitaka

2018-04-01

We summarize some applications of big bang nucleosythesis (BBN) and the cosmic microwave background (CMB) to constrain the first moments of the creation of matter in the universe. We review the basic elements of BBN and how it constraints physics of the radiation-dominated epoch. In particular, how the existence of higher dimensions impacts the cosmic expansion through the projection of curvature from the higher dimension in the "dark radiation" term. We summarize current constraints from BBN and the CMB on this brane-world dark radiation term. At the same time, the existence of extra dimensions during the earlier inflation impacts the tensor to scalar ratio and the running spectral index as measured in the CMB. We summarize how the constraints on inflation shift when embedded in higher dimensions. Finally, one expects that the universe was born out of a complicated multiverse landscape near the Planck time. In these moments the energy scale of superstrings was obtainable during the early moments of chaotic inflation. We summarize the quest for cosmological evidence of the birth of space-time out of the string theory landscape. We will explore the possibility that a superstring excitations may have made itself known via a coupling to the field of inflation. This may have left an imprint of "dips" in the power spectrum of temperature fluctuations in the cosmic microwave background. The identification of this particle as a superstring is possible because there may be evidence for different oscillator states of the same superstring that appear on different scales on the sky. It will be shown that from this imprint one can deduce the mass, number of oscillations, and coupling constant for the superstring. Although the evidence is marginal, this may constitute the first observation of a superstring in Nature.

Positron emission tomography (PET) and single photon emission computed tomography (SPECT) imaging of macrophages in large vessel vasculitis: Current status and future prospects.

PubMed

Jiemy, William Febry; Heeringa, Peter; Kamps, Jan A A M; van der Laken, Conny J; Slart, Riemer H J A; Brouwer, Elisabeth

2018-05-03

Macrophages are key players in the pathogenesis of large-vessel vasculitis (LVV) and may serve as a target for diagnostic imaging of LVV. The radiotracer, 18 F-FDG has proven to be useful in the diagnosis of giant cell arteritis (GCA), a form of LVV. Although uptake of 18 F-FDG is high in activated macrophages, it is not a specific radiotracer as its uptake is high in any proliferating cell and other activated immune cells resulting in high non-specific background radioactivity especially in aging and atherosclerotic vessels which dramatically lowers the diagnostic accuracy. Evidence also exists that the sensitivity of 18 F-FDG PET drops in patients upon glucocorticoid treatment. Therefore, there is a clinical need for more specific radiotracers in imaging GCA to improve diagnostic accuracy. Numerous clinically established and newly developed macrophage targeted radiotracers for oncological and inflammatory diseases can potentially be utilized for LVV imaging. These tracers are more target specific and therefore may provide lower background radioactivity, higher diagnostic accuracy and the ability to assess treatment effectiveness. However, current knowledge regarding macrophage subsets in LVV lesions is limited. Further understanding regarding macrophage subsets in vasculitis lesion is needed for better selection of tracers and new targets for tracer development. This review summarizes the development of macrophage targeted tracers in the last decade and the potential application of macrophage targeted tracers currently used in other inflammatory diseases in imaging LVV. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

An overview of systematic reviews of normal labor and delivery management

PubMed Central

Iravani, Mina; Janghorbani, Mohsen; Zarean, Elahe; Bahrami, Masoud

2015-01-01

Background: Despite the scientific and medical advances for management of complicated health issues, the current maternity care setting has increased risks for healthy women and their babies. The aim of this study was to conduct an overview of published systematic reviews on the interventions used most commonly for management of normal labor and delivery in the first stage of labor. Materials and Methods: The online databases through March 2013, limited to systematic reviews of clinical trials were searched. An updated search was performed in April 2014. Two reviewers independently assessed data inclusion, extraction, and quality of methodology. Results: Twenty-three reviews (16 Cochrane, 7 non-Cochrane), relating to the most common care practices for management of normal labor and delivery in the first stage of labor, were included. Evidence does not support routine enemas, routine perineal shaving, continuous electronic fetal heart rate monitoring, routine early amniotomy, and restriction of fluids and food during labor. Evidence supports continuity of midwifery care and support, encouragement to non-supine position, and freedom in movement throughout labor. There is insufficient evidence to support routine administration of intravenous fluids and antispasmodics during labor. More evidence is needed regarding delayed admission until active labor and use of partograph. Conclusions: Evidence-based maternity care emphasizes on the practices that increase safety for mother and baby. If policymakers and healthcare providers wish to promote obstetric care quality successfully, it is important that they implement evidence-based clinical practices in routine midwifery care. PMID:26120327

Evidence, Interpretation, and Persuasion: Instructional Decision Making at the District Central Office

ERIC Educational Resources Information Center

Coburn, Cynthia E.; Toure, Judith; Yamashita, Mika

2009-01-01

Background/Context: Calls for evidence-based decision making have become increasingly prominent on the educational landscape. School district central offices increasingly experience these demands. Yet there are few empirical studies of evidence use at the district level. Furthermore, research on evidence use among policy makers in noneducation…

An Empirical Model of Titan's Magnetic Environment During the Cassini Era: Evidence for Seasonal Variability

NASA Astrophysics Data System (ADS)

Simon, S.; Kabanovic, S.; Meeks, Z. C.; Neubauer, F. M.

2017-12-01

Based on the magnetic field data collected during the Cassini era, we construct an empirical model of the ambient magnetospheric field conditions along the orbit of Saturn's largest moon Titan. Observations from Cassini's close Titan flybys as well as 191 non-targeted crossings of Titan's orbit are taken into account. For each of these events we apply the classification technique of Simon et al. (2010) to categorize the ambient magnetospheric field as current sheet, lobe-like, magnetosheath, or an admixture of these regimes. Independent of Saturnian season, Titan's magnetic environment around noon local time is dominated by the perturbed fields of Saturn's broad magnetodisk current sheet. Only observations from the nightside magnetosphere reveal a slow, but steady change of the background field from southern lobe-type to northern lobe-type on a time scale of several years. This behavior is consistent with a continuous change in the curvature of the bowl-shaped magnetodisk current sheet over the course of the Saturnian year. We determine the occurrence rate of each magnetic environment category along Titan's orbit as a function of Saturnian season and local time.

Taking stock of current societal, political and academic stakeholders in the Canadian healthcare knowledge translation agenda

PubMed Central

Newton, Mandi S; Scott-Findlay, Shannon

2007-01-01

Background In the past 15 years, knowledge translation in healthcare has emerged as a multifaceted and complex agenda. Theoretical and polemical discussions, the development of a science to study and measure the effects of translating research evidence into healthcare, and the role of key stakeholders including academe, healthcare decision-makers, the public, and government funding bodies have brought scholarly, organizational, social, and political dimensions to the agenda. Objective This paper discusses the current knowledge translation agenda in Canadian healthcare and how elements in this agenda shape the discovery and translation of health knowledge. Discussion The current knowledge translation agenda in Canadian healthcare involves the influence of values, priorities, and people; stakes which greatly shape the discovery of research knowledge and how it is or is not instituted in healthcare delivery. As this agenda continues to take shape and direction, ensuring that it is accountable for its influences is essential and should be at the forefront of concern to the Canadian public and healthcare community. This transparency will allow for scrutiny, debate, and improvements in health knowledge discovery and health services delivery. PMID:17916256

Rationality versus reality: the challenges of evidence-based decision making for health policy makers

PubMed Central

2010-01-01

Background Current healthcare systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process. Discussion We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM) and evidence-based policy making (EBPM) because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence. Summary In this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial suggestions about how the EBDM/EBPM process can be improved. PMID:20504357

Undergraduate medical students’ perceptions, attitudes, and competencies in evidence-based medicine (EBM), and their understanding of EBM reality in Syria

PubMed Central

2012-01-01

Background Teaching evidence-based medicine (EBM) should be evaluated and guided by evidence of its own effectiveness. However, no data are available on adoption of EBM by Syrian undergraduate, postgraduate, or practicing physicians. In fact, the teaching of EBM in Syria is not yet a part of undergraduate medical curricula. The authors evaluated education of evidence-based medicine through a two-day intensive training course. Methods The authors evaluated education of evidence-based medicine through a two-day intensive training course that took place in 2011. The course included didactic lectures as well as interactive hands-on workshops on all topics of EBM. A comprehensive questionnaire, that included the Berlin questionnaire, was used to inspect medical students’ awareness of, attitudes toward, and competencies’ in EBM. Results According to students, problems facing proper EBM practice in Syria were the absence of the following: an EBM teaching module in medical school curriculum (94%), role models among professors and instructors (92%), a librarian (70%), institutional subscription to medical journals (94%), and sufficient IT hardware (58%). After the course, there was a statistically significant increase in medical students' perceived ability to go through steps of EBM, namely: formulating PICO questions (56.9%), searching for evidence (39.8%), appraising the evidence (27.3%), understanding statistics (48%), and applying evidence at point of care (34.1%). However, mean increase in Berlin scores after the course was 2.68, a non-statistically significant increase of 17.86%. Conclusion The road to a better EBM reality in Syria starts with teaching EBM in medical school and developing the proper environment to facilitate transforming current medical education and practice to an evidence-based standard in Syria. PMID:22882872

How Current Are Leading Evidence-Based Medical Textbooks? An Analytic Survey of Four Online Textbooks

PubMed Central

2012-01-01

Background The consistency of treatment recommendations of evidence-based medical textbooks with more recently published evidence has not been investigated to date. Inconsistencies could affect the quality of medical care. Objective To determine the frequency with which topics in leading online evidence-based medical textbooks report treatment recommendations consistent with more recently published research evidence. Methods Summarized treatment recommendations in 200 clinical topics (ie, disease states) covered in four evidence-based textbooks–UpToDate, Physicians’ Information Education Resource (PIER), DynaMed, and Best Practice–were compared with articles identified in an evidence rating service (McMaster Premium Literature Service, PLUS) since the date of the most recent topic updates in each textbook. Textbook treatment recommendations were compared with article results to determine if the articles provided different, new conclusions. From these findings, the proportion of topics which potentially require updating in each textbook was calculated. Results 478 clinical topics were assessed for inclusion to find 200 topics that were addressed by all four textbooks. The proportion of topics for which there was 1 or more recently published articles found in PLUS with evidence that differed from the textbooks’ treatment recommendations was 23% (95% CI 17-29%) for DynaMed, 52% (95% CI 45-59%) for UpToDate, 55% (95% CI 48-61%) for PIER, and 60% (95% CI 53-66%) for Best Practice (χ 2 3=65.3, P<.001). The time since the last update for each textbook averaged from 170 days (range 131-209) for DynaMed, to 488 days (range 423-554) for PIER (P<.001 across all textbooks). Conclusions In online evidence-based textbooks, the proportion of topics with potentially outdated treatment recommendations varies substantially. PMID:23220465

Performance, Facility Pressure Effects, and Stability Characterization Tests of NASA's Hall Effect Rocket with Magnetic Shielding Thruster

NASA Technical Reports Server (NTRS)

Kamhawi, Hani; Huang, Wensheng; Haag, Thomas; Yim, John; Herman, Daniel; Peterson, Peter Y.; Williams, George J.; Gilland, James; Hofer, Richard; Mikellides, Ioannis

2016-01-01

NASA's Hall Effect Rocket with Magnetic Shielding (HERMeS) 12.5 kW Technology Demonstration Unit-1 (TDU-1) has been the subject of extensive technology maturation in preparation for flight system development. Part of the technology maturation effort included experimental evaluation of the TDU-1 thruster with conducting and dielectric front pole cover materials in two different electrical configurations. A graphite front magnetic pole cover thruster configuration with the thruster body electrically tied to cathode, and an alumina front pole cover thruster configuration with the thruster body floating were evaluated. Both configurations were also evaluated at different facility background pressure conditions to evaluate background pressure effects on thruster operation. Performance characterization tests found that higher thruster performance was attained with the graphite front pole cover configuration with the thruster electrically tied to cathode. A total thrust efficiency of 68% and a total specific impulse of 2,820 s was demonstrated at a discharge voltage of 600 V and a discharge power of 12.5 kW. Thruster stability regimes were characterized with respect to the thruster discharge current oscillations and with maps of the discharge current-voltage-magnetic field (IVB). Analysis of TDU-1 discharge current waveforms found that lower normalized discharge current peak-to-peak and root mean square magnitudes were attained when the thruster was electrically floated with alumina front pole covers. Background pressure effects characterization tests indicated that the thruster performance and stability were mostly invariant to changes in the facility background pressure for vacuum chamber pressure below 1×10-5 Torr-Xe (for thruster flow rates of 20.5 mg/s). Power spectral density analysis of the discharge current waveforms showed that increasing the vacuum chamber background pressure resulted in a higher discharge current dominant breathing mode frequency. Finally, IVB maps of the TDU-1 thruster indicated that the discharge current became more oscillatory with higher discharge current peak-to-peak and RMS values with increased facility background pressure at lower thruster mass flow rates; thruster operation at higher flow rates resulted in less change to the thruster's IVB characteristics with elevated background pressure.

Electro-cortical implicit race bias does not vary with participants’ race or sex

PubMed Central

Mallan, Kimberley M.; Martin, Frances H.; Terry, Deborah J.; Smith, Joanne R.

2011-01-01

Earlier research found evidence for electro-cortical race bias towards black target faces in white American participants irrespective of the task relevance of race. The present study investigated whether an implicit race bias generalizes across cultural contexts and racial in- and out-groups. An Australian sample of 56 Chinese and Caucasian males and females completed four oddball tasks that required sex judgements for pictures of male and female Chinese and Caucasian posers. The nature of the background (across task) and of the deviant stimuli (within task) was fully counterbalanced. Event-related potentials (ERPs) to deviant stimuli recorded from three midline sites were quantified in terms of mean amplitude for four components: N1, P2, N2 and a late positive complex (LPC; 350–700 ms). Deviants that differed from the backgrounds in sex or race elicited enhanced LPC activity. These differences were not modulated by participant race or sex. The current results replicate earlier reports of effects of poser race relative to background race on the LPC component of the ERP waveform. In addition, they indicate that an implicit race bias occurs regardless of participant’s or poser’s race and is not confined to a particular cultural context. PMID:21097957

Science learning and literacy performance of typically developing, at-risk, and disabled, non-English language background students

NASA Astrophysics Data System (ADS)

Larrinaga McGee, Patria Maria

Current education reform calls for excellence, access, and equity in all areas of instruction, including science and literacy. Historically, persons of diverse backgrounds or with disabilities have been underrepresented in science. Gaps are evident between the science and literacy achievement of diverse students and their mainstream peers. The purpose of this study was to document, describe, and examine patterns of development and change in the science learning and literacy performance of Hispanic students. The two major questions of this study were: (1) How is science content knowledge, as evident in oral and written formats, manifested in the performance of typically developing, at-risk, and disabled non-English language background (NELB) students? and (2) What are the patterns of literacy performance in science, and as evident in oral and written formats, among typically developing, at-risk, and disabled NELB students? This case study was part of a larger research project, the Promise Project, undertaken at the University of Miami, Coral Gables, Florida, under the sponsorship of the National Science Foundation. The study involved 24 fourth-grade students in seven classrooms located in Promise Project schools where teachers were provided with training and materials for instruction on two units of science content: Matter and Weather. Four students were selected from among the fourth-graders for a closer analysis of their performance. Qualitative and quantitative data analysis methods were used to document, describe, and examine specific events or phenomena in the processes of science learning and literacy development. Important findings were related to (a) gains in science learning and literacy development, (b) students' science learning and literacy development needs, and (c) general and idiosyncratic attitudes toward science and literacy. Five patterns of science "explanations" identified indicated a developmental cognitive/linguistic trajectory in science learning. Students' learning needs appeared related to (a) depth of science knowledge, and (b) written communication in science. Students' performances and attitudes suggested a continuum of readiness for science inquiry. Differences in performances and attitudes revealed curricular, personal, social, cultural, cognitive, metacognitive, and linguistic aspects that could impact science learning and literacy development. Implications for instruction and assessment were discussed. Suggestions for further research were presented.

Excitation of O+ Band EMIC Waves Through H+ Ring Velocity Distributions: Van Allen Probe Observations

NASA Astrophysics Data System (ADS)

Yu, Xiongdong; Yuan, Zhigang; Huang, Shiyong; Yao, Fei; Wang, Dedong; Funsten, Herbert O.; Wygant, John R.

2018-02-01

A typical case of electromagnetic ion cyclotron (EMIC) emissions with both He+ band and O+ band waves was observed by Van Allen Probe A on 14 July 2014. These emissions occurred in the morning sector on the equator inside the plasmasphere, in which region O+ band EMIC waves prefer to appear. Through property analysis of these emissions, it is found that the He+ band EMIC waves are linearly polarized and propagating quasi-parallelly along the background magnetic field, while the O+ band ones are of linear and left-hand polarization and propagating obliquely with respect to the background magnetic field. Using the in situ observations of plasma environment and particle data, excitation of these O+ band EMIC waves has been investigated with the linear growth theory. The calculated linear growth rate shows that these O+ band EMIC waves can be locally excited by ring current protons with ring velocity distributions. The comparison of the observed wave spectral intensity and the calculated growth rate suggests that the density of H+ rings providing the free energy for the instability has decreased after the wave grows. Therefore, this paper provides a direct observational evidence to the excitation mechanism of O+ band EMIC waves: ring current protons with ring distributions provide the free energy supporting the instability in the presence of rich O+ in the plasmasphere.

Truth in research labelling.

PubMed

Noble, John H

2017-01-01

This report describes the background and context of a currently circulating petition to the US Congress that seeks amendment of Section 801 of the Public Health Services Act (42 U.S.C. 282) to close a loophole in existing law which makes possible post hoc adjustment of randomised controlled trial (RCT) results reported to the Food and Drug Administration that differ from those reported to ClinicalTrials.gov and to medical journals. The report describes the petition's rationale, underlying assumptions, and support for its proposed remedy in deontological, consequentialist, and casuist philosophical ethics theories. It addresses the several reservations of the World Association of Medical Editors (WAME) with citations of evidence for the petition's assertions. The report suggests that some medical journals are not unknowing victims but rather complicit enablers of the post hoc adjusted RCT results that they publish. Its closing remarks dwell on the negative impact that embrace of a neoliberal, anti-regulatory philosophy of government will likely have on any regulatory reform to promote the integrity of biomedical science and the future of evidence-based medicine.

Informed consent for MRI and fMRI research: Analysis of a sample of Canadian consent documents

PubMed Central

2011-01-01

Background Research ethics and the measures deployed to ensure ethical oversight of research (e.g., informed consent forms, ethics review) are vested with extremely important ethical and practical goals. Accordingly, these measures need to function effectively in real-world research and to follow high level standards. Methods We examined approved consent forms for Magnetic Resonance Imaging (MRI) and functional Magnetic Resonance Imaging (fMRI) studies approved by Canadian research ethics boards (REBs). Results We found evidence of variability in consent forms in matters of physical and psychological risk reporting. Approaches used to tackle the emerging issue of incidental findings exposed extensive variability between and within research sites. Conclusion The causes of variability in approved consent forms and studies need to be better understood. However, mounting evidence of administrative and practical hurdles within current ethics governance systems combined with potential sub-optimal provision of information to and protection of research subjects support other calls for more scrutiny of research ethics practices and applicable revisions. PMID:21235768

Analysis of trace fibers by IR-MALDESI imaging coupled with high resolving power MS

PubMed Central

Cochran, Kristin H.; Barry, Jeremy A.; Robichaud, Guillaume

2016-01-01

Trace evidence is a significant portion of forensic cases. Textile fibers are a common form of trace evidence that are gaining importance in criminal cases. Currently, qualitative techniques that do not yield structural information are primarily used for fiber analysis, but mass spectrometry is gaining an increasing role in this field. Mass spectrometry yields more quantitative structural information about the dye and polymer that can be used for more conclusive comparisons. Matrix-assisted laser desorption electrospray ionization (MALDESI) is a hybrid ambient ionization source being investigated for use in mass spectrometric fiber analysis. In this manuscript, IR-MALDESI was used as a source for mass spectrometry imaging (MSI) of a dyed nylon fiber cluster and single fiber. Information about the fiber polymer as well as the dye were obtained from a single fiber which was on the order of 10 μm in diameter. These experiments were performed directly from the surface of a tape lift of the fiber with a background of extraneous fibers. PMID:25081013

Analysis of trace fibers by IR-MALDESI imaging coupled with high resolving power MS.

PubMed

Cochran, Kristin H; Barry, Jeremy A; Robichaud, Guillaume; Muddiman, David C

2015-01-01

Trace evidence is a significant portion of forensic cases. Textile fibers are a common form of trace evidence that are gaining importance in criminal cases. Currently, qualitative techniques that do not yield structural information are primarily used for fiber analysis, but mass spectrometry is gaining an increasing role in this field. Mass spectrometry yields more quantitative structural information about the dye and polymer that can be used for more conclusive comparisons. Matrix-assisted laser desorption electrospray ionization (MALDESI) is a hybrid ambient ionization source being investigated for use in mass spectrometric fiber analysis. In this manuscript, IR-MALDESI was used as a source for mass spectrometry imaging (MSI) of a dyed nylon fiber cluster and single fiber. Information about the fiber polymer as well as the dye were obtained from a single fiber which was on the order of 10 μm in diameter. These experiments were performed directly from the surface of a tape lift of the fiber with a background of extraneous fibers.

Oral Anticoagulant Therapy

PubMed Central

Gallus, Alexander S.; Wittkowsky, Ann; Crowther, Mark; Hylek, Elaine M.; Palareti, Gualtiero

2012-01-01

Background: The objective of this article is to summarize the published literature concerning the pharmacokinetics and pharmacodynamics of oral anticoagulant drugs that are currently available for clinical use and other aspects related to their management. Methods: We carried out a standard review of published articles focusing on the laboratory and clinical characteristics of the vitamin K antagonists; the direct thrombin inhibitor, dabigatran etexilate; and the direct factor Xa inhibitor, rivaroxaban Results: The antithrombotic effect of each oral anticoagulant drug, the interactions, and the monitoring of anticoagulation intensity are described in detail and discussed without providing specific recommendations. Moreover, we describe and discuss the clinical applications and optimal dosages of oral anticoagulant therapies, practical issues related to their initiation and monitoring, adverse events such as bleeding and other potential side effects, and available strategies for reversal. Conclusions: There is a large amount of evidence on laboratory and clinical characteristics of vitamin K antagonists. A growing body of evidence is becoming available on the first new oral anticoagulant drugs available for clinical use, dabigatran and rivaroxaban. PMID:22315269

Association between smoking status and the parameters of vascular structure and function in adults: results from the EVIDENT study

PubMed Central

2013-01-01

Background The present study analyses the relation between smoking status and the parameters used to assess vascular structure and function. Methods This cross-sectional, multi-centre study involved a random sample of 1553 participants from the EVIDENT study. Measurements: The smoking status, peripheral augmentation index and ankle-brachial index were measured in all participants. In a small subset of the main population (265 participants), the carotid intima-media thickness and pulse wave velocity were also measured. Results After controlling for the effect of age, sex and other risk factors, present smokers have higher values of carotid intima-media thickness (p = 0.011). Along the same lines, current smokers have higher values of pulse wave velocity and lower mean values of ankle-brachial index but without statistical significance in both cases. Conclusions Among the parameters of vascular structure and function analysed, only the IMT shows association with the smoking status, after adjusting for confounders. PMID:24289208

Current and future health care professionals attitudes toward and knowledge of statistics: How confidence influences learning

PubMed Central

Baghi, Heibatollah; Kornides, Melanie L.

2014-01-01

Background Health care professionals require some understanding of statistics to successfully implement evidence based practice. Developing competency in statistical reasoning is necessary for students training in health care administration, research, and clinical care. Recently, the interest in healthcare professional's attitudes toward statistics has increased substantially due to evidence that these attitudes can hinder professionalism developing an understanding of statistical concepts. Methods In this study, we analyzed pre- and post-instruction attitudes towards and knowledge of statistics obtained from health science graduate students, including nurses and nurse practitioners, enrolled in an introductory graduate course in statistics (n = 165). Results and Conclusions Results show that the students already held generally positive attitudes toward statistics at the beginning of course. However, these attitudes—along with the students’ statistical proficiency—improved after 10 weeks of instruction. The results have implications for curriculum design and delivery methods as well as for health professionals’ effective use of statistics in critically evaluating and utilizing research in their practices. PMID:25419256

Advancing the evidence base in cancer: psychosocial multicenter trials

PubMed Central

2012-01-01

Background The diagnosis and treatment of cancer is associated with significant distress and psychosocial morbidity. Although psychosocial interventions have been developed in an attempt to improve psychosocial outcomes in cancer patients and survivors, there is continued debate about whether there is adequate high-level evidence to establish the effectiveness of these interventions. The evidence base is limited as a result of numerous challenges faced by those attempting to conduct psychosocial intervention trials within the health system. Barriers include insufficient participant recruitment, difficulty generalizing from single-trial studies, difficulty in building and managing research teams with multidisciplinary expertise, lack of research design expertise and a lack of incentives for researchers conducting intervention research. To strengthen the evidence base, more intervention studies employing methodologically rigorous research designs are necessary. Methods In order to advance the evidence base of interventions designed to improve psychosocial outcomes for cancer patients and survivors, we propose the formation of a collaborative trials group that conducts multicenter trials to test the effectiveness of such interventions. Results Establishment of such a group would improve the quality of the evidence base in psychosocial research in cancer patients, by increasing support for conducting intervention research and providing intervention research training opportunities. A multidisciplinary collaborative group conducting multicenter trials would have the capacity to overcome many of the barriers that currently exist. Conclusions A stronger evidence base is necessary to identify effective psychosocial interventions for cancer patients. The proposed formation of a psycho-oncology collaborative trials group that conducts multicenter trials to test the effectiveness of psychosocial interventions would assist in achieving this outcome. PMID:22992443

Social Media and Mobile Apps for Health Promotion in Australian Indigenous Populations: Scoping Review

PubMed Central

Brusse, Carl; McAullay, Daniel; Dowden, Michelle

2014-01-01

Background Health promotion organizations are increasingly embracing social media technologies to engage end users in a more interactive way and to widely disseminate their messages with the aim of improving health outcomes. However, such technologies are still in their early stages of development and, thus, evidence of their efficacy is limited. Objective The study aimed to provide a current overview of the evidence surrounding consumer-use social media and mobile software apps for health promotion interventions, with a particular focus on the Australian context and on health promotion targeted toward an Indigenous audience. Specifically, our research questions were: (1) What is the peer-reviewed evidence of benefit for social media and mobile technologies used in health promotion, intervention, self-management, and health service delivery, with regard to smoking cessation, sexual health, and otitis media? and (2) What social media and mobile software have been used in Indigenous-focused health promotion interventions in Australia with respect to smoking cessation, sexual health, or otitis media, and what is the evidence of their effectiveness and benefit? Methods We conducted a scoping study of peer-reviewed evidence for the effectiveness of social media and mobile technologies in health promotion (globally) with respect to smoking cessation, sexual health, and otitis media. A scoping review was also conducted for Australian uses of social media to reach Indigenous Australians and mobile apps produced by Australian health bodies, again with respect to these three areas. Results The review identified 17 intervention studies and seven systematic reviews that met inclusion criteria, which showed limited evidence of benefit from these interventions. We also found five Australian projects with significant social media health components targeting the Indigenous Australian population for health promotion purposes, and four mobile software apps that met inclusion criteria. No evidence of benefit was found for these projects. Conclusions Although social media technologies have the unique capacity to reach Indigenous Australians as well as other underserved populations because of their wide and instant disseminability, evidence of their capacity to do so is limited. Current interventions are neither evidence-based nor widely adopted. Health promotion organizations need to gain a more thorough understanding of their technologies, who engages with them, why they engage with them, and how, in order to be able to create successful social media projects. PMID:25498835

Identification of Rural-Background Applicants by the Talent Identification Program of WHAHEC

ERIC Educational Resources Information Center

Calkins, E. Virginia; And Others

1978-01-01

The Talent Identification Program identifies, motivates, and assists high school juniors and seniors with disadvantaged backgrounds who have potential for careers in the health sciences. The policy of assistance in applying and preparing for medical school is in accordance with evidence that rural-background students are more likely to practice…

Cannabis use and incidence of testicular cancer: a 42-year follow-up of Swedish men between 1970 and 2011

PubMed Central

Callaghan, Russell C.; Allebeck, Peter; Akre, Olof; McGlynn, Katherine A.; Sidorchuk, Anna

2018-01-01

Background Given current drug-policy reforms to decriminalize or legalize cannabis in numerous countries worldwide, it is critically important to understand the potential impacts of cannabis use on the development of cancer. The current study aims to assess the relation between cannabis use and the development of testicular cancer. Method The current study relied on a population-based sample (n = 49 343) of young men aged 18–21 years who underwent conscription assessment for Swedish military service in 1969–1970. The conscription process included a non-anonymous questionnaire eliciting information about drug use. Individual-level conscription information was linked to Swedish health and social registry data. Testicular cancers diagnosed between 1970 and 2011 were identified by ICD-7/8/9/10 testicular cancer codes in the Swedish National Patient Register, the Cancer Register, or the Cause of Death Register. Cox regression modeling was used to estimate the hazards associated with cannabis use and time to diagnosis of testicular cancer. Results No evidence was found of a significant relation between lifetime “ever” cannabis use and the subsequent development of testicular cancer [n = 45 250; 119 testicular cancer cases; adjusted hazard ratio (AHR) 1.42, 95% CI, 0.83, 2.45]. “Heavy” cannabis use (defined as usage of more than 50 times in lifetime, as measured at conscription) was associated with the incidence of testicular cancer (n = 45 250; 119 testicular cancer cases; AHR 2.57, 95% CI, 1.02, 6.50). Conclusion The current study provides additional evidence to the limited prior literature suggesting cannabis use may contribute to the development of testicular cancer. PMID:29093004

Shift work and chronic disease: the epidemiological evidence

PubMed Central

Armstrong, M. E. G.; Cairns, B. J.; Key, T. J.; Travis, R. C.

2011-01-01

Background Shift work, including night work, has been hypothesized to increase the risk of chronic diseases, including cancer, cardiovascular disease (CVD), metabolic syndrome and diabetes. Recent reviews of evidence relating to these hypotheses have focussed on specific diseases or potential mechanisms, but no general summary of the current data on shift work and chronic disease has been published. Methods Systematic and critical reviews and recent original studies indexed in PubMed prior to 31 December 2009 were retrieved, aided by manual searches of reference lists. The main conclusions from reviews and principle results from recent studies are presented in text and tables. Results Published evidence is suggestive but not conclusive for an adverse association between night work and breast cancer but limited and inconsistent for cancers at other sites and all cancers combined. Findings on shift work, in relation to risks of CVD, metabolic syndrome and diabetes are also suggestive but not conclusive for an adverse relationship. Conclusions Heterogeneity of study exposures and outcomes and emphasis on positive but non-significant results make it difficult to draw general conclusions. Further data are needed for additional disease endpoints and study populations. PMID:21355031

Patch testing with rubber series in Europe: a critical review and recommendation.

PubMed

Warburton, Katharine L; Uter, Wolfgang; Geier, Johannes; Spiewak, Radoslaw; Mahler, Vera; Crépy, Marie-Noëlle; Schuttelaar, Marie Louise; Bauer, Andrea; Wilkinson, Mark

2017-04-01

Rubber additives constitute an important group of contact allergens, particularly in certain occupations. To collect information regarding the current practice of using a 'rubber series' in Europe, and discuss this against the background of evidence concerning the prevalence of allergy in order to derive a recommendation for a 'European rubber series'. The following were performed: (i) a survey targeting all members of the COST action 'StanDerm' consortium, (ii) analysis of rubber contact allergy data in the database of the European Surveillance System on Contact Allergies, and (iii) a literature review. Information from 13 countries was available, from one or several departments of dermatology, and occasionally occupational health. Apart from some substances tested only in single departments, a broad overlap regarding important allergens was evident, but considerable variation existed between departments. An up-to-date 'European rubber series' is recommended, with the exclusion of substances only of historical concern. A 'supplementary rubber series' containing allergens of less proven importance, requiring further analysis, is recommended for departments specializing in occupational contact allergy. These should be continually updated as new evidence emerges. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Neuroplasticity of selective attention: Research foundations and preliminary evidence for a gene by intervention interaction

PubMed Central

Stevens, Courtney; Pakulak, Eric; Hampton Wray, Amanda; Bell, Theodore A.; Neville, Helen J.

2017-01-01

This article reviews the trajectory of our research program on selective attention, which has moved from basic research on the neural processes underlying selective attention to translational studies using selective attention as a neurobiological target for evidence-based interventions. We use this background to present a promising preliminary investigation of how genetic and experiential factors interact during development (i.e., gene × intervention interactions). Our findings provide evidence on how exposure to a family-based training can modify the associations between genotype (5-HTTLPR) and the neural mechanisms of selective attention in preschool children from lower socioeconomic status backgrounds. PMID:28819066

Neuroplasticity of selective attention: Research foundations and preliminary evidence for a gene by intervention interaction.

PubMed

Isbell, Elif; Stevens, Courtney; Pakulak, Eric; Hampton Wray, Amanda; Bell, Theodore A; Neville, Helen J

2017-08-29

This article reviews the trajectory of our research program on selective attention, which has moved from basic research on the neural processes underlying selective attention to translational studies using selective attention as a neurobiological target for evidence-based interventions. We use this background to present a promising preliminary investigation of how genetic and experiential factors interact during development (i.e., gene × intervention interactions). Our findings provide evidence on how exposure to a family-based training can modify the associations between genotype (5-HTTLPR) and the neural mechanisms of selective attention in preschool children from lower socioeconomic status backgrounds.

Neutral Details Associated with Emotional Events are Encoded: Evidence from a Cued Recall Paradigm

PubMed Central

Steinmetz, Katherine R. Mickley; Knight, Aubrey G.; Kensinger, Elizabeth A.

2015-01-01

Enhanced emotional memory often comes at the cost of memory for surrounding background information. Narrowed-encoding theories suggest that this is due to narrowed attention for emotional information at encoding, leading to impaired encoding of background information. Recent work has suggested that an encoding-based theory may be insufficient. Here, we examined whether cued recall – instead of previously used recognition memory tasks - would reveal evidence that non-emotional information associated with emotional information was effectively encoded. Participants encoded positive, negative, or neutral objects on neutral backgrounds. At retrieval, they were given either the item or the background as a memory cue and were asked to recall the associated scene element. Counter to narrowed-encoding theories, emotional items were more likely than neutral items to trigger recall of the associated background. This finding suggests that there is a memory trace of this contextual information and that emotional cues may facilitate retrieval of this information. PMID:26220708

Novelty's effect on memory encoding.

PubMed

Rangel-Gomez, Mauricio; Janenaite, Sigita; Meeter, Martijn

2015-07-01

It is often thought that novelty benefits memory formation. However, support for this idea mostly comes from paradigms that are open to alternative explanations. In the present study we manipulated novelty in a word-learning task through task-irrelevant background images. These background images were either standard (presented repeatedly), or novel (presented only once). Two types of background images were used: Landscape pictures and fractals. EEG was also recorded during encoding. Contrary to the idea that novelty aids memory formation, memory performance was not affected by the novelty of the background. In the evoked response potentials, we found evidence of distracting effects of novelty: both the N1 and P3b components were smaller to words studied with novel backgrounds, and the amplitude of the N2b component correlated negatively with subsequent retrieval. We conclude that although evidence from other studies does suggest benefits on a longer time scale, novelty has no instantaneous benefits for learning. Copyright © 2015 Elsevier B.V. All rights reserved.

Orientation and mobility training for adults with low vision: a new standardized approach

PubMed Central

Ballemans, Judith; Kempen, Gertrudis IJM

2013-01-01

Background: Orientation and mobility training aims to facilitate independent functioning and participation in the community of people with low vision. Objective: (1) To gain insight into current practice regarding orientation and mobility training, and (2) to develop a theory-driven standardized version of this training to teach people with low vision how to orientate and be safe in terms of mobility. Study of current practice: Insight into current practice and its strengths and weaknesses was obtained via reviewing the literature, observing orientation and mobility training sessions (n = 5) and interviewing Dutch mobility trainers (n = 18). Current practice was mainly characterized by an individual, face-to-face orientation and mobility training session concerning three components: crystallizing client’s needs, providing information and training skills. A weakness was the lack of a (structured) protocol based on evidence or theory. New theory-driven training: A new training protocol comprising two face-to-face sessions and one telephone follow-up was developed. Its content is partly based on the components of current practice, yet techniques from theoretical frameworks (e.g. social-cognitive theory and self-management) are incorporated. Discussion: A standardized, tailor-made orientation and mobility training for using the identification cane is available. The new theory-driven standardized training is generally applicable for teaching the use of every low-vision device. Its acceptability and effectiveness are currently being evaluated in a randomized controlled trial. PMID:22734105

Diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand, and the United States: a method for systematic review of studies with different designs

PubMed Central

2011-01-01

Background Diabetes in pregnancy, which includes gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM), is associated with poor outcomes for both mother and infant during pregnancy, at birth and in the longer term. Recent international guidelines recommend changes to the current GDM screening criteria. While some controversy remains, there appears to be consensus that women at high risk of T2DM, including indigenous women, should be offered screening for GDM early in pregnancy, rather than waiting until 24-28 weeks as is current practice. A range of criteria should be considered before changing screening practice in a population sub-group, including: prevalence, current practice, acceptability and whether adequate treatment pathways and follow-up systems are available. There are also specific issues related to screening in pregnancy and indigenous populations. The evidence that these criteria are met for indigenous populations is yet to be reported. A range of study designs can be considered to generate relevant evidence for these issues, including epidemiological, observational, qualitative, and intervention studies, which are not usually included within a single systematic review. The aim of this paper is to describe the methods we used to systematically review studies of different designs and present the evidence in a pragmatic format for policy discussion. Methods/Design The inclusion criteria will be broad to ensure inclusion of the critical perspectives of indigenous women. Abstracts of the search results will be reviewed by two persons; the full texts of all potentially eligible papers will be reviewed by one person, and 10% will be checked by a second person for validation. Data extraction will be standardised, using existing tools to identify risks for bias in intervention, measurement, qualitative studies and reviews; and adapting criteria for appraising risk for bias in descriptive studies. External validity (generalisability) will also be appraised. The main findings will be synthesised according to the criteria for population-based screening and summarised in an adapted "GRADE" tool. Discussion This will be the first systematic review of all the published literature on diabetes in pregnancy among indigenous women. The method provides a pragmatic approach for synthesizing relevant evidence from a range of study designs to inform the current policy discussion. PMID:22196083

AN UPDATE FOR THE CONSERVATIVE MANAGEMENT OF PATELLOFEMORAL PAIN SYNDROME: A SYSTEMATIC REVIEW OF THE LITERATURE FROM 2000 TO 2010

PubMed Central

Boling, Michelle C.

2011-01-01

Purpose/Background: Patellofemoral pain syndrome (PFPS) is one of the most common and clinically challenging knee pathologies. Historically, clinicians have used a myriad of interventions, many of which have benefited some but not all patients. Suboptimal outcomes may reflect the need for an evidence-based approach for the treatment of PFPS. The authors believe that integrating clinical expertise with the most current scientific data will enhance clinical practice. The purpose of this systematic review is to provide an update on the evidence for the conservative treatment of PFPS. Methods: The PubMed, CINAHL, and SPORTDiscus databases were searched for studies published between January 1, 2000 and December 31, 2010. Studies used were any that utilized interventions lasting a minimum of 4 weeks for subjects with PFPS. Data were examined for subject sample, intervention duration, intervention type, and pain outcomes. Results: General quadriceps strengthening continues to reduce pain in patients with PFPS. Data are inconclusive regarding the use of patellar taping, patellar bracing, knee bracing, and foot orthosis. Although emerging data suggest the importance of hip strengthening exercise, ongoing investigations are needed to better understand its effect on PFPS. Conclusions: Current evidence supports the continued use of quadriceps exercise for the conservative management of PFPS. However, inconsistent or limited data regarding the other interventions precluded the authors' ability to make conclusive recommendations about their use. Future investigations should focus on identifying cohorts of patients with PFPS who may benefit from the other treatment approaches included in this systematic review. PMID:21713229

Plant protein and animal proteins: do they differentially affect cardiovascular disease risk?

PubMed

Richter, Chesney K; Skulas-Ray, Ann C; Champagne, Catherine M; Kris-Etherton, Penny M

2015-11-01

Proteins from plant-based compared with animal-based food sources may have different effects on cardiovascular disease (CVD) risk factors. Numerous epidemiologic and intervention studies have evaluated their respective health benefits; however, it is difficult to isolate the role of plant or animal protein on CVD risk. This review evaluates the current evidence from observational and intervention studies, focusing on the specific protein-providing foods and populations studied. Dietary protein is derived from many food sources, and each provides a different composite of nonprotein compounds that can also affect CVD risk factors. Increasing the consumption of protein-rich foods also typically results in lower intakes of other nutrients, which may simultaneously influence outcomes. Given these complexities, blanket statements about plant or animal protein may be too general, and greater consideration of the specific protein food sources and the background diet is required. The potential mechanisms responsible for any specific effects of plant and animal protein are similarly multifaceted and include the amino acid content of particular foods, contributions from other nonprotein compounds provided concomitantly by the whole food, and interactions with the gut microbiome. Evidence to date is inconclusive, and additional studies are needed to further advance our understanding of the complexity of plant protein vs. animal protein comparisons. Nonetheless, current evidence supports the idea that CVD risk can be reduced by a dietary pattern that provides more plant sources of protein compared with the typical American diet and also includes animal-based protein foods that are unprocessed and low in saturated fat. © 2015 American Society for Nutrition.

Plant Protein and Animal Proteins: Do They Differentially Affect Cardiovascular Disease Risk?12

PubMed Central

Richter, Chesney K; Skulas-Ray, Ann C; Champagne, Catherine M; Kris-Etherton, Penny M

2015-01-01

Proteins from plant-based compared with animal-based food sources may have different effects on cardiovascular disease (CVD) risk factors. Numerous epidemiologic and intervention studies have evaluated their respective health benefits; however, it is difficult to isolate the role of plant or animal protein on CVD risk. This review evaluates the current evidence from observational and intervention studies, focusing on the specific protein-providing foods and populations studied. Dietary protein is derived from many food sources, and each provides a different composite of nonprotein compounds that can also affect CVD risk factors. Increasing the consumption of protein-rich foods also typically results in lower intakes of other nutrients, which may simultaneously influence outcomes. Given these complexities, blanket statements about plant or animal protein may be too general, and greater consideration of the specific protein food sources and the background diet is required. The potential mechanisms responsible for any specific effects of plant and animal protein are similarly multifaceted and include the amino acid content of particular foods, contributions from other nonprotein compounds provided concomitantly by the whole food, and interactions with the gut microbiome. Evidence to date is inconclusive, and additional studies are needed to further advance our understanding of the complexity of plant protein vs. animal protein comparisons. Nonetheless, current evidence supports the idea that CVD risk can be reduced by a dietary pattern that provides more plant sources of protein compared with the typical American diet and also includes animal-based protein foods that are unprocessed and low in saturated fat. PMID:26567196

Modeling the Impact of Smoking Cessation Treatment Policies on Quit Rates

PubMed Central

Levy, David T.; Graham, Amanda L.; Mabry, Patricia L.; Abrams, David B.; Orleans, C. Tracy

2010-01-01

Background: Smoking cessation treatment policies could yield substantial increases in adult quit rates in the U.S. Purpose: The goals of this paper are to model the effects of individual cessation treatment policies on population quit rates, and to illustrate the potential benefits of combining policies to leverage their synergistic effects. Methods: A mathematical model is updated to examine the impact of five cessation treatment policies on quit attempts, treatment use, and treatment effectiveness. Policies include: (1) Expand cessation treatment coverage and provider reimbursement; (2) Mandate adequate funding for the use and promotion of evidence-based state-sponsored telephone quitlines; (3) Support healthcare systems changes to prompt, guide, and incentivize tobacco treatment; (4) Support and promote evidence-based treatment via the Internet; and (5) Improve individually tailored, stepped care approaches and the long-term effectiveness of evidence-based treatments. Results: The annual baseline population quit rate is 4.3% of all current smokers. Implementing any policy in isolation is projected to make the quit rate increase to between 4.5% and 6%. By implementing all five policies in combination, the quit rate is projected to increase to 10.9%, or 2.5 times the baseline rate. Conclusions: If fully implemented in a coordinated fashion, cessation treatment policies could reduce smoking prevalence from its current rate of 20.5% to 17.2% within 1 year. By modeling the policy impacts on the components of the population quit rate (quit attempts, treatment use, treatment effectiveness), key indicators are identified to analyze in improving the effect of cessation treatment policies. PMID:20176309

Evolutionary dynamics of Enterococcus faecium reveals complex genomic relationships between isolates with independent emergence of vancomycin resistance

PubMed Central

Ip, Camilla L. C.; Ansari, M. Azim; Wilson, Daniel J.; Espedido, Bjorn A.; Jensen, Slade O.; Bowden, Rory

2016-01-01

Enterococcus faecium, a major cause of hospital-acquired infections, remains problematic because of its propensity to acquire resistance to vancomycin, which currently is considered first-line therapy. Here, we assess the evolution and resistance acquisition dynamics of E. faecium in a clinical context using a series of 132 bloodstream infection isolates from a single hospital. All isolates, of which 49 (37 %) were vancomycin-resistant, underwent whole-genome sequencing. E. faecium was found to be subject to high rates of recombination with little evidence of sequence importation from outside the local E. faecium population. Apart from disrupting phylogenetic reconstruction, recombination was frequent enough to invalidate MLST typing in the identification of clonal expansion and transmission events, suggesting that, where available, whole-genome sequencing should be used in tracing the epidemiology of E. faecium nosocomial infections and establishing routes of transmission. Several forms of the Tn1549-like element–vanB gene cluster, which was exclusively responsible for vancomycin resistance, appeared and spread within the hospital during the study period. Several transposon gains and losses and instances of in situ evolution were inferred and, although usually chromosomal, the resistance element was also observed on a plasmid background. There was qualitative evidence for clonal expansions of both vancomycin-resistant and vancomycin-susceptible E. faecium with evidence of hospital-specific subclonal expansion. Our data are consistent with continuing evolution of this established hospital pathogen and confirm hospital vancomycin-susceptible and vancomycin-resistant E. faecium patient transmission events, underlining the need for careful consideration before modifying current E. faecium infection control strategies. PMID:27713836

Evolutionary dynamics of Enterococcus faecium reveals complex genomic relationships between isolates with independent emergence of vancomycin resistance.

PubMed

van Hal, Sebastiaan J; Ip, Camilla L C; Ansari, M Azim; Wilson, Daniel J; Espedido, Bjorn A; Jensen, Slade O; Bowden, Rory

2016-01-19

Enterococcus faecium , a major cause of hospital-acquired infections, remains problematic because of its propensity to acquire resistance to vancomycin, which currently is considered first-line therapy. Here, we assess the evolution and resistance acquisition dynamics of E. faecium in a clinical context using a series of 132 bloodstream infection isolates from a single hospital. All isolates, of which 49 (37 %) were vancomycin-resistant, underwent whole-genome sequencing. E. faecium was found to be subject to high rates of recombination with little evidence of sequence importation from outside the local E. faecium population. Apart from disrupting phylogenetic reconstruction, recombination was frequent enough to invalidate MLST typing in the identification of clonal expansion and transmission events, suggesting that, where available, whole-genome sequencing should be used in tracing the epidemiology of E. faecium nosocomial infections and establishing routes of transmission. Several forms of the Tn 1549 -like element- vanB gene cluster, which was exclusively responsible for vancomycin resistance, appeared and spread within the hospital during the study period. Several transposon gains and losses and instances of in situ evolution were inferred and, although usually chromosomal, the resistance element was also observed on a plasmid background. There was qualitative evidence for clonal expansions of both vancomycin-resistant and vancomycin-susceptible E. faecium with evidence of hospital-specific subclonal expansion. Our data are consistent with continuing evolution of this established hospital pathogen and confirm hospital vancomycin-susceptible and vancomycin-resistant E. faecium patient transmission events, underlining the need for careful consideration before modifying current E. faecium infection control strategies.

Looking back - Looking forward: A novel multi-time slice weight-of-evidence approach for defining reference conditions to assess the impact of human activities on lake systems.

PubMed

Hollert, Henner; Crawford, Sarah E; Brack, Werner; Brinkmann, Markus; Fischer, Elske; Hartmann, Kai; Keiter, Steffen; Ottermanns, Richard; Ouellet, Jacob D; Rinke, Karsten; Rösch, Manfred; Roß-Nickoll, Martina; Schäffer, Andreas; Schüth, Christoph; Schulze, Tobias; Schwarz, Anja; Seiler, Thomas-Benjamin; Wessels, Martin; Hinderer, Matthias; Schwalb, Antje

2018-06-01

Lake ecosystems are sensitive recorders of environmental changes that provide continuous archives at annual to decadal resolution over thousands of years. The systematic investigation of land use changes and emission of pollutants archived in Holocene lake sediments as well as the reconstruction of contamination, background conditions, and sensitivity of lake systems offer an ideal opportunity to study environmental dynamics and consequences of anthropogenic impact that increasingly pose risks to human well-being. This paper discusses the use of sediment and other lines of evidence in providing a record of historical and current contamination in lake ecosystems. We present a novel approach to investigate impacts from human activities using chemical-analytical, bioanalytical, ecological, paleolimnological, paleoecotoxicological, archeological as well as modeling techniques. This multi-time slice weight-of-evidence (WOE) approach will generate knowledge on conditions prior to anthropogenic influence and provide knowledge to (i) create a better understanding of the effects of anthropogenic disturbances on biodiversity, (ii) assess water quality by using quantitative data on historical pollution and persistence of pollutants archived over thousands of years in sediments, and (iii) define environmental threshold values using modeling methods. This technique may be applied in order to gain insights into reference conditions of surface and ground waters in catchments with a long history of land use and human impact, which is still a major need that is currently not yet addressed within the context of the European Water Framework Directive. Copyright © 2018 Elsevier B.V. All rights reserved.

Measurement of a model of implementation for health care: toward a testable theory

PubMed Central

2012-01-01

Background Greenhalgh et al. used a considerable evidence-base to develop a comprehensive model of implementation of innovations in healthcare organizations [1]. However, these authors did not fully operationalize their model, making it difficult to test formally. The present paper represents a first step in operationalizing Greenhalgh et al.’s model by providing background, rationale, working definitions, and measurement of key constructs. Methods A systematic review of the literature was conducted for key words representing 53 separate sub-constructs from six of the model’s broad constructs. Using an iterative process, we reviewed existing measures and utilized or adapted items. Where no one measure was deemed appropriate, we developed other items to measure the constructs through consensus. Results The review and iterative process of team consensus identified three types of data that can been used to operationalize the constructs in the model: survey items, interview questions, and administrative data. Specific examples of each of these are reported. Conclusion Despite limitations, the mixed-methods approach to measurement using the survey, interview measure, and administrative data can facilitate research on implementation by providing investigators with a measurement tool that captures most of the constructs identified by the Greenhalgh model. These measures are currently being used to collect data concerning the implementation of two evidence-based psychotherapies disseminated nationally within Department of Veterans Affairs. Testing of psychometric properties and subsequent refinement should enhance the utility of the measures. PMID:22759451

Background Noise Acceptance and Personality Factors Involved in Library Environment Choices by College Students

ERIC Educational Resources Information Center

Gordon-Hickey, Susan; Lemley, Trey

2012-01-01

For decades, academic libraries made efforts to provide study environments differing in acoustic environment. The present study aimed to provide an evidence basis for this practice by comparing background noise acceptance and personality factors of two groups of college-aged students self identified as preferring quiet or background noise when…

The impact of culture and education on non-verbal neuropsychological measurements: a critical review.

PubMed

Rosselli, Mónica; Ardila, Alfredo

2003-08-01

Clinical neuropsychology has frequently considered visuospatial and non-verbal tests to be culturally and educationally fair or at least fairer than verbal tests. This paper reviews the cross-cultural differences in performance on visuoperceptual and visuoconstructional ability tasks and analyzes the impact of education and culture on non-verbal neuropsychological measurements. This paper compares: (1) non-verbal test performance among groups with different educational levels, and the same cultural background (inter-education intra-culture comparison); (2) the test performance among groups with the same educational level and different cultural backgrounds (intra-education inter-culture comparisons). Several studies have demonstrated a strong association between educational level and performance on common non-verbal neuropsychological tests. When neuropsychological test performance in different cultural groups is compared, significant differences are evident. Performance on non-verbal tests such as copying figures, drawing maps or listening to tones can be significantly influenced by the individual's culture. Arguments against the use of some current neuropsychological non-verbal instruments, procedures, and norms in the assessment of diverse educational and cultural groups are discussed and possible solutions to this problem are presented.

The Age of Precision Cosmology

NASA Technical Reports Server (NTRS)

Chuss, David T.

2012-01-01

In the past two decades, our understanding of the evolution and fate of the universe has increased dramatically. This "Age of Precision Cosmology" has been ushered in by measurements that have both elucidated the details of the Big Bang cosmology and set the direction for future lines of inquiry. Our universe appears to consist of 5% baryonic matter; 23% of the universe's energy content is dark matter which is responsible for the observed structure in the universe; and 72% of the energy density is so-called "dark energy" that is currently accelerating the expansion of the universe. In addition, our universe has been measured to be geometrically flat to 1 %. These observations and related details of the Big Bang paradigm have hinted that the universe underwent an epoch of accelerated expansion known as Uinflation" early in its history. In this talk, I will review the highlights of modern cosmology, focusing on the contributions made by measurements of the cosmic microwave background, the faint afterglow of the Big Bang. I will also describe new instruments designed to measure the polarization of the cosmic microwave background in order to search for evidence of cosmic inflation.

[Dementia in families with a Turkish migration background. Organization and characteristics of domestic care arrangements].

PubMed

Mogar, M; von Kutzleben, M

2015-07-01

Until recently public health and health services research has not been concerned with people suffering from dementia with a Turkish migration background as a priority. There is little evidence about the situation of this population; however, it is known that these individuals almost always live with their families and are cared for by their families generally without seeking professional support. The aim of this study was to gain insight into the organization and characteristics of home-based care arrangements for people suffering from dementia with a Turkish migration background from the family carer's perspective. Interviews with seven family carers. The principles of the grounded theory served as a framework for data analysis. Unconditional commitment to caring for a family member with dementia was identified as the main characteristic of care arrangements in families with a Turkish migration background. Dementia is not a factor that has an impact on the decision of families to assume care responsibility for an affected family member and there is a lack of knowledge about dementia in general. There are various inhibiting factors for the utilization of formal services and the family carers in this sample complained that the available services are not culturally sensitive. There seems to be an extensive need for information and counselling regarding care dependency and dementia among the Turkish community. To provide personal-centred care and relief to these families in the future, efforts should be made to adapt the current care system to the specific needs and demands of this population. Cultural sensitivity in general and individual subjective needs of persons with a Turkish migration background affected by dementia should be taken into account.

Evidence for gravitational lensing of the cosmic microwave background polarization from cross-correlation with the cosmic infrared background.

PubMed

Ade, P A R; Akiba, Y; Anthony, A E; Arnold, K; Atlas, M; Barron, D; Boettger, D; Borrill, J; Borys, C; Chapman, S; Chinone, Y; Dobbs, M; Elleflot, T; Errard, J; Fabbian, G; Feng, C; Flanigan, D; Gilbert, A; Grainger, W; Halverson, N W; Hasegawa, M; Hattori, K; Hazumi, M; Holzapfel, W L; Hori, Y; Howard, J; Hyland, P; Inoue, Y; Jaehnig, G C; Jaffe, A; Keating, B; Kermish, Z; Keskitalo, R; Kisner, T; Le Jeune, M; Lee, A T; Leitch, E M; Linder, E; Lungu, M; Matsuda, F; Matsumura, T; Meng, X; Miller, N J; Morii, H; Moyerman, S; Myers, M J; Navaroli, M; Nishino, H; Paar, H; Peloton, J; Poletti, D; Quealy, E; Rebeiz, G; Reichardt, C L; Richards, P L; Ross, C; Rotermund, K; Schanning, I; Schenck, D E; Sherwin, B D; Shimizu, A; Shimmin, C; Shimon, M; Siritanasak, P; Smecher, G; Spieler, H; Stebor, N; Steinbach, B; Stompor, R; Suzuki, A; Takakura, S; Tikhomirov, A; Tomaru, T; Wilson, B; Yadav, A; Zahn, O

2014-04-04

We reconstruct the gravitational lensing convergence signal from cosmic microwave background (CMB) polarization data taken by the Polarbear experiment and cross-correlate it with cosmic infrared background maps from the Herschel satellite. From the cross spectra, we obtain evidence for gravitational lensing of the CMB polarization at a statistical significance of 4.0σ and indication of the presence of a lensing B-mode signal at a significance of 2.3σ. We demonstrate that our results are not biased by instrumental and astrophysical systematic errors by performing null tests, checks with simulated and real data, and analytical calculations. This measurement of polarization lensing, made via the robust cross-correlation channel, not only reinforces POLARBEAR auto-correlation measurements, but also represents one of the early steps towards establishing CMB polarization lensing as a powerful new probe of cosmology and astrophysics.

Search for diffuse neutrino flux from astrophysical sources with MACRO

NASA Astrophysics Data System (ADS)

MACRO Collaboration; Ambrosio, M.; Antolini, R.; Auriemma, G.; Bakari, D.; Baldini, A.; Barbarino, G. C.; Barish, B. C.; Battistoni, G.; Becherini, Y.; Bellotti, R.; Bemporad, C.; Bernardini, P.; Bilokon, H.; Bloise, C.; Bower, C.; Brigida, M.; Bussino, S.; Cafagna, F.; Calicchio, M.; Campana, D.; Carboni, M.; Caruso, R.; Cecchini, S.; Cei, F.; Chiarella, V.; Choudhary, B. C.; Coutu, S.; Cozzi, M.; de Cataldo, G.; Dekhissi, H.; de Marzo, C.; de Mitri, I.; Derkaoui, J.; de Vincenzi, M.; di Credico, A.; Erriquez, O.; Favuzzi, C.; Forti, C.; Fusco, P.; Giacomelli, G.; Giannini, G.; Giglietto, N.; Giorgini, M.; Grassi, M.; Grillo, A.; Guarino, F.; Gustavino, C.; Habig, A.; Hanson, K.; Heinz, R.; Iarocci, E.; Katsavounidis, E.; Katsavounidis, I.; Kearns, E.; Kim, H.; Kyriazopoulou, S.; Lamanna, E.; Lane, C.; Levin, D. S.; Lipari, P.; Longley, N. P.; Longo, M. J.; Loparco, F.; Maaroufi, F.; Mancarella, G.; Mandrioli, G.; Margiotta, A.; Marini, A.; Martello, D.; Marzari-Chiesa, A.; Mazziotta, M. N.; Michael, D. G.; Monacelli, P.; Montaruli, T.; Monteno, M.; Mufson, S.; Musser, J.; Nicolò, D.; Nolty, R.; Orth, C.; Osteria, G.; Palamara, O.; Patera, V.; Patrizii, L.; Pazzi, R.; Peck, C. W.; Perrone, L.; Petrera, S.; Pistilli, P.; Popa, V.; Rainò, A.; Reynoldson, J.; Ronga, F.; Rrhioua, A.; Satriano, C.; Scapparone, E.; Scholberg, K.; Sciubba, A.; Serra, P.; Sioli, M.; Sirri, G.; Sitta, M.; Spinelli, P.; Spinetti, M.; Spurio, M.; Steinberg, R.; Stone, J. L.; Sulak, L. R.; Surdo, A.; Tarlè, G.; Togo, V.; Vakili, M.; Walter, C. W.; Webb, R.

2003-04-01

Many galactic and extragalactic astrophysical sources are currently considered promising candidates as high-energy neutrino emitters. Astrophysical neutrinos can be detected as upward-going muons produced in charged-current interactions with the medium surrounding the detector. The expected neutrino fluxes from various models start to dominate on the atmospheric neutrino background at neutrino energies above some tens of TeV. We present the results of a search for an excess of high-energy upward-going muons among the sample of data collected by MACRO during ~5.8 years of effective running time. No significant evidence for this signal was found. As a consequence, an upper limit on the flux of upward-going muons from high-energy neutrinos was set at the level of 1.7×10-14 cm-2s-1sr-1. The corresponding upper limit for the diffuse neutrino flux was evaluated assuming a neutrino power law spectrum. Our result was compared with theoretical predictions and upper limits from other experiments.

Clues of subjective social status among young adults.

PubMed

Nielsen, François; Roos, J Micah; Combs, R M

2015-07-01

We investigate determinants of subjective social status (SSS) as measured by respondents placing themselves on a ten-rung ladder from least to most "money", "education" and "respected job", in a large sample of young adults. The most potent clues of SSS are proximate in the life course, reflecting educational attainment and current socioeconomic and job situation, rather than distal characteristics such as family background, although relatively distal High school GPA has a lingering effect. Additional analyses reveal that College selectivity has a substantial impact on SSS, net of other variables in the model; Currently married does not significantly contribute to SSS, but contrary to some expectations Number of children significantly lowers SSS. We find no evidence of greater "status borrowing" by women as associations of SSS with shared household characteristics (Household income, Household assets, Home ownership) do not differ by gender. Our findings for these young adults support the conclusion of earlier research that SSS reflects a "cognitive averaging" of standard dimensions of socioeconomic status. Copyright © 2015 Elsevier Inc. All rights reserved.

The odd couple: using biomedical and intersectional approaches to address health inequities

PubMed Central

Hankivsky, Olena; Doyal, Lesley; Einstein, Gillian; Kelly, Ursula; Shim, Janet; Weber, Lynn; Repta, Robin

2017-01-01

ABSTRACT Background: Better understanding and addressing health inequities is a growing global priority. Objective: In this paper, we contribute to the literature examining complex relationships between biological and social dimensions in the field of health inequalities. Specifically, we explore the potential of intersectionality to advance current approaches to socio-biological entwinements. Design: We provide a brief overview of current approaches to combining both biological and social factors in a single study, and then investigate the contributions of an intersectional framework to such work. Results: We offer a number of concrete examples of how intersectionality has been used empirically to bring both biological and social factors together in the areas of HIV, post-traumatic stress disorder, female genital circumcision/mutilation/cutting, and cardiovascular disease. Conclusion: We argue that an intersectional approach can further research that integrates biological and social aspects of human lives and human health and ultimately generate better and more precise evidence for effective policies and practices aimed at tackling health inequities. PMID:28641056

Management of diabetes and diabetes policies in Turkey

PubMed Central

2013-01-01

Background Diabetes and its complications are among the present and future challenges of the Turkish health care system. The objective of this paper is to discuss the current situation of diabetes and its management in Turkey with special emphasis on the changing policy environment. Methods A literature review in databases such as PUBMED was performed from 2000 to 2011. This synthesis was complemented by grey literature, personal communication and contact with national and provincial health authorities and experts in diabetes from Turkey. Results The literature review and expert consultations indicated a growing policy emphasis on diabetes. Both the public and private sectors, non-governmental organizations have initiated policy papers to shape the outlook of diabetes care in the future. This is in line with the current dynamics of the healthcare system. Conclusions Diabetes care will be high on the agenda in future. Evidence based policy-making is the key to implement the policies adopted so far and a supportive environment is needed. PMID:23597065

Palliative Care in Huntington Disease: Personal Reflections and a Review of the Literature

PubMed Central

Tarolli, Christopher G.; Chesire, Amy M.; Biglan, Kevin M.

2017-01-01

Background Huntington disease is a fatal, autosomal dominant, neurodegenerative disorder manifest by the triad of a movement disorder, behavioral disturbances, and dementia. At present, no curative or disease modifying therapies exist for the condition and current treatments are symptomatic. Palliative care is an approach to care that focuses on symptom relief, patient and caregiver support, and end of life care. There is increasing evidence of the benefit of palliative care throughout the course of neurodegenerative conditions including Parkinson disease and amyotrophic lateral sclerosis. However, beyond its application at the end of life, little is known about the role of palliative care in Huntington disease. Methods In this article, we discuss what is known about palliative care in Huntington disease, specifically related to early disease burden, caregiver burnout, advance care planning, and end of life care. Results We provide a review of the current literature and discuss our own care practices. Discussion We conclude by discussing questions that remain unanswered and positing ideas for future work in the field. PMID:28428907

Wheelchair interventions, services and provision for disabled children: a mixed-method systematic review and conceptual framework

PubMed Central

2014-01-01

Background Wheelchairs for disabled children (≤18 years) can provide health, developmental and social benefits. World Health Organisation and United Kingdom Government reports demonstrate the need for improved access to wheelchairs both locally and internationally. The use of health economics within this field is lacking. Provision of wheelchairs based on cost-effectiveness evidence is not currently possible. We conducted the first systematic review in this field to incorporate evidence of effectiveness, service user perspectives, policy intentions and cost-effectiveness in order to develop a conceptual framework to inform future research and service development. Methods We used an adapted EPPI-Centre mixed-method systematic review design with narrative summary, thematic and narrative synthesis. 11 databases were searched. Studies were appraised for quality using one of seven appropriate tools. A conceptual framework was developed from synthesised evidence. Results 22 studies and 14 policies/guidelines were included. Powered wheelchairs appear to offer benefits in reduced need for caregiver assistance; improved communicative, personal-social and cognitive development; and improved mobility function and independent movement. From 14 months of age children can learn some degree of powered wheelchair driving competence. However, effectiveness evidence was limited and low quality. Children and parents placed emphasis on improving social skill and independence. Participation in wider society and development of meaningful relationships were key desired outcomes. Policy intentions and aspirations are in line with the perspectives of children and parents, although translation of policy recommendations into practice is lacking. Conclusions There is a distinct lack of high quality effectiveness and economic evidence in this field. Social and health needs should be seen as equally important when assessing the mobility needs of disabled children. Disabled children and parents placed highest priority on independence and psychosocial outcomes of wheelchair interventions. Translation of policy and guidelines into practice is lacking and more effective implementation strategies are required to improve services and outcomes. Future research should focus on outcome measure development, developing economic evaluation tools and incorporating these into high quality studies to address known research gaps. The novel conceptual framework maps current gaps in evidence and outlines areas for development. PMID:25034517

Left-to-Right Atrial Inward Rectifier Potassium Current Gradients in Patients With Paroxysmal Versus Chronic Atrial Fibrillation

PubMed Central

Voigt, Niels; Trausch, Anne; Knaut, Michael; Matschke, Klaus; Varró, András; Van Wagoner, David R.; Nattel, Stanley; Ravens, Ursula; Dobrev, Dobromir

2018-01-01

Background Recent evidence suggests that atrial fibrillation (AF) is maintained by high-frequency reentrant sources with a left-to-right–dominant frequency gradient, particularly in patients with paroxysmal AF (pAF). Unequal left-to-right distribution of inward rectifier K+ currents has been suggested to underlie this dominant frequency gradient, but this hypothesis has never been tested in humans. Methods and Results Currents were measured with whole-cell voltage-clamp in cardiomyocytes from right atrial (RA) and left (LA) atrial appendages of patients in sinus rhythm (SR) and patients with AF undergoing cardiac surgery. Western blot was used to quantify protein expression of IK1 (Kir2.1 and Kir2.3) and IK,ACh (Kir3.1 and Kir3.4) subunits. Basal current was ≈2-fold larger in chronic AF (cAF) versus SR patients, without RA-LA differences. In pAF, basal current was ≈2-fold larger in LA versus RA, indicating a left-to-right atrial gradient. In both atria, Kir2.1 expression was ≈2-fold greater in cAF but comparable in pAF versus SR. Kir2.3 levels were unchanged in cAF and RA-pAF but showed a 51% decrease in LA-pAF. In SR, carbachol-activated (2 μmol/L) IK,ACh was 70% larger in RA versus LA. This right-to-left atrial gradient was decreased in pAF and cAF caused by reduced IK,ACh in RA only. Similarly, in SR, Kir3.1 and Kir3.4 proteins were greater in RA versus LA and decreased in RA of pAF and cAF. Kir3.1 and Kir3.4 expression was unchanged in LA of pAF and cAF. Conclusions Our results support the hypothesis that a left-to-right gradient in inward rectifier background current contributes to high-frequency sources in LA that maintain pAF. These findings have potentially important implications for development of atrial-selective therapeutic approaches. PMID:20657029

Observation of tau neutrino appearance in the CNGS beam with the OPERA experiment

NASA Astrophysics Data System (ADS)

Opera Collaboration; Agafonova, N.; Aleksandrov, A.; Anokhina, A.; Aoki, S.; Ariga, A.; Ariga, T.; Asada, T.; Bender, D.; Bertolin, A.; Bozza, C.; Brugnera, R.; Buonaura, A.; Buontempo, S.; Büttner, B.; Chernyavsky, M.; Chukanov, A.; Consiglio, L.; D'Ambrosio, N.; de Lellis, G.; de Serio, M.; Del Amo Sanchez, P.; di Crescenzo, A.; di Ferdinando, D.; di Marco, N.; Dmitrievski, S.; Dracos, M.; Duchesneau, D.; Dusini, S.; Dzhatdoev, T.; Ebert, J.; Ereditato, A.; Fini, R. A.; Fukuda, T.; Galati, G.; Garfagnini, A.; Giacomelli, G.; Goellnitz, C.; Goldberg, J.; Gornushkin, Y.; Grella, G.; Guler, M.; Gustavino, C.; Hagner, C.; Hara, T.; Hayakawa, T.; Hollnagel, A.; Hosseini, B.; Ishida, H.; Ishiguro, K.; Jakovcic, K.; Jollet, C.; Kamiscioglu, C.; Kamiscioglu, M.; Katsuragawa, T.; Kawada, J.; Kawahara, H.; Kim, J. H.; Kim, S. H.; Kitagawa, N.; Klicek, B.; Kodama, K.; Komatsu, M.; Kose, U.; Kreslo, I.; Lauria, A.; Lenkeit, J.; Ljubicic, A.; Longhin, A.; Loverre, P.; Malenica, M.; Malgin, A.; Mandrioli, G.; Matsuo, T.; Matveev, V.; Mauri, N.; Medinaceli, E.; Meregaglia, A.; Meyer, M.; Mikado, S.; Miyanishi, M.; Monacelli, P.; Montesi, M. C.; Morishima, K.; Muciaccia, M. T.; Naganawa, N.; Naka, T.; Nakamura, M.; Nakano, T.; Nakatsuka, Y.; Niwa, K.; Ogawa, S.; Okateva, N.; Olshevsky, A.; Omura, T.; Ozaki, K.; Paoloni, A.; Park, B. D.; Park, I. G.; Pasqualini, L.; Pastore, A.; Patrizii, L.; Pessard, H.; Pistillo, C.; Podgrudkov, D.; Polukhina, N.; Pozzato, M.; Pupilli, F.; Roda, M.; Roganova, T.; Rokujo, H.; Rosa, G.; Ryazhskaya, O.; Sato, O.; Schembri, A.; Shakiryanova, I.; Shchedrina, T.; Sheshukov, A.; Shibuya, H.; Shiraishi, T.; Shoziyoev, G.; Simone, S.; Sioli, M.; Sirignano, C.; Sirri, G.; Spinetti, M.; Stanco, L.; Starkov, N.; Stellacci, S. M.; Stipcevic, M.; Strolin, P.; Takahashi, S.; Tenti, M.; Terranova, F.; Tioukov, V.; Tufanli, S.; Umemoto, A.; Vilain, P.; Vladimirov, M.; Votano, L.; Vuilleumier, J. L.; Wilquet, G.; Wonsak, B.; Yoon, C. S.; Yaguchi, I.; Yoshimoto, M.; Zemskova, S.; Zghiche, A.

2014-10-01

The OPERA experiment is searching for ν _μ rArr ν _tau oscillations in appearance mode, i.e., via the direct detection of tau leptons in ν _tau charged-current interactions. The evidence of ν _μ rArr ν _tau appearance has been previously reported with three ν _tau candidate events using a sub-sample of data from the 2008-2012 runs. We report here a fourth ν _tau candidate event, with the tau decaying into a hadron, found after adding the 2012 run events without any muon in the final state to the data sample. Given the number of analyzed events and the low background, ν _μ rArr ν _tau oscillations are established with a significance of 4.2σ.

Short-lived particle search procedure in the OPERA experiment. Application to charm decays

NASA Astrophysics Data System (ADS)

del Amo Sánchez, Pablo; OPERA Collaboration

2016-04-01

The OPERA experiment has recently provided evidence of νμ →ντ neutrino oscillations in appearance mode through the detection of tau leptons produced in ντ Charged Current interactions. The OPERA detector collected data from 2008 to 2012, when it was exposed to the CNGS muon neutrino beam from CERN to Gran Sasso, 730 km away from the source. We report on the search procedure for short-lived particles and on its validation with charmed hadron decays. The latter, produced in about 4% of the neutrino interactions in OPERA, are an important background to the νμ →ντ channel and an ideal control sample as their decay exhibits topological and kinematical features strongly resembling the tau's decay.

Integrating the molecular and the population approaches to dementia research to help guide the future development of appropriate therapeutics.

PubMed

Hunter, Sally; Brayne, Carol

2014-04-15

Dementia research over the last 50 years has expanded enormously and has greater international interest now than at any time in history. A variety of scientific approaches have been brought to bear on this complex disorder in which the syndrome of clinical features is its defining importance in societal terms. Little has emerged in terms of tangible benefits for people with dementia to date other than a hugely increased awareness at societal and governmental levels. One of the drivers for the increase in focus has been epidemiological evidence, which has provided background numbers for the justification of resources for dementia research. However it can be argued that this justification did not take into account the true meaning of the population evidence, drawing instead on preconceptions which were, at the time, the widely accepted interpretations of earlier evidence. Current evidence, along with the lack of single therapeutic successes, suggests that a clearer analysis is required which not only examines the value and applicability of existing knowledge, most particularly its generation and generalizability, but also where future investment should go for most likely benefit of populations. This includes a hard look at the pre-occupation of societies with single therapies, their place in the context of prevention more generally, particularly within aging populations, and how evidence is generated on likely impacts and their timeframes. Copyright © 2014 Elsevier Inc. All rights reserved.

Energy drinks mixed with alcohol: misconceptions, myths, and facts

PubMed Central

Verster, Joris C; Aufricht, Christoph; Alford, Chris

2012-01-01

Background Whilst energy drinks improve performance and feelings of alertness, recent articles suggest that energy drink consumption combined with alcohol may reduce perception of alcohol intoxication, or lead to increased alcohol or drug use. This review discusses the available scientific evidence on the effects of mixing energy drinks with alcohol. Methods A literature search was performed using the keywords “energy drink and Red Bull®” and consulting Medline/Pubmed, PsycINFO, and Embase. Results There is little evidence that energy drinks antagonize the behavioral effects of alcohol, and there is no consistent evidence that energy drinks alter the perceived level of intoxication of people who mix energy drinks with alcohol. No clinically relevant cardiovascular or other adverse effects have been reported for healthy subjects combining energy drinks with alcohol, although there are no long-term investigations currently available. Finally, whilst several surveys have shown associations, there is no direct evidence that coadministration of energy drinks increases alcohol consumption, or initiates drug and alcohol dependence or abuse. Conclusion Although some reports suggest that energy drinks lead to reduced awareness of intoxication and increased alcohol consumption, a review of the available literature shows that these views are not supported by direct or reliable scientific evidence. A personality with higher levels of risk-taking behavior may be the primary reason for increased alcohol and drug abuse per se. The coconsumption of energy drinks being one of the many expressions of that type of lifestyle and personality. PMID:22399863

The role of hospital payments in the adoption of new medical technologies: an international survey of current practice.

PubMed

Sorenson, Corinna; Drummond, Michael; Torbica, Aleksandra; Callea, Giuditta; Mateus, Ceu

2015-04-01

This study examined the role of prospective payment systems in the adoption of new medical technologies across different countries. A literature review was conducted to provide background for the study and guide development of a survey instrument. The survey was disseminated to hospital payment systems experts in 15 jurisdictions. Fifty-one surveys were disseminated, with 34 returned. The surveys returned covered 14 of the 15 jurisdictions invited to participate. The majority (71%) of countries update the patient classification system and/or payment tariffs on an annual basis to try to account for new technologies. Use of short-term separate or supplementary payments for new technologies occurs in 79% of countries to ensure adequate funding and facilitate adoption. A minority (43%) of countries use evidence of therapeutic benefit and/or costs to determine or update payment tariffs, although it is somewhat more common in establishing short-term payments. The main barrier to using evidence is uncertain or unavailable clinical evidence. Almost three-fourths of respondents believed diagnosis-related group systems incentivize or deter technology adoption, depending on the particular circumstances. Improvements are needed, such as enhanced strategies for evidence generation and linking evidence of value to payments, national and international collaboration and training to improve existing practice, and flexible timelines for short-term payments. Importantly, additional research is needed to understand how different payment policies impact technology uptake as well as quality of care and costs.

Mobile and Web 2.0 interventions for weight management: an overview of review evidence and its methodological quality

PubMed Central

Smith, Jane R.; Samaha, Laya; Abraham, Charles

2016-01-01

Abstract Background : The use of Internet and related technologies for promoting weight management (WM), physical activity (PA), or dietary-related behaviours has been examined in many articles and systematic reviews. This overview aims to summarize and assess the quality of the review evidence specifically focusing on mobile and Web 2.0 technologies, which are the most utilized, currently available technologies. Methods: Following a registered protocol (CRD42014010323), we searched 16 databases for articles published in English until 31 December 2014 discussing the use of either mobile or Web 2.0 technologies to promote WM or related behaviors, i.e. diet and physical activity (PA). Two reviewers independently selected reviews and assessed their methodological quality using the AMSTAR checklist. Citation matrices were used to determine the overlap among reviews. Results: Forty-four eligible reviews were identified, 39 of which evaluated the effects of interventions using mobile or Web 2.0 technologies. Methodological quality was generally low with only 7 reviews (16%) meeting the highest standards. Suggestive evidence exists for positive effects of mobile technologies on weight-related outcomes and, to a lesser extent, PA. Evidence is inconclusive regarding Web 2.0 technologies. Conclusions : Reviews on mobile and Web 2.0 interventions for WM and related behaviors suggest that these technologies can, under certain circumstances, be effective, but conclusions are limited by poor review quality based on a heterogeneous evidence base. PMID:27335330

What do we know about how to do audit and feedback? Pitfalls in applying evidence from a systematic review

PubMed Central

Foy, R; Eccles, MP; Jamtvedt, G; Young, J; Grimshaw, JM; Baker, R

2005-01-01

Background Improving the quality of health care requires a range of evidence-based activities. Audit and feedback is commonly used as a quality improvement tool in the UK National Health Service [NHS]. We set out to assess whether current guidance and systematic review evidence can sufficiently inform practical decisions about how to use audit and feedback to improve quality of care. Methods We selected an important chronic disease encountered in primary care: diabetes mellitus. We identified recommendations from National Institute for Clinical Excellence (NICE) guidance on conducting audit and generated questions which would be relevant to any attempt to operationalise audit and feedback in a healthcare service setting. We explored the extent to which a systematic review of audit and feedback could provide practical guidance about whether audit and feedback should be used to improve quality of diabetes care and, if so, how audit and feedback could be optimised. Results National guidance suggests the importance of securing the right organisational conditions and processes. Review evidence suggests that audit and feedback can be effective in changing healthcare professional practice. However, the available evidence says relatively little about the detail of how to use audit and feedback most efficiently. Conclusion Audit and feedback will continue to be an unreliable approach to quality improvement until we learn how and when it works best. Conceptualising audit and feedback within a theoretical framework offers a way forward. PMID:16011811

The Dose That Works: Low Level Laser Treatment of Tendinopathy

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

Tumilty, Steve; Munn, Joanne; David Baxter, G.

2010-05-31

Background: Low Level Laser Therapy (LLLT) is used in the treatment of tendon injuries. However, the clinical effectiveness of this modality remains controversial with limited agreement on the most efficacious dosage and parameter choices. Purpose: To assess the clinical effectiveness of LLLT in the treatment of tendinopathy and the validity of current dosage recommendations for treatment. Method: Medical databases were searched from inception to 1st August 2008. Controlled clinical trials evaluating LLLT as a primary intervention for any tendinopathy were included in the review. Methodological quality was classified using the PEDro scale. Appropriateness of treatment parameters were assessed using establishedmore » guidelines. Results: Twenty five trials met the inclusion criteria. There was conflicting findings from multiple trials: 12 showed positive effects and 13 were inconclusive or showed no effect. Dosages used in the 12 positive studies support the existence of an effective dosage window that closely resembled current guidelines. Where pooling of data was possible, LLLT showed a positive effect size; in high quality studies of lateral epicondylitis, participants' grip strength was 9.59 Kg higher than the control group; for participants with Achilles tendinopathy, the effect was 13.6 mm less pain on a 100 mm visual analogue scale. Conclusion: This study found conflicting evidence as to the effectiveness of LLLT in the treatment of tendinopathy. However, an effective dosage window emerged showing benefit in the treatment of tendinopathy. Strong evidence exists from the 12 positive studies that positive outcomes are associated with the use of current dosage recommendations for the treatment of tendinopathy.« less

The Dose That Works: Low Level Laser Treatment of Tendinopathy

NASA Astrophysics Data System (ADS)

Tumilty, Steve; Munn, Joanne; McDonough, Suzanne; Hurley, Deirdre A.; Basford, Jeffrey R.; David Baxter, G.

2010-05-01

Background: Low Level Laser Therapy (LLLT) is used in the treatment of tendon injuries. However, the clinical effectiveness of this modality remains controversial with limited agreement on the most efficacious dosage and parameter choices. Purpose: To assess the clinical effectiveness of LLLT in the treatment of tendinopathy and the validity of current dosage recommendations for treatment. Method: Medical databases were searched from inception to 1st August 2008. Controlled clinical trials evaluating LLLT as a primary intervention for any tendinopathy were included in the review. Methodological quality was classified using the PEDro scale. Appropriateness of treatment parameters were assessed using established guidelines. Results: Twenty five trials met the inclusion criteria. There was conflicting findings from multiple trials: 12 showed positive effects and 13 were inconclusive or showed no effect. Dosages used in the 12 positive studies support the existence of an effective dosage window that closely resembled current guidelines. Where pooling of data was possible, LLLT showed a positive effect size; in high quality studies of lateral epicondylitis, participants' grip strength was 9.59 Kg higher than the control group; for participants with Achilles tendinopathy, the effect was 13.6 mm less pain on a 100 mm visual analogue scale. Conclusion: This study found conflicting evidence as to the effectiveness of LLLT in the treatment of tendinopathy. However, an effective dosage window emerged showing benefit in the treatment of tendinopathy. Strong evidence exists from the 12 positive studies that positive outcomes are associated with the use of current dosage recommendations for the treatment of tendinopathy.

Historical and cultural aspects of the pineal gland: comparison between the theories provided by Spiritism in the 1940s and the current scientific evidence.

PubMed

Lucchetti, Giancarlo; Daher, Jorge C; Iandoli, Decio; Gonçalves, Juliane P B; Lucchetti, Alessandra L G

2013-01-01

Significance has been attached to the pineal gland in numerous different cultures and beliefs. One religion that has advanced the role of the pineal gland is Spiritism. The objective of the present study was to compile information on the pineal gland drawing on the books of Francisco Cândido Xavier written through psychography and to carry out a critical analysis of their scientific bases by comparing against evidence in the current scientific literature. A systematic search using the terms "pineal gland" and "epiphysis" was conducted of 12 works allegedly dictated by the spirit "André Luiz". All information on the pineal having potential correlation with the field of medicine and current studies was included. Specialists in the area were recruited to compile the information and draw parallels with the scientific literature. The themes related to the pineal gland were: mental health, reproductive function, endocrinology, relationship with physical activity, spiritual connection, criticism of the theory that the organ exerts no function, and description of a hormone secreted by the gland (reference alluding to melatonin, isolated 13 years later). The historical background for each theme was outlined, together with the theories present in the Spiritist books and in the relevant scientific literature. The present article provides an analysis of the knowledge the scientific community can acquire from the history of humanity and from science itself. The process of formulating hypotheses and scientific theories can benefit by drawing on the cultural aspects of civilization, taking into account so-called non-traditional reports and theories.

A Cross-National Study on Mexico-US Migration, Substance Use and Substance Use Disorders

PubMed Central

Borges, Guilherme; Breslau, Joshua; Orozco, Ricardo; Tancredi, Daniel J.; Anderson, Heather; Aguilar-Gaxiola, Sergio; Mora, Maria-Elena Medina

2011-01-01

Background Epidemiologic research has consistently found lower prevalence of alcohol and drug use disorders among Hispanic immigrants to the US than among US-born Hispanics. Recent research has begun to examine how this change occurs in the process of assimilation in the US. We aimed to study immigration, US nativity, and return migration as risk factors for alcohol and drug use among people of Mexican origin in both the US and Mexico. Methods Data come from nationally representative surveys in the United States (2001–2003; n= 1208) and Mexico (2001–2002; n=5782). We used discrete time event history models to account for time-varying and time-invariant characteristics. Results We found no evidence that current Mexican immigrants in the US have higher risk for alcohol or alcohol use disorders than Mexicans living in Mexico, but current immigrants were at higher risk for drug use and drug use disorders. Current Mexican immigrants were at lower risk for drug use and drug disorders than US-born Mexican-Americans. US nativity, regardless of parent nativity, is the main factor associated with increasing use of alcohol and drugs. Among families of migrants and among return migrants we found increased risk for alcohol use, drug use and alcohol and drug use disorders. Evidence of selective migration and return of immigrants with disorders was found regarding alcohol use disorders only. Conclusions Research efforts that combine populations from sending and receiving countries are needed. This effort will require much more complex research designs that will call for true international collaboration. PMID:21296509

Promoting Evidence-Based Decision Making in a Local Health Department, Pueblo City–County, Colorado

PubMed Central

Nevin-Woods, Christine; Proud, Sylvia; Brownson, Ross C.

2015-01-01

Background Evidence-based decision making (EBDM) is an effective strategy for addressing population health needs. Assessing and reducing barriers to using EBDM in local health departments may improve practice and provide insight into disseminating EBDM principles among public health practitioners. Community Context Administrative leaders at the Pueblo City–County Health Department, Pueblo, Colorado, used a systematic approach for implementing EBDM. Research partners engaged staff to understand factors that increase or deter its use. Methods A survey was distributed to staff members at baseline to identify gaps in administrative and individual practice of EBDM. In-depth interviews were also conducted with 11 randomly selected staff members. Results were shared with staff and administration, after which activities were implemented to improve application of EBDM. A follow up survey was administered 1 year after the initial assessment. Outcome Survey data showed evidence of progress in engaging and educating staff members, and data showed improved attitudes toward EBDM (ie, several items showed significant improvement from baseline to follow-up). For example, staff members reported having the necessary skills to develop evidence-based interventions (73.9%), the ability to effectively communicate information on evidence-based strategies to policy makers (63.0%), access to current information on improving EBDM processes (65.2%), and a belief that evidence-based interventions are designed to be self-sustaining (43.5%). Interpretation Within a local health department in which leaders have made EBDM a priority, addressing the culture and climate of the department may build EBDM. Future research may provide insight into tailoring EBDM within and across local health departments. PMID:26111156

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

PubMed Central

Giacobbe, Peter; Kennedy, Sidney H.; Blumberger, Daniel M.; Daskalakis, Zafiris J.; Downar, Jonathan; Modirrousta, Mandana; Patry, Simon; Vila-Rodriguez, Fidel; Lam, Raymond W.; MacQueen, Glenda M.; Parikh, Sagar V.; Ravindran, Arun V.

2016-01-01

Background: The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. Methods: Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. “Neurostimulation Treatments” is the fourth of six sections of the 2016 guidelines. Results: Evidence-informed responses were developed for 31 questions for 6 neurostimulation modalities: 1) transcranial direct current stimulation (tDCS), 2) repetitive transcranial magnetic stimulation (rTMS), 3) electroconvulsive therapy (ECT), 4) magnetic seizure therapy (MST), 5) vagus nerve stimulation (VNS), and 6) deep brain stimulation (DBS). Most of the neurostimulation treatments have been investigated in patients with varying degrees of treatment resistance. Conclusions: There is increasing evidence for efficacy, tolerability, and safety of neurostimulation treatments. rTMS is now a first-line recommendation for patients with MDD who have failed at least 1 antidepressant. ECT remains a second-line treatment for patients with treatment-resistant depression, although in some situations, it may be considered first line. Third-line recommendations include tDCS and VNS. MST and DBS are still considered investigational treatments. PMID:27486154

An Official American Thoracic Society Clinical Practice Guideline: Pediatric Chronic Home Invasive Ventilation

PubMed Central

Collaco, Joseph M.; Baker, Christopher D.; Carroll, John L.; Sharma, Girish D.; Brozek, Jan L.; Finder, Jonathan D.; Ackerman, Veda L.; Arens, Raanan; Boroughs, Deborah S.; Carter, Jodi; Daigle, Karen L.; Dougherty, Joan; Gozal, David; Kevill, Katharine; Kravitz, Richard M.; Kriseman, Tony; MacLusky, Ian; Rivera-Spoljaric, Katherine; Tori, Alvaro J.; Ferkol, Thomas; Halbower, Ann C.

2016-01-01

Background: Children with chronic invasive ventilator dependence living at home are a diverse group of children with special health care needs. Medical oversight, equipment management, and community resources vary widely. There are no clinical practice guidelines available to health care professionals for the safe hospital discharge and home management of these complex children. Purpose: To develop evidence-based clinical practice guidelines for the hospital discharge and home/community management of children requiring chronic invasive ventilation. Methods: The Pediatric Assembly of the American Thoracic Society assembled an interdisciplinary workgroup with expertise in the care of children requiring chronic invasive ventilation. The experts developed four questions of clinical importance and used an evidence-based strategy to identify relevant medical evidence. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to formulate and grade recommendations. Results: Clinical practice recommendations for the management of children with chronic ventilator dependence at home are provided, and the evidence supporting each recommendation is discussed. Conclusions: Collaborative generalist and subspecialist comanagement is the Medical Home model most likely to be successful for the care of children requiring chronic invasive ventilation. Standardized hospital discharge criteria are suggested. An awake, trained caregiver should be present at all times, and at least two family caregivers should be trained specifically for the child’s care. Standardized equipment for monitoring, emergency preparedness, and airway clearance are outlined. The recommendations presented are based on the current evidence and expert opinion and will require an update as new evidence and/or technologies become available. PMID:27082538

Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines

PubMed Central

Norris, Susan L.; Schulman, Sam; Hirsh, Jack; Eckman, Mark H.; Akl, Elie A.; Crowther, Mark; Vandvik, Per Olav; Eikelboom, John W.; McDonagh, Marian S.; Lewis, Sandra Zelman; Gutterman, David D.; Cook, Deborah J.; Schünemann, Holger J.

2012-01-01

Background: To develop the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: ACCP Evidence-Based Clinical Practice Guidelines (AT9), the American College of Chest Physicians (ACCP) assembled a panel of clinical experts, information scientists, decision scientists, and systematic review and guideline methodologists. Methods: Clinical areas were designated as articles, and a methodologist without important intellectual or financial conflicts of interest led a panel for each article. Only panel members without significant conflicts of interest participated in making recommendations. Panelists specified the population, intervention and alternative, and outcomes for each clinical question and defined criteria for eligible studies. Panelists and an independent evidence-based practice center executed systematic searches for relevant studies and evaluated the evidence, and where resources and evidence permitted, they created standardized tables that present the quality of the evidence and key results in a transparent fashion. Results: One or more recommendations relate to each specific clinical question, and each recommendation is clearly linked to the underlying body of evidence. Judgments regarding the quality of evidence and strength of recommendations were based on approaches developed by the Grades of Recommendations, Assessment, Development, and Evaluation Working Group. Panel members constructed scenarios describing relevant health states and rated the disutility associated with these states based on an additional systematic review of evidence regarding patient values and preferences for antithrombotic therapy. These ratings guided value and preference decisions underlying the recommendations. Each topic panel identified questions in which resource allocation issues were particularly important and, for these issues, experts in economic analysis provided additional searches and guidance. Conclusions: AT9 methodology reflects the current science of evidence-based clinical practice guideline development, with reliance on high-quality systematic reviews, a standardized process for quality assessment of individual studies and the body of evidence, an explicit process for translating the evidence into recommendations, disclosure of financial as well as intellectual conflicts of interest followed by management of disclosed conflicts, and extensive peer review. PMID:22315256

Evidence-based ethics? On evidence-based practice and the "empirical turn" from normative bioethics

PubMed Central

Goldenberg, Maya J

2005-01-01

Background The increase in empirical methods of research in bioethics over the last two decades is typically perceived as a welcomed broadening of the discipline, with increased integration of social and life scientists into the field and ethics consultants into the clinical setting, however it also represents a loss of confidence in the typical normative and analytic methods of bioethics. Discussion The recent incipiency of "Evidence-Based Ethics" attests to this phenomenon and should be rejected as a solution to the current ambivalence toward the normative resolution of moral problems in a pluralistic society. While "evidence-based" is typically read in medicine and other life and social sciences as the empirically-adequate standard of reasonable practice and a means for increasing certainty, I propose that the evidence-based movement in fact gains consensus by displacing normative discourse with aggregate or statistically-derived empirical evidence as the "bottom line". Therefore, along with wavering on the fact/value distinction, evidence-based ethics threatens bioethics' normative mandate. The appeal of the evidence-based approach is that it offers a means of negotiating the demands of moral pluralism. Rather than appealing to explicit values that are likely not shared by all, "the evidence" is proposed to adjudicate between competing claims. Quantified measures are notably more "neutral" and democratic than liberal markers like "species normal functioning". Yet the positivist notion that claims stand or fall in light of the evidence is untenable; furthermore, the legacy of positivism entails the quieting of empirically non-verifiable (or at least non-falsifiable) considerations like moral claims and judgments. As a result, evidence-based ethics proposes to operate with the implicit normativity that accompanies the production and presentation of all biomedical and scientific facts unchecked. Summary The "empirical turn" in bioethics signals a need for reconsideration of the methods used for moral evaluation and resolution, however the options should not include obscuring normative content by seemingly neutral technical measure. PMID:16277663

Perception of intelligibility and qualities of non-native accented speakers.

PubMed

Fuse, Akiko; Navichkova, Yuliya; Alloggio, Krysteena

To provide effective treatment to clients, speech-language pathologists must be understood, and be perceived to demonstrate the personal qualities necessary for therapeutic practice (e.g., resourcefulness and empathy). One factor that could interfere with the listener's perception of non-native speech is the speaker's accent. The current study explored the relationship between how accurately listeners could understand non-native speech and their perceptions of personal attributes of the speaker. Additionally, this study investigated how listeners' familiarity and experience with other languages may influence their perceptions of non-native accented speech. Through an online survey, native monolingual and bilingual English listeners rated four non-native accents (i.e., Spanish, Chinese, Russian, and Indian) on perceived intelligibility and perceived personal qualities (i.e., professionalism, intelligence, resourcefulness, empathy, and patience) necessary for speech-language pathologists. The results indicated significant relationships between the perception of intelligibility and the perception of personal qualities (i.e., professionalism, intelligence, and resourcefulness) attributed to non-native speakers. However, these findings were not supported for the Chinese accent. Bilingual listeners judged the non-native speech as more intelligible in comparison to monolingual listeners. No significant differences were found in the ratings between bilingual listeners who share the same language background as the speaker and other bilingual listeners. Based on the current findings, greater perception of intelligibility was the key to promoting a positive perception of personal qualities such as professionalism, intelligence, and resourcefulness, important for speech-language pathologists. The current study found evidence to support the claim that bilinguals have a greater ability in understanding non-native accented speech compared to monolingual listeners. The results, however, did not confirm an advantage for bilingual listeners sharing the same language backgrounds with the non-native speaker over other bilingual listeners. Copyright © 2017 Elsevier Inc. All rights reserved.

Assessing the impact of mHealth interventions in low- and middle-income countries – what has been shown to work?

PubMed Central

Hall, Charles S.; Fottrell, Edward; Wilkinson, Sophia; Byass, Peter

2014-01-01

Background Low-cost mobile devices, such as mobile phones, tablets, and personal digital assistants, which can access voice and data services, have revolutionised access to information and communication technology worldwide. These devices have a major impact on many aspects of people's lives, from business and education to health. This paper reviews the current evidence on the specific impacts of mobile technologies on tangible health outcomes (mHealth) in low- and middle-income countries (LMICs), from the perspectives of various stakeholders. Design Comprehensive literature searches were undertaken using key medical subject heading search terms on PubMed, Google Scholar, and grey literature sources. Analysis of 676 publications retrieved from the search was undertaken based on key inclusion criteria, resulting in a set of 76 papers for detailed review. The impacts of mHealth interventions reported in these papers were categorised into common mHealth applications. Results There is a growing evidence base for the efficacy of mHealth interventions in LMICs, particularly in improving treatment adherence, appointment compliance, data gathering, and developing support networks for health workers. However, the quantity and quality of the evidence is still limited in many respects. Conclusions Over all application areas, there remains a need to take small pilot studies to full scale, enabling more rigorous experimental and quasi-experimental studies to be undertaken in order to strengthen the evidence base. PMID:25361730

Aetiology of Autism: Findings and Questions

ERIC Educational Resources Information Center

Rutter, M.

2005-01-01

Background Although there is good evidence that autism is a multifactorial disorder, an adequate understanding of the genetic and non-genetic causes has yet to be achieved. Methods Empirical research findings and conceptual reviews are reviewed with respect to evidence on possible causal influences. Results Much the strongest evidence concerns the…

What Is a Culture of Evidence? How Do You Get One? And... Should You Want One?

ERIC Educational Resources Information Center

Peck, Charles A.; McDonald, Morva A.

2014-01-01

Background/Context: Contemporary state and national policy rhetoric reflects increased press for "evidence-based" decision making within programs of teacher education, including admonitions that programs develop a "culture of evidence" in making decisions regarding policy and practice. Recent case study reports suggest that…

High sensitivity of spontaneous spike frequency to sodium leak current in a Lymnaea pacemaker neuron.

PubMed

Lu, T Z; Kostelecki, W; Sun, C L F; Dong, N; Pérez Velázquez, J L; Feng, Z-P

2016-12-01

The spontaneous rhythmic firing of action potentials in pacemaker neurons depends on the biophysical properties of voltage-gated ion channels and background leak currents. The background leak current includes a large K + and a small Na + component. We previously reported that a Na + -leak current via U-type channels is required to generate spontaneous action potential firing in the identified respiratory pacemaker neuron, RPeD1, in the freshwater pond snail Lymnaea stagnalis. We further investigated the functional significance of the background Na + current in rhythmic spiking of RPeD1 neurons. Whole-cell patch-clamp recording and computational modeling approaches were carried out in isolated RPeD1 neurons. The whole-cell current of the major ion channel components in RPeD1 neurons were characterized, and a conductance-based computational model of the rhythmic pacemaker activity was simulated with the experimental measurements. We found that the spiking rate is more sensitive to changes in the Na + leak current as compared to the K + leak current, suggesting a robust function of Na + leak current in regulating spontaneous neuronal firing activity. Our study provides new insight into our current understanding of the role of Na + leak current in intrinsic properties of pacemaker neurons. © 2016 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

Evidence Acquisition and Evaluation for a U.S. Government Evidence Summit on Protecting Children outside Family Care

ERIC Educational Resources Information Center

Higgs, Elizabeth S.; Zlidar, Vera M.; Balster, Robert L.

2012-01-01

Recognizing the need for evidence to inform policies, strategies, and programs to care for vulnerable children, the U.S. Government convened an Evidence Summit on Protecting Children Outside of Family Care on December 12-13, 2011, in Washington, DC, USA. This paper summarizes the background and methods for the acquisition and evaluation of the…

A Health Economics Response to the Review of the Liverpool Care Pathway

PubMed Central

Coast, Joanna

2013-01-01

Abstract Background: In 2011 the Palliative Care Funding Review highlighted concerns about the funding, provision, and quality of care at the end of life. Two years on, an independent review of the Liverpool Care Pathway—prompted by a storm of negative media coverage— has raised concerns around a lack of funding, availability of support for the dying and their relatives, and patient centered care. There are recommendations to increase funding through a national tariff for palliative care services, address inconsistencies, and replace the Liverpool Care Pathway with individual end-of-life care plans. Objective: This paper explores the economic implications of the review's recommendations and links these to inadequacies with the current economic framework currently recommended for use in the United Kingdom by the National Institute for Health and Care Excellence, before highlighting aspects of ongoing research aimed at addressing these inadequacies. Methods: As well as the published report More Care, Less Pathway, we draw upon preliminary qualitative evidence from 19 semistructured interviews conducted with academics specializing in economics and/or end-of-life care. Conclusions: While there is a need for increased funding in the short term (highlighted in recent reviews), increasing funding to services that have little evidence base appears to be an irresponsible long-term strategy. Hence there should also be increased investment in research and increased emphasis in particular on developing economic tools to evaluate services. PMID:24199790

PHYSICAL THERAPY MANAGEMENT OF ICE HOCKEY ATHLETES: FROM THE RINK TO THE CLINIC AND BACK

PubMed Central

Davenport, Todd E.

2016-01-01

ABSTRACT Background The increasing number of athletes playing hockey compels rehabilitation professionals working in orthopedic and sports settings to understand the unique functional demands of ice hockey and the patterns of injuries they may promote. Purpose The purpose of this clinical perspective is to: (1) discuss the functional implications of different positions and age levels on injury prevalence within the sport; (2) summarize the seven most common injuries sustained by ice hockey athletes; and (3) present a conceptual model for the clinical management and prevention of these injuries by rehabilitation professionals. Methods A narrative review and synthesis was conducted of currently available literature on prevalence, etiology, rehabilitative intervention, prognosis, and prevention of ice hockey injuries. Results Research evidence is available to support the prevalence of injuries sustained while participating in ice hockey, as well as the most effective clinical treatment protocols to treat them. Most of the existing protocols are based on clinical and sports experience with incorporation of scientific data. Conclusion This clinical commentary reviews the current concepts of ice hockey injury care and prevention, based on scientific information regarding the incidence, mechanism, rehabilitation protocols, prognosis, and prevention of injuries. Science-based, patient-centered reasoning is integral to provide the highest quality of rehabilitative and preventative care for ice hockey athletes by physical therapists. Level of Evidence 5 PMID:27274432

Preventing skin cancer through reduction of indoor tanning: current evidence.

PubMed

Watson, Meg; Holman, Dawn M; Fox, Kathleen A; Guy, Gery P; Seidenberg, Andrew B; Sampson, Blake P; Sinclair, Craig; Lazovich, DeAnn

2013-06-01

Exposure to ultraviolet radiation from indoor tanning devices (tanning beds, booths, and sun lamps) or from the sun contributes to the risk of skin cancer, including melanoma, which is the type of skin cancer responsible for most deaths. Indoor tanning is common among certain groups, especially among older adolescents and young adults, adolescent girls and young women, and non-Hispanic whites. Increased understanding of the health risks associated with indoor tanning has led to many efforts to reduce use. Most environmental and systems efforts in the U.S. (e.g., age limits or requiring parental consent/accompaniment) have occurred at the state level. At the national level, the U.S. Food and Drug Administration and the Federal Trade Commission regulate indoor tanning devices and advertising, respectively. The current paper provides a brief review of (1) the evidence on indoor tanning as a risk factor for skin cancer; (2) factors that may influence use of indoor tanning devices at the population level; and (3) various environmental and systems options available for consideration when developing strategies to reduce indoor tanning. This information provides the context and background for the companion paper in this issue of the American Journal of Preventive Medicine, which summarizes highlights from an informal expert meeting convened by the CDC in August 2012 to identify opportunities to prevent skin cancer by reducing use of indoor tanning devices. Published by Elsevier Inc.

Impact of seasonal variation, age and smoking status on human semen parameters: The Massachusetts General Hospital experience

PubMed Central

Chen, Zuying; Godfrey-Bailey, Linda; Schiff, Isaac; Hauser, Russ

2004-01-01

Background To investigate the relationship of human semen parameters with season, age and smoking status. Methods The present study used data from subjects recruited into an ongoing cross-sectional study on the relationship between environmental agents and semen characteristics. Our population consisted of 306 patients who presented to the Vincent Memorial Andrology Laboratory of Massachusetts General Hospital for semen evaluation. Sperm concentration and motility were measured with computer aided sperm analysis (CASA). Sperm morphology was scored using Tygerberg Kruger strict criteria. Regression analyses were used to investigate the relationships between semen parameters and season, age and smoking status, adjusting for abstinence interval. Results Sperm concentration in the spring was significantly higher than in winter, fall and summer (p < 0.05). There was suggestive evidence of higher sperm motility and percent of sperm with normal morphology in the spring than in the other seasons. There were no statistically significant relationships between semen parameters and smoking status, though current smokers tended to have lower sperm concentration. We also did not find a statistically significant relationship between age and semen parameters. Conclusions We found seasonal variations in sperm concentration and suggestive evidence of seasonal variation in sperm motility and percent sperm with normal morphology. Although smoking status was not a significant predictor of semen parameters, this may have been due to the small number of current smokers in the study. PMID:15507127

Immunomodulators in SLE: Clinical evidence and immunologic actions

PubMed Central

Durcan, L.; Petri, M.

2016-01-01

Systemic lupus erythematosus (SLE) is a potentially fatal autoimmune disease. Current treatment strategies rely heavily on corticosteroids, which are in turn responsible for a significant burden of morbidity, and immunosuppressives which are limited by suboptimal efficacy, increased infections and malignancies. There are significant deficiencies in our immunosuppressive armamentarium, making immunomodulatory therapies crucial, offering the opportunity to prevent disease flare and the subsequent accrual of damage. Currently available immunomodulators include prasterone (synthetic dehydroeipandrosterone), vitamin D, hydroxychloroquine and belimumab. These therapies, acting via numerous cellular and cytokine pathways, have been shown to modify the aberrant immune responses associated with SLE without overt immunosuppression. Vitamin D is important in SLE and supplementation appears to have a positive impact on disease activity particularly proteinuria. Belimumab has specific immunomodulatory properties and is an effective therapy in those with specific serological and clinical characteristics predictive of response. Hydroxychloroquine is a crucial background medication in SLE with actions in many molecular pathways. It has disease specific effects in reducing flare, treating cutaneous disease and inflammatory arthralgias in addition to other effects such as reduced thrombosis, increased longevity, improved lipids, better glycemic control and blood pressure. Dehydroeipandrosterone is also an immunomodulator in SLE which can have positive effects on disease activity and has bone protective properties. This review outlines the immunologic actions of these drugs and the clinical evidence supporting their use. PMID:27371107

Miracle drug: Brazil approves never-tested cancer medicine.

PubMed

Kuchenbecker, Ricardo S; Mota, Daniel M

2017-07-01

Background Brazil recently approved synthetic phosphoetanolamine, a popularly dubbed 'cancer pill', a substance that has been shown to kill cancer cells in lab animal models but was not yet formally accessed in humans, and thus despite the existence of any evidence of its efficacy and safety. Methods The authors describe the recent decision of Brazil to aprove phosphoetanolamine in the context of growing 'judicialization' to promote access to medicines and thus reinforcing a growing sense of legal uncertainty. Results The approval of phosphoetanolamine despite the existence of any evidence of its efficacy and safety represents to the authors one of the saddest and surrealistic episodes in Brazil's recent public health history. Brazil's current economic crisis is fueling the 'judicialization' to promote access to medicines and thus reinforcing a growing sense of legal uncertainty in the context of rising economic constrains and a progressive failing state. The authors state that the Phosphoetanolamine's approval bill violates current legal prohibition of commercialisation of drugs without the Brazilian national drug regulatory agency's approval and thus may represent a potential menace to Brazil's pharmacogovernance and the country's governance to health technology assessment at the Brazilian national health systems. Conclusion Phosphoetanolamine's approval illustrates that the combination of flawed decision making, economic crisis and political interference may threaten weak governance mechanisms for drug regulation and health technology assessment and thus representing an extra burden in the sustainability of universal access-based national health systems.

Immunomodulators in SLE: Clinical evidence and immunologic actions.

PubMed

Durcan, L; Petri, M

2016-11-01

Systemic lupus erythematosus (SLE) is a potentially fatal autoimmune disease. Current treatment strategies rely heavily on corticosteroids, which are in turn responsible for a significant burden of morbidity, and immunosuppressives which are limited by suboptimal efficacy, increased infections and malignancies. There are significant deficiencies in our immunosuppressive armamentarium, making immunomodulatory therapies crucial, offering the opportunity to prevent disease flare and the subsequent accrual of damage. Currently available immunomodulators include prasterone (synthetic dehydroeipandrosterone), vitamin D, hydroxychloroquine and belimumab. These therapies, acting via numerous cellular and cytokine pathways, have been shown to modify the aberrant immune responses associated with SLE without overt immunosuppression. Vitamin D is important in SLE and supplementation appears to have a positive impact on disease activity particularly proteinuria. Belimumab has specific immunomodulatory properties and is an effective therapy in those with specific serological and clinical characteristics predictive of response. Hydroxychloroquine is a crucial background medication in SLE with actions in many molecular pathways. It has disease specific effects in reducing flare, treating cutaneous disease and inflammatory arthralgias in addition to other effects such as reduced thrombosis, increased longevity, improved lipids, better glycemic control and blood pressure. Dehydroeipandrosterone is also an immunomodulator in SLE which can have positive effects on disease activity and has bone protective properties. This review outlines the immunologic actions of these drugs and the clinical evidence supporting their use. Copyright © 2016 Elsevier Ltd. All rights reserved.

Menu Planning in Residential Aged Care—The Level of Choice and Quality of Planning of Meals Available to Residents

PubMed Central

Abbey, Karen L.; Wright, Olivia R. L.; Capra, Sandra

2015-01-01

Background: Choice of food is an imperative aspect of quality of life for residents in Residential Aged Care Homes (RACHs), where overall choice and control is diminished upon entering a home to receive care. The purpose of this study was to examine the current strategies of menu planning in a range of RACHs in Australia, and whether this facilitated appropriate levels of choice for residents receiving texture modified and general diets. Methods: The study comprised a National Menu Survey using a new survey instrument collecting general information about the RACH and foodservice system, menu information and staffing information (n = 247); a national menu analysis (n = 161) and an observational case study of 36 meal environments. Results: Choice was low for the entire sample, but particularly for those receiving pureed texture modified diets. Evidence of menu planning to facilitate the inclusion of choice and alternatives was limited. Discussion: Regulation and monitoring of the Australian Aged Care Accreditation Standards needs to be strengthened to mandate improvement of the choice and variety offered to residents, particularly those on pureed texture modified diets. Further research on how menu choice and a lack of variety in meals affects the quality of life residents is needed in this context, but current evidence suggests the effect would be detrimental and undermine resident autonomy and nutritional status. PMID:26371040

Professionals' views of fetal-monitoring support the development of devices to provide objective longer-term assessment of fetal wellbeing.

PubMed

Brown, Rebecca; Johnstone, Edward D; Heazell, Alexander E P

2016-01-01

Continuous longer-term fetal monitoring has been proposed to address limitations of current technologies in the detection of fetal compromise. We aimed to assess professionals' views regarding current fetal-monitoring techniques and proposed longer-term continuous fetal monitoring. A questionnaire was designed and validated to assess obstetricians' and midwives' use of current fetal-monitoring techniques and their views towards continuous monitoring. 125 of 173 received responses (72% obstetricians, 28% midwives) were analysed. Professionals had the strongest views about supporting evidence for the most commonly employed fetal-monitoring techniques (maternal awareness of fetal movements, ultrasound assessment of fetal growth and umbilical artery Doppler). 45.1% of professionals agreed that a continuous monitoring device would be beneficial (versus 28.7% who disagreed); this perceived benefit was not influenced by professionals' views regarding current techniques or professional background. Professionals have limited experience of continuous fetal monitoring, but most respondents believed that it would increase maternal anxiety (64.3%) and would have concerns with its use in clinical practice (81.7%). Continuous fetal monitoring would be acceptable to the majority of professionals. However, development of these technologies must be accompanied by extended examination of professionals' and women's views to determine barriers to its introduction.

The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania

PubMed Central

Mori, Amani Thomas; Kaale, Eliangiringa Amos; Ngalesoni, Frida; Norheim, Ole Frithjof; Robberstad, Bjarne

2014-01-01

Background Insufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims to describe the process of updating the Standard Treatment Guidelines and National Essential Medicine List in Tanzania and further examines the criteria and the underlying evidence used in decision-making. Methods This is a qualitative study in which data were collected by in-depth interviews and document reviews. Interviews were conducted with 18 key informants who were involved in updating the Standard Treatment Guidelines and National Essential Medicine List. We used a thematic content approach to analyse the data. Findings The Standard Treatment Guidelines and National Essential Medicine List was updated by committees of experts who were recruited mostly from referral hospitals and the Ministry of Health and Social Welfare. Efficacy, safety, availability and affordability were the most frequently utilised criteria in decision-making, although these were largely based on experience rather than evidence. In addition, recommendations from international guidelines and medicine promotions also influenced decision-making. Cost-effectiveness, despite being an important criterion for formulary decisions, was not utilised. Conclusions Recent decisions about the selection of essential medicines in Tanzania were made by committees of experts who largely used experience and discretionary judgement, leaving evidence with only a limited role in decision-making process. There may be several reasons for the current limited use of evidence in decision-making, but one hypothesis that remains to be explored is whether training experts in evidence-based decision-making would lead to a better and more explicit use of evidence. PMID:24416293

Evidence-based medicine in primary care: qualitative study of family physicians

PubMed Central

Tracy, C Shawn; Dantas, Guilherme Coelho; Upshur, Ross EG

2003-01-01

Background The objectives of this study were: a) to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM) in primary care; b) to investigate the influence of patient preferences on clinical decision-making; and c) to explore the role of intuition in family practice. Method Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Results Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Discussion Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour. PMID:12740025

A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting

PubMed Central

2013-01-01

Background Despite growing interest and urges by leading experts for the routine collection of patient reported outcome (PRO) measures in all general care patients, and in particular cancer patients, there has not been an updated comprehensive review of the evidence regarding the impact of adopting such a strategy on patients, service providers and organisations in an oncologic setting. Methods Based on a critical analysis of the three most recent systematic reviews, the current systematic review developed a six-method strategy in searching and reviewing the most relevant quantitative studies between January 2000 and October 2011 using a set of pre-determined inclusion criteria and theory-based outcome indicators. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to rate the quality and importance of the identified publications, and the synthesis of the evidence was conducted. Results The 27 identified studies showed strong evidence that the well-implemented PROs improved patient-provider communication and patient satisfaction. There was also growing evidence that it improved the monitoring of treatment response and the detection of unrecognised problems. However, there was a weak or non-existent evidence-base regarding the impact on changes to patient management and improved health outcomes, changes to patient health behaviour, the effectiveness of quality improvement of organisations, and on transparency, accountability, public reporting activities, and performance of the health care system. Conclusions Despite the existence of significant gaps in the evidence-base, there is growing evidence in support of routine PRO collection in enabling better and patient-centred care in cancer settings. PMID:23758898

Review of methods used by chiropractors to determine the site for applying manipulation

PubMed Central

2013-01-01

Background With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation. Methods Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation. Results A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement. Conclusions A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care– methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine–such as skin conductance or thermography–tend not to be supported by the available evidence. PMID:24499598

Optimization of Experimental Conditions of the Pulsed Current GTAW Parameters for Mechanical Properties of SDSS UNS S32760 Welds Based on the Taguchi Design Method

NASA Astrophysics Data System (ADS)

Yousefieh, M.; Shamanian, M.; Saatchi, A.

2012-09-01

Taguchi design method with L9 orthogonal array was implemented to optimize the pulsed current gas tungsten arc welding parameters for the hardness and the toughness of super duplex stainless steel (SDSS, UNS S32760) welds. In this regard, the hardness and the toughness were considered as performance characteristics. Pulse current, background current, % on time, and pulse frequency were chosen as main parameters. Each parameter was varied at three different levels. As a result of pooled analysis of variance, the pulse current is found to be the most significant factor for both the hardness and the toughness of SDSS welds by percentage contribution of 71.81 for hardness and 78.18 for toughness. The % on time (21.99%) and the background current (17.81%) had also the next most significant effect on the hardness and the toughness, respectively. The optimum conditions within the selected parameter values for hardness were found as the first level of pulse current (100 A), third level of background current (70 A), first level of % on time (40%), and first level of pulse frequency (1 Hz), while they were found as the second level of pulse current (120 A), second level of background current (60 A), second level of % on time (60%), and third level of pulse frequency (5 Hz) for toughness. The Taguchi method was found to be a promising tool to obtain the optimum conditions for such studies. Finally, in order to verify experimental results, confirmation tests were carried out at optimum working conditions. Under these conditions, there were good agreements between the predicted and the experimental results for the both hardness and toughness.

Evidence-based dentistry: a clinician's perspective.

PubMed

Bauer, Janet; Spackman, Sue; Chiappelli, Francesco; Prolo, Paolo; Stevenson, Richard

2006-07-01

Evidence-based dentistry is a discipline that provides best, explicit-based evidence to dentists and their patients in shared decision-making. Currently, dentists are being trained and directed to adopt the role of translational researchers in developing evidence-based dental practices. Practically, evidence-based dentistry is not usable in its current mode for the provision of labor-intensive services that characterize current dental practice. The purpose of this article is to introduce a model of evidence-based dental practice. This model conceptualizes a team approach in explaining problems and solutions to change current dental practice. These changes constitute an evidence-based dental practice that involves the electronic chart, centralized database, knowledge management software, and personnel in optimizing effective oral health care to dental patients.

Contrast in air pollution components between major streets and background locations: Particulate matter mass, black carbon, elemental composition, nitrogen oxide and ultrafine particle number

NASA Astrophysics Data System (ADS)

Boogaard, Hanna; Kos, Gerard P. A.; Weijers, Ernie P.; Janssen, Nicole A. H.; Fischer, Paul H.; van der Zee, Saskia C.; de Hartog, Jeroen J.; Hoek, Gerard

2011-01-01

Policies to reduce outdoor air pollution concentrations are often assessed on the basis of the regulated pollutants. Whether these are the most appropriate components to assess the potential health benefits is questionable, as other health-relevant pollutants may be more strongly related to traffic. The aim of this study is to compare the contrast in concentration between major roads and (sub)urban background for a large range of pollutants and to analyze the magnitude of the measured difference in the street - background for major streets with different street configurations. Measurements of PM 10, PM 2.5, particle number concentrations (PNC), black carbon (BC), elemental composition of PM 10 and PM 2.5 and NO x were conducted simultaneously in eight major streets and nine (sub)urban background locations in the Netherlands. Measurements were done six times for a week during a six month period in 2008. High contrasts between busy streets and background locations in the same city were found for chromium, copper and iron (factor 2-3). These elements were especially present in the coarse fraction of PM. In addition, high contrasts were found for BC and NO x (factor 1.8), typically indicators of direct combustion emissions. The contrast for PNC was similar to BC. NO 2 contrast was lower (factor 1.5). The largest contrast was found for two street canyons and two streets with buildings at one side of the street only. The contrast between busy streets and urban background in NO 2 was less than the contrast found for BC, PNC and elements indicative of non-exhaust emissions, adding evidence that NO 2 is not representing (current) traffic well. The study supports a substantial role for non-exhaust emissions including brake- and tyre wear and road dust in addition to direct combustion emissions. Significant underestimation of disease burden may occur when relying too much on the regulated components.

California Baseline Ozone Transport Study (CABOTS): Ozonesonde Measurements

NASA Astrophysics Data System (ADS)

Eiserloh, A. J., Jr.; Chiao, S.; Spitze, J.; Cauley, S.; Clark, J.; Roberts, M.

2016-12-01

Because the EPA recently lowered the ambient air quality standard for the 8-hr average of ozone (O3) to70 ppbv, California must continue to achieve significant reductions in ozone precursor emissions and prepare for new State Implementation Plans (SIP) to demonstrate how ground-level ambient ozone will be reduced below the new health-based standard. Prior studies suggest that background levels of ozone traveling across the Pacific Ocean can significantly influence surface ozone throughout California, particularly during the spring. Evidence has been presented indicating that background levels of ozone continue to increase in the western United States over the recent few decades, implying more ozone exceedances in the future. To better understand the contributions of the external natural and anthropogenic pollution sources as well as atmospheric processes for surface ozone concentrations in California during the spring and summer months, the California Baseline Ozone Transport Study (CABOTS) has been established. One major goal of CABOTS is to implement near daily ozonesonde measurements along the California Coast to quantify background ozone aloft before entering the State during high ozone season. CABOTS has been ongoing from May through August of 2016 launching ozonesondes from Bodega Bay and Half Moon Bay, California. The temporal progression of ozonesonde measurements and subsequent analysis of the data will be discussed with a focus on the contribution of background ozone to surface ozone sites inland as well as likely origins of layers aloft. Comparisons of current ozonesondes versus prior ozonesonde studies of California will also be performed. A few selected cases of high ozone layers moving onshore from different sources will be discussed as well.

Lead-induced anemia: Dose-response relationships and evidence for a threshold

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

Schwartz, J.; Landrigan, P.J.; Baker, E.L. Jr.

1990-02-01

We conducted a cross-sectional epidemiologic study to assess the association between blood lead level and hematocrit in 579 one to five year-old children living near a primary lead smelter in 1974. Blood lead levels ranged from 0.53 to 7.91 mumol/L (11 to 164 micrograms/dl). To predict hematocrit as a function of blood lead level and age, we derived non-linear regression models and fit percentile curves. We used logistic regression to predict the probability of hematocrit values less than 35 per cent. We found a strong non-linear, dose-response relationship between blood lead level and hematocrit. This relationship was influenced by age,more » but (in this age group) not by sex; the effect was strongest in youngest children. In one year-olds, the age group most severely affected, the risk of an hematocrit value below 35 percent was 2 percent above background at blood lead levels between 0.97 and 1.88 mumol/L (20 and 39 micrograms/dl), 18 percent above background at lead levels of 1.93 to 2.85 mumol/L (40 to 59 micrograms/dl), and 40 percent above background at lead levels of 2.9 mumol/L (60 micrograms/dl) and greater; background was defined as a blood lead level below 1.88 mumol/L (20 micrograms/dl). This effect appeared independent of iron deficiency. These findings suggest that blood lead levels close to the currently recommended limit value of 1.21 mumol/L (25 micrograms/dl) are associated with dose-related depression of hematocrit in young children.« less

Political and Institutional Influences on the Use of Evidence in Public Health Policy. A Systematic Review

PubMed Central

Liverani, Marco; Hawkins, Benjamin; Parkhurst, Justin O.

2013-01-01

Background There is increasing recognition that the development of evidence-informed health policy is not only a technical problem of knowledge exchange or translation, but also a political challenge. Yet, while political scientists have long considered the nature of political systems, the role of institutional structures, and the political contestation of policy issues as central to understanding policy decisions, these issues remain largely unexplored by scholars of evidence-informed policy making. Methods We conducted a systematic review of empirical studies that examined the influence of key features of political systems and institutional mechanisms on evidence use, and contextual factors that may contribute to the politicisation of health evidence. Eligible studies were identified through searches of seven health and social sciences databases, websites of relevant organisations, the British Library database, and manual searches of academic journals. Relevant findings were extracted using a uniform data extraction tool and synthesised by narrative review. Findings 56 studies were selected for inclusion. Relevant political and institutional aspects affecting the use of health evidence included the level of state centralisation and democratisation, the influence of external donors and organisations, the organisation and function of bureaucracies, and the framing of evidence in relation to social norms and values. However, our understanding of such influences remains piecemeal given the limited number of empirical analyses on this subject, the paucity of comparative works, and the limited consideration of political and institutional theory in these studies. Conclusions This review highlights the need for a more explicit engagement with the political and institutional factors affecting the use of health evidence in decision-making. A more nuanced understanding of evidence use in health policy making requires both additional empirical studies of evidence use, and an engagement with theories and approaches beyond the current remit of public health or knowledge utilisation studies. PMID:24204823

The Navigation Guide—Evidence-Based Medicine Meets Environmental Health: Systematic Review of Nonhuman Evidence for PFOA Effects on Fetal Growth

PubMed Central

Lam, Juleen; Sutton, Patrice; Johnson, Paula I.; Atchley, Dylan S.; Sen, Saunak; Robinson, Karen A.; Axelrad, Daniel A.; Woodruff, Tracey J.

2014-01-01

Background: In contrast to current methods of expert-based narrative review, the Navigation Guide is a systematic and transparent method for synthesizing environmental health research from multiple evidence streams. The Navigation Guide was developed to effectively and efficiently translate the available scientific evidence into timely prevention-oriented action. Objectives: We applied the Navigation Guide systematic review method to answer the question “Does fetal developmental exposure to perfluorooctanoic acid (PFOA) or its salts affect fetal growth in animals ?” and to rate the strength of the experimental animal evidence. Methods: We conducted a comprehensive search of the literature, applied prespecified criteria to the search results to identify relevant studies, extracted data from studies, obtained additional information from study authors, conducted meta-analyses, and rated the overall quality and strength of the evidence. Results: Twenty-one studies met the inclusion criteria. From the meta-analysis of eight mouse gavage data sets, we estimated that exposure of pregnant mice to increasing concentrations of PFOA was associated with a change in mean pup birth weight of –0.023 g (95% CI: –0.029, –0.016) per 1-unit increase in dose (milligrams per kilogram body weight per day). The evidence, consisting of 15 mammalian and 6 nonmammalian studies, was rated as “moderate” and “low” quality, respectively. Conclusion: Based on this first application of the Navigation Guide methodology, we found sufficient evidence that fetal developmental exposure to PFOA reduces fetal growth in animals. Citation: Koustas E, Lam J, Sutton P, Johnson PI, Atchley DS, Sen S, Robinson KA, Axelrad DA, Woodruff TJ. 2014. The Navigation Guide—evidence-based medicine meets environmental health: systematic review of nonhuman evidence for PFOA effects on fetal growth. Environ Health Perspect 122:1015–1027; http://dx.doi.org/10.1289/ehp.1307177 PMID:24968374

Effect of Background Pressure on the Performance and Plume of the HiVHAc Hall Thruster

NASA Technical Reports Server (NTRS)

Huang, Wensheng; Kamhawi, Hani; Haag, Thomas

2013-01-01

During the Single String Integration Test of the NASA HiVHAc Hall thruster, a number of plasma diagnostics were implemented to study the effect of varying facility background pressure on thruster operation. These diagnostics include thrust stand, Faraday probe, ExB probe, and retarding potential analyzer. The test results indicated a rise in thrust and discharge current with background pressure. There was also a decrease in ion energy per charge, an increase in multiply-charged species production, a decrease in plume divergence, and a decrease in ion beam current with increasing background pressure. A simplified ingestion model was applied to determine the maximum acceptable background pressure for thrust measurement. The maximum acceptable ingestion percentage was found to be around 1%. Examination of the diagnostics results suggest the ionization and acceleration zones of the thruster were shifting upstream with increasing background pressure.

Difficulties in diagnosing Marfan syndrome using current FBN1 databases.

PubMed

Groth, Kristian A; Gaustadnes, Mette; Thorsen, Kasper; Østergaard, John R; Jensen, Uffe Birk; Gravholt, Claus H; Andersen, Niels H

2016-01-01

The diagnostic criteria of Marfan syndrome (MFS) highlight the importance of a FBN1 mutation test in diagnosing MFS. As genetic sequencing becomes better, cheaper, and more accessible, the expected increase in the number of genetic tests will become evident, resulting in numerous genetic variants that need to be evaluated for disease-causing effects based on database information. The aim of this study was to evaluate genetic variants in four databases and review the relevant literature. We assessed background data on 23 common variants registered in ESP6500 and classified as causing MFS in the Human Gene Mutation Database (HGMD). We evaluated data in four variant databases (HGMD, UMD-FBN1, ClinVar, and UniProt) according to the diagnostic criteria for MFS and compared the results with the classification of each variant in the four databases. None of the 23 variants was clearly associated with MFS, even though all classifications in the databases stated otherwise. A genetic diagnosis of MFS cannot reliably be based on current variant databases because they contain incorrectly interpreted conclusions on variants. Variants must be evaluated by time-consuming review of the background material in the databases and by combining these data with expert knowledge on MFS. This is a major problem because we expect even more genetic test results in the near future as a result of the reduced cost and process time for next-generation sequencing.Genet Med 18 1, 98-102.

Assessing scientists for hiring, promotion, and tenure.

PubMed

Moher, David; Naudet, Florian; Cristea, Ioana A; Miedema, Frank; Ioannidis, John P A; Goodman, Steven N

2018-03-01

Assessment of researchers is necessary for decisions of hiring, promotion, and tenure. A burgeoning number of scientific leaders believe the current system of faculty incentives and rewards is misaligned with the needs of society and disconnected from the evidence about the causes of the reproducibility crisis and suboptimal quality of the scientific publication record. To address this issue, particularly for the clinical and life sciences, we convened a 22-member expert panel workshop in Washington, DC, in January 2017. Twenty-two academic leaders, funders, and scientists participated in the meeting. As background for the meeting, we completed a selective literature review of 22 key documents critiquing the current incentive system. From each document, we extracted how the authors perceived the problems of assessing science and scientists, the unintended consequences of maintaining the status quo for assessing scientists, and details of their proposed solutions. The resulting table was used as a seed for participant discussion. This resulted in six principles for assessing scientists and associated research and policy implications. We hope the content of this paper will serve as a basis for establishing best practices and redesigning the current approaches to assessing scientists by the many players involved in that process.

Assessing scientists for hiring, promotion, and tenure

PubMed Central

Naudet, Florian; Cristea, Ioana A.; Miedema, Frank; Ioannidis, John P. A.; Goodman, Steven N.

2018-01-01

Assessment of researchers is necessary for decisions of hiring, promotion, and tenure. A burgeoning number of scientific leaders believe the current system of faculty incentives and rewards is misaligned with the needs of society and disconnected from the evidence about the causes of the reproducibility crisis and suboptimal quality of the scientific publication record. To address this issue, particularly for the clinical and life sciences, we convened a 22-member expert panel workshop in Washington, DC, in January 2017. Twenty-two academic leaders, funders, and scientists participated in the meeting. As background for the meeting, we completed a selective literature review of 22 key documents critiquing the current incentive system. From each document, we extracted how the authors perceived the problems of assessing science and scientists, the unintended consequences of maintaining the status quo for assessing scientists, and details of their proposed solutions. The resulting table was used as a seed for participant discussion. This resulted in six principles for assessing scientists and associated research and policy implications. We hope the content of this paper will serve as a basis for establishing best practices and redesigning the current approaches to assessing scientists by the many players involved in that process. PMID:29596415

New probes of Cosmic Microwave Background large-scale anomalies

NASA Astrophysics Data System (ADS)

Aiola, Simone

Fifty years of Cosmic Microwave Background (CMB) data played a crucial role in constraining the parameters of the LambdaCDM model, where Dark Energy, Dark Matter, and Inflation are the three most important pillars not yet understood. Inflation prescribes an isotropic universe on large scales, and it generates spatially-correlated density fluctuations over the whole Hubble volume. CMB temperature fluctuations on scales bigger than a degree in the sky, affected by modes on super-horizon scale at the time of recombination, are a clean snapshot of the universe after inflation. In addition, the accelerated expansion of the universe, driven by Dark Energy, leaves a hardly detectable imprint in the large-scale temperature sky at late times. Such fundamental predictions have been tested with current CMB data and found to be in tension with what we expect from our simple LambdaCDM model. Is this tension just a random fluke or a fundamental issue with the present model? In this thesis, we present a new framework to probe the lack of large-scale correlations in the temperature sky using CMB polarization data. Our analysis shows that if a suppression in the CMB polarization correlations is detected, it will provide compelling evidence for new physics on super-horizon scale. To further analyze the statistical properties of the CMB temperature sky, we constrain the degree of statistical anisotropy of the CMB in the context of the observed large-scale dipole power asymmetry. We find evidence for a scale-dependent dipolar modulation at 2.5sigma. To isolate late-time signals from the primordial ones, we test the anomalously high Integrated Sachs-Wolfe effect signal generated by superstructures in the universe. We find that the detected signal is in tension with the expectations from LambdaCDM at the 2.5sigma level, which is somewhat smaller than what has been previously argued. To conclude, we describe the current status of CMB observations on small scales, highlighting the tensions between Planck, WMAP, and SPT temperature data and how the upcoming data release of the ACTpol experiment will contribute to this matter. We provide a description of the current status of the data-analysis pipeline and discuss its ability to recover large-scale modes.

Use of a Reflective Ultraviolet Imaging System (RUVIS) on Two-Dimensional Dust Impressions Created with Footwear on Multiple Substrates

NASA Astrophysics Data System (ADS)

Engelson, Brian Aaron

Footwear impression evidence in dust is often difficult to locate in ambient light and is a fragile medium that both collection and enhancement techniques can destroy or distort. The collection of footwear impression evidence always begins with non-destructive photographic techniques; however, current methods are limited to oblique lighting of the impression followed by an attempt to photograph in situ. For the vast majority of footwear impressions, an interactive collection method, and thus a potentially destructive procedure, is subsequently carried out to gather the evidence. Therefore, alternative non-destructive means for the preservation and enhancement of footwear impressions in dust merits further attention. Previous research performed with reflected ultraviolet (UV) photography and reflected ultraviolet imaging systems (RUVIS) has shown that there are additional non-destructive methodologies that can be applied to the search for and documentation of footwear impressions in dust. Unfortunately, these prior studies did not include robust comparisons to traditional oblique white light, instead choosing to focus on different UV wavelengths. This study, however, seeks to evaluate the use of a RUVIS device paired with a 254 nanometer (nm) UV light source to locate 2-D footwear impressions in dust on multiple substrates against standard oblique white light techniques and assess the visibility of the impression and amount of background interference present. The optimal angle of incident UV light for each substrate was also investigated. Finally, this study applied an image enhancement technique in order to evaluate its usefulness when looking at the visibility of a footwear impression and the amount of background interference present for enhanced white light and RUVIS pictures of footwear impressions in dust. A collection of eight different substrate types was gathered for investigation, including vinyl composition tile (VCT), ceramic tile, marble tile, magazine paper, steel sheet metal, vinyl flooring, wood flooring, and carpet. Heel impressions were applied to the various substrates utilizing vacuum collected dust and normal walking pressure. Each substrate was then explored and photographed in ambient fluorescent light, oblique white light at 0°, 15°, 30°, and 0° with the light source below the surface plane of the substrate, and 254 nm UV light at 0°, 15°, 30°, 45°, 60°, 75°, 90° and 0° with the light source below the surface plane of the substrate. All pictures were evaluated for clarity and visible detail of the footwear impression and the amount of background interference present, selecting for the best images within a lighting condition group. Additional intra- and intergroup comparisons were carried out to explore differences created by the various lighting conditions. Enhanced images were then created with the best scored pictures and evaluated for additional modifications in impression visibility and background interference. Photographs of footwear impressions in dust illuminated with ambient fluorescent light proved to be the most difficult conditions under which a footwear impression could be visualized. However, both oblique white light and 254 nm UV light lighting conditions showed improvements in either visualization or background dropout, or both, over ambient light conditions. An assessment of the white light and 254 nm UV light RUVIS images also demonstrated that the best angles for the light source for all substrates were oblique 0 and oblique 0° below the surface plane of the substrate lighting. It was found that white light photographs generally provided higher visibility ratings, while RUVIS 254 nm UV light photographs provided better grades for reducing background interference. Enhanced images of white light conditions provided generally poorer quality and quantity of details, while enhanced RUVIS images seemed to improve upon these areas. The use of a RUVIS to capture photographs of footwear impression evidence in dust was found to be a successful secondary non-destructive technique that can be paired with traditional oblique white light procedures. Additionally, the use of below the surface plane of the substrate lighting techniques were found to improve either visibility or background dropout, or both, over standard 0 oblique lighting, depending on the light source, and should be employed, when applicable. Finally, further investigation into digital photo-editing enhancement techniques for footwear impression evidence in dust is needed.

A Systematic Assessment of Smartphone Tools for Suicide Prevention

PubMed Central

Larsen, Mark Erik; Nicholas, Jennifer; Christensen, Helen

2016-01-01

Background Suicide is a leading cause of death globally, and there has been a rapid growth in the use of new technologies such as mobile health applications (apps) to help identify and support those at risk. However, it is not known whether these apps are evidence-based, or indeed contain potentially harmful content. This review examines the concordance of features in publicly available apps with current scientific evidence of effective suicide prevention strategies. Methods Apps referring to suicide or deliberate self-harm (DSH) were identified on the Android and iOS app stores. Systematic review methodology was employed to screen and review app content. App features were labelled using a coding scheme that reflected the broad range of evidence-based medical and population-based suicide prevention interventions. Best-practice for suicide prevention was based upon a World Health Organization report and supplemented by other reviews of the literature. Results One hundred and twenty-three apps referring to suicide were identified and downloaded for full review, 49 of which were found to contain at least one interactive suicide prevention feature. Most apps focused on obtaining support from friends and family (n = 27) and safety planning (n = 14). Of the different suicide prevention strategies contained within the apps, the strongest evidence in the literature was found for facilitating access to crisis support (n = 13). All reviewed apps contained at least one strategy that was broadly consistent with the evidence base or best-practice guidelines. Apps tended to focus on a single suicide prevention strategy (mean = 1.1), although safety plan apps provided the opportunity to provide a greater number of techniques (mean = 3.9). Potentially harmful content, such as listing lethal access to means or encouraging risky behaviour in a crisis, was also identified. Discussion Many suicide prevention apps are available, some of which provide elements of best practice, but none that provide comprehensive evidence-based support. Apps with potentially harmful content were also identified. Despite the number of apps available, and their varied purposes, there is a clear need to develop useful, pragmatic, and multifaceted mobile resources for this population. Clinicians should be wary in recommending apps, especially as potentially harmful content can be presented as helpful. Currently safety plan apps are the most comprehensive and evidence-informed, for example, “Safety Net” and “MoodTools—Depression Aid”. PMID:27073900

Quality of Mobile Phone and Tablet Mobile Apps for Speech Sound Disorders: Protocol for an Evidence-Based Appraisal

PubMed Central

Morris, Meg E; Erickson, Shane; Serry, Tanya A

2016-01-01

Background Although mobile apps are readily available for speech sound disorders (SSD), their validity has not been systematically evaluated. This evidence-based appraisal will critically review and synthesize current evidence on available therapy apps for use by children with SSD. Objective The main aims are to (1) identify the types of apps currently available for Android and iOS mobile phones and tablets, and (2) to critique their design features and content using a structured quality appraisal tool. Methods This protocol paper presents and justifies the methods used for a systematic review of mobile apps that provide intervention for use by children with SSD. The primary outcomes of interest are (1) engagement, (2) functionality, (3) aesthetics, (4) information quality, (5) subjective quality, and (6) perceived impact. Quality will be assessed by 2 certified practicing speech-language pathologists using a structured quality appraisal tool. Two app stores will be searched from the 2 largest operating platforms, Android and iOS. Systematic methods of knowledge synthesis shall include searching the app stores using a defined procedure, data extraction, and quality analysis. Results This search strategy shall enable us to determine how many SSD apps are available for Android and for iOS compatible mobile phones and tablets. It shall also identify the regions of the world responsible for the apps’ development, the content and the quality of offerings. Recommendations will be made for speech-language pathologists seeking to use mobile apps in their clinical practice. Conclusions This protocol provides a structured process for locating apps and appraising the quality, as the basis for evaluating their use in speech pathology for children in English-speaking nations. PMID:27899341

A model for the induction of autism in the ecosystem of the human body: the anatomy of a modern pandemic?

PubMed Central

Bilbo, Staci D.; Nevison, Cynthia D.; Parker, William

2015-01-01

Background The field of autism research is currently divided based on a fundamental question regarding the nature of autism: Some are convinced that autism is a pandemic of modern culture, with environmental factors at the roots. Others are convinced that the disease is not pandemic in nature, but rather that it has been with humanity for millennia, with its biological and neurological underpinnings just now being understood. Objective In this review, two lines of reasoning are examined which suggest that autism is indeed a pandemic of modern culture. First, given the widely appreciated derailment of immune function by modern culture, evidence that autism is strongly associated with aberrant immune function is examined. Second, evidence is reviewed indicating that autism is associated with ‘triggers’ that are, for the most part, a construct of modern culture. In light of this reasoning, current epidemiological evidence regarding the incidence of autism, including the role of changing awareness and diagnostic criteria, is examined. Finally, the potential role of the microbial flora (the microbiome) in the pathogenesis of autism is discussed, with the view that the microbial flora is a subset of the life associated with the human body, and that the entire human biome, including both the microbial flora and the fauna, has been radically destabilized by modern culture. Conclusions It is suggested that the unequivocal way to resolve the debate regarding the pandemic nature of autism is to perform an experiment: monitor the prevalence of autism after normalizing immune function in a Western population using readily available approaches that address the well-known factors underlying the immune dysfunction in that population. PMID:25634608

Prognostic factors for specific lower extremity and spinal musculoskeletal injuries identified through medical screening and training load monitoring in professional football (soccer): a systematic review

PubMed Central

Sergeant, Jamie C; Parkes, Matthew J; Callaghan, Michael J

2017-01-01

Background Medical screening and load monitoring procedures are commonly used in professional football to assess factors perceived to be associated with injury. Objectives To identify prognostic factors (PFs) and models for lower extremity and spinal musculoskeletal injuries in professional/elite football players from medical screening and training load monitoring processes. Methods The MEDLINE, AMED, EMBASE, CINAHL Plus, SPORTDiscus and PubMed electronic bibliographic databases were searched (from inception to January 2017). Prospective and retrospective cohort studies of lower extremity and spinal musculoskeletal injury incidence in professional/elite football players aged between 16 and 40 years were included. The Quality in Prognostic Studies appraisal tool and the modified Grading of Recommendations Assessment, Development and Evaluation synthesis approach was used to assess the quality of the evidence. Results Fourteen studies were included. 16 specific lower extremity injury outcomes were identified. No spinal injury outcomes were identified. Meta-analysis was not possible due to heterogeneity and study quality. All evidence related to PFs and specific lower extremity injury outcomes was of very low to low quality. On the few occasions where multiple studies could be used to compare PFs and outcomes, only two factors demonstrated consensus. A history of previous hamstring injuries (HSI) and increasing age may be prognostic for future HSI in male players. Conclusions The assumed ability of medical screening tests to predict specific musculoskeletal injuries is not supported by the current evidence. Screening procedures should currently be considered as benchmarks of function or performance only. The prognostic value of load monitoring modalities is unknown. PMID:29177074

From Songlines to genomes: Prehistoric assisted migration of a rain forest tree by Australian Aboriginal people

PubMed Central

Ens, Emilie J.; Honings, Thijs; Wilson, Peter D.; Yap, Jia-Yee S.; Costello, Oliver; Round, Erich R.; Bowern, Claire

2017-01-01

Background Prehistoric human activities have contributed to the dispersal of many culturally important plants. The study of these traditional interactions can alter the way we perceive the natural distribution and dynamics of species and communities. Comprehensive research on native crops combining evolutionary and anthropological data is revealing how ancient human populations influenced their distribution. Although traditional diets also included a suite of non-cultivated plants that in some cases necessitated the development of culturally important technical advances such as the treatment of toxic seed, empirical evidence for their deliberate dispersal by prehistoric peoples remains limited. Here we integrate historic and biocultural research involving Aboriginal people, with chloroplast and nuclear genomic data to demonstrate Aboriginal-mediated dispersal of a non-cultivated rainforest tree. Results We assembled new anthropological evidence of use and deliberate dispersal of Castanospermum australe (Fabaceae), a non-cultivated culturally important riparian tree that produces toxic but highly nutritious water-dispersed seed. We validated cultural evidence of recent human-mediated dispersal by revealing genomic homogeneity across extensively dissected habitat, multiple catchments and uneven topography in the southern range of this species. We excluded the potential contribution of other dispersal mechanisms based on the absence of suitable vectors and current distributional patterns at higher elevations and away from water courses, and by analyzing a comparative sample from northern Australia. Conclusions Innovative studies integrating evolutionary and anthropological data will continue to reveal the unexpected impact that prehistoric people have had on current vegetation patterns. A better understanding of how traditional practices shaped species’ distribution and assembly will directly inform cultural heritage management strategies, challenge “natural” species distribution assumptions, and provide innovative baseline data for pro-active biodiversity management. PMID:29117184

Physical activity counseling in medical school education: a systematic review

PubMed Central

Dacey, Marie L.; Kennedy, Mary A.; Polak, Rani; Phillips, Edward M.

2014-01-01

Background Despite a large evidence base to demonstrate the health benefits of regular physical activity (PA), few physicians incorporate PA counseling into office visits. Inadequate medical training has been cited as a cause for this. This review describes curricular components and assesses the effectiveness of programs that have reported outcomes of PA counseling education in medical schools. Methods The authors systematically searched MEDLINE, EMBASE, PsychINFO, and ERIC databases for articles published in English from 2000 through 2012 that met PICOS inclusion criteria of medical school programs with PA counseling skill development and evaluation of outcomes. An initial search yielded 1944 citations, and 11 studies representing 10 unique programs met criteria for this review. These studies were described and analyzed for study quality. Strength of evidence for six measured outcomes shared by multiple studies was also evaluated, that is, students’ awareness of benefits of PA, change in students’ attitudes toward PA, change in personal PA behaviors, improvements in PA counseling knowledge and skills, self-efficacy to conduct PA counseling, and change in attitude toward PA counseling. Results Considerable heterogeneity of teaching methods, duration, and placement within the curriculum was noted. Weak research designs limited an optimal evaluation of effectiveness, that is, few provided pre-/post-intervention assessments, and/or included control comparisons, or met criteria for intervention transparency and control for risk of bias. The programs with the most evidence of improvement indicated positive changes in students’ attitudes toward PA, their PA counseling knowledge and skills, and their self-efficacy to conduct PA counseling. These programs were most likely to follow previous recommendations to include experiential learning, theoretically based frameworks, and students’ personal PA behaviors. Conclusions Current results provide some support for previous recommendations, and current initiatives are underway that build upon these. However, evidence of improvements in physician practices and patient outcomes is lacking. Recommendations include future directions for curriculum development and more rigorous research designs. PMID:25062944

Practitioner Review: Engaging fathers – recommendations for a game change in parenting interventions based on a systematic review of the global evidence

PubMed Central

Panter-Brick, Catherine; Burgess, Adrienne; Eggerman, Mark; McAllister, Fiona; Pruett, Kyle; Leckman, James F

2014-01-01

Background Despite robust evidence of fathers’ impact on children and mothers, engaging with fathers is one of the least well-explored and articulated aspects of parenting interventions. It is therefore critical to evaluate implicit and explicit biases manifested in current approaches to research, intervention, and policy. Methods We conducted a systematic database and a thematic hand search of the global literature on parenting interventions. Studies were selected from Medline, Psychinfo, SSCI, and Cochrane databases, and from gray literature on parenting programs, using multiple search terms for parent, father, intervention, and evaluation. We tabulated single programs and undertook systematic quality coding to review the evidence base in terms of the scope and nature of data reporting. Results After screening 786 nonduplicate records, we identified 199 publications that presented evidence on father participation and impact in parenting interventions. With some notable exceptions, few interventions disaggregate ‘father’ or ‘couple’ effects in their evaluation, being mostly driven by a focus on the mother–child dyad. We identified seven key barriers to engaging fathers in parenting programs, pertaining to cultural, institutional, professional, operational, content, resource, and policy considerations in their design and delivery. Conclusions Barriers to engaging men as parents work against father inclusion as well as father retention, and undervalue coparenting as contrasted with mothering. Robust evaluations of father participation and father impact on child or family outcomes are stymied by the ways in which parenting interventions are currently designed, delivered, and evaluated. Three key priorities are to engage fathers and coparenting couples successfully, to disaggregate process and impact data by fathers, mothers, and coparents, and to pay greater attention to issues of reach, sustainability, cost, equity, and scale-up. Clarity of purpose with respect to gender-differentiated and coparenting issues in the design, delivery, and evaluation of parenting programs will constitute a game change in this field. PMID:24980187

Scientific basis for the Precautionary Principle.

PubMed

Vineis, Paolo

2005-09-01

The Precautionary Principle is based on two general criteria: (a) appropriate public action should be taken in response to limited, but plausible and credible, evidence of likely and substantial harm; (b) the burden of proof is shifted from demonstrating the presence of risk to demonstrating the absence of risk. Not much has been written about the scientific basis of the precautionary principle, apart from the uncertainty that characterizes epidemiologic research on chronic disease, and the use of surrogate evidence when human evidence cannot be provided. It is proposed in this paper that a new scientific paradigm, based on the theory of evolution, is emerging; this might offer stronger support to the need for precaution in the regulation of environmental risks. Environmental hazards do not consist only in direct attacks to the integrity of DNA or other macromolecules. They can consist in changes that take place already in utero, and that condition disease risks many years later. Also, environmental exposures can act as "stressors", inducing hypermutability (the mutator phenotype) as an adaptive response. Finally, environmental changes should be evaluated against a background of a not-so-easily modifiable genetic make-up, inherited from a period in which humans were mainly hunters-gatherers and had dietary habits very different from the current ones.

Current Issues in Cosmology

NASA Astrophysics Data System (ADS)

Pecker, Jean-Claude; Narlikar, Jayant

2011-09-01

Part I. Observational Facts Relating to Discrete Sources: 1. The state of cosmology G. Burbidge; 2. The redshifts of galaxies and QSOs E. M. Burbidge and G. Burbidge; 3. Accretion discs in quasars J. Sulentic; Part II. Observational Facts Relating to Background Radiation: 4. CMB observations and consequences F. Bouchet; 5. Abundances of light nuclei K. Olive; 6. Evidence for an accelerating universe or lack of A. Blanchard; Part III. Standard Cosmology: 7. Cosmology, an overview of the standard model F. Bernardeau; 8. What are the building blocks of our universe? K. C. Wali; Part IV. Large-Scale Structure: 9. Observations of large-scale structure V. de Lapparent; 10. Reconstruction of large-scale peculiar velocity fields R. Mohayaee, B. Tully and U. Frisch; Part V. Alternative Cosmologies: 11. The quasi-steady state cosmology J. V. Narlikar; 12. Evidence for iron whiskers in the universe N. C. Wickramasinghe; 13. Alternatives to dark matter: MOND + Mach D. Roscoe; 14. Anthropic principle in cosmology B. Carter; Part VI. Evidence for Anomalous Redshifts: 15. Anomalous redshifts H. C. Arp; 16. Redshifts of galaxies and QSOs: the problem of redshift periodicities G. Burbidge; 17. Statistics of redshift periodicities W. Napier; 18. Local abnormal redshifts J.-C. Pecker; 19. Gravitational lensing and anomalous redshifts J. Surdej, J.-F. Claeskens and D. Sluse; Panel discussion; General discussion; Concluding remarks.

Dissemination of effective physical activity interventions: are we applying the evidence?

PubMed Central

Ballew, Paula; Brownson, Ross C.; Haire-Joshu, Debra; Heath, Gregory W.; Kreuter, Matthew W.

2010-01-01

Background. Given sparse knowledge on dissemination, this study sought to explore key benefits, barriers and contextual factors that are perceived to be important to the adoption and implementation of the ‘Community Guide's’ evidence-based physical activity recommendations. Design. We conducted case studies in two states where extensive adoption and implementation of the Guide's recommendations have occurred and in two states where widespread dissemination has lagged. Interviews (n = 76) were semi-structured and included both quantitative and qualitative methods. Participant perceptions from the following areas were examined: (i) priority of physical activity, (ii) awareness of and ability to define the term ‘evidence-based approaches’ and (iii) awareness, adoption, facilitators, benefits, challenges and barriers to Guide adoption. Results. Key enabling factors among high capacity states included: funds and direction from the Centers for Disease Control and Prevention; leadership support; capable staff; and successful partnerships and collaborations. Restraining forces among low capacity states included: the Guide recommendations being too new; participants being too new to current job; lack of time and training on how to use the Guide recommendations; limited funds and other resources and lack of leadership. Conclusion. To be effective, we must gain an understanding of contextual factors when designing for dissemination. PMID:20156839

Management of rhinosinusitis during pregnancy: systematic review and expert panel recommendations

PubMed Central

Lal, Devyani; Jategaonkar, Ameya A.; Borish, Larry; Chambliss, Linda R.; Gnagi, Sharon H.; Hwang, Peter H.; Rank, Matthew A.; Stankiewicz, James A.; Lund, Valerie J.

2018-01-01

Background Management of rhinosinusitis during pregnancy requires special considerations. Objectives 1. Conduct a systematic literature review for acute and chronic rhinosinusitis (CRS) management during pregnancy. 2. Make evidence-based recommendations. Methods The systematic review was conducted using MEDLINE and EMBASE databases and relevant search terms. Title, abstract and full manuscript review were conducted by two authors independently. A multispecialty panel with expertise in management of Rhinological disorders, Allergy-Immunology, and Obstetrics-Gynecology was invited to review the systematic review. Recommendations were sought on use of following for CRS management during pregnancy: oral corticosteroids; antibiotics; leukotrienes; topical corticosteroid spray/irrigations/drops; aspirin desensitization; elective surgery for CRS with polyps prior to planned pregnancy; vaginal birth versus planned Caesarian for skull base erosions/ prior CSF rhinorrhea. Results Eighty-eight manuscripts underwent full review after screening 3052 abstracts. No relevant level 1, 2, or 3 studies were found. Expert panel recommendations for rhinosinusitis management during pregnancy included continuing nasal corticosteroid sprays for CRS maintenance, using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations, and discontinuing aspirin desensitization for aspirin exacerbated respiratory disease. The manuscript presents detailed recommendations. Conclusions The lack of evidence pertinent to managing rhinosinusitis during pregnancy warrants future trials. Expert recommendations constitute the current best available evidence. PMID:26800862

The Physiological and Biochemical Outcomes Associated with a Reflexology Treatment: A Systematic Review

PubMed Central

McCullough, J. E. M.; Liddle, S. D.; Sinclair, M.; Close, C.; Hughes, C. M.

2014-01-01

Background. Reflexology is one of the top forms of complementary and alternative medicine in the UK and is used for healthcare by a diverse range of people. However, it is offered by few healthcare providers as little scientific evidence is available explaining how it works or any health benefits it may confer. The aim of this review was to assess the current evidence available from reflexology randomised controlled trials (RCTs) that have investigated changes in physiological or biochemical outcomes. Methods. Guidelines from the Cochrane Handbook of Systematic Reviews of Interventions were followed: the following databases were searched from inception to December 2013: AMED, CAM Quest, CINAHL Plus, Cochrane Central Register of Controlled Trials, Embase, Medline Ovid, Proquest, and Pubmed. Risk of bias was assessed independently by two members of the review team and overall strength of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation guidelines. Results. Seventeen eligible RCTs met all inclusion criteria. A total of 34 objective outcome measures were analysed. Although twelve studies showed significant changes within the reflexology group, only three studies investigating blood pressure, cardiac index, and salivary amylase resulted in significant between group changes in favour of reflexology. The overall quality of the studies was low. PMID:24883067

A Narrative Review of Diabetes Intervention Studies to Explore Diabetes Care Opportunities for Pharmacists.

PubMed

Ayadurai, Shamala; Hattingh, H Laetitia; Tee, Lisa B G; Md Said, Siti Norlina

2016-01-01

Background. We conducted a review of current diabetes intervention studies in type 2 diabetes and identified opportunities for pharmacists to deliver quality diabetes care. Methods. A search on randomised controlled trials (RCT) on diabetes management by healthcare professionals including pharmacists published between 2010 and 2015 was conducted. Results and Discussion. Diabetes management includes multifactorial intervention which includes seven factors as outlined in diabetes guidelines, namely, glycaemic, cholesterol and blood pressure control, medication, lifestyle, education, and cardiovascular risk factors. Most studies do not provide evidence that the intervention methods used included all seven factors with exception of three RCT which indicated HbA1c (glycated hemoglobin) reduction range of 0.5% to 1.8%. The varied HbA1C reduction suggests a lack of standardised and consistent approach to diabetes care. Furthermore, the duration of most studies was from one month to two years; therefore long term outcomes could not be established. Conclusion. Although pharmacists' contribution towards improving clinical outcomes of diabetes patients was well documented, the methods used to deliver structured, consistent evidence-based care were not clearly stipulated. Therefore, approaches to achieving long term continuity of care are uncertain. An intervention strategy that encompass all seven evidence-based factors will be useful.

PREPARTICIPATION SCREENING – THE SPORTS PHYSICAL THERAPY PERSPECTIVE

PubMed Central

Blackburn, Turner A.; Boucher, Brenda

2013-01-01

Background and Purpose: The sports physical therapist (SPT) is uniquely qualified to participate in the provision of preparticipation physical examinations (PPE). The PPE is recommended prior to athletic participation and required by many jurisdictions. There is little research to support the process and components; however, a number of professional organizations have recommendations that direct the PPE process. Description of Topic and Related Evidence: This clinical commentary highlights the role of the sports physical therapist and current evidence related to the preparticipation physical examination process. Data sources were limited to include professional positions and peer reviewed publications from 1988 through January 2013. Relation to Clinical Practice: Preparticipation physicals should be useful, comprehensive, and cost effective for the athlete and the health care team. Additional research is indicated in many of the areas of the PPE. The SPT is a valuable member of the health care team and can be a primary facilitator of the PPE in concert with the physician, athletic trainer, athletic organization administrators, and others. Well‐designed and inclusive PPEs can be provided to meet the major objectives of identification of athletes at risk. Controversy continues over the extent of the cardiac screening component as well as other sport or athlete specific components. Level of Evidence: 5 PMID:23593556

No high level evidence to support the use of oral H1 antihistamines as monotherapy for eczema: a summary of a Cochrane systematic review

PubMed Central

2014-01-01

Background The most important symptom as well as one of the major diagnostic criteria for eczema is itch. Although oral antihistamines continue to be prescribed for people with eczema, it is unclear if they are effective and safe in relieving itch and skin lesions. We sought to evaluate the available evidence on effectiveness of oral antihistamines (H1 antagonists) as monotherapy in children and adults with eczema. Methods Searches included 10 databases and trial registers as well as conference proceedings (January 2014). Randomised controlled trials that assessed the effects of oral H1 antihistamines as monotherapy in children and adults with eczema were included. Results Our searches retrieved 757 references, but no randomised controlled trial met our inclusion criteria. Most studies allowed concomitant treatments, making the assessment of the individual effects of oral H1 antihistamines impossible. Conclusions There is currently no high-level evidence to support or refute the efficacy or safety of oral H1 antihistamines used as monotherapy for eczema. A further review of studies that assesses the effects of oral H1 antihistamines as ‘add-on’ therapy together with concomitant treatments is warranted to determine the beneficial effects of this group of medications in the treatment of eczema. PMID:24625301

The Acceptability Among Health Researchers and Clinicians of Social Media to Translate Research Evidence to Clinical Practice: Mixed-Methods Survey and Interview Study

PubMed Central

Tunnecliff, Jacqueline; Ilic, Dragan; Morgan, Prue; Keating, Jennifer; Gaida, James E; Clearihan, Lynette; Sadasivan, Sivalal; Davies, David; Ganesh, Shankar; Mohanty, Patitapaban; Weiner, John; Reynolds, John

2015-01-01

Background Establishing and promoting connections between health researchers and health professional clinicians may help translate research evidence to clinical practice. Social media may have the capacity to enhance these connections. Objective The aim of this study was to explore health researchers’ and clinicians’ current use of social media and their beliefs and attitudes towards the use of social media for communicating research evidence. Methods This study used a mixed-methods approach to obtain qualitative and quantitative data. Participation was open to health researchers and clinicians. Data regarding demographic details, current use of social media, and beliefs and attitudes towards the use of social media for professional purposes were obtained through an anonymous Web-based survey. The survey was distributed via email to research centers, educational and clinical institutions, and health professional associations in Australia, India, and Malaysia. Consenting participants were stratified by country and role and selected at random for semistructured telephone interviews to explore themes arising from the survey. Results A total of 856 participants completed the questionnaire with 125 participants declining to participate, resulting in a response rate of 87.3%. 69 interviews were conducted with participants from Australia, India, and Malaysia. Social media was used for recreation by 89.2% (749/840) of participants and for professional purposes by 80.0% (682/852) of participants. Significant associations were found between frequency of professional social media use and age, gender, country of residence, and graduate status. Over a quarter (26.9%, 229/852) of participants used social media for obtaining research evidence, and 15.0% (128/852) of participants used social media for disseminating research evidence. Most participants (95.9%, 810/845) felt there was a role for social media in disseminating or obtaining research evidence. Over half of the participants (449/842, 53.3%) felt they had a need for training in the use of social media for professional development. A key barrier to the professional use of social media was concerns regarding trustworthiness of information. Conclusions A large majority of health researchers and clinicians use social media in recreational and professional contexts. Social media is less frequently used for communication of research evidence. Training in the use of social media for professional development and methods to improve the trustworthiness of information obtained via social media may enhance the utility of social media for communicating research evidence. Future studies should investigate the efficacy of social media in translating research evidence to clinical practice. PMID:25995192

Performance, Facility Pressure Effects, and Stability Characterization Tests of NASA's Hall Effect Rocket with Magnetic Shielding Thruster

NASA Technical Reports Server (NTRS)

Kamhawi, Hani; Huang, Wensheng; Haag, Thomas; Yim, John; Herman, Daniel; Williams, George; Gilland, James; Peterson, Peter; Hofer, Richard; Mikellides, Ioannis

2016-01-01

NASAs Hall Effect Rocket with Magnetic Shielding (HERMeS) 12.5 kW Technology Demonstration Unit-1 (TDU-1) Hall thruster has been the subject of extensive technology maturation in preparation for flight system development. Part of the technology maturation effort included experimental evaluation of the TDU-1 thruster with conducting and dielectric front pole cover materials in two different electrical configurations. A graphite front pole cover thruster configuration with the thruster body electrically tied to cathode and an alumina front pole cover thruster configuration with the thruster body floating were evaluated. Both configurations were also evaluated at different facility background pressure conditions to evaluate background pressure effects on thruster operation. Performance characterization tests found that higher thruster performance was attained with the graphite front pole cover configuration with the thruster electrically tied to cathode. A total thrust efficiency of 68 and a total specific impulse of 2,820 s was demonstrated at a discharge voltage of 600 V and a discharge power of 12.5 kW. Thruster stability regimes were characterized with respect to the thruster discharge current oscillations and with maps of the current-voltage-magnetic field (IVB). Analysis of TDU-1 discharge current waveforms found that lower normalized discharge current peak-to-peak and root mean square magnitudes were attained when the thruster was electrically floated with alumina front pole covers. Background pressure effects characterization tests indicated that the thruster performance and stability was mostly invariant to changes in the facility background pressure for vacuum chamber pressure below 110-5 Torr-Xe (for thruster flow rate above 8 mgs). Power spectral density analysis of the discharge current waveform showed that increasing the vacuum chamber background pressure resulted in a higher discharge current dominant frequency. Finally the IVB maps of the TDU-1 thruster taken at elevated magnetic fields indicated that the discharge current became more oscillatory with increased facility background pressure at lower thruster mass flow rates, where thruster operation at higher flow rates resulted in less change to the thrusters IVB characteristics.

How current Clinical Practice Guidelines for low back pain reflect Traditional Medicine in East Asian Countries: a systematic review of Clinical Practice Guidelines and systematic reviews.

PubMed

Cho, Hyun-Woo; Hwang, Eui-Hyoung; Lim, Byungmook; Heo, Kwang-Ho; Liu, Jian-Ping; Tsutani, Kiichiro; Lee, Myeong Soo; Shin, Byung-Cheul

2014-01-01

The aims of this study were to investigate whether there is a gap between evidence of traditional medicine (TM) interventions in East-Asian countries from the current Clinical Practice Guidelines (CPGs) and evidence from current systematic reviews and meta-analyses (SR-MAs) and to analyze the impact of this gap on present CPGs. We examined 5 representative TM interventions in the health care systems of East-Asian countries. We searched seven relevant databases for CPGs to identify whether core CPGs included evidence of TM interventions, and we searched 11 databases for SR-MAs to re-evaluate current evidence on TM interventions. We then compared the gap between the evidence from CPGs and SR-MAs. Thirteen CPGs and 22 SR-MAs met our inclusion criteria. Of the 13 CPGs, 7 CPGs (54%) mentioned TM interventions, and all were for acupuncture (only one was for both acupuncture and acupressure). However, the CPGs did not recommend acupuncture (or acupressure). Of 22 SR-MAs, 16 were for acupuncture, 5 for manual therapy, 1 for cupping, and none for moxibustion and herbal medicine. Comparing the evidence from CPGs and SR-MAs, an underestimation or omission of evidence for acupuncture, cupping, and manual therapy in current CPGs was detected. Thus, applying the results from the SR-MAs, we moderately recommend acupuncture for chronic LBP, but we inconclusively recommend acupuncture for (sub)acute LBP due to the limited current evidence. Furthermore, we weakly recommend cupping and manual therapy for both (sub)acute and chronic LBP. We cannot provide recommendations for moxibustion and herbal medicine due to a lack of evidence. The current CPGs did not fully reflect the evidence for TM interventions. As relevant studies such as SR-MAs are conducted and evidence increases, the current evidence on acupuncture, cupping, and manual therapy should be rigorously considered in the process of developing or updating the CPG system.

Mobile Phones, Brain Tumors, and the Interphone Study: Where Are We Now?

PubMed Central

Feychting, Maria; Green, Adele C.; Kheifets, Leeka; Savitz, David A.

2011-01-01

Background: In the past 15 years, mobile telephone use has evolved from an uncommon activity to one with > 4.6 billion subscriptions worldwide. However, there is public concern about the possibility that mobile phones might cause cancer, especially brain tumors. Objectives: We reviewed the evidence on whether mobile phone use raises the risk of the main types of brain tumor—glioma and meningioma—with a particular focus on the recent publication of the largest epidemiologic study yet: the 13-country Interphone Study. Discussion: Methodological deficits limit the conclusions that can be drawn from the Interphone study, but its results, along with those from other epidemiologic, biological, and animal studies and brain tumor incidence trends, suggest that within about 10–15 years after first use of mobile phones there is unlikely to be a material increase in the risk of brain tumors in adults. Data for childhood tumors and for periods beyond 15 years are currently lacking. Conclusions: Although there remains some uncertainty, the trend in the accumulating evidence is increasingly against the hypothesis that mobile phone use can cause brain tumors in adults. PMID:22171384

National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

PubMed Central

Kaminski, Thomas W.; Hertel, Jay; Amendola, Ned; Docherty, Carrie L.; Dolan, Michael G.; Hopkins, J. Ty; Nussbaum, Eric; Poppy, Wendy; Richie, Doug

2013-01-01

Objective: To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. Background: Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. Recommendations: The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available. PMID:23855363

A Meta-Analysis of Serological Response Associated with Yellow Fever Vaccination.

PubMed

Jean, Kévin; Donnelly, Christl A; Ferguson, Neil M; Garske, Tini

2016-12-07

Despite previous evidence of high level of efficacy, no synthetic metric of yellow fever (YF) vaccine efficacy is currently available. Based on the studies identified in a recent systematic review, we conducted a random-effects meta-analysis of the serological response associated with YF vaccination. Eleven studies conducted between 1965 and 2011 representing 4,868 individual observations were included in the meta-analysis. The pooled estimate of serological response was 97.5% (95% confidence interval [CI] = 82.9-99.7%). There was evidence of between-study heterogeneity (I 2 = 89.1%), but this heterogeneity did not appear to be related to study size, study design, or seroconversion measurement or definition. Pooled estimates were significantly higher (P < 0.0001) among studies conducted in nonendemic settings (98.9%, 95% CI = 98.2-99.4%) than among those conducted in endemic settings (94.2%, 95% CI = 83.8-98.1%). These results provide background information against which to evaluate the efficacy of fractional doses of YF vaccine that may be used in outbreak situations. © The American Society of Tropical Medicine and Hygiene.

Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial): Study protocol for a randomized controlled trial

PubMed Central

2012-01-01

Background Laparoscopic cholecystectomy in acute calculous cholecystitis in high risk patients can lead to significant morbidity and mortality. Percutaneous cholecystostomy may be an alternative treatment option but the current literature does not provide the surgical community with evidence based advice. Methods/Design The CHOCOLATE trial is a randomised controlled, parallel-group, superiority multicenter trial. High risk patients, defined as APACHE-II score 7-14, with acute calculous cholecystitis will be randomised to laparoscopic cholecystectomy or percutaneous cholecystostomy. During a two year period 284 patients will be enrolled from 30 high volume teaching hospitals. The primary endpoint is a composite endpoint of major complications within three months following randomization and need for re-intervention and mortality during the follow-up period of one year. Secondary endpoints include all other complications, duration of hospital admission, difficulty of procedures and total costs. Discussion The CHOCOLATE trial is designed to provide the surgical community with an evidence based guideline in the treatment of acute calculous cholecystitis in high risk patients. Trial Registration Netherlands Trial Register (NTR): NTR2666 PMID:22236534

Evidence of electron neutrino appearance in a muon neutrino beam

NASA Astrophysics Data System (ADS)

Abe, K.; Abgrall, N.; Aihara, H.; Akiri, T.; Albert, J. B.; Andreopoulos, C.; Aoki, S.; Ariga, A.; Ariga, T.; Assylbekov, S.; Autiero, D.; Barbi, M.; Barker, G. J.; Barr, G.; Bass, M.; Batkiewicz, M.; Bay, F.; Bentham, S. W.; Berardi, V.; Berger, B. E.; Berkman, S.; Bertram, I.; Beznosko, D.; Bhadra, S.; Blaszczyk, F. d. M.; Blondel, A.; Bojechko, C.; Boyd, S.; Brailsford, D.; Bravar, A.; Bronner, C.; Brook-Roberge, D. G.; Buchanan, N.; Calland, R. G.; Caravaca Rodríguez, J.; Cartwright, S. L.; Castillo, R.; Catanesi, M. G.; Cervera, A.; Cherdack, D.; Christodoulou, G.; Clifton, A.; Coleman, J.; Coleman, S. J.; Collazuol, G.; Connolly, K.; Cremonesi, L.; Curioni, A.; Dabrowska, A.; Danko, I.; Das, R.; Davis, S.; Day, M.; de André, J. P. A. M.; de Perio, P.; De Rosa, G.; Dealtry, T.; Dennis, S.; Densham, C.; Di Lodovico, F.; Di Luise, S.; Dobson, J.; Drapier, O.; Duboyski, T.; Dufour, F.; Dumarchez, J.; Dytman, S.; Dziewiecki, M.; Dziomba, M.; Emery, S.; Ereditato, A.; Escudero, L.; Finch, A. J.; Frank, E.; Friend, M.; Fujii, Y.; Fukuda, Y.; Furmanski, A.; Galymov, V.; Gaudin, A.; Giffin, S.; Giganti, C.; Gilje, K.; Golan, T.; Gomez-Cadenas, J. J.; Gonin, M.; Grant, N.; Gudin, D.; Hadley, D. R.; Haesler, A.; Haigh, M. D.; Hamilton, P.; Hansen, D.; Hara, T.; Hartz, M.; Hasegawa, T.; Hastings, N. C.; Hayato, Y.; Hearty, C.; Helmer, R. L.; Hierholzer, M.; Hignight, J.; Hillairet, A.; Himmel, A.; Hiraki, T.; Hirota, S.; Holeczek, J.; Horikawa, S.; Huang, K.; Ichikawa, A. K.; Ieki, K.; Ieva, M.; Ikeda, M.; Imber, J.; Insler, J.; Irvine, T. J.; Ishida, T.; Ishii, T.; Ives, S. J.; Iyogi, K.; Izmaylov, A.; Jacob, A.; Jamieson, B.; Johnson, R. A.; Jo, J. H.; Jonsson, P.; Joo, K. K.; Jung, C. K.; Kaboth, A.; Kaji, H.; Kajita, T.; Kakuno, H.; Kameda, J.; Kanazawa, Y.; Karlen, D.; Karpikov, I.; Kearns, E.; Khabibullin, M.; Khanam, F.; Khotjantsev, A.; Kielczewska, D.; Kikawa, T.; Kilinski, A.; Kim, J. Y.; Kim, J.; Kim, S. B.; Kirby, B.; Kisiel, J.; Kitching, P.; Kobayashi, T.; Kogan, G.; Kolaceke, A.; Konaka, A.; Kormos, L. L.; Korzenev, A.; Koseki, K.; Koshio, Y.; Kowalik, K.; Kreslo, I.; Kropp, W.; Kubo, H.; Kudenko, Y.; Kumaratunga, S.; Kurjata, R.; Kutter, T.; Lagoda, J.; Laihem, K.; Laing, A.; Laveder, M.; Lawe, M.; Lazos, M.; Lee, K. P.; Licciardi, C.; Lim, I. T.; Lindner, T.; Lister, C.; Litchfield, R. P.; Longhin, A.; Lopez, G. D.; Ludovici, L.; Macaire, M.; Magaletti, L.; Mahn, K.; Malek, M.; Manly, S.; Marchionni, A.; Marino, A. D.; Marteau, J.; Martin, J. F.; Maruyama, T.; Marzec, J.; Masliah, P.; Mathie, E. L.; Matveev, V.; Mavrokoridis, K.; Mazzucato, E.; McCauley, N.; McFarland, K. S.; McGrew, C.; McLachlan, T.; Messina, M.; Metelko, C.; Mezzetto, M.; Mijakowski, P.; Miller, C. A.; Minamino, A.; Mineev, O.; Mine, S.; Missert, A.; Miura, M.; Monfregola, L.; Moriyama, S.; Mueller, Th. A.; Murakami, A.; Murdoch, M.; Murphy, S.; Myslik, J.; Nagasaki, T.; Nakadaira, T.; Nakahata, M.; Nakai, T.; Nakajima, K.; Nakamura, K.; Nakayama, S.; Nakaya, T.; Nakayoshi, K.; Naples, D.; Nicholls, T. C.; Nielsen, C.; Nirkko, M.; Nishikawa, K.; Nishimura, Y.; O'Keeffe, H. M.; Obayashi, Y.; Ohta, R.; Okumura, K.; Okusawa, T.; Oryszczak, W.; Oser, S. M.; Otani, M.; Owen, R. A.; Oyama, Y.; Pac, M. Y.; Palladino, V.; Paolone, V.; Payne, D.; Pearce, G. F.; Perevozchikov, O.; Perkin, J. D.; Petrov, Y.; Pinzon Guerra, E. S.; Plonski, P.; Poplawska, E.; Popov, B.; Posiadala, M.; Poutissou, J.-M.; Poutissou, R.; Przewlocki, P.; Quilain, B.; Radicioni, E.; Ratoff, P. N.; Ravonel, M.; Rayner, M. A. M.; Reeves, M.; Reinherz-Aronis, E.; Retiere, F.; Robert, A.; Rodrigues, P. A.; Rondio, E.; Roth, S.; Rubbia, A.; Ruterbories, D.; Sacco, R.; Sakashita, K.; Sánchez, F.; Scantamburlo, E.; Scholberg, K.; Schwehr, J.; Scott, M.; Scully, D. I.; Seiya, Y.; Sekiguchi, T.; Sekiya, H.; Sgalaberna, D.; Shibata, M.; Shiozawa, M.; Short, S.; Shustrov, Y.; Sinclair, P.; Smith, B.; Smith, R. J.; Smy, M.; Sobczyk, J. T.; Sobel, H.; Sorel, M.; Southwell, L.; Stamoulis, P.; Steinmann, J.; Still, B.; Suzuki, A.; Suzuki, K.; Suzuki, S. Y.; Suzuki, Y.; Szeglowski, T.; Szeptycka, M.; Tacik, R.; Tada, M.; Takahashi, S.; Takeda, A.; Takeuchi, Y.; Tanaka, H. A.; Tanaka, M. M.; Tanaka, M.; Taylor, I. J.; Terhorst, D.; Terri, R.; Thompson, L. F.; Thorley, A.; Tobayama, S.; Toki, W.; Tomura, T.; Totsuka, Y.; Touramanis, C.; Tsukamoto, T.; Tzanov, M.; Uchida, Y.; Ueno, K.; Vacheret, A.; Vagins, M.; Vasseur, G.; Wachala, T.; Waldron, A. V.; Walter, C. W.; Wark, D.; Wascko, M. O.; Weber, A.; Wendell, R.; Wilkes, R. J.; Wilking, M. J.; Wilkinson, C.; Williamson, Z.; Wilson, J. R.; Wilson, R. J.; Wongjirad, T.; Yamada, Y.; Yamamoto, K.; Yanagisawa, C.; Yen, S.; Yershov, N.; Yokoyama, M.; Yuan, T.; Zalewska, A.; Zambelli, L.; Zaremba, K.; Ziembicki, M.; Zimmerman, E. D.; Zito, M.; Żmuda, J.

2013-08-01

The T2K Collaboration reports evidence for electron neutrino appearance at the atmospheric mass splitting, |Δm322|≈2.4×10-3eV2. An excess of electron neutrino interactions over background is observed from a muon neutrino beam with a peak energy of 0.6 GeV at the Super-Kamiokande (SK) detector 295 km from the beam’s origin. Signal and background predictions are constrained by data from near detectors located 280 m from the neutrino production target. We observe 11 electron neutrino candidate events at the SK detector when a background of 3.3±0.4(syst) events is expected. The background-only hypothesis is rejected with a p value of 0.0009 (3.1σ), and a fit assuming νμ→νe oscillations with sin⁡22θ23=1, δCP=0 and |Δm322|=2.4×10-3eV2 yields sin⁡22θ13=0.088-0.039+0.049(stat+syst).

How biological background assumptions influence scientific risk evaluation of stacked genetically modified plants: an analysis of research hypotheses and argumentations.

PubMed

Rocca, Elena; Andersen, Fredrik

2017-08-14

Scientific risk evaluations are constructed by specific evidence, value judgements and biological background assumptions. The latter are the framework-setting suppositions we apply in order to understand some new phenomenon. That background assumptions co-determine choice of methodology, data interpretation, and choice of relevant evidence is an uncontroversial claim in modern basic science. Furthermore, it is commonly accepted that, unless explicated, disagreements in background assumptions can lead to misunderstanding as well as miscommunication. Here, we extend the discussion on background assumptions from basic science to the debate over genetically modified (GM) plants risk assessment. In this realm, while the different political, social and economic values are often mentioned, the identity and role of background assumptions at play are rarely examined. We use an example from the debate over risk assessment of stacked genetically modified plants (GM stacks), obtained by applying conventional breeding techniques to GM plants. There are two main regulatory practices of GM stacks: (i) regulate as conventional hybrids and (ii) regulate as new GM plants. We analyzed eight papers representative of these positions and found that, in all cases, additional premises are needed to reach the stated conclusions. We suggest that these premises play the role of biological background assumptions and argue that the most effective way toward a unified framework for risk analysis and regulation of GM stacks is by explicating and examining the biological background assumptions of each position. Once explicated, it is possible to either evaluate which background assumptions best reflect contemporary biological knowledge, or to apply Douglas' 'inductive risk' argument.

Refining the Global Spatial Limits of Dengue Virus Transmission by Evidence-Based Consensus

PubMed Central

Brady, Oliver J.; Gething, Peter W.; Bhatt, Samir; Messina, Jane P.; Brownstein, John S.; Hoen, Anne G.; Moyes, Catherine L.; Farlow, Andrew W.; Scott, Thomas W.; Hay, Simon I.

2012-01-01

Background Dengue is a growing problem both in its geographical spread and in its intensity, and yet current global distribution remains highly uncertain. Challenges in diagnosis and diagnostic methods as well as highly variable national health systems mean no single data source can reliably estimate the distribution of this disease. As such, there is a lack of agreement on national dengue status among international health organisations. Here we bring together all available information on dengue occurrence using a novel approach to produce an evidence consensus map of the disease range that highlights nations with an uncertain dengue status. Methods/Principal Findings A baseline methodology was used to assess a range of evidence for each country. In regions where dengue status was uncertain, additional evidence types were included to either clarify dengue status or confirm that it is unknown at this time. An algorithm was developed that assesses evidence quality and consistency, giving each country an evidence consensus score. Using this approach, we were able to generate a contemporary global map of national-level dengue status that assigns a relative measure of certainty and identifies gaps in the available evidence. Conclusion The map produced here provides a list of 128 countries for which there is good evidence of dengue occurrence, including 36 countries that have previously been classified as dengue-free by the World Health Organization and/or the US Centers for Disease Control. It also identifies disease surveillance needs, which we list in full. The disease extents and limits determined here using evidence consensus, marks the beginning of a five-year study to advance the mapping of dengue virus transmission and disease risk. Completion of this first step has allowed us to produce a preliminary estimate of population at risk with an upper bound of 3.97 billion people. This figure will be refined in future work. PMID:22880140

Swedish Council on Technology Assessment in Health Care (SBU). Chapter 5. Risk factors for sick leave - general studies.

PubMed

Allebeck, Peter; Mastekaasa, Arne

2004-01-01

Extensive information is available from official statistics and descriptive studies on the association between different socio-demographic background factors and sickness absence. This information addresses age, gender, place of residence, and socio-economic status. However, few studies have thoroughly analysed these background factors, and rigorous scientific evidence on the causal relationship between these factors and sick leave is lacking. Regarding the family, we found no scientific evidence that marital status or children living at home were associated with sickness absence. However, we found limited scientific evidence for an effect of divorce. Regarding work-related factors, we found limited scientific evidence for an effect of physically stressful work, and moderate scientific evidence for low psychological control over the work situation. We found limited scientific evidence for a correlation in time between unemployment and sickness absence, but insufficient scientific evidence for the causes of the association. There was moderate scientific evidence that the amount of sickness absence is influenced by the design of the social insurance system, but insufficient evidence on the magnitude of change required to influence the level of sickness absence. Essentially the same results apply to disability pension, although the number of studies is small. However, we found moderate scientific evidence for the effects of socio-economic status, which could be explained partly by childhood experiences.

Automatic Mechanisms for Social Attention Are Culturally Penetrable.

PubMed

Cohen, Adam S; Sasaki, Joni Y; German, Tamsin C; Kim, Heejung S

2017-01-01

Are mechanisms for social attention influenced by culture? Evidence that social attention is triggered automatically by bottom-up gaze cues and is uninfluenced by top-down verbal instructions may suggest it operates in the same way everywhere. Yet considerations from evolutionary and cultural psychology suggest that specific aspects of one's cultural background may have consequence for the way mechanisms for social attention develop and operate. In more interdependent cultures, the scope of social attention may be broader, focusing on more individuals and relations between those individuals. We administered a multi-gaze cueing task requiring participants to fixate a foreground face flanked by background faces and measured shifts in attention using eye tracking. For European Americans, gaze cueing did not depend on the direction of background gaze cues, suggesting foreground gaze alone drives automatic attention shifting; for East Asians, cueing patterns differed depending on whether the foreground cue matched or mismatched background cues, suggesting foreground and background gaze information were integrated. These results demonstrate that cultural background influences the social attention system by shifting it into a narrow or broad mode of operation and, importantly, provides evidence challenging the assumption that mechanisms underlying automatic social attention are necessarily rigid and impenetrable to culture. Copyright © 2015 Cognitive Science Society, Inc.

Is adding a new class of cones to the retina sufficient to cure color-blindness?

PubMed

Cornelissen, Frans W; Brenner, Eli

2015-01-01

New genetic methods have made it possible to substitute cone pigments in the retinas of adult nonhuman primates. Doing so influences the animals' visual abilities, demonstrating that the gene therapy was effective. However, we argue that no studies conducted so far have unambiguously demonstrated that the experimental animals have also acquired the ability to make new color distinctions. Simply put, it has been shown that animals that underwent the gene treatment can now-in addition to finding a red ball on a grayish background-find a green ball on a grayish background. However, it has not been shown that the animals can distinguish a red ball from a green one. For most people, that essential ability would be the primary reason for wanting to undergo a treatment for color-blindness in the first place, for instance, because their color-blindness currently prevents them from pursuing a career as a pilot or firefighter. It is important to point out such possible limitations of gene therapy for color-blindness to avoid unwarranted expectations in both clinicians and patients. To explain the origin of our concerns, we simulate how replacing the pigment of some cones is expected to influence the outcomes on the behavioral test used so far. The simulations show that this test does not provide conclusive evidence that the animals acquired the ability to make new chromatic distinctions. In our view, it is therefore premature to claim that human color-blindness can be cured through gene therapy. We propose a test that would provide more conclusive evidence of fundamentally altered color vision after gene therapy.

Investigating Galactic Structure with COBE/DIRBE and Simulation

NASA Technical Reports Server (NTRS)

Cohen, Martin

1999-01-01

In this work I applied the current version of the SKY model of the point source sky to the interpretation of the diffuse all-sky emission observed by COBE/DIRBE (Cosmic Background Explorer Satellite/Diffuse Infrared Background Experiment). The goal was to refine the SKY model using the all-sky DIRBE maps of the Galaxy, in order that a search could be made for an isotropic cosmic background."Faint Source Model" [FSM] was constructed to remove Galactic fore ground stars from the ZSMA products. The FSM mimics SKY version 1 but it was inadequate to seek cosmic background emission because of the sizeable residual emission in the ZSMA products after this starlight subtraction. At this point I can only support that such models are currently inadequate to reveal a cosmic background. Even SKY5 yields the same disappointing result.

Genetic and environmental origins of obesity relevant to reproduction.

PubMed

Franks, Stephen

2006-05-01

Obesity has a negative impact on reproductive health, particularly in women with polycystic ovarian syndrome (PCOS). Obesity itself is the product of both genetic and environmental influences, although the current 'epidemic' of obesity is largely related to changes in diet and lifestyle. Single gene defects leading to obesity and disordered reproductive function are rare but can are informative about metabolic pathways involved in appetite regulation. There is good evidence that PCOS has an important genetic background, which probably involves the interaction of several genes. The phenotype of PCOS and its impact on reproductive function is profoundly affected by obesity, which, in turn has both genetic and environmental influences. Understanding the genetic basis of PCOS is important but improvements in diet and lifestyle are the best means of improving reproductive function.

Evidence for νμ→ντ appearance in the CNGS neutrino beam with the OPERA experiment

NASA Astrophysics Data System (ADS)

Agafonova, N.; Aleksandrov, A.; Anokhina, A.; Aoki, S.; Ariga, A.; Ariga, T.; Asada, T.; Autiero, D.; Ben Dhahbi, A.; Badertscher, A.; Bender, D.; Bertolin, A.; Bozza, C.; Brugnera, R.; Brunet, F.; Brunetti, G.; Buonaura, A.; Buontempo, S.; Büttner, B.; Chaussard, L.; Chernyavsky, M.; Chiarella, V.; Chukanov, A.; Consiglio, L.; D'Ambrosio, N.; de Lellis, G.; de Serio, M.; Del Amo Sanchez, P.; di Crescenzo, A.; di Ferdinando, D.; di Marco, N.; Dmitrievski, S.; Dracos, M.; Duchesneau, D.; Dusini, S.; Dzhatdoev, T.; Ebert, J.; Ereditato, A.; Favier, J.; Ferber, T.; Ferone, G.; Fini, R. A.; Fukuda, T.; Galati, G.; Garfagnini, A.; Giacomelli, G.; Goellnitz, C.; Goldberg, J.; Gornushkin, Y.; Grella, G.; Grianti, F.; Guler, M.; Gustavino, C.; Hagner, C.; Hakamata, K.; Hara, T.; Hayakawa, T.; Hierholzer, M.; Hollnagel, A.; Hosseini, B.; Ishida, H.; Ishiguro, K.; Ishikawa, M.; Jakovcic, K.; Jollet, C.; Kamiscioglu, C.; Kamiscioglu, M.; Katsuragawa, T.; Kawada, J.; Kawahara, H.; Kim, J. H.; Kim, S. H.; Kimura, M.; Kitagawa, N.; Klicek, B.; Kodama, K.; Komatsu, M.; Kose, U.; Kreslo, I.; Lauria, A.; Lenkeit, J.; Ljubicic, A.; Longhin, A.; Loverre, P.; Malgin, A.; Mandrioli, G.; Marteau, J.; Matsuo, T.; Matveev, V.; Mauri, N.; Medinaceli, E.; Meregaglia, A.; Migliozzi, P.; Mikado, S.; Miyanishi, M.; Miyashita, E.; Monacelli, P.; Montesi, M. C.; Morishima, K.; Muciaccia, M. T.; Naganawa, N.; Naka, T.; Nakamura, M.; Nakano, T.; Nakatsuka, Y.; Niwa, K.; Ogawa, S.; Okateva, N.; Olshevsky, A.; Omura, T.; Ozaki, K.; Paoloni, A.; Park, B. D.; Park, I. G.; Pastore, A.; Patrizii, L.; Pennacchio, E.; Pessard, H.; Pistillo, C.; Podgrudkov, D.; Polukhina, N.; Pozzato, M.; Pretzl, K.; Pupilli, F.; Rescigno, R.; Roda, M.; Rokujo, H.; Roganova, T.; Rosa, G.; Rostovtseva, I.; Rubbia, A.; Ryazhskaya, O.; Sato, O.; Sato, Y.; Schembri, A.; Schmidt-Parzefal, W.; Shakiryanova, I.; Shchedrina, T.; Sheshukov, A.; Shibuya, H.; Shiraishi, T.; Shoziyoev, G.; Simone, S.; Sioli, M.; Sirignano, C.; Sirri, G.; Spinetti, M.; Stanco, L.; Starkov, N.; Stellacci, S. M.; Stipcevic, M.; Strauss, T.; Strolin, P.; Suzuki, K.; Takahashi, S.; Tenti, M.; Terranova, F.; Tioukov, V.; Tufanli, S.; Vilain, P.; Vladimirov, M.; Votano, L.; Vuilleumier, J. L.; Wilquet, G.; Wonsak, B.; Yoon, C. S.; Yoshida, J.; Yoshimoto, M.; Zaitsev, Y.; Zemskova, S.; Zghiche, A.; Opera Collaboration

2014-03-01

The OPERA experiment is designed to search for νμ→ντ oscillations in appearance mode, i.e., through the direct observation of the τ lepton in ντ-charged current interactions. The experiment has taken data for five years, since 2008, with the CERN Neutrino to Gran Sasso beam. Previously, two ντ candidates with a τ decaying into hadrons were observed in a subsample of data of the 2008-2011 runs. Here we report the observation of a third ντ candidate in the τ-→μ- decay channel coming from the analysis of a subsample of the 2012 run. Taking into account the estimated background, the absence of νμ→ντ oscillations is excluded at the 3.4 σ level.

Ibogaine related sudden death: a case report.

PubMed

Papadodima, Stavroula A; Dona, Artemis; Evaggelakos, Christos I; Goutas, Nikolaos; Athanaselis, Sotirios A

2013-10-01

Ibogaine is a naturally occurring alkaloid derived from the roots of the rain forest shrub Tabernanthe iboga. Deaths have occurred temporarily related to the use of ibogaine. However, although not licensed as therapeutic drug, and despite evidence that ibogaine may disturb the rhythm of the heart, this alkaloid is currently used as an anti-addiction drug in alternative medicine for detoxification purposes. We report the case of a man who died suddenly 12-24 h after ibogaine use for alcohol detoxification treatment. In the autopsy liver cirrhosis and heavy fatty infiltration was found. The concentration of ibogaine was 2 mg/l. The potential risks of ibogaine use, especially for persons with pathological medical background, are discussed. Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

[The historical background and present development of evidence-based healthcare and clinical nursing].

PubMed

Tsai, Jung-Mei

2014-12-01

Evidence-based healthcare (EBHC) emphasizes the integration of the best research evidence with patient values, specialist suggestions, and clinical circumstances during the process of clinical decision-making. EBHC is a recognized core competency in modern healthcare. Nursing is a professional discipline of empirical science that thrives in an environment marked by advances in knowledge and technology in medicine as well as in nursing. Clinical nurses must elevate their skills and professional qualifications, provide efficient and quality health services, and promote their proficiency in EBHC. The Institute of Medicine in the United States indicates that evidence-based research results often fail to disseminate efficiently to clinical decision makers. This problem highlights the importance of better promoting the evidence-based healthcare fundamentals and competencies to frontline clinical nurses. This article describes the historical background and present development of evidence-based healthcare from the perspective of modern clinical nursing in light of the importance of evidence-based healthcare in clinical nursing; describes the factors associated with evidence-based healthcare promotion; and suggests strategies and policies that may improve the promotion and application of EBHC in clinical settings. The authors hope that this paper provides a reference for efforts to improve clinical nursing in the realms of EBHC training, promotion, and application.

Personality, Cognitive Skills and Life Outcomes: Evidence from the Polish Follow-Up Study to PIAAC

ERIC Educational Resources Information Center

Palczynska, Marta; Swist, Karolina

2018-01-01

Background: There is a growing literature providing evidence on the importance of non-cognitive skills for life outcomes. However, to date there is limited evidence on the gains from incorporating such measures into large-scale competence surveys. Methods: We investigate the relationship between personality traits and eight important life…

Initial Clinician Reports of the Bottom-Up Dissemination of an Evidence-Based Intervention for Early Childhood Trauma

ERIC Educational Resources Information Center

David, Paula; Schiff, Miriam

2018-01-01

Background: Bottom-up dissemination (BUD) of evidence based treatments (EBT), entailing the spread of an intervention through a peer network in a decentralized manner, is an under-reported phenomenon in the professional literature. Objective: This paper presents findings from a study researching the feasibility of BUD of an evidence-based…

Developing a Knowledge Network for Applied Education Research to Mobilise Evidence in and for Educational Practice

ERIC Educational Resources Information Center

Campbell, Carol; Pollock, Katina; Briscoe, Patricia; Carr-Harris, Shasta; Tuters, Stephanie

2017-01-01

Background: The importance of "evidence-informed practice" has risen dramatically in education and in other public policy areas. This article focuses on the importance of knowledge mobilisation strategies, processes and outputs. It is concerned with how these can support the adaptation and implementation of evidence from research and…

Research Practice Partnerships: A Strategy for Promoting Evidence-Based Decision-Making in Education

ERIC Educational Resources Information Center

Wentworth, Laura; Mazzeo, Christopher; Connolly, Faith

2017-01-01

Background: In the United States, an emphasis on evidence-based decision-making in education has received renewed interest with the recent passage of the Every Student Succeeds Act. However, how best, in practice, to support the use of evidence in educational decision-making remains unclear. Research Practice Partnerships (RPPs) are a popular…

Teachers' Approaches to Finding and Using Research Evidence: An Information Literacy Perspective

ERIC Educational Resources Information Center

Williams, Dorothy; Coles, Louisa

2007-01-01

Background: The use of research evidence produced by others is seen as central to the reflective practice of school teachers. There have been many recent UK initiatives aimed at improving access to research evidence, but there are still concerns about the lack of engagement by teachers. Previous research has looked at this issue from different…

From Efficacy to Effectiveness and Beyond: What Next for Brief Interventions in Primary Care?

PubMed Central

O’Donnell, Amy; Wallace, Paul; Kaner, Eileen

2014-01-01

Background: Robust evidence supports the effectiveness of screening and brief alcohol interventions in primary healthcare. However, lack of understanding about their “active ingredients” and concerns over the extent to which current approaches remain faithful to their original theoretical roots has led some to demand a cautious approach to future roll-out pending further research. Against this background, this paper provides a timely overview of the development of the brief alcohol intervention evidence base to assess the extent to which it has achieved the four key levels of intervention research: efficacy, effectiveness, implementation, and demonstration. Methods: Narrative overview based on (1) the results of a review of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare and (2) synthesis of the findings of key additional primary studies on the improvement and evaluation of brief alcohol intervention implementation in routine primary healthcare. Results: The brief intervention field seems to constitute an almost perfect example of the evaluation of a complex intervention. Early evaluations of screening and brief intervention approaches included more tightly controlled efficacy trials and have been followed by more pragmatic trials of effectiveness in routine clinical practice. Most recently, attention has shifted to dissemination, implementation, and wider-scale roll-out. However, delivery in routine primary health remains inconsistent, with an identified knowledge gap around how to successfully embed brief alcohol intervention approaches in mainstream care, and as yet unanswered questions concerning what specific intervention component prompt the positive changes in alcohol consumption. Conclusion: Both the efficacy and effectiveness of brief alcohol interventions have been comprehensively demonstrated, and intervention effects seem replicable and stable over time, and across different study contexts. Thus, while unanswered questions remain, given the positive evidence amassed to date, research efforts should maintain a continued focus on promoting sustained implementation of screening and brief alcohol intervention approaches in primary care to ensure that those who might benefit from screening and brief alcohol interventions actually receive such support. PMID:25221524

A Research Synthesis of the Associations between Socioeconomic Background, Inequality, School Climate, and Academic Achievement

ERIC Educational Resources Information Center

Berkowitz, Ruth; Moore, Hadass; Astor, Ron Avi; Benbenishty, Rami

2017-01-01

Educational researchers and practitioners assert that supportive school and classroom climates can positively influence the academic outcomes of students, thus potentially reducing academic achievement gaps between students and schools of different socioeconomic status (SES) backgrounds. Nonetheless, scientific evidence establishing directional…

Human Blood Typing: A Forensic Science Approach. Part I: Background.

ERIC Educational Resources Information Center

Kobilinsky, Lawrence; Sheehan, Francis X.

1988-01-01

In this article, part I of a series, the forensic methods used in "typing" human blood, which as physical evidence is often found in the dried state, are outlined. Background information about individualization, antibody typing, fresh blood, dried blood, and additional systems is provided. (CW)

Systems for grading the quality of evidence and the strength of recommendations I: Critical appraisal of existing approaches The GRADE Working Group

PubMed Central

Atkins, David; Eccles, Martin; Flottorp, Signe; Guyatt, Gordon H; Henry, David; Hill, Suzanne; Liberati, Alessandro; O'Connell, Dianne; Oxman, Andrew D; Phillips, Bob; Schünemann, Holger; Edejer, Tessa Tan-Torres; Vist, Gunn E; Williams, John W

2004-01-01

Background A number of approaches have been used to grade levels of evidence and the strength of recommendations. The use of many different approaches detracts from one of the main reasons for having explicit approaches: to concisely characterise and communicate this information so that it can easily be understood and thereby help people make well-informed decisions. Our objective was to critically appraise six prominent systems for grading levels of evidence and the strength of recommendations as a basis for agreeing on characteristics of a common, sensible approach to grading levels of evidence and the strength of recommendations. Methods Six prominent systems for grading levels of evidence and strength of recommendations were selected and someone familiar with each system prepared a description of each of these. Twelve assessors independently evaluated each system based on twelve criteria to assess the sensibility of the different approaches. Systems used by 51 organisations were compared with these six approaches. Results There was poor agreement about the sensibility of the six systems. Only one of the systems was suitable for all four types of questions we considered (effectiveness, harm, diagnosis and prognosis). None of the systems was considered usable for all of the target groups we considered (professionals, patients and policy makers). The raters found low reproducibility of judgements made using all six systems. Systems used by 51 organisations that sponsor clinical practice guidelines included a number of minor variations of the six systems that we critically appraised. Conclusions All of the currently used approaches to grading levels of evidence and the strength of recommendations have important shortcomings. PMID:15615589

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

PubMed Central

Brown, Andrew W; Bohan Brown, Michelle M

2013-01-01

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

Evidence-based practice in Behçet’s disease: identifying areas of unmet need for 2014

PubMed Central

2014-01-01

Background Behçet’s Disease (BD) is characterized by a relapsing-remitting course, with symptoms of varying severity across almost all organ systems. There is a diverse array of therapeutic options with no universally accepted treatment regime, and it is thus important that clinical practice is evidence-based. We reviewed all currently available literature describing management of BD, and investigated whether evidence-based practice is possible for all disease manifestations, and assessed the range of therapeutic options tested. Methods We conducted an internet search of all literature describing management of BD up to August 2013, including pharmacological and non-pharmacological interventions. We recorded treatment options investigated and disease manifestations reported as primary and secondary study outcomes. Quality of data was assessed according to the Scottish Intercollegiate Guideline Network (SIGN) hierarchy of evidence. Results Whilst there is much literature describing treatment of ocular and mucocutaneous disease, there is little to guide management of rheumatoid, cardiovascular and neurological disease. This broadly reflects the prevalence of disease manifestations of BD, but not the severity. Biologic therapies are the most commonly investigated intervention. The proportion of SIGN-1 graded studies is declining, and there are no SIGN-1 graded studies investigating neurological or gastrointestinal manifestations of BD. Conclusions This is the first study to investigate trends in published literature for management of BD over time. It identifies neurological, cardiovascular and gastro-intestinal disease as particular areas of unmet need and suggests that overall quality of evidence is declining. Future research should be designed to address these areas of insufficiency to facilitate evidence-based practice in BD. PMID:24475935

Study quality on groin injury management remains low: a systematic review on treatment of groin pain in athletes

PubMed Central

Serner, Andreas; van Eijck, Casper H; Beumer, Berend R; Hölmich, Per; Weir, Adam; de Vos, Robert-Jan

2015-01-01

Background Groin pain in athletes is frequent and many different treatment options have been proposed. The current level of evidence for the efficacy of these treatments is unknown. Objective Systematically review the literature on the efficacy of treatments for groin pain in athletes. Methods Nine medical databases were searched in May 2014. Inclusion criteria: treatment studies in athletes with groin pain; randomised controlled trials, controlled clinical trials or case series; n>10; outcome measures describing number of recovered athletes, patient satisfaction, pain scores or functional outcome scores. One author screened search results, and two authors independently assessed study quality. A best evidence synthesis was performed. Relationships between quality score and outcomes were evaluated. Review registration number CRD42014010262. Results 72 studies were included for quality analysis. Four studies were high quality. There is moderate evidence that, for adductor-related groin pain, active exercises compared with passive treatments improve success, multimodal treatment with a manual therapy technique shortens the time to return to sports compared with active exercises and adductor tenotomy improves treatment success over time. There is moderate evidence that for athletes with sportsman's hernia, surgery results in better treatment success then conservative treatment. There was a moderate and inverse correlation between study quality and treatment success (p<0.001, r=−0.41), but not between study quality and publication year (p=0.09, r=0.20). Conclusions Only 6% of publications were high quality. Low-quality studies showed significantly higher treatment success and study quality has not improved since 1985. There is moderate evidence for the efficacy of conservative treatment (active exercises and multimodal treatments) and for surgery in patients with adductor-related groin pain. There is moderate evidence for efficacy of surgical treatment in sportsman's hernia. PMID:25633830

Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments

PubMed Central

Kazantzis, Nikolaos; Rickwood, Debra; Rickard, Nikki

2016-01-01

Background The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available. Objective To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps. Methods A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design. Results Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp. Conclusions Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems. PMID:26932350

The McMaster Optimal Aging Portal: Usability Evaluation of a Unique Evidence-Based Health Information Website

PubMed Central

Dobbins, Maureen; Haynes, R. Brian; Iorio, Alfonso; Lavis, John N; Raina, Parminder

2016-01-01

Background Increasingly, older adults and their informal caregivers are using the Internet to search for health-related information. There is a proliferation of health information online, but the quality of this information varies, often based on exaggerated or dramatic findings, and not easily comprehended by consumers. The McMaster Optimal Aging Portal (Portal) was developed to provide Internet users with high-quality evidence about aging and address some of these current limitations of health information posted online. The Portal includes content for health professionals coming from three best-in-class resources (MacPLUS, Health Evidence, and Health Systems Evidence) and four types of content specifically prepared for the general public (Evidence Summaries, Web Resource Ratings, Blog Posts, and Twitter messages). Objective Our objectives were to share the findings of the usability evaluation of the Portal with particular focus on the content features for the general public and to inform designers of health information websites and online resources for older adults about key usability themes. Methods Data analysis included task performance during usability testing and qualitative content analyses of both the usability sessions and interviews to identify core themes. Results A total of 37 participants took part in 33 usability testing sessions and 21 focused interviews. Qualitative analysis revealed common themes regarding the Portal’s strengths and challenges to usability. The strengths of the website were related to credibility, applicability, browsing function, design, and accessibility. The usability challenges included reluctance to register, process of registering, searching, terminology, and technical features. Conclusions The study reinforced the importance of including end users during the development of this unique, dynamic, evidence-based health information website. The feedback was applied to iteratively improve website usability. Our findings can be applied by designers of health-related websites. PMID:27170443

Physician-Delivered Injection Therapies for Mechanical Neck Disorders: A Systematic Review Update (Non-Oral, Non-Intravenous Pharmacological Interventions for Neck Pain)

PubMed Central

Gross, Anita R.; Peloso, Paul M.; Galway, Erin; Navasero, Neenah; Essen, Karis Van; Graham, Nadine; Goldsmith, Charlie H; Gzeer, Wisam; Shi, Qiyun; Haines, Ted and COG

2013-01-01

Background: Controversy persists regarding medicinal injections for mechanical neck disorders (MNDs). Objectives: To determine the effectiveness of physician-delivered injections on pain, function/disability, quality of life, global perceived effect and patient satisfaction for adults with MNDs. Search Methods: We updated our previous searches of CENTRAL, MEDLINE and EMBASE from December 2006 through to March 2012. Selection Criteria: We included randomized controlled trials of adults with neck disorders treated by physician-delivered injection therapies. Data Collection and Analysis: Two authors independently selected articles, abstracted data and assessed methodological quality. When clinical heterogeneity was absent, we combined studies using random-effects models. Results: We included 12 trials (667 participants). No high or moderate quality studies were found with evidence of benefit over control. Moderate quality evidence suggests little or no difference in pain or function/disability between nerve block injection of steroid and bupivacaine vs bupivacaine alone at short, intermediate and long-term for chronic neck pain. We found limited very low quality evidence of an effect on pain with intramuscular lidocaine vs control for chronic myofascial neck pain. Two low quality studies showed an effect on pain with anaesthetic nerve block vs saline immediately post treatment and in the short-term. All other studies were of low or very low quality with no evidence of benefit over controls. Authors' Conclusions: Current evidence does not confirm the effectiveness of IM-lidocaine injection for chronic mechanical neck pain nor anaesthetic nerve block for cervicogenic headache. There is moderate evidence of no benefit for steroid blocks vs controls for mechanical neck pain. PMID:24155806

Availability, consistency and evidence-base of policies and guidelines on the use of mask and respirator to protect hospital health care workers: a global analysis

PubMed Central

2013-01-01

Background Currently there is an ongoing debate and limited evidence on the use of masks and respirators for the prevention of respiratory infections in health care workers (HCWs). This study aimed to examine available policies and guidelines around the use of masks and respirators in HCWs and to describe areas of consistency between guidelines, as well as gaps in the recommendations, with reference to the WHO and the CDC guidelines. Methods Policies and guidelines related to mask and respirator use for the prevention of influenza, SARS and TB were examined. Guidelines from the World Health Organization (WHO), the Center for Disease Control and Prevention (CDC), three high-income countries and six low/middle-income countries were selected. Results Uniform recommendations are made by the WHO and the CDC in regards to protecting HCWs against seasonal influenza (a mask for low risk situations and a respirator for high risk situations) and TB (use of a respirator). However, for pandemic influenza and SARS, the WHO recommends mask use in low risk and respirators in high risk situations, whereas, the CDC recommends respirators in both low and high risk situations. Amongst the nine countries reviewed, there are variations in the recommendations for all three diseases. While, some countries align with the WHO recommendations, others align with those made by the CDC. The choice of respirator and the level of filtering ability vary amongst the guidelines and the different diseases. Lastly, none of the policies discuss reuse, extended use or the use of cloth masks. Conclusion Currently, there are significant variations in the policies and recommendations around mask and respirator use for protection against influenza, SARS and TB. These differences may reflect the scarcity of level-one evidence available to inform policy development. The lack of any guidelines on the use of cloth masks, despite widespread use in many low and middle-income countries, remains a policy gap. Health organizations and countries should jointly evaluate the available evidence, prioritize research to inform evidence gaps, and develop consistent policy on masks and respirator use in the health care setting. PMID:23725338

A Systematic Review of Commercial Cognitive Training Devices: Implications for Use in Sport

PubMed Central

Harris, David J.; Wilson, Mark R.; Vine, Samuel J.

2018-01-01

Background: Cognitive training (CT) aims to develop a range of skills, like attention and decision-making, through targeted training of core cognitive functions. While CT can target context specific skills, like movement anticipation, much CT is domain general, focusing on core abilities (e.g., selective attention) for transfer to a range of real-world tasks, such as spotting opponents. Commercial CT (CCT) devices are highly appealing for athletes and coaches due to their ease of use and eye-catching marketing claims. The extent to which this training transfers to performance in the sporting arena is, however, unclear. Therefore, this paper sought to provide a systematic review of evidence for beneficial training effects of CCT devices and evaluate their application to sport. Methods: An extensive search of electronic databases (PubMed, PsychInfo, GoogleScholar, and SportDiscus) was conducted to identify peer-reviewed evidence of training interventions with commercially available CT devices. Forty-three studies met the inclusion criteria and were retained for quality assessment and synthesis of results. Seventeen studies assessed transfer effects beyond laboratory cognitive tests, but only 1 directly assessed transfer to a sporting task. Results: The review of evidence showed limited support for far transfer benefits from CCT devices to sporting tasks, mainly because studies did not target the sporting environment. Additionally, a number of methodological issues with the CCT literature were identified, including small sample sizes, lack of retention tests, and limited replication of findings by researchers independent of the commercial product. Therefore, evidence for sporting benefits is currently limited by the paucity of representative transfer tests and a focus on populations with health conditions. Conclusions: Currently there is little direct evidence that the use of CCT devices can transfer to benefits for sporting performance. This conclusion, however, stems more from a lack of experimental studies in the sporting field and a lack of experimental rigor, rather than convincing null effects. Subsequently, there is an opportunity for researchers to develop more reliable findings in this area through systematic assessment in athletic populations and major methodological improvements.

Concepts of mental capacity for patients requesting assisted suicide: a qualitative analysis of expert evidence presented to the Commission on Assisted Dying

PubMed Central

2014-01-01

Background In May 2013 a new Assisted Dying Bill was tabled in the House of Lords and is currently scheduled for a second reading in May 2014. The Bill was informed by the report of the Commission on Assisted Dying which itself was informed by evidence presented by invited experts. This study aims to explore how the experts presenting evidence to the Commission on Assisted Dying conceptualised mental capacity for patients requesting assisted suicide and examine these concepts particularly in relation to the principles of the Mental Capacity Act 2005. Methods This study was a secondary qualitative analysis of 36 transcripts of oral evidence and 12 pieces of written evidence submitted by invited experts to the Commission on Assisted Dying using a framework approach. Results There was agreement on the importance of mental capacity as a central safeguard in proposed assisted dying legislation. Concepts of mental capacity, however, were inconsistent. There was a tendency towards a conceptual and clinical shift toward a presumption of incapacity. This appeared to be based on the belief that assisted suicide should only be open to those with a high degree of mental capacity to make the decision. The ‘boundaries’ around the definition of mental capacity appeared to be on a continuum between a circumscribed legal ‘cognitive’ definition of capacity (in which most applicants would be found to have capacity unless significantly cognitively impaired) and a more inclusive definition which would take into account wider concepts such as autonomy, rationality, voluntariness and decision specific factors such as motivation for decision making. Conclusion Ideas presented to the Commission on Assisted Dying about mental capacity as it relates to assisted suicide were inconsistent and in a number of cases at variance with the principles of the Mental Capacity Act 2005. Further work needs to be done to establish a consensus as to what constitutes capacity for this decision and whether current legal frameworks are able to support clinicians in determining capacity for this group. PMID:24755362

Reprint of Mechanisms of maintaining high suspended sediment concentration over tide-dominated offshore shoals in the southern Yellow Sea

NASA Astrophysics Data System (ADS)

Xiong, Jilian; Wang, Xiao Hua; Wang, Ya Ping; Chen, Jingdong; Shi, Benwei; Gao, Jianhua; Yang, Yang; Yu, Qian; Li, Mingliang; Yang, Lei; Gong, Xulong

2018-06-01

An understanding of the dynamics and behaviors of suspended sediments is vital in analysis of morphological, environmental, and ecological processes occurring in coastal marine environments. To study the mechanisms of maintaining high suspended sediment concentrations (SSCs) on a tide-dominated offshore shoal, we measured water depths, current velocities, SSCs, wave parameters and bottom sediment compositions in the southern Yellow Sea. These data were then used to calculate bottom shear stresses generated by currents (τc), waves (τw), and wave-current interactions (τcw). SSCs time series exhibited strong quarter-diurnal peaks during spring tides, in contrast to the semidiurnal signal during neap tides. A Fourier analysis showed that suspended sediment variations within tidal cycles was mainly controlled by resuspension in most stations. There existed relatively stable background SSCs (maintaining high SSCs among tidal cycles) values at all four stations during both windy (wind speed > 9.0 m/s) and normal weather conditions (wind speed < 3.0 m/s). The background SSCs had strong relationship with spring/neap-averaged τcw, indicating background SSCs were mainly controlled by mean bottom shear stress, with a minimum value of 0.21 N/m2. On account of the strong tidal currents, background SSCs of spring tides were greater than that of neap tides. In addition, on the base of wavelet, statistics analyses and turbulence dissipation parameter, background SSCs during slack tide in the study area may be maintained by intermittent turbulence events induced by a combined tidal current and wave action.

Mechanisms of maintaining high suspended sediment concentration over tide-dominated offshore shoals in the southern Yellow Sea

NASA Astrophysics Data System (ADS)

Xiong, Jilian; Wang, Xiao Hua; Wang, Ya Ping; Chen, Jingdong; Shi, Benwei; Gao, Jianhua; Yang, Yang; Yu, Qian; Li, Mingliang; Yang, Lei; Gong, Xulong

2017-05-01

An understanding of the dynamics and behaviors of suspended sediments is vital in analysis of morphological, environmental, and ecological processes occurring in coastal marine environments. To study the mechanisms of maintaining high suspended sediment concentrations (SSCs) on a tide-dominated offshore shoal, we measured water depths, current velocities, SSCs, wave parameters and bottom sediment compositions in the southern Yellow Sea. These data were then used to calculate bottom shear stresses generated by currents (τc), waves (τw), and wave-current interactions (τcw). SSCs time series exhibited strong quarter-diurnal peaks during spring tides, in contrast to the semidiurnal signal during neap tides. A Fourier analysis showed that suspended sediment variations within tidal cycles was mainly controlled by resuspension in most stations. There existed relatively stable background SSCs (maintaining high SSCs among tidal cycles) values at all four stations during both windy (wind speed > 9.0 m/s) and normal weather conditions (wind speed < 3.0 m/s). The background SSCs had strong relationship with spring/neap-averaged τcw, indicating background SSCs were mainly controlled by mean bottom shear stress, with a minimum value of 0.21 N/m2. On account of the strong tidal currents, background SSCs of spring tides were greater than that of neap tides. In addition, on the base of wavelet, statistics analyses and turbulence dissipation parameter, background SSCs during slack tide in the study area may be maintained by intermittent turbulence events induced by a combined tidal current and wave action.

Firearm Acquisition Without Background Checks: Results of a National Survey.

PubMed

Miller, Matthew; Hepburn, Lisa; Azrael, Deborah

2017-02-21

In 1994, 40% of U.S. gun owners who had recently acquired a firearm did so without a background check. No contemporary estimates exist. To estimate the proportion of current U.S. gun owners who acquired their most recent firearm without a background check, by time since and manner of acquisition, for the nation as a whole and separately in states with and without legislation regulating private sales. Probability-based online survey. United States, 2015. 1613 adult gun owners. Current gun owners were asked where and when they acquired their last firearm; if they purchased the firearm; and whether, as part of that acquisition, they had a background check (or were asked to show a firearm license or permit). 22% (95% CI, 16% to 27%) of gun owners who reported obtaining their most recent firearm within the previous 2 years reported doing so without a background check. For firearms purchased privately within the previous 2 years (that is, other than from a store or pawnshop, including sales between individuals in person, online, or at gun shows), 50% (CI, 35% to 65%) were obtained without a background check. This percentage was 26% (CI, 5% to 47%) for owners residing in states regulating private firearm sales and 57% (CI, 40% to 75%) for those living in states without regulations on private firearm sales. Potential inaccuracies due to recall and social desirability bias. 22% of current U.S. gun owners who acquired a firearm within the past 2 years did so without a background check. Although this represents a smaller proportion of gun owners obtaining firearms without background checks than in the past, millions of U.S. adults continue to acquire guns without background checks, especially in states that do not regulate private firearm sales. Fund for a Safer Future and the Joyce Foundation.

Functional Impairment In People with Schizophrenia: Focus on Employability and Eligibility for Disability Compensation

PubMed Central

Harvey, Philip D.; Heaton, Robert K.; Carpenter, William T.; Green, Michael F.; Gold, James M.; Schoenbaum, Michael

2012-01-01

Background The Social Security Administration (SSA) is considering whether schizophrenia may warrant inclusion in their new “Compassionate Allowance” process, which aims to identify diseases and other medical conditions that invariably quality for Social Security disability benefits and require no more than minimal objective medical information. This paper summarizes evidence on the empirical association between schizophrenia and vocational disability. A companion paper examines the reliability and validity of schizophrenia diagnosis which is critically relevant for granting a long-term disability on the basis of current diagnosis. Methods This is a selective literature review and synthesis, based on a work plan developed in a meeting of experts convened by the National Institute of Mental Health and the SSA. This review of the prevalence of disability is focused on the criteria for receipt of disability compensation for psychotic disorders currently employed by the SSA. Results Disability in multiple functional domains is detected in nearly every person with schizophrenia. Clinical remission is much more common than functional recovery, but most patients experience occasional relapses even with treatment adherence, and remissions do not predict functional recovery. Under SSA’s current disability determination process, approximately 80% of SSDI/SSI applications in SSA’s diagnostic category of “Schizophrenia/Paranoid Functional Disorders” are allowed, compared to around half of SSDI/SSI applications overall. Moreover, the allowance rate is even higher among applicants with schizophrenia. Many unsuccessful applicants are not denied, but rather simply are unable to manage the process of appeal after initial denials. Discussion Research evidence suggests that disability applicants with a valid diagnosis of schizophrenia have significant impairment across multiple dimensions of functioning, and will typically remain impaired for the duration of normal working ages or until new interventions are developed. PMID:22503642

Nurse-physician communication - An integrated review.

PubMed

Tan, Tit-Chai; Zhou, Huaqiong; Kelly, Michelle

2017-12-01

To present a comprehensive review of current evidence on the factors which impact on nurse-physician communication and interventions developed to improve nurse-physician communication. The challenges in nurse-physician communication persist since the term 'nurse-doctor game' was first used in 1967, leading to poor patient outcomes such as treatment delays and potential patient harm. Inconsistent evidence was found on the factors and interventions which foster or impair effective nurse-physician communication. An integrative review was conducted following a five-stage process: problem identification, literature search, data evaluation, data analysis and presentation. Five electronic databases were searched from 2005 to April 2016 using key search terms: "improve*," "nurse-physician," "nurse," "physician" and "communication" in five electronic databases including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PubMed, Science Direct and Scopus. A total of 22 studies were included in the review. Four themes emerged from the data synthesis, namely communication styles; factors that facilitate nurse-physician communication; barriers to effective nurse-physician communication; and interventions to improve nurse-physician communication. This integrative review suggests that nurse-physician communication still remains ineffective. Current interventions only address information needs of nurses and physicians in limited situations and specific settings but cannot adequately address the interprofessional communication skills that are lacking in practice. The disparate views of nurses and physicians on communication due to differing training backgrounds confound the effectiveness of current interventions or strategies. Cross-training and interprofessional educational from undergraduate to postgraduate programmes will better align the training of nurses and physicians to communicate effectively. Further research is needed to determine the feasibility and generalisability of interventions, such as localising physicians and using communication tools, to improve nurse-physician communication. Organisational and cultural changes are needed to overcome ingrained practices impeding nurse-physician communication. © 2017 John Wiley & Sons Ltd.

Cannabis Use and Incidence of Testicular Cancer: A 42-Year Follow-up of Swedish Men between 1970 and 2011.

PubMed

Callaghan, Russell C; Allebeck, Peter; Akre, Olof; McGlynn, Katherine A; Sidorchuk, Anna

2017-11-01

Background: Given current drug policy reforms to decriminalize or legalize cannabis in numerous countries worldwide, the current study assesses the relation between cannabis use and the development of testicular cancer. Methods: The study included a population-based sample ( n = 49,343) of young men ages 18-21 years who underwent conscription assessment for Swedish military service in 1969-1970. The conscription process included a nonanonymous questionnaire eliciting information about drug use. Conscription information was linked to Swedish health and administrative registry data. Testicular cancers diagnosed between 1970 and 2011 were identified by International Classification of Diseases-7/8/9/10 testicular cancer codes in the Swedish National Patient Register, the Cancer Register, or the Cause of Death Register. Cox regression modeling was used to estimate the hazards associated with cannabis use and time to diagnosis of testicular cancer. Results: No evidence was found of a significant relation between lifetime "ever" cannabis use and the subsequent development of testicular cancer [ n = 45,250; 119 testicular cancer cases; adjusted HR (aHR), 1.42; 95% confidence interval (CI), 0.83-2.45]. "Heavy" cannabis use (defined as usage of more than 50 times in lifetime, as measured at conscription) was associated with the incidence of testicular cancer ( n = 45,250; 119 testicular cancer cases; aHR 2.57; 95% CI, 1.02-6.50). Conclusions: The current study provides additional evidence to the limited prior literature suggesting cannabis use may contribute to the development of testicular cancer. Impact: Emerging changes to cannabis drug policy should consider the potential role of cannabis use in the development of testicular cancer. Cancer Epidemiol Biomarkers Prev; 26(11); 1644-52. ©2017 AACR . ©2017 American Association for Cancer Research.

Substance P Depolarizes Lamprey Spinal Cord Neurons by Inhibiting Background Potassium Channels.

PubMed

Thörn Pérez, Carolina; Hill, Russell H; Grillner, Sten

2015-01-01

Substance P is endogenously released in the adult lamprey spinal cord and accelerates the burst frequency of fictive locomotion. This is achieved by multiple effects on interneurons and motoneurons, including an attenuation of calcium currents, potentiation of NMDA currents and reduction of the reciprocal inhibition. While substance P also depolarizes spinal cord neurons, the underlying mechanism has not been resolved. Here we show that effects of substance P on background K+ channels are the main source for this depolarization. Hyperpolarizing steps induced inward currents during whole-cell voltage clamp that were reduced by substance P. These background K+ channels are pH sensitive and are selectively blocked by anandamide and AVE1231. These blockers counteracted the effect of substance P on these channels and the resting membrane potential depolarization in spinal cord neurons. Thus, we have shown now that substance P inhibits background K+ channels that in turn induce depolarization, which is likely to contribute to the frequency increase observed with substance P during fictive locomotion.

Substance P Depolarizes Lamprey Spinal Cord Neurons by Inhibiting Background Potassium Channels

PubMed Central

Thörn Pérez, Carolina; Hill, Russell H.; Grillner, Sten

2015-01-01

Substance P is endogenously released in the adult lamprey spinal cord and accelerates the burst frequency of fictive locomotion. This is achieved by multiple effects on interneurons and motoneurons, including an attenuation of calcium currents, potentiation of NMDA currents and reduction of the reciprocal inhibition. While substance P also depolarizes spinal cord neurons, the underlying mechanism has not been resolved. Here we show that effects of substance P on background K+ channels are the main source for this depolarization. Hyperpolarizing steps induced inward currents during whole-cell voltage clamp that were reduced by substance P. These background K+ channels are pH sensitive and are selectively blocked by anandamide and AVE1231. These blockers counteracted the effect of substance P on these channels and the resting membrane potential depolarization in spinal cord neurons. Thus, we have shown now that substance P inhibits background K+ channels that in turn induce depolarization, which is likely to contribute to the frequency increase observed with substance P during fictive locomotion. PMID:26197458

A Survey of Elementary and Secondary Music Educators' Professional Background, Teaching Responsibilities and Job Satisfaction in the United States

ERIC Educational Resources Information Center

Matthews, Wendy K.; Koner, Karen

2017-01-01

The focus of this exploratory study was to examine the current trends of K-12 music educators in the United States regarding their (a) professional background, (b) classroom teaching responsibilities, and (c) job satisfaction. Participants included seven thousand four hundred and sixty-three (N = 7,463) currently employed music teachers who were…

Microhabitat choice in island lizards enhances camouflage against avian predators.

PubMed

Marshall, Kate L A; Philpot, Kate E; Stevens, Martin

2016-01-25

Camouflage can often be enhanced by genetic adaptation to different local environments. However, it is less clear how individual behaviour improves camouflage effectiveness. We investigated whether individual Aegean wall lizards (Podarcis erhardii) inhabiting different islands rest on backgrounds that improve camouflage against avian predators. In free-ranging lizards, we found that dorsal regions were better matched against chosen backgrounds than against other backgrounds on the same island. This suggests that P. erhardii make background choices that heighten individual-specific concealment. In achromatic camouflage, this effect was more evident in females and was less distinct in an island population with lower predation risk. This suggests that behavioural enhancement of camouflage may be more important in females than in sexually competing males and related to predation risk. However, in an arena experiment, lizards did not choose the background that improved camouflage, most likely due to the artificial conditions. Overall, our results provide evidence that behavioural preferences for substrates can enhance individual camouflage of lizards in natural microhabitats, and that such adaptations may be sexually dimorphic and dependent on local environments. This research emphasizes the importance of considering links between ecology, behaviour, and appearance in studies of intraspecific colour variation and local adaptation.

Microhabitat choice in island lizards enhances camouflage against avian predators

PubMed Central

Marshall, Kate L. A.; Philpot, Kate E.; Stevens, Martin

2016-01-01

Camouflage can often be enhanced by genetic adaptation to different local environments. However, it is less clear how individual behaviour improves camouflage effectiveness. We investigated whether individual Aegean wall lizards (Podarcis erhardii) inhabiting different islands rest on backgrounds that improve camouflage against avian predators. In free-ranging lizards, we found that dorsal regions were better matched against chosen backgrounds than against other backgrounds on the same island. This suggests that P. erhardii make background choices that heighten individual-specific concealment. In achromatic camouflage, this effect was more evident in females and was less distinct in an island population with lower predation risk. This suggests that behavioural enhancement of camouflage may be more important in females than in sexually competing males and related to predation risk. However, in an arena experiment, lizards did not choose the background that improved camouflage, most likely due to the artificial conditions. Overall, our results provide evidence that behavioural preferences for substrates can enhance individual camouflage of lizards in natural microhabitats, and that such adaptations may be sexually dimorphic and dependent on local environments. This research emphasizes the importance of considering links between ecology, behaviour, and appearance in studies of intraspecific colour variation and local adaptation. PMID:26804463

From "~" to Precision Science: Cosmology from 1995 to 2025

NASA Astrophysics Data System (ADS)

Kamionkowski, Marc; Spergel, David N.

2016-01-01

Over the past decade and a half, astronomical measurements, primarily of fluctuations in the cosmic microwave background, have transformed cosmology from an order-of-magnitude game into a paragon of precision science. From these measurements has emerged a 6-parameter cosmological "standard model": a flat universe filled with dark matter and dark energy and seeded by a nearly scale-invariant spectrum of Gaussian random-phase density perturbations. The striking resemblance between these perturbations and those expected from inflation motivates the search for a unique "B-mode" signature of inflation in the polarization of the cosmic microwave background. While the fluctuation spectrum is close to scale invariant, WMAP, Planck and ground-based CMB experiments now have strong evidence for a departure from scale invariance in primordial perturbations. This suggests, in simple models of inflation that these B modes should be within striking distance within the next 5-10 years. The advent of a new generation of galaxy surveys will, over similar timescales, shed additional light not only on the physics of inflation, but also the nature of the dark matter and dark energy required by the current cosmological standard model, and perhaps on the new physics that determines the baryon density.

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

Aartsen, M. G.; Abraham, K.; Ackermann, M.

Observation of a point source of astrophysical neutrinos would be a “smoking gun” signature of a cosmic-ray accelerator. While IceCube has recently discovered a diffuse flux of astrophysical neutrinos, no localized point source has been observed. Previous IceCube searches for point sources in the southern sky were restricted by either an energy threshold above a few hundred TeV or poor neutrino angular resolution. Here we present a search for southern sky point sources with greatly improved sensitivities to neutrinos with energies below 100 TeV. By selecting charged-current ν{sub μ} interacting inside the detector, we reduce the atmospheric background while retainingmore » efficiency for astrophysical neutrino-induced events reconstructed with sub-degree angular resolution. The new event sample covers three years of detector data and leads to a factor of 10 improvement in sensitivity to point sources emitting below 100 TeV in the southern sky. No statistically significant evidence of point sources was found, and upper limits are set on neutrino emission from individual sources. A posteriori analysis of the highest-energy (∼100 TeV) starting event in the sample found that this event alone represents a 2.8 σ deviation from the hypothesis that the data consists only of atmospheric background.« less

Smoot Cosmology Group

Science.gov Websites

the Cosmic Background Radiation as a tool to understand the structure and history of the Universe and its relation to the structure of space-time. Likewise, gravitational lensing, the search for evidence of cosmic strings, and the cosmic infrared background tell us about the structure of space-time and

Friendship networks and physical activity and sedentary behavior among youth: a systematized review

PubMed Central

2013-01-01

Background Low levels of physical activity and increased participation in sedentary leisure-time activities are two important obesity-risk behaviors that impact the health of today’s youth. Friend’s health behaviors have been shown to influence individual health behaviors; however, current evidence on the specific role of friendship networks in relation to levels of physical activity and sedentary behavior is limited. The purpose of this review was to summarize evidence on friendship networks and both physical activity and sedentary behavior among children and adolescents. Method After a search of seven scientific databases and reference scans, a total of thirteen articles were eligible for inclusion. All assessed the association between friendship networks and physical activity, while three also assessed sedentary behavior. Results Overall, higher levels of physical activity among friends are associated with higher levels of physical activity of the individual. Longitudinal studies reveal that an individual’s level of physical activity changes to reflect his/her friends’ higher level of physical activity. Boys tend to be influenced by their friendship network to a greater extent than girls. There is mixed evidence surrounding a friend’s sedentary behavior and individual sedentary behavior. Conclusion Friends’ physical activity level appears to have a significant influence on individual’s physical activity level. Evidence surrounding sedentary behavior is limited and mixed. Results from this review could inform effective public health interventions that harness the influence of friends to increase physical activity levels among children and adolescents. PMID:24289113

An Official ATS Clinical Practice Guideline: Interpretation of Exhaled Nitric Oxide Levels (FeNO) for Clinical Applications

PubMed Central

Dweik, Raed A.; Boggs, Peter B.; Erzurum, Serpil C.; Irvin, Charles G.; Leigh, Margaret W.; Lundberg, Jon O.; Olin, Anna-Carin; Plummer, Alan L.; Taylor, D. Robin

2011-01-01

Background: Measurement of fractional nitric oxide (NO) concentration in exhaled breath (FeNO) is a quantitative, noninvasive, simple, and safe method of measuring airway inflammation that provides a complementary tool to other ways of assessing airways disease, including asthma. While FeNO measurement has been standardized, there is currently no reference guideline for practicing health care providers to guide them in the appropriate use and interpretation of FeNO in clinical practice. Purpose: To develop evidence-based guidelines for the interpretation of FeNO measurements that incorporate evidence that has accumulated over the past decade. Methods: We created a multidisciplinary committee with expertise in the clinical care, clinical science, or basic science of airway disease and/or NO. The committee identified important clinical questions, synthesized the evidence, and formulated recommendations. Recommendations were developed using pragmatic systematic reviews of the literature and the GRADE approach. Results: The evidence related to the use of FeNO measurements is reviewed and clinical practice recommendations are provided. Conclusions: In the setting of chronic inflammatory airway disease including asthma, conventional tests such as FEV1 reversibility or provocation tests are only indirectly associated with airway inflammation. FeNO offers added advantages for patient care including, but not limited to (1) detecting of eosinophilic airway inflammation, (2) determining the likelihood of corticosteroid responsiveness, (3) monitoring of airway inflammation to determine the potential need for corticosteroid, and (4) unmasking of otherwise unsuspected nonadherence to corticosteroid therapy. PMID:21885636

Evidence-based guideline summary: Evaluation, diagnosis, and management of congenital muscular dystrophy

PubMed Central

Kang, Peter B.; Morrison, Leslie; Iannaccone, Susan T.; Graham, Robert J.; Bönnemann, Carsten G.; Rutkowski, Anne; Hornyak, Joseph; Wang, Ching H.; North, Kathryn; Oskoui, Maryam; Getchius, Thomas S.D.; Cox, Julie A.; Hagen, Erin E.; Gronseth, Gary; Griggs, Robert C.

2015-01-01

Objective: To delineate optimal diagnostic and therapeutic approaches to congenital muscular dystrophy (CMD) through a systematic review and analysis of the currently available literature. Methods: Relevant, peer-reviewed research articles were identified using a literature search of the MEDLINE, EMBASE, and Scopus databases. Diagnostic and therapeutic data from these articles were extracted and analyzed in accordance with the American Academy of Neurology classification of evidence schemes for diagnostic, prognostic, and therapeutic studies. Recommendations were linked to the strength of the evidence, other related literature, and general principles of care. Results: The geographic and ethnic backgrounds, clinical features, brain imaging studies, muscle imaging studies, and muscle biopsies of children with suspected CMD help predict subtype-specific diagnoses. Genetic testing can confirm some subtype-specific diagnoses, but not all causative genes for CMD have been described. Seizures and respiratory complications occur in specific subtypes. There is insufficient evidence to determine the efficacy of various treatment interventions to optimize respiratory, orthopedic, and nutritional outcomes, and more data are needed regarding complications. Recommendations: Multidisciplinary care by experienced teams is important for diagnosing and promoting the health of children with CMD. Accurate assessment of clinical presentations and genetic data will help in identifying the correct subtype-specific diagnosis in many cases. Multiorgan system complications occur frequently; surveillance and prompt interventions are likely to be beneficial for affected children. More research is needed to fill gaps in knowledge regarding this category of muscular dystrophies. PMID:25825463

Overt and Latent Cardiac Effects of Ozone Inhalation in Rats: Evidence for Autonomic Modulation and Increased Myocardial Vulnerability

EPA Science Inventory

Background: Ozone (03) is a well-documented respiratory oxidant, but increasing epidemiologic evidence points to extra-pulmonary effects including positive associations between ambient 03 concentrations and cardiovascular morbidity/mortality. Objectives: With preliminary reports ...

What do we know about grant peer review in the health sciences?

PubMed Central

Guthrie, Susan; Ghiga, Ioana; Wooding, Steven

2018-01-01

Background: Peer review decisions award an estimated >95% of academic medical research funding, so it is crucial to understand how well they work and if they could be improved. Methods: This paper summarises evidence from 105 papers identified through a literature search on the effectiveness and burden of peer review for grant funding. Results: There is a remarkable paucity of evidence about the efficiency of peer review for funding allocation, given its centrality to the modern system of science. From the available evidence, we can identify some conclusions around the effectiveness and burden of peer review. The strongest evidence around effectiveness indicates a bias against innovative research. There is also fairly clear evidence that peer review is, at best, a weak predictor of future research performance, and that ratings vary considerably between reviewers. There is some evidence of age bias and cronyism. Good evidence shows that the burden of peer review is high and that around 75% of it falls on applicants. By contrast, many of the efforts to reduce burden are focused on funders and reviewers/panel members. Conclusions: We suggest funders should acknowledge, assess and analyse the uncertainty around peer review, even using reviewers’ uncertainty as an input to funding decisions. Funders could consider a lottery element in some parts of their funding allocation process, to reduce both burden and bias, and allow better evaluation of decision processes. Alternatively, the distribution of scores from different reviewers could be better utilised as a possible way to identify novel, innovative research. Above all, there is a need for open, transparent experimentation and evaluation of different ways to fund research. This also requires more openness across the wider scientific community to support such investigations, acknowledging the lack of evidence about the primacy of the current system and the impossibility of achieving perfection. PMID:29707193

Health Reporting in Print Media in Lebanon: Evidence, Quality and Role in Informing Policymaking

PubMed Central

El-Jardali, Fadi; Bou Karroum, Lama; Bawab, Lamya; Kdouh, Ola; El-Sayed, Farah; Rachidi, Hala; Makki, Malak

2015-01-01

Background Media plays a vital role in shaping public policies and opinions through disseminating health-related information. This study aims at exploring the role of media in informing health policies in Lebanon, identifying the factors influencing health reporting and investigating the role of evidence in health journalism and the quality of health reporting. It also identifies strategies to enhance the use of evidence in health journalism and improve the quality of health reporting. Methods Media analysis was conducted to assess the way media reports on health-related issues and the quality of reporting using a quality assessment tool. Semi-structured interviews were also conducted with 27 journalists, researchers and policymakers to explore their perception on the role of media in health policymaking and the factors influencing health reporting. In addition, a validation workshop was conducted. Results Out of 1,279 health-related news articles identified, 318 articles used certain type of evidence to report health issues 39.8% of which relied on experts’ opinions as their source of evidence while only 5.9% referenced peer-reviewed research studies. The quality of health reporting was judged to be low based on a quality assessment tool consisting of a set of ten criteria. Journalists raised concerns about issues impeding them from referring to evidence. Journalists also reported difficulties with the investigative health journalism. Policymakers and researchers viewed media as an important tool for evidence-informed health policies, however, serious concerns were voiced in terms of the current practice and capacities. Conclusion Our study provides a structured reflection on the role of media and the factors that influence health reporting including context-specific strategies that would enhance the quality and promote the use of evidence in health reporting. In the light of the political changes in many Middle Eastern countries, findings from this study can contribute to redefining the role of media in strengthening health systems. PMID:26308077

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-making. Some of the identified supports may increase the use of research evidence by decision-makers, which may then lead to more informed decisions, and hopefully to a strengthened health system and improved health. PMID:23915278

"We're not short of people telling us what the problems are. We're short of people telling us what to do": An appraisal of public policy and mental health

PubMed Central

Petticrew, Mark; Platt, Stephen; McCollam, Allyson; Wilson, Sarah; Thomas, Sian

2008-01-01

Background There is sustained interest in public health circles in assessing the effects of policies on health and health inequalities. We report on the theory, methods and findings of a project which involved an appraisal of current Scottish policy with respect to its potential impacts on mental health and wellbeing. Methods We developed a method of assessing the degree of alignment between Government policies and the 'evidence base', involving: reviewing theoretical frameworks; analysis of policy documents, and nineteen in-depth interviews with policymakers which explored influences on, and barriers to cross-cutting policymaking and the use of research evidence in decisionmaking. Results Most policy documents did not refer to mental health; however most referred indirectly to the determinants of mental health and well-being. Unsurprisingly research evidence was rarely cited; this was more common in health policy documents. The interviews highlighted the barriers to intersectoral policy making, and pointed to the relative value of qualitative and quantitative research, as well as to the imbalance of evidence between "what is known" and "what is to be done". Conclusion Healthy public policy depends on effective intersectoral working between government departments, along with better use of research evidence to identify policy impacts. This study identified barriers to both these. We also demonstrated an approach to rapidly appraising the mental health effects of mainly non-health sector policies, drawing on theoretical understandings of mental health and its determinants, research evidence and policy documents. In the case of the social determinants of health, we conclude that an evidence-based approach to policymaking and to policy appraisal requires drawing strongly upon existing theoretical frameworks, as well as upon research evidence, but that there are significant practical barriers and disincentives. PMID:18793414

The magnocellular visual pathway and facial emotion misattribution errors in schizophrenia.

PubMed

Bedwell, Jeffrey S; Chan, Chi C; Cohen, Ovad; Karbi, Yinnon; Shamir, Eyal; Rassovsky, Yuri

2013-07-01

Many individuals with schizophrenia show impairment in labeling the emotion depicted by faces, and tend to ascribe anger or fear to neutral expressions. Preliminary research has linked some of these difficulties to dysfunction in the magnocellular (M) visual pathway, which has direct projections to subcortical emotion processing regions. The current study attempted to clarify these relationships using a novel paradigm that included a red background. Diffuse red light is known to suppress the M-pathway in nonpsychiatric adults, and there is preliminary evidence that it may have the opposite (stimulating) effect in schizophrenia-spectrum disorders (SSDs). Twenty-five individuals with SSDs were compared with 31 nonpsychiatric controls using a facial emotion identification task depicting happy, angry, fearful, and sad emotions on red, green, and gray backgrounds. There was a robust interaction of group by change in errors to the red (vs. green) background for misattributing fear expressions as depicting anger (p=.001, ή(2)=.18). Specifically, controls showed a significant decrease in this type of error with the red background (p=.003, d=0.77), while the SSD group tended to increase this type of error (p=.07, d=0.54). These findings suggest that the well-established M-pathway abnormalities in SSDs may contribute to the heightened misperception of other emotions such as anger, which in turn may cause social misperceptions in the environment and elicit symptoms such as paranoia and social withdrawal. As the ventral striatum plays a primary role in identifying anger and receives efferent input from the M-pathway, it may serve as the neuroanatomical substrate in the perception of anger. Copyright © 2013 Elsevier Inc. All rights reserved.

The Ontario printed educational message (OPEM) trial to narrow the evidence-practice gap with respect to prescribing practices of general and family physicians: a cluster randomized controlled trial, targeting the care of individuals with diabetes and hypertension in Ontario, Canada

PubMed Central

Zwarenstein, Merrick; Hux, Janet E; Kelsall, Diane; Paterson, Michael; Grimshaw, Jeremy; Davis, Dave; Laupacis, Andreas; Evans, Michael; Austin, Peter C; Slaughter, Pamela M; Shiller, Susan K; Croxford, Ruth; Tu, Karen

2007-01-01

Background There are gaps between what family practitioners do in clinical practice and the evidence-based ideal. The most commonly used strategy to narrow these gaps is the printed educational message (PEM); however, the attributes of successful printed educational messages and their overall effectiveness in changing physician practice are not clear. The current endeavor aims to determine whether such messages change prescribing quality in primary care practice, and whether these effects differ with the format of the message. Methods/design The design is a large, simple, factorial, unblinded cluster-randomized controlled trial. PEMs will be distributed with informed, a quarterly evidence-based synopsis of current clinical information produced by the Institute for Clinical Evaluative Sciences, Toronto, Canada, and will be sent to all eligible general and family practitioners in Ontario. There will be three replicates of the trial, with three different educational messages, each aimed at narrowing a specific evidence-practice gap as follows: 1) angiotensin-converting enzyme inhibitors, hypertension treatment, and cholesterol lowering agents for diabetes; 2) retinal screening for diabetes; and 3) diuretics for hypertension. For each of the three replicates there will be three intervention groups. The first group will receive informed with an attached postcard-sized, short, directive "outsert." The second intervention group will receive informed with a two-page explanatory "insert" on the same topic. The third intervention group will receive informed, with both the above-mentioned outsert and insert. The control group will receive informed only, without either an outsert or insert. Routinely collected physician billing, prescription, and hospital data found in Ontario's administrative databases will be used to monitor pre-defined prescribing changes relevant and specific to each replicate, following delivery of the educational messages. Multi-level modeling will be used to study patterns in physician-prescribing quality over four quarters, before and after each of the three interventions. Subgroup analyses will be performed to assess the association between the characteristics of the physician's place of practice and target behaviours. A further analysis of the immediate and delayed impacts of the PEMs will be performed using time-series analysis and interventional, auto-regressive, integrated moving average modeling. Trial registration number Current controlled trial ISRCTN72772651. PMID:18039361

Observation of increased space-charge limited thermionic electron emission current by neutral gas ionization in a weakly-ionized deuterium plasma

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

Hollmann, E. M.; Yu, J. H.; Doerner, R. P.

2015-09-14

The thermionic electron emission current emitted from a laser-produced hot spot on a tungsten target in weakly-ionized deuterium plasma is measured. It is found to be one to two orders of magnitude larger than expected for bipolar space charge limited thermionic emission current assuming an unperturbed background plasma. This difference is attributed to the plasma being modified by ionization of background neutrals by the emitted electrons. This result indicates that the allowable level of emitted thermionic electron current can be significantly enhanced in weakly-ionized plasmas due to the presence of large neutral densities.

Magnetospheric Reconnection in Modified Current-Sheet Equilibria

NASA Astrophysics Data System (ADS)

Newman, D. L.; Goldman, M. V.; Lapenta, G.; Markidis, S.

2012-10-01

Particle simulations of magnetic reconnection in Earth's magnetosphere are frequently initialized with a current-carrying Harris equilibrium superposed on a current-free uniform background plasma. The Harris equilibrium satisfies local charge neutrality, but requires that the sheet current be dominated by the hotter species -- often the ions in Earth's magnetosphere. This constraint is not necessarily consistent with observations. A modified kinetic equilibrium that relaxes this constraint on the currents was proposed by Yamada et al. [Phys. Plasmas., 7, 1781 (2000)] with no background population. These modified equilibria were characterized by an asymptotic converging or diverging electrostatic field normal to the current sheet. By reintroducing the background plasma, we have developed new families of equilibria where the asymptotic fields are suppressed by Debye shielding. Because the electrostatic potential profiles of these new equilibria contain wells and/or barriers capable of spatially isolating different populations of electrons and/or ions, these solutions can be further generalized to include classes of asymmetric kinetic equilibria. Examples of both symmetric and asymmetric equilibria will be presented. The dynamical evolution of these equilibria, when perturbed, will be further explored by means of implicit 2D PIC reconnection simulations, including comparisons with simulations employing standard Harris-equilibrium initializations.

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

PubMed Central

Puig, Ignasi; López-Góngora, Sheila; Calvet, Xavier; Villoria, Albert; Baylina, Mireia; Sanchez-Delgado, Jordi; Suarez, David; García-Hernando, Victor; Gisbert, Javier P.

2015-01-01

Background: Susceptibility-guided therapies (SGTs) have been proposed as preferable to empirical rescue treatments after two treatment failures. The aim of this study was to perform a systematic review and meta-analysis evaluating the effectiveness and efficacy of SGT as third-line therapy. Methods: A systematic search was performed in multiple databases. Studies reporting cure rates of Helicobacter pylori with SGT in third-line therapy were selected. A qualitative analysis describing the current evidence and a pooled mean analysis summarizing the cure rates of SGT in third-line therapy was performed. Results: No randomized controlled trials or comparative studies were found. Four observational studies reported cure rates with SGT in third-line treatment, and three studies which mixed patients with second- and third-line treatment also reported cure rates with SGT. The majority of the studies included the patients when culture had been already obtained, and so the effectiveness of SGT and empirical therapy has never been compared. A pooled mean analysis including four observational studies (283 patients) showed intention-to-treat and per-protocol eradication rates with SGT of 72% (95% confidence interval 56–87%; I2: 92%) and 80% (95% confidence interval 71–90%; I2: 80%), respectively. Conclusions: SGT may be an acceptable option as rescue treatment. However, cure rates are, at best, moderate and this approach has never been compared with a well-devised empirical therapy. The evidence in favor of SGT as rescue therapy is currently insufficient to recommend its use. PMID:27366212

Polio vaccines: WHO position paper, January 2014--recommendations.

PubMed

2014-07-16

This article presents the World Health Organizations (WHO) evidence and recommendations for the use of polio vaccination from the WHO position paper on polio vaccines - January 2014 recently published in the Weekly Epidemiological Record [1]. This position paper summarizes the WHO position on the introduction of at least one dose of inactivated polio vaccine (IPV) into routine immunization schedules as a strategy to mitigate the potential risk of re-emergence of type 2 polio following the withdrawal of Sabin type 2 strains from oral polio vaccine (OPV). The current document replaces the position paper on the use of polio vaccines published in 2010 [2]. Footnotes to this paper provide a number of core references. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. This paper reflects the recommendations of WHO's Strategic Advisory Group of Experts (SAGE) on immunization. These recommendations were discussed by SAGE at its November 2013 meeting. Evidence presented at the meeting can be accessed at http://www.who.int/immunization/sage/previous/en/index.html. Copyright © 2014 World Health Organization. Published by Elsevier Ltd.. All rights reserved.

Impact of Smoking on the Risk of Pancreatitis: A Systematic Review and Meta-Analysis

PubMed Central

Ye, Xiaohua; Lu, Guangrong; Huai, Jiaping; Ding, Jin

2015-01-01

Background and objective Cigarette smoking may increase the risk of developing pancreatic cancer, although its impact on pancreatitis has only been discerned in recent years. However, the results of previous studies differ. We performed a meta-analysis to provide a quantitative pooled risk estimate of the association of cigarette smoking with pancreatitis. Method A literature search of the MEDLINE and Embase databases was conducted, and studies were selected that investigated the association of cigarette smoking with pancreatitis. Summary relative risks (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Results Twenty-two studies were included. The summary RRs (95% CI) associated with ever, current and former smokers for acute and chronic pancreatitis (AP/CP) were as follows: 1.51 (1.10, 2.07)/3.00 (1.46, 6.17), 1.42 (1.08, 1.87)/2.72 (1.74, 4.24), and 1.22 (0.99, 1.52)/1.27 (1.00, 1.62), respectively. Moreover, studies that analyzed both AP and CP were also summarized: 1.73 (1.18, 2.54) for ever smokers, 1.67 (1.03, 2.68) for current smokers and 1.56 (1.16, 2.11) for former smokers, respectively. There was no evidence of publication bias across the studies. Conclusion The evidence suggests a positive association of cigarette smoking with the development of pancreatitis. It is possible that smoking cessation may be a useful strategy for the management of pancreatitis. PMID:25879541

Vaccines and vaccination against yellow fever: WHO Position Paper, June 2013--recommendations.

PubMed

2015-01-01

This article presents the World Health Organizations (WHO) evidence and recommendations for the use of yellow fever (YF) vaccination from "Vaccines and vaccination against yellow fever: WHO Position Paper - June 2013" published in the Weekly Epidemiological Record. This position paper summarizes the WHO position on the use of YF vaccination, in particular that a single dose of YF vaccine is sufficient to confer sustained life-long protective immunity against YF disease. A booster dose is not necessary. The current document replaces the position paper on the use of yellow fever vaccines and vaccination published in 2003. Footnotes to this paper provide a number of core references. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. This paper reflects the recommendations of WHO's Strategic Advisory Group of Experts (SAGE) on immunization. These recommendations were discussed by SAGE at its April 2013 meeting. Evidence presented at the meeting can be accessed at http://www.who.int/immunization/sage/previous/en/index.html. Copyright © 2014. Published by Elsevier Ltd.

The Quality and Accuracy of Mobile Apps to Prevent Driving After Drinking Alcohol

PubMed Central

Stoyanov, Stoyan R; Gandabhai, Shailen; Baldwin, Alexander

2016-01-01

Background Driving after the consumption of alcohol represents a significant problem globally. Individual prevention countermeasures such as personalized mobile apps aimed at preventing such behavior are widespread, but there is little research on their accuracy and evidence base. There has been no known assessment investigating the quality of such apps. Objective This study aimed to determine the quality and accuracy of apps for drink driving prevention by conducting a review and evaluation of relevant mobile apps. Methods A systematic app search was conducted following PRISMA guidelines. App quality was assessed using the Mobile App Rating Scale (MARS). Apps providing blood alcohol calculators (hereafter “calculators”) were reviewed against current alcohol advice for accuracy. Results A total of 58 apps (30 iOS and 28 Android) met inclusion criteria and were included in the final analysis. Drink driving prevention apps had significantly lower engagement and overall quality scores than alcohol management apps. Most calculators provided conservative blood alcohol content (BAC) time until sober calculations. None of the apps had been evaluated to determine their efficacy in changing either drinking or driving behaviors. Conclusions This novel study demonstrates that most drink driving prevention apps are not engaging and lack accuracy. They could be improved by increasing engagement features, such as gamification. Further research should examine the context and motivations for using apps to prevent driving after drinking in at-risk populations. Development of drink driving prevention apps should incorporate evidence-based information and guidance, lacking in current apps. PMID:27502956

Mechanisms Underlying Latent Disease Risk Associated with Early-Life Arsenic Exposure: Current Research Trends and Scientific Gaps

PubMed Central

Bailey, Kathryn A.; Smith, Allan H.; Tokar, Erik J.; Graziano, Joseph H.; Kim, Kyoung-Woong; Navasumrit, Panida; Ruchirawat, Mathuros; Thiantanawat, Apinya; Suk, William A.; Fry, Rebecca C.

2015-01-01

Background Millions of individuals worldwide, particularly those living in rural and developing areas, are exposed to harmful levels of inorganic arsenic (iAs) in their drinking water. Inorganic As exposure during key developmental periods is associated with a variety of adverse health effects, including those that are evident in adulthood. There is considerable interest in identifying the molecular mechanisms that relate early-life iAs exposure to the development of these latent diseases, particularly in relationship to cancer. Objectives This work summarizes research on the molecular mechanisms that underlie the increased risk of cancer development in adulthood that is associated with early-life iAs exposure. Discussion Epigenetic reprogramming that imparts functional changes in gene expression, the development of cancer stem cells, and immunomodulation are plausible underlying mechanisms by which early-life iAs exposure elicits latent carcinogenic effects. Conclusions Evidence is mounting that relates early-life iAs exposure and cancer development later in life. Future research should include animal studies that address mechanistic hypotheses and studies of human populations that integrate early-life exposure, molecular alterations, and latent disease outcomes. Citation Bailey KA, Smith AH, Tokar EJ, Graziano JH, Kim KW, Navasumrit P, Ruchirawat M, Thiantanawat A, Suk WA, Fry RC. 2016. Mechanisms underlying latent disease risk associated with early-life arsenic exposure: current research trends and scientific gaps. Environ Health Perspect 124:170–175; http://dx.doi.org/10.1289/ehp.1409360 PMID:26115410

Evidence That the Directly Imaged Planet HD 131399 Ab Is a Background Star

NASA Astrophysics Data System (ADS)

Nielsen, Eric L.; De Rosa, Robert J.; Rameau, Julien; Wang, Jason J.; Esposito, Thomas M.; Millar-Blanchaer, Maxwell A.; Marois, Christian; Vigan, Arthur; Ammons, S. Mark; Artigau, Etienne; Bailey, Vanessa P.; Blunt, Sarah; Bulger, Joanna; Chilcote, Jeffrey; Cotten, Tara; Doyon, René; Duchêne, Gaspard; Fabrycky, Daniel; Fitzgerald, Michael P.; Follette, Katherine B.; Gerard, Benjamin L.; Goodsell, Stephen J.; Graham, James R.; Greenbaum, Alexandra Z.; Hibon, Pascale; Hinkley, Sasha; Hung, Li-Wei; Ingraham, Patrick; Jensen-Clem, Rebecca; Kalas, Paul; Konopacky, Quinn; Larkin, James E.; Macintosh, Bruce; Maire, Jérôme; Marchis, Franck; Metchev, Stanimir; Morzinski, Katie M.; Murray-Clay, Ruth A.; Oppenheimer, Rebecca; Palmer, David; Patience, Jennifer; Perrin, Marshall; Poyneer, Lisa; Pueyo, Laurent; Rafikov, Roman R.; Rajan, Abhijith; Rantakyrö, Fredrik T.; Ruffio, Jean-Baptiste; Savransky, Dmitry; Schneider, Adam C.; Sivaramakrishnan, Anand; Song, Inseok; Soummer, Remi; Thomas, Sandrine; Wallace, J. Kent; Ward-Duong, Kimberly; Wiktorowicz, Sloane; Wolff, Schuyler

2017-12-01

We present evidence that the recently discovered, directly imaged planet HD 131399 Ab is a background star with nonzero proper motion. From new JHK1L‧ photometry and spectroscopy obtained with the Gemini Planet Imager, VLT/SPHERE, and Keck/NIRC2, and a reanalysis of the discovery data obtained with VLT/SPHERE, we derive colors, spectra, and astrometry for HD 131399 Ab. The broader wavelength coverage and higher data quality allow us to reinvestigate its status. Its near-infrared spectral energy distribution excludes spectral types later than L0 and is consistent with a K or M dwarf, which are the most likely candidates for a background object in this direction at the apparent magnitude observed. If it were a physically associated object, the projected velocity of HD 131399 Ab would exceed escape velocity given the mass and distance to HD 131399 A. We show that HD 131399 Ab is also not following the expected track for a stationary background star at infinite distance. Solving for the proper motion and parallax required to explain the relative motion of HD 131399 Ab, we find a proper motion of 12.3 mas yr-1. When compared to predicted background objects drawn from a galactic model, we find this proper motion to be high but consistent with the top 4% fastest-moving background stars. From our analysis, we conclude that HD 131399 Ab is a background K or M dwarf.

Cutaneous T cell lymphoma: Current practices in blood assessment and the utility of T-cell receptor Vβ chain restriction

PubMed Central

Gibson, Juliet F; Huang, Jing; Liu, Kristina J; Carlson, Kacie R; Foss, Francine; Choi, Jaehyuk; Edelson, Richard; Hussong, Jerry W.; Mohl, Ramsey; Hill, Sally; Girardi, Sally

2016-01-01

Background Accurate quantification of malignant cells in the peripheral blood of patients with cutaneous T cell lymphoma (CTCL) is important for early detection, prognosis, and monitoring disease burden. Objective Determine the spectrum of current clinical practices; critically evaluate elements of current ISCL B1 and B2 staging criteria; and assess the potential role of TCR-Vβ analysis by flow cytometry. Methods We assessed current clinical practices by survey, and performed a retrospective analysis of 161 patients evaluated at Yale (2011-2014) to compare the sensitivity, specificity, PPV, and NPV of parameters for ISCL B2 staging. Results There was heterogeneity in clinical practices among institutions. ISCL B1 criteria did not capture five Yale cohort patients with immunophenotypic abnormalities who later progressed. TCR-Vβ testing was more specific than PCR and aided diagnosis in detecting clonality, but was of limited benefit in quantification of tumor burden. Limitations Because of limited follow-up involving a single center, further investigation will be necessary to conclude whether our proposed diagnostic algorithm is of general clinical benefit. Conclusion We propose further study of “modified B1 criteria”: CD4/CD8 ratio ≥5, %CD4+/CD26- ≥ 20%, %CD4+/CD7- ≥ 20%, with evidence of clonality. TCR-Vβ testing should be considered in future diagnostic and staging algorithms. PMID:26874819

Adenosine Triphosphate (ATP) Inhibits Voltage-Sensitive Potassium Currents in Isolated Hensen's Cells and Nifedipine Protects Against Noise-Induced Hearing Loss in Guinea Pigs.

PubMed

Ye, Rui; Liu, Jun; Jia, Zhiying; Wang, Hongyang; Wang, YongAn; Sun, Wei; Wu, Xuan; Zhao, Zhifei; Niu, Baolong; Li, Xingqi; Dai, Guanghai; Li, Jianxiong

2016-06-13

BACKGROUND There is increasing evidence that adenosine triphosphate (ATP), a well-known neurotransmitter and neuromodulator in the central nervous system, plays an important role as an extracellular chemical messenger in the cochlea. MATERIAL AND METHODS Using a whole-cell recording technique, we studied the effects of ATP on isolated Hensen's cells, which are supporting cells in the cochlea, to determine if they are involved in the transduction of ions with hair cells. RESULTS ATP (0.1-10 µM) reduced the potassium current (IK+) in the majority of the recorded Hensen's cells (21 out of 25 cells). An inward current was also induced by high concentrations of ATP (100 µM to 10 mM), which was reversibly blocked by 100 µM suramin (a purinergic antagonist) and blocked by nifedipine (an L-type calcium channel blocker). After the cochleas were perfused with artificial perilymph solutions containing nifedipine and exposed to noise, the amplitude increase in the compound action potential (CAP) threshold and the reduction in cochlear microphonics was lower than when they were exposed to noise alone. CONCLUSIONS Our results suggest that ATP can block IK+ channels at a low concentration and induce an inward Ca2+ current at high concentrations, which is reversed by purinergic receptors. Nifedipine may have a partially protective effect on noise-induced hearing loss (NIHL).

Interplay of Dysphoria and Anxiety Sensitivity in Relation to Emotion Regulatory Cognitions of Smoking Among Treatment-seeking Smokers

PubMed Central

Garey, Lorra; Bakhshaie, Jafar; Brandt, Charles P.; Langdon, Kirsten J.; Kauffman, Brooke Y.; Schmidt, Norman B.; Leventhal, Adam M.; Zvolensky, Michael J.

2017-01-01

Background and Objectives There is evidence that anxiety sensitivity (AS) plays a role in the maintenance of smoking, yet there is little understanding of how AS interplays with other affective symptomatology variables that are also related to smoking, such as dysphoria. Therefore, the current cross-sectional study evaluated the interactive effects of AS and dysphoria on emotion regulatory cognitions, including smoking negative affect reduction expectancies, perceived barriers for cessation, and smoking-specific experiential avoidance. Method A total of 448 adult treatment-seeking daily smokers, who responded to study advertisements, were recruited to participate in a smoking cessation treatment trial (47.8% female; Mage = 37.2, SD =13.5). The current study utilized self-report baseline data from trial participants. Results After accounting for covariates, simple slope analyses revealed that AS was positively related to negative affect reduction expectancies (β = .03, p =.01), perceived barriers to cessation (β =.22, p = .002), and smoking avoidance and inflexibility (β =.07, p = .04), among smokers with lower (versus higher) levels of dysphoria. Conclusions The current findings suggest that higher levels of dysphoria may mitigate the relation between AS and emotion regulatory cognitions of smoking. Scientific Significance The current findings highlight the unique and additive clinical relevance of AS and dysphoria regarding emotion regulatory smoking cognitions that may impede quit success. PMID:27122303

Transcranial Direct Current Stimulation in Post Stroke Aphasia and Primary Progressive Aphasia: Current Knowledge and Future Clinical Applications

PubMed Central

Sebastian, Rajani; Tsapkini, Kyrana; Tippett, Donna C.

2016-01-01

BACKGROUND The application of transcranial direct current stimulation (tDCS) in chronic post stroke aphasia is documented in a substantial literature, and there is some new evidence that tDCS can augment favorable language outcomes in primary progressive aphasia. Anodal tDCS is most often applied to the left hemisphere language areas to increase cortical excitability (increase the threshold of activation) and cathodal tDCS is most often applied to the right hemisphere homotopic areas to inhibit over activation in contralesional right homologues of language areas. Outcomes usually are based on neuropsychological and language test performance, following a medical model which emphasizes impairment of function, rather than a model which emphasizes functional communication. OBJECTIVE In this paper, we review current literature of tDCS as it is being used as a research tool, and discuss future implementation of tDCS as an adjuvant treatment to behavioral speech-language pathology intervention. METHODS We review literature describing non-invasive brain stimulation, the mechanism of tDCS, and studies of tDCS in aphasia and neurodegenerative disorders. We discuss future clinical applications. RESULTS/CONCLUSIONS tDCS is a promising adjunct to traditional speech-language pathology intervention to address speech-language deficits after stroke and in the neurodegenerative disease, primary progressive aphasia. Limited data are available regarding how performance on these types of specific tasks translates to functional communication outcomes. PMID:27314871

Development of the other-race effect during infancy: evidence toward universality?

PubMed

Kelly, David J; Liu, Shaoying; Lee, Kang; Quinn, Paul C; Pascalis, Olivier; Slater, Alan M; Ge, Liezhong

2009-09-01

The other-race effect in face processing develops within the first year of life in Caucasian infants. It is currently unknown whether the developmental trajectory observed in Caucasian infants can be extended to other cultures. This is an important issue to investigate because recent findings from cross-cultural psychology have suggested that individuals from Eastern and Western backgrounds tend to perceive the world in fundamentally different ways. To this end, the current study investigated 3-, 6-, and 9-month-old Chinese infants' ability to discriminate faces within their own racial group and within two other racial groups (African and Caucasian). The 3-month-olds demonstrated recognition in all conditions, whereas the 6-month-olds recognized Chinese faces and displayed marginal recognition for Caucasian faces but did not recognize African faces. The 9-month-olds' recognition was limited to Chinese faces. This pattern of development is consistent with the perceptual narrowing hypothesis that our perceptual systems are shaped by experience to be optimally sensitive to stimuli most commonly encountered in one's unique cultural environment.

Circulating microparticles: square the circle

PubMed Central

2013-01-01

Background The present review summarizes current knowledge about microparticles (MPs) and provides a systematic overview of last 20 years of research on circulating MPs, with particular focus on their clinical relevance. Results MPs are a heterogeneous population of cell-derived vesicles, with sizes ranging between 50 and 1000 nm. MPs are capable of transferring peptides, proteins, lipid components, microRNA, mRNA, and DNA from one cell to another without direct cell-to-cell contact. Growing evidence suggests that MPs present in peripheral blood and body fluids contribute to the development and progression of cancer, and are of pathophysiological relevance for autoimmune, inflammatory, infectious, cardiovascular, hematological, and other diseases. MPs have large diagnostic potential as biomarkers; however, due to current technological limitations in purification of MPs and an absence of standardized methods of MP detection, challenges remain in validating the potential of MPs as a non-invasive and early diagnostic platform. Conclusions Improvements in the effective deciphering of MP molecular signatures will be critical not only for diagnostics, but also for the evaluation of treatment regimens and predicting disease outcomes. PMID:23607880

Health effects associated with exposure to ambient air pollution.

PubMed

Samet, Jonathan; Krewski, Daniel

2007-02-01

The World Health Organization has identified ambient air pollution as a high public health priority, based on estimates of air pollution related death and disability-adjusted life years derived in its Global Burden of Disease initiative. The NERAM Colloquium Series on Health and Air Quality was initiated to strengthen the linkage between scientists, policymakers, and other stakeholders by reviewing the current state of science, identifying policy-relevant gaps and uncertainties in the scientific evidence, and proposing a path forward for research and policy to improve air quality and public health. The objective of this paper is to review the current state of science addressing the impacts of air pollution on human health. The paper is one of four background papers prepared for the 2003 NERAM/AirNet Conference on Strategies for Clean Air and Health, the third meeting in the international Colloquium Series. The review is based on the framework and findings of the U.S. National Research Committee (NRC) on Research Priorities for Airborne Particulate Matter and addresses key questions underlying air quality risk management policy decisions.

Pediatric fatty liver disease: Role of ethnicity and genetics

PubMed Central

Marzuillo, Pierluigi; Miraglia del Giudice, Emanuele; Santoro, Nicola

2014-01-01

Non-alcoholic fatty liver disease (NAFLD) comprehends a wide range of conditions, encompassing from fatty liver or steatohepatitis with or without fibrosis, to cirrhosis and its complications. NAFLD has become the most common form of liver disease in childhood as its prevalence has more than doubled over the past 20 years, paralleling the increased prevalence of childhood obesity. It currently affects between 3% and 11% of the pediatric population reaching the rate of 46% among overweight and obese children and adolescents. The prevalence of hepatic steatosis varies among different ethnic groups. The ethnic group with the highest prevalence is the Hispanic one followed by the Caucasian and the African-American. This evidence suggests that there is a strong genetic background in the predisposition to fatty liver. In fact, since 2008 several common gene variants have been implicated in the pathogenesis of fatty liver disease. The most important is probably the patatin like phospholipase containing domain 3 gene (PNPLA3) discovered by the Hobbs’ group in 2008. This article reviews the current knowledge regarding the role of ethnicity and genetics in pathogenesis of pediatric fatty liver. PMID:24966605

[The link between self-construal and mental distress in Turkish migrants and German women with depression].

PubMed

Balkir, Nazli; Arens, Elisabeth A; Wolff, Carolin; Barnow, Sven

2013-04-01

The current study aims to analyze cultural differences in the patterns of self-construals (interdependent vs. independent) and their relation to mental distress in a sample of depressed Turkish migrants and German women. A total number of 56 in-patients with a diagnosis of major depression were compared in terms of self-construals and their relations to different aspects of mental distress. Turkish patients exhibited a stronger interdependent self-construal compared to Germans, whereas no group differences were observed with respect to independence. While for Turkish patients a higher level of interdependence was associated with lower levels of mental distress, the reverse was true for German patients. However, there were no significant ethnic differences in the associations between independence and mental distress. The current study provides evidence that the relation between self-construal and mental distress is moderated by patient's cultural background. The findings have implications for integrating self-construals into psychotherapy practice with culturally diverse populations, in order to adjust therapy goals and intervention techniques. © Georg Thieme Verlag KG Stuttgart · New York.

BioUSeR: a semantic-based tool for retrieving Life Science web resources driven by text-rich user requirements

PubMed Central

2013-01-01

Background Open metadata registries are a fundamental tool for researchers in the Life Sciences trying to locate resources. While most current registries assume that resources are annotated with well-structured metadata, evidence shows that most of the resource annotations simply consists of informal free text. This reality must be taken into account in order to develop effective techniques for resource discovery in Life Sciences. Results BioUSeR is a semantic-based tool aimed at retrieving Life Sciences resources described in free text. The retrieval process is driven by the user requirements, which consist of a target task and a set of facets of interest, both expressed in free text. BioUSeR is able to effectively exploit the available textual descriptions to find relevant resources by using semantic-aware techniques. Conclusions BioUSeR overcomes the limitations of the current registries thanks to: (i) rich specification of user information needs, (ii) use of semantics to manage textual descriptions, (iii) retrieval and ranking of resources based on user requirements. PMID:23635042

Barking up the Wrong Tree: Why and How We May Need to Revise Alcohol Addiction Therapy

PubMed Central

Stock, Ann-Kathrin

2017-01-01

One of the main characteristics of alcohol abuse and addiction is the loss of control over alcohol intake and the continuation of drinking in the face of negative consequences. Mounting evidence strongly suggests that an alcohol-induced imbalance between goal-directed and habitual behavior may be one of the main driving factors of this key feature of addiction and furthermore play a key role in staying abstinent. Current therapies often focus only on deficient inhibitory control (i.e., goal-directed behavior), but largely neglect the potential of the well-functioning habit formation found in patients. Yet, focusing on intact habitual/automatic mechanisms in addition to or maybe even instead of deficient cognitive control might equip us with a more effective tool to battle the current alcohol abuse and addiction epidemic, especially with respect to more severely impacted patients who likely suffer from permanent alcohol-induced brain damage. Against this background, I would like to advocate the application and scientific evaluation of habit reversal therapy (HRT) for alcohol abuse and addiction. PMID:28611718

The Atacama Cosmology Telescope (ACT): Beam Profiles and First SZ Cluster Maps

NASA Technical Reports Server (NTRS)

Hincks, A. D.; Acquaviva, V.; Ade, P. A.; Aguirre, P.; Amiri, M.; Appel, J. W.; Barrientos, L. F.; Battistelli, E. S.; Bond, J. R.; Brown, B.;

Search for heavy vector-like quarks coupling to light quarks in proton–proton collisions at s = 7   TeV with the ATLAS detector

DOE PAGES

Aad, G.; Abbott, B.; Abdallah, J.; ...

2012-05-01

This Letter presents a search for singly produced vector-like quarks, Q, coupling to light quarks, q. The search is sensitive to both charged current (CC) and neutral current (NC) processes, pp→Qq→Wqq' and pp→Qq→Zqq' with a leptonic decay of the vector gauge boson. In 1.04fb -1 of data taken in 2011 by the ATLAS experiment at a center-of-mass energy √s=7TeV, no evidence of such heavy vector-like quarks is observed above the expected Standard Model background. Limits on the heavy vector-like quark production cross section times branching ratio as a function of mass m Q are obtained. For a coupling κ qQ=v/mmore » Q, where v is the Higgs vacuum expectation value, 95% C.L. lower limits on the mass of a vector-like quark are set at 900 GeV and 760 GeV from CC and NC processes, respectively.« less

Federal Child Care Policy. Current and Proposed. Family Impact Seminar (Washington, D.C., April 28, 1989). Meeting Highlights and Background Briefing Report.

ERIC Educational Resources Information Center

Ooms, Theodora; Herendeen, Lisa

The purpose of this policy seminar, one of a series of family impact seminars, was to consider current and proposed policies of the federal government that concern child care. This document provides highlights of presentations by the seminar panelists and a background briefing report prepared before the meeting. The highlights section summarizes:…

Fair Share or Freeride: Burden Sharing in Post-Cold War NATO

DTIC Science & Technology

2015-05-23

military facilities in Europe. 56 Carl Elk, NATO Common Funds Burdensharing: Background and Current Issues (Washington DC: Congressional Research...Defense Minister Franz Joseph Jung replied, “our contribution is excellent.”114 Germany was clearly proud of its contribution to NATO operations, but...Monsanto, Portugal: NATO Joint Analysis Lessons Learned Centre (JALLC), 2011. Elk, Carl . NATO Common Funds Burdensharing: Background and Current

Educational Attainment and Smoking Status in a National Sample of American Adults; Evidence for the Blacks’ Diminished Return

PubMed Central

Mistry, Ritesh

2018-01-01

Background: Although higher socioeconomic status (SES) indicators such as educational attainment are linked with health behaviors, the Blacks’ Diminished Return theory posits that the protective effects of SES are systemically smaller for Blacks than Whites. Aims: To explore the Black/White differences in the association between education and smoking. Methods: This cross-sectional study used the Health Information National Trends Survey (HINTS) 2017 (n = 3217). HINTS is a national survey of American adults. The current analysis included 2277 adults who were either Whites (n = 1868; 82%) or Blacks (n = 409; 18%). The independent variable was educational attainment, and the dependent variables were ever and current (past 30-day) smoking. Demographic factors (age and gender) were covariates. Race was the focal moderator. Results: In the pooled sample, higher educational attainment was associated with lower odds of ever and current smoking. Race interacted with the effects of higher educational attainment on current smoking, suggesting a stronger protective effect of higher education against current smoking for Whites than Blacks. Race did not interact with the effect of educational attainment on odds of ever smoking. Conclusions: In line with previous research in the United States, education is more strongly associated with health and health behaviors in Whites than Blacks. Smaller protective effects of education on health behaviors may be due to the existing racism across institutions such as the education system and labor market. PMID:29659482

Attitudes Toward Adoption of Evidence-Based Practice Among Physical Therapists and Social Workers: A Lesson for Interprofessional Continuing Education.

PubMed

Gudjonsdottir, Bjorg; Arnadottir, Hervor A; Gudmundsson, Halldor S; Juliusdottir, Sigrun; Arnadottir, Solveig A

2017-01-01

Professionals who embrace evidence-based practice (EBP) continually search for research evidence, appraise, and apply it, while interacting with each client in his/her situation. This dynamic learning process takes a substantial commitment from professionals and requires a positive attitude toward EBP. The main objective of this research was to explore the following: 1) distinct dimensions of attitudes toward adoption of EBP among physical therapists and social workers and 2) the relationship between these dimensions of attitudes and selected background characteristics of the compared professions. Cross-sectional web-based surveys were conducted in 2012 and 2013 on a population-based sample from the Icelandic Physical Therapy Association and the Icelandic Association of Social Workers. The participants were 214 physical therapists (76.3% women) and 163 social workers (92.2% women). The Evidence-Based Practice Attitude Scale (EBPAS) and its four subscales were used to survey dimensions of attitudes toward EBP. Scores on the total EBPAS range from zero to five, with a higher score indicating a more positive attitude toward EBPs. Linear regression was used to explore the relationship between the EBPAS scales and selected background variables. The overall response rate was 39%. Both professions generally held positive attitudes toward adoption of EBP, with an average EBPAS total score of 3.06 (SD = 0.46). The professionals' background characteristics were independently related to at least one dimension of attitudes toward EBP. More positive attitudes were associated with being a physical therapist, a woman, in a younger age group, having a graduate degree, working with individual clients, and having at least five same-profession coworkers. The results may be useful to design continuing education focusing on EBP. Such inventions should be targeted to professional attitudes, background, and other contextual factors.

The role of evidence based medicine in neurotrauma.

PubMed

Honeybul, S; Ho, K M

2015-04-01

The introduction of evidence based medicine de-emphasised clinical experience and so-called "background information" and stressed the importance of evidence gained from clinical research when making clinical decisions. For many years randomised controlled trials have been seen to be the only way to advance clinical practice, however, applying this methodology in the context of severe trauma can be problematic. In addition, it is increasingly recognised that considerable clinical experience is required in order to critically evaluate the quality of the evidence and the validity of the conclusions as presented. A contemporary example is seen when considering the role of decompressive craniectomy in the management of neurotrauma. Although there is a considerable amount of evidence available attesting to the efficacy of the procedure, considerable clinical expertise is required in order to properly interpret the results of these studies and the implications for clinical practice. Given these limitations the time may have come for a redesign of the traditional pyramid of evidence, to a model that re-emphasises the importance of "background information" such as pathophysiology and acknowledges the role of clinical experience such that the evidence can be critically evaluated in its appropriate context and the subsequent implications for clinical practice be clearly and objectively defined. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

What Goes Around Can Come Around: An Unexpected Deleterious Effect of Using Mouse Running Wheels for Environmental Enrichment

PubMed Central

Leduc, Renee Y M; Rauw, Gail; Baker, Glen B; McDermid, Heather E

2017-01-01

Environmental enrichment items such as running wheels can promote the wellbeing of laboratory mice. Growing evidence suggests that wheel running simulates exercise effects in many mouse models of human conditions, but this activity also might change other aspects of mouse behavior. In this case study, we show that the presence of running wheels leads to pronounced and permanent circling behavior with route-tracing in a proportion of the male mice of a genetically distinct cohort. The genetic background of this cohort includes a mutation in Arhgap19, but genetic crosses showed that an unknown second-site mutation likely caused the induced circling behavior. Behavioral tests for inner-ear function indicated a normal sense of gravity in the circling mice. However, the levels of dopamine, serotonin, and some dopamine metabolites were lower in the brains of circling male mice than in mice of the same genetic background that were weaned without wheels. Circling was seen in both singly and socially housed male mice. The additional stress of fighting may have exacerbated the predisposition to circling in the socially housed animals. Singly and socially housed male mice without wheels did not circle. Our current findings highlight the importance and possibly confounding nature of the environmental and genetic background in mouse behavioral studies, given that the circling behavior and alterations in dopamine and serotonin levels in this mouse cohort occurred only when the male mice were housed with running wheels. PMID:28315651

Metabolic and Respiratory Costs of Increasing Song Amplitude in Zebra Finches

PubMed Central

Zollinger, Sue Anne; Goller, Franz; Brumm, Henrik

2011-01-01

Bird song is a widely used model in the study of animal communication and sexual selection, and several song features have been shown to reflect the quality of the singer. Recent studies have demonstrated that song amplitude may be an honest signal of current condition in males and that females prefer high amplitude songs. In addition, birds raise the amplitude of their songs to communicate in noisy environments. Although it is generally assumed that louder song should be more costly to produce, there has been little empirical evidence to support this assumption. We tested the assumption by measuring oxygen consumption and respiratory patterns in adult male zebra finches (Taeniopygia guttata) singing at different amplitudes in different background noise conditions. As background noise levels increased, birds significantly increased the sound pressure level of their songs. We found that louder songs required significantly greater subsyringeal air sac pressure than quieter songs. Though increased pressure is probably achieved by increasing respiratory muscle activity, these increases did not correlate with measurable increases in oxygen consumption. In addition, we found that oxygen consumption increased in higher background noise, independent of singing behaviour. This observation supports previous research in mammals showing that high levels of environmental noise can induce physiological stress responses. While our study did not find that increasing vocal amplitude increased metabolic costs, further research is needed to determine whether there are other non-metabolic costs of singing louder or costs associated with chronic noise exposure. PMID:21915258

Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 2. Results: Primary care management and community orientation.

PubMed

Hummers-Pradier, Eva; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri Ejh; Topsever, Pinar; Ungan, Mehmet; van Royen, Paul

2010-03-01

At the WONCA Europe conference 2009 the recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' was presented. It is a background paper and reference manual, providing advocacy of general practice/family medicine (GP/FM) in Europe. The Research Agenda summarizes the evidence relating to the core competencies and characteristics of the WONCA Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In this second article, the results for the core competencies 'primary care management' and 'community orientation' are presented. Though there is a large body of research on various aspects of 'primary care management', it represents a very scattered rather than a meta view. Many studies focus on care for specific diseases, the primary/secondary care interface, or the implications of electronic patient records. Cost efficiency or process indicators of quality are current outcomes. Current literature on community orientation is mainly descriptive, and focuses on either care for specific diseases, or specific patient populations, or on the uptake of preventive services. Most papers correspond poorly to the WONCA concept. For both core competencies, there is a lack of research with a longitudinal perspective and/or relevant health or quality of life outcomes as well as research on patients' preferences and education for organizational aspects of GP/FM.

Repeal of Comprehensive Background Check Policies and Firearm Homicide and Suicide.

PubMed

Kagawa, Rose M C; Castillo-Carniglia, Alvaro; Vernick, Jon S; Webster, Daniel; Crifasi, Cassandra; Rudolph, Kara E; Cerdá, Magdalena; Shev, Aaron; Wintemute, Garen J

2018-04-02

In 2016, firearms killed 38,658 people in the United States. Federal law requires licensed gun dealers, but not private parties, to conduct background checks on prospective firearm purchasers with the goal of preventing prohibited persons from obtaining firearms. Our objective was to estimate the effect of the repeal of comprehensive background check laws - requiring a background check for all handgun sales, not just sales by licensed dealers - on firearm homicide and suicide rates in Indiana and Tennessee. We compared age-adjusted firearm homicide and suicide rates, measured annually from 1981-2008 and 1994-2008 in Indiana and Tennessee, respectively, to rates in control groups constructed using the synthetic control method. The average rates of firearm homicide and suicide in Indiana and Tennessee following repeal were within the range of what could be expected given natural variation (differences = 0.7 firearm homicides and 0.5 firearm suicides per 100,000 residents in Indiana and 0.4 firearm homicides and 0.3 firearm suicides per 100,000 residents in Tennessee). Sensitivity analyses resulted in similar findings. We found no evidence of an association between the repeal of comprehensive background check policies and firearm homicide and suicide rates in Indiana and Tennessee. In order to understand whether comprehensive background check policies reduce firearm deaths in the United States generally, more evidence on the impact of such policies from other states is needed.

An operational amplifier B1404UD1A-1 in the patch-clamp current-to-voltage converter.

PubMed

Korzun, A M; Rozinov, S V; Abashin, G I

1997-01-01

The applicability of the home-made operational amplifier B1404UD1A-1 in a patch-clamp current-to-voltage converter was analyzed. Its parameters (background noise, input bias current, and gain-bandwidth product) were estimated. Schematic solutions and practical recommendations for the use of this amplifier in a current-to-voltage converter were given. Based on the background noise and frequency parameters of the converter, we found that this device can be used for measuring ion channel currents with a high sensitivity and within a broad frequency range (0.055 pA, to 1 kHz; 0.4 pA, to 10 kHz). An example of the converter application in experiments is given.

General Aviation in Nebraska: Nebraska SATS Project Background Paper No. 1

NASA Technical Reports Server (NTRS)

Smith, Russell; Wachal, Jocelyn

2000-01-01

The Nebraska SATS project is a state-level component of NASA's Small Aircraft Transportation System (SATS). During the next several years the project will examine several different factors affecting SATS implementation in Nebraska. These include economic and taxation issues, public policy issues, airport planning processes, information dissemination strategies, and systemic change factors. This background paper profiles the general aviation system in Nebraska. It is written to provide information about the "context" within which SATS will be pursued. The primary focus is thus on describing and providing background information about the current situation. A secondary focus is on drawing general conclusions about the ability of the current system to incorporate the types of changes implied by SATS. First, some brief information on the U.S. aviation system is provided. The next two sections profile the current general aviation aircraft and pilot base. Nebraska's system of general aviation airports is then described. Within this section of the paper, information is provided on the different types of general aviation airports in Nebraska, airport activity levels and current infrastructure. The fourth major section of the background paper looks at Nebraska's local airport authorities. These special purpose local governments oversee the majority of the general aviation airports in the state. Among the items examined are total expenditures, capital expenditures and planning activities. Next, the paper provides background information on the Nebraska Department of Aeronautics (NDA) and recent Federal funding for general aviation in Nebraska. The final section presents summary conclusions.

X-ray Survey of Centaurus A.

PubMed

Byram, E T; Chubb, T A; Friedman, H

1970-07-24

An x-ray survey of Centaurus A has given marginal evidence of its x-ray flux. If taken as an upper limit on inverse Compton x-rays generated by scattering interactions between relativistic electrons and cosmological background photons, the observation implies an upper limit of close to 3 degrees K for the background radiation temperature.

Effects of Background Noise on Cortical Encoding of Speech in Autism Spectrum Disorders

ERIC Educational Resources Information Center

Russo, Nicole; Zecker, Steven; Trommer, Barbara; Chen, Julia; Kraus, Nina

2009-01-01

This study provides new evidence of deficient auditory cortical processing of speech in noise in autism spectrum disorders (ASD). Speech-evoked responses (approximately 100-300 ms) in quiet and background noise were evaluated in typically-developing (TD) children and children with ASD. ASD responses showed delayed timing (both conditions) and…

Five C Framework: A Student-Centered Approach for Teaching Programming Courses to Students with Diverse Disciplinary Background

ERIC Educational Resources Information Center

Tom, Mary

2015-01-01

The already existing complexities of teaching and learning computer programming are increased where students are diverse in their disciplinary backgrounds, language skills, and culture. Learners experience emotional issues of anxiety, fear or boredom. Identifying opportunities for improvement and applying theoretical and empirical evidence found…

Building Background Knowledge To Improve Reading Comprehension through Use of Technology.

ERIC Educational Resources Information Center

Ferguson, Iyla

This study describes a program designed to increase student background knowledge in order to improve reading comprehension. The targeted first grade class is located in a Midwest, middle class, metropolitan community. More than half of the school's population is identified as low-income. Evidence for the existence of the problem was obtained…

The MAJORANA DEMONSTRATOR for 0νββ: Current Status and Future Plans

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

Green, M. P.; Abgrall, N.; Aguayo, Estanislao

2015-03-24

The Majorana Demonstrator will search for neutrinoless-double-beta decay in 76Ge, while establishing the feasibility of a future tonne-scale germanium-based neutrinoless-double-beta decay experiment, and performing searches for new physics beyond the Standard Model. The experiment, currently under construction at the Sanford Underground Research Facility in Lead, SD, will consist of a pair of modular high-purity germanium detector arrays housed inside of a compact copper, lead, and polyethylene shield. Through a combination of strict materials qualifications and assay, low-background design, and powerful background rejection techniques, the Demonstrator aims to achieve a background rate in the neutrinoless-double-beta decay region of interest (ROI) ofmore » no more than 3cnts/(ROI-t-y). The current status of the Demonstrator is discussed, as are plans for its completion.« less

Illuminating the Background: Topics in Cosmic Microwave Background Polarization Research

NASA Astrophysics Data System (ADS)

Miller, Nathan J.

The cosmic microwave background provides a wealth of information about the origin and history of the universe. The statistics of the anisotropy and the polarization of the cosmic microwave background, among other things, can tell us about the distribution of matter, the redshift of reionization, and the nature of the primordial uctuations. From the lensing of cosmic microwave background due to intervening matter, we can extract information about neutrinos and the equation of state of dark energy. A measurement of the large angular scale B-mode polarization has been called the "smoking gun" of in ation, a theory that describes a possible early rapid expansion of the universe. The focus of current experiments is to measure this B-mode polarization, while several experiments, such as POLARBEAR, are also looking to measure the lensing of the cosmic microwave background. This dissertation will discuss several different topics in cosmic microwave background polarization research. I will make predictions for future experiments and I will also show analysis for two current experiments, POLARBEAR and BICEP. I will show how beam systematics affect the measurement of cosmological parameters and how well we must limit these systematics in order to get unbiased constraints on cosmological parameters for future experiments. I will discuss a novel way of using the temperature-polarization cross correlation to constrain the amount of inflationary gravitational waves. Through Markov Chain Monte Carlo methods, I will determine how well future experiments will be able to constrain the neutrino masses and their degeneracy parameters. I will show results from current data analysis and calibration being done on the Cedar Flat deployment for the POLARBEAR experiment which is currently being constructed in the Atacama desert in Chile. Finally, I will analyze the claim of detection of cosmological birefringence in the BICEP data and show that there is reason to believe it is due to systematic effects in the data.

Cultural competence education for health professionals.

PubMed

Horvat, Lidia; Horey, Dell; Romios, Panayiota; Kis-Rigo, John

2014-05-05

Cultural competence education for health professionals aims to ensure all people receive equitable, effective health care, particularly those from culturally and linguistically diverse (CALD) backgrounds. It has emerged as a strategy in high-income English-speaking countries in response to evidence of health disparities, structural inequalities, and poorer quality health care and outcomes among people from minority CALD backgrounds. However there is a paucity of evidence to link cultural competence education with patient, professional and organisational outcomes. To assess efficacy, for this review we developed a four-dimensional conceptual framework comprising educational content, pedagogical approach, structure of the intervention, and participant characteristics to provide consistency in describing and assessing interventions. We use the term 'CALD participants' when referring to minority CALD populations as a whole. When referring to participants in included studies we describe them in terms used by study authors. To assess the effects of cultural competence education interventions for health professionals on patient-related outcomes, health professional outcomes, and healthcare organisation outcomes. We searched: MEDLINE (OvidSP) (1946 to June 2012); Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) (June 2012); EMBASE (OvidSP) (1988 to June 2012); CINAHL (EbscoHOST) (1981 to June 2012); PsycINFO (OvidSP) (1806 to June 2012); Proquest Dissertations and Theses database (1861 to October 2011); ERIC (CSA) (1966 to October 2011); LILACS (1982 to March 2012); and Current Contents (OvidSP) (1993 Week 27 to June 2012).Searches in MEDLINE, CENTRAL, PsycINFO, EMBASE, Proquest Dissertations and Theses, ERIC and Current Contents were updated in February 2014. Searches in CINAHL were updated in March 2014.There were no language restrictions. We included randomised controlled trials (RCTs), cluster RCTs, and controlled clinical trials of educational interventions for health professionals working in health settings that aimed to improve: health outcomes of patients/consumers of minority cultural and linguistic backgrounds; knowledge, skills and attitudes of health professionals in delivering culturally competent care; and healthcare organisation performance in culturally competent care. We used the conceptual framework as the basis for data extraction. Two review authors independently extracted data on interventions, methods, and outcome measures and mapped them against the framework. Additional information was sought from study authors. We present results in narrative and tabular form. We included five RCTs involving 337 healthcare professionals and 8400 patients; at least 3463 (41%) were from CALD backgrounds. Trials compared the effects of cultural competence training for health professionals, with no training. Three studies were from the USA, one from Canada and one from The Netherlands. They involved health professionals of diverse backgrounds, although most were not from CALD minorities. Cultural background was determined using a validated scale (one study), self-report (two studies) or not reported (two studies). The design effect from clustering meant an effective minimum sample size of 3164 CALD participants. No meta-analyses were performed. The quality of evidence for each outcome was judged to be low.Two trials comparing cultural competence training with no training found no evidence of effect for treatment outcomes, including the proportion of patients with diabetes achieving LDL cholesterol control targets (risk difference (RD) -0.02, 95% CI -0.06 to 0.02; 1 study, USA, 2699 "black" patients, moderate quality), or change in weight loss (standardised mean difference (SMD) 0.07, 95% CI -0.41 to 0.55, 1 study, USA, effective sample size (ESS) 68 patients, low quality).Health behaviour (client concordance with attendance) improved significantly among intervention participants compared with controls (relative risk (RR) 1.53, 95% CI 1.03 to 2.27, 1 study, USA, ESS 28 women, low quality). Involvement in care by "non-Western" patients (described as "mainly Turkish, Moroccan, Cape Verdean and Surinamese patients") with largely "Western" doctors improved in terms of mutual understanding (SMD 0.21, 95% CI 0.00 to 0.42, 1 study, The Netherlands, 109 patients, low quality). Evaluations of care were mixed (three studies). Two studies found no evidence of effect in: proportion of patients reporting satisfaction with consultations (RD 0.14, 95% CI -0.03 to 0.31, 1 study, The Netherlands, 109 patients, low quality); patient scores of physician cultural competency (SMD 0.11 95% CI -0.63 to 0.85, 1 study, USA, ESS 68 "Caucasian" and "non-Causcasian" patients (described as Latino, African American, Asian and other, low quality). Client perceptions of health professionals were significantly higher in the intervention group (SMD 1.60 95% CI 1.05 to 2.15, 1 study, USA, ESS 28 "Black" women, low quality).No study assessed adverse outcomes.There was no evidence of effect on clinician awareness of "racial" differences in quality of care among clients at a USA health centre (RR 1.37, 95% CI 0.97 to 1.94. P = 0.07) with no adjustment for clustering. Included studies did not measure other outcomes of interest. Sensitivity analyses using different values for the Intra-cluster coefficient (ICC) did not substantially alter the magnitude or significance of summary effect sizes.All four domains of the conceptual framework were addressed, suggesting agreement on core components of cultural competence education interventions may be possible. Cultural competence continues to be developed as a major strategy to address health inequities. Five studies assessed the effects of cultural competence education for health professionals on patient-related outcomes. There was positive, albeit low-quality evidence, showing improvements in the involvement of CALD patients. Findings either showed support for the educational interventions or no evidence of effect. No studies assessed adverse outcomes. The quality of evidence is insufficient to draw generalisable conclusions, largely due to heterogeneity of the interventions in content, scope, design, duration, implementation and outcomes selected.Further research is required to establish greater methodological rigour and uniformity on core components of education interventions, including how they are described and evaluated. Our conceptual framework provides a basis for establishing consensus to improve reporting and allow assessment across studies and populations. Future studies should measure the patient outcomes used: treatment outcomes; health behaviours; involvement in care and evaluations of care. Studies should also measure the impact of these types of interventions on healthcare organisations, as these are likely to affect uptake and sustainability.

Stochastic Gravitational-Wave Background due to Primordial Binary Black Hole Mergers.

PubMed

Mandic, Vuk; Bird, Simeon; Cholis, Ilias

2016-11-11

Recent Advanced LIGO detections of binary black hole mergers have prompted multiple studies investigating the possibility that the heavy GW150914 binary system was of primordial origin, and hence could be evidence for dark matter in the form of black holes. We compute the stochastic background arising from the incoherent superposition of such primordial binary black hole systems in the Universe and compare it to the similar background spectrum due to binary black hole systems of stellar origin. We investigate the possibility of detecting this background with future gravitational-wave detectors, and conclude that constraining the dark matter component in the form of black holes using stochastic gravitational-wave background measurements will be very challenging.

Setting up a Cohort Study in Speech and Language Therapy: Lessons from the UK Cleft Collective Speech and Language (CC-SL) Study

ERIC Educational Resources Information Center

Wren, Yvonne; Humphries, Kerry; Stock, Nicola Marie; Rumsey, Nichola; Lewis, Sarah; Davies, Amy; Bennett, Rhiannon; Sandy, Jonathan

2018-01-01

Background: Efforts to increase the evidence base in speech and language therapy are often limited by methodological factors that have restricted the strength of the evidence to the lower levels of the evidence hierarchy. Where higher graded studies, such as randomized controlled trials, have been carried out, it has sometimes been difficult to…

School-Based Programs Aimed at the Prevention and Treatment of Obesity: Evidence-Based Interventions for Youth in Latin America

ERIC Educational Resources Information Center

Lobelo, Felipe; Garcia de Quevedo, Isabel; Holub, Christina K.; Nagle, Brian J.; Arredondo, Elva M.; Barquera, Simon; Elder, John P.

2013-01-01

Background: Rapidly rising childhood obesity rates constitute a public health priority in Latin America which makes it imperative to develop evidence-based strategies. Schools are a promising setting but to date it is unclear how many school-based obesity interventions have been documented in Latin America and what level of evidence can be…

Owls May Use Faeces and Prey Feathers to Signal Current Reproduction

PubMed Central

Penteriani, Vincenzo; del Mar Delgado, Maria

2008-01-01

Background Many animals communicate by marking focal elements of their home range with different kinds of materials. Visual signaling has been demonstrated to play a previously unrecognized role in the intraspecific communication of eagle owls (Bubo bubo), in both territorial and parent-offspring contexts. Visual signals may play a role in a variety of circumstances in this crepuscular and nocturnal species. Methodology/Principal Findings Here, we report that a large amount of extremely visible white faeces and prey feathers appear during the breeding season on posts and plucking sites in proximity to the nest, potentially representing a way for eagle owls to mark their territory. We present descriptive and experimental evidence showing that faeces and prey remains could act as previously unrecognized visual signals in a nocturnal avian predator. This novel signaling behavior could indicate the owls' current reproductive status to potential intruders, such as other territorial owls or non-breeding floaters. Faeces and prey feather markings may also advertise an owl's reproductive status or function in mate-mate communication. Conclusions/Significance We speculate that faeces marks and plucking may represent an overlooked but widespread method for communicating current reproduction to conspecifics. Such marking behavior may be common in birds, and we may now be exploring other questions and mechanisms in territoriality. PMID:18714382

Collective-Intelligence Recommender Systems: Advancing Computer Tailoring for Health Behavior Change Into the 21st Century

PubMed Central

Cutrona, Sarah L; Kinney, Rebecca L; Marlin, Benjamin M; Mazor, Kathleen M; Lemon, Stephenie C; Houston, Thomas K

2016-01-01

Background What is the next frontier for computer-tailored health communication (CTHC) research? In current CTHC systems, study designers who have expertise in behavioral theory and mapping theory into CTHC systems select the variables and develop the rules that specify how the content should be tailored, based on their knowledge of the targeted population, the literature, and health behavior theories. In collective-intelligence recommender systems (hereafter recommender systems) used by Web 2.0 companies (eg, Netflix and Amazon), machine learning algorithms combine user profiles and continuous feedback ratings of content (from themselves and other users) to empirically tailor content. Augmenting current theory-based CTHC with empirical recommender systems could be evaluated as the next frontier for CTHC. Objective The objective of our study was to uncover barriers and challenges to using recommender systems in health promotion. Methods We conducted a focused literature review, interviewed subject experts (n=8), and synthesized the results. Results We describe (1) limitations of current CTHC systems, (2) advantages of incorporating recommender systems to move CTHC forward, and (3) challenges to incorporating recommender systems into CTHC. Based on the evidence presented, we propose a future research agenda for CTHC systems. Conclusions We promote discussion of ways to move CTHC into the 21st century by incorporation of recommender systems. PMID:26952574

The Changing Tobacco Landscape: What Dental Professionals Need To Know

PubMed Central

Couch, Elizabeth T.; Chaffee, Benjamin W.; Gansky, Stuart A.; Walsh, Margaret M.

2016-01-01

Background Recently, the range of tobacco products available in the United States and the patterns of tobacco product use have changed. While cigarette smoking prevalence has declined, dental professionals are likely to encounter many more users of new and alternative tobacco products among their patients. Approach This paper reviews conventional and new tobacco products currently available, their adverse oral and systemic health effects, and their prevalence of use in the US. Results Tobacco products other than cigarettes currently account for a substantial portion of tobacco use. For this reason, tobacco prevention and cessation counseling provided by dental professionals must address all tobacco products, including cigarettes, cigars, waterpipes (hookahs), and electronic cigarettes, as well as conventional and new smokeless tobacco products. Cigarette smoking and smokeless tobacco use are associated with immediate and long-term adverse health effects, including nicotine addiction, oral and systemic disease, and death. Novel products may attract new tobacco users, potentially leading to addiction that results in enduring tobacco product use and associated adverse health effects. Practical Implications Dental professionals regularly treat patients who use tobacco or who are at risk of initiating use. Therefore, it is essential that dental professionals are knowledgeable about tobacco products currently available and are able to answer patients' questions and to provide them with evidence-based tobacco-related counseling. PMID:26988178

Current Concepts: Osteochondritis Dissecans of the Capitellum and the Role of Osteochondral Autograft Transplantation.

PubMed

Kirsch, Jacob M; Thomas, Jared; Bedi, Asheesh; Lawton, Jeffrey N

2016-12-01

Background: Osteochondritis dissecans (OCD) of the capitellum is a painful condition, which often affects young throwing athletes. Our current understanding regarding the etiology, risks factors, diagnosis, and efficacy of the available treatment options has expanded over recent years, however remains suboptimal. Recent data on patient-reported outcomes following osteochondral autograft transplantation (OAT) for the treatment of large osteochondral lesions of the capitellum have been promising but limited. This review seeks to critically analyze and summarize the available literature on the etiology, diagnosis, and reported outcomes associated with OCD of the capitellum and the use of OAT for its treatment. Methods: A comprehensive literature search was conducted. Unique and customized search strategies were formulated in PubMed, Embase, Scopus, Web of Science, and CENTRAL. Combinations of keywords and controlled vocabulary terms were utilized in order to cast a broad net. Relevant clinical, biomechanical, anatomic and imaging studies were reviewed along with recent review articles, and case series. Results: Forty-three articles from our initial literature search were found to be relevant for this review. The majority of these articles were either review articles, clinical studies, anatomic or imaging studies or biomechanical studies. Conclusions: Current evidence suggests that OAT may lead to better and more consistent outcomes than previously described methods for treating large OCD lesions of the capitellum.

Adequacy of Current State Setbacks for Directional High-Volume Hydraulic Fracturing in the Marcellus, Barnett, and Niobrara Shale Plays

PubMed Central

Haley, Marsha; McCawley, Michael; Epstein, Anne C.; Arrington, Bob; Bjerke, Elizabeth Ferrell

2016-01-01

Background: There is an increasing awareness of the multiple potential pathways leading to human health risks from hydraulic fracturing. Setback distances are a legislative method to mitigate potential risks. Objectives: We attempted to determine whether legal setback distances between well-pad sites and the public are adequate in three shale plays. Methods: We reviewed geography, current statutes and regulations, evacuations, thermal modeling, air pollution studies, and vapor cloud modeling within the Marcellus, Barnett, and Niobrara Shale Plays. Discussion: The evidence suggests that presently utilized setbacks may leave the public vulnerable to explosions, radiant heat, toxic gas clouds, and air pollution from hydraulic fracturing activities. Conclusions: Our results suggest that setbacks may not be sufficient to reduce potential threats to human health in areas where hydraulic fracturing occurs. It is more likely that a combination of reasonable setbacks with controls for other sources of pollution associated with the process will be required. Citation: Haley M, McCawley M, Epstein AC, Arrington B, Bjerke EF. 2016. Adequacy of current state setbacks for directional high-volume hydraulic fracturing in the Marcellus, Barnett, and Niobrara Shale Plays. Environ Health Perspect 124:1323–1333; http://dx.doi.org/10.1289/ehp.1510547 PMID:26895553

The Relative Influence of Childhood Sexual Abuse and Other Family Background Risk Factors on Adult Adversities in Female Outpatients Treated for Anxiety Disorders and Depression

ERIC Educational Resources Information Center

Peleikis, Dawn E.; Mykletun, Arnstein; Dahl, Alv A.

2004-01-01

Objective: This study from Norway examines the relative influence of child sexual abuse (CSA) and family background risk factors (FBRF) on the risk for current mental disorders and the quality of current intimate relationships in women with CSA treated for anxiety disorders and/or depression. Women with these disorders frequently seek treatment,…

Implementation in Practice: Adaptations to Sexuality Education Curricula in California

ERIC Educational Resources Information Center

Arons, Abigail; Decker, Mara; Yarger, Jennifer; Malvin, Jan; Brindis, Claire D.

2016-01-01

Background: Local implementation of evidence-based curricula, including sex education, has received increasing attention. Although there are expectations that practitioners will implement evidence-based programs with fidelity, little is known regarding the experiences of instructors in meeting such standards. During 2005 to 2009, the California…

Psychopathology, Temperament and Unintentional Injury: Cross-Sectional and Longitudinal Relationships

ERIC Educational Resources Information Center

Rowe, Richard; Simonoff, Emily; Silberg, Judy L.

2007-01-01

Background: Growing evidence indicates a link between unintentional injury and both disruptive and emotional psychopathology. We present further evidence of these associations and address the underlying mechanisms. We also examine the genetic contribution to unintentional injury. Methods: The Virginia Twin Study of Adolescent Behavioral…

Peer Victimization and Depression in Early-Mid Adolescence: A Longitudinal Study

ERIC Educational Resources Information Center

Sweeting, Helen; Young, Robert; West, Patrick; Der, Geoff

2006-01-01

Background: Despite considerable evidence for psychological distress among children and young people who experience peer victimization, cross-sectional studies cannot determine the direction of the relationship. Several recent studies have examined associations between victimization and distress. The majority find evidence for both directions but…

Vulnerability of freshwater native biodiversity to non-native species invasions across the continental United States

EPA Science Inventory

Background/Question/Methods Non-native species pose one of the greatest threats to native biodiversity. The literature provides plentiful empirical and anecdotal evidence of this phenomenon; however, such evidence is limited to local or regional scales. Employing geospatial analy...

Intensive current transfer in membrane systems: modelling, mechanisms and application in electrodialysis.

PubMed

Nikonenko, Victor V; Pismenskaya, Natalia D; Belova, Elena I; Sistat, Philippe; Huguet, Patrice; Pourcelly, Gérald; Larchet, Christian

2010-10-15

Usually in electrochemical systems, the direct current densities not exceeding the limiting current density are applied. However, the recent practice of electrodialysis evidences the interest of other current modes where either the imposed direct current is over the limiting one or a non-constant asymmetrical (such as pulsed) current is used. The paper is devoted to make the mechanisms of mass transfer under these current regimes more clear. The theoretical background for mathematical modelling of mass transfer at overlimiting currents is described. Four effects providing overlimiting current conductance are examined. Two of them are related to water splitting: the appearance of additional charge carriers (H(+) and OH(-) ions) and exaltation effect. Two others are due to coupled convection partially destroying the diffusion boundary layer: gravitational convection and electroconvection. These effects result from formation of concentration gradients (known as concentration polarization) caused by the current flowing under conditions where ionic transport numbers are different in the membrane and solution. Similar effects take place not only in electrodialysis membrane systems, but in electrode ones, in electrophoresis and electrokinetic micro- and nanofluidic devices such as micropumps. The relation of these effects to the properties of the membrane surface (the chemical nature of the fixed groups, the degree of heterogeneity and hydrophobicity, and the geometrical shape of the surface) is analyzed. The interaction between the coupled effects is studied, and the conditions under which one or another effect becomes dominant are discussed. The application of intensive current modes in electrodialysis, the state-of-the-art and perspectives, are considered. It is shown that the intensive current modes are compatible with new trends in water treatment oriented towards Zero Liquid Discharge (ZLD) technologies. The main idea of these hybrid schemes including pressure- and electro-driven processes as well as conventional methods is to provide the precipitation of hardness salts before the membrane modules and that of well dissolved salts after. Copyright © 2010 Elsevier B.V. All rights reserved.

The current status of evidence-based practice in juvenile justice.

PubMed

McKee, Esther Chao; Rapp, Lisa

2014-01-01

The advent of evidence-based practice (EBP) has significantly changed the juvenile justice system while producing intense controversy. The intent of this article is to provide an update on the current status of EBP in the juvenile justice system. Specifically, this article will describe the evolution of juvenile justice philosophy as it has informed current juvenile justice policies and programs, discuss the scope of current juvenile justice research regarding EBP, identify barriers to implementing EBP, expound on the development of EBP in juvenile justice, discern the characteristics of evidence-based interventions in the juvenile justice system, and finally describe how to select and assess evidence-based practices and interventions.

Prevention of Acute Exacerbations of COPD

PubMed Central

Bourbeau, Jean; Diekemper, Rebecca L.; Ouellette, Daniel R.; Goodridge, Donna; Hernandez, Paul; Curren, Kristen; Balter, Meyer S.; Bhutani, Mohit; Camp, Pat G.; Celli, Bartolome R.; Dechman, Gail; Dransfield, Mark T.; Fiel, Stanley B.; Foreman, Marilyn G.; Hanania, Nicola A.; Ireland, Belinda K.; Marchetti, Nathaniel; Marciniuk, Darcy D.; Mularski, Richard A.; Ornelas, Joseph; Stickland, Michael K.

2015-01-01

BACKGROUND: COPD is a major cause of morbidity and mortality in the United States as well as throughout the rest of the world. An exacerbation of COPD (periodic escalations of symptoms of cough, dyspnea, and sputum production) is a major contributor to worsening lung function, impairment in quality of life, need for urgent care or hospitalization, and cost of care in COPD. Research conducted over the past decade has contributed much to our current understanding of the pathogenesis and treatment of COPD. Additionally, an evolving literature has accumulated about the prevention of acute exacerbations. METHODS: In recognition of the importance of preventing exacerbations in patients with COPD, the American College of Chest Physicians (CHEST) and Canadian Thoracic Society (CTS) joint evidence-based guideline (AECOPD Guideline) was developed to provide a practical, clinically useful document to describe the current state of knowledge regarding the prevention of acute exacerbations according to major categories of prevention therapies. Three key clinical questions developed using the PICO (population, intervention, comparator, and outcome) format addressed the prevention of acute exacerbations of COPD: nonpharmacologic therapies, inhaled therapies, and oral therapies. We used recognized document evaluation tools to assess and choose the most appropriate studies and to extract meaningful data and grade the level of evidence to support the recommendations in each PICO question in a balanced and unbiased fashion. RESULTS: The AECOPD Guideline is unique not only for its topic, the prevention of acute exacerbations of COPD, but also for the first-in-kind partnership between two of the largest thoracic societies in North America. The CHEST Guidelines Oversight Committee in partnership with the CTS COPD Clinical Assembly launched this project with the objective that a systematic review and critical evaluation of the published literature by clinical experts and researchers in the field of COPD would lead to a series of recommendations to assist clinicians in their management of the patient with COPD. CONCLUSIONS: This guideline is unique because it provides an up-to-date, rigorous, evidence-based analysis of current randomized controlled trial data regarding the prevention of COPD exacerbations. PMID:25321320

Are selective serotonin reuptake inhibitors safe for drivers? What is the evidence?

PubMed

Ravera, Silvia; Ramaekers, Johannes G; de Jong-van den Berg, Lolkje T W; de Gier, Johan J

2012-05-01

Selective serotonin reuptake inhibitors (SSRIs) are widely used medications to treat several psychiatric diseases and, above all, depression. They seem to be as effective as older antidepressants but have a different adverse effect profile. Despite their favorable safety profile, little is known about their influence on traffic safety. To conduct a literature review to summarize the current evidence on the role of SSRIs in traffic safety, particularly concerning undesirable effects that could potentially impair fitness to drive, experimental and pharmacoepidemiologic studies on driving impairment, 2 existing categorization systems for driving-impairing medications, and the European legislative procedures for assessing fitness to drive before issuing a driver's license and driving under the influence of medicines. The article search was performed in the following electronic databases: MEDLINE, PsycINFO, ScienceDirect, and SafetyLit. The English-language scientific literature was searched using key words such as SSRIs and psychomotor performance, car crash or traffic accident, and adverse effects. For inclusion in this review, papers had to be full-text articles, refer to possible driving-related adverse effects, and be experimental or pharmacoepidemiologic studies on SSRIs and traffic accident risks. No restrictions concerning publication year were applied. Ten articles were selected as background information on driving-related adverse effects, and 15 articles were selected regarding experimental and pharmacoepidemiologic work. Regarding SSRI adverse effects, the most reported undesirable effects referring to driving impairment were anxiety, agitation, sleep disturbances, headache, increased risk of suicidal behavior, and deliberate self-harm. Regarding the remaining issues addressed in this article, inconsistencies were found between the outcomes of the selected experimental and epidemiologic studies and between the 2 existing categorization systems under evaluation. Some pitfalls of the current legislative scenario were identified as well. Based on the current evidence, it was concluded that more experimental and epidemiologic research is needed to elucidate the relationship between SSRI use and traffic safety. Furthermore, a revision of the existing categorization systems and harmonized European legislation in the field of medication use and driving were highly recommended. Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

National Athletic Trainers' Association Position Statement: Anabolic-Androgenic Steroids

PubMed Central

Kersey, Robert D.; Elliot, Diane L.; Goldberg, Linn; Kanayama, Gen; Leone, James E.; Pavlovich, Mike; Pope, Harrison G.

2012-01-01

This NATA position statement was developed by the NATA Research & Education Foundation. Objective This manuscript summarizes the best available scholarly evidence related to anabolic-androgenic steroids (AAS) as a reference for health care professionals, including athletic trainers, educators, and interested others. Background Health care professionals associated with sports or exercise should understand and be prepared to educate others about AAS. These synthetic, testosterone-based derivatives are widely abused by athletes and nonathletes to gain athletic performance advantages, develop their physiques, and improve their body image. Although AAS can be ergogenic, their abuse may lead to numerous negative health effects. Recommendations Abusers of AAS often rely on questionable information sources. Sports medicine professionals can therefore serve an important role by providing accurate, reliable information. The recommendations provide health care professionals with a current and accurate synopsis of the AAS-related research. PMID:23068595

Unilateral facial palsy in an infant: an unusual presentation of familial multiple cerebral cavernous malformation

PubMed Central

Zakaria, Zaitun; Kaliaperumal, Chandrasekaran; Caird, John; Sattar, Mohammad

2012-01-01

Cerebral cavernous malformation (CCM) in infants tends to have genetic predisposition. These cavernomas have a progressive course of events and associated neurological symptoms with increase in age. They most commonly present with seizure and syndrome of increased intracranial pressure comprising of headache, vomiting and focal neurological signs. We describe a case of a 7-month-old infant who presented with an acute onset of right facial paralysis with a background of familial CCM. The CT and MRI scan revealed fresh haemorrhage in the right cerebellar and pontine cavernomas with surrounding oedema and no evidence of obstructive hydrocephalus. These two cavernomas re-bled in a week duration causing episodes of incessant crying and irritability. After discussing the pros and cons of treatment, owing to stable clinical status, the patient is currently been managed conservatively. PMID:23203183

Physical plausibility of cold star models satisfying Karmarkar conditions

NASA Astrophysics Data System (ADS)

Fuloria, Pratibha; Pant, Neeraj

2017-11-01

In the present article, we have obtained a new well behaved solution to Einstein's field equations in the background of Karmarkar spacetime. The solution has been used for stellar modelling within the demand of current observational evidences. All the physical parameters are well behaved inside the stellar interior and our model satisfies all the required conditions to be physically realizable. The obtained compactness parameter is within the Buchdahl limit, i.e. 2M/R ≤ 8/9 . The TOV equation is well maintained inside the fluid spheres. The stability of the models has been further confirmed by using Herrera's cracking method. The models proposed in the present work are compatible with observational data of compact objects 4U1608-52 and PSRJ1903+327. The necessary graphs have been shown to authenticate the physical viability of our models.

National Athletic Trainers' Association Position Statement: Prevention of Pediatric Overuse Injuries

PubMed Central

Valovich McLeod, Tamara C.; Decoster, Laura C.; Loud, Keith J.; Micheli, Lyle J.; Parker, J. Terry; Sandrey, Michelle A.; White, Christopher

2011-01-01

Abstract Objective: To provide certified athletic trainers, physicians, and other health care professionals with recommendations on best practices for the prevention of overuse sports injuries in pediatric athletes (aged 6–18 years). Background: Participation in sports by the pediatric population has grown tremendously over the years. Although the health benefits of participation in competitive and recreational athletic events are numerous, one adverse consequence is sport-related injury. Overuse or repetitive trauma injuries represent approximately 50% of all pediatric sport-related injuries. It is speculated that more than half of these injuries may be preventable with simple approaches. Recommendations: Recommendations are provided based on current evidence regarding pediatric injury surveillance, identification of risk factors for injury, preparticipation physical examinations, proper supervision and education (coaching and medical), sport alterations, training and conditioning programs, and delayed specialization. PMID:21391806

Lupus community panel proposals for optimising clinical trials: 2018

PubMed Central

Merrill, Joan T; Manzi, Susan; Aranow, Cynthia; Askenase, Anca; Bruce, Ian; Chakravarty, Eliza; Chong, Ben; Costenbader, Karen; Dall’Era, Maria; Ginzler, Ellen; Hanrahan, Leslie; Kalunian, Ken; Merola, Joseph; Raymond, Sandra; Rovin, Brad; Saxena, Amit; Werth, Victoria P

2018-01-01

Formidable impediments stand in the way of treatment development for lupus. These include the unwieldy size of current trials, international competition for scarce patients, complex outcome measures and a poor understanding of these outcomes in the world at large. The heterogeneity of the disease itself coupled to superimposition of variegated background polypharmacy has created enough immunological noise to virtually ensure the failure of lupus treatment trials, leaving an understandable suspicion that at least some of the results in testing failed drugs over the years may not have been negative, but merely uninterpretable. The authors have consulted with many clinical trial investigators, biopharmaceutical developers and stakeholders from government and voluntary sectors. This paper examines the available evidence that supports workable trial designs and proposes approaches to improve the odds of completing interpretable treatment development programs for lupus. PMID:29657738

Treatment of oral squamous cell carcinoma using anti-HER2 immunonanoshells

PubMed Central

Fekrazad, Reza; Hakimiha, Neda; Farokhi, Enice; Rasaee, Mohammad Javad; Ardestani, Mehdi Shafiee; Kalhori, Katayoun AM; Sheikholeslami, Farzaneh

2011-01-01

Background Worldwide, oral squamous cell carcinoma (potentially mediated by HER2) is recognized as the most commonly occurring malignant neoplasm of the oral cavity. Anti-HER2 nanobodies conjugated to gold-silica nanoshells and used as photothermal treatment for oral squamous cell carcinoma may provide a novel therapeutic alternative to current treatment for this disease. Methods KB epithelial or HeLaS3 cell cultures (controls) were exposed to these immunonanoshells, and plasmon resonance electron initiation specific to gold was employed to burn the tumor cells. Results Following this treatment, significant cell death occurred in the KB tumor cell cultures while there was no evidence of cellular damage or death in the HeLaS3 cell cultures. Conclusion These findings suggest that photothermal treatment of oral squamous cell carcinoma has considerable advantages. PMID:22131825

The Individual and Family Self-Management Theory: background and perspectives on context, process, and outcomes.

PubMed

Ryan, Polly; Sawin, Kathleen J

2009-01-01

Current evidence indicates that individuals and families who engage in self-management (SM) behaviors improve their health outcomes. While the results of these studies are promising, there is little agreement as to the critical components of SM or directions for future study. This article offers an organized perspective of similar and divergent ideas related to SM. Unique contributions of prior work are highlighted and findings from studies are summarized. A new descriptive mid-range theory, Individual and Family Self-management Theory, is presented; assumptions are identified, concepts defined, and proposed relationships are outlined. This theory adds to the literature on SM by focusing on individuals, dyads within the family, or the family unit as a whole; explicating process components of SM; and proposing use of proximal and distal outcomes.

The Individual and Family Self-management Theory: Background and Perspectives on Context, Process, and Outcomes

PubMed Central

Ryan, Polly; Sawin, Kathleen J.

2009-01-01

Current evidence indicates that individuals and families who engage in self-management (SM) behaviors improve their health outcomes. While the results of these studies are promising, there is little agreement as to the critical components of SM or directions for future study. This paper offers an organized perspective of similar and divergent ideas related to SM. Unique contributions of prior work are highlighted and findings from studies are summarized. A new descriptive mid-range theory, Individual and Family Self-management Theory, is presented; assumptions identified, concepts defined, and proposed relationships outlined. This theory adds to the literature on self-management by focusing on individual, dyads within the family, or the family unit as a whole; explicating process components of self-management; and proposing use of proximal and distal outcomes. PMID:19631064

Radiation detection method and system using the sequential probability ratio test

DOEpatents

Nelson, Karl E [Livermore, CA; Valentine, John D [Redwood City, CA; Beauchamp, Brock R [San Ramon, CA

2007-07-17

A method and system using the Sequential Probability Ratio Test to enhance the detection of an elevated level of radiation, by determining whether a set of observations are consistent with a specified model within a given bounds of statistical significance. In particular, the SPRT is used in the present invention to maximize the range of detection, by providing processing mechanisms for estimating the dynamic background radiation, adjusting the models to reflect the amount of background knowledge at the current point in time, analyzing the current sample using the models to determine statistical significance, and determining when the sample has returned to the expected background conditions.

Gravitational-wave stochastic background from cosmic strings.

PubMed

Siemens, Xavier; Mandic, Vuk; Creighton, Jolien

2007-03-16

We consider the stochastic background of gravitational waves produced by a network of cosmic strings and assess their accessibility to current and planned gravitational wave detectors, as well as to big bang nucleosynthesis (BBN), cosmic microwave background (CMB), and pulsar timing constraints. We find that current data from interferometric gravitational wave detectors, such as Laser Interferometer Gravitational Wave Observatory (LIGO), are sensitive to areas of parameter space of cosmic string models complementary to those accessible to pulsar, BBN, and CMB bounds. Future more sensitive LIGO runs and interferometers such as Advanced LIGO and Laser Interferometer Space Antenna (LISA) will be able to explore substantial parts of the parameter space.

How Long Is the Shadow? The Relationships of Family Background to Selected Adult Outcomes: Results from PIAAC

ERIC Educational Resources Information Center

Braun, Henry

2018-01-01

Background: Ongoing interest in the relationships between family background and adult outcomes is motivated by concerns regarding the intergenerational transmission of advantage/disadvantage. Currently all countries are far from achieving the ideal that all individuals, irrespective of their starting points or their demographic characteristics,…

Development, Validation, and Deployment of a Revised Air Traffic Control Color Vision Test: Incorporating Advanced Technologies and Oceanic Procedures and En Route Automation Modernization Systems

DTIC Science & Technology

2013-09-01

through direct sampling of form and content of critical display data. Evidence of construct validity is provided by correlation with the Colour ...measured by the Colour Assessment and Diagnosis (CAD; ARTS Background Colors STARS Background Colors ERAM Background Colors Figure 3...Gelade, G. (1980). A feature-integration theory of attention. Cognitive Psychology , 12, 97–136. Xing, J. & Schroeder, D.J. (2006). Reexamination of

Evidence based post graduate training. A systematic review of reviews based on the WFME quality framework

PubMed Central

2011-01-01

Background A framework for high quality in post graduate training has been defined by the World Federation of Medical Education (WFME). The objective of this paper is to perform a systematic review of reviews to find current evidence regarding aspects of quality of post graduate training and to organise the results following the 9 areas of the WFME framework. Methods The systematic literature review was conducted in 2009 in Medline Ovid, EMBASE, ERIC and RDRB databases from 1995 onward. The reviews were selected by two independent researchers and a quality appraisal was based on the SIGN tool. Results 31 reviews met inclusion criteria. The majority of the reviews provided information about the training process (WFME area 2), the assessment of trainees (WFME area 3) and the trainees (WFME area 4). One review covered the area 8 'governance and administration'. No review was found in relation to the mission and outcomes, the evaluation of the training process and the continuous renewal (respectively areas 1, 7 and 9 of the WFME framework). Conclusions The majority of the reviews provided information about the training process, the assessment of trainees and the trainees. Indicators used for quality assessment purposes of post graduate training should be based on this evidence but further research is needed for some areas in particular to assess the quality of the training process. PMID:21977898

Raising the Level of Awareness of Nurse-to-Nurse Lateral Violence in a Critical Access Hospital.

PubMed

Embree, Jennifer L; Bruner, Deborah A; White, Ann

2013-01-01

Background/Significance of Problem. Nurse-to-nurse lateral violence (NNLV) has been internationally reported for greater than two decades and results in new nurse turnover and serious negative outcomes. Clinical Question/Project Objective. Will NNLV and cognitive rehearsal (CR) education result in a decrease in perceived nurse-to-nurse lateral violence in a critical access hospital (CAH)? The scope of this project was to determine perceived extent and increase awareness of NNLV through an educational project about NNLV and CR. Clinical Appraisal of Literature/Best Evidence. Trends of NNLV were assessed through an extensive literature review from Health Source, CINAHL, ProQuest Health, and Medical Complete. An educational forum about NNLV with CR was advocated for newly licensed nurses and current nurses (potential perpetrators of NNLV) with the goal of liberation of oppressed individuals. Integration into Practice/Discussion of Results. An interventional study with one group and pre-/postintervention was used to determine NNLV and CR education on perceived levels of lateral violence. Evidence-based measurement occurred through use of the Nurse Workplace Scale and the Silencing the Self-Work Scale. Outcomes were analyzed quantitatively through independent t-tests. Awareness of NNLV was increased. Evaluation of Evidence-Based Practice/Implications. Organizations must learn to eliminate NNLV. With increased levels of awareness of NNLV, nurses requested additional assistance in dealing with inappropriate behavior.

Raising the Level of Awareness of Nurse-to-Nurse Lateral Violence in a Critical Access Hospital

PubMed Central

Embree, Jennifer L.; Bruner, Deborah A.; White, Ann

2013-01-01

Background/Significance of Problem. Nurse-to-nurse lateral violence (NNLV) has been internationally reported for greater than two decades and results in new nurse turnover and serious negative outcomes. Clinical Question/Project Objective. Will NNLV and cognitive rehearsal (CR) education result in a decrease in perceived nurse-to-nurse lateral violence in a critical access hospital (CAH)? The scope of this project was to determine perceived extent and increase awareness of NNLV through an educational project about NNLV and CR. Clinical Appraisal of Literature/Best Evidence. Trends of NNLV were assessed through an extensive literature review from Health Source, CINAHL, ProQuest Health, and Medical Complete. An educational forum about NNLV with CR was advocated for newly licensed nurses and current nurses (potential perpetrators of NNLV) with the goal of liberation of oppressed individuals. Integration into Practice/Discussion of Results. An interventional study with one group and pre-/postintervention was used to determine NNLV and CR education on perceived levels of lateral violence. Evidence-based measurement occurred through use of the Nurse Workplace Scale and the Silencing the Self-Work Scale. Outcomes were analyzed quantitatively through independent t-tests. Awareness of NNLV was increased. Evaluation of Evidence-Based Practice/Implications. Organizations must learn to eliminate NNLV. With increased levels of awareness of NNLV, nurses requested additional assistance in dealing with inappropriate behavior. PMID:23991337

Active Ottumwa: Adapting Evidence-Based Recommendations to Promote Physical Activity in a Micropolitan New Destination Community

PubMed Central

Baquero, Barbara; Ashida, Sato; Daniel-Ulloa, Jason; Laroche, Helena H.; Haines, Heidi; Bucklin, Rebecca; Maldonado, Adriana; Coronado Garcia, Mayra; Berto, Sandy; Sewell, Dan; Janz, Kathleen; Gates, Claudia; Parker, Edith A.

2018-01-01

Background: Evidence-based interventions have been developed and tested to promote physical activity, but fewer studies have focused on identifying effective intervention strategies for mid-size rural communities, especially new immigrant destinations. We report here on the design and implementation of Active Ottumwa, a community-wide intervention using a lay health advisor approach to increase physical activity in a micropolitan new destination community in the rural state of Iowa. Methods: The Active Ottumwa study is part of a community-academic partnership in Ottumwa, IA. Evidence-based strategies recommended by the Community Guide for Preventive Services guided study implementation and included behavioral and social, campaign and informational, and environmental and policy approaches. Evaluation methods for this study are multi-faceted and include a cross-sectional community survey, longitudinal cohort assessment, observational data, key informant interviews, and project records. Results: We are currently in our second year of intervention implementation, with 45 lay health advisors (termed physical activity leaders here) trained to carry out behavioral and social intervention approaches, including walking groups, tai chi, and yoga. We have completed a communication and informational campaign utilizing five channels. Our longitudinal cohort has been recruited, with baseline and 12-month data collection completed. Conclusions: This study will assess the effectiveness and impact of a community-wide intervention to support physical activity. PMID:29734709

Active Ottumwa: Adapting Evidence-Based Recommendations to Promote Physical Activity in a Micropolitan New Destination Community.

PubMed

Baquero, Barbara; Kava, Christine M; Ashida, Sato; Daniel-Ulloa, Jason; Laroche, Helena H; Haines, Heidi; Bucklin, Rebecca; Maldonado, Adriana; Coronado Garcia, Mayra; Berto, Sandy; Sewell, Dan; Novak, Nicole; Janz, Kathleen; Gates, Claudia; Parker, Edith A

2018-05-04

Background : Evidence-based interventions have been developed and tested to promote physical activity, but fewer studies have focused on identifying effective intervention strategies for mid-size rural communities, especially new immigrant destinations. We report here on the design and implementation of Active Ottumwa, a community-wide intervention using a lay health advisor approach to increase physical activity in a micropolitan new destination community in the rural state of Iowa. Methods : The Active Ottumwa study is part of a community-academic partnership in Ottumwa, IA. Evidence-based strategies recommended by the Community Guide for Preventive Services guided study implementation and included behavioral and social, campaign and informational, and environmental and policy approaches. Evaluation methods for this study are multi-faceted and include a cross-sectional community survey, longitudinal cohort assessment, observational data, key informant interviews, and project records. Results : We are currently in our second year of intervention implementation, with 45 lay health advisors (termed physical activity leaders here) trained to carry out behavioral and social intervention approaches, including walking groups, tai chi, and yoga. We have completed a communication and informational campaign utilizing five channels. Our longitudinal cohort has been recruited, with baseline and 12-month data collection completed. Conclusions : This study will assess the effectiveness and impact of a community-wide intervention to support physical activity.

Redesigning Radiotherapy Quality Assurance: Opportunities to Develop an Efficient, Evidence-Based System to Support Clinical Trials

PubMed Central

Bekelman, Justin E.; Deye, James A.; Vikram, Bhadrasain; Bentzen, Soren M.; Bruner, Deborah; Curran, Walter J.; Dignam, James; Efstathiou, Jason A.; FitzGerald, T. J.; Hurkmans, Coen; Ibbott, Geoffrey S.; Lee, J. Jack; Merchant, Timothy E.; Michalski, Jeff; Palta, Jatinder R.; Simon, Richard; Ten Haken, Randal K.; Timmerman, Robert; Tunis, Sean; Coleman, C. Norman; Purdy, James

2012-01-01

Background In the context of national calls for reorganizing cancer clinical trials, the National Cancer Institute (NCI) sponsored a two day workshop to examine the challenges and opportunities for optimizing radiotherapy quality assurance (QA) in clinical trial design. Methods Participants reviewed the current processes of clinical trial QA and noted the QA challenges presented by advanced technologies. Lessons learned from the radiotherapy QA programs of recent trials were discussed in detail. Four potential opportunities for optimizing radiotherapy QA were explored, including the use of normal tissue toxicity and tumor control metrics, biomarkers of radiation toxicity, new radiotherapy modalities like proton beam therapy, and the international harmonization of clinical trial QA. Results Four recommendations were made: 1) Develop a tiered (and more efficient) system for radiotherapy QA and tailor intensity of QA to clinical trial objectives. Tiers include (i) general credentialing, (ii) trial specific credentialing, and (iii) individual case review; 2) Establish a case QA repository; 3) Develop an evidence base for clinical trial QA and introduce innovative prospective trial designs to evaluate radiotherapy QA in clinical trials; and 4) Explore the feasibility of consolidating clinical trial QA in the United States. Conclusion Radiotherapy QA may impact clinical trial accrual, cost, outcomes and generalizability. To achieve maximum benefit, QA programs must become more efficient and evidence-based. PMID:22425219