Teaching evidence-based medicine: Impact on students' literature use and inpatient clinical documentation.

PubMed

Sastre, Elizabeth Ann; Denny, Joshua C; McCoy, Jacob A; McCoy, Allison B; Spickard, Anderson

2011-01-01

Effective teaching of evidence-based medicine (EBM) to medical students is important for lifelong self-directed learning. We implemented a brief workshop designed to teach literature searching skills to third-year medical students. We assessed its impact on students' utilization of EBM resources during their clinical rotation and the quality of EBM integration in inpatient notes. We developed a physician-led, hands-on workshop to introduce EBM resources to all internal medicine clerks. Pre- and post-workshop measures included student's attitudes to EBM, citations of EBM resources in their clinical notes, and quality of the EBM component of the discussion in the note. Computer log analysis recorded students' online search attempts. After the workshop, students reported improved comfort using EBM and increased utilization of EBM resources. EBM integration into the discussion component of the notes also showed significant improvement. Computer log analysis of students' searches demonstrated increased utilization of EBM resources following the workshop. We describe the successful implementation of a workshop designed to teach third-year medical students how to perform an efficient EBM literature search. We demonstrated improvements in students' confidence regarding EBM, increased utilization of EBM resources, and improved integration of EBM into inpatient notes.

Factors associated with practicing evidence-based medicine: a study of family medicine residents.

PubMed

Paulsen, Justin; Al Achkar, Morhaf

2018-01-01

Evidence-based medicine (EBM) plays a critical part in ensuring that practitioners use the soundest available medical procedures while avoiding ineffective ones. As such, it plays a key role in medical residency education. However, little research has shown what factors influence residents' adoption of habits in, self-efficacy in, and skills of EBM. This study gathered responses from a cross section of family medicine residents and new interns from 40 different residencies across the USA. The survey was based on Taylor et al's survey of EBM attitudes and behaviors and the Fresno test's assessment of EBM knowledge and skills. The study used negative binomial regression, ordinary least squares regression, and nonparametric tests of difference to assess the impact of residents' background (year in residency, type of residency, previous EBM training, and previous research experience) on these EBM outcomes. Residents with previous research experience are associated with stronger EBM habits, more self-efficacy in applying EBM, and greater ability in using EBM skills. Previous research experience had a bigger impact on these outcomes than any other predictor. EBM habits, self-efficacy, and skills did not appear to show even increases by year in residency. Previous EBM training was associated with more hours spent reading the literature and higher EBM skill test scores. Our findings suggest the practice of EBM may benefit from medical education increasing research experiences and EBM training. Research experiences provide the practical training, while EBM training provides focused instruction necessary for EBM self-efficacy, habits, and skills. These EBM outcomes are not inherently gained through time in family medicine residency. Future research, particularly longitudinal designs, should continue to pursue this line of inquiry.

How can we teach EBM in clinical practice? An analysis of barriers to implementation of on-the-job EBM teaching and learning.

PubMed

Oude Rengerink, Katrien; Thangaratinam, Shakila; Barnfield, Gemma; Suter, Katja; Horvath, Andrea R; Walczak, Jacek; Wełmińska, Anna; Weinbrenner, Susanne; Meyerrose, Berit; Arvanitis, Theodoros N; Onody, Rita; Zanrei, Gianni; Kunz, Regina; Arditi, Chantal; Burnand, Bernard; Gee, Harry; Khan, Khalid S; Mol, Ben W J

2011-01-01

Evidence-based medicine (EBM) improves the quality of health care. Courses on how to teach EBM in practice are available, but knowledge does not automatically imply its application in teaching. We aimed to identify and compare barriers and facilitators for teaching EBM in clinical practice in various European countries. A questionnaire was constructed listing potential barriers and facilitators for EBM teaching in clinical practice. Answers were reported on a 7-point Likert scale ranging from not at all being a barrier to being an insurmountable barrier. The questionnaire was completed by 120 clinical EBM teachers from 11 countries. Lack of time was the strongest barrier for teaching EBM in practice (median 5). Moderate barriers were the lack of requirements for EBM skills and a pyramid hierarchy in health care management structure (median 4). In Germany, Hungary and Poland, reading and understanding articles in English was a higher barrier than in the other countries. Incorporation of teaching EBM in practice faces several barriers to implementation. Teaching EBM in clinical settings is most successful where EBM principles are culturally embedded and form part and parcel of everyday clinical decisions and medical practice.

Teaching trainers to incorporate evidence-based medicine (EBM) teaching in clinical practice: the EU-EBM project.

PubMed

Thangaratinam, Shakila; Barnfield, Gemma; Weinbrenner, Susanne; Meyerrose, Berit; Arvanitis, Theodoros N; Horvath, Andrea R; Zanrei, Gianni; Kunz, Regina; Suter, Katja; Walczak, Jacek; Kaleta, Anna; Oude Rengerink, Katrien; Gee, Harry; Mol, Ben W J; Khan, Khalid S

2009-09-10

Evidence based medicine (EBM) is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However, clinical teachers lack confidence in teaching EBM in workplace and are often unsure of the existing opportunities for teaching EBM in the clinical setting. There is a need for continuing professional development (CPD) courses that train clinical trainers to teach EBM through on-the-job training by demonstration of applied EBM real time in clinical practice. We developed such a course to encourage clinically relevant teaching of EBM in post-graduate education in various clinical environments. We devised an e-learning course targeting trainers with EBM knowledge to impart educational methods needed to teach application of EBM teaching in commonly used clinical settings. The curriculum development group comprised experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions in seven European countries. The e-learning sessions were designed to allow participants (teachers) to undertake the course in the workplace during short breaks within clinical activities. An independent European steering committee provided input into the process. The curriculum defined specific learning objectives for teaching EBM by exploiting educational opportunities in six different clinical settings. The e-modules incorporated video clips that demonstrate practical and effective methods of EBM teaching in everyday clinical practice. The course encouraged focussed teaching activities embedded within a trainer's personal learning plan and documentation in a CPD portfolio for reflection. This curriculum will help senior clinicians to identify and make the best use of available opportunities in everyday practice in clinical situations to teach various steps of EBM and demonstrate their applicability to clinical practice. Once fully implemented, the ultimate outcome of this pilot project will be a European qualification in teaching EBM, which will be used by doctors, hospitals, professional bodies responsible for postgraduate qualifications and continuing medical education.

Teaching trainers to incorporate evidence-based medicine (EBM) teaching in clinical practice: the EU-EBM project

PubMed Central

Thangaratinam, Shakila; Barnfield, Gemma; Weinbrenner, Susanne; Meyerrose, Berit; Arvanitis, Theodoros N; Horvath, Andrea R; Zanrei, Gianni; Kunz, Regina; Suter, Katja; Walczak, Jacek; Kaleta, Anna; Rengerink, Katrien Oude; Gee, Harry; Mol, Ben WJ; Khan, Khalid S

2009-01-01

Background Evidence based medicine (EBM) is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However, clinical teachers lack confidence in teaching EBM in workplace and are often unsure of the existing opportunities for teaching EBM in the clinical setting. There is a need for continuing professional development (CPD) courses that train clinical trainers to teach EBM through on-the-job training by demonstration of applied EBM real time in clinical practice. We developed such a course to encourage clinically relevant teaching of EBM in post-graduate education in various clinical environments. Methods We devised an e-learning course targeting trainers with EBM knowledge to impart educational methods needed to teach application of EBM teaching in commonly used clinical settings. The curriculum development group comprised experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions in seven European countries. The e-learning sessions were designed to allow participants (teachers) to undertake the course in the workplace during short breaks within clinical activities. An independent European steering committee provided input into the process. Results The curriculum defined specific learning objectives for teaching EBM by exploiting educational opportunities in six different clinical settings. The e-modules incorporated video clips that demonstrate practical and effective methods of EBM teaching in everyday clinical practice. The course encouraged focussed teaching activities embedded within a trainer's personal learning plan and documentation in a CPD portfolio for reflection. Conclusion This curriculum will help senior clinicians to identify and make the best use of available opportunities in everyday practice in clinical situations to teach various steps of EBM and demonstrate their applicability to clinical practice. Once fully implemented, the ultimate outcome of this pilot project will be a European qualification in teaching EBM, which will be used by doctors, hospitals, professional bodies responsible for postgraduate qualifications and continuing medical education. PMID:19744327

Evidence-based medicine knowledge, attitudes, and practices among doctors in Sri Lanka.

PubMed

Abeysena, Chrishantha; Jayawardana, Pushpa; Wickremasinghe, Rajitha; Wickramasinghe, Uthpala

2010-05-01

To assess knowledge, attitudes, and practices on evidence-based medicine (EBM) among doctors in selected hospitals in Sri Lanka. A cross-sectional descriptive study was conducted among 315 doctors in five government hospitals in Sri Lanka between December 2007 and January 2008. A pre-tested self-administered questionnaire was used to gather information on knowledge, attitudes, and practices. Of the 407 invited, 315 doctors participated, among whom, 87% (271) had heard the term EBM, 30% (n= 94) were aware of the Cochrane Library, and 8.5% (n= 27) were current users of it. Forty-seven per cent (n= 148) claimed to understand the terms systematic review and 37% (n= 115) meta-analysis. Twenty-four per cent (n= 77) had been exposed to some form of EBM training. All three components of EBM were known by 18% (n= 56) of participants. Attitudes toward EBM were positive among 76% (n= 239), 80% (n= 251) believed the practice of EBM would lead to improved patient care, and 77% (n= 243) considered EBM to be fundamental to professional practice. Just 3% (n= 13) considered it unimportant. EBM was used in clinical practice by 54% (n= 169) of participants. Thirty-six per cent (n= 114) referred to EBM sources when relevant. Available clinical guidelines were referred to by 56% (n= 176), and 34% (n= 107) thought that available guidelines provide sufficient support for the practice of EBM. The main barriers to practicing EBM were insufficient resources, overwork, lack of exposure to EBM, and lack of time and lack of endorsement of the need to practice EBM. Knowledge and practices of EBM among Sri Lanka doctors were poor. However, attitudes toward EBM were relatively good. © 2010 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

EBM E-learning: Feasible and Effective for Occupational Physicians in Different Countries.

PubMed

Hugenholtz, Nathalie Ir; Sluiter, Judith K; van Dijk, Frank Jh; Nieuwenhuijsen, Karen

2012-09-01

Although evidence-based medicine (EBM) is a useful method for integrating evidence into the decision-making process of occupational physicians, occupational physicians lack EBM knowledge and skills, and do not have the time to learn the EBM method. In order to enable them to educate themselves at the time and place they prefer, we designed an electronic EBM course. We studied the feasibility and utility of the course as well as its effectiveness in increasing EBM knowledge, skills, and behaviour. Occupational physicians from various countries were included in a within-subjects study. Measurements were conducted on participants' EBM knowledge, skills, behaviour, and determinants of behaviour at baseline, directly after finishing the course and 2 months later (n = 36). The feasibility and utility of the course were evaluated directly after the course (n = 42). The course is applicable as an introductory course on EBM for occupational physicians in various countries. The course is effective in enhancing EBM knowledge and self-efficacy in practising EBM. No significant effect was found on EBM skills, behaviour, and determinants of behaviour. After the course, more occupational physicians use the international journals to solve a case. An electronic introductory EBM course is suitable for occupational physicians. Although it is an effective method for increasing EBM knowledge, it does not seem effective in improving skills and behaviour. We recommend integrating e-learning courses with blended learning, where it can be used side by side with other educational methods that are effective in changing behaviour.

'We hold these truths to be self-evident': deconstructing 'evidence-based' medical practice.

PubMed

Devisch, Ignaas; Murray, Stuart J

2009-12-01

Rationale, aims and objectives Evidence-based medicine (EBM) claims to be based on 'evidence', rather than 'intuition'. However, EBM's fundamental distinction between quantitative 'evidence' and qualitative 'intuition' is not self-evident. The meaning of 'evidence' is unclear and no studies of quality exist to demonstrate the superiority of EBM in health care settings. This paper argues that, despite itself, EBM holds out only the illusion of conclusive scientific rigour for clinical decision making, and that EBM ultimately is unable to fulfil its own structural criteria for 'evidence'. Methods Our deconstructive analysis of EBM draws on the work of the French philosopher, Jacques Derrida. Deconstruction works in the name of justice to lay bare, to expose what has been hidden from view. In plain language, we deconstruct EBM's paradigm of 'evidence', the randomized controlled trial (RCT), to demonstrate that there cannot be incontrovertible evidence for EBM as such. We argue that EBM therefore 'auto-deconstructs' its own paradigm, and that medical practitioners, policymakers and patients alike ought to be aware of this failure within EBM itself. Results EBM's strict distinction between admissible evidence (based on RCTs) and other supposedly inadmissible evidence is not itself based on evidence, but rather, on intuition. In other words, according to EBM's own logic, there can be no 'evidentiary' basis for its distinction between admissible and inadmissible evidence. Ultimately, to uphold this fundamental distinction, EBM must seek recourse in (bio)political ideology and an epistemology akin to faith.

Fatigue Life of Titanium Alloys Fabricated by Additive Layer Manufacturing Techniques for Dental Implants

NASA Astrophysics Data System (ADS)

Chan, Kwai S.; Koike, Marie; Mason, Robert L.; Okabe, Toru

2013-02-01

Additive layer deposition techniques such as electron beam melting (EBM) and laser beam melting (LBM) have been utilized to fabricate rectangular plates of Ti-6Al-4V with extra low interstitial (ELI) contents. The layer-by-layer deposition techniques resulted in plates that have different surface finishes which can impact significantly on the fatigue life by providing potential sites for fatigue cracks to initiate. The fatigue life of Ti-6Al-4V ELI alloys fabricated by EBM and LBM deposition techniques was investigated by three-point testing of rectangular beams of as-fabricated and electro-discharge machined surfaces under stress-controlled conditions at 10 Hz until complete fracture. Fatigue life tests were also performed on rolled plates of Ti-6Al-4V ELI, regular Ti-6Al-4V, and CP Ti as controls. Fatigue surfaces were characterized by scanning electron microscopy to identify the crack initiation site in the various types of specimen surfaces. The fatigue life data were analyzed statistically using both analysis of variance techniques and the Kaplan-Meier survival analysis method with the Gehan-Breslow test. The results indicate that the LBM Ti-6Al-4V ELI material exhibits a longer fatigue life than the EBM counterpart and CP Ti, but a shorter fatigue life compared to rolled Ti-6Al-4V ELI. The difference in the fatigue life behavior may be largely attributed to the presence of rough surface features that act as fatigue crack initiation sites in the EBM material.

The status of marine and coastal EBM among a large sample of U.S. federal programs: a social network approach

NASA Astrophysics Data System (ADS)

Dell'Apa, A.; Fullerton, A.; Schwing, F. B.; Brady, M.

2016-12-01

Ecosystem-based management (EBM) is an integrated management approach that considers the entire ecosystem, including humans, across multiple sectors, with the goal to collectively manage natural resources, habitat, and species in a sustainable manner while maintaining ecosystem services to humans on the long-term. In the United States, the National Ocean Council (NOC) established a federal interagency subgroup (National Ocean Policy EBM-Subgroup) to provide policy advice on EBM strategies and technical representation from the federal agencies that are part of the NOC. As part of the NOP EBM-Subgroup effort, this study summarizes the status of EBM for several federal programs within the NOC agencies that implement or support marine and coastal EBM activities. Our objective was to provide an overview of the current state of practice among the many and varied U.S. federal programs employing EBM approaches in the ocean, coastal zone, and the Great Lakes. We used social network analysis techniques to explore similarities among programs in different topic areas (e.g., type of audience, partners, training, EBM best management practices and principles). Results highlight substantial differences in perceived and effective performances across programs, with Management programs showing a higher level of integration of EBM approaches than Non-Management programs. The use of EBM best management practices and principles among programs is unbalanced, with some key elements of EBM strategies less commonly employed in the management planning. This analysis identified gaps in the implementation of EBM strategies that can inform natural resource managers and planners

The status of marine and coastal EBM among a large sample of U.S. federal programs: a social network approach

NASA Astrophysics Data System (ADS)

Dell'Apa, A.; Fullerton, A.; Schwing, F. B.; Brady, M.

2016-02-01

Ecosystem-based management (EBM) is an integrated management approach that considers the entire ecosystem, including humans, across multiple sectors, with the goal to collectively manage natural resources, habitat, and species in a sustainable manner while maintaining ecosystem services to humans on the long-term. In the United States, the National Ocean Council (NOC) established a federal interagency subgroup (National Ocean Policy EBM-Subgroup) to provide policy advice on EBM strategies and technical representation from the federal agencies that are part of the NOC. As part of the NOP EBM-Subgroup effort, this study summarizes the status of EBM for several federal programs within the NOC agencies that implement or support marine and coastal EBM activities. Our objective was to provide an overview of the current state of practice among the many and varied U.S. federal programs employing EBM approaches in the ocean, coastal zone, and the Great Lakes. We used social network analysis techniques to explore similarities among programs in different topic areas (e.g., type of audience, partners, training, EBM best management practices and principles). Results highlight substantial differences in perceived and effective performances across programs, with Management programs showing a higher level of integration of EBM approaches than Non-Management programs. The use of EBM best management practices and principles among programs is unbalanced, with some key elements of EBM strategies less commonly employed in the management planning. This analysis identified gaps in the implementation of EBM strategies that can inform natural resource managers and planners

Ambulatory Morning Report: A Case-Based Method of Teaching EBM Through Experiential Learning.

PubMed

Luciano, Gina L; Visintainer, Paul F; Kleppel, Reva; Rothberg, Michael B

2016-02-01

Evidence-based medicine (EBM) skills are important to daily practice, but residents generally feel unskilled incorporating EBM into practice. The Kolb experiential learning theory, as applied to curricular planning, offers a unique methodology to help learners build an EBM skill set based on clinical experiences. We sought to blend the learner-centered, case-based merits of the morning report with an experientially based EBM curriculum. We describe and evaluate a patient-centered ambulatory morning report combining the User's Guides to the Medical Literature approach to EBM and experiential learning theory in the internal medicine department at Baystate Medical Center. The Kolb experiential learning theory postulates that experience transforms knowledge; within that premise we designed a curriculum to build EBM skills incorporating residents' patient encounters. By developing structured clinical questions based on recent clinical problems, residents activate prior knowledge. Residents acquire new knowledge through selection and evaluation of an article that addresses the structured clinical questions. Residents then apply and use new knowledge in future patient encounters. To assess the curriculum, we designed an 18-question EBM test, which addressed applied knowledge and EBM skills based on the User's Guides approach. Of the 66 residents who could participate in the curriculum, 61 (92%) completed the test. There was a modest improvement in EBM knowledge, primarily during the first year of training. Our experiential curriculum teaches EBM skills essential to clinical practice. The curriculum differs from traditional EBM curricula in that ours blends experiential learning with an EBM skill set; learners use new knowledge in real time.

A survey study of evidence-based medicine training in US and Canadian medical schools

PubMed Central

Blanco, Maria A.; Capello, Carol F.; Dorsch, Josephine L.; Perry, Gerald (Jerry); Zanetti, Mary L.

2014-01-01

Purpose: The authors conducted a survey examining (1) the current state of evidence-based medicine (EBM) curricula in US and Canadian medical schools and corresponding learning objectives, (2) medical educators' and librarians' participation in EBM training, and (3) barriers to EBM training. Methods: A survey instrument with thirty-four closed and open-ended questions was sent to curricular deans at US and Canadian medical schools. The survey sought information on enrollment and class size; EBM learning objectives, curricular activities, and assessment approaches by year of training; EBM faculty; EBM tools; barriers to implementing EBM curricula and possible ways to overcome them; and innovative approaches to EBM education. Both qualitative and quantitative methods were used for data analysis. Measurable learning objectives were categorized using Bloom's taxonomy. Results: One hundred fifteen medical schools (77.2%) responded. Over half (53%) of the 900 reported learning objectives were measurable. Knowledge application was the predominant category from Bloom's categories. Most schools integrated EBM into other curricular activities; activities and formal assessment decreased significantly with advanced training. EBM faculty consisted primarily of clinicians, followed by basic scientists and librarians. Various EBM tools were used, with PubMed and the Cochrane database most frequently cited. Lack of time in curricula was rated the most significant barrier. National agreement on required EBM competencies was an extremely helpful factor. Few schools shared innovative approaches. Conclusions: Schools need help in overcoming barriers related to EBM curriculum development, implementation, and assessment. Implications: Findings can provide a starting point for discussion to develop a standardized competency framework. PMID:25031556

A survey study of evidence-based medicine training in US and Canadian medical schools.

PubMed

Blanco, Maria A; Capello, Carol F; Dorsch, Josephine L; Perry, Gerald; Zanetti, Mary L

2014-07-01

The authors conducted a survey examining (1) the current state of evidence-based medicine (EBM) curricula in US and Canadian medical schools and corresponding learning objectives, (2) medical educators' and librarians' participation in EBM training, and (3) barriers to EBM training. A survey instrument with thirty-four closed and open-ended questions was sent to curricular deans at US and Canadian medical schools. The survey sought information on enrollment and class size; EBM learning objectives, curricular activities, and assessment approaches by year of training; EBM faculty; EBM tools; barriers to implementing EBM curricula and possible ways to overcome them; and innovative approaches to EBM education. Both qualitative and quantitative methods were used for data analysis. Measurable learning objectives were categorized using Bloom's taxonomy. One hundred fifteen medical schools (77.2%) responded. Over half (53%) of the 900 reported learning objectives were measurable. Knowledge application was the predominant category from Bloom's categories. Most schools integrated EBM into other curricular activities; activities and formal assessment decreased significantly with advanced training. EBM faculty consisted primarily of clinicians, followed by basic scientists and librarians. Various EBM tools were used, with PubMed and the Cochrane database most frequently cited. Lack of time in curricula was rated the most significant barrier. National agreement on required EBM competencies was an extremely helpful factor. Few schools shared innovative approaches. Schools need help in overcoming barriers related to EBM curriculum development, implementation, and assessment. Findings can provide a starting point for discussion to develop a standardized competency framework.

Teaching of evidence-based medicine to medical students in Mexico: a randomized controlled trial

PubMed Central

2012-01-01

Background Evidence-Based Medicine (EBM) is an important competency for the healthcare professional. Experimental evidence of EBM educational interventions from rigorous research studies is limited. The main objective of this study was to assess EBM learning (knowledge, attitudes and self-reported skills) in undergraduate medical students with a randomized controlled trial. Methods The educational intervention was a one-semester EBM course in the 5th year of a public medical school in Mexico. The study design was an experimental parallel group randomized controlled trial for the main outcome measures in the 5th year class (M5 EBM vs. M5 non-EBM groups), and quasi-experimental with static-groups comparisons for the 4th year (M4, not yet exposed) and 6th year (M6, exposed 6 months to a year earlier) groups. EBM attitudes, knowledge and self-reported skills were measured using Taylor’s questionnaire and a summative exam which comprised of a 100-item multiple-choice question (MCQ) test. Results 289 Medical students were assessed: M5 EBM=48, M5 non-EBM=47, M4=87, and M6=107. There was a higher reported use of the Cochrane Library and secondary journals in the intervention group (M5 vs. M5 non-EBM). Critical appraisal skills and attitude scores were higher in the intervention group (M5) and in the group of students exposed to EBM instruction during the previous year (M6). The knowledge level was higher after the intervention in the M5 EBM group compared to the M5 non-EBM group (p<0.001, Cohen's d=0.88 with Taylor's instrument and 3.54 with the 100-item MCQ test). M6 Students that received the intervention in the previous year had a knowledge score higher than the M4 and M5 non-EBM groups, but lower than the M5 EBM group. Conclusions Formal medical student training in EBM produced higher scores in attitudes, knowledge and self-reported critical appraisal skills compared with a randomized control group. Data from the concurrent groups add validity evidence to the study, but rigorous follow-up needs to be done to document retention of EBM abilities. PMID:23131115

Microstructural Architecture, Microstructures, and Mechanical Properties for a Nickel-Base Superalloy Fabricated by Electron Beam Melting

NASA Astrophysics Data System (ADS)

Murr, L. E.; Martinez, E.; Gaytan, S. M.; Ramirez, D. A.; Machado, B. I.; Shindo, P. W.; Martinez, J. L.; Medina, F.; Wooten, J.; Ciscel, D.; Ackelid, U.; Wicker, R. B.

2011-11-01

Microstructures and a microstructural, columnar architecture as well as mechanical behavior of as-fabricated and processed INCONEL alloy 625 components produced by additive manufacturing using electron beam melting (EBM) of prealloyed precursor powder are examined in this study. As-fabricated and hot-isostatically pressed ("hipped") [at 1393 K (1120 °C)] cylinders examined by optical metallography (OM), scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy-dispersive (X-ray) spectrometry (EDS), and X-ray diffraction (XRD) exhibited an initial EBM-developed γ″ (bct) Ni3Nb precipitate platelet columnar architecture within columnar [200] textured γ (fcc) Ni-Cr grains aligned in the cylinder axis, parallel to the EBM build direction. Upon annealing at 1393 K (1120 °C) (hot-isostatic press (HIP)), these precipitate columns dissolve and the columnar, γ, grains recrystallized forming generally equiaxed grains (with coherent {111} annealing twins), containing NbCr2 laves precipitates. Microindentation hardnesses decreased from 2.7 to 2.2 GPa following hot-isostatic pressing ("hipping"), and the corresponding engineering (0.2 pct) offset yield stress decreased from 0.41 to 0.33 GPa, while the UTS increased from 0.75 to 0.77 GPa. However, the corresponding elongation increased from 44 to 69 pct for the hipped components.

Evaluating factors affecting the implementation of evidence based medicine in primary healthcare centers in Dubai.

PubMed

Albarrak, Ahmed I; Ali Abbdulrahim, Suhair Aqil; Mohammed, Rafiuddin

2014-07-01

To assess the current evidence based medicine (EBM) knowledge, attitude and perceptions of physicians at Dubai Primary Health Care Sector (PHCS). Further to evaluate barrier and facilitator factors toward implementing the EBM practice. A cross-sectional study, at Dubai PHCS, UAE between June and August 2010. The survey was composed of two phases. The first phase was a self administrated questionnaire employed for data collection and the second phase was qualitative method, which was in the form of individual interviews. Statistical Package for Social Sciences (SPSS) was used for data analysis. In total 48 participants responded to the survey questionnaire and 13 responded to individual interviews. The response rate was 70.0%. Mean age was 42.18 (SD 10.46). The majority were females (64.6%). The physicians who attended EBM courses reported 70.30% using EBM and showed statistical significance (p = 0.002) from those who did not attend the EBM courses. 65.0% believe that 50-75% of the patients are capable of participating in clinical decision while 71.8% disagreed that the concept of EBM is not applicable to their culture. In addition they showed significance (p = 0.03) between physician beliefs with regard to patient capacity to take decision. About 67.0% of the family physicians were knowledgeable and followed systematic review as the strongest evidence. They had no access to the EBM resources (37.0%) and had no time to practice the EBM (38.0%). Nearly 40.0% interviewees reported lack of encouragement to attend EBM courses. EBM activities (22.0%) and active audit (18.0%) were top rated facilitating factors. EBM is not fully utilized by indefinite physicians in the Dubai PHC sector. Factors associated with non-utilization of EBM in the PHCS are lack of encouragement to attend EBM courses, senior physicians resist adoption of EBM, lack of time and insufficient dissemination process for implementing the clinical guideline.

Evaluating factors affecting the implementation of evidence based medicine in primary healthcare centers in Dubai

PubMed Central

Albarrak, Ahmed I.; Ali Abbdulrahim, Suhair Aqil; Mohammed, Rafiuddin

2013-01-01

Objectives To assess the current evidence based medicine (EBM) knowledge, attitude and perceptions of physicians at Dubai Primary Health Care Sector (PHCS). Further to evaluate barrier and facilitator factors toward implementing the EBM practice. Methodology A cross-sectional study, at Dubai PHCS, UAE between June and August 2010. The survey was composed of two phases. The first phase was a self administrated questionnaire employed for data collection and the second phase was qualitative method, which was in the form of individual interviews. Statistical Package for Social Sciences (SPSS) was used for data analysis. Results In total 48 participants responded to the survey questionnaire and 13 responded to individual interviews. The response rate was 70.0%. Mean age was 42.18 (SD 10.46). The majority were females (64.6%). The physicians who attended EBM courses reported 70.30% using EBM and showed statistical significance (p = 0.002) from those who did not attend the EBM courses. 65.0% believe that 50–75% of the patients are capable of participating in clinical decision while 71.8% disagreed that the concept of EBM is not applicable to their culture. In addition they showed significance (p = 0.03) between physician beliefs with regard to patient capacity to take decision. About 67.0% of the family physicians were knowledgeable and followed systematic review as the strongest evidence. They had no access to the EBM resources (37.0%) and had no time to practice the EBM (38.0%). Nearly 40.0% interviewees reported lack of encouragement to attend EBM courses. EBM activities (22.0%) and active audit (18.0%) were top rated facilitating factors. Conclusions EBM is not fully utilized by indefinite physicians in the Dubai PHC sector. Factors associated with non-utilization of EBM in the PHCS are lack of encouragement to attend EBM courses, senior physicians resist adoption of EBM, lack of time and insufficient dissemination process for implementing the clinical guideline. PMID:25061405

Adopting a blended learning approach to teaching evidence based medicine: a mixed methods study

PubMed Central

2013-01-01

Background Evidence Based Medicine (EBM) is a core unit delivered across many medical schools. Few studies have investigated the most effective method of teaching a course in EBM to medical students. The objective of this study was to identify whether a blended-learning approach to teaching EBM is more effective a didactic-based approach at increasing medical student competency in EBM. Methods A mixed-methods study was conducted consisting of a controlled trial and focus groups with second year graduate medical students. Students received the EBM course delivered using either a didactic approach (DID) to learning EBM or a blended-learning approach (BL). Student competency in EBM was assessed using the Berlin tool and a criterion-based assessment task, with student perceptions on the interventions assessed qualitatively. Results A total of 61 students (85.9%) participated in the study. Competency in EBM did not differ between the groups when assessed using the Berlin tool (p = 0.29). Students using the BL approach performed significantly better in one of the criterion-based assessment tasks (p = 0.01) and reported significantly higher self-perceived competence in critical appraisal skills. Qualitative analysis identified that students had a preference for the EBM course to be delivered using the BL approach. Conclusions Implementing a blended-learning approach to EBM teaching promotes greater student appreciation of EBM principles within the clinical setting. Integrating a variety of teaching modalities and approaches can increase student self-confidence and assist in bridging the gap between the theory and practice of EBM. PMID:24341502

Spall Response of Additive Manufactured Ti-6Al-4V

NASA Astrophysics Data System (ADS)

Brown, Andrew; Gregg, Adam; Escobedo, Jp; Hazell, Paul; East, Daniel; Quadir, Zakaria

2017-06-01

Additive manufactured (AM) Ti-6Al-4V was produced via electron beam melting (EBM) and laser melting deposition (LMD) techniques. The dynamic response of AM varieties of common aerospace and infrastructure metals are yet to be fully characterized and compared to their traditionally processed counterparts. Spall damage is one of the primary failure modes in metals subjected to shock loading from high velocity impact. Both EBM and LMD Ti-6Al-4V were shock loaded via flyer-target plate impact using a single-stage light gas gun. Target plates were subjected to pressures just above the spall strength of the material (3-5 GPa) to investigate the early onset of damage nucleation as a function of processing technique and shock orientation with respect to the AM-build direction. Post-mortem characterization of the spall damage and surrounding microstructure was performed using a combination of optical microscopy, scanning electron microscopy, and electron backscatter diffraction.

A randomised controlled trial of a blended learning education intervention for teaching evidence-based medicine.

PubMed

Ilic, Dragan; Nordin, Rusli Bin; Glasziou, Paul; Tilson, Julie K; Villanueva, Elmer

2015-03-10

Few studies have been performed to inform how best to teach evidence-based medicine (EBM) to medical trainees. Current evidence can only conclude that any form of teaching increases EBM competency, but cannot distinguish which form of teaching is most effective at increasing student competency in EBM. This study compared the effectiveness of a blended learning (BL) versus didactic learning (DL) approach of teaching EBM to medical students with respect to competency, self-efficacy, attitudes and behaviour toward EBM. A mixed methods study consisting of a randomised controlled trial (RCT) and qualitative case study was performed with medical students undertaking their first clinical year of training in EBM. Students were randomly assigned to receive EBM teaching via either a BL approach or the incumbent DL approach. Competency in EBM was assessed using the Berlin questionnaire and the 'Assessing Competency in EBM' (ACE) tool. Students' self-efficacy, attitudes and behaviour was also assessed. A series of focus groups was also performed to contextualise the quantitative results. A total of 147 students completed the RCT, and a further 29 students participated in six focus group discussions. Students who received the BL approach to teaching EBM had significantly higher scores in 5 out of 6 behaviour domains, 3 out of 4 attitude domains and 10 out of 14 self-efficacy domains. Competency in EBM did not differ significantly between students receiving the BL approach versus those receiving the DL approach [Mean Difference (MD)=-0.68, (95% CI-1.71, 0.34), p=0.19]. No significant difference was observed between sites (p=0.89) or by student type (p=0.58). Focus group discussions suggested a strong student preference for teaching using a BL approach, which integrates lectures, online learning and small group activities. BL is no more effective than DL at increasing medical students' knowledge and skills in EBM, but was significantly more effective at increasing student attitudes toward EBM and self-reported use of EBM in clinical practice. Given the various learning styles preferred by students, a multifaceted approach (incorporating BL) may be best suited when teaching EBM to medical students. Further research on the cost-effectiveness of EBM teaching modalities is required.

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

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

PubMed

Alahdab, Fares; Firwana, Belal; Hasan, Rim; Sonbol, Mohamad Bassam; Fares, Munes; Alnahhas, Iyad; Sabouni, Ammar; Ferwana, Mazen

2012-08-12

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. 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. 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%. 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.

Message to complementary and alternative medicine: evidence is a better friend than power

PubMed Central

Vickers, Andrew J

2001-01-01

Background Evidence-based medicine (EBM) is being embraced by an increasing number of practitioners and advocates of complementary and alternative medicine (CAM). A significant constituency within CAM, however, appears to have substantive doubts about EBM and some are expressly hostile. Discussion Many of the arguments raised against EBM within the CAM community are based on a caricature radically at odds with established, accepted and published principles of EBM practice. Contrary to what has sometimes been argued, EBM is not cookbook medicine that ignores individual needs. Neither does EBM mandate that only proven therapies should be used. Before EBM, decisions on health care tended to be based on tradition, power and influence. Such modes usually act to the disadvantage of marginal groups. Conclusion By placing CAM on an equal footing with conventional medicine - what matters for both is evidence of effectiveness - EBM provides an opportunity for CAM to find an appropriate and just place in health care. PMID:11346455

The importance of values in evidence-based medicine.

PubMed

Kelly, Michael P; Heath, Iona; Howick, Jeremy; Greenhalgh, Trisha

2015-10-12

Evidence-based medicine (EBM) has always required integration of patient values with 'best' clinical evidence. It is widely recognized that scientific practices and discoveries, including those of EBM, are value-laden. But to date, the science of EBM has focused primarily on methods for reducing bias in the evidence, while the role of values in the different aspects of the EBM process has been almost completely ignored. In this paper, we address this gap by demonstrating how a consideration of values can enhance every aspect of EBM, including: prioritizing which tests and treatments to investigate, selecting research designs and methods, assessing effectiveness and efficiency, supporting patient choice and taking account of the limited time and resources available to busy clinicians. Since values are integral to the practice of EBM, it follows that the highest standards of EBM require values to be made explicit, systematically explored, and integrated into decision making. Through 'values based' approaches, EBM's connection to the humanitarian principles upon which it was founded will be strengthened.

Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice? A cluster randomised controlled trial

PubMed Central

Kortekaas, M F; Bartelink, M E L; Zuithoff, N P A; van der Heijden, G J M G; de Wit, N J; Hoes, A W

2016-01-01

Objectives Evidence-based medicine (EBM) is an important element in the general practice (GP) specialty training. Studies show that integrating EBM training into clinical practice brings larger benefits than stand-alone modules. However, these studies have neither been performed in GP nor assessed EBM behaviour of former trainees in daily clinical practice. Setting GP specialty training in the Netherlands. Participants All 82 third year GP trainees who started their final third year in 2011 were approached for inclusion, of whom 79 (96%) participated: 39 in the intervention group and 40 in the control group. Intervention Integrated EBM training, in which EBM is embedded closely within the clinical context by joint assignments for the trainee and supervisor in daily practice, and teaching sessions based on dilemmas from actual patient consultations. Comparison Stand-alone EBM training at the institute only. Primary and secondary outcomes Our primary outcome was EBM behaviour, assessed by measuring guideline adherence (incorporating rational, motivated deviation) and information-seeking behaviour. Our secondary outcomes were EBM attitude and EBM knowledge. Data were acquired using logbooks and questionnaires, respectively. Analyses were performed using mixed models. Results Logbook data were available from 76 (96%) of the participating trainees at baseline (7614 consultations), 60 (76%) at the end of the third year (T1, 4973 consultations) and 53 (67%) 1 year after graduation (T2, 3307 consultations). We found no significant differences in outcomes between the 2 groups, with relative risks for guideline adherence varying between 0.96 and 0.99 (95% CI 0.86 to 1.11) at T1, and 0.99 and 1.10 (95% CI 0.92 to 1.25) at T2, and for information-seeking behaviour between 0.97 and 1.16 (95% CI 0.70 to 1.91) and 0.90 and 1.10 (95% CI 0.70 to 1.32), respectively. Conclusions Integrated EBM training compared with stand-alone EBM training does not improve EBM behaviour, attitude or knowledge of (future) GPs. PMID:27625052

Current Use of Evidence-Based Medicine in Pediatric Spine Surgery.

PubMed

Oetgen, Matthew E

2018-04-01

Evidence-based medicine (EBM) is a process of decision-making aimed at making the best clinical decisions as they relate to patients' health. The current use of EBM in pediatric spine surgery is varied, based mainly on the availability of high-quality data. The use of EBM is limited in idiopathic scoliosis, whereas EBM has been used to investigate the treatment of pediatric spondylolysis. Studies on early onset scoliosis are of low quality, making EBM difficult in this condition. Future focus and commitment to study quality in pediatric spinal surgery will likely increase the role of EBM in these conditions. Copyright © 2017 Elsevier Inc. All rights reserved.

Training of patient and consumer representatives in the basic competencies of evidence-based medicine: a feasibility study.

PubMed

Berger, Bettina; Steckelberg, Anke; Meyer, Gabriele; Kasper, Jürgen; Mühlhauser, Ingrid

2010-02-11

Evidence-based medicine (EBM) has become standard approach in medicine. Patients and health authorities increasingly claim active patient roles in decision making. Education to cope with these roles might be useful. We investigated the feasibility, acceptability and possible impact of EBM training courses for patient and consumer representatives. We designed a generic one-week EBM course based on previous experience with EBM courses for non-medical health professionals. A course specific competence test has been developed and validated to measure EBM skills. Formative and summative evaluation of the course comprised: 1) EBM skills; 2) individual learning goals; 3) self-reported implementation after six months using semi-structured interviews; 4) group-based feedback by content analysis. EBM skills' achievement was compared to results gathered by a group of undergraduate University students of Health Sciences and Education who had attended a comparable EBM seminar. Fourteen EBM courses were conducted including 161 participants without previous EBM training (n = 54 self-help group representatives, n = 64 professional counsellors, n = 36 patient advocates, n = 7 others); 71% had a higher education degree; all but five finished the course. Most participants stated personal learning goals explicitly related to practicing EBM such as acquisition of critical appraisal skills (n = 130) or research competencies (n = 67). They rated the respective relevance of the course on average with 80% (SD 4) on a visual analogue scale ranging from 0 to 100%.Participants passed the competence test with a mean score of 14.7 (SD 3.0, n = 123) out of 19.5 points. The comparison group of students achieved a mean score of 14.4 (SD 3.3, n = 43). Group-based feedback revealed increases of self confidence, empowerment through EBM methodology and statistical literacy, and acquisition of new concepts of patient information and counselling. Implementation of EBM skills was reported by 84 of the 129 (65%) participants available for follow-up interviews. Barriers included lack of further support, limited possibilities to exchange experiences, and feeling discouraged by negative reactions of health professionals. Training in basic EBM competencies for selected patient and consumer representatives is feasible and accepted and may affect counselling and advocacy activities. Implementation of EBM skills needs support beyond the training course.

Characteristics of evidence-based medicine training in Royal College of Physicians and Surgeons of Canada emergency medicine residencies - a national survey of program directors.

PubMed

Bednarczyk, Joseph; Pauls, Merril; Fridfinnson, Jason; Weldon, Erin

2014-03-21

Recent surveys suggest few emergency medicine (EM) training programs have formal evidence-based medicine (EBM) or journal club curricula. Our primary objective was to describe the methods of EBM training in Royal College of Physicians and Surgeons of Canada (RCPSC) EM residencies. Secondary objectives were to explore attitudes regarding current educational practices including e-learning, investigate barriers to journal club and EBM education, and assess the desire for national collaboration. A 16-question survey containing binary, open-ended, and 5-pt Likert scale questions was distributed to the 14 RCPSC-EM program directors. Proportions of respondents (%), median, and IQR are reported. The response rate was 93% (13/14). Most programs (85%) had established EBM curricula. Curricula content was delivered most frequently via journal club, with 62% of programs having 10 or more sessions annually. Less than half of journal clubs (46%) were led consistently by EBM experts. Four programs did not use a critical appraisal tool in their sessions (31%). Additional teaching formats included didactic and small group sessions, self-directed e-learning, EBM workshops, and library tutorials. 54% of programs operated educational websites with EBM resources. Program directors attributed highest importance to two core goals in EBM training curricula: critical appraisal of medical literature, and application of literature to patient care (85% rating 5 - "most importance", respectively). Podcasts, blogs, and online journal clubs were valued for EBM teaching roles including creating exposure to literature (4, IQR 1.5) and linking literature to clinical practice experience (4, IQR 1.5) (1-no merit, 5-strong merit). Five of thirteen respondents rated lack of expert leadership and trained faculty educators as potential limitations to EBM education. The majority of respondents supported the creation of a national unified EBM educational resource (4, IQR 1) (1-no support, 5- strongly support). RCPSC-EM programs have established EBM teaching curricula and deliver content most frequently via journal club. A lack of EBM expert educators may limit content delivery at certain sites. Program directors supported the nationalization of EBM educational resources. A growing usage of electronic resources may represent an avenue to link national EBM educational expertise, facilitating future collaborative educational efforts.

The Impact of an Evidence-Based Medicine Workshop on Residents' Attitudes towards and Self-Reported Ability in Evidence-Based Practice.

PubMed

Baum, Karyn D

2003-12-01

Evidence-based medicine (EBM) is a part of many medical school and residency curricula worldwide, but there is little research into the most effective methods to teach these skills. To evaluate whether a course on EBM utilizing adult learning principals leads to both immediate and short-term attitudinal, confidence, and behavioral change. Seventy-three (73) Internal Medicine and Internal Medicine/Pediatric residents attended a half-day seminar on EBM. Participants completed pre- and post-course 5-point Likert questionnaires, and set two personal goals for integrating EBM into their daily practice. We performed nonparametric two -sample Wilcoxon Rank-Sum tests to compare responses. We also elicited the self-reported success of the residents in meeting their goals one-month post-course. Attitudes about EBM improved (3.5 pre-course vs. 3.7 post-course), as well as selfreported EBM skills (3.0 vs. 3.3). Seventy-two percent of residents reported having met at least one of their two goals for the integration of EBM into their practice. An EBM workshop based upon adult learning principles was successful in meeting multiple educational goals. The links between andragogy, learners' internal drive for behavior change, and successful EBM education should be further explored.

Refining knowledge, attitude and practice of evidence-based medicine (EBM) among pharmacy students for professional challenges.

PubMed

Abu-Gharbieh, Eman; Khalidi, Doaa Al; Baig, Mirza R; Khan, Saeed A

2015-04-01

Practicing evidence based medicine (EBM) is a professional need for the future clinical pharmacist in UAE and around the world. An attempt was made to evaluate pharmacy student's knowledge, attitude and proficiency in the practice of EBM. A within-subject study design with pre and post survey and skill test were conducted using case based practice of EBM through a validated questionnaire. The results were tabulated and there was a statistically significant increase in pharmacy students' perceived ability to go through steps of EBM, namely: formulating PICO questions (95.3%), searching for evidence (97%), appraising the evidence (81%), understanding statistics (78.1%), and applying evidence at point of care (81.2%). In this study, workshops and (Problem Based Learning) PBLs were used as a module of EBM teaching and practices, which has been shown to be an effective educational method in terms of improving students' skills, knowledge and attitude toward EBM. Incorporating hands on experience, PBLs will become an impetus for developing EBM skills and critical appraisal of research evidence alongside routine clinical practice. This integration would constitute the cornerstone in lifting EBM in UAE up to the needed standards and would enable pharmacy students to become efficient pharmacists that rely on evidence in their health practice.

Improved quality and more attractive work by applying EBM in disability evaluations: a qualitative survey.

PubMed

Hoving, Jan L; Kok, Rob; Ketelaar, Sarah M; Smits, Paul B A; van Dijk, Frank J H; Verbeek, Jos H

2016-02-29

The uptake of evidence in practice by physicians, even if they are trained in the systematic method of evidence-based medicine (EBM), remains difficult to improve. The aim of this study was to explore perceptions and experiences of physicians doing disability evaluations regarding motivators and preconditions for the implementation of EBM in daily practice. This qualitative study was nested in a cluster randomized controlled trial (Trial registration NTR1767; 20-apr-2009) evaluating the effects of training in EBM. The 45 physicians that participated received a comprehensive 6-months training program in EBM of which the last course day included audio-recorded interviews in groups. During these interviews participating physicians discussed perceptions and experiences regarding EBM application in daily practice. In an iterative process we searched for common motivators or preconditions for the implementation of EBM. Three main concepts or themes emerged after analyzing the transcriptions of the discussions: 1) improved quality of physicians' actions, such as clients benefiting from the application of EBM; 2) improved work attractiveness of physicians; and 3) preconditions that have to be met in order to work in an evidence-based manner including professional competence, facilitating material conditions and organizational support and demands. Physicians trained in EBM are motivated to use EBM because they perceive it as a factor improving the quality of their work and making their work more attractive. In addition to personal investments and gains, organizational support should further facilitate the uptake of evidence in practice.

A pilot study exploring the relationship between lifelong learning and factors associated with evidence-based medicine.

PubMed

Mi, Misa; Halalau, Alexandra

2016-07-03

To explore possible relationships between residents' lifelong learning orientation, skills in practicing evidence-based medicine (EBM), and perceptions of the environment for learning and practicing EBM. This was a pilot study with a cross-sectional survey design. Out of 60 residents in a medical residency program, 29 participated in the study. Data were collected using a survey that comprised three sections: the JeffSPLL Scale, EBM Environment Scale, and an EBM skill questionnaire. Data were analyzed using SPSS and were reported with descriptive and inferential statistics (mean, standard deviation, Pearson's correlation, and a two-sample t-test). Mean scores on the JeffSPLL Scale were significantly correlated with perceptions of the EBM Scale and use of EBM resources to keep up to date or solve a specific patient care problem. There was a significant correlation between mean scores on the EBM Scale and hours per week spent in reading medical literature to solve a patient care problem. Two-sample t-tests show that residents with previous training in research methods had significantly higher scores on the JeffSPLL Scale (p=0.04), EBM Scale (p=0.006), and self-efficacy scale (p =0.024). Given the fact that physicians are expected to be lifelong learners over the course of their professional career, developing residents' EBM skills and creating interventions to improve specific areas in the EBM environment would likely foster residents' lifelong learning orientation.

Development and evaluation of the evidence-based medicine program in surgery: a spiral approach

PubMed Central

Elçin, Melih; Turan, Sevgi; Odabaşı, Orhan; Sayek, İskender

2014-01-01

Background Evidence-based medicine (EBM) aims to provide skills that help physicians answer clinically important questions, determine new evidence, and incorporate the acquired knowledge in practice. EBM skills are necessary for the practice of modern medicine, since physicians should use up-to-date knowledge and information to justify their medical decisions. Purpose We aimed to evaluate the EBM program implemented at Hacettepe University School of Medicine. Methods In 2004, a spiral program for the teaching and practice of EBM was developed for the first 3 years of medical school. Following this program, a practice of EBM was included in the fourth year during the surgery clerkship, after an introductory lecture. The students worked within collaborative teams of 3–5 and practiced EBM with actual cases seen in the surgical service in which they were involved. Each student was asked to complete a questionnaire that evaluated the more theoretical program from the first 3 years and the practical application in the fourth year. Results Nearly half of the students stated that the preclinical years of the EBM program were ‘adequate’, but only 30% of the students indicated that the program was practical. They stated that ‘more practical approaches were used in the fourth year, whereas more theory-based approaches were used during the preclinical years’. More than 75% of the students declared that the practice of EBM in the fourth year was useful and appropriate for team-based learning. Conclusions The EBM program was evaluated as ‘adequate’. EBM courses should be included in the entire curriculum in an integrated manner. The students understand the main philosophy of EBM in the clinical year when involved in its practical application with actual patients. PMID:24767706

How learning style affects evidence-based medicine: a survey study

PubMed Central

2011-01-01

Background Learning styles determine how people manage new information. Evidence-based medicine (EBM) involves the management of information in clinical practice. As a consequence, the way in which a person uses EBM can be related to his or her learning style. In order to tailor EBM education to the individual learner, this study aims to determine whether there is a relationship between an individual's learning style and EBM competence (knowledge/skills, attitude, behaviour). Methods In 2008, we conducted a survey among 140 novice GP trainees in order to assess their EBM competence and learning styles (Accommodator, Diverger, Assimilator, Converger, or mixed learning style). Results The trainees' EBM knowledge/skills (scale 0-15; mean 6.8; 95%CI 6.4-7.2) were adequate and their attitudes towards EBM (scale 0-100; mean 63; 95%CI 61.3-64.3) were positive. We found no relationship between their knowledge/skills or attitudes and their learning styles (p = 0.21; p = 0.19). Of the trainees, 40% used guidelines to answer clinical questions and 55% agreed that the use of guidelines is the most appropriate way of applying EBM in general practice. Trainees preferred using evidence from summaries to using evidence from single studies. There were no differences in medical decision-making or in EBM use (p = 0.59) for the various learning styles. However, we did find a link between having an Accommodating or Converging learning style and making greater use of intuition. Moreover, trainees with different learning styles expressed different ideas about the optimal use of EBM in primary care. Conclusions We found that EBM knowledge/skills and EBM attitudes did not differ with respect to the learning styles of GP trainees. However, we did find differences relating to the use of intuition and the trainees' ideas regarding the use of evidence in decision-making. PMID:21982307

Effective or just practical? An evaluation of an online postgraduate module on evidence-based medicine (EBM)

PubMed Central

2013-01-01

Background Teaching the steps of evidence-based medicine (EBM) to undergraduate as well as postgraduate health care professionals is crucial for implementation of effective, beneficial health care practices and abandonment of ineffective, harmful ones. Stellenbosch University in Cape Town, South Africa, offers a 12-week, completely online module on EBM within the Family Medicine division, to medical specialists in their first year of training. The aim of this study was to formatively evaluate this module; assessing both the mode of delivery; as well as the perceived effectiveness and usefulness thereof. Methods We used mixed methods to evaluate this module: A document review to assess whether the content of the module reflects important EBM competencies; a survey of the students to determine their experiences of the module; and semi-structured interviews with the tutors to explore their perspectives of the module. Ethics approval was obtained. Results The document review indicated that EBM competencies were covered adequately, although critical appraisal only focused on randomised controlled trials and guidelines. Students had a positive attitude towards the module, but felt that they needed more support from the tutors. Tutors felt that students engaged actively in discussions, but experienced difficulties with understanding certain concepts of EBM. Furthermore, they felt that it was challenging explaining these via the online learning platform and saw the need to incorporate more advanced technology to better connect with the students. In their view the key to successful learning of EBM was to keep it relevant and applicable to everyday practice. Tutors also felt that an online module on EBM was advantageous, since doctors from all over the world were able to participate. Conclusion Our study has shown that the online module on EBM was effective in increasing EBM knowledge and skills of postgraduate students and was well received by both students and tutors. Students and tutors experienced generic challenges that accompany any educational intervention of EBM (e.g. understanding difficult concepts), but in addition had to deal with challenges unique to the online learning environment. Teachers of EBM should acknowledge these so as to enhance and successfully implement EBM teaching and learning for all students. PMID:23710548

Self-perception and knowledge of evidence based medicine by physicians.

PubMed

Aguirre-Raya, Karen A; Castilla-Peón, María F; Barajas-Nava, Leticia A; Torres-Rodríguez, Violeta; Muñoz-Hernández, Onofre; Garduño-Espinosa, Juan

2016-06-29

The influence, legitimacy and application of Evidence Based Medicine (EBM) in the world is growing as a tool that integrates, the best available evidence to decision making in patient care. Our goal was to identify the relationship between self-perception about the relevance of Evidence Based Medicine (EBM) and the degree of basic knowledge of this discipline in a group of physicians. A survey was carried out in a third level public hospital in Mexico City. Self-perception was measured by means of a structured scale, and the degree of knowledge through parameter or "rubrics" methodology. A total of 320 questionnaires were given to 55 medical students (17 %); 45 pre-graduate medical interns (14 %); 118 medical residents (37 %) and 102 appointed physicians of different specialties (32 %). Self-perception of EBM: The majority of those surveyed (n = 274, 86 %) declared that they were very or moderately familiar with EBM. The great majority (n = 270, 84 %) believe that EBM is very important in clinical practice and 197 physicians (61 %) said that they implement it always or usually. The global index of self-perception was 75 %. Knowledge of EBM: Definition of EBM; Seven of those surveyed (2 %) included 3 of the 4 characteristics of the definition, 82 (26 %) mentioned only two characteristics of the definition, 152 (48 %) mentioned only one characteristic and 79 (25 %) did not include any characteristic of EBM. Phases of the EBM process: The majority of those surveyed (n = 218, 68 %) did not include the steps that characterize the practice of EBM, of which 79 participants (25 %) mentioned elements not related to it. The global index of knowledge was 19 %. The majority of the surveyed physicians have a high self-perception of the relevance of EBM. In spite of this, the majority of them did not know the characteristics that define the EBM and phases of the process for its practice. A major discrepancy was found between self-perception and the level of basic knowledge of EBM among the surveyed physicians.

Effective or just practical? An evaluation of an online postgraduate module on evidence-based medicine (EBM).

PubMed

Rohwer, Anke; Young, Taryn; van Schalkwyk, Susan

2013-05-27

Teaching the steps of evidence-based medicine (EBM) to undergraduate as well as postgraduate health care professionals is crucial for implementation of effective, beneficial health care practices and abandonment of ineffective, harmful ones. Stellenbosch University in Cape Town, South Africa, offers a 12-week, completely online module on EBM within the Family Medicine division, to medical specialists in their first year of training. The aim of this study was to formatively evaluate this module; assessing both the mode of delivery; as well as the perceived effectiveness and usefulness thereof. We used mixed methods to evaluate this module: A document review to assess whether the content of the module reflects important EBM competencies; a survey of the students to determine their experiences of the module; and semi-structured interviews with the tutors to explore their perspectives of the module. Ethics approval was obtained. The document review indicated that EBM competencies were covered adequately, although critical appraisal only focused on randomised controlled trials and guidelines. Students had a positive attitude towards the module, but felt that they needed more support from the tutors. Tutors felt that students engaged actively in discussions, but experienced difficulties with understanding certain concepts of EBM. Furthermore, they felt that it was challenging explaining these via the online learning platform and saw the need to incorporate more advanced technology to better connect with the students. In their view the key to successful learning of EBM was to keep it relevant and applicable to everyday practice. Tutors also felt that an online module on EBM was advantageous, since doctors from all over the world were able to participate. Our study has shown that the online module on EBM was effective in increasing EBM knowledge and skills of postgraduate students and was well received by both students and tutors. Students and tutors experienced generic challenges that accompany any educational intervention of EBM (e.g. understanding difficult concepts), but in addition had to deal with challenges unique to the online learning environment. Teachers of EBM should acknowledge these so as to enhance and successfully implement EBM teaching and learning for all students.

The role of librarians in teaching evidence-based medicine to pediatric residents: a survey of pediatric residency program directors.

PubMed

Boykan, Rachel; Jacobson, Robert M

2017-10-01

The research sought to identify the general use of medical librarians in pediatric residency training, to define the role of medical librarians in teaching evidence-based medicine (EBM) to pediatric residents, and to describe strategies and curricula for teaching EBM used in pediatric residency training programs. We sent a 13-question web-based survey through the Association of Pediatric Program Directors to 200 pediatric residency program directors between August and December 2015. A total of 91 (46%) pediatric residency program directors responded. Most (76%) programs had formal EBM curricula, and more than 75% of curricula addressed question formation, searching, assessment of validity, generalizability, quantitative importance, statistical significance, and applicability. The venues for teaching EBM that program directors perceived to be most effective included journal clubs (84%), conferences (44%), and morning report (36%). While 80% of programs utilized medical librarians, most of these librarians assisted with scholarly or research projects (74%), addressed clinical questions (62%), and taught on any topic not necessarily EBM (58%). Only 17% of program directors stated that librarians were involved in teaching EBM on a regular basis. The use of a librarian was not associated with having an EBM curriculum but was significantly associated with the size of the program. Smaller programs were more likely to utilize librarians (100%) than were medium (71%) or large programs (75%). While most pediatric residency programs have an EBM curriculum and engage medical librarians in various ways, librarians' expertise in teaching EBM is underutilized. Programs should work to better integrate librarians' expertise, both in the didactic and clinical teaching of EBM.

Evidence-Based Medicine Curriculum Improves Pediatric Emergency Fellows' Scores on In-Training Examinations.

PubMed

Tavarez, Melissa M; Kenkre, Tanya S; Zuckerbraun, Noel

2017-05-30

The aim of this study was to determine if implementation of our evidence-based medicine (EBM) curriculum had an effect on pediatric emergency medicine fellows' scores on the relevant section of the in-training examination (ITE). We obtained deidentified subscores for 22 fellows over 6 academic years for the Core Knowledge in Scholarly Activities (SA) and, as a balance measure, Emergencies Treated Medically sections. We divided the subscores into the following 3 instruction periods: "baseline" for academic years before our current EBM curriculum, "transition" for academic years with use of a research method curriculum with some overlapping EBM content, and "EBM" for academic years with our current EBM curriculum. We analyzed data using the Kruskal-Wallis test, the Mann-Whitney U test, and multivariate mixed-effects linear models. The SA subscore median was higher during the EBM period in comparison with the baseline and transition periods. In contrast, the Emergencies Treated Medically subscore median was similar across instruction periods. Multivariate modeling demonstrated that our EBM curriculum had the following independent effects on the fellows' SA subscore: (1) in comparison with the transition period, the fellows' SA subscore was 21 percentage points higher (P = 0.005); and (2) in comparison to the baseline period, the fellows' SA subscore was 28 percentage points higher during the EBM curriculum instruction period (P < 0.001). Our EBM curriculum was associated with significantly higher scores on the SA section of the ITE. Pediatric emergency medicine educators could consider using fellows' scores on this section of the ITE to assess the effect of their EBM curricula.

Teaching evidence-based medicine more effectively.

PubMed

Hatmi, Zinat Nadia; Tahvildari, Sousan; Dabiran, Soheila; Soheili, Suraya; Sabouri Kashani, Ahmad; Raznahan, Maedeh

2010-01-01

Evidence-based Medicine (EBM) is becoming an integral component of graduate medical education competency and a requirement for grad medical education practice-based learning core competency. This study tries to compare the efficacy of conferences utilizing small-group discussions with the traditional conference method in enhancing EBM competency. The participants in this randomized controlled trial (RCT) were 170 members of the medical faculty who were divided into two groups of 86 (intervention) and 84 (control). Following the intervention, EBM competency was assessed by a written examination. statistical analysis made use of chi-square test, independent sample t-test and relative risks for univariate analysis. Mantel-Hanszel was used for bivariate analysis. Cox proportional hazard models were used to evaluate multivariate-adjusted associations between EBM educational intervention and EBM knowledge, attitude and skills. A new indicator of number needed to intervention (NNI) was defined and computed. The results proved conference along with small-group discussion to be a more effective teaching method with P=0.001 on knowledge, P<0.001 for attitude and skills P<0.001 in an EBM exam when compared with medical faculty members who did not participate in EBM educational intervention (n=84). Moreover, they had also increased confidence with critical appraisal skills, and searching EBM resources. Conferences followed by small-group discussions significantly enhance EBM knowledge, attitude, critical appraisal skills and literature review skills.

Micro- to Macroroughness of Additively Manufactured Titanium Implants in Terms of Coagulation and Contact Activation.

PubMed

Klingvall Ek, Rebecca; Hong, Jaan; Thor, Andreas; Bäckström, Mikael; Rännar, Lars-Erik

This study aimed to evaluate how as-built electron beam melting (EBM) surface properties affect the onset of blood coagulation. The properties of EBM-manufactured implant surfaces for placement have, until now, remained largely unexplored in literature. Implants with conventional designs and custom-made implants have been manufactured using EBM technology and later placed into the human body. Many of the conventional implants used today, such as dental implants, display modified surfaces to optimize bone ingrowth, whereas custom-made implants, by and large, have machined surfaces. However, titanium in itself demonstrates good material properties for the purpose of bone ingrowth. Specimens manufactured using EBM were selected according to their surface roughness and process parameters. EBM-produced specimens, conventional machined titanium surfaces, as well as PVC surfaces for control were evaluated using the slide chamber model. A significant increase in activation was found, in all factors evaluated, between the machined samples and EBM-manufactured samples. The results show that EBM-manufactured implants with as-built surfaces augment the thrombogenic properties. EBM that uses Ti6Al4V powder appears to be a good manufacturing solution for load-bearing implants with bone anchorage. The as-built surfaces can be used "as is" for direct bone contact, although any surface treatment available for conventional implants can be performed on EBM-manufactured implants with a conventional design.

[From library to clinical decision support systems: access of general practitioner to quality information].

PubMed

Fauquert, B

2012-09-01

Since 2003, the following tools have been implemented in Belgium for improving the access of general practioners to the EBM literature: the Digital Library for Health and the evidence-linker of the CEBAM, the portal EBMPracticeNet.be and the multidimensional electronic clinical decision support EBMeDS. The aim of this article is to show the progress achieved in the information dissemination toward the belgian general practioners, particularly the access from the electronic health record. From the literature published these last years, the opportunities cited by the users are for using EBM and the strong willingness for using these literature access in the future; the limits are the medical data coding, the irrelevance of the search results, the alerts fatigue induced by EBMeDS. The achievements done and planned for the new EBMPracticeNet guidelines portal and the EBMeDS system are explained in the aim of informing belgian healthcare professionals. These projects are claiming for lauching a participatory process in the production and dissemination of EBM information. The discussion is focused on the belgian healthcare system advantages, the solutions for a reasonable implementation of these projects and for increasing the place of an evidence-based information in the healthcare decision process. Finally the input of these projects to the continuing medical education and to the healthcare quality are discussed, in a context of multifactorial interaction healthcare design (complexity design).

Clinical Teachers' Attitudes toward the Efficacy of Evidence-Based Medicine Workshop and Self-Reported Ability in Evidence-Based Practice in Iran

ERIC Educational Resources Information Center

Kouhpayehzadeh, Jalil; Baradaran, Hamid; Arabshahi, Kamran Soltani; Knill-Jones, Robin

2006-01-01

Introduction: Evidence-based medicine (EBM) has been introduced in medical schools worldwide, but there is little known about effective methods for teaching EBM skills, particularly in developing countries. This study assesses the impact of an EBM workshop on clinical teachers' attitudes and use of EBM skills. Methods: Seventy-two clinical…

Evidence-based medicine: what has happened in the past 50 years?

PubMed

Mellis, Craig

2015-01-01

Although the phrase 'evidence-based medicine' (EBM) was used for the first time in the medical literature less than 25 years ago, the history of EBM goes back for centuries. What is remarkable is how popular and how globally accepted the EBM movement has become in such a short time. Many famous, past clinicians have played major roles in the disciplines that preceded EBM, particularly 'clinical epidemiology'. It soon became clear to the early EBM champions that 'evidence' was only part of the clinical decision-making process. Consequently, both clinical expertise and the patient's values and preferences were rapidly incorporated into the concept we now know as 'EBM'. The current need for high-quality, easily accessible 'evidence-based summaries' for busy clinicians is now apparent, as traditional EBM requires both considerable time and skill. Consequently, there is a progressive move away from the primary literature (such as randomised controlled trials) to systematic reviews and other 'evidence-based summaries'. The future of EBM will almost certainly involve widespread utilisation of 'clinical (computer)-based decision support systems'. © 2014 The Author. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Teaching evidence-based medicine using a problem-oriented approach.

PubMed

Hosny, Somaya; Ghaly, Mona S

2014-04-01

Faculty of Medicine, Suez Canal University is adopting an innovative curriculum. Evidence-based medicine (EBM) has been integrated into problem based learning (PBL) sessions as a responsive innovative paradigm for the practice and teaching of clinical medicine. To integrate EBM in the problem based sessions of the sixth-year students, and to assess students' and tutor satisfaction with this change. EBM training was conducted for sixth-year students (196) including four theoretical, and eight practical sessions. Sixteen EBM educational scenarios (problems) were formulated, according to sixth-year curriculum. Each problem was discussed in two sessions through steps of EBM, namely: formulating PICO questions, searching for and appraising evidence, applying the evidence to the clinical scenario and analysing the practice. Students and tutors satisfaction were evaluated using a 3-point ratings questionnaire. The majority of students and faculty expressed their satisfaction about integrating EBM with PBL and agreed that the problems were more stimulating. However, 33.6% of students indicated that available time was insufficient for searching literatures. Integrating EBM into PBL sessions tends to be more interesting and stimulating than traditional PBL sessions for final year students and helps them to practice and implement EBM in clinical context.

Evidence-based medicine and the development of medical libraries in China.

PubMed

Huang, Michael Bailou; Cheng, Aijun; Ma, Lu

2009-07-01

This article elaborates on the opportunities and challenges that evidence-based medicine (EBM) has posed to the development of medical libraries and summarizes the research in the field of evidence-based medicine and achievements of EBM practice in Chinese medical libraries. Issues such as building collections of information resources, transformation of information services models, human resources management, and training of medical librarians, clinicians, and EBM users are addressed. In view of problems encountered in EBM research and practice, several suggestions are made about important roles medical libraries can play in the future development of EBM in China.

A model structure for an EBM program in a multihospital system.

PubMed

Schumacher, Dale N; Stock, Joseph R; Richards, Joan K

2003-01-01

Evidence-based medicine (EBM) offers a great opportunity to translate advances in medical science into advances in clinical practice. We describe the structure of a comprehensive EBM program in a multihospital community teaching system. This EBM model is distinct and separate from the peer review process and has achieved substantial physician involvement. The program emanates from the Board of Directors Quality of Care Committee and has strong administrative support. The approach relies extensively on physician involvement and expert physician panels to enhance existing EBM practice guidelines, with an explicit strategy of performance reports and feedback.

Bone marrow-on-a-chip replicates hematopoietic niche physiology in vitro.

PubMed

Torisawa, Yu-suke; Spina, Catherine S; Mammoto, Tadanori; Mammoto, Akiko; Weaver, James C; Tat, Tracy; Collins, James J; Ingber, Donald E

2014-06-01

Current in vitro hematopoiesis models fail to demonstrate the cellular diversity and complex functions of living bone marrow; hence, most translational studies relevant to the hematologic system are conducted in live animals. Here we describe a method for fabricating 'bone marrow-on-a-chip' that permits culture of living marrow with a functional hematopoietic niche in vitro by first engineering new bone in vivo, removing it whole and perfusing it with culture medium in a microfluidic device. The engineered bone marrow (eBM) retains hematopoietic stem and progenitor cells in normal in vivo-like proportions for at least 1 week in culture. eBM models organ-level marrow toxicity responses and protective effects of radiation countermeasure drugs, whereas conventional bone marrow culture methods do not. This biomimetic microdevice offers a new approach for analysis of drug responses and toxicities in bone marrow as well as for study of hematopoiesis and hematologic diseases in vitro.

The Mastery Rubric for Evidence-Based Medicine: Institutional Validation via Multidimensional Scaling.

PubMed

Tractenberg, Rochelle E; Gushta, Matthew M; Weinfeld, Jeffrey M

2016-01-01

CONSTRUCT: In this study we describe a multidimensional scaling (MDS) exercise to validate the curricular elements composing a new Mastery Rubric (MR) for a curriculum in evidence-based medicine (EBM). This MR-EBM comprises 10 elements of knowledge, skills, and abilities (KSAs) representing our institutional learning goals of career-spanning engagement with EBM. An MR also includes developmental trajectories for each KSA, beginning with medical school coursework, including residency training, and outlining the qualifications of individuals to teach and mentor in EBM. The development was not part of the validation effort, as our curriculum is focused at a single stage (undergraduate medical students). An MR comprises the desired KSAs for an entire curriculum, together with descriptions of a learner's performance and/or capabilities as they develop from novice to proficiency of the curricular target(s). The MR construct is intended to support curriculum development or refinement by capturing the KSAs that support the articulation of concrete learning goals; it also promotes assessment that demonstrates development in the target KSAs and encourages reflection and self-directed learning throughout the learner's career. Two other MRs have been published, and this is the first one specific to teaching and learning in medicine; this is also the first one created specifically to evaluate an existing curriculum. To validate the dispersion of the elements of the EBM curriculum, the nine clinical instructors in the EBM two-course curriculum completed an MDS exercise, rating the similarities of the 10 curricular elements. MDS is a mathematical approach to understanding relationships among concepts/objects when these relationships are difficult to quantify. Eliciting similarity ratings biased the responses toward the null hypothesis (that the elements are not different). MDS results suggested that the MR represents 10 different, although related, facets of the construct "evidence-based medicine." The results support the makeup of the MR-EBM, and its use to revise our EBM curriculum so that it is more closely aligned with this MR. An MR is a tool, and the MR-EBM that we describe can be useful to develop or evaluate a curriculum in EBM. The MR tool is particularly compatible with the objectives of training for EBM and practice and can be applied to create or evaluate a curriculum using any topical KSA framework. The MR-EBM we describe could be adopted or adapted to represent other institutional objectives for EBM training.

Maintenance of a bone collagen phenotype by osteoblast-like cells in 3D periodic porous titanium (Ti-6Al-4 V) structures fabricated by selective electron beam melting

PubMed Central

Hrabe, Nikolas W.; Heinl, Peter; Bordia, Rajendra K.; Körner, Carolin; Fernandes, Russell J.

2013-01-01

Regular 3D periodic porous Ti-6Al-4 V structures were fabricated by the selective electron beam melting method (EBM) over a range of relative densities (0.17–0.40) and pore sizes (500–1500 μm). Structures were seeded with human osteoblast-like cells (SAOS-2) and cultured for four weeks. Cells multiplied within these structures and extracellular matrix collagen content increased. Type I and type V collagens typically synthesized by osteoblasts were deposited in the newly formed matrix with time in culture. High magnification scanning electron microscopy revealed cells attached to surfaces on the interior of the structures with an increasingly fibrous matrix. The in-vitro results demonstrate that the novel EBM-processed porous structures, designed to address the effect of stress-shielding, are conducive to osteoblast attachment, proliferation and deposition of a collagenous matrix characteristic of bone. PMID:23869614

Evidence-based medicine for every day, everyone, and every therapeutic study.

PubMed

Govindarajan, Raghav; Narayanaswami, Pushpa

2018-04-17

The rapid growth in published medical literature makes it difficult for clinicians to keep up with advances in their fields. This may result in a cursory scan of the abstract and conclusion of a study without critically evaluating study quality. The application of evidence-based medicine (EBM) is the process of converting the abstract task of reading the literature into a practical method of using the literature to inform care in a specific clinical context while simultaneously expanding one's knowledge. EBM involves 4 steps: (1) stating the clinical problem in a defined question; (2) searching the literature for the evidence; (3) critically appraising the evidence for its validity; and (4) applying the evidence in the context of the patient's situation, preferences, and values. In this review, we use the recently published trial of thymectomy in myasthenia gravis as an example and systematically go through the steps of assessing internal validity, precision, and external validity. Muscle Nerve, 2018. © 2018 Wiley Periodicals, Inc.

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

PubMed Central

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

2013-01-01

Clinical scientists are at the unique interface between laboratory science and frontline clinical practice for supporting clinical partnerships for evidence-based practice. In an era of molecular diagnostics and personalised medicine, evidence-based laboratory practice (EBLP) is also crucial in aiding clinical scientists to keep up-to-date with this expanding knowledge base. However, there are recognised barriers to the implementation of EBLP and its training. The aim of this review is to provide a practical summary of potential strategies for training clinician-scientists of the next generation. Current evidence suggests that clinically integrated evidence-based medicine (EBM) training is effective. Tailored e-learning EBM packages and evidence-based journal clubs have been shown to improve knowledge and skills of EBM. Moreover, e-learning is no longer restricted to computer-assisted learning packages. For example, social media platforms such as Twitter have been used to complement existing journal clubs and provide additional post-publication appraisal information for journals. In addition, the delivery of an EBLP curriculum has influence on its success. Although e-learning of EBM skills is effective, having EBM trained teachers available locally promotes the implementation of EBM training. Training courses, such as Training the Trainers, are now available to help trainers identify and make use of EBM training opportunities in clinical practice. On the other hand, peer-assisted learning and trainee-led support networks can strengthen self-directed learning of EBM and research participation among clinical scientists in training. Finally, we emphasise the need to evaluate any EBLP training programme using validated assessment tools to help identify the most crucial ingredients of effective EBLP training. In summary, we recommend on-the-job training of EBM with additional focus on overcoming barriers to its implementation. In addition, future studies evaluating the effectiveness of EBM training should use validated outcome tools, endeavour to achieve adequate power and consider the effects of EBM training on learning environment and patient outcomes. PMID:24151345

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

PubMed

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

2013-08-01

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

Why is there variation in the practice of evidence-based medicine in primary care? A qualitative study

PubMed Central

Hisham, Ranita; Ng, Chirk Jenn; Liew, Su May; Hamzah, Nurazira; Ho, Gah Juan

2016-01-01

Objective To explore the factors, including barriers and facilitators, influencing the practice of evidence-based medicine (EBM) across various primary care settings in Malaysia based on the doctors’ views and experiences. Research design The qualitative study was used to answer the research question. 37 primary care physicians participated in six focus group discussions and six individual in-depth interviews. A semistructured topic guide was used to facilitate both the interviews and focus groups, which were audio recorded, transcribed verbatim, checked and analysed using a thematic approach. Participants 37 primary care doctors including medical officers, family medicine specialists, primary care lecturers and general practitioners with different working experiences and in different settings. Setting The study was conducted across three primary care settings—an academic primary care practice, private and public health clinics in Klang Valley, Malaysia. Results The doctors in this study were aware of the importance of EBM but seldom practised it. Three main factors influenced the implementation of EBM in the doctors’ daily practice. First, there was a lack of knowledge and skills in searching for and applying evidence. Second, workplace culture influenced doctors’ practice of EBM. Third, some doctors considered EBM as a threat to good clinical practice. They were concerned that rigid application of evidence compromised personalised patient care and felt that EBM did not consider the importance of clinical experience. Conclusions Despite being aware of and having a positive attitude towards EBM, doctors in this study seldom practised EBM in their routine clinical practice. Besides commonly cited barriers such as having a heavy workload and lack of training, workplace ‘EBM culture’ had an important influence on the doctors’ behaviour. Strategies targeting barriers at the practice level should be considered when implementing EBM in primary care. PMID:26962037

Ecosystem Based Management in Transition: From Ocean Policy to Application

NASA Astrophysics Data System (ADS)

Saumweber, W. J.; Goldman, E.

2016-02-01

Ecosystem-based management (EBM) has been proposed as a means to improve resource management and stewardship for more than two decades. Over this history, its exact goals and approaches have evolved in concert with advances in science and policy, including a greater understanding of ecosystem function, valuation, and thresholds for change, along with direct reference to EBM principles in statute, regulation, and other Executive Actions. Most recently, and explicitly, the Administration's National Ocean Policy (NOP) called for the development of a Federal EBM framework that would outline principles and guidelines for implementing EBM under existing authorities. This cross-agency framework has yet to be developed, but, the NOP, and related Administration initiatives, have resulted in the practical application of EBM principles in several issue-specific policy initiatives ranging from fisheries and marine protected area management to coastal adaptation and water resource infrastructure investment. In each case, the application of EBM principles uses apparently unique policy mechanisms (e.g. marine planning, ecosystem services assessment, adaptive management, dynamic ocean management, etc.). Despite differences in terminology and policy context, each of these policy initiatives is linked at its core to concepts of integrated and adaptive management that consider broad ecosystem function and services. This practical history of EBM implementation speaks to both the challenges and opportunities in broad incorporation of EBM across diverse policy initiatives and frameworks. We suggest that the continued growth of EBM as a practical policy concept will require a move away from broad frameworks, and towards the identification of specific resource management issues and accompanying policy levers with which to address those issues. In order to promote this progression, Federal policy should recognize and articulate the diverse set of policy mechanisms encompassed under the rubric of EBM and seek to require similar approaches across the spectra of resource management issues.

Ecosystem Based Management in Transition: From Ocean Policy to Application

NASA Astrophysics Data System (ADS)

Saumweber, W. J.; Goldman, E.

2016-12-01

Ecosystem-based management (EBM) has been proposed as a means to improve resource management and stewardship for more than two decades. Over this history, its exact goals and approaches have evolved in concert with advances in science and policy, including a greater understanding of ecosystem function, valuation, and thresholds for change, along with direct reference to EBM principles in statute, regulation, and other Executive Actions. Most recently, and explicitly, the Administration's National Ocean Policy (NOP) called for the development of a Federal EBM framework that would outline principles and guidelines for implementing EBM under existing authorities. This cross-agency framework has yet to be developed, but, the NOP, and related Administration initiatives, have resulted in the practical application of EBM principles in several issue-specific policy initiatives ranging from fisheries and marine protected area management to coastal adaptation and water resource infrastructure investment. In each case, the application of EBM principles uses apparently unique policy mechanisms (e.g. marine planning, ecosystem services assessment, adaptive management, dynamic ocean management, etc.). Despite differences in terminology and policy context, each of these policy initiatives is linked at its core to concepts of integrated and adaptive management that consider broad ecosystem function and services. This practical history of EBM implementation speaks to both the challenges and opportunities in broad incorporation of EBM across diverse policy initiatives and frameworks. We suggest that the continued growth of EBM as a practical policy concept will require a move away from broad frameworks, and towards the identification of specific resource management issues and accompanying policy levers with which to address those issues. In order to promote this progression, Federal policy should recognize and articulate the diverse set of policy mechanisms encompassed under the rubric of EBM and seek to require similar approaches across the spectra of resource management issues.

The role of librarians in teaching evidence-based medicine to pediatric residents: a survey of pediatric residency program directors

PubMed Central

Boykan, Rachel; Jacobson, Robert M.

2017-01-01

Objective: The research sought to identify the general use of medical librarians in pediatric residency training, to define the role of medical librarians in teaching evidence-based medicine (EBM) to pediatric residents, and to describe strategies and curricula for teaching EBM used in pediatric residency training programs. Methods: We sent a 13-question web-based survey through the Association of Pediatric Program Directors to 200 pediatric residency program directors between August and December 2015. Results: A total of 91 (46%) pediatric residency program directors responded. Most (76%) programs had formal EBM curricula, and more than 75% of curricula addressed question formation, searching, assessment of validity, generalizability, quantitative importance, statistical significance, and applicability. The venues for teaching EBM that program directors perceived to be most effective included journal clubs (84%), conferences (44%), and morning report (36%). While 80% of programs utilized medical librarians, most of these librarians assisted with scholarly or research projects (74%), addressed clinical questions (62%), and taught on any topic not necessarily EBM (58%). Only 17% of program directors stated that librarians were involved in teaching EBM on a regular basis. The use of a librarian was not associated with having an EBM curriculum but was significantly associated with the size of the program. Smaller programs were more likely to utilize librarians (100%) than were medium (71%) or large programs (75%). Conclusions: While most pediatric residency programs have an EBM curriculum and engage medical librarians in various ways, librarians’ expertise in teaching EBM is underutilized. Programs should work to better integrate librarians’ expertise, both in the didactic and clinical teaching of EBM. PMID:28983199

Early Introduction of an Evidence-based Medicine Course to Preclinical Medical Students

PubMed Central

Srinivasan, Malathi; Weiner, Michael; Breitfeld, Philip P; Brahmi, Fran; Dickerson, Keith L; Weiner, Gary

2002-01-01

Evidence-based Medicine (EBM) has been increasingly integrated into medical education curricula. Using an observational research design, we evaluated the feasibility of introducing a 1-month problem-based EBM course for 139 first-year medical students at a large university center. We assessed program performance through the use of a web-based curricular component and practice exam, final examination scores, student satisfaction surveys, and a faculty questionnaire. Students demonstrated active involvement in learning EBM and ability to use EBM principles. Facilitators felt that students performed well and compared favorably with residents whom they had supervised in the past year. Both faculty and students were satisfied with the EBM course. To our knowledge, this is the first report to demonstrate that early introduction of EBM principles as a short course to preclinical medical students is feasible and practical. PMID:11903776

Engaging Australian physicians in evidence-based medicine: a representative national survey.

PubMed

Toulkidis, V; Donnelly, N J; Ward, J E

2005-01-01

To assess Australian adult physicians' views about evidence-based medicine (EBM) and quality improvement (QI). Cross-sectional postal survey of two hundred and forty-four randomly selected Australian physicians (78.5% response rate). Physicians' views about the promotion of EBM and QI and their impact on patient care, strategies to support better clinical practice and self-reported understanding of EBM terms. Sixty-eight per cent (95% confidence interval (CI): 62-74%) of physicians had a positive view of the current promotion of EBM in Australia. Significantly fewer (45%; 95% CI: 38-51%) were so positive about QI (P <0.001). Although 74% (95% CI: 68-79%) indicated that EBM improves patient care, significantly fewer (46%; 95% CI: 40-53%) held this view with respect to QI (P <0.001). Although 70% (95% CI: 64-76%) of physicians agreed they had adequate skills to search for evidence, significantly fewer (21%; 95% CI: 17-27%) agreed they had sufficient time to do so (P <0.001). EBM skills were positively associated with involvement in teaching. Physicians were significantly more positive about approaches exclusive to themselves compared with those involving other disciplines. Although Australian physicians have positive views of EBM, QI appears less well regarded. Initiatives to improve quality and safety that incorporate principles and language of EBM will likely be received better by physicians than isolated QI. Further enhancement of EBM requires concomitant attention to physician training, workplace infrastructure and supportive professional development.

Evidence-based Medicine in Facial Plastic Surgery: Current State and Future Directions.

PubMed

Dedhia, Raj; Hsieh, Tsung-Yen; Tollefson, Travis T; Ishii, Lisa E

2016-08-01

Evidence-based medicine (EBM) encompasses the evaluation and application of best available evidence, incorporation of clinical experience, and emphasis on patient preference and values. Different scales are used to rate levels of evidence. Translating available data for interventions to clinical practice guidelines requires an assessment of both the quality of evidence and the strength of recommendation. Essential to the practice of EBM is evaluating the effectiveness of an intervention through outcome measures. This article discusses principles essential to EBM, resources commonly used in EBM practice, and the strengths and limitations of EBM in facial plastic and reconstructive surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Who's afraid of EBM? Medical professionalism from the perspective of evidence-based medicine.

PubMed

Salloch, Sabine

2017-03-01

Evidence-based medicine (EBM) and medical professionalism are two prominent notions in current medical debates. However, proponents of professionalism fear a restriction in doctors' freedom to make their best decisions for individual patients caused by the influence of EBM and highly standardised decision procedures. The challenge which EBM allegedly poses to physicians' discretion forms the starting point for an analysis of the relationship between professionalism, as an inherent value system of medical practice, and EBM, as an approach to optimise the decision-making for individual patients. The analysis starts with a brief conceptual clarification of the ambiguous term "professionalism". It then focuses on three key aspects of medical professionalism which may come into conflict with the basic tenets of EBM. The potential tensions between (a) professional autonomy and clinical practice guidelines, (b) individualised care and standardisation, and (c) esoteric authority and public accountability are analysed and a suggestion for reconcilement regarding each point is made. The article closes with a summary on how a better reflection on medical professionalism may help towards a fuller understanding of EBM and vice versa.

Developing and using a rubric for evaluating evidence-based medicine point-of-care tools.

PubMed

Shurtz, Suzanne; Foster, Margaret J

2011-07-01

The research sought to establish a rubric for evaluating evidence-based medicine (EBM) point-of-care tools in a health sciences library. The authors searched the literature for EBM tool evaluations and found that most previous reviews were designed to evaluate the ability of an EBM tool to answer a clinical question. The researchers' goal was to develop and complete rubrics for assessing these tools based on criteria for a general evaluation of tools (reviewing content, search options, quality control, and grading) and criteria for an evaluation of clinical summaries (searching tools for treatments of common diagnoses and evaluating summaries for quality control). Differences between EBM tools' options, content coverage, and usability were minimal. However, the products' methods for locating and grading evidence varied widely in transparency and process. As EBM tools are constantly updating and evolving, evaluation of these tools needs to be conducted frequently. Standards for evaluating EBM tools need to be established, with one method being the use of objective rubrics. In addition, EBM tools need to provide more information about authorship, reviewers, methods for evidence collection, and grading system employed.

Teaching evidence-based medicine: a regional dissemination model.

PubMed

Leipzig, Rosanne M; Wallace, Eleanor Z; Smith, Lawrence G; Sullivant, Jean; Dunn, Kathel; McGinn, Thomas

2003-01-01

Evidence-based medicine (EBM) is a framework for critically appraising medical literature and applying it to the care of individual patients. Lack of faculty skilled in practicing and teaching EBM limits the ability to train residents in this area. A 31/2-day interactive course, called Teaching Evidence-Based Medicine, was given in 1996, 1998, and 1999. The goal of the course was to create a cadre of faculty within New York State's internal medicine residency programs educated in EBM knowledge and skills who could integrate EBM into their training program. Thirty (58.8%) of 51 metropolitan New York internal medicine residency programs and three of 12 upstate programs sent participants. The postcourse ratings showed increased self-rated knowledge and a willingness to apply the teaching methods at their home institutions. There is a high demand for the opportunity to learn EBM skills and in turn to implement EBM at home institutions

Underdetermination in evidence-based medicine.

PubMed

Chin-Yee, Benjamin H

2014-12-01

This article explores the philosophical implications of evidence-based medicine's (EBM's) epistemology in terms of the problem of underdetermination of theory by evidence as expounded by the Duhem-Quine thesis. EBM hierarchies of evidence privilege clinical research over basic science, exacerbating the problem of underdetermination. Because of severe underdetermination, EBM is unable to meaningfully test core medical beliefs that form the basis of our understanding of disease and therapeutics. As a result, EBM adopts an epistemic attitude that is sceptical of explanations from the basic biological sciences, and is relegated to a view of disease at a population level. EBM's epistemic attitude provides a limited research heuristic by preventing the development of a theoretical framework required for understanding disease mechanism and integrating knowledge to develop new therapies. Medical epistemology should remain pluralistic and include complementary approaches of basic science and clinical research, thus avoiding the limited epistemic attitude entailed by EBM hierarchies. © 2014 John Wiley & Sons, Ltd.

Developing an integrated evidence-based medicine curriculum for family medicine residency at the University of Alberta.

PubMed

Allan, G Michael; Korownyk, Christina; Tan, Amy; Hindle, Hugh; Kung, Lina; Manca, Donna

2008-06-01

There is general consensus in the academic community that evidence-based medicine (EBM) teaching is essential. Unfortunately, many postgraduate programs have significant weakness in their EBM programs. The Family Medicine Residency committee at the University of Alberta felt their EBM curriculum would benefit from critical review and revision. An EBM Curriculum Committee was created to evaluate previous components and develop new strategies as needed. Input from stakeholders including faculty and residents was sought, and evidence regarding the teaching and practical application of EBM was gathered. The committee drafted goals and objectives, the primary of which were to assist residents to (1) become competent self-directed, lifelong learners with skills to effectively and efficiently keep up to date, and 2) develop EBM skills to solve problems encountered in daily practice. New curriculum components, each evidence based, were introduced in 2005 and include a family medicine EBM workshop to establish basic EBM knowledge; a Web-based Family Medicine Desktop promoting easier access to evidence-based Internet resources; a brief evidence-based assessment of the research project enhancing integration of EBM into daily practice; and a journal club to support peer learning and growth of rapid appraisal skills. Issues including time use, costs, and change management are discussed. Ongoing evaluation of the curriculum and its components is a principal factor of the design, allowing critical review and adaptation of the curriculum. The first two years of the curriculum have yielded positive feedback from faculty and statistically significant improvement in multiple areas of residents' opinions of the curriculum and comfort with evidence-based practice.

[Evidence-based medicine--method, critical appraisal and usefulness for professionalized business practice in medical].

PubMed

Portwich, P

2005-05-01

The concept of evidence-based medicine (EBM) describes 5 steps that lead to a scientifically based solution of clinical problems. EBM is often reduced to the search for the best evidence (randomised controlled trials, meta-analyses) or the introduction of guidelines. This causes criticism and may have consequences for medicine. But EBM also emphasizes the so-called clinical expertise of the doctor, which is important for reference to the individual patient. This point of EBM is being developed further. Connected with the theory of professionalization by U. Oevermann, stressing the importance of hermeneutical competence, EBM turns out to be a sophisticated model of professional medical practice.

Barriers to GPs' use of evidence-based medicine: a systematic review

PubMed Central

Zwolsman, Sandra; te Pas, Ellen; Hooft, Lotty; Waard, Margreet Wieringa-de; van Dijk, Nynke

2012-01-01

Background GPs report various barriers to the use and practice of evidence-based medicine (EBM). A review of research on these barriers may help solve problems regarding the uptake of evidence in clinical outpatient practice. Aim To determine the barriers encountered by GPs in the practice of EBM and to come up with solutions to the barriers identified. Design A systematic review of the literature. Method The following databases were searched: MEDLINE® (PubMed®), Embase, CINAHL®, ERIC, and the Cochrane Library, until February 2011. Primary studies (all methods, all languages) that explore the barriers that GPs encounter in the practice of EBM were included. Results A total of 14 700 articles were identified, of which 22 fulfilled all inclusion criteria. Of the latter, nine concerned qualitative, 12 concerned quantitative, and one concerned both qualitative and quantitative research methods. The barriers described in the articles cover the categories: evidence (including the accompanying EBM steps), the GP’s preferences (experience, expertise, education), and the patient’s preferences. The particular GP setting also has important barriers to the use of EBM. Barriers found in this review, among others, include lack of time, EBM skills, and available evidence; patient-related factors; and the attitude of the GP. Conclusion Various barriers are encountered when using EBM in GP practice. Interventions that help GPs to overcome these barriers are needed, both within EBM education and in clinical practice. PMID:22781999

Evidence-based medicine in HBP surgery: Is there any?

PubMed Central

Thorlacius, Henrik

2005-01-01

Background. Evidence-based medicine (EBM) has become widely accepted as a basis for clinical decision in many fields of medicine. This review examines the specific role of EBM in hepato-biliary and pancreatic (HBP) surgery. EBM relies on four main sources, including clinical guidelines, meta-analyses, primary information and clinical experience. Randomized controlled trials (RCTs) constitute the cornerstone of EBM and a recent study reported that there are relatively few RCTs evaluating the effectiveness of surgical therapies and procedures (1,530 out of 45,342 or 3.4% in five leading surgical journals) and only a few in HBP surgery. Although the effort must be to implement EBM as far as possible in HBP surgery, there are several obstacles to conducting RCTs in HBP surgery, including problems associated with standardization of surgical skills, sham-operations often impossible to perform, and the general applicability of specific findings may be uncertain. Discussion. This paper will provide two relevant examples of EBM in HBP surgery in patients with hepatic metastases and pancreatic adenocarcinoma, illustrating some problems but also the potential of introducing EBM in HBP surgery. In the future, our effort must be devoted to implementing EBM in applicable areas of HBP surgery but also remembering that in certain areas accumulated knowledge from observational studies, including drainage of abscesses and surgical treatment of intestinal obstruction, may have similar or even higher clinical value than RCTs. PMID:18333189

Electron beam mask writer EBM-9500 for logic 7nm node generation

NASA Astrophysics Data System (ADS)

Matsui, Hideki; Kamikubo, Takashi; Nakahashi, Satoshi; Nomura, Haruyuki; Nakayamada, Noriaki; Suganuma, Mizuna; Kato, Yasuo; Yashima, Jun; Katsap, Victor; Saito, Kenichi; Kobayashi, Ryoei; Miyamoto, Nobuo; Ogasawara, Munehiro

2016-10-01

Semiconductor scaling is slowing down because of difficulties of device manufacturing below logic 7nm node generation. Various lithography candidates which include ArF immersion with resolution enhancement technology (like Inversed Lithography technology), Extreme Ultra Violet lithography and Nano Imprint lithography are being developed to address the situation. In such advanced lithography, shot counts of mask patterns are estimated to increase explosively in critical layers, and then it is hoped that multi beam mask writer (MBMW) is released to handle them within realistic write time. However, ArF immersion technology with multiple patterning will continue to be a mainstream lithography solution for most of the layers. Then, the shot counts in less critical layers are estimated to be stable because of the limitation of resolution in ArF immersion technology. Therefore, single beam mask writer (SBMW) can play an important role for mask production still, relative to MBMW. Also the demand of SBMW seems actually strong for the logic 7nm node. To realize this, we have developed a new SBMW, EBM-9500 for mask fabrication in this generation. A newly introduced electron beam source enables higher current density of 1200A/cm2. Heating effect correction function has also been newly introduced to satisfy the requirements for both pattern accuracy and throughput. In this paper, we will report the configuration and performance of EBM-9500.

Health care professionals' attitudes towards evidence-based medicine in the workers' compensation setting: a cohort study.

PubMed

Elbers, Nieke A; Chase, Robin; Craig, Ashley; Guy, Lyn; Harris, Ian A; Middleton, James W; Nicholas, Michael K; Rebbeck, Trudy; Walsh, John; Willcock, Simon; Lockwood, Keri; Cameron, Ian D

2017-05-22

Problems may arise during the approval process of treatment after a compensable work injury, which include excess paperwork, delays in approving services, disputes, and allegations of over-servicing. This is perceived as undesirable for injured people, health care professionals and claims managers, and costly to the health care system, compensation system, workplaces and society. Introducing an Evidence Based Medicine (EBM) decision tool in the workers' compensation system could provide a partial solution, by reducing uncertainty about effective treatment. The aim of this study was to investigate attitudes of health care professionals (HCP) to the potential implementation of an EBM tool in the workers' compensation setting. The study has a mixed methods design. The quantitative study consisted of an online questionnaire asking about self-reported knowledge, attitudes and behaviour to EBM in general. The qualitative study consisted of interviews about an EBM tool being applied in the workers' compensation process. Participants were health care practitioners from different clinical specialties. They were recruited through the investigators' clinical networks and the workers' compensation government regulator's website. Participants completing the questionnaire (n = 231) indicated they were knowledgeable about the evidence-base in their field, but perceived some difficulties when applying EBM. General practitioners reported having the greatest obstacles to applying EBM. Participants who were interviewed (n = 15) perceived that an EBM tool in the workers' compensation setting could potentially have some advantages, such as reducing inappropriate treatment, or over-servicing, and providing guidance for clinicians. However, participants expressed substantial concerns that the EBM tool would not adequately reflect the impact of psychosocial factors on recovery. They also highlighted a lack of timeliness in decision making and proper assessment, particularly in pain management. Overall, HCP are supportive of EBM, but have strong concerns about implementation of EBM based decision making in the workers' compensation setting. The participants felt that an EBM tool should not be applied rigidly and should take into account clinical judgement and patient variability and preferences. In general, the treatment approval process in the workers' compensation insurance system is a sensitive area, in which the interaction between HCP and claims managers can be improved.

Evidence-based surgery: knowledge, attitudes, and perceived barriers among surgical trainees.

PubMed

Mittal, Rohin; Perakath, Benjamin

2010-01-01

This study was conducted to assess the knowledge and attitude of surgical trainees toward evidence-based medicine (EBM) and their perceived barriers to its practice. The McColl questionnaire and the BARRIERS scale were modified and incorporated into a single questionnaire, which was administered to all surgical trainees attending a Continuing Surgical Education meeting. Department of Surgery, Christian Medical College, Vellore, India. One hundred ten surgical trainees from 22 medical colleges. In all, 84.5% (93/110) trainees returned the questionnaire. The attitudes toward EBM were welcoming, although individual participants reported they welcomed EBM more than their colleagues did. Participants agreed that EBM was useful in everyday practice and that it improved patient care. About 50% of actual practice was considered evidence based. In all, 12.6% (10/89) of participants had received formal training in EBM, and 64.3% (54/84) of participants were aware of the Cochrane database of systemic reviews, but only 35.7% (30/84) read it regularly. Also, 67.8% (61/90) of respondents used protocols and guidelines developed by colleagues. However, 61.5% (56/91) of participants were interested in learning the skills of EBM. The terms absolute risk, relative risk, and clinical effectiveness were understood by >80% of respondents, whereas publication bias, confidence interval, and heterogeneity were poorly understood. The major barriers to practice of EBM were the inability to understand statistical analysis, inadequate facilities for implementation, lack of a single compiled source of literature, relevant literature not being readily available, and insufficient time on the job. Surgical trainees have a positive attitude towards EBM and have some familiarity with the common terms used in EBM. There is a need to increase awareness of, and provide access to, available sources of medical literature. Formal training in EBM, as well as basic statistical analysis, should form a part of the surgical curriculum to foster an environment favorable to the practice of EBM. Copyright © 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

A real-world approach to Evidence-Based Medicine in general practice: a competency framework derived from a systematic review and Delphi process.

PubMed

Galbraith, Kevin; Ward, Alison; Heneghan, Carl

2017-05-03

Evidence-Based Medicine (EBM) skills have been included in general practice curricula and competency frameworks. However, GPs experience numerous barriers to developing and maintaining EBM skills, and some GPs feel the EBM movement misunderstands, and threatens their traditional role. We therefore need a new approach that acknowledges the constraints encountered in real-world general practice. The aim of this study was to synthesise from empirical research a real-world EBM competency framework for general practice, which could be applied in training, in the individual pursuit of continuing professional development, and in routine care. We sought to integrate evidence from the literature with evidence derived from the opinions of experts in the fields of general practice and EBM. We synthesised two sets of themes describing the meaning of EBM in general practice. One set of themes was derived from a mixed-methods systematic review of the literature; the other set was derived from the further development of those themes using a Delphi process among a panel of EBM and general practice experts. From these two sets of themes we constructed a real-world EBM competency framework for general practice. A simple competency framework was constructed, that acknowledges the constraints of real-world general practice: (1) mindfulness - in one's approach towards EBM itself, and to the influences on decision-making; (2) pragmatism - in one's approach to finding and evaluating evidence; and (3) knowledge of the patient - as the most useful resource in effective communication of evidence. We present a clinical scenario to illustrate how a GP might demonstrate these competencies in their routine daily work. We have proposed a real-world EBM competency framework for general practice, derived from empirical research, which acknowledges the constraints encountered in modern general practice. Further validation of these competencies is required, both as an educational resource and as a strategy for actual practice.

EBM regeneration and changes in EBM component mRNA expression in stromal cells after corneal injury

PubMed Central

Santhanam, Abirami; Marino, Gustavo K.; Torricelli, Andre A. M.

2017-01-01

Purpose To investigate the production of the epithelial basement membrane (EBM) component mRNAs at time points before lamina lucida and lamina densa regeneration in anterior stromal cells after corneal injury that would heal with and without fibrosis. Methods Rabbit corneas were removed from 2 to 19 days after −4.5D or −9.0D photorefractive keratectomy (PRK) with the VISX S4 IR laser. Corneas were evaluated with transmission electron microscopy (TEM) for full regeneration of the lamina lucida and the lamina densa. Laser capture microdissection (LCM) based quantitative real-time (RT)–PCR was used to quantitate the expression of mRNAs for laminin α-3 (LAMA3), perlecan, nidogen-1, and nidogen-2 in the anterior stroma. Results After −4.5D PRK, EBM was found to be fully regenerated at 8 to 10 days after surgery. At 4 days after PRK, the nidogen-2 and LAMA3 mRNAs levels were detected at statistically significantly lower levels in the anterior stroma of the −9.0D PRK corneas (where the EBM would not fully regenerate) compared to the −4.5D PRK corneas (where the EBM was destined to fully regenerate). At 7 days after PRK, nidogen-2 and LAMA3 mRNAs continued to be statistically significantly lower in the anterior stroma of the −9.0D PRK corneas compared to their expression in the anterior stroma of the −4.5D PRK corneas. Conclusions Key EBM components LAMA3 and nidogen-2 mRNAs are expressed at higher levels in the anterior stroma during EBM regeneration in the −4.5D PRK corneas where the EBM is destined to fully regenerate and no haze developed compared to the −9.0D PRK corneas where the EBM will not fully regenerate and myofibroblast-related stromal fibrosis (haze) will develop. PMID:28275314

Developing and using a rubric for evaluating evidence-based medicine point-of-care tools

PubMed Central

Foster, Margaret J

2011-01-01

Objective: The research sought to establish a rubric for evaluating evidence-based medicine (EBM) point-of-care tools in a health sciences library. Methods: The authors searched the literature for EBM tool evaluations and found that most previous reviews were designed to evaluate the ability of an EBM tool to answer a clinical question. The researchers' goal was to develop and complete rubrics for assessing these tools based on criteria for a general evaluation of tools (reviewing content, search options, quality control, and grading) and criteria for an evaluation of clinical summaries (searching tools for treatments of common diagnoses and evaluating summaries for quality control). Results: Differences between EBM tools' options, content coverage, and usability were minimal. However, the products' methods for locating and grading evidence varied widely in transparency and process. Conclusions: As EBM tools are constantly updating and evolving, evaluation of these tools needs to be conducted frequently. Standards for evaluating EBM tools need to be established, with one method being the use of objective rubrics. In addition, EBM tools need to provide more information about authorship, reviewers, methods for evidence collection, and grading system employed. PMID:21753917

History and development of evidence-based medicine.

PubMed

Claridge, Jeffrey A; Fabian, Timothy C

2005-05-01

This article illustrates the timeline of the development of evidence-based medicine (EBM). The term "evidence-based medicine" is relatively new. In fact, as far as we can tell, investigators from McMaster's University began using the term during the 1990s. EBM was defined as "a systemic approach to analyze published research as the basis of clinical decision making." Then in 1996, the term was more formally defined by Sacket et al., who stated that EBM was "the conscientious and judicious use of current best evidence from clinical care research in the management of individual patients." Ancient era EBM consists of ancient historical or anecdotal accounts of what may be loosely termed EBM. This was followed by the development of the renaissance era of EBM, which began roughly during the seventeenth century. During this era personal journals were kept and textbooks began to become more prominent. This was followed by the 1900s, during an era we term the transitional era of EBM (1900-1970s). Knowledge during this era could be shared more easily in textbooks and eventually peer-reviewed journals. Finally, during the 1970s we enter the modern era of EBM. Technology has had a large role in the advancement of EBM. Computers and database software have allowed compilation of large amounts of data. The Index Medicus has become a medical dinosaur of the past that students of today likely do not recognize. The Internet has also allowed incredible access to masses of data and information. However, we must be careful with an overabundance of "unfiltered" data. As history, as clearly shown us, evidence and data do not immediately translate into evidence based practice.

A clinically integrated curriculum in Evidence-based Medicine for just-in-time learning through on-the-job training: The EU-EBM project

PubMed Central

Coppus, Sjors FPJ; Emparanza, Jose I; Hadley, Julie; Kulier, Regina; Weinbrenner, Susanne; Arvanitis, Theodoros N; Burls, Amanda; Cabello, Juan B; Decsi, Tamas; Horvath, Andrea R; Kaczor, Marcin; Zanrei, Gianni; Pierer, Karin; Stawiarz, Katarzyna; Kunz, Regina; Mol, Ben WJ; Khan, Khalid S

2007-01-01

Background Over the last years key stake holders in the healthcare sector have increasingly recognised evidence based medicine (EBM) as a means to improving the quality of healthcare. However, there is considerable uncertainty about the best way to disseminate basic knowledge of EBM. As a result, huge variation in EBM educational provision, setting, duration, intensity, content, and teaching methodology exists across Europe and worldwide. Most courses for health care professionals are delivered outside the work context ('stand alone') and lack adaptation to the specific needs for EBM at the learners' workplace. Courses with modern 'adaptive' EBM teaching that employ principles of effective continuing education might fill that gap. We aimed to develop a course for post-graduate education which is clinically integrated and allows maximum flexibility for teachers and learners. Methods A group of experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions from eight European countries participated. We used an established methodology of curriculum development to design a clinically integrated EBM course with substantial components of e-learning. An independent European steering committee provided input into the process. Results We defined explicit learning objectives about knowledge, skills, attitudes and behaviour for the five steps of EBM. A handbook guides facilitator and learner through five modules with clinical and e-learning components. Focussed activities and targeted assignments round off the learning process, after which each module is formally assessed. Conclusion The course is learner-centred, problem-based, integrated with activities in the workplace and flexible. When successfully implemented, the course is designed to provide just-in-time learning through on-the-job-training, with the potential for teaching and learning to directly impact on practice. PMID:18042271

A clinically integrated curriculum in evidence-based medicine for just-in-time learning through on-the-job training: the EU-EBM project.

PubMed

Coppus, Sjors F P J; Emparanza, Jose I; Hadley, Julie; Kulier, Regina; Weinbrenner, Susanne; Arvanitis, Theodoros N; Burls, Amanda; Cabello, Juan B; Decsi, Tamas; Horvath, Andrea R; Kaczor, Marcin; Zanrei, Gianni; Pierer, Karin; Stawiarz, Katarzyna; Kunz, Regina; Mol, Ben W J; Khan, Khalid S

2007-11-27

Over the last years key stake holders in the healthcare sector have increasingly recognised evidence based medicine (EBM) as a means to improving the quality of healthcare. However, there is considerable uncertainty about the best way to disseminate basic knowledge of EBM. As a result, huge variation in EBM educational provision, setting, duration, intensity, content, and teaching methodology exists across Europe and worldwide. Most courses for health care professionals are delivered outside the work context ('stand alone') and lack adaptation to the specific needs for EBM at the learners' workplace. Courses with modern 'adaptive' EBM teaching that employ principles of effective continuing education might fill that gap. We aimed to develop a course for post-graduate education which is clinically integrated and allows maximum flexibility for teachers and learners. A group of experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions from eight European countries participated. We used an established methodology of curriculum development to design a clinically integrated EBM course with substantial components of e-learning. An independent European steering committee provided input into the process. We defined explicit learning objectives about knowledge, skills, attitudes and behaviour for the five steps of EBM. A handbook guides facilitator and learner through five modules with clinical and e-learning components. Focussed activities and targeted assignments round off the learning process, after which each module is formally assessed. The course is learner-centred, problem-based, integrated with activities in the workplace and flexible. When successfully implemented, the course is designed to provide just-in-time learning through on-the-job-training, with the potential for teaching and learning to directly impact on practice.

Evidence-based medicine training in a resource-poor country, the importance of leveraging personal and institutional relationships

PubMed Central

Tomatis, Cristina; Taramona, Claudia; Rizo-Patrón, Emiliana; Hernández, Fiorela; Rodríguez, Patricia; Piscoya, Alejandro; Gonzales, Elsa; Gotuzzo, Eduardo; Heudebert, Gustavo; Centor, Robert M.; Estrada, Carlos A.

2011-01-01

Rationale, aims and objectives Efforts to implement evidence-based medicine (EBM) training in developing countries are limited. We describe the results of an international effort to improve research capacity in a developing country; we conducted a course aimed at improving basic EBM attitudes and identified challenges. Method Between 2005 and 2009, we conducted an annual 3-day course in Perú consisting of interactive lectures and case-based workshops. We assessed self-reported competence and importance in EBM using a Likert scale (1 = low, 5 = high). Results Totally 220 clinicians participated. For phase I (2005–2007), self-reported EBM competence increased from a median of 2 to 3 (P < 0.001) and the perceived importance of EBM did not change (median = 5). For phase II (2008–2009), before the course, 8–72% graded their competence very low (score of 1–2). After the course, 67–92% of subjects graded their increase in knowledge very high (score of 4–5). The challenges included limited availability of studies relevant to the local reality written in Spanish, participants’ limited time and lack of long-term follow-up on practice change. Informal discussion and written evaluation from participants were universally in agreement that more training in EBM is needed. Conclusions In an EBM course in a resource-poor country, the baseline self-reported competence and experience on EBM were low, and the course had measurable improvements of self-reported competence, perceived utility and readiness to incorporate EBM into their practices. Similar to developed countries, translational research and building the research capacity in developing countries is critical for translating best available evidence into practice. PMID:21276140

Effectiveness of national evidence-based medicine competition in Taiwan

PubMed Central

2013-01-01

Background Competition and education are intimately related and can be combined in many ways. The role of competition in medical education of evidence-based medicine (EBM) has not been investigated. In order to enhance the dissemination and implementation of EBM in Taiwan, EBM competitions have been established among healthcare professionals. This study was to evaluate the impact of competition in EBM learning. Methods The EBM competition used PICO (patient, intervention, comparison, and outcome) queries to examine participants’ skills in framing an answerable question, literature search, critical appraisal and clinical application among interdisciplinary teams. A structured questionnaire survey was conducted to investigate EBM among participants in the years of 2009 and 2011. Participants completed a baseline questionnaire survey at three months prior to the competition and finished the same questionnaire right after the competition. Results Valid questionnaires were collected from 358 participants, included 162 physicians, 71 nurses, 101 pharmacists, and 24 other allied healthcare professionals. There were significant increases in participants’ knowledge of and skills in EBM (p < 0.001). Their barriers to literature searching and forming answerable questions significantly decreased (p < 0.01). Furthermore, there were significant increases in their access to the evidence-based retrieval databases, including the Cochrane Library (p < 0.001), MD Consult (p < 0.001), ProQuest (p < 0.001), UpToDate (p = 0.001), CINAHL (p = 0.001), and MicroMedex (p = 0.024). Conclusions The current study demonstrates a method that successfully enhanced the knowledge of, skills in, and behavior of EBM. The data suggest competition using PICO queries may serve as an effective way to facilitate the learning of EBM. PMID:23651869

In vitro cytotoxicity and surface topography evaluation of additive manufacturing titanium implant materials.

PubMed

Tuomi, Jukka T; Björkstrand, Roy V; Pernu, Mikael L; Salmi, Mika V J; Huotilainen, Eero I; Wolff, Jan E H; Vallittu, Pekka K; Mäkitie, Antti A

2017-03-01

Custom-designed patient-specific implants and reconstruction plates are to date commonly manufactured using two different additive manufacturing (AM) technologies: direct metal laser sintering (DMLS) and electron beam melting (EBM). The purpose of this investigation was to characterize the surface structure and to assess the cytotoxicity of titanium alloys processed using DMLS and EBM technologies as the existing information on these issues is scarce. "Processed" and "polished" DMLS and EBM disks were assessed. Microscopic examination revealed titanium alloy particles and surface flaws on the processed materials. These surface flaws were subsequently removed by polishing. Surface roughness of EBM processed titanium was higher than that of DMLS processed. The cytotoxicity results of the DMLS and EBM discs were compared with a "gold standard" commercially available titanium mandible reconstruction plate. The mean cell viability for all discs was 82.6% (range, 77.4 to 89.7) and 83.3% for the control reconstruction plate. The DMLS and EBM manufactured titanium plates were non-cytotoxic both in "processed" and in "polished" forms.

False dichotomies: EBM, clinical freedom, and the art of medicine.

PubMed

Parker, M

2005-06-01

According to numerous commentators, clinical freedom, the art of medicine, and, by implication, a degree of patient welfare, are threatened by evidence based medicine (EBM). As EBM has developed over the last fifteen years, claims about better evidence for medical treatments, and improvements in healthcare delivery, have been matched by critiques of EBM's reductionism and uniformity, its problematic application to individual patients, and its alleged denial of the continuing need for clinical interpretation, insight, and judgment. Most of these attacks on EBM and defences of clinical freedom fail. They are based on erroneous understandings of the relationships between inductive knowledge, clinical uncertainty, and action. Evidence based medicine is a necessary condition for clinical freedom, not a threat to it, and EBM is not something to be balanced with either clinical experience or patient preferences. The art and science of medicine are more conceptually and practically connected than the defenders of clinical freedom, whatever they conceive that to be, are willing to admit.

[Does evidence-b(i)ased psychiatry have its limitations?].

PubMed

Vandenberghe, J

2008-01-01

Evidence-based medicine (EBM) is an algorithm that integrates information technology and the results of outcome research into clinical work. EBM, if well understood, is a valuable and critical bottom-up method that promotes a dialectical process by which the practitioner is able to arrive at an informed treatment choice; the method starts from the individual patient and involves discussion with the patient and critical reading of the relevant literature. However, there is a risk that EBM will become an ideology unless we are aware of its assumptions and epistemology. It is not valuefree, but is driven by an implicit objectivist view of man. EBM attaches greater value to biomedical sciences that to the humanities, to empiricism than to hermeneutics and to quantitative research than to qualitative research. EBM focuses on internal validity, but is in danger of neglecting factors such as qualitative changes that are difficult to measure, ecological validity and effectiveness and may hinder the generalisation of research results to clinical practice. The limitations of EBM are even more poignant in psychiatry, because psychiatry is highly sensitive to context and values. EBM is a blessing if we use it critically and remain aware of its limitations and underlying philosophy and if we supplement it with strategies such as value-based medicine (VBM). EBM, however, does not teach us what is useful or valuable, whereas VBM helps us to explain and weigh up the values that are at stake.

[Alternative medicines and "Evidence-Based Medicine" a possible reconciliation?].

PubMed

Vanherweghem, J-L

2015-09-01

The contrast between the efficiency of Evidence-Based Medicine (EBM), a scientific fact, and the popularity of Complementary and Alternative Medicines (CAM) is a paradox of the art of healing. EBM is based on the paradigm of positivism and materialism while CAM are based on those of relativism and vitalism. These paradigms are diametrically opposed and the aim of an integrative medicine is aporetic. However, EBM is today in a dead end. The objective proof of a disease according to the rules of EBM is often lacking face to the expectations of patients demanding their illness to be taken into account. EBM and CAM have thus to coexist. Lessons can be drawn from CAM : patient expectations should be given a meaning and be integrated in his or her psychosocial context.

In vitro dermal and epidermal cellular response to titanium alloy implants fabricated with electron beam melting.

PubMed

Springer, Jessica Collins; Harrysson, Ola L A; Marcellin-Little, Denis J; Bernacki, Susan H

2014-10-01

Transdermal osseointegrated prostheses (TOPs) are emerging as an alternative to socket prostheses. Electron beam melting (EBM) is a promising additive manufacturing technology for manufacture of custom, freeform titanium alloy (Ti6Al4V) implants. Skin ongrowth for infection resistance and mechanical stability are critically important to the success of TOP, which can be influenced by material composition and surface characteristics. We assessed viability and proliferation of normal human epidermal keratinocytes (NHEK) and normal human dermal fibroblasts (NHDF) on several Ti6Al4V surfaces: solid polished commercial, solid polished EBM, solid unpolished EBM and porous unpolished EBM. Cell proliferation was evaluated at days 2 and 7 using alamarBlue(®) and cell viability was analyzed with a fluorescence-based live-dead assay after 1 week. NHDF and NHEK were viable and proliferated on all Ti6Al4V surfaces. NHDF proliferation was highest on commercial and EBM polished surfaces. NHEK was highest on commercial polished surfaces. All EBM Ti6Al4V discs exhibited an acceptable biocompatibility profile compared to solid Ti6Al4V discs from a commercial source for dermal and epidermal cells. EBM may be considered as an option for fabrication of custom transdermal implants. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

The design, fate and impact of a hospital-wide training program in evidence-based medicine for physicians - an observational study.

PubMed

Thor, Johan; Olsson, Daniel; Nordenström, Jörgen

2016-03-08

Many doctors fail to practice Evidence-Based Medicine (EBM) effectively, in part due to insufficient training. We report on the design, fate and impact of a short learner-centered EBM train-the-trainer program aimed at all 2400 doctors at the Karolinska University Hospital in Sweden on the heels of a tumultuous merger, focusing particularly on whether it affected the doctors' knowledge, attitudes and skills regarding EBM. We used a validated EBM instrument in a before-and-after design to assess the impact of the training. Changes in responses were analyzed at the individual level using the Wilcoxon matched pairs test. We also reviewed documentation from the program - including the modular EBM training schedule and the template for participants' Critically Appraised Topic reports - to describe the training's content, design, conduct, and fate. The training, designed to be delivered in modules of 45 min totaling 1.5 days, failed to reach most doctors at the hospital, due to cost cutting pressures and competing demands. Among study participants (n = 174), many reported suboptimal EBM knowledge and skills before the training. Respondents' strategies for solving clinical problems changed after the training: the proportion of respondents reporting to use (or intend to use) secondary sources "Often/very often" changed from 5 % before the training to 76 % after the training; in parallel, reliance on textbooks and on colleagues fell (48 to 23 % and 79 to 65 %, respectively). Participants' confidence in assessing scientific articles increased and their attitudes toward EBM became more positive. The proportion of correct answers in the EBM knowledge test increased from 52 to 71 %. All these changes were statistically significant at p < 0.05. Many study participants, despite working at a university hospital, lacked basic EBM knowledge and skills and used the scientific literature suboptimally. The kind of short learner-centered EBM training evaluated here brought significant improvements among the minority of hospital doctors who were able to participate and, if applied widely, could contribute to better, safer and more cost-effective care.

Strategy for Texture Management in Metals Additive Manufacturing

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

Kirka, Michael M.; Lee, Yousub; Greeley, Duncan A.

Additive manufacturing (AM) technologies have long been recognized for their ability to fabricate complex geometric components directly from models conceptualized through computers, allowing for complicated designs and assemblies to be fabricated at lower costs, with shorter time to market, and improved function. Lacking behind the design complexity aspect is the ability to fully exploit AM processes for control over texture within AM components. Currently, standard heat-fill strategies utilized in AM processes result in largely columnar grain structures. Here, we propose a point heat source fill for the electron beam melting (EBM) process through which the texture in AM materials canmore » be controlled. Using this point heat source strategy, the ability to form either columnar or equiaxed grain structures upon solidification through changes in the process parameters associated with the point heat source fill is demonstrated for the nickel-base superalloy, Inconel 718. Mechanically, the material is demonstrated to exhibit either anisotropic properties for the columnar-grained material fabricated through using the standard raster scan of the EBM process or isotropic properties for the equiaxed material fabricated using the point heat source fill.« less

Strategy for Texture Management in Metals Additive Manufacturing

DOE PAGES

Kirka, Michael M.; Lee, Yousub; Greeley, Duncan A.; ...

2017-01-31

Additive manufacturing (AM) technologies have long been recognized for their ability to fabricate complex geometric components directly from models conceptualized through computers, allowing for complicated designs and assemblies to be fabricated at lower costs, with shorter time to market, and improved function. Lacking behind the design complexity aspect is the ability to fully exploit AM processes for control over texture within AM components. Currently, standard heat-fill strategies utilized in AM processes result in largely columnar grain structures. Here, we propose a point heat source fill for the electron beam melting (EBM) process through which the texture in AM materials canmore » be controlled. Using this point heat source strategy, the ability to form either columnar or equiaxed grain structures upon solidification through changes in the process parameters associated with the point heat source fill is demonstrated for the nickel-base superalloy, Inconel 718. Mechanically, the material is demonstrated to exhibit either anisotropic properties for the columnar-grained material fabricated through using the standard raster scan of the EBM process or isotropic properties for the equiaxed material fabricated using the point heat source fill.« less

How to confidently teach EBM on foot: development and evaluation of a web-based e-learning course.

PubMed

Weberschock, Tobias; Sorinola, Olanrewaju; Thangaratinam, Shakila; Oude Rengerink, Katrien; Arvanitis, Theodoros N; Khan, Khalid S

2013-10-01

Scarcity of well-trained clinical tutors is a key constraint in integrating teaching of evidence-based medicine (EBM) into clinical activities. We developed a web-based educational course for clinical trainers to confidently teach EBM principles in everyday practice. Its e-learning modules defined the learning objectives and incorporated video clips of practical and effective EBM teaching methods for exploiting educational opportunities in six different clinical settings. We evaluated the course with clinical tutors in different specialties across six European countries using a questionnaire to capture learning achievement against preset objectives. Among 56 tutors, 47 participants (84%) improved their scores from baseline. The mean pre-course score was 69.2 (SD=10.4), which increased to 77.3 (SD=11.7) postcourse (p<0.0001). The effect size was moderate with a Cohen's d of 0.73. An e-learning approach incorporating videos of applied EBM teaching and learning based on real clinical scenarios in the workplace can be useful in facilitating EBM teaching on foot. It can be integrated in the continuing professional development programmes for clinical trainers.

Evaluation of an Evidence-based Medicine Educational Program for Pharmacists and Pharmacy Students.

PubMed

Shimizu, Tadashi; Ueda, Masahiro; Toyoyama, Mikoto; Ohmori, Shiho; Takagaki, Nobumasa

2017-01-01

This study evaluated the effect of an evidence-based medicine (EBM) educational program on EBM-related knowledge and skills of pharmacists and pharmacy students. Our preliminary educational program included the following four sessions: 1) ice breaker, 2) formulation of answerable clinical questions from virtual clinical scenario using the PICO criteria, 3) critical appraisal of the literature using a checklist, and 4) critical appraisal of the results and integrating the evidence with experience and patients values. Change in knowledge and skills related to EBM were evaluated using pre- and post-seminar 4-point scale questionnaires comprising of 14 questions. A total of 23 pharmacists, 1 care manager, and 5 pharmacy students participated in our EBM educational seminar. Knowledge and skills related to several variables improved significantly post-seminar (pre-seminar 2.80 versus 3.26 post-seminar; p<0.001). Specifically, the skills of formulating answerable clinical questions from virtual clinical scenario and critical appraisal of the literature using a checklist improved. Our findings suggested that EBM educational program using problem-based learning was effective in improving EBM-related knowledge and skills of pharmacists and pharmacy students.

The judgement process in evidence-based medicine and health technology assessment.

PubMed

Kelly, Michael P; Moore, Tessa A

2012-02-01

This article describes the judgements used to interpret evidence in evidence-based medicine (EBM) and health technology assessment (HTA). It outlines the methods and processes of EBM and HTA. Respectively, EBM and HTA are approaches to medical clinical decision making and efficient allocation of scarce health resources. At the heart of both is a concern to review and synthesise evidence, especially evidence derived from randomised controlled trials (RCTs) of clinical effectiveness. The driver of the approach of both is a desire to eliminate, or at least reduce, bias. The hierarchy of evidence, which is used as an indicator of the likelihood of bias, features heavily in the process and methods of EBM and HTA. The epistemological underpinnings of EBM and HTA are explored with particular reference to the distinction between rationalism and empiricism, developed by the philosopher David Hume and elaborated by Immanuel Kant in the Critique of Pure Reason. The importance of Humian and Kantian principles for understanding the projects of EBM and HTA is considered and the ways in which decisions are made in both, within a judgemental framework originally outlined by Kant, are explored.

How to understand and conduct evidence-based medicine.

PubMed

Kang, Hyun

2016-10-01

Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions regarding the care of individual patients. This concept has gained popularity recently, and its applications have been steadily expanding. Nowadays, the term "evidence-based" is used in numerous situations and conditions, such as evidence-based medicine, evidence-based practice, evidence-based health care, evidence-based social work, evidence-based policy, and evidence-based education. However, many anesthesiologists and their colleagues have not previously been accustomed to utilizing EBM, and they have experienced difficulty in understanding and applying the techniques of EBM to their practice. In this article, the author discusses the brief history, definition, methods, and limitations of EBM. As EBM also involves making use of the best available information to answer questions in clinical practice, the author emphasizes the process of performing evidence-based medicine: generate the clinical question, find the best evidence, perform critical appraisal, apply the evidence, and then evaluate. Levels of evidence and strength of recommendation were also explained. The author expects that this article may be of assistance to readers in understanding, conducting, and evaluating EBM.

Evidence-based medicine and quality of care.

PubMed

Dickenson, Donna; Vineis, Paolo

2002-01-01

In this paper we set out to examine the arguments for and against the claim that Evidence-Based Medicine (EBM) will improve the quality of care. In particular, we examine the following issues: 1. Are there hidden ethical assumptions in the methodology of EBM? 2. Is there a tension between the duty of care and EBM? 3. How can patient preferences be incorporated into quality guidelines and effectiveness studies? 4. Is there a tension between the quality of a particular intervention and overall quality of care? 5. Are certain branches of medicine and patient groups innately or prima facie disadvantaged by a shift to EBM? In addition we consider a case study in the ethics of EBM, on a clinical trial concerning the collection of umbilical cord blood in utero and ex utero, during or after labour in childbirth.

Development and validation of the Evidence Based Medicine Questionnaire (EBMQ) to assess doctors' knowledge, practice and barriers regarding the implementation of evidence-based medicine in primary care.

PubMed

Hisham, Ranita; Ng, Chirk Jenn; Liew, Su May; Lai, Pauline Siew Mei; Chia, Yook Chin; Khoo, Ee Ming; Hanafi, Nik Sherina; Othman, Sajaratulnisah; Lee, Ping Yein; Abdullah, Khatijah Lim; Chinna, Karuthan

2018-06-23

Evidence-Based Medicine (EBM) integrates best available evidence from literature and patients' values, which then informs clinical decision making. However, there is a lack of validated instruments to assess the knowledge, practice and barriers of primary care physicians in the implementation of EBM. This study aimed to develop and validate an Evidence-Based Medicine Questionnaire (EBMQ) in Malaysia. The EBMQ was developed based on a qualitative study, literature review and an expert panel. Face and content validity was verified by the expert panel and piloted among 10 participants. Primary care physicians with or without EBM training who could understand English were recruited from December 2015 to January 2016. The EBMQ was administered at baseline and two weeks later. A higher score indicates better knowledge, better practice of EBM and less barriers towards the implementation of EBM. We hypothesized that the EBMQ would have three domains: knowledge, practice and barriers. The final version of the EBMQ consists of 80 items: 62 items were measured on a nominal scale, 22 items were measured on a 5 point Likert-scale. Flesch reading ease was 61.2. A total of 343 participants were approached; of whom 320 agreed to participate (response rate = 93.2%). Factor analysis revealed that the EBMQ had eight domains after 13 items were removed: "EBM websites", "evidence-based journals", "types of studies", "terms related to EBM", "practice", "access", "patient preferences" and "support". Cronbach alpha for the overall EBMQ was 0.909, whilst the Cronbach alpha for the individual domain ranged from 0.657-0.940. The EBMQ was able to discriminate between doctors with and without EBM training for 24 out of 42 items. At test-retest, kappa values ranged from 0.155 to 0.620. The EBMQ was found to be a valid and reliable instrument to assess the knowledge, practice and barriers towards the implementation of EBM among primary care physicians in Malaysia.

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

PubMed

Gaeta, Rodolfo; Gentile, Nelida

2016-08-01

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

School Funding in Ohio: From "DeRolph" to the Evidence-Based Model (EBM) and beyond

ERIC Educational Resources Information Center

Pittner, Nicholas A.; Carleton, Melissa M.; Casto, Cassandra

2010-01-01

Beginning in 1997, a series of Ohio Supreme Court decisions ruled that Ohio's school foundation-based funding system was unconstitutional. Despite judicially mandated reform directives, little change was made until recently when Ohio adopted a modified Evidence-Based Model (EBM) into its statutory funding scheme. Ohio's EBM is intended to remedy…

"Us and them": a social network analysis of physicians' professional networks and their attitudes towards EBM.

PubMed

Mascia, Daniele; Cicchetti, Americo; Damiani, Gianfranco

2013-10-22

Extant research suggests that there is a strong social component to Evidence-Based Medicine (EBM) adoption since professional networks amongst physicians are strongly associated with their attitudes towards EBM. Despite this evidence, it is still unknown whether individual attitudes to use scientific evidence in clinical decision-making influence the position that physicians hold in their professional network. This paper explores how physicians' attitudes towards EBM is related to the network position they occupy within healthcare organizations. Data pertain to a sample of Italian physicians, whose professional network relationships, demographics and work-profile characteristics were collected. A social network analysis was performed to capture the structural importance of physicians in the collaboration network by the means of a core-periphery analysis and the computation of network centrality indicators. Then, regression analysis was used to test the association between the network position of individual clinicians and their attitudes towards EBM. Findings documented that the overall network structure is made up of a dense cohesive core of physicians and of less connected clinicians who occupy the periphery. A negative association between the physicians' attitudes towards EBM and the coreness they exhibited in the professional network was also found. Network centrality indicators confirmed these results documenting a negative association between physicians' propensity to use EBM and their structural importance in the professional network. Attitudes that physicians show towards EBM are related to the part (core or periphery) of the professional networks to which they belong as well as to their structural importance. By identifying virtuous attitudes and behaviors of professionals within their organizations, policymakers and executives may avoid marginalization and stimulate integration and continuity of care, both within and across the boundaries of healthcare providers.

Research Trends in Evidence-Based Medicine: A Joinpoint Regression Analysis of More than 50 Years of Publication Data

PubMed Central

Hung, Bui The; Long, Nguyen Phuoc; Hung, Le Phi; Luan, Nguyen Thien; Anh, Nguyen Hoang; Nghi, Tran Diem; Van Hieu, Mai; Trang, Nguyen Thi Huyen; Rafidinarivo, Herizo Fabien; Anh, Nguyen Ky; Hawkes, David; Huy, Nguyen Tien; Hirayama, Kenji

2015-01-01

Background Evidence-based medicine (EBM) has developed as the dominant paradigm of assessment of evidence that is used in clinical practice. Since its development, EBM has been applied to integrate the best available research into diagnosis and treatment with the purpose of improving patient care. In the EBM era, a hierarchy of evidence has been proposed, including various types of research methods, such as meta-analysis (MA), systematic review (SRV), randomized controlled trial (RCT), case report (CR), practice guideline (PGL), and so on. Although there are numerous studies examining the impact and importance of specific cases of EBM in clinical practice, there is a lack of research quantitatively measuring publication trends in the growth and development of EBM. Therefore, a bibliometric analysis was constructed to determine the scientific productivity of EBM research over decades. Methods NCBI PubMed database was used to search, retrieve and classify publications according to research method and year of publication. Joinpoint regression analysis was undertaken to analyze trends in research productivity and the prevalence of individual research methods. Findings Analysis indicates that MA and SRV, which are classified as the highest ranking of evidence in the EBM, accounted for a relatively small but auspicious number of publications. For most research methods, the annual percent change (APC) indicates a consistent increase in publication frequency. MA, SRV and RCT show the highest rate of publication growth in the past twenty years. Only controlled clinical trials (CCT) shows a non-significant reduction in publications over the past ten years. Conclusions Higher quality research methods, such as MA, SRV and RCT, are showing continuous publication growth, which suggests an acknowledgement of the value of these methods. This study provides the first quantitative assessment of research method publication trends in EBM. PMID:25849641

Effectiveness of training in evidence-based medicine skills for healthcare professionals: a systematic review.

PubMed

Hecht, Lars; Buhse, Susanne; Meyer, Gabriele

2016-04-04

Basic skills in evidence-based medicine (EbM) are indispensable for healthcare professionals to promote consumer-centred, evidence-based treatment. EbM training courses are complex interventions - a fact that has not been methodologically reflected by previous systematic reviews. This review evaluates the effects of EbM training for healthcare professionals as well as the quality of reporting of such training interventions. We searched PubMed, EMBASE, CINAHL, Cochrane Library, ERIC, Campbell Library and PsycINFO up to 9/2014. Randomised controlled trials, controlled clinical trials as well as before-after trials were included. Authors were contacted in order to obtain missing data. Two independent reviewers extracted data and assessed risk of bias. We reviewed 14.507 articles; n = 61 appeared potentially eligible; n = 13 involving 1,120 participants were included. EbM training shows some impact on knowledge and skills, whereas the impact on practical EbM application remains unclear. Risk of bias of included trials raises uncertainty about the effects. Description of complex interventions was poor. EbM training has some positive effects on knowledge and skills of healthcare professionals. Appropriate methods for development, piloting, evaluation, reporting and implementation of the training should be applied.

Influence of Inherent Surface and Internal Defects on Mechanical Properties of Additively Manufactured Ti6Al4V Alloy: Comparison between Selective Laser Melting and Electron Beam Melting

PubMed Central

Fousová, Michaela; Vojtěch, Dalibor; Doubrava, Karel; Daniel, Matěj; Lin, Chiu-Feng

2018-01-01

Additive manufacture (AM) appears to be the most suitable technology to produce sophisticated, high quality, lightweight parts from Ti6Al4V alloy. However, the fatigue life of AM parts is of concern. In our study, we focused on a comparison of two techniques of additive manufacture—selective laser melting (SLM) and electron beam melting (EBM)—in terms of the mechanical properties during both static and dynamic loading. All of the samples were untreated to focus on the influence of surface condition inherent to SLM and EBM. The EBM samples were studied in the as-built state, while SLM was followed by heat treatment. The resulting similarity of microstructures led to comparable mechanical properties in tension, but, due to differences in surface roughness and specific internal defects, the fatigue strength of the EBM samples reached only half the value of the SLM samples. Higher surface roughness that is inherent to EBM contributed to multiple initiations of fatigue cracks, while only one crack initiated on the SLM surface. Also, facets that were formed by an intergranular cleavage fracture were observed in the EBM samples. PMID:29614712

The judgement process in evidence-based medicine and health technology assessment

PubMed Central

Kelly, Michael P; Moore, Tessa A

2012-01-01

This article describes the judgements used to interpret evidence in evidence-based medicine (EBM) and health technology assessment (HTA). It outlines the methods and processes of EBM and HTA. Respectively, EBM and HTA are approaches to medical clinical decision making and efficient allocation of scarce health resources. At the heart of both is a concern to review and synthesise evidence, especially evidence derived from randomised controlled trials (RCTs) of clinical effectiveness. The driver of the approach of both is a desire to eliminate, or at least reduce, bias. The hierarchy of evidence, which is used as an indicator of the likelihood of bias, features heavily in the process and methods of EBM and HTA. The epistemological underpinnings of EBM and HTA are explored with particular reference to the distinction between rationalism and empiricism, developed by the philosopher David Hume and elaborated by Immanuel Kant in the Critique of Pure Reason. The importance of Humian and Kantian principles for understanding the projects of EBM and HTA is considered and the ways in which decisions are made in both, within a judgemental framework originally outlined by Kant, are explored. PMID:23226973

Influence of Inherent Surface and Internal Defects on Mechanical Properties of Additively Manufactured Ti6Al4V Alloy: Comparison between Selective Laser Melting and Electron Beam Melting.

PubMed

Fousová, Michaela; Vojtěch, Dalibor; Doubrava, Karel; Daniel, Matěj; Lin, Chiu-Feng

2018-03-31

Additive manufacture (AM) appears to be the most suitable technology to produce sophisticated, high quality, lightweight parts from Ti6Al4V alloy. However, the fatigue life of AM parts is of concern. In our study, we focused on a comparison of two techniques of additive manufacture-selective laser melting (SLM) and electron beam melting (EBM)-in terms of the mechanical properties during both static and dynamic loading. All of the samples were untreated to focus on the influence of surface condition inherent to SLM and EBM. The EBM samples were studied in the as-built state, while SLM was followed by heat treatment. The resulting similarity of microstructures led to comparable mechanical properties in tension, but, due to differences in surface roughness and specific internal defects, the fatigue strength of the EBM samples reached only half the value of the SLM samples. Higher surface roughness that is inherent to EBM contributed to multiple initiations of fatigue cracks, while only one crack initiated on the SLM surface. Also, facets that were formed by an intergranular cleavage fracture were observed in the EBM samples.

Evidence-Based Medicine and the Practicing Clinician

PubMed Central

McAlister, Finlay A; Graham, Ian; Karr, Gerald W; Laupacis, Andreas

1999-01-01

OBJECTIVE To assess the attitudes of practicing general internists toward evidence-based medicine (EBM—defined as the process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions) and their perceived barriers to its use. DESIGN Cross-sectional, self-administered mail questionnaire conducted between June and October 1997. SETTING Canada. PARTICIPANTS Questionnaires were sent to all 521 physician members of the Canadian Society of Internal Medicine with Canadian mailing addresses; 296 (60%) of 495 eligible physicians responded. Exclusion of two incomplete surveys resulted in a final sample size of 294. MAIN RESULTS Mean age of respondents was 46 years, 80% were male, and 52% worked in large urban medical centers. Participants reported using EBM in their clinical practice always (33, 11%), often (173, 59%), sometimes (80, 27%), or rarely/never (8, 3%). There were no significant differences in demographics, training, or practice types or locales on univariate or multivariate analyses between those who reported using EBM often or always and those who did not. Both groups reported high usage of traditional (non-EBM) information sources: clinical experience (93%), review articles (73%), the opinion of colleagues (61%), and textbooks (45%). Only a minority used EBM-related information sources such as primary research studies (45%), clinical practice guidelines (27%), or Cochrane Collaboration Reviews (5%) on a regular basis. Barriers to the use of EBM cited by respondents included lack of relevant evidence (26%), newness of the concept (25%), impracticality for use in day-to-day practice (14%), and negative impact on traditional medical skills and “the art of medicine” (11%). Less than half of respondents were confident in basic skills of EBM such as conducting a literature search (46%) or evaluating the methodology of published studies (34%). However, respondents demonstrated a high level of interest in further education about these tasks. CONCLUSIONS The likelihood that physicians will incorporate EBM into their practice cannot be predicted by any demographic or practice-related factors. Even those physicians who are most enthusiastic about EBM rely more on traditional information sources than EBM-related sources. The most important barriers to increased use of EBM by practicing clinicians appear to be lack of knowledge and familiarity with the basic skills, rather than skepticism about the concept. PMID:10203636

[Radionuclide bone scan in patients with newly diagnosed prostate cancer. Clinical aspects and cost analysis].

PubMed

Klatte, T; Klatte, D; Böhm, M; Allhoff, E P

2006-10-01

The indication for a radionuclide bone scan in patients with newly diagnosed, untreated prostate cancer remains controversial. In this retrospective study we examined 406 patients who had received a staging bone scan irrespective of their PSA serum level and histology. We evaluated different guidelines and recommendations with respect to their usefulness. The costs were calculated according to EBM and GOA. We evaluated the classification systems of bone metastases according to Soloway, Crawford, and Rigaud. The bone scan was positive in 41 (10%) of 406 patients. The EAU guidelines turned out to be useful with respect to both clinical value and cost efficiency. The Rigaud classification of bone metastases predicted outcome better than the Soloway or Crawford classification. The EAU guidelines from 2005 are a useful tool to decide whether to perform a bone scan in patients with newly diagnosed, untreated prostate cancer. A bone scan should be performed if PSA levels exceed 20 ng/ml in patients with a G1/G2 histology, and in patients with G3 histology and locally advanced disease irrespective of PSA level. Bone scan metastases should be classified according to Rigaud.

An instrument to characterize the environment for residents' evidence-based medicine learning and practice.

PubMed

Mi, Misa; Moseley, James L; Green, Michael L

2012-02-01

Many residency programs offer training in evidence-based medicine (EBM). However, these curricula often fail to achieve optimal learning outcomes, perhaps because they neglect various contextual factors in the learning environment. We developed and validated an instrument to characterize the environment for EBM learning and practice in residency programs. An EBM Environment Scale was developed following scale development principles. A survey was administered to residents across six programs in primary care specialties at four medical centers. Internal consistency reliability was analyzed with Cronbach's coefficient alpha. Validity was assessed by comparing predetermined subscales with the survey's internal structure as assessed via factor analysis. Scores were also compared for subgroups based on residency program affiliation and residency characteristics. Out of 262 eligible residents, 124 completed the survey (response rate 47%). The overall mean score was 3.89 (standard deviation=0.56). The initial reliability analysis of the 48-item scale had a high reliability coefficient (Cronbach α=.94). Factor analysis and further item analysis resulted in a shorter 36-item scale with a satisfactory reliability coefficient (Cronbach α=.86). Scores were higher for residents with prior EBM training in medical school (4.14 versus 3.62) and in residency (4.25 versus 3.69). If further testing confirms its properties, the EBM Environment Scale may be used to understand the influence of the learning environment on the effectiveness of EBM training. Additionally, it may detect changes in the EBM learning environment in response to programmatic or institutional interventions.

Attitude, knowledge and behaviour towards evidence-based medicine of physical therapists, students, teachers and supervisors in the Netherlands: a survey.

PubMed

Scholten-Peeters, Gwendolijne G M; Beekman-Evers, Monique S; van Boxel, Annemiek C J W; van Hemert, Sjanna; Paulis, Winifred D; van der Wouden, Johannes C; Verhagen, Arianne P

2013-08-01

Evidence-based medicine (EBM) has gained widespread acceptance in physical therapy. However, because little is known about the attitudes, knowledge and behaviour of physical therapists towards EBM, and their participation in research to generate EBM, we explored these aspects among physical therapy students, teachers, supervisors and practising physical therapists. This is a cross-sectional survey in which participants completed a web-based questionnaire to determine their attitudes, knowledge and behaviour regarding EBM, and their participation in research. Questionnaires were sent to 814 participants of which 165 were returned. The overall mean score for attitude was 4.3 [standard deviation (SD) 1.0; range 1-7], which indicates a weak positive attitude. Teachers scored the highest (4.9, SD 1.2) and students the lowest (4.1, SD 0.8). Although most participants had some understanding of the technical terms used in EBM, only teachers felt able to explain these terms to others. Of the students, 45% rated their perceived EBM knowledge as bad and 45% as average, whereas 78% of the teachers considered that they had good knowledge. To answer clinical questions, most students generally use textbooks (96%) and the opinion of their supervisors (87.7%). There is a weak positive attitude of physical therapists, teachers, supervisors and students towards participating in research in general practice, but there is a lack of knowledge and active behaviour regarding EBM, especially among physical therapy students. © 2011 John Wiley & Sons Ltd.

Effectiveness of evidence-based medicine training for undergraduate students at a Chinese Military Medical University: a self-controlled trial.

PubMed

Ma, Xiangyu; Xu, Bin; Liu, Qingyun; Zhang, Yao; Xiong, Hongyan; Li, Yafei

2014-07-04

To evaluate the effect of the integration of evidence-based medicine (EBM) into medical curriculum by measuring undergraduate medical students' EBM knowledge, attitudes, personal application, and anticipated future use. A self-controlled trial was conducted with 251 undergraduate students at a Chinese Military Medical University, using a validated questionnaire regarding the students' evidence-based practice (EBP) about knowledge (EBP-K), attitude (EBP-A), personal application (EBP-P), and future anticipated use (EBP-F). The educational intervention was a 20-hour EBM course formally included in the university's medical curriculum, combining lectures with small group discussion and student-teacher exchange sessions. Data were analyzed using paired t-tests to test the significance of the difference between a before and after comparison. The difference between the pre- and post-training scores were statistically significant for EBP-K, EBP-A, EBP-P, and EBP-F. The scores for EBP-P showed the most pronounced percentage change after EBM training (48.97 ± 8.6%), followed by EBP-A (20.83 ± 2.1%), EBP-K (19.21 ± 3.2%), and EBP-F (17.82 ± 5.7%). Stratified analyses by gender, and program subtypes did not result in any significant changes to the results. The integration of EBM into the medical curriculum improved undergraduate medical students' EBM knowledge, attitudes, personal application, and anticipated future use. A well-designed EBM training course and objective outcome measurements are necessary to ensure the optimum learning opportunity for students.

Senior internal medicine residents' confidence with essential topics in evidence-based medicine taught during internship.

PubMed

Keddis, Mira T; Beckman, Thomas J; Cullen, Michael W; Reed, Darcy A; Halvorsen, Andrew J; Wittich, Christopher M; West, Colin P; McDonald, Furman S

2011-12-01

Few studies have examined residents' retained knowledge and confidence regarding essential evidence-based medicine (EBM) topics. To compare postgraduate year-3 (PGY-3) residents' confidence with EBM topics taught during internship with that of PGY-1 residents before and after exposure to an EBM curriculum. All residents participated in an EBM curriculum during their intern year. We surveyed residents in 2009. PGY-1 residents completed a Likert-scale type survey (which included questions from the validated Berlin questionnaire and others, developed based on input from local EBM experts). We administered the Berlin questionnaire to a subset of PGY-3 residents. Forty-five PGY-3 (88%; n  =  51) and 42 PGY-1 (91%; n  =  46) residents completed the survey. Compared with PGY-1 residents pre-curriculum, PGY-3 residents were significantly more confident in their knowledge of pre- and posttest probability (mean difference, 1.14; P  =  .002), number needed to harm (mean difference, 1.09; P  =  .002), likelihood ratio (mean difference, 1.01; P  =  .003), formulation of a focused clinical question (mean difference, 0.98; P  =  .001), and critical appraisal of therapy articles (mean difference, 0.91; P  =  .002). Perceived confidence was significantly lower for PGY-3 than post-curriculum PGY-1 residents on relative risk (mean difference, -0.86; P  =  .002), study design for prognosis questions (mean difference, -0.75; P  =  .004), number needed to harm (mean difference, -0.67; P  =  .01), ability to critically appraise systematic reviews (mean difference, -0.65, P  =  .009), and retrieval of evidence (mean difference, -0.56; P  =  .008), among others. There was no relationship between confidence with and actual knowledge of EBM topics. Our findings demonstrate lower confidence among PGY-3 than among PGY-1 internal medicine residents for several EBM topics. PGY-3 residents demonstrated poor knowledge of several core topics taught during internship. Longitudinal EBM curricula throughout residency 5 help reinforce residents' EBM knowledge and their confidence.

Senior Internal Medicine Residents' Confidence with Essential Topics in Evidence-Based Medicine Taught During Internship

PubMed Central

Keddis, Mira T.; Beckman, Thomas J.; Cullen, Michael W.; Reed, Darcy A.; Halvorsen, Andrew J.; Wittich, Christopher M.; West, Colin P.; McDonald, Furman S.

2011-01-01

Background Few studies have examined residents' retained knowledge and confidence regarding essential evidence-based medicine (EBM) topics. Objective To compare postgraduate year-3 (PGY-3) residents' confidence with EBM topics taught during internship with that of PGY-1 residents before and after exposure to an EBM curriculum. Methods All residents participated in an EBM curriculum during their intern year. We surveyed residents in 2009. PGY-1 residents completed a Likert-scale type survey (which included questions from the validated Berlin questionnaire and others, developed based on input from local EBM experts). We administered the Berlin questionnaire to a subset of PGY-3 residents. Results Forty-five PGY-3 (88%; n  =  51) and 42 PGY-1 (91%; n  =  46) residents completed the survey. Compared with PGY-1 residents pre-curriculum, PGY-3 residents were significantly more confident in their knowledge of pre- and posttest probability (mean difference, 1.14; P  =  .002), number needed to harm (mean difference, 1.09; P  =  .002), likelihood ratio (mean difference, 1.01; P  =  .003), formulation of a focused clinical question (mean difference, 0.98; P  =  .001), and critical appraisal of therapy articles (mean difference, 0.91; P  =  .002). Perceived confidence was significantly lower for PGY-3 than post-curriculum PGY-1 residents on relative risk (mean difference, −0.86; P  =  .002), study design for prognosis questions (mean difference, −0.75; P  =  .004), number needed to harm (mean difference, −0.67; P  =  .01), ability to critically appraise systematic reviews (mean difference, −0.65, P  =  .009), and retrieval of evidence (mean difference, −0.56; P  =  .008), among others. There was no relationship between confidence with and actual knowledge of EBM topics. Conclusions Our findings demonstrate lower confidence among PGY-3 than among PGY-1 internal medicine residents for several EBM topics. PGY-3 residents demonstrated poor knowledge of several core topics taught during internship. Longitudinal EBM curricula throughout residency 5 help reinforce residents' EBM knowledge and their confidence. PMID:23205197

[The forgotten capitulation of evidence-based medicine].

PubMed

Schoemaker, Casper G; Smulders, Yvo M

2015-01-01

In 1992, the Canadian physician Gordon Guyatt wrote an article that is generally regarded as the starting point of evidence-based medicine (EBM). He described the ideas behind the McMaster residency programme for 'evidence-based practitioners', founded by David Sackett. Eight years later, in 2000, Guyatt concluded that this programme was too ambitious. In a new publication he described most doctors as 'evidence-users'. This editorial marks the transition from an individual to a collective form of EBM, emphasizing the use of evidence-based guidelines. The starting point of this collective form of EBM is not the well-known 1992 paper, but the forgotten editorial in 2000, which was described by Guyatt's colleagues as the capitulation of EBM.

Effect of Alkali-Acid-Heat Chemical Surface Treatment on Electron Beam Melted Porous Titanium and Its Apatite Forming Ability

PubMed Central

Bsat, Suzan; Amin Yavari, Saber; Munsch, Maximilian; Valstar, Edward R.; Zadpoor, Amir A.

2015-01-01

Advanced additive manufacturing techniques such as electron beam melting (EBM), can produce highly porous structures that resemble the mechanical properties and structure of native bone. However, for orthopaedic applications, such as joint prostheses or bone substitution, the surface must also be bio-functionalized to promote bone growth. In the current work, EBM porous Ti6Al4V alloy was exposed to an alkali acid heat (AlAcH) treatment to bio-functionalize the surface of the porous structure. Various molar concentrations (3, 5, 10M) and immersion times (6, 24 h) of the alkali treatment were used to determine optimal parameters. The apatite forming ability of the samples was evaluated using simulated body fluid (SBF) immersion testing. The micro-topography and surface chemistry of AlAcH treated samples were evaluated before and after SBF testing using scanning electron microscopy and energy dispersive X-ray spectroscopy. The AlAcH treatment successfully modified the topographical and chemical characteristics of EBM porous titanium surface creating nano-topographical features ranging from 200–300 nm in size with a titania layer ideal for apatite formation. After 1 and 3 week immersion in SBF, there was no Ca or P present on the surface of as manufactured porous titanium while both elements were present on all AlAcH treated samples except those exposed to 3M, 6 h alkali treatment. An increase in molar concentration and/or immersion time of alkali treatment resulted in an increase in the number of nano-topographical features per unit area as well as the amount of titania on the surface. PMID:28788021

Effect of Energy Input on Microstructure and Mechanical Properties of Titanium Aluminide Alloy Fabricated by the Additive Manufacturing Process of Electron Beam Melting

PubMed Central

Mohammad, Ashfaq; Alahmari, Abdulrahman M.; Mohammed, Muneer Khan; Renganayagalu, Ravi Kottan; Moiduddin, Khaja

2017-01-01

Titanium aluminides qualify adequately for advanced aero-engine applications in place of conventional nickel based superalloys. The combination of high temperature properties and lower density gives an edge to the titanium aluminide alloys. Nevertheless, challenges remain on how to process these essentially intermetallic alloys in to an actual product. Electron Beam Melting (EBM), an Additive Manufacturing Method, can build complex shaped solid parts from a given feedstock powder, thus overcoming the shortcomings of the conventional processing techniques such as machining and forging. The amount of energy supplied by the electron beam has considerable influence on the final build quality in the EBM process. Energy input is decided by the beam voltage, beam scan speed, beam current, and track offset distance. In the current work, beam current and track offset were varied to reflect three levels of energy input. Microstructural and mechanical properties were evaluated for these samples. The microstructure gradually coarsened from top to bottom along the build direction. Whereas higher energy favored lath microstructure, lower energy tended toward equiaxed grains. Computed tomography analysis revealed a greater amount of porosity in low energy samples. In addition, the lack of bonding defects led to premature failure in the tension test of low energy samples. Increase in energy to a medium level largely cancelled out the porosity, thereby increasing the strength. However, this trend did not continue with the high energy samples. Electron microscopy and X-ray diffraction investigations were carried out to understand this non-linear behavior of the strength in the three samples. Overall, the results of this work suggest that the input energy should be considered primarily whenever any new alloy system has to be processed through the EBM route. PMID:28772572

Effect of Energy Input on Microstructure and Mechanical Properties of Titanium Aluminide Alloy Fabricated by the Additive Manufacturing Process of Electron Beam Melting.

PubMed

Mohammad, Ashfaq; Alahmari, Abdulrahman M; Mohammed, Muneer Khan; Renganayagalu, Ravi Kottan; Moiduddin, Khaja

2017-02-21

Titanium aluminides qualify adequately for advanced aero-engine applications in place of conventional nickel based superalloys. The combination of high temperature properties and lower density gives an edge to the titanium aluminide alloys. Nevertheless, challenges remain on how to process these essentially intermetallic alloys in to an actual product. Electron Beam Melting (EBM), an Additive Manufacturing Method, can build complex shaped solid parts from a given feedstock powder, thus overcoming the shortcomings of the conventional processing techniques such as machining and forging. The amount of energy supplied by the electron beam has considerable influence on the final build quality in the EBM process. Energy input is decided by the beam voltage, beam scan speed, beam current, and track offset distance. In the current work, beam current and track offset were varied to reflect three levels of energy input. Microstructural and mechanical properties were evaluated for these samples. The microstructure gradually coarsened from top to bottom along the build direction. Whereas higher energy favored lath microstructure, lower energy tended toward equiaxed grains. Computed tomography analysis revealed a greater amount of porosity in low energy samples. In addition, the lack of bonding defects led to premature failure in the tension test of low energy samples. Increase in energy to a medium level largely cancelled out the porosity, thereby increasing the strength. However, this trend did not continue with the high energy samples. Electron microscopy and X-ray diffraction investigations were carried out to understand this non-linear behavior of the strength in the three samples. Overall, the results of this work suggest that the input energy should be considered primarily whenever any new alloy system has to be processed through the EBM route.

Effect of Alkali-Acid-Heat Chemical Surface Treatment on Electron Beam Melted Porous Titanium and Its Apatite Forming Ability.

PubMed

Bsat, Suzan; Yavari, Saber Amin; Munsch, Maximilian; Valstar, Edward R; Zadpoor, Amir A

2015-04-08

Advanced additive manufacturing techniques such as electron beam melting (EBM), can produce highly porous structures that resemble the mechanical properties and structure of native bone. However, for orthopaedic applications, such as joint prostheses or bone substitution, the surface must also be bio-functionalized to promote bone growth. In the current work, EBM porous Ti6Al4V alloy was exposed to an alkali acid heat (AlAcH) treatment to bio-functionalize the surface of the porous structure. Various molar concentrations (3, 5, 10M) and immersion times (6, 24 h) of the alkali treatment were used to determine optimal parameters. The apatite forming ability of the samples was evaluated using simulated body fluid (SBF) immersion testing. The micro-topography and surface chemistry of AlAcH treated samples were evaluated before and after SBF testing using scanning electron microscopy and energy dispersive X-ray spectroscopy. The AlAcH treatment successfully modified the topographical and chemical characteristics of EBM porous titanium surface creating nano-topographical features ranging from 200-300 nm in size with a titania layer ideal for apatite formation. After 1 and 3 week immersion in SBF, there was no Ca or P present on the surface of as manufactured porous titanium while both elements were present on all AlAcH treated samples except those exposed to 3M, 6 h alkali treatment. An increase in molar concentration and/or immersion time of alkali treatment resulted in an increase in the number of nano-topographical features per unit area as well as the amount of titania on the surface.

Progress in evidence-based medicine: a quarter century on.

PubMed

Djulbegovic, Benjamin; Guyatt, Gordon H

2017-07-22

In response to limitations in the understanding and use of published evidence, evidence-based medicine (EBM) began as a movement in the early 1990s. EBM's initial focus was on educating clinicians in the understanding and use of published literature to optimise clinical care, including the science of systematic reviews. EBM progressed to recognise limitations of evidence alone, and has increasingly stressed the need to combine critical appraisal of the evidence with patient's values and preferences through shared decision making. In another progress, EBM incorporated and further developed the science of producing trustworthy clinical practice guidelines pioneered by investigators in the 1980s. EBM's enduring contributions to clinical medicine include placing the practice of medicine on a solid scientific basis, the development of more sophisticated hierarchies of evidence, the recognition of the crucial role of patient values and preferences in clinical decision making, and the development of the methodology for generating trustworthy recommendations. Copyright © 2017 Elsevier Ltd. All rights reserved.

The first center for evidence-based medicine in Lithuania: an opportunity to change culture and improve clinical practice.

PubMed

Beinortas, Tumas; Bauza, Karolis; Howick, Jeremy; Nunan, David; Mahtani, Kamal Ram

2015-05-01

In post-Soviet countries, where medical practice largely relies on experience alone, the incorporation of the best research evidence in clinical practice is limited. In order to promote the awareness and utilization of evidence-based medicine (EBM) among Lithuanian doctors, we organized EBM conferences in each of the two Lithuanian medical schools. More than 500 medical professionals and students attended the conferences in Vilnius (2013) and Kaunas (2014) demonstrating that there is a high demand for formal EBM teaching. Building on the success of these seminal conferences, and to start addressing the lack of EBM practice in the country, the first Lithuanian Centre for Evidence-Based Medicine was established at Vilnius University Medical Faculty in 2014. The Centre will focus on the implementation of EBM teaching in medical school curriculum, formulating management guidelines, writing systematic reviews and supporting Lithuanian authors in doing so. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

Evidence-based Medicine Search: a customizable federated search engine.

PubMed

Bracke, Paul J; Howse, David K; Keim, Samuel M

2008-04-01

This paper reports on the development of a tool by the Arizona Health Sciences Library (AHSL) for searching clinical evidence that can be customized for different user groups. The AHSL provides services to the University of Arizona's (UA's) health sciences programs and to the University Medical Center. Librarians at AHSL collaborated with UA College of Medicine faculty to create an innovative search engine, Evidence-based Medicine (EBM) Search, that provides users with a simple search interface to EBM resources and presents results organized according to an evidence pyramid. EBM Search was developed with a web-based configuration component that allows the tool to be customized for different specialties. Informal and anecdotal feedback from physicians indicates that EBM Search is a useful tool with potential in teaching evidence-based decision making. While formal evaluation is still being planned, a tool such as EBM Search, which can be configured for specific user populations, may help lower barriers to information resources in an academic health sciences center.

The impact of critical appraisal workshops on residents' evidence based medicine skills and knowledge.

PubMed

Nasr, Justine A; Falatko, John; Halalau, Alexandra

2018-01-01

To assess the impact of four evidence based medicine (EBM) critical appraisal education workshops in improving residents' EBM knowledge and skills. The eligible participants in the workshops were 88 residents-in-training, postgraduate years one through four, rotating through the outpatient internal medicine clinic. Four EBM workshops, consisting of 3 days each (30 minutes daily), were taught by our faculty. Topics covered included critical appraisal of randomized controlled trials, case-control and cohort studies, diagnosis studies, and systematic reviews. As a program evaluation, anonymous pre-workshop and post-workshop tests were administered. Each of the four sets of tests showed improvement in scores: therapy from 58% to 77% (42% response rate), harm from 65% to 73% (38% response rate), diagnosis from 49% to 68% (49% response rate), and systematic review from 57% to 72% (30% response rate). We found that teaching EBM in four short workshops improved EBM knowledge and critical appraisal skills related to the four topics.

Evidence-based Medicine Search: a customizable federated search engine

PubMed Central

Bracke, Paul J.; Howse, David K.; Keim, Samuel M.

2008-01-01

Purpose: This paper reports on the development of a tool by the Arizona Health Sciences Library (AHSL) for searching clinical evidence that can be customized for different user groups. Brief Description: The AHSL provides services to the University of Arizona's (UA's) health sciences programs and to the University Medical Center. Librarians at AHSL collaborated with UA College of Medicine faculty to create an innovative search engine, Evidence-based Medicine (EBM) Search, that provides users with a simple search interface to EBM resources and presents results organized according to an evidence pyramid. EBM Search was developed with a web-based configuration component that allows the tool to be customized for different specialties. Outcomes/Conclusion: Informal and anecdotal feedback from physicians indicates that EBM Search is a useful tool with potential in teaching evidence-based decision making. While formal evaluation is still being planned, a tool such as EBM Search, which can be configured for specific user populations, may help lower barriers to information resources in an academic health sciences center. PMID:18379665

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

Neurocognitive Effect of Nootropic Drug Brahmi (Bacopa monnieri) in Alzheimer's Disease

PubMed Central

Chaudhari, Kaustubh S.; Tiwari, Nishant R.; Tiwari, Rakesh R.; Sharma, Rohan S.

2017-01-01

Alzheimer's disease (AD) is a progressive neurodegenerative disease of the elderly. The rapid increase in its incidence has necessitated development of newer drugs. Ayurvedic herbal medications are increasingly researched due to their biosafety profile and usefulness in cognitive impairment. In this article, we critically reviewed one such Medhya Rasayana (nootropic drug) Brahmi-derived from extract of Bacopa monnieri (EBm). Studies have shown that EBm promotes free radical scavenger mechanisms and protects cells in prefrontal cortex, hippocampus, and striatum against cytotoxicity and DNA damage implicated in AD. It also reduces lipoxygenase activity reducing lipid peroxidation, increases glutathione peroxidase and chelates iron. Administration of EBm was seen to protect the cholinergic neurons and reduce anticholinesterase activity comparable to donepezil, rivastigmine, and galantamine. It also reduces hippocampal β-amyloid deposition and stress-induced hippocampal damage. The neuroprotective effect of EBm is also due to nitric oxide-mediated cerebral vasodilation. EBm improved the total memory score and maximum improvement was seen in logical memory and paired associate learning in humans and reversed phenytoin-induced memory impairment in experimental model. EBm has not shown any serious clinical, neurological, hematological complications, or vital organs damage in experimental studies. Rats showed marked reduction in fertility; however, libido was unaffected. There is no experimental evidence of genotoxicity or teratogenesis by use of EBm. Mild nausea and gastrointestinal upset are seen in humans. Brahmi promises to be a novel agent in AD; however, further human trials are recommended to verify the efficacy and rule out any side effects as evidenced by the experimental models. PMID:28588366

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

PubMed

Tracy, C Shawn; Dantas, Guilherme Coelho; Upshur, Ross E G

2003-05-09

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. 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. 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. 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.

Using tablet computers to teach evidence-based medicine to pediatrics residents: a prospective study.

PubMed

Soma, David B; Homme, Jason H; Jacobson, Robert M

2013-01-01

We sought to determine if tablet computers-supported by a laboratory experience focused upon skill-development-would improve not only evidence-based medicine (EBM) knowledge but also skills and behavior. We conducted a prospective cohort study where we provided tablet computers to our pediatric residents and then held a series of laboratory sessions focused on speed and efficiency in performing EBM at the bedside. We evaluated the intervention with pre- and postintervention tests and surveys based on a validated tool available for use on MedEdPORTAL. The attending pediatric hospitalists also completed surveys regarding their observations of the residents' behavior. All 38 pediatric residents completed the preintervention test and the pre- and postintervention surveys. All but one completed the posttest. All 7 attending pediatric hospitalists completed their surveys. The testing, targeted to assess EBM knowledge, revealed a median increase of 16 points out of a possible 60 points (P < .0001). We found substantial increases in individual resident's test scores across all 3 years of residency. Resident responses demonstrated statistically significant improvements in self-reported comfort with 6 out of 6 EBM skills and statistically significant increases in self-reported frequencies for 4 out of 7 EBM behaviors. Attending pediatric hospitalists reported improvements in 5 of 7 resident behaviors. This novel approach for teaching EBM to pediatric residents improved knowledge, skills, and behavior through the introduction of a tablet computer and laboratory sessions designed to teach the quick and efficient application of EBM at the bedside. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Effectiveness of evidence-based medicine training for undergraduate students at a Chinese Military Medical University: a self-controlled trial

PubMed Central

2014-01-01

Background To evaluate the effect of the integration of evidence-based medicine (EBM) into medical curriculum by measuring undergraduate medical students’ EBM knowledge, attitudes, personal application, and anticipated future use. Methods A self-controlled trial was conducted with 251 undergraduate students at a Chinese Military Medical University, using a validated questionnaire regarding the students’ evidence-based practice (EBP) about knowledge (EBP-K), attitude (EBP-A), personal application (EBP-P), and future anticipated use (EBP-F). The educational intervention was a 20-hour EBM course formally included in the university’s medical curriculum, combining lectures with small group discussion and student-teacher exchange sessions. Data were analyzed using paired t-tests to test the significance of the difference between a before and after comparison. Results The difference between the pre- and post-training scores were statistically significant for EBP-K, EBP-A, EBP-P, and EBP-F. The scores for EBP-P showed the most pronounced percentage change after EBM training (48.97 ± 8.6%), followed by EBP-A (20.83 ± 2.1%), EBP-K (19.21 ± 3.2%), and EBP-F (17.82 ± 5.7%). Stratified analyses by gender, and program subtypes did not result in any significant changes to the results. Conclusions The integration of EBM into the medical curriculum improved undergraduate medical students’ EBM knowledge, attitudes, personal application, and anticipated future use. A well-designed EBM training course and objective outcome measurements are necessary to ensure the optimum learning opportunity for students. PMID:24996537

Regeneration of defective epithelial basement membrane and restoration of corneal transparency

PubMed Central

Marino, Gustavo K.; Santhiago, Marcony R.; Santhanam, Abirami; Torricelli, Andre A. M.; Wilson, Steven E.

2018-01-01

PURPOSE To study regeneration of the normal ultrastructure of the epithelial basement membrane (EBM) in rabbit corneas that had -9D photorefractive keratectomy (PRK) and developed late haze (fibrosis) with restoration of transparency over one to four months after surgery and in corneas that had incisional wounds. METHODS Twenty-four rabbits had one of their eyes included into one of the two procedure groups (-9D PRK or nearly full-thickness incisional wounds), while the opposite eye serving as unwounded controls. All corneas were evaluated with slit lamp photos, transmission electron microscopy and immunohistochemistry for the myofibroblast marker alpha-smooth muscle actin and collagen type III. RESULTS In the ‘-9D PRK group’, corneas at one month after surgery had dense corneal haze and no evidence of regenerated EBM ultrastructure. By two months after surgery, however, small areas of stromal clearing began to appear within the confluent opacity (lacunae), and these corresponded to small islands of normally-regenerated EBM detected within larger area of the excimer laser-ablated zone with no evidence of normal EBM. By four months after surgery, the EBM was fully-regenerated and the corneal transparency was completely restored to the ablated zone. In the ‘Incisional wound group’, the two dense, linear corneal opacities were observed at one month after surgery and progressively faded by two and three months after surgery. The EBM ultrastructure was fully regenerated at the site of the incisions, including around epithelial plugs that extended into the stroma, by one month after surgery in all eyes. CONCLUSIONS In the rabbit model, spontaneous resolution of corneal fibrosis (haze) after high correction PRK is triggered by regeneration of EBM with normal ultrastructure in the excimer laser- ablated zone. Conversely, incisional wounds heal in rabbit corneas without the development of myofibroblasts because the EBM regenerates normally by one month after surgery. PMID:28486725

Teaching evidence based medicine to surgery residents-is journal club the best format? A systematic review of the literature.

PubMed

Ahmadi, Negar; McKenzie, Margaret E; Maclean, Anthony; Brown, Carl J; Mastracci, Tara; McLeod, Robin S

2012-01-01

Systematic reviews were performed to assess methods of teaching the evidence-based medicine (EBM) process and determine which format or what components of journal club appear to be most effective in teaching critical appraisal skills to surgical residents and have the highest user satisfaction. MEDLINE, Embase, Web of Science, AMED, PsychINFO, PubMed, Cochrane Library, and Google scholar were searched to identify relevant articles. To be included, studies had to provide details about the format of their EBM curriculum or journal club and report on the effectiveness or participant satisfaction. Potentially relevant articles were independently reviewed by 2 authors and data were extracted on separate data forms. Seven studies met the inclusion criteria for assessment of teaching EBM and 8 studies (including 3 in the EBM systematic review) met criteria for assessment of journal club format. Overall, study quality was poor. Only 2 studies were randomized controlled trials. Five were before-after studies, which showed significant improvement in critical appraisal skills or statistical knowledge following an EBM course or journal club. The 2 randomized controlled trials (RCTs) compared teaching EBM or critical appraisal skills in lecture format or journal club to online learning. There was no significant difference in mean scores in 1 study whereas the other reported significantly better scores in the journal club format. Four studies reported high participant satisfaction with the EBM course or journal club format. There is some evidence that courses with or without the addition of journal clubs lead to improved knowledge of the EBM process although the impact on patient care is unknown. Journal clubs seem to be the preferred way of teaching critical appraisal skills but while some components of journal clubs are favored by participants, it remains unclear which elements are most important for resident learning. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Evidence-based medicine in daily surgical decision making: a survey-based comparison between the UK and Germany.

PubMed

Schnitzbauer, Andreas A; Proneth, Andrea; Pengel, Liset; Ansorg, Jörg; Anthuber, Matthias; Bechstein, Wolf O; Schlitt, Hans J; Geissler, Edward K

2015-01-01

Evidence-based medicine (EbM) is a vital part of reasonable and conclusive decision making for clinicians in daily clinical work. To analyze the knowledge and the attitude of surgeons towards EbM, a survey was performed in the UK and Germany. A web-based questionnaire was distributed via mailing lists from the Royal College of Surgeons of England (RCSE) and the Berufsverband Deutscher Chirurgen (BDC). Our primary aim was to get information about knowledge of EbM amongst German and British surgeons. A total of 549 individuals opened the questionnaire, but only 198 questionnaires were complete and valid for analysis. In total, 40,000 recipients were approached via the mailing lists of the BDC and RCSE. The response rate was equally low in both countries. On a scale from 1 (unimportant) to 10 (very important), all participants rated EbM as very important for daily clinical decision making (7.3 ± 1.9) as well as for patients (7.8 ± 1.9) and the national health system (7.8 ± 1.9). On a scale from 1 (unimportant) to 5 (very important), systematic reviews (4.6 ± 0.6) and randomized controlled trials (4.6 ± 0.6) were identified as the highest levels of study designs to enhance evidence in medicine. British surgeons considered EbM to be more important in daily clinical work when compared to data from German surgeons (7.9 ± 1.6 vs. 6.7 ± 2.1, p < 0.001). Subgroup analysis showed different results in some categories; however, a pattern to explain the differences was not evident. Personal requirements expressed in a free text field emphasized the results and reflected concerns such as broad unwillingness and lack of interdisciplinary approaches for patients (n = 59: 25 in the UK and 34 in Germany). The overall results show that EbM is believed to be important by surgeons in the UK and Germany. However, perception of EbM in the respective health system (UK vs. Germany) may be different. Nonetheless, EbM is an important tool to navigate through daily clinical problems although a discrepancy between the knowledge of theoretical abstract terms and difficulties in implementing EbM in daily clinical work has been detected. The provision of infrastructure, courses and structured education as a permanent instrument will advance the knowledge, application and improvement of EbM in the future. © 2014 S. Karger AG, Basel.

Visualization studies on evidence-based medicine domain knowledge (series 3): visualization for dissemination of evidence based medicine information.

PubMed

Shen, Jiantong; Yao, Leye; Li, Youping; Clarke, Mike; Gan, Qi; Li, Yifei; Fan, Yi; Gou, Yongchao; Wang, Li

2011-05-01

To identify patterns in information sharing between a series of Chinese evidence based medicine (EBM) journals and the Cochrane Database of Systematic Reviews, to determine key evidence dissemination areas for EBM and to provide a scientific basis for improving the dissemination of EBM research. Data were collected on citing and cited from the Chinese Journal of Evidence-Based Medicine (CJEBM), Journal of Evidence-Based Medicine (JEBMc), Chinese Journal of Evidence Based Pediatrics (CJEBP), and the Cochrane Database of Systematic Reviews (CDSR). Relationships between citations were visualized. High-frequency key words from these sources were identified, to build a word co-occurrence matrix and to map research subjects. CDSR contains a large collection of information of relevance to EBM and its contents are widely cited across many journals, suggesting a well-developed citation environment. The content and citation of the Chinese journals have been increasing in recent years. However, their citation environments are much less developed, and there is a wide variation in the breadth and strength of their knowledge communication, with the ranking from highest to lowest being CJEBM, JEBMc and CJEBP. The content of CDSR is almost exclusively Cochrane intervention reviews examining the effects of healthcare interventions, so it's contribution to EBM is mostly in disease control and treatment. On the other hand, the Chinese journals on evidence-based medicine and practice focused more on areas such as education and research, design and quality of clinical trials, evidence based policymaking, evidence based clinical practice, tumor treatment, and pediatrics. Knowledge and findings of EBM are widely communicated and disseminated. However, citation environments and range of knowledge communication differ greatly between the journals examined in this study. This finds that Chinese EBM has focused mainly on clinical medicine, Traditional Chinese Medicine, pediatrics, tumor treatment, nursing, health economic and management, and medical education. Internationally, EBM research topics have begun to shift, from drug treatment to surgery or other non-pharmacological treatments; from therapy to diagnosis, rehabilitation, and prevention; from evidence based clinical practice to evidence based management and policymaking. The philosophy and method of EBM, evidence production and translation are also shifting from well resourced settings to low- and middle-income countries, especially those in which English is not a major language. © 2011 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

[Existing laparoscopic simulators and their benefit for the surgeon].

PubMed

Kalvach, J; Ryska, O; Ryska, M

2016-01-01

Nowadays, laparoscopic operations are a common part of surgical practice. However, they have their own characteristics and require a specific method of preparation. Recently, simulation techniques have been increasingly used for the training of skills. The aim of this review is to provide a summary of available literature on the topic of laparoscopic simulators, to assess their contribution to the training of surgeons, and to identify the most effective type of simulation. PubMed database, Web of Science and Cochrane Library were used to search for relevant publications. The keywords "laparoscopy, simulator, surgery, assessment" were used in the search. The search was limited to prospective studies published in the last 5 years in the English language. From a total of 354 studies found, we included in the survey 26 that matched our criteria. Nine studies compared individual simulators to one another. Five studies evaluated "high and low fidelity" (a virtual box simulator) as equally effective (EBM 2a). In three cases the "low fidelity" box simulator was found to be more efficient (EBM 2a3b). Only one study preferred the virtual simulator (VR) (EBM2b).Thirteen studies evaluated the benefits of simulators for practice. Twelve found training on a simulator to be an effective method of preparation (EBM 1b3b). In contrast, one study did not find any difference between the training simulator and traditional preparation (EBM 3b). Nine studies evaluated directly one of the methods of evaluating laparoscopic skills. Three studies evaluated VR simulator as a useful assessment tool. Other studies evaluated as successful the scoring system GOALS-GH. The hand motion analysis model was successful in one case. Most studies were observational (EBM 3b) and only 2 studies were of higher quality (EBM 2b). Simulators are an effective tool for practicing laparoscopic techniques (EBM: 1b). It cannot be determined based on available data which of the simulators is most effective. The virtual simulator, however, still remains the most self-sufficient unit suitable for teaching as well as evaluation of laparoscopic techniques (EBM 2b3b). Further studies are needed to find an effective system and parameters for an objective evaluation of skills. laparoscopy - simulator - surgery assessment.

Multiple strategy peer-taught evidence-based medicine course in a poor resource setting.

PubMed

Sabouni, Ammar; Bdaiwi, Yamama; Janoudi, Saad L; Namous, Lubaba O; Turk, Tarek; Alkhatib, Mahmoud; Abbas, Fatima; Yafi, Ruba Zuhri

2017-05-04

Teaching Evidence Based Medicine (EBM) is becoming a priority in the healthcare process. For undergraduates, it has been proved that integrating multiple strategies in teaching EBM yields better results than a single, short-duration strategy. However, there is a lack of evidence on applying EBM educational interventions in developing countries. In this study, we aim to evaluate the effectiveness of a multiple strategy peer-taught online course in improving EBM awareness and skills among medical students in two developing countries, Syria and Egypt. We conducted a prospective study with pre- and post- course assessment of 84 medical students in three universities, using the Berlin questionnaire and a set of self-reported questions which studied the students' EBM knowledge, attitude and competencies. The educational intervention was a peer-taught online course consisting of six sessions (90 min each) presented over six weeks, and integrated with assignments, group discussions, and two workshops. The mean score of pre- and post-course Berlin tests was 3.5 (95% CI: 2.94-4.06) and 5.5 (95% CI: 4.74-6.26) respectively, increasing by 2 marks (95% CI: 1.112-2.888; p-value <0.001), which indicates a statistically significant increase in students' EBM knowledge and skill, similar to a previous expert-taught face to face contact course. Self-reported confidences also increased significantly. However, our course did not have a major effect on students' attitudes toward EBM (1.9-10.8%; p-value: 0.12-0.99). In developing countries, multiple strategy peer-taught online courses may be an effective alternative to face to face expert-taught courses, especially in the short term.

Evidence-based medicine for neurosurgeons: introduction and methodology.

PubMed

Linskey, Mark E

2006-01-01

Evidence-based medicine is a tool of considerable value for medicine and neurosurgery that provides a secure base for clinical practice and practice improvement, but is not without inherent drawbacks, weaknesses and limitations. EBM finds answers to only those questions open to its techniques, and the best available evidence can be a far cry from scientific truth. With the support and backing of governmental agencies, professional medical societies, the AAMC, the ACGME, and the ABMS, EBM is likely here to stay. The fact that: (1) EBM philosophy and critical appraisal techniques have become fully integrated into the training and culture of our younger colleagues, (2) that maintenance of certification will require individuals to demonstrate personal evidence based practice based on tracking and critical analysis of personal practice outcomes as part of the performance-based learning and improvement competency, and (3) that the progressively growing national healthcare expenditures will necessitate increasing basis of reimbursement and funding based on evidence-based effectiveness and guidelines, all point to the likelihood that complete immersion of neurosurgical practice in EBM is inevitable. This article thoroughly explores the history of EBM in medicine in general and in neurosurgery in particular. Emphasis is placed on identifying the legislative and regulatory motive forces at work behind its promulgation and the role that organized medicine has taken to facilitate and foster its acceptance and implementation. An accounting of resources open to neurosurgeons, and a detailed description EBM clinical decision-making methodology is presented. Special emphasis is placed on outlining the methodology as well as the limitations of meta-analyses, randomized clinic trials, and clinical practice parameter guidelines. Commonly perceived objections, as well as substantive problems and limitations of EBM assumptions, tools, and approaches both for individual clinical practice and health policy design and implementation are explored in detail.

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

Applying evidence-based surgery in daily clinical routine: a feasibility study.

PubMed

Krahn, Jan; Sauerland, Stefan; Rixen, Dieter; Gregor, Sven; Bouillon, Bertil; Neugebauer, Edmund A M

2006-03-01

Although the word evidence-based medicine (EBM) has gained wide popularity, only a few studies have evaluated how EBM works in clinical practice. We have prospectively evaluated the feasibility of evidence-based trauma surgery. Orthopaedic trauma surgeons were asked to produce clinical questions related to the treatment of current patients. An informaticist searched the literature (Medline, Cochrane Library, practice guidelines and textbooks) and reported the findings on every following day. The study's main endpoints were the rate of questions for which relevant evidence (>level V) was available and the time necessary to find and critically appraise medical evidence. In total, 44 EBM questions were formulated, mainly concerning treatment options. PubMed was searched for 39 questions, textbooks for 14, the Cochrane Library for 11, online guidelines for 9 and other sources were used for 4 questions. On average, 157 text items (three per questions) were identified as potentially relevant. Journal articles predominated (83%) over textbooks (10%). Sixty-eight percent of the questions (30 of 44) were answered, either on the basis level 1 (n=13 questions), level 2 (n=6), or level 4 evidence (n=14). Trying to answer a question required 53 min on average, split up between 39 min of database searches and 25 min of obtaining full text articles. In four cases, the evidence suggested a change in clinical management. The physicians were very appreciative of our project and found the provided evidence very helpful for their clinical decisions. Time will be the main barrier against the introduction of clinical EBM. It is likely that clinicians reduce EBM to those situations where evidence is likely to be found. Although the impact of EBM on patient-care was limited, the concept of EBM was successfully implemented.

Beyond 'faith-based medicine' and EBM.

PubMed

De Simone, John

2006-08-01

Longstanding debate on evidence-based medicine (EBM) may have reached a critical saturation point. I briefly report on systematic reviews on the recurring themes in the critical literature. In this context, some criticisms to EBM are substantial and enduring, although convincing arguments to contrast unresolved issues have yet to be produced. Nonetheless, few changes have been adopted and conservative attitudes persist in EBM. Despite its 'success', implementation in practice has been inexorably overshadowed leading to paradoxical shortcomings. This controversial scenario offers a formidable occasion to gain needed insight. The aim of this paper is to attempt a comprehensive analysis by reframing a number of key concerns, while furnishing pragmatic, interdisciplinary solutions for these deep-rooted dilemmas. In the interests of all stakeholders, I seek to promote a concerted effort to resolve conflict and build consensus. This paper explores a strategically unifying vision of primary care, based on current understanding of practice patterns, having a research-friendly 'common ground' where practitioners' information needs may be met. In addition, an analysis of existing problems identifies underlying 'root causes'. Moreover, I expediently reframe crucial matters by focusing on EBM, more than as a paradigm, as an organisation, hence amenable to a variety of cross-disciplinary analyses and solutions. Finally, recent state-of-the-art reviews on implementation and dissemination research are cited for the pertinent implications for study design and practice. Present policies and influential testimonials on behalf of EBM encounter the pitfalls of hindering learning and progress through defensive attitudes and mechanisms. Current study designs and evaluation criteria must strive to adapt to real-world settings, rather than vice versa. The arguments exposed herein alter the terms of the debate on EBM and may outline a basis for initiatives with conflict-resolution and consensus-building scopes.

The need for evidence-based, non-drug medicine.

PubMed

Ventegodt, Søren; Orr, Gary; Merrick, Joav

2011-11-04

Evidence-based medicine (EBM) is defined as "the integration of best research evidence with clinical expertise and patient values." EBM is based on three equally important key factors: i) the best available scientific evidence; ii) the physician's experience and intuition; and, iii) the preferences and values of the patient. EBM uses a hierarchy of evidence and critical appraisal of the sources, which makes it possible to balance high quality evidence with documented effectiveness. A treatment that is more safe and effective, but less well documented may very well be the treatment of choice. Ethics (not putting the patient at risk of harm with a treatment if this can be avoided at all) is an important part of EBM. Many pharmaceutical drugs have a number needed to treat (NNT) of approximately 20 [NNT=20, confidence interval CI (5-50)] and the number needed to harm is less well understood and documented. The adverse effect profile of pharmacological agents can be more harmful than non-drug medicine. Most EBM-treatments are likely to be non-drug treatments in the future. There are six steps to the practice of EBM: i) the patients and the physician must work together to define the problem; ii) the patients and the physician must explore the patient's values and preferences; iii) the information about the possible alternative medical interventions must be discussed and critically appraised; iv) the best, relevant evidence must be applied to the patient as a treatment or cure; v) together, the patient and the physician must evaluate how useful the intervention was; and vi) if the intervention did not help sufficiently, the process must begin again. In this review, we explain, in our opinion, how non-drug EBM should be practiced.

Mapping cognitive overlaps between practice-based learning and improvement and evidence-based medicine: an operational definition for assessing resident physician competence.

PubMed

Chatterji, Madhabi; Graham, Mark J; Wyer, Peter C

2009-12-01

The complex competency labeled practice-based learning and improvement (PBLI) by the Accreditation Council for Graduate Medical Education (ACGME) incorporates core knowledge in evidence-based medicine (EBM). The purpose of this study was to operationally define a "PBLI-EBM" domain for assessing resident physician competence. The authors used an iterative design process to first content analyze and map correspondences between ACGME and EBM literature sources. The project team, including content and measurement experts and residents/fellows, parsed, classified, and hierarchically organized embedded learning outcomes using a literature-supported cognitive taxonomy. A pool of 141 items was produced from the domain and assessment specifications. The PBLI-EBM domain and resulting items were content validated through formal reviews by a national panel of experts. The final domain represents overlapping PBLI and EBM cognitive dimensions measurable through written, multiple-choice assessments. It is organized as 4 subdomains of clinical action: Therapy, Prognosis, Diagnosis, and Harm. Four broad cognitive skill branches (Ask, Acquire, Appraise, and Apply) are subsumed under each subdomain. Each skill branch is defined by enabling skills that specify the cognitive processes, content, and conditions pertinent to demonstrable competence. Most items passed content validity screening criteria and were prepared for test form assembly and administration. The operational definition of PBLI-EBM competence is based on a rigorously developed and validated domain and item pool, and substantially expands conventional understandings of EBM. The domain, assessment specifications, and procedures outlined may be used to design written assessments to tap important cognitive dimensions of the overall PBLI competency, as given by ACGME. For more comprehensive coverage of the PBLI competency, such instruments need to be complemented with performance assessments.

[Martin Heidegger, beneficence, health, and evidence based medicine--contemplations regarding ethics and complementary and alternative medicine].

PubMed

Oberbaum, Menachem; Gropp, Cornelius

2015-03-01

Beneficence is considered a core principle of medical ethics. Evidence Based Medicine (EBM) is used almost synonymously with beneficence and has become the gold standard of efficiency of conventional medicine. Conventional modern medicine and EBM in particular are based on what Heidegger called calculative thinking, whereas complementary medicine (CM) is often based on contemplative thinking according to Heidegger's distinction of different thinking processes. A central issue of beneficence is the striving for health and wellbeing. EBM is little concerned directly with wellbeing, though it does claim to aim at improving quality of life by correcting pathological processes and conditions like infectious diseases, ischemic heart disease but also hypertension and hyperlipidemia. On the other hand, wellbeing is central to therapeutic efforts of CM. Scientific methods to gauge results of EBM are quantitative and based on calculative thinking, while results of treatments with CM are expressed in a qualitative way and based on meditative thinking. In order to maximize beneficence it seems important and feasible to use both approaches, by combining EBM and CM in the best interest of the individual patient.

Medication use pattern and predictors of optimal therapy at discharge in 8176 patients with acute coronary syndrome from 6 Middle Eastern countries: data from the gulf registry of acute coronary events.

PubMed

Al-Zakwani, Ibrahim; Zubaid, Mohammad; Panduranga, Prashanth; Rashed, Wafa; Sulaiman, Kadhim; Almahmeed, Wael; Al-Motarreb, Ahmed; Al Suwaidi, Jassim; Amin, Haitham

2011-08-01

We evaluated the use of quadruple evidence-based medication (EBM) combination consisting of antiplatelet therapy, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, β-blocker, and lipid-lowering agent concurrently at discharge among patients (n = 8154) with acute coronary syndrome (ACS) in 6 Middle Eastern countries. In all, 49% of the patients received the quadruple EBM combination concurrently at discharge. An adjusted model demonstrated that old age, diabetes mellitus, hyperlipidemia, hypertension, ST-segment elevation myocardial infarction, cardiac catheterization, as well as cardiologists as care providers and hospitals with cardiac catheterization facilities were all positively correlated with the use of the quadruple EBM combination. However, patients with cardiogenic shock, renal impairment, higher risk score, congestive heart failure, recurrent ischemia, and those admitted to academic hospitals were negatively correlated with the use of the quadruple EBM combination. Guideline adherence to the concurrent use of quadruple EBM combination in patients with ACS at discharge was suboptimal with wide disparity among the 6 countries.

Distribution of anti-CD68 (EBM11) immunoreactivity in formalin-fixed, paraffin-embedded bovine tissues.

PubMed

Ackermann, M R; DeBey, B M; Stabel, T J; Gold, J H; Register, K B; Meehan, J T

1994-05-01

A commercially acquired anti-human macrophage antibody (anti-CD68; EBM11) was used in an immunocytochemical technique to detect macrophages in formalin-fixed, paraffin-embedded tissues from cattle, pigs, humans, rats, turkeys, dogs, and cats. In healthy cattle, the antibody labeled alveolar macrophages, pulmonary intravascular cells (presumably intravascular macrophages), and macrophage-like cells in other tissues. In bovine lungs infected with Pasteurella haemolytica, EBM11 antibody labeled 95% of alveolar macrophages and macrophages within alveolar septa but only 0-2% of streaming or "oat" leukocytes. Alveolar macrophages were also stained by EBM11 in pigs but not in rats, turkeys, dogs, and cats. The antibody also stained macrophage aggregates in the mesenteric lymph nodes and intestinal lamina propria of Mycobacterium paratuberculosis-infected cattle. This study shows that the anti-CD68 (EBM11) antibody is a useful marker of macrophages in normal bovine tissues or tissues from areas of acute or chronic inflammation that have been routinely processed. The study also adds strength to the growing evidence suggesting that streaming leukocytes seen in pneumonic pasteurellosis are neutrophils.

Information-seeking trends of medical professionals and students from middle-income countries: a focus on the Philippines.

PubMed

Gavino, Alex I; Ho, Beverly Lorraine C; Wee, Pura Angela A; Marcelo, Alvin B; Fontelo, Paul

2013-12-01

Increased emphasis has been given to the practice of evidence-based medicine (EBM) worldwide. Access to quality health information is essential to the practice of EBM in developing countries. To understand the information needs and sources of information of physicians from low- and middle-income countries (LMICs). Medical doctors and students participated in an 18-question online or paper study. Of the 156 respondents from six LMICs, 146 (94%) came from the Philippines. Eighty-eight per cent encountered at least one clinical question daily, while 58% were very likely to search for answers. A basic mobile phone was the most used device at home (94%) and at work (82%). More than half had Internet connectivity at home (62%) and just under half at work (46%). In decreasing order, short messaging services (SMS), email, instant messaging and multimedia messaging services (MMS) were the most commonly used messaging tools at home and at work. The primary source for medication questions was a formulary, but for diagnostic dilemmas, colleagues were consulted first. PubMed use was high for therapy and management questions. The use of health information from the Internet through mobile devices may be increasing. Access to health information was higher at home than at work. These results may be useful when planning resources for healthcare givers in resource-poor settings. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

Observation, Sherlock Holmes, and Evidence Based Medicine.

PubMed

Osborn, John

2002-01-01

Sir Arthur Conan Doyle, the creator of the fictional detective Sherlock Holmes, studied medicine at the University of Edinburgh between 1876 and 1881 under Doctor Joseph Bell who emphasised in his teaching the importance of observation, deduction and evidence. Sherlock Holmes was modelled on Joseph Bell. The modern notions of Evidence Based Medicine (EBM) are not new. A very brief indication of some of the history of EBM is presented including a discussion of the important and usually overlooked contribution of statisticians to the Popperian philosophy of EBM.

Partner-built ecosystem science - The National Ocean Partnership Program as a builder of EBM Tools and Data

NASA Astrophysics Data System (ADS)

Hoffman, P. L.; Green, R. E.; Kohanowich, K. M.

2016-02-01

The National Ocean Partnership Program (NOPP) was created in 1997 by federal public law to identify "and carry out partnerships among federal agencies, academia, industry, and other members of the oceanographic scientific community in the areas of data, resources, education, and communications." Since that time, numerous federal agencies have pooled talent, funding, and scientific resources (e.g. ships, aircraft, remote sensors and computing capability) to address pressing ocean science needs which no one entity can manage alone. In this presentation, we will address the ways the National Ocean Policy identifies ecosystem-based management (EBM) as a foundation for providing sound science-based and adaptable management to maintain the health, productivity, and resilience of U.S. ocean, coastal, and Great Lakes ecosystems. Because EBM is an important approach for efficient and effective interagency, multi-jurisdictional, and cross-sectoral marine planning and management, ocean science partnerships such as those provided by NOPP create a pool of regionally-pertinent, nationally-available data from which EBM decision makers can draw to address critical management issues. Specifically, we will provide examples drawn from the last five years of funding to illustrate how the NOPP process works, how it is managed by a federal Interagency Working Group (IWG-OP), and how EBM practitioners can both partner with others through the NOPP and offer guidance on the implementation of projects beneficial to the regional needs of the EBM community. Projects to be discussed have been carried out under the following themes: Arctic Cumulative Impacts: Marine Arctic Ecosystem Study (MARES) - Ecosystem Dynamics and Monitoring of the Beaufort Sea: An Integrated Science Approach. Biodiversity Indicators: Demonstration of a U.S. Marine Biodiversity Observation Network (Marine BON) Long-Term Observations: Coordinated Regional Efforts That Further the U.S. Integrated Ocean Observing System (IOOS) Best Practices: Developing Environmental Protocols and Monitoring to Support Ocean Renewable Energy and Stewardship. We intend to leave the EBM community with a recognition that the NOPP already serves as a valuable partner source for science to inform EBM and to encourage participation in the process.

Partner-built ecosystem science - The National Ocean Partnership Program as a builder of EBM Tools and Data

NASA Astrophysics Data System (ADS)

Hoffman, P. L.; Green, R. E.; Kohanowich, K. M.

2016-12-01

The National Ocean Partnership Program (NOPP) was created in 1997 by federal public law to identify "and carry out partnerships among federal agencies, academia, industry, and other members of the oceanographic scientific community in the areas of data, resources, education, and communications." Since that time, numerous federal agencies have pooled talent, funding, and scientific resources (e.g. ships, aircraft, remote sensors and computing capability) to address pressing ocean science needs which no one entity can manage alone. In this presentation, we will address the ways the National Ocean Policy identifies ecosystem-based management (EBM) as a foundation for providing sound science-based and adaptable management to maintain the health, productivity, and resilience of U.S. ocean, coastal, and Great Lakes ecosystems. Because EBM is an important approach for efficient and effective interagency, multi-jurisdictional, and cross-sectoral marine planning and management, ocean science partnerships such as those provided by NOPP create a pool of regionally-pertinent, nationally-available data from which EBM decision makers can draw to address critical management issues. Specifically, we will provide examples drawn from the last five years of funding to illustrate how the NOPP process works, how it is managed by a federal Interagency Working Group (IWG-OP), and how EBM practitioners can both partner with others through the NOPP and offer guidance on the implementation of projects beneficial to the regional needs of the EBM community. Projects to be discussed have been carried out under the following themes: Arctic Cumulative Impacts: Marine Arctic Ecosystem Study (MARES) - Ecosystem Dynamics and Monitoring of the Beaufort Sea: An Integrated Science Approach. Biodiversity Indicators: Demonstration of a U.S. Marine Biodiversity Observation Network (Marine BON) Long-Term Observations: Coordinated Regional Efforts That Further the U.S. Integrated Ocean Observing System (IOOS) Best Practices: Developing Environmental Protocols and Monitoring to Support Ocean Renewable Energy and Stewardship. We intend to leave the EBM community with a recognition that the NOPP already serves as a valuable partner source for science to inform EBM and to encourage participation in the process.

Next Generation Orthopaedic Implants by Additive Manufacturing Using Electron Beam Melting

PubMed Central

Murr, Lawrence E.; Gaytan, Sara M.; Martinez, Edwin; Medina, Frank; Wicker, Ryan B.

2012-01-01

This paper presents some examples of knee and hip implant components containing porous structures and fabricated in monolithic forms utilizing electron beam melting (EBM). In addition, utilizing stiffness or relative stiffness versus relative density design plots for open-cellular structures (mesh and foam components) of Ti-6Al-4V and Co-29Cr-6Mo alloy fabricated by EBM, it is demonstrated that stiffness-compatible implants can be fabricated for optimal stress shielding for bone regimes as well as bone cell ingrowth. Implications for the fabrication of patient-specific, monolithic, multifunctional orthopaedic implants using EBM are described along with microstructures and mechanical properties characteristic of both Ti-6Al-4V and Co-29Cr-6Mo alloy prototypes, including both solid and open-cellular prototypes manufactured by additive manufacturing (AM) using EBM. PMID:22956957

Iconoclast or creed? Objectivism, pragmatism, and the hierarchy of evidence.

PubMed

Goldenberg, Maya J

2009-01-01

Because "evidence" is at issue in evidence-based medicine (EBM), the critical responses to the movement have taken up themes from post-positivist philosophy of science to demonstrate the untenability of the objectivist account of evidence. While these post-positivist critiques seem largely correct, I propose that when they focus their analyses on what counts as evidence, the critics miss important and desirable pragmatic features of the evidence-based approach. This article redirects critical attention toward EBM's rigid hierarchy of evidence as the culprit of its objectionable epistemic practices. It reframes the EBM discourse in light of a distinction between objectivist and pragmatic epistemology, which allows for a more nuanced analysis of EBM than previously offered: one that is not either/or in its evaluation of the decision-making technology as either iconoclastic or creedal.

[Evidence-based medicine and 'The Cochrane Collaboration'].

PubMed

Kawamura, T; Tamakoshi, A; Wakai, K; Ohno, Y

1999-06-01

In Evidence-Based Medicine (EBM), a clinical decision is based neither on pathophysiological theories nor personal experience but on the results derived from scientifically designed clinical epidemiological studies (i.e., evidence). EBM is used in various clinical applications, such as therapy, diagnosis, and prognosis prediction. The process includes (1) asking a clinical question consisting of the three elements of "patient", "exposure", and "outcome"; (2) searching for the best evidence using MEDLINE or Cochrane Library; (3) appraising critically the validity of the method and the magnitude and probability of the result; and finally (4) applying the evidence of the patient. In actual clinical practice, clinical expertise and patient preferences should be as much regarded as research evidence. 'The Cochrane Collaboration' supplies systematic reviews of clinical trials carried out all over the world to its consumers. Its fruit, 'The Cochrane Library (CD-ROM),' is a highly valuable resource. 'The Cochrane Collaboration' serves as the infrastructure for EBM. EBM, which was originally developed for the individual patient care, can also be applicable to community- or workplace-healthcare and policy making by governments. Thus, EBM is both a philosophy and a method to provide people with the most appropriate medical practice.

Impact of chemical polishing on surface roughness and dimensional quality of electron beam melting process (EBM) parts

NASA Astrophysics Data System (ADS)

Dolimont, Adrien; Rivière-Lorphèvre, Edouard; Ducobu, François; Backaert, Stéphane

2018-05-01

Additive manufacturing is growing faster and faster. This leads us to study the functionalization of the parts that are produced by these processes. Electron Beam melting (EBM) is one of these technologies. It is a powder based additive manufacturing (AM) method. With this process, it is possible to manufacture high-density metal parts with complex topology. One of the big problems with these technologies is the surface finish. To improve the quality of the surface, some finishing operations are needed. In this study, the focus is set on chemical polishing. The goal is to determine how the chemical etching impacts the dimensional accuracy and the surface roughness of EBM parts. To this end, an experimental campaign was carried out on the most widely used material in EBM, Ti6Al4V. Different exposure times were tested. The impact of these times on surface quality was evaluated. To help predicting the excess thickness to be provided, the dimensional impact of chemical polishing on EBM parts was estimated. 15 parts were measured before and after chemical machining. The improvement of surface quality was also evaluated after each treatment.

[Training 5th-Year Clinical Pharmacy Students to Collect and Evaluate Information from Original Articles].

PubMed

Esumi, Satoru; Kawasaki, Yoichi; Ida, Hiromi; Kitamura, Yoshihisa; Sendo, Toshiaki

2018-01-01

　Pharmacists are required to contribute to evidence-based medicine (EBM) by providing drug information, which can be collected from various sources such as books, websites, and original articles. In particular, information from original articles is needed in some situations. For example, original articles by international researchers are used to aid the management of novel in-hospital preparations on which little knowledge is available. We introduced an information evaluation program, the Okayama University Hospital EBM Model, into the clinical training of 5th-year pharmacy students. It aims to enable students to evaluate the validity of novel in-hospital preparations using original articles. This program has improved students' knowledge of EBM, and the satisfaction level of those enrolled was high. In addition, customer satisfaction analysis revealed that the overall degree of student satisfaction was related to their understanding of the necessity for EBM and the difficulty of practical training. In addition, students' achievements were evaluated using rubrics, and that method allowed the achievements of each student to be assessed appropriately. We hope to revise this program with the aim of improving students' understanding of EBM.

'What the patient wants': an investigation of the methods of ascertaining patient values in evidence-based medicine and values-based practice.

PubMed

Wieten, Sarah

2018-02-01

Evidence-Based Medicine (EBM), Values-Based Practice (VBP) and Person-Centered Healthcare (PCH) are all concerned with the values in play in the clinical encounter. However, these recent movements are not in agreement about how to discover these relevant values. In some parts of EBM textbooks, the prescribed method for discovering values is through social science research on the average values in a particular population. VBP by contrast always investigates the individually held values of the different stakeholders in the particular clinical encounter, although the account has some other difficulties. I argue that although average values for populations might be very useful in informing questions of resource distribution and policy making, their use cannot replace the individual solicitation of patient (and other stakeholder) values in the clinical encounter. Because of the inconsistency of the EBM stance on values, the incompatibility of some versions of the EBM treatment of values with PCH, and EBM's attempt to transplant research methods from science into the realm of values, I must recommend the use of the VBP account of values discovery. © 2015 John Wiley & Sons, Ltd.

How evidence-based medicine is failing due to biased trials and selective publication.

PubMed

Every-Palmer, Susanna; Howick, Jeremy

2014-12-01

Evidence-based medicine (EBM) was announced in the early 1990s as a 'new paradigm' for improving patient care. Yet there is currently little evidence that EBM has achieved its aim. Since its introduction, health care costs have increased while there remains a lack of high-quality evidence suggesting EBM has resulted in substantial population-level health gains. In this paper we suggest that EBM's potential for improving patients' health care has been thwarted by bias in the choice of hypotheses tested, manipulation of study design and selective publication. Evidence for these flaws is clearest in industry-funded studies. We argue EBM's indiscriminate acceptance of industry-generated 'evidence' is akin to letting politicians count their own votes. Given that most intervention studies are industry funded, this is a serious problem for the overall evidence base. Clinical decisions based on such evidence are likely to be misinformed, with patients given less effective, harmful or more expensive treatments. More investment in independent research is urgently required. Independent bodies, informed democratically, need to set research priorities. We also propose that evidence rating schemes are formally modified so research with conflict of interest bias is explicitly downgraded in value. © 2014 John Wiley & Sons, Ltd.

NASA/ORNL/AFRL Project Work on EBM LSHR: Additive Manufacturing of High-Temperature Gamma-Prime Strengthened Ni-Based Superalloys

NASA Technical Reports Server (NTRS)

Sudbrack, Chantal K.; Kirka, Michael M.; Dehoff, Ryan R.; Carter, Robert W.; Semiatin, Sheldon L.; Gabb, Timothy P.

2016-01-01

Powder-bed fabrication of aerospace alloys may revolutionize production by eliminating the need for extensive machining and expensive tooling. Heated-bed electron-beam melting (EBM) offers advantages over non-heated laser additive manufacturing (AM) methods, including lower residual stress, reduced risk of contamination, slower cooling rates, and faster build times. NASA Glenn Research Center has joint project work with Oak Ridge National Lab and the Air Force Research Laboratory to explore the feasibility of fabricating advanced Ni-based gamma-prime superalloys with EBM AM.

3D Metal Printing - Additive Manufacturing Technologies for Frameworks of Implant-Borne Fixed Dental Prosthesis.

PubMed

Revilla León, M; Klemm, I M; García-Arranz, J; Özcan, M

2017-09-01

An edentulous patient was rehabilitated with maxillary metal-ceramic and mandibular metal-resin implant-supported fixed dental prosthesis (FDP). Metal frameworks of the FDPs were fabricated using 3D additive manufacturing technologies utilizing selective laser melting (SLM) and electron beam melting (EBM) processes. Both SLM and EBM technologies were employed in combination with computer numerical control (CNC) post-machining at the implant interface. This report highlights the technical and clinical protocol for fabrication of FDPs using SLM and EBM additive technologies. Copyright© 2017 Dennis Barber Ltd.

Developing resident learning profiles: Do scientific evidence epistemology beliefs, EBM self-efficacy beliefs and EBM skills matter?

NASA Astrophysics Data System (ADS)

Robert, Nancy J.

This study investigated resident scientific evidence epistemology beliefs, evidence based medicine (EBM) self-efficacy beliefs, and EBM skills. A convenience sample of fifty-one residents located in six U.S. based residency programs completed an online instrument. Hofer's epistemology survey questionnaire was modified to test responses based on four types of scientific evidence encountered in medical practice (Clinical Trial Phase 1, Clinical Trial Phase 3, Meta-analysis and Qualitative). It was hypothesized that epistemology beliefs would differ based on the type of scientific evidence considered. A principal components analysis produced a two factor solution that was significant across type of scientific evidence suggesting that when evaluating epistemology beliefs context does matter. Factor 1 is related to the certainty of research methods and the certainty of medical conclusions and factor 2 denotes medical justification. For each type of scientific evidence, both factors differed on questions comprising the factor structure with significant differences found for the factor 1 and 2 questions. A justification belief case problem using checklist format was triangulated with the survey results, and as predicted the survey and checklist justification z scores indicated no significant differences, and two new justification themes emerged. Modified versions of Finney and Schraw's statistical self-efficacy and skill instruments produced expected significant EBM score correlations with unexpected results indicating that the number of EBM and statistics courses are not significant for EBM self-efficacy and skill scores. The study results were applied to the construction of a learning profile that provided residents belief and skill feedback specific to individual learning needs. The learning profile design incorporated core values related to 'Believer' populations that focus on art, harmony, tact and diplomacy. Future research recommendations include testing context and case problems in other domains with larger sample sizes, offering belief feedback profiles to understand how individuals value and apply belief knowledge, and conducting belief and skill testing using online access.

A Cross-Sectional Study of Medical Student Knowledge of Evidence-Based Medicine as Measured by the Fresno Test of Evidence-Based Medicine.

PubMed

Smith, Amy B; Semler, Lauren; Rehman, Elizabeth A; Haddad, Zachary G; Ahmadzadeh, Katie L; Crellin, Steven J; Falkowska, Katarzyna; Kendig, Kalif A; Steinweg, Brent H; Dusza, Stephen W; Glenn-Porter, Bernadette; Kane, Bryan G

2016-05-01

Evidence-based medicine (EBM) has been included in the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Emergency Medicine (ABEM) milestones project as a required component during emergency medicine (EM) residency training. Milestone Level One states that graduating medical students must be able to "describe basic principles of EBM." We sought to identify the EBM skills of third- and fourth-year medical students. Our institution, a network with 17 different residencies, hosts U.S. osteopathic and allopathic medical students. As a part of orientation, students are required to complete an entry Fresno Test of EBM (FTEBM). Retrospectively, medical student FTEBM scores from 2011 were assessed using descriptive statistics. Four hundred seventeen FTEBM scores were analyzed. Participants represented 40 medical schools, including 17 allopathic (MD) and 23 osteopathic (DO) schools. Fifty percent of participants (n = 210) were female, and 51.6% (n = 215) were from a DO medical school. Overall mean performance for the FTEBM was 47.2%. Exploring the results by individual question were (individual EBM question topics are in parentheses): 1A (study question), 62.0%; 1B (study question), 64.4%: 2 (sources of evidence), 67.6%; 3 (study design), 57.1%; 4 (search strategies), 53.2%; 5 (relevance), 41.2%; 6 (internal validity), 43.6%; 7 (magnitude), 37.8%; 8 (two-by-two grids), 30.0%; 9 (number needed to treat), 16.9%; 10 (confidence intervals), 34.3%; 11 (diagnosis), 5.0%; and 12 (prognosis), 43.4%. As measured by the FTEBM, senior medical students demonstrate understanding of about half of EBM. EM residencies can anticipate the need to instruct their residents in EBM concepts in order to meet ACGME/ABEM milestone requirements. Copyright © 2016 Elsevier Inc. All rights reserved.

Evidence based medicine guidelines: a solution to rationing or politics disguised as science?

PubMed

Saarni, S I; Gylling, H A

2004-04-01

"Evidence based medicine" (EBM) is often seen as a scientific tool for quality improvement, even though its application requires the combination of scientific facts with value judgments and the costing of different treatments. How this is done depends on whether we approach the problem from the perspective of individual patients, doctors, or public health administrators. Evidence based medicine exerts a fundamental influence on certain key aspects of medical professionalism. Since, when clinical practice guidelines are created, costs affect the content of EBM, EBM inevitably becomes a form of rationing and adopts a public health point of view. This challenges traditional professionalism in much the same way as managed care has done in the US. Here we chart some of these major philosophical issues and show why simple solutions cannot be found. The profession needs to pay more attention to different uses of EBM in order to preserve the good aspects of professionalism.

Impact of breast milk on IQ, brain size and white matter development

PubMed Central

Isaacs, Elizabeth B.; Fischl, Bruce R.; Quinn, Brian T.; Chong, Wui K.; Gadian, David G.; Lucas, Alan

2010-01-01

Although observational findings linking breast milk to higher scores on cognitive tests may be confounded by factors associated with mothers’ choice to breastfeed, it has been suggested that one or more constituents of breast milk facilitate cognitive development, particularly in preterms. Because cognitive scores are related to head size, we hypothesised that breast milk mediates cognitive effects by affecting brain growth. We used detailed data from a randomized feeding trial to calculate percentage of breast milk (%EBM) in the infant diet of 50 adolescents. MRI scans were obtained (mean age=15y9m), allowing volumes of total brain (TBV), white and grey matter (WMV, GMV) to be calculated. In the total group %EBM correlated significantly with Verbal IQ (VIQ); in boys, with all IQ scores, TBV and WMV. VIQ was, in turn, correlated with WMV and, in boys only, additionally with TBV. No significant relationships were seen in girls or with grey matter. These data support the hypothesis that breast milk promotes brain development, particularly white matter growth. The selective effect in males accords with animal and human evidence regarding gender effects of early diet. Our data have important neurobiological and public health implications and identify areas for future mechanistic study. PMID:20035247

Impact of breast milk on intelligence quotient, brain size, and white matter development.

PubMed

Isaacs, Elizabeth B; Fischl, Bruce R; Quinn, Brian T; Chong, Wui K; Gadian, David G; Lucas, Alan

2010-04-01

Although observational findings linking breast milk to higher scores on cognitive tests may be confounded by factors associated with mothers' choice to breastfeed, it has been suggested that one or more constituents of breast milk facilitate cognitive development, particularly in preterms. Because cognitive scores are related to head size, we hypothesized that breast milk mediates cognitive effects by affecting brain growth. We used detailed data from a randomized feeding trial to calculate percentage of expressed maternal breast milk (%EBM) in the infant diet of 50 adolescents. MRI scans were obtained (mean age=15 y 9 mo), allowing volumes of total brain (TBV) and white and gray matter (WMV, GMV) to be calculated. In the total group, %EBM correlated significantly with verbal intelligence quotient (VIQ); in boys, with all IQ scores, TBV and WMV. VIQ was, in turn, correlated with WMV and, in boys only, additionally with TBV. No significant relationships were seen in girls or with gray matter. These data support the hypothesis that breast milk promotes brain development, particularly white matter growth. The selective effect in males accords with animal and human evidence regarding gender effects of early diet. Our data have important neurobiological and public health implications and identify areas for future mechanistic study.

Evidence-based medicine teaching requirements in the USA: taxonomy and themes.

PubMed

Shaughnessy, Allen F; Torro, John R; Frame, Kara A; Bakshi, Munish

2016-05-01

In the USA, recent changes to oversight of residency training codify the requirements for teaching evidence-based medicine and information mastery (lifelong learning) knowledge, skills, and attitudes. The goal of this project is to determine current requirements for teaching of evidence-based medicine (EBM) and information mastery (IM) in specialty residency education in the USA. The project was a qualitative thematic analysis using content analysis. The source of the requirements for EBM and IM were the "milestone" statements for all 28 major specialties and transition year programs. Milestone descriptors related to EBM/IM were extracted and codes were developed and applied to each descriptor by four researchers. The resulting codes were coalesced into themes and tested against the milestone descriptors. The coding process identified 15 content areas comprising five themes. Two themes related to the knowledge and skills of EBM and three themes related to the knowledge, skills, and attitudes of IM. EBM themes encompassed basic critical appraisal skills and knowledge of clinical epidemiology principles and statistics. IM themes centered on identifying one's information needs for patient-specific information, using information sources, and using current awareness services to remain abreast of changes in medicine. In general, they align well with the Sicily Statement on Evidence-Based Practice. No specialty required competence in all areas. New training requirements for specialties in the USA require the development of both classic EBM skills as well as skills for managing information. However, there is marked variation in the requirements among specific specialties. © 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

Peer-teaching of evidence-based medicine.

PubMed

Rees, Eliot; Sinha, Yashashwi; Chitnis, Abhishek; Archer, James; Fotheringham, Victoria; Renwick, Stephen

2014-07-01

Many medical schools teach the principles of evidence-based medicine (EBM) as part of their undergraduate curriculum. Medical students perceive that EBM is valuable to their undergraduate and postgraduate career. Students may experience barriers to applying EBM principles, especially when searching for evidence or identifying high-quality resources. The UK National Institute for Health and Care Excellence (NICE) Evidence Search is a service that enables access to authoritative clinical and non-clinical evidence and best practice through a web-based portal. Evidence-based medicine workshops were organised and delivered by fourth-year medical students, having first received training from NICE to become NICE student champions. The workshops covered the basic principles of EBM and focused on retrieving EBM resources for study through the NICE Evidence Search portal. The scheme was evaluated using a pre-workshop survey and an 8-12 week post-workshop survey. Self-reported confidence in searching for evidence-based resources increased from 29 per cent before the workshop to 87 per cent after the workshop. Only 1 per cent of students rated evidence-based resources as their first preference pre-workshop, compared with 31 per cent post-workshop. The results show that although many students were aware of evidence-based resources, they tended not to use them as their preferred resource. Despite appreciating the value of evidence-based resources, few students were confident in accessing and using such resources for pre-clinical study. A peer-taught workshop in EBM improved students' confidence with, and use of, evidence-based resources. © 2014 John Wiley & Sons Ltd.

Corrosion resistance characteristics of a Ti-6Al-4V alloy scaffold that is fabricated by electron beam melting and selective laser melting for implantation in vivo.

PubMed

Zhao, Bingjing; Wang, Hong; Qiao, Ning; Wang, Chao; Hu, Min

2017-01-01

The purpose of this study is to determine the corrosion resistance of Ti-6Al-4V alloy fabricated with electron beam melting and selective laser melting for implantation in vivo. Ti-6Al-4V alloy specimens were fabricated with electron beam melting (EBM) and selective laser melting (SLM). A wrought form of Ti-6Al-4V alloy was used as a control. Surface morphology observation, component analysis, corrosion resistance experimental results, electrochemical impedance spectroscopy, crevice corrosion resistance experimental results, immersion test and metal ions precipitation analysis were processed, respectively. The thermal stability of EBM specimen was the worst, based on the result of open circuit potential (OCP) result. The result of electrochemical impedance spectroscopy indicated that the corrosion resistance of the SLM specimen was the best under the low electric potential. The result of potentiodynamic polarization suggested that the corrosion resistance of the SLM specimen was the best under the low electric potential (<1.5V) and EBM specimen was the best under the high electric potential (>1.5V).The crevice corrosion resistance of the EBM specimen was the best. The corrosion resistance of SLM specimen was the best, based on the result of immersion test. The content of Ti, Al and V ions of EBM, SLM and wrought specimens was very low. In general, the scaffolds that were fabricated with EBM and SLM had good corrosion resistance, and were suitable for implantation in vivo. Copyright © 2016 Elsevier B.V. All rights reserved.

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

PubMed

Safari, Ameneh; Safari, Yahya

2018-08-01

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

Evidence-based radiology: how to quickly assess the validity and strength of publications in the diagnostic radiology literature.

PubMed

Dodd, Jonathan D; MacEneaney, Peter M; Malone, Dermot E

2004-05-01

The aim of this study was to show how evidence-based medicine (EBM) techniques can be applied to the appraisal of diagnostic radiology publications. A clinical scenario is described: a gastroenterologist has questioned the diagnostic performance of magnetic resonance cholangiopancreatography (MRCP) in a patient who may have common bile duct (CBD) stones. His opinion was based on an article on MRCP published in "Gut." The principles of EBM are described and then applied to the critical appraisal of this paper. Another paper on the same subject was obtained from the radiology literature and was also critically appraised using explicit EBM criteria. The principles for assessing the validity and strength of both studies are outlined. All statistical parameters were generated quickly using a spreadsheet in Excel format. The results of EBM assessment of both papers are presented. The calculation and application of confidence intervals (CIs) and likelihood ratios (LRs) for both studies are described. These statistical results are applied to individual patient scenarios using graphs of conditional probability (GCP). Basic EBM principles are described and additional points relevant to radiologists discussed. Online resources for EBR practice are identified. The principles of EBM and their application to radiology are discussed. It is emphasized that sensitivity and specificity are point estimates of the "true" characteristics of a test in clinical practice. A spreadsheet can be used to quickly calculate CIs, LRs and GCPs. These give the radiologist a better understanding of the meaning of diagnostic test results in any patient or population of patients.

Clinical Epidemiology (CE) and Evidence-Based Medicine (EBM) in the Asia Pacific region (Round Table Forum).

PubMed

Su, Tin Tin; Bulgiba, Awang M; Sampatanukul, Pichet; Sastroasmoro, Sudigdo; Chang, Peter; Tharyan, Prathap; Lin, Vivian; Wong, Yut Lin

2013-01-01

Clinical Epidemiology (CE) and Evidence-Based Medicine (EBM) have become increasingly important in an era of rising costs, patient safety concerns and evidence-based health care. CE and EBM research in the Asia Pacific region have grown significantly. However, there are three main challenges such as linking evidence to practice and policy; developing a strong collaborative network; and a need for resources and technical expertise to produce evidence. The Cochrane Collaboration is a possible solution to resolve above challenges identified, particularly the challenge of transforming evidence to practice. In addition, training can be carried out to enhance technical expertise in the region and there is also the promising potential that collaborations could extend beyond systematic reviews. To improve the adoption of evidence-based health policy, selection of the best evidence for the right audience and focusing on the relevant issues through appropriate methodology are essential. Information on effectiveness and cost effectiveness needs to be highlighted for policy makers. The way forward to strengthen research and capacity building is to establish the Asia Pacific Consortium for CE and EBM. The consortium would help to create mutually rewarding scientific research and collaborations that will augur well for advances in CE and EBM. Copyright © 2013 Elsevier Inc. All rights reserved.

Computational modeling of residual stress formation during the electron beam melting process for Inconel 718

DOE PAGES

Prabhakar, P.; Sames, William J.; Dehoff, Ryan R.; ...

2015-03-28

Here, a computational modeling approach to simulate residual stress formation during the electron beam melting (EBM) process within the additive manufacturing (AM) technologies for Inconel 718 is presented in this paper. The EBM process has demonstrated a high potential to fabricate components with complex geometries, but the resulting components are influenced by the thermal cycles observed during the manufacturing process. When processing nickel based superalloys, very high temperatures (approx. 1000 °C) are observed in the powder bed, base plate, and build. These high temperatures, when combined with substrate adherence, can result in warping of the base plate and affect themore » final component by causing defects. It is important to have an understanding of the thermo-mechanical response of the entire system, that is, its mechanical behavior towards thermal loading occurring during the EBM process prior to manufacturing a component. Therefore, computational models to predict the response of the system during the EBM process will aid in eliminating the undesired process conditions, a priori, in order to fabricate the optimum component. Such a comprehensive computational modeling approach is demonstrated to analyze warping of the base plate, stress and plastic strain accumulation within the material, and thermal cycles in the system during different stages of the EBM process.« less

Developing Traditional Chinese Medicine in the Era of Evidence-Based Medicine: Current Evidences and Challenges

PubMed Central

Fung, Foon Yin; Linn, Yeh Ching

2015-01-01

Evidence-based medicine (EBM), by integrating individual clinical expertise with the best available clinical evidence from systematic research, has in recent years been established as the standard of modern medical practice for greater treatment efficacy and safety. Traditional Chinese Medicine (TCM), on the other hand, evolved as a system of medical practice from ancient China more than 2000 years ago based on empirical knowledge as well as theories and concepts which are yet to be mapped by scientific equivalents. Despite the expanding TCM usage and the recognition of its therapeutic benefits worldwide, the lack of robust evidence from the EBM perspective is hindering acceptance of TCM by the Western medicine community and its integration into mainstream healthcare. For TCM to become an integral component of the healthcare system so that its benefits can be rationally harnessed in the best interests of patients, it is essential for TCM to demonstrate its efficacy and safety by high-level evidence in accordance with EBM, though much debate remains on the validity and feasibility of applying the EBM model on this traditional practice. This review aims to discuss the current status of research in TCM, explore the evidences available on its efficacy and safety, and highlight the issues and challenges faced in applying EBM to TCM. PMID:25949261

Evidence-based medicine at the intersection of research interests between academic health sciences librarians and medical educators: a review of the literature.

PubMed

Dorsch, Josephine L; Perry, Gerald Jerry

2012-10-01

In 2008, the Association of Academic Health Sciences Libraries established an Education Research Task Force (ERTF) to plan research addressing research priorities outlined in key Association of American Medical Colleges reports. ERTF members conducted a literature review to describe the state of collaborative research at the intersection of medical education and health sciences librarianship. Analysis of initial results revealed instruction in evidence-based medicine (EBM) was a shared interest and is thus the focus of this review. Searches on EBM teaching programs were conducted, and results were posted to a shared online citation management service. Individual articles were assessed and assigned metadata describing subject matter, scope, and format. Article analysis identified key themes. Most papers were descriptive narratives of curricular development. Evaluation studies were also prominent and often based on student satisfaction or self-reported competency. A smaller number of controlled studies provide evidence of impacts of librarian involvement in EBM instruction. Scholarship of EBM instruction is of common interest between medical educators and health sciences librarians. Coauthorship between the groups and distribution of literature points to a productive collaboration. An emerging literature of controlled studies measuring the impact of cross-disciplinary efforts signals continued progress in the arena of EBM instruction.

Evidence-based medicine at the intersection of research interests between academic health sciences librarians and medical educators: a review of the literature

PubMed Central

Dorsch, Josephine L.; Perry, Gerald (Jerry)

2012-01-01

Objectives: In 2008, the Association of Academic Health Sciences Libraries established an Education Research Task Force (ERTF) to plan research addressing research priorities outlined in key Association of American Medical Colleges reports. ERTF members conducted a literature review to describe the state of collaborative research at the intersection of medical education and health sciences librarianship. Analysis of initial results revealed instruction in evidence-based medicine (EBM) was a shared interest and is thus the focus of this review. Methods: Searches on EBM teaching programs were conducted, and results were posted to a shared online citation management service. Individual articles were assessed and assigned metadata describing subject matter, scope, and format. Results: Article analysis identified key themes. Most papers were descriptive narratives of curricular development. Evaluation studies were also prominent and often based on student satisfaction or self-reported competency. A smaller number of controlled studies provide evidence of impacts of librarian involvement in EBM instruction. Conclusions: Scholarship of EBM instruction is of common interest between medical educators and health sciences librarians. Coauthorship between the groups and distribution of literature points to a productive collaboration. An emerging literature of controlled studies measuring the impact of cross-disciplinary efforts signals continued progress in the arena of EBM instruction. PMID:23133324

Knowledge and attitudes towards evidence-based medicine of mentors in general practice can be influenced by using medical students as academic detailers.

PubMed

Vrdoljak, Davorka; Petric, Dragomir; Diminić Lisica, Ines; Kranjčević, Ksenija; Došen Janković, Sanja; Delija, Ita; Puljak, Livia

2015-01-01

Regular use of evidence-based medicine (EBM) among general practitioners (GP) is insufficient. To analyse whether knowledge and attitudes about EBM can be improved among mentors in general practice by involving sixth-year medical students as academic detailers. An interventional non-randomized before-and-after study included 98 GPs (49 in the intervention group of mentors and 49 controls) and 174 medical students attending family medicine clinical rotations. A telephone survey on knowledge and attitudes towards EBM was conducted among participating physicians before, and six months after the rotation. During the rotation, each mentor chose two cases from real life, and the students' task was to form an answerable clinical question, find the evidence-based answer and to write a brief report. The mentor reviewed the report and discussed it with the student. Students' EBM detailing intervention led to significant improvement in knowledge and attitudes about EBM in the intervention group of mentors in general practice compared to control GPs (relative increase in knowledge was 20 ± 46.9% vs 6 ± 12.1%, respectively; P = 0.042). Among participants with Ph.D. or specialization in family medicine, the observed effects of the intervention were similar as in the total sample, and statistically significant, but not in the group of participants with neither scientific degree nor specialization in family medicine. Knowledge and attitudes of GP mentors towards EBM can be improved by involving medical students as academic detailers. Further studies should explore the effectiveness of this method among GPs that are not mentors, and who do not have a specialization or research degree.

Evidence Based Medicine – New Approaches and Challenges

PubMed Central

Masic, Izet; Miokovic, Milan; Muhamedagic, Belma

2008-01-01

CONFLICT OF INTEREST: NONE DECLARED Evidence based medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information. It is a movement which aims to increase the use of high quality clinical research in clinical decision making. EBM requires new skills of the clinician, including efficient literature-searching, and the application of formal rules of evidence in evaluating the clinical literature. The practice of evidence-based medicine is a process of lifelong, self-directed, problem-based learning in which caring for one’s own patients creates the need for clinically important information about diagnosis, prognosis, therapy and other clinical and health care issues. It is not “cookbook” with recipes, but its good application brings cost-effective and better health care. The key difference between evidence-based medicine and traditional medicine is not that EBM considers the evidence while the latter does not. Both take evidence into account; however, EBM demands better evidence than has traditionally been used. One of the greatest achievements of evidence-based medicine has been the development of systematic reviews and meta-analyses, methods by which researchers identify multiple studies on a topic, separate the best ones and then critically analyze them to come up with a summary of the best available evidence. The EBM-oriented clinicians of tomorrow have three tasks: a) to use evidence summaries in clinical practice; b) to help develop and update selected systematic reviews or evidence-based guidelines in their area of expertise; and c) to enrol patients in studies of treatment, diagnosis and prognosis on which medical practice is based. PMID:24109156

Evaluation of Titanium Alloys Fabricated Using Rapid Prototyping Technologies—Electron Beam Melting and Laser Beam Melting

PubMed Central

Koike, Mari; Greer, Preston; Owen, Kelly; Lilly, Guo; Murr, Lawrence E.; Gaytan, Sara M.; Martinez, Edwin; Okabe, Toru

2011-01-01

This study characterized properties of Ti-6Al-4V ELI (extra low interstitial, ASTM grade 23) specimens fabricated by a laser beam melting (LBM) and an electron beam melting (EBM) system for dental applications. Titanium alloy specimens were made into required size and shape for each standard test using fabrication methods. The LBM specimens were made by an LBM machine utilizing 20 µm of Ti-6Al-4V ELI powder. Ti-6Al-4V ELI specimens were also fabricated by an EBM using 40 µm of Ti-6Al-4V ELI powder (average diameter, 40 µm: Arcam AB®) in a vacuum. As a control, cast Ti-6Al-4V ELI specimens (Cast) were made using a centrifugal casting machine in an MgO-based mold. Also, a wrought form of Ti-6Al-4V ELI (Wrought) was used as a control. The mechanical properties, corrosion properties and grindability (wear properties) were evaluated and data was analyzed using ANOVA and a non-parametric method (α = 0.05). The strength of the LBM and wrought specimens were similar, whereas the EBM specimens were slightly lower than those two specimens. The hardness of both the LBM and EBM specimens was similar and slightly higher than that of the cast and wrought alloys. For the higher grindability speed at 1,250 m/min, the volume loss of Ti64 LBM and EBM showed no significant differences among all the fabrication methods. LBM and EBM exhibited favorable results in fabricating dental appliances with excellent properties as found for specimens made by other fabricating methods. PMID:28824107

From data to evidence: evaluative methods in evidence-based medicine.

PubMed

Landry, M D; Sibbald, W J

2001-11-01

The amount of published information is increasing exponentially, and recent technologic advances have created systems whereby mass distribution of this information can occur at an infinite rate. This is particularly true in the broad field of medicine, as the absolute volume of data available to the practicing clinician is creating new challenges in the management of relevant information flow. Evidence-based medicine (EBM) is an information management and learning strategy that seeks to integrate clinical expertise with the best evidence available in order to make effective clinical decisions that will ultimately improve patient care. The systematic approach underlying EBM encourages the clinician to formulate specific and relevant questions, which are answered in an iterative manner through accessing the best available published evidence. The arguments against EBM stem from the idea that there are inherent weaknesses in research methodologies and that emphasis placed on published research may ignore clinical skills and individual patient needs. Despite these arguments, EBM is gaining momentum and is consistently used as a method of learning and improving health care delivery. However, if EBM is to be effective, the clinician needs to have a critical understanding of research methodology in order to judge the value and level of a particular data source. Without critical analysis of research methodology, there is an inherent risk of drawing incorrect conclusions that may affect clinical decision-making. Currently, there is a trend toward using secondary pre-appraised data rather than primary sources as best evidence. We review the qualitative and quantitative methodology commonly used in EBM and argue that it is necessary for the clinician to preferentially use primary rather than secondary sources in making clinically relevant decisions.

The EBM-DPSER Conceptual Model: Integrating Ecosystem Services into the DPSIR Framework

PubMed Central

Kelble, Christopher R.; Loomis, Dave K.; Lovelace, Susan; Nuttle, William K.; Ortner, Peter B.; Fletcher, Pamela; Cook, Geoffrey S.; Lorenz, Jerry J.; Boyer, Joseph N.

2013-01-01

There is a pressing need to integrate biophysical and human dimensions science to better inform holistic ecosystem management supporting the transition from single species or single-sector management to multi-sector ecosystem-based management. Ecosystem-based management should focus upon ecosystem services, since they reflect societal goals, values, desires, and benefits. The inclusion of ecosystem services into holistic management strategies improves management by better capturing the diversity of positive and negative human-natural interactions and making explicit the benefits to society. To facilitate this inclusion, we propose a conceptual model that merges the broadly applied Driver, Pressure, State, Impact, and Response (DPSIR) conceptual model with ecosystem services yielding a Driver, Pressure, State, Ecosystem service, and Response (EBM-DPSER) conceptual model. The impact module in traditional DPSIR models focuses attention upon negative anthropomorphic impacts on the ecosystem; by replacing impacts with ecosystem services the EBM-DPSER model incorporates not only negative, but also positive changes in the ecosystem. Responses occur as a result of changes in ecosystem services and include inter alia management actions directed at proactively altering human population or individual behavior and infrastructure to meet societal goals. The EBM-DPSER conceptual model was applied to the Florida Keys and Dry Tortugas marine ecosystem as a case study to illustrate how it can inform management decisions. This case study captures our system-level understanding and results in a more holistic representation of ecosystem and human society interactions, thus improving our ability to identify trade-offs. The EBM-DPSER model should be a useful operational tool for implementing EBM, in that it fully integrates our knowledge of all ecosystem components while focusing management attention upon those aspects of the ecosystem most important to human society and does so within a framework already familiar to resource managers. PMID:23951002

Evaluation of Titanium Alloys Fabricated Using Rapid Prototyping Technologies-Electron Beam Melting and Laser Beam Melting.

PubMed

Koike, Mari; Greer, Preston; Owen, Kelly; Lilly, Guo; Murr, Lawrence E; Gaytan, Sara M; Martinez, Edwin; Okabe, Toru

2011-10-10

This study characterized properties of Ti-6Al-4V ELI (extra low interstitial, ASTM grade 23) specimens fabricated by a laser beam melting (LBM) and an electron beam melting (EBM) system for dental applications. Titanium alloy specimens were made into required size and shape for each standard test using fabrication methods. The LBM specimens were made by an LBM machine utilizing 20 µm of Ti-6Al-4V ELI powder. Ti-6Al-4V ELI specimens were also fabricated by an EBM using 40 µm of Ti-6Al-4V ELI powder (average diameter, 40 µm: Arcam AB Ò ) in a vacuum. As a control, cast Ti-6Al-4V ELI specimens (Cast) were made using a centrifugal casting machine in an MgO-based mold. Also, a wrought form of Ti-6Al-4V ELI (Wrought) was used as a control. The mechanical properties, corrosion properties and grindability (wear properties) were evaluated and data was analyzed using ANOVA and a non-parametric method (α = 0.05). The strength of the LBM and wrought specimens were similar, whereas the EBM specimens were slightly lower than those two specimens. The hardness of both the LBM and EBM specimens was similar and slightly higher than that of the cast and wrought alloys. For the higher grindability speed at 1,250 m/min, the volume loss of Ti64 LBM and EBM showed no significant differences among all the fabrication methods. LBM and EBM exhibited favorable results in fabricating dental appliances with excellent properties as found for specimens made by other fabricating methods.

The EBM-DPSER conceptual model: integrating ecosystem services into the DPSIR framework.

PubMed

Kelble, Christopher R; Loomis, Dave K; Lovelace, Susan; Nuttle, William K; Ortner, Peter B; Fletcher, Pamela; Cook, Geoffrey S; Lorenz, Jerry J; Boyer, Joseph N

2013-01-01

There is a pressing need to integrate biophysical and human dimensions science to better inform holistic ecosystem management supporting the transition from single species or single-sector management to multi-sector ecosystem-based management. Ecosystem-based management should focus upon ecosystem services, since they reflect societal goals, values, desires, and benefits. The inclusion of ecosystem services into holistic management strategies improves management by better capturing the diversity of positive and negative human-natural interactions and making explicit the benefits to society. To facilitate this inclusion, we propose a conceptual model that merges the broadly applied Driver, Pressure, State, Impact, and Response (DPSIR) conceptual model with ecosystem services yielding a Driver, Pressure, State, Ecosystem service, and Response (EBM-DPSER) conceptual model. The impact module in traditional DPSIR models focuses attention upon negative anthropomorphic impacts on the ecosystem; by replacing impacts with ecosystem services the EBM-DPSER model incorporates not only negative, but also positive changes in the ecosystem. Responses occur as a result of changes in ecosystem services and include inter alia management actions directed at proactively altering human population or individual behavior and infrastructure to meet societal goals. The EBM-DPSER conceptual model was applied to the Florida Keys and Dry Tortugas marine ecosystem as a case study to illustrate how it can inform management decisions. This case study captures our system-level understanding and results in a more holistic representation of ecosystem and human society interactions, thus improving our ability to identify trade-offs. The EBM-DPSER model should be a useful operational tool for implementing EBM, in that it fully integrates our knowledge of all ecosystem components while focusing management attention upon those aspects of the ecosystem most important to human society and does so within a framework already familiar to resource managers.

Mapping Cognitive Overlaps Between Practice-Based Learning and Improvement and Evidence-Based Medicine: An Operational Definition for Assessing Resident Physician Competence

PubMed Central

Chatterji, Madhabi; Graham, Mark J.; Wyer, Peter C.

2009-01-01

Purpose The complex competency labeled practice-based learning and improvement (PBLI) by the Accreditation Council for Graduate Medical Education (ACGME) incorporates core knowledge in evidence-based medicine (EBM). The purpose of this study was to operationally define a “PBLI-EBM” domain for assessing resident physician competence. Method The authors used an iterative design process to first content analyze and map correspondences between ACGME and EBM literature sources. The project team, including content and measurement experts and residents/fellows, parsed, classified, and hierarchically organized embedded learning outcomes using a literature-supported cognitive taxonomy. A pool of 141 items was produced from the domain and assessment specifications. The PBLI-EBM domain and resulting items were content validated through formal reviews by a national panel of experts. Results The final domain represents overlapping PBLI and EBM cognitive dimensions measurable through written, multiple-choice assessments. It is organized as 4 subdomains of clinical action: Therapy, Prognosis, Diagnosis, and Harm. Four broad cognitive skill branches (Ask, Acquire, Appraise, and Apply) are subsumed under each subdomain. Each skill branch is defined by enabling skills that specify the cognitive processes, content, and conditions pertinent to demonstrable competence. Most items passed content validity screening criteria and were prepared for test form assembly and administration. Conclusions The operational definition of PBLI-EBM competence is based on a rigorously developed and validated domain and item pool, and substantially expands conventional understandings of EBM. The domain, assessment specifications, and procedures outlined may be used to design written assessments to tap important cognitive dimensions of the overall PBLI competency, as given by ACGME. For more comprehensive coverage of the PBLI competency, such instruments need to be complemented with performance assessments. PMID:21975994

Walking the CER Path.

PubMed

Adams, Katherine T

2009-08-01

Evidence-based medicine has been a rallying cry for payers, but an inability to define value, conflicting clinical trial designs, physician practice variations, and payment incentives confound efforts to make EBM go mainstream. CER may give EBM some legs - just as the biologics pipeline is about to overflow.

Study of flow stress and spall strength of additively manufactured Ti-6-4 alloy

NASA Astrophysics Data System (ADS)

Cohen, Amitay; Paris, Vitaly; Yosef-Hai, Arnon; Gudinetsky, Eli; Tiferet, Eitan

2017-06-01

The use of additive manufacturing (AM) by Electron Beam Melting (EBM) or Selective Laser Melting (SLM) has extensively grown in the past few years. A major goal in AM is to manufacture materials with mechanical properties at least as good as traditionally manufactured materials. In this work we present results of planar impact tests and Split Hopkinson Pressure Bar tests (SHPB) on Ti-6-4 manufactured by EBM and SLM processes. Results of planar impact tests on SLM samples display slightly higher spall strength compared to EBM while the stress at Hugoniot elastic limit (HEL) is practically the same. Stress strain curves based on SHPB measurements at two different strain rates present similar plastic flow stresses for SLM and EBM processed Ti-6-4 alloy, while the flow stress is about 20% higher than reported for commercial reference material. The strain to failure of both materials shows considerable strain rate sensitivity. The results of post-mortem analysis of spall fracture will also be presented.

Ethics, EBM, and hospital management.

PubMed

Biller-Andorno, N; Lenk, C; Leititis, J

2004-04-01

Matters of hospital management do not figure prominently on the medical ethics agenda. However, management decisions that have to be taken in the area of hospital care are in fact riddled with ethical questions and do have significant impact on patients, staff members, and the community being served. In this decision making process evidence based medicine (EBM) plays an increasingly important role as a tool for rationalising as well as rationing health care resources. In this article, ethical issues of hospital management and the role of EBM will be explored, with particular reference to disease management programs, diagnosis related groups, and clinical pathways as recent developments in the German health care system.

[The benefit of multi-disciplines combination in evidence-based medicine teaching practice].

PubMed

Fang, Xianghua; Wang, Chunxiu

2016-01-01

In this article, we gave a detail description on the experience of teaching evidence-based medicine (EBM) in undergraduate students and graduate students as well as for continue medical education. The staff of Department of EBM was from variety of sub-discipline, including epidemiologists, physicians, surgeons and librarian. To make the course smoothly, the member of the department discussed the plan together frequently, and had conduct test lecture, which make the course to become perfect. The key for the development in our department is powerful organization and leadership, pursuing perfect, keeping with the progress of the EBM and team-working.

Evidence-Based Medicine: A Genealogy of the Dominant Science of Medical Education.

PubMed

Hanemaayer, Ariane

2016-12-01

Debates about how knowledge is made and valued in evidence-based medicine (EBM) have yet to understand what discursive, social, and historical conditions allowed the EBM approach to stabilize and proliferate across western medical education. This paper uses a genealogical approach to examine the epistemological tensions that emerged as a result of various problematizations of uncertainty in medical practice. I explain how the problematization of uncertainty in the literature and the contingency of specific social, political, economic, and historical relations allowed the EBM approach to become a programmatic and pedagogical focus of the Faculty of Medicine at McMaster University and beyond.

[Evidence-based medicine: the art of applying scientific knowledge in clinical practice].

PubMed

Lopes, A A

2000-01-01

This article was written with the objective of describing the concept of Evidence Based Medicine (EBM) and the competences required for its practice. EBM should be viewed as an integration of clinical experience with the ability to analyze and rationally apply the scientific information while taking care of patients. The application of methods and strategies to enhance the scientific background of the physician while taking into account the humanitarian values of the medical profession should contribute to improve the quality of the medical care that is offered in Brazil. The Medical Schools and Associations may play important roles in the promotion of EBM.

Effecting Change in an Evidence-Based Medicine Curriculum: Librarians' Role in a Pediatric Residency Program.

PubMed

Zeblisky, Kathy; Birr, Rebecca A; Sjursen Guerrero, Anne Marie

2015-01-01

Librarians for the joint Phoenix Children's Hospital/Maricopa Medical Center Pediatric Residency Program were asked to assist on the Evidence-Based Medicine (EBM) Subcommittee for the program. Faculty was open to recommendations for revising and improving the curriculum and desired librarian assistance in completing the task. The annual program review and conference evaluations revealed a gap between the objectives of the EBM curriculum and the residents' perceived abilities to integrate knowledge into meaningful literature searches. This column demonstrates how librarians can collaborate with their residency programs to revise and improve processes to effect change in their program's EBM curriculum.

Librarians in Evidence-Based Medicine Curricula: A Qualitative Study of Librarian Roles, Training, and Desires for Future Development.

PubMed

Maggio, Lauren A; Durieux, Nancy; Tannery, Nancy H

2015-01-01

This study aims to describe librarians' roles in evidence-based medicine (EBM) from the librarian perspective, identify how librarians are trained to teach, and highlight preferences for professional development. A multiinstitution qualitative study was conducted. Nine medical librarians identified by their faculty as integrated into EBM training were interviewed. Participants' descriptions indicated that they were active in curriculum development, deployment (including teaching activities), and assessment to support EBM. Participants identified direct experience and workshop participation as primary methods of learning to teach. Participants desired continuing development as teachers and requested opportunities for in-person workshops, shadowing physicians, and online training.

Evidence-based medicine was bound to fail: a report to Alvan Feinstein.

PubMed

Fava, Giovanni A

2017-04-01

John Ioannidis has provided a lucid account, in the form of a report to David Sackett, of how evidence-based medicine (EBM) was hijacked to serve vested interests: major randomized controlled trials are largely done by and for the benefit of the industry; meta-analyses and guidelines are flooded with conflicts of interest; national and federal research funds are unable to address basic clinical questions. Nonetheless, EBM would remain a worthwhile goal. In this paper, in the form of a report to Alvan Feinstein, it is argued that current developments were largely predictable. EBM certainly gave an important contribution to questioning unsubstantiated therapeutic claims. Time has come, however, to become aware of its considerable limitations, including overall reductionism and insufficient consideration of problems related to financial conflicts of interest. EBM does not represent the scientific approach to medicine: it is only a restrictive interpretation of the scientific approach to clinical practice. EBM drives the prescribing clinician to an overestimated consideration of potential benefits, paying little attention to the likelihood of responsiveness and to potential vulnerabilities in relations to the adverse effects of treatment. It is time to substitute the fashionable popularity of a strategy developed outside of clinical medicine with models and research based on the insights of clinical judgment and patient-doctor interaction, as Feinstein had outlined. Copyright © 2017 Elsevier Inc. All rights reserved.

Generalised and Fractional Langevin Equations-Implications for Energy Balance Models

NASA Astrophysics Data System (ADS)

Watkins, N. W.; Chapman, S. C.; Chechkin, A.; Ford, I.; Klages, R.; Stainforth, D. A.

2017-12-01

Energy Balance Models (EBMs) have a long heritage in climate science, including their use in modelling anomalies in global mean temperature. Many types of EBM have now been studied, and this presentation concerns the stochastic EBMs, which allow direct treatment of climate fluctuations and noise. Some recent stochastic EBMs (e.g. [1]) map on to Langevin's original form of his equation, with temperature anomaly replacing velocity, and other corresponding replacements being made. Considerable sophistication has now been reached in the application of multivariate stochastic Langevin modelling in many areas of climate. Our work is complementary in intent and investigates the Mori-Kubo "Generalised Langevin Equation" (GLE) which incorporates non-Markovian noise and response in a univariate framework, as a tool for modelling GMT [2]. We show how, if it is present, long memory simplifies the GLE to a fractional Langevin equation (FLE). Evidence for long range memory in global temperature, and the success of fractional Gaussian noise in its prediction [5] has already motivated investigation of a power law response model [3,4,5]. We go beyond this work to ask whether an EBM of FLE-type exists, and what its solutions would be. [l] Padilla et al, J. Climate (2011); [2] Watkins, GRL (2013); [3] Rypdal, JGR (2012); [4] Rypdal and Rypdal, J. Climate (2014); [5] Lovejoy et al, ESDD (2015).

Barriers to evidence-based medicine: a systematic review.

PubMed

Sadeghi-Bazargani, Homayoun; Tabrizi, Jafar Sadegh; Azami-Aghdash, Saber

2014-12-01

Evidence-based medicine (EBM) has emerged as an effective strategy to improve health care quality. The aim of this study was to systematically review and carry out an analysis on the barriers to EBM. Different database searching methods and also manual search were employed in this study using the search words ('evidence-based' or 'evidence-based medicine' or 'evidence-based practice' or 'evidence-based guidelines' or 'research utilization') and (barrier* or challenge or hinder) in the following databases: PubMed, Scopus, Web of Knowledge, Cochrane library, Pro Quest, Magiran, SID. Out of 2592 articles, 106 articles were finally identified for study. Research barriers, lack of resources, lack of time, inadequate skills, and inadequate access, lack of knowledge and financial barriers were found to be the most common barriers to EBM. Examples of these barriers were found in primary care, hospital/specialist care, rehabilitation care, medical education, management and decision making. The most common barriers to research utilization were research barriers, cooperation barriers and changing barriers. Lack of resources was the most common barrier to implementation of guidelines. The result of this study shows that there are many barriers to the implementation and use of EBM. Identifying barriers is just the first step to removing barriers to the use of EBM. Extra resources will be needed if these barriers are to be tackled. © 2014 John Wiley & Sons, Ltd.

Implementing evidence-based medicine in general practice: a focus group based study

PubMed Central

Hannes, Karin; Leys, Marcus; Vermeire, Etienne; Aertgeerts, Bert; Buntinx, Frank; Depoorter, Anne-Marie

2005-01-01

Background Over the past years concerns are rising about the use of Evidence-Based Medicine (EBM) in health care. The calls for an increase in the practice of EBM, seem to be obstructed by many barriers preventing the implementation of evidence-based thinking and acting in general practice. This study aims to explore the barriers of Flemish GPs (General Practitioners) to the implementation of EBM in routine clinical work and to identify possible strategies for integrating EBM in daily work. Methods We used a qualitative research strategy to gather and analyse data. We organised focus groups between September 2002 and April 2003. The focus group data were analysed using a combined strategy of 'between-case' analysis and 'grounded theory approach'. Thirty-one general practitioners participated in four focus groups. Purposeful sampling was used to recruit participants. Results A basic classification model documents the influencing factors and actors on a micro-, meso- as well as macro-level. Patients, colleagues, competences, logistics and time were identified on the micro-level (the GPs' individual practice), commercial and consumer organisations on the meso-level (institutions, organisations) and health care policy, media and specific characteristics of evidence on the macro-level (policy level and international scientific community). Existing barriers and possible strategies to overcome these barriers were described. Conclusion In order to implement EBM in routine general practice, an integrated approach on different levels needs to be developed. PMID:16153300

Influence of a vertical subject on research in biomedicine and activities of The Cochrane Collaboration branch on medical students' knowledge and attitudes toward evidence-based medicine

PubMed Central

Balajić, Karolina; Barac-Latas, Vesna; Drenjančević, Ines; Ostojić, Marko; Fabijanić, Damir; Puljak, Livia

2012-01-01

Aim To investigate whether the introduction of a vertical subject on research in biomedicine and founding of The Cochrane Collaboration branch at the University of Split School of Medicine influenced students’ knowledge and attitudes toward evidence-based medicine (EBM), including the use of research literature. Methods We used a 26-item questionnaire on EBM knowledge and attitudes to survey 1232 medical students of all study years in 3 medical schools in Croatia (Split, Rijeka, Osijek) and the Croatian-speaking medical school in Mostar (Bosnia and Herzegovina). Results Students from the University of Split School of Medicine who had been exposed to the vertical subject on research in biomedicine and activities of The Cochrane Collaboration at the school had better knowledge and more positive attitudes toward EBM. In general, students rarely searched for evidence; 28% of students searched for evidence more than once a month and 96% of students used only textbooks in Croatian and teachers’ handouts, even though 74% of students agreed that articles from scholarly journals were an important supplement for textbooks. Conclusion Building up an environment that fosters EBM may be beneficial for students’ knowledge and attitudes toward EBM. Teachers should encourage and require using evidence during all the courses in medical school. PMID:22911530

An observational examination of the literature in diagnostic anatomic pathology.

PubMed

Foucar, Elliott; Wick, Mark R

2005-05-01

Original research published in the medical literature confronts the reader with three very basic and closely linked questions--are the authors' conclusions true in the contextual setting in which the work was performed (internally valid); if so, are the conclusions also applicable in other practice settings (externally valid); and, if the conclusions of the study are bona fide, do they represent an important contribution to medical practice or are they true-but-insignificant? Most publications attempt to convince readers that the researchers' conclusions are both internally valid and important, and occasionally papers also directly address external validity. Developing standardized methods to facilitate the prospective determination of research importance would be useful to both journals and their readers, but has proven difficult. In contrast, the evidence-based medicine (EBM) movement has had more success with understanding and codifying factors thought to promote research validity. Of the many variables that can influence research validity, research design is the one that has received the most attention. The present paper reviews the contributions of EBM to understanding research validity, looking for areas where EBM's body of knowledge is applicable to the anatomic pathology (AP) literature. As part of this project, the authors performed a pilot observational analysis of a representative sample of the current pertinent literature on diagnostic tissue pathology. The results of that review showed that most of the latter publications employ one of the four categories of "observational" research design that have been delineated by the EBM movement, and that the most common of these observational designs is a "cross-sectional" comparison. Pathologists do not presently use the "experimental" research designs so admired by advocates of EBM. Slightly > 50% of AP observational studies employed statistical evaluations to support their final conclusions. Comparison of the current AP literature with a selected group of papers published in 1977 shows a discernible change over that period that has affected not just technological procedures, but also research design and use of statistics. Although we feel that advocates of EBM deserve credit for bringing attention to the close link between research design and research validity, much of the EBM effort has centered on refining "experimental" methodology, and the complexities of observational research have often been treated in an inappropriately dismissive manner. For advocates of EBM, an observational study is what you are relegated to as a second choice when you are unable to do an experimental study. The latter viewpoint may be true for evaluating new chemotherapeutic agents, but is unacceptable to pathologists, whose research advances are currently completely dependent on well-conducted observational research. Rather than succumb to randomization envy and accept EBM's assertion that observational research is second best, the challenge to AP is to develop and adhere to standards for observational research that will allow our patients to benefit from the full potential of this time tested approach to developing valid insights into disease.

Novel approaches to effects-based monitoring: 21st century tools for bio-effects prediction and surveillance

EPA Science Inventory

Effects-based monitoring (EBM) has been employed as a complement to chemical monitoring to help address knowledge gaps between chemical occurrence and biological effects. We have piloted several pathway-based approaches to EBM, that utilize modern bioinformatic and high throughpu...

The Medical Literature as a Resource for Health Care Practice.

ERIC Educational Resources Information Center

McKibbon, K. Ann; And Others

1995-01-01

Discussion of evidence-based medicine (EBM) focuses on information tools to facilitate the practice of EBM that were developed, evaluated, and made more accessible by the McMaster University (Canada) Faculty of Health Sciences. Highlights include users' guides to medical literature, strategies for improving MEDLINE searches, new journals, and…

Ecological function as a target for ecosystem-based management: Defining when change matters in decision making

EPA Science Inventory

Ecosystem-based management (EBM) accounts for both direct and indirect drivers of ecological change for decision making. Just as with direct management of a resource, EBM requires a definition of management thresholds that define when change in function is sufficient to merit ma...

Analgesic Effect of Oral Glucose in Neonates.

PubMed

Jatana, S K; Dalal, S S; Wilson, C G

2003-04-01

The International Association for the Study of Pain, has defined pain as "an unpleasant sensory and emotional experience connected with actual or potential tissue damage or described in terms of such damage". It was thought that the newborn baby does not experience pain because of incompletely developed nervous system. However, it has been shown that neurological system known to be associated with pain transmission and modulation, is intact and functional. A study was conducted in our center to study the analgesic effect of administration of oral glucose in various concentrations, in neonates undergoing heel punctures, for collection of blood for investigations. This was compared with the analgesic effects of breast milk (which contains lactose). 125 full term normal neonates with no history of birth asphyxia or underlying neurological abnormality, requiring heel punctures for collection of blood for various investigations were selected for the study. They were matched for gestational age, birth weight and sex distribution and divided into 5 groups of 25 each. One group comprised control subjects and was administered sterile water. 3 groups were administered 1 ml of varying strengths of glucose solutions i.e. 10%, 25% and 50% respectively. The last group was given 1 ml of expressed breast milk (EBM). Prior to heel pricks, state of arousal, baseline heart rate (HR) and transcutaneous oxygen saturation (SpO2) were recorded by pulse oximeter in each neonate. Autolet, a mechanical device for capillary sampling, was used for heel pricks to give equal strength of painful stimulus in each procedure. Audio tape recorder was used to record the cry. The oral solution was administered slowly over 30 seconds by means of a syringe placed in the mouth. Heel puncture was done after 2 minutes, taking all aseptic precautions. HR and SpO2 were monitored using pulse oximeter. Pain response was assessed, by recording duration of crying, change in HR, change in SpO2 and facial action score after the procedure. Mean duration of cry and total cry over 5 minutes was significantly less in groups given 25% and 50% glucose solutions as compared to the control group and babies given EBM. Difference in mean increase in HR, fall in SpO2 were statistically significant between control group, EBM group and neonates given 25% and 50% glucose solutions respectively. Compared to control group, all other administered solutions (10%, 25%, 50% glucose and EBM) were found to reduce physiological and behavioral responses in neonates undergoing heel punctures. 25% and 50% glucose solutions were found to have maximal analgesic effect and both were found to be equally effective. EBM and 10% glucose solution have an equal analgesic effect but less than 25% or 50% glucose. This simple, cheap and safe method of oral analgesia can be easily used in neonates undergoing heel prick procedures during routine neonatal care.

Biological Effects–Based Tools for Monitoring Impacted Surface Waters in the Great Lakes: A Multiagency Program in Support of the Great Lakes Restoration Initiative

EPA Science Inventory

There is increasing demand for the implementation of effects-based monitoring and surveillance (EBMS) approaches in the Great Lakes Basin to complement traditional chemical monitoring. Herein, we describe an ongoing multiagency effort to develop and implement EBMS tools, particul...

Revealing martensitic transformation and α/β interface evolution in electron beam melting three-dimensional-printed Ti-6Al-4V

PubMed Central

Tan, Xipeng; Kok, Yihong; Toh, Wei Quan; Tan, Yu Jun; Descoins, Marion; Mangelinck, Dominique; Tor, Shu Beng; Leong, Kah Fai; Chua, Chee Kai

2016-01-01

As an important metal three-dimensional printing technology, electron beam melting (EBM) is gaining increasing attention due to its huge potential applications in aerospace and biomedical fields. EBM processing of Ti-6Al-4V as well as its microstructure and mechanical properties were extensively investigated. However, it is still lack of quantitative studies regarding its microstructural evolution, indicative of EBM thermal process. Here, we report α′ martensitic transformation and α/β interface evolution in varied printing thicknesses of EBM-printed Ti-6Al-4V block samples by means of atom probe tomography. Quantitative chemical composition analysis suggests a general phase transformation sequence. By increasing in-fill hatched thickness, elemental partitioning ratios arise and β volume fraction is increased. Furthermore, we observe kinetic vanadium segregation and aluminum depletion at interface front and the resultant α/β interface widening phenomenon. It may give rise to an increased α/β lattice mismatch and weakened α/β interfaces, which could account for the degraded strength as printing thickness increases. PMID:27185285

Materials Characterization of Electron Beam Melted Ti-6Al-4V

NASA Technical Reports Server (NTRS)

Draper, Susan L.; Lerch, Bradley A.; Telesman, Jack; Martin, Richard E.; Locci, Ivan E.; Garg, Anita; Ring, Andrew J.

2016-01-01

An in-depth material characterization of Electron Beam Melted (EBM) Ti-6Al-4V material has been completed on samples fabricated on an ARCAM A2X EBM machine. The specimens were fabricated under eight separate builds with the material divided into two lots for material testing purposes. Hot Isostatic Pressing (HIP) was utilized to close porosity from fabrication and also served as a material heat treatment to obtain the desired microstructure. The changes in the microstructure and chemistry from the powder to pre-HIP and post-HIP material have been analyzed. Several nondestructive evaluation (NDE) techniques were utilized to characterize the samples both before and after HIP. The test matrix included tensile, high cycle fatigue, low cycle fatigue, fracture toughness, and fatigue crack growth at cryogenic, room, and elevated temperatures. The mechanical properties of the EBM Ti-6Al-4V are compared to conventional Ti-6Al-4V in the annealed condition. Fractography was performed to determine failure initiation site. The EBM Ti-6Al-4V had similar or superior mechanical properties compared to conventionally manufactured Ti-6Al-4V.

Physicians' propensity to collaborate and their attitude towards EBM: A cross-sectional study

PubMed Central

2011-01-01

Background The healthcare management literature states that physicians often coordinate their activities within and between organizations through social networks. Previous studies have also documented the relationship between professional networks and physicians' attitudes toward evidence-based medicine (EBM). The present study sought associations between physicians' self-reported attitudes toward EBM and the formation of inter-physician collaborative network ties. Methods Primary data were collected from 297 clinicians at six hospitals belonging to one of the largest local health units of the Italian National Health Service. Data collection used a survey questionnaire that inquired about professional networks and physicians' characteristics. Social network analysis was performed to describe inter-physician professional networks. Multiple regression quadratic assignment procedures were performed to assess the relationship between self-reported attitudes toward EBM and clinicians' propensity to collaborate. Results Physicians who reported similar attitudes toward EBM were more likely to exchange information and advice through collaborative relationships (β = 0.0198; p < 0.05). Similarities in other characteristics, such as field of specialization (β = 0.1988; p < 0.01), individual affiliations with hospital sites (β = 0.0845; p < 0.01), and organizational clinical directorates (β = 0.0459; p < 0.01), were also significantly related to physicians' propensity to collaborate. Conclusions Communities of practice within healthcare organizations are likely to contain separate clusters of physicians whose members are highly similar. Organizational interventions are needed to foster heterophily whenever multidisciplinary cooperation is required to provide effective health care. PMID:21787395

High-Value Consults: A Curriculum to Promote Point-of-Care, Evidence-Based Recommendations.

PubMed

Nandiwada, Deepa Rani; Kohli, Amar; McNamara, Megan; Smith, Kenneth J; Zimmer, Shanta; McNeil, Melissa; Spagnoletti, Carla; Rubio, Doris; Berlacher, Kathryn

2017-10-01

In an era when value-based care is paramount, teaching trainees to explicitly communicate the evidence behind recommendations fosters high-value care (HVC) in the consultation process. To implement an HVC consult curriculum highlighting the need for clear consult questions, evidence-based recommendations to improve consult teaching, clinical decision-making, and the educational value of consults. A pilot curriculum was implemented for residents on cardiology consult electives utilizing faculty and fellows as evidence-based medicine (EBM) coaches. The curriculum included an online module, an EBM teaching point template, EBM presentations on rounds, and "coach" feedback on notes. A total of 15 residents and 4 fellows on cardiology consults participated, and 87% (13 of 15) of residents on consults felt the curriculum was educationally valuable. A total of 80% (72 of 90) of residents on general medicine rotations responded to the survey, and 25 of 72 residents (35%) had a consult with the EBM template. General medicine teams felt the EBM teaching points affected clinical decision-making (48%, 12 of 25) and favored dissemination of the curriculum (90%, 72 of 80). Checklist-guided chart review showed a 22% improvement in evidence-based summaries behind recommendations (7 of 36 precurriculum to 70 of 146 charts postcurriculum, P  = .015). The HVC consult curriculum during a cardiology elective was perceived by residents to influence clinical decision-making and evidence-based recommendations, and was found to be educationally valuable on both parties in the consult process.

Improved osseointegration with as-built electron beam melted textured implants and improved peri‑implant bone volume with whole body vibration.

PubMed

Ruppert, David S; Harrysson, Ola L A; Marcellin-Little, Denis J; Dahners, Laurence E; Weinhold, Paul S

2018-06-11

Transcutaneous osseointegrated prostheses provide stable connections to the skeleton while eliminating skin lesions experienced with socket prosthetics. Additive manufacturing can create custom textured implants capable of interfacing with amputees' residual bones. Our objective was to compare osseointegration of textured surface implants made by electron beam melting (EBM), an additive manufacturing process, to machine threaded implants. Whole body vibration was investigated to accelerate osseointegration. Two cohorts of Sprague-Dawley rats received bilateral, titanium implants (EBM vs. threaded) in their tibiae. One cohort comprising five groups vibrated at 45 Hz: 0.0 (control), 0.15, 0.3, 0.6 or 1.2 g was followed for six weeks. Osseointegration was evaluated through torsional testing and bone volume fraction (BV/TV). A second cohort, divided into two groups (control and 0.6 g), was followed for 24 days and evaluated for resonant frequency, bone-implant contact (BIC) and fluorochrome labeling. The EBM textured implants exhibited significantly improved mechanical stability independent of vibration, highlighting the benefits of using EBM to produce custom textured surfaces. Bone formation on and around the EBM textured implants increased compared to machined implants, as seen by BIC and fluorescence. No difference in torque, BIC or fluorescence among vibration levels was detected. BV/TV significantly increased at 0.6 g compared to control for both implant types. Copyright © 2018 IPEM. Published by Elsevier Ltd. All rights reserved.

The Vanguard Faculty program: research training for complementary and alternative medicine faculty.

PubMed

Connelly, Erin N; Elmer, Patricia J; Morris, Cynthia D; Zwickey, Heather

2010-10-01

The increasing use of complementary and alternative medicine (CAM) treatment is paralleled by a growing demand for an evidence-based approach to CAM practice. In 2007, the Helfgott Research Institute at the National College of Natural Medicine (NCNM), in partnership with Oregon Health & Science University (OHSU), both in Portland, OR, began a National Institutes of Health-funded initiative to increase the quality and quantity of evidence-based medicine (EBM) content in the curricula at NCNM. One key strategy of the Research in Complementary and Alternative Medicine Program (R-CAMP) initiative was to create a faculty development program that included four components: intensive training in EBM; professional skills enhancement; peer and mentored support; and, ultimately, utilization of these skills to incorporate EBM into the curricula. This initiative is centered on a core group of faculty at NCNM, called the Vanguard Faculty, who receives early, intensive training in EBM and works to incorporate this training into classes. Training consists of an intensive, week-long course, monthly group meetings, and periodic individualized meetings. Vanguard Faculty members also receive mentorship and access to resources to pursue individualized faculty development, research or scholarly activities. Early evaluations indicate that this effort has been successful in increasing EBM content in the curricula at NCNM. This article describes the Vanguard Faculty program in an effort to share the successes and challenges of implementing a wide-ranging faculty development and curricular initiative at a complementary and alternative medicine institution.

Vitamin Content of Breast Milk From HIV-1–Infected Mothers Before and After Flash-Heat Treatment

PubMed Central

Israel-Ballard, Kiersten A.; Abrams, Barbara F.; Coutsoudis, Anna; Sibeko, Lindiwe N.; Cheryk, Lynn A.; Chantry, Caroline J.

2010-01-01

Background World Health Organization advocates heat treatment of expressed breastmilk (EBM) as one method to reduce postnatal transmission of human immunodeficiency virus (HIV) in developing countries. Flash-heat is a simple heat treatment method shown to inactivate cell-free HIV. Objective To determine the effect of flash-heat on vitamin content of milk. Methods Fresh EBM was collected from 50 HIV+ mothers in Durban, South Africa. Mothers washed their hands and then manually expressed 75–150 mL EBM into sterile jars. Milk was aliquoted to unheated controls or flash-heat (50 mL EBM in a glass jar heated in a 450-mL water jacket in an aluminum pan until water boiled, then EBM removed) simulating field conditions with an open flame. Samples were stored at −70°C and then analyzed for the effect of flash-heat on vitamins [A, ascorbic acid, riboflavin (B2), pyridoxal-5-phosphate (B6), folate, and B12]. Results Vitamin A was not significantly affected by flash-heat and vitamins B12 and C and folate increased significantly. Vitamins B2 and B6 were decreased to 59% (95% confidence interval 44 to 81) and 96% (95% confidence interval 92 to 99), respectively, of that found in unheated milk. Conclusions The percentage remaining after flash-heat suggests that most vitamin concentrations are retained after heating. Flash-heat may be a practical and nutritious infant feeding method for mothers in developing countries. PMID:18614920

Behavioral change of pharmacists by online evidence-based medicine-style education programs.

PubMed

Aoshima, Syuichi; Kuwabara, Hidenori; Yamamoto, Masahiro

2017-12-01

Although e-learning evidence-based medicine (EBM) courses have proven useful in improving the knowledge and skills of residents, it was still unclear for pharmacists in non-English-speaking countries. Thus, we investigated the behavioral change of Japanese pharmacists who participated in an EBM-style e-learning educational program available online. This EBM-style e-learning program, the Japanese Journal Club for Clinical Pharmacists, was operated by three pharmacists through Skype. It comprised an online questionnaire administered to the program viewers. Two frequencies, the opportunity to be aware of EBM practices and that of reading an article, were compared before and after viewing the broadcast. Frequencies were classified into five categories: "almost every day," "1-2 times a week," "1-2 times a month," "1-2 times a year," and "not at all." The changes before and after viewing the broadcast were evaluated using a Wilcoxon signed-rank test. The announcement of the questionnaire survey on the web was conducted during the journal club on August 24 and September 7, 2014. The maximum number of simultaneous audiences at the time was 113 persons. Among them, we analyzed data from 36 people who answered the questionnaire. Among these, "1-2 times a week" and "almost every day" were increased, whereas "not at all" was greatly reduced. Indeed, a significant difference was observed in overall change of each frequency before and after viewing the broadcast ( P <.001). EBM-style learning programs may play an important role in the postgraduate clinical education of pharmacists.

Vitamin content of breast milk from HIV-1-infected mothers before and after flash-heat treatment.

PubMed

Israel-Ballard, Kiersten A; Abrams, Barbara F; Coutsoudis, Anna; Sibeko, Lindiwe N; Cheryk, Lynn A; Chantry, Caroline J

2008-08-01

World Health Organization advocates heat treatment of expressed breastmilk (EBM) as one method to reduce postnatal transmission of human immunodeficiency virus (HIV) in developing countries. Flash-heat is a simple heat treatment method shown to inactivate cell-free HIV. To determine the effect of flash-heat on vitamin content of milk. Fresh EBM was collected from 50 HIV+ mothers in Durban, South Africa. Mothers washed their hands and then manually expressed 75-150 mL EBM into sterile jars. Milk was aliquoted to unheated controls or flash-heat (50 mL EBM in a glass jar heated in a 450-mL water jacket in an aluminum pan until water boiled, then EBM removed) simulating field conditions with an open flame. Samples were stored at -70 degrees C and then analyzed for the effect of flash-heat on vitamins [A, ascorbic acid, riboflavin (B2), pyridoxal-5-phosphate (B6), folate, and B12]. Vitamin A was not significantly affected by flash-heat and vitamins B12 and C and folate increased significantly. Vitamins B2 and B6 were decreased to 59% (95% confidence interval 44 to 81) and 96% (95% confidence interval 92 to 99), respectively, of that found in unheated milk. The percentage remaining after flash-heat suggests that most vitamin concentrations are retained after heating. Flash-heat may be a practical and nutritious infant feeding method for mothers in developing countries.

Value-based medicine: concepts and application.

PubMed

Bae, Jong-Myon

2015-01-01

Global healthcare in the 21st century is characterized by evidence-based medicine (EBM), patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM) as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and converts it to patient value-based data, so that it allows clinicians to deliver higher quality patient care than EBM alone. The final goals of VBM are improving quality of healthcare and using healthcare resources efficiently. This paper introduces the concepts and application of VBM and suggests some strategies for promoting related research.

Not a Humbug: the evolution of patient-centred medical decision-making.

PubMed

Trump, Benjamin D; Linkov, Faina; Edwards, Robert P; Linkov, Igor

2015-12-01

This 'Christmas Issue'-type paper uses the framework of 'A Christmas Carol' to tell about the evolution of decision-making in evidence-based medicine (EBM). The Ghost of the Past represents paternalistic medicine, the Ghost of the Present symbolises EBM, while the Ghost of the Future serves as a patient-centred system where research data and tools of decision science are jointly used to make optimal medical decisions for individual patients. We argue that this shift towards a patient-centred approach to EBM and medical care is the next step in the evolution of medical decision-making, which would help to empower patients with the capability to make educated decisions throughout the course of their medical treatment.

Value-based medicine: concepts and application

PubMed Central

Bae, Jong-Myon

2015-01-01

Global healthcare in the 21st century is characterized by evidence-based medicine (EBM), patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM) as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and converts it to patient value-based data, so that it allows clinicians to deliver higher quality patient care than EBM alone. The final goals of VBM are improving quality of healthcare and using healthcare resources efficiently. This paper introduces the concepts and application of VBM and suggests some strategies for promoting related research. PMID:25773441

Effectiveness of an e-learning course in evidence-based medicine for foundation (internship) training.

PubMed

Hadley, Julie; Kulier, Regina; Zamora, Javier; Coppus, Sjors F P J; Weinbrenner, Susanne; Meyerrose, Berrit; Decsi, Tamas; Horvath, Andrea R; Nagy, Eva; Emparanza, Jose I; Arvanitis, Theodoros N; Burls, Amanda; Cabello, Juan B; Kaczor, Marcin; Zanrei, Gianni; Pierer, Karen; Kunz, Regina; Wilkie, Veronica; Wall, David; Mol, Ben Wj; Khan, Khalid S

2010-07-01

To evaluate the educational effectiveness of a clinically integrated e-learning course for teaching basic evidence-based medicine (EBM) among postgraduate medical trainees compared to a traditional lecture-based course of equivalent content. We conducted a cluster randomized controlled trial to compare a clinically integrated e-learning EBM course (intervention) to a lecture-based course (control) among postgraduate trainees at foundation or internship level in seven teaching hospitals in the UK West Midlands region. Knowledge gain among participants was measured with a validated instrument using multiple choice questions. Change in knowledge was compared between groups taking into account the cluster design and adjusted for covariates at baseline using generalized estimating equations (GEE) model. There were seven clusters involving teaching of 237 trainees (122 in the intervention and 115 in the control group). The total number of postgraduate trainees who completed the course was 88 in the intervention group and 72 in the control group. After adjusting for baseline knowledge, there was no difference in the amount of improvement in knowledge of EBM between the two groups. The adjusted post course difference between the intervention group and the control group was only 0.1 scoring points (95% CI -1.2-1.4). An e-learning course in EBM was as effective in improving knowledge as a standard lecture-based course. The benefits of an e-learning approach need to be considered when planning EBM curricula as it allows standardization of teaching materials and is a potential cost-effective alternative to standard lecture-based teaching.

Development and Validation of a Measurement Scale to Analyze the Environment for Evidence-Based Medicine Learning and Practice by Medical Residents

ERIC Educational Resources Information Center

Mi, Fangqiong

2010-01-01

A growing number of residency programs are instituting curricula to include the component of evidence-based medicine (EBM) principles and process. However, these curricula may not be able to achieve the optimal learning outcomes, perhaps because various contextual factors are often overlooked when EBM training is being designed, developed, and…

Proliferation of mouse fibroblast-like and osteoblast-like cells on pure titanium films manufactured by electron beam melting.

PubMed

Kawase, Mayu; Hayashi, Tatsuhide; Asakura, Masaki; Tomino, Masafumi; Mieki, Akimichi; Kawai, Tatsushi

2016-10-01

The physical characteristics and biological compatibility of surfaces produced by electron beam melting (EBM) are not well known. In particular, there are not many reports on biocompatibility qualities. In this study, pure Ti films were manufactured using EBM. While it is reported that moderately hydrophilic biomaterial surfaces display improved cell growth and biocompatibility, contact angle measurements on the EBM-produced pure Ti films showed slight hydrophobicity. Nonetheless, we found the cell count of both fibroblast-like cells (L929) and osteoblast-like cells (MC3T3-E1) increased on pure Ti films, especially the MC3T3-E1, which increased more than that of the control. In addition, the morphology of L929 and MC3T3-E1 was polygonal and spindle-shaped and the cytoskeleton was well developed in the pure Ti surface groups. Upon staining with Alizarin red S, a slight calcium deposition was observed and this level gradually rose to a remarkable level. These results indicate that pure Ti films manufactured by EBM have good biocompatibility and could be widely applied as biomedical materials in the near future. © 2016 International Federation for Cell Biology.

[Application of evidence based medicine to the individual patient: the role of decision analysis].

PubMed

Housset, B; Junod, A F

2003-11-01

The objective of evidence based medicine (EBM) is to contribute to medical decision making by providing the best possible information in terms of validity and relevance. This allows evaluation in a specific manner of the benefits and risks of a decision. The limitations and hazards of this approach are discussed in relation to a clinical case where the diagnosis of pulmonary embolism was under consideration. The individual details and the limited availability of some technical procedures illustrate the need to adapt the data of EBM to the circumstances. The choice between two diagnostic tests (d-dimers and ultrasound of the legs) and their optimal timing is analysed with integration of the consequences for the patient of the treatments proposed. This allows discussion of the concept of utility and the use of sensitivity analysis. If EBM is the cornerstone of rational and explicit practise it should also allow for the constraints of real life. Decision analysis, which depends on the same critical demands as EBM but can also take account of the individual features of each patient and test the robustness of a decision, gives a unique opportunity reconcile rigorous reasoning with individualisation of management.

Study on the Factors Affecting the Mechanical Behavior of Electron Beam Melted Ti6Al4V

NASA Astrophysics Data System (ADS)

Pirozzi, Carmine; Franchitti, Stefania; Borrelli, Rosario; Caiazzo, Fabrizia; Alfieri, Vittorio; Argenio, Paolo

2017-09-01

In this study, a mechanical characterization has been performed on EBM built Ti-6Al-4V tensile samples. The results of tensile tests have shown a different behavior between two sets of specimens: as built and machined ones. Supporting investigations have been carried out in order to physically explain the statistical difference of mechanical performances. Cylindrical samples which represent the tensile specimens geometry have been EBM manufactured and then investigated in their as built conditions from macrostructural and microstructural point of view. In order to make robust this study, cylindrical samples have been EBM manufactured with different size and at different height from build plate. The reason of this choice was arisen from the need of understanding if other factors as the massivity and specific location could affect the microstructure and defects generations consequently influencing the mechanical behavior of the EBMed components. The results of this study have proved that the irregularity of external circular surfaces of examined cylinders, reducing significantly the true cross section withstanding the applied load, has given a comprehensive physical explanation of the different tensile behavior of the two sets of tensile specimens.

Making the improbable probable: communication across models of medical practice.

PubMed

Buetow, Stephen

2014-06-01

Cooperation and conversation in the public sphere may overcome historical and other barriers to rational argumentation. As an alternative to evidence-based medicine (EBM) and patient-centered care (PCC), the recent development of a modern version of person-centered medicine (PCM) signals an opportunity for a conversational pluralogue to replace parallel monologues between EBM and its critics, and the calls to EBM to debate its critics. This article draws upon elements of Habermas's theory of communicative action in order to suggest the kind of pluralogue that is required for stakeholders in modern medicine to benefit more from publicly conversing with each other than speaking alone or using debate to argue against each other. This reasoned perspective has lessons for all discourse when deep value-based and epistemological differences cannot be easily adjudicated.

The corneal fibrosis response to epithelial-stromal injury

PubMed Central

Torricelli, Andre A. M.; Santhanam, Abirami; Wu, Jiahui; Singh, Vivek; Wilson, Steven E.

2014-01-01

The corneal wound healing response, including the development of stromal opacity in some eyes, is a process that often leads to scarring that occurs after injury, surgery or infection to the cornea. Immediately after epithelial and stromal injury, a complex sequence of processes contributes to wound repair and regeneration of normal corneal structure and function. In some corneas, however, often depending on the type and extent of injury, the response may also lead to the development of mature vimentin+ α-smooth muscle actin+ desmin+ myofibroblasts. Myofibroblasts are specialized fibroblastic cells generated in the cornea from keratocyte-derived or bone marrow-derived precursor cells. The disorganized extracellular matrix components secreted by myofibroblasts, in addition to decreased expression of corneal crystallins in these cells, are central biological processes that result in corneal stromal fibrosis associated with opacity or “haze”. Several factors are associated with myofibroblast generation and haze development after PRK surgery in rabbits, a reproducible model of scarring, including the amount of tissue ablated, which may relate to the extent of keratocyte apoptosis in the early response to injury, irregularity of stromal surface after surgery, and changes on corneal stromal proteoglycans, but normal regeneration of the epithelial basement membrane (EBM) appears to be a critical factor determining whether a cornea heals with relative transparency or vision-limiting stromal opacity. Structural and functional abnormalities of the regenerated EBM facilitate prolonged entry of epithelium-derived growth factors such as transforming growth factor β (TGF-β) and platelet-derived growth factor (PDGF) into the stroma that both drive development of mature myofibroblasts from precursor cells and lead to persistence of the cells in the anterior stroma. A major discovery that has contributed to our understanding of haze development is that keratocytes and corneal fibroblasts, but not myofibroblasts, produce large amounts of critical EBM components, such as nidogen-1, nidogen-2 and perlecan, that are essential for complete regeneration of a normal EBM once laminin secreted by epithelial cells self-polymerizes into a nascent EBM. Mature myofibroblasts that become established in the anterior stroma are a barrier to keratocyte contributions to the nascent EBM. These myofibroblasts, and the opacity they produce, often persist for months or years after the injury. Transparency is subsequently restored when the EBM is completely regenerated, myofibroblasts are deprived of TGFβ and undergo apoptosis, and the keratocytes re-occupy the anterior stroma and reabsorb disordered extracellular matrix. The aim of this review is to highlight factors involved in the generation of stromal haze and its subsequent removal. PMID:26675407

Calibrating IR Cameras for In-Situ Temperature Measurement During the Electron Beam Melting Process using Inconel 718 and Ti-Al6-V4

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

Dinwiddie, Ralph Barton; Lloyd, Peter D; Dehoff, Ryan R

2016-01-01

The Department of Energy s (DOE) Manufacturing Demonstration Facility (MDF) at Oak Ridge National Laboratory (ORNL) provides world-leading capabilities in advanced manufacturing (AM) facilities which leverage previous, on-going government investments in materials science research and characterization. MDF contains systems for fabricating components with complex geometries using AM techniques (i.e. 3D-Printing). Various metal alloy printers, for example, use electron beam melting (EBM) systems for creating these components which are otherwise extremely difficult- if not impossible- to machine. ORNL has partnered with manufacturers on improving the final part quality of components and developing new materials for further advancing these devices. One methodmore » being used to study (AM) processes in more depth relies on the advanced imaging capabilities at ORNL. High performance mid-wave infrared (IR) cameras are used for in-situ process monitoring and temperature measurements. However, standard factory calibrations are insufficient due to very low transmissions of the leaded glass window required for X-ray absorption. Two techniques for temperature calibrations will be presented and compared. In-situ measurement of emittance will also be discussed. Ample information can be learned from in-situ IR process monitoring of the EBM process. Ultimately, these imaging systems have the potential for routine use for online quality assurance and feedback control.« less

Effects of Build Orientation on Surface Morphology and Bone Cell Activity of Additively Manufactured Ti6Al4V Specimens.

PubMed

Weißmann, Volker; Drescher, Philipp; Seitz, Hermann; Hansmann, Harald; Bader, Rainer; Seyfarth, Anika; Klinder, Annett; Jonitz-Heincke, Anika

2018-05-29

Additive manufacturing of lightweight or functional structures by selective laser beam (SLM) or electron beam melting (EBM) is widespread, especially in the field of medical applications. SLM and EBM processes were applied to prepare Ti6Al4V test specimens with different surface orientations (0°, 45° and 90°). Roughness measurements of the surfaces were conducted and cell behavior on these surfaces was analyzed. Hence, human osteoblasts were seeded on test specimens to determine cell viability (metabolic activity, live-dead staining) and gene expression of collagen type 1 (Col1A1), matrix metalloprotease (MMP) 1 and its natural inhibitor, TIMP1, after 3 and 7 days. The surface orientation of specimens during the manufacturing process significantly influenced the roughness. Surface roughness showed significant impact on cellular viability, whereas differences between the time points day 3 and 7 were not found. Collagen type 1 mRNA synthesis rates in human osteoblasts were enhanced with increasing roughness. Both manufacturing techniques further influenced the induction of bone formation process in the cell culture. Moreover, the relationship between osteoblastic collagen type 1 mRNA synthesis rates and specimen orientation during the building process could be characterized by functional formulas. These findings are useful in the designing of biomedical applications and medical devices.

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

PubMed

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

2016-03-05

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

The attitude of Belgian social insurance physicians towards evidence-based practice and clinical practice guidelines.

PubMed

Heselmans, Annemie; Donceel, Peter; Aertgeerts, Bert; Van de Velde, Stijn; Ramaekers, Dirk

2009-09-09

Evidence-based medicine has broadened its scope and is starting to reach insurance medicine. Although still in its initial stages, physicians in the area of insurance medicine should keep up-to-date with the evidence on various diseases in order to correctly assess disability and to give appropriate advice about health care reimbursement. In order to explore future opportunities of evidence-based medicine to improve daily insurance medicine, there is a need for qualitative studies to better understand insurance physicians' perceptions of EBM. The present study was designed to identify the attitude of insurance physicians towards evidence-based medicine and clinical practice guidelines, and to determine their ability to access, retrieve and appraise the health evidence and the barriers for applying evidence to practice. A cross-sectional survey study was carried out among all Dutch-speaking insurance physicians employed at one of the six Belgian social insurance sickness funds and at the National Institute of Disability and Health care Insurance (n = 224). Chi-square tests were used to compare nominal and ordinal variables. Student's t-tests, ANOVA, Mann-Whitney and Kruskal-Wallis were used to compare means of continuous variables for different groups. The response rate was 48.7%. The majority of respondents were positive towards evidence-based medicine and clinical practice guidelines. Their knowledge of EBM was rather poor. Perceived barriers for applying evidence to practice were mainly time and lack of EBM skills. Although the majority of physicians were positive towards EBM and welcomed more guidelines, the use of evidence and clinical practice guidelines in insurance medicine is low at present. It is in the first place important to eradicate the perceived inertia which limits the use of EBM and to further investigate the EBM principles in the context of insurance medicine. Available high-quality evidence-based resources (at the moment mainly originating from other medical fields) need to be structured in a way that is useful for insurance physicians and global access to this information needs to be ensured.

The attitude of Belgian social insurance physicians towards evidence-based practice and clinical practice guidelines

PubMed Central

Heselmans, Annemie; Donceel, Peter; Aertgeerts, Bert; Van de Velde, Stijn; Ramaekers, Dirk

2009-01-01

Background Evidence-based medicine has broadened its scope and is starting to reach insurance medicine. Although still in its initial stages, physicians in the area of insurance medicine should keep up-to-date with the evidence on various diseases in order to correctly assess disability and to give appropriate advice about health care reimbursement. In order to explore future opportunities of evidence-based medicine to improve daily insurance medicine, there is a need for qualitative studies to better understand insurance physicians' perceptions of EBM. The present study was designed to identify the attitude of insurance physicians towards evidence-based medicine and clinical practice guidelines, and to determine their ability to access, retrieve and appraise the health evidence and the barriers for applying evidence to practice. Methods A cross-sectional survey study was carried out among all Dutch-speaking insurance physicians employed at one of the six Belgian social insurance sickness funds and at the National Institute of Disability and Health care Insurance (n = 224). Chi-square tests were used to compare nominal and ordinal variables. Student's t-tests, ANOVA, Mann-Whitney and Kruskal-Wallis were used to compare means of continuous variables for different groups. Results The response rate was 48.7%. The majority of respondents were positive towards evidence-based medicine and clinical practice guidelines. Their knowledge of EBM was rather poor. Perceived barriers for applying evidence to practice were mainly time and lack of EBM skills. Conclusion Although the majority of physicians were positive towards EBM and welcomed more guidelines, the use of evidence and clinical practice guidelines in insurance medicine is low at present. It is in the first place important to eradicate the perceived inertia which limits the use of EBM and to further investigate the EBM principles in the context of insurance medicine. Available high-quality evidence-based resources (at the moment mainly originating from other medical fields) need to be structured in a way that is useful for insurance physicians and global access to this information needs to be ensured. PMID:19740436

Effectiveness of teaching evidence-based medicine to undergraduate medical students: a BEME systematic review.

PubMed

Ahmadi, Seyed-Foad; Baradaran, Hamid R; Ahmadi, Emad

2015-01-01

Despite the widespread teaching of evidence-based medicine (EBM) to medical students, the relevant literature has not been synthesized appropriately as to its value and effectiveness. To systematically review the literature regarding the impact of teaching EBM to medical students on their EBM knowledge, attitudes, skills and behaviors. MEDLINE, SCOPUS, Web of science, ERIC, CINAHL and Current Controlled Trials up to May 2011 were searched; backward and forward reference checking of included and relevant studies was also carried out. Two investigators independently extracted data and assessed the quality of the studies. 10,111 potential studies were initially found, of which 27 were included in the review. Six studies examined the effect of clinically integrated methods, of which five had a low quality and the other one used no validated assessment tool. Twelve studies evaluated the effects of seminars, workshops and short courses, of which 11 had a low quality and the other one lacked a validated assessment tool. Six studies examined e-learning, of which five having a high or acceptable quality reported e-learning to be as effective as traditional teaching in improving knowledge, attitudes and skills. One robust study found problem-based learning less effective compared to usual teaching. Two studies with high or moderate quality linked multicomponent interventions to improved knowledge and attitudes. No included study assessed the long-term effects of the teaching of EBM. Our findings indicated that some EBM teaching strategies have the potential to improve knowledge, attitudes and skills in undergraduate medical students, but the evidenced base does not demonstrate superiority of one method. There is no evidence demonstrating transfer to clinical practice.

[Basic assessment of needs for training in evidence-based medicine in Slovakia].

PubMed

Bacharova, L; Hlavacka, S; Rusnakova, V

2001-01-01

The health care reform in Slovakia produces a desire for greater responsibility for and control of strategic decisions and to be better able to evaluate international knowledge and experience in the specific national social and professional contexts. Evidence based medicine (EBM) provides an increasingly organised and accessible database of international knowledge in health and health care, capable of informing decisions at the macro and micro levels. The aim of this pilot study was to assess education, training and other capacity building needs in EBM and evidence based health care. This study was primarily qualitative and based on a triangular approach, which included: (1) The analysis of the situation in pre- and postgraduate education in Slovakia aiming to the estimation of needs in EBM and critical appraisal skills training; (2) The analysis of questionnaires distributed in a sample of 50 medical doctors and university educated public health workers undergoing a postgraduate training; (3) The discussion in focused groups. The findings and analysis uncovered a gap in knowledge and experience of EBM approaches, particularly of searching for evidence, utilising information technology, of undertaking critical appraisals of the validity and quality of external evidence and of knowledge of English. On the other hand the findings revealed a high access to information including the Internet access at the workplace, an increasing awareness of the need for up-date information, a demand for training and potential opportunities for action. The effective implementation introduction of EBM approach would require changes in broader political, cultural and behavioural contexts, including changes in pre- and postgraduate systems of professional and managerial education, changes in professional and managerial attitudes and changes in emphasis in skills and capacity building and improvements in knowledge management systems at the national level.

A Global Assessment of Access to and Use of Medical Information: The State of Evidence-Based Surgery.

PubMed

LaGrone, Lacey N; Fuhs, Amy K; Egoavil, Eduardo Huaman; Langdale, Lorrie A; Fuangworawong, Phupit; Hamasaki, Jose Luis; Gyedu, Adam; Mock, Charles N

2018-02-01

We aimed to assess surgeons' access to and use of medical information, as well as their training and perceptions about evidence-based medicine (EBM), in order to identify priority areas for improvement. An anonymous survey conducted among surgeons from the USA, Ghana, Peru, and Thailand examined access to, and use and perception of, medical literature. Of 307 participants, 98% reported access to "OK" or "good" internet. Fifty-one percent reported that language was a barrier to accessing needed medical information; most frequently in Peru (73%) and Thailand (64%). Access to priced full-text journals was poorest in Peru, where 54% lacked access, followed by Ghana (42%) and Thailand (32%). US respondents scored highest on the EBM knowledge test (1.4, SD 0.8), followed by Thailand (1.3, SD 0.9), Ghana (1.1, SD 0.8), and Peru (0.9, SD 0.8) (p < 0.001). Adjusted analysis revealed Ghanaians and Peruvians spent 5% and 1% more on medical information, respectively, relative to country income, than persons from other countries (p < 0.01). After adjustment, employment in a large and/or urban hospital and history of EBM training were associated with better EBM test scores, while middle-income origin and public hospital employment were associated with worse scores (p < 0.05). Language, access to priced full-text journals, and training are significant barriers to surgeons' practice of EBM globally. The way forward involves collaboration among surgical societies, publishers, hospital employers, and international policymakers in providing surgeons from all country income levels with the access and training necessary to interpret and apply medical information.

Successful teaching in evidence-based medicine.

PubMed

Ghali, W A; Saitz, R; Eskew, A H; Gupta, M; Quan, H; Hershman, W Y

2000-01-01

Several published articles have described the importance of exposing medical trainees to the 'new paradigm' of evidence-based medicine (EBM). Recognizing this, we sought to develop and objectively evaluate a mini-course in EBM for third-year medical students. We developed a mini-course consisting of four sessions in which students learn to derive sequentially focused questions, search MEDLINE, review articles critically and apply information from the literature to specific clinical questions. To evaluate the teaching intervention, we performed a controlled educational study. Students at the intervention site (n=34) attended the EBM mini-course, while students at the control site (n=26) received more 'traditional' didactic teaching on various clinical topics. Intervention and control students were surveyed immediately before and after the mini-course to assess changes in reading and literature searching skills, as well as a tendency to use the literature to answer clinical questions. Boston University School of Medicine. Third-year medical students. The intervention was associated with significant changes in students' self-assessed skills and attitudes. MEDLINE and critical appraisal skills increased significantly in the intervention group relative to the control group (significance of between group differences: P=0.002 for MEDLINE and P=0.0002 for critical appraisal), as did students' tendency to use MEDLINE and original research articles to solve clinical problems (significance of between group differences: P=0.002 and P=0.0008, respectively). We conclude that this brief teaching intervention in EBM has had a positive impact on student skills and attitudes at our medical school. We believe that the key elements of this intervention are (1) active student involvement, (2), clinical relevance of exercises and (3) integrated teaching targeting each of the component skills of EBM.

General practitioners, complementary therapies and evidence-based medicine: the defence of clinical autonomy.

PubMed

Adams, J

2000-12-01

Amidst the substantial change currently gripping primary health care are two developments central to contemporary debate regarding the very nature, territory and identity of general practice - the integration of complementary and alternative medicine (CAM) and the rise of evidence-based medicine (EBM). This paper reports findings from a study based upon 25 in-depth interviews with general practitioners (GPs) personally practising complementary therapies alongside more conventional medicine to treat their NHS patients. The paper outlines the GPs' perceptions of EBM, its relationship to their personal development of CAM, and their notions of good clinical practice more generally. Analysis of the GPs' accounts demonstrates how CAM can be seen as a useful resource with which some GPs defend their clinical autonomy from what they perceive to be the threat of EBM. Copyright 2000 Harcourt Publishers Ltd.

Ethics and Evidence-Based Medicine: Is There a Conflict?

PubMed Central

Loewy, Erich H.

2007-01-01

This article addresses the advantages, disadvantages, and traps to which evidence-based medicine (EBM) may lead and suggests that, to be ethically valid, EBM must be aimed at the patient's best interests and not at the financial interests of others. While financial considerations are by no means trivial, it is hypocritical – if not dangerous – to hide them behind words like “evidence” or “quality.” PMID:18092036

Evidence Based Medicine in Pediatric Practice: Brief Review

PubMed Central

Kianifar, Hamid-Reza; Akhondian, Javad; Najafi-Sani, Mehri; Sadeghi, Ramin

2010-01-01

Practicing medicine according to the best evidence is gaining popularity in the medical societies. Although this concept, which is usually called Evidence Based Medicine (EBM) has been explained in many resources, it has not been addressed enough in pediatrics. In this review, we briefly explained Evidence Based Medicine approach and its applications in pediatrics in order to help the pediatricians to efficiently integrate EBM into their daily practice. PMID:23056715

The impact of a dedicated research education month for anesthesiology residents.

PubMed

Freundlich, Robert E; Newman, Jessica W; Tremper, Kevin K; Mhyre, Jill M; Kheterpal, Sachin; Sanford, Theodore J; Tait, Alan R

2015-01-01

An educational intervention was implemented at the University of Michigan starting in 2008, in which anesthesiology interns complete a dedicated month-long didactic rotation in evidence-based medicine (EBM) and research methodology. We sought to assess its utility. Scores on a validated EBM test before and after the rotation were compared and assessed for significance of improvement. A survey was also given to gauge satisfaction with the quality of the rotation and self-reported improvement in understanding of EBM topics. Fourteen consecutive interns completed the research rotation during the study period. One hundred percent completed both the pre- and postrotation test. The mean pretest score was 7.78 ± 2.46 (median = 7.5, 0-15 scale, and interquartile range 7.0-10.0) and the mean posttest score was 10.00 ± 2.35 (median = 9.5, interquartile range 8.0-12.3), which represented a statistically significant increase (P = 0.011, Wilcoxon signed-rank test). All fourteen of the residents "agreed" or "strongly agreed" that they would recommend the course to future interns and that the course increased their ability to critically review the literature. Our findings demonstrate that this can be an effective means of improving understanding of EBM topics and anesthesiology research.

Evidence-based librarianship: an overview.

PubMed

Eldredge, J D

2000-10-01

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

Evidence-based librarianship: an overview

PubMed Central

Eldredge, Jonathan D.

2000-01-01

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

Access, attitudes and training in information technologies and evidence-based medicine among medical students at University of Zimbabwe College of Health Sciences.

PubMed

Parve, Swapnil; Ershadi, Ali; Karimov, Alexandr; Dougherty, Anne; Ndhlovu, Chiratidzo E; Chidzonga, Midion M; Sadigh, Majid

2016-09-01

The Medical Education Partnership Initiative, has helped to mitigate the digital divide in Africa. The aim of the study was to assess the level of access, attitude, and training concerning meaningful use of electronic resources and EBM among medical students at an African medical school. The study involved medical students at the University of Zimbabwe College of Health Sciences, Harare. The needs assessment tool consisted of a 21-question, paper-based, voluntary and anonymous survey. A total of 61/67 (91%), responded to the survey. 60% of the medical students were 'third-year medical students'. Among medical students, 85% of responders had access to digital medical resources, but 54% still preferred printed medical textbooks. Although 25% of responders had received training in EBM, but only 7% found it adequate. 98% of the participants did not receive formal training in journal club presentation or analytical reading of medical literature, but 77 % of them showed interest in learning these skills. Lack of training in EBM, journal club presentation and analytical reading skills have limited the impact of upgraded technology in enhancing the level of knowledge. This impact can be boosted by developing a curriculum with skills necessary in using EBM.

Additive manufacturing of titanium alloys in the biomedical field: processes, properties and applications.

PubMed

Trevisan, Francesco; Calignano, Flaviana; Aversa, Alberta; Marchese, Giulio; Lombardi, Mariangela; Biamino, Sara; Ugues, Daniele; Manfredi, Diego

2018-04-01

The mechanical properties and biocompatibility of titanium alloy medical devices and implants produced by additive manufacturing (AM) technologies - in particular, selective laser melting (SLM), electron beam melting (EBM) and laser metal deposition (LMD) - have been investigated by several researchers demonstrating how these innovative processes are able to fulfil medical requirements for clinical applications. This work reviews the advantages given by these technologies, which include the possibility to create porous complex structures to improve osseointegration and mechanical properties (best match with the modulus of elasticity of local bone), to lower processing costs, to produce custom-made implants according to the data for the patient acquired via computed tomography and to reduce waste.

Evidence, illness, and causation: an epidemiological perspective on the Russo-Williamson Thesis.

PubMed

Fiorentino, Alexander R; Dammann, Olaf

2015-12-01

According to the Russo-Williamson Thesis, causal claims in the health sciences need to be supported by both difference-making and mechanistic evidence. In this article, we attempt to determine whether Evidence-based Medicine (EBM) can be improved through the consideration of mechanistic evidence. We discuss the practical composition and function of each RWT evidence type and propose that exposure-outcome evidence (previously known as difference-making evidence) provides associations that can be explained through a hypothesis of causation, while mechanistic evidence provides finer-grained associations and knowledge of entities that ultimately explains a causal hypothesis. We suggest that mechanistic evidence holds untapped potential to add value to the assessment of evidence quality in EBM and propose initial recommendations for the integration of mechanistic and exposure-outcome evidence to improve EBM by robustly leveraging available evidence in support of good medical decisions. Copyright © 2015 Elsevier Ltd. All rights reserved.

Specimen plastic containers used to store expressed breast milk in neonatal care units: a case of precautionary principle.

PubMed

Blouin, Mélissa; Coulombe, Martin; Rhainds, Marc

2014-05-09

Breast milk is the only milk that meets both the nutritional and immunitary needs of infants. Since breastfeeding is widely promoted, public health measures to preserve the nutritional qualities of expressed breast milk (EBM) should be applied in hospital care settings. The Health Technology Assessment Unit (HTAU) of the Centre hospitalier universitaire de Québec was requested by the Neonatal Care Unit to assess the acceptability of a plastic specimen container, designed to harvest tissues and body fluids, for storing collected EBM. An evidence-based public health perspective approach was taken to evaluate the safety of the specimen container. The HTAU recommended that plastic specimen containers no longer be used for storing EBM and that other options should be evaluated for neonatal care units. These recommendations are in accordance with the public health precaution principle and with legal considerations.

EBM, HTA, and CER: clearing the confusion.

PubMed

Luce, Bryan R; Drummond, Michael; Jönsson, Bengt; Neumann, Peter J; Schwartz, J Sanford; Siebert, Uwe; Sullivan, Sean D

2010-06-01

The terms evidence-based medicine (EBM), health technology assessment (HTA), comparative effectiveness research (CER), and other related terms lack clarity and so could lead to miscommunication, confusion, and poor decision making. The objective of this article is to clarify their definitions and the relationships among key terms and concepts. This article used the relevant methods and policy literature as well as the websites of organizations engaged in evidence-based activities to develop a framework to explain the relationships among the terms EBM, HTA, and CER. This article proposes an organizing framework and presents a graphic demonstrating the differences and relationships among these terms and concepts. More specific terminology and concepts are necessary for an informed and clear public policy debate. They are even more important to inform decision making at all levels and to engender more accountability by the organizations and individuals responsible for these decisions.

Characterization of high-purity niobium structures fabricated using the electron beam melting process

NASA Astrophysics Data System (ADS)

Terrazas Najera, Cesar Adrian

Additive Manufacturing (AM) refers to the varied set of technologies utilized for the fabrication of complex 3D components from digital data in a layer-by-layer fashion. The use of these technologies promises to revolutionize the manufacturing industry. The electron beam melting (EBM) process has been utilized for the fabrication of fully dense near-net-shape components from various metallic materials. This process, catalogued as a powder bed fusion technology, consists of the deposition of thin layers (50 - 120microm) of metallic powder particles which are fused by the use of a high energy electron beam and has been commercialized by Swedish company Arcam AB. Superconducting radio frequency (SRF) cavities are key components that are used in linear accelerators and other light sources for studies of elemental physics. Currently, cavity fabrication is done by employing different forming processes including deep-drawing and spinning. In both of the latter techniques, a feedstock high-purity niobium sheet with a thickness ranging from 3-4 mm is mechanically deformed and shaped into the desired geometry. In this manner, half cavities are formed that are later joined by electron beam welding (EBW). The welding step causes variability in the shape of the cavity and can also introduce impurities at the surface of the weld interface. The processing route and the purity of niobium are also of utmost importance since the presence of impurities such as inclusions or defects can be detrimental for the SRF properties of cavities. The focus of this research was the use of the EBM process in the manufacture of high purity niobium parts with potential SRF applications. Reactor grade niobium was plasma atomized and used as the precursor material for fabrication using EBM. An Arcam A2 system was utilized for the fabrication. The system had all internal components of the fabrication chamber replaced and was cleaned to prevent contamination of niobium powder. A mini-vat, developed at the W.M. Keck Center for 3D Innovation was used for fabrication due to the limited amount of niobium powder available. Sifting of the material for reuse was done inside a glovebox conditioned to sustain a positive pressure using nitrogen gas and help in delaying moisture adsorption by the powder. The initial step in the research was the optimization of the fabrication parameters to obtain nearly fully dense (% Relative density > 99%) components followed by the fabrication of application-specific parts to be used for measuring mechanical and physical properties. Such parts, which included a probe or antenna measuring ˜85mm tall, were used in the characterization of the thermal conductivity and the residual resistivity ratio of the material; both properties are important in SRF applications. The purity of the material was monitored at different stages from the niobium stock, to the plasma atomized powder, and finally, in the EBM-fabricated parts. For the niobium stock, niobium powder, and in EBM-fabricated parts, chemical analysis was performed using ICP fusion and LECO combustion. A residual gas analyzer (RGA) was used to monitor the vacuum environment during EBM fabrication. X-ray diffraction (XRD) was also used to assess the purity of EBM-fabricated niobium. A second milestone was the characterization of the tensile properties of EBM-fabricated niobium for the first time. These properties included the average yield and ultimate tensile strengths that measured 140MPa and 255MPa respectively. Measurements of the percent elongation were done using visual feedback from a video camera. Similarly, a boundary detection algorithm was used to approximate the percent reduction in area, because only rectangular specimens were available for experimentation. The measured values averaged 34% elongation and 98% reduction in area. Microscopy was also employed to characterize the microstructure of the EBM niobium and SEM images of the fractured specimens utilized in a fractography analysis. The microstructure observed in the horizontal plane of reference was of nearly equiaxed grains with a measured size of roughly 250mum. In the vertical plane, the microstructure was of columnar grains that elongated parallel to the EBM build direction. The fractography images revealed the ductile nature of the material with the presence of micro-void coalescence in the fracture surface. The mechanical properties and microstructure of EBM-fabricated niobium were compared against those of reactor grade niobium. As will be detailed later, the reactor grade niobium had yield and ultimate tensile strengths of 135MPa and 205MPa respectively. The percent elongation was measured at 45.2% and the percent reduction in area at 97.2% for the reactor grade niobium.

Indicators of Arctic Sea Ice Bistability in Climate Model Simulations and Observations

DTIC Science & Technology

2014-09-30

ultimately developed a novel mathematical method to solve the system of equations involving the addition of a numerical “ ghost ” layer, as described in the...balance models ( EBMs ) and (ii) seasonally-varying single-column models (SCMs). As described in Approach item #1, we developed an idealized model that...includes both latitudinal and seasonal variations (Fig. 1). The model reduces to a standard EBM or SCM as limiting cases in the parameter space, thus

Biological effects-based tools for monitoring impacted surface waters in the Great Lakes: a multiagency program in support of the Great Lakes Restoration Initiative

USGS Publications Warehouse

Ekman, Drew R.; Ankley, Gerald T.; Blazer, Vicki; Collette, Timothy W.; Garcia-Reyero, Natàlia; Iwanowicz, Luke R.; Jorgensen, Zachary G.; Lee, Kathy E.; Mazik, Pat M.; Miller, David H.; Perkins, Edward J.; Smith, Edwin T.; Tietge, Joseph E.; Villeneuve, Daniel L.

2013-01-01

There is increasing demand for the implementation of effects-based monitoring and surveillance (EBMS) approaches in the Great Lakes Basin to complement traditional chemical monitoring. Herein, we describe an ongoing multiagency effort to develop and implement EBMS tools, particularly with regard to monitoring potentially toxic chemicals and assessing Areas of Concern (AOCs), as envisioned by the Great Lakes Restoration Initiative (GLRI). Our strategy includes use of both targeted and open-ended/discovery techniques, as appropriate to the amount of information available, to guide a priori end point and/or assay selection. Specifically, a combination of in vivo and in vitro tools is employed by using both wild and caged fish (in vivo), and a variety of receptor- and cell-based assays (in vitro). We employ a work flow that progressively emphasizes in vitro tools for long-term or high-intensity monitoring because of their greater practicality (e.g., lower cost, labor) and relying on in vivo assays for initial surveillance and verification. Our strategy takes advantage of the strengths of a diversity of tools, balancing the depth, breadth, and specificity of information they provide against their costs, transferability, and practicality. Finally, a series of illustrative scenarios is examined that align EBMS options with management goals to illustrate the adaptability and scaling of EBMS approaches and how they can be used in management decisions.

Characterization and analysis of surface notches on Ti-alloy plates fabricated by additive manufacturing techniques

NASA Astrophysics Data System (ADS)

Chan, Kwai S.

2015-12-01

Rectangular plates of Ti-6Al-4V with extra low interstitial (ELI) were fabricated by layer-by-layer deposition techniques that included electron beam melting (EBM) and laser beam melting (LBM). The surface conditions of these plates were characterized using x-ray micro-computed tomography. The depth and radius of surface notch-like features on the LBM and EBM plates were measured from sectional images of individual virtual slices of the rectangular plates. The stress concentration factors of individual surface notches were computed and analyzed statistically to determine the appropriate distributions for the notch depth, notch radius, and stress concentration factor. These results were correlated with the fatigue life of the Ti-6Al-4V ELI alloys from an earlier investigation. A surface notch analysis was performed to assess the debit in the fatigue strength due to the surface notches. The assessment revealed that the fatigue lives of the additively manufactured plates with rough surface topographies and notch-like features are dominated by the fatigue crack growth of large cracks for both the LBM and EBM materials. The fatigue strength reduction due to the surface notches can be as large as 60%-75%. It is concluded that for better fatigue performance, the surface notches on EBM and LBM materials need to be removed by machining and the surface roughness be improved to a surface finish of about 1 μm.

Using Educational Prescriptions to Teach Medical Students Evidence-based Medicine

PubMed Central

Umscheid, Craig A.; Maenner, Matthew J.; Mull, Nikhil; Veesenmeyer, Angela F.; Farrar, John T.; Goldfarb, Stanley; Morrison, Gail; Albanese, Mark A.; Frohna, John G.; Feldstein, David A.

2018-01-01

Purpose To evaluate feasibility and impact of evidence-based medicine (EBM) educational prescriptions (EPs) in medical student clerkships. Methods Students answered clinical questions during clerkships using EPs, which guide learners through the “four As” of EBM. Epidemiology fellows graded EPs using a rubric. Feasibility was assessed using descriptive statistics and student and fellow end-of-study questionnaires, which also measured impact. In addition, for each EP, students reported patient impact. Impact on EBM skills was assessed by change in EP scores over time and scores on an EBM objective structured clinical exam (OSCE) that were compared to controls from the prior year. Results 117 students completed 402 EPs evaluated by 24 fellows. Average score was 7.34/9.00 (SD 1.58). 69 students (59%) and 21 fellows (88%) completed questionnaires. Most students thought EPs improved “Acquiring” and “Appraising.” Almost half thought EPs improved “Asking” and “Applying.” Fellows did not value grading EPs. For 18%of EPs, students reported a “change” or “potential change” in treatment. 56% “confirmed” treatment. EP scores increased by 1.27 (95% CI: 0.81–1.72). There were no differences in OSCE scores between cohorts. Conclusions Integrating EPs into clerkships is feasible and has impact, yet OSCEs were unchanged, and research fellows had limitations as evaluators. PMID:27075864

Effect of kangaroo mother care vs expressed breast milk administration on pain associated with removal of adhesive tape in very low birth weight neonates: a randomized controlled trial.

PubMed

Nanavati, Ruchi N; Balan, Rajiv; Kabra, Nandkishor S

2013-11-08

To compare the pain relief effect of Kangaroo Mother Care (KMC) and Expressed Breast Milk (EBM) on the pain associated with adhesive tape removal in very low birth weight (VLBW) neonates. Randomized Controlled Trial. Neonatal intensive care unit of a tertiary care teaching hospital. 15 VLBW neonates who needed adhesive tape removal for the first part and 50 VLBW neonates needing adhesive tape removal for the second part. In first stage of the study, we studied whether adhesive tape removal in VLBW neonates was painful. In the second stage, eligible VLBW neonates were randomised to compare the efficacy of KMC and EBM in reducing the pain during the procedure of adhesive tape removal. Premature Infant Pain Profile (PIPP) Score, heart rate, oxygen saturation. There was significant increase in pain associated with the removal of adhesive tape (Mean pre-procedure PIPP score 3.47 ± 0.74; post-procedure mean PIPP score 12.13 ± 2.59; P<0.0001). The post intervention mean PIPP pain score was not significantly different between the KMC and EBM groups (P= 0.62). Removal of adhesive tape is a painful procedure for VLBW neonates. There was no difference between KMC and EBM in relieving pain associated with adhesive tape removal.

Evidence-based Surgery of Aortic Regurgitation: Results of a Questionnaire in German-speaking Countries.

PubMed

Dinges, Christian; Steindl, Johannes; Hitzl, Wolfgang; Kiesslich, Tobias; Seitelberger, Rainald

2018-06-01

evidence-based medicine (EBM) approaches have reached broad acceptance, both in conservative and surgical disciplines. The aim of this study is to clarify the role of EBM in a rare condition of aortic regurgitation (AR) with surgical indication. A purpose-built Internet-based questionnaire was sent to 607 cardiovascular surgeons in Germany, Austria, and Switzerland. A virtual 64-year-old patient's medical history was presented, including two ultrasound images and one computed tomography scan, showing a 58-mm aortic root aneurysm and a severe trileaflet regurgitant aortic valve. Participants had to choose their preferred therapeutic strategy from a list. Additionally, demographics including nationality, the center size, and the frequency of similar types of patients referred to their departments were collected. Of 607 questionnaires, 100 were returned (16%). One participant was excluded due to conflicting answers. Most surgeons ( n  = 84; 84%) chose a valve-sparing root replacement (VSRR). A Bentall procedure was preferred by 13 surgeons (13%). Two surgeons voted for aortic valve replacement combined with partial root resection. The decision-making process was not significantly influenced by center size, nationality, or frequency of patients. Applying the current guidelines to our virtual study patient, 84% of participants acted accordingly choosing VSRR. Remarkably, 14% of these surgeons see less than 10 and 43% see not more than 20 comparable patients per year. Since the guidelines reserve VSRR for competent centers, those numbers as well as the guidelines themselves should be further discussed. Georg Thieme Verlag KG Stuttgart · New York.

EBM apps that help you search for answers to your clinical questions.

PubMed

Windish, Donna

2014-06-01

In the age of smartphones and tablets, it has become common place to find apps that help you do or find almost anything. The quality and breadth of medical apps has improved greatly in recent years. You can now find medical apps that recreate textbooks, search for current articles, calculate likelihood ratios and find point-of-care answers to clinical questions. This article describes and reviews apps aimed at helping clinicians search for evidence to support the practice of EBM.

Comparison of bacterial counts in expressed breast milk following standard or strict infection control regimens in neonatal intensive care units: compliance of mothers does matter.

PubMed

Haiden, N; Pimpel, B; Assadian, O; Binder, C; Kreissl, A; Repa, A; Thanhäuser, M; Roberts, C D; Berger, A

2016-03-01

Bacterial counts in 1466 expressed breast milk (EBM) samples from women following one of two infection control regimens (standard vs strict) were investigated. Overall, 12% of samples yielded Gram-negative bacteria, with no significant differences between the standard [11.9% (94/788)] and strict [12.1% (82/678)] regimens (P = 0.92). Significantly more samples were contaminated when expressed at home (standard regimen home/hospital: 17.9% vs 6.1%; strict regimen home/hospital: 19.6% vs 3.4%; P < 0.001). Bacterial contamination of EBM was not associated with the regimen, but was associated with the location of breast milk expression. Attempts to improve personal hygiene during milk collection seem to be of limited value. Good hygiene of collection and storage equipment is likely to be the most important way to ensure the microbiological quality of EBM. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Teaching and learning of medical biochemistry according to clinical realities: A case study.

PubMed

Jabaut, Joshua M; Dudum, Ramzi; Margulies, Samantha L; Mehta, Akshita; Han, Zhiyong

2016-01-01

To foster medical students to become physicians who will be lifelong independent learners and critical thinkers with healthy skepticism and provide high-quality patient care guided by the best evidence, teaching of evidence-based medicine (EBM) has become an important component of medical education. Currently, the teaching and learning of biochemistry in medical schools incorporates its medical relevance and applications. However, to our knowledge there have been no reports on integrating EBM with teaching and learning medical biochemistry. Here, we present a case study to illustrate the significance of this approach. This case study was based on a biochemistry/nutrition question in a popular board review book about whether a homeless alcoholic man is at risk of developing a deficiency of vitamin E. The possible answers and explanation provided in the book raised a question about the correct answer, which provided us with an opportunity to adapt the philosophy and certain basic EBM principles to find evidence for the clinical applicability of a commonly taught biochemistry topic. The outcome of this case study not only taught us how to conduct an EBM exercise to answer a specific patient question, but also provided us with an opportunity for in-depth teaching and learning of the medical relevance of a specific biochemistry topic based on the best clinical evidence obtained from a systematic research of medical literature. © 2015 The International Union of Biochemistry and Molecular Biology.

Analyzing the impact of modeling choices and assumptions in compartmental epidemiological models

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

Nutaro, James J.; Pullum, Laura L.; Ramanathan, Arvind

In this study, computational models have become increasingly used as part of modeling, predicting, and understanding how infectious diseases spread within large populations. These models can be broadly classified into differential equation-based models (EBM) and agent-based models (ABM). Both types of models are central in aiding public health officials design intervention strategies in case of large epidemic outbreaks. We examine these models in the context of illuminating their hidden assumptions and the impact these may have on the model outcomes. Very few ABM/EBMs are evaluated for their suitability to address a particular public health concern, and drawing relevant conclusions aboutmore » their suitability requires reliable and relevant information regarding the different modeling strategies and associated assumptions. Hence, there is a need to determine how the different modeling strategies, choices of various parameters, and the resolution of information for EBMs and ABMs affect outcomes, including predictions of disease spread. In this study, we present a quantitative analysis of how the selection of model types (i.e., EBM vs. ABM), the underlying assumptions that are enforced by model types to model the disease propagation process, and the choice of time advance (continuous vs. discrete) affect the overall outcomes of modeling disease spread. Our study reveals that the magnitude and velocity of the simulated epidemic depends critically on the selection of modeling principles, various assumptions of disease process, and the choice of time advance.« less

Analyzing the impact of modeling choices and assumptions in compartmental epidemiological models

DOE PAGES

Nutaro, James J.; Pullum, Laura L.; Ramanathan, Arvind; ...

2016-05-01

In this study, computational models have become increasingly used as part of modeling, predicting, and understanding how infectious diseases spread within large populations. These models can be broadly classified into differential equation-based models (EBM) and agent-based models (ABM). Both types of models are central in aiding public health officials design intervention strategies in case of large epidemic outbreaks. We examine these models in the context of illuminating their hidden assumptions and the impact these may have on the model outcomes. Very few ABM/EBMs are evaluated for their suitability to address a particular public health concern, and drawing relevant conclusions aboutmore » their suitability requires reliable and relevant information regarding the different modeling strategies and associated assumptions. Hence, there is a need to determine how the different modeling strategies, choices of various parameters, and the resolution of information for EBMs and ABMs affect outcomes, including predictions of disease spread. In this study, we present a quantitative analysis of how the selection of model types (i.e., EBM vs. ABM), the underlying assumptions that are enforced by model types to model the disease propagation process, and the choice of time advance (continuous vs. discrete) affect the overall outcomes of modeling disease spread. Our study reveals that the magnitude and velocity of the simulated epidemic depends critically on the selection of modeling principles, various assumptions of disease process, and the choice of time advance.« less

From the EBM pyramid to the Greek temple: a new conceptual approach to Guidelines as implementation tools in mental health.

PubMed

Salvador-Carulla, L; Lukersmith, S; Sullivan, W

2017-04-01

Guideline methods to develop recommendations dedicate most effort around organising discovery and corroboration knowledge following the evidence-based medicine (EBM) framework. Guidelines typically use a single dimension of information, and generally discard contextual evidence and formal expert knowledge and consumer's experiences in the process. In recognition of the limitations of guidelines in complex cases, complex interventions and systems research, there has been significant effort to develop new tools, guides, resources and structures to use alongside EBM methods of guideline development. In addition to these advances, a new framework based on the philosophy of science is required. Guidelines should be defined as implementation decision support tools for improving the decision-making process in real-world practice and not only as a procedure to optimise the knowledge base of scientific discovery and corroboration. A shift from the model of the EBM pyramid of corroboration of evidence to the use of broader multi-domain perspective graphically depicted as 'Greek temple' could be considered. This model takes into account the different stages of scientific knowledge (discovery, corroboration and implementation), the sources of knowledge relevant to guideline development (experimental, observational, contextual, expert-based and experiential); their underlying inference mechanisms (deduction, induction, abduction, means-end inferences) and a more precise definition of evidence and related terms. The applicability of this broader approach is presented for the development of the Canadian Consensus Guidelines for the Primary Care of People with Developmental Disabilities.

Identifying Thresholds for Ecosystem-Based Management

PubMed Central

Samhouri, Jameal F.; Levin, Phillip S.; Ainsworth, Cameron H.

2010-01-01

Background One of the greatest obstacles to moving ecosystem-based management (EBM) from concept to practice is the lack of a systematic approach to defining ecosystem-level decision criteria, or reference points that trigger management action. Methodology/Principal Findings To assist resource managers and policymakers in developing EBM decision criteria, we introduce a quantitative, transferable method for identifying utility thresholds. A utility threshold is the level of human-induced pressure (e.g., pollution) at which small changes produce substantial improvements toward the EBM goal of protecting an ecosystem's structural (e.g., diversity) and functional (e.g., resilience) attributes. The analytical approach is based on the detection of nonlinearities in relationships between ecosystem attributes and pressures. We illustrate the method with a hypothetical case study of (1) fishing and (2) nearshore habitat pressure using an empirically-validated marine ecosystem model for British Columbia, Canada, and derive numerical threshold values in terms of the density of two empirically-tractable indicator groups, sablefish and jellyfish. We also describe how to incorporate uncertainty into the estimation of utility thresholds and highlight their value in the context of understanding EBM trade-offs. Conclusions/Significance For any policy scenario, an understanding of utility thresholds provides insight into the amount and type of management intervention required to make significant progress toward improved ecosystem structure and function. The approach outlined in this paper can be applied in the context of single or multiple human-induced pressures, to any marine, freshwater, or terrestrial ecosystem, and should facilitate more effective management. PMID:20126647

21 CFR 892.1350 - Nuclear scanning bed.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Nuclear scanning bed. 892.1350 Section 892.1350...) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1350 Nuclear scanning bed. (a) Identification. A nuclear scanning bed is an adjustable bed intended to support a patient during a nuclear medicine...

21 CFR 892.1350 - Nuclear scanning bed.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nuclear scanning bed. 892.1350 Section 892.1350...) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1350 Nuclear scanning bed. (a) Identification. A nuclear scanning bed is an adjustable bed intended to support a patient during a nuclear medicine...

21 CFR 892.1350 - Nuclear scanning bed.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nuclear scanning bed. 892.1350 Section 892.1350...) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1350 Nuclear scanning bed. (a) Identification. A nuclear scanning bed is an adjustable bed intended to support a patient during a nuclear medicine...

21 CFR 892.1350 - Nuclear scanning bed.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Nuclear scanning bed. 892.1350 Section 892.1350...) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1350 Nuclear scanning bed. (a) Identification. A nuclear scanning bed is an adjustable bed intended to support a patient during a nuclear medicine...

21 CFR 892.1350 - Nuclear scanning bed.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Nuclear scanning bed. 892.1350 Section 892.1350...) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1350 Nuclear scanning bed. (a) Identification. A nuclear scanning bed is an adjustable bed intended to support a patient during a nuclear medicine...

Dissecting the HMO-benefits managers relationship: what to measure and why.

PubMed

Peltier, J W; Westfall, J

2000-01-01

The relationship between health maintenance organizations (HMO) and employee benefits managers (EBM) is multidimensional and complex. Relationship marketing theory is used to illustrate its role in strengthening interorganizational bonds and reducing defections to other health plans. The importance of various service dimensions in the HMO-EBM relationship can change depending on whether the measure used is overall satisfaction, overall quality, and loyalty to the HMO. By dissecting relationships in this way, HMOs can develop strategies that take multiple routes for building and maintaining strong partnerships with employee benefits managers.

Characterization of cellular solids in Ti6Al4V for orthopaedic implant applications: Trabecular titanium.

PubMed

Marin, E; Fusi, S; Pressacco, M; Paussa, L; Fedrizzi, L

2010-07-01

EBM (Electron Beam Melting) technology can be used successfully to obtain cellular solids in metallic biomaterials that can greatly increase osseointegration in arthroprothesis and at the same time maintain good mechanical properties. The investigated structures, called Trabecular Titanium, usually cannot be obtained by traditional machining. Two samples: (A) with a smaller single cell area and, (B) with a bigger single cell area, were produced and studied in this project. They have been completely characterized and compared with the results in similar literature pertinent to Ti6Al4V EBM structures. Relative density was evaluated using different methods, the mean diameter of the open porosities was calculated by Scanning Electron Microscope images; the composition was evaluated using Energy-Dispersive X-Ray Spectroscopy; the microstructure (alpha-beta) was investigated using chemical etching and, the mechanical proprieties were investigated using UMTS. The mean porosity values resulted comparable with spongy bone (63% for A and 72% for B). The mean diameter of the single porosity (650 mum for A and 1400 mum for B) resulted compatible with the osseointegration data from the literature, in particular for sample A. The Vickers micro-hardness tests and the chemical etching demonstrated that the structure is fine, uniform and well distributed. The mechanical test proved that sample (A) was more resistant than sample (B), but sample (B) showed an elastic modulus almost equal to the value of spongy bone. The results of this study suggest that the two Ti6Al4V cellular solids can be used in biomedical applications to promote osseointegration demonstrating that they maybe successfully used in prosthetic implants. Additional implant results will be published in the near future. Copyright 2010 Elsevier Ltd. All rights reserved.

The New S-RAM Air Variable Compressor/Expander for Heat Pump and Waste Heat to Power Application

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

Dehoff, Ryan R; Jestings, Lee; Conde, Ricardo

S-RAM Dynamics (S-RAM) has designed an innovative heat pump system targeted for commercial and industrial applications. This new heat pump system is more efficient than anything currently on the market and utilizes air as the refrigerant instead of hydrofluorocarbon (HFC) refrigerants, leading to lower operating costs, minimal environmental costs or concerns, and lower maintenance costs. The heat pumps will be manufactured in the United States. This project was aimed at determining the feasibility of utilizing additive manufacturing to make the heat exchanger device for the new heat pump system. ORNL and S-RAM Dynamics collaborated on determining the prototype performance andmore » subsequently printing of the prototype using additive manufacturing. Complex heat exchanger designs were fabricated using the Arcam electron beam melting (EBM) powder bed technology using Ti-6Al-4V material. An ultrasonic welding system was utilized in order to remove the powder from the small openings of the heat exchanger. The majority of powder in the small chambers was removed, however, the amount of powder remaining in the heat exchanger was a function of geometry. Therefore, only certain geometries of heat exchangers could be fabricated. SRAM Dynamics evaluated a preliminary heat exchanger design. Although the results of the additive manufacturing of the heat exchanger were not optimum, a less complex geometry was demonstrated. A sleeve valve was used as a demonstration piece, as engine designs from S-RAM Dynamics require the engine to have a very high density. Preliminary designs of this geometry were successfully fabricated using the EBM technology.« less

Biochip scanner device

DOEpatents

Perov, Alexander; Belgovskiy, Alexander I.; Mirzabekov, Andrei D.

2001-01-01

A biochip scanner device used to detect and acquire fluorescence signal data from biological microchips or biochips and method of use are provided. The biochip scanner device includes a laser for emitting a laser beam. A modulator, such as an optical chopper modulates the laser beam. A scanning head receives the modulated laser beam and a scanning mechanics coupled to the scanning head moves the scanning head relative to the biochip. An optical fiber delivers the modulated laser beam to the scanning head. The scanning head collects the fluorescence light from the biochip, launches it into the same optical fiber, which delivers the fluorescence into a photodetector, such as a photodiode. The biochip scanner device is used in a row scanning method to scan selected rows of the biochip with the laser beam size matching the size of the immobilization site.

[Comparison of time-oriented cost accounting catalogs to control a department of radiology].

PubMed

Hackländer, T; Mertens, H; Cramer, B M

2005-03-01

Within a hospital, the radiology department has taken over the role of a cost center. Cost accounting can be applied to analyze the costs for the performance of services. By assigning the expenditures of resources to the service, the cash value can directly be distributed to the costs of equipment, material and rooms. Time-oriented catalogs of services are predefined to calculate the number of the employees for a radiology department. Using our own survey of time data, we examined whether such catalogs correctly represent the time consumed in a radiology department. Only services relevant for the turnover were compared. For 96 primary radiological services defined by the score-oriented German fee catalog for physicians (Gebuhrenordnung fur Arzte), a ranking list was made for the annual procedures in descending frequency order. According to the Pareto principle, the 11 services with the highest frequency were chosen and the time consumed for the technical and medical services was collected over a period of 2 months. This survey was compared with the time-oriented catalogs TARMED and EBM 2000plus. The included 11 relevant radiological services represented 80.3 % of the annual procedures of our radiology department. When comparing the technical services between the time-oriented catalogs and our own survey, TARMED gives a better description of the time consumed in 7 of the 11 services and EMB 2000plus in 3 services. When comparing the medical services, TARMED gives a better description of the time consumed in 6 of the 11 services and EBM 2000plus in 4 services. When averaging all the radiological services, TARMED overestimates the current number of physicians necessary for primary reading by a factor of 10.0 % and EBM 2000plus by a factor of 2.6 %. As to the time spent on performing the relevant radiological services, TARMED is slightly superior to describe the radiology department of a hospital than EBM 2000plus. For calculating the number of physicians necessary for primary reading, EBM 2000plus is superior to TARMED.

The vexing problem of defining the meaning, role and measurement of values in treatment decision-making.

PubMed

Charles, Cathy; Gafni, Amiram

2014-03-01

Two international movements, evidence-based medicine (EBM) and shared decision-making (SDM) have grappled for some time with issues related to defining the meaning, role and measurement of values/preferences in their respective models of treatment decision-making. In this article, we identify and describe unresolved problems in the way that each movement addresses these issues. The starting point for this discussion is that at least two essential ingredients are needed for treatment decision-making: research information about treatment options and their potential benefits and risks; and the values/preferences of participants in the decision-making process. Both the EBM and SDM movements have encountered difficulties in defining the meaning, role and measurement of values/preferences in treatment decision-making. In the EBM model of practice, there is no clear and consistent definition of patient values/preferences and no guidance is provided on how to integrate these into an EBM model of practice. Methods advocated to measure patient values are also problematic. Within the SDM movement, patient values/preferences tend to be defined and measured in a restrictive and reductionist way as patient preferences for treatment options or attributes of options, while broader underlying value structures are ignored. In both models of practice, the meaning and expected role of physician values in decision-making are unclear. Values clarification exercises embedded in patient decision aids are suggested by SDM advocates to identify and communicate patient values/preferences for different treatment outcomes. Such exercises have the potential to impose a particular decision-making theory and/or process onto patients, which can change the way they think about and process information, potentially impeding them from making decisions that are consistent with their true values. The tasks of clarifying the meaning, role and measurement of values/preferences in treatment decision-making models such as EBM and SDM, and determining whose values ought to count are complex and difficult tasks that will not be resolved quickly. Additional conceptual thinking and research are needed to explore and clarify these issues. To date, the values component of these models remains elusive and underdeveloped.

Bad News: Analysis of the Quality of Information on Influenza Prevention Returned by Google in English and Italian

PubMed Central

Maki, Ali; Evans, Roger; Ghezzi, Pietro

2015-01-01

Information available to the public influences the approach of the population toward vaccination against influenza compared with other preventative approaches. In this study, we have analyzed the first 200 websites returned by searching Google on two topics (prevention of influenza and influenza vaccine), in English and Italian. For all the four searches above, websites were classified according to their typology (government, commercial, professional, portals, etc.) and for their trustworthiness as defined by the Journal of the American Medical Association (JAMA) score, which assesses whether they provide some basic elements of information quality (IQ): authorship, currency, disclosure, and references. The type of information described was also assessed to add another dimension of IQ. Websites on influenza prevention were classified according to the type of preventative approach mentioned (vaccine, lifestyle, hygiene, complementary medicine, etc.), whether the approaches were in agreement with evidence-based medicine (EBM) or not. Websites on influenza vaccination were classified as pro- or anti-vaccine, or neutral. The great majority of websites described EBM approaches to influenza prevention and had a pro-vaccine orientation. Government websites mainly pointed at EBM preventative approaches and had a pro-vaccine orientation, while there was a higher proportion of commercial websites among those which promote non-EBM approaches. Although the JAMA score was lower in commercial websites, it did not correlate with the preventative approaches suggested or the orientation toward vaccines. For each of the four search engine result pages (SERP), only one website displayed the health-of-the-net (HON) seal. In the SERP on vaccines, journalistic websites were the most abundant category and ranked higher than average in both languages. Analysis using natural language processing showed that journalistic websites were mostly reporting news about two specific topics (different in the two languages). While the ranking by Google favors EBM approaches and, in English, does not promote commercial websites, in both languages it gives a great advantage to news. Thus, the type of news published during the influenza season probably has a key importance in orienting the public opinion due to its high visibility. This raises important questions on the relationships between health IQ, trustworthiness, and newsworthiness. PMID:26697012

Has evidence-based medicine ever been modern? A Latour-inspired understanding of a changing EBM.

PubMed

Wieringa, Sietse; Engebretsen, Eivind; Heggen, Kristin; Greenhalgh, Trish

2017-10-01

Evidence-based health care (EBHC), previously evidence-based medicine (EBM), is considered by many to have modernized health care and brought it from an authority-based past to a more rationalist, scientific grounding. But recent concerns and criticisms pose serious challenges and urge us to look at the fundamentals of a changing EBHC. In this paper, we present French philosopher Bruno Latour's vision on modernity as a framework to discuss current changes in the discourse on EBHC/EBM. Drawing on Latour's work, we argue that the early EBM movement had a strong modernist agenda with an aim to "purify" clinical reality into a dichotomy of objective "evidence" from nature and subjective "preferences" from human society and culture. However, we argue that this shift has proved impossible to achieve in reality. Several recent developments appear to point to a demise of purified evidence in the EBHC discourse and a growing recognition-albeit implicit and undertheorized-that evidence in clinical decision making is relentlessly situated and contextual. The unique, individual patient, not abstracted truths from distant research studies, must be the starting point for clinical practice. It follows that the EBHC community needs to reconsider the assumption that science should be abstracted from culture and acknowledge that knowledge from human culture and nature both need translation and interpretation. The implications for clinical reasoning are far reaching. We offer some preliminary principles for conceptualizing EBHC as a "situated practice" rather than as a sequence of research-driven abstract decisions. © 2017 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

Applying 'evidence-based medicine' theory to interventional radiology. Part 2: a spreadsheet for swift assessment of procedural benefit and harm.

PubMed

Maceneaney, P M; Malone, D E

2000-12-01

To design a spreadsheet program to analyse interventional radiology (IR) data rapidly produced in local research or reported in the literature using 'evidence-based medicine' (EBM) parameters of treatment benefit and harm. Microsoft Excel(TM)was used. The spreadsheet consists of three worksheets. The first shows the 'Levels of Evidence and Grades of Recommendations' that can be assigned to therapeutic studies as defined by the Oxford Centre for EBM. The second and third worksheets facilitate the EBM assessment of therapeutic benefit and harm. Validity criteria are described. These include the assessment of the adequacy of sample size in the detection of possible procedural complications. A contingency (2 x 2) table for raw data on comparative outcomes in treated patients and controls has been incorporated. Formulae for EBM calculations are related to these numerators and denominators in the spreadsheet. The parameters calculated are benefit - relative risk reduction, absolute risk reduction, number needed to treat (NNT). Harm - relative risk, relative odds, number needed to harm (NNH). Ninety-five per cent confidence intervals are calculated for all these indices. The results change automatically when the data in the therapeutic outcome cells are changed. A final section allows the user to correct the NNT or NNH in their application to individual patients. This spreadsheet can be used on desktop and palmtop computers. The MS Excel(TM)version can be downloaded via the Internet from the URL ftp://radiography.com/pub/TxHarm00.xls. A spreadsheet is useful for the rapid analysis of the clinical benefit and harm from IR procedures.

Evidence-based medicine: is translating evidence into practice a solution to the cost-quality challenges facing medicine?

PubMed

Larson, E B

1999-09-01

Evidence-based medicine (EBM) and practice guidelines have been embraced by increasing numbers of scholars, administrators, and medical journalists as an intellectually attractive solution to the dilemma of improving health care quality while reducing costs. However, certain factors have thus far limited the role that EBM might play in resolving cost-quality trade-offs. Beyond the quality of the guideline and the evidence base itself, critical factors for success include local clinician involvement, a unified or closed medical staff, protocols that minimize use of clinical judgment and that call for involvement of so-called physician extenders (such as nurse practitioners and physician assistants), and financial incentive. TROUBLESOME ISSUES RELATED TO COST-QUALITY TRADE-OFFS: Rationing presents many dilemmas, but for physicians one critical problem is determining what is the physician's responsibility. Is the physician to be the patient's advocate, or should the physician be the advocate of all patients (the patients' advocate)? How do we get physicians out of potentially conflicted roles? EBM guidelines are needed to help minimize the number of instances physicians are asked to ration care at the bedside. If the public can decide to share and limit resources--presumably based on shared priorities--physicians would have a basis to act as advocates for all patients. Although EBM alone is not a simple solution to the problems of increasing costs and public expectations, it can be an important source of input and information in relating the value of service and medical technology to public priorities.

Breast milk and glucose for pain relief in preterm infants: a noninferiority randomized controlled trial.

PubMed

Bueno, Mariana; Stevens, Bonnie; de Camargo, Patrícia Ponce; Toma, Edi; Krebs, Vera Lúcia Jornada; Kimura, Amélia Fumiko

2012-04-01

The study goal was to compare the efficacy of expressed breast milk (EBM) versus 25% glucose on pain responses of late preterm infants during heel lancing. In a noninferiority randomized controlled trial, a total of 113 newborns were randomized to receive EBM (experimental group [EG]) or 25% glucose (control group [CG]) before undergoing heel lancing. The primary outcome was pain intensity (Premature Infant Pain Profile [PIPP]) and a 10% noninferiority margin was established. Secondary outcomes were incidence of cry and percentage of time spent crying and adverse events. Intention-to-treat (ITT) analysis was used. Groups were similar regarding demographics and clinical characteristics, except for birth weight and weight at data collection day. There were lower pain scores in the CG over 3 minutes after lancing (P < .001). A higher number of infants in the CG had PIPP scores indicative of minimal pain or absence of pain (P = .002 and P = .003 on ITT analysis) at 30 seconds after lancing, and the mean difference in PIPP scores was 3 (95% confidence interval: 1.507-4.483). Lower incidence of cry (P = .001) and shorter duration of crying (P = .014) were observed for CG. Adverse events were benign and self-limited, and there was no significant difference between groups (P = .736 and P = .637 on ITT analysis). Results based on PIPP scores and crying time indicate poorer effects of EBM compared with 25% glucose during heel lancing. Additional studies exploring the vol and administration of EBM and its combination with other strategies such as skin-to-skin contact and sucking are necessary.

Has evidence‐based medicine ever been modern? A Latour‐inspired understanding of a changing EBM

PubMed Central

Engebretsen, Eivind; Heggen, Kristin; Greenhalgh, Trish

2017-01-01

Abstract Evidence‐based health care (EBHC), previously evidence‐based medicine (EBM), is considered by many to have modernized health care and brought it from an authority‐based past to a more rationalist, scientific grounding. But recent concerns and criticisms pose serious challenges and urge us to look at the fundamentals of a changing EBHC. In this paper, we present French philosopher Bruno Latour's vision on modernity as a framework to discuss current changes in the discourse on EBHC/EBM. Drawing on Latour's work, we argue that the early EBM movement had a strong modernist agenda with an aim to “purify” clinical reality into a dichotomy of objective “evidence” from nature and subjective “preferences” from human society and culture. However, we argue that this shift has proved impossible to achieve in reality. Several recent developments appear to point to a demise of purified evidence in the EBHC discourse and a growing recognition—albeit implicit and undertheorized—that evidence in clinical decision making is relentlessly situated and contextual. The unique, individual patient, not abstracted truths from distant research studies, must be the starting point for clinical practice. It follows that the EBHC community needs to reconsider the assumption that science should be abstracted from culture and acknowledge that knowledge from human culture and nature both need translation and interpretation. The implications for clinical reasoning are far reaching. We offer some preliminary principles for conceptualizing EBHC as a “situated practice” rather than as a sequence of research‐driven abstract decisions. PMID:28508440

Survey of Chinese Medicine Students to Determine Research and Evidence-Based Medicine Perspectives at Pacific College of Oriental Medicine.

PubMed

Anderson, Belinda J; Kligler, Benjamin; Cohen, Hillel W; Marantz, Paul R

2016-01-01

Research literacy and the practice of evidence-based medicine (EBM) are important initiatives in complementary and alternative medicine (CAM), which requires cultural change within educational institutions for successful implementation. To determine the self-assessed research and EBM perspectives of Chinese medicine Masters degree students at Pacific College of Oriental Medicine, New York campus (PCOM-NY). A survey with 17 close-ended questions and one open-ended question was administered through Survey Monkey to students at PCOM-NY. The survey was sent to 420 Masters students and 176 (41.9%) responded. Students in all four years of the Masters degree indicated a generally high degree of interest in, and support for the value of research. However, increasing years (one to four years) in the program was associated with lower interest in post-graduation research participation and entering the doctoral program, and the fourth year students reported low levels of interest in having greater research content and training in their Masters degree programs. Students who responded to the open-ended question (23% of respondents) expressed enthusiasm for research and concerns about the relevance of research in Chinese medicine. Consistent with findings in similar studies at CAM colleges, interest in research, and EBM of the PCOM-NY Masters students appeared to decline with increasing years in the program. Concerns around paradigm and epistemological issues associated with research and EBM among Chinese medicine students and practitioners warrants further investigation, and may be an important challenge for integrative medicine. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect of Hypoeutectic Boron Additions on the Grain Size and Mechanical Properties of Ti-6Al-4V Manufactured with Powder Bed Electron Beam Additive Manufacturing

NASA Astrophysics Data System (ADS)

Mahbooba, Zaynab; West, Harvey; Harrysson, Ola; Wojcieszynski, Andrzej; Dehoff, Ryan; Nandwana, Peeyush; Horn, Timothy

2017-03-01

In additive manufacturing, microstructural control is feasible via processing parameter alteration. However, the window for parameter variation for certain materials, such as Ti-6Al-4V, is limited, and alternative methods must be employed to customize microstructures. Grain refinement and homogenization in cast titanium alloys has been demonstrated through the addition of hypoeutectic concentrations of boron. This work explores the influence of 0.00 wt.%, 0.25 wt.%, 0.50 wt.%, and 1.0 wt.% boron additions on the microstructure and bulk mechanical properties of Ti-6Al-4V samples fabricated in an Arcam A2 electron beam melting (EBM) system with commercial processing parameters for Ti-6Al-4V. Analyses of EBM fabricated Ti-6Al-4V + B indicate that the addition of 0.25-1.0 wt.% boron progressively refines the grain structure, and it improves hardness and elastic modulus. Despite a reduction in size, the β grain structure remained columnar as a result of directional heat transfer during EBM fabrication.

Results of a laboratory experiment that tests rotating unbalanced-mass devices for scanning gimbaled payloads and free-flying spacecraft

NASA Technical Reports Server (NTRS)

Alhorn, D. C.; Polites, M. E.

1994-01-01

Rotating unbalanced-mass (RUM) devices are a new way to scan space-based, balloon-borne, and ground-based gimbaled payloads, like x-ray and gamma-ray telescopes. They can also be used to scan free-flying spacecraft. Circular scans, linear scans, and raster scans can be generated. A pair of RUM devices generates the basic scan motion and an auxiliary control system using torque motors, control moment gyros, or reaction wheels keeps the scan centered on the target and produces some complementary motion for raster scanning. Previous analyses and simulation results show that this approach offers significant power savings compared to scanning only with the auxiliary control system, especially with large payloads and high scan frequencies. However, these claims have never been proven until now. This paper describes a laboratory experiment which tests the concept of scanning a gimbaled payload with RUM devices. A description of the experiment is given and test results that prove the concept are presented. The test results are compared with those from a computer simulation model of the experiment and the differences are discussed.

75 FR 34482 - Certain Biometric Scanning Devices, Components Thereof, Associated Software, and Products...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-17

..., Components Thereof, Associated Software, and Products Containing the Same; Notice of Investigation AGENCY: U... scanning devices, components thereof, associated software, and products containing the same by reason of... after importation of certain biometric scanning devices, components thereof, associated software, or...

The Adaptive Ecosystem Climatology (AEC): Design and Development

NASA Astrophysics Data System (ADS)

deRada, S.; Penta, B.; McCarthy, S.; Gould, R. W., Jr.

2016-02-01

The concept of ecosystem-based management (EBM), recently introduced to rectify the shortcomings of single-species management policies, has been widely accepted as a basis for the conservation and management of natural resources. In line with NOAA's Integrated Ecosystem Assessment (IEA) Program, EBM is an integrated approach that considers the entire ecosystem and the interactions among species rather than focusing on individual components. This integrative approach relies on heterogeneous data, physical as well as biogeochemical data, among many others. Relative to physical data, however, marine biogeochemical records, also critical in IEA and EBM, are still lacking, both in terms of mature models and in terms of observational data availability. TheAdaptive Ecosystem Climatology (AEC) was conceived as a novel approach to address these limitations, mitigating the shortcomings of the individual components and combining their strengths to enhance decision-making activities. AEC is designed on the concept that a high-frequency climatology can be used as a baseline into which available observational data can be ingested to produce a higher accuracy product. In the absence of observations, the climatology acts as a best estimate. AEC was developed using a long-term simulation of a coupled biophysical numerical model configured for the Gulf of Mexico. Using the model results, we constructed a three-dimensional, dynamically balanced, gridded, static climatology for each calendar day. Using this `static' climatology as a background `first guess', observations from a particular date are ingested via optimal interpolation to `nudge' the climatology toward current conditions, thus providing representative fields for that date (adaptive climatology). With this adaptive approach, AEC can support a variety of EBM objectives, from fisheries, to resource management, to coastal resilience.

Direct vs. Expressed Breast Milk Feeding: Relation to Duration of Breastfeeding.

PubMed

Pang, Wei Wei; Bernard, Jonathan Y; Thavamani, Geetha; Chan, Yiong Huak; Fok, Doris; Soh, Shu-E; Chua, Mei Chien; Lim, Sok Bee; Shek, Lynette P; Yap, Fabian; Tan, Kok Hian; Gluckman, Peter D; Godfrey, Keith M; van Dam, Rob M; Kramer, Michael S; Chong, Yap-Seng

2017-05-27

Studies examining direct vs. expressed breast milk feeding are scarce. We explored the predictors of mode of breastfeeding and its association with breastfeeding duration in a multi-ethnic Asian population. We included 541 breastfeeding mother-infant pairs from the Growing Up in Singapore Toward healthy Outcomes cohort. Mode of breastfeeding (feeding directly at the breast, expressed breast milk (EBM) feeding only, or mixed feeding (a combination of the former 2 modes)) was ascertained at three months postpartum. Ordinal logistic regression analyses identified predictors of breast milk expression. Cox regression models examined the association between mode of breastfeeding and duration of any and of full breastfeeding. Maternal factors independently associated with a greater likelihood of breast milk expression instead of direct breastfeeding were Chinese (vs. Indian) ethnicity, (adjusted odds ratio, 95% CI; 3.41, 1.97-5.91), tertiary education (vs. secondary education or lower) (2.22, 1.22-4.04), primiparity (1.54, 1.04-2.26) and employment during pregnancy (2.53, 1.60-4.02). Relative to those who fed their infants directly at the breast, mothers who fed their infants EBM only had a higher likelihood of early weaning among all mothers who were breastfeeding (adjusted hazard ratio, 95% CI; 2.20, 1.61-3.02), and among those who were fully breastfeeding (2.39, 1.05-5.41). Mothers who practiced mixed feeding, however, were not at higher risk of earlier termination of any or of full breastfeeding. Mothers who fed their infants EBM exclusively, but not those who practiced mixed feeding, were at a higher risk of terminating breastfeeding earlier than those who fed their infants directly at the breast. More education and support are required for women who feed their infants EBM only.

Linking 1D coastal ocean modelling to environmental management: an ensemble approach

NASA Astrophysics Data System (ADS)

Mussap, Giulia; Zavatarelli, Marco; Pinardi, Nadia

2017-12-01

The use of a one-dimensional interdisciplinary numerical model of the coastal ocean as a tool contributing to the formulation of ecosystem-based management (EBM) is explored. The focus is on the definition of an experimental design based on ensemble simulations, integrating variability linked to scenarios (characterised by changes in the system forcing) and to the concurrent variation of selected, and poorly constrained, model parameters. The modelling system used was previously specifically designed for the use in "data-rich" areas, so that horizontal dynamics can be resolved by a diagnostic approach and external inputs can be parameterised by nudging schemes properly calibrated. Ensembles determined by changes in the simulated environmental (physical and biogeochemical) dynamics, under joint forcing and parameterisation variations, highlight the uncertainties associated to the application of specific scenarios that are relevant to EBM, providing an assessment of the reliability of the predicted changes. The work has been carried out by implementing the coupled modelling system BFM-POM1D in an area of Gulf of Trieste (northern Adriatic Sea), considered homogeneous from the point of view of hydrological properties, and forcing it by changing climatic (warming) and anthropogenic (reduction of the land-based nutrient input) pressure. Model parameters affected by considerable uncertainties (due to the lack of relevant observations) were varied jointly with the scenarios of change. The resulting large set of ensemble simulations provided a general estimation of the model uncertainties related to the joint variation of pressures and model parameters. The information of the model result variability aimed at conveying efficiently and comprehensibly the information on the uncertainties/reliability of the model results to non-technical EBM planners and stakeholders, in order to have the model-based information effectively contributing to EBM.

What's Happening on the West Coast? The National Ocean Policy, EBM and Ocean Governance on the West Coast of the U.S.

NASA Astrophysics Data System (ADS)

Hansen, J. R.

2016-02-01

A robust update on the latest ocean governance developments in the West Coast region of the U.S. will be provided, highlighting implementation of the National Ocean Policy and ongoing dialog among federal, state and tribal entities and coastal stakeholders at a range of scales. The link between ecosystem-based management (EBM) as a guiding principle and meaningful management outcomes will discussed, guided by the latest ocean policy priorities from local, state, tribal and regional scales in the West Coast. The West Coast Regional Planning Body has been recently initiated under the framework provided by the National Ocean Policy, bringing together a formal partnership of state and tribal governments with federal agencies in a way never before achieved in the region. The newly reformed West Coast Ocean Partnership builds upon efforts of the West Coast Governors Alliance on Ocean Health to continue to address priority ocean policy topics, while other regional efforts are identifying data, science and tools to support an EBM approach. All of these will be discussed in detail, providing both up-to-date reports on the latest West Coast activities, while illustrating lessons learned from past regional efforts and exactly how EBM has been effectively integrated. The West Coast of the U.S. is a unique region in terms of geographic scale, governance structure and history of innovative ocean management approaches. Using opportunities provided by recent state, tribal, regional and national policy initiatives, the West Coast has undertaken a range of activities to better coordinate ocean management while enhancing dialogs to support it. This presentation will provide a concise summary of current efforts, demonstrating how policy is being translated into significant action and highlighting opportunities to build on successful outcomes to date.

Key species and impact of fishery through food web analysis: A case study from Baja California Sur, Mexico

NASA Astrophysics Data System (ADS)

Rocchi, Marta; Scotti, Marco; Micheli, Fiorenza; Bodini, Antonio

2017-01-01

Ecosystem-Based Management (EBM) aims to support the protection of natural ecosystems and to improve economic activities. It requires considering all of the actors interacting in social-ecological systems (e.g., fish and fishers) in the understanding that their interplay determines the dynamic behavior of the single actors as well as that of the system as a whole. Connections are thus central to EBM. Within the ecological dimension of socio-ecological systems, interactions between species define such connections. Understanding how connections affect ecosystem and species dynamics is often impaired by a lack of data. We propose food web network analysis as a tool to help bridge the gap between EBM theory and practice in data-poor contexts, and illustrate this approach through its application to a coastal marine ecosystem in Baja California Sur, Mexico. First, we calculated centrality indices to identify which key (i.e., most central) species must be considered when designing strategies for sustainable resource management. Second, we analyzed the resilience of the system by measuring changes in food web structure due to the local extinction of vulnerable species (i.e., by mimicking the possible effect of excessive fishing pressure). The consequences of species removals were quantified in terms of impacts on global structural indices and species' centrality indices. Overall, we found that this coastal ecosystem shows high resilience to species loss. We identified species (e.g., Octopus sp. and the kelp bass, Paralabrax clathratus) whose protection could further decrease the risk of potential negative impacts of fishing activities on the Baja California Sur food web. This work introduces an approach that can be applied to other ecosystems to aid the implementation of EBM in data-poor contexts.

Integrating Ecosystem-Based Management Principles of Adaptive Management and Stakeholder Engagement in California Fisheries

NASA Astrophysics Data System (ADS)

Erickson, A.; Martone, R. G.; Hazen, L.; Mease, L.; Gourlie, D.; Le Cornu, E.; Ourens, R.; Micheli, F.

2016-12-01

California's fisheries management law, the Marine Life Management Act (MLMA) of 1998, signaled a transformative shift from traditional single-species management to an ecosystem-based approach. In response, the fisheries management community in California is striving to integrate new science and management innovations while maximizing its limited capacity. However, data gaps, high compliance costs, capacity constraints, and limited access to the best available data and technologies persist. Here we present two decision support tools being developed to aid California fisheries managers as they continue to implement ecosystem-based management (EBM). First, to practice adaptive management, a key principle of EBM, managers must know whether and how their decisions are meeting their management objectives over time. Based on a cross-walk of MLMA goals with metrics and indicators from sustainable fishery certification programs, we present a flexible and practical tool for tracking fishery management performance in California. We showcase a draft series of decision trees and questionnaires managers can use to quantitatively or qualitatively measure both ecological and social outcomes, helping them to prioritize management options and limited resources. Second, state fisheries managers acknowledge the need for more effective stakeholder engagement to facilitate and inform decision-making and long-term outcomes, another key principle of EBM. Here, we present a pilot version of a decision-support tool to aid managers in choosing the most appropriate stakeholder engagement strategies in various types of decision contexts. This online tool will help staff identify their engagement goals, when they can strategically engage stakeholders based on their needs, and the fishery characteristics that will inform how engagement strategies are tailored to specific contexts. We also share opportunities to expand these EBM tools to other resource management contexts and scales.

Evaluating the impact of clinical librarians on clinical questions during inpatient rounds

PubMed Central

Brian, Riley; Orlov, Nicola; Werner, Debra; Martin, Shannon K.; Arora, Vineet M.; Alkureishi, Maria

2018-01-01

Objective The investigation sought to determine the effects of a clinical librarian (CL) on inpatient team clinical questioning quality and quantity, learner self-reported literature searching skills, and use of evidence-based medicine (EBM). Methods Clinical questioning was observed over 50 days of inpatient pediatric and internal medicine attending rounds. A CL was present for 25 days and absent for 25 days. Questioning was compared between groups. Question quality was assessed by a blinded evaluator, who used a rubric adapted from the Fresno Test of Competence in Evidence-Based Medicine. Team members were surveyed to assess perceived impacts of the CL on rounds. Results Rounds with a CL (CLR) were associated with significantly increased median number of questions asked (5 questions CLR vs. 3 NCLR; p<0.01) and answered (3 CLR vs. 2 NCLR; p<0.01) compared to rounds without a CL (NCLR). CLR were also associated with increased mean time spent asking (1.39 minutes CLR vs. 0.52 NCLR; p<0.01) and answering (2.15 minutes CLR vs. 1.05 NCLR; p=0.02) questions. Rounding time per patient was not significantly different between CLR and NCLR. Questions during CLR were 2 times higher in adapted Fresno Test quality than during NCLR (p<0.01). Select participants described how the CL’s presence improved their EBM skills and care decisions. Conclusions Inpatient CLR were associated with more and improved clinical questioning and subjectively perceived to improve clinicians’ EBM skills. CLs may directly affect patient care; further study is required to assess this. CLs on inpatient rounds may be an effective means for clinicians to learn and use EBM skills. PMID:29632440

Integrating Ecosystem-Based Management Principles of Adaptive Management and Stakeholder Engagement in California Fisheries

NASA Astrophysics Data System (ADS)

Erickson, A.; Martone, R. G.; Hazen, L.; Mease, L.; Gourlie, D.; Le Cornu, E.; Ourens, R.; Micheli, F.

2016-02-01

California's fisheries management law, the Marine Life Management Act (MLMA) of 1998, signaled a transformative shift from traditional single-species management to an ecosystem-based approach. In response, the fisheries management community in California is striving to integrate new science and management innovations while maximizing its limited capacity. However, data gaps, high compliance costs, capacity constraints, and limited access to the best available data and technologies persist. Here we present two decision support tools being developed to aid California fisheries managers as they continue to implement ecosystem-based management (EBM). First, to practice adaptive management, a key principle of EBM, managers must know whether and how their decisions are meeting their management objectives over time. Based on a cross-walk of MLMA goals with metrics and indicators from sustainable fishery certification programs, we present a flexible and practical tool for tracking fishery management performance in California. We showcase a draft series of decision trees and questionnaires managers can use to quantitatively or qualitatively measure both ecological and social outcomes, helping them to prioritize management options and limited resources. Second, state fisheries managers acknowledge the need for more effective stakeholder engagement to facilitate and inform decision-making and long-term outcomes, another key principle of EBM. Here, we present a pilot version of a decision-support tool to aid managers in choosing the most appropriate stakeholder engagement strategies in various types of decision contexts. This online tool will help staff identify their engagement goals, when they can strategically engage stakeholders based on their needs, and the fishery characteristics that will inform how engagement strategies are tailored to specific contexts. We also share opportunities to expand these EBM tools to other resource management contexts and scales.

Evidence-based medicine: is it a bridge too far?

PubMed

Fernandez, Ana; Sturmberg, Joachim; Lukersmith, Sue; Madden, Rosamond; Torkfar, Ghazal; Colagiuri, Ruth; Salvador-Carulla, Luis

2015-11-06

This paper aims to describe the contextual factors that gave rise to evidence-based medicine (EBM), as well as its controversies and limitations in the current health context. Our analysis utilizes two frameworks: (1) a complex adaptive view of health that sees both health and healthcare as non-linear phenomena emerging from their different components; and (2) the unified approach to the philosophy of science that provides a new background for understanding the differences between the phases of discovery, corroboration, and implementation in science. The need for standardization, the development of clinical epidemiology, concerns about the economic sustainability of health systems and increasing numbers of clinical trials, together with the increase in the computer's ability to handle large amounts of data, have paved the way for the development of the EBM movement. It was quickly adopted on the basis of authoritative knowledge rather than evidence of its own capacity to improve the efficiency and equity of health systems. The main problem with the EBM approach is the restricted and simplistic approach to scientific knowledge, which prioritizes internal validity as the major quality of the studies to be included in clinical guidelines. As a corollary, the preferred method for generating evidence is the explanatory randomized controlled trial. This method can be useful in the phase of discovery but is inadequate in the field of implementation, which needs to incorporate additional information including expert knowledge, patients' values and the context. EBM needs to move forward and perceive health and healthcare as a complex interaction, i.e. an interconnected, non-linear phenomenon that may be better analysed using a variety of complexity science techniques.

What's Happening on the West Coast? The National Ocean Policy, EBM and Ocean Governance on the West Coast of the U.S.

NASA Astrophysics Data System (ADS)

Hansen, J. R.

2016-12-01

A robust update on the latest ocean governance developments in the West Coast region of the U.S. will be provided, highlighting implementation of the National Ocean Policy and ongoing dialog among federal, state and tribal entities and coastal stakeholders at a range of scales. The link between ecosystem-based management (EBM) as a guiding principle and meaningful management outcomes will discussed, guided by the latest ocean policy priorities from local, state, tribal and regional scales in the West Coast. The West Coast Regional Planning Body has been recently initiated under the framework provided by the National Ocean Policy, bringing together a formal partnership of state and tribal governments with federal agencies in a way never before achieved in the region. The newly reformed West Coast Ocean Partnership builds upon efforts of the West Coast Governors Alliance on Ocean Health to continue to address priority ocean policy topics, while other regional efforts are identifying data, science and tools to support an EBM approach. All of these will be discussed in detail, providing both up-to-date reports on the latest West Coast activities, while illustrating lessons learned from past regional efforts and exactly how EBM has been effectively integrated. The West Coast of the U.S. is a unique region in terms of geographic scale, governance structure and history of innovative ocean management approaches. Using opportunities provided by recent state, tribal, regional and national policy initiatives, the West Coast has undertaken a range of activities to better coordinate ocean management while enhancing dialogs to support it. This presentation will provide a concise summary of current efforts, demonstrating how policy is being translated into significant action and highlighting opportunities to build on successful outcomes to date.

Evidence-based medicine and epistemological imperialism: narrowing the divide between evidence and illness.

PubMed

Crowther, Helen; Lipworth, Wendy; Kerridge, Ian

2011-10-01

Evidence-based medicine (EBM) has been rapidly and widely adopted because it claims to provide a method for determining the safety and efficacy of medical therapies and public health interventions more generally. However, as others have noted, EBM may be riven through with cultural bias, both in the generation of evidence and in its translation. We suggest that technological and scientific advances in medicine accentuate and entrench these cultural biases, to the extent that they may invalidate the evidence we have about disease and its treatment. This creates a significant ethical, epistemological and ontological challenge for medicine. © 2011 Blackwell Publishing Ltd.

Ecosystem-based management of coastal zones in face of climate change impacts: Challenges and inequalities.

PubMed

Fernandino, Gerson; Elliff, Carla I; Silva, Iracema R

2018-06-01

Climate change effects have the potential of affecting both ocean and atmospheric processes. These changes pose serious threats to the millions of people that live by the coast. Thus, the objective of the present review is to discuss how climate change is altering (and will continue to alter) atmospheric and oceanic processes, what are the main implications of these alterations along the coastline, and which are the ecosystem-based management (EBM) strategies that have been proposed and applied to address these issues. While ocean warming, ocean acidification and increasing sea level have been more extensively studied, investigations on the effects of climate change to wind and wave climates are less frequent. Coastal ecosystems and their respective natural resources will respond differently according to location, environmental drivers and coastal processes. EBM strategies have mostly concentrated on improving ecosystem services, which can be used to assist in mitigating climate change effects. The main challenge for developing nations regards gaps in information and scarcity of resources. Thus, for effective management and adaptive EBM strategies to be developed worldwide, information at a local level is greatly needed. Copyright © 2018 Elsevier Ltd. All rights reserved.

Effects of heat treatments on microstructure and properties of Ti-6Al-4V ELI alloy fabricated by electron beam melting (EBM)

DOE PAGES

Galarraga, Haize; Warren, Robert J.; Lados, Diana A.; ...

2017-01-06

Electron beam melting (EBM) is a metal powder bed fusion additive manufacturing (AM) technology that is used to fabricate three-dimensional near-net-shaped parts directly from computer models. Ti-6Al-4V is the most widely used and studied alloy for this technology and is the focus of this work in its ELI (Extra Low Interstitial) variation. The mechanisms of microstructure formation, evolution, and its subsequent influence on mechanical properties of the alloy in as-fabricated condition have been documented by various researchers. In the present work, the thermal history resulting in the formation of the as-fabricated microstructure was analyzed and studied by a thermal simulation.more » Subsequently different heat treatments were performed based on three approaches in order to study the effects of heat treatments on the singular and exclusive microstructure formed during the EBM fabrication process. In the first approach, the effect of cooling rate after the solutionizing process was studied. In the second approach, the variation of α lath thickness during annealing treatment and correlation with mechanical properties was established. In the last approach, several solutionizing and aging experiments were conducted.« less

Effect of hypoeutectic boron additions on the grain size and mechanical properties of Ti-6Al-4V manufactured with powder bed electron beam additive manufacturing

DOE PAGES

Mahbooba, Zaynab; West, Harvey; Harrysson, Ola; ...

2016-12-02

In additive manufacturing, microstructural control is feasible via processing parameter alteration. However, the window for parameter variation for certain materials, such as Ti-6Al-4V, is limited, and alternative methods must be employed to customize microstructures. Grain refinement and homogenization in cast titanium alloys has been demonstrated through the addition of hypoeutectic concentrations of boron. This work explores the influence of 0.00 wt.%, 0.25 wt.%, 0.50 wt.%, and 1.0 wt.% boron additions on the microstructure and bulk mechanical properties of Ti-6Al-4V samples fabricated in an Arcam A2 electron beam melting (EBM) system with commercial processing parameters for Ti-6Al-4V. Analyses of EBM fabricatedmore » Ti-6Al-4V + B indicate that the addition of 0.25–1.0 wt.% boron progressively refines the grain structure, and it improves hardness and elastic modulus. Furthermore, despite a reduction in size, the β grain structure remained columnar as a result of directional heat transfer during EBM fabrication.« less

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

PubMed

Schwartz, Alan; Millam, Gregory

2006-03-16

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. 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. A web-based EBM library consult model may provide a useful way for informationists to assist clinicians, and is feasible to implement.

Microstructure Development in Electron Beam-Melted Inconel 718 and Associated Tensile Properties

DOE PAGES

Kirka, M. M.; Unocic, K. A.; Raghavan, N.; ...

2016-02-12

During the electron beam melting (EBM) process, builds occur at temperatures in excess of 800°C for nickel-base superalloys such as Inconel 718. When coupled with the temporal differences between the start and end of a build, a top-to-bottom microstructure gradient forms. Characterized in this study is the microstructure gradient and associated tensile property gradient that are common to all EBM Inconel 718 builds. From the characteristic microstructure elements observed in EBM Inconel 718 material, the microstructure gradient can be classified into three distinct regions. Region 1 (top of a build) and is comprised of a cored dendritic structure that includesmore » carbides and Laves phase within the interdendritic regions. Region 2 is an intermediate transition zone characterized by a diffuse dendritic structure, dissolution of the Laves phase, and precipitation of δ needle networks within the interdendritic regions. The bulk structure (Region 3) is comprised of a columnar grain structure lacking dendritic characteristics with δ networks having precipitated within the grain interiors. Mechanically at both 20°C and 650° C, the yield strength, ultimate tensile strength, and elongation at failure exhibit the general trend of increasing with increasing build height.« less

Particularism in health care: challenging the authority of the aggregate.

PubMed

Tanenbaum, Sandra J

2014-12-01

In health care, particularism asserts the primacy of the individual case. Moral particularists, such as Jonsen and Toulmin, reject deduction from universal moral principles and instead seek warrants for action from the multiple sources unique to a given patient. Another kind of health care particularism, here referred to as the knowledge of particulars, is offered as a corrective to evidence-based medicine (EBM), its influence on health care practice and policy, and specifically to EBM's reliance on the aggregate. This paper describes the knowledge of particulars and identifies strategies for its legitimation in health care policy and practice. First, the paper documents the ascendancy of the aggregate through EBM's definition of 'what works' in health care. Second, it delineates the limits of health care knowledge based on the analysis of aggregates, not only for the care of individual patients but for the formulation of policies about patient care. Third, the paper analyses prominent rejections of the particular in contemporary health policy discourse and relates them to larger political purposes. Finally, it depicts the knowledge of particulars as the basis for clinical prudence and offers three potential strategies for promoting particularism as essential to high-quality care. © 2014 John Wiley & Sons, Ltd.

Effect of hypoeutectic boron additions on the grain size and mechanical properties of Ti-6Al-4V manufactured with powder bed electron beam additive manufacturing

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

Mahbooba, Zaynab; West, Harvey; Harrysson, Ola

In additive manufacturing, microstructural control is feasible via processing parameter alteration. However, the window for parameter variation for certain materials, such as Ti-6Al-4V, is limited, and alternative methods must be employed to customize microstructures. Grain refinement and homogenization in cast titanium alloys has been demonstrated through the addition of hypoeutectic concentrations of boron. This work explores the influence of 0.00 wt.%, 0.25 wt.%, 0.50 wt.%, and 1.0 wt.% boron additions on the microstructure and bulk mechanical properties of Ti-6Al-4V samples fabricated in an Arcam A2 electron beam melting (EBM) system with commercial processing parameters for Ti-6Al-4V. Analyses of EBM fabricatedmore » Ti-6Al-4V + B indicate that the addition of 0.25–1.0 wt.% boron progressively refines the grain structure, and it improves hardness and elastic modulus. Furthermore, despite a reduction in size, the β grain structure remained columnar as a result of directional heat transfer during EBM fabrication.« less

Studies in using a universal exchange and inference language for evidence based medicine. Semi-automated learning and reasoning for PICO methodology, systematic review, and environmental epidemiology.

PubMed

Robson, Barry

2016-12-01

The Q-UEL language of XML-like tags and the associated software applications are providing a valuable toolkit for Evidence Based Medicine (EBM). In this paper the already existing applications, data bases, and tags are brought together with new ones. The particular Q-UEL embodiment used here is the BioIngine. The main challenge is one of bringing together the methods of symbolic reasoning and calculative probabilistic inference that underlie EBM and medical decision making. Some space is taken to review this background. The unification is greatly facilitated by Q-UEL's roots in the notation and algebra of Dirac, and by extending Q-UEL into the Wolfram programming environment. Further, the overall problem of integration is also a relatively simple one because of the nature of Q-UEL as a language for interoperability in healthcare and biomedicine, while the notion of workflow is facilitated because of the EBM best practice known as PICO. What remains difficult is achieving a high degree of overall automation because of a well-known difficulty in capturing human expertise in computers: the Feigenbaum bottleneck. Copyright © 2016 Elsevier Ltd. All rights reserved.

[EBM, guidelines, protocols: knowledge, attitudes and utilization in the era of law on professional responsibility and safety of health care.

PubMed

Minozzi, Silvia; Ruggiero, Francesca; Capobussi, Matteo; González-Lorenzo, Marien; La Regina, Micaela; Squizzato, Alessandro; Moja, Lorenzo; Orlandini, Francesco

2018-05-01

The knowledge of principles and methods of Evidence Based Medicine (EBM) and the use of Clinical Practice Guidelines to inform clinical decisions are recognised as key instruments to improve the quality of care. In Italy the Parliament has revised the legal system that rules the responsibilities of health professionals and health care safety, prescribing health professionals to adhere to guidelines and good practice recommendations. The objective of the study was to evaluate guidelines and clinical pathways developed at local level and to assess knowledge and attitudes of healthcare workers toward EBM and guidelines. At the l'ASL 5 Liguria La Spezia we performed a census of all the documents registered as "guidelines" or "clinical pathways" at the Direzione Generale by the end of May 2016. We assessed their methodological quality by the "Recognition Card for Clinical Pathways Production and Revision Activity" prepared by the Ligurian Region. We conducted semi-structured interviews to assess attitudes and knowledge of healthcare workers. We found 17 clinical pathways, 41% contained organizational/management recommendations, and 59% contained mainly clinical recommendations. 41% was produced by assimilating already existing guidelines. 29% did not describe the method of production. Only one document linked directly each recommendation with scientific evidence. 10 healthcare workers out of 32 invited actually accepted to conduct the interview. Respondents showed a positive attitude toward the EBM and guidelines but a poor knowledge of the methodology of production and the instruments and principles for critical appraising of scientific literature. Nobody knew the GRADE approach. The most relevant barriers identified were: lack of time, poor knowledge of English and statistical methods, poor applicability of the international guidelines to local setting and real patients encountered in clinical practice. Despite the initiatives of the legislator toward civil responsibility and safety of care that should increase the use of guidelines, we found an overall poor knowledge of the concepts of EBM and method of guidelines production. Though the attitudes of responders to the interview were positive, barriers to use seemed to be predominant and considered more as obstacles than as a stimulus. In peripheral settings or in hospitals of medium/small size, clinical guidelines could remain confined to a merely juridical role, with weak impact on professional practice.

Neuropsychiatric Clinical Trials: Should They Accommodate Real-World Practices or Set Standards for Clinical Practices?

PubMed Central

Becker, Robert E.; Greig, Nigel H.

2012-01-01

The fundamental tenet of Evidence-Based Medicine (EBM) is to “integrate the best research evidence with clinical expertise and patient values,”1(p1) a commitment accepted in neuropsychiatry.2,3 The EBM group recognizes various factors that undermine the quality and use of evidence generated in research, “three limitations…to science and medicine-shortage of coherent evidence, difficulties applying evidence in care, and barriers to quality practice-and further impediments to EBM practice-practitioners lacking skills evaluating evidence sources, having limited time, and being unaware of support for EBM working, thus failing to follow its practices.”1(p7) Other risks to validity are less widely acknowledged. Clinical trials (CTs), especially randomized controlled trials (RCTs), and summary reviews of results from more than 1 RCT provide EBM’s gold standard sources for sound evidence.1(pp105-144) Sackett et al 1 and other authors suggest subjecting RCTs and reviews of RCTs to specific tests of validity before the practitioner uses the evidence. We recently compiled additional threats to validity of the neuropsychiatric evidence base,4,5 a list already incomplete in view of recent concerns with industry influence evidenced by ghost authorships 6 and selective reporting.7,8 Each of the factors we compiled potentially affects the reliability and therefore the validity of the RCT evidence base, is not addressed systematically in EBM guidance on how to develop and use the research literature, and potentially impacts neuropsychiatric research by allowing drugs to fail because of the factor functioning as a methodological weakness in clinical studies.5 In this article, we (1) cull from the literature factors that methodologically put clinical research and the evidence base at risk, (2) uncover assumptions that may account for these factors going unnoticed as risks to medicine’s evidence base, and (3) suggest steps to increase the effectiveness of neuropsychiatric drug developments, CTs, and validity and use of the evidence base for practitioners. Specifically, we provide evidence that problems of unreliability caused by human errors and biases currently undermine the validity of psychiatric research. We suggest revisions of some assumptions behind research methods and practices as part of an effort to protect research from these errors and biases.4 PMID:19142109

[Evaluation of an internet site on evidence-based medicine].

PubMed

Mathys, J; Steurer, J

2000-10-19

The present study evaluated a Swiss internet provider of Evidence-based Medicine (EBM) with regard to its utilization and function for medical practitioners. The internet provider under study (www.evimed.ch) primarily provides abstracts of original articles relevant to medical practice that are presented according to the criteria of EBM and includes information about EBM itself. In March 1999 a survey was conducted to better appraise the benefits gained from the information provided from the website visitors' point of view. Around 400 persons who had entered their names in the homepage guest book were informed about the survey by e-mail. A total of 167 questionnaires were filled in online, which is equivalent to the reply rate of close to 42%. The majority of the replies (63.5%) were from private-practice physicians, 22.2% from hospital-based physicians. The average age ranged between 40 and 49 years. 67.7% of the 167 respondents had internet access at their workplace, 72.5% had private internet access. For their own practical work, 61.1% of the respondents rated the information provided by www.evimed.ch as generally useful. The clinical relevance of the studies presented in the Journal Club was rated as good by 55.7% and as very good by 26.9%. The reliability of the information provided was rated as good by 56.3% and as very good by 35.3%. The majority regarded the following homepage sites as personally important: Journal Club (55.7%), articles about EBM (46.1%), MEDLINE access (37.7%) and article citations/links (41.3%). The homepage was visited at an average frequency of 1-3 times a month. 50.3% preferred electronic media (40.1% using various internet providers, 10.2% www.evimed.ch) and 44.3% preferred print media to search for specialist information on a specific medical subject. With regard to new medical findings, 44.9% of the respondents stated that they used print media, 17.4% the www.evimed.ch homepage and 28.7% other internet sources as their primary information medium. Based on this survey, the majority of the respondents gave a positive rating of the www.evimed.ch homepage. Information about EBM and critically appraised studies were evaluated as particularly useful.

Individual A-Scan Signal Normalization Between Two Spectral Domain Optical Coherence Tomography Devices

PubMed Central

Chen, Chieh-Li; Ishikawa, Hiroshi; Wollstein, Gadi; Ling, Yun; Bilonick, Richard A.; Kagemann, Larry; Sigal, Ian A.; Schuman, Joel S.

2013-01-01

Purpose. We developed a method to normalize optical coherence tomography (OCT) signal profiles from two spectral-domain (SD) OCT devices so that the comparability between devices increases. Methods. We scanned 21 eyes from 14 healthy and 7 glaucoma subjects with two SD-OCT devices on the same day, with equivalent cube scan patterns centered on the fovea (Cirrus HD-OCT and RTVue). Foveola positions were selected manually and used as the center for registration of the corresponding images. A-scan signals were sampled 1.8 mm from the foveola in the temporal, superior, nasal, and inferior quadrants. After oversampling and rescaling RTVue data along the Z-axis to match the corresponding Cirrus data format, speckle noise reduction and amplitude normalization were applied. For comparison between normalized A-scan profiles, mean absolute difference in amplitude in percentage was measured at each sampling point. As a reference, the mean absolute difference between two Cirrus scans on the same eye also was measured. Results. The mean residual of the A-scan profile amplitude was reduced significantly after signal normalization (12.7% vs. 6.2%, P < 0.0001, paired t-test). All four quadrants also showed statistically significant reduction (all P < 0.0001). Mean absolute difference after normalization was smaller than the one between two Cirrus scans. No performance difference was detected between health and glaucomatous eyes. Conclusions. The reported signal normalization method successfully reduced the A-scan profile differences between two SD-OCT devices. This signal normalization processing may improve the direct comparability of OCT image analysis and measurement on various devices. PMID:23611992

Feasibility and Limitations of Vaccine Two-Dimensional Barcoding Using Mobile Devices.

PubMed

Bell, Cameron; Guerinet, Julien; Atkinson, Katherine M; Wilson, Kumanan

2016-06-23

Two-dimensional (2D) barcoding has the potential to enhance documentation of vaccine encounters at the point of care. However, this is currently limited to environments equipped with dedicated barcode scanners and compatible record systems. Mobile devices may present a cost-effective alternative to leverage 2D vaccine vial barcodes and improve vaccine product-specific information residing in digital health records. Mobile devices have the potential to capture product-specific information from 2D vaccine vial barcodes. We sought to examine the feasibility, performance, and potential limitations of scanning 2D barcodes on vaccine vials using 4 different mobile phones. A unique barcode scanning app was developed for Android and iOS operating systems. The impact of 4 variables on the scan success rate, data accuracy, and time to scan were examined: barcode size, curvature, fading, and ambient lighting conditions. Two experimenters performed 4 trials 10 times each, amounting to a total of 2160 barcode scan attempts. Of the 1832 successful scans performed in this evaluation, zero produced incorrect data. Five-millimeter barcodes were the slowest to scan, although only by 0.5 seconds on average. Barcodes with up to 50% fading had a 100% success rate, but success rate deteriorated beyond 60% fading. Curved barcodes took longer to scan compared with flat, but success rate deterioration was only observed at a vial diameter of 10 mm. Light conditions did not affect success rate or scan time between 500 lux and 20 lux. Conditions below 20 lux impeded the device's ability to scan successfully. Variability in scan time was observed across devices in all trials performed. 2D vaccine barcoding is possible using mobile devices and is successful under the majority of conditions examined. Manufacturers utilizing 2D barcodes should take into consideration the impact of factors that limit scan success rates. Future studies should evaluate the effect of mobile barcoding on workflow and vaccine administrator acceptance.

Criteria for evidence-based practice in Iranian traditional medicine.

PubMed

Soltani Arabshahi, SeyyedKamran; Mohammadi Kenari, Hoorieh; Kordafshari, Gholamreza; Shams-Ardakani, MohammadReza; Bigdeli, Shoaleh

2015-07-01

The major difference between Iranian traditional medicine and allopathic medicine is in the application  of  evidence  and  documents.  In  this  study,  criteria  for  evidence-based  practice  in  Iranian traditional medicine and its rules of practice were studied. The experts' views were investigated through in- depth, semi-structured interviews and the results were categorized into four main categories including Designing clinical questions/clinical question-based search, critical appraisal, resource search criteria and clinical prescription appraisal. Although the application of evidence in Iranian traditional medicine follows Evidence Based Medicine (EBM) principles but it benefits from its own rules, regulations, and criteria that are compatible with EBM.

Optical Coherence Tomography (OCT) Device Independent Intraretinal Layer Segmentation

PubMed Central

Ehnes, Alexander; Wenner, Yaroslava; Friedburg, Christoph; Preising, Markus N.; Bowl, Wadim; Sekundo, Walter; zu Bexten, Erdmuthe Meyer; Stieger, Knut; Lorenz, Birgit

2014-01-01

Purpose To develop and test an algorithm to segment intraretinal layers irrespectively of the actual Optical Coherence Tomography (OCT) device used. Methods The developed algorithm is based on the graph theory optimization. The algorithm's performance was evaluated against that of three expert graders for unsigned boundary position difference and thickness measurement of a retinal layer group in 50 and 41 B-scans, respectively. Reproducibility of the algorithm was tested in 30 C-scans of 10 healthy subjects each with the Spectralis and the Stratus OCT. Comparability between different devices was evaluated in 84 C-scans (volume or radial scans) obtained from 21 healthy subjects, two scans per subject with the Spectralis OCT, and one scan per subject each with the Stratus OCT and the RTVue-100 OCT. Each C-scan was segmented and the mean thickness for each retinal layer in sections of the early treatment of diabetic retinopathy study (ETDRS) grid was measured. Results The algorithm was able to segment up to 11 intraretinal layers. Measurements with the algorithm were within the 95% confidence interval of a single grader and the difference was smaller than the interindividual difference between the expert graders themselves. The cross-device examination of ETDRS-grid related layer thicknesses highly agreed between the three OCT devices. The algorithm correctly segmented a C-scan of a patient with X-linked retinitis pigmentosa. Conclusions The segmentation software provides device-independent, reliable, and reproducible analysis of intraretinal layers, similar to what is obtained from expert graders. Translational Relevance Potential application of the software includes routine clinical practice and multicenter clinical trials. PMID:24820053

Effects of the microstructure and porosity on properties of Ti-6Al-4V ELI alloy fabricated by electron beam melting (EBM)

DOE PAGES

Galarraga, Haize; Lados, Diana A.; Dehoff, Ryan R.; ...

2016-01-01

Electron Beam Melting (EBM) is a metal powder bed-based Additive Manufacturing (AM) technology that makes possible the fabrication of three dimensional near-net-shaped parts directly from computer models. EBM technology has been in continuously updating, obtaining optimized properties of the processed alloys. Ti-6Al-4V titanium alloy is the most widely used and studied alloy for this technology and is the focus of this work. Several research works have been completed to study the mechanisms of microstructure formation as well as its influence on mechanical properties. However, the relationship is not completely understood, and more systematic research work is necessary in order tomore » attain a better understanding of these features. In this work, samples fabricated at different locations, orientations, and distances from the build platform have been characterized, studying the relationship of these variables with the resulting material intrinsic characteristics and properties (surface topography, microstructure, porosity, micro-hardness and static mechanical properties). This study has revealed that porosity is the main factor controlling mechanical properties relative to the other studied variables. Therefore, in future process developments, decreasing of the porosity should be considered as the primary goal in order to improve mechanical properties.« less

[Evidence based medicine (EBM) in health care system and treatment of individual patient. Part iii. Teaching of epidemiological methodology and statistics].

PubMed

Borkowski, Włodzimierz

2009-01-01

The question arises--what role the doctor will meet in the web society. Is it going to be a creative person in the assessment of knowledge and application at the bedside of the patient, disciplined executor of he clinical guidelines, or a loyal client of pharmaceutical companies. Medical theories are usually at the high degree of complexity, so the evaluation of the validity of the research questions, the adequacy ot models, appraisal of clinical trials, and the use of statistical analysis requires new teaching. Teaching epidemiology and statistics for EBM is designed to prepare doctors for applyinig scientific advances in clinical practice, skills in appraisal and use of the publicated results. Effects of teaching on courses organised by CMKP shows that the barrier in learning of statistical concepts are caused by defective curricula and their faulty implementation, and not by narrow perception of physicians. According to the author, such teaching should also be applied during graduated medical studies, as optional. After co-ordination with the physiology, genetics, biochemistry, informatics EBM oriented teaching would be particularly attractive for students who have a view on the work of research and research careers. Bearing in mind the time needed for implementation, it is urgent need to start this work as soon as possible.

Randomised trials in context: practical problems and social aspects of evidence-based medicine and policy.

PubMed

Pearce, Warren; Raman, Sujatha; Turner, Andrew

2015-09-01

Randomised trials can provide excellent evidence of treatment benefit in medicine. Over the last 50 years, they have been cemented in the regulatory requirements for the approval of new treatments. Randomised trials make up a large and seemingly high-quality proportion of the medical evidence-base. However, it has also been acknowledged that a distorted evidence-base places a severe limitation on the practice of evidence-based medicine (EBM). We describe four important ways in which the evidence from randomised trials is limited or partial: the problem of applying results, the problem of bias in the conduct of randomised trials, the problem of conducting the wrong trials and the problem of conducting the right trials the wrong way. These problems are not intrinsic to the method of randomised trials or the EBM philosophy of evidence; nevertheless, they are genuine problems that undermine the evidence that randomised trials provide for decision-making and therefore undermine EBM in practice. Finally, we discuss the social dimensions of these problems and how they highlight the indispensable role of judgement when generating and using evidence for medicine. This is the paradox of randomised trial evidence: the trials open up expert judgment to scrutiny, but this scrutiny in turn requires further expertise.

Computer-based teaching is as good as face to face lecture-based teaching of evidence based medicine: a randomised controlled trial

PubMed Central

2007-01-01

Background At postgraduate level evidence based medicine (EBM) is currently taught through tutor based lectures. Computer based sessions fit around doctors' workloads, and standardise the quality of educational provision. There have been no randomized controlled trials comparing computer based sessions with traditional lectures at postgraduate level within medicine. Methods This was a randomised controlled trial involving six postgraduate education centres in the West Midlands, U.K. Fifty five newly qualified foundation year one doctors (U.S internship equivalent) were randomised to either computer based sessions or an equivalent lecture in EBM and systematic reviews. The change from pre to post-intervention score was measured using a validated questionnaire assessing knowledge (primary outcome) and attitudes (secondary outcome). Results Both groups were similar at baseline. Participants' improvement in knowledge in the computer based group was equivalent to the lecture based group (gain in score: 2.1 [S.D = 2.0] versus 1.9 [S.D = 2.4]; ANCOVA p = 0.078). Attitudinal gains were similar in both groups. Conclusion On the basis of our findings we feel computer based teaching and learning is as effective as typical lecture based teaching sessions for educating postgraduates in EBM and systematic reviews. PMID:17659076

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

Using the Biology Card Sorting Task to Measure Changes in Conceptual Expertise during Postsecondary Biology Education

PubMed Central

Bissonnette, Sarah A.; Combs, Elijah D.; Nagami, Paul H.; Byers, Victor; Fernandez, Juliana; Le, Dinh; Realin, Jared; Woodham, Selina; Smith, Julia I.; Tanner, Kimberly D.

2017-01-01

While there have been concerted efforts to reform undergraduate biology toward teaching students to organize their conceptual knowledge like experts, there are few tools that attempt to measure this. We previously developed the Biology Card Sorting Task (BCST), designed to probe how individuals organize their conceptual biological knowledge. Previous results showed the BCST could differentiate between different populations, namely non–biology majors (NBM) and biology faculty (BF). In this study, we administered the BCST to three additional populations, using a cross-sectional design: entering biology majors (EBM), advanced biology majors (ABM), and biology graduate students (BGS). Intriguingly, ABM did not initially sort like experts any more frequently than EBM. However, once the deep-feature framework was revealed, ABM were able to sort like experts more readily than did EBM. These results are consistent with the conclusion that biology education enables advanced biology students to use an expert-like conceptual framework. However, these results are also consistent with a process of “selection,” wherein students who persist in the major may have already had an expert-like conceptual framework to begin with. These results demonstrate the utility of the BCST in measuring differences between groups of students over the course of their undergraduate education. PMID:28213584

[Study on the geometric characteristics and distribution of porosities in three-dimensional printed Ti-6Al-4V titanium alloy].

PubMed

Wan, Zhipeng; Jiang, Wentao; Wang, Chong; Wang, Qingyuan; Li, Yalan

2017-10-01

Three dimensional (3D) printing is considered as an advanced manufacturing technology because of its additive nature. Electron beam melting (EBM) is a widely used 3D printing processes for the manufacturing of metal components. However, the products printed via this process generally contain micro porosities which affect mechanical properties, especially the fatigue property. In this paper, two types of EBM printed samples of the Ti-6Al-4V alloy, one with a round cross section and the other with a triangle cross section, were employed to investigate the existence of porosities using computed tomography (CT). Statistical analyses were conducted on the number, volume, shape, and distribution of pores. The results show that small pores (less than 0.000 2 mm 3 ) account for 80% of all pores in each type of samples. Additionally, to some extent, the shape of sample has influence on the number of micro porosities in EBM made Ti-6Al-4V. The sphericity of the pores is relatively low and is inversely proportional to pore volume. It is found that re-melting on the free surface effectively reduce pore density near the surface. This study may help produce a medical implant with better fatigue resistance.

Selecting Indicator Portfolios for Marine Species and Food Webs: A Puget Sound Case Study

PubMed Central

Kershner, Jessi; Samhouri, Jameal F.; James, C. Andrew; Levin, Phillip S.

2011-01-01

Ecosystem-based management (EBM) has emerged as a promising approach for maintaining the benefits humans want and need from the ocean, yet concrete approaches for implementing EBM remain scarce. A key challenge lies in the development of indicators that can provide useful information on ecosystem status and trends, and assess progress towards management goals. In this paper, we describe a generalized framework for the methodical and transparent selection of ecosystem indicators. We apply the framework to the second largest estuary in the United States – Puget Sound, Washington – where one of the most advanced EBM processes is currently underway. Rather than introduce a new method, this paper integrates a variety of familiar approaches into one step-by-step approach that will lead to more consistent and reliable reporting on ecosystem condition. Importantly, we demonstrate how a framework linking indicators to policy goals, as well as a clearly defined indicator evaluation and scoring process, can result in a portfolio of useful and complementary indicators based on the needs of different users (e.g., policy makers and scientists). Although the set of indicators described in this paper is specific to marine species and food webs, we provide a general approach that could be applied to any set of management objectives or ecological system. PMID:21991305

Evidence-based clinical practice, [corrected] evidence-based medicine and the Cochrane collaboration.

PubMed

Gambrill, E

1999-03-01

Encouraging professionals in training and later to consider practice-related research findings when making important clinical decisions is an on-going concern. Evidenced-Based Medicine (EBM) and the Cochrane Collaboration (CC) provide a source of tools and ideas for doing so, as well as a roster of colleagues who share this interest. Evidenced-based medicine involves integrating clinical expertise with the best available external evidence from systematic research as well as considering the values and expectations of patients/clients. Advantage can be taken of educational formats developed in EBM, such as problem-based learning and critical-appraisal workshops in which participants learn how to ask key answerable questions related to important clinical practice questions (e.g., regarding effectiveness, accuracy of assessment measures, prediction, prevention, and quality of clinical practice guidelines) and to access and critically appraise related research. The Cochrane Collaboration is a world-wide network of centers that prepare, maintain, and disseminate high-quality systematic reviews on the efficacy of healthcare. These databases allow access to evidence related to clinical practice decisions. Forging reciprocal working relationships with those involved in EBM reciprocal and the CC should contribute to the pursuit of shared goals such as basing clinical decisions on the best-available evidence and involving clients as informed consumers.

Infection control professionals' information-seeking preferences.

PubMed

Mortensen, Heidi J; Alexander, Jeffrey L; Nehrenz, Guy M; Porter, Cynthia

2013-03-01

The aims of this study were to: 1) establish whether infection control professionals (ICPs) who had access to and utilised medical librarian services for evidence-based medicine (EBM) research perceived this assistance to be useful and 2) to establish whether ICPs who used electronic or hard copy resources for EBM research perceived that those resources had a significant impact on their work. Convenience sampling was used to collect quantitative data via a questionnaire. Study participants were members of South-west and Western chapters of the Association for Professionals in Infection Control and Epidemiology. There were 264 questionnaires distributed in this study; 179 participants completed the questionnaire. The response rate for eligible respondents was 59.5% (157). Results indicated 56.7% (51) of the ICPs with librarian access reported requesting assistance from their work facility librarian. In reference to locating infection control information, 77.9% (95), 87.3% (124) and 93.3% (138) of ICPs found textbooks, journals and the Internet 'very useful' or 'useful', respectively. Study results indicated ICPs who used the assistance of medical librarians and/or hard copy or electronic resources for EBM research perceived such sources to be valuable for obtaining infection control information. © 2012 The authors. Health Information and Libraries Journal © 2012 Health Libraries Group.

[Approach to Evidence-based Medicine Exercises Using Flipped Teaching: Introductory Education for Clinical Practice for 4th-Year Pharmacy Students].

PubMed

Onda, Mitsuko; Takagaki, Nobumasa

2018-01-01

　Osaka University of Pharmaceutical Sciences has included an evidence-based medicine (EBM) exercise in the introductory education for clinical practice for 4th-year pharmacy students since 2015. The purpose of this exercise is to learn the process of practice and basic concepts of EBM, especially to cultivate the practical ability to solve patients' problems and answer their questions. Additionally, in 2016, we have attempted flipped teaching. The students are instructed to review the basic knowledge necessary for active learning in this exercise by watching video teaching materials and to bring reports summarizing the contents on the flipped teaching days. The program includes short lectures [overview of EBM, document retrieval, randomized controlled trials (RCTs), and systematic review], exercises [patient, intervention, comparison, outcome (PICO) structuring, critical appraisal of papers in small groups with tutors], and presentations. The program includes: step 1, PICO structuring based on scenarios; step 2, critical appraisal of English-language papers on RCTs using evaluation worksheets; and step 3, reviewing the results of the PICO exercise with patients. The results of the review are shared among groups through general discussion. In this symposium, I discuss students' attitudes, the effectiveness of small group discussions using flipped teaching, and future challenges to be addressed in this program.

Dynamic focus-tracking MEMS scanning micromirror with low actuation voltages for endoscopic imaging.

PubMed

Strathman, Matthew; Liu, Yunbo; Li, Xingde; Lin, Lih Y

2013-10-07

We demonstrate a 3-D scanning micromirror device that combines 2-D beam scanning with focus control in the same device using micro-electro-mechanical-systems (MEMS) technology. 2-D beam scanning is achieved with a biaxial gimbal structure and focus control is obtained with a deformable mirror membrane surface. The micromirror with 800 micrometer diameter is designed to be sufficiently compact and efficient so that it can be incorporated into an endoscopic imaging probe in the future. The design, fabrication and characterization of the device are described in this paper. Using the focus-tracking MEMS scanning mirror, we achieved an optical scanning range of >16 degrees with <40 V actuation voltage at resonance and a tunable focal length between infinity and 25 mm with <100V applied bias.

Evaluation of Biological Properties of Electron Beam Melted Ti6Al4V Implant with Biomimetic Coating In Vitro and In Vivo

PubMed Central

Wang, Cheng-Tao; Li, Guo-Chen; Lei, Wei; Zhang, Zhi-Yong; Wang, Lin

2012-01-01

Background High strength porous titanium implants are widely used for the reconstruction of craniofacial defects because of their similar mechanical properties to those of bone. The recent introduction of electron beam melting (EBM) technique allows a direct digitally enabled fabrication of patient specific porous titanium implants, whereas both their in vitro and in vivo biological performance need further investigation. Methods In the present study, we fabricated porous Ti6Al4V implants with controlled porous structure by EBM process, analyzed their mechanical properties, and conducted the surface modification with biomimetic approach. The bioactivities of EBM porous titanium in vitro and in vivo were evaluated between implants with and without biomimetic apatite coating. Results The physical property of the porous implants, containing the compressive strength being 163 - 286 MPa and the Young’s modulus being 14.5–38.5 GPa, is similar to cortical bone. The in vitro culture of osteoblasts on the porous Ti6Al4V implants has shown a favorable circumstance for cell attachment and proliferation as well as cell morphology and spreading, which were comparable with the implants coating with bone-like apatite. In vivo, histological analysis has obtained a rapid ingrowth of bone tissue from calvarial margins toward the center of bone defect in 12 weeks. We observed similar increasing rate of bone ingrowth and percentage of bone formation within coated and uncoated implants, all of which achieved a successful bridging of the defect in 12 weeks after the implantation. Conclusions This study demonstrated that the EBM porous Ti6Al4V implant not only reduced the stress-shielding but also exerted appropriate osteoconductive properties, as well as the apatite coated group. The results opened up the possibility of using purely porous titanium alloy scaffolds to reconstruct specific bone defects in the maxillofacial and orthopedic fields. PMID:23272208

The identification of clinically important elements within medical journal abstracts: Patient-Population-Problem, Exposure-Intervention, Comparison, Outcome, Duration and Results (PECODR).

PubMed

Dawes, Martin; Pluye, Pierre; Shea, Laura; Grad, Roland; Greenberg, Arlene; Nie, Jian-Yun

2007-01-01

Information retrieval in primary care is becoming more difficult as the volume of medical information held in electronic databases expands. The lexical structure of this information might permit automatic indexing and improved retrieval. To determine the possibility of identifying the key elements of clinical studies, namely Patient-Population-Problem, Exposure-Intervention, Comparison, Outcome, Duration and Results (PECODR), from abstracts of medical journals. We used a convenience sample of 20 synopses from the journal Evidence-Based Medicine (EBM) and their matching original journal article abstracts obtained from PubMed. Three independent primary care professionals identified PECODR-related extracts of text. Rules were developed to define each PECODR element and the selection process of characters, words, phrases and sentences. From the extracts of text related to PECODR elements, potential lexical patterns that might help identify those elements were proposed and assessed using NVivo software. A total of 835 PECODR-related text extracts containing 41,263 individual text characters were identified from 20 EBM journal synopses. There were 759 extracts in the corresponding PubMed abstracts containing 31,947 characters. PECODR elements were found in nearly all abstracts and synopses with the exception of duration. There was agreement on 86.6% of the extracts from the 20 EBM synopses and 85.0% on the corresponding PubMed abstracts. After consensus this rose to 98.4% and 96.9% respectively. We found potential text patterns in the Comparison, Outcome and Results elements of both EBM synopses and PubMed abstracts. Some phrases and words are used frequently and are specific for these elements in both synopses and abstracts. Results suggest a PECODR-related structure exists in medical abstracts and that there might be lexical patterns specific to these elements. More sophisticated computer-assisted lexical-semantic analysis might refine these results, and pave the way to automating PECODR indexing, and improve information retrieval in primary care.

EBMPracticeNet: A Bilingual National Electronic Point-Of-Care Project for Retrieval of Evidence-Based Clinical Guideline Information and Decision Support

PubMed Central

2013-01-01

Background In Belgium, the construction of a national electronic point-of-care information service, EBMPracticeNet, was initiated in 2011 to optimize quality of care by promoting evidence-based decision-making. The collaboration of the government, health care providers, evidence-based medicine (EBM) partners, and vendors of electronic health records (EHR) is unique to this project. All Belgian health care professionals get free access to an up-to-date database of validated Belgian and nearly 1000 international guidelines, incorporated in a portal that also provides EBM information from other sources than guidelines, including computerized clinical decision support that is integrated in the EHRs. Objective The objective of this paper was to describe the development strategy, the overall content, and the management of EBMPracticeNet which may be of relevance to other health organizations creating national or regional electronic point-of-care information services. Methods Several candidate providers of comprehensive guideline solutions were evaluated and one database was selected. Translation of the guidelines to Dutch and French was done with translation software, post-editing by translators and medical proofreading. A strategy is determined to adapt the guideline content to the Belgian context. Acceptance of the computerized clinical decision support tool has been tested and a randomized controlled trial is planned to evaluate the effect on process and patient outcomes. Results Currently, EBMPracticeNet is in "work in progress" state. Reference is made to the results of a pilot study and to further planned research including a randomized controlled trial. Conclusions The collaboration of government, health care providers, EBM partners, and vendors of EHRs is unique. The potential value of the project is great. The link between all the EHRs from different vendors and a national database held on a single platform that is controlled by all EBM organizations in Belgium are the strengths of EBMPracticeNet. PMID:23842038

Performance of a three-dimensional-printed microscanner in a laser scanning microscopy application

NASA Astrophysics Data System (ADS)

Oyman, Hilmi Artun; Gokdel, Yigit Daghan; Ferhanoglu, Onur; Yalcinkaya, Arda Deniz

2018-04-01

A magnetically actuated microscanner is used in a laser scanning microscopy application. Stress distribution along the circular-profiled flexure is compared with a rectangular counterpart in finite-element environment. Magnetic actuation mechanism of the scanning unit is explained in detail. Moreover, reliability of the scanner is tested for 3×106 cycle. The scanning device is designed to meet a confocal microscopy application providing 100 μm×100 μm field of view and <3-μm lateral resolution. The resonance frequencies of the device were analytically modeled, where we obtained 130- and 268-Hz resonance values for the out-of-plane and torsion modes, respectively. The scanning device provided an optical scan angle about 2.5 deg for 170-mA drive current, enabling the desired field of view for our custom built confocal microscope setup. Finally, imaging experiments were conducted on a resolution target, showcasing the desired scan area and resolution.

Optical scanning holography based on compressive sensing using a digital micro-mirror device

NASA Astrophysics Data System (ADS)

A-qian, Sun; Ding-fu, Zhou; Sheng, Yuan; You-jun, Hu; Peng, Zhang; Jian-ming, Yue; xin, Zhou

2017-02-01

Optical scanning holography (OSH) is a distinct digital holography technique, which uses a single two-dimensional (2D) scanning process to record the hologram of a three-dimensional (3D) object. Usually, these 2D scanning processes are in the form of mechanical scanning, and the quality of recorded hologram may be affected due to the limitation of mechanical scanning accuracy and unavoidable vibration of stepper motor's start-stop. In this paper, we propose a new framework, which replaces the 2D mechanical scanning mirrors with a Digital Micro-mirror Device (DMD) to modulate the scanning light field, and we call it OSH based on Compressive Sensing (CS) using a digital micro-mirror device (CS-OSH). CS-OSH can reconstruct the hologram of an object through the use of compressive sensing theory, and then restore the image of object itself. Numerical simulation results confirm this new type OSH can get a reconstructed image with favorable visual quality even under the condition of a low sample rate.

Why evidence-based medicine is a good approach in physical and rehabilitation medicine. Thesis.

PubMed

Negrini, S

2014-10-01

According to a good definition, evidence-based medicine (EBM) is: "The explicit, conscientious, and judicious use of the current best evidence in making decisions about the care of individual patients (and populations)". More appropriate in a clinical context like that of physical and rehabilitation medicine (PRM) is looking at evidence based clinical practice (EBCP), whose definition is: "The integration of best research evidence with clinical expertise and patient values". In the past the term evidence-based physical and rehabilitation medicine (EBPRM) was also proposed. In this thesis, after some historical notes on EBM and on PRM, we will discuss why in our view EBPRM must be the real foundation of our everyday PRM clinical practice.

Examining the cognitive effects of a special extract of Bacopa monniera (CDRI08: Keenmnd): a review of ten years of research at Swinburne University.

PubMed

Stough, Con; Scholey, Andrew; Cropley, Vanessa; Wesnes, Keith; Zangara, Andrea; Pase, Matthew; Savage, Karen; Nolidin, Karen; Lomas, Justine; Downey, Luke

2013-01-01

Bacopa monniera (EBm), an Indian aquatic herb, has been used in traditional Ayurvedic medicine for centuries for indications related to memory and inflammation. More recently specific extracts of EBm have emerged that have been subjected to rigorous in vitro, animal and now human clinical trials. In this paper we discuss some of these studies with special reference to mechanisms and efficacy of a special extract of Bacopa (CDRI08). Studies using this extract indicate that CDRI08 has several modes of action on the human brain. Promising indications for use in humans include improving cognition in the elderly and in patients with neurodegenerative disorders.

Medicine Based Evidence and Personalized Care of Patients.

PubMed

Horwitz, Ralph I; Charlson, Mary E; Singer, Burton H

2018-04-27

For the past 70 years, evidence generation for patient management in clinical medicine has been dominated by Evidence Based Medicine (EBM) with its emphasis on Randomized Controlled Trials (RCTs). EBM can tell us about the benefits of treatment in the average patient but not for the patient at hand; for how to initiate treatment but not how to adjust or modify therapy after treatment has started; for treatment efficacy when compared to placebo but less often when compared to other effective treatments; when outcomes are chosen as hard endpoints, but not when the predominant concerns of patients are physical limitations or social functioning or psychological distress. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Dynamic focus-tracking MEMS scanning micromirror with low actuation voltages for endoscopic imaging

PubMed Central

Strathman, Matthew; Liu, Yunbo; Li, Xingde; Lin, Lih Y.

2013-01-01

We demonstrate a 3-D scanning micromirror device that combines 2-D beam scanning with focus control in the same device using micro-electro-mechanical-systems (MEMS) technology. 2-D beam scanning is achieved with a biaxial gimbal structure and focus control is obtained with a deformable mirror membrane surface. The micromirror with 800 micrometer diameter is designed to be sufficiently compact and efficient so that it can be incorporated into an endoscopic imaging probe in the future. The design, fabrication and characterization of the device are described in this paper. Using the focus-tracking MEMS scanning mirror, we achieved an optical scanning range of >16 degrees with <40 V actuation voltage at resonance and a tunable focal length between infinity and 25 mm with <100V applied bias. PMID:24104304

Integrating evidence based medicine into undergraduate medical education: combining online instruction with clinical clerkships.

PubMed

Aronoff, Stephen C; Evans, Barry; Fleece, David; Lyons, Paul; Kaplan, Lawrence; Rojas, Roberto

2010-07-01

Incorporation of evidence based medicine into the undergraduate curriculum varies from school to school. The purpose of this study was to determine if an online course in evidence based medicine run concurrently with the clinical clerkships in the 3rd year of undergraduate medical education provided effective instruction in evidence based medicine (EBM). During the first 18 weeks of the 3rd year, students completed 6 online, didactic modules. Over the next 24 weeks, students developed questions independently from patients seen during clerkships and then retrieved and appraised relevant evidence. Online, faculty mentors reviewed student assignments submitted throughout the course to monitor progress. Mastery of the skills of EBM was assessed prior to and at the conclusion of the course using the Fresno test of competency. Paired data were available from 139 students. Postcourse test scores (M= 77.7; 95% CI = 59-96.4) were significantly higher than precourse scores (M= 66.6; 95% CI = 46.5-86.7), p< .001. Paired evaluations demonstrated an average improvement of 11.1 +/- 20.0 points. All of the students submitted 4 independently derived questions and successfully retrieved and appraised evidence. Medical students successfully acquired and independently applied EBM skills following extended, online, faculty mentored instruction. This method of instruction provided uniform instruction across geographic sites and medical specialties and permitted efficient use of faculty time.

Performance and stability of mask process correction for EBM-7000

NASA Astrophysics Data System (ADS)

Saito, Yasuko; Chen, George; Wang, Jen-Shiang; Bai, Shufeng; Howell, Rafael; Li, Jiangwei; Tao, Jun; VanDenBroeke, Doug; Wiley, Jim; Takigawa, Tadahiro; Ohnishi, Takayuki; Kamikubo, Takashi; Hara, Shigehiro; Anze, Hirohito; Hattori, Yoshiaki; Tamamushi, Shuichi

2010-05-01

In order to support complex optical masks today and EUV masks in the near future, it is critical to correct mask patterning errors with a magnitude of up to 20nm over a range of 2000nm at mask scale caused by short range mask process proximity effects. A new mask process correction technology, MPC+, has been developed to achieve the target requirements for the next generation node. In this paper, the accuracy and throughput performance of MPC+ technology is evaluated using the most advanced mask writing tool, the EBM-70001), and high quality mask metrology . The accuracy of MPC+ is achieved by using a new comprehensive mask model. The results of through-pitch and through-linewidth linearity curves and error statistics for multiple pattern layouts (including both 1D and 2D patterns) are demonstrated and show post-correction accuracy of 2.34nm 3σ for through-pitch/through-linewidth linearity. Implementing faster mask model simulation and more efficient correction recipes; full mask area (100cm2) processing run time is less than 7 hours for 32nm half-pitch technology node. From these results, it can be concluded that MPC+ with its higher precision and speed is a practical technology for the 32nm node and future technology generations, including EUV, when used with advance mask writing processes like the EBM-7000.

Ecosystem-based management and the wealth of ecosystems.

PubMed

Yun, Seong Do; Hutniczak, Barbara; Abbott, Joshua K; Fenichel, Eli P

2017-06-20

We merge inclusive wealth theory with ecosystem-based management (EBM) to address two challenges in the science of sustainable management of ecosystems. First, we generalize natural capital theory to approximate realized shadow prices for multiple interacting natural capital stocks (species) making up an ecosystem. These prices enable ecosystem components to be better included in wealth-based sustainability measures. We show that ecosystems are best envisioned as portfolios of assets, where the portfolio's performance depends on the performance of the underlying assets influenced by their interactions. Second, changes in ecosystem wealth provide an attractive headline index for EBM, regardless of whether ecosystem wealth is ultimately included in a broader wealth index. We apply our approach to the Baltic Sea ecosystem, focusing on the interacting community of three commercially important fish species: cod, herring, and sprat. Our results incorporate supporting services embodied in the shadow price of a species through its trophic interactions. Prey fish have greater shadow prices than expected based on market value, and predatory fish have lower shadow prices than expected based on market value. These results are because correctly measured shadow prices reflect interdependence and limits to substitution. We project that ecosystem wealth in the Baltic Sea fishery ecosystem generally increases conditional on the EBM-inspired multispecies maximum sustainable yield management beginning in 2017, whereas continuing the current single-species management generally results in declining wealth.

Electron Beam Melting Manufacturing Technology for Individually Manufactured Jaw Prosthesis: A Case Report.

PubMed

Suska, Felicia; Kjeller, Göran; Tarnow, Peter; Hryha, Eduard; Nyborg, Lars; Snis, Anders; Palmquist, Anders

2016-08-01

In the field of maxillofacial reconstruction, additive manufacturing technologies, specifically electron beam melting (EBM), offer clinicians the potential for patient-customized design of jaw prostheses, which match both load-bearing and esthetic demands. The technique allows an innovative, functional design, combining integrated porous regions for bone ingrowth and secondary biological fixation with solid load-bearing regions ensuring the biomechanical performance. A patient-specific mandibular prosthesis manufactured using EBM was successfully used to reconstruct a patient's mandibular defect after en bloc resection. Over a 9-month follow-up period, the patient had no complications. A short operating time, good esthetic outcome, and high level of patient satisfaction as measured by quality-of-life questionnaires-the European Organisation for Research and Treatment of Cancer QLQ-C30 (30-item quality-of-life core questionnaire) and H&N35 (head and neck cancer module)-were reported for this case. Individually planned and designed EBM-produced prostheses may be suggested as a possible future alternative to fibular grafts or other reconstructive methods. However, the role of porosity, the role of geometry, and the optimal combination of solid and porous parts, as well as surface properties in relation to soft tissues, should be carefully evaluated in long-term clinical trials. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Translational Systems Biology and Voice Pathophysiology

PubMed Central

Li, Nicole Y. K.; Abbott, Katherine Verdolini; Rosen, Clark; An, Gary; Hebda, Patricia A.; Vodovotz, Yoram

2011-01-01

Objectives/Hypothesis Personalized medicine has been called upon to tailor healthcare to an individual's needs. Evidence-based medicine (EBM) has advocated using randomized clinical trials with large populations to evaluate treatment effects. However, due to large variations across patients, the results are likely not to apply to an individual patient. We suggest that a complementary, systems biology approach using computational modeling may help tackle biological complexity in order to improve ultimate patient care. The purpose of the article is: 1) to review the pros and cons of EBM, and 2) to discuss the alternative systems biology method and present its utility in clinical voice research. Study Design Tutorial Methods Literature review and discussion. Results We propose that translational systems biology can address many of the limitations of EBM pertinent to voice and other health care domains, and thus complement current health research models. In particular, recent work using mathematical modeling suggests that systems biology has the ability to quantify the highly complex biologic processes underlying voice pathophysiology. Recent data support the premise that this approach can be applied specifically in the case of phonotrauma and surgically induced vocal fold trauma, and may have particular power to address personalized medicine. Conclusions We propose that evidence around vocal health and disease be expanded beyond a population-based method to consider more fully issues of complexity and systems interactions, especially in implementing personalized medicine in voice care and beyond. PMID:20025041

Ecosystem-based management and the wealth of ecosystems

PubMed Central

Yun, Seong Do; Hutniczak, Barbara; Abbott, Joshua K.; Fenichel, Eli P.

2017-01-01

We merge inclusive wealth theory with ecosystem-based management (EBM) to address two challenges in the science of sustainable management of ecosystems. First, we generalize natural capital theory to approximate realized shadow prices for multiple interacting natural capital stocks (species) making up an ecosystem. These prices enable ecosystem components to be better included in wealth-based sustainability measures. We show that ecosystems are best envisioned as portfolios of assets, where the portfolio’s performance depends on the performance of the underlying assets influenced by their interactions. Second, changes in ecosystem wealth provide an attractive headline index for EBM, regardless of whether ecosystem wealth is ultimately included in a broader wealth index. We apply our approach to the Baltic Sea ecosystem, focusing on the interacting community of three commercially important fish species: cod, herring, and sprat. Our results incorporate supporting services embodied in the shadow price of a species through its trophic interactions. Prey fish have greater shadow prices than expected based on market value, and predatory fish have lower shadow prices than expected based on market value. These results are because correctly measured shadow prices reflect interdependence and limits to substitution. We project that ecosystem wealth in the Baltic Sea fishery ecosystem generally increases conditional on the EBM-inspired multispecies maximum sustainable yield management beginning in 2017, whereas continuing the current single-species management generally results in declining wealth. PMID:28588145

Effect of an EBM course in combination with case method learning sessions: an RCT on professional performance, job satisfaction, and self-efficacy of occupational physicians.

PubMed

Hugenholtz, Nathalie I R; Schaafsma, Frederieke G; Nieuwenhuijsen, Karen; van Dijk, Frank J H

2008-10-01

An intervention existing of an evidence-based medicine (EBM) course in combination with case method learning sessions (CMLSs) was designed to enhance the professional performance, self-efficacy and job satisfaction of occupational physicians. A cluster randomized controlled trial was set up and data were collected through questionnaires at baseline (T0), directly after the intervention (T1) and 7 months after baseline (T2). The data of the intervention group [T0 (n = 49), T1 (n = 31), T2 (n = 29)] and control group [T0 (n = 49), T1 (n = 28), T2 (n = 28)] were analysed in mixed model analyses. Mean scores of the perceived value of the CMLS were calculated in the intervention group. The overall effect of the intervention over time comparing the intervention with the control group was statistically significant for professional performance (p < 0.001). Job satisfaction and self-efficacy changes were small and not statistically significant between the groups. The perceived value of the CMLS to gain new insights and to improve the quality of their performance increased with the number of sessions followed. An EBM course in combination with case method learning sessions is perceived as valuable and offers evidence to enhance the professional performance of occupational physicians. However, it does not seem to influence their self-efficacy and job satisfaction.

Perceived barriers to guidelines in peritoneal dialysis.

PubMed

Allen, Nathan; Schwartz, Daniel; Sood, Amy R; Mendelssohn, David; Verrelli, Mauro; Tanna, Gemini; Schiff, Jeff; Komenda, Paul; Rigatto, Claudio; Sood, Manish M

2011-05-01

Little is known regarding barriers to guideline adherence in the nephrology community. We set out to identify perceived barriers to evidence-based medicine (EBM) and measurement of continuous quality indicators (CQI) in an international cohort of peritoneal dialysis (PD) practitioners. Subscribers to an online nephrology education site (Nephrology Now) were invited to participate in an online survey. Nephrology Now is a non-profit, monthly mailing list that highlights clinically relevant articles in nephrology. Four hundred and seventy-five physicians supplying PD care participated in an online survey assessing their use of EBM and CQI in their PD practice. Ordinal logistic regression was utilized to determine relationships between baseline characteristics and EBM and CQI practices. The majority of physicians were nephrologists (89.7%), and 50.4% worked in an academic centre. Respondents were from the following geographic regions: 13.5% Canadian, 24% American, 23.8% European, 4.4% Australian, 5.3% South American, 10.7% African and 12.2% Asian. Adherence to PD clinical practice guidelines were generally strong; however, lower adherence was associated with countries with lower healthcare expenditure, not using personal digital assistant (PDA), the longer the physician had been practising and smaller (< 20 patients per centre) PD practice. International variation in guideline adherence may be influenced by a country's healthcare expenditure, physician's PDA use and experience, and size of PD practice which may impact future guideline development and implementation.

Flat panel ferroelectric electron emission display system

DOEpatents

Sampayan, Stephen E.; Orvis, William J.; Caporaso, George J.; Wieskamp, Ted F.

1996-01-01

A device which can produce a bright, raster scanned or non-raster scanned image from a flat panel. Unlike many flat panel technologies, this device does not require ambient light or auxiliary illumination for viewing the image. Rather, this device relies on electrons emitted from a ferroelectric emitter impinging on a phosphor. This device takes advantage of a new electron emitter technology which emits electrons with significant kinetic energy and beam current density.

Provision of magnetic resonance imaging for patients with 'MR-conditional' cardiac implantable electronic devices: an unmet clinical need.

PubMed

Sabzevari, Kian; Oldman, James; Herrey, Anna S; Moon, James C; Kydd, Anna C; Manisty, Charlotte

2017-03-01

Increasing need for magnetic resonance imaging (MRI) has driven the development of MR-conditional cardiac implantable electronic devices (CIEDs; pacemakers and defibrillators); however, patients still report difficulties obtaining scans. We sought to establish current provision for MRI scanning of patients with CIEDs in England. A survey was distributed to all hospitals in England with MRI, to assess current practice. Information requested included whether hospitals currently offer MRI to this patient group, the number and type of scans acquired, local safety considerations, complications experienced and perceived obstacles to service provision in those departments not currently offering it. Responses were received from 195 of 227 (86%) of hospitals surveyed. Although 98% of departments were aware of MR-conditional devices, only 46% (n = 89) currently offer MRI scans to patients with CIED's; of these, 85% of departments perform ≤10 scans per year. No major complications were reported from MRI scanning in patients with MR-conditional devices. Current barriers to service expansion include perceived concerns regarding potential risk, lack of training, logistical difficulties, and lack of cardiology support. Provision of MRI for patients with CIEDs is currently poor, despite increasing numbers of patients with MR-conditional devices and extremely low reported complication rates. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

System and method for chromatography and electrophoresis using circular optical scanning

DOEpatents

Balch, Joseph W.; Brewer, Laurence R.; Davidson, James C.; Kimbrough, Joseph R.

2001-01-01

A system and method is disclosed for chromatography and electrophoresis using circular optical scanning. One or more rectangular microchannel plates or radial microchannel plates has a set of analysis channels for insertion of molecular samples. One or more scanning devices repeatedly pass over the analysis channels in one direction at a predetermined rotational velocity and with a predetermined rotational radius. The rotational radius may be dynamically varied so as to monitor the molecular sample at various positions along a analysis channel. Sample loading robots may also be used to input molecular samples into the analysis channels. Radial microchannel plates are built from a substrate whose analysis channels are disposed at a non-parallel angle with respect to each other. A first step in the method accesses either a rectangular or radial microchannel plate, having a set of analysis channels, and second step passes a scanning device repeatedly in one direction over the analysis channels. As a third step, the scanning device is passed over the analysis channels at dynamically varying distances from a centerpoint of the scanning device. As a fourth step, molecular samples are loaded into the analysis channels with a robot.

Predicting scattering scanning near-field optical microscopy of mass-produced plasmonic devices

NASA Astrophysics Data System (ADS)

Otto, Lauren M.; Burgos, Stanley P.; Staffaroni, Matteo; Ren, Shen; Süzer, Özgün; Stipe, Barry C.; Ashby, Paul D.; Hammack, Aeron T.

2018-05-01

Scattering scanning near-field optical microscopy enables optical imaging and characterization of plasmonic devices with nanometer-scale resolution well below the diffraction limit. This technique enables developers to probe and understand the waveguide-coupled plasmonic antenna in as-fabricated heat-assisted magnetic recording heads. In order to validate and predict results and to extract information from experimental measurements that is physically comparable to simulations, a model was developed to translate the simulated electric field into expected near-field measurements using physical parameters specific to scattering scanning near-field optical microscopy physics. The methods used in this paper prove that scattering scanning near-field optical microscopy can be used to determine critical sub-diffraction-limited dimensions of optical field confinement, which is a crucial metrology requirement for the future of nano-optics, semiconductor photonic devices, and biological sensing where the near-field character of light is fundamental to device operation.

Educational strategies for teaching evidence-based practice to undergraduate health students: systematic review

PubMed Central

2016-01-01

Purpose The aim of this systematic review was to find best teaching strategies for teaching evidence-based practice (EBP) to undergraduate health students that have been adopted over the last years in healthcare institutions worldwide. Methods The authors carried out a systematic, comprehensive bibliographic search using Medline database for the years 2005 to March 2015 (updated in March 2016). Search terms used were chosen from the USNLM Institutes of Health list of MeSH (Medical Subject Headings) and free text key terms were used as well. Selected articles were measured based on the inclusion criteria of this study and initially compared in terms of titles or abstracts. Finally, articles relevant to the subject of this review were retrieved in full text. Critical appraisal was done to determine the effects of strategy of teaching evidence-based medicine (EBM). Results Twenty articles were included in the review. The majority of the studies sampled medical students (n=13) and only few conducted among nursing (n=2), pharmacy (n=2), physiotherapy/therapy (n=1), dentistry (n=1), or mixed disciplines (n=1) students. Studies evaluated a variety of educational interventions of varying duration, frequency and format (lectures, tutorials, workshops, conferences, journal clubs, and online sessions), or combination of these to teach EBP. We categorized interventions into single interventions covering a workshop, conference, lecture, journal club, or e-learning and multifaceted interventions where a combination of strategies had been assessed. Seven studies reported an overall increase to all EBP domains indicating a higher EBP competence and two studies focused on the searching databases skill. Conclusion Followings were deduced from above analysis: multifaceted approach may be best suited when teaching EBM to health students; the use of technology to promote EBP through mobile devices, simulation, and the web is on the rise; and the duration of the interventions varying form some hours to even months was not related to the students’ EBP competence. PMID:27649902

Educational strategies for teaching evidence-based practice to undergraduate health students: systematic review.

PubMed

Kyriakoulis, Konstantinos; Patelarou, Athina; Laliotis, Aggelos; Wan, Andrew C; Matalliotakis, Michail; Tsiou, Chrysoula; Patelarou, Evridiki

2016-01-01

The aim of this systematic review was to find best teaching strategies for teaching evidence-based practice (EBP) to undergraduate health students that have been adopted over the last years in healthcare institutions worldwide. The authors carried out a systematic, comprehensive bibliographic search using Medline database for the years 2005 to March 2015 (updated in March 2016). Search terms used were chosen from the USNLM Institutes of Health list of MeSH (Medical Subject Headings) and free text key terms were used as well. Selected articles were measured based on the inclusion criteria of this study and initially compared in terms of titles or abstracts. Finally, articles relevant to the subject of this review were retrieved in full text. Critical appraisal was done to determine the effects of strategy of teaching evidence-based medicine (EBM). Twenty articles were included in the review. The majority of the studies sampled medical students (n=13) and only few conducted among nursing (n=2), pharmacy (n=2), physiotherapy/therapy (n=1), dentistry (n=1), or mixed disciplines (n=1) students. Studies evaluated a variety of educational interventions of varying duration, frequency and format (lectures, tutorials, workshops, conferences, journal clubs, and online sessions), or combination of these to teach EBP. We categorized interventions into single interventions covering a workshop, conference, lecture, journal club, or e-learning and multifaceted interventions where a combination of strategies had been assessed. Seven studies reported an overall increase to all EBP domains indicating a higher EBP competence and two studies focused on the searching databases skill. Followings were deduced from above analysis: multifaceted approach may be best suited when teaching EBM to health students; the use of technology to promote EBP through mobile devices, simulation, and the web is on the rise; and the duration of the interventions varying form some hours to even months was not related to the students' EBP competence.

System and method for evaluating wind flow fields using remote sensing devices

DOEpatents

Schroeder, John; Hirth, Brian; Guynes, Jerry

2016-12-13

The present invention provides a system and method for obtaining data to determine one or more characteristics of a wind field using a first remote sensing device and a second remote sensing device. Coordinated data is collected from the first and second remote sensing devices and analyzed to determine the one or more characteristics of the wind field. The first remote sensing device is positioned to have a portion of the wind field within a first scanning sector of the first remote sensing device. The second remote sensing device is positioned to have the portion of the wind field disposed within a second scanning sector of the second remote sensing device.

Quantitative (31)P NMR spectroscopy and (1)H MRI measurements of bone mineral and matrix density differentiate metabolic bone diseases in rat models.

PubMed

Cao, Haihui; Nazarian, Ara; Ackerman, Jerome L; Snyder, Brian D; Rosenberg, Andrew E; Nazarian, Rosalynn M; Hrovat, Mirko I; Dai, Guangping; Mintzopoulos, Dionyssios; Wu, Yaotang

2010-06-01

In this study, bone mineral density (BMD) of normal (CON), ovariectomized (OVX), and partially nephrectomized (NFR) rats was measured by (31)P NMR spectroscopy; bone matrix density was measured by (1)H water- and fat-suppressed projection imaging (WASPI); and the extent of bone mineralization (EBM) was obtained by the ratio of BMD/bone matrix density. The capability of these MR methods to distinguish the bone composition of the CON, OVX, and NFR groups was evaluated against chemical analysis (gravimetry). For cortical bone specimens, BMD of the CON and OVX groups was not significantly different; BMD of the NFR group was 22.1% (by (31)P NMR) and 17.5% (by gravimetry) lower than CON. For trabecular bone specimens, BMD of the OVX group was 40.5% (by (31)P NMR) and 24.6% (by gravimetry) lower than CON; BMD of the NFR group was 26.8% (by (31)P NMR) and 21.5% (by gravimetry) lower than CON. No significant change of cortical bone matrix density between CON and OVX was observed by WASPI or gravimetry; NFR cortical bone matrix density was 10.3% (by WASPI) and 13.9% (by gravimetry) lower than CON. OVX trabecular bone matrix density was 38.0% (by WASPI) and 30.8% (by gravimetry) lower than CON, while no significant change in NFR trabecular bone matrix density was observed by either method. The EBMs of OVX cortical and trabecular specimens were slightly higher than CON but not significantly different from CON. Importantly, EBMs of NFR cortical and trabecular specimens were 12.4% and 26.3% lower than CON by (31)P NMR/WASPI, respectively, and 4.0% and 11.9% lower by gravimetry. Histopathology showed evidence of osteoporosis in the OVX group and severe secondary hyperparathyroidism (renal osteodystrophy) in the NFR group. These results demonstrate that the combined (31)P NMR/WASPI method is capable of discerning the difference in EBM between animals with osteoporosis and those with impaired bone mineralization. Copyright 2010 Elsevier Inc. All rights reserved.

10 years of mindlines: a systematic review and commentary.

PubMed

Wieringa, Sietse; Greenhalgh, Trisha

2015-04-09

In 2004, Gabbay and le May showed that clinicians generally base their decisions on mindlines-internalised and collectively reinforced tacit guidelines-rather than consulting written clinical guidelines. We considered how the concept of mindlines has been taken forward since. We searched databases from 2004 to 2014 for the term 'mindline(s)' and tracked all sources citing Gabbay and le May's 2004 article. We read and re-read papers to gain familiarity and developed an interpretive analysis and taxonomy by drawing on the principles of meta-narrative systematic review. In our synthesis of 340 papers, distinguished between authors who used mindlines purely in name ('nominal' view) sometimes dismissing them as a harmful phenomenon, and authors who appeared to have understood the term's philosophical foundations. The latter took an 'in-practice' view (studying how mindlines emerge and spread in real-world settings), a 'theoretical and philosophical' view (extending theory) or a 'solution focused' view (exploring how to promote and support mindline development). We found that it is not just clinicians who develop mindlines: so do patients, in face-to-face and (potentially) online communities. Theoretical publications on mindlines have continued to challenge the rationalist assumptions of evidence-based medicine (EBM). Conventional EBM assumes a single, knowable reality and seeks to strip away context to generate universal predictive rules. In contrast, mindlines are predicated on a more fluid, embodied and intersubjective view of knowledge; they accommodate context and acknowledge multiple realities. When considering how knowledge spreads, the concept of mindlines requires us to go beyond the constraining notions of 'dissemination' and 'translation' to study tacit knowledge and the interactive human processes by which such knowledge is created, enacted and shared. Solution-focused publications described mindline-promoting initiatives such as relationship-building, collaborative learning and thought leadership. The concept of mindlines challenges the naïve rationalist view of knowledge implicit in some EBM publications, but the term appears to have been misunderstood (and prematurely dismissed) by some authors. By further studying mindlines empirically and theoretically, there is potential to expand EBM's conceptual toolkit to produce richer forms of 'evidence-based' knowledge. We outline a suggested research agenda for achieving this goal.

Improving the Representation of Estuarine Processes in Earth System Models

NASA Astrophysics Data System (ADS)

Sun, Q.; Whitney, M. M.; Bryan, F.; Tseng, Y. H.

2016-12-01

The exchange of freshwater between the rivers and estuaries and the open ocean represents a unique form of scale-interaction in the climate system. The local variability in the terrestrial hydrologic cycle is integrated by rivers over potentially large drainage basins (up to semi-continental scales), and is then imposed on the coastal ocean at the scale of a river mouth. Appropriately treating riverine freshwater discharge into the oceans in Earth system models is a challenging problem. Commonly, the river runoff is discharged into the ocean models with zero salinity and arbitrarily distributed either horizontally or vertically over several grid cells. Those approaches entirely neglect estuarine physical processes that modify river inputs before they reach the open ocean. A physically based Estuary Box Model (EBM) is developed to parameterize the mixing processes in estuaries. The EBM has a two-layer structure representing the mixing processes driven by tides and shear flow within the estuaries. It predicts the magnitude of the mixing driven exchange flow, bringing saltier lower-layer shelf water into the estuary to mix with river water prior to discharge to the upper-layer open ocean. The EBM has been tested against observations and high-resolution three-dimensional simulations of the Columbia River estuary, showing excellent agreement in the predictions of the strength of the exchange flow and the salinity of the discharged water, including modulation with the spring-neap tidal cycle. The EBM is implemented globally at every river discharge point of the Community Earth System Model (CESM). In coupled ocean-sea ice experiments driven by CORE surface forcing, the sea surface salinity (SSS) in the coastal ocean is increased globally compared to the standard model, contributing to a decrease in coastal stratification. The SSS near the mouths of some of the largest rivers is decreased due to the reduction in the area over which riverine fresh water is discharged. The results from experiments with the fully coupled CESM are broadly consistent, supporting the inclusion of the parameterization in CESM version 2 to be released in late 2016.

The Precautionary Principle, Evidence-Based Medicine, and Decision Theory in Public Health Evaluation

PubMed Central

Fischer, Alastair J.; Ghelardi, Gemma

2016-01-01

The precautionary principle (PP) has been used in the evaluation of the effectiveness and/or cost-effectiveness of interventions designed to prevent future harms in a range of activities, particularly in the area of the environment. Here, we provide details of circumstances under which the PP can be applied to the topic of harm reduction in Public Health. The definition of PP that we use says that the PP reverses the onus of proof of effectiveness between an intervention and its comparator when the intervention has been designed to reduce harm. We first describe the two frameworks used for health-care evaluation: evidence-based medicine (EBM) and decision theory (DT). EBM is usually used in treatment effectiveness evaluation, while either EBM or DT may be used in evaluating the effectiveness of the prevention of illness. For cost-effectiveness, DT is always used. The expectation in Public Health is that interventions employed to reduce harm will not actually increase harm, where “harm” in this context does not include opportunity cost. That implies that an intervention’s effectiveness can often be assumed. Attention should therefore focus on its cost-effectiveness. This view is consistent with the conclusions of DT. It is also very close to the PP notion of reversing the onus of proof, but is not consistent with EBM as normally practiced, where the onus is on showing a new practice to be superior to usual practice with a sufficiently high degree of certainty. Under our definitions, we show that where DT and the PP differ in their evaluation is in cost-effectiveness, but only for decisions that involve potential catastrophic circumstances, where the nation-state will act as if it is risk-averse. In those cases, it is likely that the state will pay more, and possibly much more, than DT would allow, in an attempt to mitigate impending disaster. That is, the rules that until now have governed all cost-effectiveness analyses are shown not to apply to catastrophic situations, where the PP applies. PMID:27458575

The Precautionary Principle, Evidence-Based Medicine, and Decision Theory in Public Health Evaluation.

PubMed

Fischer, Alastair J; Ghelardi, Gemma

2016-01-01

The precautionary principle (PP) has been used in the evaluation of the effectiveness and/or cost-effectiveness of interventions designed to prevent future harms in a range of activities, particularly in the area of the environment. Here, we provide details of circumstances under which the PP can be applied to the topic of harm reduction in Public Health. The definition of PP that we use says that the PP reverses the onus of proof of effectiveness between an intervention and its comparator when the intervention has been designed to reduce harm. We first describe the two frameworks used for health-care evaluation: evidence-based medicine (EBM) and decision theory (DT). EBM is usually used in treatment effectiveness evaluation, while either EBM or DT may be used in evaluating the effectiveness of the prevention of illness. For cost-effectiveness, DT is always used. The expectation in Public Health is that interventions employed to reduce harm will not actually increase harm, where "harm" in this context does not include opportunity cost. That implies that an intervention's effectiveness can often be assumed. Attention should therefore focus on its cost-effectiveness. This view is consistent with the conclusions of DT. It is also very close to the PP notion of reversing the onus of proof, but is not consistent with EBM as normally practiced, where the onus is on showing a new practice to be superior to usual practice with a sufficiently high degree of certainty. Under our definitions, we show that where DT and the PP differ in their evaluation is in cost-effectiveness, but only for decisions that involve potential catastrophic circumstances, where the nation-state will act as if it is risk-averse. In those cases, it is likely that the state will pay more, and possibly much more, than DT would allow, in an attempt to mitigate impending disaster. That is, the rules that until now have governed all cost-effectiveness analyses are shown not to apply to catastrophic situations, where the PP applies.

Flat panel ferroelectric electron emission display system

DOEpatents

Sampayan, S.E.; Orvis, W.J.; Caporaso, G.J.; Wieskamp, T.F.

1996-04-16

A device is disclosed which can produce a bright, raster scanned or non-raster scanned image from a flat panel. Unlike many flat panel technologies, this device does not require ambient light or auxiliary illumination for viewing the image. Rather, this device relies on electrons emitted from a ferroelectric emitter impinging on a phosphor. This device takes advantage of a new electron emitter technology which emits electrons with significant kinetic energy and beam current density. 6 figs.

Device-independent color scanning

NASA Astrophysics Data System (ADS)

Burger, Rudolph E.

1993-08-01

Color calibration technology is being incorporated into both Apple and Microsoft's operating systems. These color savvy operating systems will produce a market pull towards 'smart color' scanners and printers which, in turn, will lead towards a distributed architecture for color management systems (CMS). Today's desktop scanners produce red-green-blue color signals that do not accurately describe the color of the object being scanned. Future scanners will be self-calibrating and communicate their own 'device profile' to the operating system based CMS. This paper describes some of the key technologies required for this next generation of smart color scanners. Topics covered include a comparison of colorimetric and conventional scanning technologies, and the impact of metamerism, dye fluorescence and chromatic adaptation on device independent color scanning.

Thermally-induced voltage alteration for analysis of microelectromechanical devices

DOEpatents

Walraven, Jeremy A.; Cole, Jr., Edward I.

2002-01-01

A thermally-induced voltage alteration (TIVA) apparatus and method are disclosed for analyzing a microelectromechanical (MEM) device with or without on-board integrated circuitry. One embodiment of the TIVA apparatus uses constant-current biasing of the MEM device while scanning a focused laser beam over electrically-active members therein to produce localized heating which alters the power demand of the MEM device and thereby changes the voltage of the constant-current source. This changing voltage of the constant-current source can be measured and used in combination with the position of the focused and scanned laser beam to generate an image of any short-circuit defects in the MEM device (e.g. due to stiction or fabrication defects). In another embodiment of the TIVA apparatus, an image can be generated directly from a thermoelectric potential produced by localized laser heating at the location of any short-circuit defects in the MEM device, without any need for supplying power to the MEM device. The TIVA apparatus can be formed, in part, from a scanning optical microscope, and has applications for qualification testing or failure analysis of MEM devices.

Integrating Information Literacy and Evidence-Based Medicine Content within a New School of Medicine Curriculum: Process and Outcome.

PubMed

Muellenbach, Joanne M; Houk, Kathryn M; E Thimons, Dana; Rodriguez, Bredny

2018-01-01

This column describes a process for integrating information literacy (IL) and evidence-based medicine (EBM) content within a new school of medicine curriculum. The project was a collaborative effort among health sciences librarians, curriculum deans, directors, and faculty. The health sciences librarians became members of the curriculum committees, developed a successful proposal for IL and EBM content within the curriculum, and were invited to become course instructors for Analytics in Medicine. As course instructors, the librarians worked with the other faculty instructors to design and deliver active learning class sessions based on a flipped classroom approach using a proprietary Information Mastery curriculum. Results of this collaboration may add to the knowledge base of attitudes and skills needed to practice as full faculty partners in curricular design and instruction.

Toward Evidence-Based Chinese Medicine: Status Quo, Opportunities and Challenges.

PubMed

Chen, Yao-Long; Zhao, Chen; Zhang, Li; Li, Bo; Wu, Chuan-Hong; Mu, Wei; Wang, Jia-Ying; Yang, Ke-Hu; Li, You-Ping; Chen, Chiehfeng; Wang, Yong-Yan; Wang, Chen; Bian, Zhao-Xiang; Shang, Hong-Cai

2018-03-01

How to test the treatments of Chinese medicine (CM) and make them more widely accepted by practitioners of Western medicine and the international healthcare community is a major concern for practitioners and researchers of CM. For centuries, various approaches have been used to identify and measure the efficacy and safety of CM. However, the high-quality evidence related to CM that produced in China is still rare. Over the recent years, evidence-based medicine (EBM) has been increasingly applied to CM, strengthening its theoretical basis. This paper reviews the past and present state of CM, analyzes the status quo, challenges and opportunities of basic research, clinical trials, systematic reviews, clinical practice guidelines and clinical pathways and evidence-based education developed or conducted in China, pointing out how EBM can help to make CM more widely used and recognized worldwide.

Balance of trade: export-import in family medicine.

PubMed

Pust, Ronald E

2007-01-01

North American family physicians leaving for less-developed countries (LDCs) may not be aware of internationally validated diagnostic and treatment technologies originating in LDCs. Thus they may bring with them inappropriate models and methods of medical care. More useful "exports" are based in sharing our collaborative vocational perspective with dedicated indigenous generalist clinicians who serve their communities. More specifically, Western doctors abroad can promote local reanalyses of international evidence-based medicine (EBM) studies, efficient deployment of scarce clinical resources, and a family medicine/generalist career ladder, ultimately reversing the "brain drain" from LDCs. Balancing these exports, we should import the growing number of EBM best practices originated in World Health Organization and other LDCs research that are applicable in developed nations. Many generalist colleagues, expatriate and indigenous, with long-term LDC experience stand ready to help us import these practices and perspectives.

EBM

PubMed Central

Isaac, Carol A.; Franceschi, Amy

2008-01-01

The purpose of this paper is to explore new perspectives about difficulties academicians may have communicating with clinicians, obtaining subjects, and gaining compliance for their research. Sackett et al1 defined evidence-based medicine (EBM) as an integration of best research evidence, clinical expertise, and patient values. However, Guyatt et al2 places clinical observation and experience last in the evidence hierarchy with the randomized controlled trial held as the standard for clinical intervention. The hierarchical discourse of medical knowledge produces opposition rather than collaboration between researcher, clinician, and patient. Foucault gave new perspectives describing how power circulates through individuals within organizational discourse.3 Drawing on literature and experience, this paper describes how the hierarchical model of power in the research community obstructs new areas of knowledge, and how clinicians create resistance. Alleviating perceptions of dominance and creating connections produces cohesion within medical communities. PMID:19018888

The effectiveness of a clinically integrated e-learning course in evidence-based medicine: a cluster randomised controlled trial.

PubMed

Kulier, Regina; Coppus, Sjors F P J; Zamora, Javier; Hadley, Julie; Malick, Sadia; Das, Kausik; Weinbrenner, Susanne; Meyerrose, Berrit; Decsi, Tamas; Horvath, Andrea R; Nagy, Eva; Emparanza, Jose I; Arvanitis, Theodoros N; Burls, Amanda; Cabello, Juan B; Kaczor, Marcin; Zanrei, Gianni; Pierer, Karen; Stawiarz, Katarzyna; Kunz, Regina; Mol, Ben W J; Khan, Khalid S

2009-05-12

To evaluate the educational effects of a clinically integrated e-learning course for teaching basic evidence-based medicine (EBM) among postgraduates compared to a traditional lecture-based course of equivalent content. We conducted a cluster randomised controlled trial in the Netherlands and the UK involving postgraduate trainees in six obstetrics and gynaecology departments. Outcomes (knowledge gain and change in attitude towards EBM) were compared between the clinically integrated e-learning course (intervention) and the traditional lecture based course (control). We measured change from pre- to post-intervention scores using a validated questionnaire assessing knowledge (primary outcome) and attitudes (secondary outcome). There were six clusters involving teaching of 61 postgraduate trainees (28 in the intervention and 33 in the control group). The intervention group achieved slightly higher scores for knowledge gain compared to the control, but these results were not statistically significant (difference in knowledge gain: 3.5 points, 95% CI -2.7 to 9.8, p = 0.27). The attitudinal changes were similar for both groups. A clinically integrated e-learning course was at least as effective as a traditional lecture based course and was well accepted. Being less costly than traditional teaching and allowing for more independent learning through materials that can be easily updated, there is a place for incorporating e-learning into postgraduate EBM curricula that offer on-the-job training for just-in-time learning. ACTRN12609000022268.

Linking research to practice: the rise of evidence-based health sciences librarianship.

PubMed

Marshall, Joanne Gard

2014-01-01

The lecture explores the origins of evidence-based practice (EBP) in health sciences librarianship beginning with examples from the work of Janet Doe and past Doe lecturers. Additional sources of evidence are used to document the rise of research and EBP as integral components of our professional work. FOUR SOURCES OF EVIDENCE ARE USED TO EXAMINE THE RISE OF EBP: (1) a publication by Doe and research-related content in past Doe lectures, (2) research-related word usage in articles in the Bulletin of the Medical Library Association and Journal of the Medical Library Association between 1961 and 2010, (3) Medical Library Association activities, and (4) EBP as an international movement. These sources of evidence confirm the rise of EBP in health sciences librarianship. International initiatives sparked the rise of evidence-based librarianship and continue to characterize the movement. This review shows the emergence of a unique form of EBP that, although inspired by evidence-based medicine (EBM), has developed its own view of evidence and its application in library and information practice. Health sciences librarians have played a key role in initiating, nurturing, and spreading EBP in other branches of our profession. Our close association with EBM set the stage for developing our own EBP. While we relied on EBM as a model for our early efforts, we can observe the continuing evolution of our own unique approach to using, creating, and applying evidence from a variety of sources to improve the quality of health information services.

Fabrication of Turbine Disk Materials by Additive Manufacturing

NASA Technical Reports Server (NTRS)

Sudbrack, Chantal; Bean, Quincy A.; Cooper, Ken; Carter, Robert; Semiatin, S. Lee; Gabb, Tim

2014-01-01

Precipitation-strengthened, nickel-based superalloys are widely used in the aerospace and energy industries due to their excellent environmental resistance and outstanding mechanical properties under extreme conditions. Powder-bed additive manufacturing (AM) technologies offer the potential to revolutionize the processing of superalloy turbine components by eliminating the need for extensive inventory or expensive legacy tooling. Like selective laser melting (SLM), electron beam melting (EBM) constructs three-dimensional dense components layer-by-layer by melting and solidification of atomized, pre-alloyed powder feedstock within 50-200 micron layers. While SLM has been more widely used for AM of nickel alloys like 718, EBM offers several distinct advantages, such as less retained residual stress, lower risk of contamination, and faster build rates with multiple-electron-beam configurations. These advantages are particularly attractive for turbine disks, for which excessive residual stress and contamination can shorten disk life during high-temperature operation. In this presentation, we will discuss the feasibility of fabricating disk superalloy components using EBM AM. Originally developed using powder metallurgy forging processing, disk superalloys contain a higher refractory content and precipitate volume fraction than alloy 718, thus making them more prone to thermal cracking during AM. This and other challenges to produce homogeneous builds with desired properties will be presented. In particular, the quality of lab-scale samples fabricated via a design of experiments, in which the beam current, build temperature, and beam velocity were varied, will be summarized. The relationship between processing parameters, microstructure, grain orientation, and mechanical response will be discussed.

From Evidence-based Medicine to Human-based Medicine in Psychosomatics.

PubMed

Musalek, Michael

2016-08-23

Human-based medicine (HbM), a form of psychiatry that focuses not only on fragments and constructs but on the whole person, no longer finds its theoretical basis in the positivism of the modern era, but rather owes its central maxims to the post-modernist ideal that ultimate truths or objectivity in identifying the final cause of illness remain hidden from us for theoretical reasons alone. Evidence-based medicine (EbM) and HbM are thus not mutually exclusive opposites; rather, despite superficial differences in methods of diagnosis and treatment, EbM must be integrated into HbM as an indispensable component of the latter. Probably the most important difference between EbM and HbM lies in the aims and methods of treatment. In HbM the goal is no longer simply to make illnesses disappear but rather to allow the patient to return to a life that is as autonomous and happy as possible. The human being with all his or her potential and limitations once again becomes the measure of all things. This also implies, however, that the multidimensional diagnostics of HbM are oriented not only towards symptoms, pathogenesis, process and understanding but also to a greater degree towards the patient's resources. Treatment options and forms of therapy do not put the disease construct at the centre of the diagnostic and therapeutic interest, but have as their primary aim the reopening of the possibility of a largely autonomous and joyful life for the patient.

Phytotherapy in Functional Gastrointestinal Disorders.

PubMed

Kelber, Olaf; Bauer, Rudolf; Kubelka, Wolfgang

2017-01-01

Phytotherapy is an important therapeutic option in functional gastrointestinal diseases (FGID). It has a large tradition, with different approaches in different regions of the world, some of which have made their way into modern evidence-based medicine (EBM). Taking into account the number of herbs in use, and also the cumulated scientific evidence on them, FGID are possibly the most important indication in phytotherapy. This does not only apply for European phytotherapy, but also for other regions, such as Asia. Within European phytotherapy, herbs active in FGID are usually classified according to their main active constituents and their activities. Typically, the herbs used in FGID are grouped into amara, aromatica, amara aromatica combining both properties, herbs stimulating gastric secretion, herbs containing spasmolytic and carminative essential oils or spasmolytic alkaloids, mucilaginosa soothing the mucosa, and flavonoid containing drugs with anti-inflammatory properties. In phytotherapy, different plants are frequently combined to maximize effectiveness and specificity of action. Very potent combination products can be developed when the mechanisms of action of the combination partners are complementary. This approach can be demonstrated by the example of STW 5. For this herbal combination product, therapeutic efficacy in FGID has been clinically proven according to the highest standards of EBM. This example also underlines that modern rational phytotherapy is definitely part of modern EBM. Key Messages: FGID is one of the most important indications in phytotherapy and rationally combined herbal preparations are established evidence-based therapeutic options. © 2018 The Author(s) Published by S. Karger AG, Basel.

Fabrication in Space - What Materials are Needed?

NASA Technical Reports Server (NTRS)

Good, J

2007-01-01

In order to sustain life on the moon, and especially on Mars, the inhabitants must be self-sufficient. As on Earth, electronic and mechanical systems will break down and must be repaired. It is not realistic to "send" parts to the moon or Mars in an effort to replace failed ones or have spares for all components. It will be important to have spares on hand and even better would be to have the capability to fabricate parts in situ. The In Situ Fabrication and Repair (ISFR) team is working to develop the Arcam Electron Beam Melting (EBM) machine as the manufacturing process that will have the capability to produce repair parts, as well as new designs, and tooling on the lunar surface and eventually on Mars. What materials will be available for the inhabitants to use? What materials would be most useful? The EBM process is versatile and can handle a multitude of materials. These include titanium, stainless steels, aluminums, inconels, and copper alloys. Research has shown what parts have failed during past space missions and this data has been compiled and assessed. The EBM machine is fully capable of processing these materials of choice. Additionally, the long-term goal is to use the lunar regolith as a viable feedstock. Preliminary work has been performed to assess the feasibility of using raw lunar regolith as a material source or use a binder combined with the regolith to achieve a good melt.

Managing bay and estuarine ecosystems for multiple services

USGS Publications Warehouse

Needles, Lisa A.; Lester, Sarah E.; Ambrose, Richard; Andren, Anders; Beyeler, Marc; Connor, Michael S.; Eckman, James E.; Costa-Pierce, Barry A.; Gaines, Steven D.; Lafferty, Kevin D.; Lenihan, Junter S.; Parrish, Julia; Peterson, Mark S.; Scaroni, Amy E.; Weis, Judith S.; Wendt, Dean E.

2013-01-01

Managers are moving from a model of managing individual sectors, human activities, or ecosystem services to an ecosystem-based management (EBM) approach which attempts to balance the range of services provided by ecosystems. Applying EBM is often difficult due to inherent tradeoffs in managing for different services. This challenge particularly holds for estuarine systems, which have been heavily altered in most regions and are often subject to intense management interventions. Estuarine managers can often choose among a range of management tactics to enhance a particular service; although some management actions will result in strong tradeoffs, others may enhance multiple services simultaneously. Management of estuarine ecosystems could be improved by distinguishing between optimal management actions for enhancing multiple services and those that have severe tradeoffs. This requires a framework that evaluates tradeoff scenarios and identifies management actions likely to benefit multiple services. We created a management action-services matrix as a first step towards assessing tradeoffs and providing managers with a decision support tool. We found that management actions that restored or enhanced natural vegetation (e.g., salt marsh and mangroves) and some shellfish (particularly oysters and oyster reef habitat) benefited multiple services. In contrast, management actions such as desalination, salt pond creation, sand mining, and large container shipping had large net negative effects on several of the other services considered in the matrix. Our framework provides resource managers a simple way to inform EBM decisions and can also be used as a first step in more sophisticated approaches that model service delivery.

A Methodology for Evaluating and Ranking Water Quantity Indicators in Support of Ecosystem-Based Management

NASA Astrophysics Data System (ADS)

James, C. Andrew; Kershner, Jessi; Samhouri, Jameal; O'Neill, Sandra; Levin, Phillip S.

2012-03-01

Ecosystem-based Management (EBM) is an approach that includes different management priorities and requires a balance between anthropogenic and ecological resource demands. Indicators can be used to monitor ecosystem status and trends, and assess whether projects and/or programs are leading to the achievement of management goals. As such, the careful selection of a suite of indicators is a crucial exercise. In this paper we describe an indicator evaluation and selection process designed to support the EBM approach in Puget Sound. The first step in this process was the development of a general framework for selecting indicators. The framework, designed to transparently include both scientific and policy considerations into the selection and evaluation process, was developed and then utilized in the organization and determination of a preliminary set of indicators. Next, the indicators were assessed against a set of nineteen distinct criteria that describe the model characteristics of an indicator. A literature review was performed for each indicator to determine the extent to which it satisfied each of the evaluation criteria. The result of each literature review was summarized in a numerical matrix, allowing comparison, and demonstrating the extent of scientific reliability. Finally, an approach for ranking indicators was developed to explore the effects of intended purpose on indicator selection. We identified several sets of scientifically valid and policy-relevant indicators that included metrics such as annual-7 day low flow and water system reliability, which are supportive of the EBM approach in the Puget Sound.

Additive manufacturing of liquid/gas diffusion layers for low-cost and high-efficiency hydrogen production

DOE PAGES

Mo, Jingke; Zhang, Feng -Yuan; Dehoff, Ryan R.; ...

2016-01-14

The electron beam melting (EBM) additive manufacturing technology was used to fabricate titanium liquid/gas diffusion media with high-corrosion resistances and well-controllable multifunctional parameters, including two-phase transport and excellent electric/thermal conductivities, has been first demonstrated. Their applications in proton exchange membrane eletrolyzer cells have been explored in-situ in a cell and characterized ex-situ with SEM and XRD. Compared with the conventional woven liquid/gas diffusion layers (LGDLs), much better performance with EBM fabricated LGDLs is obtained due to their significant reduction of ohmic loss. The EBM technology components exhibited several distinguished advantages in fabricating gas diffusion layer: well-controllable pore morphology and structure,more » rapid prototyping, fast manufacturing, highly customizing and economic. In addition, by taking advantage of additive manufacturing, it possible to fabricate complicated three-dimensional designs of virtually any shape from a digital model into one single solid object faster, cheaper and easier, especially for titanium. More importantly, this development will provide LGDLs with control of pore size, pore shape, pore distribution, and therefore porosity and permeability, which will be very valuable to develop modeling and to validate simulations of electrolyzers with optimal and repeatable performance. Further, it will lead to a manufacturing solution to greatly simplify the PEMEC/fuel cell components and to couple the LGDLs with other parts, since they can be easily integrated together with this advanced manufacturing process« less

In vivo tooth-color measurement with a new 3D intraoral scanning system in comparison to conventional digital and visual color determination methods.

PubMed

Mehl, Albert; Bosch, Gabriel; Fischer, Carolin; Ender, Andreas

Three-dimensional (3D) intraoral scanning systems allow for the simultaneous acquisition of 3D information about tooth surfaces and a photorealistic view of the patient's tooth colors. The goal of this study was the in vivo comparison of a new 3D scanner with a color acquisition mode and conventional visual and digital color measurements. The colors of 40 teeth of 20 patients were evaluated in seven ways: 1) By dentists using the Vita 3D-Master; 2) By dental technicians using the Vita 3D-Master; 3) With the 3Shape Trios device; 4) With the Vita Easyshade device; 5) With the Vita Easyshade Advance device; 6) With the SpectroShade device; and 7) With the SpectroShade Micro device. Digital measurements of Groups 3 to 7 were repeated three times for each tooth. For all groups, both the CIE Lab values and the Vita 3D-Master values were recorded. The repeatability and relative accuracy of the Vita 3D-Master values were analyzed statistically using Pearson's chi-squared test (α < 0.05). ΔE values were calculated from the CIE Lab values, which served as a basis for performing multidimensional scaling (MDS) and evaluating differences between the groups using the one-way ANOVA with post hoc Tamhane's test (α < 0.05). The results of the ΔE values showed that clinically relevant differences between the evaluation by dentists, dental technicians, and the intraoral scanning device (3Shape) are negligible. The intraoral 3D scanning device (Group 3) and the digital systems (Groups 4 to 7) did not differ significantly in the repeatability of color shade management. The SpectroShade Micro (Group 7) had significantly better relative accuracy than the other devices. The results demonstrate that intraoral scanning systems can be used to measure both tooth color and tooth surface in 3D. Intraoral optical scanning devices allow for the acquisition of accurate 3D surface data. Tooth color can be evaluated simultaneously and can be used to determine the color of restorations without requiring additional conventional color-measurement methods.

Improvement of the Raman detection system for pesticide residues on/in fruits and vegetables

NASA Astrophysics Data System (ADS)

Li, Yan; Peng, Yankun; Zhai, Chen; Chao, Kuanglin; Qin, Jianwei

2017-05-01

Pesticide residue is one of the major challenges to fruits safety, while the traditional detection methods of pesticide residue on fruits and vegetables can't afford the demand of rapid detection in actual production because of timeconsuming. Thus rapid identification and detection methods for pesticide residue are urgently needed at present. While most Raman detection systems in the market are spot detection systems, which limits the range of application. In the study, our lab develops a Raman detection system to achieve area-scan thorough the self-developed spot detection Raman system with a control software and two devices. In the system, the scanning area is composed of many scanning spots, which means every spot needs to be detected and more time will be taken than area-scan Raman system. But lower detection limit will be achieved in this method. And some detection device is needed towards fruits and vegetables in different shape. Two detection devices are developed to detect spherical fruits and leaf vegetables. During the detection, the device will make spherical fruit rotate along its axis of symmetry, and leaf vegetables will be pressed in the test surface smoothly. The detection probe will be set to keep a proper distance to the surface of fruits and vegetables. It should make sure the laser shins on the surface of spherical fruit vertically. And two software are used to detect spherical fruits and leaf vegetables will be integrated to one, which make the operator easier to switch. Accordingly two detection devices for spherical fruits and leaf vegetables will also be portable devices to make it easier to change. In the study, a new way is developed to achieve area-scan result by spot-scan Raman detection system.

Rotating-unbalanced-mass Devices for Scanning Balloon-borne Experiments, Free-flying Spacecraft, and Space Shuttle/space Station Experiments

NASA Technical Reports Server (NTRS)

Polites, Michael E.

1990-01-01

A new method is presented for scanning balloon-borne experiments, free-flying spacecraft, and gimballed experiments mounted to the space shuttle or the space station. It uses rotating-unbalanced-mass (RUM) devices for generating circular, line, or raster scan patterns and an auxiliary control system for target acquisition, keeping the scan centered on the target, and producing complementary motion for raster scanning. It is ideal for applications where the only possible way to accomplish the required scan is to physically scan the entire experiment or spacecraft as in x ray and gamma ray experiments. In such cases, this new method should have advantages over prior methods in terms of either power, weight, cost, performance, stability, or a combination of these.

Safe Active Scanning for Energy Delivery Systems Final Report

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

Helms, J.; Salazar, B.; Scheibel, P.

The Department of Energy’s Cybersecurity for Energy Delivery Systems Program has funded Safe(r) Active Scanning for Energy Delivery Systems, led by Lawrence Livermore National Laboratory, to investigate and analyze the impacts of active scanning in the operational environment of energy delivery systems. In collaboration with Pacific Northwest National Laboratory and Idaho National Laboratory, active scans across three testbeds including 38 devices were performed. This report gives a summary of the initial literature survey performed on the SASEDS project as well as industry partner interview summaries and main findings from Phase 1 of the project. Additionally, the report goes into themore » details of scanning techniques, methodologies for testing, testbed descriptions, and scanning results, with appendices to elaborate on the specific scans that were performed. As a result of testing, a single device out of 38 exhibited problems when actively scanned, and a reboot was required to fix it. This single failure indicates that active scanning is not likely to have a detrimental effect on the safety and resilience of energy delivery systems. We provide a path forward for future research that could enable wide adoption of active scanning and lead utilities to incorporate active scanning as part of their default network security plans to discover and rectify rogue devices, adversaries, and services that may be on the network. This increased network visibility will allow operational technology cybersecurity practitioners to improve their situational awareness of networks and their vulnerabilities.« less

Digital Thickness Measurement of a Transparent Plastic Orthodontic Device

NASA Astrophysics Data System (ADS)

Kim, Yoon-Hwan; Rhim, Sung-Han

2018-05-01

A transparent orthodontic device is used to move the teeth to the final calibration position to form a proper set of teeth. Because the uniform thickness of the device plays an important role in tooth positioning, the accuracy of the device's thickness profile is important for effective orthodontic treatment. However, due to the complexity of the device's geometry and the transparency of the device's material, measuring the complete thickness profile has been difficult. In the present study, a new optical scanning method to measure the thickness profile of transparent plastic orthodontic devices is proposed and evaluated by using scanning electron microscopy (SEM). The error of the new measurement method is less than ±18 μm. The new method can be used to measure the thickness of non-specific, multi-curved, transparent orthodontic devices.

Two-dimensional scanning high-energy particle diagnostic system in Large Helical Device

NASA Astrophysics Data System (ADS)

Ozaki, T.; Goncharov, P.; Sudo, S.; Shoji, M.; Kawahata, K.; Kaneko, O.; Murakami, S.

2004-10-01

A high-energy neutral particle measurement is one of the important diagnostics for ion temperature and high-energy particle confinement analysis. The neutral particle analyzer in the large helical device is capable of wide range scanning as a feature. We have obtained various data using the horizontal scan of the analyzer. Recently, in addition to the horizontal scan, a high-speed perpendicular scan became possible which enables acquisition of new information in the poloidal direction. Two stainless blocks are set on the opposite sides of the chain in order to balance the weight (700 kg) of the analyzer and reduce the load for the motor. Therefore a very high scan speed of 1°/s can be obtained. The scanning speed is 1°/s. By adding the vertical scan, the ion temperature profile and the radial variation of the signal loss associated with the resonant loss was obtained in preliminary experimental results.

A versatile LabVIEW and field-programmable gate array-based scanning probe microscope for in operando electronic device characterization.

PubMed

Berger, Andrew J; Page, Michael R; Jacob, Jan; Young, Justin R; Lewis, Jim; Wenzel, Lothar; Bhallamudi, Vidya P; Johnston-Halperin, Ezekiel; Pelekhov, Denis V; Hammel, P Chris

2014-12-01

Understanding the complex properties of electronic and spintronic devices at the micro- and nano-scale is a topic of intense current interest as it becomes increasingly important for scientific progress and technological applications. In operando characterization of such devices by scanning probe techniques is particularly well-suited for the microscopic study of these properties. We have developed a scanning probe microscope (SPM) which is capable of both standard force imaging (atomic, magnetic, electrostatic) and simultaneous electrical transport measurements. We utilize flexible and inexpensive FPGA (field-programmable gate array) hardware and a custom software framework developed in National Instrument's LabVIEW environment to perform the various aspects of microscope operation and device measurement. The FPGA-based approach enables sensitive, real-time cantilever frequency-shift detection. Using this system, we demonstrate electrostatic force microscopy of an electrically biased graphene field-effect transistor device. The combination of SPM and electrical transport also enables imaging of the transport response to a localized perturbation provided by the scanned cantilever tip. Facilitated by the broad presence of LabVIEW in the experimental sciences and the openness of our software solution, our system permits a wide variety of combined scanning and transport measurements by providing standardized interfaces and flexible access to all aspects of a measurement (input and output signals, and processed data). Our system also enables precise control of timing (synchronization of scanning and transport operations) and implementation of sophisticated feedback protocols, and thus should be broadly interesting and useful to practitioners in the field.

A versatile LabVIEW and field-programmable gate array-based scanning probe microscope for in operando electronic device characterization

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

Berger, Andrew J., E-mail: berger.156@osu.edu; Page, Michael R.; Young, Justin R.

Understanding the complex properties of electronic and spintronic devices at the micro- and nano-scale is a topic of intense current interest as it becomes increasingly important for scientific progress and technological applications. In operando characterization of such devices by scanning probe techniques is particularly well-suited for the microscopic study of these properties. We have developed a scanning probe microscope (SPM) which is capable of both standard force imaging (atomic, magnetic, electrostatic) and simultaneous electrical transport measurements. We utilize flexible and inexpensive FPGA (field-programmable gate array) hardware and a custom software framework developed in National Instrument's LabVIEW environment to perform themore » various aspects of microscope operation and device measurement. The FPGA-based approach enables sensitive, real-time cantilever frequency-shift detection. Using this system, we demonstrate electrostatic force microscopy of an electrically biased graphene field-effect transistor device. The combination of SPM and electrical transport also enables imaging of the transport response to a localized perturbation provided by the scanned cantilever tip. Facilitated by the broad presence of LabVIEW in the experimental sciences and the openness of our software solution, our system permits a wide variety of combined scanning and transport measurements by providing standardized interfaces and flexible access to all aspects of a measurement (input and output signals, and processed data). Our system also enables precise control of timing (synchronization of scanning and transport operations) and implementation of sophisticated feedback protocols, and thus should be broadly interesting and useful to practitioners in the field.« less

Multi-beam and single-chip LIDAR with discrete beam steering by digital micromirror device

NASA Astrophysics Data System (ADS)

Rodriguez, Joshua; Smith, Braden; Hellman, Brandon; Gin, Adley; Espinoza, Alonzo; Takashima, Yuzuru

2018-02-01

A novel Digital Micromirror Device (DMD) based beam steering enables a single chip Light Detection and Ranging (LIDAR) system for discrete scanning points. We present increasing number of scanning point by using multiple laser diodes for Multi-beam and Single-chip DMD-based LIDAR.

76 FR 52970 - In the Matter of Certain Biometric Scanning Devices, Components Thereof, Associated Software, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-24

... INTERNATIONAL TRADE COMMISSION [Investigation No. 337-TA-720] In the Matter of Certain Biometric... accessing its Internet server at http://www.usitc.gov . The public record for this investigation may be... certain biometric scanning devices, components thereof, associated software, and products containing the...

Corroborating evidence-based medicine.

PubMed

Mebius, Alexander

2014-12-01

Proponents of evidence-based medicine (EBM) have argued convincingly for applying this scientific method to medicine. However, the current methodological framework of the EBM movement has recently been called into question, especially in epidemiology and the philosophy of science. The debate has focused on whether the methodology of randomized controlled trials provides the best evidence available. This paper attempts to shift the focus of the debate by arguing that clinical reasoning involves a patchwork of evidential approaches and that the emphasis on evidence hierarchies of methodology fails to lend credence to the common practice of corroboration in medicine. I argue that the strength of evidence lies in the evidence itself, and not the methodology used to obtain that evidence. Ultimately, when it comes to evaluating the effectiveness of medical interventions, it is the evidence obtained from the methodology rather than the methodology that should establish the strength of the evidence. © 2014 John Wiley & Sons, Ltd.

Finishing of additively manufactured titanium alloy by shape adaptive grinding (SAG)

NASA Astrophysics Data System (ADS)

Beaucamp, Anthony T.; Namba, Yoshiharu; Charlton, Phillip; Jain, Samyak; Graziano, Arthur A.

2015-06-01

In recent years, rapid prototyping of titanium alloy components for medical and aeronautics application has become viable thanks to advances in technologies such as electron beam melting (EBM) and selective laser sintering (SLS). However, for many applications the high surface roughness generated by additive manufacturing techniques demands a post-finishing operation to improve the surface quality prior to usage. In this paper, the novel shape adaptive grinding process has been applied to finishing titanium alloy (Ti6Al4V) additively manufactured by EBM and SLS. It is shown that the micro-structured surface layer resulting from the melting process can be removed, and the surface can then be smoothed down to less than 10 nm Ra (starting from 4-5 μm Ra) using only three different diamond grit sizes. This paper also demonstrates application of the technology to freeform shapes, and documents the dimensional accuracy of finished artifacts.

Deciphering the complexity of acute inflammation using mathematical models.

PubMed

Vodovotz, Yoram

2006-01-01

Various stresses elicit an acute, complex inflammatory response, leading to healing but sometimes also to organ dysfunction and death. We constructed both equation-based models (EBM) and agent-based models (ABM) of various degrees of granularity--which encompass the dynamics of relevant cells, cytokines, and the resulting global tissue dysfunction--in order to begin to unravel these inflammatory interactions. The EBMs describe and predict various features of septic shock and trauma/hemorrhage (including the response to anthrax, preconditioning phenomena, and irreversible hemorrhage) and were used to simulate anti-inflammatory strategies in clinical trials. The ABMs that describe the interrelationship between inflammation and wound healing yielded insights into intestinal healing in necrotizing enterocolitis, vocal fold healing during phonotrauma, and skin healing in the setting of diabetic foot ulcers. Modeling may help in understanding the complex interactions among the components of inflammation and response to stress, and therefore aid in the development of novel therapies and diagnostics.

Flipped classroom model for learning evidence-based medicine.

PubMed

Rucker, Sydney Y; Ozdogan, Zulfukar; Al Achkar, Morhaf

2017-01-01

Journal club (JC), as a pedagogical strategy, has long been used in graduate medical education (GME). As evidence-based medicine (EBM) becomes a mainstay in GME, traditional models of JC present a number of insufficiencies and call for novel models of instruction. A flipped classroom model appears to be an ideal strategy to meet the demands to connect evidence to practice while creating engaged, culturally competent, and technologically literate physicians. In this article, we describe a novel model of flipped classroom in JC. We present the flow of learning activities during the online and face-to-face instruction, and then we highlight specific considerations for implementing a flipped classroom model. We show that implementing a flipped classroom model to teach EBM in a residency program not only is possible but also may constitute improved learning opportunity for residents. Follow-up work is needed to evaluate the effectiveness of this model on both learning and clinical practice.

[From evidence-based medicine to value-based medicine].

PubMed

Zhang, Shao-dan; Liang, Yuan-bo; Li, Si-zhen

2006-11-01

Evidence base medicine (EBM) is based on objective evidence, which provides best available knowledge for physicians to scientifically make medical and therapeutic decisions for the care of all individual patients in order to improve the effectiveness of treatment and to prolong the life of patients. EBM has made a significant progress in clinical practice. But medical therapies cannot always bring a better life quality and clinically, patients' preference should be always taken into account. Value-based medicine medicine (VBM) is the practice of medicine that emphasizes the value received from an intervention. It takes evidence-based data to a higher level by combining the parameters of patient-perceived value with the cost of an intervention. The fundamental instrument of VBM is cost-utility analysis. VBM will provide a better practice model to evaluate the therapeutic package and cost effectiveness for individual and general health care.

Flipped classroom model for learning evidence-based medicine

PubMed Central

Rucker, Sydney Y; Ozdogan, Zulfukar; Al Achkar, Morhaf

2017-01-01

Journal club (JC), as a pedagogical strategy, has long been used in graduate medical education (GME). As evidence-based medicine (EBM) becomes a mainstay in GME, traditional models of JC present a number of insufficiencies and call for novel models of instruction. A flipped classroom model appears to be an ideal strategy to meet the demands to connect evidence to practice while creating engaged, culturally competent, and technologically literate physicians. In this article, we describe a novel model of flipped classroom in JC. We present the flow of learning activities during the online and face-to-face instruction, and then we highlight specific considerations for implementing a flipped classroom model. We show that implementing a flipped classroom model to teach EBM in a residency program not only is possible but also may constitute improved learning opportunity for residents. Follow-up work is needed to evaluate the effectiveness of this model on both learning and clinical practice. PMID:28919831

Location specific solidification microstructure control in electron beam melting of Ti-6Al-4V

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

Narra, Sneha P.; Cunningham, Ross; Beuth, Jack

Relationships between prior beta grain size in solidified Ti-6Al-4V and melting process parameters in the Electron Beam Melting (EBM) process are investigated. Samples are built by varying a machine-dependent proprietary speed function to cover the process space. Optical microscopy is used to measure prior beta grain widths and assess the number of prior beta grains present in a melt pool in the raster region of the build. Despite the complicated evolution of beta grain sizes, the beta grain width scales with melt pool width. The resulting understanding of the relationship between primary machine variables and prior beta grain widths ismore » a key step toward enabling the location specific control of as-built microstructure in the EBM process. Control of grain width in separate specimens and within a single specimen is demonstrated.« less

Why evidence-based medicine failed in patient care and medicine-based evidence will succeed.

PubMed

Horwitz, Ralph I; Singer, Burton H

2017-04-01

Evidence-based medicine (EBM) has succeeded in strengthening the evidence base for population medicine. Where EBM has failed is in answering the practicing doctor's question of what a likely outcome would be when a given treatment is administered to a particular patient with her own distinctive biological and biographical (life experience) profile. We propose Medicine-based evidence (MBE), based on the profiles of individual patients, as the evidence base for individualized or personalized medicine. MBE will build an archive of patient profiles using data from all study types and data sources, and will include both clinical and socio-behavioral information. The clinician seeking guidance for the management of an individual patient will start with the patient's longitudinal profile and find approximate matches in the archive that describes how similar patients responded to a contemplated treatment and alternative treatments. Copyright © 2017 Elsevier Inc. All rights reserved.

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

PubMed Central

Castelnuovo, Gianluca

2010-01-01

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

Benefits and challenges of transitioning preterm infants to at-breast feedings

PubMed Central

Buckley, Kathleen M; Charles, Gloria E

2006-01-01

Upon hospital discharge it is not unusual for mothers of preterm infants to continue to meet all or most of their infants' nutritional needs through bottle feedings of expressed breast milk (EBM) because of infants' physiological immaturity and maternal concerns with an inadequacy of milk supply. Although for some mothers the challenge of transitioning the infant to feeding at the breast may be beyond their ability and resources, for others it appears to be based on a conscious choice. Mothers are often unaware of the advantages of breastfeeding at the breast. The purpose of this article is to examine some of the factors that may contribute to the inability and resistance of mothers to transition their preterm infants, and to report on the potential short and long-term advantages associated with feeding at the breast as opposed to feeding bottles of EBM. PMID:16945150

Rationalism, Empiricism, and Evidence-Based Medicine: A Call for a New Galenic Synthesis.

PubMed

Webb, William M

2018-04-25

Thirty years after the rise of the evidence-based medicine (EBM) movement, formal training in philosophy remains poorly represented among medical students and their educators. In this paper, I argue that EBM’s reception in this context has resulted in a privileging of empiricism over rationalism in clinical reasoning with unintended consequences for medical practice. After a limited review of the history of medical epistemology, I argue that a solution to this problem can be found in the method of the 2nd-century Roman physician Galen, who brought empiricism and rationalism together in a synthesis anticipating the scientific method. Next, I review several of the problems that have been identified as resulting from a staunch commitment to empiricism in medical practice. Finally, I conclude that greater epistemological awareness in the medical community would precipitate a Galenic shift toward a more epistemically balanced, scientific approach to clinical research.

Science and Pseudoscience in Medicine: Evidence-Based vs. Evidence-Biased Medicine.

PubMed

Jakovljević, Miro; Ostojić, Ljerka

2016-12-01

The concept of evidence-based medicine (EBM), as the highest standard of health care, came into existence in 1990s to promote a systematic approach to helping clinicians in their practice to be guided by the best available scientific evidence. However, there has been an increasing number of warning reports that in modern research, misrepresented, false and unuseful findings may be the majority or even the vast majority of published research claims In spite of the huge scientific progress, pseudoscience and associated evidence biased medicine represent a serious threat to the concept of the EBM. Effective education in medicine, proper research motivation, sound systems and creative thinking and culture of scientific dialogue may significantly contribute to better science and evidence-based medicine. The seven key words of good science, research and publishing are: integrity, motivation, capacity, understanding, knowledge, experience, and creativity.

Development of scanning graphene Hall probes for magnetic microscopy

NASA Astrophysics Data System (ADS)

Schaefer, Brian T.; Wang, Lei; McEuen, Paul L.; Nowack, Katja C.

We discuss our progress on developing scanning Hall probes fabricated from hexagonal boron nitride (hBN)-encapsulated graphene, with the goal to image magnetic fields with submicron resolution. In contrast to scanning superconducting quantum interference device (SQUID) microscopy, this technique is compatible with a large applied magnetic field and not limited to cryogenic temperatures. The field sensitivity of a Hall probe depends inversely on carrier density, while the primary source of noise in the measurement is Johnson noise originating from the device resistance. hBN-encapsulated graphene demonstrates high carrier mobility at low carrier densities, therefore making it an ideal material for sensitive Hall probes. Furthermore, engineering the dielectric environment of graphene by encapsulating in hBN reduces low-frequency charge noise and disorder from the substrate. We outline our plans for adapting these devices for scanning, including characterization of the point spread function with a scanned current loop and fabrication of a deep-etched structure that enables positioning the sensitive area within 100 nanometers of the sample surface.

Control electronics for a multi-laser/multi-detector scanning system

NASA Technical Reports Server (NTRS)

Kennedy, W.

1980-01-01

The Mars Rover Laser Scanning system uses a precision laser pointing mechanism, a photodetector array, and the concept of triangulation to perform three dimensional scene analysis. The system is used for real time terrain sensing and vision. The Multi-Laser/Multi-Detector laser scanning system is controlled by a digital device called the ML/MD controller. A next generation laser scanning system, based on the Level 2 controller, is microprocessor based. The new controller capabilities far exceed those of the ML/MD device. The first draft circuit details and general software structure are presented.

Definition and design of an experiment to test raster scanning with rotating unbalanced-mass devices on gimbaled payloads

NASA Technical Reports Server (NTRS)

Lightsey, W. D.; Alhorn, D. C.; Polites, M. E.

1992-01-01

An experiment designed to test the feasibility of using rotating unbalanced-mass (RUM) devices for line and raster scanning gimbaled payloads, while expending very little power is described. The experiment is configured for ground-based testing, but the scan concept is applicable to ground-based, balloon-borne, and space-based payloads, as well as free-flying spacecraft. The servos used in scanning are defined; the electronic hardware is specified; and a computer simulation model of the system is described. Simulation results are presented that predict system performance and verify the servo designs.

Huffman and linear scanning methods with statistical language models.

PubMed

Roark, Brian; Fried-Oken, Melanie; Gibbons, Chris

2015-03-01

Current scanning access methods for text generation in AAC devices are limited to relatively few options, most notably row/column variations within a matrix. We present Huffman scanning, a new method for applying statistical language models to binary-switch, static-grid typing AAC interfaces, and compare it to other scanning options under a variety of conditions. We present results for 16 adults without disabilities and one 36-year-old man with locked-in syndrome who presents with complex communication needs and uses AAC scanning devices for writing. Huffman scanning with a statistical language model yielded significant typing speedups for the 16 participants without disabilities versus any of the other methods tested, including two row/column scanning methods. A similar pattern of results was found with the individual with locked-in syndrome. Interestingly, faster typing speeds were obtained with Huffman scanning using a more leisurely scan rate than relatively fast individually calibrated scan rates. Overall, the results reported here demonstrate great promise for the usability of Huffman scanning as a faster alternative to row/column scanning.

A novel near real-time laser scanning device for geometrical determination of pleural cavity surface.

PubMed

Kim, Michele M; Zhu, Timothy C

2013-02-02

During HPPH-mediated pleural photodynamic therapy (PDT), it is critical to determine the anatomic geometry of the pleural surface quickly as there may be movement during treatment resulting in changes with the cavity. We have developed a laser scanning device for this purpose, which has the potential to obtain the surface geometry in real-time. A red diode laser with a holographic template to create a pattern and a camera with auto-focusing abilities are used to scan the cavity. In conjunction with a calibration with a known surface, we can use methods of triangulation to reconstruct the surface. Using a chest phantom, we are able to obtain a 360 degree scan of the interior in under 1 minute. The chest phantom scan was compared to an existing CT scan to determine its accuracy. The laser-camera separation can be determined through the calibration with 2mm accuracy. The device is best suited for environments that are on the scale of a chest cavity (between 10cm and 40cm). This technique has the potential to produce cavity geometry in real-time during treatment. This would enable PDT treatment dosage to be determined with greater accuracy. Works are ongoing to build a miniaturized device that moves the light source and camera via a fiber-optics bundle commonly used for endoscopy with increased accuracy.

Are Portable Stereophotogrammetric Devices Reliable in Facial Imaging? A Validation Study of VECTRA H1 Device.

PubMed

Gibelli, Daniele; Pucciarelli, Valentina; Cappella, Annalisa; Dolci, Claudia; Sforza, Chiarella

2018-01-31

Modern 3-dimensional (3D) image acquisition systems represent a crucial technologic development in facial anatomy because of their accuracy and precision. The recently introduced portable devices can improve facial databases by increasing the number of applications. In the present study, the VECTRA H1 portable stereophotogrammetric device was validated to verify its applicability to 3D facial analysis. Fifty volunteers underwent 4 facial scans using portable VECTRA H1 and static VECTRA M3 devices (2 for each instrument). Repeatability of linear, angular, surface area, and volume measurements was verified within the device and between devices using the Bland-Altman test and the calculation of absolute and relative technical errors of measurement (TEM and rTEM, respectively). In addition, the 2 scans obtained by the same device and the 2 scans obtained by different devices were registered and superimposed to calculate the root mean square (RMS; point-to-point) distance between the 2 surfaces. Most linear, angular, and surface area measurements had high repeatability in M3 versus M3, H1 versus H1, and M3 versus H1 comparisons (range, 82.2 to 98.7%; TEM range, 0.3 to 2.0 mm, 0.4° to 1.8°; rTEM range, 0.2 to 3.1%). In contrast, volumes and RMS distances showed evident differences in M3 versus M3 and H1 versus H1 comparisons and reached the maximum when scans from the 2 different devices were compared. The portable VECTRA H1 device proved reliable for assessing linear measurements, angles, and surface areas; conversely, the influence of involuntary facial movements on volumes and RMS distances was more important compared with the static device. Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Transmissive liquid-crystal device correcting primary coma aberration and astigmatism in laser scanning microscopy

NASA Astrophysics Data System (ADS)

Tanabe, Ayano; Hibi, Terumasa; Ipponjima, Sari; Matsumoto, Kenji; Yokoyama, Masafumi; Kurihara, Makoto; Hashimoto, Nobuyuki; Nemoto, Tomomi

2016-03-01

Laser scanning microscopy allows 3D cross-sectional imaging inside biospecimens. However, certain aberrations produced can degrade the quality of the resulting images. We previously reported a transmissive liquid-crystal device that could compensate for the predominant spherical aberrations during the observations, particularly in deep regions of the samples. The device, inserted between the objective lens and the microscope revolver, improved the image quality of fixed-mouse-brain slices that were observed using two-photon excitation laser scanning microscopy, which was originally degraded by spherical aberration. In this study, we developed a transmissive device that corrects primary coma aberration and astigmatism, motivated by the fact that these asymmetric aberrations can also often considerably deteriorate image quality, even near the sample surface. The device's performance was evaluated by observing fluorescent beads using single-photon excitation laser scanning microscopy. The fluorescence intensity in the image of the bead under a cover slip tilted in the y-direction was increased by 1.5 times after correction by the device. Furthermore, the y- and z-widths of the imaged bead were reduced to 66% and 65%, respectively. On the other hand, for the imaged bead sucked into a glass capillary in the longitudinal x-direction, correction with the device increased the fluorescence intensity by 2.2 times compared to that of the aberrated image. In addition, the x-, y-, and z-widths of the bead image were reduced to 75%, 53%, and 40%, respectively. Our device successfully corrected several asymmetric aberrations to improve the fluorescent signal and spatial resolution, and might be useful for observing various biospecimens.

Linking research to practice: the rise of evidence-based health sciences librarianship*

PubMed Central

Marshall, Joanne Gard

2014-01-01

Purpose: The lecture explores the origins of evidence-based practice (EBP) in health sciences librarianship beginning with examples from the work of Janet Doe and past Doe lecturers. Additional sources of evidence are used to document the rise of research and EBP as integral components of our professional work. Methods: Four sources of evidence are used to examine the rise of EBP: (1) a publication by Doe and research-related content in past Doe lectures, (2) research-related word usage in articles in the Bulletin of the Medical Library Association and Journal of the Medical Library Association between 1961 and 2010, (3) Medical Library Association activities, and (4) EBP as an international movement. Results: These sources of evidence confirm the rise of EBP in health sciences librarianship. International initiatives sparked the rise of evidence-based librarianship and continue to characterize the movement. This review shows the emergence of a unique form of EBP that, although inspired by evidence-based medicine (EBM), has developed its own view of evidence and its application in library and information practice. Implications: Health sciences librarians have played a key role in initiating, nurturing, and spreading EBP in other branches of our profession. Our close association with EBM set the stage for developing our own EBP. While we relied on EBM as a model for our early efforts, we can observe the continuing evolution of our own unique approach to using, creating, and applying evidence from a variety of sources to improve the quality of health information services. PMID:24415915

Increasing utilization of Internet-based resources following efforts to promote evidence-based medicine: a national study in Taiwan.

PubMed

Weng, Yi-Hao; Kuo, Ken N; Yang, Chun-Yuh; Lo, Heng-Lien; Shih, Ya-Hui; Chen, Chiehfeng; Chiu, Ya-Wen

2013-01-07

Since the beginning of 2007, the National Health Research Institutes has been promoting the dissemination of evidence-based medicine (EBM). The current study examined longitudinal trends of behaviors in how hospital-based physicians and nurses have searched for medical information during the spread of EBM. Cross-sectional postal questionnaire surveys were conducted in nationally representative regional hospitals of Taiwan thrice in 2007, 2009, and 2011. Demographic data were gathered concerning gender, age, working experience, teaching appointment, academic degree, and administrative position. Linear and logistic regression models were used to examine predictors and changes over time. Data from physicians and nurses were collected in 2007 (n = 1156), 2009 (n = 2975), and 2011 (n = 3999). There were significant increases in the use of four Internet-based resources - Web portals, online databases, electronic journals, and electronic books - across the three survey years among physicians and nurses (p < 0.001). Access to textbooks and printed journals, however, did not change over the 4-year study period. In addition, there were significant relationships between the usage of Internet-based resources and users' characteristics. Age and faculty position were important predictors in relation to the usage among physicians and nurses, while academic degree served as a critical factor among nurses only. Physicians and nurses used a variety of sources to look for medical information. There was a steady increase in use of Internet-based resources during the diffusion period of EBM. The findings highlight the importance of the Internet as a prominent source of medical information for main healthcare professionals.

Effect of an EBM course in combination with case method learning sessions: an RCT on professional performance, job satisfaction, and self-efficacy of occupational physicians

PubMed Central

Schaafsma, Frederieke G.; Nieuwenhuijsen, Karen; van Dijk, Frank J. H.

2008-01-01

Objective An intervention existing of an evidence-based medicine (EBM) course in combination with case method learning sessions (CMLSs) was designed to enhance the professional performance, self-efficacy and job satisfaction of occupational physicians. Methods A cluster randomized controlled trial was set up and data were collected through questionnaires at baseline (T0), directly after the intervention (T1) and 7 months after baseline (T2). The data of the intervention group [T0 (n = 49), T1 (n = 31), T2 (n = 29)] and control group [T0 (n = 49), T1 (n = 28), T2 (n = 28)] were analysed in mixed model analyses. Mean scores of the perceived value of the CMLS were calculated in the intervention group. Results The overall effect of the intervention over time comparing the intervention with the control group was statistically significant for professional performance (p < 0.001). Job satisfaction and self-efficacy changes were small and not statistically significant between the groups. The perceived value of the CMLS to gain new insights and to improve the quality of their performance increased with the number of sessions followed. Conclusion An EBM course in combination with case method learning sessions is perceived as valuable and offers evidence to enhance the professional performance of occupational physicians. However, it does not seem to influence their self-efficacy and job satisfaction. PMID:18386046

Investigating the Abscopal Effects of Radioablation on Shielded Bone Marrow in Rodent Models Using Multimodality Imaging.

PubMed

Afshar, Solmaz F; Zawaski, Janice A; Inoue, Taeko; Rendon, David A; Zieske, Arthur W; Punia, Jyotinder N; Sabek, Omaima M; Gaber, M Waleed

2017-07-01

The abscopal effect is the response to radiation at sites that are distant from the irradiated site of an organism, and it is thought to play a role in bone marrow (BM) recovery by initiating responses in the unirradiated bone marrow. Understanding the mechanism of this effect has applications in treating BM failure (BMF) and BM transplantation (BMT), and improving survival of nuclear disaster victims. Here, we investigated the use of multimodality imaging as a translational tool to longitudinally assess bone marrow recovery. We used positron emission tomography/computed tomography (PET/CT), magnetic resonance imaging (MRI) and optical imaging to quantify bone marrow activity, vascular response and marrow repopulation in fully and partially irradiated rodent models. We further measured the effects of radiation on serum cytokine levels, hematopoietic cell counts and histology. PET/CT imaging revealed a radiation-induced increase in proliferation in the shielded bone marrow (SBM) compared to exposed bone marrow (EBM) and sham controls. T 2 -weighted MRI showed radiation-induced hemorrhaging in the EBM and unirradiated SBM. In the EBM and SBM groups, we found alterations in serum cytokine and hormone levels and in hematopoietic cell population proportions, and histological evidence of osteoblast activation at the bone marrow interface. Importantly, we generated a BMT mouse model using fluorescent-labeled bone marrow donor cells and performed fluorescent imaging to reveal the migration of bone marrow cells from shielded to radioablated sites. Our study validates the use of multimodality imaging to monitor bone marrow recovery and provides evidence for the abscopal response in promoting bone marrow recovery after irradiation.

Study on Language Rehabilitation for Aphasia.

PubMed

Yu, Zeng-Zhi; Jiang, Shu-Jun; Jia, Zi-Shan; Xiao, Hong-Yu; Zhou, Mei-Qi

2017-06-20

The aim is to update our clinical recommendations for evidence-based language rehabilitation of people with aphasia, based on a systematic review of the literature from 1999 to 2015. Articles referred to in this systematic review of the Medline and PubMed published in English language literatures were from 1998 to 2015. The terms used in the literature searches were aphasia and evidenced-based. The task force initially identified citations for 51 published articles. Of the 51 articles, 44 studies were selected after further detailed review. Six articles, which were not written in English, and one study related to laryngectomy rehabilitation interventions, were excluded from the study. This study referred to all the important and English literature in full. Aphasia is the linguistic disability, which usually results from injuries to the dominant hemisphere of the brain. The rehabilitation of aphasia is until in the process of being debated and researched. Evidence-based medicine (EBM), EBM based on the clinical evidence, promotes the practice of combining the clinicians' first-hand experience and the existing objective and scientific evidence encouraging making decisions based on both empirical evidence and the scientific evidence. Currently, EBM is being gradually implemented in the clinical practice as the aim of the development of modern medicine. At present, the research for the aphasia rehabilitation mainly focuses on the cognitive language rehabilitation and the intensive treatment and the precise treatment, etc. There is now sufficient information to support evidence-based protocols and implement empirically-supported treatments for linguistic disability after traumatic brain injury and stroke, which can be used to develop linguistic rehabilitation guidelines for patients with aphasia.

Marine Planning Benefits the Environment

EPA Science Inventory

Coastal and Marine Spatial Planning (CMSP) and Ecosystem-Based Management (EBM) are management approaches that allow sustainable coastal and ocean planning. The basic unit of management under CMSP is a large region, with the United States coastlines and Great Lakes divided into ...

Energy Balance Models of planetary climate as a tool for investigating the habitability of terrestrial planets and its evolution

NASA Astrophysics Data System (ADS)

Ferri, G.; Murante, G.; Provenzale, A.; Silva, L.; Vladilo, G.

2012-04-01

The study of the habitability and potential for life formation of terrestrial planets requires a considerable work of modelization owing to the limited amount of experimental constraints typical of this type of research. As an example, the paucity of experimental Archean data severely limits the study of the habitability of the primitive Earth at the epoch of the origin of life. In the case of exoplanets the amount of experimental information available is quite limited and the need for modelization strong. Here we focus on the modelization of the surface planetary temperature, a key thermodynamical quantity used to define the habitability. Energy Balance Models (EBM) of planetary climate provide a simple way to calculate the temperature-latitude profile of terrestrial planets with a small amount of computing resources. Thanks to this fact EBMs offer an excellent tool to exploring a wide range of parameter space and therefore testing the effects of variations of physical/chemical quantities unconstrained by experimental data. In particular, one can easily probe possible scenarios of habitability at different stages of planetary evolution. We have recently implemented one-dimensional EBMs featuring the possibility of probing variations of astronomical and geophysical parameters, such as stellar luminosity, orbital semi-major axis and eccentricity, obliquity of the planetary axis, planet rotational velocity, land/ocean surface fractions and thermal capacities, and latitudinal heat diffusion. After testing our models against results obtained in previous work (Williams & Kasting 1997, Icarus, 129, 254; Spiegel et al. 2008, ApJ, 681, 1609), we introduced a novel parametrization of the diffusion coefficient as a function of the stellar zenith distance. Our models have been validated using the mean temperature-latitude profiles of the present Earth and its seasonal variations; the global albedo has been used as an additional constraint. In this work we present specific examples of application of our EBMs to studies of habitability of terrestrial planets. In the first part we focus on the primitive Earth, taking into account the effects of the higher speed of Earth rotation and reduced solar luminosity at the epoch of life formation. In the second part we provide examples of habitability studies of planetary systems discovered in surveys of exoplanets. These examples allow us to critically discuss the concept of circumstellar habitable zone.

1D-Var multilayer assimilation of X-band SAR data into a detailed snowpack model

NASA Astrophysics Data System (ADS)

Phan, X. V.; Ferro-Famil, L.; Gay, M.; Durand, Y.; Dumont, M.; Morin, S.; Allain, S.; D'Urso, G.; Girard, A.

2014-10-01

The structure and physical properties of a snowpack and their temporal evolution may be simulated using meteorological data and a snow metamorphism model. Such an approach may meet limitations related to potential divergences and accumulated errors, to a limited spatial resolution, to wind or topography-induced local modulations of the physical properties of a snow cover, etc. Exogenous data are then required in order to constrain the simulator and improve its performance over time. Synthetic-aperture radars (SARs) and, in particular, recent sensors provide reflectivity maps of snow-covered environments with high temporal and spatial resolutions. The radiometric properties of a snowpack measured at sufficiently high carrier frequencies are known to be tightly related to some of its main physical parameters, like its depth, snow grain size and density. SAR acquisitions may then be used, together with an electromagnetic backscattering model (EBM) able to simulate the reflectivity of a snowpack from a set of physical descriptors, in order to constrain a physical snowpack model. In this study, we introduce a variational data assimilation scheme coupling TerraSAR-X radiometric data into the snowpack evolution model Crocus. The physical properties of a snowpack, such as snow density and optical diameter of each layer, are simulated by Crocus, fed by the local reanalysis of meteorological data (SAFRAN) at a French Alpine location. These snowpack properties are used as inputs of an EBM based on dense media radiative transfer (DMRT) theory, which simulates the total backscattering coefficient of a dry snow medium at X and higher frequency bands. After evaluating the sensitivity of the EBM to snowpack parameters, a 1D-Var data assimilation scheme is implemented in order to minimize the discrepancies between EBM simulations and observations obtained from TerraSAR-X acquisitions by modifying the physical parameters of the Crocus-simulated snowpack. The algorithm then re-initializes Crocus with the modified snowpack physical parameters, allowing it to continue the simulation of snowpack evolution, with adjustments based on remote sensing information. This method is evaluated using multi-temporal TerraSAR-X images acquired over the specific site of the Argentière glacier (Mont-Blanc massif, French Alps) to constrain the evolution of Crocus. Results indicate that X-band SAR data can be taken into account to modify the evolution of snowpack simulated by Crocus.

Comparing Scanning Modes for Youths with Cerebral Palsy. Final Report.

ERIC Educational Resources Information Center

Ottenbacher, Kenneth J.; Angelo, Jennifer

This study of 22 individuals (ages 13-20) with cerebral palsy investigated the use of scanning, an interface technique that allows access to assistive devices such as communication boards, electronic augmentative communication devices, and computers by using a pointer, either a finger or a cursor. This packet of information includes the findings…

In situ scanning tunneling microscope tip treatment device for spin polarization imaging

DOEpatents

Li, An-Ping [Oak Ridge, TN; Jianxing, Ma [Oak Ridge, TN; Shen, Jian [Knoxville, TN

2008-04-22

A tip treatment device for use in an ultrahigh vacuum in situ scanning tunneling microscope (STM). The device provides spin polarization functionality to new or existing variable temperature STM systems. The tip treatment device readily converts a conventional STM to a spin-polarized tip, and thereby converts a standard STM system into a spin-polarized STM system. The tip treatment device also has functions of tip cleaning and tip flashing a STM tip to high temperature (>2000.degree. C.) in an extremely localized fashion. Tip coating functions can also be carried out, providing the tip sharp end with monolayers of coating materials including magnetic films. The device is also fully compatible with ultrahigh vacuum sample transfer setups.

Scanning SQUID sampler with 40-ps time resolution

NASA Astrophysics Data System (ADS)

Cui, Zheng; Kirtley, John R.; Wang, Yihua; Kratz, Philip A.; Rosenberg, Aaron J.; Watson, Christopher A.; Gibson, Gerald W.; Ketchen, Mark B.; Moler, Kathryn. A.

2017-08-01

Scanning Superconducting QUantum Interference Device (SQUID) microscopy provides valuable information about magnetic properties of materials and devices. The magnetic flux response of the SQUID is often linearized with a flux-locked feedback loop, which limits the response time to microseconds or longer. In this work, we present the design, fabrication, and characterization of a novel scanning SQUID sampler with a 40-ps time resolution and linearized response to periodically triggered signals. Other design features include a micron-scale pickup loop for the detection of local magnetic flux, a field coil to apply a local magnetic field to the sample, and a modulation coil to operate the SQUID sampler in a flux-locked loop to linearize the flux response. The entire sampler device is fabricated on a 2 mm × 2 mm chip and can be scanned over macroscopic planar samples. The flux noise at 4.2 K with 100 kHz repetition rate and 1 s of averaging is of order 1 mΦ0. This SQUID sampler will be useful for imaging dynamics in magnetic and superconducting materials and devices.

Scanning SQUID sampler with 40-ps time resolution.

PubMed

Cui, Zheng; Kirtley, John R; Wang, Yihua; Kratz, Philip A; Rosenberg, Aaron J; Watson, Christopher A; Gibson, Gerald W; Ketchen, Mark B; Moler, Kathryn A

2017-08-01

Scanning Superconducting QUantum Interference Device (SQUID) microscopy provides valuable information about magnetic properties of materials and devices. The magnetic flux response of the SQUID is often linearized with a flux-locked feedback loop, which limits the response time to microseconds or longer. In this work, we present the design, fabrication, and characterization of a novel scanning SQUID sampler with a 40-ps time resolution and linearized response to periodically triggered signals. Other design features include a micron-scale pickup loop for the detection of local magnetic flux, a field coil to apply a local magnetic field to the sample, and a modulation coil to operate the SQUID sampler in a flux-locked loop to linearize the flux response. The entire sampler device is fabricated on a 2 mm × 2 mm chip and can be scanned over macroscopic planar samples. The flux noise at 4.2 K with 100 kHz repetition rate and 1 s of averaging is of order 1 mΦ 0 . This SQUID sampler will be useful for imaging dynamics in magnetic and superconducting materials and devices.

Fast scan control for deflection type mass spectrometers

NASA Technical Reports Server (NTRS)

Yeager, P. R.; Gaetano, G.; Hughes, D. B. (Inventor)

1974-01-01

A high speed scan device is reported that allows most any scanning sector mass spectrometer to measure preselected gases at a very high sampling rate. The device generates a rapidly changing staircase output which is applied to the accelerator of the spectrometer and it also generates defocusing pulses that are applied to one of the deflecting plates of the spectrometer which when shorted to ground deflects the ion beam away from the collector. A defocusing pulse occurs each time there is a change in the staircase output.

Magnetic Resonance Imaging in Nondependent Pacemaker Patients with Pacemakers and Defibrillators with a Nearly Depleted Battery.

PubMed

Okamura, Hideo; Padmanabhan, Deepak; Watson, Robert E; Dalzell, Connie; Acker, Nancy; Jondal, Mary; Romme, Abby L; Cha, Yong-Mei; Asirvatham, Samuel J; Felmlee, Joel P; Friedman, Paul A

2017-05-01

Magnetic resonance imaging (MRI) in patients with non-MRI-conditional cardiac implantable electronic devices (CIEDs) has been shown to be safe when performed under closely monitored protocols. However, the safety of MRI in patients with devices with a nearly depleted battery has not been reported. Prospective data were collected between January 2008 and May 2015 in patients with non-MRI-conditional CIEDs undergoing clinically indicated MRI under institutional protocol. Patients who were pacemaker dependent were excluded. Patients whose devices were at elective replacement indicator (ERI) at the time of MRI or close to ERI (ERI or replacement for battery depletion within 3 months of scan) were identified through database review and analyzed for clinical events. MRI scans (n = 569) were performed in 442 patients. Of these, we identified 13 scans performed with a nearly depleted battery in nine patients. All scans with implantable cardioverter defibrillators (ICDs, n = 9) were uneventful. However, two scans with pacemakers close to ERI resulted in a power-on-reset (PoR) event. One scan with a pacemaker close to ERI that was programmed to DOO mode reached ERI during MRI and automatically changed to VVI mode. Additionally, one scan with a pacemaker at ERI did not allow programming. All pacemakers with events were implanted before 2005. Patients with pacemakers and ICDs with a nearly depleted battery can safely undergo MRI when patients are not pacemaker dependent. Attention should be paid because old devices can result in PoR or ERI during MRI, which may lead to oversensing and inhibition of pacing. © 2017 Wiley Periodicals, Inc.

Thermo-Acoustic Ultrasound for Detection of RF-Induced Device Lead Heating in MRI.

PubMed

Dixit, Neerav; Stang, Pascal P; Pauly, John M; Scott, Greig C

2018-02-01

Patients who have implanted medical devices with long conductive leads are often restricted from receiving MRI scans due to the danger of RF-induced heating near the lead tips. Phantom studies have shown that this heating varies significantly on a case-by-case basis, indicating that many patients with implanted devices can receive clinically useful MRI scans without harm. However, the difficulty of predicting RF-induced lead tip heating prior to scanning prevents numerous implant recipients from being scanned. Here, we demonstrate that thermo-acoustic ultrasound (TAUS) has the potential to be utilized for a pre-scan procedure assessing the risk of RF-induced lead tip heating in MRI. A system was developed to detect TAUS signals by four different TAUS acquisition methods. We then integrated this system with an MRI scanner and detected a peak in RF power absorption near the tip of a model lead when transmitting from the scanner's body coil. We also developed and experimentally validated simulations to characterize the thermo-acoustic signal generated near lead tips. These results indicate that TAUS is a promising method for assessing RF implant safety, and with further development, a TAUS pre-scan could allow many more patients to have access to MRI scans of significant clinical value.

X-Ray Scan Detection for Cargo Integrity

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

Valencia, Juan D.; Miller, Steven D.

ABSTRACT The increase of terrorism and its global impact has made the determination of the contents of cargo containers a necessity. Existing technology allows non-intrusive inspections to determine the contents of a container rapidly and accurately. However, some cargo shipments are exempt from such inspections. Hence, there is a need for a technology that enables rapid and accurate means of detecting whether such containers were non-intrusively inspected. Non-intrusive inspections are most commonly performed utilizing high powered X-ray equipment. The challenge is creating a device that can detect short duration X-ray scans while maintaining a portable, battery powered, low cost, andmore » easy to use platform. The Pacific Northwest National Laboratory (PNNL) has developed a methodology and prototype device focused on this challenge. The prototype, developed by PNNL, is a battery powered electronic device that continuously measures its X-ray and Gamma exposure, calculates the dose equivalent rate, and makes a determination of whether the device has been exposed to the amount of radiation experienced during an X-ray inspection. Once an inspection is detected, the device will record a timestamp of the event and relay the information to authorized personnel via a visual alert, USB connection, and/or wireless communication. The results of this research demonstrate that PNNL’s prototype device can be effective at determining whether a container was scanned by X-ray equipment typically used for cargo container inspections. This paper focuses on laboratory measurements and test results acquired with the PNNL prototype device using several X-ray radiation levels. Keywords: Radiation, Scan, X-ray, Gamma, Detection, Cargo, Container, Wireless, RF« less

Accuracy analysis for triangulation and tracking based on time-multiplexed structured light.

PubMed

Wagner, Benjamin; Stüber, Patrick; Wissel, Tobias; Bruder, Ralf; Schweikard, Achim; Ernst, Floris

2014-08-01

The authors' research group is currently developing a new optical head tracking system for intracranial radiosurgery. This tracking system utilizes infrared laser light to measure features of the soft tissue on the patient's forehead. These features are intended to offer highly accurate registration with respect to the rigid skull structure by means of compensating for the soft tissue. In this context, the system also has to be able to quickly generate accurate reconstructions of the skin surface. For this purpose, the authors have developed a laser scanning device which uses time-multiplexed structured light to triangulate surface points. The accuracy of the authors' laser scanning device is analyzed and compared for different triangulation methods. These methods are given by the Linear-Eigen method and a nonlinear least squares method. Since Microsoft's Kinect camera represents an alternative for fast surface reconstruction, the authors' results are also compared to the triangulation accuracy of the Kinect device. Moreover, the authors' laser scanning device was used for tracking of a rigid object to determine how this process is influenced by the remaining triangulation errors. For this experiment, the scanning device was mounted to the end-effector of a robot to be able to calculate a ground truth for the tracking. The analysis of the triangulation accuracy of the authors' laser scanning device revealed a root mean square (RMS) error of 0.16 mm. In comparison, the analysis of the triangulation accuracy of the Kinect device revealed a RMS error of 0.89 mm. It turned out that the remaining triangulation errors only cause small inaccuracies for the tracking of a rigid object. Here, the tracking accuracy was given by a RMS translational error of 0.33 mm and a RMS rotational error of 0.12°. This paper shows that time-multiplexed structured light can be used to generate highly accurate reconstructions of surfaces. Furthermore, the reconstructed point sets can be used for high-accuracy tracking of objects, meeting the strict requirements of intracranial radiosurgery.

Ecosystem Services in the Gulf of Maine

EPA Science Inventory

The primary goal of ecosystem-based management (EBM) is to sustain the long-term capacity of the natural world to provide ecosystem services. A technical workshop was held with the object of moving toward identifying, mapping, quantifying, and valuing ecosystem services in the G...

Applications and requirements for MEMS scanner mirrors

NASA Astrophysics Data System (ADS)

Wolter, Alexander; Hsu, Shu-Ting; Schenk, Harald; Lakner, Hubert K.

2005-01-01

Micro scanning mirrors are quite versatile MEMS devices for the deflection of a laser beam or a shaped beam from another light source. The most exciting application is certainly in laser-scanned displays. Laser television, home cinema and data projectors will display the most brilliant colors exceeding even plasma, OLED and CRT. Devices for front and rear projection will have advantages in size, weight and price. These advantages will be even more important in near-eye virtual displays like head-mounted displays or viewfinders in digital cameras and potentially in UMTS handsets. Optical pattern generation by scanning a modulated beam over an area can be used also in a number of other applications: laser printers, direct writing of photo resist for printed circuit boards or laser marking and with higher laser power laser ablation or material processing. Scanning a continuous laser beam over a printed pattern and analyzing the scattered reflection is the principle of barcode reading in 1D and 2D. This principle works also for identification of signatures, coins, bank notes, vehicles and other objects. With a focused white-light or RGB beam even full color imaging with high resolution is possible from an amazingly small device. The form factor is also very interesting for the application in endoscopes. Further applications are light curtains for intrusion control and the generation of arbitrary line patterns for triangulation. Scanning a measurement beam extends point measurements to 1D or 2D scans. Automotive LIDAR (laser RADAR) or scanning confocal microscopy are just two examples. Last but not least there is the field of beam steering. E.g. for all-optical fiber switches or positioning of read-/write heads in optical storage devices. The variety of possible applications also brings a variety of specifications. This publication discusses various applications and their requirements.

Characterizing the Nature of Scan Results Discussions: Insights Into Why Patients Misunderstand Their Prognosis

PubMed Central

Singh, Sarguni; Cortez, Dagoberto; Maynard, Douglas; Cleary, James F.; DuBenske, Lori

2017-01-01

Introduction: Patients with incurable cancer have poor prognostic awareness. We present a detailed analysis of the dialogue between oncologists and patients in conversations with prognostic implications. Methods: A total of 128 audio-recorded encounters from a large multisite trial were obtained, and 64 involved scan results. We used conversation analysis, a qualitative method for studying human interaction, to analyze typical patterns and conversational devices. Results: Four components consistently occurred in sequential order: symptom-talk, scan-talk, treatment-talk, and logistic-talk. Six of the encounters (19%) were identified as good news, 15 (45%) as stable news, and 12 (36%) as bad news. The visit duration varied by the type of news: good, 15 minutes (07:00-29:00); stable, 17 minutes (07:00-41:00); and bad, 20 minutes (07:00-28:00). Conversational devices were common, appearing in half of recordings. Treatment-talk occupied 50% of bad-news encounters, 31% of good-news encounters, and 19% of stable-news encounters. Scan-talk occupied less than 10% of all conversations. There were only four instances of frank prognosis discussion. Conclusion: Oncologists and patients are complicit in constructing the typical encounter. Oncologists spend little time discussing scan results and the prognostic implications in favor of treatment-related talk. Conversational devices routinely help transition from scan-talk to detailed discussions about treatment options. We observed an opportunity to create prognosis-talk after scan-talk with a new conversational device, the question “Would you like to talk about what this means?” as the oncologist seeks permission to disclose prognostic information while ceding control to the patient. PMID:28095172

Device localization and dynamic scan plane selection using a wireless magnetic resonance imaging detector array.

PubMed

Riffe, Matthew J; Yutzy, Stephen R; Jiang, Yun; Twieg, Michael D; Blumenthal, Colin J; Hsu, Daniel P; Pan, Li; Gilson, Wesley D; Sunshine, Jeffrey L; Flask, Christopher A; Duerk, Jeffrey L; Nakamoto, Dean; Gulani, Vikas; Griswold, Mark A

2014-06-01

A prototype wireless guidance device using single sideband amplitude modulation (SSB) is presented for a 1.5T magnetic resonance imaging system. The device contained three fiducial markers each mounted to an independent receiver coil equipped with wireless SSB technology. Acquiring orthogonal projections of these markers determined the position and orientation of the device, which was used to define the scan plane for a subsequent image acquisition. Device localization and scan plane update required approximately 30 ms, so it could be interleaved with high temporal resolution imaging. Since the wireless device is used for localization and does not require full imaging capability, the design of the SSB wireless system was simplified by allowing an asynchronous clock between the transmitter and receiver. When coupled to a high readout bandwidth, the error caused by the lack of a shared frequency reference was quantified to be less than one pixel (0.78 mm) in the projection acquisitions. Image guidance with the prototype was demonstrated with a phantom where a needle was successfully guided to a target and contrast was delivered. The feasibility of active tracking with a wireless detector array is demonstrated. Wireless arrays could be incorporated into devices to assist in image-guided procedures. Copyright © 2013 Wiley Periodicals, Inc.

Device localization and dynamic scan plane selection using a wireless MRI detector array

PubMed Central

Riffe, Matthew J.; Yutzy, Stephen R.; Jiang, Yun; Twieg, Michael D.; Blumenthal, Colin J.; Hsu, Daniel P.; Pan, Li; Gilson, Wesley D.; Sunshine, Jeffrey L.; Flask, Christopher A.; Duerk, Jeffrey L.; Nakamoto, Dean; Gulani, Vikas; Griswold, Mark A.

2013-01-01

Purpose A prototype wireless guidance device using single sideband amplitude modulation (SSB) is presented for a 1.5T MRI system. Methods The device contained three fiducial markers each mounted to an independent receiver coil equipped with wireless SSB technology. Acquiring orthogonal projections of these markers determined the position and orientation of the device, which was used to define the scan plane for a subsequent image acquisition. Device localization and scan plane update required approximately 30 ms, so it could be interleaved with high temporal resolution imaging. Since the wireless device is used for localization and doesn’t require full imaging capability, the design of the SSB wireless system was simplified by allowing an asynchronous clock between the transmitter and receiver. Results When coupled to a high readout bandwidth, the error caused by the lack of a shared frequency reference was quantified to be less than one pixel (0.78 mm) in the projection acquisitions. Image-guidance with the prototype was demonstrated with a phantom where a needle was successfully guided to a target and contrast was delivered. Conclusion The feasibility of active tracking with a wireless detector array is demonstrated. Wireless arrays could be incorporated into devices to assist in image-guided procedures. PMID:23900921

Mechanical behavior of post-processed Inconel 718 manufactured through the electron beam melting process

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

Kirka, Michael M.; Medina, Frank; Dehoff, Ryan R.

Here, the electron beam melting (EBM) process was used to fabricate Inconel 718. The microstructure and tensile properties were characterized in both the as-fabricated and post-processed state transverse (T-orientation) and longitudinal (L-orientation) to the build direction. Post-processing involved both a hot isostatic pressing (HIP) and solution treatment and aging (STA) to homogenize the microstructure. In the as-fabricated state, EBM Inconel 718 exhibits a spatially dependent microstructure that is a function of build height. Spanning the last few layers is a cored dendritic structure comprised of the products (carbides and Laves phase) predicted under equilibrium solidification conditions. With increasing distance frommore » the build's top surface, the cored dendritic structure becomes increasingly homogeneous with complete dissolution of the secondary dendrite arms. Further, temporal phase kinetics are observed to lead to the dissolution of the strengthening γ"γ" and precipitation of networks of fine δ needles that span the grains. Microstructurally, post-processing resulted in dissolution of the δ networks and homogeneous precipitation of γ'"γ'" throughout the height of the build. In the as-fabricated state, the monotonic tensile behavior exhibits a height sensitivity within the T-orientation at both 20 and 650 °C. Along the L-orientation, the tensile behavior exhibits strength values comparable to the reference wrought material in the fully heat-treated state. After post-processing, the yield strength, ultimate strength, and elongation at failure for the EBM Inconel 718 were observed to have beneficially increased compared to the as-fabricated material. Further, as a result of post-processing the spatial variance of the ultimate yield strength and elongation at failure within the transverse direction decreased by 4 and 3× respectively.« less

Mechanical behavior of post-processed Inconel 718 manufactured through the electron beam melting process

DOE PAGES

Kirka, Michael M.; Medina, Frank; Dehoff, Ryan R.; ...

2016-10-21

Here, the electron beam melting (EBM) process was used to fabricate Inconel 718. The microstructure and tensile properties were characterized in both the as-fabricated and post-processed state transverse (T-orientation) and longitudinal (L-orientation) to the build direction. Post-processing involved both a hot isostatic pressing (HIP) and solution treatment and aging (STA) to homogenize the microstructure. In the as-fabricated state, EBM Inconel 718 exhibits a spatially dependent microstructure that is a function of build height. Spanning the last few layers is a cored dendritic structure comprised of the products (carbides and Laves phase) predicted under equilibrium solidification conditions. With increasing distance frommore » the build's top surface, the cored dendritic structure becomes increasingly homogeneous with complete dissolution of the secondary dendrite arms. Further, temporal phase kinetics are observed to lead to the dissolution of the strengthening γ"γ" and precipitation of networks of fine δ needles that span the grains. Microstructurally, post-processing resulted in dissolution of the δ networks and homogeneous precipitation of γ'"γ'" throughout the height of the build. In the as-fabricated state, the monotonic tensile behavior exhibits a height sensitivity within the T-orientation at both 20 and 650 °C. Along the L-orientation, the tensile behavior exhibits strength values comparable to the reference wrought material in the fully heat-treated state. After post-processing, the yield strength, ultimate strength, and elongation at failure for the EBM Inconel 718 were observed to have beneficially increased compared to the as-fabricated material. Further, as a result of post-processing the spatial variance of the ultimate yield strength and elongation at failure within the transverse direction decreased by 4 and 3× respectively.« less

Mask CD relationship to temperature at the time backscatter is received

NASA Astrophysics Data System (ADS)

Zable, Harold; Kronmiller, Tom; Pearman, Ryan; Guthrie, Bill; Shirali, Nagesh; Masuda, Yukihiro; Kamikubo, Takashi; Nakayamada, Noriaki; Fujimura, Aki

2017-07-01

Mask writers need to be able to write sub-50nm features accurately. Nano-imprint lithography (NIL) masters need to create sub-20nm line and space (L:S) patterns reliably. Increasingly slower resists are deployed, but mask write times need to remain reasonable. The leading edge EBM-9500 offers 1200A/cm2 current density to shoot variable shaped beam (VSB) to write the masks. Last year, thermal effect correction (TEC) was introduced by NuFlare in the EBM-95001. It is a GPU-accelerated inline correction for the effect that the temperature of the resist has on CD. For example, a 100nm CD may print at 102nm where that area was at a comparably high temperature at the time of the shot. Since thermal effect is a temporal effect, the simulated temperature of the surface of the mask is dynamically updated for the effect of each shot in order to accurately predict the cumulative effect that is the temperature at the location of the shot at the time of the shot and therefore its impact on CD. The shot dose is changed to reverse the effects of the temperature change. This paper for the first time reveals an enhancement to this thermal model and a simulator for it. It turns out that the temperature at the time each location receives backscatter from other shots also make a difference to the CD. The effect is secondary, but still measurable for some resists and substrates. Results of a test-chip study will be presented. The computation required for the backscatter effect is substantial. It has been demonstrated that this calculation can be performed fast enough to be inline with the EBM-9500 with a reasonable-sized computing platform. Run-time results and the computing architecture will be presented.

Relationship between the Arctic oscillation and surface air temperature in multi-decadal time-scale

NASA Astrophysics Data System (ADS)

Tanaka, Hiroshi L.; Tamura, Mina

2016-09-01

In this study, a simple energy balance model (EBM) was integrated in time, considering a hypothetical long-term variability in ice-albedo feedback mimicking the observed multi-decadal temperature variability. A natural variability was superimposed on a linear warming trend due to the increasing radiative forcing of CO2. The result demonstrates that the superposition of the natural variability and the background linear trend can offset with each other to show the warming hiatus for some period. It is also stressed that the rapid warming during 1970-2000 can be explained by the superposition of the natural variability and the background linear trend at least within the simple model. The key process of the fluctuating planetary albedo in multi-decadal time scale is investigated using the JRA-55 reanalysis data. It is found that the planetary albedo increased for 1958-1970, decreased for 1970-2000, and increased for 2000-2012, as expected by the simple EBM experiments. The multi-decadal variability in the planetary albedo is compared with the time series of the AO mode and Barents Sea mode of surface air temperature. It is shown that the recent AO negative pattern showing warm Arctic and cold mid-latitudes is in good agreement with planetary albedo change indicating negative anomaly in high latitudes and positive anomaly in mid-latitudes. Moreover, the Barents Sea mode with the warm Barents Sea and cold mid-latitudes shows long-term variability similar to planetary albedo change. Although further studies are needed, the natural variabilities of both the AO mode and Barents Sea mode indicate some possible link to the planetary albedo as suggested by the simple EBM to cause the warming hiatus in recent years.

Effect of anisotropy and texture on the low cycle fatigue behavior of Inconel 718 processed via electron beam melting

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

Kirka, Michael M.; Greeley, Duncan A.; Hawkins, Charles S.

Here in this study, the impact of texture (columnar/equiax grain structure) and influence of material orientation on the low cycle fatigue (LCF) behavior of hot isostatic pressed (HIP) and heat-treated Inconel 718 fabricated through electron beam melting (EBM) is investigated. Material was tested both parallel and perpendicular (transverse) to the build direction. In all instances, the EBM HIP and heat-treated Inconel 718 performed similarly or exceeded the LCF life of wrought Inconel 718 plate and bar stock under fully reversed strain-controlled loading at 650 °C. Amongst the textures, the columnar grains oriented parallel to the build direction exhibited the highestmore » life on average compared to the transverse columnar and equiax EBM material. Further, in relation to the reference wrought material the parallel columnar grain material exhibited a greater life. While a negligible life difference was observed in the equiax grained material between the two orientations, a consistently lower accumulated inelastic strain was measured for the material loaded parallel to the build direction than the transverse orientation. Failure of the parallel columnar material occurred in a transgranular manner with cracks emanating from the surface whereas the transverse columnar material failed in a intergranular manner, with crack growth occurring through repeated rupture of oxide at the crack-tip. Finally, in the case of the equiax material, an influence of material orientation was not observed on the failure mechanism with crack propagation occurring through a combination of debonded/cracked carbides and void formation along twin boundaries resulting in a mixture of intergranular and transgranular crack propagation.« less

Using the Biology Card Sorting Task to Measure Changes in Conceptual Expertise during Postsecondary Biology Education.

PubMed

Bissonnette, Sarah A; Combs, Elijah D; Nagami, Paul H; Byers, Victor; Fernandez, Juliana; Le, Dinh; Realin, Jared; Woodham, Selina; Smith, Julia I; Tanner, Kimberly D

2017-01-01

While there have been concerted efforts to reform undergraduate biology toward teaching students to organize their conceptual knowledge like experts, there are few tools that attempt to measure this. We previously developed the Biology Card Sorting Task (BCST), designed to probe how individuals organize their conceptual biological knowledge. Previous results showed the BCST could differentiate between different populations, namely non-biology majors (NBM) and biology faculty (BF). In this study, we administered the BCST to three additional populations, using a cross-sectional design: entering biology majors (EBM), advanced biology majors (ABM), and biology graduate students (BGS). Intriguingly, ABM did not initially sort like experts any more frequently than EBM. However, once the deep-feature framework was revealed, ABM were able to sort like experts more readily than did EBM. These results are consistent with the conclusion that biology education enables advanced biology students to use an expert-like conceptual framework. However, these results are also consistent with a process of "selection," wherein students who persist in the major may have already had an expert-like conceptual framework to begin with. These results demonstrate the utility of the BCST in measuring differences between groups of students over the course of their undergraduate education. © 2017 S. A. Bissonnette et al. CBE—Life Sciences Education © 2017 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Evidence-based medical review update: pharmacological and surgical treatments of Parkinson's disease: 2001 to 2004.

PubMed

Goetz, Christopher G; Poewe, Werner; Rascol, Olivier; Sampaio, Cristina

2005-05-01

The objective of this study is to update a previous evidence-based medicine (EBM) review on Parkinson's disease (PD) treatments, adding January 2001 to January 2004 information. The Movement Disorder Society (MDS) Task Force prepared an EBM review of PD treatments covering data up to January 2001. The authors reviewed Level I (randomized clinical trials) reports of pharmacological and surgical interventions for PD, published as full articles in English (January 2001-January 2004). Inclusion criteria and ranking followed the original program and adhered to EBM methodology. For Efficacy Conclusions, treatments were designated Efficacious, Likely Efficacious, Non-Efficacious, or Insufficient Data. Four clinical indications were considered for each intervention: prevention of disease progression; treatment of Parkinsonism, as monotherapy and as adjuncts to levodopa where indicated; prevention of motor complications; treatment of motor complications. Twenty-seven new studies qualified for efficacy review, and others covered new safety issues. Apomorphine, piribedil, unilateral pallidotomy, and subthalamic nucleus stimulation moved upward in efficacy ratings. Rasagiline, was newly rated as Efficacious monotherapy for control of Parkinsonism. New Level I data moved human fetal nigral transplants, as performed to date, from Insufficient Data to Non- efficacious for the treatment of Parkinsonism, motor fluctuations, and dyskinesias. Selegiline was reassigned as Non-efficacious for the prevention of dyskinesias. Other designations did not change. In a field as active in clinical trials as PD, frequent updating of therapy-based reviews is essential. We consider a 3-year period a reasonable time frame for published updates and are working to establish a Web-based mechanism to update the report in an ongoing manner. Copyright 2005 Movement Disorder Society.

Effect of anisotropy and texture on the low cycle fatigue behavior of Inconel 718 processed via electron beam melting

DOE PAGES

Kirka, Michael M.; Greeley, Duncan A.; Hawkins, Charles S.; ...

2017-09-11

Here in this study, the impact of texture (columnar/equiax grain structure) and influence of material orientation on the low cycle fatigue (LCF) behavior of hot isostatic pressed (HIP) and heat-treated Inconel 718 fabricated through electron beam melting (EBM) is investigated. Material was tested both parallel and perpendicular (transverse) to the build direction. In all instances, the EBM HIP and heat-treated Inconel 718 performed similarly or exceeded the LCF life of wrought Inconel 718 plate and bar stock under fully reversed strain-controlled loading at 650 °C. Amongst the textures, the columnar grains oriented parallel to the build direction exhibited the highestmore » life on average compared to the transverse columnar and equiax EBM material. Further, in relation to the reference wrought material the parallel columnar grain material exhibited a greater life. While a negligible life difference was observed in the equiax grained material between the two orientations, a consistently lower accumulated inelastic strain was measured for the material loaded parallel to the build direction than the transverse orientation. Failure of the parallel columnar material occurred in a transgranular manner with cracks emanating from the surface whereas the transverse columnar material failed in a intergranular manner, with crack growth occurring through repeated rupture of oxide at the crack-tip. Finally, in the case of the equiax material, an influence of material orientation was not observed on the failure mechanism with crack propagation occurring through a combination of debonded/cracked carbides and void formation along twin boundaries resulting in a mixture of intergranular and transgranular crack propagation.« less

Answering questions at the point of care: do residents practice EBM or manage information sources?

PubMed

McCord, Gary; Smucker, William D; Selius, Brian A; Hannan, Scott; Davidson, Elliot; Schrop, Susan Labuda; Rao, Vinod; Albrecht, Paula

2007-03-01

To determine the types of information sources that evidence-based medicine (EBM)-trained, family medicine residents use to answer clinical questions at the point of care, to assess whether the sources are evidence-based, and to provide suggestions for more effective information-management strategies in residency training. In 2005, trained medical students directly observed (for two half-days per physician) how 25 third-year family medicine residents retrieved information to answer clinical questions arising at the point of care and documented the type and name of each source, the retrieval location, and the estimated time spent consulting the source. An end-of-study questionnaire asked 37 full-time faculty and the participating residents about the best information sources available, subscriptions owned, why they use a personal digital assistant (PDA) to practice medicine, and their experience in preventing medical errors using a PDA. Forty-four percent of questions were answered by attending physicians, 23% by consulting PDAs, and 20% from books. Seventy-two percent of questions were answered within two minutes. Residents rated UptoDate as the best source for evidence-based information, but they used this source only five times. PDAs were used because of ease of use, time factors, and accessibility. All examples of medical errors discovered or prevented with PDA programs were medication related. None of the participants' residencies required the use of a specific medical information resource. The results support the Agency for Health Care Research and Quality's call for medical system improvements at the point of care. Additionally, it may be necessary to teach residents better information-management skills in addition to EBM skills.

How are medical students trained to locate biomedical information to practice evidence-based medicine? a review of the 2007–2012 literature

PubMed Central

Maggio, Lauren A.; Kung, Janice Y.

2014-01-01

Objectives: This study describes how information retrieval skills are taught in evidence-based medicine (EBM) at the undergraduate medical education (UGME) level. Methods: The authors systematically searched MEDLINE, Scopus, Educational Resource Information Center, Web of Science, and Evidence-Based Medicine Reviews for English-language articles published between 2007 and 2012 describing information retrieval training to support EBM. Data on learning environment, frequency of training, learner characteristics, resources and information skills taught, teaching modalities, and instructor roles were compiled and analyzed. Results: Twelve studies were identified for analysis. Studies were set in the United States (9), Australia (1), the Czech Republic (1), and Iran (1). Most trainings (7) featured multiple sessions with trainings offered to preclinical students (5) and clinical students (6). A single study described a longitudinal training experience. A variety of information resources were introduced, including PubMed, DynaMed, UpToDate, and AccessMedicine. The majority of the interventions (10) were classified as interactive teaching sessions in classroom settings. Librarians played major and collaborative roles with physicians in teaching and designing training. Unfortunately, few studies provided details of information skills activities or evaluations, making them difficult to evaluate and replicate. Conclusions: This study reviewed the literature and characterized how EBM search skills are taught in UGME. Details are provided on learning environment, frequency of training, level of learners, resources and skills trained, and instructor roles. Implications: The results suggest a number of steps that librarians can take to improve information skills training including using a longitudinal approach, integrating consumer health resources, and developing robust assessments. PMID:25031559

Increasing utilization of Internet-based resources following efforts to promote evidence-based medicine: a national study in Taiwan

PubMed Central

2013-01-01

Background Since the beginning of 2007, the National Health Research Institutes has been promoting the dissemination of evidence-based medicine (EBM). The current study examined longitudinal trends of behaviors in how hospital-based physicians and nurses have searched for medical information during the spread of EBM. Methods Cross-sectional postal questionnaire surveys were conducted in nationally representative regional hospitals of Taiwan thrice in 2007, 2009, and 2011. Demographic data were gathered concerning gender, age, working experience, teaching appointment, academic degree, and administrative position. Linear and logistic regression models were used to examine predictors and changes over time. Results Data from physicians and nurses were collected in 2007 (n = 1156), 2009 (n = 2975), and 2011 (n = 3999). There were significant increases in the use of four Internet-based resources – Web portals, online databases, electronic journals, and electronic books – across the three survey years among physicians and nurses (p < 0.001). Access to textbooks and printed journals, however, did not change over the 4-year study period. In addition, there were significant relationships between the usage of Internet-based resources and users’ characteristics. Age and faculty position were important predictors in relation to the usage among physicians and nurses, while academic degree served as a critical factor among nurses only. Conclusions Physicians and nurses used a variety of sources to look for medical information. There was a steady increase in use of Internet-based resources during the diffusion period of EBM. The findings highlight the importance of the Internet as a prominent source of medical information for main healthcare professionals. PMID:23289500

Health Outcomes of Sarcopenia: A Systematic Review and Meta-Analysis

PubMed Central

Beaudart, Charlotte; Zaaria, Myriam; Pasleau, Françoise; Reginster, Jean-Yves; Bruyère, Olivier

2017-01-01

Objective The purpose of this study was to perform a systematic review to assess the short-, middle- and long-term consequences of sarcopenia. Methods Prospective studies assessing the consequences of sarcopenia were searched across different electronic databases (MEDLINE, EMBASE, EBM Reviews, Cochrane Database of Systematic Reviews, EBM Reviews ACP Journal Club, EBM Reviews DARE and AMED). Only studies that used the definition of the European Working Group on Sarcopenia in Older People to diagnose sarcopenia were included. Study selection and data extraction were performed by two independent reviewers. For outcomes reported by three or more studies, a meta-analysis was performed. The study results are expressed as odds ratios (OR) with 95% CI. Results Of the 772 references identified through the database search, 17 were included in this systematic review. The number of participants in the included studies ranged from 99 to 6658, and the duration of follow-up varied from 3 months to 9.8 years. Eleven out of 12 studies assessed the impact of sarcopenia on mortality. The results showed a higher rate of mortality among sarcopenic subjects (pooled OR of 3.596 (95% CI 2.96–4.37)). The effect was higher in people aged 79 years or older compared with younger subjects (p = 0.02). Sarcopenia is also associated with functional decline (pooled OR of 6 studies 3.03 (95% CI 1.80–5.12)), a higher rate of falls (2/2 studies found a significant association) and a higher incidence of hospitalizations (1/1 study). The impact of sarcopenia on the incidence of fractures and the length of hospital stay was less clear (only 1/2 studies showed an association for both outcomes). Conclusion Sarcopenia is associated with several harmful outcomes, making this geriatric syndrome a real public health burden. PMID:28095426

Multi-channel electronically scanned cryogenic pressure sensor

NASA Technical Reports Server (NTRS)

Chapman, John J. (Inventor); Hopson, Purnell, Jr. (Inventor); Kruse, Nancy M. H. (Inventor)

1995-01-01

A miniature, multi-channel, electronically scanned pressure measuring device uses electrostatically bonded silicon dies in a multielement array. These dies are bonded at specific sites on a glass, prepatterned substrate. Thermal data is multiplexed and recorded on each individual pressure measuring diaphragm. The device functions in a cryogenic environment without the need of heaters to keep the sensor at constant temperatures.

A 3D Polymer Based Printed Two-Dimensional Laser Scanner

NASA Astrophysics Data System (ADS)

Oyman, H. A.; Gokdel, Y. D.; Ferhanoglu, O.; Yalcinkaya, A. D.

2016-10-01

A two-dimensional (2D) polymer based scanning mirror with magnetic actuation is developed for imaging applications. Proposed device consists of a circular suspension holding a rectangular mirror and can generate a 2D scan pattern. Three dimensional (3D) printing technology which is used for implementation of the device, offers added flexibility in controlling the cross-sectional profile as well as the stress distribution compared to the traditional planar process technologies. The mirror device is developed to meet a portable, miniaturized confocal microscope application in mind, delivering 4.5 and 4.8 degrees of optical scan angles at 111 and 267 Hz, respectively. As a result of this mechanical performance, the resulting microscope incorporating the mirror is estimated to accomplish a field of view (FOV) of 350 µm × 350 µm.

Combining Crowd and Expert Labels using Decision Theoretic Active Learning

DTIC Science & Technology

2015-10-11

meta-data such as titles, author information and keywords. Motivating Application: Biomedical Systematic Reviews Evidence - based medicine (EBM) aims to...individuals trained in evidence - based medicine ; usually MDs) reading the entire set of citations retrieved via database search to identify the small

The practice of evidence-based medicine involves the care of whole persons.

PubMed

Richardson, W Scott

2017-04-01

In this issue of the Journal, Dr. Fava posits that evidence-based medicine (EBM) was bound to fail. I share some of the concerns he expresses, yet I see more reasons for optimism. Having been on rounds with both Drs. Engel and Sackett, I reckon they would have agreed more than they disagreed. Their central teaching was the compassionate and well-informed care of sick persons. The model that emerged from these rounds was that patient care could be both person-centered and evidence-based, that clinical judgment was essential to both, and the decisions could and should be shared. Both clinicians and patients can bring knowledge from several sources into the shared decision making process in the clinical encounter, including evidence from clinical care research. I thank Dr. Fava for expressing legitimate doubts and providing useful criticism, yet I am cautiously optimistic that the model of EBM described here is robust enough to meet the challenges and is not doomed to fail. Copyright © 2017 Elsevier Inc. All rights reserved.

Making generic tutorials content specific: recycling evidence-based practice (EBP) tutorials for two disciplines.

PubMed

Jeffery, Keven M; Maggio, Lauren; Blanchard, Mary

2009-01-01

Librarians at the Boston University Medical Center constructed two interactive online tutorials, "Introduction to EBM" and "Formulating a Clinical Question (PICO)," for a Family Medicine Clerkship and then quickly repurposed the existing tutorials to support an Evidence-based Dentistry course. Adobe's ColdFusion software was used to populate the tutorials with course-specific content based on the URL used to enter each tutorial, and a MySQL database was used to collect student input. Student responses were viewable immediately by course faculty on a password-protected Web site. The tutorials ensured that all students received the same baseline training and allowed librarians to tailor a subsequent library skills workshop to student tutorial answers. The tutorials were well-received by the medical and dental schools and have been added to mandatory first-year Evidence-based Medicine (EBM) and Evidence-based Dentistry (EBD) courses, meaning that every medical and dental student at BUMC will be expected to complete these tutorials.

Thermal Effects on Microstructural Heterogeneity of Inconel 718 Materials Fabricated by Electron Beam Melting

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

Sames, William J.; Unocic, Kinga A.; Dehoff, Ryan R.

2014-07-28

Additive manufacturing (AM) technologies, also known as 3D printing, have demonstrated the potential to fabricate complex geometrical components, but the resulting microstructures and mechanical properties of these materials are not well understood due to unique and complex thermal cycles observed during processing. The electron beam melting (EBM) process is unique because the powder bed temperature can be elevated and maintained at temperatures over 1000 °C for the duration of the process. This results in three specific stages of microstructural phase evolution: (a) rapid cool down from the melting temperature to the process temperature, (b) extended hold at the process temperature,more » and (c) slow cool down to the room temperature. In this work, the mechanisms for reported microstructural differences in EBM are rationalized for Inconel 718 based on measured thermal cycles, preliminary thermal modeling, and computational thermodynamics models. The relationship between processing parameters, solidification microstructure, interdendritic segregation, and phase precipitation (δ, γ´, and γ´´) are discussed.« less

[Patient's individuality and application of guidelines in surgery].

PubMed

Schulte, Michael

2005-01-01

Individual treatment decisions can become considerably conflictual in view of the co-existence of medical professional guidelines, recommendations based on evidence-based medicine (EBM), and juridical and economical directions. Medical guidelines are not subject to an external review process; also, due to reduced practicability, the surgeons' compliance with guidelines remains relatively low. Surgical treatment strategies can rely on randomized clinical trials (RCTs) in approximately 20% of the surgical procedures and on non-randomized trials in approximately 70% of the cases. No evidence is given in approximately 10% of the cases. Specific problems of implementation of EBM in surgical disciplines are represented by the difficulty of standardized procedures, the heterogeneity of the population, the impossibility to conduct double-blinded RCTs, a low statistical power, and a publication bias. Since individual diseases cannot be reduced to surgical cases manageable only by the application of guidelines, adequate treatment of individual patients requires the critical application of both external evidence and surgeon expertise (internal evidence).

Typology and indicators of ecosystem services for marine spatial planning and management.

PubMed

Böhnke-Henrichs, Anne; Baulcomb, Corinne; Koss, Rebecca; Hussain, S Salman; de Groot, Rudolf S

2013-11-30

The ecosystem services concept provides both an analytical and communicative tool to identify and quantify the link between human welfare and the environment, and thus to evaluate the ramifications of management interventions. Marine spatial planning (MSP) and Ecosystem-based Management (EBM) are a form of management intervention that has become increasingly popular and important globally. The ecosystem service concept is rarely applied in marine planning and management to date which we argue is due to the lack of a well-structured, systematic classification and assessment of marine ecosystem services. In this paper we not only develop such a typology but also provide guidance to select appropriate indicators for all relevant ecosystem services. We apply this marine-specific ecosystem service typology to MSP and EBM. We thus provide not only a novel theoretical construct but also show how the ecosystem services concept can be used in marine planning and management. Copyright © 2013 Elsevier Ltd. All rights reserved.

A simple model of the effect of ocean ventilation on ocean heat uptake

NASA Astrophysics Data System (ADS)

Nadiga, Balu; Urban, Nathan

2017-11-01

Transport of water from the surface mixed layer into the ocean interior is achieved, in large part, by the process of ventilation-a process associated with outcropping isopycnals. Starting from such a configuration of outcropping isopycnals, we derive a simple model of the effect of ventilation on ocean uptake of anomalous radiative forcing. This model can be seen as an improvement of the popular anomaly-diffusing class of energy balance models (AD-EBM) that are routinely employed to analyze and emulate the warming response of both observed and simulated Earth system. We demonstrate that neither multi-layer, nor continuous-diffusion AD-EBM variants can properly represent both surface-warming and the vertical distribution of ocean heat uptake. The new model overcomes this deficiency. The simplicity of the models notwithstanding, the analysis presented and the necessity of the modification is indicative of the role played by processes related to the down-welling branch of global ocean circulation in shaping the vertical distribution of ocean heat uptake.

The use of mechanistic evidence in drug approval.

PubMed

Aronson, Jeffrey K; La Caze, Adam; Kelly, Michael P; Parkkinen, Veli-Pekka; Williamson, Jon

2018-06-11

The role of mechanistic evidence tends to be under-appreciated in current evidence-based medicine (EBM), which focusses on clinical studies, tending to restrict attention to randomized controlled studies (RCTs) when they are available. The EBM+ programme seeks to redress this imbalance, by suggesting methods for evaluating mechanistic studies alongside clinical studies. Drug approval is a problematic case for the view that mechanistic evidence should be taken into account, because RCTs are almost always available. Nevertheless, we argue that mechanistic evidence is central to all the key tasks in the drug approval process: in drug discovery and development; assessing pharmaceutical quality; devising dosage regimens; assessing efficacy, harms, external validity, and cost-effectiveness; evaluating adherence; and extending product licences. We recommend that, when preparing for meetings in which any aspect of drug approval is to be discussed, mechanistic evidence should be systematically analysed and presented to the committee members alongside analyses of clinical studies. © 2018 The Authors Journal of Evaluation in Clinical Practice Published by John Wiley & Sons Ltd.

Building the U.S. First Offshore Wind Farm-Applying EBM Approaches to Successfully Address Offshore Energy, Commercial Fisheries, and Recreational Boating interactions

NASA Astrophysics Data System (ADS)

Lipsky, A.

2016-12-01

In August 2015 construction commenced on the Block Island Wind Farm, the first offshore wind energy project in the U.S. This pilot-scale offshore energy project, located 18 miles offshore of the Rhode Island mainland, was sited through a comprehensive ocean planning process. As the project progressed into design and construction, our team utilized potent ecosystem based management approaches to great advantage to address the human and resource interactions that existed in the project area. These practices have included designing and executing collaborative long-term monitoring ventures to fill key science gaps and reconcile fisheries concerns, establishing effective industry to industry engagement, and developing durable multi-sector agreements. This presentation will describe the specific EBM approaches used after the planning process was completed to bring the project to construction; highlighting where key aspects of the National Ocean Policy goals and principles have been successfully applied.

Building the U.S. First Offshore Wind Farm-Applying EBM Approaches to Successfully Address Offshore Energy, Commercial Fisheries, and Recreational Boating interactions

NASA Astrophysics Data System (ADS)

Lipsky, A.

2016-02-01

In August 2015 construction commenced on the Block Island Wind Farm, the first offshore wind energy project in the U.S. This pilot-scale offshore energy project, located 18 miles offshore of the Rhode Island mainland, was sited through a comprehensive ocean planning process. As the project progressed into design and construction, our team utilized potent ecosystem based management approaches to great advantage to address the human and resource interactions that existed in the project area. These practices have included designing and executing collaborative long-term monitoring ventures to fill key science gaps and reconcile fisheries concerns, establishing effective industry to industry engagement, and developing durable multi-sector agreements. This presentation will describe the specific EBM approaches used after the planning process was completed to bring the project to construction; highlighting where key aspects of the National Ocean Policy goals and principles have been successfully applied.

Feasibility of in situ controlled heat treatment (ISHT) of Inconel 718 during electron beam melting additive manufacturing

DOE PAGES

Sames, William J.; Unocic, Kinga A.; Helmreich, Grant W.; ...

2016-10-07

A novel technique was developed to control the microstructure evolution in Alloy 718 processed using Electron Beam Melting (EBM). In situ solution treatment and aging of Alloy 718 was performed by heating the top surface of the build after build completion scanning an electron beam to act as a planar heat source during the cool down process. Results demonstrate that the measured hardness (478 ± 7 HV) of the material processed using in situ heat treatment similar to that of peak-aged Inconel 718. Large solidification grains and cracks formed, which are identified as the likely mechanism leading to failure ofmore » tensile tests of the in situ heat treatment material under loading. Despite poor tensile performance, the technique proposed was shown to successively age Alloy 718 (increase precipitate size and hardness) without removing the sample from the process chamber, which can reduce the number of process steps in producing a part. Lastly, tighter controls on processing temperature during layer melting to lower process temperature and selective heating during in situ heat treatment to reduce over-sintering are proposed as methods for improving the process.« less

Run-to-Run Optimization Control Within Exact Inverse Framework for Scan Tracking.

PubMed

Yeoh, Ivan L; Reinhall, Per G; Berg, Martin C; Chizeck, Howard J; Seibel, Eric J

2017-09-01

A run-to-run optimization controller uses a reduced set of measurement parameters, in comparison to more general feedback controllers, to converge to the best control point for a repetitive process. A new run-to-run optimization controller is presented for the scanning fiber device used for image acquisition and display. This controller utilizes very sparse measurements to estimate a system energy measure and updates the input parameterizations iteratively within a feedforward with exact-inversion framework. Analysis, simulation, and experimental investigations on the scanning fiber device demonstrate improved scan accuracy over previous methods and automatic controller adaptation to changing operating temperature. A specific application example and quantitative error analyses are provided of a scanning fiber endoscope that maintains high image quality continuously across a 20 °C temperature rise without interruption of the 56 Hz video.

Performing magnetic resonance imaging in patients with implantable pacemakers and defibrillators: results of a European Heart Rhythm Association survey.

PubMed

Marinskis, Germanas; Bongiorni, Maria Grazia; Dagres, Nikolaos; Dobreanu, Dan; Lewalter, Thorsten; Blomström-Lundqvist, Carina

2012-12-01

The purpose of our survey was to evaluate the experience, current practice and attitudes of performing magnetic resonance imaging (MRI) studies in patients with cardiac implantable electronic devices. Fifty-one centre-members of European Heart Rhythm Association Research network have responded to the survey. According to the obtained data, 55.2% of responding centres do not perform MRI scans in patients with non-MRI-certified pacemakers and 65.8% in patients with such implantable cardioverter defibrillators (ICDs). Reported complication rate in patients with non-MRI-certified devices is low and conforms to the literature data. Experience with newer MRI-compatible pacemakers and ICDs is limited to single cases in most centres. This survey shows limited experience with performing MRI studies in patients with implanted pacemakers and ICDs. In concordance with available guidelines, most centres limit MRI scans in patients with non-MRI-certified devices. The implant numbers for MRI-certified devices and experience with performing MRI scans in these patients are still low.

Multi-Channel Electronically Scanned Cryogenic Pressure Sensor And Method For Making Same

NASA Technical Reports Server (NTRS)

Chapman, John J. (Inventor); Hopson, Purnell, Jr. (Inventor); Holloway, Nancy M. (Inventor)

2001-01-01

A miniature, multi-channel, electronically scanned pressure measuring device uses electrostatically bonded silicon dies in a multi-element array. These dies are bonded at specific sites on a glass, pre-patterned substrate. Thermal data is multiplexed and recorded on each individual pressure measuring diaphragm. The device functions in a cryogenic environment without the need of heaters to keep the sensor at constant temperatures.

Modern Pacemaker and Implantable Cardioverter/Defibrillator Systems Can Be Magnetic Resonance Imaging Safe

PubMed Central

Roguin, Ariel; Zviman, Menekhem M.; Meininger, Glenn R.; Rodrigues, E. Rene; Dickfeld, Timm M.; Bluemke, David A.; Lardo, Albert; Berger, Ronald D.; Calkins, Hugh; Halperin, Henry R.

2011-01-01

Background MRI has unparalleled soft-tissue imaging capabilities. The presence of devices such as pacemakers and implantable cardioverter/defibrillators (ICDs), however, is historically considered a contraindication to MRI. These devices are now smaller, with less magnetic material and improved electromagnetic interference protection. Our aim was to determine whether these modern systems can be used in an MR environment. Methods and Results We tested in vitro and in vivo lead heating, device function, force acting on the device, and image distortion at 1.5 T. Clinical MR protocols and in vivo measurements yielded temperature changes <0.5°C. Older (manufactured before 2000) ICDs were damaged by the MR scans. Newer ICD systems and most pacemakers, however, were not. The maximal force acting on newer devices was <100 g. Modern (manufactured after 2000) ICD systems were implanted in dogs (n=18), and after 4 weeks, 3- to 4-hour MR scans were performed (n=15). No device dysfunction occurred. The images were of high quality with distortion dependent on the scan sequence and plane. Pacing threshold and intracardiac electrogram amplitude were unchanged over the 8 weeks, except in 1 animal that, after MRI, had a transient (<12 hours) capture failure. Pathological data of the scanned animals revealed very limited necrosis or fibrosis at the tip of the lead area, which was not different from controls (n=3) not subjected to MRI. Conclusions These data suggest that certain modern pacemaker and ICD systems may indeed be MRI safe. This may have major clinical implications for current imaging practices. PMID:15277324

78 FR 53731 - North Pacific Fishery Management Council; Notice of Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-30

... meetings. SUMMARY: The North Pacific Fishery Management Council (Council) Ecosystem Committee will meet in... agenda will be as follows: Development of Ecosystem-based management (EMB) vision statement; Operationalizing EBM in Council projects, including the Aleutian Islands Fishery Ecosystem Plan, the Arctic Fishery...

A family of position- and orientation-independent embedded boundary methods for viscous flow and fluid-structure interaction problems

NASA Astrophysics Data System (ADS)

Huang, Daniel Z.; De Santis, Dante; Farhat, Charbel

2018-07-01

The Finite Volume method with Exact two-material Riemann Problems (FIVER) is both a computational framework for multi-material flows characterized by large density jumps, and an Embedded Boundary Method (EBM) for computational fluid dynamics and highly nonlinear Fluid-Structure Interaction (FSI) problems. This paper deals with the EBM aspect of FIVER. For FSI problems, this EBM has already demonstrated the ability to address viscous effects along wall boundaries, and large deformations and topological changes of such boundaries. However, like for most EBMs - also known as immersed boundary methods - the performance of FIVER in the vicinity of a wall boundary can be sensitive with respect to the position and orientation of this boundary relative to the embedding mesh. This is mainly due to ill-conditioning issues that arise when an embedded interface becomes too close to a node of the embedding mesh, which may lead to spurious oscillations in the computed solution gradients at the wall boundary. This paper resolves these issues by introducing an alternative definition of the active/inactive status of a mesh node that leads to the removal of all sources of potential ill-conditioning from all spatial approximations performed by FIVER in the vicinity of a fluid-structure interface. It also makes two additional contributions. The first one is a new procedure for constructing the fluid-structure half Riemann problem underlying the semi-discretization by FIVER of the convective fluxes. This procedure eliminates one extrapolation from the conventional treatment of the wall boundary conditions and replaces it by an interpolation, which improves robustness. The second contribution is a post-processing algorithm for computing quantities of interest at the wall that achieves smoothness in the computed solution and its gradients. Lessons learned from these enhancements and contributions that are triggered by the new definition of the status of a mesh node are then generalized and exploited to eliminate from the original version of the FIVER method its sensitivities with respect to both of the position and orientation of the wall boundary relative to the embedding mesh, while maintaining the original definition of the status of a mesh node. This leads to a family of second-generation FIVER methods whose performance is illustrated in this paper for several flow and FSI problems. These include a challenging flow problem over a bird wing characterized by a feather-induced surface roughness, and a complex flexible flapping wing problem for which experimental data is available.

Comparison of the biometric values obtained by two different A-mode ultrasound devices (Eye Cubed vs. PalmScan): a transversal, descriptive, and comparative study.

PubMed

Velez-Montoya, Raul; Shusterman, Eugene Mark; López-Miranda, Miriam Jessica; Mayorquin-Ruiz, Mariana; Salcedo-Villanueva, Guillermo; Quiroz-Mercado, Hugo; Morales-Cantón, Virgilio

2010-03-24

To assess the reliability of the measurements obtained with the PalmScan, when compared with another standardized A-mode ultrasound device, and assess the consistency and correlation between the two methods. Transversal, descriptive, and comparative study. We recorded the axial length (AL), anterior chamber depth (ACD) and lens thickness (LT) obtained with two A-mode ultrasounds (PalmScan A2000 and Eye Cubed) using an immersion technique. We compared the measurements with a two-sample t-test. Agreement between the two devices was assessed with Bland-Altman plots and 95% limits of agreement. 70 eyes of 70 patients were enrolled in this study. The measurements with the Eye Cubed of AL and ACD were shorter than the measurements taken by the PalmScan. The differences were not statistically significant regarding AL (p < 0.4) but significant regarding ACD (p < 0.001). The highest agreement between the two devices was obtained during LT measurement. The PalmScan measurements were shorter, but not statistically significantly (p < 0.2). The values of AL and LT, obtained with both devices are not identical, but within the limits of agreement. The agreement is not affected by the magnitude of the ocular dimensions (but only between range of 20 mm to 27 mm of AL and 3.5 mm to 5.7 mm of LT). A correction of about 0.5 D could be considered if an intraocular lens is being calculated. However due to the large variability of the results, the authors recommend discretion in using this conversion factor, and to adjust the power of the intraocular lenses based upon the personal experience of the surgeon.

Safety evaluation of a leadless transcatheter pacemaker for magnetic resonance imaging use.

PubMed

Soejima, Kyoko; Edmonson, Jonathan; Ellingson, Michael L; Herberg, Ben; Wiklund, Craig; Zhao, Jing

2016-10-01

Increased magnetic resonance imaging (MRI) adoption and demand are driving the need for device patients to have safe access to MRI. The aim of this study was to address the interactions of MRI with the Micra transcatheter pacemaker system. A strategy was developed to evaluate potential MRI risks including device heating, unintended cardiac stimulation, force, torque, vibration, and device malfunction. Assessment of MRI-induced device heating was conducted using a phantom containing gelled saline, and Monte Carlo simulations incorporating these results were conducted to simulate numerous combinations of human body models, position locations in the MRI scanner bore, and a variety of coil designs. Lastly, a patient with a Micra pacemaker who underwent a clinically indicated MRI scan is presented. Compared to traditional MRI conditional pacemakers, the overall risk with Micra was greatly reduced because of the small size of the device and the absence of a lead. The modeling results predicted that the nonperfused temperature rise of the device would be less than 0.4°C at 1.5 T and 0.5°C at 3 T and that the risk of device heating with multiple device implants was not increased as compared with a single device. The clinical case study revealed no MRI-related complications. The MRI safety assessment tests conducted for the Micra pacemaker demonstrate that patients with a single device or multiple devices can safely undergo MRI scans in both 1.5- and 3-T MRI scanners. No MRI-related complications were observed in a patient implanted with a Micra pacemaker undergoing a clinically indicated scan. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Safety and utility of magnetic resonance imaging in patients with cardiac implantable electronic devices.

PubMed

Strom, Jordan B; Whelan, Jill B; Shen, Changyu; Zheng, Shuang Qi; Mortele, Koenraad J; Kramer, Daniel B

2017-08-01

Off-label magnetic resonance imaging (MRI) for patients with cardiac implantable electrical devices has been limited owing to concerns about safety and unclear diagnostic and prognostic utility. The purpose of this study was to define major and minor adverse events with off-label MRI scans. We prospectively evaluated patients with non-MRI-conditional cardiac implantable electrical devices referred for MRI scans under a strict clinical protocol. The primary safety outcome was incidence of major adverse events (loss of pacing, inappropriate shock or antitachycardia pacing, need for system revision, or death) or minor adverse events (inappropriate pacing, arrhythmias, power-on-reset events, heating at the generator site, or changes in device parameters at baseline or at 6 months). A total of 189 MRI scans were performed in 123 patients (63.1% [78] men; median age 70 ± 18.5 years; 56.9% [70] patients with implantable cardioverter-defibrillators; 33.3% [41] pacemaker-dependent patients) predominantly for brain or spinal conditions. A minority of scans (22.7% [43]) were performed for urgent or emergent indications. Major adverse events were rare: 1 patient with loss of pacing, no deaths, or system revisions (overall rate 0.5%; 95% confidence interval 0.01-2.91). Minor adverse events were similarly rare (overall rate 1.6%; 95% confidence interval 0.3-4.6). Nearly all studies (98.4% [186]) were interpretable, while 75.1% [142] were determined to change management according to the prespecified criteria. No clinically significant changes were observed in device parameters acutely after MRI or at 6 months as compared with baseline across all patient and device categories. Off-label MRI scans performed under a strict protocol demonstrated excellent short- and medium-term safety while providing interpretable imaging that frequently influenced clinical care. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Safety and utility of magnetic resonance imaging in patients with cardiac implantable electronic devices

PubMed Central

Strom, Jordan B.; Whelan, Jill B.; Shen, Changyu; Zheng, Shuang Qi; Mortele, Koenraad J.; Kramer, Daniel B.

2017-01-01

BACKGROUND Off-label magnetic resonance imaging (MRI) for patients with cardiac implantable electrical devices has been limited owing to concerns about safety and unclear diagnostic and prognostic utility. OBJECTIVE The purpose of this study was to define major and minor adverse events with off-label MRI scans. METHODS We prospectively evaluated patients with non–MRI-conditional cardiac implantable electrical devices referred for MRI scans under a strict clinical protocol. The primary safety outcome was incidence of major adverse events (loss of pacing, inappropriate shock or antitachycardia pacing, need for system revision, or death) or minor adverse events (inappropriate pacing, arrhythmias, power-on-reset events, heating at the generator site, or changes in device parameters at baseline or at 6 months). RESULTS A total of 189 MRI scans were performed in 123 patients (63.1% [78] men; median age 70 ± 18.5 years; 37.0% [70] patients with implantable cardioverter-defibrillators; 21.8% [41] pacemaker-dependent patients) predominantly for brain or spinal conditions. A minority of scans (22.7% [43]) were performed for urgent or emergent indications. Major adverse events were rare: 1 patient with loss of pacing, no deaths, or system revisions (overall rate 0.5%; 95% confidence interval 0.01–2.91). Minor adverse events were similarly rare (overall rate 1.6%; 95% confidence interval 0.3–4.6). Nearly all studies (98.4% [186]) were interpretable, while 74.9% [142] were determined to change management according to the prespecified criteria. No clinically significant changes were observed in device parameters acutely after MRI or at 6 months as compared with baseline across all patient and device categories. CONCLUSION Off-label MRI scans performed under a strict protocol demonstrated excellent short- and medium-term safety while providing interpretable imaging that frequently influenced clinical care. PMID:28385671

Transmission environmental scanning electron microscope with scintillation gaseous detection device.

PubMed

Danilatos, Gerasimos; Kollia, Mary; Dracopoulos, Vassileios

2015-03-01

A transmission environmental scanning electron microscope with use of a scintillation gaseous detection device has been implemented. This corresponds to a transmission scanning electron microscope but with addition of a gaseous environment acting both as environmental and detection medium. A commercial type of low vacuum machine has been employed together with appropriate modifications to the detection configuration. This involves controlled screening of various emitted signals in conjunction with a scintillation gaseous detection device already provided with the machine for regular surface imaging. Dark field and bright field imaging has been obtained along with other detection conditions. With a progressive series of modifications and tests, the theory and practice of a novel type of microscopy is briefly shown now ushering further significant improvements and developments in electron microscopy as a whole. Copyright © 2014 Elsevier B.V. All rights reserved.

New Beam Scanning Device for Active Beam Delivery System (BDS) in Proton Therapy

NASA Astrophysics Data System (ADS)

Variale, V.; Mastromarco, M.; Colamaria, F.; Colella, D.

A new Beam Delivery System (BDS) has been studied in the framework of a new proton therapy project, called AMIDERHA. It is characterized by an active scanning system for target irradiation with a pencil beam. The project is based on the use of a Linac with variable final energy and the Robotized Patient Positioning System instead of the traditional gantry. As a consequence, in the active BDS of AMIDERHA a pencil beam scanning system with a relatively long Source to Axis Distance (SAD) can be used. In this contribution, the idea of using a unique new device capable of both horizontal and vertical beam scansion for the AMIDERHA active BDS will be presented and discussed. Furthermore, a preliminary design of that device will be shown, together with the results of simulations.

Architecture for removable media USB-ARM

DOEpatents

Shue, Craig A.; Lamb, Logan M.; Paul, Nathanael R.

2015-07-14

A storage device is coupled to a computing system comprising an operating system and application software. Access to the storage device is blocked by a kernel filter driver, except exclusive access is granted to a first anti-virus engine. The first anti-virus engine is directed to scan the storage device for malicious software and report results. Exclusive access may be granted to one or more other anti-virus engines and they may be directed to scan the storage device and report results. Approval of all or a portion of the information on the storage device is based on the results from the first anti-virus engine and the other anti-virus engines. The storage device is presented to the operating system and access is granted to the approved information. The operating system may be a Microsoft Windows operating system. The kernel filter driver and usage of anti-virus engines may be configurable by a user.

Magnetic resonance imaging-conditional devices: Luxury or real clinical need?

PubMed

Mavrogeni, Sophie I; Poulos, George; Kolovou, Genovefa; Theodorakis, George

Although the risk of MRI scanning on patients with conventional devices is lower than initially thought, the patient's safety can only be guaranteed when using MRI-conditional devices. The most important modifications in MRI-conditional devices include a) Reduction in ferromagnetic components to reduce magnetic attraction and susceptibility artifacts; b) Replacement of the reed switch by a Hall sensor in order to avoid unpredictable reed switch behavior; c) Lead coil design to minimize lead heating and electrical current induction; d) Filter circuitry to prevent damage to the internal power supply; and e) Dedicated pacemaker programming to prevent inappropriate pacemaker inhibition and competing rhythms. Although many companies claim to have MRI-conditional devices, adoption in clinical practice is limited because a) Not all companies have MRI-conditional devices approved for both 1.5 and 3T; b) Not all companies offer the option of unlimited MRI scanning (without an exclusion zone in the thorax); c) Certain companies allow only a 30-min MRI scanning and only in afebrile patients; and d) Despite having MRI-conditional pacemakers, certain companies do not have MRI-conditional defibrillators and CRT systems. It is clear that this new technology opens the door for MRI to a growing number of patients; however, the widespread adoption of MRI-conditional devices will depend on real-life issues, such as cost, clinical indications for such a device and the permanent education of health care professionals. Copyright © 2017 Hellenic Society of Cardiology. Published by Elsevier B.V. All rights reserved.

Reliability and accuracy of four dental shade-matching devices.

PubMed

Kim-Pusateri, Seungyee; Brewer, Jane D; Davis, Elaine L; Wee, Alvin G

2009-03-01

There are several electronic shade-matching instruments available for clinical use, but the reliability and accuracy of these instruments have not been thoroughly investigated. The purpose of this in vitro study was to evaluate the reliability and accuracy of 4 dental shade-matching instruments in a standardized environment. Four shade-matching devices were tested: SpectroShade, ShadeVision, VITA Easyshade, and ShadeScan. Color measurements were made of 3 commercial shade guides (Vitapan Classical, Vitapan 3D-Master, and Chromascop). Shade tabs were placed in the middle of a gingival matrix (Shofu GUMY) with shade tabs of the same nominal shade from additional shade guides placed on both sides. Measurements were made of the central region of the shade tab positioned inside a black box. For the reliability assessment, each shade tab from each of the 3 shade guide types was measured 10 times. For the accuracy assessment, each shade tab from 10 guides of each of the 3 types evaluated was measured once. Differences in reliability and accuracy were evaluated using the Standard Normal z test (2 sided) (alpha=.05) with Bonferroni correction. Reliability of devices was as follows: ShadeVision, 99.0%; SpectroShade, 96.9%; VITA Easyshade, 96.4%; and ShadeScan, 87.4%. A significant difference in reliability was found between ShadeVision and ShadeScan (P=.008). All other comparisons showed similar reliability. Accuracy of devices was as follows: VITA Easyshade, 92.6%; ShadeVision, 84.8%; SpectroShade, 80.2%; and ShadeScan, 66.8%. Significant differences in accuracy were found between all device pairs (P<.001) for all comparisons except for SpectroShade versus ShadeVision (P=.033). Most devices had similar high reliability (over 96%), indicating predictable shade values from repeated measurements. However, there was more variability in accuracy among devices (67-93%), and differences in accuracy were seen with most device comparisons.

Optical Sensing Device Containing Fiber Bragg Gratings

DTIC Science & Technology

2000-08-01

Fabry - Perot (SFP) filter-based interrogation (Kersey et al. Opt. Lett.. 18, 1370-2. 1993), tunable acousto-optic filter inteiTOgation (Geiger et al...a tunable Fabry - Perot filter, and a tunable acousto-optical filter. Alternatively, scanning filter 28 can be omitted in device 10 of the present...invention when broadband light source 20 is a tunable broadband light source. More preferably, scanning filter 28 is a tunable Fabry - Perot filter

Comparison of laser ray-tracing and skiascopic ocular wavefront-sensing devices

PubMed Central

Bartsch, D-UG; Bessho, K; Gomez, L; Freeman, WR

2009-01-01

Purpose To compare two wavefront-sensing devices based on different principles. Methods Thirty-eight healthy eyes of 19 patients were measured five times in the reproducibility study. Twenty eyes of 10 patients were measured in the comparison study. The Tracey Visual Function Analyzer (VFA), based on the ray-tracing principle and the Nidek optical pathway difference (OPD)-Scan, based on the dynamic skiascopy principle were compared. Standard deviation (SD) of root mean square (RMS) errors was compared to verify the reproducibility. We evaluated RMS errors, Zernike terms and conventional refractive indexes (Sph, Cyl, Ax, and spherical equivalent). Results In RMS errors reading, both devices showed similar ratios of SD to the mean measurement value (VFA: 57.5±11.7%, OPD-Scan: 53.9±10.9%). Comparison on the same eye showed that almost all terms were significantly greater using the VFA than using the OPD-Scan. However, certain high spatial frequency aberrations (tetrafoil, pentafoil, and hexafoil) were consistently measured near zero with the OPD-Scan. Conclusion Both devices showed similar level of reproducibility; however, there was considerable difference in the wavefront reading between machines when measuring the same eye. Differences in the number of sample points, centration, and measurement algorithms between the two instruments may explain our results. PMID:17571088

Analysis of Multilayer Devices for Superconducting Electronics by High-Resolution Scanning Transmission Electron Microscopy and Energy Dispersive Spectroscopy

DOE PAGES

Missert, Nancy; Kotula, Paul G.; Rye, Michael; ...

2017-02-15

We used a focused ion beam to obtain cross-sectional specimens from both magnetic multilayer and Nb/Al-AlOx/Nb Josephson junction devices for characterization by scanning transmission electron microscopy (STEM) and energy dispersive X-ray spectroscopy (EDX). An automated multivariate statistical analysis of the EDX spectral images produced chemically unique component images of individual layers within the multilayer structures. STEM imaging elucidated distinct variations in film morphology, interface quality, and/or etch artifacts that could be correlated to magnetic and/or electrical properties measured on the same devices.

Fabrication of Gate-tunable Graphene Devices for Scanning Tunneling Microscopy Studies with Coulomb Impurities

PubMed Central

Jung, Han Sae; Tsai, Hsin-Zon; Wong, Dillon; Germany, Chad; Kahn, Salman; Kim, Youngkyou; Aikawa, Andrew S.; Desai, Dhruv K.; Rodgers, Griffin F.; Bradley, Aaron J.; Velasco, Jairo; Watanabe, Kenji; Taniguchi, Takashi; Wang, Feng; Zettl, Alex; Crommie, Michael F.

2015-01-01

Owing to its relativistic low-energy charge carriers, the interaction between graphene and various impurities leads to a wealth of new physics and degrees of freedom to control electronic devices. In particular, the behavior of graphene’s charge carriers in response to potentials from charged Coulomb impurities is predicted to differ significantly from that of most materials. Scanning tunneling microscopy (STM) and scanning tunneling spectroscopy (STS) can provide detailed information on both the spatial and energy dependence of graphene's electronic structure in the presence of a charged impurity. The design of a hybrid impurity-graphene device, fabricated using controlled deposition of impurities onto a back-gated graphene surface, has enabled several novel methods for controllably tuning graphene’s electronic properties.1-8 Electrostatic gating enables control of the charge carrier density in graphene and the ability to reversibly tune the charge2 and/or molecular5 states of an impurity. This paper outlines the process of fabricating a gate-tunable graphene device decorated with individual Coulomb impurities for combined STM/STS studies.2-5 These studies provide valuable insights into the underlying physics, as well as signposts for designing hybrid graphene devices. PMID:26273961

System and Method for Scan Range Gating

NASA Technical Reports Server (NTRS)

Lindemann, Scott (Inventor); Zuk, David M. (Inventor)

2017-01-01

A system for scanning light to define a range gated signal includes a pulsed coherent light source that directs light into the atmosphere, a light gathering instrument that receives the light modified by atmospheric backscatter and transfers the light onto an image plane, a scanner that scans collimated light from the image plane to form a range gated signal from the light modified by atmospheric backscatter, a control circuit that coordinates timing of a scan rate of the scanner and a pulse rate of the pulsed coherent light source so that the range gated signal is formed according to a desired range gate, an optical device onto which an image of the range gated signal is scanned, and an interferometer to which the image of the range gated signal is directed by the optical device. The interferometer is configured to modify the image according to a desired analysis.

Evaluating indicators of human well-being for ecosystem-based management

Treesearch

Sara Jo Breslow; Margaret Allen; Danielle Holstein; Brit Sojka; Raz Barnea; Xavier Basurto; Courtney Carothers; Susan Charnley; Sarah Coulthard; Nives Dolšak; Jamie Donatuto; Carlos García-Quijano; Christina C. Hicks; Arielle Levine; Michael B. Mascia; Karma Norman; Melissa Poe; Terre Satterfield; Kevin St. Martin; Phillip S. Levin

2017-01-01

Introduction: Interrelated social and ecological challenges demand an understanding of how environmental change and management decisions affect human well-being. This paper outlines a framework for measuring human well-being for ecosystem-based management (EBM). We present a prototype that can be adapted and developed for various scales and...

MAMMARY GLAND DEVELOPMENT AS A SENSITIVE END-POINT FOLLOWING ACUTE PERNATAL EXPOSURE TO A LOW DOSE ATRAZINE METABOLITE MIXTURE IN FEMALE LONG EVANS RATS

EPA Science Inventory

In order to characterize the potential developmental effects of atrazine (ATR) metabolites at low doses, an environmentally-based mixture (EBM) of ATR and its metabolites hydroxyatrazine, diaminochlorotriazine, deethylatrazine, and deisopropylatrazine was formulated based on surv...

Faculty Training in Evidence-Based Medicine: Improving Evidence Acquisition and Critical Appraisal

ERIC Educational Resources Information Center

Nicholson, Laura J.; Warde, Carole M.; Boker, John R.

2007-01-01

Introduction: Evidence-based medicine (EBM) integrates published clinical evidence with patient values and clinical expertise, the output of which is informed medical decision making. Key skills for evidence-based practice include acquisition and appraisal of clinical information. Faculty clinicians often lack expertise in these skills and are…

Evidence-Based Practice for Outpatient Clinical Teams

ERIC Educational Resources Information Center

Hamilton, John D.

2006-01-01

This column focuses on evidence-based practice (EBP) within multidisciplinary outpatient settings, but first provides some definitions. Besides EBP (Burns and Hoagwood, 2005; Guyatt and Rennie, 2002), there are also evidence-based medicine (EBM; March et al., 2005), evidence-based service (EBS; Chorpita et al., 2002), and evidence-based treatment…

Another Fine MeSH: Clinical Medicine Meets Information Science.

ERIC Educational Resources Information Center

O'Rourke, Alan; Booth, Andrew; Ford, Nigel

1999-01-01

Discusses evidence-based medicine (EBM) and the need for systematic use of databases like MEDLINE with more sophisticated search strategies to optimize the retrieval of relevant papers. Describes an empirical study of hospital libraries that examined requests for information and search strategies using both structured and unstructured forms.…

An Exploration of Mechanisms for Mediating the Influence of Extratropical Glaciation on the Tropical Climate

NASA Astrophysics Data System (ADS)

Pierrehumbert, R. T.; Frierson, D. M.

2006-05-01

To obtain a better understanding of the basic mechanisms by which the atmosphere transmits extratropical influences into the tropics, we have analyzed a series of general circulation model experiments carried out with idealized continental boundary conditions. These experiments were carried out with the FOAM1.5 model, which is in essence a portable Beowulf-oriented reimplementation of CCM3. In accord with our focus on the atmosphere in this work, the atmospheric model is coupled to a mixed-layer ocean with lateral ocean heat flux set to zero. The continental geometry consists of a pair of zonally symmetric continents, one centered on each pole. The Southern Hemisphere continent extends to 65S, and is kept glaciated in all experiments. The Northern Hemisphere continent extends to 42N, and is glaciated in the NHCOLD experiment but bare land in the NHWARM experiment. Sea ice feedback was suppressed in these simulations, but given the geometry of the Northern Hemisphere continent, the NHCOLD case can be taken as representing the combined forcing due to land glaciation and equatorward advance of sea ice. These experiments allow us to examine, in a very clean way, the response of the tropics to a very large extratropical cooling imposed at the surface, in a model which is energetically closed. Comparison of the two simulations has yielded the following results. The principal means by which the midlatitude glaciation affects the tropics is via a marked increase in poleward NH wintertime sensible heat flux, which is uncompensated by reduction in latent heat flux. The coupling of the storm tracks to the tropics is weak, however, and causes only a moderate cooling in the Northern subtropics and hardly any south of the Equator. The dynamics behind this barrier effect are discussed. The increased sensible heat flux,however, causes a considerable strengthening of the Hadley circulation; this strengthening allows the ITCZ precipitation to remain approximately unchanged between the NHWARM and NHCOLD cases, despite the substantial reduction in atmospheric water vapor in the cold case. The extremely strong midlatitude cooling produces a modest southward shift in the January ITCZ, and none at all in the July ITCZ, indicating that basic Hadley dynamics can make the ITCZ very resistant to moving; we find that the ITCZ position closely follows the tropical temperature maximum. The ITCZ shifts are discussed in terms of theoretical concepts applying to the Hadley circulation. Using an energy balance model (EBM) based on diffusion of moist static energy, Frierson and Held have shown that there is a compensation between changes in latent and sensible heat transport as climate warms, provided the meridional distribution of absorbed solar radiation remains fixed. We have extended this analysis to the case in which the solar forcing gradient is allowed to change, as is the case in our simulations owing to the change in surface albedo between the two simulations. In this case, the EBM does not require strict compensation, and in fact correctly reproduces the fact that tropical heat export increases in the NHCOLD case. However, the EBM over-estimates the penetration of the cooling past the Equator, owing to inadequacies in the diffusive treatment of the Hadley circulation. The EBM also misprepresents the magnitude of midlatitude heat flux changes, owing to the bottom-trapped nature of extratropical cooling seen in the GCM experiments, which is not reflected in the assumptions about the vertical profile of temperature built into the EBM. The implications of incorporating this effect will be discussed.

Original research in pathology: judgment, or evidence-based medicine?

PubMed

Crawford, James M

2007-02-01

Pathology is both a medical specialty and an investigative scientific discipline, concerned with understanding the essential nature of human disease. Ultimately, pathology is accountable as well, as measured by the accuracy of our diagnoses and the resultant patient care outcomes. As such, we must consider the evidence base underlying our practices. Within the realm of Laboratory Medicine, extensive attention has been given to testing accuracy and precision. Critical examination of the evidence base supporting the clinical use of specific laboratory tests or technologies is a separate endeavor, to which specific attention must be given. In the case of anatomic pathology and more specifically surgical pathology, the expertise required to render a diagnosis is derived foremost from experience, both personal and literature-based. In the first instance, knowledge of the linkage between one's own diagnoses and individual patient outcomes is required, to validate the role of one's own interpretations in the clinical course of patients. Experience comes from seeing this linkage first hand, from which hopefully comes wisdom and, ultimately, good clinical judgment. In the second instance, reading the literature and learning from experts is required. Only a minority of the relevant literature is published in pathology journals to which one may subscribe. A substantial portion of major papers relevant to the practice of anatomic pathology are published in collateral clinical specialty journals devoted to specific disease areas or organs. Active effort is therefore required to seek out the literature beyond the domain of pathology journals. In examining the published literature, the essential question then becomes: Does the practice of anatomic pathology fulfill the tenets of 'evidence-based medicine' (EBM)? If the pinnacle of EBM is 'systematic review of randomized clinical trials, with or without meta-analysis', then anatomic pathology falls far short. Our published literature is largely observational in nature, with reports of case series (with or without statistical analysis) constituting the majority of our 'evidence base'. Moreover, anatomic pathology is subject to 'interobserver variation', and potentially to 'error'. Taken further, individual interpretation of tissue samples is not an objective endeavor, and it is not easy to fulfill the role of a 'gold standard'. Both for rendering of an overall interpretation, and for providing the semi-quantitative and quantitative numerical 'scores' which support evidence-based clinical treatment algorithms, the Pathologist has to exercise a high level of interpretive judgment. Nevertheless, the contribution of anatomic pathology to 'EBM' is remarkably strong. To the extent that our judgmental interpretations become data, our tissue interpretations become the arbiters of patient care management decisions. In a more global sense, we support highly successful cancer screening programs, and play critical roles in the multidisciplinary management of complex patients. The true error is for the clinical practitioners of 'EBM' to forget the contribution to the supporting evidence base of the physicians that are Anatomic Pathologists. Finally, the academic productivity of pathology faculty who operate in the clinical realm must be considered. A survey of six North American academic pathology departments reveals that 26% of all papers published in 2005 came from 'unfunded' clinical faculty. While it is likely that their academic productivity is lower than that of 'funded' research faculty, the contribution of clinical faculty to the knowledge base for the practice of modern medicine, and to the academic reputation of the department, must not be overlooked. The ability of clinical faculty in academic departments of pathology to pursue original scholarship must be supported if our specialty is to retain its preeminence as an investigative scientific discipline in the age of EBM.

Reliability and accuracy of sleep apnea scans in novel cardiac resynchronization therapy devices: an independent report of two cases.

PubMed

Fox, Henrik; Nölker, Georg; Gutleben, Klaus-Jürgen; Bitter, Thomas; Horstkotte, Dieter; Oldenburg, Olaf

2014-03-01

Pacemaker apnea scan algorithms are able to screen for sleep apnea. We investigated whether these systems were able to accurately detect sleep-disordered breathing (SDB) in two patients from an outpatient clinic. The first patient suffered from ischemic heart failure and severe central sleep apnea (CSA) and underwent adaptive servoventilation therapy (ASV). The second patient suffered from dilated cardiomyopathy and moderate obstructive sleep apnea (OSA). Pacemaker read-outs did not match polysomnography (PSG) recordings well and overestimated the apnea-hypopnea index. However, ASV therapy-induced SDB improvements were adequately recognized by the apnea scan of the Boston Scientific INVIVE® cardiac resynchronization therapy pacemaker. Detection of obstructive respiratory events using impedance-based technology may underestimate the number of events, as frustrane breathing efforts induce impedance changes without significant airflow. By contrast, in the second case, apnea scan overestimated the number of total events and of obstructive events, perhaps owing to a very sensitive but less specific hypopnea definition and detection within the diagnostic algorithm of the device. These two cases show that a pacemaker apnea scan is able to reflect SDB, but PSG precision is not met by far. The device scan revealed the decline of SDB through ASV therapy for CSA in one patient, but not for OSA in the second case. To achieve reliable monitoring of SDB, further technical developments and clinical studies are necessary.

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

Krempasky, J.; Flechsig, U.; Korhonen, T.

Synchronous monochromator and insertion device energy scans were implemented at the Surfaces/Interfaces:Microscopy (SIM) beamline in order to provide the users fast X-ray magnetic dichroism studies (XMCD). A simple software control scheme is proposed based on a fast monochromator run-time energy readback which quickly updates the insertion device requested energy during an on-the-fly X-ray absorption scan (XAS). In this scheme the Plain Grating Monochromator (PGM) motion control, being much slower compared with the insertion device (APPLE-II type undulator), acts as a 'master' controlling the undulator 'slave' energy position. This master-slave software implementation exploits EPICS distributed device control over computer network andmore » allows for a quasi-synchronous motion control combined with data acquisition needed for the XAS or XMCD experiment.« less

Functional Scanning Probe Imaging of Nanostructured Solar Energy Materials.

PubMed

Giridharagopal, Rajiv; Cox, Phillip A; Ginger, David S

2016-09-20

From hybrid perovskites to semiconducting polymer/fullerene blends for organic photovoltaics, many new materials being explored for energy harvesting and storage exhibit performance characteristics that depend sensitively on their nanoscale morphology. At the same time, rapid advances in the capability and accessibility of scanning probe microscopy methods over the past decade have made it possible to study processing/structure/function relationships ranging from photocurrent collection to photocarrier lifetimes with resolutions on the scale of tens of nanometers or better. Importantly, such scanning probe methods offer the potential to combine measurements of local structure with local function, and they can be implemented to study materials in situ or devices in operando to better understand how materials evolve in time in response to an external stimulus or environmental perturbation. This Account highlights recent advances in the development and application of scanning probe microscopy methods that can help address such questions while filling key gaps between the capabilities of conventional electron microscopy and newer super-resolution optical methods. Focusing on semiconductor materials for solar energy applications, we highlight a range of electrical and optoelectronic scanning probe microscopy methods that exploit the local dynamics of an atomic force microscope tip to probe key properties of the solar cell material or device structure. We discuss how it is possible to extract relevant device properties using noncontact scanning probe methods as well as how these properties guide materials development. Specifically, we discuss intensity-modulated scanning Kelvin probe microscopy (IM-SKPM), time-resolved electrostatic force microscopy (trEFM), frequency-modulated electrostatic force microscopy (FM-EFM), and cantilever ringdown imaging. We explain these developments in the context of classic atomic force microscopy (AFM) methods that exploit the physics of cantilever motion and photocarrier generation to provide robust, nanoscale measurements of materials physics that are correlated with device operation. We predict that the multidimensional data sets made possible by these types of methods will become increasingly important as advances in data science expand capabilities and opportunities for image correlation and discovery.

Two-dimensional profiling of carriers in terahertz quantum cascade lasers using calibrated scanning spreading resistance microscopy and scanning capacitance microscopy.

PubMed

Dhar, R S; Ban, D

2013-07-01

The distribution of charge carriers inside the active region of a terahertz (THz) quantum cascade laser (QCL) has been measured with scanning spreading resistance microscopy (SSRM) and scanning capacitance microscopy (SCM). Individual quantum well-barrier modules with a 35.7-nm single module thickness in the active region of the device have been resolved for the first time using high-resolution SSRM and SCM techniques at room temperature. SSRM and SCM measurements on the quantum well-barrier structure were calibrated utilizing known GaAs dopant staircase samples. Doping concentrations derived from SSRM and SCM measurements were found to be in quantitative agreement with the designed average doping values of the n-type active region in the terahertz quantum cascade laser. The secondary ion mass spectroscopy provides a partial picture of internal device parameters, and we have demonstrated with our results the efficacy of uniting calibrated SSRM and SCM to delineate quantitatively the transverse cross-sectional structure of complex two-dimensional terahertz quantum cascade laser devices. © 2013 The Authors Journal of Microscopy © 2013 Royal Microscopical Society.

Optical scanning tests of complex CMOS microcircuits

NASA Technical Reports Server (NTRS)

Levy, M. E.; Erickson, J. J.

1977-01-01

The new test method was based on the use of a raster-scanned optical stimulus in combination with special electrical test procedures. The raster-scanned optical stimulus was provided by an optical spot scanner, an instrument that combines a scanning optical microscope with electronic instrumentation to process and display the electric photoresponse signal induced in a device that is being tested.

SDVSRM - a new SSRM based technique featuring dynamically adjusted, scanner synchronized sample voltages for measurement of actively operated devices.

PubMed

Doering, Stefan; Wachowiak, Andre; Roetz, Hagen; Eckl, Stefan; Mikolajick, Thomas

2018-06-01

Scanning spreading resistance microscopy (SSRM) with its high spatial resolution and high dynamic signal range is a powerful tool for two-dimensional characterization of semiconductor dopant areas. However, the application of the method is limited to devices in equilibrium condition, as the investigation of actively operated devices would imply potential differences within the device, whereas SSRM relies on a constant voltage difference between sample surface and probe tip. Furthermore, the standard preparation includes short circuiting of all device components, limiting applications to devices in equilibrium condition. In this work scanning dynamic voltage spreading resistance microscopy (SDVSRM), a new SSRM based two pass atomic force microscopy (AFM) technique is introduced, overcoming these limitations. Instead of short circuiting the samples during preparation, wire bond devices are used allowing for active control of the individual device components. SDVSRM consists of two passes. In the first pass the local sample surface voltage dependent on the dc biases applied to the components of the actively driven device is measured as in scanning voltage microscopy (SVM). The local spreading resistance is measured within the second pass, in which the afore obtained local surface voltage is used to dynamically adjust the terminal voltages of the device under test. This is done in a way that the local potential difference across the nano-electrical contact matches the software set SSRM measurement voltage, and at the same time, the internal voltage differences within the device under test are maintained. In this work the proof of the concept could be demonstrated by obtaining spreading resistance data of an actively driven photodiode test device. SDVSRM adds a higher level of flexibility in general to SSRM, as occurring differences in cross section surface voltage are taken into account. These differences are immanent for actively driven devices, but can also be present at standard, short circuited samples. Therefore, SDVSRM could improve the characterization under equilibrium conditions as well. Copyright © 2018. Published by Elsevier B.V.

Enhanced Axial Resolution of Wide-Field Two-Photon Excitation Microscopy by Line Scanning Using a Digital Micromirror Device.

PubMed

Park, Jong Kang; Rowlands, Christopher J; So, Peter T C

2017-01-01

Temporal focusing multiphoton microscopy is a technique for performing highly parallelized multiphoton microscopy while still maintaining depth discrimination. While the conventional wide-field configuration for temporal focusing suffers from sub-optimal axial resolution, line scanning temporal focusing, implemented here using a digital micromirror device (DMD), can provide substantial improvement. The DMD-based line scanning temporal focusing technique dynamically trades off the degree of parallelization, and hence imaging speed, for axial resolution, allowing performance parameters to be adapted to the experimental requirements. We demonstrate this new instrument in calibration specimens and in biological specimens, including a mouse kidney slice.

Enhanced Axial Resolution of Wide-Field Two-Photon Excitation Microscopy by Line Scanning Using a Digital Micromirror Device

PubMed Central

Park, Jong Kang; Rowlands, Christopher J.; So, Peter T. C.

2017-01-01

Temporal focusing multiphoton microscopy is a technique for performing highly parallelized multiphoton microscopy while still maintaining depth discrimination. While the conventional wide-field configuration for temporal focusing suffers from sub-optimal axial resolution, line scanning temporal focusing, implemented here using a digital micromirror device (DMD), can provide substantial improvement. The DMD-based line scanning temporal focusing technique dynamically trades off the degree of parallelization, and hence imaging speed, for axial resolution, allowing performance parameters to be adapted to the experimental requirements. We demonstrate this new instrument in calibration specimens and in biological specimens, including a mouse kidney slice. PMID:29387484

Use of digital micromirror devices as dynamic pinhole arrays for adaptive confocal fluorescence microscopy

NASA Astrophysics Data System (ADS)

Pozzi, Paolo; Wilding, Dean; Soloviev, Oleg; Vdovin, Gleb; Verhaegen, Michel

2018-02-01

In this work, we present a new confocal laser scanning microscope capable to perform sensorless wavefront optimization in real time. The device is a parallelized laser scanning microscope in which the excitation light is structured in a lattice of spots by a spatial light modulator, while a deformable mirror provides aberration correction and scanning. A binary DMD is positioned in an image plane of the detection optical path, acting as a dynamic array of reflective confocal pinholes, images by a high performance cmos camera. A second camera detects images of the light rejected by the pinholes for sensorless aberration correction.

Optimum Filters and Pulsed Signal Storage Devices,

DTIC Science & Technology

1982-05-05

condition is usually fulfilled in practice, with the exception of cases of very fast targets, superlong pulses and very short wavelengths. After passing...the repetition period of the system should be used to create slow scanning. The scope with fast scanning is used to measure speed and the one with slow...b. Consideration of these functions shows the intermit - tent amplitude variation of the pulse characteristic of a two-stage storage device. This is

Note: Automated optical focusing on encapsulated devices for scanning light stimulation systems

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

Bitzer, L. A.; Benson, N., E-mail: niels.benson@uni-due.de; Schmechel, R.

Recently, a scanning light stimulation system with an automated, adaptive focus correction during the measurement was introduced. Here, its application on encapsulated devices is discussed. This includes the changes an encapsulating optical medium introduces to the focusing process as well as to the subsequent light stimulation measurement. Further, the focusing method is modified to compensate for the influence of refraction and to maintain a minimum beam diameter on the sample surface.

Scanning and Measuring Device for Diagnostic of Barrel Bore

NASA Astrophysics Data System (ADS)

Marvan, Ales; Hajek, Josef; Vana, Jan; Dvorak, Radim; Drahansky, Martin; Jankovych, Robert; Skvarek, Jozef

The article discusses the design, mechanical design, electronics and software for robot diagnosis of barrels with caliber of 120 mm to 155 mm. This diagnostic device is intended primarily for experimental research and verification of appropriate methods and technologies for the diagnosis of the main bore guns. Article also discusses the design of sensors and software, the issue of data processing and image reconstruction obtained by scanning of the surface of the bore.

Ensuring safety of implanted devices under MRI using reversed RF polarization.

PubMed

Overall, William R; Pauly, John M; Stang, Pascal P; Scott, Greig C

2010-09-01

Patients with long-wire medical implants are currently prevented from undergoing magnetic resonance imaging (MRI) scans due to the risk of radio frequency (RF) heating. We have developed a simple technique for determining the heating potential for these implants using reversed radio frequency (RF) polarization. This technique could be used on a patient-to-patient basis as a part of the standard prescan procedure to ensure that the subject's device does not pose a heating risk. By using reversed quadrature polarization, the MR scan can be sensitized exclusively to the potentially dangerous currents in the device. Here, we derive the physical principles governing the technique and explore the primary sources of inaccuracy. These principles are verified through finite-difference simulations and through phantom scans of implant leads. These studies demonstrate the potential of the technique for sensitively detecting potentially dangerous coupling conditions before they can do any harm. 2010 Wiley-Liss, Inc.

Ultrafast axial scanning for two-photon microscopy via a digital micromirror device and binary holography.

PubMed

Cheng, Jiyi; Gu, Chenglin; Zhang, Dapeng; Wang, Dien; Chen, Shih-Chi

2016-04-01

In this Letter, we present an ultrafast nonmechanical axial scanning method for two-photon excitation (TPE) microscopy based on binary holography using a digital micromirror device (DMD), achieving a scanning rate of 4.2 kHz, scanning range of ∼180  μm, and scanning resolution (minimum step size) of ∼270  nm. Axial scanning is achieved by projecting the femtosecond laser to a DMD programmed with binary holograms of spherical wavefronts of increasing/decreasing radii. To guide the scanner design, we have derived the parametric relationships between the DMD parameters (i.e., aperture and pixel size), and the axial scanning characteristics, including (1) maximum optical power, (2) minimum step size, and (3) scan range. To verify the results, the DMD scanner is integrated with a custom-built TPE microscope that operates at 60 frames per second. In the experiment, we scanned a pollen sample via both the DMD scanner and a precision z-stage. The results show the DMD scanner generates images of equal quality throughout the scanning range. The overall efficiency of the TPE system was measured to be ∼3%. With the high scanning rate, the DMD scanner may find important applications in random-access imaging or high-speed volumetric imaging that enables visualization of highly dynamic biological processes in 3D with submillisecond temporal resolution.

Assessment of Safety and Interference Issues of Radio Frequency Identification Devices in 0.3 Tesla Magnetic Resonance Imaging and Computed Tomography

PubMed Central

Periyasamy, M.; Dhanasekaran, R.

2014-01-01

The objective of this study was to evaluate two issues regarding magnetic resonance imaging (MRI) including device functionality and image artifacts for the presence of radio frequency identification devices (RFID) in association with 0.3 Tesla at 12.7 MHz MRI and computed tomography (CT) scanning. Fifteen samples of RFID tags with two different sizes (wristband and ID card types) were tested. The tags were exposed to several MR-imaging conditions during MRI examination and X-rays of CT scan. Throughout the test, the tags were oriented in three different directions (axial, coronal, and sagittal) relative to MRI system in order to cover all possible situations with respect to the patient undergoing MRI and CT scanning, wearing a RFID tag on wrist. We observed that the tags did not sustain physical damage with their functionality remaining unaffected even after MRI and CT scanning, and there was no alternation in previously stored data as well. In addition, no evidence of either signal loss or artifact was seen in the acquired MR and CT images. Therefore, we can conclude that the use of this passive RFID tag is safe for a patient undergoing MRI at 0.3 T/12.7 MHz and CT Scanning. PMID:24701187

Analysis of the dynamics and frequency spectrum synthesis of an optical-mechanical scanning device

NASA Technical Reports Server (NTRS)

Andryushkevichyus, A. I.; Kumpikas, A. L.; Kumpikas, K. L.

1973-01-01

A two-coordinate optical-mechanical scanning device (OMSD), the operating unit of which is a scanning disk, with directional and focusing optics and a board, on which the data carrier is placed, is examined. The disk and board are kinematically connected by a transmission mechanism, consisting of a worm and complex gear drive and a tightening screw-nut with correcting device, and it is run by a synchronous type motor. The dynamic errors in the system depend, first, on irregularities in rotation of the disk, fluctuations in its axis and vibrations of the table in the plane parallel to the plane of the disk. The basic sources of the fluctuations referred to above are residual disbalance of the rotor and other rotating masses, the periodic component of the driving torque of the synchronous motor, variability in the resistance, kinematic errors in the drive and other things. The fluctuations can be transmitted to the operating units through the kinematic link as a flexural-torsional system, as well as through vibrations of the housing of the device.

A Smartphone Client-Server Teleradiology System for Primary Diagnosis of Acute Stroke

PubMed Central

2011-01-01

Background Recent advances in the treatment of acute ischemic stroke have made rapid acquisition, visualization, and interpretation of images a key factor for positive patient outcomes. We have developed a new teleradiology system based on a client-server architecture that enables rapid access to interactive advanced 2-D and 3-D visualization on a current generation smartphone device (Apple iPhone or iPod Touch, or an Android phone) without requiring patient image data to be stored on the device. Instead, a server loads and renders the patient images, then transmits a rendered frame to the remote device. Objective Our objective was to determine if a new smartphone client-server teleradiology system is capable of providing accuracies and interpretation times sufficient for diagnosis of acute stroke. Methods This was a retrospective study. We obtained 120 recent consecutive noncontrast computed tomography (NCCT) brain scans and 70 computed tomography angiogram (CTA) head scans from the Calgary Stroke Program database. Scans were read by two neuroradiologists, one on a medical diagnostic workstation and an iPod or iPhone (hereafter referred to as an iOS device) and the other only on an iOS device. NCCT brain scans were evaluated for early signs of infarction, which includes early parenchymal ischemic changes and dense vessel sign, and to exclude acute intraparenchymal hemorrhage and stroke mimics. CTA brain scans were evaluated for any intracranial vessel occlusion. The interpretations made on an iOS device were compared with those made at a workstation. The total interpretation times were recorded for both platforms. Interrater agreement was assessed. True positives, true negatives, false positives, and false negatives were obtained, and sensitivity, specificity, and accuracy of detecting the abnormalities on the iOS device were computed. Results The sensitivity, specificity, and accuracy of detecting intraparenchymal hemorrhage were 100% using the iOS device with a perfect interrater agreement (kappa = 1). The sensitivity, specificity, and accuracy of detecting acute parenchymal ischemic change were 94.1%, 100%, and 98.09% respectively for reader 1 and 97.05%, 100%, and 99.04% for reader 2 with nearly perfect interrater agreement (kappa = .8). The sensitivity, specificity, and accuracy of detecting dense vessel sign were 100%, 95.4%, and 96.19% respectively for reader 1 and 72.2%, 100%, and 95.23% for reader 2 using the iOS device with a good interrater agreement (kappa = .69). The sensitivity, specificity, and accuracy of detecting vessel occlusion on CT angiography scans were 94.4%, 100%, and 98.46% respectively for both readers using the iOS device, with perfect interrater agreement (kappa = 1). No significant difference (P < .05) was noted in the interpretation time between the workstation and iOS device. Conclusion The smartphone client-server teleradiology system appears promising and may have the potential to allow urgent management decisions in acute stroke. However, this study was retrospective, involved relatively few patient studies, and only two readers. Generalizing conclusions about its clinical utility, especially in other diagnostic use cases, should not be made until additional studies are performed. PMID:21550961

A smartphone client-server teleradiology system for primary diagnosis of acute stroke.

PubMed

Mitchell, J Ross; Sharma, Pranshu; Modi, Jayesh; Simpson, Mark; Thomas, Monroe; Hill, Michael D; Goyal, Mayank

2011-05-06

Recent advances in the treatment of acute ischemic stroke have made rapid acquisition, visualization, and interpretation of images a key factor for positive patient outcomes. We have developed a new teleradiology system based on a client-server architecture that enables rapid access to interactive advanced 2-D and 3-D visualization on a current generation smartphone device (Apple iPhone or iPod Touch, or an Android phone) without requiring patient image data to be stored on the device. Instead, a server loads and renders the patient images, then transmits a rendered frame to the remote device. Our objective was to determine if a new smartphone client-server teleradiology system is capable of providing accuracies and interpretation times sufficient for diagnosis of acute stroke. This was a retrospective study. We obtained 120 recent consecutive noncontrast computed tomography (NCCT) brain scans and 70 computed tomography angiogram (CTA) head scans from the Calgary Stroke Program database. Scans were read by two neuroradiologists, one on a medical diagnostic workstation and an iPod or iPhone (hereafter referred to as an iOS device) and the other only on an iOS device. NCCT brain scans were evaluated for early signs of infarction, which includes early parenchymal ischemic changes and dense vessel sign, and to exclude acute intraparenchymal hemorrhage and stroke mimics. CTA brain scans were evaluated for any intracranial vessel occlusion. The interpretations made on an iOS device were compared with those made at a workstation. The total interpretation times were recorded for both platforms. Interrater agreement was assessed. True positives, true negatives, false positives, and false negatives were obtained, and sensitivity, specificity, and accuracy of detecting the abnormalities on the iOS device were computed. The sensitivity, specificity, and accuracy of detecting intraparenchymal hemorrhage were 100% using the iOS device with a perfect interrater agreement (kappa=1). The sensitivity, specificity, and accuracy of detecting acute parenchymal ischemic change were 94.1%, 100%, and 98.09% respectively for reader 1 and 97.05%, 100%, and 99.04% for reader 2 with nearly perfect interrater agreement (kappa=.8). The sensitivity, specificity, and accuracy of detecting dense vessel sign were 100%, 95.4%, and 96.19% respectively for reader 1 and 72.2%, 100%, and 95.23% for reader 2 using the iOS device with a good interrater agreement (kappa=.69). The sensitivity, specificity, and accuracy of detecting vessel occlusion on CT angiography scans were 94.4%, 100%, and 98.46% respectively for both readers using the iOS device, with perfect interrater agreement (kappa=1). No significant difference (P<.05) was noted in the interpretation time between the workstation and iOS device. The smartphone client-server teleradiology system appears promising and may have the potential to allow urgent management decisions in acute stroke. However, this study was retrospective, involved relatively few patient studies, and only two readers. Generalizing conclusions about its clinical utility, especially in other diagnostic use cases, should not be made until additional studies are performed. ©J Ross Mitchell, Pranshu Sharma, Jayesh Modi, Mark Simpson, Monroe Thomas, Michael D. Hill, Mayank Goyal.

X-ray scan detection for cargo integrity

NASA Astrophysics Data System (ADS)

Valencia, Juan; Miller, Steve

2011-04-01

The increase of terrorism and its global impact has made the determination of the contents of cargo containers a necessity. Existing technology allows non-intrusive inspections to determine the contents of a container rapidly and accurately. However, some cargo shipments are exempt from such inspections. Hence, there is a need for a technology that enables rapid and accurate means of detecting whether such containers were non-intrusively inspected. Non-intrusive inspections are most commonly performed utilizing high powered X-ray equipment. The challenge is creating a device that can detect short duration X-ray scans while maintaining a portable, battery powered, low cost, and easy to use platform. The Pacific Northwest National Laboratory (PNNL) has developed a methodology and prototype device focused on this challenge. The prototype, developed by PNNL, is a battery powered electronic device that continuously measures its X-ray and Gamma exposure, calculates the dose equivalent rate, and makes a determination of whether the device has been exposed to the amount of radiation experienced during an X-ray inspection. Once an inspection is detected, the device will record a timestamp of the event and relay the information to authorized personnel via a visual alert, USB connection, and/or wireless communication. The results of this research demonstrate that PNNL's prototype device can be effective at determining whether a container was scanned by X-ray equipment typically used for cargo container inspections. This paper focuses on laboratory measurements and test results acquired with the PNNL prototype device using several X-ray radiation levels.

[Magnetic resonance imaging in patients with implantable devices for treatment of disturbed heart rhythm: review of the current situation].

PubMed

Sviridova, A A

The question of the possibility of MRI scanning in patients with cardiac implantable electronic devices (CIED) appeared simultaneously with the introduction of MRI in clinical practice. A lot of in-vitro, in-vivo and clinical researches were performed to estimate wat going on with CIED in strong magnetic field and is it possible to perform some unified protocol of safe MRI-scanning for these patients. Recommendations were provided, but not for the wide practice. MRI remained strongly contraindicated for CIED patient. To meet the clinical need CIEM manufacturers changed the design of devices to made them MRI-compatible, including reducing of ferromagnetic components, additional filters, new software. Lead coil design was changed as well to minimize lead heating and electrical current induction. Now all leaders of CIED industry have in their portfolio all types of MRI-conditional implanted cardiac rhythm management devices (pacemakers, ICDs, CRTs). "Conditional" means MRI scanning can be done only under specific condition. For MRI device and lead in one system have to be from the same manufacturer. Now, if you need to implant the device, you must proceed from the fact that the patient is more likely to need an MRI in the future and choose the appropriate model, not forgetting that the electrodes should also be MRI-compatible.

Unexpected surface implanted layer in static random access memory devices observed by microwave impedance microscope

NASA Astrophysics Data System (ADS)

Kundhikanjana, W.; Yang, Y.; Tanga, Q.; Zhang, K.; Lai, K.; Ma, Y.; Kelly, M. A.; Li, X. X.; Shen, Z.-X.

2013-02-01

Real-space mapping of doping concentration in semiconductor devices is of great importance for the microelectronics industry. In this work, a scanning microwave impedance microscope (MIM) is employed to resolve the local conductivity distribution of a static random access memory sample. The MIM electronics can also be adjusted to the scanning capacitance microscopy (SCM) mode, allowing both measurements on the same region. Interestingly, while the conventional SCM images match the nominal device structure, the MIM results display certain unexpected features, which originate from a thin layer of the dopant ions penetrating through the protective layers during the heavy implantation steps.

Radar Array Processing of Experimental Data Via the Scan-MUSIC Algorithm

DTIC Science & Technology

2004-06-01

Radar Array Processing of Experimental Data Via the Scan- MUSIC Algorithm by Canh Ly ARL-TR-3135 June 2004...Processing of Experimental Data Via the Scan- MUSIC Algorithm Canh Ly Sensors and Electron Devices Directorate, ARL...NUMBER 5b. GRANT NUMBER 4. TITLE AND SUBTITLE Radar Array Processing of Experimental Data Via the Scan- MUSIC Algorithm 5c. PROGRAM ELEMENT NUMBER 5d

Evidence-based guidelines: Improving AGREEment on consistence evaluation

PubMed Central

Vincenzi, Bruno; Napolitano, Andrea; Santini, Daniele; Maiello, Evaristo; Torri, Valter; Tonini, Giuseppe

2012-01-01

Modern clinical practice relies on evidence-based medicine (EBM) and evidence-based guidelines (EBGs). The critical evaluation of EBGs value is therefore an essential step to further improve clinical practice. In our opinion, correlating levels of evidence and grades of recommendation can be an easy tool to quickly display internal consistence of EBGs. PMID:26909252

[A Critical Condition of Clinical Studies in Japan -- A Battle of Clinical Study Groups].

PubMed

Furukawa, Hiroshi

2016-04-01

The post-marketing clinical study groups have been losing their activity due to stop of financial support. As the result, clinical study groups cannot achieve any EBM for treatment guidelines. Financial supports should be restarted immediately not to extinguish the post-marketing clinical studies and study groups.

Teaching and Learning of Medical Biochemistry According to Clinical Realities: A Case Study

ERIC Educational Resources Information Center

Jabaut, Joshua M.; Dudum, Ramzi; Margulies, Samantha L.; Mehta, Akshita; Han, Zhiyong

2016-01-01

To foster medical students to become physicians who will be lifelong independent learners and critical thinkers with healthy skepticism and provide high-quality patient care guided by the best evidence, teaching of evidence-based medicine (EBM) has become an important component of medical education. Currently, the teaching and learning of…

Graduate Medical Education Training in Clinical Epidemiology, Critical Appraisal, and Evidence-Based Medicine: A Critical Review of Curricula.

ERIC Educational Resources Information Center

Green, Michael L.

1999-01-01

A study systematically reviewed published literature on graduate medical-education curricula in clinical epidemiology, critical appraisal, and evidence-based medicine (EBM). The 18 reports found in the search provide useful guidelines for medical educators but many suffer from incomplete descriptions and inadequate curriculum evaluations.…