Contemporary forest restoration: A review emphasizing function

Treesearch

John A. Stanturf; Brian J. Palik; R. Kasten Dumroese

2014-01-01

The forest restoration challenge (globally 2 billion ha) and the prospect of changing climate with increasing frequency of extreme events argues for approaching restoration from a functional and landscape perspective. Because the practice of restoration utilizes many techniques common to silviculture, no clear line separates ordinary forestry practices from restoration...

Common Practices for Evaluating Post-Secondary Online Instructors

ERIC Educational Resources Information Center

Thomas, Jonathan E.; Graham, Charles R.

2017-01-01

This literature review explores current post-secondary practices for evaluating online instructors. As enrollment of students in online courses has steadily increased over the last few decades, instructor evaluation has lagged behind. Through a thematic analysis of existing literature, this review seeks to answer these questions: (1) How are…

Centering Pregnancy: practical tips for your practice.

PubMed

DeCesare, Julie Z; Jackson, Jessica R

2015-03-01

With increased access to care, current health delivery systems will need expansion to meet higher demands and needs. To define Centering Pregnancy and practical tips for implementation into both private and academic practices. Evidence was gathered through literature reviews. It was found that Centering Pregnancy offers a patient-centered, evidence-based approach to helping with access issues, as well as improving outcomes. This article describes the benefits of Centering Pregnancy to the practice, the provider, and the patient. Practical implementation tips will be offered, with suggestions for negating common implementation barriers.

Historical Fiction, the Common Core, and Disciplinary Habits of Mind

ERIC Educational Resources Information Center

Schwebel, Sara L.

2014-01-01

The Common Core State Standards call for the increased presence of nonfiction in the school curriculum and for students' exposure to narratives characterized by textual complexity. At first glance, these recommendations may discourage classroom teachers from continuing the longstanding instructional practice of using historical fiction to…

How common is multiple general practice attendance in Australia?

PubMed

Wright, Michael; Hall, Jane; van Gool, Kees; Haas, Marion

2018-05-01

Australians can seek general practice care from multiple general practitioners (GPs) in multiple locations. This provides high levels of patient choice but may reduce continuity of care. The aim of this study was to estimate the prevalence of attendance at multiple general practices in Australia, and identify patient characteristics associated with multiple practice attendances. A cross-sectional survey of 2477 Australian adults was conducted online in July 2013. Respondents reported whether they had attended more than one general practice in the past year, and whether they had a usual general practice and GP. Demographic information, health service use and practice characteristics were also obtained from the survey. Over one-quarter of the sample reported attending more than one practice in the previous year. Multiple practice attendance is less common with increasing age, and less likely for survey respondents from regional Australia, compared with respondents from metropolitan areas. Multiple practice attenders are just as likely as single practice attenders to have a usual GP. A significant proportion of general practice care is delivered away from usual practices. This may have implications for health policy, in terms of continuity and quality of primary care.

Meeting patient needs trumps adherence. A cross-sectional study of adherence and adaptations when national guidelines are used in practice.

PubMed

Kakeeto, Mikael; Lundmark, Robert; Hasson, Henna; von Thiele Schwarz, Ulrica

2017-08-01

In the evidence-to-practice pathway, guidelines are developed to provide a practical summary of evidence and stimulate change. However, when guidelines are used in practice, adherence to the recommendations in guidelines is limited, and adaptations are common. Thus, we need more detailed knowledge about adherence and adaptations when guidelines are used in practice to understand the end of the evidence-to-practice pathway. Subsequently, the aim is to examine adherence to and adaptations of recommendations in the Swedish National Guidelines for Methods of Preventing Disease. A questionnaire was sent to healthcare professionals and managers in Stockholm between January and March 2014. Adherence to the recommendations was compared between practice settings, and the frequency of different adaptations and reasons for adaptations was analysed. Partial adherence to the guidelines was found. The adherence was significantly greater within primary care than at the hospitals (P < .001). Modifications formed the most common category of adaptations (55%) and included mainly prioritization of specific patient groups and increased patient customization. The most common reason for adaptations (25%) was to meet the patients' specific needs and capabilities. This study provides insight into adherence and adaptation when guidelines are used in practice. Work with lifestyle habits was partially done in accordance with the guidelines. Lack of time and lack of resources were not the most common reasons for adaptations. Rather, the findings suggest that when patient needs and capabilities contrast with guideline recommendations, patient needs trump adherence to guidelines. © 2017 John Wiley & Sons, Ltd.

Influence of Varroa mite (Varroa destructor) infestation levels and management practices on insecticide sensitivity in the honey bee (Apis mellifera)

USDA-ARS?s Scientific Manuscript database

Because Varroa mites may cause devastating losses of honey bees through direct feeding, transmitting diseases, and increasing pathogen susceptibility, chemical and mechanical practices commonly are used to reduce mite infestation. While miticide applications are typically the most consistent and eff...

Soil nitrogen dynamics and leaching under conservation tillage in the Atlantic Coastal Plain, Georgia, USA

USDA-ARS?s Scientific Manuscript database

Conservation tillage (CsT) involves management that reduces soil erosion by maintaining crop residue cover on farm fields. Typically, both infiltration and soil organic matter increase over time with CsT practices. We compared the impact of a commonly used CsT practice, strip tillage (ST), to conven...

Looping: Supporting Student Learning through Long-Term Relationships.

ERIC Educational Resources Information Center

Northeast and Islands Regional Educational Lab. at Brown Univ., Providence, RI.

Looping refers to the increasingly common practice of keeping groups of students together for two or more years with the same teacher. This booklet, first in a series of "Themes in Education" provides information on the educational practice of looping and includes selected current references on the topic. The booklet outlines the history of this…

Online Discussion Boards: The Practice of Building Community for Adult Learners

ERIC Educational Resources Information Center

Covelli, Bonnie J.

2017-01-01

Online education continues to grow, and the application of theory to practice becomes increasingly important as practitioners examine the impact technology has on e-classroom interaction. Adult students, in particular, look for interaction that is collaborative and student-centered. A common area for dialogue within the online classroom is the…

Formative Assessment in Practice: A Process of Inquiry and Action

ERIC Educational Resources Information Center

Heritage, Margaret

2013-01-01

Margaret Heritage presents a practical guide to formative assessment as a process of "inquiry and action" essential to twenty-first century learning. In the wake of the development of the Common Core standards and the effort to develop the appropriate assessments to accompany them, formative assessment has attracted increasing attention…

The Immortal Life of Henrietta Lacks: Using a Common Read to Transform a Learning Community

ERIC Educational Resources Information Center

Virtue, Emily; Wells, Gayle; MacKusick, Carol; Murphy-Nugen, Amy; Rose, Amy

2018-01-01

First-year seminars and learning communities (LC) have been used to help increase retention, provide continuity, and support students as they transition to the university setting. Another high impact educational practice--common intellectual experiences (CIE)--includes student activities centered on a theme to help facilitate learning, increase…

Common Core Science Standards: Implications for Students with Learning Disabilities

ERIC Educational Resources Information Center

Scruggs, Thomas E.; Brigham, Frederick J.; Mastropieri, Margo A.

2013-01-01

The Common Core Science Standards represent a new effort to increase science learning for all students. These standards include a focus on English and language arts aspects of science learning, and three dimensions of science standards, including practices of science, crosscutting concepts of science, and disciplinary core ideas in the various…

Fully Capitated Payment Breakeven Rate for a Mid-Size Pediatric Practice.

PubMed

Farmer, Steven A; Shalowitz, Joel; George, Meaghan; McStay, Frank; Patel, Kavita; Perrin, James; Moghtaderi, Ali; McClellan, Mark

2016-08-01

Payers are implementing alternative payment models that attempt to align payment with high-value care. This study calculates the breakeven capitated payment rate for a midsize pediatric practice and explores how several different staffing scenarios affect the rate. We supplemented a literature review and data from >200 practices with interviews of practice administrators, physicians, and payers to construct an income statement for a hypothetical, independent, midsize pediatric practice in fee-for-service. The practice was transitioned to full capitation to calculate the breakeven capitated rate, holding all practice parameters constant. Panel size, overhead, physician salary, and staffing ratios were varied to assess their impact on the breakeven per-member per-month (PMPM) rate. Finally, payment rates from an existing health plan were applied to the practice. The calculated breakeven PMPM was $24.10. When an economic simulation allowed core practice parameters to vary across a broad range, 80% of practices broke even with a PMPM of $35.00. The breakeven PMPM increased by 12% ($3.00) when the staffing ratio increased by 25% and increased by 23% ($5.50) when the staffing ratio increased by 38%. The practice was viable, even with primary care medical home staffing ratios, when rates from a real-world payer were applied. Practices are more likely to succeed in capitated models if pediatricians understand how these models alter practice finances. Staffing changes that are common in patient-centered medical home models increased the breakeven capitated rate. The degree to which team-based care will increase panel size and offset increased cost is unknown. Copyright © 2016 by the American Academy of Pediatrics.

Continuing Dermatology Education for Rural Physician Assistants in Ghana: An Assessment of Needs and Effectiveness.

PubMed

Truong, Amanda; Cobb, Nadia M; Hawkes, Jason E; Adjase, Emmanuel T; Goldgar, David E; Powell, Douglas L; Lewis, Bethany K H

2018-03-01

To assess the effectiveness of lectures for continuing medical education (CME) in dermatology in a global health setting and to determine provider and patient demographics of physician assistants (PAs) practicing in rural Ghana. Physician assistants from Ghana who attended dermatology lectures at the International Seminar for Physician Assistants in 2011 or 2014 were included in this study. Surveys were administered to participants to determine dermatology resource availability, commonly encountered skin diseases, and management practices. Quizzes were administered before and after CME dermatology lectures to assess short-term retention of lecture material. In all, 353 PAs participated in this study. Physician assistants reported seeing an average of 55 patients per day. The most commonly seen skin diseases were infections, with antifungals and antibiotics being the most commonly prescribed medications. Dermatology-related complaints represented 9.5% of total clinic visits. Among practicing PAs, 23.2% reported having internet access. A total of 332 PAs completed the quizzes, and a statistically significant increase in test scores was noted in postlecture quizzes. This study reinforces the importance of dermatology education for PAs practicing in rural areas of Ghana and lends insight to critical topics for dermatology curriculum development. In addition, the increase in test scores after CME sessions suggests that lectures are an effective tool for short-term retention of dermatology-related topics. Our study indicates that as the need for health workers increases globally and a paradigm shift away from the traditional physician model of care occurs, dermatology training of PAs is not only important but also achievable.

Physical Examination for the Academic Psychiatrist: Primer and Common Clinical Scenarios.

PubMed

Azzam, Pierre N; Gopalan, Priya; Brown, Jennifer R; Aquino, Patrick R

2016-04-01

As clinical psychiatry has evolved to mirror the patient care model followed in other medical specialties, psychiatrists are called upon increasingly to utilize general medical skills in routine practice. Psychiatrists who practice in academic settings are often required to generate broad differential diagnoses that include medical and neurologic conditions and, as a result, benefit from incorporating physical examination into their psychiatric assessments. Physical examination allows psychiatrists to follow and to teach patient-informed clinical practices and comprehensive treatment approaches. In this commentary, the authors encourage routine use of a targeted physical examination and outline common scenarios in which physical examination would be useful for the academic psychiatrist: delirium, toxidromes, and unexplained medical conditions (e.g., somatic symptom disorders).

The best of both worlds: Building on the COPUS and RTOP observation protocols to easily and reliably measure various levels of reformed instructional practice.

PubMed

Lund, Travis J; Pilarz, Matthew; Velasco, Jonathan B; Chakraverty, Devasmita; Rosploch, Kaitlyn; Undersander, Molly; Stains, Marilyne

2015-01-01

Researchers, university administrators, and faculty members are increasingly interested in measuring and describing instructional practices provided in science, technology, engineering, and mathematics (STEM) courses at the college level. Specifically, there is keen interest in comparing instructional practices between courses, monitoring changes over time, and mapping observed practices to research-based teaching. While increasingly common observation protocols (Reformed Teaching Observation Protocol [RTOP] and Classroom Observation Protocol in Undergraduate STEM [COPUS]) at the postsecondary level help achieve some of these goals, they also suffer from weaknesses that limit their applicability. In this study, we leverage the strengths of these protocols to provide an easy method that enables the reliable and valid characterization of instructional practices. This method was developed empirically via a cluster analysis using observations of 269 individual class periods, corresponding to 73 different faculty members, 28 different research-intensive institutions, and various STEM disciplines. Ten clusters, called COPUS profiles, emerged from this analysis; they represent the most common types of instructional practices enacted in the classrooms observed for this study. RTOP scores were used to validate the alignment of the 10 COPUS profiles with reformed teaching. Herein, we present a detailed description of the cluster analysis method, the COPUS profiles, and the distribution of the COPUS profiles across various STEM courses at research-intensive universities. © 2015 T. J. Lund et al. CBE—Life Sciences Education © 2015 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).

Interdisciplinarity in an Era of New Public Management: A Case Study of Graduate Business Schools

ERIC Educational Resources Information Center

Ryan, Suzanne; Neumann, Ruth

2013-01-01

In an era of rapid knowledge transmission and creation spurred on by advances in technology and globalisation, calls for interdisciplinarity to solve "wicked" problems are common. In the same era, universities are increasingly adopting new public management practices. The extent to which these practices affect knowledge production is an…

Teaching Business Ethics: The Effectiveness of Common Pedagogical Practices in Developing Students' Moral Judgment Competence

ERIC Educational Resources Information Center

Bosco, Susan M.; Melchar, David E.; Beauvais, Laura L.; Desplaces, David E.

2010-01-01

This study investigates the effectiveness of pedagogical practices used to teach business ethics. The business community has greatly increased its demands for better ethics education in business programs. Educators have generally agreed that the ethical principles of business people have declined. It is important, then, to examine how common…

The Role of Program Consistency in a Summer Therapeutic Camp for Students with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Quinn, Colleen; Nowosielski, Ashley; Kitchen, Tom; Belfiore, Phillip J.

2014-01-01

Although evidenced-based practices, delivered with procedural integrity are increasingly common in the field of autism, generalizing those practices to less traditional settings is not. The present study, conducted at a summer therapeutic camp used a single subject multiple baseline across participants research design to evaluate the effects of…

Community-based telemonitoring for hypertension management: practical challenges and potential solutions.

PubMed

Hovey, Lauren; Kaylor, Mary Beth; Alwan, Majd; Resnick, Helaine E

2011-10-01

Older adults residing in rural areas often lack convenient, patient-centered, community-based approaches to facilitate receipt of routine care to manage common chronic conditions. Without adequate access to appropriate disease management resources, the risk of seniors' experiencing acute events related to these common conditions increases substantially. Further, poorly managed chronic conditions are costly and place seniors at increased risk of institutionalization and permanent loss of independence. Novel, telehealth-based approaches to management of common chronic conditions like hypertension may not only improve the health of older adults, but may also lead to substantial cost savings associated with acute care episodes and institutionalization. The aim of this report is to summarize practical considerations related to operations and logistics of a unique community-based telemonitoring pilot study targeting rural seniors who utilize community-based senior centers. This article reviews the technological challenges encountered during the study and proposes solutions relevant to future research and implementation of telehealth in community-based, congregate settings.

Sport-Related Concussion and Occupational Therapy: Expanding the Scope of Practice

ERIC Educational Resources Information Center

Reed, Nick

2011-01-01

Sport participation is a common occupation for many children and youth and can lead to improved physical and psychosocial health. Despite these benefits, it exposes children and youth to the increased risk of injury. Concussion, also referred to as mild traumatic brain injury (mTBI), is one of the most common sports injuries reported in the…

EFFECTS OF LIME (CAO) ON THE ENDOTOXIN LEVELS OF BIOSOLIDS

EPA Science Inventory

Lime addition is a common practice for treating biosolids in order to meet EPA 503 requirements for land application. Since this treatment kills the majority of microorganisms, will it increase the level of endotoxins present in biosolids? And, if endotoxin levels are increased, ...

Knowledge, Attitude And Practice Of Common Cold And Its Management Among Doctors Of Pakistan.

PubMed

Rehman, Muneeb-Ur-; Tariq, Naseer Alam; Ahmed, Mamoon; Ahmad, Maryam; Zahid, Areej; Chaudhry, Quratulain; Tahir, Bisma; Islam, Zoraiz Ul; Ud Din, Zahoor Mohi

2016-01-01

Antibiotic misuse for upper respiratory tract infections such as the common cold is widespread in clinical practice. Excessive prescription of antibiotics by doctors has resulted in increased antimicrobial resistance. This led to our objective of determining the percentage of doctors in Pakistan prescribing antibiotics for the treatment of common cold and to know about their knowledge in preventing the spread of this disease. It was a cross-sectional descriptive study, conducted in 9 cities of Pakistan including Rawalpindi, Islamabad, Peshawar, Lahore, Karachi, Faisalabad, Sargodha, Multan and D.G. Khan over a period of 03 months -from October to December, 2013. Questionnaire regarding the disease spread and its treatment was distributed among 300 randomly selected doctors in nine cities of Pakistan from both public and private sector. Eighteen percent of the doctors prescribe antibiotics for common cold. Only 113 (37.7%) doctors correctly responded that mean incubation period for common cold was 1-2 days. Two hundred and nine (69.7%) answered correctly that cold weather increases susceptibility to common cold. Only 84 (28%) responded correctly by choosing that regular and frequent hand-washing with good quality soaps was the most effective way to prevent spread of this disease in day-to-day life. Antibiotics are being prescribed for treatment of common cold by a large proportion of doctors. There is insufficient knowledge among our doctors regarding the factors which aggravate or alleviate common cold symptoms as well as the methods by which these infections can be prevented.

What can we learn from corporate sustainability reporting? Deriving propositions for research and practice from over 9,500 corporate sustainability reports published between 1999 and 2015 using topic modelling technique

PubMed Central

vom Brocke, Jan

2017-01-01

Organizations are increasingly using sustainability reports to inform their stakeholders and the public about their sustainability practices. We apply topic modelling to 9,514 sustainability reports published between 1999 and 2015 in order to identify common topics and, thus, the most common practices described in these reports. In particular, we identify forty-two topics that reflect sustainability and focus on the coverage and trends of economic, environmental, and social sustainability topics. Among the first to analyse such a large amount of data on organizations’ sustainability reporting, the paper serves as an example of how to apply natural language processing as a strategy of inquiry in sustainability research. The paper also derives from the data analysis ten propositions for future research and practice that are of immediate value for organizations and researchers. PMID:28403158

What can we learn from corporate sustainability reporting? Deriving propositions for research and practice from over 9,500 corporate sustainability reports published between 1999 and 2015 using topic modelling technique.

PubMed

Székely, Nadine; Vom Brocke, Jan

2017-01-01

Organizations are increasingly using sustainability reports to inform their stakeholders and the public about their sustainability practices. We apply topic modelling to 9,514 sustainability reports published between 1999 and 2015 in order to identify common topics and, thus, the most common practices described in these reports. In particular, we identify forty-two topics that reflect sustainability and focus on the coverage and trends of economic, environmental, and social sustainability topics. Among the first to analyse such a large amount of data on organizations' sustainability reporting, the paper serves as an example of how to apply natural language processing as a strategy of inquiry in sustainability research. The paper also derives from the data analysis ten propositions for future research and practice that are of immediate value for organizations and researchers.

Publishing scientifically sound papers in Traditional and Complementary Medicine.

PubMed

Isidoro, Ciro; Huang, Chia-Chi; Sheen, Lee-Yan

2016-01-01

Non-conventional medical practices that make use of dietary supplements, herbal extracts, physical manipulations, and other practices typically associated with folk and Traditional Medicine are increasingly becoming popular in Western Countries. These practices are commonly referred to by the generic, all-inclusive term "Complementary and Alternative Medicine." Scientists, practitioners, and medical institutions bear the responsibility of testing and proving the effectiveness of these non-conventional medical practices in the interest of patients. In this context, the number of peer-reviewed journals and published articles on this topic has greatly increased in the recent decades. In this editorial article, we illustrate the policy of the Journal of Traditional and Complementary Medicine for publishing solid and scientifically sound papers in the field of Traditional and Complementary Medicine.

Stellite-based classification of tillage practices in the U.S.

NASA Astrophysics Data System (ADS)

Azzari, G.; Lobell, D. B.

2017-12-01

The number of applications based on Machine learning algorithms applied to satellite images has been increasing steadily in last few years. While in the context of agricultural monitoring these techiques are most commonly used for land cover type and crop classification, they also show a great potential for monitoring management practices. In this study, we present some preliminary results on classifying tillage practices in the U.S. midwest using Landsat 8 and Sentinel 2 data.

Risk management in clinical practice. Part 10. Periodontology.

PubMed

Baker, P; Needleman, I

2010-12-11

A sizeable proportion of patients in clinical practice will have some form of periodontal disease and most of these patients can be well managed in primary care. Unfortunately, dento-legal claims regarding inappropriate periodontal care are increasing rapidly and are now one of the most common reasons for litigation in dentistry. In this paper we will look at aspects of contemporary management of periodontal disease in clinical practice and offer guidance for examination, management and referral.

The Best of Both Worlds: Building on the COPUS and RTOP Observation Protocols to Easily and Reliably Measure Various Levels of Reformed Instructional Practice

PubMed Central

Lund, Travis J.; Pilarz, Matthew; Velasco, Jonathan B.; Chakraverty, Devasmita; Rosploch, Kaitlyn; Undersander, Molly; Stains, Marilyne

2015-01-01

Researchers, university administrators, and faculty members are increasingly interested in measuring and describing instructional practices provided in science, technology, engineering, and mathematics (STEM) courses at the college level. Specifically, there is keen interest in comparing instructional practices between courses, monitoring changes over time, and mapping observed practices to research-based teaching. While increasingly common observation protocols (Reformed Teaching Observation Protocol [RTOP] and Classroom Observation Protocol in Undergraduate STEM [COPUS]) at the postsecondary level help achieve some of these goals, they also suffer from weaknesses that limit their applicability. In this study, we leverage the strengths of these protocols to provide an easy method that enables the reliable and valid characterization of instructional practices. This method was developed empirically via a cluster analysis using observations of 269 individual class periods, corresponding to 73 different faculty members, 28 different research-intensive institutions, and various STEM disciplines. Ten clusters, called COPUS profiles, emerged from this analysis; they represent the most common types of instructional practices enacted in the classrooms observed for this study. RTOP scores were used to validate the alignment of the 10 COPUS profiles with reformed teaching. Herein, we present a detailed description of the cluster analysis method, the COPUS profiles, and the distribution of the COPUS profiles across various STEM courses at research-intensive universities. PMID:25976654

The Dynamics of Community Health Care Consolidation: Acquisition of Physician Practices

PubMed Central

Christianson, Jon B; Carlin, Caroline S; Warrick, Louise H

2014-01-01

Context Health care delivery systems are becoming increasingly consolidated in urban areas of the United States. While this consolidation could increase efficiency and improve quality, it also could raise the cost of health care for payers. This article traces the consolidation trajectory in a single community, focusing on factors influencing recent acquisitions of physician practices by integrated delivery systems. Methods We used key informant interviews, supplemented by document analysis. Findings The acquisition of physician practices is a process that will be difficult to reverse in the current health care environment. Provider revenue uncertainty is a key factor driving consolidation, with public and private attempts to control health care costs contributing to that uncertainty. As these efforts will likely continue, and possibly intensify, community health care systems now are less consolidated than they will be in the future. Acquisitions of multispecialty and primary care practices by integrated delivery systems follow a common process, with relatively predictable issues relating to purchase agreements, employment contracts, and compensation. Acquisitions of single-specialty practices are less common, with motivations for acquisitions likely to vary by specialty type, group size, and market structure. Total cost of care contracting could be an important catalyst for practice acquisitions in the future. Conclusions In the past, market and regulatory forces aimed at controlling costs have both encouraged and rewarded the consolidation of providers, with important new developments likely to create momentum for further consolidation, including acquisitions of physician practices. PMID:25199899

The dynamics of community health care consolidation: acquisition of physician practices.

PubMed

Christianson, Jon B; Carlin, Caroline S; Warrick, Louise H

2014-09-01

Health care delivery systems are becoming increasingly consolidated in urban areas of the United States. While this consolidation could increase efficiency and improve quality, it also could raise the cost of health care for payers. This article traces the consolidation trajectory in a single community, focusing on factors influencing recent acquisitions of physician practices by integrated delivery systems. We used key informant interviews, supplemented by document analysis. The acquisition of physician practices is a process that will be difficult to reverse in the current health care environment. Provider revenue uncertainty is a key factor driving consolidation, with public and private attempts to control health care costs contributing to that uncertainty. As these efforts will likely continue, and possibly intensify, community health care systems now are less consolidated than they will be in the future. Acquisitions of multispecialty and primary care practices by integrated delivery systems follow a common process, with relatively predictable issues relating to purchase agreements, employment contracts, and compensation. Acquisitions of single-specialty practices are less common, with motivations for acquisitions likely to vary by specialty type, group size, and market structure. Total cost of care contracting could be an important catalyst for practice acquisitions in the future. In the past, market and regulatory forces aimed at controlling costs have both encouraged and rewarded the consolidation of providers, with important new developments likely to create momentum for further consolidation, including acquisitions of physician practices. © 2014 Milbank Memorial Fund.

A Profile of Giving Patterns and Donor Behavior at a Suburban Community College

ERIC Educational Resources Information Center

Gyllin, John; Miller, Michael T.; Morris, Adam A.; Grover, Kenda S.

2015-01-01

Community colleges have become increasingly reliant on diversifying their revenue sources, and turning to private fund raising has become a common strategy for many of them. Although fund raising has been a common practice in higher education since its inception, it has only emerged in the two-year college sector in the past several decades. The…

What are the learning outcomes of a short postgraduate training course in dermatology for primary care doctors?

PubMed Central

2011-01-01

Background There are increasing expectations on primary care doctors to shoulder a bigger share of care for patients with common dermatological problems in the community. This study examined the learning outcomes of a short postgraduate course in dermatology for primary care doctors. Methods A self-reported questionnaire developed by the research team was sent to the Course graduates. A retrospective design was adopted to compare their clinical practice characteristics before and after the Course. Differences in the ratings were analysed using the nonparametric Wilcoxon signed rank test to evaluate the effectiveness of the Course in various aspects. Results Sixty-nine graduates replied with a response rate of 42.9% (69/161). Most were confident of diagnosing (91.2%) and managing (88.4%) common dermatological problems after the Course, compared to 61.8% and 58.0% respectively before the Course. Most had also modified their approach and increased their attention to patients with dermatological problems. The number of patients with dermatological problems seen by the graduates per day showed significant increase after the Course, while the average percentage of referrals to dermatologists dropped from 31.9% to 23.5%. The proportion of graduates interested in following up patients with chronic dermatological problems increased from 60.3% to 77.9%. Conclusions Graduates of the Course reported improved confidence, attitudes and skills in treating common dermatological problems. They also reported to handle more patients with common dermatological problems in their practice and refer fewer patients. PMID:21575191

Compliance with recommended care at trauma centers: association with patient outcomes.

PubMed

Shafi, Shahid; Barnes, Sunni A; Rayan, Nadine; Kudyakov, Rustam; Foreman, Michael; Cryer, H Gil; Alam, Hasan B; Hoff, William; Holcomb, John

2014-08-01

State health departments and the American College of Surgeons focus on the availability of optimal resources to designate hospitals as trauma centers, with little emphasis on actual delivery of care. There is no systematic information on clinical practices at designated trauma centers. The objective of this study was to measure compliance with 22 commonly recommended clinical practices at trauma centers and its association with in-hospital mortality. This retrospective observational study was conducted at 5 Level I trauma centers across the country. Participants were adult patients with moderate to severe injuries (n = 3,867). The association between compliance with 22 commonly recommended clinical practices and in-hospital mortality was measured after adjusting for patient demographics and injuries and their severity. Compliance with individual clinical practices ranged from as low as 12% to as high as 94%. After adjusting for patient demographics and injury severity, each 10% increase in compliance with recommended care was associated with a 14% reduction in the risk of death. Patients who received all recommended care were 58% less likely to die (odds ratio = 0.42; 95% CI, 0.28-0.62) compared with those who did not. Compliance with commonly recommended clinical practices remains suboptimal at designated trauma centers. Improved adoption of these practices can reduce mortality. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Veterinarian Nominated Common Conditions of Rabbits and Guinea Pigs Compared with Published Literature

PubMed Central

Robinson, Natalie J.; Lyons, Emma; Grindlay, Douglas

2017-01-01

Rabbits and guinea pigs are increasingly popular pets in the UK, yet little is known about their common ailments, or how these relate to what appears in the published literature. The aim of this study was to characterise the common conditions of rabbits and guinea pigs, and to compare these with the topics found in the published literature. Information about the common conditions seen in rabbits and guinea pigs in clinical practice was obtained from a survey of UK veterinarians. The common conditions seen were compared with results from a structured literature search. Conditions relating to the dental (29.9%), and skin (37.6%) body systems were commonly nominated by veterinarians for rabbits and guinea pigs, respectively. A total of 655 rabbit and 1086 guinea pig citations were examined and there appeared to be a mismatch between the conditions nominated in the veterinary questionnaire, and those found in the literature. This is the first time that the published literature has been compared to the nominated caseload of veterinarians in practice, and there is concern that the literature about rabbits and guinea pigs may not be representative of, or relevant to the caseload seen in clinical practice. This is of importance for clinicians being able to apply an objective, evidence-based approach. The publishing of clinically-relevant, research-based evidence should be prioritised. PMID:29165371

Are persistent early onset child conduct problems predicted by the trajectories and initial levels of discipline practices?

PubMed

Lorber, Michael F; Slep, Amy M Smith

2015-08-01

In the present investigation we focused on 2 broad sets of questions: Do parental overreactivity, laxness, and corporal punishment show evidence of normative change in early to middle childhood? Are persistently elevated child conduct problems (CPs) associated with deviations from normative changes in, as well as high initial levels of, discipline practices? Four hundred fifty-three couples with 3- to 7-year-old children were recruited via random digit dialing and studied at 3 annual assessments. Parents completed questionnaire measures of all study constructs. Normative declines were found in maternal corporal punishment and laxness. Maternal overreactivity showed a normative increase. For fathers, only corporal punishment showed evidence of a normative decline. The declines in mothers' corporal punishment and laxness, and in fathers' corporal punishment, exhibited little variability. In contrast, the trajectories of maternal overreactivity were significantly variable. High-increasing CPs were more common than low-stable CPs in families with greater increases in maternal overreactivity. High-increasing CPs were also more common in families with greater initial maternal overreactivity and corporal punishment. Yet in no case did discipline practices significantly distinguish children on high-increasing versus high-decreasing CPs trajectories. In tests of alternative models, child effects were found for all parenting variables, suggesting reciprocal causation. The findings are discussed relative to etiological models of CPs and implications for preventive intervention. (c) 2015 APA, all rights reserved).

Teledermatology in the United States: An Update in a Dynamic Era.

PubMed

Yim, Kaitlyn M; Florek, Aleksandra G; Oh, Dennis H; McKoy, Karen; Armstrong, April W

2018-01-22

Teledermatology is rapidly advancing in the United States. The last comprehensive survey of U.S. teledermatology programs was conducted in 2011. This article provides an update regarding the state of teledermatology programs in the United States. Active programs were identified and surveyed from November 2014 to January 2017. Findings regarding practice settings, consult volumes, payment methods, and delivery modalities were compared to those from the 2011 survey. Findings from the Veterans Affairs (VA) were reported as an aggregate. There were 40 active nongovernmental programs, amounting to a 48% increase and 30% discontinuation rate over five years. Academia remained the most common practice setting (50%). Median annual consultation volume was comparable with 263 consultations, but maximum annual consultation volume increased (range: 20-20,000). The most frequent payment method was self-pay (53%). Store-and-forward continued to be the most common delivery modality. In Fiscal Year 2016, the VA System consisted of 62 consultation sites and performed a total of 101,507 consultations. The limitations of this study were that consult volume and payment methods were not available from all programs. U.S. teledermatology programs have increased in number and annual consultation volume. Academia is the most prevalent practice setting, and self-pay is the dominant accepted payment method. Innovative platforms and the provision of direct-to-patient care are changing the practice of teledermatology.

Differences in gay men's AIDS risk knowledge and behavior patterns in high and low AIDS prevalence cities.

PubMed

St Lawrence, J S; Hood, H V; Brasfield, T; Kelly, J A

1989-01-01

Several studies have found reductions in acquired immunodeficiency syndrome (AIDS) risk practices among gay men in high AIDS-prevalence cities since the start of the AIDS crisis. Much less is known about risk behavior patterns among gay men in smaller cities, where AIDS cases are less common and the prevalence of human immunodeficiency virus infection is relatively lower. In the study, men entering gay bars in three cities, one large and two small, completed anonymous surveys of sexual practices and AIDS risk knowledge. Men in high AIDS-prevalence areas were found to have had a greater number of sexual partners, were more knowledgeable about AIDS, were much more likely to engage in low-risk practices (such as mutual masturbation or body rubbing), and had unprotected anal intercourse less frequently than gay men in smaller cities. The most common sexual activity among gay men in the larger city was mutual masturbation, a low-risk practice. The most common sexual activity among gay men in the smaller cities was unprotected anal intercourse. Increased efforts are needed to educate gay men and to promote risk behavior changes among those living in smaller cities and in communities outside the prominent AIDS epicenters.

The Continuing Quest for Rationality in Curriculum Practice.

ERIC Educational Resources Information Center

Gay, Geneva

1979-01-01

Suggests that understanding different conceptual models of curriculum making will increase the effectiveness and rationality of the development process. Presents four commonly used models of curriculum development: empiricism, rationalism, pragmatism, and humanism. (Author/JM)

Effects of intensive management practices on 10-year Douglas-fir growth, soil nutrient pools, and vegetation communities in the Pacific Northwest, USA

Treesearch

Robert A. Slesak; Timothy B. Harrington; Dave Peter; Daniel G. DeBruler; Stephen H. Schoenholtz; Brian D. Strahm

2016-01-01

Intensive management practices are commonly used to increase fiber production from forests, but potential tradeoffs with maintenance of long-term productivity and early successional biodiversity have yet to be quantified. We assessed soil and vegetation responses in replicated manipulations of logging debris (LD; either retained or removed) and competing vegetation...

Interaction of ice storms and management practices on current carbon sequestration in forests with potential mitigation under future CO2 atmosphere

Treesearch

Heather R. McCarthy; Ram Oren; Hyun-Seok Kim; Kurt H. Johnsen; Chris Maier; Seth G. Pritchard; Michael A. Davis

2006-01-01

Ice storms are disturbance events with potential impacts on carbon sequestration. Common forest management practices, such as fertilization and thinning, can change wood and stand properties and thus may change vulnerability to ice storm damage. At the same time, increasing atmospheric CO2 levels may also influence ice storm vulnerability. Here...

Practical guidelines for familial combined hyperlipidemia diagnosis: an up-date

PubMed Central

Gaddi, Antonio; Cicero, AFG; Odoo, FO; Poli A, A; Paoletti, R

2007-01-01

Familial combined hyperlidemia (FCH) is a common metabolic disorder characterized by: (a) increase in cholesterolemia and/or triglyceridemia in at least two members of the same family, (b) intra-individual and intrafamilial variability of the lipid phenotype, and (c) increased risk of premature coronary heart disease (CHD). FCH is very frequent and is one of the most common genetic hyperlipidemias in the general population (prevalence estimated: 0.5%–2.0%), being the most frequent in patients affected by CHD (10%) and among acute myocardial infarction survivors aged less than 60 (11.3%). This percentage increases to 40% when all the myocardial infarction survivors are considered without age limits. However, because of the peculiar variability of laboratory parameters, and because of the frequent overlapping with the features of metabolic syndrome, this serious disease is often not recognized and treated. The aim of this review is to define the main characteristics of the disease in order to simplify its detection and early treatment by all physicians by mean of practical guidelines. PMID:18200807

Practical guidelines for familial combined hyperlipidemia diagnosis: an up-date.

PubMed

Gaddi, Antonio; Cicero, A F G; Odoo, F O; Poli, A A; Paoletti, R

2007-01-01

Familial combined hyperlidemia (FCH) is a common metabolic disorder characterized by: (a) increase in cholesterolemia and/or triglyceridemia in at least two members of the same family, (b) intra-individual and intrafamilial variability of the lipid phenotype, and (c) increased risk of premature coronary heart disease (CHD). FCH is very frequent and is one of the most common genetic hyperlipidemias in the general population (prevalence estimated: 0.5%-2.0%), being the most frequent in patients affected by CHD (10%) and among acute myocardial infarction survivors aged less than 60 (11.3%). This percentage increases to 40% when all the myocardial infarction survivors are considered without age limits. However, because of the peculiar variability of laboratory parameters, and because of the frequent overlapping with the features of metabolic syndrome, this serious disease is often not recognized and treated. The aim of this review is to define the main characteristics of the disease in order to simplify its detection and early treatment by all physicians by mean of practical guidelines.

Lifting Kindergarteners' Writing to Meet the Common Core Learning Standards: A Collaborative Inquiry

ERIC Educational Resources Information Center

Heskial, Joyce; Wamba, Nathalis G.

2013-01-01

The advent of Common Core Standards in New York State has forced a revisitation of past practices. With a goal of ensuring that all students are college and career-ready by the end of high school these standards call for increased rigor and higher expectations at all grade levels. The purpose of this study was to analyze through collaborative…

Equal contributions and credit: an emerging trend in the characterization of authorship in major spine journals during a 10-year period.

PubMed

Jia, Zhiwei; Wu, Yaohong; Tang, Yong; Ji, Wei; Li, Wei; Zhao, Xiyan; Li, Hao; He, Qing; Ruan, Dike

2016-03-01

The practice of giving certain authors equal credit in scientific publications has become increasingly common in some medical specialties. However, whether this trend also exists in major spine journals remains unclear. This study aimed to investigate the prevalence and characteristics of the practice of giving authors equal credit in major spine journals. Manual searches were performed to identify original research articles with equally credited authors (ECA) published between January 1, 2004 and December 31, 2013 in three major spine journals: Spine, European Spine Journal, and The Spine Journal. The number of authors with ECA and their positions in the byline, total number of authors, year of publication, and country of origin were analysed. The practice of ECA was found in all three journals. Articles with ECA comprised a greater proportion of the total number of publications in each journal in 2013 versus 2004 (Spine, 7.2 vs. 0.2%; European Spine Journal, 7.5 vs. 0.0%; and The Spine Journal, 6.2 vs. 0.0%). There was a statistically significant increasing trend in the annual proportion of papers with ECA for all three spine journals (p < 0.0001). The practice of ECA was applied in nearly every position in the byline, and the first two authors received equal credit in most cases. Articles with ECA were published by authors from various countries and regions around the world. However, none of the three spine journals provided specific guidance on this practice in their author instructions. The practice of ECA in original research articles is increasingly common in major spine journals. A guideline for authors regarding when and how to designate equal credit is warranted in the future.

Practice variation on use of antibiotics: An international survey among pediatric urologists.

PubMed

Kim, Jin K; Chua, Michael E; Ming, Jessica M; Braga, Luis H; Smith, Grahame H H; Driver, Christopher; Koyle, Martin A

2018-05-19

Although there is abundance in literature focusing on the use of prophylactic antibiotics for adult urological procedures, the evidence for using antibiotics following common pediatric urological procedures is limited with no specific guidelines for use. Consequently, current practices on antibiotic usage for common interventions may be variable among practicing pediatric urologists, lacking evidence-based support. The aim was to evaluate the current practice pattern on antibiotic usage for common interventions amongst pediatric urologists (PU) practicing in four English-speaking sectors of the world. An anonymous survey of five scenarios with multiple choice options was disseminated to all active practicing members of the Pediatric Urologist of Canada (PUC) and Society of Pediatric Urology of Australia and New Zealand (SPUNZA), as well as all those attending the 2016 British Association of Pediatric Urology (BAPU) and 2017 American Association of Pediatric Urology (AAPU) meetings. The response for each scenario was summarized for overall practice pattern variation and the pattern for each sector was compared using the Fisher exact test. A total of 126 respondents completed the survey (68.5% response rate) with at least a 65% response rate for each of the four sectors. The majority of respondents do not use antibiotics for indwelling urethral (46.8%) and suprapubic catheters (53.4%); however, they do give antibiotics for J-J stent placement (65.1%) and hypospadias surgery (84.9%), and use antibiotics after hypospadias surgery where catheters or stents are left indwelling (80.9%, 84.2%, respectively). Among those surveyed, the PUC members and AAPU PU demonstrated similar practice patterns which often significantly differed from that of SPUNZA members and BAPU attendees. Specifically, a significantly larger proportion of the North American pediatric urologists do not use antibiotics for common procedures compared with Australia, New Zealand, and the UK (Table). In the absence of prospective studies in antibiotic use for pediatric patients to guide clinicians, there is a clear variability among sectors in the use of antibiotics for most clinical scenarios investigated. With increasing resistance patterns and possible adverse effects of antibiotics, it is important that the international pediatric urology community engage in discussions and collaborations to address this issue. Practice patterns in antibiotic usage amongst PU varies widely, some of which may be associated with their local "culture." There is a need to understand these differences and begin to standardize treatment in the hopes of increasing appropriate use of antibiotics internationally. Copyright © 2018 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Human Non-persons, Feticide, and the Erosion of Dignity

PubMed Central

2010-01-01

Feticide, the practice of terminating the life of an otherwise viable fetus in utero, has become an increasingly common practice in obstetric centres around the globe, a concomitant of antenatal screening technologies. This paper examines this expanding practice in light of the concept of human dignity. Although it is assumed from the outset that even viable human fetuses are not persons and as such do not enjoy full membership in the moral community, it is argued that the fact that these are nevertheless human fetuses affords them prima facie moral status. Thus even those who accept a liberal position with regard to therapeutic abortion, should be concerned about these more recent developments. Indeed, how we treat viable human fetuses has implications for our prospective treatment of other human non-persons and could undermine the common human dignity we all share. PMID:21212811

Does Displaying the Class Results Affect Student Discussion during Peer Instruction?

PubMed Central

Strauss, Eric A.; Downey, Nicholas; Galbraith, Anne; Jeanne, Robert; Cooper, Scott

2010-01-01

The use of personal response systems, or clickers, is increasingly common in college classrooms. Although clickers can increase student engagement and discussion, their benefits also can be overstated. A common practice is to ask the class a question, display the responses, allow the students to discuss the question, and then collect the responses a second time. In an introductory biology course, we asked whether showing students the class responses to a question biased their second response. Some sections of the course displayed a bar graph of the student responses and others served as a control group in which discussion occurred without seeing the most common answer chosen by the class. If students saw the bar graph, they were 30% more likely to switch from a less common to the most common response. This trend was more pronounced in true/false questions (38%) than multiple-choice questions (28%). These results suggest that observing the most common response can bias a student's second vote on a question and may be misinterpreted as an increase in performance due to student discussion alone. PMID:20516358

Using Design Experiments to Understand Secondary Classroom Comprehension Practices

ERIC Educational Resources Information Center

Vaughn, Sharon; Simmons, Deborah; Wanzek, Jeanne

2013-01-01

Adolescents in the United States and their teachers face an enormous academic challenge with respect to reading comprehension. College and career readiness standards outlined in the Common Core (2012) place increased emphasis on preparing students to read increasingly complex text across a range of disciplinary content areas. At issue is how to…

An NCME Instructional Module on Polytomous Item Response Theory Models

ERIC Educational Resources Information Center

Penfield, Randall David

2014-01-01

A polytomous item is one for which the responses are scored according to three or more categories. Given the increasing use of polytomous items in assessment practices, item response theory (IRT) models specialized for polytomous items are becoming increasingly common. The purpose of this ITEMS module is to provide an accessible overview of…

Comparison of a standardized procedure with current laboratory practices for the detection of lupus anticoagulant in France. Working Group on Hemostasis of the Société Française de Biologie Clinique.

PubMed

1993-11-15

A multicenter study involving 13 laboratories was designed to compare a common procedure for screening lupus anticoagulants (LA) to the different practices currently in use in these laboratories. The common procedure combined 3 phospholipid-dependent assays, including mixing studies and a phospholipid neutralizing test. Due to the heterogeneity of LA expression, an abnormal result in at least one of the tests was sufficient to classify a sample as positive for LA. Consecutive samples referred for LA diagnosis were evaluated in parallel by each participant and the data found using the common procedure were analyzed independently according to mutually agreed cut-offs and criteria for sample classification. Within a period of 3 months, 535 samples were included, of which 147 were judged LA positive, 29 undetermined and 359 negative by the respective laboratories using their current practice. When using the common procedure, 149 plasmas were said to be positive, 38 undetermined and 348 negative. Absolute concordance occurred for 81% of the specimen population and absolute discordance (positive versus negative) for 7%. The level of agreement between the common procedure and the current practices, assessed by kappa indexes, indicated noticeable variations in the rates of detection from laboratory to laboratory. Among the different tests used in the common procedure, regular APTT was the least sensitive (about 50% detection) but none of the other tests alone recognized more than 73% of specimens from the LA positive population. This yield increased to about 90% with any combination of 2 sensitive tests.(ABSTRACT TRUNCATED AT 250 WORDS)

DEVELOPMENT AND IMPLEMENTATION OF A PRACTICAL PUBLIC HEALTH TRAINING SYSTEM IN CHINA.

PubMed

Liu, Changjiang; Zhang, Junyue; Chen, Guoyuan; Yang, Kedi

2015-03-01

Public health education is becoming an increasing priority among educators of medicine. In China, little attention has been paid to public health education reform. A new public health training system was introduced in China in 2007. We conducted this study during 2006-2012 to evaluate the graduate core competencies under the new system. Data were collected from 231 graduates and 49 public health agencies. The 144 graduates who enrolled in 2006 and were trained under the old system constituted the control group; the 87 graduates who enrolled in 2007 and were trained under the new system constituted the experimental group. Surveys of graduate core competencies found analyzing and solving problems in the laboratory, conducting on-site practice and learning new technologies were the top three abilities most expected by public health agencies. After 5-year practical ability training, the graduates in the experimental group had better performance; on-site practical ability and laboratory practical ability increased significantly by 24.5% and 20.0%, respectively. Three other important competencies also improved: designing epidemiologic surveys, collecting information from the literature and doing statistical analyses. However, preventing and controlling common diseases and dealing with emergencies remained weak. These results show the new training system should be continued, but revisions are needed to improve this training system, especially in the areas of preventing and controlling common diseases and dealing with emergencies.

Safe Use of Complementary Health Products and Practices for Anxiety

MedlinePlus

... Summer 2015 Table of Contents Anxiety and College Students "Anxiety has now surpassed depression as the most common mental health diagnosis among college students," even though depression is also increasing among young people. In fact, " ...

The Louisiana State University Law Center's Bijural Program.

ERIC Educational Resources Information Center

Costonis, John J.

2002-01-01

Describes the bijural program of Louisiana State University Law Center. The program educates all first-degree law students in both the common law and civil law traditions, preparing them for the increasing globalization of legal practice. (EV)

Causal inference as an emerging statistical approach in neurology: an example for epilepsy in the elderly.

PubMed

Moura, Lidia Mvr; Westover, M Brandon; Kwasnik, David; Cole, Andrew J; Hsu, John

2017-01-01

The elderly population faces an increasing number of cases of chronic neurological conditions, such as epilepsy and Alzheimer's disease. Because the elderly with epilepsy are commonly excluded from randomized controlled clinical trials, there are few rigorous studies to guide clinical practice. When the elderly are eligible for trials, they either rarely participate or frequently have poor adherence to therapy, thus limiting both generalizability and validity. In contrast, large observational data sets are increasingly available, but are susceptible to bias when using common analytic approaches. Recent developments in causal inference-analytic approaches also introduce the possibility of emulating randomized controlled trials to yield valid estimates. We provide a practical example of the application of the principles of causal inference to a large observational data set of patients with epilepsy. This review also provides a framework for comparative-effectiveness research in chronic neurological conditions.

Current State of Overlapping, Concurrent, and Multiple-Room Surgery in Otolaryngology: A National Survey.

PubMed

Cognetti, David M; Nussenbaum, Brian; Brenner, Michael J; Chi, David H; McCormick, Michael E; Venkatraman, Giri; Zhan, Tingting; McKinlay, Alex J

2017-12-01

Objective Multiple-room surgery has gained attention due to reports in the lay press scrutinizing the activity, with hospitals and the government collecting data on current practice. We studied practices and attitudes toward multiple-room surgery in otolaryngology. Methods A survey was developed by members of the Patient Safety and Quality Improvement Committee of the American Academy of Otolaryngology-Head and Neck Surgery. The survey was distributed to members of the Academy and included questions on demographics, current practices, and opinions regarding multiple-room surgery. The survey was designed to capture the spectrum of multidisciplinary, overlapping, and simultaneous/concurrent surgery practices. Data were collected via SurveyMonkey. Results A total of 907 of 9520 members completed the survey. Of the respondents, 40.4% reported performing some form of multiple-room surgery. Multiple-room surgery is more common amongst subspecialists than general otolaryngologists. Most believed that regulations disallowing multiple-room surgery would result in an increase in late starts (73.5%), an increase in the time to schedule surgery (84.5%), a detriment to residency training (63.1%), and no improvement in patient safety (60%.) Discussion Multiple-room surgery is common among responding otolaryngologists. Most respondents consider the practice to serve a role in facilitating access, efficiency, and training. Implications for Practice Due to recent attention placed on multiple-room surgery, institutions are reviewing policies regarding the practice. This survey suggests that policy changes that restrict multiple-room surgery must consider a potential unintended negative impact on patient care and access.

70,489 primary care encounters: retrospective analysis of morbidity at a primary care centre in Ireland.

PubMed

Molony, D; Beame, C; Behan, W; Crowley, J; Dennehy, T; Quinlan, M; Cullen, W

2016-11-01

While considerable changes are happening in primary care in Ireland and considerable potential exists in intelligence derived from practice-based data to inform these changes, relatively few large-scale general morbidity surveys have been published. To examine the most common reasons why people attend primary care, specifically 'reasons for encounter' (RFEs) among the general practice population and among specific demographic groups (i.e., young children and older adults). We retrospectively examined clinical encounters (which had a diagnostic code) over a 4-year time period. Descriptive analyses were conducted on anonymised data. 70,489 RFEs consultations were recorded (mean 13.53 recorded RFEs per person per annum) and consultations involving multiple RFEs were common. RFE categories for which codes were most commonly recorded were: 'general/unspecified' (31.6 %), 'respiratory' (15.4 %) and 'musculoskeletal' (12.6 %). Most commonly recorded codes were: 'medication renewal' (6.8 %), 'cough' (6.6 %), and 'health maintenance/prevention' (5.8 %). There was considerable variation in the number of RFEs recorded per age group. 6239 RFEs (8.9 %) were recorded by children under 6 years and 15,295 RFEs (21.7 %) were recorded by adults aged over 70. RFEs recorded per calendar month increased consistently through the study period and there was a marked seasonal and temporal variation in the number of RFEs recorded. Practice databases can generate intelligence on morbidity and health service utilisation in the community. Future research to optimise diagnostic coding at a practice level and to promote this activity in a more representative sample of practices is a priority.

A risk-management approach for effective integration of biomarkers in clinical trials: perspectives of an NCI, NCRI, and EORTC working group.

PubMed

Hall, Jacqueline Anne; Salgado, Roberto; Lively, Tracy; Sweep, Fred; Schuh, Anna

2014-04-01

Clinical cancer research today often includes testing the value of biomarkers to direct treatment and for drug development. However, the practical challenges of integration of molecular information into clinical trial protocols are increasingly appreciated. Inherent difficulties include evidence gaps in available biomarker data, a paucity of robust assay methods, and the design of appropriate studies within the constraints of feasible trial operations, and finite resources. Scalable and proportionate approaches are needed to systematically cope with these challenges. Therefore, we assembled international experts from three clinical trials organisations to identify the common challenges and common solutions. We present a practical risk-assessment framework allowing targeting of scarce resources to crucial issues coupled with a library of useful resources and a simple actionable checklist of recommendations. We hope that these practical methods will be useful for running biomarker-driven trials and ultimately help to develop biomarkers that are ready for integration in routine practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

Finding Common Ground: Interprofessional Collaborative Practice Competencies in Patient-Centered Medical Homes.

PubMed

Swihart, Diana

2016-01-01

The patient-centered medical home model is predicated on interprofessional collaborative practice and team-based care. While information on the roles of various providers is increasingly woven into the literature, the competencies of those providers have been generally profession-specific. In 2011, the Interprofessional Education Collaborative comprising the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Dental Education Association, the Association of American Medical Colleges, and the Association of Schools of Public Health sponsored an expert panel of their members to identify and develop 4 domains of core competencies needed for a successful interprofessional collaborative practice: (1) Values/Ethics for Interprofessional Practice; (2) Roles/Responsibilities; (3) Interprofessional Communication; and (4) Teams and Teamwork. Their findings and recommendations were recorded in their Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. This article explores these 4 domains and how they provide common ground for team-based care within the context of the medical home model approach to patient-centered primary care.

Literature Circles in a Fifth Grade Classroom: A Qualitative Study Examining How the Teacher and Students Used Literature Circles and the Impact They Have on Student Learning

ERIC Educational Resources Information Center

Pambianchi, Laura Claypool

2017-01-01

State and national standards, including the Common Core State Standards, state that students should be expected to learn to discuss and analyze texts, comprehend ideas in increasingly complex texts, and justify their thinking. Literature circles are an instructional practice suggested by many educational writers as an instructional practice that…

Development of Principles for Multimodal Displays in Army Human-Robot Operations

DTIC Science & Technology

2010-06-01

Research Laboratory ATTN: RDRL- HRM -D Aberdeen Proving Ground, MD 21005-5425 10. SPONSOR/MONITOR’S ACRONYM(S) 11. SPONSOR/MONITOR’S REPORT...the practical limitations of various cognitive resource channels for HRI tasks. 2.1.2 Purpose Now that MRT and the common workload manipulations...with more mission targets. • Workload conditions were not counter-balanced for practice effects. 7 Increasing task difficulty generally

Melanocytic lesions in a private pathology practice. Comparison of histologic features in different tumor types with particular reference to dysplastic nevi.

PubMed

Hastrup, N; Hou-Jensen, K

1993-11-01

This study reviews a total of 1000 melanocytic lesions--two separate 500 consecutive sample groupings from 1980 and 1989, respectively--diagnosed in a private non-hospital-associated pathology practice. Lesions were classified as lentigo simplex, congenital nevus, "common" nevus, dysplastic nevus, blue nevus, Spitz's nevus or malignant melanoma. A comparison of the two periods reveals an increase in dysplastic nevi from one in 1980 to nine in 1989. The histologic changes in these nevi were compared to those of the other tumors. Pronounced cytologic atypia was seen in the melanocytes of a few "common" nevi, but more often in the dysplastic nevi and in all of the melanomas. Slight nuclear atypia was usual in "common" nevi and lentigines, and also fibroplasia, lymphocytic infiltration, vessel proliferation and pigment incontinence were seen in both "common" nevi and dysplastic nevi. It is concluded that no single histologic variable was specific for dysplastic nevi.

Adult urethral stricture: practice of Turkish urologists

PubMed Central

Akyuz, Mehmet; Sertkaya, Zulfu; Koca, Orhan; Calıskan, Selahattin; Kutluhan, Musab Ali; Karaman, Muhammet Ihsan

2016-01-01

ABSTRACT Objectives: To evaluate national practice patterns in the treatment of male anterior urethral strictures among Turkish urologists. Materials and Methods: A survey form including 12 questions prepared to determine active Turkish urologists' approach to diagnosis and treatment of the adult urethral stricture (US) were filled out. Based on the survey results, the institutions which 218 urologists work and their years of expertise, methods they used for diagnosis and treatment, whether or not they perform open urethroplasty and timing of open urethroplasty were investigated. Results: Optic internal urethrotomy and dilatation are the most commonly used minimal invasive procedures in treatment of US with the ratios of 93.5% and 63.3% respectively. On the other hand it was seen that urethroplasty was a less commonly used procedure, compared to minimal invasive techniques, with the ratio of 36.7%. Survey results showed us that the number of US cases observed and open urethroplasty procedures performed increases with increasing years of professional experience. Conclusions: As a method demanding special surgical experience and known as a time-consuming and challenging procedure, open urethroplasty will be able to take a greater part in current urological practice with the help of theoretical education and practical courses given by specific centers and experienced authors. PMID:27256189

[Clinical application evaluation of Guidelines for Diagnosis and Treatment of Common Diseases of Otolaryngology in Traditional Chinese Medicine].

PubMed

Liu, Yu-Qi; Liu, Meng-Yu; Li, Chun; Shi, Nan-Nan; Wang, Yue-Xi; Wang, Li-Ying; Zhao, Xue-Yao; Kou, Shuang; Han, Xue-Jie; Wang, Yan-Ping

2017-09-01

This study is to assess the Guidelines for Diagnosis and Treatment of Common Diseases of Otolaryngology in Traditional Chinese Medicine in clinical application and provide evidence for further guideline revision. The assessment was divided into applicability assessment and practicability assessment. The applicability assessment based on questionnaire survey and the traditional Chinese medicine (TCM) practitioners were asked to independently fill the Questionnaire for Applicability Assessment on the Guidelines for Diagnosis and Treatment in Traditional Chinese Medicine. The practicability assessment was based on prospective case investigation and analysis method and the TCM practitioners-in-charge filled the Case Investigation Questionnaire for Practicability Assessment on the Guidelines for Diagnosis and Treatment in Traditional Chinese Medicine. The data were analyzed in descriptive statistics. 151 questionnaires were investigated for applicability assessment and 1 016 patients were included for practicability assessment. The results showed that 88.74% of them were familiar with the guidelines and 45.70% used them. The guidelines quality and related items were similar in applicability assessment and practicability assessment, and scored highly as more than 85.00% except the "recuperating and prevention". The results suggested that the quality of Guidelines for Diagnosis and Treatment of Common Diseases of Otolaryngology in Traditional Chinese Medicine was high and could better guide the clinical practice. The "recuperating and prevention" part should be improved and the evidence data should be included in future guideline revision, so that the clinical utilization rate could be increased. Copyright© by the Chinese Pharmaceutical Association.

Severe anemia following uvulectomy in Kenya.

PubMed

Lowe, Karla R

2004-09-01

Uvulectomy is a common practice in eastern Africa for treatment of a variety of throat conditions. Traditional healers perform the procedure. I present a case report to illustrate a complication of uvulectomy. This is a report of a child who presented with severe anemia secondary to uvulectomy performed for treatment of chronic cough. This case report is intended to illustrate a procedure not commonly performed by western otolaryngologists and to describe the management of a severe complication. Western physicians are increasingly being tasked in medical situations in which they encounter traditional medical practices outside of their scope of training. The intent of this report is to familiarize western physicians with one such procedure and its potential complications.

Optimizing Language for Stroke Motor Rehabilitation: Recommendations from the ACRM Stroke Movement Interventions Subcommittee

PubMed Central

Page, Stephen J.; Schmid, Arlene; Harris, Jocelyn

2012-01-01

As knowledge and interest in stroke motor rehabilitation continue to increase, consistent terminologies that are specific to this discipline must be established. Such language is critical to effective rehabilitative team communication, and is important to facilitating communication among the diverse groups interested in the science and practice of stroke motor rehabilitation. The purpose of this paper is to provide operational definitions for three concepts that are common - and commonly mislabeled - attributes of stroke motor rehabilitation interventions: intensity, duration, and frequency. In developing these guidelines, conceptual frameworks used in the pharmaceutical, exercise, and rehabilitative therapy realms were used. Implications of these definitions for research and clinical practice are also discussed. PMID:22446292

Rock Climbing Injuries: Acute and Chronic Repetitive Trauma.

PubMed

Chang, Connie Y; Torriani, Martin; Huang, Ambrose J

2016-01-01

Rock climbing has increased in popularity as a sport, and specific injuries related to its practice are becoming more common. Chronic repetitive injuries are more common than acute injuries, although acute injuries tend to be more severe. We review both acute and chronic upper and lower extremity injuries. Understanding the injury pattern in rock climbers is important for accurate diagnosis. Copyright © 2015 Mosby, Inc. All rights reserved.

Cosmetic medicine: facial resurfacing and injectables.

PubMed

Nguyen, Alexander T; Ahmad, Jamil; Fagien, Steven; Rohrich, Rod J

2012-01-01

After studying this article, the participant should be able to: 1. Describe the most common options available for minimally invasive facial rejuvenation. 2. Identify key elements essential to each treatment option. 3. Know how to avoid and manage complications for these procedures. Minimally invasive cosmetic procedures continue to increase in popularity. This article is intended to provide a broad and practical overview of common minimally invasive cosmetic techniques available to the plastic surgeon.

Survey of Oxygen Delivery Practices in UK Paediatric Intensive Care Units

PubMed Central

Peters, Mark J.

2016-01-01

Purpose. Administration of supplemental oxygen is common in paediatric intensive care. We explored the current practice of oxygen administration using a case vignette in paediatric intensive care units (PICU) in the united kingdom. Methods. We conducted an online survey of Paediatric Intensive Care Society members in the UK. The survey outlined a clinical scenario followed by questions on oxygenation targets for 5 common diagnoses seen in critically ill children. Results. Fifty-three paediatric intensive care unit members from 10 institutions completed the survey. In a child with moderate ventilatory requirements, 21 respondents (42%) did not follow arterial partial pressure of oxygen (PaO2) targets. In acute respiratory distress syndrome, cardiac arrest, and sepsis, there was a trend to aim for lower PaO2 as the fraction of inspired oxygen (FiO2) increased. Conversely, in traumatic brain injury and pulmonary hypertension, respondents aimed for normal PaO2 even as the FiO2 increased. Conclusions. In this sample of clinicians PaO2 targets were not commonly used. Clinicians target lower PaO2 as FiO2 increases in acute respiratory distress syndrome, cardiac arrest, and sepsis whilst targeting normal range irrespective of FiO2 in traumatic brain injury and pulmonary hypertension. PMID:27516901

A practical method to rapidly dissolve metallic stents.

PubMed

Bradshaw, Scott H; Kennedy, Lloyd; Dexter, David F; Veinot, John P

2009-01-01

Metallic stents are commonly used in many clinical applications including peripheral vascular disease intervention, biliary obstruction, endovascular repair of aneurysms, and percutaneous coronary interventions. In the examination of vascular stent placement, it is important to determine if the stent is open or has become obstructed. This is increasingly important in the era of drug-eluting stent usage in coronary arteries. We describe a practical, rapid and cost-effective method to dissolve most metallic stents leaving the vascular and luminal tissues intact. This practical method may replace the laborious and expensive plastic embedding methods currently utilized.

Beyond Resistance: Exploring Health Managers' Propensity for Participatory Evaluation in a Developing Country

ERIC Educational Resources Information Center

Smits, Pernelle A.; Champagne, Francois; Farand, Lambert

2012-01-01

The evaluation of interventions is becoming increasing common and now often seeks to involve managers in the process. Such practical participatory evaluation (PPE) aims to increase the use of evaluation results through the participation of stakeholders. This study focuses on the propensity of health managers for PPE, as measured through the…

Management of Non-Progressive Dysarthria: Practice Patterns of Speech and Language Therapists in the Republic of Ireland

ERIC Educational Resources Information Center

Conway, Aifric; Walshe, Margaret

2015-01-01

Background: Dysarthria is a commonly acquired speech disorder. Rising numbers of people surviving stroke and traumatic brain injury (TBI) mean the numbers of people with non-progressive dysarthria are likely to increase, with increased challenges for speech and language therapists (SLTs), service providers and key stakeholders. The evidence base…

Modern trends in infection control practices in intensive care units.

PubMed

Gandra, Sumanth; Ellison, Richard T

2014-01-01

Hospital-acquired infections (HAIs) are common in intensive care unit (ICU) patients and are associated with increased morbidity and mortality. There has been an increasing effort to prevent HAIs, and infection control practices are paramount in avoiding these complications. In the last several years, numerous developments have been seen in the infection prevention strategies in various health care settings. This article reviews the modern trends in infection control practices to prevent HAIs in ICUs with a focus on methods for monitoring hand hygiene, updates in isolation precautions, new methods for environmental cleaning, antimicrobial bathing, prevention of ventilator-associated pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and Clostridium difficile infection. © The Author(s) 2013.

Factors influencing breast feeding.

PubMed Central

McKean, K S; Baum, J D; Sloper, K

1975-01-01

A survey is reported of infant feeding practice at the time of discharge from a single maternity ward. It is shown that a change in the attitude of nursing staff increased the number of mothers breast feeding their infants and eliminated the practice of giving the infants formula feed complements. This change in attitude, however, did nothing to prevent the rapid decline in lactation after leaving hospital, such that 50% of mothers discharged breast feeding were no longer doing so by 2 months. The early introduction of solid feeds was common practice, 50% of mothers discharged breast feeding having introduced mixed feeds within 2 months. Successful lactation was found to be commoner in those mothers who had themselves been breast fed in infancy and in mothers from socioeconomic classes I and II. Successful lactation was not related to parity. The survey also shows the influential role of the health visitor, district nurse, and midwife upon mothers' decisions about infant feeding. PMID:1170810

Potential drivers of virulence evolution in aquaculture

USGS Publications Warehouse

Kennedy, David A.; Kurath, Gael; Brito, Ilana L.; Purcell, Maureen K.; Read, Andrew F.; Winton, James R.; Wargo, Andrew R.

2016-01-01

Infectious diseases are economically detrimental to aquaculture, and with continued expansion and intensification of aquaculture, the importance of managing infectious diseases will likely increase in the future. Here, we use evolution of virulence theory, along with examples, to identify aquaculture practices that might lead to the evolution of increased pathogen virulence. We identify eight practices common in aquaculture that theory predicts may favor evolution toward higher pathogen virulence. Four are related to intensive aquaculture operations, and four others are related specifically to infectious disease control. Our intention is to make aquaculture managers aware of these risks, such that with increased vigilance, they might be able to detect and prevent the emergence and spread of increasingly troublesome pathogen strains in the future.

Differences in gay men's AIDS risk knowledge and behavior patterns in high and low AIDS prevalence cities.

PubMed Central

St Lawrence, J S; Hood, H V; Brasfield, T; Kelly, J A

1989-01-01

Several studies have found reductions in acquired immunodeficiency syndrome (AIDS) risk practices among gay men in high AIDS-prevalence cities since the start of the AIDS crisis. Much less is known about risk behavior patterns among gay men in smaller cities, where AIDS cases are less common and the prevalence of human immunodeficiency virus infection is relatively lower. In the study, men entering gay bars in three cities, one large and two small, completed anonymous surveys of sexual practices and AIDS risk knowledge. Men in high AIDS-prevalence areas were found to have had a greater number of sexual partners, were more knowledgeable about AIDS, were much more likely to engage in low-risk practices (such as mutual masturbation or body rubbing), and had unprotected anal intercourse less frequently than gay men in smaller cities. The most common sexual activity among gay men in the larger city was mutual masturbation, a low-risk practice. The most common sexual activity among gay men in the smaller cities was unprotected anal intercourse. Increased efforts are needed to educate gay men and to promote risk behavior changes among those living in smaller cities and in communities outside the prominent AIDS epicenters. PMID:2502813

Personal Trainer Demographics, Current Practice Trends and Common Trainee Injuries.

PubMed

Waryasz, Gregory R; Daniels, Alan H; Gil, Joseph A; Suric, Vladimir; Eberson, Craig P

2016-09-19

Increasing emphasis on maintaining a healthy lifestyle has led many individuals to seek advice on exercise from personal trainers. There are few studies to date that evaluate personal trainer education, practice trends, and injuries they have seen while training clients. A survey was distributed to personal trainers using Survey Monkey® (Palo Alto, CA, USA) with 605 personal trainers accessing the survey. An exercise related bachelor's degree was held by 64.2% of survey participants and a certification in personal training by 89.0%. The most common personal trainer certifications were from American College of Sports Medicine (59.2%) and National Strength and Conditioning Association (28.9%). Only 2.9% of all personal trainers surveyed had no exercise-related bachelor's degree and no personal trainer certification. The most common injuries seen by personal trainers during sessions were lumbar muscle strain (10.7%), rotator cuff tear/tendonitis (8.9%), shin splints (8.1%), ankle sprain (7.5%), and cervical muscle strain (7.4%). There is variability in the practices between different personal trainers when analyzing differences in collegiate education, personal trainer certifications, and strength and conditioning certifications. The clinical implication of the differences in practices is unknown as to the impact on injuries or exercise prescription effectiveness.

Personal Trainer Demographics, Current Practice Trends and Common Trainee Injuries

PubMed Central

Waryasz, Gregory R.; Daniels, Alan H.; Gil, Joseph A.; Suric, Vladimir; Eberson, Craig P.

2016-01-01

Increasing emphasis on maintaining a healthy lifestyle has led many individuals to seek advice on exercise from personal trainers. There are few studies to date that evaluate personal trainer education, practice trends, and injuries they have seen while training clients. A survey was distributed to personal trainers using Survey Monkey® (Palo Alto, CA, USA) with 605 personal trainers accessing the survey. An exercise related bachelor’s degree was held by 64.2% of survey participants and a certification in personal training by 89.0%. The most common personal trainer certifications were from American College of Sports Medicine (59.2%) and National Strength and Conditioning Association (28.9%). Only 2.9% of all personal trainers surveyed had no exercise-related bachelor’s degree and no personal trainer certification. The most common injuries seen by personal trainers during sessions were lumbar muscle strain (10.7%), rotator cuff tear/tendonitis (8.9%), shin splints (8.1%), ankle sprain (7.5%), and cervical muscle strain (7.4%). There is variability in the practices between different personal trainers when analyzing differences in collegiate education, personal trainer certifications, and strength and conditioning certifications. The clinical implication of the differences in practices is unknown as to the impact on injuries or exercise prescription effectiveness. PMID:27761219

Basal cell carcinoma of the skin (part 1): epidemiology, pathology and genetic syndromes.

PubMed

Correia de Sá, Tiago Ribeiro; Silva, Roberto; Lopes, José Manuel

2015-11-01

Basal cell carcinoma (BCC) is the most common skin cancer worldwide with increasing incidence, but difficult to assess due to the current under registration practice. Despite the low mortality rate, BCC is a cause of great morbidity and an economic burden to health services. There are several risk factors that increase the risk of BCC and partly explain its incidence. Low-penetrance susceptibility alleles, as well as genetic alterations in signaling pathways, namely SHH pathway, also contribute to the carcinogenesis. BCC associate with several genetic syndromes, of which basal cell nevus syndrome is the most common.

Practical advantages of evolutionary computation

NASA Astrophysics Data System (ADS)

Fogel, David B.

1997-10-01

Evolutionary computation is becoming a common technique for solving difficult, real-world problems in industry, medicine, and defense. This paper reviews some of the practical advantages to using evolutionary algorithms as compared with classic methods of optimization or artificial intelligence. Specific advantages include the flexibility of the procedures, as well as their ability to self-adapt the search for optimum solutions on the fly. As desktop computers increase in speed, the application of evolutionary algorithms will become routine.

An evidence-based review of commonly used dietary supplements.

PubMed

Laird, John

2015-07-01

Use of complementary and alternative medicine (CAM) is increasing in the United States. Physician assistants need to know about the efficacy of CAM therapies if they practice integrative medicine (which combines CAM and traditional therapies), recommend a CAM therapy occasionally as part of their treatment plan, refer patients to CAM providers, or have patients who self-select CAM therapies. This article describes integrative medicine and reviews the most commonly used dietary supplements.

[IMCI and the maternal practice of African descendants' living on the Colombian Caribbean coast regarding the common cold and diarrhea].

PubMed

Díaz-Cárdenas, Shyrley; Arrieta-Vergara, Katherine; Ramos-Martínez, Ketty

2013-01-01

Evaluating maternal practice regarding diarrhoea and the common cold. This was a cross-sectional descriptive study which was conducted on the island of Barú, near Cartagena, Colombia. It involved 127 mothers of African descent and their 138 children aged less than 5 years of age; convenience sampling was used. The Integrated Management of Childhood Illness (IMCI) instrument was used for the survey during a one-day healthcare session. The prevalence of diarrhoea and the common cold during the 7 days immediately before the survey were estimated, as were maternal practice regarding these and the occurrence of other risks and protective factors; a history of breastfeeding, complementary feeding and vaccination was compiled. Descriptive statistics were used and the χ² test was used for ascertaining the significance of the relationships between variables. Diarrhoea prevalence was 71.7 % (64-79 95 % CI), this being lower for girls aged 2 months to 5 years-old (p = 0,02) and common cold prevalence was 99.2 % (97-100 95 % CI), this being higher in girls aged older than 2 months (p=0.004). 86.9 % (81-92 95 % CI) of the mothers did not know how to identify warning signs for these diseases, 84.9 % (78-90 95 % CI) of the practices were inadequate and 73.3% of the mothers took their children to a doctor as their first line medical practice (p=0.05). Efforts must be increased regarding the implementation of the IMCI strategy in vulnerable communities, through effective channels of communication and innovative ways to reduce child morbidity and mortality indices, thereby promoting the island's social development.

Cardiology office computer use: primer, pointers, pitfalls.

PubMed

Shepard, R B; Blum, R I

1986-10-01

An office computer is a utility, like an automobile, with benefits and costs that are both direct and hidden and potential for disaster. For the cardiologist or cardiovascular surgeon, the increasing power and decreasing costs of computer hardware and the availability of software make use of an office computer system an increasingly attractive possibility. Management of office business functions is common; handling and scientific analysis of practice medical information are less common. The cardiologist can also access national medical information systems for literature searches and for interactive further education. Selection and testing of programs and the entire computer system before purchase of computer hardware will reduce the chances of disappointment or serious problems. Personnel pretraining and planning for office information flow and medical information security are necessary. Some cardiologists design their own office systems, buy hardware and software as needed, write programs for themselves and carry out the implementation themselves. For most cardiologists, the better course will be to take advantage of the professional experience of expert advisors. This article provides a starting point from which the practicing cardiologist can approach considering, specifying or implementing an office computer system for business functions and for scientific analysis of practice results.

Puncturing the myths of acupuncture.

PubMed

Mallory, Molly J; Do, Alexander; Bublitz, Sara E; Veleber, Susan J; Bauer, Brent A; Bhagra, Anjali

2016-09-01

Acupuncture is a widely practiced system of medicine that has been in place for thousands of years. Consumer interest and use of acupuncture are becoming increasingly popular in the United States, as it is used to treat a multitude of symptoms and disease processes as well as to maintain health and prevent illness. A growing body of evidence increasingly validates the practice of acupuncture. Further developing scientific data will play an important role in the future of acupuncture and other complementary and alternative medicines in public health. Acupuncture is commonly used concurrently with conventional medicine. Although acupuncture is embraced by consumers and medical professionals, misconceptions abound. We have explored and dispelled ten misconceptions common to the practice of acupuncture, utilizing an evidence-based approach. As the trend of merging conventional medical care with acupuncture treatment grows, it is important to develop a conceptual model of integrative medicine. Using a scientific evidence approach will create a structure from which to begin and grow confidence among conventional medical providers. Acupuncture is a safe and effective modality when performed properly by trained professionals. Educating both the consumer and medical community is important to enable appropriate and evidence-based applications of acupuncture and integration with conventional medicine for high-quality patient care.

The social media: its impact on a vascular surgery practice.

PubMed

Turnipseed, William D

2013-04-01

Social media has revolutionized interpersonal communication and has become a commonly used public informational resource. This study evaluates the impact of intranet informatics on a specialty practice of vascular surgery. Referral patterns for patients with chronic compartment syndrome (CCS) and popliteal entrapment syndrome (PAES) between 2008 and 2011 were analyzed. Demographics included referral source (physicians, nonphysicians), media resource, and case volume change. Prior to 2008, referrals came from local or regional sports medicine practices (100%). Since 2008 this pattern has changed; local/regional (80%), national (15%), and international (5%). Physician referrals dropped from 97% to 70%, and nonphysician referrals increased from 3% to 30%. Both CCS procedures and PAES procedures increased as remote geographic and public referrals increased. Referral change was associated with social media searches using applications such as PubMed and Google. Social media is an evolving source of medical information and patient referrals which physicians should cautiously embrace.

Amplifying the benefits of agroecology by using the right cultivars.

PubMed

Noguera, D; Laossi, K-R; Lavelle, P; De Carvalho, M H Cruz; Asakawa, N; Botero, C; Barot, S

2011-10-01

Tropical soils are particularly vulnerable to fertility losses due to their low capacity to retain organic matter and mineral nutrients. This urges the development of new agricultural practices to manage mineral nutrients and organic matter in a more sustainable way while relying less on fertilizer inputs. Two methods pertaining to ecological engineering and agroecology have been tested with some success: (1) the addition of biochar to the soil, and (2) the maintenance of higher earthworm densities. However, modern crop varieties have been selected to be adapted to agricultural practices and to the soil conditions they lead to and common cultivars might not be adapted to new practices. Using rice as a model plant, we compared the responsiveness to biochar and earthworms of five rice cultivars with contrasted selection histories. These cultivars had contrasted responsivenesses to earthworms, biochar, and the combination of both. The mean relative increase in grain biomass, among all treatments and cultivars, was 94% and 32%, respectively, with and without fertilization. Choosing the best combination of cultivar and treatment led to a more than fourfold increase in this mean benefit (a 437% and a 353% relative increase in grain biomass, respectively, with and without fertilization). Besides, the more rustic cultivar, a local landrace adapted to diverse and difficult conditions, responded the best to earthworms in terms of total biomass, while a modern common cultivar responded the best in term of grain biomass. This suggests that cultivars could be selected to amplify the benefit of biochar- and earthworm-based practices. Overall, selecting new cultivars interacting more closely with soil organisms and soil heterogeneity could increase agriculture sustainability, fostering the positive feedback loop between soils and plants that has evolved in natural ecosystems.

Vocal Hygiene Habits and Vocal Handicap Among Conservatory Students of Classical Singing.

PubMed

Achey, Meredith A; He, Mike Z; Akst, Lee M

2016-03-01

This study sought to assess classical singing students' compliance with vocal hygiene practices identified in the literature and to explore the relationship between self-reported vocal hygiene practice and self-reported singing voice handicap in this population. The primary hypothesis was that increased attention to commonly recommended vocal hygiene practices would correlate with reduced singing voice handicap. This is a cross-sectional, survey-based study. An anonymous survey assessing demographics, attention to 11 common vocal hygiene recommendations in both performance and nonperformance periods, and the Singing Voice Handicap Index 10 (SVHI-10) was distributed to classical singing teachers to be administered to their students at two major schools of music. Of the 215 surveys distributed, 108 were returned (50.2%), of which 4 were incomplete and discarded from analysis. Conservatory students of classical singing reported a moderate degree of vocal handicap (mean SVHI-10, 12; range, 0-29). Singers reported considering all 11 vocal hygiene factors more frequently when preparing for performances than when not preparing for performances. Of these, significant correlations with increased handicap were identified for consideration of stress reduction in nonperformance (P = 0.01) and performance periods (P = 0.02) and with decreased handicap for consideration of singing voice use in performance periods alone (P = 0.02). Conservatory students of classical singing report more assiduous attention to vocal hygiene practices when preparing for performances and report moderate degrees of vocal handicap overall. These students may have elevated risk for dysphonia and voice disorders which is not effectively addressed through common vocal hygiene recommendations alone. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

A concise history of central venous access.

PubMed

Beheshti, Michael V

2011-12-01

Central venous access has become a mainstay of modern interventional radiology practice. Its history has paralleled and enabled many current medical therapies. This short overview provides an interesting historical perspective of these increasingly common interventional procedures. Copyright © 2011 Elsevier Inc. All rights reserved.

The normalization heuristic: an untested hypothesis that may misguide medical decisions.

PubMed

Aberegg, Scott K; O'Brien, James M

2009-06-01

Medical practice is increasingly informed by the evidence from randomized controlled trials. When such evidence is not available, clinical hypotheses based on pathophysiological reasoning and common sense guide clinical decision making. One commonly utilized general clinical hypothesis is the assumption that normalizing abnormal laboratory values and physiological parameters will lead to improved patient outcomes. We refer to the general use of this clinical hypothesis to guide medical therapeutics as the "normalization heuristic". In this paper, we operationally define this heuristic and discuss its limitations as a rule of thumb for clinical decision making. We review historical and contemporaneous examples of normalization practices as empirical evidence for the normalization heuristic and to highlight its frailty as a guide for clinical decision making.

Effects of post-fire logging on forest surface air temperatures in the Siskiyou Mountains, Oregon, USA

Treesearch

Joseph B. Fontaine; Daniel C. Donato; John L. Campbell; Jonathan G. Martin; Beverley E. Law

2010-01-01

Following stand-replacing wildfire, post-fire (salvage) logging of fire-killed trees is a widely implemented management practice in many forest types. A common hypothesis is that removal of fire-killed trees increases surface temperatures due to loss of shade and increased solar radiation, thereby influencing vegetation establishment and possibly stand development. Six...

Practical strategies for increasing efficiency and effectiveness in critical care education.

PubMed

Joyce, Maurice F; Berg, Sheri; Bittner, Edward A

2017-02-04

Technological advances and evolving demands in medical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs.

Community Currencies: An Ideology of Abundance

ERIC Educational Resources Information Center

Winfrey, Nancy

2017-01-01

This essay explores the concept of "cultural commons" and provides an illustration of a cultural commons practice from an ethnographic study of a community currency. The following section links cultural commons practices to situated and social cognitive learning theories, and then provides practical application to the higher education…

Integrating Shared Mobility into Multimodal Transportation Planning: Improving Regional Performance to Meet Public Goals

DOT National Transportation Integrated Search

2018-02-01

New shared mobility services have become increasingly common and important modes of travel in U.S. cities, but transportation planning practices are only beginning to adapt in response. This white paper provides a framework and examples to assist tra...

Operations analysis (study 2.1). Payload designs for space servicing, addendum

NASA Technical Reports Server (NTRS)

Wolfe, R. R.

1974-01-01

Space replaceable units and payload configurations are revised to reflect increased levels of redundancy to be more consistent with current design practices. A reassessment of expendable payload design reliabilities was performed to provide a common basis for comparison with space serviceable configurations.

Distributed Pedagogical Leadership and Generative Dialogue in Educational Nodes

ERIC Educational Resources Information Center

Jappinen, Aini-Kristiina; Sarja, Anneli

2012-01-01

The article presents practices of distributed pedagogical leadership and generative dialogue as a tool with which management and personnel can better operate in the increasingly turbulent world of education. Distributed pedagogical leadership includes common characteristics of a professional learning community when the educational actors…

Low Cost Wireless Fatigue Crack Monitoring System Using RFID Arrays

DOT National Transportation Integrated Search

2018-03-23

The use of welded steel cover plates had been a common design practice to increase beam section capacity in regions ofhigh torsion for decades. Many steel girder bridges with cover plates are still in service. Steel girder bridges are subject to cycl...

Focus on Wage and Salary Programs.

ERIC Educational Resources Information Center

Risher, Howard W.

1989-01-01

Budget pressures, tightening labor markets, and increasing public interest should prompt colleges and universities to review their wage and salary programs. Many administrators have never been exposed to practices other than those common to higher education, and trustees with corporate experience may provide some insight. (Author/MSE)

Non-destructive and destructive investigation of aged-in-the field carbon FRP-wrapped columns.

DOT National Transportation Integrated Search

2011-06-01

The common practice of applying deicing salts on highway bridges increases the potential of reinforcing steel in these structures to experience extensive corrosion in the decks as well as the substructure. A new rehabilitation method which is believe...

Impact of a Randomized Controlled Trial to Reduce Bedsharing on Breastfeeding Rates and Duration for African-American Infants.

PubMed

Moon, Rachel Y; Mathews, Anita; Joyner, Brandi L; Oden, Rosalind P; He, Jianping; McCarter, Robert

2017-08-01

Bedsharing is associated with both increased breastfeeding and increased risk of sudden and unexpected infant deaths. The objective was to determine impact of sleep location and counseling about sleep location on breastfeeding exclusivity and duration in African-Americans. 1194 mothers of newborns were randomized to receive messaging emphasizing either safe sleep practices to reduce SIDS risk or safe sleep practices to prevent SIDS/suffocation. Mothers completed four interviews in the 6 months after delivery. The most common sleep arrangement was roomsharing without bedsharing ("roomsharing"). Duration of any breastfeeding was 6.1 and 5.3 weeks for infants who usually bedshared or roomshared, respectively (p = 0.01). Duration of exclusive breastfeeding was 3.0 and 1.6 weeks for infants who usually bedshared or roomshared, respectively (p < 0.001). Group assignment did not affect breastfeeding duration. The most common sleep arrangement for African-American infants <6 months was roomsharing. An intervention designed to discourage bedsharing did not impact breastfeeding duration.

Common Practices from Two Decades of Water Resources Modelling Published in Environmental Modelling & Software: 1997 to 2016

NASA Astrophysics Data System (ADS)

Ames, D. P.; Peterson, M.; Larsen, J.

2016-12-01

A steady flow of manuscripts describing integrated water resources management (IWRM) modelling has been published in Environmental Modelling & Software since the journal's inaugural issue in 1997. These papers represent two decades of peer-reviewed scientific knowledge regarding methods, practices, and protocols for conducting IWRM. We have undertaken to explore this specific assemblage of literature with the intention of identifying commonly reported procedures in terms of data integration methods, modelling techniques, approaches to stakeholder participation, means of communication of model results, and other elements of the model development and application life cycle. Initial results from this effort will be presented including a summary of commonly used practices, and their evolution over the past two decades. We anticipate that results will show a pattern of movement toward greater use of both stakeholder/participatory modelling methods as well as increased use of automated methods for data integration and model preparation. Interestingly, such results could be interpreted to show that the availability of better, faster, and more integrated software tools and technologies free the modeler to take a less technocratic and more human approach to water resources modelling.

Factors Associated with Awareness, Attitudes and Practices Regarding Common Eye Diseases in the General Population in a Rural District in Bangladesh: The Bangladesh Population-based Diabetes and Eye Study (BPDES).

PubMed

Islam, Fakir M Amirul; Chakrabarti, Rahul; Islam, Silvia Z; Finger, Robert P; Critchley, Christine

2015-01-01

To assess the awareness, attitudes, and practices associated with common eye diseases and eye care utilization in a rural district of Bangladesh. Data were collected using a multilevel cluster random sampling technique from 3104 adults aged ≥30 years from the Banshgram union with a questionnaire assessing the awareness, attitudes and practice about diabetes and common eye diseases, educational attainment, socio-economic status, and medical history. Participants were aged between 30 and 89 years with a mean (SD) age of 51 (12) years and 65% were female. The majority of participants had heard of cataracts (90%), trachoma (86%) and Pterygium (84%), yet only 4% had heard of diabetic retinopathy (DR), 7% of glaucoma and 8% of Age-related macular degeneration (AMD). However, 58% of participants did not know vision loss could be prevented. Factors associated with lower awareness regarding common eye diseases were increasing age, lack of formal schooling, and lower socio-economic status. A lower proportion (57%) of people with no schooling compared to those who had attained at least secondary school certificate education (72%) reported that they knew that vision loss could be prevented (p<0.001). Overall 51% of people had heard of at least six (67%) out of nine items relating to awareness of common eye diseases. This included 41% of participants aged 65 years or older compared to 61% of those aged 30-35 years (p<0.001). Only 4% had an eye check at least once a year and higher education and better SES were associated with higher frequency of eye checks. In rural Bangladesh awareness of cataract, trachoma and pterygium was good but limited in relation to the potentially blinding conditions of glaucoma, DR, and AMD. The results show a large gap between public awareness and treatment practices about common eye diseases. Public health promotion should be designed to address these knowledge gaps.

Transdermal fentanyl in deliberate overdose in pediatrics.

PubMed

Lyttle, Mark D; Verma, Sapna; Isaac, Rhian

2012-05-01

The use of the fentanyl skin patch to provide pain relief in chronic pain conditions and oncology in adult practice has been common for several years, and an increase in use is now being seen in pediatric practice. Its use in drug misuse and suicide has also increased in recent years. We present the case of an adolescent who deliberately overdosed using fentanyl skin patches and describe the implications for management. This report serves to remind clinicians to consider this method of drug administration in children who display signs of opioid toxicity, where overdose may be subsequent to its use in therapy, recreation, or deliberate self-harm.

New hope for the health care field.

PubMed

Mabbett, P

1993-03-01

Creativity is required for solving many of the problems that face the health care system. As a group, caregivers tend to underestimate their own creativity and its potential impact on the systems in which they work. This article reviews common misconceptions about creativity and describes forces that erode its expression. Suggestions are made for how creativity can be increased within traditional-practice settings. Steps in a creative process are reviewed as well as internal and external factors that support the occurrence of creative moments. The benefits to be gained from increased creativity range from practical improvements within the system to personal gratification for individual caregivers.

Mental health impacts of flooding: a controlled interrupted time series analysis of prescribing data in England

PubMed Central

Milojevic, Ai; Armstrong, Ben; Wilkinson, Paul

2017-01-01

Background There is emerging evidence that people affected by flooding suffer adverse impacts on their mental well-being, mostly based on self-reports. Methods We examined prescription records for drugs used in the management of common mental disorder among primary care practices located in the vicinity of recent large flood events in England, 2011–2014. A controlled interrupted time series analysis was conducted of the number of prescribing items for antidepressant drugs in the year before and after the flood onset. Pre–post changes were compared by distance of the practice from the inundated boundaries among 930 practices located within 10 km of a flood. Results After control for deprivation and population density, there was an increase of 0.59% (95% CI 0.24 to 0.94) prescriptions in the postflood year among practices located within 1 km of a flood over and above the change observed in the furthest distance band. The increase was greater in more deprived areas. Conclusions This study suggests an increase in prescribed antidepressant drugs in the year after flooding in primary care practices close to recent major floods in England. The degree to which the increase is actually concentrated in those flooded can only be determined by more detailed linkage studies. PMID:28860201

What we think we learn from watching others: the moderating role of ability on perceptions of learning from observation.

PubMed

Hodges, Nicola J; Coppola, Thomas

2015-07-01

Despite increased interest in the processes guiding action observation and observational learning, we know little about what people think they learn from watching, how well perceptions of learning marry with actual ability and how ability perceptions develop across multiple observation trials. Based on common coding ideas, we would think that ability and perceptions of ability from watching should be well matched. We conducted two studies to answer these questions that involved repeated observation of a 2-ball juggling task. After each video observation, observers judged if they could perform the skill and gave a confidence score (0-100%). In Experiment 1, an Observe-only group was compared to an Observe + Physical practice and No-practice group. Both observer groups showed a better physical approximation of the juggling action after practice and in retention and their confidence increased in a linear fashion. Confidence showed a small, yet significant relationship to actual success. In Experiment 2, we limited physical practice to 5 attempts (across 50 observation trials). In general, people who had high perceptions of ability following a demonstration were overconfident, whereas those with lower perceptions of ability were accurate in their assessments. Confidence generally increased across practice, particularly for trials following observation rather than physical practice. We conclude that while perceptions of ability and actual ability show congruence across trials and individuals, observational practice increases people's confidence in their ability to perform a skill, even despite physical experiences to the contrary.

Leading the Common Core State Standards: From Common Sense to Common Practice

ERIC Educational Resources Information Center

Dunkle, Cheryl A.

2012-01-01

Many educators agree that we already know how to foster student success, so what is keeping common sense from becoming common practice? The author provides step-by-step guidance for overcoming the barriers to adopting the Common Core State Standards (CCSS) and achieving equity and excellence for all students. As an experienced teacher and…

Qualitative interviews with healthcare staff in four European countries to inform adaptation of an intervention to increase chlamydia testing

PubMed Central

McNulty, Cliodna; Ricketts, Ellie J; Fredlund, Hans; Uusküla, Anneli; Town, Katy; Rugman, Claire; Tisler-Sala, Anna; Mani, Alix; Dunais, Brigitte; Folkard, Kate; Allison, Rosalie; Touboul, Pia

2017-01-01

Objective To determine the needs of primary healthcare general practice (GP) staff, stakeholders and trainers to inform the adaptation of a locally successful complex intervention (Chlamydia Intervention Randomised Trial (CIRT)) aimed at increasing chlamydia testing within primary healthcare within South West England to three EU countries (Estonia, France and Sweden) and throughout England. Design Qualitative interviews. Setting European primary healthcare in England, France, Sweden and Estonia with a range of chlamydia screening provision in 2013. Participants 45 GP staff, 13 trainers and 18 stakeholders. Interviews The iterative interview schedule explored participants’ personal attitudes, subjective norms and perceived behavioural controls around provision of chlamydia testing, sexual health services and training in general practice. Researchers used a common thematic analysis. Results Findings were similar across all countries. Most participants agreed that chlamydia testing and sexual health services should be offered in general practice. There was no culture of GP staff routinely offering opportunistic chlamydia testing or sexual health advice, and due to other priorities, participants reported this would be challenging. All participants indicated that the CIRT workshop covering chlamydia testing and sexual health would be useful if practice based, included all practice staff and action planning, and was adequately resourced. Participants suggested minor adaptations to CIRT to suit their country’s health services. Conclusions A common complex intervention can be adapted for use across Europe, despite varied sexual health provision. The intervention (ChlamydiA Testing Training in Europe (CATTE)) should comprise: a staff workshop covering sexual health and chlamydia testing rates and procedures, action planning and patient materials and staff reminders via computer prompts, emails or newsletters, with testing feedback through practice champions. CATTE materials are available at: www.STItraining.eu. PMID:28951413

What Is Developmentally Appropriate Teaching?

ERIC Educational Resources Information Center

Clements, Douglas H.; Fuson, Karen C.; Sarama, Julie

2017-01-01

Teachers are on the front line in any educational controversy. Increasingly, some bloggers, newspaper articles, and other media have criticized the Common Core State Standards for Mathematics (CCSSM) (CCSSI 2010) as being inappropriate for children in kindergarten and first grade. However, both research and expert practice reveal that children are…

Treatment of Not-Administered Items on Individually Administered Intelligence Tests

ERIC Educational Resources Information Center

He, Wei; Wolfe, Edward W.

2012-01-01

In administration of individually administered intelligence tests, items are commonly presented in a sequence of increasing difficulty, and test administration is terminated after a predetermined number of incorrect answers. This practice produces stochastically censored data, a form of nonignorable missing data. By manipulating four factors…

Nitrate removal effectiveness of fluidized sulfur-based autotrophic denitrification biofilters for recirculating aquaculture systems

USDA-ARS?s Scientific Manuscript database

There is a need to develop practical methods to reduce nitrate -nitrogen loads from recirculating aqua-culture systems to facilitate increased food protein production simultaneously with attainment of water quality goals. The most common wastewater denitrification treatment systems utilize methanol-...

Elevated relative humidity increases the incidence of boron deficiency in bedding plants

USDA-ARS?s Scientific Manuscript database

High relative humidity (RH) can cause lower concentrations of B accumulating in plants. The common greenhouse practice of controlling excess temperatures by applying mist irrigation to youngplants (plugs) results in elevated RH levels. Reports of boron (B) deficiency have become more prevalent ove...

Instructional Utility and Learning Efficacy of Common Active Learning Strategies

ERIC Educational Resources Information Center

McConell, David A.; Chapman, LeeAnna; Czaijka, C. Douglas; Jones, Jason P.; Ryker, Katherine D.; Wiggen, Jennifer

2017-01-01

The adoption of active learning instructional practices in college science, technology, engineering, and mathematics (STEM) courses has been shown to result in improvements in student learning, contribute to increased retention rates, and reduce the achievement gap among different student populations. Descriptions of active learning strategies…

Water yield and hydrology

Treesearch

Pamela J. Edwards; Charles A. Troendle

2012-01-01

Investigations of hydrologic responses resulting from reducing vegetation density are fairly common throughout the Eastern United States. Although most studies have focused on the potential for increasing water yields or documenting effects from intensive practices that far exceed what would be done for fuel-reduction objectives, data from some less-intensive...

Effects of different irrigation practices using treated wastewater on tomato yields, quality, water productivity, and soil and fruit mineral contents.

PubMed

Demir, Azize Dogan; Sahin, Ustun

2017-11-01

Wastewater use in agricultural irrigation is becoming a common practice in order to meet the rising water demands in arid and semi-arid regions. The study was conducted to determine the effects of the full (FI), deficit (DI), and partial root-zone drying (PRD) irrigation practices using treated municipal wastewater (TWW) and freshwater (FW) on tomato yield, water use, fruit quality, and soil and fruit heavy metal concentrations. The TWW significantly increased marketable yield compared to the FW, as well as decreased water consumption. Therefore, water use efficiency (WUE) in the TWW was significantly higher than in the FW. Although the DI and the PRD practices caused less yields, these practices significantly increased WUE values due to less irrigation water applied. The water-yield linear relationships were statistically significant. TWW significantly increased titratable acidity and vitamin C contents. Reduced irrigation provided significantly lower titratable acidity, vitamin C, and lycopene contents. TWW increased the surface soil and fruit mineral contents in response to FW. Greater increases were observed under FI, and mineral contents declined with reduction in irrigation water. Heavy metal accumulation in soils was within safe limits. However, Cd and Pb contents in fruits exceeded standard limits given by FAO/WHO. Higher metal pollution index values determined for fruits also indicated that TWW application, especially under FI, might cause health risks in long term.

Genes and inheritance.

PubMed

Middelton, L A; Peters, K F

2001-10-01

The information gained from the Human Genome Project and related genetic research will undoubtedly create significant changes in healthcare practice. It is becoming increasingly clear that nurses in all areas of clinical practice will require a fundamental understanding of basic genetics. This article provides the oncology nurse with an overview of basic genetic concepts, including inheritance patterns of single gene conditions, pedigree construction, chromosome aberrations, and the multifactorial basis underlying the common diseases of adulthood. Normal gene structure and function are introduced and the biochemistry of genetic errors is described.

The history of craniotomy for headache treatment.

PubMed

Assina, Rachid; Sarris, Christina E; Mammis, Antonios

2014-04-01

Both the history of headache and the practice of craniotomy can be traced to antiquity. From ancient times through the present day, numerous civilizations and scholars have performed craniotomy in attempts to treat headache. Today, surgical intervention for headache management is becoming increasingly more common due to improved technology and greater understanding of headache. By tracing the evolution of the understanding of headache alongside the practice of craniotomy, investigators can better evaluate the mechanisms of headache and the therapeutic treatments used today.

Safety and compliance-related hazards in the medical practice: Part one.

PubMed

Calway, R C

2001-01-01

Safety and risk management hazards are a fact of life for the medical practice, and the costs of these incidents can place the group at significant risk of liability. Good compliance and risk management programs help minimize these incidents, improve staff morale, increase a practice's visibility in the community, and positively affect the practice's financial and operational bottom line performance. Medical practices that implement effective safety and risk management programs can realize savings in staffing costs, operational efficiency, morale, insurance premiums, and improved third-party relationships while at the same time avoiding embarrassing risks, fines, and liability. This article outlines some of the most common safety and risk management-related deficiencies seen in medical practices today. The author explains how to remedy these deficiencies and provides a self-test tool to enable the reader to assess areas within his or her own practice in need of attention.

Documenting risk: A comparison of policy and information pamphlets for using epidural or water in labour.

PubMed

Newnham, Elizabeth C; McKellar, Lois V; Pincombe, Jan I

2015-09-01

Approximately 30% of Australian women use epidural analgesia for pain relief in labour, and its use is increasing. While epidural analgesia is considered a safe option from an anaesthetic point of view, its use transfers a labouring woman out of the category of 'normal' labour and increases her risk of intervention. Judicious use of epidural may be beneficial in particular situations, but its current common use needs to be assessed more closely. This has not yet been explored in the Australian context. To examine personal, social, institutional and cultural influences on women in their decision to use epidural analgesia in labour. Examining this one event in depth illuminates other birth practices, which can also be analysed according to how they fit within prevailing cultural beliefs about birth. Ethnography, underpinned by a critical medical anthropology methodology. These findings describe the influence of risk culture on labour ward practice; specifically, the policies and practices surrounding the use of epidural analgesia are contrasted with those on the use of water. Engaging with current risk theory, we identify the role of power in conceptualisations of risk, which are commonly perpetuated by authority rather than evidence. As we move towards a risk-driven society, it is vital to identify both the conception and the consequences of promulgations of risk. The construction of waterbirth as a 'risky' practice had the effect of limiting midwifery practice and women's choices, despite evidence that points to the epidural as the more 'dangerous' option. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Big Data in Public Health: Terminology, Machine Learning, and Privacy.

PubMed

Mooney, Stephen J; Pejaver, Vikas

2018-04-01

The digital world is generating data at a staggering and still increasing rate. While these "big data" have unlocked novel opportunities to understand public health, they hold still greater potential for research and practice. This review explores several key issues that have arisen around big data. First, we propose a taxonomy of sources of big data to clarify terminology and identify threads common across some subtypes of big data. Next, we consider common public health research and practice uses for big data, including surveillance, hypothesis-generating research, and causal inference, while exploring the role that machine learning may play in each use. We then consider the ethical implications of the big data revolution with particular emphasis on maintaining appropriate care for privacy in a world in which technology is rapidly changing social norms regarding the need for (and even the meaning of) privacy. Finally, we make suggestions regarding structuring teams and training to succeed in working with big data in research and practice.

Dementia with Lewy bodies: a comprehensive review for nurses.

PubMed

Ajon Gealogo, Gretchel

2013-12-01

Much of the current nursing literature on dementia focuses on Alzheimer disease (AD), the dementia subtype most commonly diagnosed in the older adults. There is a paucity of nursing literature on dementia with Lewy bodies (DLB), the second most common subtype of dementia, which is closely associated with Parkinson disease with dementia (PDD), considered the third most common dementia subtype. Both are aging-related disorders attributed to Lewy bodies, abnormal protein aggregates or "clumps" found to cause cumulative neurodegeneration over time. DLB is defined as dementia onset that is preceded by Parkinsonian symptoms for 1 year or less, whereas in PDD, 2 or more years of Parkinsonian symptoms precede dementia onset. Although basic science knowledge of DLB has increased exponentially, the lack of nursing research on DLB indicates that this knowledge excludes the nursing perspective and its implications for nursing practice. The purpose of this article is to provide nurses with a comprehensive overview of DLB as it compares with PDD and Alzheimer disease and to propose key nursing interventions for clinical practice.

The neural mechanisms of semantic and response conflicts: an fMRI study of practice-related effects in the Stroop task.

PubMed

Chen, Zhencai; Lei, Xu; Ding, Cody; Li, Hong; Chen, Antao

2013-02-01

Previous studies have demonstrated that there are separate neural mechanisms underlying semantic and response conflicts in the Stroop task. However, the practice effects of these conflicts need to be elucidated and the possible involvements of common neural mechanisms are yet to be established. We employed functional magnetic resonance imaging (fMRI) in a 4-2 mapping practice-related Stroop task to determine the neural substrates under these conflicts. Results showed that different patterns of brain activations are associated with practice in the attentional networks (e.g., dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), and posterior parietal cortex (PPC)) for both conflicts, response control regions (e.g., inferior frontal junction (IFJ), inferior frontal gyrus (IFG)/insula, and pre-supplementary motor areas (pre-SMA)) for semantic conflict, and posterior cortex for response conflict. We also found areas of common activation in the left hemisphere within the attentional networks, for the early practice stage in semantic conflict and the late stage in "pure" response conflict using conjunction analysis. The different practice effects indicate that there are distinct mechanisms underlying these two conflict types: semantic conflict practice effects are attributable to the automation of stimulus processing, conflict and response control; response conflict practice effects are attributable to the proportional increase of conflict-related cognitive resources. In addition, the areas of common activation suggest that the semantic conflict effect may contain a partial response conflict effect, particularly at the beginning of the task. These findings indicate that there are two kinds of response conflicts contained in the key-pressing Stroop task: the vocal-level (mainly in the early stage) and key-pressing (mainly in the late stage) response conflicts; thus, the use of the subtraction method for the exploration of semantic and response conflicts may need to be further examined. Copyright © 2012 Elsevier Inc. All rights reserved.

Marriage and Family Therapy Students' Experience with Common Factors Training.

PubMed

Fife, Stephen T; D'Aniello, Carissa; Scott, Sarah; Sullivan, Erin

2018-04-27

With the increased empirical and theoretical support for common factors in the psychotherapy literature, marriage and family therapy (MFT) scholars have begun discussing the inclusion of common factors in MFT training. However, there is very little empirical research on common factors training or how to include common factors in MFT curricula. The purpose of this phenomenological study was to investigate MFT students' experience with common factors training. Seventeen master's degree students who received training in common factors participated in the study. Data was comprised of participants' journal reflections and focus group interviews on their experience learning about common factors and how this influenced their work with clients. Participants' responses to the training were overwhelmingly positive and highlighted the ways in which studying common factors enhanced their confidence, understanding of MFT models, conceptual abilities, and clinical practice. Additional results and discussion about incorporating common factors in MFT training are presented. © 2018 American Association for Marriage and Family Therapy.

Internationalisation of the Curriculum: Putting Theory into Practice in a Physiotherapy Program

ERIC Educational Resources Information Center

Das, Rebekah

2005-01-01

Increasing numbers of international students studying health sciences in Australia necessitates research into appropriate ways to support cultural diversity in teaching. International students commonly face problems in adapting to culturally different education and health care systems and this complicates the development of the discipline specific…

Critical Components of Community College Enrollment Management Planning

ERIC Educational Resources Information Center

Bucher, Karen Hart

2010-01-01

Enrollment management has become a common practice at four-year institutions, but has not been extensively explored at community colleges. As students have more educational options available to them, community colleges have begun to explore ways to grow their enrollment, improve student retention and increase graduation rates. This study explored…

Management practices to reduce lupine-induced Crooked Calf Syndrome in the Northwest

USDA-ARS?s Scientific Manuscript database

Many factors contribute to the incidence of lupine-induced “Crooked Calf Syndrome” (CCS) in the northwestern U.S. A 1-5% incidence of CCS is common on many ranches and higher incidences occur when environmental conditions are conducive to lupine population increases. Multiple management strategies s...

Strategies for Critiquing Global Citizenry: Undergraduate Research as a Possible Vehicle

ERIC Educational Resources Information Center

Henderson, Juliet

2013-01-01

Even as an increasing number of universities commit to producing graduates possessing the attributes of "a global citizen", discussions between academics suggest it is common practice to design programme outcomes which include the attribute of global citizenship without advancing discussion as to ways of embedding them in deeper…

Minimally Invasive Mitral Valve Surgery III

PubMed Central

Lehr, Eric J.; Guy, T. Sloane; Smith, Robert L.; Grossi, Eugene A.; Shemin, Richard J.; Rodriguez, Evelio; Ailawadi, Gorav; Agnihotri, Arvind K.; Fayers, Trevor M.; Hargrove, W. Clark; Hummel, Brian W.; Khan, Junaid H.; Malaisrie, S. Chris; Mehall, John R.; Murphy, Douglas A.; Ryan, William H.; Salemi, Arash; Segurola, Romualdo J.; Smith, J. Michael; Wolfe, J. Alan; Weldner, Paul W.; Barnhart, Glenn R.; Goldman, Scott M.; Lewis, Clifton T. P.

2016-01-01

Abstract Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program. PMID:27662478

Content and Workflow Management for Library Websites: Case Studies

ERIC Educational Resources Information Center

Yu, Holly, Ed.

2005-01-01

Using database-driven web pages or web content management (WCM) systems to manage increasingly diverse web content and to streamline workflows is a commonly practiced solution recognized in libraries today. However, limited library web content management models and funding constraints prevent many libraries from purchasing commercially available…

Adapting Job Analysis Methodology to Improve Evaluation Practice

ERIC Educational Resources Information Center

Jenkins, Susan M.; Curtin, Patrick

2006-01-01

This article describes how job analysis, a method commonly used in personnel research and organizational psychology, provides a systematic method for documenting program staffing and service delivery that can improve evaluators' knowledge about program operations. Job analysis data can be used to increase evaluators' insight into how staffs…

Using Generic Examples to Make Viable Arguments

ERIC Educational Resources Information Center

Adams, Anne E.; Ely, Rob; Yopp, David

2017-01-01

The twenty-first century has seen an increased call to train students to craft mathematical arguments. The third of the Common Core's (CCSS) Standards for Mathematical Practice (SMP 3) (CCSSI 2010) calls for all mathematically proficient students to "construct viable arguments" to support the truth of their ideas and to "critique…

Examining Interprofessional Education through the Lens of Interdisciplinarity: Power, Knowledge and New Ontological Subjects

ERIC Educational Resources Information Center

Olson, Rebecca E.; Brosnan, Caragh

2017-01-01

Interprofessional education (IPE)--students of different professions learning together, from and about each other--is increasingly common in health professional degrees. Despite its explicit aims of transforming identities, practices and relationships within/across health professions, IPE remains under-theorised sociologically, with most IPE…

Distant yet Near: Promoting Interdisciplinary Learning in Significantly Diverse Teams through Socially Responsible Projects

ERIC Educational Resources Information Center

Adya, Monica; Temple, Bryan K.; Hepburn, Donald M.

2015-01-01

With global specialization of work units within organizations, interdisciplinary work practices comprised of collaborative efforts between technical and business teams are increasingly common in today's workplace. While higher education has responded by creating opportunities for remote teams to learn from collaborative work, occasions for…

Mitigating Illusory Results through Preregistration in Education

ERIC Educational Resources Information Center

Gehlbach, Hunter; Robinson, Carly D.

2018-01-01

Like performance-enhancing drugs inflating apparent athletic achievements, several common social science practices contribute to the production of illusory results. In this article, we examine the processes that lead to illusory findings and describe their consequences. We borrow from an approach used increasingly by other disciplines--the norm of…

Overcoming Common Misunderstandings about Students with Disabilities Who Are English Language Learners

ERIC Educational Resources Information Center

Cheatham, Gregory A.; Hart Barnett, Juliet E.

2017-01-01

Special education programs are increasingly serving students with disabilities who are English language learners and their families. Facilitating bilingualism is an effective practice and aligns with culturally responsive special education service provision. It is critical for special educators and service providers to learn about bilingualism,…

The Great Irish Head Shop Controversy

ERIC Educational Resources Information Center

Ryall, Graham; Butler, Shane

2011-01-01

This research describes and analyses recent policy developments in Ireland in relation to the practice of selling psychoactive substances which, while not themselves illegal, mimic the effects of commonly used illegal drugs. These so-called "legal highs" had been sold in Ireland through an increasing number of "head shops"…

A Senior Medical Student Seminar Designed to Promote Problem-Solving.

ERIC Educational Resources Information Center

Donohue, James F.; Shumway, James M.

1983-01-01

A seminar was developed to increase students' learning opportunities in respiratory disease and to identify common problem areas in hospital medical care. It provided practice in clinical diagnosis and patient management by promoting dialog, faculty feedback, and self-evaluation. Specific case studies are used for discussion. (MSE)

Classroom Animals Provide More than Just Science Education

ERIC Educational Resources Information Center

Herbert, Sandra; Lynch, Julianne

2017-01-01

Keeping classroom animals is a common practice in many classrooms. Their value for learning is often seen narrowly as the potential to involve children in learning biological science. They also provide opportunities for increased empathy, as well as socio-emotional development. Realization of their potential for enhancing primary children's…

Online Tools to Support the Delivery of Evidence-Based Practices for Students with ASD

ERIC Educational Resources Information Center

Sam, Ann M.; Kucharczyk, Suzanne; Waters, Victoria

2018-01-01

Educators continually encounter new challenges that require different tools or ways to utilize current tools in novel ways. Common challenges when working with students with autism spectrum disorder (ASD) may include addressing interfering behavior, developing communication systems, increasing social opportunities for students, and addressing…

Benchmarking with the BLASST Sessional Staff Standards Framework

ERIC Educational Resources Information Center

Luzia, Karina; Harvey, Marina; Parker, Nicola; McCormack, Coralie; Brown, Natalie R.

2013-01-01

Benchmarking as a type of knowledge-sharing around good practice within and between institutions is increasingly common in the higher education sector. More recently, benchmarking as a process that can contribute to quality enhancement has been deployed across numerous institutions with a view to systematising frameworks to assure and enhance the…

Quantification and fragment analysis of soil and cotton root-associated fungal and bacterial populations under different tillage managements

USDA-ARS?s Scientific Manuscript database

Background: Conservation tillage is a common management practice utilized in the hopes of reducing soil erosion and increasing soil carbon. Evidence suggests that conservation tillage may lead to habitat improvement for soil microorganisms, in particular rhizospheric bacteria and arbuscular mycorrhi...

STEAM by Another Name: Transdisciplinary Practice in Art and Design Education

ERIC Educational Resources Information Center

Costantino, Tracie

2018-01-01

The recent movement to include art and design in Science, Technology, Engineering, and Mathematics (STEM) education has made Science, Technology, Engineering, Arts, and Mathematics (STEAM) an increasingly common acronym in the education lexicon. The STEAM movement builds on existing models of interdisciplinary curriculum, but what makes the union…

Reinforcement Sensitivity and Responsiveness to Performance Feedback: A Preliminary Investigation

ERIC Educational Resources Information Center

Lovett, Benjamin J.; Eckert, Tanya L.

2009-01-01

Variability in responsiveness to academic interventions is a common phenomenon in school psychology practice, but the variables associated with this responsiveness are not well understood. Reinforcement sensitivity, a generalized tendency to learn quickly in reward contingency situations, is one variable for increased understanding. In the present…

Adult Education as Vocation: A Critical Role for the Adult Educator.

ERIC Educational Resources Information Center

Collins, Michael

Fixation on technique, erosion of autonomous and community interests, and efforts to increase professionalization of adult education (which tends to emphasize the differences between adult educators and adult learners rather than their common interests) have created a crisis in adult education. Contemporary practice and research on self-directed…

Video Simulations to Develop Preservice Mathematics Teachers' Discourse Practices

ERIC Educational Resources Information Center

Amador, Julie M.

2018-01-01

The incorporation of video technology in teacher education programmes is increasingly prevalent, with teacher educators commonly using three traditional forms of videos: published video, preservice teachers' own videos and colleagues' videos. This study explored a fourth type of video, self-created scripted video simulations in which preservice…

Student Learning Outcomes Assessment in College Foreign Language Programs

ERIC Educational Resources Information Center

Norris, John M., Ed.; Davis, John McE., Ed.

2015-01-01

Changes in accreditation policies and institutional practices have led to the emergence of student learning outcomes assessment as an important, increasingly common expectation in U.S. college foreign language programs. This volume investigates contemporary outcomes assessment activity, with a primary focus on useful assessment, that is,…

Key Determinants of Student Satisfaction When Undertaking Group Work

ERIC Educational Resources Information Center

Pang, Elvy; Tong, Canon; Wong, Anthony

2011-01-01

The increasing popularity of team structures in business environment coupled with the common practice of including group projects/assignments in university curricula means that business schools should direct efforts towards maximizing team as well as personal results. Yet, most frameworks for studying teams center exclusively on team level…

Teachers' Increased Use of Informational Text: A Phenomenological Study of Five Primary Classrooms

ERIC Educational Resources Information Center

Young, Heather D.; Goering, Christian Z.

2018-01-01

The purpose of this phenomenological study was to explain how the Common Core State Standards may have influenced teachers' practices and philosophies regarding literacy instruction. Conducted in five kindergarten through second-grade classrooms within one elementary school, this research study collected semi-structured interviews, classroom…

The Development of a Professional Statistics Teaching Identity

ERIC Educational Resources Information Center

Whitaker, Douglas

2016-01-01

Motivated by the increased statistics expectations for students and their teachers because of the widespread adoption of the Common Core State Standards for Mathematics, this study explores exemplary, in-service statistics teachers' professional identities using a theoretical framework informed by Gee (2000) and communities of practice (Lave &…

Total Quality Management: Public Sector Applications for Training Programs.

ERIC Educational Resources Information Center

Davis, David S.

Total quality management (TQM) is based on the fundamental philosophy that it is always more effective to do something right the first time than it is to correct deficiencies. It seeks to improve quality and increase customer satisfaction by restructuring traditional management and organizational practices. Common characteristics of TQM include…

Using the core curriculum on childhood trauma to strengthen clinical knowledge in evidence-based practitioners.

PubMed

Layne, Christopher M; Strand, Virginia; Popescu, Marciana; Kaplow, Julie B; Abramovitz, Robert; Stuber, Margaret; Amaya-Jackson, Lisa; Ross, Leslie; Pynoos, Robert S

2014-01-01

The high prevalence of trauma exposure in mental health service-seeking populations, combined with advances in evidence-based practice, competency-based training, common-elements research, and adult learning make this an opportune time to train the mental health workforce in trauma competencies. The Core Curriculum on Childhood Trauma (CCCT) utilizes a five-tiered conceptual framework (comprising Empirical Evidence, Core Trauma Concepts, Intervention Objectives, Practice Elements, and Skills), coupled with problem-based learning, to build foundational trauma knowledge and clinical reasoning skills. We present findings from three studies: Study 1 found that social work graduate students' participation in a CCCT course (N = 1,031) was linked to significant pre-post increases in self-reported confidence in applying core trauma concepts to their clinical work. Study 2 found significant pre-post increases in self-reported conceptual readiness (N = 576) and field readiness (N = 303) among social work graduate students participating in a "Gold Standard Plus" educational model that integrated classroom instruction in core trauma concepts, training in evidence-based trauma treatment (EBTT), and implementation of that EBTT in a supervised field placement. Students ranked the core concepts course as an equivalent or greater contributor to field readiness compared to standard EBTT training. Study 3 used qualitative methods to "distill" common elements (35 intervention objectives, 59 practice elements) from 26 manualized trauma interventions. The CCCT is a promising tool for educating "next-generation" evidence-based practitioners who possess competencies needed to implement modularized, individually tailored trauma interventions by strengthening clinical knowledge, clinical reasoning, and familiarity with common elements.

Sustainability versus yield in agricultural soils under various crop production practices - a microbial perspective

NASA Astrophysics Data System (ADS)

Pereg, Lily; Aldorri, Sind; McMillan, Mary

2017-04-01

Wheat and cotton are important food and cash crops often grown in rotation on black, grey and red clay soil, in Australia. The common practice of nitrogen and phosphate fertilizers have been solely in the form of agrochemicals, however, a few growers have incorporated manure or composted plant material into the soil before planting. While the cotton yield in studied farms was comparable, we found that the use of such organic amendments significantly enhanced the pool of nitrogen cycling genes, suggesting increased potential of soil microbial function as well as increased microbial metabolic diversity and abundance. Therefore, the regular use of organic amendments contributed to improved soil sustainability.

Associations between attention, affect and cardiac activity in a single yoga session for female cancer survivors: an enactive neurophenomenology-based approach.

PubMed

Mackenzie, Michael J; Carlson, Linda E; Paskevich, David M; Ekkekakis, Panteleimon; Wurz, Amanda J; Wytsma, Kathryn; Krenz, Katie A; McAuley, Edward; Culos-Reed, S Nicole

2014-07-01

Yoga practice is reported to lead to improvements in quality of life, psychological functioning, and symptom indices in cancer survivors. Importantly, meditative states experienced within yoga practice are correlated to neurophysiological systems that moderate both focus of attention and affective valence. The current study used a mixed methods approach based in neurophenomenology to investigate associations between attention, affect, and cardiac activity during a single yoga session for female cancer survivors. Yoga practice was associated with a linear increase in associative attention and positive affective valence, while shifts in cardiac activity were related to the intensity of each yoga sequence. Changes in attention and affect were predicted by concurrently assessed cardiac activity. Awareness of breathing, physical movement, and increased relaxation were reported by participants as potential mechanisms for yoga's salutary effects. While yoga practice shares commonalities with exercise and relaxation training, yoga may serve primarily as a promising meditative attention-affect regulation training methodology. Copyright © 2014 Elsevier Inc. All rights reserved.

The Complexity of Multiple Contraceptive Method Use and the Anxiety That Informs It: Implications for Theory and Practice.

PubMed

Frohwirth, Lori; Blades, Nakeisha; Moore, Ann M; Wurtz, Heather

2016-11-01

Despite clinical guidelines and national data describing the use of one contraceptive method as the best and most common way to prevent unintended pregnancy, limited evidence indicates a more complex picture of actual contraceptive practice. Face-to-face in-depth interviews were conducted in November of 2013 with a sample of women from two cities in the United States (n = 52). The interviews explored the ways participants used contraception to protect themselves from unintended pregnancy over the past 12 months. Most respondents reported using multiple methods, many of which are considered to be less-effective, within this timeframe. The practice of combining methods in order to increase one's level of protection from pregnancy was prevalent, and was mainly enacted in two ways: by backing up inconsistent method use with other methods and by "buttressing" methods. These practices were found to be more common, and more complex, than previously described in the literature. These behaviors were mainly informed by a deep anxiety about both the efficacy of contraceptive methods, and about respondents' own perceived ability to prevent pregnancy. These findings challenge prevailing assumptions about women's contraceptive method use and have implications for clinical contraceptive counseling practice.

Clinical practice guideline on diagnosis and treatment of hyponatraemia.

PubMed

Spasovski, Goce; Vanholder, Raymond; Allolio, Bruno; Annane, Djillali; Ball, Steve; Bichet, Daniel; Decaux, Guy; Fenske, Wiebke; Hoorn, Ewout J; Ichai, Carole; Joannidis, Michael; Soupart, Alain; Zietse, Robert; Haller, Maria; van der Veer, Sabine; Van Biesen, Wim; Nagler, Evi

2014-04-01

Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.

Clinical practice guideline on diagnosis and treatment of hyponatraemia.

PubMed

Spasovski, Goce; Vanholder, Raymond; Allolio, Bruno; Annane, Djillali; Ball, Steve; Bichet, Daniel; Decaux, Guy; Fenske, Wiebke; Hoorn, Ewout J; Ichai, Carole; Joannidis, Michael; Soupart, Alain; Zietse, Robert; Haller, Maria; van der Veer, Sabine; Van Biesen, Wim; Nagler, Evi

2014-03-01

Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.

Dengue Knowledge and Preventive Practices in Iquitos, Peru.

PubMed

Paz-Soldán, Valerie A; Morrison, Amy C; Cordova Lopez, Jhonny J; Lenhart, Audrey; Scott, Thomas W; Elder, John P; Sihuincha, Moises; Kochel, Tadeusz J; Halsey, Eric S; Astete, Helvio; McCall, Philip J

2015-12-01

As part of a cluster-randomized trial to evaluate insecticide-treated curtains for dengue prevention in Iquitos, Peru, we surveyed 1,333 study participants to examine knowledge and reported practices associated with dengue and its prevention. Entomological data from 1,133 of these households were linked to the survey. Most participants knew that dengue was transmitted by mosquito bite (85.6%), but only few (18.6%) knew that dengue vectors bite during daytime. Most commonly recognized dengue symptoms were fever (86.6%), headache (76.4%), and muscle/joint pain (67.9%). Most commonly reported correct practices for mosquito control were cleaning homes (61.6%), using insecticide sprays (23%), and avoiding having standing water at home (12.3%). Higher education was associated with higher knowledge about dengue, including transmission and vector control. Higher socioeconomic status was associated with increased reported use of preventive practices requiring money expenditure. We were less likely to find Aedes aegypti eggs, larvae, or pupae in households that had < 5-year-old children at home. Although dengue has been transmitted in Iquitos since the 1990s and the Regional Health Authority routinely fumigates households, treats domestic water containers with larvicide, and issues health education messages through mass media, knowledge of dengue transmission and household practices for prevention could be improved. © The American Society of Tropical Medicine and Hygiene.

Dengue Knowledge and Preventive Practices in Iquitos, Peru

PubMed Central

Paz-Soldán, Valerie A.; Morrison, Amy C.; Cordova Lopez, Jhonny J.; Lenhart, Audrey; Scott, Thomas W.; Elder, John P.; Sihuincha, Moises; Kochel, Tadeusz J.; Halsey, Eric S.; Astete, Helvio; McCall, Philip J.

2015-01-01

As part of a cluster-randomized trial to evaluate insecticide-treated curtains for dengue prevention in Iquitos, Peru, we surveyed 1,333 study participants to examine knowledge and reported practices associated with dengue and its prevention. Entomological data from 1,133 of these households were linked to the survey. Most participants knew that dengue was transmitted by mosquito bite (85.6%), but only few (18.6%) knew that dengue vectors bite during daytime. Most commonly recognized dengue symptoms were fever (86.6%), headache (76.4%), and muscle/joint pain (67.9%). Most commonly reported correct practices for mosquito control were cleaning homes (61.6%), using insecticide sprays (23%), and avoiding having standing water at home (12.3%). Higher education was associated with higher knowledge about dengue, including transmission and vector control. Higher socioeconomic status was associated with increased reported use of preventive practices requiring money expenditure. We were less likely to find Aedes aegypti eggs, larvae, or pupae in households that had < 5-year-old children at home. Although dengue has been transmitted in Iquitos since the 1990s and the Regional Health Authority routinely fumigates households, treats domestic water containers with larvicide, and issues health education messages through mass media, knowledge of dengue transmission and household practices for prevention could be improved. PMID:26503276

Online research article discussion board to increase knowledge translation during emergency medicine residency.

PubMed

Stoneking, Lisa R; Grall, Kristi H; Min, Alice A; Panchal, Ashish R

2013-01-01

Many clinicians have difficulties reading current best practice journal articles on a regular basis. Discussion boards are one method of online asynchronous learning that facilitates active learning and participation. We hypothesized that an online repository of best practice articles with a discussion board would increase journal article reading by emergency medicine residents. PARTICIPANTS ANSWERED THREE QUESTIONS WEEKLY ON A DISCUSSION BOARD: What question does this study address? What does this study add to our knowledge? How might this change clinical practice? A survey regarding perceived barriers to participating was then distributed. Most participants completed an article summary once or twice in total (23/32, 71.9%). Only three were involved most weeks (3/32, 9.4%) whereas 5/32 (15.6%) participated monthly. The most common barriers were lack of time (20/32, 62.5%), difficulty logging on (7/32, 21.9%), and forgetting (6/32, 18.8%). Although subjects were provided weekly with an article link, email, and feedback, journal article reading frequency did not increase.

A longitudinal study of parental discipline of young children.

PubMed

Socolar, Rebecca R S; Savage, Eric; Evans, Hughes

2007-05-01

To determine how discipline practices changed over time for young children. A cohort of parents with young children were interviewed in clinic about a broad array of disciplinary practices at two points in time. A total of 182 parents were interviewed at Time 1, and 94 were interviewed at Time 1 and 2. Mean age of the child was 16.2 months at Time 1 and 35.8 months at Time 2. Monitoring, verbal communication, and distracting were the most common types of discipline when the children were one year old. Corporal punishment (P < 0.05), verbal communication (P < 0.001), timeout (< 0.0001), removing privileges (< 0.0001), negative demeanor (< 0.0001), and sternness (< 0.0001) increased significantly from Time 1 to Time 2. Distracting (< 0.001) decreased significantly and positive demeanor also decreased. Most discipline practices increased in frequency over the 20 months of this study. The increase in parental negative demeanor seems particularly important and worthy of further study.

Pharmacy students' preference for using mobile devices in a clinical setting for practice-related tasks.

PubMed

Richard, Craig A H; Hastings, Justine F; Bryant, Jennifer E

2015-03-25

To examine pharmacy students' ownership of, use of, and preference for using a mobile device in a practice setting. Eighty-one pharmacy students were recruited and completed a pretest that collected information about their demographics and mobile devices and also had them rank the iPhone, iPad mini, and iPad for preferred use in a pharmacy practice setting. Students used the 3 devices to perform pharmacy practice-related tasks and then completed a posttest to again rank the devices for preferred use in a pharmacy practice setting. The iPhone was the most commonly owned mobile device (59.3% of students), and the iPad mini was the least commonly owned (18.5%). About 70% of the students used their mobile devices at least once a week in a pharmacy practice setting. The iPhone was the most commonly used device in a practice setting (46.9% of students), and the iPod Touch was the least commonly used device (1.2%). The iPad mini was the most preferred device for use in a pharmacy practice setting prior to performing pharmacy practice-related tasks (49.4% of students), and was preferred by significantly more students after performing the tasks (70.4%). Pharmacy students commonly use their mobile devices in pharmacy practice settings and most selected the iPad mini as the preferred device for use in a practice setting even though it was the device owned by the fewest students.

Sci—Thur PM: Imaging — 06: Canada's National Computed Tomography (CT) Survey

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

Wardlaw, GM; Martel, N; Blackler, W

2014-08-15

The value of computed tomography (CT) in medical imaging is reflected in its' increased use and availability since the early 1990's; however, given CT's relatively larger exposures (vs. planar x-ray) greater care must be taken to ensure that CT procedures are optimised in terms of providing the smallest dose possible while maintaining sufficient diagnostic image quality. The development of CT Diagnostic Reference Levels (DRLs) supports this process. DRLs have been suggested/supported by international/national bodies since the early 1990's and widely adopted elsewhere, but not on a national basis in Canada. Essentially, CT DRLs provide guidance on what is considered goodmore » practice for common CT exams, but require a representative sample of CT examination data to make any recommendations. Canada's National CT Survey project, in collaboration with provincial/territorial authorities, has collected a large national sample of CT practice data for 7 common examinations (with associated clinical indications) of both adult and pediatric patients. Following completion of data entry into a common database, a survey summary report and recommendations will be made on CT DRLs from this data. It is hoped that these can then be used by local regions to promote CT practice optimisation and support any dose reduction initiatives.« less

Engineers' professional learning: a practice-theory perspective

NASA Astrophysics Data System (ADS)

Reich, Ann; Rooney, Donna; Gardner, Anne; Willey, Keith; Boud, David; Fitzgerald, Terry

2015-07-01

With the increasing challenges facing professional engineers working in more complex, global and interdisciplinary contexts, different approaches to understanding how engineers practice and learn are necessary. This paper draws on recent research in the social sciences from the field of workplace learning, to suggest that a practice-theory perspective on engineers' professional learning is fruitful. It shifts the focus from the attributes of the individual learner (knowledge, skills and attitudes) to the attributes of the practice (interactions, materiality, opportunities and challenges). Learning is thus more than the technical acquisition and transfer of knowledge, but a complex bundle of activities, that is, social, material, embodied and emerging. The paper is illustrated with examples from a research study of the learning of experienced engineers in the construction industry to demonstrate common practices - site walks and design review meetings - in which learning takes place.

Ethical obligation for restricting the number of embryos transferred to women: combating the multiple-birth epidemic from in vitro fertilization.

PubMed

Van Voorhis, Bradley J; Ryan, Ginny L

2010-07-01

In vitro fertilization (IVF) is an increasingly effective and popular means of achieving pregnancy for infertile women, but contributes to a growing incidence of risky twin pregnancies. Despite studies demonstrating cost-effective means to achieve IVF pregnancy while strictly limiting the number of embryos transferred, multiple-embryo transfer remains the most common practice in the United States, and twin pregnancies continue to increase. IVF providers resist restricting these practices, arguing that this is counter to principles of procreative liberty, patient and professional autonomy, and free-market economics. We counter that physicians have a professional fiduciary responsibility to weigh issues of nonmaleficence to patients and just use of health care resources with patient desires. With oversight from professional organizations, providers should follow strict but medically appropriate restrictions on embryo transfer practices and work toward safer means of optimizing IVF outcomes than multiple-embryo transfer. Thieme Medical Publishers.

[Sexuality of our seniors: happy end or new beginning?].

PubMed

Degauquier, C; Absil, A S; Meuris, S; Psalti, I; Jurysta, F

2012-01-01

Comparing surveys from successive periods demonstrates that elderly people now enjoy a better and more varied sexual life than previous generations. The proportion of older people who remain sexually active has significantly increased, and the practices of masturbation or oral sex have spread considerably. The generation effect has an incidence upon sexual behaviour: older people's repertoire of sexual practices differs from that of younger people, in the sense that it focuses less on sexual intercourse and oral sex. Women and men, beyond the common trends towards sexuality characterised by a more open repertoire of sexual practices, differ in terms of sexual interest and subjective sexual wellbeing. The cessation of sexual activity by individuals who had previously been sexually active is often the result of a cascade of reactions, such as the occurrence of a sexual dysfunction in one or both partners, anticipation of failure, increased anxiety, lack of adaptation of sexuality and/or avoidance behaviour.

Practice guideline for the performance of breast ultrasound elastography.

PubMed

Lee, Su Hyun; Chang, Jung Min; Cho, Nariya; Koo, Hye Ryoung; Yi, Ann; Kim, Seung Ja; Youk, Ji Hyun; Son, Eun Ju; Choi, Seon Hyeong; Kook, Shin Ho; Chung, Jin; Cha, Eun Suk; Park, Jeong Seon; Jung, Hae Kyoung; Ko, Kyung Hee; Choi, Hye Young; Ryu, Eun Bi; Moon, Woo Kyung

2014-01-01

Ultrasound (US) elastography is a valuable imaging technique for tissue characterization. Two main types of elastography, strain and shear-wave, are commonly used to image breast tissue. The use of elastography is expected to increase, particularly with the increased use of US for breast screening. Recently, the US elastographic features of breast masses have been incorporated into the 2nd edition of the Breast Imaging Reporting and Data System (BI-RADS) US lexicon as associated findings. This review suggests practical guidelines for breast US elastography in consensus with the Korean Breast Elastography Study Group, which was formed in August 2013 to perform a multicenter prospective study on the use of elastography for US breast screening. This article is focused on the role of elastography in combination with B-mode US for the evaluation of breast masses. Practical tips for adequate data acquisition and the interpretation of elastography results are also presented.

Women, Poverty, and Trauma: An Empowerment Practice Approach.

PubMed

East, Jean Francis; Roll, Susan J

2015-10-01

This article describes an empowerment approach for working with diverse women who experience poverty, trauma, and multiple structural oppressions. The approach is the result of 20 years of experience developing, implementing, and evaluating this practice in a metropolitan community, and is grounded in women's empowerment theory and relational-cultural theory. The interventions combine social work's clinical interventions with community organizing strategies to promote personal and collective empowerment, supporting the "personal is political" tenet of feminist practice. The interventions, including nonclinical interviews, story circles, and leadership and advocacy education and training, can guide practitioners in providing services and programs that create a space for women to make changes in their personal lives and in their community. Program outcomes report successful changes for women in improving symptoms, increasing self-efficacy, and engaging in community advocacy. Women who participated also reported an increased sense of power, balancing commonality and difference among women, and a sense of hope for their future.

Examining Exam Reviews: A Comparison of Exam Scores and Attitudes

ERIC Educational Resources Information Center

Hackathorn, Jana; Cornell, Kathryn; Garczynski, Amy M.; Solomon, Erin D.; Blankmeyer, Katheryn E.; Tennial, Rachel E.

2012-01-01

Instructors commonly use exam reviews to help students prepare for exams and to increase student success. The current study compared the effects of traditional, trivia, and practice test-based exam reviews on actual exam scores, as well as students' attitudes toward each review. Findings suggested that students' exam scores were significantly…

Lessons Learned and Global Partnerships: Stories of Sexual and Reproductive Health from Namibia

ERIC Educational Resources Information Center

Maurer, Lis; Kelly, Maureen

2005-01-01

Through a Global Partnership Project, Planned Parenthood of the Southern Finger Lakes in Ithaca, New York and the Namibian Planned Parenthood Association (NAPPA) in Windhoek, Namibia have joined together to share best practices, technical assistance, support, and resources. The Global Partners share the common goal of increasing awareness,…

Master's Education: A Guide for Faculty and Administrators. A Policy Statement.

ERIC Educational Resources Information Center

Borchert, Mary Ann E.

This publication addresses Master's in Education programs and some commonly accepted standards of good practice particularly in light of the degree's increasing importance as a primary credential for those seeking to improve and upgrade their professional skills. After a brief review of the history of Master's degrees, a section on the degree…

Noncredit Enrollment in Workforce Education: State Policies and Community College Practices

ERIC Educational Resources Information Center

Van Noy, Michelle; Jacobs, James; Korey, Suzanne; Bailey, Thomas; Hughes, Katherine L.

2008-01-01

Postsecondary noncredit education has become increasingly common; many community colleges now enroll more noncredit than credit students. Much of the growth has occurred in workforce instruction and contract training, programs are noted for their role in meeting shifting workforce demands and providing skills in a way that is flexible and…

Behavioral changes in neonatal swine after an 8-hour rest during prolonged transportation

USDA-ARS?s Scientific Manuscript database

Long distance transportation of weaned piglets is an increasingly common practice in the U.S. and may result in detrimental behavior in neonatal swine. A potential solution is a mid-journey rest. The objective of this study was to determine if a mid-journey rest (lairage) was beneficial for behavior...

Wildland road removal: research needs

Treesearch

T. Adam Switalski; John A. Bissonette; Tom H. Deluca; Charles H. Luce; Mary Ann Madej

2003-01-01

Wildland road removal is a common practice across the U.S. and in some parts of Canada. The main types of road removal include ripping, stream crossing restoration, and full recontour. Road removal creates a short-term disturbance that may temporarily increase sediment loss. However, research and long-term monitoring have shown that road removal both reduces erosion...

Improving fumigation efficiency by increasing drip-tape number and using low permeability film in raised-bed production systems

USDA-ARS?s Scientific Manuscript database

Drip fumigation is commonly used for controlling soilborne pests in raised-bed strawberry production systems in California. However, the high emission loss and poor pest control indicate that the current fumigation practice with two drip tapes and polyethylene film (PE) covering need to be improved....

Nursery culture impacts cold hardiness in longleaf pine (Pinus palustris) seedlings

Treesearch

Anthony S. Davis; Amy L. Ross-Davis; R. Kasten Dumroese

2011-01-01

Success in restoring longleaf pine ecosystems depends on outplanting high-quality longleaf pine seedlings. One important and relatively understudied attribute of seedling quality is cold hardiness. A suite of trials was conducted to investigate the influence of common nursery cultural practices on longleaf pine cold hardiness. Cold hardiness was increased with higher...

Creating Games as Authentic Learning in the Information Technology Classroom

ERIC Educational Resources Information Center

Frydenberg, Mark

2015-01-01

Teaching students to create computer games has become a common practice in both K-12 and tertiary education to introducing programming concepts, increasing student engagement, and recruiting majors and minors in technology fields. This study describes a project where first-year college students in an introductory technology concepts course use a…

Practices and Benefits of Reading in the Mathematics Curriculum

ERIC Educational Resources Information Center

Caputo, Matthew G.

2015-01-01

In the past several years, especially with the adoption of the Common Core State Standards, emphasis has been placed on connectivity among different academic subjects as well as between those subjects and the world. Simultaneously, there has been an increasing trend toward examination questions that are wordier and require more thinking and…

Mental Health Issues in Recently Returning Women Veterans: Implications for Practice

ERIC Educational Resources Information Center

Carlson, Bonnie E.; Stromwall, Layne K.; Lietz, Cynthia A.

2013-01-01

Increasing numbers of women are found in the military, and they are now performing roles very similar to those of male service members. More returning servicewomen and veterans have been exposed to stressful and traumatic experiences, such as combat and difficult living circumstances, and military sexual trauma is common. These experiences have…

From Design to Interpretation: Lessons from a Public Health Campaign Promoting Physical Activity

ERIC Educational Resources Information Center

Goodwin, Denise May; Peerbhoy, Denise; Murphy, Rebecca; Stratton, Gareth

2014-01-01

Objective: Rising inactivity has led to an increase in health promotion campaigns aimed at encouraging healthy behaviour change. While this has become common place, often practices advised by social marketing to maximise effectiveness are overlooked. This study investigates the development and effectiveness of one particular physical activity…

Application of a Socio-Ecological Model to Mother-Infant Bed-Sharing

ERIC Educational Resources Information Center

Salm Ward, Trina C.; Doering, Jennifer J.

2014-01-01

Mother-infant bed-sharing has been associated with an increased risk of sleep-related infant deaths, and thus, health messaging has aimed to discourage this behavior. Despite this messaging, bed-sharing remains a common practice in the United States, especially among minority families. Moreover, rates of accidental suffocation and strangulation in…

Leaning on Mathematical Habits of Mind

ERIC Educational Resources Information Center

Sword, Sarah; Matsuura, Ryota; Cuoco, Al; Kang, Jane; Gates, Miriam

2018-01-01

Mathematical modeling has taken on increasing curricular importance in the past decade due in no small measure to the Common Core State Standards in Mathematics (CCSSM) identifying modeling as one of the Standards for Mathematical Practice (SMP 4, CCSSI 2010, p. 7). Although researchers have worked on mathematical modeling (Lesh and Doerr 2003;…

The Use of Structure Coefficients to Address Multicollinearity in Sport and Exercise Science

ERIC Educational Resources Information Center

Yeatts, Paul E.; Barton, Mitch; Henson, Robin K.; Martin, Scott B.

2017-01-01

A common practice in general linear model (GLM) analyses is to interpret regression coefficients (e.g., standardized ß weights) as indicators of variable importance. However, focusing solely on standardized beta weights may provide limited or erroneous information. For example, ß weights become increasingly unreliable when predictor variables are…

Where Are We Now? Statistics on Capstone Courses Nationwide

ERIC Educational Resources Information Center

Howe, Susannah

2010-01-01

Capstone design courses are an increasingly common component of engineering curricula nationwide, but how much do we really know about the current practices? How do capstone courses differ across departments and institutions? How have capstone courses changed in the past 10 years? This paper highlights data from a survey of engineering capstone…

Sexting Behavior among College Students: Implications for College Clinicians

ERIC Educational Resources Information Center

Hertlein, Katherine M.; Twist, Markie L. C.

2017-01-01

The practice of sexting is becoming increasingly common among college students but has the potential to both initiate productive interactions with others and interfere with relationship development. The purpose of this paper is to report on the findings of a study on sexting among college students and to provide a framework through which…

Doctoral Supervisors' and Supervisees' Responses to Co-Supervision

ERIC Educational Resources Information Center

Olmos-López, Pamela; Sunderland, Jane

2017-01-01

With the increasing demand for doctoral education, co-supervision, understood as the formally agreed supervision of a research student by two or more academics in doctoral programmes, has become common practice in postgraduate circles in the UK. If supervision with one supervisor is complex due to personal, academic, ethical and sometimes…

Managing Smallness: Promising Fiscal Practices for Rural School District Administrators.

ERIC Educational Resources Information Center

Freitas, Deborah Inman

Based on a mail survey of over 100 rural school administrators in 34 states, this handbook outlines common problems and successful strategies in the financial management of rural, small school districts. Major problems are related to revenue and cash flow, increasing expenditures, providing quality education programs, and staffing to handle the…

Streamside Management Zones Affect Movement of Silvicultural Nitrogen and Phosphorus Fertilizers to Piedmont Streams

Treesearch

Joseph M. Secoges; Wallace M. Aust; John R. Seiler; C. Andrew Dolloff; William A. Lakel

2013-01-01

Forestry best management practices (BMP) recommendations for streamside management zones (SMZs) are based on limited data regarding SMZ width, partial harvests, and nutrient movements after forest fertilization. Agricultural fertilization is commonly linked to increased stream nutrients. However, less is known about effectiveness of SMZ options for controlling nutrient...

Surveillance Cameras in Schools: An Ethical Analysis

ERIC Educational Resources Information Center

Warnick, Bryan R.

2007-01-01

In this essay, Bryan R. Warnick responds to the increasing use of surveillance cameras in public schools by examining the ethical questions raised by their use. He explores the extent of a student's right to privacy in schools, stipulates how video surveillance is similar to and different from commonly accepted in-person surveillance practices,…

Overhead and operations: cutting where it counts.

PubMed

Shorr, Jay A

2014-01-01

To remain a profitable entity, whether a retail operation, manufacturing plant, or a medical practice, the common denominator is the same: where can you cut your costs, increase your revenue, and maintain additional profitability? Learning where to cut your operational expenses is as important to your business's profit-ability as bringing in additional dollars.

Adjusting slash pine growth and yield for silvicultural treatments

Treesearch

Stephen R. Logan; Barry D. Shiver

2006-01-01

With intensive silvicultural treatments such as fertilization and competition control now commonplace in today's slash pine (Pinus elliottii Engelm.) plantations, a method to adjust current growth and yield models is required to accurately account for yield increases due to these practices. Some commonly used ad-hoc methods, such as raising site...

Evidence-Based Practices to Reduce Challenging Behaviors of Young Children with Autism

ERIC Educational Resources Information Center

Rahn, Naomi L.; Coogle, Christan Grygas; Hanna, Alexajo; Lewellen, Traysha

2017-01-01

Challenging behaviors refer to those behaviors that decrease the child's ability to engage and participate in classroom routines (Dunlap, Wilson, Strain, & Lee, 2013), and therefore, the dilemma in the scenario above is common to early childhood and early childhood special education teachers due to an increase in children experiencing autism…

Completing a PhD by Publication: A Review of Australian Policy and Implications for Practice

ERIC Educational Resources Information Center

Jackson, Denise

2013-01-01

There is increasing impetus for higher-degree-by-research students to publish during candidature. Research performance, including higher degree completions and publication output, commonly determines university funding, and doctorates with publishing experience are better positioned for a career in softening academic labour markets. The PhD by…

The Benefits of Standards-Based Grading: A Critical Evaluation of Modern Grading Practices

ERIC Educational Resources Information Center

Iamarino, Danielle L.

2014-01-01

This paper explores the methodology and application of an assessment philosophy known as standards-based grading, via a critical comparison of standards-based grading to other assessment philosophies commonly employed at the elementary, secondary, and post-secondary levels of education. Evidenced by examples of increased student engagement and…

Fostering a New Model of Multigenerational Learning: Older Adult Perspectives, Community Partners, and Higher Education

ERIC Educational Resources Information Center

Dauenhauer, Jason; Steitz, David W.; Cochran, Lynda J.

2016-01-01

Intergenerational service-learning initiatives are an increasingly common educational practice designed to engage college students and older adults with one another. The growth of the baby boomer population and a growing interest in lifelong learning opportunities among older adults have the potential to create new models of multigenerational…

Physical education, obesity, and academic achievement: a 2-year longitudinal investigation of Australian elementary school children.

PubMed

Telford, Richard D; Cunningham, Ross B; Fitzgerald, Robert; Olive, Lisa S; Prosser, Laurence; Jiang, Xiaoli; Telford, Rohan M

2012-02-01

We determined whether physical education (PE) taught by specialists contributed to academic development and prevention of obesity in elementary school children. Our 2-year longitudinal study involved 620 boys and girls initially in grade 3 in Australia, all receiving 150 minutes per week of PE. One group (specialist-taught PE; n = 312) included 90 minutes per week of PE from visiting specialists; the other (common-practice PE; n = 308) received all PE from generalist classroom teachers. Measurements included percentage of body fat (measured by dual-emission x-ray absorptiometry) and writing, numeracy, and reading proficiency (by government tests). Compared with common-practice PE, specialist-taught PE was associated with a smaller increase in age-related percentage of body fat (P = .02). Specialist-taught PE was also associated with greater improvements in numeracy (P < .03) and writing (P = .13) scores. There was no evidence of a reading effect. The attenuated age-related increases in percentage of body fat and enhanced numeracy development among elementary school children receiving PE from specialists provides support for the role of PE in both preventive medicine and academic development.

Ethics and transparent risk communication start with proper risk assessment methodologies

NASA Astrophysics Data System (ADS)

Oboni, Franco; Oboni, Cesar

2014-05-01

We will use throught this paper a "dialogue" between two professionals. One is aware of the misleading character of many risk assessments and wants to foster better approaches. A discomforting set of statements sets the background of the "story": public reactions to risk assessments are generally negative, the developer find it difficult to understand the reasons for general public negative reactions, many projects get often rejected without valid reasons by the public, anywhere in the world. Common practice approaches in Risk Assessment are discussed from the angle of public rejection, taking into account various studies that explicitly expose common practices limitations and voids. The hiatus between rational and well-balanced risk assessments and common practices is explored. Finally solutions to overcome the limitations of common practices and deliver to the public more realistic risk assessment on which to build a widespread consensus are reviewed. The paper conclusions relate to the need of: properly communicating risk throughout the life of a project, from cradle to grave, avoiding conflict of interest, having estimates that are understandable to foster good understanding of what a risk assessment can bring to better Human existence, in an ethical and fair way. The paper delivers a list of possible remedies and shows that "Common Practices" do not equate to "Best Practices": common practices are not to be proposed/used any longer if we want to avoid public distrust and misrepresentations. Many of the "modern" issues ranging from public distrust to insurance denial could be relieved or mitigated ahead of time if misrepresentation was kept at bay using five simple rules. Common practice Risk Assessments, especially those developed under conflict of interest situations, generally misrepresent risks and fail to give the "big picture", hence do not help taking valid decision and are prone to generating/fostering public distrust.

A survey of castration methods and associated livestock management practices performed by bovine veterinarians in the United States

PubMed Central

2010-01-01

Background Castration of male calves destined for beef production is a common management practice performed in the United States amounting to approximately 15 million procedures per year. Societal concern about the moral and ethical treatment of animals is increasing. Therefore, production agriculture is faced with the challenge of formulating animal welfare policies relating to routine management practices such as castration. To enable the livestock industry to effectively respond to these challenges there is a need for more data on management practices that are commonly used in cattle production systems. The objective of this survey was to describe castration methods, adverse events and husbandry procedures performed by U.S. veterinarians at the time of castration. Invitations to participate in the survey were sent to email addresses of 1,669 members of the American Association of Bovine Practitioners and 303 members of the Academy of Veterinary Consultants. Results After partially completed surveys and missing data were omitted, 189 responses were included in the analysis. Surgical castration with a scalpel followed by testicular removal by twisting (calves <90 kg) or an emasculator (calves >90 kg) was the most common method of castration used. The potential risk of injury to the operator, size of the calf, handling facilities and experience with the technique were the most important considerations used to determine the method of castration used. Swelling, stiffness and increased lying time were the most prevalent adverse events observed following castration. One in five practitioners report using an analgesic or local anesthetic at the time of castration. Approximately 90% of respondents indicated that they vaccinate and dehorn calves at the time of castration. Over half the respondents use disinfectants, prophylactic antimicrobials and tetanus toxoid to reduce complications following castration. Conclusions The results of this survey describe current methods of castration and associated management practices employed by bovine veterinarians in the U.S. Such data are needed to guide future animal well-being research, the outcomes of which can be used to develop industry-relevant welfare guidelines. PMID:20199669

A survey of castration methods and associated livestock management practices performed by bovine veterinarians in the United States.

PubMed

Coetzee, Johann F; Nutsch, Abbey L; Barbur, Laura A; Bradburn, Ryan M

2010-03-03

Castration of male calves destined for beef production is a common management practice performed in the United States amounting to approximately 15 million procedures per year. Societal concern about the moral and ethical treatment of animals is increasing. Therefore, production agriculture is faced with the challenge of formulating animal welfare policies relating to routine management practices such as castration. To enable the livestock industry to effectively respond to these challenges there is a need for more data on management practices that are commonly used in cattle production systems. The objective of this survey was to describe castration methods, adverse events and husbandry procedures performed by U.S. veterinarians at the time of castration. Invitations to participate in the survey were sent to email addresses of 1,669 members of the American Association of Bovine Practitioners and 303 members of the Academy of Veterinary Consultants. After partially completed surveys and missing data were omitted, 189 responses were included in the analysis. Surgical castration with a scalpel followed by testicular removal by twisting (calves <90 kg) or an emasculator (calves >90 kg) was the most common method of castration used. The potential risk of injury to the operator, size of the calf, handling facilities and experience with the technique were the most important considerations used to determine the method of castration used. Swelling, stiffness and increased lying time were the most prevalent adverse events observed following castration. One in five practitioners report using an analgesic or local anesthetic at the time of castration. Approximately 90% of respondents indicated that they vaccinate and dehorn calves at the time of castration. Over half the respondents use disinfectants, prophylactic antimicrobials and tetanus toxoid to reduce complications following castration. The results of this survey describe current methods of castration and associated management practices employed by bovine veterinarians in the U.S. Such data are needed to guide future animal well-being research, the outcomes of which can be used to develop industry-relevant welfare guidelines.

Guidelines on nuclear medicine imaging in neuroblastoma.

PubMed

Bar-Sever, Zvi; Biassoni, Lorenzo; Shulkin, Barry; Kong, Grace; Hofman, Michael S; Lopci, Egesta; Manea, Irina; Koziorowski, Jacek; Castellani, Rita; Boubaker, Ariane; Lambert, Bieke; Pfluger, Thomas; Nadel, Helen; Sharp, Susan; Giammarile, Francesco

2018-06-25

Nuclear medicine has a central role in the diagnosis, staging, response assessment and long-term follow-up of neuroblastoma, the most common solid extracranial tumour in children. These EANM guidelines include updated information on 123 I-mIBG, the most common study in nuclear medicine for the evaluation of neuroblastoma, and on PET/CT imaging with 18 F-FDG, 18 F-DOPA and 68 Ga-DOTA peptides. These PET/CT studies are increasingly employed in clinical practice. Indications, advantages and limitations are presented along with recommendations on study protocols, interpretation of findings and reporting results.

Pharmacy Students’ Preference for Using Mobile Devices in a Clinical Setting for Practice-Related Tasks

PubMed Central

Hastings, Justine F.; Bryant, Jennifer E.

2015-01-01

Objective. To examine pharmacy students’ ownership of, use of, and preference for using a mobile device in a practice setting. Methods. Eighty-one pharmacy students were recruited and completed a pretest that collected information about their demographics and mobile devices and also had them rank the iPhone, iPad mini, and iPad for preferred use in a pharmacy practice setting. Students used the 3 devices to perform pharmacy practice-related tasks and then completed a posttest to again rank the devices for preferred use in a pharmacy practice setting. Results. The iPhone was the most commonly owned mobile device (59.3% of students), and the iPad mini was the least commonly owned (18.5%). About 70% of the students used their mobile devices at least once a week in a pharmacy practice setting. The iPhone was the most commonly used device in a practice setting (46.9% of students), and the iPod Touch was the least commonly used device (1.2%). The iPad mini was the most preferred device for use in a pharmacy practice setting prior to performing pharmacy practice-related tasks (49.4% of students), and was preferred by significantly more students after performing the tasks (70.4%). Conclusion. Pharmacy students commonly use their mobile devices in pharmacy practice settings and most selected the iPad mini as the preferred device for use in a practice setting even though it was the device owned by the fewest students. PMID:25861103

Factors Associated with Awareness, Attitudes and Practices Regarding Common Eye Diseases in the General Population in a Rural District in Bangladesh: The Bangladesh Population-based Diabetes and Eye Study (BPDES)

PubMed Central

Islam, Fakir M. Amirul; Chakrabarti, Rahul; Islam, Silvia Z.; Finger, Robert P.; Critchley, Christine

2015-01-01

Background To assess the awareness, attitudes, and practices associated with common eye diseases and eye care utilization in a rural district of Bangladesh. Methods Data were collected using a multilevel cluster random sampling technique from 3104 adults aged ≥30 years from the Banshgram union with a questionnaire assessing the awareness, attitudes and practice about diabetes and common eye diseases, educational attainment, socio-economic status, and medical history. Results Participants were aged between 30 and 89 years with a mean (SD) age of 51 (12) years and 65% were female. The majority of participants had heard of cataracts (90%), trachoma (86%) and Pterygium (84%), yet only 4% had heard of diabetic retinopathy (DR), 7% of glaucoma and 8% of Age-related macular degeneration (AMD). However, 58% of participants did not know vision loss could be prevented. Factors associated with lower awareness regarding common eye diseases were increasing age, lack of formal schooling, and lower socio-economic status. A lower proportion (57%) of people with no schooling compared to those who had attained at least secondary school certificate education (72%) reported that they knew that vision loss could be prevented (p<0.001). Overall 51% of people had heard of at least six (67%) out of nine items relating to awareness of common eye diseases. This included 41% of participants aged 65 years or older compared to 61% of those aged 30–35 years (p<0.001). Only 4% had an eye check at least once a year and higher education and better SES were associated with higher frequency of eye checks. Conclusions In rural Bangladesh awareness of cataract, trachoma and pterygium was good but limited in relation to the potentially blinding conditions of glaucoma, DR, and AMD. The results show a large gap between public awareness and treatment practices about common eye diseases. Public health promotion should be designed to address these knowledge gaps. PMID:26200458

Optimal medical outcomes with limited liability: risk management principles for medical practices at the intersection of medicine, law, and business.

PubMed

Paterick, Timothy J; Paterick, Timothy E; Waterhouse, Blake E

2007-01-01

Physicians practice at the intersection of medicine, law, and business. Each discipline creates its own challenges for the practicing physician: to practice efficient, effective medicine; to limit potential liability; and to create a positive financial outcome. Those challenges increase with escalating costs and reduced reimbursements. In this paper, the common clinical presentation of chest pain has been used to create a paradigm to educate physicians to understand efficient and effective approaches to diagnosis and treatment, and how effective communication with patients and meticulous documentation of all medical encounters can limit the potential for liability. Ultimately, given today's reimbursement formulas, physicians must also understand the cost of testing, in relation to its benefits, in an attempt to yield a positive financial outcome.

A New Perspective: The Common Factors Model as a Foundation for Social Work Practice Education

ERIC Educational Resources Information Center

Cameron, Mark; Keenan, Elizabeth King

2009-01-01

Foundation social work practice education is critical to the preparation of BSW practitioners for professional practice and the establishment of a theoretical and skill base upon which graduate students may build competencies in the advanced curriculum. Issues in the foundation practice curriculum may hinder this development. The common factors…

Certified Athletic Trainers' Knowledge of Methicillin-Resistant Staphylococcus aureus and Common Disinfectants

PubMed Central

Kahanov, Leamor; Gilmore, Elizabeth J.; Eberman, Lindsey E.; Roberts, Jeffrey; Semerjian, Tamar; Baldwin, Linda

2011-01-01

Context: Methicillin-resistant Staphylococcus aureus (MRSA) infections are increasingly common in athletic settings. The MRSA knowledge and infection-control practices of certified athletic trainers (ATs) and the cleanliness of the athletic training room are important factors in preventing MRSA infections. Objective: To assess knowledge of MRSA and the use of common disinfectants among ATs and to explore their infection-control practices. Design: Cross-sectional study. Setting: High school and collegiate athletic training rooms. Patients or Other Participants: A total of 163 ATs from National Collegiate Athletic Association Divisions I, II, and III and high schools, representing all 10 National Athletic Trainers' Association districts. Main Outcome Measure(s): Frequencies, analyses of variance, and χ2 tests were used to assess current practices and opinions and relationships between factors. Results: Methicillin-resistant Staphylococcus aureus was perceived as a national problem by 92% of respondents; 57% perceived MRSA as a problem in their practice setting. Most respondents had treated general infections (88%), staphylococcal infections (75%), and MRSA infections (57%). Male sex was associated with treating all 3 types of infections (χ2 test, P < .05). Noncurriculum education was associated with a lack of recognition of environmental issues as risk factors and with the use of isopropyl alcohol for disinfection (χ2 test, P < .05). For example, 10% of respondents did not recognize that contaminated whirlpools can be a source of MRSA infection. Respondents also incorrectly identified effective cleaning solutions. Thirty percent of respondents cleaned their hands frequently or sometimes before treating each athlete and 35% cleaned their hands sometimes, occasionally, or never after seeing each athlete. Conclusions: The majority of ATs were informed about MRSA and made correct disinfection choices. However, improvements are still needed, and not all ATs were using proper disinfection practices. PMID:21944074

Actual vs perceived performance debriefing in surgery: practice far from perfect.

PubMed

Ahmed, Maria; Sevdalis, Nick; Vincent, Charles; Arora, Sonal

2013-04-01

Performance feedback or debriefing in surgery is increasingly recognized as an essential means to optimize learning in the operating room (OR). However, there is a lack of evidence regarding the current practice and barriers to debriefing in the OR. Phase 1 consisted of semistructured interviews with surgical trainers and trainees to identify features of an effective debriefing and perceived barriers to debriefing. Phase 2 consisted of ethnographic observations of surgical cases to identify current practice and observed barriers to debriefing. Surgical trainers and trainees identified key features of effective debriefing with regard to the approach and content; however, these were not commonly identified in practice. Culture was recognized as a significant barrier to debriefing across both phases of the study. There is a disparity between what the surgical community views as effective debriefing and actual debriefing practices in the OR. Improvements to the current debriefing culture and practice within the field of surgery should be considered to facilitate learning from clinical practice. Copyright © 2013. Published by Elsevier Inc.

Multiple Differential-Amplifier MMICs Embedded in Waveguides

NASA Technical Reports Server (NTRS)

Kangaslahti, Pekka; Schlecht, Erich

2010-01-01

Compact amplifier assemblies of a type now being developed for operation at frequencies of hundreds of gigahertz comprise multiple amplifier units in parallel arrangements to increase power and/or cascade arrangements to increase gains. Each amplifier unit is a monolithic microwave integrated circuit (MMIC) implementation of a pair of amplifiers in differential (in contradistinction to single-ended) configuration. Heretofore, in cascading amplifiers to increase gain, it has been common practice to interconnect the amplifiers by use of wires and/or thin films on substrates. This practice has not yielded satisfactory results at frequencies greater than 200 Hz, in each case, for either or both of two reasons: Wire bonds introduce large discontinuities. Because the interconnections are typically tens of wavelengths long, any impedance mismatches give rise to ripples in the gain-vs.-frequency response, which degrade the performance of the cascade.

Opinions and practices of healthcare professionals on assessment of disease associated malnutrition in children: Results from an international survey.

PubMed

Huysentruyt, Koen; Hulst, Jessie; Bian, Feifei; Shamir, Raanan; White, Melinda; Galera-Martinez, Raphael; Morais-Lopez, Anna; Kansu, Aydan; Gerasimidis, Konstantinos

2018-04-05

Lack of consensus on clinical indicators for the assessment of pediatric disease associated malnutrition (DAM) may explain its under-recognition in clinical practice. This study surveyed the opinions of health professionals (HP) on clinical indicators of DAM and barriers impeding routine nutritional screening in children. Web-based questionnaire survey (April 2013-August 2015) in Australia, Belgium, Israel, Spain, The Netherlands, Turkey and UK. There were 937 questionnaires returned via local professional associations, of which 693 respondents fulfilled the inclusion criteria and were included in the final analysis; 315 pediatric gastroenterologists and 378 pediatric dieticians. The most important clinical indicators of DAM were ongoing weight loss (80.4%), increased energy/nutrient losses (73.0%), suboptimal energy/macronutrient intake (68.6%), a high nutritional risk condition (67.2%) and increased energy/nutrient requirements (66.2%). These findings were consistent across countries and professions. The most common approach to screen for DAM was assessment of weight changes (85%), followed by the usage of growth charts (77-80%). Common perceived barriers for routine nutritional screening/assessment were low staff awareness (47.5%), no local policy or guidelines (33.4%) and lack of time to screen (33.4%). HP who routinely assess and treat children with DAM identified ongoing weight loss, increased losses, increased requirements, low intake and high nutritional risk conditions as the most important clinical indicators of DAM. These clinical indicators should now serve as a basis to form clinical-based criteria for the identification of DAM in routine clinical practice. Low awareness, lack of guidelines or local policy and lack of resources were the most important barriers of routine screening. Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

The role of community-based and philanthropic organizations in meeting cancer patient and caregiver needs.

PubMed

Shelby, Rebecca A; Taylor, Kathryn L; Kerner, Jon F; Coleman, Ellen; Blum, Diane

2002-01-01

We examined information from community-based and philanthropic organizations to document the cancer-related services that are currently available, establish which services are still needed, and determine who utilizes these formal support networks. In Phase I, 32 of 41 eligible organizations participated in a survey conducted from December 1999 to March 2000. The most common mission focus among participating organizations was information/referral-centered. The most common services provided were referrals to information resources and provision of cancer-related information. Only two of the organizations in Phase I provided client demographic information and both indicated that client populations were predominantly white, female, and over age 40. Phase II of the study involved analyzing patient data from Cancer Care, Inc., a national service organizations for cancer patients. Between 1983 and 1997, there were 2,714 prostate cancer patients and 9,451 breast cancer patients included in the Cancer Care database. Their most commonly reported problems were related to personal adjustment to illness, financial, home care, and transportation needs. There were significant differences in problems reported depending upon age and disease status. In addition, the results of this study support the idea that those at highest risk for developing and dying of cancer are the least likely to utilize formal support networks. Further, a gap in service provision for assistance with practical needs (e.g., transportation, home care, child care, psychosocial support) was identified. Due to the increasing use of outpatient care for cancer patients, a greater demand for practical assistance can be expected in the future. The availability of practical services will need to be increased in order to effectively meet cancer patient needs.

An observational descriptive study of the epidemiology and treatment of neuropathic pain in a UK general population

PubMed Central

2013-01-01

Background This study updated our knowledge of UK primary care neuropathic pain incidence rates and prescribing practices. Methods Patients with a first diagnosis of post-herpetic neuralgia (PHN), painful diabetic neuropathy (PDN) or phantom limb pain (PLP) were identified from the General Practice Research Database (2006 – 2010) and incidence rates were calculated. Prescription records were searched for pain treatments from diagnosis of these conditions and the duration and daily dose estimated for first-line and subsequent treatment regimens. Recording of neuropathic back and post-operative pain was investigated. Results The study included 5,920 patients with PHN, 5,340 with PDN, and 185 with PLP. The incidence per 10,000 person-years was 3.4 (95% CI 3.4, 3.5) for PHN; and 0.11 (95% CI 0.09, 0.12) for PLP. Validation of the PDN case definition suggested that was not sensitive. Incident PHN increased over the study period. The most common first-line treatments were amitriptyline or gabapentin in the PDN and PLP cohorts, and amitriptyline or co-codamol (codeine-paracetamol) in PHN. Paracetamol, co-dydramol (paracetamol-dihydrocodeine) and capsaicin were also often prescribed in one or more condition. Most first-line treatments comprised only one therapeutic class. Use of antiepileptics licensed for neuropathic pain treatment had increased since 2002–2005. Amitriptyline was the only antidepressant prescribed commonly as a first-line treatment. Conclusion The UK incidence of diagnosed PHN has increased with the incidence of back-pain and post-operative pain unclear. While use of licenced antiepileptics increased, prescribing of therapy with little evidence of efficacy in neuropathic pain is still common and consequently treatment was often not in-line with current guidance. PMID:23442783

An observational descriptive study of the epidemiology and treatment of neuropathic pain in a UK general population.

PubMed

Hall, Gillian C; Morant, Steve V; Carroll, Dawn; Gabriel, Zahava L; McQuay, Henry J

2013-02-26

This study updated our knowledge of UK primary care neuropathic pain incidence rates and prescribing practices. Patients with a first diagnosis of post-herpetic neuralgia (PHN), painful diabetic neuropathy (PDN) or phantom limb pain (PLP) were identified from the General Practice Research Database (2006 - 2010) and incidence rates were calculated. Prescription records were searched for pain treatments from diagnosis of these conditions and the duration and daily dose estimated for first-line and subsequent treatment regimens. Recording of neuropathic back and post-operative pain was investigated. The study included 5,920 patients with PHN, 5,340 with PDN, and 185 with PLP. The incidence per 10,000 person-years was 3.4 (95% CI 3.4, 3.5) for PHN; and 0.11 (95% CI 0.09, 0.12) for PLP. Validation of the PDN case definition suggested that was not sensitive. Incident PHN increased over the study period. The most common first-line treatments were amitriptyline or gabapentin in the PDN and PLP cohorts, and amitriptyline or co-codamol (codeine-paracetamol) in PHN. Paracetamol, co-dydramol (paracetamol-dihydrocodeine) and capsaicin were also often prescribed in one or more condition. Most first-line treatments comprised only one therapeutic class. Use of antiepileptics licensed for neuropathic pain treatment had increased since 2002-2005. Amitriptyline was the only antidepressant prescribed commonly as a first-line treatment. The UK incidence of diagnosed PHN has increased with the incidence of back-pain and post-operative pain unclear. While use of licensed antiepileptics increased, prescribing of therapy with little evidence of efficacy in neuropathic pain is still common and consequently treatment was often not in-line with current guidance.

Landscape characteristics and livestock presence influence common ravens: Relevance to greater sage-grouse conservation

USGS Publications Warehouse

Coates, Peter S.; Brussee, Brianne E.; Howe, Kristy; Gustafson, K. Ben; Casazza, Michael L.; Delehanty, David J.

2016-01-01

Common raven (Corvus corax; hereafter, raven) population abundance in the sagebrush steppe of the American West has increased threefold during the previous four decades, largely as a result of unintended resource subsidies from human land-use practices. This is concerning because ravens frequently depredate nests of species of conservation concern, such as greater sage-grouse (Centrocercus urophasianus; hereafter, sage-grouse). Grazing by livestock in sagebrush ecosystems is common practice on most public lands, but associations between livestock and ravens are poorly understood. The primary objective of this study was to identify the effects of livestock on raven occurrence while accounting for landscape characteristics within human-altered sagebrush steppe habitat, particularly in areas occupied by breeding sage-grouse. Using data from southeastern Idaho collected during spring and summer across 3 yr, we modeled raven occurrence as a function of the presence of livestock while accounting for multiple landscape covariates, including land cover features, topographical features, and proximity to sage-grouse lek sites (breeding grounds), as well as site-level anthropogenic features. While accounting for landscape characteristics, we found that the odds of raven occurrence increased 45.8% in areas where livestock were present. In addition, ravens selected areas near sage-grouse leks, with the odds of occurrence decreasing 8.9% for every 1-km distance, increase away from the lek. We did not find an association between livestock use and distance to lek. We also found that ravens selected sites with relatively lower elevation containing increased amounts of cropland, wet meadow, and urbanization. Limiting raven access to key anthropogenic subsidies and spatially segregating livestock from sage-grouse breeding areas would likely reduce exposure of predatory ravens to sage-grouse nests and chicks.

A qualitative analysis of email interactions of children who use augmentative and alternative communication.

PubMed

Sundqvist, Anett; Rönnberg, Jerker

2010-12-01

The aim of this study was to introduce email as a form of interaction for a group of six children who used augmentative and alternative communication. In a 12-week exploratory study, aspects of the email messages sent were analyzed. The content of the messages was analyzed by an inductive qualitative method, and seven descriptive categories emerged. The most frequently occurring categories were Social Etiquette, Personal/Family Statistics and Personal Common Ground. The children utilized different email strategies that included use of most of the above-mentioned categories. Through the email writing practice, the children developed new social skills and increased their social participation. Email practice may be a good strategy to increase children's social networks.

Cognitive load in distributed and massed practice in virtual reality mastoidectomy simulation.

PubMed

Andersen, Steven Arild Wuyts; Mikkelsen, Peter Trier; Konge, Lars; Cayé-Thomasen, Per; Sørensen, Mads Sølvsten

2016-02-01

Cognitive load theory states that working memory is limited. This has implications for learning and suggests that reducing cognitive load (CL) could promote learning and skills acquisition. This study aims to explore the effect of repeated practice and simulator-integrated tutoring on CL in virtual reality (VR) mastoidectomy simulation. Prospective trial. Forty novice medical students performed 12 repeated virtual mastoidectomy procedures in the Visible Ear Simulator: 21 completed distributed practice with practice blocks spaced in time and 19 participants completed massed practice (all practices performed in 1 day). Participants were randomized for tutoring with the simulator-integrated tutor function. Cognitive load was estimated by measuring reaction time in a secondary task. Data were analyzed using linear mixed models for repeated measurements. The mean reaction time increased by 37% during the procedure compared with baseline, demonstrating that the procedure placed substantial cognitive demands. Repeated practice significantly lowered CL in the distributed practice group but not in massed practice group. In addition, CL was found to be further increased by 10.3% in the later and more complex stages of the procedure. The simulator-integrated tutor function did not have an impact on CL. Distributed practice decreased CL in repeated VR mastoidectomy training more consistently than was seen in massed practice. This suggests a possible effect of skills and memory consolidation occurring over time. To optimize technical skills learning, training should be organized as time-distributed practice rather than as a massed block of practice, which is common in skills-training courses. N/A. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Toward Scholarship in Practice

ERIC Educational Resources Information Center

Singer-Gabella, Marcy

2012-01-01

Background/Context: Over the past decade, scholars of teaching and teacher education have concluded that the field lacks a common conceptual vocabulary to undergird systematic investigation of practice. Absent a shared language, we can neither articulate common questions nor establish common tools--essential elements for building knowledge and…

The genetic basis of female reproductive disorders: Etiology and clinical testing ☆

PubMed Central

Layman, Lawrence C.

2013-01-01

With the advent of improved molecular biology techniques, the genetic basis of an increasing number of reproductive disorders has been elucidated. Mutations in at least 20 genes cause hypogonadotropic hypogonadism including Kallmann syndrome in about 35–40% of patients. The two most commonly involved genes are FGFR1 and CHD7. When combined pituitary hormone deficiency includes hypogonadotropic hypogonadism as a feature, PROP1 mutations are the most common of the six genes involved. For hypergonadotropic hypogonadism, mutations in 14 genes cause gonadal failure in 15% of affected females, most commonly in FMR1. In eugonadal disorders, activating FSHR mutations have been identified for spontaneous ovarian hyperstimulation syndrome; and WNT4 mutations have been described in mullerian aplasia. For other eugonadal disorders, such as endometriosis, polycystic ovary syndrome, and leiomyomata, specific germline gene mutations have not been identified, but some chromosomal regions are associated with the corresponding phenotype. Practical genetic testing is possible to perform in both hypogonadotropic and hypergonadotropic hypogonadism and spontaneous ovarian hyperstimulation syndrome. However, clinical testing for endometriosis, polycystic ovary syndrome, and leiomyomata is not currently practical for the clinician. PMID:23499866

Sport-Related Concussion: Optimizing Treatment Through Evidence-Informed Practice.

PubMed

Schneider, Kathryn J

2016-08-01

Concussion is one of the most common injuries in sport and recreation today. Reports of concussion have increased in recent years, likely due to increased societal awareness and the risk of longer-term sequelae. Presently, treatment includes a period of prescribed rest in the acute period following injury, followed by a protocol of graded exertion. Despite an initial period of rest and attempts at a gradual return to play, up to 30% of individuals may have ongoing symptoms past the acute period. The goal of this viewpoint is to introduce the reader to the most common symptoms of concussion and the need for a new, more active paradigm during treatment. J Orthop Sports Phys Ther 2016;46(8):613-616. doi:10.2519/jospt.2016.0607.

Chiropractors' perception of occupational stress and its influencing factors: a qualitative study using responses to open-ended questions.

PubMed

Williams, Shawn

2016-01-01

Job stress and emotional exhaustion have been shown to have a negative impact on the helping professional. The development and causal relations of job stress and emotional exhaustion are rather unclear in the chiropractic profession. The objective of this study is to understand the main sources of occupational stress and emotional exhaustion among doctors of chiropractic. Analysis of the written responses to web-based open-ended questionnaire was performed using an interpretive research methodology. Additionally, cross tabulation and Chi square statistical tests were conducted to match and couple the demographic data with the categorical themes. Fourteen professional stress categories emerged from the 970 completed surveys. "Managed Care Organization regulation", "Managed Care reimbursement" and "Scope of Practice Issues" were the most common stressors that negatively influenced chiropractors' professional and personal lives. The results of the categorical analysis suggests that age, marital status, number of years in practice and location of practice may have an influence on the category of stress reported by chiropractors. The qualitative approach revealed common, conventional and culture-specific job stressors in doctors of chiropractic. Notably, these findings suggest an association between third-party payer influences (increased regulation/decreased reimbursement) with that of increased job stress. Further research will be undertaken to refine the stress and satisfaction parameters and address stress interventions.

Injuries among talented young dancers: findings from the U.K. Centres for Advanced Training.

PubMed

Steinberg, N; Aujla, I; Zeev, A; Redding, E

2014-03-01

The aim of the present study was to characterize the injuries of young dancers attending Centres for Advanced Training. 806 dancers, ages 10-18 years responded to surveys regarding their biological profile, dance experience and injury history, and were examined for their anthropometric profile. Of the 806 dancers, 347 reported an injury. Based on 4 age groups, the total hours of practice per week increased significantly with increasing age. Incidence of injuries per 1000 h of dance practice for dancers ages 11-12 were found to be significantly higher compared to the incidence for dancers ages 13-18 (p<0.05). Foot and ankle and other lower extremities were the most common injury location, and muscle injuries were the most common type of injury. Total months in CAT training (OR=1.044, 95% CI=1.014-1.075) and hours per week in creative style practice (OR=1.282, 95% CI=1.068-1.539) were found to be significantly associated with injuries. In conclusion, both young and mature dancers are exposed to extensive risk of injury. The intensity of training (such as number of months and number of hours of training per week) is important factor that should be taken into account in order to decrease future injuries among young dancers. © Georg Thieme Verlag KG Stuttgart · New York.

What do consistently high-performing in vitro fertilization programs in the U.S. do?

PubMed

Van Voorhis, Bradley J; Thomas, Mika; Surrey, Eric S; Sparks, Amy

2010-09-01

To identify common clinical and laboratory practices among consistently high-performing IVF programs. Questionnaire study of selected IVF programs. Academic and private practice IVF programs. Ten of 12 programs identified as having consistently high singleton delivery rates per cycle. None. Common clinical practices. Common clinical practices identified among these programs included testing all patients for ovarian reserve, endometrial defects, and hydrosalpinges; use of a mixed LH and FSH stimulation protocol with step-down dosing; and use of ultrasound guidance for ET. Common laboratory practices included selective use of intracytoplasmic sperm injection, group culture of embryos in microdrops, and use of blastocyst ET in selected cases. Common laboratory features included good air quality using filtration and heated stages for oocyte and embryo work. Although a number of factors were identified in this best-practices questionnaire, programs often differed in many aspects of care. However, high-performing programs cited experience of physicians, embryologists, and staff members as well as consistency of approach, attention to detail, and good communication as being vital to excellent outcomes. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Infection control in hemodialysis units: a quick access to essential elements.

PubMed

Karkar, Ayman; Bouhaha, Betty Mandin; Dammang, Mienalyn Lim

2014-05-01

Infection is the most common cause of hospitalization and the second most common cause of mortality among hemodialysis (HD) patients, after cardiovascular disease. HD patients as well as the dialysis staff are vulnerable to contracting health-care-associated infections (HAIs) due to frequent and prolonged exposure to many possible contaminants in the dialysis environment. The extracorporeal nature of the therapy, the associated common environmental conditions and the immune compromised status of HD patients are major predisposing factors. The evident increased potential for transmission of infections in the HD settings led to the creation and implementation of specific and stricter infection prevention and control measures in addition to the usual standard precautions. Different international organizations have generated guidelines and recommendations on infection prevention and control for implementation in the HD settings. These include the Centers for Disease Control and Prevention (CDC), the Association of Professionals in Infection Control (APIC), the Kidney Disease Outcomes Quality Initiative (K/DOQI), the European Best Practice Guidelines/European Renal Best Practice (EBPG/ERBP) and the Kidney Disease: Improving Global Outcomes (KDIGO). However, these guidelines are extensive and sometimes vary among different guideline-producing bodies. Our aim in this review is to facilitate the access, increase the awareness and encourage implementation among dialysis providers by reviewing, extracting and comparing the essential elements of guidelines and recommendations on infection prevention and control in HD units.

Knowledge management and informatics considerations for comparative effectiveness research: a case-driven exploration.

PubMed

Embi, Peter J; Hebert, Courtney; Gordillo, Gayle; Kelleher, Kelly; Payne, Philip R O

2013-08-01

As clinical data are increasingly collected and stored electronically, their potential use for comparative effectiveness research (CER) grows. Despite this promise, challenges face those wishing to leverage such data. In this paper we aim to enumerate some of the knowledge management and informatics issues common to such data reuse. After reviewing the current state of knowledge regarding biomedical informatics challenges and best practices related to CER, we then present 2 research projects at our institution. We analyze these and highlight several common themes and challenges related to the conduct of CER studies. Finally, we represent these emergent themes. The informatics challenges commonly encountered by those conducting CER studies include issues related to data information and knowledge management (eg, data reuse, data preparation) as well as those related to people and organizational issues (eg, sociotechnical factors and organizational factors). Examples of these are described in further detail and a formal framework for describing these findings is presented. Significant challenges face researchers attempting to use often diverse and heterogeneous datasets for CER. These challenges must be understood in order to be dealt with successfully and can often be overcome with the appropriate use of informatics best practices. Many research and policy questions remain to be answered in order to realize the full potential of the increasingly electronic clinical data available for such research.

Smartphone use in dermatology for clinical photography and consultation: Current practice and the law.

PubMed

Abbott, Lisa M; Magnusson, Roger S; Gibbs, Emma; Smith, Saxon D

2018-05-01

Smartphones are rapidly changing the way doctors capture and communicate clinical information, particularly in highly visual specialties such as dermatology. An understanding of how and why smartphones are currently used in clinical practice is critical in order to evaluate professional and legal risks, and to formulate policies that enable safe use of mobile technologies for the maximal benefit of practitioners and patients. Australian dermatologists and dermatology trainees were surveyed on their current practices relating to clinical smartphone use. Of the 105 respondents, 101 provided useable results. The data show clinical smartphone use is common and frequent, with more than 50% of respondents sending and receiving images on their smartphones at least weekly. Clinical photographs were usually sent via multimedia message or email and were commonly stored on smartphones (46%). Security measures adopted to protect data were limited. There was inadequate documentation of consent for transmission of photographs and advice provided. Only 22% of respondents were aware of clear policies in their workplace regarding smartphone use, and a majority desired further education on digital image management. Given the frequency of use and the degree of importance placed on the ability to send and receive clinical images, clinical smartphone use will persist and will likely increase over time. Current practices are insufficient to comply with professional and legal obligations, and increase practitioners' vulnerability to civil and disciplinary proceedings. Further education, realistic policies and adequate software resources are critical to ensure protection of patients, practitioners and the reputation of the dermatological profession. © 2017 The Australasian College of Dermatologists.

A Survey of Knowledge, Attitude, and Practice of Consumers at a Tertiary Care Hospital Regarding the Disposal of Unused Medicines.

PubMed

Sonowal, Supriya; Desai, Chetna; Kapadia, Jigar D; Desai, Mira K

2016-12-01

To evaluate the knowledge, attitude and practice of consumers in India about disposal of unused medicines. A questionnaire comprising 11 questions evaluating the Knowledge (2), Attitude (3) and Practice (6) of unused medicines was prepared and pre validated before administering to 200 consumers of medicines attending the outpatient department of Civil Hospital Ahmedabad, a tertiary care teaching hospital in Western India. Requisite permissions from Institutional Ethics Committee and informed consent were obtained prior to recruiting them for the study. Responses were recorded, in Microsoft Excel ® spreadsheet and evaluated for percentage response. Majority of the respondents (136, 68%) stored unused medicines at home. Analgesics (26.5%) were the most common unused medicine stored. Safe disposal of medicine was considered necessary by majority respondents (160, 80%) for different reasons like prevention of illegal/unintended use (84, 42%), prevention of environmental pollution (32, 16%) or possible ADR caused by old drugs (54, 27%). Only 78 (39%) respondents were aware of appropriate methods of disposal. Disposal in household trash (61, 30.5%) was the most common method used. Majority of respondents felt the need for a facility or programme to collect unused medicines (152, 76%) and an increased awareness among consumers regarding hazards and methods of disposal of unused medicines (154, 77%). Majority of consumers are aware about the need for safe disposal of unused medicines. But the right attitude for and practice of safe disposal of medicines is lacking. A need for increased awareness regarding safe disposal of medicines is acknowledged by majority of consumers.

What are the necessary practice competencies for two providers: dermal fillers and botulinum toxin type A injections?

PubMed

Spear, Marcia

2010-01-01

There has been a steady increase in the number of individuals who undergo dermal fillers and botulinum toxin Type A injections. The majority of these procedures are performed by nurse providers. The purpose of this study was to collect national data on the current practice among nursing providers within the American Society of Plastic Surgical Nurses (ASPSN). The goal was to utilize the national data and develop a document of the necessary competencies to guide the practice of providers of dermal fillers and botulinum toxin Type A injections. A survey tool was developed and validated for content by expert nursing providers among the membership of the ASPSN and disseminated via e-mail to the membership of the ASPSN. In addition, data from investigator training, mentoring, and evidence from a review of the literature were also incorporated into the competency document utilizing the Competency Outcomes and Performance Assessment (COPA) model. Common core issues became apparent that included contraindications for the use of botulinum toxin Type A and dermal fillers, postprocedure complications as well as strategies in terms of managing complications. The data also revealed that there is no common method providers are taught to assess the aesthetic patient and a lack of a collaborative relationship in current practice. Overwhelmingly, the respondents supported the need for defined practice competencies. A competency document to guide the practice of providers of dermal fillers and botulinum toxin Type A has been developed for completion of this DNP project.

Comprehensive Shoulder US Examination: A Standardized Approach with Multimodality Correlation for Common Shoulder Disease

PubMed Central

Sheehan, Scott E.; Orwin, John F.; Lee, Kenneth S.

2016-01-01

Shoulder pain is one of the most common musculoskeletal conditions encountered in primary care and specialty orthopedic clinic settings. Although magnetic resonance (MR) imaging is typically the modality of choice for evaluating the soft-tissue structures of the shoulder, ultrasonography (US) is becoming an important complementary imaging tool in the evaluation of superficial soft-tissue structures such as the rotator cuff, subacromial-subdeltoid bursa, and biceps tendon. The advantages of US driving its recent increased use include low cost, accessibility, and capability for real-time high-resolution imaging that enables dynamic assessment and needle guidance. As more radiologists are considering incorporating shoulder US into their practices, the development of a standardized approach to performing shoulder US should be a priority to facilitate the delivery of high-quality patient care. Familiarity with and comfort in performing a standardized shoulder US examination, as well as knowledge of the types of anomalies that can be evaluated well with US, will enhance the expertise of those working in musculoskeletal radiology practices and add value in the form of increased patient and health care provider satisfaction. This review describes the utility and benefits of shoulder US as a tool that complements MR imaging in the assessment of shoulder pain. A standardized approach to the shoulder US examination is also described, with a review of the basic technique of this examination, normal anatomy of the shoulder, common indications for shoulder US, and characteristic US findings of common shoulder diseases—with select MR imaging and arthroscopic correlation. Online supplemental material is available for this article. ©RSNA, 2016 PMID:27726738

Dental health of children with cerebral palsy

PubMed Central

Jan, Basil M.; Jan, Mohammed M.

2016-01-01

Cerebral palsy (CP) is a common chronic motor disorder with associated cognitive, communicative, and seizure disorders. Children with CP have a higher risk of dental problems creating significant morbidity that can further affect their wellbeing and negatively impact their quality of life. Screening for dental disease should be part of the initial assessment of any child with CP. The objective of this article is to present an updated overview of dental health issues in children with CP and outline important preventative and practical strategies to the management of this common comorbidity. Providing adequate oral care requires adaptation of special dental skills to help families manage the ongoing health issues that may arise. As oral health is increasingly recognized as a foundation for general wellbeing, caregivers for CP patients should be considered an important component of the oral health team and must become knowledgeable and competent in home oral health practices. PMID:27744459

On the Asclepian spirit and the future of psychoanalysis.

PubMed

Whitehead, Clay C

2002-01-01

The dynamics of the Asclepian myth are analyzed, and generic dynamics of the healing imperative are illustrated. The story teaches much about the early theories and practice of ancient medicine, and originated the healing symbol of the staff and serpent which appears on the emblem of the American Academy. The multi-modal therapeutic approach used at the Asclepia was often climaxed by dream incubation as a centerpiece of the treatment. Dreams from modern physicians in analysis will be introduced to show that while our practice has changed in external trappings, the underlying dynamics of ancient and modern healers reflect a common humanity. Modern therapists have reacquired the use of dreams and invented a new set of explanatory myths. Consideration of future developments leads to linking the "psychosomatic model" of antiquity with the psychopharmacological interventions which are now common-place in psychodynamic psychotherapy. The Asclepian emphasis on spirituality is also finding increasing recognition among psychoanalysts and other scientists.

Measuring and Understanding Authentic Youth Engagement: The Youth-Adult Partnership Rubric

ERIC Educational Resources Information Center

Wu, Heng-Chieh Jamie; Kornbluh, Mariah; Weiss, John; Roddy, Lori

2016-01-01

Commonly described as youth-led or youth-driven, the youth-adult partnership (Y-AP) model has gained increasing popularity in out-of-school time (OST) programs in the past two decades (Larson, Walker, & Pearce, 2005; Zeldin, Christens, & Powers, 2013). The Y-AP model is defined as "the practice of (a) multiple youth and multiple…

Committees and Controversy: Consultants in the Construction of Education Policy

ERIC Educational Resources Information Center

Gabriel, Rachael; Paulus, Trena

2015-01-01

The increasingly common practice of engaging consulting firms to assist states with educational policy agendas requires an analysis of the role these consultants play in what is positioned as a democratic decision-making process. In this study, we examine the discourse of a state-level advisory committee formed to develop a new teacher evaluation…

An Ultra-Sensitive Method for the Analysis of Perfluorinated Alkyl Acids in Drinking Water using a Column Switching High-Performance Liquid Chromatography Tandem Mass Spectrometry

EPA Science Inventory

In epidemiological research, it has become increasingly important to assess subjects' exposure to different classes of chemicals in multiple environmental media. It is a common practice to aliquot limited volumes of samples into smaller quantities for specific trace level chemi...

Structures and Technology Encouraging Discussion in Human Sexuality Courses: Strategies to Engage a Range of Students

ERIC Educational Resources Information Center

Angera, Jeffrey J.; Latty, Christopher R.

2015-01-01

Human sexuality courses are common across many college/university campuses. The methods of instruction typically encourage discussion to increase knowledge and critical thinking about self, relationships, and professional pathways. However, often the pedagogical practices do not include methods to draw out students with a range of personalities,…

Swine manure application effects on ammonia volatilization, forage quality, and yield in the Pre-Amazon Region of Brazil

USDA-ARS?s Scientific Manuscript database

The use of swine manure as a nutrient source for pastures is increasingly common in Brazil, due to its low cost. However, this practice can cause nitrogen (N) losses in agricultural soil, where ammonia volatilization may be the main drawback, generating undesirable economic and environmental consequ...

Reflections on the Use of Iterative, Agile and Collaborative Approaches for Blended Flipped Learning Development

ERIC Educational Resources Information Center

Owen, Hazel; Dunham, Nicola

2015-01-01

E-learning experiences are widely becoming common practice in many schools, tertiary institutions and other organisations. However despite this increased use of technology to enhance learning and the associated investment involved the result does not always equate to more engaged, knowledgeable and skilled learners. We have observed two key…

The Frustrated Career: Casual Employment in Higher Education

ERIC Educational Resources Information Center

Gottschalk, Lorene; McEachern, Steve

2010-01-01

The use of casual staff, including casual teaching staff, is a common practice in Australian universities and the numbers of casual staff in the sector has increased significantly in the last decade. The traditional profile for casual teachers was that of industry expert and students. Recent research has shown that the casual teacher is now more…

Who Exactly Is the Moderator? A Consideration of Online Knowledge Management Network Moderation in Educational Organisations

ERIC Educational Resources Information Center

Gairin-Sallan, Joaquin; Rodriguez-Gomez, David; Armengol-Asparo, Carme

2010-01-01

In the knowledge society, the appearance and development of new networked working and learning environments is increasingly common. In the "Accelera" project, which is the basis for this paper, we have developed an online community of practice which enables experiences and knowledge to be shared between various educational agents, and…

Effects of Midrotation Intensive Silviculture on Forest Soils in East Texas: First-Year Results

Treesearch

S.A. Wilson; K.W. Farrish; B.P. Oswald; H.M. Williams; J.L. Yeiser

2002-01-01

Intensive forest management is becoming increasingly common in east Texas.Included in intensive management are such practices as mid-rotation fertilization, prescribed fire, and herbicide application. There is insufficient information about the effects of these treatments on soil physical, chemical, and biological properties when applied at mid-rotation. The objectives...

Ultra-high surface speed for metal removal, artillery shell

NASA Astrophysics Data System (ADS)

Pugh, R. F.; Walsh, M. R.; Pohl, R. F.

1981-07-01

Four types of steel (AISI 1340, 4140, 4340, and HF-1) which are commonly used in large caliber projectile manufacture were machined with five types of tools at different hardness ranges representing the as-forged and the heat-treated condition. Results show that machining speeds can be increased significantly over current practice using the present available tooling.

Towards a Dynamic Conceptual Framework for English-Medium Education in Multilingual University Settings

ERIC Educational Resources Information Center

Dafouz, Emma; Smit, Ute

2016-01-01

At a time of increasing internationalization in tertiary education, English-Medium Education in Multilingual University Settings (EMEMUS) has become a common practice. While there is already ample research describing this phenomenon at a local level (Smit and Dafouz 2012a), the theoretical side needs to be elaborated. This article thus aims to…

The LSU Law Center -- Canada Bijuralism Conference. Introduction: Global Law and the Law School Curriculum.

ERIC Educational Resources Information Center

Costonis, John J.

2002-01-01

Introduces papers from a conference focused on the bijural programs of Louisiana State University Law Center and McGill University Faculty of Law. The programs educate all first-degree law students in both the common law and civil law traditions, preparing them for the increasing globalization of legal practice. (EV)

Allometric equations for urban ash trees (Fraxinus spp.) in Oakville, Southern Ontario, Canada

Treesearch

Paula J. Peper; Claudia P. Alzate; John W. McNeil; Jalil Hashemi

2014-01-01

Tree growth equations are an important and common tool used to effectively assess the yield and determine management practices in forest plantations. Increasingly, they are being developed for urban forests, providing tools to assist urban forest managers with species selection, placement, and estimation of management costs and ecosystem services. This study describes...

Evaluation of the Effects of Sensory Integration-Based Intervention by a Preschool Special Education Teacher

ERIC Educational Resources Information Center

Bonggat, Penelope Wong; Hall, Laura J.

2010-01-01

This study addresses the call for increased research on common public school practices and progress monitoring by public school teachers. An alternating treatment design was implemented by a preschool teacher to evaluate the effect of sensory-integration based activities compared with an attention control on the on task behavior of three…

Integrating Graphic Nonfiction into Classroom Reading and Content Area Instruction: A Critical Literacy Focus on Selection Issues

ERIC Educational Resources Information Center

Möller, Karla J.

2015-01-01

An understanding of the importance of nonfiction literature in classroom instruction is not new within the field of education. The recent implementation of the Common Core State Standards (National Governors Association Center for Best Practices & Council of Chief State School Officers, 2010) has brought an increased policy focus. The Common…

Beyond Racism: Some Opinions about Racialism and American Archaeology

ERIC Educational Resources Information Center

Echo-Hawk, Roger; Zimmerman, Larry J.

2006-01-01

The scrutiny of racism as a cultural practice is well established in scholarship and in American public discourse. The underlying problem of race itself is also a common topic in academic writings and is a matter of ever-increasing consensus in anthropology and biology. But the significance of race as an inherently flawed interpretation of human…

A Study of the Pedagogy of Selected Non-Western Musical Traditions in Collegiate World Music Ensembles

ERIC Educational Resources Information Center

Morford, James B.

2007-01-01

Music teachers are often influenced by pedagogical practices in the collegiate ensembles in which they performed. Opportunities to participate in collegiate world music ensembles have increased in recent decades; West African ensembles and steel bands represent the second and third most common of these in the United States. The absence of…

Early forest thinning changes aboveground carbon distribution among pools, but not total amount

Treesearch

Michael S. Schaedel; Andrew J. Larson; David L. R. Affleck; Travis Belote; John M. Goodburn; Deborah S. Page-Dumroese

2017-01-01

Mounting concerns about global climate change have increased interest in the potential to use common forest management practices, such as forest density management with thinning, in climate change mitigation and adaptation efforts. Long-term effects of forest density management on total aboveground C are not well understood, especially for precommercial thinning (PCT)...

Expressing Disagreement in ELF Business Negotiations: Theory and Practice

ERIC Educational Resources Information Center

Bjorge, Anne Kari

2012-01-01

English spoken by those who do not share their first language is increasingly referred to as English lingua franca (ELF). For ELF speakers, it can be a challenge to express conflicting opinions, as a common language and/or cultural background cannot be taken for granted. This is recognized by writers of business English textbooks, who provide…

Increasing Access to Learning for the Adult Basic Education Learner with Learning Disabilities: Evidence-Based Accommodation Research

ERIC Educational Resources Information Center

Gregg, Noel

2012-01-01

Accommodating adult basic education (ABE) learners with learning disabilities (LD) is common practice across many instructional, testing, and work settings. However, the results from this literature search indicate that very few empirically based studies are available to support or reject the effectiveness of a great deal of accommodation…

PCR cycles above routine numbers do not compromise high-throughput DNA barcoding results.

PubMed

Vierna, J; Doña, J; Vizcaíno, A; Serrano, D; Jovani, R

2017-10-01

High-throughput DNA barcoding has become essential in ecology and evolution, but some technical questions still remain. Increasing the number of PCR cycles above the routine 20-30 cycles is a common practice when working with old-type specimens, which provide little amounts of DNA, or when facing annealing issues with the primers. However, increasing the number of cycles can raise the number of artificial mutations due to polymerase errors. In this work, we sequenced 20 COI libraries in the Illumina MiSeq platform. Libraries were prepared with 40, 45, 50, 55, and 60 PCR cycles from four individuals belonging to four species of four genera of cephalopods. We found no relationship between the number of PCR cycles and the number of mutations despite using a nonproofreading polymerase. Moreover, even when using a high number of PCR cycles, the resulting number of mutations was low enough not to be an issue in the context of high-throughput DNA barcoding (but may still remain an issue in DNA metabarcoding due to chimera formation). We conclude that the common practice of increasing the number of PCR cycles should not negatively impact the outcome of a high-throughput DNA barcoding study in terms of the occurrence of point mutations.

Community perceptions of state forest ownership and management: a case study of the Sundarbans Mangrove Forest in Bangladesh.

PubMed

Roy, Anjan Kumer Dev; Alam, Khorshed; Gow, Jeff

2013-03-15

The Sundarbans Mangrove Forest (SMF) is the world's largest mangrove forest and it provides livelihoods to 3.5 million forest-dependent people in coastal Bangladesh. The first study aim was to analyse the efficacy of the state property regime in managing the forest through a close examination of the relationship between property rights and mangrove conservation practices. The second study aim was to explore forest-dependent communities' (FDCs) perceptions about their participation in management and conservation practices. The Schlager and Ostrom theoretical framework was adopted to examine the role of potential ownership variations in a common property resource regime. A survey of 412 FDC households was undertaken. Current management by the Bangladesh Forest Department (BFD) does not result in implementation of mandated mangrove conservation practices. It was found that allocation of property rights to FDCs would be expected to increase conservation practices. 92% of respondents expressed the view that the evidenced rapid degradation over the past 30 years was due primarily to corruption in the BFD. About half of FDCs (46%) surveyed are willing to participate in mangrove conservation through involvement in management as proprietors. Consistent with Schlager and Ostrom's theory, the results indicate the necessity for de facto and de jure ownership and management change from a state to common property regime to ensure FDCs' participation in conservation practices. Copyright © 2012 Elsevier Ltd. All rights reserved.

Review: the legal duty of care for nurses and other health professionals.

PubMed

Young, Andy

2009-11-01

To explore the nature and extent of the legal duty of care in relation to contemporary healthcare practice. The paper seeks to re-frame and update the legal duty of care for clinical nursing practice in the 21st century, taking into account collaborative and partnership working in healthcare practice. Doctrinal legal 'approach'. 'Black letter' legal research methodology used for data collection and analysis. Literature search using Westlaw and LexisNexis database(s) to identify recent common law decisions. There has been a perceptible doctrinal shift away from paternalism and toward patient empowerment and autonomy in the last decade. This has implications for nurses and other healthcare professionals in terms of consenting patients and acting reasonably to ensure quality patient care. A number of experienced nurses are currently assuming extended roles and some are completing medical tasks, traditionally allocated to doctors. These specialist practitioners must remember that additional responsibility invariably means increased professional risk and accountability. Therefore, it is essential that those engaging in advanced nursing practice, fully understand the nature and reach of their professional duty of care and the significance of statutory and common law developments. Nurses and other healthcare professionals must update their clinical skills and practice within a legal framework and to certain standards. The cases cited and discussed are relevant to all branches of nursing and indeed to all health professions.

How is Primary Health Care conceptualised in nursing in Australia? A review of the literature.

PubMed

Henderson, Julie; Koehne, Kristy; Verrall, Claire; Gebbie, Kristine; Fuller, Jeffrey

2014-07-01

Australia, in common with many other countries, is expanding the role of Primary Health Care (PHC) to manage the growing burden of chronic disease and prevent hospitalisation. Australia's First National Primary Health Care Strategy released in 2010 places general practice at the centre of care delivery, reflecting a constitutional division of labour in which the Commonwealth government's primary means of affecting care delivery in this sector is through rebates for services delivered from the universal healthcare system Medicare. A review of Australian nursing literature was undertaken for 2006-2011. This review explores three issues in relation to these changes: How PHC is conceptualised within Australian nursing literature; who is viewed as providing PHC; and barriers and enablers to the provision of comprehensive PHC. A review of the literature suggests that the terms 'PHC' and 'primary care' are used interchangeably and that PHC is now commonly associated with services provided by practice nurses. Four structural factors are identified for a shift away from comprehensive PHC, namely fiscal barriers, educational preparation for primary care practice, poor role definition and interprofessional relationships. The paper concludes that while moves towards increasing capacity in general practice have enhanced nursing roles, current policy and the nature of private business funding alongside some medical opposition limit opportunities for Australian nurses working in general practice. © 2013 John Wiley & Sons Ltd.

Methodology capture: discriminating between the "best" and the rest of community practice

PubMed Central

Eales, James M; Pinney, John W; Stevens, Robert D; Robertson, David L

2008-01-01

Background The methodologies we use both enable and help define our research. However, as experimental complexity has increased the choice of appropriate methodologies has become an increasingly difficult task. This makes it difficult to keep track of available bioinformatics software, let alone the most suitable protocols in a specific research area. To remedy this we present an approach for capturing methodology from literature in order to identify and, thus, define best practice within a field. Results Our approach is to implement data extraction techniques on the full-text of scientific articles to obtain the set of experimental protocols used by an entire scientific discipline, molecular phylogenetics. Our methodology for identifying methodologies could in principle be applied to any scientific discipline, whether or not computer-based. We find a number of issues related to the nature of best practice, as opposed to community practice. We find that there is much heterogeneity in the use of molecular phylogenetic methods and software, some of which is related to poor specification of protocols. We also find that phylogenetic practice exhibits field-specific tendencies that have increased through time, despite the generic nature of the available software. We used the practice of highly published and widely collaborative researchers ("expert" researchers) to analyse the influence of authority on community practice. We find expert authors exhibit patterns of practice common to their field and therefore act as useful field-specific practice indicators. Conclusion We have identified a structured community of phylogenetic researchers performing analyses that are customary in their own local community and significantly different from those in other areas. Best practice information can help to bridge such subtle differences by increasing communication of protocols to a wider audience. We propose that the practice of expert authors from the field of evolutionary biology is the closest to contemporary best practice in phylogenetic experimental design. Capturing best practice is, however, a complex task and should also acknowledge the differences between fields such as the specific context of the analysis. PMID:18761740

Make Change Happen at the Program or Institutional Scale: Converting Community Expertise into Practical Guidance

NASA Astrophysics Data System (ADS)

McDaris, J. R.; Manduca, C. A.; Orr, C. H.

2016-12-01

As geoscience and STEM programs address common challenges like increasing the diversity of graduates or implementing active learning pedagogies, it is important to learn from the experiences of others in the community. Individual faculty members embody a wealth of experience on these topics but distilling that experience into practical guidance that has value for a broad audience is not as simple as knowing exactly what one person did. Context is important, not only because activities used in similar contexts are easier to adapt, but also because activities that work across multiple contexts are more robust. The development of any best practices guidance benefits from the engagement of a community. Synthesizing across multiple viewpoints leads to a consensus that builds on the diversity of individual experiences. The Science Education Resource Center (SERC) at Carleton College has had success generating such resources in geoscience and STEM education. Working with different groups of educators, we have helped develop content around making change happen at the program or institutional levels, increasing the diversity of students graduating in geoscience and STEM, fostering interdisciplinary learning, translating the results of education research into practice, and several others. These resources draw out common practices, situate them in the education research base, and highlight examples of their use in the real world but also communicate the different ways individuals or institutions have adapted these practices for their particular situation. These resources were developed through a group synthesis process involving the contribution of individual or group expertise, a face-to-face meeting of teams working on themes drawn from the contributed work, and asynchronous group revision and review following the meeting. The materials developed via this process provide reliable and adaptable guidance firmly rooted in the community's experience. This presentation will showcase these materials and describe the development process in detail. The materials that have been developed are being added to SERC's For Higher Ed portal (serc.carleton.edu/highered/index.html).

Qualitative interviews with healthcare staff in four European countries to inform adaptation of an intervention to increase chlamydia testing.

PubMed

McNulty, Cliodna; Ricketts, Ellie J; Fredlund, Hans; Uusküla, Anneli; Town, Katy; Rugman, Claire; Tisler-Sala, Anna; Mani, Alix; Dunais, Brigitte; Folkard, Kate; Allison, Rosalie; Touboul, Pia

2017-09-25

To determine the needs of primary healthcare general practice (GP) staff, stakeholders and trainers to inform the adaptation of a locally successful complex intervention (Chlamydia Intervention Randomised Trial (CIRT)) aimed at increasing chlamydia testing within primary healthcare within South West England to three EU countries (Estonia, France and Sweden) and throughout England. Qualitative interviews. European primary healthcare in England, France, Sweden and Estonia with a range of chlamydia screening provision in 2013. 45 GP staff, 13 trainers and 18 stakeholders. The iterative interview schedule explored participants' personal attitudes, subjective norms and perceived behavioural controls around provision of chlamydia testing, sexual health services and training in general practice. Researchers used a common thematic analysis. Findings were similar across all countries. Most participants agreed that chlamydia testing and sexual health services should be offered in general practice. There was no culture of GP staff routinely offering opportunistic chlamydia testing or sexual health advice, and due to other priorities, participants reported this would be challenging. All participants indicated that the CIRT workshop covering chlamydia testing and sexual health would be useful if practice based, included all practice staff and action planning, and was adequately resourced. Participants suggested minor adaptations to CIRT to suit their country's health services. A common complex intervention can be adapted for use across Europe, despite varied sexual health provision. The intervention (ChlamydiA Testing Training in Europe (CATTE)) should comprise: a staff workshop covering sexual health and chlamydia testing rates and procedures, action planning and patient materials and staff reminders via computer prompts, emails or newsletters, with testing feedback through practice champions. CATTE materials are available at: www.STItraining.eu. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The American Academy of Clinical Neuropsychology, National Academy of Neuropsychology, and Society for Clinical Neuropsychology (APA Division 40) 2015 TCN Professional Practice and 'Salary Survey': Professional Practices, Beliefs, and Incomes of U.S. Neuropsychologists.

PubMed

Sweet, Jerry J; Benson, Laura M; Nelson, Nathaniel W; Moberg, Paul J

2015-01-01

The current survey updated professional practice and income information pertaining to clinical neuropsychology. Doctoral-level members of the American Academy of Clinical Neuropsychology, Division 40 (Clinical Neuropsychology) of the American Psychological Association, and the National Academy of Neuropsychology and other neuropsychologists, as well as postdoctoral trainees in the Association of Postdoctoral Programs in Clinical Neuropsychology and at other training sites were invited to participate in a web-based survey in early 2015. The sample of 1777 respondents, of whom 1579 were doctoral-level practitioners and 198 were postdoctoral trainees, was larger than the prior 2010 income and practice survey. The substantial proportional change in gender has continued, with women now a clear majority in the postdoctoral trainee sample as well as in the practitioner sample. Dissimilar from the median age trajectory of American Psychological Association members, the median age of clinical neuropsychologists remains essentially unchanged since 1989, indicating a substantial annual influx of young neuropsychologists. The question of whether the Houston Conference training model has become an important influence in the specialty can now be considered settled in the affirmative among postdoctoral trainees and practitioners. Testing assistant usage remains commonplace, and continues to be more common in institutions. The vast majority of clinical neuropsychologists work full-time and very few are unemployed and seeking employment. The numbers of neuropsychologists planning to retire in the coming 5-10 years do not suggest a "baby boomer" effect or an unexpected bolus of planned retirements in the next 10 years that would be large enough to be worrisome. Average length of time reported for evaluations appears to be increasing across time. The most common factors affecting evaluation length were identified, with the top three being: (1) goal of evaluation, (2) stamina/health of examinee, and (3) age of examinee. Pediatric specialists remain more likely than others to work part-time, more likely to work in institutions, report lower incomes than respondents with a lifespan professional identity, and are far more likely to be women. Incomes continue to vary considerably by years of clinical practice, work setting, amount of forensic practice, state, and region of country. Neurologists are the number one referral source in institutions and in private practice, as well as for pediatric, adult, and lifespan practitioners. Learning disability is no longer among the top five conditions seen by pediatric neuropsychologists; traumatic brain injury and seizure disorder are common reasons for clinical evaluations at all age ranges. There is a continued increase in forensic practice and a clear consensus on the use of validity testing. There is a substantial interest in subspecialization board certification, with the greatest interest evident among postdoctoral trainees. Income satisfaction, job satisfaction, and work-life balance satisfaction are higher for men. Job satisfaction varies across general work setting and across age range of practice. Work-life balance satisfaction is moderately correlated with income satisfaction and job satisfaction. Again in this five-year interval survey, a substantial majority of respondents reported increased incomes, despite experiencing substantial negative practice effects related to changes in the US health care system. Numerous breakdowns related to income and professional activities are provided. Professional practice survey information continues to provide valuable perspectives regarding consistency and change in the activities, beliefs, and incomes of US clinical neuropsychologists.

Self-reported benefits and risks of yoga in individuals with bipolar disorder.

PubMed

Uebelacker, Lisa A; Weinstock, Lauren M; Kraines, Morganne A

2014-09-01

Although hatha yoga has frequently been recommended for patients with bipolar disorder (BD) and there is preliminary evidence that it alleviates depression, there are no published data on the benefits-and potential risks-of yoga for patients with BD. Thus, the goal of this study was to assess the risks and benefits of yoga in individuals with BD. We recruited self-identified yoga practitioners with BD (N=109) to complete an Internet survey that included measures of demographic and clinical information and open-ended questions about yoga practice and the impact of yoga. 86 respondents provided sufficient information for analysis, 70 of whom met positive screening criteria for a lifetime history of mania or hypomania. The most common styles of yoga preferred were hatha and vinyasa. When asked what impact yoga had on their life, participants responded most commonly with positive emotional effects, particularly reduced anxiety, positive cognitive effects (e.g., acceptance, focus, or "a break from my thoughts"), or positive physical effects (e.g., weight loss, increased energy). Some respondents considered yoga to be significantly life changing. The most common negative effect of yoga was physical injury or pain. Five respondents gave examples of specific instances or a yoga practice that they believed increased agitation or manic symptoms; five respondents gave examples of times that yoga increased depression or lethargy. Many individuals who self-identify as having BD believe that yoga has benefits for mental health. However, yoga is not without potential risks. It is possible that yoga could serve as a useful adjunctive treatment for BD.

First trimester medication abortion practice in the United States and Canada.

PubMed

Jones, Heidi E; O'Connell White, Katharine; Norman, Wendy V; Guilbert, Edith; Lichtenberg, E Steve; Paul, Maureen

2017-01-01

We conducted a cross-sectional survey of abortion facilities from professional networks in the United States (US, n = 703) and Canada (n = 94) to estimate the prevalence of medication abortion practices in these settings and to look at regional differences. Administrators responded to questions on gestational limits, while up to five clinicians per facility reported on 2012 medication abortion practice. At the time of fielding, mifepristone was not approved in Canada. 383 (54.5%) US and 78 (83.0%) Canadian facilities participated. In the US, 95.3% offered first trimester medication abortion compared to 25.6% in Canada. While 100% of providers were physicians in Canada, just under half (49.4%) were advanced practice clinicians in the US, which was more common in Eastern and Western states. All Canadian providers used misoprostol; 85.3% with methotrexate. 91.4% of US providers used 200 mg of mifepristone and 800 mcg of misoprostol, with 96.7% reporting home misoprostol administration. More than three-quarters of providers in both countries required an in-person follow-up visit, generally with ultrasound. 87.7% of US providers routinely prescribed antibiotics compared to 26.2% in Canada. Nonsteroidal anti-inflammatory drugs were the most commonly reported analgesic, with regional variation in opioid narcotic prescription. In conclusion, medication abortion practice follows evidence-based guidelines in the US and Canada. Efforts to update practice based on the latest evidence for reducing in-person visits and increasing provision by advanced practice clinicians could strengthen these services and reduce barriers to access. Research is needed on optimal antibiotic and analgesic use.

Mental health impacts of flooding: a controlled interrupted time series analysis of prescribing data in England.

PubMed

Milojevic, Ai; Armstrong, Ben; Wilkinson, Paul

2017-10-01

There is emerging evidence that people affected by flooding suffer adverse impacts on their mental well-being, mostly based on self-reports. We examined prescription records for drugs used in the management of common mental disorder among primary care practices located in the vicinity of recent large flood events in England, 2011-2014. A controlled interrupted time series analysis was conducted of the number of prescribing items for antidepressant drugs in the year before and after the flood onset. Pre-post changes were compared by distance of the practice from the inundated boundaries among 930 practices located within 10 km of a flood. After control for deprivation and population density, there was an increase of 0.59% (95% CI 0.24 to 0.94) prescriptions in the postflood year among practices located within 1 km of a flood over and above the change observed in the furthest distance band. The increase was greater in more deprived areas. This study suggests an increase in prescribed antidepressant drugs in the year after flooding in primary care practices close to recent major floods in England. The degree to which the increase is actually concentrated in those flooded can only be determined by more detailed linkage studies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Racial and Ethnic Disparities in Cardiovascular Disease: An Assessment of Obstetrician-Gynecologists' Knowledge, Attitudes, and Practice Patterns.

PubMed

Jones, Katherine M; Carter, Michele M; Schulkin, Jay

2015-06-01

African American and Hispanic women are disproportionately affected by cardiovascular disease (CVD) and its many risk factors. Obstetrician-gynecologists (OB/GYNs) play an integral role in well-woman care and have a unique opportunity to provide CVD counseling and screening to these at-risk and underserved groups. To assess whether OB/GYN race/ethnicity and OB/GYN practices with increasing minority patient populations predicted differences in OB/GYNs' knowledge, attitudes, and practice patterns relevant to racial/ethnic disparities in CVD. This study also sought to determine provider and patient-related barriers to CVD care. A questionnaire on CVD was mailed to 273 members of The American College of Obstetricians and Gynecologists in March-July 2013. African American and Hispanic OB/GYNs and OB/GYN practices with increasing minority patient populations were more knowledgeable of CVD disparities. These OB/GYNs reported greater concern for minority women's CVD risk relative to White OB/GYNs. Overall, OB/GYNs appear less knowledgeable and concerned with Hispanics' increased CVD risk relative to African Americans'. The most commonly reported provider and patient-related barriers to CVD care were time constraints, patient nonadherence to treatment recommendations, and inadequate training. It is likely that minority OB/GYNs and those with practices with increasing minority patient populations have greater exposure to women at risk for CVD. Dissemination of educational information regarding Hispanic women's CVD risk profile may improve OB/GYN knowledge, counseling, and screening. Increased training in CVD and multicultural competency during medical school and residency should help OB/GYNs overcome what they report as primary barriers to CVD care.

Self-therapy practices among university students in Palestine: focus on herbal remedies.

PubMed

Sawalha, Ansam F; Sweileh, Waleed M; Zyoud, Sa'ed H; Jabi, Samah W

2008-12-01

Herbal self-therapy is a common practice among Palestinians. However, no published data are available on herbal self-therapy in the Middle East in general, and in Palestine in particular. This study was conducted to (1) determine the extent of herbal self-therapy among university students, (2) investigate the different types of herbal remedies used and (3) investigate the correlates and reasons associated with such practices. This cross-sectional, descriptive study was carried out using a structured questionnaire that contained five sections: (1) demographics; (2) medication knowledge and self-care orientation; (3) types of herbal remedies used; (4) clinical conditions treated; and finally, (5) the reasons reported by students for herbal self-therapy practice. Pearson chi(2), multiple logistic regression and one-way ANOVA were performed using SPSS 13 program. 33.9% of the respondents reported using herbal remedies in self-therapy. Female gender, students at medical colleges and those with high self-care orientation were significant predictive model for herbal use. Sage (Salvia fruticosa L.), chamomile (Chamaemelum nobile L.), anise (Pimpinella anisum L.), and thyme (Thymus vulgaris L.) were the most commonly utilized herbal remedies. The types of herbal remedies selected were significantly influenced by gender, but not by the level of medication knowledge or self-care orientation. Herbal remedies were used primarily for the treatment of headache, flu, menstrual pain and sore throat. The main motivating factor for using herbal remedies reported for using herbal remedies was simplicity of symptoms. Herbal self-therapy was a common practice among university students. Health care providers need to be aware of the students' self-therapy practices and need to have sufficient knowledge regarding herbs not simply because of the widespread use, but also because of significant reported side effects. Academics need to consider offering courses about herbal remedies to students in both the medical and non-medical faculties to broaden their treatment capabilities during this time of increased unregulated medical interventions such as herbal therapy.

On the practice of ignoring center-patient interactions in evaluating hospital performance.

PubMed

Varewyck, Machteld; Vansteelandt, Stijn; Eriksson, Marie; Goetghebeur, Els

2016-01-30

We evaluate the performance of medical centers based on a continuous or binary patient outcome (e.g., 30-day mortality). Common practice adjusts for differences in patient mix through outcome regression models, which include patient-specific baseline covariates (e.g., age and disease stage) besides center effects. Because a large number of centers may need to be evaluated, the typical model postulates that the effect of a center on outcome is constant over patient characteristics. This may be violated, for example, when some centers are specialized in children or geriatric patients. Including interactions between certain patient characteristics and the many fixed center effects in the model increases the risk for overfitting, however, and could imply a loss of power for detecting centers with deviating mortality. Therefore, we assess how the common practice of ignoring such interactions impacts the bias and precision of directly and indirectly standardized risks. The reassuring conclusion is that the common practice of working with the main effects of a center has minor impact on hospital evaluation, unless some centers actually perform substantially better on a specific group of patients and there is strong confounding through the corresponding patient characteristic. The bias is then driven by an interplay of the relative center size, the overlap between covariate distributions, and the magnitude of the interaction effect. Interestingly, the bias on indirectly standardized risks is smaller than on directly standardized risks. We illustrate our findings by simulation and in an analysis of 30-day mortality on Riksstroke. © 2015 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.

Maintaining professionalism in today's business environment: ethical challenges for the pain medicine specialist.

PubMed

Lebovits, Allen

2012-09-01

There are many external influences in today's market force that impair the relationship between the pain medicine specialist and the patient, and ultimately prevent optimal quality of care. This article explores the ethical challenges facing the pain medicine specialist in today's increasingly "business" environment and will offer solutions for maintaining the professionalism of pain medicine. Four commonly encountered bioethical principles in the practice of pain medicine are reviewed: beneficence, nonmaleficence, justice, and autonomy. The following ethical challenges of the pain medicine specialist are reviewed: practicing outside ones specialty area, practice characteristics, the consultant role, the economic lure of aggressive intervention, not evaluating for and treating comorbid psychopathology, reimbursement pressures, workers' compensation, and use of unproven methods. Solutions offered include collegial associations, social responsibility, legislative initiatives, pain education, interdisciplinary evaluation and treatment, improved relationships with third-party payers, reduced racial disparities, and ethics education. Ethics is the "roadmap" that enables the pain medicine specialist to navigate the increasingly murky waters of practicing pain management today by maintaining the professionalism necessary to combat today's "business" pressures. Wiley Periodicals, Inc.

A descriptive study of 'kangaroo gait' in sheep in northern Britain.

PubMed

Clements, A C A; Mellor, D J; Innocent, G T; Fitzpatrick, J L

2003-10-15

Two questionnaires were undertaken to obtain improved knowledge of the signalment, incidence and risk factors of the condition termed 'kangaroo gait' (KG; a forelimb locomotor disorder of adult female sheep). The first survey was mailed to 221 veterinary surgeons in practices in northern Britain which provided veterinary care for sheep, and the second was mailed to 438 sheep-flock owners and managers located in the Scottish Borders, who were recruited via their veterinary surgeons. Responses of 84.7 and 30.7% were achieved, respectively. In total, 29.7% of veterinary practices and 24.1% of flock owners and managers had identified one or more cases of KG in their practice area or flocks since the first case was reported in 1976. Almost all respondents indicated that adult females were affected-usually during lactation (and less commonly during late gestation). KG was more common among commercial crossbreeds and less common among sheep grazing hill pasture (than sheep grazing upland or lowland pasture). Cases usually occurred between March and June while sheep were at grass, although it was unclear whether the temporal pattern was associated with grazing or lambing patterns. Stocking densities were significantly higher among affected flocks than among non-affected flocks. The annual number of individuals and flocks identified as being affected had increased since the condition first was identified. Most cases of locomotor disorders resembling KG were not reported to veterinary surgeons.

Education in medical billing benefits both neurology trainees and academic departments.

PubMed

Waugh, Jeff L

2014-11-11

The objective of residency training is to produce physicians who can function independently within their chosen subspecialty and practice environment. Skills in the business of medicine, such as clinical billing, are widely applicable in academic and private practices but are not commonly addressed during formal medical education. Residency and fellowship training include limited exposure to medical billing, but our academic department's performance of these skills was inadequate: in 56% of trainee-generated outpatient notes, documentation was insufficient to sustain the chosen billing level. We developed a curriculum to improve the accuracy of documentation and coding and introduced practice changes to address our largest sources of error. In parallel, we developed tools that increased the speed and efficiency of documentation. Over 15 months, we progressively eliminated note devaluation, increased the mean level billed by trainees to nearly match that of attending physicians, and increased outpatient revenue by $34,313/trainee/year. Our experience suggests that inclusion of billing education topics into the formal medical curriculum benefits both academic medical centers and trainees. © 2014 American Academy of Neurology.

Auditory rhythmic cueing in movement rehabilitation: findings and possible mechanisms

PubMed Central

Schaefer, Rebecca S.

2014-01-01

Moving to music is intuitive and spontaneous, and music is widely used to support movement, most commonly during exercise. Auditory cues are increasingly also used in the rehabilitation of disordered movement, by aligning actions to sounds such as a metronome or music. Here, the effect of rhythmic auditory cueing on movement is discussed and representative findings of cued movement rehabilitation are considered for several movement disorders, specifically post-stroke motor impairment, Parkinson's disease and Huntington's disease. There are multiple explanations for the efficacy of cued movement practice. Potentially relevant, non-mutually exclusive mechanisms include the acceleration of learning; qualitatively different motor learning owing to an auditory context; effects of increased temporal skills through rhythmic practices and motivational aspects of musical rhythm. Further considerations of rehabilitation paradigm efficacy focus on specific movement disorders, intervention methods and complexity of the auditory cues. Although clinical interventions using rhythmic auditory cueing do not show consistently positive results, it is argued that internal mechanisms of temporal prediction and tracking are crucial, and further research may inform rehabilitation practice to increase intervention efficacy. PMID:25385780

Traumatic brain injury

PubMed Central

Risdall, Jane E.; Menon, David K.

2011-01-01

There is an increasing incidence of military traumatic brain injury (TBI), and similar injuries are seen in civilians in war zones or terrorist incidents. Indeed, blast-induced mild TBI has been referred to as the signature injury of the conflicts in Iraq and Afghanistan. Assessment involves schemes that are common in civilcian practice but, in common with civilian TBI, takes little account of information available from modern imaging (particularly diffusion tensor magnetic resonance imaging) and emerging biomarkers. The efficient logistics of clinical care delivery in the field may have a role in optimizing outcome. Clinical care has much in common with civilian TBI, but intracranial pressure monitoring is not always available, and protocols need to be modified to take account of this. In addition, severe early oedema has led to increasing use of decompressive craniectomy, and blast TBI may be associated with a higher incidence of vasospasm and pseudoaneurysm formation. Visual and/or auditory deficits are common, and there is a significant risk of post-traumatic epilepsy. TBI is rarely an isolated finding in this setting, and persistent post-concussive symptoms are commonly associated with post-traumatic stress disorder and chronic pain, a constellation of findings that has been called the polytrauma clinical triad. PMID:21149359

Disinfection in the laboratory: theory and practice in disinfection policy in late C19th and early C20th England.

PubMed

Whyte, Rebecca

2015-03-01

This article examines the relationship between theory and practice in nineteenth century English public health disinfection practice. Disinfection undertaken by local authorities and practised on objects, spaces and people became an increasingly common public health practice in the last quarter of the nineteenth century, and was part of a newly developed public health system of 'stamping out' disease as described by Hardy. Despite disinfection's key role in public health policy, it has thus far not received significant investigation or historiographical attending. This article explores the development of disinfection policy at local level, highlighting that despite commentators assumptions that increasingly exacting standards of disinfection required professional oversight rather than that of the 'amateur' public, there was a significant gap between laboratory based knowledge and evidence derived from practical experience. Laboratory conditions could not replicate those found in day-to-day disinfection, and there were myriad debates about how to create a mutually understandable scientific standard for testing. Despite increasing efforts to bring local disinfection in line with new ideas promulgated by central government and disinfection researchers, the mismatches between the two meant that there was greater divergence. This tension lay at the heart of the changes in disinfection theory and practice in the second half of the nineteenth century, and illustrate the complexities of the impact of germ theory on public health policy. Copyright © 2015 Elsevier Ltd. All rights reserved.

Promoting Employee Health Through an American Cancer Society Program, The CEOs Challenge, Washington State, 2013-2015.

PubMed

Harris, Jeffrey R; Parrish, Amanda T; Kohn, Marlana; Hammerback, Kristen; McMillan, Becca; Hannon, Peggy A

2015-12-17

Evidence-based practices in the workplace can increase levels of healthy eating, cancer screening, physical activity, and tobacco cessation but are underused, even in large workplaces. This report summarizes an evaluation of the first year of The CEOs Challenge, a program developed by the American Cancer Society to promote implementation and maintenance of health-promoting, evidence-based workplace practices by large companies. Use of 17 evidence-based practices by 17 companies in the Washington State Chapter of the American Cancer Society's CEOs Against Cancer network was assessed via survey and scored from 0 to 100. Companies received a written report of their baseline performance, followed by at least quarterly consultations with American Cancer Society staff members trained to assist in implementation of these practices. Follow-up performance was measured at 1 year. At baseline, implementation scores were 54.8 for cancer screening, 46.5 for healthy eating, 59.8 for physical activity, and 68.2 for tobacco cessation. At follow-up, scores increased by 19.6 for cancer screening, 19.4 for healthy eating, 16.0 for physical activity, and 9.4 points for tobacco cessation. The CEOs Challenge is a promising approach to chronic disease prevention via the workplace. It brings together one of the nation's largest health-promoting voluntary agencies with the nation's largest employers to promote evidence-based practices targeted at the most common causes of disease and death. The program increased the adoption of these practices and was well-accepted.

Factors influencing the choice of a career in food-animal practice among recent graduates and current students of Texas A&M University, College of Veterinary Medicine.

PubMed

Lenarduzzi, Roland; Sheppard, Guy A; Slater, Margaret R

2009-01-01

Concerns about a shortage of large and mixed-animal veterinarians have been discussed in the profession. To better understand veterinary career choices among currently enrolled veterinary students (classes of 2007-2010) and recent graduate veterinarians in Texas (classes of 2002-2006), an online survey was developed. The objectives were to examine: (1) the respondents' backgrounds, demographic data, and experiences; (2) the respondents' working conditions and rural lifestyle considerations; (3) the respondents' perceptions of large/mixed-animal practice; and (4) the factors that have influenced respondents' career choices. The response rate was 37% (390/1,042). Overall, 72% of students and 55% of recent graduates were interested in large/mixed-animal practice. More than 70% of respondents indicated that veterinary practitioners had the strongest personal influence on career choices. Respondents who were no longer interested in large/mixed-animal practice, or who had never been interested, reported no experience with large animals (42% and 64%, respectively) as the most common reason for their lack of interest. Previous and current interest in large/mixed-animal practice were associated with working in a large/mixed-animal practice, any agricultural experience, and working for at least 6 months on a farm or ranch. Any 4-H experience increased the likelihood of previous interest, while being married decreased the likelihood of current interest. Student contact with practitioners (82%) and financial considerations (77%) were most commonly cited as factors that would make a career in large/mixed-animal practice more attractive. Rural lifestyle drawbacks influenced respondents' career choices. Many forms of agricultural experience may expose and encourage students to consider large/mixed-animal practice.

Worldwide end-of-life practice for patients in ICUs.

PubMed

Wong, Wai-Tat; Phua, Jason; Joynt, Gavin M

2018-04-01

Published data and practice recommendations on end-of-life (EOL) generally reflect Western practice frameworks. Understanding worldwide practices is important because improving economic conditions are promoting rapid expansion of intensive care services in many previously disadvantaged regions, and increasing migration has promoted a new cultural diversity previously predominantly unicultural societies. This review explores current knowledge of similarities and differences in EOL practice between regions and possible causes and implications of these differences. Recent observational and survey data shows a marked variability in the practice of withholding and withdrawing life sustaining therapy worldwide. Some evidence supports the view that culture, religion, and socioeconomic factors influence EOL practice, and individually or together account for differences observed. There are also likely to be commonly desired values and expectations for EOL practice, and recent attempts at establishing where worldwide consensus may lie have improved our understanding of shared values and practices. Awareness of differences, understanding their likely complex causes, and using this knowledge to inform individualized care at EOL is likely to improve the quality of care for patients. Further research should clarify the causes of EOL practice variability, monitor trends, and objectively evaluate the quality of EOL practice worldwide.

A Systematic Review of Associations between Amount of Meditation Practice and Outcomes in Interventions Using the Four Immeasurables Meditations

PubMed Central

Zeng, Xianglong; Chio, Floria H. N.; Oei, Tian P. S.; Leung, Freedom Y. K.; Liu, Xiangping

2017-01-01

Interventions using the “Four Immeasurables Meditations” (FIM) are effective for various outcomes; however, whether increased meditation practice in these interventions leads to better results has not been well investigated. This systematic review included 22 FIM interventions that reported associations between the amount of meditation practice and its outcomes. Despite the heterogeneity in intervention components and outcome variables, there were generally few significant associations between amount of meditation practice and its outcomes. Specifically, only five studies reported that more than half of the calculated results were significant. In comparison with correlations between total amount of practice and overall outcomes, the short-term influence of meditation practice was evaluated in fewer studies; however, it had a better association with outcomes. More studies are required that address the underlying mechanisms that elucidate how meditation practice leads to outcome changes in daily life. In this study, two promising mechanisms with initial evidence were discussed. This review also summarized common methodological issues including a lack of experimental manipulation and inaccurate measuring of meditation practice. PMID:28220101

A Systematic Review of Associations between Amount of Meditation Practice and Outcomes in Interventions Using the Four Immeasurables Meditations.

PubMed

Zeng, Xianglong; Chio, Floria H N; Oei, Tian P S; Leung, Freedom Y K; Liu, Xiangping

2017-01-01

Interventions using the "Four Immeasurables Meditations" (FIM) are effective for various outcomes; however, whether increased meditation practice in these interventions leads to better results has not been well investigated. This systematic review included 22 FIM interventions that reported associations between the amount of meditation practice and its outcomes. Despite the heterogeneity in intervention components and outcome variables, there were generally few significant associations between amount of meditation practice and its outcomes. Specifically, only five studies reported that more than half of the calculated results were significant. In comparison with correlations between total amount of practice and overall outcomes, the short-term influence of meditation practice was evaluated in fewer studies; however, it had a better association with outcomes. More studies are required that address the underlying mechanisms that elucidate how meditation practice leads to outcome changes in daily life. In this study, two promising mechanisms with initial evidence were discussed. This review also summarized common methodological issues including a lack of experimental manipulation and inaccurate measuring of meditation practice.

[Current emergency medicine for neurological disorders in children].

PubMed

Osamura, Toshio

2010-01-01

In 2006, the number of pediatric outpatients consulting our hospital during non-practice hours increased by 218.1% of that in 1996. The number of pediatric inpatients during non-practice hours in 2006 increased by 71.3% of that in 1996. In 2006, the number of patients who were admitted with neurological disorders in children during non-practice hours increased to 213.3% of that in 1996. The proportion of these pediatric patients among those who were admitted during non-practice hours was 16.6% in our hospital, suggesting the importance of neurological disorders in pediatric emergency medicine. More than 60% of inpatients with neurological disorders in children were 3 years old or younger. The most common neurological symptoms observed at admission included convulsion (81.6%) and disturbance of consciousness (8.5%). The disorders were mainly febrile seizure (41.4%) and epilepsy (29.0%). Most patients with severe disorders requiring emergency medicine, such as head bruise, acute encephalitis/encephalopathy, purulent meningitis, and head trauma, were admitted during non-practice hours. The prognoses of most neurological disorders in children were favorable. However, patients with sequelae (especially, hypoxic encephalopathy, acute encephalitis/encephalopathy) showed an unfavorable neurological prognosis. Early rehabilitation during admission was useful as a support method for their families. In the future, a comprehensive rehabilitation program for children with acquired brain injury should be established and laws to promote home care must be passed.

Effects of commonly used cooking practices on total mercury concentration in fish and their impact on exposure assessments.

PubMed

Morgan, J N; Berry, M R; Graves, R L

1997-01-01

The effects of cooking practices commonly used by Native Americans on total mercury concentrations in fish were investigated. A preparation factor relating mercury concentrations in fish as prepared for consumption to mercury concentration data as measured in typical environmental monitoring programs was calculated. Preparation factors are needed to provide risk assessors with a more accurate estimate of the actual amount of mercury ingested through consumption of contaminated fish. Data on fish preparation and consumption practices of two communities of Chippewa residing on the shores of Lake Superior in northern Wisconsin were used to select practices for study. The most commonly consumed species, walleye and lake trout, were selected. Whitefish livers were also selected for study. Commonly used cooking techniques including panfrying, deep-frying, baking, boiling, and smoking were duplicated in the laboratory. Total mercury concentrations were determined in fish portions before and after cooking and in a portion representative of that analyzed in programs to assess water quality (skin-on fillets). Total mercury was determined by microwave digestion-cold vapor atomic absorption spectroscopy. Mercury concentrations (wet weight basis) in panfried, baked, and boiled walleye fillets and deep-fried and baked whitefish livers ranged from 1.1 to 1.5 times higher than in corresponding raw portions. In lake trout, mercury concentrations were 1.5 to 2.0 times higher in cooked portions than in the raw portion. However, total mercury levels were constant before and after cooking, indicating the concentration effect is caused by weight (moisture and fat) loss. The addition of lemon juice to potentially release mercury from its bound state and promote volatilization did not exert any measurable influence on mercury concentrations in cooked walleye. In some cases mercury concentrations were increased with increased cooking times due to further loss of moisture and fat. Preparation factors (defined as the ratio of mercury concentration in cooked fish to the mercury concentration in the environmental portion) ranged from 1.3 to 2.0. Results suggest that consideration be given to the use of preparation factors in risk assessments, exposure assessments, or issuance of fish advisories where mercury concentration in raw fish tissue are used in conjunction with cooked fish meal sizes.

Observing the sick child: Part 2c. Respiratory auscultation.

PubMed

Aylott, Marion

2007-04-01

Nursing continues to extend its practice base as the acuity of children in general wards often with complex illnesses and treatment increases. There is a need for ongoing development of the physical assessment skills of nurses who care for children and young people in order to facilitate early recognition of clinical problems. Respiratory dysfunction is the common precursor to adverse events. The skill of auscultation adds another dimension that augments the respiratory assessment repertoire of the nurse. This article builds on the palpation skills presented in February issue and provides a practical step-by-step introduction to auscultation.

ACOG Technology Assessment No. 11: Genetics and molecular diagnostic testing.

PubMed

2014-02-01

Human genetics and molecular testing are playing an increasingly important role in medicine, including obstetric and gynecologic practice. As the genetic basis for reproductive disorders, common diseases, and cancer is elucidated with improved molecular technology, genetic testing opportunities are expanding and influencing treatment options and prevention strategies. It is essential that obstetrician-gynecologists be aware of advances in the understanding of genetic disease and the fundamental principles of genetic screening and molecular testing as genetics becomes a more integral part of routine medical practice. This document reviews the basics of genetic transmission and genetic technologies in current use.

Hematopoietic growth factors in neonatal medicine: the use of enterally administered hematopoietic growth factors in the neonatal intensive care unit.

PubMed

Calhoun, Darlene A; Christensen, Robert D

2004-03-01

The practice of complete bowel rest in prematurely delivered neonates and those who have undergone surgery for congenital anomalies of the gastrointestinal (GI) tract is common in neonatal intensive care units (NICU). However, increased recognition of the critical role of growth factors in GI development suggests that this practice might be modified to include the administration of synthetic amniotic fluid-like solutions designed to bridge the neonate between their intra-uterine environment and that of the NICU. This article reviews advances in administering synthetic amniotic fluid-like solutions in the NICU.

The context & clinical evidence for common nursing practices during labor.

PubMed

Simpson, Kathleen Rice

2005-01-01

The purpose of this article is to review the context and current evidence for common nursing care practices during labor and birth. Although many nursing interventions during labor and birth are based on physician orders, there are a number of care processes that are mainly within the realm of nursing practice. In many cases, particularly in community hospitals, routine physician orders for intrapartum care provide wide latitude for nurses in how they ultimately carry out those orders. An important consideration of common nursing practices during labor is the context or practice model in which those practices occur. Nursing practice is not the same in all clinical environments. Intrapartum nursing practice consists of an assortment of different roles depending on the circumstances, hospital setting, and context in which it takes place. A variety of intrapartum nursing practice models have evolved as a result and in response to the range of sizes, locations, and provider practice styles found in hospitals providing obstetric services. A summary of intrapartum nursing models is presented. The evidence is reviewed for the three most common clinical practices for which nurses have primary responsibility in most settings and that comprise the majority of their time in caring for women during labor: (1) maternal-fetal assessment, (2) management of oxytocin infusions, and (3) second-stage care. Evidence exists for these nursing interventions that can be used to promote maternal-fetal well-being, minimize risk, and enhance patient safety.

Individualized Anesthetic Management for Patients Undergoing Electroconvulsive Therapy: A Review of Current Practice.

PubMed

Bryson, Ethan O; Aloysi, Amy S; Farber, Kate G; Kellner, Charles H

2017-06-01

Electroconvulsive therapy (ECT) remains an indispensable treatment for severe psychiatric illness. It is practiced extensively in the United States and around the world, yet there is little guidance for anesthesiologists involved with this common practice. Communication between the anesthesiologist and the proceduralist is particularly important for ECT, because the choice of anesthetic and management of physiologic sequelae of the therapeutic seizure can directly impact both the efficacy and safety of the treatment. In this review, we examine the literature on anesthetic management for ECT. A casual or "one-size-fits-all" approach may lead to less-than-optimal outcomes; customizing the anesthetic management for each patient is essential and can significantly increase treatment success rate and patient satisfaction.

Approach to Patient with a Generalized Rash

PubMed Central

Leung, Lawrence; Soeyonggo, Tony

2013-01-01

Background: Generalized rash is amongst the most common conditions presented to practicing General Practitioners and common differentials include contact dermatitis, atopic eczema, sun-induced damage, drug eruption and general manifestations of systemic diseases or infections. Materials and Methods: We illustrate with differential diagnoses our clinical case of a generalized rash in a 55-year-old man with pathognomonic signs of a diagnosis, which has received increasing global concern. Conclusion: Despite the array of available laboratory tests, a detailed history and physical examination is still of paramount importance to arrive at the most likely diagnosis for any patient with a generalized skin rash. PMID:26664833

NOTE: Cell-phone interference with pocket dosimeters

NASA Astrophysics Data System (ADS)

Djajaputra, David; Nehru, Ramasamy; Bruch, Philip M.; Ayyangar, Komanduri M.; Raman, Natarajan V.; Enke, Charles A.

2005-05-01

Accurate reporting of personal dose is required by regulation for hospital personnel that work with radioactive material. Pocket dosimeters are commonly used for monitoring this personal dose. We show that operating a cell phone in the vicinity of a pocket dosimeter can introduce large and erroneous readings of the dosimeter. This note reports a systematic study of this electromagnetic interference. We found that simple practical measures are enough to mitigate this problem, such as increasing the distance between the cell phone and the dosimeter or shielding the dosimeter, while maintaining its sensitivity to ionizing radiation, by placing it inside a common anti-static bag.

Surgical Management of Common Disorders of Feedlot Calves.

PubMed

Miesner, Matt D; Anderson, David E

2015-11-01

Procedures to improve animal and handler safety, shape production parameters, and directly address the prosperity of individuals in need of assistance are performed routinely. Techniques to accomplish these tasks have been described in many venues. Painful procedures are expected in feedlot practice. Assessing and managing pain and welfare for these procedures has strengthened significantly over the past decade to address increased public concerns and also to support the desires of the operators/managers to progress. Methods to perform common procedures are described, including evidence and techniques for managing the pain and distress while performing them. Published by Elsevier Inc.

Impressions of defensive medical practice and medical litigation among South African neurosurgeons.

PubMed

Roytowski, D; Smith, T R; Fieggen, A G; Taylor, A

2014-11-01

From a litigation perspective, neurosurgery is considered a 'super high-risk' field, and this has been associated with rapidly increasing malpractice cover costs. In 2013 the annual Medical Protection Society fee for cover was R250,900. We wished to determine whether high malpractice cover was influencing how neurosurgeons managed patients. A 40-question online survey asking questions on defensive medicine was distributed to determine perceptions around liability risk and whether these influenced how patients were managed. Eighty-four per cent of respondents agreed that a medicolegal crisis existed, and over half (53.8%) had been sued for malpractice during their career. Altering practice behaviour to minimise the risk of a lawsuit is common. The increasing number of legal claims against respondents in this survey has resulted in most neurosurgeons practising defensive medicine. Arguably this will result in increased healthcare costs, inferior patient care and decreased access to skilled surgeons.

Neurologic disorders associated with weight lifting and bodybuilding.

PubMed

Busche, Kevin

2008-02-01

Weight lifting and other forms of strength training are becoming more common because of an increased awareness of the need to maintain individual physical fitness. Emergency room data indicate that injuries caused by weight training have become more universal over time, likely because of increased participation rates. Neurologic injuries can result from weight lifting and related practices. Although predominantly peripheral nervous system injuries have been described, central nervous system disease may also occur. This article illustrates the types of neurologic disorders associated with weight lifting.

Neurologic disorders associated with weight lifting and bodybuilding.

PubMed

Busche, Kevin

2009-02-01

Weight lifting and other forms of strength training are becoming more common because of an increased awareness of the need to maintain individual physical fitness. Emergency room data indicate that injuries caused by weight training have become more universal over time, likely because of increased participation rates. Neurologic injuries can result from weight lifting and related practices. Although predominantly peripheral nervous system injuries have been described, central nervous system disease may also occur. This article illustrates the types of neurologic disorders associated with weight lifting.

The Influences of Middle School Mathematics Teachers' Practical Rationality on Instructional Decision Making Regarding the Common Core State Standards for Mathematical Practices

ERIC Educational Resources Information Center

Sobolewski-McMahon, Lauren M.

2017-01-01

The purpose of this study was to examine the influences of various facets of middle school mathematics teachers' practical rationality on their instructional decision making as they plan to enact the Common Core State Standards for Mathematical Practice, CCSS-MP1 (perseverance in problem solving) and CCSS-MP3 (communicating and critiquing). The…

When the group practice breaks up: a qualitative study

PubMed Central

2013-01-01

Background Group practices are increasingly common for primary care physicians worldwide. Although breakups are likely to happen frequently within group practices, their process has not been studied to date. The aims of this study were therefore to explore the reasons for breakups of group practices of general practitioners and to describe the associated feelings. Methods We conducted a qualitative study consisting of in-depth interviews of 21 general practitioners and one secretary from past group practices in the Rhône-Alpes region, France, who experienced a breakup. Results When getting started in group practice for the first time, young doctors did not feel ready and supported, and did not necessarily share the same expectations as their partners. The reasons for the breakups involved imbalances within the groups, contrasting working and management styles, and breakdowns in communication. The breakup process often generated long-persistent feelings of suffering and failure for almost every partner who experienced a breakup, particularly for the partner who was leaving. Conclusions Weakening factors exist from the very beginning of a partnership, and problems are likely to increase at every change or event occurring in the group. We provide several recommendations, including fair management, a shared project based on a precise contract, the consultation of third parties as necessary and, in the worst case scenario, leaving the group practice in time. PMID:23642277

Overall Findings: Common Practices and Procedures across Schools. High Achieving Schools Study. Synthesis Report

ERIC Educational Resources Information Center

Mohajeri-Nelson, Nazanin; Bamberry, Lynn; Dunaway, Wendy; Hunter, Ellen; Klein, Jeff; Kuntz, Courtney; Negley, Tina; Singer, Robin; Ottenbreit, Rebekah; Young, Eric

2015-01-01

This report summarizes the factors that were commonly noted across five high achieving elementary schools in Colorado: (1) Burlington; (2) Canyon Creek; (3) Soaring Eagles; (4) South Lakewood; and (5) Tavelli. After 10 days of onsite visits to participating schools, noteworthy commonalities surfaced across the schools. Policies, practices, and…

Requirements for diagnosis of malaria at different levels of the laboratory network in Africa.

PubMed

Long, Earl G

2009-06-01

The rapid increase of resistance to cheap, reliable antimalarials, the increasing cost of effective drugs, and the low specificity of clinical diagnosis has increased the need for more reliable diagnostic methods for malaria. The most commonly used and most reliable remains microscopic examination of stained blood smears, but this technique requires skilled personnel, precision instruments, and ideally a source of electricity. Microscopy has the advantage of enabling the examiner to identify the species, stage, and density of an infection. An alternative to microscopy is the rapid diagnostic test (RDT), which uses a labeled monoclonal antibody to detect circulating parasitic antigens. This test is most commonly used to detect Plasmodium falciparum infections and is available in a plastic cassette format. Both microscopy and RDTs should be available at all levels of laboratory service in endemic areas, but in peripheral laboratories with minimally trained staff, the RDT may be a more practical diagnostic method.

A heterogeneous landscape does not guarantee high crop pollination

PubMed Central

Hambäck, Peter A.; Lemessa, Debissa; Nemomissa, Sileshi; Hylander, Kristoffer

2016-01-01

The expansion of pollinator-dependent crops, especially in the developing world, together with reports of worldwide pollinator declines, raises concern of possible yield gaps. Farmers directly reliant on pollination services for food supply often live in regions where our knowledge of pollination services is poor. In a manipulative experiment replicated at 23 sites across an Ethiopian agricultural landscape, we found poor pollination services and severe pollen limitation in a common oil crop. With supplementary pollination, the yield increased on average by 91%. Despite the heterogeneous agricultural matrix, we found a low bee abundance, which may explain poor pollination services. The variation in pollen limitation was unrelated to surrounding forest cover, local bee richness and bee abundance. While practices that commonly increase pollinators (restricted pesticide use, flower strips) are an integral part of the landscape, these elements are apparently insufficient. Management to increase pollination services is therefore in need of urgent investigation. PMID:27629036

Changes in soil microbial community structure influenced by agricultural management practices in a mediterranean agro-ecosystem.

PubMed

García-Orenes, Fuensanta; Morugán-Coronado, Alicia; Zornoza, Raul; Cerdà, Artemi; Scow, Kate

2013-01-01

Agricultural practices have proven to be unsuitable in many cases, causing considerable reductions in soil quality. Land management practices can provide solutions to this problem and contribute to get a sustainable agriculture model. The main objective of this work was to assess the effect of different agricultural management practices on soil microbial community structure (evaluated as abundance of phospholipid fatty acids, PLFA). Five different treatments were selected, based on the most common practices used by farmers in the study area (eastern Spain): residual herbicides, tillage, tillage with oats and oats straw mulching; these agricultural practices were evaluated against an abandoned land after farming and an adjacent long term wild forest coverage. The results showed a substantial level of differentiation in the microbial community structure, in terms of management practices, which was highly associated with soil organic matter content. Addition of oats straw led to a microbial community structure closer to wild forest coverage soil, associated with increases in organic carbon, microbial biomass and fungal abundances. The microbial community composition of the abandoned agricultural soil was characterised by increases in both fungal abundances and the metabolic quotient (soil respiration per unit of microbial biomass), suggesting an increase in the stability of organic carbon. The ratio of bacteria:fungi was higher in wild forest coverage and land abandoned systems, as well as in the soil treated with oat straw. The most intensively managed soils showed higher abundances of bacteria and actinobacteria. Thus, the application of organic matter, such as oats straw, appears to be a sustainable management practice that enhances organic carbon, microbial biomass and activity and fungal abundances, thereby changing the microbial community structure to one more similar to those observed in soils under wild forest coverage.

The Impact of Statistical Adjustment on Conditional Standard Errors of Measurement in the Assessment of Physician Communication Skills

ERIC Educational Resources Information Center

Raymond, Mark R.; Clauser, Brian E.; Furman, Gail E.

2010-01-01

The use of standardized patients to assess communication skills is now an essential part of assessing a physician's readiness for practice. To improve the reliability of communication scores, it has become increasingly common in recent years to use statistical models to adjust ratings provided by standardized patients. This study employed ordinary…

Biventricular Takotsubo cardiomyopathy in Graves hyperthyroidism.

PubMed

Perkins, Matthew J; Schachter, David T

2014-03-01

Graves hyperthyroidism is commonly seen in clinical practice and Takotsubo stress cardiomyopathy is an increasingly recognized cardiac complication of physical or emotional stress. We report the rare case of a patient with Graves hyperthyroidism that was complicated by severe biventricular takotsubo cardiomyopathy, which was demonstrated on heart catheterization. After appropriate pharmacologic treatment of her hyperthyroidism, she had complete resolution of her cardiomyopathy.

Practical breeding programs for jack pine in the Lake States

Treesearch

James P. King

1973-01-01

Jack pine (Pinus banksiana Lamb.) is the most common pine in the Lake States and is expected to play an increasingly important role in Lake States planting programs. This species is easy to plant successfully even on dry, sandy soils. Its rapid growth during the first 30 years makes it suitable for intensive-culture, short-rotation forestry. And it...

Good Practices in Team Teaching in Japan, South Korea and Hong Kong

ERIC Educational Resources Information Center

Carless, David R.

2006-01-01

Team teaching between native English speaking teachers and local L2 English teachers has become an increasingly common phenomenon in schooling in the East Asia region. The relevant literature reports some positive impacts of team teaching and also highlights some of the challenges or conflicts which arise. The aim of this paper is to focus on…

Comparing Formative and Summative Instruments: What Tools Inform Practice and Guide Teacher Candidate Decision Making?

ERIC Educational Resources Information Center

Wilcoxen, Christina L.

2017-01-01

With an increased focus on field-based preparation, the relationship between P12 school districts and universities has been forced to change with little or no support to create effective third space environments. The complexity of the student teaching experience is compounded by the need for redefined roles, the lack of a common lexicon and the…

The Framework for 21st Century Learning: A First-Rate Foundation for Music Education Assessment and Teacher Evaluation

ERIC Educational Resources Information Center

Gilbert, Ashley Danielle

2016-01-01

Federal laws and funding initiatives, such as the No Child Left Behind Act and the Race to the Top campaign, have created an increasing incentive for schools nationwide to document student progress, standardize assessment practices, and evaluate teachers according to student success. In response, the Common Core State Standards, a popular yet…

[News on hyponatremia].

PubMed

Fenske, Wiebke; Christ-Crain, Mirjam

2016-04-01

Hyponatremia is the most common electrolyte disorder in clinical practice with often severe and devastating complications. Hyponatremia itself as well as its inappropriate management is associated with pronounced morbidity and increased mortality risk. This manuscript presents some relevant novel findings in this field and discusses them in the context of the recently elaborated first European Guideline of hyponatremia. © Georg Thieme Verlag KG Stuttgart · New York.

Reading in the Crawl Space: A Study of an Urban School's Literacy-Focused Community of Practice

ERIC Educational Resources Information Center

Francois, Chantal

2013-01-01

Background/Context: The pressure to understand "what works" to advance adolescents' reading development has increased as the Common Core State Standards' call for youth to grapple with a range of complex texts. While we have learned more about promising reading programs and interventions for adolescent students in schools, few…

Designing economic impact assessments for USFS wildfire programs

Treesearch

Karen L. Abt; Robert J. Jr. Huggett; Thomas P. Holmes

2008-01-01

As often happens in the wake of a series of extreme fire seasons, such as those in 2000, 2002 and 2003, federal wildfire policy is being scrutinized and recommendations regarding changes both large and small are prevalent (Stephens and Ruth 2005, Busenberg 2004, Dellasalla et al. 2004, Dombeck et al. 2004). It is common practice for increases in acres burned and in...

Examining the Changing Landscape of School Psychology Practice: A Survey of School-Based Practitioners regarding Response to Intervention

ERIC Educational Resources Information Center

Sullivan, Amanda L.; Long, Lori

2010-01-01

As Response to Intervention (RtI) approaches become more common in educational systems throughout the country, it is increasingly important to identify how practitioners perceive these changes and how they obtain the skills necessary to face emergent roles and responsibilities. In this exploratory study, a national sample of 557 school…

Systemic Data-Based Decision Making: A Systems Approach for Using Data in Schools

ERIC Educational Resources Information Center

Walser, Tamara M.

2009-01-01

No Child Left Behind has increased data collection and reporting, the development of data systems, and interest in using data for decision-making in schools and classrooms. Ends-driven decision making has become common educational practice, where the ends justify the means at all costs, and short-term results trump longer-term outcomes and the…

Multiple Perspectives on Integrated Education for Children with Disabilities in the Context of Early Childhood Centres in Hong Kong

ERIC Educational Resources Information Center

Lai, Yuk Ching; Gill, Judith

2014-01-01

The integration of children with disabilities in mainstream early childhood settings is a common practice in many developed and developing countries world-wide. A number of key points have been raised concerning such integration, including the increased attention to civil education about the rights of persons with disabilities, training for…

School Subject Paradigms and Teaching Practice in Lower Secondary Swedish Schools Influenced by ICT and Media

ERIC Educational Resources Information Center

Erixon, Per-Olof

2010-01-01

This article deals with how school subjects' paradigms, i.e. the established content of the teaching and the way in which the teaching is traditionally organised, are influenced when digital media are becoming increasingly common in educational contexts. The study is based on interviews in so-called focus groups with teachers of different school…

Prevalence of lactose fermenting coliforms resistant to third generation cephalosporins in cattle feedlot throughout a production cycle and molecular characterization of resistant isolates

USDA-ARS?s Scientific Manuscript database

Introduction: Increases in incidence of human infections caused by Enterobacteriaceae resistant to 3rd generation cephalosporins (3GC) have become a public health concern. The 3GC ceftiofur is commonly used for the therapeutic treatment of feedlot cattle but the impact this practice has on public h...

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

Kalavapudi, M.; Iyengar, V.

Increased industrial activities in developing countries have degraded the environment, and the impact on the environment is further magnified because of an ever-increasing population, the prime receptors. Independent of the geographical location, it is possible to adopt effective strategies to solve environmental problems. In the United States, waste characterization and remediation practices are commonly used for quantifying toxic contaminants in air, water, and soil. Previously, such procedures were extraneous, ineffective, and cost-intensive. Reconciliation between the government and stakeholders, reinforced by valid data analysis and environmental exposure assessments, has allowed the {open_quotes}Brownfields{close_quotes} to be a successful approach. Certified reference materials andmore » standard reference materials from the National Institute of Standards (NIST) are indispensable tools for solving environmental problems and help to validate data quality and the demands of legal metrology. Certified reference materials are commonly available, essential tools for developing good quality secondary and in-house reference materials that also enhance analytical quality. This paper cites examples of environmental conditions in developing countries, i.e., industrial pollution problems in India, polluted beaches in Brazil, and deteriorating air quality in countries, such as Korea, China, and Japan. The paper also highlights practical and effective approaches for remediating these problems. 23 refs., 7 figs., 1 tab.« less

Physical Education, Obesity, and Academic Achievement: A 2-Year Longitudinal Investigation of Australian Elementary School Children

PubMed Central

Cunningham, Ross B.; Fitzgerald, Robert; Olive, Lisa S.; Prosser, Laurence; Jiang, Xiaoli; Telford, Rohan M.

2012-01-01

Objectives. We determined whether physical education (PE) taught by specialists contributed to academic development and prevention of obesity in elementary school children. Methods. Our 2-year longitudinal study involved 620 boys and girls initially in grade 3 in Australia, all receiving 150 minutes per week of PE. One group (specialist-taught PE; n = 312) included 90 minutes per week of PE from visiting specialists; the other (common-practice PE; n = 308) received all PE from generalist classroom teachers. Measurements included percentage of body fat (measured by dual-emission x-ray absorptiometry) and writing, numeracy, and reading proficiency (by government tests). Results. Compared with common-practice PE, specialist-taught PE was associated with a smaller increase in age-related percentage of body fat (P = .02). Specialist-taught PE was also associated with greater improvements in numeracy (P < .03) and writing (P = .13) scores. There was no evidence of a reading effect. Conclusions. The attenuated age-related increases in percentage of body fat and enhanced numeracy development among elementary school children receiving PE from specialists provides support for the role of PE in both preventive medicine and academic development. PMID:21940922

Food Safety Practices in the U.S. Meat Slaughter and Processing Industry: Changes from 2005 to 2015.

PubMed

Viator, Catherine L; Cates, Sheryl C; Karns, Shawn A; Muth, Mary K

2017-08-01

Meat slaughter establishments use a multipronged approach to ensure beef and pork products are safe for human consumption. To determine the approaches most commonly used, we conducted a national survey of federally inspected meat slaughter and processing establishments (376 completed surveys, 66% response rate) in 2015. We compared the results with a survey that was conducted in 2005, albeit of potentially different establishments, by using a similar questionnaire and similar data collection methods, thus allowing for an evaluation of trends in food safety practices over time. The use of some food safety practices has increased over the 10-yr time period, whereas others remained the same or decreased. For example, the use of chemical sanitizers or hot water for food contact surfaces and tools increased from 51 to 93%. As another example, microbiological testing of raw meat after fabrication, in addition to that required by regulation, increased from 50 to 72%. However, the use of organic acid rinse on carcasses in the slaughter area remained the same, at 66% of establishments. Written policies and procedures to control the use of hazardous chemicals decreased from 75 to 65% of establishments. The survey findings can be used to characterize food safety practices and technologies in the meat slaughter and processing industry and identify areas for improvement.

Infinite occupation number basis of bosons: Solving a numerical challenge

NASA Astrophysics Data System (ADS)

Geißler, Andreas; Hofstetter, Walter

2017-06-01

In any bosonic lattice system, which is not dominated by local interactions and thus "frozen" in a Mott-type state, numerical methods have to cope with the infinite size of the corresponding Hilbert space even for finite lattice sizes. While it is common practice to restrict the local occupation number basis to Nc lowest occupied states, the presence of a finite condensate fraction requires the complete number basis for an exact representation of the many-body ground state. In this work we present a truncation scheme to account for contributions from higher number states. By simply adding a single coherent-tail state to this common truncation, we demonstrate increased numerical accuracy and the possible increase in numerical efficiency of this method for the Gutzwiller variational wave function and within dynamical mean-field theory.

International best practices for negotiating 'reimbursement contracts' with price rebates from pharmaceutical companies.

PubMed

Morgan, Steven; Daw, Jamie; Thomson, Paige

2013-04-01

Reimbursement contracts, in which health insurers receive rebates from drug manufacturers instead of paying the transparent list price, are becoming increasingly common worldwide. Through interviews with policy makers in nine high-income countries, we describe the use of these contracts around the globe and identify related policy challenges and best practices. Of the nine countries surveyed, the majority routinely use confidential reimbursement contracts. This alternative to drug coverage at list prices offers benefits but is not without challenges. Payers face increased administrative costs, difficulties enforcing contracts, and reduced information about prices paid by others. Among the best practices identified, policy makers recommend establishing clear and consistent processes for negotiating contracts with relatively simple rebate structures and transparency to the public about the existence, purpose, and type of reimbursement contracts in place. Policy makers should also work to address undesirable price disparities within their countries and internationally, which may occur as a result of this new pricing paradigm.

Prescribing by general practitioners after an osteoporotic fracture.

PubMed

Torgerson, D J; Dolan, P

1998-06-01

Osteoporosis is a major cause of morbidity and cost. Patients sustaining one osteoporotic fracture are at increased risk of having another fracture. The objective of this study was to examine the use of "bone drugs" for the prevention of further osteoporotic fractures among patients who have had a "typical" osteoporotic fracture. This study took a random sample of 300 women aged 50 and over who had sustained either a vertebral, hip or Colles fracture in 1995 from the General Practice Research Database (GPRD) and compared their use of bone drugs with 300 age and practice matched controls. Compared with age and practice matched control patients only vertebral fracture patients showed a statistically significant increase in the use of bone drugs in the year after fracture (39% and 2% for cases and controls respectively; 95% CI of difference 27% to 47%). Etidronate was the most commonly used compound. The majority of patients sustaining an osteoporotic fracture are not prescribed any pharmaceutical agents for the secondary prevention of fracture one year after a primary fracture.

Effects of processing on the proximate and metal contents in three fish species from Nigerian coastal waters

PubMed Central

Bassey, Francisca I; Oguntunde, Fehintola C; Iwegbue, Chukwujindu M A; Osabor, Vincent N; Edem, Christopher A

2014-01-01

The effects of culinary practices such as boiling, frying, and grilling on the proximate compositions and concentrations of metals (Cd, Pb, Cr, Zn, Fe, Cu, Mn, Ni, and Hg) in commonly consumed fish species from the Nigerian coastal waters were investigated. The selected fish species were Polydactylus quadratifilis, Chrysicthys nigrodigitatus and Cynoglossus senegalensis. The culinary practices lead to increased protein, fat, and ash contents and decreased moisture contents of these fish species. The culinary practices resulted significant increase in the concentrations of most of the studied metals and decrease in the concentrations of Fe, Cr, and Pb in some fish types. The concentrations and estimated dietary intakes of Cd, Pb, Cr, Zn, Fe, Cu, Mn, Ni, and Hg from consumption of the processed fish were within their statutory safe limits. The individual metal target hazard quotient (THQ) values and the total THQs were less than 1 which indicates that no health risks would arise from the long-term consumption of these fish species. PMID:24936297

Toward generally accepted forensic assessment practices among clinical neuropsychologists: a survey of professional practice and common test use.

PubMed

LaDuke, Casey; Barr, William; Brodale, Donald L; Rabin, Laura A

2018-01-01

This study investigated professional practice and common test use among clinical neuropsychologists engaging in forensic assessment.  Doctorate-level psychologists active in the practice of neuropsychology and on the INS and NAN membership listings (n = 502) were surveyed about their demographics, professional practice, and common test use. Participants who reported engaging in forensic practice (n = 255) were further surveyed about their forensic practice. Forensic participants were more likely to be male and Caucasian, and reported higher ages, more years of professional experience, and a higher prevalence of board certification. While characteristics of their professional and forensic practice varied, forensic participants reported spending most of their professional time conducting neuropsychological assessments with adult clients in a private or group practice setting, focusing on civil referrals and civil legal questions involving older adult issues, developmental issues, head injury, and psychiatric issues. Common test use across neuropsychological assessment domains is presented for board-certified forensic participants (n = 77). An examination of these results reveals that the current pattern of test use is similar to the results of a more general survey of neuropsychological test use.  The findings provide insight into the practice of forensic neuropsychological assessment, and further establish the admissibility of neuropsychological evidence in the United States legal system. Results will be useful for clinical neuropsychologists, field leaders, and legal professionals hoping to gain insight into the role of clinical neuropsychology in civil and criminal legal decision-making.

A qualitative study of physicians' own wellness-promotion practices

PubMed Central

Weiner, Eric L; Swain, Geoffrey R; Wolf, Barbara; Gottlieb, Mark

2001-01-01

Objective To delineate the specific practices that physicians use to promote their own well-being. Design, setting, and participants 304 members of a primary care practice-based research group responded by mail to a survey on physician well-being. From the original survey, 130 subjects responded to an open-ended survey item regarding their own wellness-promotion practices. Methods Qualitative content analysis was used to identify the common themes in the physicians' responses to the open-ended question. A validated 18-item instrument, the Scales of Psychological Well-Being (SPWB), was used for measurement. Main outcome measures Similarities and differences between the various wellness-promotion practices that respondents reported using and associations between the use of these practices and SPWB scores. Results The 5 primary wellness-promotion practices that evolved from thematic analysis of the survey responses included “relationships,” “religion or spirituality,” “self-care,” “work,” and “approaches to life.” The use of the last type of practice was significantly associated with increased psychological well-being (SPWB) scores compared with the use of any of the other wellness-promotion practice categories (P<0.01), and there was a trend toward increased well-being among users of any category of wellness-promotion practices. Comments by our respondents provide specific descriptions of how physicians attend to their emotional, spiritual, and psychological well-being. Conclusion Physicians use a variety of approaches to promote their own well-being, which sort themselves into 5 main categories and appear to correlate with improved levels of psychological well-being among users. PMID:11154656

Radiology practices and their contracts with hospitals, 1989-1990: a representative sample survey.

PubMed

Sunshine, J; Chan, W C; Kassing, P J

1991-12-01

Because of concern about pressures from hospitals for changes in their contracts with radiology practices, the American College of Radiology undertook a stratified sample survey of radiology practices and their contracts with hospitals in late 1989 and early 1990. After three remailings, the survey obtained 904 valid responses for a 64% response rate. It found (weighting data to represent all radiology practices in the nation) that 91% of radiology practices provide services in hospitals. There are contracts at 57% of these hospital sites, and hospitals use tax-exempt bond financing in 54% of the sites with contracts. One year is the most common duration of contracts, and 90 days is the most common cancellation period (89% of contracts can be canceled during the contract's term). Eighty-six percent of contracts are exclusive; 73% are automatically renewable ("evergreen"). Separate billing exists in well over 90% of hospitals with contracts. Two percent of contracts require radiologists to provide equipment; 4% require them to provide support staff. There are fixed-fee arrangements in 9% of contracts and percent compensation arrangements in 3%. Hospitals share in radiologists' fees as a charge for contractual privileges in 5% of contracts. Twenty-seven percent of contracts require hospital approval for radiologists' fee increases; 19% require radiologists to participate with Blue Shield or Medicare. If a contract characteristic is predominant nationally, it is predominant in every region, for solo, small, medium, and large practices, and whether or not hospitals use tax-exempt bond financing. There is, however, some modest variation in frequency of contract provisions. Multivariate analysis shows that most such variation reflects true effects of region and other variables, not statistical artifacts. Region was a statistically significant determinant of 11 of 17 contract characteristics studied. Practice size was a statistically significant determinant of only about half as many characteristics. The survey found some interference in the independence of radiology practices (e.g., required hospital approval of fee increases), questionable clauses (e.g., mandated provision of equipment), and even illegal ones (hospitals charging a fee for contract privileges). Knowledge of the survey findings can make individual radiology practices more effective in negotiations with hospitals and assist the profession in forming a strategy to oppose disadvantageous and illegal provisions.

Evidence based practice readiness: A concept analysis.

PubMed

Schaefer, Jessica D; Welton, John M

2018-01-15

To analyse and define the concept "evidence based practice readiness" in nurses. Evidence based practice readiness is a term commonly used in health literature, but without a clear understanding of what readiness means. Concept analysis is needed to define the meaning of evidence based practice readiness. A concept analysis was conducted using Walker and Avant's method to clarify the defining attributes of evidence based practice readiness as well as antecedents and consequences. A Boolean search of PubMed and Cumulative Index for Nursing and Allied Health Literature was conducted and limited to those published after the year 2000. Eleven articles met the inclusion criteria for this analysis. Evidence based practice readiness incorporates personal and organisational readiness. Antecedents include the ability to recognize the need for evidence based practice, ability to access and interpret evidence based practice, and a supportive environment. The concept analysis demonstrates the complexity of the concept and its implications for nursing practice. The four pillars of evidence based practice readiness: nursing, training, equipping and leadership support are necessary to achieve evidence based practice readiness. Nurse managers are in the position to address all elements of evidence based practice readiness. Creating an environment that fosters evidence based practice can improve patient outcomes, decreased health care cost, increase nurses' job satisfaction and decrease nursing turnover. © 2018 John Wiley & Sons Ltd.

Measuring parent food practices: a systematic review of existing measures and examination of instruments

PubMed Central

2013-01-01

During the last decade, there has been a rapid increase in development of instruments to measure parent food practices. Because these instruments often measure different constructs, or define common constructs differently, an evaluation of these instruments is needed. A systematic review of the literature was conducted to identify existing measures of parent food practices and to assess the quality of their development. The initial search used terms capturing home environment, parenting behaviors, feeding practices and eating behaviors, and was performed in October of 2009 using PubMed/Medline, PsychInfo, Web of knowledge (ISI), and ERIC, and updated in July of 2012. A review of titles and abstracts was used to narrow results, after which full articles were retrieved and reviewed. Only articles describing development of measures of parenting food practices designed for families with children 2-12 years old were retained for the current review. For each article, two reviewers extracted data and appraised the quality of processes used for instrument development and evaluation. The initial search yielded 28,378 unique titles; review of titles and abstracts narrowed the pool to 1,352 articles; from which 57 unique instruments were identified. The review update yielded 1,772 new titles from which14 additional instruments were identified. The extraction and appraisal process found that 49% of instruments clearly identified and defined concepts to be measured, and 46% used theory to guide instrument development. Most instruments (80%) had some reliability testing, with internal consistency being the most common (79%). Test-retest or inter-rater reliability was reported for less than half the instruments. Some form of validity evidence was reported for 84% of instruments. Construct validity was most commonly presented (86%), usually with analysis of associations with child diet or weight/BMI. While many measures of food parenting practices have emerged, particularly in recent years, few have demonstrated solid development methods. Substantial variation in items across different scales/constructs makes comparison between instruments extremely difficult. Future efforts should be directed toward consensus development of food parenting practices constructs and measures. PMID:23688157

Overcoming the ten most common barriers to effective team communication.

PubMed

Hills, Laura

2013-01-01

Communication is at the heart of medical practice management. Yet there are many barriers to effective communication that can interfere with the smooth running of the practice. This article describes the 10 most common barriers to effective medical practice team communication and offers six steps the practice manager can take to break them down. This article also suggests that the practice develop a team communication strategy. It suggests 10 communication principles readers can share directly with their teams and describes three hallmarks of effective team communication. Finally, this article provides a list of 25 practical questions practice managers can use to improve their team's communication.

The Effects of Common Core State Standards on School Superintendent Leadership and School Culture

ERIC Educational Resources Information Center

Boulton, Sean Mark

2017-01-01

Researchers have suggested that the implementation of Common Core State Standards has the potential to influence school leadership styles and practices. It was not known, however, how implementation of Common Core State Standards influenced school superintendent leadership styles and practices and overall school culture in the state of California.…

Probiotic guidelines and physician practice: a cross-sectional survey and overview of the literature.

PubMed

Draper, K; Ley, C; Parsonnet, J

2017-08-24

Probiotic use by patients and physicians has dramatically increased over the last decade, although definitive evidence is often lacking for their use. We examined probiotic-prescribing practices among health care providers (HCP) at a tertiary medical centre and compared these practices to clinical guidelines. HCP at the Stanford Medical Center received a survey on probiotic prescribing practices including choice of probiotic and primary indications. A broad overview of the literature was performed. Among 2,331 HCP surveyed, 632 responded. Of the 582 of these who routinely prescribed medications, 61% had recommended probiotic foods or supplements to their patients. Women and gastroenterologists were more likely to prescribe probiotics (odds ratio (OR): 1.5, 95% confidence interval (CI): 1.0-2.1; OR: 3.9, 95% CI: 1.5-10.1, respectively). Among probiotic prescribers, 50% prescribed inconsistently or upon patient request, and 40% left probiotic choice to the patient. Common indications for probiotics, particularly Lactobacillus GG, were prevention and treatment of antibiotic-associated diarrhoea (79 and 66%, respectively). Probiotics were often prescribed for 'general bowel health' or at patient request (27 and 39% of responders, respectively). Most respondents (63%) thought an electronic medical record (EMR) pop-up would change probiotic prescribing patterns. However, a review of published guidelines and large trials found inconsistencies in probiotic indications, dosages and strain selection. Probiotic prescribing is common but lacks consistency, with choice of probiotic frequently left to the patient, even for indications with some strain-specific evidence. Implementation of EMR pop-ups/pocket guides may increase consistency in probiotic prescribing, although the lack of clear and consistent guidelines must first be addressed with large, well-designed clinical trials.

A Survey of Knowledge, Attitude, and Practice of Consumers at a Tertiary Care Hospital Regarding the Disposal of Unused Medicines

PubMed Central

Sonowal, Supriya; Desai, Chetna; Kapadia, Jigar D.; Desai, Mira K.

2016-01-01

Objectives: To evaluate the knowledge, attitude and practice of consumers in India about disposal of unused medicines. Materials and Methods: A questionnaire comprising 11 questions evaluating the Knowledge (2), Attitude (3) and Practice (6) of unused medicines was prepared and pre validated before administering to 200 consumers of medicines attending the outpatient department of Civil Hospital Ahmedabad, a tertiary care teaching hospital in Western India. Requisite permissions from Institutional Ethics Committee and informed consent were obtained prior to recruiting them for the study. Responses were recorded, in Microsoft Excel® spreadsheet and evaluated for percentage response. Results: Majority of the respondents (136, 68%) stored unused medicines at home. Analgesics (26.5%) were the most common unused medicine stored. Safe disposal of medicine was considered necessary by majority respondents (160, 80%) for different reasons like prevention of illegal/unintended use (84, 42%), prevention of environmental pollution (32, 16%) or possible ADR caused by old drugs (54, 27%). Only 78 (39%) respondents were aware of appropriate methods of disposal. Disposal in household trash (61, 30.5%) was the most common method used. Majority of respondents felt the need for a facility or programme to collect unused medicines (152, 76%) and an increased awareness among consumers regarding hazards and methods of disposal of unused medicines (154, 77%). Conclusion: Majority of consumers are aware about the need for safe disposal of unused medicines. But the right attitude for and practice of safe disposal of medicines is lacking. A need for increased awareness regarding safe disposal of medicines is acknowledged by majority of consumers. PMID:28104967

Antibiotic Use in 2016 by Members of the American Association of Endodontists: Report of a National Survey.

PubMed

Germack, Mark; Sedgley, Christine M; Sabbah, Wael; Whitten, Brian

2017-10-01

This study surveyed the antibiotic prescribing practices of endodontists, and data were compared with previous surveys conducted in 1994 and 1999. A 17-question survey was sent via www.surveymonkey.com to 3000 active members of the American Association of Endodontists for responses about antibiotic prescribing practices and demographics. The data were analyzed using descriptive statistics, chi-square tests, and linear regression analyses. Six hundred eighty-six participants (22.86%) completed the survey. The most frequently prescribed antibiotics were amoxicillin (60.71%) followed by penicillin V (30.43%) and clindamycin for patients with allergies (95.4%). Respondents reported prescribing antibiotics for irreversible pulpitis with mild symptoms (1.75%), irreversible pulpitis with moderate symptoms (6.41%), necrotic pulp with symptomatic apical periodontitis (43.59%), chronic apical abscess without (10.50%) or with symptoms (29.74%), acute apical abscess (95.92%), avulsion (70.26%), endodontic surgery (41.69%), retreatment (silver point [23.76%] or gutta-percha [15.60%]), postoperative pain after instrumentation or obturation (12.39%), and perforation repair (5.98%). The type of practice (solo/group) and geographic region (Southeast) were significant predictors of increased antibiotic prescribing; 36.89% of respondents reported prescribing antibiotics that are not necessary, most commonly because of patient expectations. Since 1999, there has been a significant shift from prescribing penicillin V to amoxicillin as endodontists' first choice of antibiotic and a significant increase in the use of clindamycin for penicillin-allergic patients. Antibiotics continue to be prescribed in clinical situations for which they are typically not indicated, most commonly because of patient expectations. Regional differences in antibiotic prescribing practices by endodontists exist in the United States. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

An overview of systematic reviews of normal labor and delivery management

PubMed Central

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

2015-01-01

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

An overview of systematic reviews of normal labor and delivery management.

PubMed

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

2015-01-01

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

Current Ketamine Practice: Results of the 2016 American Society of Pain Management Nursing Survey on Ketamine.

PubMed

Klaess, Cynthia C; Jungquist, Carla R

2018-06-01

Ketamine is increasingly utilized for a variety of pain management challenges. Audience comments from a ketamine presentation at the 2015 American Society of Pain Management Nursing (ASPMN) Conference reflected wide variation in ketamine practices as well as barriers to use. The goal was to gain a greater understanding of ASPMN member practice patterns and barriers related to ketamine as adjunctive therapy for pain management. A questionnaire survey design was used. Respondents represented 35 states and 2 countries. The participants were 146 respondents from ASPMN membership (1,485 members). The survey was distributed by ASPMN on SurveyMonkey. Practice setting and ketamine administration practices were assessed with areas for comments. Results were reviewed using frequencies to describe responses and formatted into tables. Comments were individually reviewed and grouped into common themes. Administration of ketamine as an analgesic was reported by 63% of respondents. Continuous intravenous ketamine infusions were the most common route of administration (65%); however, wide variability in dosing and length of therapy was reported. A wide variety of practices and challenges related to ketamine utilization were noted. Numerous studies have indicated the analgesic benefits of ketamine in pain management. The lack of practice standardization has created challenges to its consistent use and outcome measurement. Additionally, the off-label use of ketamine for pain management creates its own unique challenges. However, given the current national climate with intense focus on pain management, interdisciplinary practitioners have an ideal opportunity to evaluate ketamine's use in a comprehensive approach to pain management. Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Injuries in Japanese Mini-Basketball Players During Practices and Games

PubMed Central

Kuzuhara, Kenji; Shibata, Masashi; Uchida, Ryo

2016-01-01

Context: Mini-basketball is one of the most popular junior sports in Japan. Mini-basketball–related injuries may increase because of early specialization. However, no reports have been published to date concerning basketball injuries in children younger than 12 years of age. Objective: To prospectively study the incidence, sites, types, and mechanisms of injuries in mini-basketball teams. Design: Descriptive epidemiology study. Setting: Mini-basketball teams in Kobe, Japan. Patients or Other Participants: A total of 95 players in 7 community-based mini-basketball club teams (age range, 9 through 12 years). Main Outcome Measure(s): Data on all practice and game injuries for the 2013–2014 season were collected using an injury report form. Injury rates were calculated according to site, type, and mechanism. Results: The overall injury rate was 3.83 per 1000 athlete-hours (AHs). The game injury rate (12.92/1000 AHs) was higher than the practice injury rate (3.13/1000 AHs; P < .05). The most common anatomical areas of injury during games and practices were the head and neck (36.4%, 4.70/1000 AHs) and the upper limbs (47.8%, 1.50/1000 AHs). Sprains (42.9%, n = 39) were the most common type of injuries overall, followed by contusions (29.7%, n = 27). Most game injuries resulted from body contact (45.5%, 5.87/1000 AHs), whereas most practice injuries resulted from other contact (56.5%, 1.77/1000 AHs). Conclusions: Game injury rates were higher than practice injury rates in Japanese mini-basketball players. The high practice injury rate in this study may be due to specific factors related to growth, such as individual differences in height, or to skills, such as inexperience in ball handling. PMID:27922287

Injuries in Japanese Mini-Basketball Players During Practices and Games.

PubMed

Kuzuhara, Kenji; Shibata, Masashi; Uchida, Ryo

2016-12-01

Mini-basketball is one of the most popular junior sports in Japan. Mini-basketball-related injuries may increase because of early specialization. However, no reports have been published to date concerning basketball injuries in children younger than 12 years of age. To prospectively study the incidence, sites, types, and mechanisms of injuries in mini-basketball teams. Descriptive epidemiology study. Mini-basketball teams in Kobe, Japan. A total of 95 players in 7 community-based mini-basketball club teams (age range, 9 through 12 years). Data on all practice and game injuries for the 2013-2014 season were collected using an injury report form. Injury rates were calculated according to site, type, and mechanism. The overall injury rate was 3.83 per 1000 athlete-hours (AHs). The game injury rate ( 12.92/1000 AHs) was higher than the practice injury rate (3.13/1000 AHs; P < .05). The most common anatomical areas of injury during games and practices were the head and neck (36.4%, 4.70/1000 AHs) and the upper limbs (47.8%, 1.50/1000 AHs). Sprains (42.9%, n = 39) were the most common type of injuries overall, followed by contusions (29.7%, n = 27). Most game injuries resulted from body contact (45.5%, 5.87/1000 AHs), whereas most practice injuries resulted from other contact (56.5%, 1.77/1000 AHs). Game injury rates were higher than practice injury rates in Japanese mini-basketball players. The high practice injury rate in this study may be due to specific factors related to growth, such as individual differences in height, or to skills, such as inexperience in ball handling.

Traditional Arabic & Islamic medicine: validation and empirical assessment of a conceptual model in Qatar.

PubMed

AlRawi, Sara N; Khidir, Amal; Elnashar, Maha S; Abdelrahim, Huda A; Killawi, Amal K; Hammoud, Maya M; Fetters, Michael D

2017-03-14

Evidence indicates traditional medicine is no longer only used for the healthcare of the poor, its prevalence is also increasing in countries where allopathic medicine is predominant in the healthcare system. While these healing practices have been utilized for thousands of years in the Arabian Gulf, only recently has a theoretical model been developed illustrating the linkages and components of such practices articulated as Traditional Arabic & Islamic Medicine (TAIM). Despite previous theoretical work presenting development of the TAIM model, empirical support has been lacking. The objective of this research is to provide empirical support for the TAIM model and illustrate real world applicability. Using an ethnographic approach, we recruited 84 individuals (43 women and 41 men) who were speakers of one of four common languages in Qatar; Arabic, English, Hindi, and Urdu, Through in-depth interviews, we sought confirming and disconfirming evidence of the model components, namely, health practices, beliefs and philosophy to treat, diagnose, and prevent illnesses and/or maintain well-being, as well as patterns of communication about their TAIM practices with their allopathic providers. Based on our analysis, we find empirical support for all elements of the TAIM model. Participants in this research, visitors to major healthcare centers, mentioned using all elements of the TAIM model: herbal medicines, spiritual therapies, dietary practices, mind-body methods, and manual techniques, applied singularly or in combination. Participants had varying levels of comfort sharing information about TAIM practices with allopathic practitioners. These findings confirm an empirical basis for the elements of the TAIM model. Three elements, namely, spiritual healing, herbal medicine, and dietary practices, were most commonly found. Future research should examine the prevalence of TAIM element use, how it differs among various populations, and its impact on health.

Changes in water budgets and sediment yields from a hypothetical agricultural field as a function of landscape and management characteristics--A unit field modeling approach

USGS Publications Warehouse

Roth, Jason L.; Capel, Paul D.

2012-01-01

Crop agriculture occupies 13 percent of the conterminous United States. Agricultural management practices, such as crop and tillage types, affect the hydrologic flow paths through the landscape. Some agricultural practices, such as drainage and irrigation, create entirely new hydrologic flow paths upon the landscapes where they are implemented. These hydrologic changes can affect the magnitude and partitioning of water budgets and sediment erosion. Given the wide degree of variability amongst agricultural settings, changes in the magnitudes of hydrologic flow paths and sediment erosion induced by agricultural management practices commonly are difficult to characterize, quantify, and compare using only field observations. The Water Erosion Prediction Project (WEPP) model was used to simulate two landscape characteristics (slope and soil texture) and three agricultural management practices (land cover/crop type, tillage type, and selected agricultural land management practices) to evaluate their effects on the water budgets of and sediment yield from agricultural lands. An array of sixty-eight 60-year simulations were run, each representing a distinct natural or agricultural scenario with various slopes, soil textures, crop or land cover types, tillage types, and select agricultural management practices on an isolated 16.2-hectare field. Simulations were made to represent two common agricultural climate regimes: arid with sprinkler irrigation and humid. These climate regimes were constructed with actual climate and irrigation data. The results of these simulations demonstrate the magnitudes of potential changes in water budgets and sediment yields from lands as a result of landscape characteristics and agricultural practices adopted on them. These simulations showed that variations in landscape characteristics, such as slope and soil type, had appreciable effects on water budgets and sediment yields. As slopes increased, sediment yields increased in both the arid and humid environments. However, runoff did not increase with slope in the arid environment as was observed in the humid environment. In both environments, clayey soils exhibited the greatest amount of runoff and sediment yields while sandy soils had greater recharge and lessor runoff and sediment yield. Scenarios simulating the effects of the timing and type of tillage practice showed that no-till, conservation, and contouring tillages reduced sediment yields and, with the exception of no-till, runoff in both environments. Changes in land cover and crop type simulated the changes between the evapotransporative potential and surface roughness imparted by specific vegetations. Substantial differences in water budgets and sediment yields were observed between most agricultural crops and the natural covers selected for each environment: scrub and prairie grass for the arid environment and forest and prairie grass for the humid environment. Finally, a group of simulations was performed to model selected agricultural management practices. Among the selected practices subsurface drainage and strip cropping exhibited the largest shifts in water budgets and sediment yields. The practice of crop rotation (corn/soybean) and cover cropping (corn/rye) were predicted to increase sediment yields from a field planted as conventional corn.

Influence of Systematic Increases in Treadmill Walking Speed on Gait Kinematics After Stroke

PubMed Central

Tyrell, Christine M.; Roos, Margaret A.; Rudolph, Katherine S.

2011-01-01

Background Fast treadmill training improves walking speed to a greater extent than training at a self-selected speed after stroke. It is unclear whether fast treadmill walking facilitates a more normal gait pattern after stroke, as has been suggested for treadmill training at self-selected speeds. Given the massed stepping practice that occurs during treadmill training, it is important for therapists to understand how the treadmill speed selected influences the gait pattern that is practiced on the treadmill. Objective The purpose of this study was to characterize the effect of systematic increases in treadmill speed on common gait deviations observed after stroke. Design A repeated-measures design was used. Methods Twenty patients with stroke walked on a treadmill at their self-selected walking speed, their fastest speed, and 2 speeds in between. Using a motion capture system, spatiotemporal gait parameters and kinematic gait compensations were measured. Results Significant improvements in paretic- and nonparetic-limb step length and in single- and double-limb support were found. Asymmetry of these measures improved only for step length. Significant improvements in paretic hip extension, trailing limb position, and knee flexion during swing also were found as speed increased. No increases in circumduction or hip hiking were found with increasing speed. Limitations Caution should be used when generalizing these results to survivors of a stroke with a self-selected walking speed of less than 0.4 m/s. This study did not address changes with speed during overground walking. Conclusions Faster treadmill walking facilitates a more normal walking pattern after stroke, without concomitant increases in common gait compensations, such as circumduction. The improvements in gait deviations were observed with small increases in walking speed. PMID:21252308

Internal medicine board certification and career pathways in Japan.

PubMed

Koike, Soichi; Matsumoto, Masatoshi; Ide, Hiroo; Kawaguchi, Hideaki; Shimpo, Masahisa; Yasunaga, Hideo

2017-05-08

Establishing and managing a board certification system is a common concern for many countries. In Japan, the board certification system is under revision. The purpose of this study was to describe present status of internal medicine specialist board certification, to identify factors associated with maintenance of board certification and to investigate changes in area of practice when physicians move from hospital to clinic practice. We analyzed 2010 and 2012 data from the Survey of Physicians, Dentists and Pharmacists. We conducted logistic regression analysis to identify factors associated with the maintenance of board certification between 2010 and 2012. We also analyzed data on career transition from hospitals to clinics for hospital physicians with board certification. It was common for physicians seeking board certification to do so in their early career. The odds of maintaining board certification were lower in women and those working in locations other than academic hospitals, and higher in physicians with subspecialty practice areas. Among hospital physicians with board certification who moved to clinics between 2010 and 2012, 95.8% remained in internal medicine or its subspecialty areas and 87.7% maintained board certification but changed their practice from a subspecialty area to more general internal medicine. Revisions of the internal medicine board certification system must consider different physician career pathways including mid-career moves while maintaining certification quality. This will help to secure an adequate number and distribution of specialists. To meet the increasing demand for generalist physicians, it is important to design programs to train specialists in general practice.

Time to Consider Use of the Sodium-to-Potassium Ratio for Practical Sodium Reduction and Potassium Increase

PubMed Central

Miura, Katsuyuki; Ueshima, Hirotsugu

2017-01-01

Pathogenetic studies have demonstrated that the interdependency of sodium and potassium affects blood pressure. Emerging evidences on the sodium-to-potassium ratio show benefits for a reduction in sodium and an increase in potassium compared to sodium and potassium separately. As presently there is no known review, this article examined the practical use of the sodium-to-potassium ratio in daily practice. Epidemiological studies suggest that the urinary sodium-to-potassium ratio may be a superior metric as compared to separate sodium and potassium values for determining the relation to blood pressure and cardiovascular disease risks. Higher correlations and better agreements are seen for the casual urine sodium-to-potassium ratio than for casual urine sodium or potassium alone when compared with the 24-h urine values. Repeated measurements of the casual urine provide reliable estimates of the 7-day 24-h urine value with less bias for the sodium-to-potassium ratio as compared to the common formulas used for estimating the single 24-h urine from the casual urine for sodium and potassium separately. Self-monitoring devices for the urinary sodium-to-potassium ratio measurement makes it possible to provide prompt onsite feedback. Although these devices have been evaluated with a view to support an individual approach for sodium reduction and potassium increase, there has yet to be an accepted recommended guideline for the sodium-to-potassium ratio. This review concludes with a look at the practical use of the sodium-to-potassium ratio for assistance in practical sodium reduction and potassium increase. PMID:28678188

Successful magnesium sulfate tocolysis: is "weaning" the drug necessary?

PubMed

Lewis, D F; Bergstedt, S; Edwards, M S; Burlison, S; Gallaspy, J W; Brooks, G G; Adair, C D

1997-10-01

Magnesium sulfate is the most commonly used tocolytic agent for preterm labor. A common clinical practice is to slowly discontinue the drug (wean) after successful tocolysis. Our objective was to determine the necessity of this practice. A prospective, randomized clinical trial was performed from June 1993 to July 1996. After successful magnesium sulfate tocolysis, patients with preterm labor were randomized to two groups: stopping the drug abruptly (no weaning) or gradually weaning the drug (approximately 1 gm every 4 hours). Preterm labor was defined as documented cervical change with regular uterine contractions or regular uterine contractions with a cervix of 2 cm and 75% effacement. The primary outcome variable was the necessity to reinstitute magnesium sulfate therapy within 24 hours of discontinuation of successful tocolysis. One hundred forty-one patients completed the study. No patient in the no-wean group required retocolysis within 24 hours of magnesium discontinuation. However, eight patients in the wean group required retocolysis within 24 hours of magnesium discontinuation (p = 0.01). Significantly more patients in the wean group had retocolysis during pregnancy (3 vs 12, p = 0.03). Patients in the wean group were also in the labor and delivery unit longer and, as would be anticipated, received magnesium sulfate significantly longer. No differences in the neonatal outcomes were noted between the two groups. Seventy-seven percent of the patients in the study were delivered prematurely. This study demonstrated an increased need for retocolysis in the group weaned from magnesium sulfate. We also found that patients in the wean group had an increased labor and delivery time and a longer administration time of magnesium sulfate. Thus weaning magnesium sulfate increases health care cost. The practice of weaning magnesium sulfate does not appear beneficial.

Impacts Of Climate Change On Ecosystems Management In Africa: An Assessment Of Disaster Risk Management And Adaptation

NASA Astrophysics Data System (ADS)

Ndebele-Murisa, M. R.

2015-12-01

This paper is a synthesis of eight studies which demonstrate the interface between disaster risk management (DRM) and adaptation. The studies; conducted from November 2011 to July 2012 included diverse ecosystems from forests, coastlines, rural areas to a lake region and showed that climate change/variability are major factors among other factors such as deforestation and land degradation, unsustainable land use practices, overharvesting of natural products and invasive species encroachment that are causing changes in ecosystems. The most common extreme events reported included shifts in and shorter rainfall seasons, extended droughts, increased temperatures, extreme heat, heavy rainfall, flooding, inundation, strong winds and sea level rises. As a result of these climate phenomena, adverse impacts on ecosystems and communities were reported as biodiversity loss, reduced fish catch, reduced water for forests/agriculture/consumption, increased rough waves, coastal erosion/sediment deposition and lastly land/mud slides in order of commonality. In response to these impacts communities are practicing coping and adaptation strategies but there is a huge gap between proper DRM and adaptation. This is mainly because the adaptation is practiced as an aftermath with very little effort propelled towards proactive DRM or preparedness. In addition, national level policies are archaic and do not address the current environmental changes. This was demonstrated in Togo where wood energy potential is deteriorating at an unprecedented rate but is projected to increase between 6.4% and 101% in the near and far future if the national forest action plans are implemented; preventing an energy crisis in the country. This shows that appropriate legal and policy frameworks and well planned responses to projected extreme events and climate changes are crucial in order to prevent disasters and to achieve sustainable utilisation of resources in the continent.

How should we teach faculty about research-based teaching?

NASA Astrophysics Data System (ADS)

Olmstead, Alice; Turpen, Chandra; Prather, Edward E.

2015-01-01

Faculty professional development (PD) workshops are the primary mechanism used to increase the adoption and adaptation of research-based instructional strategies (RBIS). PD workshops draw in large numbers of physics and astronomy instructors and can serve a critical role in changing instructional practices within our community. Our research focuses on two of the largest and longest-running PD workshops accessible to faculty: the New Physics and Astronomy Faculty Workshop and the Center for Astronomy Education Tier I Teaching Excellence Workshop. We seek to reveal opportunities to improve these workshops through increased awareness of instructors' experiences and prior knowledge, and increased awareness of how these workshops are designed and implemented.Other studies often assume that instructors have coherent theories of teaching and learning, and conclude that many have wrong ideas that need to be confronted or 'fixed'. Our approach is to first investigate the ideas that instructors have about teaching and learning, and identify what we call their 'potentially productive resources'. This approach is better suited to inform respectful PD efforts that build on instructors' intuitions, and we have analyzed interviews with several young astronomy/physics faculty members who were about to attend these PD workshops to demonstrate how this approach can be applied. The primary findings of our first study are: 1) instructors are trying out practices that show some alignment with common RBIS; 2) instructors' values show alignment with common discipline-based education research goals; and 3) instructors often experience dissatisfaction with specific aspects of their instruction. Taken together our findings are poised to inform changes to existing PD efforts.Our ongoing research focuses on the development of a real-time observation tool to document what happens during workshops and what learning opportunities these PD practices create for participants. We will show the preliminary results of this work.

A Literature Review on the Practice of Placentophagia.

PubMed

Joseph, Rachel; Giovinazzo, Marissa; Brown, Megan

Placentophagia (consuming the placenta) has historically not been a common practice among humans. Over the past few decades the practice has gained attention as more women, particularly educated, middle-class, White American women, choose to partake in this practice. Purported benefits of placentophagia include pain relief, increased breast milk production, and decreased risk of postpartum depression; however, there is a lack of evidence to support these claims. The placenta can be consumed raw, cooked, or encapsulated; it can be used for keepsakes; or it can be used to make topical applications such as dermatologic creams and hair-growth products. Placentophagia has typically been viewed as a personal choice, resulting in little rigorous scientific research on the topic. More research is necessary to determine if the purported health benefits of placentophagia are proven. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

Zones of consensus and zones of conflict: questioning the "common morality" presumption in bioethics.

PubMed

Turner, Leigh

2003-09-01

Many bioethicists assume that morality is in a state of wide reflective equilibrium. According to this model of moral deliberation, public policymaking can build upon a core common morality that is pretheoretical and provides a basis for practical reasoning. Proponents of the common morality approach to moral deliberation make three assumptions that deserve to be viewed with skepticism. First, they commonly assume that there is a universal, transhistorical common morality that can serve as a normative baseline for judging various actions and practices. Second, advocates of the common morality approach assume that the common morality is in a state of relatively stable, ordered, wide reflective equilibrium. Third, casuists, principlists, and other proponents of common morality approaches assume that the common morality can serve as a basis for the specification of particular policies and practical recommendations. These three claims fail to recognize the plural moral traditions that are found in multicultural, multiethnic, multifaith societies such as the United States and Canada. A more realistic recognition of multiple moral traditions in pluralist societies would be considerable more skeptical about the contributions that common morality approaches in bioethics can make to resolving contentious moral issues.

Measures for assessing practice change in medical practitioners

PubMed Central

Hakkennes, Sharon; Green, Sally

2006-01-01

Background There are increasing numbers of randomised trials and systematic reviews examining the efficacy of interventions designed to bring about a change in clinical practice. The findings of this research are being used to guide strategies to increase the uptake of evidence into clinical practice. Knowledge of the outcomes measured by these trials is vital not only for the interpretation and application of the work done to date, but also to inform future research in this expanding area of endeavour and to assist in collation of results in systematic reviews and meta-analyses. Methods The objective of this review was to identify methods used to measure change in the clinical practices of health professionals following an intervention aimed at increasing the uptake of evidence into practice. All published trials included in a recent, comprehensive Health Technology Assessment of interventions to implement clinical practice guidelines and change clinical practice (n = 228) formed the sample for this study. Using a standardised data extraction form, one reviewer (SH), extracted the relevant information from the methods and/or results sections of the trials. Results Measures of a change of health practitioner behaviour were the most common, with 88.8% of trials using these as outcome measures. Measures that assessed change at a patient level, either actual measures of change or surrogate measures of change, were used in 28.8% and 36.7% of studies (respectively). Health practitioners' knowledge and attitudes were assessed in 22.8% of the studies and changes at an organisational level were assessed in 17.6%. Conclusion Most trials of interventions aimed at changing clinical practice measured the effect of the intervention at the level of the practitioner, i.e. did the practitioner change what they do, or has their knowledge of and/or attitude toward that practice changed? Less than one-third of the trials measured, whether or not any change in practice, resulted in a change in the ultimate end-point of patient health status. PMID:17150111

Measures for assessing practice change in medical practitioners.

PubMed

Hakkennes, Sharon; Green, Sally

2006-12-06

There are increasing numbers of randomised trials and systematic reviews examining the efficacy of interventions designed to bring about a change in clinical practice. The findings of this research are being used to guide strategies to increase the uptake of evidence into clinical practice. Knowledge of the outcomes measured by these trials is vital not only for the interpretation and application of the work done to date, but also to inform future research in this expanding area of endeavour and to assist in collation of results in systematic reviews and meta-analyses. The objective of this review was to identify methods used to measure change in the clinical practices of health professionals following an intervention aimed at increasing the uptake of evidence into practice. All published trials included in a recent, comprehensive Health Technology Assessment of interventions to implement clinical practice guidelines and change clinical practice (n = 228) formed the sample for this study. Using a standardised data extraction form, one reviewer (SH), extracted the relevant information from the methods and/or results sections of the trials. Measures of a change of health practitioner behaviour were the most common, with 88.8% of trials using these as outcome measures. Measures that assessed change at a patient level, either actual measures of change or surrogate measures of change, were used in 28.8% and 36.7% of studies (respectively). Health practitioners' knowledge and attitudes were assessed in 22.8% of the studies and changes at an organisational level were assessed in 17.6%. Most trials of interventions aimed at changing clinical practice measured the effect of the intervention at the level of the practitioner, i.e. did the practitioner change what they do, or has their knowledge of and/or attitude toward that practice changed? Less than one-third of the trials measured, whether or not any change in practice, resulted in a change in the ultimate end-point of patient health status.

The TCN/AACN 2010 "salary survey": professional practices, beliefs, and incomes of U.S. neuropsychologists.

PubMed

Sweet, Jerry J; Meyer, Dawn Giuffre; Nelson, Nathaniel W; Moberg, Paul J

2011-01-01

Doctoral-level members of the American Academy of Clinical Neuropsychology, Division 40 (Clinical Neuropsychology) of the American Psychological Association, and the National Academy of Neuropsychology, and other neuropsychologists, were invited to participate in a web-based survey in early 2010. The sample of respondents was 56% larger than a prior related income and practice survey in 2005. The substantial proportional change in gender taking place in the field has continued, with 7 of 10 post-doctoral residents being women and, for the first time ever, more than half of the total sample of respondents being women. Whereas the median age of APA members has been over 50 since the early 1990s, the current median age of clinical neuropsychologists remains at 47 and has remained essentially unchanged since 1989, indicating substantial entrance of young psychologists into the field. The Houston Conference training model has influenced the vast majority of residency training sites, and is endorsed as compatible with prior training by two-thirds of all respondents. Testing assistant usage remains commonplace, and is much more common in institutions. The "flexible battery" approach has again increased in popularity and predominates, whereas endorsement of the "fixed/standardized battery" approach has continued to decline. The vast majority of clinical neuropsychologists work full time. Average length of time reported for evaluations increased significantly from 2005, which does not appear to be explained by changes in common referral sources or common diagnostic conditions being evaluated. The most common factors affecting evaluation length were identified, with the top three being goal of evaluation, stamina/health of examinee, and age of examinee. Pediatric specialists are more likely than others to work part time, more likely to be women, more likely to work in institutions, and report lower incomes than respondents whose professional identity is purely adult or a combination of adult and pediatric. Incomes once again vary considerably by years of clinical practice, work setting, amount of forensic practice, state, and region of country. Job satisfaction has little relationship to income and is comparable across most variables (e.g., work setting, professional identity, amount of forensic activity), whereas income satisfaction has a stronger relationship to actual income, and income satisfaction and job satisfaction are moderately correlated. Job satisfaction of neuropsychologists in general is higher than reported for other US jobs. Fewer than 5% of respondents are considering changing job position. As was true in the 2005 survey, a substantial majority of respondents reported increased incomes over the last 5 years. Actual reported income values were meaningfully higher than in 2005 across general work settings and professional identities, and were also higher for entry-level positions. Numerous breakdowns related to income and professional activities are provided.

Health technology assessment of utilization, practice and ethical issues of self-pay services in the German ambulatory health care setting.

PubMed

Hunger, Theresa; Schnell-Inderst, Petra; Hintringer, Katharina; Schwarzer, Ruth; Seifert-Klauss, Vanadin; Gothe, Holger; Wasem, Jürgen; Siebert, Uwe

2014-02-01

The provision of self-pay medical services is common across health care systems, but understudied. According to the German Medical Association, such services should be medically necessary, recommended or at least justifiable, and requested by the patient. We investigated the empirical evidence regarding frequency and practice of self-pay services as well as related ethical, social, and legal issues (ELSI). A systematic literature search in electronic databases and a structured internet search on stakeholder websites with qualitative and quantitative information synthesis. Of 1,345 references, we included 64 articles. Between 19 and 53 % of insured persons received self-pay service offers from their physician; 16-19 % actively requested such services. Intraocular pressure measurement was the most common service, followed by ultrasound investigations. There is a major discussion about ELSI in the context of individual health services. Self-pay services are common medical procedures in Germany. However, the empirical evidence is limited in quality and extent, even for the most frequently provided services. Transparency of their provision should be increased and independent evidence-based patient information should be supplied.

Driving social impact with common global indicators for healthy lifestyle programs: lessons learned.

PubMed

Robinson, Nicole R; Gin, Julia; Kamath-Jha, Shilpa; Infantes, Michel; Hernandez, Ricardo; Alberg-Seberich, Michael; Suri, Devika; Pérez-Escamilla, Rafael

2014-09-01

Partnerships between corporate entities and non-governmental organizations (NGOs) involved in delivering community focused health and well-being programs are becoming increasingly valuable especially in the context of promoting healthy lifestyles around the globe. The Mondelēz International Foundation (MIF) has funded healthy lifestyles community based programs targeting children and youth through partnership with seven global NGOs. To assess collective impact of these programs, it is crucial to identify best practices and common impact indicators that can be measured across programs. MIF therefore organized the Healthy Lifestyles Evaluation Workshop to explore these pertinent questions. Share best practices and identify common impact indicators to measure the success of current and future MIF funded healthy lifestyles programs. Analysis of the Program Impact Pathways (PIPs) and measured output of each of the seven programs. Individual and combined analysis of PIPs of the seven NGO programs led to identification of three critical impact indicators: nutrition knowledge, physical activity, and healthier eating, and also enabled NGOs to identify pathways to improve program delivery among the target population. This workshop enabled MIF and partner NGOs to came together to align on metrics and future engagement approaches for promoting and evaluating community based healthy lifestyles programs.

Ultrasonographic evaluation of equine fetal growth throughout gestation in normal mares using a convex transducer.

PubMed

Murase, Harutaka; Endo, Yoshiro; Tsuchiya, Takeru; Kotoyori, Yasumitsu; Shikichi, Mitsumori; Ito, Katsumi; Sato, Fumio; Nambo, Yasuo

2014-07-01

It has not been common to perform regular ultrasound examination of the fetus in equine practice, due to the increasing volume of the uterus caused by fetal development. The convex three-dimensional transducer is bulb-shaped and is able to observe wide areas. In addition, its operation is simple, making it easy to create appropriate angles for various indices using a transrectal approach. The aim of this study was to measure Thoroughbred fetal growth indices throughout gestation using a convex transducer and to clarify the detectable period of some indices for clinical use. We demonstrated changes in fetal indices, such as crown rump length (CRL), fetal heart rate (FHR), fetal eye and kidney and the combined thickness of uterus and placenta (CTUP). CTUP increased from 30 weeks of gestation, and FHR peaked at 8 weeks and then decreased to term. CRL could be observed until 13 weeks due to its wide angle, longer than in previous reports. Fetal eye and kidney could be observed from 10 and 28 weeks, respectively, and these increased with pregnancy progress. The present results showed the advantage of transrectal examination using a convex transducer for evaluation of normal fetal development. Although ultrasonographic examination in mid- to late-gestation is not common in equine reproductive practice, our comprehensive results would be a useful basis for equine pregnancy examination.

Educational provision for children with specific speech and language difficulties: perspectives of speech and language therapy service managers.

PubMed

Dockrell, Julie E; Lindsay, Geoff; Letchford, Becky; Mackie, Clare

2006-01-01

Children with specific speech and language difficulties (SSLD) pose a challenge to the education system, and to speech and language therapists who support them, as a result of their language needs and associated educational and social-behavioural difficulties. The development of inclusion raises questions regarding appropriate provision, whether the tradition of language units or full inclusion into mainstream schools. To gather the views of speech and language therapy service managers in England and Wales regarding approaches to service delivery, terminology and decision-making for educational provision, and the use of direct and indirect (consultancy) models of intervention. The study reports on a national survey of speech and language therapy (SLT) services in England and Wales (129 respondents, 72.1% response rate) and interviews with 39 SLT service managers. Provision varied by age group with support to children in the mainstream common from pre-school to the end of Key Stage 2 (up to 11 years), and to those in designated specialist provision, common at Key Stages 1/2 (ages 5-11 years), but less prevalent at Key Stages 3/4 (11-16 years). Decision-making regarding provision was influenced by the lack of common terminology, with SSLD and specific language impairment (SLI) the most common, and criteria, including the use of the discrepancy model for defining SSLD. Practice was influenced by the difficulties in distinguishing children with SSLD from those with autistic spectrum disorder, and difficulties translating policies into practice. The implications of the study are discussed with reference to SLT practice, including consultancy models, and the increasingly prevalent policy in local education authorities of inclusion of children with special educational needs.

USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE IN GEORGIA.

PubMed

Nadareishvili, I; Lunze, K; Tabagari, N; Beraia, A; Pkhakadze, G

2017-11-01

In Georgia, like in most countries globally, people commonly resort to complementary and alternative medicine (CAM). However, not much is known about CAM practices there. The aim of the study was to document common practices of CAM in Georgia and related patient attitudes. We collected data from peoples who commonly use CAM at 20 service provision centers in Georgia using cluster sampling from 300 patients. We admininstered a cross-sectional survey and conducted descriptive statistical analyses. People in Georgia use CAM either for prevention to improve general health (33%) or to treat chronic conditions (36%), spending about 25 Euros per month out of pocket. Most (77%) get their knowledge about CAM from family or friends , less than half (44%) from books or media, and 11% from medical providers. A close person's advice or experience was the most common rationale given for CAM use (54%). In our sample, 17% either don't trust or are unsatisfied with conventional medicine, 29% found CAM treatment "very effective" and 61% "quite/partially" effective; only 5% not effective. Conventional treatment was stopped in half of the cases. 35% of respondents informed their physicians of their CAM use, while about half did not. Public mistrust towards conventional medicine, CAM user high satisfaction, relatively low cost of such services in Georgia - are the factors letting us to suggest that CAM use will further increase. Frequent self taking decisions made by patients to stop physician prescribed treatment, not informing physicians on CAM use, as well as other factors put patients health at risk. Further research and capacity building in practice, education and other related aspects are needed to establish evidence-based regulation and standards for CAM in Georgia that ensure informed decision making and patient safety.

Patient information leaflets: informing or frightening? A focus group study exploring patients' emotional reactions and subsequent behavior towards package leaflets of commonly prescribed medications in family practices.

PubMed

Herber, Oliver Rudolf; Gies, Verena; Schwappach, David; Thürmann, Petra; Wilm, Stefan

2014-10-02

The purpose of patient information leaflets (PILs) is to inform patients about the administration, precautions and potential side effects of their prescribed medication. Despite European Commission guidelines aiming at increasing readability and comprehension of PILs little is known about the potential risk information has on patients. This article explores patients' reactions and subsequent behavior towards risk information conveyed in PILs of commonly prescribed drugs by general practitioners (GPs) for the treatment of Type 2 diabetes, hypertension or hypercholesterolemia; the most frequent cause for consultations in family practices in Germany. We conducted six focus groups comprising 35 patients which were recruited in GP practices. Transcripts were read and coded for themes; categories were created by abstracting data and further refined into a coding framework. Three interrelated categories are presented: (i) The vast amount of side effects and drug interactions commonly described in PILs provoke various emotional reactions in patients which (ii) lead to specific patient behavior of which (iii) consulting the GP for assistance is among the most common. Findings show that current description of potential risk information caused feelings of fear and anxiety in the reader resulting in undesirable behavioral reactions. Future PILs need to convey potential risk information in a language that is less frightening while retaining the information content required to make informed decisions about the prescribed medication. Thus, during the production process greater emphasis needs to be placed on testing the degree of emotional arousal provoked in patients when reading risk information to allow them to undertake a benefit-risk-assessment of their medication that is based on rational rather than emotional (fearful) reactions.

Moral hazard.

PubMed

Chambers, David W

2009-01-01

Civil societies set aside a common pool of resources to help those with whom chance has dealt harshly. Frequently we allow access to these common resources when bad luck is assisted by foolishness and lack of foresight. Sometimes we may even help ourselves to a few of those common assets since others are doing so and they are public goods, the cost of which is shared and has already been paid. Moral hazard is the questionable ethical practice of increasing opportunity for individual gain while shifting risk for loss to the group. Bailout is an example. What makes moral hazard so widespread and difficult to manage is that it is easier for individuals to see their advantage than it is for groups to see theirs. Runaway American healthcare costs can be explained in these terms. Cheating, overtreatment, commercialism, and other moral problems in dentistry can be traced to the interaction between opportunistic individual behavior and permissive group responses common in moral hazard.

Toxic anterior segment syndrome: Update on the most common causes.

PubMed

Bodnar, Zachary; Clouser, Sue; Mamalis, Nick

2012-11-01

To determine how the most common risk factors for toxic anterior segment syndrome (TASS) have evolved over the past decade. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Cross-sectional study. This was a retrospective analysis of surveys from centers reporting cases of TASS from June 1, 2007, through March 1, 2012, and information from visits to afflicted sites between October 1, 2005, and December 31, 2011. Results from June 1, 2009, to March 1, 2012, were compared with those collected before June 1, 2009. The data from 130 questionnaires and 71 site visits were analyzed. The reporting centers performed approximately 69 000 surgeries and reported 1454 cases of TASS. Several trends were noted when comparing the most recent data with previously reported results. There was a 26% reduction in sites reporting inadequate handpiece flushing volumes and a 27% increase in sites using a deionized/distilled final rinse. At sites visited, there was a 36% reduction in the use of preserved epinephrine and a 36% reduction in the use of enzymatic detergents. However, there was a 21% increase in handling of intraocular lenses or instrument tips with gloved hands, a 47% increase in poor instrument maintenance, and a 34% increase in ultrasound bath use without adequate routine cleaning. Education may have improved some instrument-cleaning and perioperative practices that increase the risk for TASS; however, other practices may be headed in an unfavorable direction. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Clinical Practices and Outcomes in Elderly Hemodialysis Patients: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)

PubMed Central

Tong, Lin; Tentori, Francesca; Akiba, Takashi; Karaboyas, Angelo; Gillespie, Brenda; Akizawa, Tadao; Pisoni, Ronald L.; Bommer, Juergen; Port, Friedrich K.

2011-01-01

Summary Background and objectives Demand for hemodialysis among elderly patients is increasing worldwide. Although clinical care of this high-risk group is complex and challenging, no guidelines exist to inform hemodialysis practices. The Dialysis Outcomes and Practice Patterns Study (DOPPS) provides a unique opportunity to assess dialysis practices and associated outcomes among elderly versus younger patients on chronic in-center hemodialysis in 12 countries. Design, setting, participants, & measurements Clinical characteristics, dialysis practices, and outcomes of elderly versus younger patients were compared among participants in four DOPPS regions in 2005 through 2007. Results Although participant mean age increased over time in all DOPPS countries, the percentage of elderly varied widely. Overall, comorbidities and malnutrition were more common in the elderly. Fistulae were used less frequently among elderly versus younger patients in Europe and North America but not in Australia, New Zealand, and Japan. No difference in treatment time was observed between elderly and younger patients after normalizing for body weight. In all regions, ultrafiltration rates were lower among elderly patients. Elderly patients reported poorer quality of life with respect to the physical but not mental component scores. Mortality risk was three- to sixfold higher in the elderly group, whereas causes of death overall were similar for elderly and younger patients. Conclusions Elderly patients represent a different proportion of DOPPS participants across countries, possibly reflecting differences in policies and clinical practices. In general, hemodialysis practices in the elderly reflected each region's clinical patterns, with some variation by age group depending upon the practice. PMID:21734085

Analyzing How Formalist, Cognitive-Processing, and Literacy Practices Learning Paradigms are Shaping the Implementation of the Common Core State Standards

ERIC Educational Resources Information Center

Beach, Richard

2011-01-01

This paper analyzes the influence of three different learning paradigms for learning literacy--formalist, cognitive-processing, and literacy practices--on the implementation of the Common Core State Standards. It argues that the Common Core State Standards are based largely on a formalist paradigm as evident in the emphasis on teaching text…

The private-practice perspective of the manpower crisis in radiology: greener pastures?

PubMed

Swayne, Lawrence C

2004-11-01

Rising consumer expectations and a rapidly aging population point to a long-term shortage of all physicians, including radiologists. While attention has been drawn to the escalating manpower crisis in academic radiology departments, the private-practice perspective has been generally overlooked. Although clinical workloads and income are higher in private practice, studies have shown higher satisfaction levels (likely because of a greater variety of work) among academic radiologists. As the distinction between community and teaching hospitals has become increasingly blurred, there is now considerable overlap in the skill sets, sources of job satisfaction, and stresses that are encountered in both practice settings. Perhaps more than at any time in the recent past, diagnostic radiologists in academic and private practice share more in common than any perceived differences. Both groups must work together in concert with the ACR to address the growing manpower shortage, as well as the other challenges that confront diagnostic radiology at the beginning of the 21st century.

Test-retest reliability and practice effects of the Wechsler Memory Scale-III.

PubMed

Lo, Ada H Y; Humphreys, Michael; Byrne, Gerard J; Pachana, Nancy A

2012-09-01

Although serial administration of cognitive tests is increasingly common, there is a paucity of research on test-retest reliabilities and practice effects, both of which are important for evaluating changes in functioning. Reliability is generally conceptualized as involving short-lasting changes in performance. However, when repeated testing occurs over a period of years, there will be some longer lasting effects. The implications of these longer lasting effects and practice effects on reliability were examined in the context of repeated administrations of the Wechsler Memory Scale-III in 339 community-dwelling women aged 40-79 years over 2 to 7 years. The results showed that Logical Memory and Verbal Paired Associates subtests were consistently the most reliable subtests across the age cohorts. The magnitude of practice effects varied as a function of subtests and age. The largest practice effects were found in the youngest age cohort, especially on the Faces, Logical Memory, and Verbal Paired Associates subtests. ©2012 The British Psychological Society.

Common and conflicting interests in the engagements between conservation organizations and corporations.

PubMed

Robinson, John G

2012-12-01

The conservation community increasingly views the corporate sector as a positive force for conservation. Collaborations between corporations and nongovernmental conservation organizations (NGOs) seek to mitigate the negative effects of corporate activities and augment positive conservation outcomes. I reviewed the establishment of corporate social responsibility (CSR) policies by corporations; the emerging focus on environmental practices and sustainability; and the history of engagement between corporations and nongovernmental organizations. I considered the ethical and reputation vulnerabilities of these collaborations, which depend especially on the financial nature of the relationship and reviewed how CSR approaches have influenced corporate practices. I concluded that whereas CSR practices can act to mitigate negative environmental impact, to date they have had limited positive effect on biodiversity conservation. ©2012 Society for Conservation Biology.

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

Dillon, C.

Over the past few years, numerous Accreditation Bodies, Regulatory Agencies, and State Regulations have implemented requirements for Radiation Safety Surveys following installation or modification to x-ray rooms. The objective of this session is to review best practices in performing radiation safety surveys for both Therapy and Diagnostic installations, as well as a review of appropriate survey instruments. This session will be appropriate for both therapy and imaging physicists who are looking to increase their working knowledge of radiation safety surveys. Learning Objectives: Identify Appropriate Survey Meters for Radiation Safety Surveys Develop best practices for Radiation Safety Surveys for Therapy unitsmore » that include common areas of concern. Develop best practices for Radiation Safety Surveys of Diagnostic and Nuclear Medicine rooms. Identify acceptable dose levels and the factors that affect the calculations associated with performing Radiation Safety Surveys.« less

Globalisation And Local Indigenous Education In Mexico

NASA Astrophysics Data System (ADS)

Reinke, Leanne

2004-11-01

Globalisation is often viewed as a threat to cultural and linguistic diversity and therefore is a central concern of educational practices and policy. The present study challenges this common view by demonstrating that local communities can use global means to support and enhance their specific practices and policies. An historical exploration of education policy in Mexico reveals that there has been a continuing struggle by indigenous peoples to maintain locally relevant modes of teaching. Indigenous peoples have increasingly used technology to maintain their languages and local cultural practices. Such accentuation of the local in a global context is exemplified by the people of Chiapas: They live in subsistence-type communities, yet their recent education movements and appeals to international solidarity (such as in the Zapatista rebellion) have employed computer-aided technologies.

"We Are All for Diversity, but . . .": How Faculty Hiring Committees Reproduce Whiteness and Practical Suggestions for How They Can Change

ERIC Educational Resources Information Center

Sensoy, Özlem; DiAngelo, Robin

2017-01-01

Despite stated commitments to diversity, predominantly White academic institutions still have not increased racial diversity among their faculty. In this article Robin DiAngelo and Özlem Sensoy focus on one entry point for doing so--the faculty hiring process. They analyze a typical faculty hiring scenario and identify the most common practices…

Practice tip. Producing newsletters - criteria for success.

PubMed

Eckermann, Sarah Louise; McIntyre, Ellen; Magarey, Anne

2007-01-01

Newsletters, while informal when compared to peer reviewed journals and organisational reports, are a popular communication tool used to provide and share information, for and about people with a common interest or need. Newsletters are an effective way to build networks and improve communication. As the editors of several newsletters in primary health care, the authors have developed criteria that aim to increase the success of a newsletter.

Initial response to understory plant diversity and overstory tree diameter growth to a green tree retention harvest

Treesearch

Malcolm North; Jiquan Chen; Gordon Smith; Lucy Krakowlak; Jerry Franklin

1996-01-01

The increasing use of harvest techniques other than clearcutting in forests west of the Cascade mountains has created an urgent need to understand the effects of these practices on ecosystem species composition and structure. One common alternative, "green tree retention" (GTR), leaves some live trees on a harvest site to more closely mimic a moderate-...

The Puerto Rico Gap Analysis Project Volume 1: land cover, vertebrate species distributions, and land stewardship

Treesearch

W. A. Gould; C. Alarcon; B. Fevold; M.E. Jimenez; S. Martinuzzi; G. Potts; M. Quinones; M. Solórzano; E. Ventosa

2008-01-01

Puerto Rico faces a number of problems common to much of the world. Population is increasing while land area is not, and there are reassessments of land use policy and practice to accommodate growing populations, shifting economies, and changing public value systems. Puerto Rico shares similarities with the Eastern United States with its history of agricultural...

Finding the Common Ground: Is There a Place for Sustainability Education in VET? A National Vocational Education and Training Research and Evaluation Program Report

ERIC Educational Resources Information Center

Goldney, David; Murphy, Tom; Fien, John; Kent, Jenny

2007-01-01

Society is becoming increasingly aware of the need for education to play a key role in integrating knowledge and understanding about sustainability into practical, vocational skills which can be used in the workplace. Education for sustainability is now a widely accepted concept which seeks to promote and develop sustainability skills and…

Supporting College and University Students with Invisible Disabilities: A Guide for Faculty and Staff Working with Students with Autism, AD/HD, Language Processing Disorders, Anxiety, and Mental Illness

ERIC Educational Resources Information Center

Oslund, Christy

2013-01-01

With increasing numbers of students with invisible disabilities attending college and university, faculty and staff find themselves faced with new challenges. This practical handbook provides lecturers, tutors, disability services, and administrative staff with an overview of the invisible disabilities they may encounter, dispelling common myths…

Student Learning Abroad: What Our Students Are Learning, What They're Not, and What We Can Do about It

ERIC Educational Resources Information Center

Vande Berg, Michael, Ed.; Paige, R. Michael, Ed.; Lou, Kris Hemming, Ed.

2012-01-01

A central purpose of this book is to question the claims commonly made about the educational benefits of study abroad. Traditional metrics of enrollment increases and student self-report, and practices of structural immersion, are being questioned as educators voice growing uncertainty about what students are or are not in fact learning abroad.…

Web-Based versus Paper-Based Data Collection for the Evaluation of Teaching Activity: Empirical Evidence from a Case Study

ERIC Educational Resources Information Center

Lalla, Michele; Ferrari, Davide

2011-01-01

The collection of teaching evaluation questionnaires in the traditional paper-and-pencil format is a costly and time-consuming process and yet it is a common assessment practice in many university systems. Web-based data collection would reduce costs and significantly increase the efficiency of the overall evaluation process in numerous ways.…

How State and Federal Accountability Policies Have Influenced Curriculum and Instruction in Three States: Common Findings from Rhode Island, Illinois, and Washington

ERIC Educational Resources Information Center

Srikantaiah, Deepa

2009-01-01

This report takes an in-depth look at how classroom practices in Rhode Island, Illinois, and Washington State have been influenced by state accountability policies and the No Child Left Behind Act (NCLB). It examines how teachers and administrators have responded to increased accountability and pressure to meet state standards. Drawing from case…

Knowledge, attitude and practice of cervical cancer screening in women visiting a tertiary care hospital of Delhi.

PubMed

Singh, M; Ranjan, R; Das, B; Gupta, K

2014-01-01

Background: Cervical cancer being a major cause of morbidity and mortality in women in developing countries, its awareness is essential. Aim: The aim of this study is to assess the knowledge, attitude and practices of women regarding the basic screening test for detection of cancer cervix. Settings and Design: Population based cross-sectional study. Materials and Methods: Cross-sectional prospective study was conducted. Information from consenting participants (450) was collected using structured questionnaire. Answers were described in terms of knowledge, attitude and practice and their respective adequacy with respect to Papanicolaou (Pap) test, the most common test used for early detection of cervical cancer. Adequacy was compared between the categories of socio demographic and clinical variables. Statistical Analysis: The data collected was analyzed using statistical package (SPSS version 18.0). Adequacy was compared between the categories of the control variables by χ2 test with a 5% significance level. Results: Knowledge, attitude and practices regarding Pap test were adequate in 32.7%, 18.2% and 7.3% of women respectively. Major impediment to adequate practice was lack of request by physician. Knowledge, attitudes and practices were found to increase significantly with increasing age and education. Conclusion: Effective information, education and communication strategies are required to improve the level of awareness of public. Health-care professional should be proactive in imparting knowledge at every opportunity.

Provision of specific dental procedures by general dentists in the National Dental Practice-Based Research Network: questionnaire findings.

PubMed

Gilbert, Gregg H; Gordan, Valeria V; Korelitz, James J; Fellows, Jeffrey L; Meyerowitz, Cyril; Oates, Thomas W; Rindal, D Brad; Gregory, Randall J

2015-01-22

Objectives were to: (1) determine whether and how often general dentists (GDs) provide specific dental procedures; and (2) test the hypothesis that provision is associated with key dentist, practice, and patient characteristics. GDs (n = 2,367) in the United States National Dental Practice-Based Research Network completed an Enrollment Questionnaire that included: (1) dentist; (2) practice; and (3) patient characteristics, and how commonly they provide each of 10 dental procedures. We determined how commonly procedures were provided and tested the hypothesis that provision was substantively related to the three sets of characteristics. Two procedure categories were classified as "uncommon" (orthodontics, periodontal surgery), three were "common" (molar endodontics; implants; non-surgical periodontics), and five were "very common" (restorative; esthetic procedures; extractions; removable prosthetics; non-molar endodontics). Dentist, practice, and patient characteristics were substantively related to procedure provision; several characteristics seemed to have pervasive effects, such as dentist gender, training after dental school, full-time/part-time status, private practice vs. institutional practice, presence of a specialist in the same practice, and insurance status of patients. As a group, GDs provide a comprehensive range of procedures. However, provision by individual dentists is substantively related to certain dentist, practice, and patient characteristics. A large number and broad range of factors seem to influence which procedures GDs provide. This may have implications for how GDs respond to the ever-changing landscape of dental care utilization, patient population demography, scope of practice, delivery models and GDs' evolving role in primary care.

A survey of US dental practices' use of social media.

PubMed

Henry, Rachel K; Molnar, Amy; Henry, Jon C

2012-03-01

Social media is becoming the way for businesses, including health care professionals, to communicate with consumers. The study examines the use of social media by dental practices in the US. An electronic survey was sent to 22,682 dentists in the United States. The survey consisted of questions related to the use of social media in the dental practice. Data was analyzed using descriptive statistics and comparisons were made using a Fisher's exact test. A total of 573 responses were received. Social media was used in 52% of dental practices, the most common being Facebook. The use of social media was most commonly for marketing purposes (91%). Dentists younger than 45 years old were more likely to use social media in their practice than dentists 45 years or older (p > 0.001). Dental practices actively use social media for marketing and communication. Many dentists are unsure how to measure the success of social media in their practice. Additional research is needed to measure the success of social media in a dental practice. Social media is a common way practices market and interact with their patients. There are some difficulties in determining what appropriate content for social media is and how to evaluate the success.

Conflicts of Interest in Sports Medicine.

PubMed

Tucker, Andrew M

2016-04-01

Conflict of interest is common in the practice of medicine, and likely more so in the practice of sports medicine at the highest levels of competition. Two areas where conflict of interest frequently manifest in sports medicine are confidentiality and clinical decision making. Confidentiality can be challenging by the team physician's dual responsibilities to the player-patient and the team. Clinical decision making, traditionally associated with a patient's long term health interests, can be complicated by short term interests rooted in pursuit of winning. These issues are reviewed, hopefully to increase awareness in clinicians who find themselves in these unique situations. Copyright © 2016 Elsevier Inc. All rights reserved.

Using Cardiac Biomarkers in Veterinary Practice.

PubMed

Oyama, Mark A

2015-09-01

Blood-based assays for various cardiac biomarkers can assist in the diagnosis of heart disease in dogs and cats. The two most common markers are cardiac troponin-I and N-terminal pro-B-type natriuretic peptide. Biomarker assays can assist in differentiating cardiac from noncardiac causes of respiratory signs and detection of preclinical cardiomyopathy. Increasingly, studies indicate that cardiac biomarker testing can help assess the risk of morbidity and mortality in animals with heart disease. Usage of cardiac biomarker testing in clinical practice relies on proper patient selection, correct interpretation of test results, and incorporation of biomarker testing into existing diagnostic methods. Copyright © 2015 Elsevier Inc. All rights reserved.

Using cardiac biomarkers in veterinary practice.

PubMed

Oyama, Mark A

2013-11-01

Blood-based assays for various cardiac biomarkers can assist in the diagnosis of heart disease in dogs and cats. The two most common markers are cardiac troponin-I and N-terminal pro-B-type natriuretic peptide. Biomarker assays can assist in differentiating cardiac from noncardiac causes of respiratory signs and detection of preclinical cardiomyopathy. Increasingly, studies indicate that cardiac biomarker testing can help assess the risk of morbidity and mortality in animals with heart disease. Usage of cardiac biomarker testing in clinical practice relies on proper patient selection, correct interpretation of test results, and incorporation of biomarker testing into existing diagnostic methods. Copyright © 2013 Elsevier Inc. All rights reserved.

Using Written Narratives in Public Health Practice: A Creative Writing Perspective

PubMed Central

Kreuter, Matthew W.

2014-01-01

Narratives have become an increasingly common health communication tool in recent years. Vivid, engaging writing can help audiences identify with storytellers and understand health messages, but few public health practitioners are trained to create such stories. A transdisciplinary perspective, informed by both creative writing advice and evidence-based public health practices, can help public health professionals use stories more effectively in their work. This article provides techniques for creating written narratives that communicate health information for chronic disease prevention. We guide public health professionals through the process of soliciting, writing, and revising such stories, and we discuss challenges and potential solutions. PMID:24901794

Oncology of Reptiles: Diseases, Diagnosis, and Treatment.

PubMed

Christman, Jane; Devau, Michael; Wilson-Robles, Heather; Hoppes, Sharman; Rech, Raquel; Russell, Karen E; Heatley, J Jill

2017-01-01

Based on necropsy review, neoplasia in reptiles has a comparable frequency to that of mammals and birds. Reptile neoplasia is now more frequently diagnosed in clinical practice based on increased use of advanced diagnostic techniques and improvements in reptilian husbandry allowing greater longevity of these species. This article reviews the current literature on neoplasia in reptiles, and focuses on advanced diagnostics and therapeutic options for reptilian patientssuffering neoplastic disease. Although most applied clinical reptile oncology is translated from dog and cat oncology, considerations specific to reptilian patients commonly encountered in clinical practice (turtles, tortoises, snakes, and lizards) are presented. Copyright © 2016 Elsevier Inc. All rights reserved.

Power and Control: Contracts and the Patient-Physician Relationship

PubMed Central

Lieber, Sarah R.; Kim, Scotty Y.; Volk, Michael L.

2011-01-01

Contracts with patients have become increasingly common in clinical practice and the medical literature. These include behavioral contracts for managing “difficult patients” 1, opioid contracts2–5, suicide prevention contracts6,7, and healthy living contracts8. Some physician practices have even asked patients to sign contracts promising not to litigate or post defamatory comments on the Internet9. Despite widespread adoption, few have stopped to consider the potential risks and ethical concerns with using these documents. This perspective will describe how patient contracts are ultimately about power and control, and if not used carefully could damage the patient-physician relationship. PMID:22093528

Psychotherapeutic issues with "kinky" clients: clinical problems, yours and theirs.

PubMed

Nichols, Margaret

2006-01-01

People whose sexual repertoire includes BDSM, fetish, or other "kinky" practices have become increasingly visible, on the Internet, in the real world, and in psychotherapists' offices. Unfortunately, the prevailing psychiatric view of BDSM remains a negative one: These sexual practices are usually considered paraphilias, i.e., de facto evidence of pathology. A different, affirming view of BDSM is taken in this paper. After defining BDSM and reviewing common misconceptions, a variety of issues the practitioner will face are described. These include problems of countertransference, of working with people with newly emerging sexual identities, working with spouses and partners, and discriminating between abuse and sexual "play."

Effects of Intertidal Harvest Practices on Levels of Vibrio parahaemolyticus and Vibrio vulnificus Bacteria in Oysters.

PubMed

Jones, J L; Kinsey, T P; Johnson, L W; Porso, R; Friedman, B; Curtis, M; Wesighan, P; Schuster, R; Bowers, J C

2016-08-01

Vibrio parahaemolyticus and Vibrio vulnificus can grow rapidly in shellfish subjected to ambient air conditions, such as during intertidal exposure. In this study, levels of total and pathogenic (tdh(+) and/or trh(+)) V. parahaemolyticus and total V. vulnificus were determined in oysters collected from two study locations where intertidal harvest practices are common. Samples were collected directly off intertidal flats, after exposure (ambient air [Washington State] or refrigerated [New Jersey]), and after reimmersion by natural tidal cycles. Samples were processed using a most-probable-number (MPN) real-time PCR method for total and pathogenic V. parahaemolyticus or V. vulnificus In Washington State, the mean levels of V. parahaemolyticus increased 1.38 log MPN/g following intertidal exposure and dropped 1.41 log MPN/g after reimmersion for 1 day, but the levels were dependent upon the container type utilized. Pathogenic V. parahaemolyticus levels followed a similar trend. However, V. vulnificus levels increased 0.10 log MPN/g during intertidal exposure in Washington but decreased by >1 log MPN/g after reimmersion. In New Jersey, initial levels of all vibrios studied were not significantly altered during the refrigerated sorting and containerizing process. However, there was an increase in levels after the first day of reimmersion by 0.79, 0.72, 0.92, and 0.71 log MPN/g for total, tdh(+) and trh(+) V. parahaemolyticus, and V. vulnificus, respectively. The levels of all targets decreased to those similar to background after a second day of reimmersion. These data indicate that the intertidal harvest and handling practices for oysters that were studied in Washington and New Jersey do not increase the risk of illness from V. parahaemolyticus or V. vulnificus Vibrio parahaemolyticus and Vibrio vulnificus are the leading causes of seafood-associated infectious morbidity and mortality in the United States. Vibrio spp. can grow rapidly in shellfish subjected to ambient air conditions, such as during periods of intertidal exposure. When oysters are submersed with the incoming tide, the vibrios can be purged. However, data on the rates of increase and purging during intertidal harvest are scarce, which limits the accuracy of risk assessments. The objective of this study was to help fill these data gaps by determining the levels of total and pathogenic (tdh(+) and/or trh(+)) V. parahaemolyticus and V. vulnificus in oysters from two locations where intertidal harvest practices are common, using the current industry practices. The data generated provide insight into the responses of Vibrio spp. to relevant practices of the industry and public health, which can be incorporated into risk management decisions. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

Vocal cord paralysis in children.

PubMed

King, Ericka F; Blumin, Joel H

2009-12-01

Vocal fold paralysis (VFP) is an increasingly commonly identified problem in the pediatric patient. Diagnostic and management techniques honed in adult laryngologic practice have been successfully applied to children. Iatrogenic causes, including cardiothoracic procedures, remain a common cause of unilateral VFP. Neurologic disorders predominate in the cause of bilateral VFP. Diagnosis with electromyography is currently being evaluated in children. Treatment of VFP is centered around symptomology, which is commonly divided between voice and airway concerns. Speech therapy shows promise in older children. Surgical management for unilateral VFP with injection laryngoplasty is commonly performed and well tolerated. Laryngeal reinnervation is currently being applied to the pediatric population as a permanent treatment and offers several advantages over laryngeal framework procedures. For bilateral VFP, tracheotomy is still commonly performed. Glottic dilation procedures are performed both openly and endoscopically with a high degree of success. VFP is a well recognized problem in pediatric patients with disordered voice and breathing. Some patients will spontaneously recover their laryngeal function. For those who do not, a variety of reliable techniques are available for rehabilitative treatment.

A waste of time: the problem of common morality in Principles of Biomedical Ethics.

PubMed

Karlsen, Jan Reinert; Solbakk, Jan Helge

2011-10-01

From the 5th edition of Beauchamp and Childress' Principles of Biomedical Ethics, the problem of common morality has been given a more prominent role and emphasis. With the publication of the 6th and latest edition, the authors not only attempt to ground their theory in common morality, but there is also an increased tendency to identify the former with the latter. While this stratagem may give the impression of a more robust, and hence stable, foundation for their theoretical construct, we fear that it comes with a cost, namely the need to keep any theory in medical ethics open to, and thereby aware of, the challenges arising from biomedical research and clinical practice, as well as healthcare systems. By too readily identifying the moral life of common morality with rule-following behaviour, Beauchamp and Childress may even be wrong about the nature of common morality as such, thereby founding their, by now, classic theory on quicksand instead of solid rock.

Everyday Ethics: Ethical Issues and Stress in Nursing Practice

PubMed Central

Ulrich, Connie M.; Taylor, Carol; Soeken, Karen; O'Donnell, Patricia; Farrar, Adrienne; Danis, Marion; Grady, Christine

2010-01-01

Aim This paper is a report of a study of the type, frequency, and level of stress of ethical issues encountered by nurses in their everyday practice. Background Everyday ethical issues in nursing practice attract little attention but can create stress for nurses. Nurses often feel uncomfortable in addressing the ethical issues they encounter in patient care. Methods A self-administered survey was sent in 2004 to 1000 nurses in four states in four different census regions of the United States of America. The adjusted response rate was 52%. Data were analyzed using descriptive statistics, cross-tabulations and Pearson correlations. Results A total of 422 questionnaires were used in the analysis. The five most frequently-occurring and most stressful ethical and patient care issues were protecting patients' rights; autonomy and informed consent to treatment; staffing patterns; advanced care planning; and surrogate decision-making. Other common occurrences were unethical practices of healthcare professionals; breaches of patient confidentiality or right to privacy; and end-of-life decision-making. Younger nurses and those with fewer years of experience encountered ethical issues more frequently and reported higher levels of stress. Nurses from different regions also experienced specific types of ethical problems more commonly. Conclusion Nurses face daily ethical challenges in the provision of quality care. To retain nurses, targeted ethics-related interventions that address caring for an increasingly complex patient population are needed. PMID:20735502

Everyday ethics: ethical issues and stress in nursing practice.

PubMed

Ulrich, Connie M; Taylor, Carol; Soeken, Karen; O'Donnell, Patricia; Farrar, Adrienne; Danis, Marion; Grady, Christine

2010-11-01

This paper is a report of a study of the type, frequency, and level of stress of ethical issues encountered by nurses in their everyday practice. Everyday ethical issues in nursing practice attract little attention but can create stress for nurses. Nurses often feel uncomfortable in addressing the ethical issues they encounter in patient care. A self-administered survey was sent in 2004 to 1000 nurses in four states in four different census regions of the United States of America. The adjusted response rate was 52%. Data were analysed using descriptive statistics, cross-tabulations and Pearson correlations. A total of 422 questionnaires were used in the analysis. The five most frequently occurring and most stressful ethical and patient care issues were protecting patients' rights; autonomy and informed consent to treatment; staffing patterns; advanced care planning; and surrogate decision-making. Other common occurrences were unethical practices of healthcare professionals; breaches of patient confidentiality or right to privacy; and end-of-life decision-making. Younger nurses and those with fewer years of experience encountered ethical issues more frequently and reported higher levels of stress. Nurses from different regions also experienced specific types of ethical problems more commonly. Nurses face daily ethical challenges in the provision of quality care. To retain nurses, targeted ethics-related interventions that address caring for an increasingly complex patient population are needed. © 2010 Blackwell Publishing Ltd.

Dental Emergencies: Management Strategies That Improve Outcomes [Digest].

PubMed

Pedigo, Ryan Anthony; Zaurova, Milana

2017-06-22

Points & Pearls is a digest of Emergency Medicine Practice . Acute dental emergencies are a common chief complaint presenting to emergency departments, and they are increasing substantially in frequency. The diagnosis and management of dental emergencies is a core competency of the emergency clinician, and proper therapeutic strategies can significantly improve cosmetic and functional outcomes for patients. This issue provides a systematic review of the literature on common acute traumatic and atraumatic dental emergencies with a focus on the historical and physical examination findings that must be understood to identify life-threatening infections, relieve pain, salvage natural teeth, and communicate with specialists in the further management of patients after emergency treatment.

Severe anion gap metabolic acidosis from acetaminophen use secondary to 5-oxoproline (pyroglutamic acid) accumulation.

PubMed

Zand, Ladan; Muriithi, Angela; Nelsen, Eric; Franco, Pablo M; Greene, Eddie L; Qian, Qi; El-Zoghby, Ziad M

2012-12-01

Anion gap metabolic acidosis (AGMA) is commonly encountered in medical practice. Acetaminophen-induced AGMA is, however, not widely recognized. We report 2 cases of high anion gap metabolic acidosis secondary to 5-oxoproline accumulation resulting from acetaminophen consumption: the first case caused by acute one-time ingestion of large quantities of acetaminophen and the second case caused by chronic repeated ingestion in a patient with chronic liver disease. Recognition of this entity facilitated timely diagnosis and effective treatment. Given acetaminophen is commonly used over the counter medication, increased recognition of this adverse effect is of important clinical significance.

Treatment of Fungal Urinary Tract Infection.

PubMed

Thomas, Lewis; Tracy, Chad R

2015-11-01

Funguria, and particularly candiduria, is an increasingly common problem encountered by the practicing urologist and is associated with high-acuity care, indwelling catheters, diabetes mellitus, antibiotic and steroid use, and urinary tract disease. In most cases, candiduria is asymptomatic and follows a benign clinical course with antifungal therapy only required in symptomatic or high-risk cases, because spontaneous resolution is common in patients with asymptomatic colonization. Rarely, invasive infections can occur (such as fungus balls or renal abscesses) and may require percutaneous and endoscopic interventions. This article highlights the workup and treatment of funguria and its related urologic manifestations. Copyright © 2015 Elsevier Inc. All rights reserved.

Prevalence of and factors that influence board certification among pharmacy practice faculty at United States colleges and schools of pharmacy.

PubMed

Toussaint, Kimberly A; Watson, Kristin; Marrs, Joel C; Sturpe, Deborah A; Anderson, Sarah L; Haines, Stuart T

2013-01-01

Board certification is a means of demonstrating expertise above the minimum licensing standards. For many health care professionals, this credential is a necessity. As pharmacists become involved in more advanced patient care services, board certification becomes an essential component to ensuring quality care. The prevalence of United States pharmacy practice faculty members who are board certified, however, is unknown. In addition, to our knowledge, factors that serve to motivate or discourage faculty from obtaining board certification have not been previously described; thus, 900 pharmacy practice faculty members listed in the American Association of Colleges of Pharmacy (AACP) online directory were invited to complete an online survey regarding motivators and barriers for board certification. In addition, a list of board-certified pharmacists, obtained from the Board of Pharmacy Specialties, was used to check the board certification status of all pharmacy practice faculty members listed in the AACP directory. In 2011, the prevalence of board certification among the 2867 pharmacy practice faculty members was 37% (1063 pharmacists), with the highest prevalence found among assistant professors (39.4%). A total of 322 faculty members (36% response rate) completed the survey; of these, 308 self-identified as pharmacy practice faculty, and their responses were included in the analysis. Current board certification in pharmacy specialties was reported by 163 respondents (52.9%); 14 (4.5%) were previously certified. Among the 308 respondents, the most common perceived reason why pharmacy practice faculty become board certified was the desire to be recognized as an expert in the field (71.5%). Those who were currently board certified indicated personal growth as the most important reason (60.1%). Those previously certified indicated no perceived benefit as the most common reason for not recertifying (71.4%). Among those never certified, no perceived need (52.0%) or benefit (44.8%) were the most common reasons for not becoming certified; however, a majority of those never certified (68%) stated that they would become board certified if there was no associated cost and they were confident they would pass. To increase the prevalence of board certification in pharmacy practice faculty at U.S. schools and colleges of pharmacy, the benefits of this credential must be addressed at each institution. Steps should be taken to assist and encourage board certification. © 2012 Pharmacotherapy Publications, Inc.

Reaching out to Ebola victims: Coercion, persuasion or an appeal for self-sacrifice?

PubMed

Calain, Philippe; Poncin, Marc

2015-12-01

The 2014-2015 Ebola crisis in West Africa has highlighted the practical limits of upholding human rights and common ethical principles when applying emergency public-health measures. The role of medical teams in the implementation of quarantine and isolation has been equivocal, particularly when such measures are opposed by communities who are coerced by the temporary suspension of civil liberties. In their encounters with Ebola victims, outreach teams face moral dilemmas, where the boundaries are unclear between coercion, persuasion and appeals for self-sacrifice. For those teams, we propose a set of practical recommendations aimed at respecting the autonomy of epidemic victims and easing tensions within communities. We recognize that some of these recommendations are progressively achievable, depending on the specific stage or setting of an outbreak. Yet with the increasing availability of experimental treatments and research interventions, weighing patients' autonomy against the common good will become an even more pressing ethical obligation. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Precision Cardiovascular Medicine: State of Genetic Testing.

PubMed

Giudicessi, John R; Kullo, Iftikhar J; Ackerman, Michael J

2017-04-01

In the 15 years following the release of the first complete human genome sequences, our understanding of rare and common genetic variation as determinants of cardiovascular disease susceptibility, prognosis, and therapeutic response has grown exponentially. As such, the use of genomics to enhance the care of patients with cardiovascular diseases has garnered increased attention from clinicians, researchers, and regulatory agencies eager to realize the promise of precision genomic medicine. However, owing to a large burden of "complex" common diseases, emphasis on evidence-based practice, and a degree of unfamiliarity/discomfort with the language of genomic medicine, the development and implementation of genomics-guided approaches designed to further individualize the clinical management of a variety of cardiovascular disorders remains a challenge. In this review, we detail a practical approach to genetic testing initiation and interpretation as well as review the current state of cardiovascular genetic and pharmacogenomic testing in the context of relevant society and regulatory agency recommendations/guidelines. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

A pseudo-outbreak of skin disease in British troops.

PubMed Central

Croft, A; Smith, H; Creamer, I

1996-01-01

When a newspaper report claimed that a serious outbreak of skin disease had occurred in British Army troops stationed at the Bocac Dam, in western Bosnia, all troops at the Bocac Dam location (n = 96), followed by a matched control group of troops (n = 91) at a nearby location, were examined by two investigators. 14% of the study population and 21% of the control group were found to have skin disorders. Most were complaints that are commonly encountered in general medical practice. There was a striking absence of skin infestations. The historical consultation rate for skin disorders had not increased. It was concluded that an outbreak of skin disease had not occurred in British troops guarding the dam. This epidemiological study shows that, even under conditions of modern field hygiene, up to one in five soldiers will have skin disease. Skin infestations, however, have become progressively less common during military campaigns this century, probably because of better personal hygiene, good preventive medicine practices and better access to effective health care. PMID:8976888

Management of adults with paediatric-onset chronic liver disease: strategic issues for transition care.

PubMed

Vajro, Pietro; Ferrante, Lorenza; Lenta, Selvaggia; Mandato, Claudia; Persico, Marcello

2014-04-01

Advances in the management of children with chronic liver disease have enabled many to survive into adulthood with or without their native livers, so that the most common of these conditions are becoming increasingly common in adult hepatology practice. Because the aetiologies of chronic liver disease in children may vary significantly from those in adulthood, adults with paediatric-onset chronic liver disease may often present with clinical manifestations unfamiliar to their adulthood physician. Transition of medical care to adult practice requires that the adulthood medical staff (primary physicians and subspecialists) have a comprehensive knowledge of childhood liver disease and their implications, and of the differences in caring for these patients. Pending still unavailable Scientific Society guidelines, this article examines causes, presentation modes, evaluation, management, and complications of the main paediatric-onset chronic liver diseases, and discusses key issues to aid in planning a program of transition from paediatric to adult patients. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

PS2-06: Best Practices for Advancing Multi-site Chart Abstraction Research

PubMed Central

Blick, Noelle; Cole, Deanna; King, Colleen; Riordan, Rick; Von Worley, Ann; Yarbro, Patty

2012-01-01

Background/Aims Multi-site chart abstraction studies are becoming increasingly common within the HMORN. Differences in systems among HMORN sites can pose significant obstacles to the success of these studies. It is therefore crucial to standardize abstraction activities by following best practices for multi-site chart abstraction, as consistency of processes across sites will increase efficiencies and enhance data quality. Methods Over the past few months the authors have been meeting to identify obstacles to multi-site chart abstraction and to address ways in which multi-site chart abstraction processes can be systemized and standardized. The aim of this workgroup is to create a best practice guide for multi-site chart abstraction studies. Focus areas include: abstractor training, format for chart abstraction (database, paper, etc), data quality, redaction, mechanism for transferring data, site specific access to medical records, IRB/HIPAA concerns, and budgetary issues. Results The results of the workgroup’s efforts (the best practice guide) will be presented by a panel of experts at the 2012 HMORN conference. The presentation format will also focus on discussion among attendees to elicit further input and to identify areas that need to be further addressed. Subsequently, the best practice guide will be posted on the HMORN website. Discussion The best practice guide for multi-site chart abstraction studies will establish sound guidelines and serve as an aid to researchers embarking on multi-site chart abstraction studies. Efficiencies and data quality will be further enhanced with standardized multi-site chart abstraction practices.

Management practices used by white-tailed deer farms in Pennsylvania and herd health problems.

PubMed

Brooks, Jason W; Jayarao, Bhushan M

2008-01-01

To determine current management practices used by white-tailed deer farms in Pennsylvania and identify animal health problems that exist in these herds. Cross-sectional study. Owners and managers of 233 farms in Pennsylvania that raised white-tailed deer. A self-administered questionnaire was mailed to participants. Herds ranged in size from 1 to 350 deer. Land holdings ranged from 0.07 to 607 hectares (0.17 to 1,500 acres). Stocking density ranged from 0.1 to 118.6 deer/hectare (0.04 to 48 deer/acre). Most (84%) respondents raised deer for breeding or hunting stock; 13% raised deer exclusively as pets or for hobby purposes, and purpose varied by herd size. Multiple associations were identified between management or disease factors and herd size. The use of vaccines, use of veterinary and diagnostic services, use of pasture, and use of artificial insemination increased as herd size increased. The most common conditions in herds of all sizes were respiratory tract disease, diarrhea, parasitism, and sudden death. The prevalence of respiratory tract disease increased as herd size increased. Results suggested that many aspects of herd management for white-tailed deer farms in Pennsylvania were associated with herd size, but that regardless of herd size, many preventive medicine practices were improperly used or underused in many herds.

Preeclampsia Risks in Kidney Donors and Recipients.

PubMed

Shah, Pratik B; Samra, Manpreet; Josephson, Michelle A

2018-06-08

To review the studies and practice guidelines on the preeclampsia risks in kidney donors and recipients. There is a small increased risk of gestational hypertension and preeclampsia in pregnancies that follow kidney donation. Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline (2017) and the 2015 American Society of Transplantation (AST) consensus conference statement recommends counseling kidney donors about this increased risk. There is no observed increase in fetal complications or eclampsia post-kidney donation. Preeclampsia is more commonly observed in kidney transplant recipients than the general population and these patients should be co-managed with an obstetrician with experience in managing high risk pregnancies. Although preeclampsia has not been found to have a deleterious effect on renal graft function, it can cause premature delivery. Risk calculators have been proposed and an elevated pre-pregnancy creatinine seems to be an important risk. KDIGO Clinical Practice Guidelines (2009) recommends attempting pregnancy when kidney function is stable with proteinuria of less than 1 g per day. The use of novel biomarkers for preeclampsia has not been published in this population. Preeclampsia is an important concern for female kidney donors and recipients of child-bearing age. These individuals should be appropriately counseled.

Evaluating The Role Of Payment Policy In Driving Vertical Integration In The Oncology Market.

PubMed

Alpert, Abby; Hsi, Helen; Jacobson, Mireille

2017-04-01

The health care industry has experienced massive consolidation over the past decade. Much of the consolidation has been vertical (with hospitals acquiring physician practices) instead of horizontal (with physician practices or hospitals merging with similar entities). We documented the increase in vertical integration in the market for cancer care in the period 2003-15, finding that the rate of hospital or health system ownership of practices doubled from about 30 percent to about 60 percent. The two most commonly cited explanations for this consolidation are a 2005 Medicare Part B payment reform that dramatically reduced reimbursement for chemotherapy drugs, and the expansion of hospital eligibility for the 340B Drug Discount Program under the Affordable Care Act (ACA). To evaluate the evidence for these explanations, we used difference-in-differences methods to assess whether consolidation increased more in areas with greater exposure to each policy than in areas with less exposure. We found little evidence that either policy contributed to vertical integration. Rather, increased consolidation in the market for cancer care may be part of a broader post-ACA trend toward integrated health care systems. Project HOPE—The People-to-People Health Foundation, Inc.

The Art of Leadership: A Study of Administrative Practices in Florida's Schools of the Arts

ERIC Educational Resources Information Center

Perry, Kevin Gardner

2012-01-01

The purpose of this exploratory study was to identify common practices of school-of-the-arts administrators and to determine if these commonalities differ from the practices of effective school leaders in general. A sample of administrators (n = 92) completed a 3-part Likert survey based on the 21 attributes identified in the balanced leadership…

Does enhancing personal care assistants' own oral health influence their attitudes and practices towards oral care for residents - a pilot study.

PubMed

Knevel, Rjm; Foley, J; Gussy, M; Karimi, L

2016-11-01

To investigate whether, within a residential care facility, increasing personal care assistants' (PCAs) awareness of their own oral health status and self-care skills would alter existing attitudes and behavioural intentions related to the oral health care of residents. PCAs (n = 15) in the dementia care unit of a residential care facility in Melbourne, Australia, were invited to participate in a small research project that appeared to test the effectiveness of a work-place oral health educational programme in enhancing their own oral health whilst masking the actual outcome of interest, namely its effect on PCAs oral healthcare attitudes and practices towards the residents. Post-intervention, the self-reported confidence of the PCAs to identify their personal risk for oral health problems, identifying common oral health conditions and determining the factors contributing to their personal oral health was increased significantly (P < 0.05). Post-intervention, the self-reported confidence of the PCAs to feeling confident to identify factors that could contribute to poor oral health of residents, identify resident's higher risk for poor oral health and feeling confident in identifying common oral health conditions in residents was also increased significantly (P < 0.05). The results of this pilot study show that the educational intervention to increase the personal care assistants' (PCAs) awareness of their own oral health status and self-care skills increased the confidence of the carers to identify oral health risks in the residents, as well as increasing their self-reported confidence in providing oral care to residents. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Burden of oral disease in the Middle East: Opportunities for dental public health.

PubMed

Morgano, S M; Doumit, M; Shammari, K F Al-; Al-Suwayed, A; Al-Suwaidi, A; Debaybo, D; Al-Mubarak, S

2010-06-01

A significant increase in the burden of oral-health related diseases in the Middle East has been observed recently. This increase has been largely the result of poor awareness concerning the importance of oral health and best practices towards achieving good oral hygiene. Contributing factors to this burden include but are not limited to: increased sugar consumption, inadequate oral hygiene practices and a high prevalence of smoking. All these factors are known to have considerable influence on the development of the most common oral diseases, such as dental caries, periodontal diseases, oral precancerous lesions and cancer. Although oral diseases represent a significant burden on the quality of life and healthcare economics of Middle Eastern countries, restorative and preventive dental care have not been given nearly enough attention. The prevention of dental diseases is critical to preserving not only oral health but also to maintaining general well being. This Supplement will address the need for oral disease preventative approaches with the use of epidemiological data, and will focus on the management and prevention of dental caries and periodontal disease, providing practical advice on for the management of plaque biofilm. There is a significant need for increased public awareness and regular surveillance of oral hygiene practices in the Middle East, as well as the complications associated with poor oral hygiene. In addition, development of guidelines, public health awareness programmess and dental community educational programmes are urgently needed. 2010 FDI/World Dental Press.

Unusual increase in reported cases of paratyphoid A fever among travellers returning from Cambodia, January to September 2013.

PubMed

Tourdjman, M; Le Hello, S; Gossner, C; Delmas, G; Tubiana, S; Fabre, L; Kerléguer, A; Tarantola, A; Fruth, A; Friesema, I; Thorstensen Brandal, L; Lawrence, J; Fisher, I; Dufour, M; Weill, F X; de Valk, H

2013-09-26

From January to September 2013, a marked increase in notifications of Salmonella Paratyphi A infections among travellers returning from Cambodia occurred in France. An investigation revealed 35 cases without a common source: 21 in France, five in Germany, three in the Netherlands, one in Norway, one in the United Kingdom, four in New-Zealand. Data suggest an ongoing event that should trigger further investigation. Travellers to Cambodia should observe preventive measures including good personal hygiene and food handling practices.

Critical care nurses' knowledge and practice of delirium assessment.

PubMed

Rowley-Conwy, Gabby

2017-04-13

The aim of this study was to examine perceived barriers to assessment of delirium for critical care nurses, and the impact of education on their knowledge and practice. Delirium is a significant problem in critical care, leading to increased morbidity and mortality. Many authors have found variations in assessment by critical care nurses, but there has been limited analysis of the reasons for this. Education on the topic improves knowledge and practice, but the best approach has not been examined. A questionnaire survey design. A self-reported questionnaire was distributed to critical care nurses (n=31) at a district general hospital. Data were analysed with descriptive statistics. Knowledge and practice were variable, but correlation was seen between nursing band and years of experience with better scores. Any type of education led to significantly improved scores. Several barriers to assessment were found, with the most common being lack of knowledge and difficulty in assessing intubated patients. It is essential to improve practice in delirium assessment and management. Education is vital to improve the knowledge and practice of critical care nurses regarding delirium.

Perceived outcomes of web-based modules designed to enhance athletic trainers' knowledge of evidence-based practice.

PubMed

Welch, Cailee E; Van Lunen, Bonnie L; Hankemeier, Dorice A; Wyant, Aimee L; Mutchler, Jessica M; Pitney, William A; Hays, Danica G

2014-01-01

The release of evidence-based practice (EBP) Web-based learning modules to the membership of the National Athletic Trainers' Association has provided athletic trainers (ATs) the opportunity to enhance their knowledge of the various EBP concepts. Whereas increasing the knowledge of EBP among ATs is important, assessing whether this newfound knowledge is being translated into clinical practice and didactic education is crucial. To explore the effectiveness of an educational intervention regarding EBP on the didactic instruction patterns of athletic training educators and the clinical practice behaviors of clinicians. Qualitative study. Individual telephone interviews. A total of 25 ATs (12 educators, 13 clinicians; experience as an AT = 16.00 ± 9.41 years) were interviewed. We conducted 1 individual telephone interview with each participant. After transcription, the data were analyzed and coded into common themes and categories. Triangulation of the data occurred via the use of multiple researchers and member checking to confirm the accuracy of the data. Participants perceived the EBP Web-based modules to produce numerous outcomes regarding education and clinical practice. These outcomes included perceived knowledge gain among participants, an increase in the importance and scope of EBP, a positive effect on educators' didactic instruction patterns and on instilling value and practice of EBP among students, and an enhanced ability among clinicians to implement EBP within clinical practice. However, some clinicians reported the Web-based modules had no current effect on clinical practice. Although the EBP Web-based modules were successful at enhancing knowledge among ATs, translation of knowledge into the classroom and clinical practice remains limited. Researchers should aim to identify effective strategies to help ATs implement EBP concepts into didactic education and clinical practice.

Perceived Outcomes of Web-Based Modules Designed to Enhance Athletic Trainers' Knowledge of Evidence-Based Practice

PubMed Central

Welch, Cailee E.; Van Lunen, Bonnie L.; Hankemeier, Dorice A.; Wyant, Aimee L.; Mutchler, Jessica M.; Pitney, William A.; Hays, Danica G.

2014-01-01

Context: The release of evidence-based practice (EBP) Web-based learning modules to the membership of the National Athletic Trainers' Association has provided athletic trainers (ATs) the opportunity to enhance their knowledge of the various EBP concepts. Whereas increasing the knowledge of EBP among ATs is important, assessing whether this newfound knowledge is being translated into clinical practice and didactic education is crucial. Objective: To explore the effectiveness of an educational intervention regarding EBP on the didactic instruction patterns of athletic training educators and the clinical practice behaviors of clinicians. Design: Qualitative study. Setting: Individual telephone interviews. Patients or Other Participants: A total of 25 ATs (12 educators, 13 clinicians; experience as an AT = 16.00 ± 9.41 years) were interviewed. Data Collection and Analysis: We conducted 1 individual telephone interview with each participant. After transcription, the data were analyzed and coded into common themes and categories. Triangulation of the data occurred via the use of multiple researchers and member checking to confirm the accuracy of the data. Results: Participants perceived the EBP Web-based modules to produce numerous outcomes regarding education and clinical practice. These outcomes included perceived knowledge gain among participants, an increase in the importance and scope of EBP, a positive effect on educators' didactic instruction patterns and on instilling value and practice of EBP among students, and an enhanced ability among clinicians to implement EBP within clinical practice. However, some clinicians reported the Web-based modules had no current effect on clinical practice. Conclusions: Although the EBP Web-based modules were successful at enhancing knowledge among ATs, translation of knowledge into the classroom and clinical practice remains limited. Researchers should aim to identify effective strategies to help ATs implement EBP concepts into didactic education and clinical practice. PMID:24576306

Exploration of over the counter sales of antibiotics in community pharmacies of Addis Ababa, Ethiopia: pharmacy professionals' perspective.

PubMed

Gebretekle, Gebremedhin Beedemariam; Serbessa, Mirgissa Kaba

2016-01-01

Over the counter sale of antibiotics is a global problem and it is increasingly recognized as a source of antibiotic misuse and is believed to increase treatment costs, adverse effects of treatment and emergence of resistance. The increasing trend of over the counter sale of antibiotics in Ethiopia calls for exploration of why such dispensing is practiced. This study aims to explore reasons for over the counter sale of antibiotics in the community pharmacies of Addis Ababa, Ethiopia. A phenomenological qualitative study was conducted in five randomly selected community pharmacies of Addis Ababa. One pharmacy professional from each pharmacy were interviewed at the spot using semi-structured, open-ended interview checklist. Besides, observation of professionals' dispensing practice was made for at least one hour in the same community pharmacies using an observation checklist. Findings were categorized into specific themes that were developed following the objectives. This was facilitated by use of OpenCode 3.6 software. All participants pointed out that antibiotics were frequently dispensed without prescription and contend that the trend of such dispensing has been increasing. The findings indicated that the nonprescription sales of antibiotics were common for Amoxicillin, Ciprofloxacin and Cotrimoxazole. The poor, less educated and younger groups of the population were reported to frequently request antibiotics without prescription. The main reasons for nonprescription sale of antibiotics by pharmacy professionals were found to be related to pharmacy owner's influence to maximize revenue, customer's pressure, weak regulatory mechanism and professional conflicts of interest. The study shows that nonprescription sale of antibiotics was common practice at least in Addis Ababa. The main reasons for this malpractice were the need to maximize revenue and weak regulatory mechanism. Hence, strong regulatory enforcement and community awareness campaign is called for to limit nonprescription sale of antibiotics.

Associations between motor timing, music practice, and intelligence studied in a large sample of twins.

PubMed

Ullén, Fredrik; Mosing, Miriam A; Madison, Guy

2015-03-01

Music performance depends critically on precise processing of time. A common model behavior in studies of motor timing is isochronous serial interval production (ISIP), that is, hand/finger movements with a regular beat. ISIP accuracy is related to both music practice and intelligence. Here we present a study of these associations in a large twin cohort, demonstrating that the effects of music practice and intelligence on motor timing are additive, with no significant multiplicative (interaction) effect. Furthermore, the association between music practice and motor timing was analyzed with the use of a co-twin control design using intrapair differences. These analyses revealed that the phenotypic association disappeared when all genetic and common environmental factors were controlled. This suggests that the observed association may not reflect a causal effect of music practice on ISIP performance but rather reflect common influences (e.g., genetic effects) on both outcomes. The relevance of these findings for models of practice and expert performance is discussed. © 2014 New York Academy of Sciences.

Radiofrequency energy antenna coupling to common laparoscopic instruments: practical implications.

PubMed

Jones, Edward L; Robinson, Thomas N; McHenry, Jennifer R; Dunn, Christina L; Montero, Paul N; Govekar, Henry R; Stiegmann, Greg V

2012-11-01

Electromagnetic coupling can occur between the monopolar "Bovie" instrument and other laparoscopic instruments without direct contact by a phenomenon termed antenna coupling. The purpose of this study was to determine if, and to what extent, radiofrequency energy couples to other common laparoscopic instruments and to describe practical steps that can minimize the magnitude of antenna coupling. In a laparoscopic simulator, monopolar radiofrequency energy was delivered to an L-hook. The tips of standard, nonelectrical laparoscopic instruments (either an unlit 10 mm telescope or a 5 mm grasper) were placed adjacent to bovine liver tissue and were never in contact with the active electrode. Thermal imaging quantified the change in tissue temperature nearest the tip of the telescope or grasper at the end of a 5 s activation of the active electrode. A 5 s activation (30 watts, coagulation mode, 4 cm separation between instruments) increased tissue temperature compared with baseline adjacent to the grasper tip (2.2 ± 2.2 °C; p = 0.013) and telescope tip (38.2 ± 8.0 °C; p < 0.001). The laparoscopic telescope tip increased tissue temperature more than the laparoscopic grasper tip (p < 0.001). Lowering the generator power from 30 to 15 Watts decreased the heat generated at the telescope tip (38.2 ± 8.0 vs. 13.5 ± 7.5 °C; p < 0.001). Complete separation of the camera/light cords and the active electrode cord decreased the heat generated near the telescope tip compared with parallel bundling of the cords (38.2 ± 8.0 vs. 15.7 ± 11.6 °C; p < 0.001). Commonly used laparoscopic instruments couple monopolar radiofrequency energy without direct contact with the active electrode, a phenomenon that results in heat transfer from a nonelectrically active instrument tip to adjacent tissue. Practical steps to minimize heat transfer resulting from antenna coupling include reducing the monopolar generator power setting and avoiding of parallel bundling of the telescope and active electrode cords.

Obstetric and gynecologic malpractice claims in Saudi Arabia: Incidence and cause.

PubMed

AlDakhil, Lateefa O

2016-05-01

The occurrence of a bad outcome, injury or death of a patient during treatment increases the chance of malpractice litigation, increases legal responsibility and leads to increased fees for malpractice insurance. Physicians practicing obstetrics and gynecology face among the highest risks of malpractice litigation, and such litigation has led to an increase in the practice of defensive medicine and has made this specialty less appealing. Previous clinical data from Saudi Arabia have shown that more malpractice litigation concerns claims in obstetrics and gynecology than claims in any other field of medicine. To identify the main causes of obstetrics and gynecology (OBGYN) professional liability claims in Saudi Arabia to have a better understanding and management of risks. All OBGYN claims opened in Saudi Arabia between 2008 and 2013 were analyzed to identify the most common causes of claims. The results of these claims and the times until a final judgment made were also analyzed. Out of a total of 463 malpractice claims that were closed during the study period, 114 (24.6%) claims were in obstetrics and gynecology, and 92 (80.7%) of these claims concerned complications related to delivery room events. The most common causes of obstetric malpractice litigation were shoulder dystocia (brachial plexus injury) and fetal distress (hypoxic ischemic encephalopathy). Urinary system injury was the most common cause of gynecology cases. Most cases were decided in favor of the defendants with the exception of cases for which maternal and/or fetal death was the cause of litigation; nearly all of those cases were decided against the defendants. Obstetricians face a high risk of malpractice claims in Saudi Arabia, although most claims do not end in payments to plaintiffs. However, the effects of such claims on obstetric care should not be underestimated. Adherence to standards of care and careful documentation may decrease litigation and the number of indefensible malpractice claims. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Bioethics consultation practices and procedures: a survey of a large Canadian community of practice.

PubMed

Greenberg, R A; Anstey, K W; Macri, R; Heesters, A; Bean, S; Zlotnik Shaul, R

2014-06-01

The literature fails to reflect general agreement over the nature of the services and procedures provided by bioethicists, and the training and core competencies this work requires. If bioethicists are to define their activities in a consistent way, it makes sense to look for common ground in shared communities of practice. We report results of a survey of the services and procedures among bioethicists affiliated with the University of Toronto Joint Centre for Bioethics (JCB). This is the largest group of bioethicists working in healthcare organizations in Canada. The results suggest there are many common services and procedures of JCB bioethicists. This survey can serve as a baseline for further exploration of the work of JCB bioethicists. Common practices exist with respect to the domains of practice, individual reporting relationships, service availability within business hours and the education and training of the bioethicist.

The rise in metastasectomy across cancer types over the past decade.

PubMed

Bartlett, Edmund K; Simmons, Kristina D; Wachtel, Heather; Roses, Robert E; Fraker, Douglas L; Kelz, Rachel R; Karakousis, Giorgos C

2015-03-01

Although studies of metastasectomy have been limited primarily to institutional experiences, reports of favorable long-term outcomes have generated increasing interest. In the current study, the authors attempted to define the national practice patterns in metastasectomy for 4 common malignancies with varying responsiveness to systemic therapy. The National (Nationwide) Inpatient Sample was used to estimate the national incidence of metastasectomy for colorectal cancer, lung cancer, breast cancer, and melanoma from 2000 through 2011. Incidence-adjusted rates were determined for liver, lung, brain, small bowel, and adrenal metastasectomies. The average annual percentage change (AAPC) in metastasectomy by cancer type was calculated using joinpoint regression. Colorectal cancer was the most common indication for metastasectomy (87,407 cases; 95% confidence interval [95% CI], 86,307-88,507 cases) followed by lung cancer (58,245 cases; 95% CI, 57,453-59,036 cases), breast cancer (26,271 cases; 95% CI, 25,672-26,870 cases), and melanoma (20,298 cases; 95% CI, 19,897-20,699 cases). Metastasectomy increased significantly for all cancer types over the study period: colorectal cancer (AAPC, 6.83; 95% CI, 5.7-7.9), lung cancer (AAPC, 5.8; 95% CI, 5.1-6.4), breast cancer (AAPC, 5.5; 95% CI, 3.7-7.3), and melanoma (AAPC, 4.03; 95% CI, 2.1-6.0). Despite an increasing number of comorbidities in patients undergoing metastasectomy (P<.05 for each cancer type), inpatient mortality rates after metastasectomy fell for all cancer types, most significantly for colorectal (AAPC, -5.49; 95% CI, -8.2 to -2.7) and lung (AAPC, -6.2; 95% CI, -11.7 to -0.3) cancers. The increasing performance of metastasectomy was largely driven by high-volume institutions, in which patients had a lower mean number of comorbidities (P<.01 for all cancer types) and lower inpatient mortality (P<.01 for all cancers except melanoma). From 2000 through 2011, the performance of metastasectomy increased substantially across common cancer types, notwithstanding various advances in systemic therapies. Metastasectomy was performed more safely, despite increasing patient comorbidity. High-volume institutions appeared to drive practice patterns. © 2014 American Cancer Society.

Professional Experiences of International Medical Graduates Practicing Primary Care in the United States

PubMed Central

Nunez-Smith, Marcella; Bernheim, Susannah May; Berg, David; Gozu, Aysegul; Curry, Leslie Ann

2010-01-01

Background International medical graduates (IMGs) comprise approximately 25% of the US physician workforce, with significant representation in primary care and care of vulnerable populations. Despite the central role of IMGs in the US healthcare system, understanding of their professional experiences is limited. Objective To characterize the professional experiences of non-US born IMGs from limited-resource nations practicing primary care in the US. Design Qualitative study based on in-depth in-person interviews. Participants Purposeful sample of IMGs (n = 25) diverse in country of origin, length of practice in the US, specialty (internal medicine, family medicine and pediatrics), age and gender. Participants were currently practicing primary care physicians in New York, New Jersey or Connecticut. Approach A standardized interview guide was used to explore professional experiences of IMGs. Key Results Four recurrent and unifying themes characterize these experiences: 1) IMGs experience both overt and subtle forms of workplace bias and discrimination; 2) IMGs recognize professional limitations as part of “the deal”; 3) IMGs describe challenges in the transition to the culture and practice of medicine in the US; 4) IMGs bring unique skills and advantages to the workplace. Conclusions Our data reveal that IMGs face workplace challenges throughout their careers. Despite diversity in professional background and demographic characteristics, IMGs in our study reported common experiences in the transition to and practice of medicine in the US. Findings suggest that both workforce and workplace interventions are needed to enable IMG physicians to sustain their essential and growing role in the US healthcare system. Finally, commonalities with experiences of other minority groups within the US healthcare system suggest that optimizing IMGs’ experiences may also improve the experiences of an increasingly diverse healthcare workforce. PMID:20502974

Professional experiences of international medical graduates practicing primary care in the United States.

PubMed

Chen, Peggy Guey-Chi; Nunez-Smith, Marcella; Bernheim, Susannah May; Berg, David; Gozu, Aysegul; Curry, Leslie Ann

2010-09-01

International medical graduates (IMGs) comprise approximately 25% of the US physician workforce, with significant representation in primary care and care of vulnerable populations. Despite the central role of IMGs in the US healthcare system, understanding of their professional experiences is limited. To characterize the professional experiences of non-US born IMGs from limited-resource nations practicing primary care in the US. Qualitative study based on in-depth in-person interviews. Purposeful sample of IMGs (n = 25) diverse in country of origin, length of practice in the US, specialty (internal medicine, family medicine and pediatrics), age and gender. Participants were currently practicing primary care physicians in New York, New Jersey or Connecticut. A standardized interview guide was used to explore professional experiences of IMGs. Four recurrent and unifying themes characterize these experiences: 1) IMGs experience both overt and subtle forms of workplace bias and discrimination; 2) IMGs recognize professional limitations as part of "the deal"; 3) IMGs describe challenges in the transition to the culture and practice of medicine in the US; 4) IMGs bring unique skills and advantages to the workplace. Our data reveal that IMGs face workplace challenges throughout their careers. Despite diversity in professional background and demographic characteristics, IMGs in our study reported common experiences in the transition to and practice of medicine in the US. Findings suggest that both workforce and workplace interventions are needed to enable IMG physicians to sustain their essential and growing role in the US healthcare system. Finally, commonalities with experiences of other minority groups within the US healthcare system suggest that optimizing IMGs' experiences may also improve the experiences of an increasingly diverse healthcare workforce.

Incident reporting in dentistry: Clinical supervisor's awareness, practice and perceived barriers.

PubMed

AlBlaihed, R M; AlSaeed, M I; Abuabat, A A; Ahsan, S H

2017-12-21

The significance of patient safety and risk management in dentistry has surfaced as dental settings bear delicate procedures carried out by teams utilising numerous devices and tools in complex environments. Our aim is to assess awareness, practice, attitude and perceived barriers of reporting incidents amongst dental clinical supervisors working at dental colleges in Riyadh, Saudi Arabia. The objectives are as follows: (i) Determine if correlations exist between socio-demographic data and supervisors' awareness, practice, attitude and perceived barriers. (ii) Identify most common perceived barriers. An online questionnaire was sent to the 450 clinical supervisors working at five dental colleges of Riyadh. The collected data included items assessing the awareness, practice and attitude of reporting students' incidents along with the perceived barriers. A response rate of (60.1% n = 264 of 450) was established. The majority of the respondents (62.9% n = 166) were aware of the incident reporting policy. Yet, only (35.4% n = 93) of them had completed an incident reporting form before. Most of the participants (90.5% n = 239) agreed on the necessity of reporting student's incidents, but only (67.0% n = 177) agreed on the necessity of reporting well-handled incidents. The possible negative relationship with students was the most agreed on barrier to reporting. This study shows that certain demographics of supervisors had significant relationship with their awareness, attitude, perceived barriers and practice. Awareness of the policy and form was linked to the increase in supervisors' practice, although they tend to report verbally rather than in writing. The possible negative relationship with students was the most common perceived barrier. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The Effectiveness of Professional Development Using a Checklist of Common Core State Standards for Mathematical Practice for Designing and Delivering Instruction on Algebra I Achievement

ERIC Educational Resources Information Center

Peretin, Janeen

2014-01-01

This study was designed to determine whether or not the use of focused professional development using a checklist based on the Common Core State Standards Mathematical Practices impacted students' math scores as measured by an assessment that requires the use of the practices. Additionally, the researcher sought to determine whether or not the use…

Hand hygiene practices of veterinary support staff in small animal private practice.

PubMed

Nakamura, R K; Tompkins, E; Braasch, E L; Martinez, J G; Bianco, D

2012-03-01

To evaluate the hand hygiene (HH) practices among veterinary technicians (VT) and veterinary support staff (VSS) in small animal private practice. This was a prospective questionnaire-based study involving 182 VT and VSS from 18 small animal hospitals in the USA. Questions asked included gender, number of animals handled per work shift, frequency of hand washing, reason for not washing more frequently, most common available hand washing agent, education regarding the importance of HH and frequency of ring wearing. Less than half of the respondents [76 of 182 (41·7%)] reported washing their hands regularly between handling patients and 154 of 182 (85·6%) believed they should have washed more frequently. The most commonly employed HH agent was hand soap [154 of 182 (84·6%)] and the most common reason cited for not washing more frequently was being too busy [132 of 182 (72·5%)]. Only 96 of 182 (52·7%) respondents were educated by doctors at their hospital regarding the importance of HH. The HH practices among VT and VSS in small animal private practice is poor. Hand soap was the most commonly employed agent among respondents in this study. Education of VT and VSS regarding the importance of HH requires improvement. © 2012 British Small Animal Veterinary Association.

Traditional Postpartum Practices Among Malaysian Mothers: A Review.

PubMed

Fadzil, Fariza; Shamsuddin, Khadijah; Wan Puteh, Sharifa Ezat

2016-07-01

To briefly describe the postpartum practices among the three major ethnic groups in Malaysia and to identify commonalities in their traditional postpartum beliefs and practices. This narrative review collated information on traditional postpartum practices among Malaysian mothers through a literature search for published research papers on traditional postpartum practices in Malaysia. This review shows that Malaysian mothers have certain postpartum practices that they considered to be important for preventing future ill health. Despite the perceived differences in intra-ethnic postpartum practices, most Malaysian mothers, although from different ethnicities, share similarities in their postpartum regimens and practices in terms of beliefs and adherence to food taboos, use of traditional postpartum massage and traditional herbs, and acknowledgment of the role of older female family members in postpartum care. Health care providers should be aware of multiethnic traditional postpartum practices and use the commonalities in these practices as part of their postpartum care regimen.

Optical coherence tomography: A guide to interpretation of common macular diseases

PubMed Central

Bhende, Muna; Shetty, Sharan; Parthasarathy, Mohana Kuppuswamy; Ramya, S

2018-01-01

Optical coherence tomography is a quick, non invasive and reproducible imaging tool for macular lesions and has become an essential part of retina practice. This review address the common protocols for imaging the macula, basics of image interpretation, features of common macular disorders with clues to differentiate mimickers and an introduction to choroidal imaging. It includes case examples and also a practical algorithm for interpretation. PMID:29283118

[Application of case-based method in genetics and eugenics teaching].

PubMed

Li, Ya-Xuan; Zhao, Xin; Zhang, Fei-Xiong; Hu, Ying-Kao; Yan, Yue-Ming; Cai, Min-Hua; Li, Xiao-Hui

2012-05-01

Genetics and Eugenics is a cross-discipline between genetics and eugenics. It is a common curriculum in many Chinese universities. In order to increase the learning interest, we introduced case teaching method and got a better teaching effect. Based on our teaching practices, we summarized some experiences about this subject. In this article, the main problem of case-based method applied in Genetics and Eugenics teaching was discussed.

Increased Expectations, Widening Gaps, and Opportunities to Engage Students: Extending the Conversation Begun by Cassidy, Ortlieb, and Grote-Garcia

ERIC Educational Resources Information Center

Fisher, Douglas; Frey, Nancy

2016-01-01

The Common Core State Standards (CCSS; National Governors Association [NGA] Center for Best Practices & Council of Chief State School Officers [CCSSO], 2010) are "hot," and authors Douglas Fisher and Nancy Frey think that is the way they should be. In this article they explain why they think that it is worth the time to focus on the…

Using Online Learning for Credit Recovery: Getting Back on Track to Graduation. Promising Practices in Blended and Online Learning Series

ERIC Educational Resources Information Center

Powell, Allison; Roberts, Verena; Patrick, Susan

2015-01-01

Our country has been trying to address the graduation crisis in many ways. We are seeing the impact of the efforts to improve graduation rates over the past twenty years including agreement among states to implement a common cohort-based graduation rate, research-based efforts to improve the transition to 9th grade, increased academic and social…

Outpatient Infection Prevention: A Practical Primer

PubMed Central

Steinkuller, Fozia; Harris, Kristofer; Vigil, Karen J; Ostrosky-Zeichner, Luis

2018-01-01

Abstract As more patients seek care in the outpatient setting, the opportunities for health care–acquired infections and associated outbreaks will increase. Without uptake of core infection prevention and control strategies through formal initiation of infection prevention programs, outbreaks and patient safety issues will surface. This review provides a step-wise approach for implementing an outpatient infection control program, highlighting some of the common pitfalls and high-priority areas. PMID:29740593

Topography- and management-mediated resource gradients maintain rare and common plant diversity around paddy terraces.

PubMed

Uematsu, Yuta; Ushimaru, Atushi

2013-09-01

Examining the causes of interspecific differences in susceptibility to bidirectional land-use changes (land abandonment and use-intensification) is important for understanding the mechanisms of global biodiversity loss in agricultural landscapes. We tested the hypothesis that rare (endangered) plant species prefer wet and oligotrophic areas within topography- and management-mediated resource (soil water content, nutrient, and aboveground biomass) gradients, making them more susceptible to both abandonment and use-intensification of agricultural lands. We demonstrated that topography and management practices generated resource gradients in seminatural grasslands around traditional paddy terraces. Terraced topography and management practices produced a soil moisture gradient within levees and a nutrient gradient within paddy terraces. Both total and rare species diversity increased with soil water content. Total species diversity increased in more eutrophied areas with low aboveground biomass, whereas rare species diversity was high under oligotrophic conditions. Rare and common species were differentially distributed along the human-induced nutrient gradient, with rare species preferring wet, nutrient-poor environments in the agricultural landscapes studied. We suggest that conservation efforts should concentrate on wet, nutrient-poor areas within such landscapes, which can be located easily using land-use and topography maps. This strategy would reduce the costs of finding and conserving rare grassland species in a given agricultural landscape.

Periconception Weight Loss: Common Sense for Mothers, but What about for Babies?

PubMed Central

Barrett, Helen L.; Callaway, Leonie K.; Nitert, Marloes Dekker

2014-01-01

Obesity in the childbearing population is increasingly common. Obesity is associated with increased risk for a number of maternal and neonatal pregnancy complications. Some of these complications, such as gestational diabetes, are risk factors for long-term disease in both mother and baby. While clinical practice guidelines advocate for healthy weight prior to pregnancy, there is not a clear directive for achieving healthy weight before conception. There are known benefits to even moderate weight loss prior to pregnancy, but there are potential adverse effects of restricted nutrition during the periconceptional period. Epidemiological and animal studies point to differences in offspring conceived during a time of maternal nutritional restriction. These include changes in hypothalamic-pituitary-adrenal axis function, body composition, glucose metabolism, and cardiovascular function. The periconceptional period is therefore believed to play an important role in programming offspring physiological function and is sensitive to nutritional insult. This review summarizes the evidence to date for offspring programming as a result of maternal periconception weight loss. Further research is needed in humans to clearly identify benefits and potential risks of losing weight in the months before conceiving. This may then inform us of clinical practice guidelines for optimal approaches to achieving a healthy weight before pregnancy. PMID:24804085

Periconception weight loss: common sense for mothers, but what about for babies?

PubMed

Matusiak, Kristine; Barrett, Helen L; Callaway, Leonie K; Nitert, Marloes Dekker

2014-01-01

Obesity in the childbearing population is increasingly common. Obesity is associated with increased risk for a number of maternal and neonatal pregnancy complications. Some of these complications, such as gestational diabetes, are risk factors for long-term disease in both mother and baby. While clinical practice guidelines advocate for healthy weight prior to pregnancy, there is not a clear directive for achieving healthy weight before conception. There are known benefits to even moderate weight loss prior to pregnancy, but there are potential adverse effects of restricted nutrition during the periconceptional period. Epidemiological and animal studies point to differences in offspring conceived during a time of maternal nutritional restriction. These include changes in hypothalamic-pituitary-adrenal axis function, body composition, glucose metabolism, and cardiovascular function. The periconceptional period is therefore believed to play an important role in programming offspring physiological function and is sensitive to nutritional insult. This review summarizes the evidence to date for offspring programming as a result of maternal periconception weight loss. Further research is needed in humans to clearly identify benefits and potential risks of losing weight in the months before conceiving. This may then inform us of clinical practice guidelines for optimal approaches to achieving a healthy weight before pregnancy.

Serum Bicarbonate in Acute Heart Failure: Relationship to Treatment Strategies and Clinical Outcomes.

PubMed

Cooper, Lauren B; Mentz, Robert J; Gallup, Dianne; Lala, Anuradha; DeVore, Adam D; Vader, Justin M; AbouEzzeddine, Omar F; Bart, Bradley A; Anstrom, Kevin J; Hernandez, Adrian F; Felker, G Michael

2016-09-01

Though commonly noted in clinical practice, it is unknown if decongestion in acute heart failure (AHF) results in increased serum bicarbonate. For 678 AHF patients in the DOSE-AHF, CARRESS-HF, and ROSE-AHF trials, we assessed change in bicarbonate (baseline to 72-96 hours) according to decongestion strategy, and the relationship between bicarbonate change and protocol-defined decongestion. Median baseline bicarbonate was 28 mEq/L. Patients with baseline bicarbonate ≥28 mEq/L had lower ejection fraction, worse renal function and higher N-terminal pro-B-type natriuretic peptide than those with baseline bicarbonate <28 mEq/L. There were no differences in bicarbonate change between treatment groups in DOSE-AHF or ROSE-AHF (all P > .1). In CARRESS-HF, bicarbonate increased with pharmacologic care but decreased with ultrafiltration (median +3.3 vs -0.9 mEq/L, respectively; P < .001). Bicarbonate change was not associated with successful decongestion (P > .2 for all trials). In AHF, serum bicarbonate is most commonly elevated in patients with more severe heart failure. Despite being used in clinical practice as an indicator for decongestion, change in serum bicarbonate was not associated with significant decongestion. Copyright © 2016 Elsevier Inc. All rights reserved.

42 CFR 411.352 - Group practice.

Code of Federal Regulations, 2012 CFR

2012-10-01

... practices under common ownership or control through a physician practice management company, hospital... of whether the member's time in the HPSA is spent in a group practice, clinic, or office setting. (5...

Home Care Pharmacy Practice in Canada: A Cross-Sectional Survey of Services Provided, Remuneration, Barriers, and Facilitators.

PubMed

Houle, Sherilyn; MacKeigan, Linda

2017-01-01

As the population ages, and individuals desire to remain in their homes as long as possible, the need for in-home care is expected to increase. However, pharmacists have rarely been included in studies of in-home care, and little is known about the prevalence or effectiveness of pharmacists' home-based services in Canada. To identify pharmacy practices in Canada that regularly provide in-home patient care and to identify specific services provided, remuneration obtained, and barriers and facilitators influencing the provision of home-based care. A link to a web-based survey was posted in e-newsletters of provincial, territorial, and national pharmacy associations in Canada. In addition, pharmacists known to the researchers as providing in-home clinical services were contacted directly. The survey was open from October to December 2015. Practices or organizations that performed at least one home visit per week for clinical purposes, with documentation of the services provided, were eligible to participate. One response per practice or organization was allowed. Seventeen practices meeting the inclusion criteria were identified, representing community, hospital, and clinic settings. Home visits were most commonly performed for individuals with complex medication regimens or nonadherence to medication therapy. The most common services were conducting medication reconciliation and reviews and counselling patients about medication adherence. No practices or organizations billed patients for these services, yet lack of remuneration was an important barrier identified by many respondents. Although 12 (71%) of the respondents collected data for evaluative purposes, collection of clinical or health system outcome data was rare. Few Canadian pharmacy practices that provide in-home patient care at least once a week could be identified. Data collection suitable to establish an evidence base for this service was infrequently performed by practices and organizations providing home-based care. Such evidence is needed to justify the expansion of this service nationally, including consistent and adequate remuneration from governments or other payers.

Advancing Evidence-Based Practice in Physical Therapy Settings: Multinational Perspectives on Implementation Strategies and Interventions.

PubMed

Bernhardsson, Susanne; Lynch, Elizabeth; Dizon, Janine Margarita; Fernandes, Jasmin; Gonzalez-Suarez, Consuelo; Lizarondo, Lucylynn; Luker, Julie; Wiles, Louise; Grimmer, Karen

2017-01-01

It is of critical importance that findings from the wealth of clinical physical therapist research are transferred into clinical practice without unnecessary delays. There is a lack of knowledge about strategies that can be used to effectively implement physical therapist research findings and evidence-based practice (EBP) into everyday clinical practice in different national settings and contexts. The purpose of this article is to contribute to knowledge about effective strategies for implementing EBP that have been studied in different national physical therapy settings. The specific aims of this article are to share experiences and provide a current multinational perspective on different approaches and strategies for implementing EBP and to highlight important considerations and implications for both research and practice. Six research studies from various settings in 3 countries are described and synthesized. Key characteristics of the studies and intervention components are tabulated and mapped to the Cochrane Effective Practice and Organisation of Care taxonomy. Commonalities and differences are presented. The implementation strategies described were: a theory-based guideline implementation tailored to identified barriers and facilitators; a multifaceted EBP training package; journal clubs; a multifaceted strategy comprising contextualized procedures, protocols, and standardized resources; barrier identification, education, audit, feedback, and reminders; and contextualized guidelines. Commonalities were the use of a multifaceted approach, educational measures, and clinical guidelines. Key outcomes across the studies were improved attitudes and increased awareness, knowledge, skills, and confidence in EBP; better access to clinical practice guidelines and other EBP resources; identification of barriers that could be targeted in future implementation activities; earlier referrals; and use of recommended outcome measures. The article can serve as a template for other physical therapist researchers in designing implementation studies, as well as to inform policies and practice for health care managers and decision makers who are looking for ways to implement research findings in their organizations. © 2017 American Physical Therapy Association.

The Effect of Offloading Heels on Sacral Pressure.

PubMed

Al-Majid, Sadeeka; Vuncanon, Barbara; Carlson, Nika; Rakovski, Cyril

2017-09-01

Offloading a patient's heels during supine surgical procedures is a common practice to prevent heel pressure injuries. This practice may increase sacral pressure and jeopardize sacral skin integrity, but prophylactic dressings may help protect sacral skin. The purpose of this study was to examine the effects of offloading the heels and of multilayered silicone foam dressings on sacral pressure. We measured the sacral pressure of 50 healthy volunteers using a pressure-mapping system under four conditions: heels not offloaded and sacral dressing applied, heels offloaded and dressing applied, heels not offloaded and no dressing, and heels offloaded and no dressing. We used linear mixed-effects modeling to compare the effects of these conditions on sacral pressure. Offloading the heels significantly increased sacral pressure (P < .001), whereas the dressing had no effect on sacral pressure (P = .49). Offloading a patient's heels may increase the risk of sacral pressure injuries. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Role of solute-transport models in the analysis of groundwater salinity problems in agricultural areas

USGS Publications Warehouse

Konikow, Leonard F.

1981-01-01

Undesirable salinity increases occur in both groundwater and surface water and are commonly related to agricultural practices. Groundwater recharge from precipitation or irrigation will transport and disperse residual salts concentrated by evapotranspiration, salts leached from soil and aquifer materials, as well as some dissolved fertilizers and pesticides. Where stream salinity is affected by agricultural practices, the increases in salt load usually are attributable mostly to a groundwater component of flow. Thus, efforts to predict, manage, or control stream salinity increases should consider the role of groundwater in salt transport. Two examples of groundwater salinity problems in Colorado, U.S.A., illustrate that a model which simulates accurately the transport and dispersion of solutes in flowing groundwater can be (1) a valuable investigative tool to help understand the processes and parameters controlling the movement and fate of the salt, and (2) a valuable management tool for predicting responses and optimizing the development and use of the total water resource. ?? 1981.

[Sports, use of performance enhancing drugs and addiction. A conceptual and epidemiological review].

PubMed

Franques, P; Auriacombe, M; Tignol, J

2001-11-01

Both the general public and non-sports medicine health professionals have recently been made aware of a large use of performance enhancing drugs among sports practicing subjects. It has been suggested that this behavior is similar to that of substance dependence. Also some have reported that practice of a sport could be in itself an addictive behavior. The main objective was to address the following question: is performance enhancing drug use in sports an addictive behavior? Methodology. We first reviewed the definition of performance enhancing drug use in sports and the diagnostic criteria of substance dependence as they are currently accepted and attempted to determine a possible common factor. Secondly we reviewed epidemiological data from the literature according to three approaches: Use of performance enhancing drugs is an important and increasing phenomenon among adolescents. It is sometimes associated to risk taking behaviors for health (syringe use and sharing). Competition participants are at increased risk (up to 20% according to some authors) and some substances (anabolic steroids) are also used by non-sports practicing individuals. It has not been shown that sports practicing subjects were more at risk of using addictive substances compared to non-sports practicing subjects. It is not established that practice of a sport is by itself a risk factor for substance use. However, it could be that a sub-group of individuals that practice certain types of sports in an intensive way, that use both performance enhancing drugs and addictive substances and that engage in health risk taking behaviors have an increased risk for developing a dependence syndrome to both addictive and performance enhancing drugs. This sub-group is even more at risk because some performance enhancing drugs (anabolic steroids) could increase the risk for occurrence of a substance dependence syndrome through neurobiological actions. Yet, the few available clinical studies show that at most only half of regular users actually meet criteria for dependence. Also, one study has reported an overrepresentation of sports professionals among patients seeking treatment for heroin addiction. The large majority of sports practicing subjects have no dependence to either performance enhancing or addictive drugs. However, a subgroup of individuals that practice sports intensely and makes use of both addictive and performance enhancing drugs appear to be at increased risk for developing a substance dependence syndrome.

International practices in the provision of teratology information: a survey of international teratogen information programmes and comparisons with the North American model.

PubMed

Hancock, Rebecca L; Ungar, Wendy J; Einarson, Adrienne; Koren, Gideon

2010-10-01

Teratology Information Services (TIS) provide health care professionals and the public with information regarding the safety and/or risk of exposures during pregnancy and lactation, mainly via telephone consultations. An international comparison of clinical practices at TIS has never been conducted. The survey objective was to compare international TIS to North American TIS, with an aim to identify strengths and challenges that can lead to service improvement. Twenty-two international TIS were approached for participation during an international conference. TIS were surveyed on information in six categories: services, staffing, operations, data collection, knowledge transfer activities and additional information. Data were summarized using descriptive statistics. Statistical tests were conducted using SPSS®. Sixteen TIS from 12 countries participated. Survey results were compared with previously reported results from a similar survey of North American TIS (16 US, two Canadian). TIS exist in a variety of departments and settings, but most commonly are in university hospitals. Pregnant women were the most commonly counselled group worldwide. International TIS spent significantly more time fielding inquiries regarding medications, while North American TIS had a wider variety of inquiry categories. All TIS could improve budget tracking. Overall, service practices and goals were similar, although international TIS conducted more follow-up with service users than North American TIS. This report offers TIS the first ever opportunity to compare practices. Increased dialogue between TIS encourages sharing of best practices and improves the ability of these important public health programmes to support women and health care providers. © 2010 Blackwell Publishing Ltd.

A regional teaching fellow community of practice.

PubMed

Little, David; Butcher, Katrina; Atkinson, Simon; Still, Duncan; Vasant, Julia

2014-12-01

Increasing numbers of clinical teaching fellows are responsible for a significant proportion of undergraduate teaching nationally. Developing a regional community of practice can help overcome the isolation of these posts, with potential benefits for all involved. A community of practice relies on the mutual engagement of people in a similar situation working towards a common goal. Working together and sharing resources enables teaching fellows to make the most of their post, which ultimately benefits those that they are teaching. We developed a regional clinical teaching fellow community of practice in Bristol in 2010/11. Our community has continued to develop since completing our posts as clinical teaching fellows, and has provided a platform for new communities to develop amongst the groups of subsequent teaching fellows coming through. We encourage all regions who have clinical teaching fellows to develop a regional community of practice We encourage all regions who have clinical teaching fellows to develop a regional community of practice. We also encourage trainees to join TASME (Trainees in the Association for the Study of Medical Education), a new national community of practice for trainees involved in medical education. © 2014 John Wiley & Sons Ltd.

Traditional Practices of Mothers in the Postpartum Period: Evidence from Turkey.

PubMed

Altuntuğ, Kamile; Anık, Yeşim; Ege, Emel

2018-03-01

In various cultures, the postpartum period is a sensitive time and various traditional practices are applied to protect the health of the mother and the baby. The aim of this study was to determine traditional practices of mother care in the postpartum period in Konya City of Turkey. The research was a descriptive, cross-sectional study carried out among 291 women at the first 8 weeks of postpartum period who visited to family health centers from June 1 to December 1, 2015. The data were collected using questionnaires. Statistical analysis of the data was done with SSPS version 22.0. Descriptive statistics were used to analyze the data. Based on the results, 84.5% of women applied a traditional mother care practice during the postpartum period. The most popular, were practices for increasing of breast milk (97.9%), preventing incubus "albasması" (81.8%), getting rid of incubus (74.9%), and preventing postpartum bleeding (14.1%).The findings of the study show that traditional practices towards mother care in the period after birth are common. In order to provide better health services, it is important for health professionals to understand the traditional beliefs and practices of the individuals, families, and society that they serve.

Ethical considerations in aesthetic rhinoplasty: a survey, critical analysis, and review.

PubMed

Karimi, Kian; McKneally, Martin F; Adamson, Peter A

2012-11-01

Although the practice of medicine is built on a foundation of ethics, science, and common sense, the increasing complexity of medical interventions, social interactions, and societal norms of behavior challenges the ethical practice of aesthetic surgeons. We report a survey of the opinions, practices, and attitudes of experienced and novice facial plastic surgeons. The survey consisted of 15 clinical vignettes addressing ethical quandaries in aesthetic rhinoplasty. The vignettes are based on the experience and observations of the senior author (P.A.A.) over nearly 30 years of practice and teaching. Fellowship directors and facial plastic surgery fellows of the American Academy of Facial Plastic and Reconstructive Surgery were surveyed anonymously. Five of the 15 vignettes demonstrated significant differences between the responses of the fellowship directors and the fellows. No single vignette had a unanimous consensus in either group. Aesthetic rhinoplasty surgeons encounter ethical issues that should be reflected on by both experienced and inexperienced facial plastic surgeons, preferably before being faced with them in practice. We present a practical approach to ethical issues in clinical practice. Our survey can also be used as a stimulus for further discussion and teaching.

God: Do I have your attention?

PubMed

Colzato, Lorenza S; van Beest, Ilja; van den Wildenberg, Wery P M; Scorolli, Claudia; Dorchin, Shirley; Meiran, Nachshon; Borghi, Anna M; Hommel, Bernhard

2010-10-01

Religion is commonly defined as a set of rules, developed as part of a culture. Here we provide evidence that practice in following these rules systematically changes the way people attend to visual stimuli, as indicated by the individual sizes of the global precedence effect (better performance to global than to local features). We show that this effect is significantly reduced in Calvinism, a religion emphasizing individual responsibility, and increased in Catholicism and Judaism, religions emphasizing social solidarity. We also show that this effect is long-lasting (still affecting baptized atheists) and that its size systematically varies as a function of the amount and strictness of religious practices. These findings suggest that religious practice induces particular cognitive-control styles that induce chronic, directional biases in the control of visual attention. Copyright 2010 Elsevier B.V. All rights reserved.

Supporting chronic disease self-management: translating policies and principles into clinical practice.

PubMed

Higgins, Rosemary; Murphy, Barbara; Worcester, Marian; Daffey, Angela

2012-01-01

To support self-management, health professionals need to adopt a client-centred approach and learn to deliver evidence-based behaviour change interventions. This paper reports on the evaluation of 1- and 2-day training programs developed to improve health professionals' capacity to support chronic disease self-management (CDSM). The 321 participants attended one of eighteen supporting CDSM courses held in urban and rural settings. Participants included nurses, allied health professionals, Aboriginal health workers and general practitioners. Data were collected at three time points: before participation; immediately after the training; and, for a sub-sample of 37 participants, 2 months after the training. Results revealed a significant and sustained increase in CDSM self-efficacy following training regardless of participants' gender, age or qualifications. A thematic analysis of the responses concerning intended practice revealed four main areas of intended practice change, namely: use behavioural strategies; improve communication with clients; adopt a client-centred approach; and improve goal setting. The number of practice changes at 2 months reported by a sub-sample of participants ranged from 1 to 20 with a mean of 14 (s.d.=4). The three most common areas of practice change point to the adoption by health professionals of a collaborative approach with chronic disease patients. Lack of staff trained in CDSM was seen as a major barrier to practice change, with lack of support and finance also named as barriers to practice change. Participants identified that increased training, support and awareness of the principles of supporting CDSM would help to overcome barriers to practice change. These results indicate a readiness among health professionals to adopt a more collaborative approach given the skills and the tools to put this approach into practice.

Common Practice Lightning Strike Protection Characterization Technique to Quantify Damage Mechanisms on Composite Substrates

NASA Technical Reports Server (NTRS)

Szatkowski, George N.; Dudley, Kenneth L.; Koppen, Sandra V.; Ely, Jay J.; Nguyen, Truong X.; Ticatch, Larry A.; Mielnik, John J.; Mcneill, Patrick A.

2013-01-01

To support FAA certification airworthiness standards, composite substrates are subjected to lightning direct-effect electrical waveforms to determine performance characteristics of the lightning strike protection (LSP) conductive layers used to protect composite substrates. Test results collected from independent LSP studies are often incomparable due to variability in test procedures & applied practices at different organizations, which impairs performance correlations between different LSP data sets. Under a NASA supported contract, The Boeing Company developed technical procedures and documentation as guidance in order to facilitate a test method for conducting universal common practice lightning strike protection test procedures. The procedures obtain conformity in future lightning strike protection evaluations to allow meaningful performance correlations across data sets. This universal common practice guidance provides the manufacturing specifications to fabricate carbon fiber reinforced plastic (CFRP) test panels, including finish, grounding configuration, and acceptable methods for pretest nondestructive inspection (NDI) and posttest destructive inspection. The test operations guidance elaborates on the provisions contained in SAE ARP5416 to address inconsistencies in the generation of damage protection performance data, so as to provide for maximum achievable correlation across capable lab facilities. In addition, the guidance details a direct effects test bed design to aid in quantification of the multi-physical phenomena surrounding a lightning direct attachment supporting validation data requirements for the development of predictive computational modeling. The lightning test bed is designed to accommodate a repeatable installation procedure to secure the test panel and eliminate test installation uncertainty. It also facilitates a means to capture the electrical waveform parameters in 2 dimensions, along with the mechanical displacement and thermal heating parameters which occur during lightning attachment. Following guidance defined in the universal common practice LSP test documents, protected and unprotected CFRP panels were evaluated at 20, 40 and 100KAmps. This report presents analyzed data demonstrating the scientific usefulness of the common practice approach. Descriptions of the common practice CFRP test articles, LSP test bed fixture, and monitoring techniques to capture the electrical, mechanical and thermal parameters during lightning attachment are presented here. Two methods of measuring the electrical currents were evaluated, inductive current probes and a newly developed fiberoptic sensor. Two mechanical displacement methods were also examined, optical laser measurement sensors and a digital imaging correlation camera system. Recommendations are provided to help users implement the common practice test approach and obtain LSP test characterizations comparable across data sets.

'It's Fast, It's Quick, It Stops Me Being Sick': How to influence preparation of opioid tablets for injection.

PubMed

Lafferty, Lise; Treloar, Carla; van Breda, Nick; Steele, Maureen; Hiley, Sarah; Flaherty, Ian; Salmon, Allison

2017-09-01

Injection of pharmaceutical opioids (PO) among people who inject drugs has increased in many countries. The common method for preparing PO tablets for injection uses heat, resulting in greater particulate matter and therefore increased risk of local infection risk and damage to veins and organs. A cold preparation process has fewer risks, but this preparation method is not commonly used. This study seeks to explore how people who inject PO learn to prepare injections and how health promotion efforts could influence practice. Between March and December 2013, qualitative interviews were undertaken with 33 clients of Sydney's Medically Supervised Injecting Centre who inject PO tablets regarding sources of knowledge and current preparation methods for injection of POs. Overwhelmingly, the most commonly reported source of knowledge around injection of tablets was others who inject. Most participants reported heating the solution as the quickest way to administer the drug. Attitudes to the use of wheel filters varied, with some participants reporting that they would use the filters if they were shown how, while others reported a number of barriers to using filters, including complexity of use. Harnessing the power of social connections may provide avenues for education about safer injecting of tablets, including the use of wheel filters. Further work is required to debunk myths about the relative potencies of cold versus hot drug solution. Collaborations between harm reduction workers and peer workers would assist in knowledge dissemination regarding safer injecting practices. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Self-Rated Health in Healthy Adults and Susceptibility to the Common Cold.

PubMed

Cohen, Sheldon; Janicki-Deverts, Denise; Doyle, William J

2015-01-01

To explore the association of self-rated health (SRH) with host resistance to illness after exposure to a common cold virus and identify mechanisms linking SRH to future health status. We analyzed archival data from 360 healthy adults (mean [standard deviation] age = 33.07 [10.69] years, 45.6% women). Each person completed validated questionnaires that assessed SRH (excellent, very good, good, fair, poor), socioemotional factors, and health practices and was subsequently exposed to a common cold virus and monitored for 5 days for clinical illness (infection and objective signs of illness). Poorer SRH was associated in a graded fashion with greater susceptibility to developing clinical illness (good/fair versus excellent: odds ratio = 3.21, 95% confidence interval = 1.47-6.99; very good versus excellent: odds ratio = 2.60, 95% confidence interval = 1.27-5.32), independent of age, sex, race, prechallenge immunity (specific antibody), body mass, season, education, and income. Greater illness risk was not attributable to infection, but to increased likelihood of developing objective signs of illness once infected. Poorer SRH also correlated with poorer health practices, increased stress, lower positive emotions, and other socioemotional factors. However, none of these (alone or together) accounted for the association between SRH and host resistance. Additional data (separate study) indicated that history of having colds was unrelated to susceptibility and hence also did not account for the SRH link with immunocompetence. Poorer SRH is associated with poorer immunocompetence, possibly reflecting sensitivity to sensations associated with premorbid immune dysfunction. In turn, poorer immune function may be a major contributing mechanism linking SRH to future health.

Gastrointestinal temperature trends in football linemen during physical exertion under heat stress.

PubMed

Coris, Eric E; Mehra, Shabnam; Walz, Stephen M; Duncanson, Robert; Jennings, Jason; Nugent, Dylan; Zwygart, Kira; Pescasio, Michele

2009-06-01

Exertional heat stroke is the third leading cause of death in US athletes. Elevations in core temperature in the digestive tract (TGI) have correlated with core temperature and are possible indicators of those at increased risk of heat stroke. The primary objective was to compare a.m. vs. p.m. TGI variation in collegiate football linemen during intense "two-a-day" preseason practice. A secondary objective was to compare longitudinal TGI in offensive and defensive linemen. Cross-sectional observational study. Division I Intercollegiate Athletics Football Program. TGI was monitored during consecutive preseason sessions. TGI, heat illness, weight changes, environmental stress, and subjective symptoms. Mean TGI were 37.8°C and 38.3°C during a.m. and p.m. practices, respectively. The a.m. practices revealed higher TGI gain (1.8°C) compared to p.m. (1.4°C). The p.m. practices had higher maximum TGI than a.m. practices (39.1°C versus 38.8, P=0.0001). Mean time to maximum temperature (Tmax) was 1 hr and 30 min for a.m. and 1 hr and 22 min for p.m. practices. Offensive linemen trended toward higher mean TGI than defensive players (38.0°C vs. 36.7°C, P = 0.069). The rate of rise in TGI was significantly greater in a.m. practices. A decrease in rate of TGI rise was seen from the first to last a.m. practices of the week (P = 0.004). Significant TGI elevations in asymptomatic athletes are common in extreme heat during football practice. Intense a.m. practices in full gear result in higher net temperature gain and rate of temperature gain than p.m. practices. Offensive linemen trended toward higher TGI than defensive linemen. As players acclimatized, a decrease in the rate of TGI increase was appreciable, particularly in a.m. practices. Appreciating cumulative heat stress and variations in heat stress related to scheduling of practice is critical.

Rainwater harvesting in the United States: a survey of common system practices

EPA Science Inventory

Rainwater harvesting (RWH) systems in the United States vary in terms of design and operation. To better understand common practices in the RWH community and motivation for collecting harvested rainwater, an electronic survey was used to poll members of the American Rainwater Cat...

Stream ecosystem integrity is impaired by logging and shifting agriculture in a global megadiversity center (Sarawak, Borneo).

PubMed

Jinggut, Tajang; Yule, Catherine M; Boyero, Luz

2012-10-15

In common with most of Borneo, the Bakun region of Sarawak is currently subject to heavy deforestation mainly due to logging and, to a lesser extent, traditional slash-and-burn farming practices. This has the potential to affect stream ecosystems, which are integrators of environmental change in the surrounding terrestrial landscape. This study evaluated the effects of both types of deforestation by using functional and structural indicators (leaf litter decomposition rates and associated detritivores or 'shredders', respectively) to compare a fundamental ecosystem process, leaf litter decomposition, within logged, farmed and pristine streams. Slash-and-burn agricultural practices increased the overall rate of decomposition despite a decrease in shredder species richness (but not shredder abundance) due to increased microbial decomposition. In contrast, decomposition by microbes and invertebrates was slowed down in the logged streams, where shredders were less abundant and less species rich. This study suggests that shredder communities are less affected by traditional agricultural farming practices, while modern mechanized deforestation has an adverse effect on both shredder communities and leaf breakdown. Copyright © 2012 Elsevier B.V. All rights reserved.

A patient-focused framework integrating self-management and informatics.

PubMed

Knight, Elizabeth P; Shea, Kimberly

2014-03-01

This article introduces a framework to (a) guide chronic illness self-management interventions through the integration of self-management and nursing informatics, (b) focus self-management research, and (c) promote ethical, patient-empowering technology use by practicing nurses. Existing theory and research focusing on chronic illness, self-management, health-enabling technology, and nursing informatics were reviewed and examined and key concepts were identified. A care paradigm focusing on concordance, rather than compliance, served as the overall guiding principle. This framework identifies key relationships among self-management (patient behaviors), health force (patient characteristics), and patient-defined goals. The role of health-enabling technology supporting these relationships is explored in the context of nursing informatics. The Empowerment Informatics framework can guide intervention design and evaluation and support practicing nurses' ethical use of technology as part of self-management support. Nurses worldwide provide support to patients who are living with chronic illnesses. As pressures related to cost and access to care increase, technology-enabled self-management interventions will become increasingly common. This patient-focused framework can guide nursing practice using technology that prioritizes patient needs. © 2013 Sigma Theta Tau International.

Impact of direct drug delivery via gastric access devices.

PubMed

Kurien, Matthew; Penny, Hugo; Sanders, David S

2015-03-01

Gastric access devices such as nasogastric tubes and gastrostomy tubes are increasingly being used in clinical practice to provide both short- and long-term nutrition support therapy. Increasingly these devices are being utilized to help deliver oral medications, where swallowing is impaired. This concomitant administration of medications and enteral formulas could derive potential benefits in regard to time and cost; however, uncertainty exists regarding potential drug and nutrient interactions and the influence this may have on both safety and efficacy. This article provides an overview of the differing gastric access devices used in clinical practice and evaluates the evidence base for using oral medications via these routes. Alternative methods of drug administration are discussed, alongside common drug nutrient interactions and potential complications. Delivering medications via gastric access devices can be performed safely; however, careful consideration needs to be made regarding tube and patient influences, alongside drug-nutrient interactions. Improving practice in this area in the future necessitates enhancement of an evidence base to substantiate the safety of drug delivery via gastric access devices and improvement in education among healthcare professionals about the potential problems.

Epidemiology, surveillance, and prevention of hepatitis C virus infections in hemodialysis patients.

PubMed

Patel, Priti R; Thompson, Nicola D; Kallen, Alexander J; Arduino, Matthew J

2010-08-01

Hepatitis C virus (HCV) infection is the most common chronic blood-borne infection in the United States; the prevalence in maintenance hemodialysis patients substantially exceeds that in the general population. In hemodialysis patients, HCV infection has been associated with increased occurrence of cirrhosis and hepatocellular carcinoma and increased mortality. Injection drug use and receipt of blood transfusions before 1992 has accounted for most prevalent HCV infections in the United States. However, HCV transmission among patients undergoing hemodialysis has been documented frequently. Outbreak investigations have implicated lapses in infection control practices as the cause of HCV infections. Preventing these infections is an emerging priority for renal care providers, public health agencies, and regulators. Adherence to recommended infection control practices is effective in preventing HCV transmission in hemodialysis facilities. In addition, adoption of routine screening to facilitate the detection of incident HCV infections and hemodialysis-related transmission is an essential component of patient safety and infection prevention efforts. This article describes the current epidemiology of HCV infection in US maintenance hemodialysis patients and prevention practices to decrease its incidence and transmission. Published by Elsevier Inc.

[Testicular cancer--self-awareness and testicular self-examination in soldiers and physicians in the Israeli army].

PubMed

Tichler, T; Weitzen, R; Feinstone, A; Orvieto, R; Moskovitz, M; Singer, A

2000-08-01

Testicular cancer is the most common malignancy in young men. To evaluate knowledge and awareness of that cancer, and of the practice of testicular self-examination (TSE), we developed a questionnaire which was distributed to 717 male soldiers and 200 of their military physicians. 21% of the soldiers had received some explanation of the importance of TSE, but only 16% were actually instructed how to perform TSE, and only 2% practiced it regularly. 24% had never examined their testicles before, 185 only rarely, and 6% often. With increased age, TSE frequency increased, but previous education, type of military unit, and ethnic origin had no affect. 99% of military physicians had been taught how to examine breasts, but only 70% had been taught routine testicular examination. 22% performed it, but 27% never did. 84% had never taught their soldiers the importance of TSE, although 51% taught female soldiers breast self-examination. There was a significant lack of awareness of the importance of regular practice of TSE among both soldiers and their army physicians.

Common Adult Skin and Soft Tissue Lesions

PubMed Central

Trost, Jeffrey G.; Applebaum, Danielle S.; Orengo, Ida

2016-01-01

A strong foundational knowledge of dermatologic disease is crucial for a successful practice in plastic surgery. A plastic surgeon should be able to identify and appreciate common dermatologic diseases that may require medical and/or surgical evaluation and management. In this article, the authors describe epidermal/dermal, infectious, pigmented, and malignant cutaneous lesions that are commonly encountered in practice. Descriptions include the epidemiology, pathogenesis, clinical course, and management options for each type of lesion. PMID:27478418

Cognitive processes in anesthesiology decision making.

PubMed

Stiegler, Marjorie Podraza; Tung, Avery

2014-01-01

The quality and safety of health care are under increasing scrutiny. Recent studies suggest that medical errors, practice variability, and guideline noncompliance are common, and that cognitive error contributes significantly to delayed or incorrect diagnoses. These observations have increased interest in understanding decision-making psychology.Many nonrational (i.e., not purely based in statistics) cognitive factors influence medical decisions and may lead to error. The most well-studied include heuristics, preferences for certainty, overconfidence, affective (emotional) influences, memory distortions, bias, and social forces such as fairness or blame.Although the extent to which such cognitive processes play a role in anesthesia practice is unknown, anesthesia care frequently requires rapid, complex decisions that are most susceptible to decision errors. This review will examine current theories of human decision behavior, identify effects of nonrational cognitive processes on decision making, describe characteristic anesthesia decisions in this context, and suggest strategies to improve decision making.

Practical Tips for Working as an Expedition Doctor on High-Altitude Expeditions.

PubMed

Brants, Anne; Metcalfe, Tracee

2017-09-01

Brants, Anne, and Tracee Metcalfe. Practical tips for working as an expedition doctor on high-altitude expeditions. High Alt Med Biol. 18:193-198, 2017.-With the explosion of adventure travel over the past decade, there has been a concurrent increase in mountaineering expeditions to extreme elevations, including many of the 8000-m peaks. This trend has created an increased demand for qualified expedition doctors to provide specialized medical advice and care to climbers and expedition staff. This review is intended to help physicians prepare for work on such expeditions. The authors rely heavily on their own experience and discuss the types of work available on high-altitude expeditions; how to identify a safe and reputable guiding company; personal and medical preparation; priorities in selecting or building an appropriate medical kit; and medical conditions commonly encountered on expeditions. The review concludes by considering ethical dilemmas and other difficult issues unique to this work.

Perceptual learning effect on decision and confidence thresholds.

PubMed

Solovey, Guillermo; Shalom, Diego; Pérez-Schuster, Verónica; Sigman, Mariano

2016-10-01

Practice can enhance of perceptual sensitivity, a well-known phenomenon called perceptual learning. However, the effect of practice on subjective perception has received little attention. We approach this problem from a visual psychophysics and computational modeling perspective. In a sequence of visual search experiments, subjects significantly increased the ability to detect a "trained target". Before and after training, subjects performed two psychophysical protocols that parametrically vary the visibility of the "trained target": an attentional blink and a visual masking task. We found that confidence increased after learning only in the attentional blink task. Despite large differences in some observables and task settings, we identify common mechanisms for decision-making and confidence. Specifically, our behavioral results and computational model suggest that perceptual ability is independent of processing time, indicating that changes in early cortical representations are effective, and learning changes decision criteria to convey choice and confidence. Copyright © 2016 Elsevier Inc. All rights reserved.

Attending physician work hours: ethical considerations and the last doctor standing.

PubMed

Mercurio, Mark R; Peterec, Steven M

2009-08-01

Based at least in part on concerns for patient safety and evidence that long shifts are associated with an increased risk of physician error, residents' and fellows' work hours have been strictly limited for the past several years. Little attention has been paid, however, to excessive attending physician shift duration, although there seems to be no reason to assume that this common practice poses any less risk to patients. Potential justifications for allowing attending physicians to work without hourly limits include physician autonomy, workforce shortages in certain communities or subspecialties, continuity of care, and financial considerations. None of these clearly justify the apparent increased risk to patients, with the exception in some settings of workforce shortage. In many hospital settings, the practice of allowing attending physicians to work with no limit on shift duration could pose an unnecessary risk to patients.

Warped linear mixed models for the genetic analysis of transformed phenotypes

PubMed Central

Fusi, Nicolo; Lippert, Christoph; Lawrence, Neil D.; Stegle, Oliver

2014-01-01

Linear mixed models (LMMs) are a powerful and established tool for studying genotype–phenotype relationships. A limitation of the LMM is that the model assumes Gaussian distributed residuals, a requirement that rarely holds in practice. Violations of this assumption can lead to false conclusions and loss in power. To mitigate this problem, it is common practice to pre-process the phenotypic values to make them as Gaussian as possible, for instance by applying logarithmic or other nonlinear transformations. Unfortunately, different phenotypes require different transformations, and choosing an appropriate transformation is challenging and subjective. Here we present an extension of the LMM that estimates an optimal transformation from the observed data. In simulations and applications to real data from human, mouse and yeast, we show that using transformations inferred by our model increases power in genome-wide association studies and increases the accuracy of heritability estimation and phenotype prediction. PMID:25234577

Warped linear mixed models for the genetic analysis of transformed phenotypes.

PubMed

Fusi, Nicolo; Lippert, Christoph; Lawrence, Neil D; Stegle, Oliver

2014-09-19

Linear mixed models (LMMs) are a powerful and established tool for studying genotype-phenotype relationships. A limitation of the LMM is that the model assumes Gaussian distributed residuals, a requirement that rarely holds in practice. Violations of this assumption can lead to false conclusions and loss in power. To mitigate this problem, it is common practice to pre-process the phenotypic values to make them as Gaussian as possible, for instance by applying logarithmic or other nonlinear transformations. Unfortunately, different phenotypes require different transformations, and choosing an appropriate transformation is challenging and subjective. Here we present an extension of the LMM that estimates an optimal transformation from the observed data. In simulations and applications to real data from human, mouse and yeast, we show that using transformations inferred by our model increases power in genome-wide association studies and increases the accuracy of heritability estimation and phenotype prediction.

From the Field: Learning Leaders

ERIC Educational Resources Information Center

Weigel, Kathleen; Jones, Richard

2015-01-01

Leadership is essential to successful schools. One of the ways to support effective school leadership is to share ideas and best practices to address the common challenges faced by school leaders. This question and response format addresses common challenges and questions from practicing school leaders in the manner that a mentor might respond to…

Common quandaries and their practical solutions in Bayesian network modeling

Treesearch

Bruce G. Marcot

2017-01-01

Use and popularity of Bayesian network (BN) modeling has greatly expanded in recent years, but many common problems remain. Here, I summarize key problems in BN model construction and interpretation,along with suggested practical solutions. Problems in BN model construction include parameterizing probability values, variable definition, complex network structures,...

EFFECTS OF COMMONLY USED COOKING PRACTICES ON TOTAL MERCURY CONCENTRATION IN FISH AND THEIR IMPACT ON EXPOSURE ASSESSMENTS

EPA Science Inventory

The effects of cooking practices commonly used by Native Americans on total mercury concentrations in fish were investigated. A preparation factor relating mercury concentrations in fish as prepared for consumption to mercury concentration data as measured in typical environmenta...

Knowledge and perception of plastic surgery among tertiary education students in Enugu, South-East Nigeria.

PubMed

Isiguzo, C M; Nwachukwu, C D

2016-01-01

Knowledge, perception, and acceptance of plastic surgery among any population are influenced by channel of presentation. A good understanding of the public awareness will define the way plastic surgery services will be provided. To assess the knowledge, awareness of availability, and acceptance of plastic surgery practice in Enugu, South East Nigeria. A questionnaire-based prospective study. The electronic media is the most common medium of awareness. Less than half the sample knew about the existence of plastic surgeons in Enugu even though a large proportion was aware of the existence of plastic surgery as a specialty. The concentration of plastic surgeons in a center is directly related to awareness of plastic surgery services in that facility. The most common esthetic procedure done by a plastic surgeon in Enugu is tattoo removal and scar refashioning. Orthopedic surgeons are thought to be key players in the management of burn patients as much as the plastic surgeons due to the "SIGNPOST EFFECT." The level of awareness is high in the sampled population with associated increase in acceptance of its practice and willing utilization. All public hospitals should be encouraged to employ the services of plastic surgeons. Appropriate branding of specialized hospitals where plastic surgery service is available will advance the practice significantly.

A naturalistic study of changes in pharmacological prescription for borderline personality disorder in clinical practice: from APA to NICE guidelines.

PubMed

Pascual, Juan C; Martín-Blanco, Ana; Soler, Joaquim; Ferrer, Alicia; Tiana, Thais; Alvarez, Enrique; Pérez, Víctor

2010-11-01

Although no psychotropic agents are specifically licensed for the management of borderline personality disorder (BPD), pharmacological treatment appears to be common. This study aimed to examine the drug prescriptions for patients with BPD in clinical practice, analyze the prescription patterns from the appearance of the American Psychiatric Association guidelines in 2001 until the National Institute for Health and Clinical Excellence guidelines in 2009, and identify the factors associated with such prescription of each type of drug. Naturalistic study on 226 consecutive BPD patients admitted to an outpatient BPD program. Socio-demographic, clinical and pharmacological treatment information was collected; factors associated with drug prescription were examined using logistic regression analyses for dichotomous outcomes measures. Changes in prescription patterns over time were also evaluated. Patients received an average of 2.7 drugs; only 6% were drug-free; 56% were taking ≥3 drugs and 30% ≥4 drugs. Over the past 8 years, prescription of antidepressants has remained stable; there has been a significant reduction in prescription of benzodiazepines and an increase in the use of mood stabilizers and atypical antipsychotics. Comorbidity with Axis I disorders was the main factor associated with drug prescription. Drug prescription and polypharmacy are common in the management of BPD in clinical practice.

An Overview of Interrater Agreement on Likert Scales for Researchers and Practitioners

PubMed Central

O'Neill, Thomas A.

2017-01-01

Applications of interrater agreement (IRA) statistics for Likert scales are plentiful in research and practice. IRA may be implicated in job analysis, performance appraisal, panel interviews, and any other approach to gathering systematic observations. Any rating system involving subject-matter experts can also benefit from IRA as a measure of consensus. Further, IRA is fundamental to aggregation in multilevel research, which is becoming increasingly common in order to address nesting. Although, several technical descriptions of a few specific IRA statistics exist, this paper aims to provide a tractable orientation to common IRA indices to support application. The introductory overview is written with the intent of facilitating contrasts among IRA statistics by critically reviewing equations, interpretations, strengths, and weaknesses. Statistics considered include rwg, rwg*, r′wg, rwg(p), average deviation (AD), awg, standard deviation (Swg), and the coefficient of variation (CVwg). Equations support quick calculation and contrasting of different agreement indices. The article also includes a “quick reference” table and three figures in order to help readers identify how IRA statistics differ and how interpretations of IRA will depend strongly on the statistic employed. A brief consideration of recommended practices involving statistical and practical cutoff standards is presented, and conclusions are offered in light of the current literature. PMID:28553257

Prevalence and Frequency of Heterosexual Anal Intercourse Among Young People: A Systematic Review and Meta-analysis.

PubMed

Owen, Branwen N; Brock, Patrick M; Butler, Ailsa R; Pickles, Michael; Brisson, Marc; Baggaley, Rebecca F; Boily, Marie-Claude

2015-07-01

We aim to assess if heterosexual anal intercourse (AI) is commonly practiced and how frequently it is practiced by young people. We searched PubMed for articles published 1975 to July 2014 reporting data on the proportion of young people (mean age <25) practicing heterosexual AI (AI prevalence) and on number of AI acts (AI frequency). Stratified random-effects meta-analysis and meta-regression were used to produce summary estimates and assess the influence of participant and study characteristics on AI prevalence. Eighty-three and thirteen of the 136 included articles reported data on lifetime AI prevalence and monthly AI frequency, respectively. Estimates were heterogenous. Overall summary estimates of lifetime AI prevalence were 22 % (95 % confidence interval 20-24) among sexually active young people, with no statistically significant differences by gender, continent or age. Prevalence increased significantly with confidentiality of interview method and, among males and in Europe, by survey year. Prevalence did not significantly differ by recall period. An estimated 3-24 % of all reported sex acts were AI. Reported heterosexual AI is common but variable among young people worldwide. To fully understand its impact on STI spread, more and better quality data on frequency of unprotected AI, and trends over time are required.

Practical use and pitfalls of hepatocyte-specific contrast agents (HSCAs) for pediatric hepatic and biliary magnetic resonance imaging.

PubMed

Ayyala, Rama S; Anupindi, Sudha A; Callahan, Michael J

2017-02-01

Magnetic resonance imaging is commonly used to evaluate for hepatic and biliary pathology in the pediatric population. Recently, there has been increased use of hepatocyte-specific contrast agents (HSCAs), such as Gadoxetate disodium in children. Traditionally, HSCAs have been used to characterize focal liver lesions. However, these agents can also be used to problem solve specific hepatic or biliary diagnostic dilemmas. The purpose of this manuscript is to review the practical uses of HSCA in children with both hepatic and biliary indications, and review the corresponding imaging findings. We will highlight the diagnostic uses of HSCA in children, as well as pitfalls encountered.

"Have you seen your aura lately?" examining boundary-work in holistic health pamphlets.

PubMed

Ho, Evelyn Y

2007-01-01

An increasing number of people in the United States are using holistic therapies. Both encouraging and informing this trend in growth, printed leaflets are a popular and important medium for holistic health practitioners. Using a discourse analytic approach, the author analyzed pamphlets and printed texts distributed at a holistic health fair. These texts reflect and construct specific understandings of holistic health and proper health care. Understood through the notion of boundary-work, pamphlets demarcated holism as the proper way of conceptualizing health and health care. However, holistic medicine's boundaries are quite porous, as these practices are also legitimized through the use of scientific conventions and the practice of integration, both commonly associated with biomedicine.

Captive care and welfare considerations for beavers.

PubMed

Campbell-Palmer, Róisín; Rosell, Frank

2015-01-01

Beavers (Castor spp.) tend not to be a commonly held species and little published material exists relating to their captive care. We review published material and discuss husbandry issues taking into account the requirements of wild beavers. As social mammals with complex chemical communication systems and with such an ability to modify their environments, studies of wild counterparts suggest the captive requirements of beavers may actually be more sophisticated than generally perceived. Common field techniques may have practical application in the captive setting. Their widespread utilisation in conservation, including reintroductions, translocations and habitat management, also requires components of captive care. As welfare science advances there is increasing pressure on captive collections to improve standards and justify the keeping of animals. Conservation science is increasingly challenged to address individual welfare standards. Further research focusing on the captive care of beavers is required. © 2015 Wiley Periodicals, Inc.

Inter-individual differences in the initial 80 minutes of motor learning of handrim wheelchair propulsion.

PubMed

Vegter, Riemer J K; Lamoth, Claudine J; de Groot, Sonja; Veeger, Dirkjan H E J; van der Woude, Lucas H V

2014-01-01

Handrim wheelchair propulsion is a cyclic skill that needs to be learned during rehabilitation. Yet it is unclear how inter-individual differences in motor learning impact wheelchair propulsion practice. Therefore we studied how early-identified motor learning styles in novice able-bodied participants impact the outcome of a low-intensity wheelchair-practice intervention. Over a 12-minute pre-test, 39 participants were split in two groups based on a relative 10% increase in mechanical efficiency. Following the pretest the participants continued one of four different low-intensity wheelchair practice interventions, yet all performed in the same trial-setup with a total 80-minute dose at 1.11 m/s at 0.20 W/kg. Instead of focusing on the effect of the different interventions, we focused on differences in motor learning between participants over the intervention. Twenty-six participants started the pretest with a lower mechanical efficiency and a less optimal propulsion technique, but showed a fast improvement during the first 12 minutes and this effect continued over the 80 minutes of practice. Eventually these initially fast improvers benefitted more from the given practice indicated by a better propulsion technique (like reduced frequency and increased stroke angle) and a higher mechanical efficiency. The initially fast improvers also had a higher intra-individual variability in the pre and posttest, which possibly relates to the increased motor learning of the initially fast improvers. Further exploration of the common characteristics of different types of learners will help to better tailor rehabilitation to the needs of wheelchair-dependent persons and improve our understanding of cyclic motor learning processes.

Improving waste segregation while reducing costs in a tertiary-care hospital in a lower-middle-income country in Central America.

PubMed

Johnson, Kyle M; González, Miriam L; Dueñas, Lourdes; Gamero, Mario; Relyea, George; Luque, Laura E; Caniza, Miguela A

2013-07-01

Healthcare waste (HCW) management and segregation are essential to ensure safety, environmental protection and cost control. Poor HCW management increase risks and costs for healthcare institutions. On-going surveillance and training are important to maintain good HCW practices. Our objectives were to evaluate and improve HCW practices at Hospital Bloom, San Salvador, El Salvador. We studied HCW disposal practices by observing waste containers, re-segregating waste placed in biohazardous waste bags, and administering a seven-itemsknowledge survey before and after training in waste management at Hospital Bloom. The training was based on national and international standards. We followed total biohazardous waste production before and after the training. The hospital staff was knowledgeable about waste segregation practices, but had poor compliance with national policies. Re-segregating waste in biohazardous waste bags showed that 61% of this waste was common waste, suggesting that the staff was possibly unaware of the cost of mis-segregating healthcare waste. After staff training in HCW management, the correct responses increased by 44% and biohazardous waste disposal at the hospital reduced by 48%. Better segregation of biohazardous waste and important savings can be obtained by HCW management education of hospital staff. Hospitals can benefit from maximising the use of available resources by sustaining best practices of HCW, especially those in hospitals in lower-middle-income countries.

Postfire management in forested public lands of the western USA

USGS Publications Warehouse

Beschta, R.L.; Rhodes, J.J.; Kauffman, J.B.; Gresswell, Robert E.; Minshall, G.W.; Frissell, C.A.; Perry, D.A.; Hauer, R.

2004-01-01

Forest ecosystems in the western United States evolved over many millennia in response to disturbances such as wildfires. Land use and management practices have altered these ecosystems, however, including fire regimes in some areas. Forest ecosystems are especially vulnerable to postfire management practices because such practices may influence forest dynamics and aquatic systems for decades to centuries. Thus, there is an increasing need to evaluate the effect of postfire treatments from the perspective of ecosystem recovery. We examined, via the published literature and our collective experience, the ecological effects of some common postfire treatments. Based on this examination, promising postfire restoration measures include retention of large trees, rehabilitation of firelines and roads, and, in some cases, planting of native species. The following practices are generally inconsistent with efforts to restore ecosystem functions after fire: seeding exotic species, livestock grazing, placement of physical structures in and near stream channels, ground-based postfire logging, removal of large trees, and road construction. Practices that adversely affect soil integrity, persistence or recovery of native species, riparian functions, or water quality generally impede ecological recovery after fire. Although research provides a basis for evaluating the efficacy of postfire treatments, there is a continuing need to increase our understanding of the effects of such treatments within the context of societal and ecological goals for forested public lands of the western United States.

Determining if an older adult can make and execute decisions to live safely at home: a capacity assessment and intervention model

PubMed Central

Skelton, Felicia; Kunik, Mark E.; Regev, Tziona; Naik, Aanand D.

2009-01-01

Determining an older adult’s capacity to live safely and independently in the community presents a serious and complicated challenge to the health care system. Evaluating one’s ability to make and execute decisions regarding safe and independent living incorporates clinical assessments, bioethical considerations, and often legal declarations of capacity. Capacity assessments usually result in life changes for patients and their families, including a caregiver managing some everyday tasks, placement outside of the home, and even legal guardianship. The process of determining capacity and recommending intervention is often inefficient and highly variable in most cases. Physicians are rarely trained to conduct capacity assessments and assessment methods are heterogeneous. An interdisciplinary team of clinicians developed the capacity assessment and intervention (CAI) model at a community outpatient geriatrics clinic to address these critical gaps. This report follows one patient through the entire CAI model, describing processes for a typical case. It then examines two additional case reports that highlight common challenges in capacity assessment. The CAI model uses assessment methods common to geriatrics clinical practice and conducts assessments and interventions in a standardized fashion. Reliance on common, validated measures increases generalizability of the model across geriatrics practice settings and patient populations. PMID:19481271

A History of Infant Feeding

PubMed Central

Stevens, Emily E; Patrick, Thelma E; Pickler, Rita

2009-01-01

The historical evolution of infant feeding includes wet nursing, the feeding bottle, and formula use. Before the invention of bottles and formula, wet nursing was the safest and most common alternative to the natural mother's breastmilk. Society's negative view of wet nursing, combined with improvements of the feeding bottle, the availability of animal's milk, and advances in formula development, gradually led to the substitution of artificial feeding for wet nursing. In addition, the advertising and safety of formula products increased their popularity and use among society. Currently, infant formula-feeding is widely practiced in the United States and appears to contribute to the development of several common childhood illnesses, including atopy, diabetes mellitus, and childhood obesity. PMID:20190854

Preventing device-associated infections in US hospitals: national surveys from 2005 to 2013.

PubMed

Krein, Sarah L; Fowler, Karen E; Ratz, David; Meddings, Jennifer; Saint, Sanjay

2015-06-01

Numerous initiatives have focused on reducing device-associated infections, contributing to an overall decrease in infections nationwide. To better understand factors associated with this decline, we assessed the use of key practices to prevent device-associated infections by US acute care hospitals from 2005 to 2013. We mailed surveys to infection preventionists at a national random sample of ∼600 US acute care hospitals in 2005, 2009 and 2013. Our survey asked about the use of practices to prevent the 3 most common device-associated infections: central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI). Using sample weights, we estimated the per cent of hospitals reporting regular use (a score of 4 or 5 on a scale from 1 (never use) to 5 (always use)) of prevention practices from 2005 to 2013. The response rate was about 70% in all 3 periods. Use of most recommended prevention practices increased significantly over time. Among those showing the greatest increase were use of an antimicrobial dressing for preventing CLABSI (25-78%, p<0.001), use of an antimicrobial mouth rinse for preventing VAP (41-79%, p<0.001) and use of catheter removal prompts for preventing CAUTI (9-53%, p<0.001). Likewise, a significant increase in facility-wide surveillance was found for all three infections. Practices for which little change was observed included use of antimicrobial catheters to prevent either CLABSI or CAUTI. US hospitals have responded to the call to reduce infection by increasing use of key recommended practices. Vigilance is needed to ensure sustained improvement and additional strategies may still be required, given an apparent continuing lag in CAUTI prevention efforts. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Reducing insecticide and fungicide loads in runoff from plastic mulch with vegetative-covered furrows.

PubMed

Rice, Pamela J; Harman-Fetcho, Jennifer A; Sadeghi, Ali M; McConnell, Laura L; Coffman, C Benjamin; Teasdale, John R; Abdul-Baki, Aref; Starr, James L; McCarty, Gregory W; Herbert, Rachel R; Hapeman, Cathleen J

2007-02-21

A common management practice for the production of fresh-market vegetables utilizes polyethylene (plastic) mulch because it increases soil temperature, decreases weed pressure, maintains soil moisture, and minimizes soil contact with the product. However, rain events afford much more erosion and runoff because 50-75% of the field is covered with an impervious surface. A plot study was conducted to compare and to quantify the off-site movement of soil, insecticides, and fungicides associated with runoff from plots planted with Sunbeam tomatoes (Lycopersicon esculentum Mill) using the conventional polyethylene mulch management practice vs an alternative management practice-polyethylene mulch-covered beds with cereal rye (Secale cereale) planted in the furrows between the beds. The use of cereal rye-covered furrows with the conventional polyethylene system decreased runoff volume by more than 40%, soil erosion by more than 80%, and pesticide loads by 48-74%. Results indicate that vegetative furrows are critical to minimizing the negative aspects of this management practice.

Taking stock of youth organizing: an interdisciplinary perspective.

PubMed

Christens, Brian D; Kirshner, Ben

2011-01-01

Youth organizing combines elements of community organizing, with its emphasis on ordinary people working collectively to advance shared interests, and positive youth development, with its emphasis on asset-based approaches to working with young people. It is expanding from an innovative, but marginal approach to youth and community development into a more widely recognized model for practice among nonprofit organizations and foundations. Along the way, it has garnered attention from researchers interested in civic engagement, social movements, and resiliency. A growing body of published work evidences the increasing interest of researchers, who have applied an assortment of theoretical perspectives to their observations of youth organizing processes. Through an appraisal of the current state of this still-emerging area of practice and research, including case examples, the authors identify common elements of the practice of youth organizing--relationship development, popular education, social action, and participatory research and evaluation--and conclude with a discussion of promising future directions for research and practice. Copyright © 2011 Wiley Periodicals, Inc., A Wiley Company.

How medical doctors and students should use Social Media: a review of the main guidelines for proposing practical recommendations.

PubMed

Mayer, Miguel Angel; Leis, Angela; Mayer, Alex; Rodriguez-Gonzalez, Alejandro

2012-01-01

Social Media has grown exponentially and in the last few years there has been an increasing use amongst medical doctors and students. There is intense debate about the complexities of ensuring medical professionalism in the digital age and especially on using open and massive online services. The objectives of this paper are: first, to gather the main recommendations on using Social Media platforms and websites by medical doctors and students, which are proposed by several international organizations, institutions and universities of reference and second, to propose a set of practical recommendations, based on the comparison of the statements and items of the guidelines, in order to find agreements and differences among them and select the most common and practical items stated. A Decalogue of good practices has been drawn up, pointing out the most important aspects that should be considered, highlighting the relevance of maintaining professional behavior in these environments, taking into account the advantages and drawbacks when using them.

Who Supports the Successful Implementation and Sustainability of Evidence-Based Practices? Defining and Understanding the Roles of Intermediary and Purveyor Organizations.

PubMed

Franks, Robert P; Bory, Christopher T

2015-01-01

Research on implementation science has increased significantly over the past decade. In particular, psychologists have looked closely at the value and importance of bridging the gap between science and practice. As evidence-based practices (EBPs) become more prevalent, concrete mechanisms are needed to bring these scientifically supported treatments and interventions to community-based settings. Intermediary and purveyor organizations (IPOs) have emerged in recent years that specialize in bringing research to practice. Using a framework developed by Franks (), this descriptive study surveyed respondents that self-identified as IPOs and focused on identifying shared definitions, functions, and activities. Results indicated that seven descriptive roles previously identified were supported by this survey and many common shared activities, goals, and functions across these organizations were observed. Further, these organizations appear to be influenced by the growing field of implementation science. Limitations and implications of this study are discussed. © 2015 Wiley Periodicals, Inc.

Good documentation practice in clinical research

PubMed Central

Bargaje, Chitra

2011-01-01

One of the most common inspection findings in investigator site inspections is lack of reliable, accurate and adequate source documentation. This also happens to be the most common pitfall identified during sponsor audits. The importance of good documentation practice needs to be emphasized to investigator sites to ensure that the study results are built on the foundation of credible and valid data. This article focuses on the key principles of good documentation practice and offers suggestions for improvement. PMID:21731856

Good documentation practice in clinical research.

PubMed

Bargaje, Chitra

2011-04-01

One of the most common inspection findings in investigator site inspections is lack of reliable, accurate and adequate source documentation. This also happens to be the most common pitfall identified during sponsor audits. The importance of good documentation practice needs to be emphasized to investigator sites to ensure that the study results are built on the foundation of credible and valid data. This article focuses on the key principles of good documentation practice and offers suggestions for improvement.

Research and Development for Health and Environmental Hazard Assessment. Task Order 5. Occupational and Environmental Hazards Associated with the Formulation and Use of White Phosphorus-Felt and Red Phosphorus-Butyl Rubber Screening Smokes

DTIC Science & Technology

1981-03-01

conditions. Past PFA "phossy water" disposal practice, via surface ditch and creek drainage to Yellow Lake, resulted in documented correlation with...increase could be expected as a consequence of ab- sorption of phosphorus through the burned tissue. A fall in phosphate excretion is common in kidney

The National SShipbuilding Research Program. 1997 Ship Production Symposium. Proceedings

DTIC Science & Technology

1997-04-01

continues to advance the value and potential benefit of an ISO style process management system will increase. ISO provides the framework that is...understanding of systemic management beyond the buzzword level. In fairness , this probably is attributed to the fact that middle managers often perceive they...common or accepted practice. In the United States, the phrase of laisse - faire , or freedom of choice coupled with a lack of uniform standards continues to

Osteoporotic fractures in older adults

PubMed Central

Colón-Emeric, Cathleen S.; Saag, Kenneth G.

2007-01-01

Osteoporotic fractures are emerging as a major public health problem in the aging population. Fractures result in increased morbidity, mortality and health expenditures. This article reviews current evidence for the management of common issues following osteoporotic fractures in older adults including: (1) thromboembolism prevention; (2) delirium prevention; (3) pain management; (4) rehabilitation; (5) assessing the cause of fracture; and (6) prevention of subsequent fractures. Areas for practice improvement and further research are highlighted. PMID:16979533

Google and Women's Health-Related Issues: What Does the Search Engine Data Reveal?

PubMed

Baazeem, Mazin; Abenhaim, Haim

2014-01-01

Identifying the gaps in public knowledge of women's health related issues has always been difficult. With the increasing number of Internet users in the United States, we sought to use the Internet as a tool to help us identify such gaps and to estimate women's most prevalent health concerns by examining commonly searched health-related keywords in Google search engine. We collected a large pool of possible search keywords from two independent practicing obstetrician/gynecologists and classified them into five main categories (obstetrics, gynecology, infertility, urogynecology/menopause and oncology), and measured the monthly average search volume within the United States for each keyword with all its possible combinations using Google AdWords tool. We found that pregnancy related keywords were less frequently searched in general compared to other categories with an average of 145,400 hits per month for the top twenty keywords. Among the most common pregnancy-related keywords was "pregnancy and sex' while pregnancy-related diseases were uncommonly searched. HPV alone was searched 305,400 times per month. Of the cancers affecting women, breast cancer was the most commonly searched with an average of 247,190 times per month, followed by cervical cancer then ovarian cancer. The commonly searched keywords are often issues that are not discussed in our daily practice as well as in public health messages. The search volume is relatively related to disease prevalence with the exception of ovarian cancer which could signify a public fear.

Supporting shared decision making beyond consumer-prescriber interactions: Initial development of the CommonGround fidelity scale

PubMed Central

Fukui, Sadaaki; Salyers, Michelle P.; Rapp, Charlie; Goscha, Rick; Young, Leslie; Mabry, Ally

2015-01-01

Shared decision-making has become a central tenet of recovery-oriented, person-centered mental health care, yet the practice is not always transferred to the routine psychiatric visit. Supporting the practice at the system level, beyond the interactions of consumers and medication prescribers, is needed for successful adoption of shared decision-making. CommonGround is a systemic approach, intended to be part of a larger integration of shared decision-making tools and practices at the system level. We discuss the organizational components that CommonGround uses to facilitate shared decision-making, and we present a fidelity scale to assess how well the system is being implemented. PMID:28090194

Problems with mitigation translocation of herpetofauna.

PubMed

Sullivan, Brian K; Nowak, Erika M; Kwiatkowski, Matthew A

2015-02-01

Mitigation translocation of nuisance animals is a commonly used management practice aimed at resolution of human-animal conflict by removal and release of an individual animal. Long considered a reasonable undertaking, especially by the general public, it is now known that translocated subjects are negatively affected by the practice. Mitigation translocation is typically undertaken with individual adult organisms and has a much lower success rate than the more widely practiced conservation translocation of threatened and endangered species. Nonetheless, the public and many conservation practitioners believe that because population-level conservation translocations have been successful that mitigation translocation can be satisfactorily applied to a wide variety of human-wildlife conflict situations. We reviewed mitigation translocations of reptiles, including our own work with 3 long-lived species (Gila monsters [Heloderma suspectum], Sonoran desert tortoises [Gopherus morafkai], and western diamond-backed rattlesnakes [Crotalus atrox]). Overall, mitigation translocation had a low success rate when judged either by effects on individuals (in all studies reviewed they exhibited increased movement or increased mortality) or by the success of the resolution of the human-animal conflict (translocated individuals often returned to the capture site). Careful planning and identification of knowledge gaps are critical to increasing success rates in mitigation translocations in the face of increasing pressure to find solutions for species threatened by diverse anthropogenic factors, including climate change and exurban and energy development. © 2014 Society for Conservation Biology.

[Topical terbinafine. Reduction of duration of therapy for tinea pedis].

PubMed

Schmid-Wendtner, M-H; Korting, H

2008-12-01

Superficial fungal infections are common and worldwide in distribution. Latest estimates suggest one- third of the population in Europe has a fungal infection of their feet, with dermatophyte infections of the skin of the feet (tinea pedis) most common. Tinea pedis interdigitalis is by far most common and can be effectively treated topically. Common agents include azoles, hydroxypyridones and allylamines, with morpholines used less frequently. While most antifungals have mainly fungistatic effects on dermatophytes, the causative agents of tinea pedis, terbinafine--an allylamine--is fungicidal. Due to this feature shorter treatment periods are possible using topical terbinafine. For effective treatment of uncomplicated tinea pedis interdigitalis, azole cream preparations are often used twice daily for four weeks whereas 1% terbinafine cream can be applied once a day for one week. Since 2006, 1% terbinafine is also available as a film-forming solution (FFS), which makes single-dose treatment possible. FFS may prove superior in daily practice with increased compliance and thus reduced recurrences.

Noncompliance and drug toxicity in black, poor, and aged patients.

PubMed

Miller, R L; Algee, J

1978-10-01

Drug toxicity is a common medical problem. Continued increases in drug toxicity are related to the extensive, indiscriminate use of drugs. This is a national health problem which is caused partly by gaps in pharmacology as a basic and clinical science and partly by the rapid proliferation of drugs (the drug explosion) in the past 30 years. Socioeconomically disadvantaged (black, poor, and aged) patients are particularly vulnerable to compliance problems and drug toxicity. In this presentation we discuss the basis for this increased vulnerability and suggest strategies that practicing physicians can use to minimize both compliance problems and drug toxicity.

Allergy in the elderly: case note review.

PubMed

Gray, N J; Redshaw, E L; Isaacs, D; Tarzi, M D; Smith, H E; Frew, A J

2018-05-19

The prevalence of IgE-mediated disease increased significantly during the 20th century. In developed countries, about 20% of people have atopic disease, which consumes significant amounts of healthcare funding. For example, in UK general practice, allergic conditions account for 6% of consultations and ~10% of prescribing costs [1]. Whilst most studies of allergy focus on children and adolescents, relatively little has been written about allergy in older people, although food allergy may be increasingly common in this group [2]. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Best practices in LGBT care: A guide for primary care physicians.

PubMed

McNamara, Megan C; Ng, Henry

2016-07-01

Lesbian, gay, bisexual, and transgender (LGBT) people have unique healthcare needs. While all LGBT people are at an increased risk for mental health and substance abuse disorders, certain health conditions vary by group. Overweight and obesity are more common in lesbian and bisexual women, whereas sexual minority men are at increased risk for infections such as human immunodeficiency virus (HIV) and syphilis. Breast, cervical, and prostate cancer screening should be offered to all LGBT individuals according to national guidelines and with consideration of a transgender person's natal and surgical anatomy. Copyright © 2016 Cleveland Clinic.